Thomas First Aid Neuro 2

Front 1

what is lesion:
ipso UMN signs below lesion level
ipso dorsal column loss
contralateral pain and temp loss
ipso loss of all sensation at level of lesion
LMN signs at level of lesion

Back 1

Brown-Sequard Syndrome

(hemiparesis of spinal cord)

Front 2

Horner's must be lesion above what level?

3 associated findings

Back 2

T1

ptosis
anhidrosis and flushing on afffected side
miosis (pupil constriction)

Front 3

name dermatomes:
skull cap
nipple
kneecaps
inguinal ligament
sensation of penile/anal zones (3)
low collar shirt
xiphoid process
umbilicus
turtleneck shirt

Back 3

skull cap- C2
turtleneck- C3
low collar shirt- C4
nipple- T4
xiphoid process- T7
Umbilicus- T10
Inguinal Ligament- L1 (jok strap)
Kneecaps- L4 ("down on L4s)
penile/anal sensation and
erection- S2,S3,S4 ("S2,3,4 keep the penis off the floor")

Front 4

primitive reflexes usually disappear by

Back 4

1 year old

can reemerge if frontal lobe injury

Front 5

Pineal gland fxn:
pinealoma can lead to what neuological deficit

Back 5

secretes melatonin, regulates circadian rhythms

pinealoma can compress superior colliculus, cause Parinaud Syndrome - paralysis of conjugate gaze and/or cannot look up

Front 6

superior colliculus does what?
inferior colliculus?

Back 6

"eyes above ears"
superior does conjugate gaze= eyes moving together (damage results in Parinaud syndrome)
inferior helps with hearing

Front 7

What is nucleus for parasympathetic innervation of face? carried to eye by what nerve?

Back 7

Edinger-Westfall

CNIII (has muscarinic receptor)

Front 8

stapedius muscle of ear innervated by what CN

Back 8

VII (from second arch)

Front 9

what innervation comes from alar plate? lateral or medial?

Back 9

Alar plate- Sensory (lateral)

Basal plate- Motor (Medial on brainstem)

Front 10

glossopharyngeal muscle innervation

Back 10

stylopharyngeus

Front 11

lacrimation reflex: afferent CN and efferent

Back 11

CN V1

CN VII

Front 12

Jaw jerk reflex afferent and efferent CN

Back 12

V3 (muscle spindle from masseter), V3 (masseter)

Front 13

Nucleus Solitarius CNs

Back 13

visceral Sensory for CN VII, IX, X

Front 14

nucleus aMbiguus CNs

Back 14

visceral Motor for IX, X, XI

Front 15

Dorsal Motor Nucleus fxn (in brainstem)

Back 15

parasympathetic fibers fibers to heart, lungs, GI

Front 16

What are exits out of the middle cranial fossa through the sphenoid bone?

Back 16

Optic canal -CN II

"Standing room only"
Superior Orbital Fissue- V1, CN III, CN IV, CN VI, opthalmic vein, sympathetic fibers
Foramen rotundum- V2
Foramen Ovale- V3

foramen spinosum - middle meningeal artery

Front 17

what structures come out of superior orbital fissure (6)

Back 17

CN III, CN IV, CN VI, sympathetic fibers, opthalmic vein, CN V1

Front 18

what CN come out the internal auditory meatus?

Back 18

CN VII, CN VIII

Front 19

what comes out jugular foramen (4)

Back 19

jugular vein, CN IX, CN X, CN XI

CN XII DOES NOT, comes out hypoglossal canal

Front 20

does CN come out jugular foramen or foramen magnum?

Back 20

Both!

nerve comes out jugular foramen, spinal roots come out foramen magnum

Front 21

opthalmoplegia, opthalmic and maxillary sensory loss is what?

Back 21

cavernous sinus syndrome

Front 22

structures that run through cavernous sinus (7)? this drains to where?

Back 22

cavernous sinus runs on either side of pituitary gland
contains:
CN III, CN IV, CN VI, postganglionic sympathetic fibers
V1, V2
internal carotid artery

abducens only free nerve running

Front 23

CN V lesion causes contra/ipso jaw deviation

Back 23

ipsolateral

Front 24

CN X lesion, uvula deviates toward or away side of lesion?

Back 24

away

Front 25

CN XI, should weak ipso or contra? weakness turning head ipso or contra?

