Popie 2-8-08 Cns Path 3

Front 1

Congenital toxoplasmosis produces what brain pathology

Back 1

basal ganglia calcification

Front 2

mc cause of space occupying lesion in AIDS pt

Back 2

toxoplasma gondii

Front 3

where in brain does toxo gondii work

Back 3

at junx of white and gray

Front 4

dots inside toxo cyst are called what

Back 4

tachyzoite

Front 5

IgM in cord blood means what

Back 5

congenital infection

Front 6

key to CMV encephalitis diagnosis in newborn

Back 6

periventricular calcifications

Front 7

spleen is necessary to remove what two organisms

Back 7

salmonella
streptococcus pneumonia

(pt with no spleen will get sepsis)

Front 8

why is osteonyelitis caused by salmonella in sickle cell pts

Back 8

autosplenectomy

Front 9

handling brains gives you spngiform encephalopathy. what is eponymous disease name

Back 9

C-J disease

Front 10

HLA of multiple scleriosis

Back 10

HLA-DR2

Front 11

HLA of rheumatoid arthritis

Back 11

HLA-DR4

Front 12

trigger for RA in HLA-DR4 person

Back 12

CMV

Front 13

gender mc with MS

Back 13

female

Front 14

biggest path of MS

Back 14

destruction of oligodendrocytes or myelin sheaths by CD8 T cells

Abs attacking oligodendrocyte protein

Front 15

test question:
ID a gross picture of MS demyelination

Back 15

white matter has grey spots in it

Front 16

Does MS change intellect

Back 16

no - no dementia

Front 17

Does MS always progress into crippling disease?

Back 17

no

Front 18

what kind of tremor does MS pt have

Back 18

intention tremor

Front 19

describe MS speech pattern

Back 19

scanning speech

Front 20

describe gait of MS pt

Back 20

ataxic

Front 21

mc cause of optic neuritis

Back 21

MS

Front 22

pathognomonic for MS

*** high yield for board

Back 22

bilateral internuclear ophthalmoplegia

demyelination of motor fasciculus

Front 23

LP of MS

Back 23

(1) Increased CSF leukocyte count
• Primarily T lymphocytes
(2) Increased CSF protein
• Primarily an increase in γ-globulins
(3) Increased CSF myelin basic protein
• Indicates active disease
(4) Normal CSF glucose

Increased CSF protein but no cells
• Oligoclonal bands present on high resolution electrophoresis

Front 24

how do you see "oligoclonal bands" in MS

Back 24

high resolution electrophoresis

Front 25

Central pontine myelinolysis

Back 25

due to rapid intravenous correction of hyponatremia

Front 26

sign of Central pontine myelinolysis

Back 26

quadriplegia

Front 27

causes of dementia

Back 27

hypothyroidism
lacunar infarcts
alzheimers
etc (lots)

rule out all before dx with alzheimers

Front 28

key chromosome for alz

Back 28

21 - makes amyloid precursor protein

Front 29

3 secretases

Back 29

(1) α-Secretases cleave APP into fragments that cannot produce Aβ.
(2) β followed by γ-secretases cleave APP into fragments that are converted to Aβ.
(3) Aβ deposits in neurons are neurotoxic.
• They also deposit in the walls of cerebral blood vessels.

Front 30

beta amyloid protein. why is it bad

Back 30

knocks off neurons

Front 31

alz in 35 year old. What;s the pt's other disease

Back 31

Down's

Front 32

tau protein?

Back 32

maintains microtubules in neurons

Front 33

what if tau proteins are hyperphosphorylated?

Back 33

tau protein makes fibers that make neurofibrillary tangles

Front 34

Pin 1 (prolyl isomerase)
• what does it do?

Back 34

normally strips excess phosphate molecules from NF restoring it to its original shape.

*****

Front 35

do alz pts have Pin 1 ?

Back 35

Important in preventing formation of NF tangles; often absent in AD brains

****

Front 36

lobe spared atrophy in alz

Back 36

occipital

Front 37

Congo red stain shows what with amyloid

Back 37

apple-green birefringence

Front 38

what does silver stain show

Back 38

"red" amyloid on yellow background

good to see senile plaques

Front 39

key: how do you diagnose alz when person is alive?

Back 39

purely cognitive testing.

presumptive diagnosis

Front 40

voluntary muscle mov't controlled by what

Back 40

striatum

Front 41

main neurotransmitter in substantia nigra

Back 41

DA

Front 42

Grossly, what does black midbrain substantia nigra look like in parkinsonism pt

Back 42

blackness disappears

Front 43

type of rigidity with Parkinsonism

Back 43

cogwheel

Front 44

describe gait of parkinsonism

Back 44

shuffling

Front 45

Lewy body:

Back 45

Neurons contain intracytoplasmic, eosinophilic bodies
• Ubiquinated damaged neurofilaments

Front 46

ubiquitin is stress protein that marks cells for death

what is Lewy body in the liver called?