Back 25

weakness turning head conrtalateral, weak shoulder ipsolateral

Front 26

Bell's Palsy causes (6)

Back 26

AIDS
Lyme disease
Herpes
Sarcoidosis
Tumor
Diabetes
"ALexander graHam BELL with STD"

Front 27

1 muscle that closes jaw, 3 that open

Back 27

1 open - lateral pterygoid

close - Medial Pterygoid, Masseter, teMporalis

all by V3

Front 28

does ciliary muscle contract for near or far vision?

Back 28

near (zonular fibers relax, lens relaxes and becomes more convex)

Front 29

monocular vision loss with pale retina and cherry red macula indicate

Back 29

retinal artery occlusion (macula supplied by choroid)

Front 30

what causes lens to change shape as age

Back 30

sclerosis and loss of elasticity

Front 31

what actions does each receptor have in eye and relationship to glaucoma
a1
beta
m3

Back 31

a1- pupillary dilator muscle (myadrisis), can cause closed angle glaucoma
beta- produce aqueous humor (because use beta blockers to inhibit production)
m3- contracts ciliary muscle (relieving Open angle glaucoma), constrict pupillary sphincter (miosis, relieving Closed angle glaucoma)

Front 32

open angle glaucoma:
cause
3 risk factors
more/less common than closed angle?

Back 32

blockage of canal of schlemm

increased age
myopia (nearsightedness, can't see far away= I have myopia)
African Americans

Front 33

Closed angle (acute angle) glaucoma:
cause
DO NOT GIVE what?

Back 33

obstruction of flow between iris and lens

don't give Epi

(but other sympathmimetics, dim light, or anything else that can dilate the eye can cause it)

Front 34

3 metabolic causes of cataracts

Back 34

classic galactosemia
galactokinase deficiency
diabetes

Front 35

elevated optic disk with blurred margins is

Back 35

papilledema

Front 36

problems with vision while reading newspaper or going down stairs indicate

Back 36

CN IV lesion

Front 37

to test the inferior oblique extra ocular muscle, have the patient look where?

Back 37

look up

"IOU"

Front 38

2 causes of afferent pupillary defect (Marcus Gunn pupil) = decreased bilateral constriction when light shown in one eye

Back 38

retinal detachment

damage to optic nerve

Front 39

does Meyer's loop run through temporal or parietal lobe?

Back 39

temporal (so would cause bilateral superior quadrantinopia

Front 40

CN III:
what affects motor over parasympathetic fibers? what affects parasympathetic over motor?

Back 40

motor- vascular problems (diabetes: glucose- sorbitol)

parasympathetic- compression affects more (on outside)

Front 41

retinal detachment:
separates from what?
can be secondary to what (2)

Back 41

separates from pigmented epithelium

trauma, diabetes

Front 42

"Dry" vs "Wet" Macular Degeneration:
cause of each

Back 42

Dry- slow progressive loss of central vision (scotomas) due to fat deposits

wet- fast loss of central vision (scotoma as well) because of neovascularization

Front 43

when patient looks left, right eye stops at midline and left eye looks left with right-beating nystagmus
what is condition
lesion where
associated with what disease

Back 43

Internuclear Opthalmoplegia

Right MLF lesion

MS

Front 44

Presenilin is associated with what disease

Back 44

EARLY ONSET Alzheimers

Front 45

APP gene is associated with what disease

Back 45

EARLY onset Alzheimers

Front 46

2 lipoproteins associated with neurological function?

Back 46

APO E4 - late onset Alzheimers

APO E2 - protective against Alzheimers

Front 47

Alzheimer's disease can get intracranial hemorrhage, from what?

Back 47

extracellular beta-amyloid plaques can cause amyloid angiopathy--> hemorrhage

Front 48

Neurofibrillary tangles in Alzheimers are composed of what, tangles correlate to what?

Back 48

neurofibrillary tangles composed of improperly phosphorylated tau protein (intracellular, unlike amyloid plaques)

tangles correlate with degree of dementia

Front 49

Parkinsonism with dementia and hallucinations is? what protein found

Back 49

Lewy Body dementia

alpha-synuclein defect

Front 50

Dementia with aphasia, change in personality, parkinsonian aspects is what dementia?
what part of brain degenerates, what seen in cells?

Back 50

Pick's Disease
-also called fronto-temporal dementia, because atrophy selectively to frontal and proximal temporal lobes

Pick Bodies (aggregates of tau protein) seen

Front 51

rapidly progressive dementia with myoclonus, multiple vacuoles in gray matter is what?
what change seen in cortex?