Back 46

Mallory body

Front 47

gas poisoning that can causes parkinsonism

Back 47

CO

Front 48

by product of meperidine that causes parkinsonism

Back 48

MPTP

Front 49

tail of caudate is atrophic. AD disease. what is it

Back 49

huntington

Front 50

genetic problem in Huntington's

Back 50

trinucleotide repeats

Front 51

"anticipation"

Back 51

trinucleotide repeat tail gets longer with more generations - disease gets more severe

Front 52

What disease?
1. Autosomal recessive disease
• Trinucleotide repeat disorder (GAA)
affects cerebellum

Back 52

Friedreich’s ataxia

Front 53

part of brain involved in Friedreich’s ataxia

Back 53

dorsal columns
lateral corticospinal tract
posterior spinocerebellar tract

Front 54

heart problem assoc with Friedreich's

Back 54

Hypertrophic cardiomyopathy

Front 55

endocrine prob assoc with Friedrich's

Back 55

diabetes mellitus

Front 56

desribe neuro exam in parkinsonism

Back 56

normal

Front 57

ALS: Popie's signs and symptoms

Back 57

fasciulations all over
weakness

Front 58

ALS is upper or lower motor disorder?

Back 58

both

Front 59

first muscles to atrophy in ALS

Back 59

intrinsic muscles of hand
tongue

Front 60

why do motor neurons break in ALS

Back 60

free radical damage

Front 61

Werdnig-Hoffmann disease
• What is it

Back 61

Lower motor neuron disease that occurs in children

Front 62

can't eliminate Cu in bile. Cu stays in the liver.
Ceruloplasmin is decreased
What's the disease

Back 62

Wilsons

Front 63

key to Wilson's: total serum Cu. 90-95% of value is bound to ceruloplasmin. The free Cu is dangerous.

What's total serum Cu level in Wilson's disease?

Back 63

decreased

Front 64

how does Cu hurt the liver

Back 64

free radicals

Front 65

end stage wilson's

Back 65

cirrhosis
HCC
parkinsonism
dementia

Front 66

Kayser-Fleischer ring?

Back 66

brown pigment of outer cornea

Front 67

lenticular degeneration?

Back 67

atrophy/cavitation of basal ganglia
in Wilson's dis

Front 68

endproduct of degredation of heme

Back 68

bilirubin

Front 69

does hemoglobin have color

Back 69

no (heme does)

Front 70

deficient enzyme in AIP

Back 70

uroporphyrinogen I synthase
(alias porphobilinogen deaminase)

Front 71

rate limiting step of heme pathway

Back 71

ALA synthase (PLP)

Front 72

Urine is colorless when first voided. why?

Back 72

(1) Exposure to light causes oxidation of porphobilinogen to porphobilin producing port-wine color.
(2) Classic "window-sill test"

Front 73

neuro problems in Pb poisoning caused by what?

Back 73

δ-aminolevulinic acid (ALA)

Front 74

neuro problems in AIP caused by what?

Back 74

δ-aminolevulinic acid (ALA)

Front 75

belly full of scars: multiple surgeries finding no cause of abdominal pain.
pt can have dementia, neuro probs (ALA), etc. What can be cause

Back 75

AIP

Front 76

what precipitates attacks of pain in AIP pt

Back 76

alcohol

CYP450 system has heme in it. the cytochrome is heme.
ALA synthase is revved up b/c/ heme is gone

Front 77

diff b/w syringomyelia and ALS

Back 77

ALS is purely motor

Front 78

B12 defici affects the same tracts in spinal cord as what disease

Back 78

Friedrich's ataxia

Dorsal column, lateral corticospinal tract, and spinocerebellar tract demyelination

Front 79

diff b/w B12 and folate defici

Back 79

no neuro symps in folate defici

Front 80

alcohol CNS disease

atrophy of what part of brain

Back 80

cortical/cerebellar atrophy

Front 81

Wernicke-Korsakoff syndrome
a. Most often due to what

Back 81

thiamine deficiency

mc due to alcoholism

Front 82

b. Gross and microscopic findings of
Wernicke-Korsakoff syndrome

Back 82

(1) Hemorrhages with hemosiderin deposits; sites−
• Mamillary bodies, wall of the third and fourth ventricles (Slide 47)
(2) Neuronal loss, gliosis, vessel hemorrhage

Front 83

thiamine is major cofactor for reactions producing what?

Back 83

ATP

Front 84

pyruvate --> acetyl CoA gives how many NADH

Back 84

2

Front 85

cofactor for pyruvate dehydrogenase

Back 85

thiamine

Front 86

how does gucose/saline IV induce Wernicke's encephalopathy in alcoholic

Back 86

IV is given without thiamine

Front 87

Wernicke's encephalopathy symptoms

Back 87

confusion
ataxia
nystagmus
ophthalmoplegia

Front 88

where are hemorrhages of wernicke's

Back 88

Mamillary bodies, wall of the third and fourth ventricles

Front 89

tumors. what do you need to know

Back 89

which ones are in adults and which are in adults

locations

Front 90

where are 70% of adult brain tumors

Back 90

supratentorial

Front 91

where are 70% of kids' brain tumors

Back 91

infratentorial

Front 92

primary adult brain tumor

Back 92

Glioblastoma multiforme

Front 93

original cell of glioblastoma multiforme

Back 93

astrocyte

Front 94

brain tumor in adult: In order of decreasing frequency−

Back 94

• Glioblastoma multiforme, meningioma, ependymoma

Front 95

brain tumors in kids In order of decreasing frequency−

Back 95

• Cystic cerebellar astrocytoma, medulloblastoma, brainstem glioma

Front 96

glioblastoma multiforme is famous for going across what

Back 96

corpus callosum

Front 97

meningioma : more commen in which gender

Back 97

women

estrogen receptors

Front 98

mc presentation of meningioma

Back 98

focal epileptic seizure
woman

Front 99

psammoma bodies? in what brain tumor

Back 99

meningioma

Front 100

ependymoma: where is it?

Back 100

kids: 4th vent

adults: cauda equina

Front 101

Malignant small cell tumor
• Primarily occurs in children
external granular cell layer of the cerebellum
Often seeds the neuraxis and invades the fourth ventricle

Back 101

Medulloblastoma

Front 102

40 yr old male
seizure
frontal mass w/ calcification
looks like fried eggs

Back 102

Oligodendroglioma

Front 103

lymphoma of the brain. mc primary or mets?

Back 103

mets



Majority are metastatic high-grade B cell non-Hodgkin’s lymphomas

Front 104

Primary CNS lymphomas due to what?

Back 104

a. Most often associated with AIDS
b. Epstein-Barr virus–mediated B-cell lymphomas
c. Rapidly increasing due to the increase in AIDS

Front 105

board question:

the rapid incr in primary CNS lymphoma in the USA is due to what

Back 105

HIV

Front 106

mc cancer of the brain? (not primary)

Back 106

mets

Front 107

a board question about mets has what clues in the stem

Back 107

multiple lesions
wt loss

Front 108

burning feet at night
like ant bites

Back 108

peripheral neuropathy

Front 109

mc genetic peripheral neuropathy

Back 109

Charcot-Marie-Tooth (AD)

affects common peroneal nerve of the leg

(inverted bottle leg)

Front 110

mc acute peripheral neuropathy

Back 110

Guillain-Barre syndrome

Front 111

mc infections that then precede to some ascending paralysis

(Autoimmune demyelination syndrome)

Back 111

EBV
mycoplasma pneumonia
campylobacter jejuni

Front 112

mc cause of periph neuropathy

Back 112

DM

Front 113

what cells have aldose reductase

Back 113

lens of eye
schwann cells
pericytes around retinal vessels

Front 114

what's the big deal about sorbitol

Back 114

osmotically active
sucks water to it

-aneurysms of retinal vessels
-refractive change of lenses
-cataracts

Front 115

toxins that produce peripheral neuropathy

Back 115

heavy metal
alcohol
diphtheria toxin

Front 116

nerve to close eyes

Back 116

VII - orbicularis oculi

Front 117

nerve to open eye

Back 117

III - levator palpebri

Front 118

can lower motor bell's pt wrinkle eyebrows

Back 118

no

Front 119

mc cause of bell's

Back 119

HSV (mc)

, HIV, sarcoidosis, Lyme disease

Front 120

#1 nerve involved in Lyme's

Back 120

VII (bilateral)

Front 121

if forehead works, where's the problem?

Back 121

upper - in the brain

Front 122

acoustic neuroma slide looks like what african animal

Back 122

zebra

light and dark areas

Front 123

is there vertigo acoustic neuroma?