Back 51

Creutfeldt-Jacob Disease

spongiform cortex

prions change alpha helices to beta sheets (resistant to proteases)

Front 52

Behing Alzheimers, what is second most common cause of dementia in elderly?

Back 52

multiple infarcts

Front 53

4 dementia causes that are not Alzheimers, Lewy Body, Pick's, or CJD
(1 nutrient, 2 infectious agents, 1 accumulation)

Back 53

B12
HIV
Syphilis
Wilson's disease

Front 54

nystagmus, scanning speech (abnormal pauses between words/syllables), intention tremor indicate, incontinence

Back 54

MS

Front 55

What finding is diagnostic for MS?
what is diagnostic gold standard?
what commonly seen in brain?

Back 55

pathopneumonic- oligoclonal bands in CSF

gold standard- MRI

commonly seen in brain- periventricular plaques (reactive gliosis from degraded oligodendrocytes, but axons remain because MS only affects myelin)

Front 56

Guillan Barre:
-2 populations of nerve fibers affected most
-what is presentation

Back 56

demyelination of peripheral nerves and anterior motor roots

symmetric ascending paralysis beginning is distal extremities

Front 57

Guillan Barre:
-problem?
-associated with what protein
-what 2 infections
-CSF finding
-intracerebral finding

Back 57

abs develop against peripheral myelin
protein- AIDP
campy and herpes
CSF finding- increased protein but normal cell count
-increased intracerebral pressure from increased protein

Front 58

Progressive Multifocal Leukoencephalopathy caused by what? causes damage to what?

Back 58

caused by JC virus (double stranded circular DNA polyomavirus) in immuncocompromised, demyleination of oligodendrocytes (see multifocal lesions in white matter of brain)

Front 59

multifocal perivenular inflammation and demyelination after an infection is what?

Back 59

acute dissemintated encephalomyelitis (ex. chickenpox, measles, vaccines to rabies or smallpox)

Front 60

Arylsulfate accumulation indicates?
inheritance?

Back 60

Metachromatic Leukodystrophy
lysosomal storage disease that causes buildup of sufatides leading to impaired myelin sheath production
AR

Front 61

hereditary sensory and motor neuropathy characterized by problems with peripheral nerve myelin sheaths

Back 61

Charcot Marie Tooth

(what Samantha has)

Front 62

3 most common cause of stroke in kids?
adults?
elderly?

Back 62

kids- genetic, infection (febrile), trauma
adults- tumors, trauma, stroke
elderly- stoke, tumors, trauma

(stroke at end for adults, shifts to front for elderly)

Front 63

most common location of partial seizure to start

Back 63

medial temporal lobe

Front 64

2 types of partial seizure:

Back 64

simple partial: no impaired consciousness, can be sensory/motor/autonomic/psychic

complex partial: impaired consciousness and post-ictal state

Front 65

5 types of complete seizures

Back 65

Absence Seizures (petit mal, 3 Hz)
Tonic-Clonic (grand mal)- alternating between jerking and stiffness
Tonic - stiff
Mycoclonic- jerking
Atonic- drops to floor

Front 66

unilateral head pulsating pain 4-72 hours, photo/phonophobia, "aura" of neurological symptoms before headache like visual/speech/sensory disturbances?
cause?
2 treatments chronic
1 treatment acute

Back 66

migraines
irritation of CN V and release of substance P and vasoactive peptides (cerebral vasodilation and low 5-HT levels seen)
propranolol, NSAIDs

acute- sumatriptan (can cause MI in patients with CAD)

Front 67

bilateral headache for more than 30 minutes not exacerbated by light?

Back 67

Tension headache

Front 68

unilateral recurrent headache with lacrimation, rhinorrhea, Horner's?
treatment?

Back 68

Cluster headache

treatment- sumatriptans

Front 69

Peripheral vs Central vertigo:
what will be difference of nystagmus on positional testing?
where is problem in each case?