Back 123

no, but it's in meniere's

Front 124

what is ophthalmia neonatorum

Back 124

Conjunctivitis in newborn

Front 125

what is time line of eye pus (ophthalmia neonatorum) in chlamydia and gono

Back 125

gono - 1st week
chlamydia - 2nd week

Front 126

pathogens causing bacterial conjuctivitis

Back 126

Pathogens: Staphylococcus aureus (most common), Streptococcus pneumoniae, Hemophilus influenzae (aegyptius, pink eye)

Front 127

symptoms of bacterial conjuctivitis

Back 127

Purulent conjunctivitis. Pain but no blurry vision

Front 128

sympt and cause of viral conjuctivitis

Back 128

Watery exudate
Adenovirus: viral cause of pink eye, preauricular lymphadenopathy
HSV-1: keratoconjunctivitis with dendritic ulcers noted with fluorescein staining

Front 129

Seasonal itching of eyes

Back 129

Allergic conjunctivitis

Front 130

What causes Severe keratoconjunctivitis in patients who do not clean their contact lenses properly

Back 130

Acanthamoeba conjunctivitis

Front 131

Stye (hordeolum) cause

Back 131

staph aureus

Front 132

Granulomatous inflammation involving the meibomian gland in the eyelid

Back 132

Chalazion

Front 133

orbital cellulitis what does it look like?

Back 133

rubor, tumor of both upper/lower lids of eye

extension of sinusitis

Front 134

bad sequellae of orbital cellulitis

Back 134

spread from ethmoid sinus to cavernous sinus!

Front 135

pterygium common in what geography

Back 135

windy, dry, sandy, sunny

Front 136

optic neuritis: presents with pale disc with blurry vision or loss of vision, may cause optic atrophy

mc cause

Back 136

MS

other: methanol poisoning

Front 137

Central retinal artery occlusion:

what are wymps

Back 137

sudden, painless, complete loss of vision in one eye, pallor of optic disc, "boxcar" segmentation of blood in retinal veins

Front 138

artery involved with central retinal artery occlusion

Back 138

ophthalmic artery

Front 139

central retinal vein occlusion
causes and symptoms

Back 139

Causes: hypercoagulable state (e.g., polycythemia vera)
Clinical: sudden, painless, unilateral loss of vision, swelling of optic disc, engorged retinal veins with hemorrhage

Front 140

aqueous humor maked by what

Back 140

ciliary body

Front 141

aqueous humor exits anterior chamber where

Back 141

trabecular meshwork (schlemm)

Front 142

cause of open angle glaucoma

Back 142

block of treabecular meshwork

Front 143

Tx of open angle glaucoma

Back 143

beta blocker - decreases aqueous production

Front 144

presentation of open angle glauc

Back 144

bilateral eye pain
bad peripheral vision
bad night vision

Front 145

why closed angle glaucoma

Back 145

iris pushed anteriorly
narrow angle blocks aqueous drainage

Front 146

treatment for acute closed angle glauc

Back 146

pilocarpine (miotic agent = closes pupils)

Front 147

mc cause of optic nerve atrophy

Back 147

glaucoma
optic neuritis

Front 148

uveitis: what's it look like

Back 148

inflam of uveal tract:
choroid, iris, ciliary body

lots of vascularity visible, blurry vision, will go blind w/o eye specialist

Front 149

disease that cause uveitis

Back 149

sarcoid

Front 150

mc cause of permanent vision impairmentn in old people

Back 150

macular degeneration

Front 151

what does dry type macular degeneration (break down of Brooks membrane of retina) look like

Back 151

little droplets around macula

drusen

Front 152

how do you know if it's wet MD

Back 152

blood

Front 153

helper T cell count of 50
blindness
cotton wool exudates

Back 153

CMV retinitis

Front 154

treatment of CMV retinits

Back 154

ganciclovir
Foscarnet if it doesn't work

Front 155

mc cause of cataract

Back 155

age

Front 156

other causes of cataracts

Back 156

DM
systemic corticosteroids
infection (e.g., rubella),

Front 157

mechanism of cataract in DM

Back 157

osmotic damage (sorbitol)

Front 158

mc cause of white eye reflex in new borns

Back 158

retinoblastoma

Front 159

too much endolymph in inner ear
fullness complaint
tinnitus
vertigo
sensorinrual hearing loss

Back 159

Meniere's disease

Front 160

how's Meniere's diff from acoustic neuritis

Back 160

vertigo in Meniere's, not in AN

Front 161

mc cause of sensorineural hearing loss in old people

Back 161

Presbycusis

Front 162

mc cause of conductive hearing loss in old person

Back 162

otosclerosis

Front 163

mc cause of conduction deafness in children

Back 163

otitis media

Front 164

swimmer's ear

Back 164

external otitis

due to Pseudomonas aeruginosa, S. aureus, Aspergillus species

Front 165

Malignant external otitis: severe infection of outer ear canal in patients with diabetes mellitus.

mc cause?

Back 165

Pseudomonas aeruginosa most common cause