Back 69

Peripheral: will have DELAYED nystagmus on positional testing. indicates problem in inner ear (Meniere's disease, CN VIII, semicircular canal debris). this is more common

Central Vertigo: will have IMMEDIATE nystagmus (indicates cerebellar or brainstem lesion)

Front 70

Port-wine stain in V1 distribution?
what type of tumor may be present?
4 complications

Back 70

Sturge-Webber (will have ipsolateral leptomeningeal angiomas in brain)
-can also have pheochromocytomas

complications- seizures, glaucoma, hemiparesis, mental retardation

Front 71

dark papules on face, nodules on skin, light spots on skin, leathery spot on skin?
3 tumors associated
2 other problems associated

Back 71

hamartomas, sebaceous adenoma, cafe-au-lait spots, leathery spot- shagreen patch = tuberous sclerosis (AD)

tumors- subependymal giant cell astrocytoma, cardiac rhabdomyoma, angiomyolipoma (benign tumor of kidney)

can cause mental retardation, seizures

Front 72

brown spots on iris, nodules on skin, light skin patches?

3 tumors associated
chromosome associated

Back 72

lisch nodules (hamartomas on iris), neurofibromas (benign nerve sheath tumor), caf-au-lait spots= NF1

optic gliomas (from glial cells, technically low grade astrocytoma), pheochromocytoma, meningioma

NF1 on chromosome 17

Front 73

3 conditions not MEN with pheochromocytomas

Back 73

all neurocutaneous disorders except tuberous sclerosis

Sturge-Webber
Von Hippel Lindau
NF1

Front 74

3 problems in Von Hippel Lindau

inheritance, mutation and location

Back 74

Renal Cell Carcinoma
Hemangioblastoma (retina, brainstem, cerebellum)
Pheochromocytoma

AD
VHL gene on chromosome 3

Front 75

3 most common adult tumors

Back 75

3 Ms
Metastases (at gray-white border)
glioblastoma Multiforme
Meningioma

Front 76

3 most common kid tumors

Back 76

in cerebellum
Pilocytic astrocytoma
Medulloblastoma
Ependymoma

Front 77

butterfly pattern tumor?
will stain positive for what
what seen on histo

Back 77

Glioblastoma multiforme
astrocytoma, so will stain GFAP (+)
"pseudopallisading" cells- central areas of necrosis and hemorrhage surrounded by tumor cells

most will live less than 1 year

Front 78

brain tumor:
histo: whorled pattern with small calcficiations
arise from

Back 78

Meningioma (2nd most common in adults)

calcifications= psammoma bodies

tumor arises from arachnoid cells

Front 79

bilateral schwannomas stain positive for what

Back 79

S-100

Front 80

brain tumor:
round nuclei with clear cytoplasm in frontal lobe, may have calcifications

Back 80

Oligodendroglioma

"chicken-wire" capillary pattern
"fried-egg" nuclei

seen in adults

Front 81

2 tumors that presents with bitemporal hemianopsia from what embryonic structure

Back 81

pituitary adenoma
rathke's pouch

craniopharyngeoma (most common supratentorial tumor in kids, can be calcified)
from rathke's pouch remnants

Front 82

Brain tumor:
histo: eosinophilic corkscrew fibers
gross: cystic and solid

will stain positive for what?

Back 82

Pilocytic astrocytoma (most common kid tumor)

Rosenthal fibers are eosinophilic fibers

these can be supratentorial, but are usually in posterior fossa like others

GFAP (+)
(because an astrocytoma)

Front 83

2 child tumors that can present with pseudorosettes, hydrocephalus? how different in producing hydrocephalus

Back 83

Medulloblastoma- compress 4th ventricle

Ependymoma- in 4th ventricle

Front 84

Medulloblastoma

from what cells, cell characteristics on histo

Back 84

a primitive neuroectodermal tumor (PNET)

small blue cells

Front 85

hemangioblastoma:
usually found where
when found where, suggest VHL
histo findings (2):
paraneoplastic:

Back 85

usually found in cerebellum

VHL- retina

histo findings- foamy cells and high vascularity

Epo

Front 86

Uncal herniation:
is what
uncus is what?
causes what neurological findings, can cause compression of what 2 vessels

Back 86

Transtentorial herniation: herniation of uncus (medial temporal lobe) below tentorium

ipso dilated pupil (stretches CN III)
contralateral homonymous hemianopsia (compresses PCA)
caudal displacement of brainstem (paramedian artery rupture)

Front 87

subfalcine (Cingulate) herniation can compress what artery

Back 87

ACA

Front 88

4 causes of ring-enhancing lesions

Back 88

metastases, abscess, Toxiplasmosis, AIDS lymphoma

Front 89

3 causes of uniform-enhancing brain lesions

Back 89

lymphoma, meningioma, some metastases

Front 90

heterogenously enhancing lesion in brain indicates

Back 90

glioblastoma multiforme