Usmle First Aid Neurology

Front 1

What cells make up the inner lining of the ventricles?

Back 1

ependymal cells

Front 2

What cells have the same embryologic origin as microglia?

Back 2

Macrophages; remember: Microglia, like Macrophages, originate from Mesoderm

Front 3

Microglia originate from what embryologic layer?

Back 3

Mesoderm

Front 4

Except for microglia, all central and peripheral nervous system supportive cells originate from what layer?

Back 4

The ectoderm

Front 5

What is the function of ependymal cells?

Back 5

Ependymal cells make cerebrospinal fluid

Front 6

Which two types of cells derive from neural crest cells?

Back 6

Schwann cells and PNS neurons

Front 7

CNS neurons are derived from ________ (neuroectoderm/neural crest) while PNS neurons derive from (neuroectoderm/neural crest).

Back 7

neuroectoderm; neural crest

Front 8

Neuroectoderm is the embryologic derivative of which four types of cells?

Back 8

oligodendroglia, CNS neurons, astrocytes, ependymal cells

Front 9

What comprises the RER in neurons?

Back 9

Nissl substance

Front 10

True or False: Nissl substance is located in the cell body, dendrites and axon of neurons.

Back 10

False: Nissl substance is NOT located in the axon of neurons

Front 11

Neurons are _____ (permanent/temporary) cells that _____ (do/do not) divide in adulthood.

Back 11

permanent; do not divide

Front 12

Which organelle is particularly prominent in neurons?

Back 12

nucleoli

Front 13

What is the response of astrocytes to injury known as?

Back 13

reactive gliosis

Front 14

What are the five functions of astrocytes?

Back 14

physical support, repair, potassium metabolism, removal of excess neurotransmitters, and maintenance of the blood brain barrier

Front 15

Which cells comprise the blood-brain barrier?

Back 15

astrocytes

Front 16

What is the molecular marker for astrocytes?

Back 16

GFAP

Front 17

In HIV-infected patients, microglia fuse to form _____ _____ _____ in the central nervous system.

Back 17

mutlinucleated giant cells

Front 18

In HIV-infected patients, microglia fuse to form _____ _____ _____ in the central nervous system.

Back 18

large ameboid phagocytic cells

Front 19

Microglia are not readily discernible in what kind of stains?

Back 19

Nissl stain

Front 20

What central nervous system support cell has small irregular nuclei and relatively little cytoplasm?

Back 20

microglia

Front 21

What is the main function of microglia?

Back 21

Phagocytosis (in the setting of tissue damage)

Front 22

True or False: The embryologic origin of microglia is the ectoderm.

Back 22

False; microglia are derived from mesoderm

Front 23

Which cells in the central nervous system are destroyed in multiple sclerosis?

Back 23

Oligodendrocytes (myelinating cells in the CNS)

Front 24

What type of cell myelinates multiple (up to 30 each) central nervous system axons?

Back 24

oligodendrocytes

Front 25

In Nissl stains, what type of cells appear as small nuclei with dark chromatin and little cytoplasm?

Back 25

Oligodendrocytes

Front 26

Oligodendrocytes are the predominant type of glial cell in _____ (gray/white) matter.

Back 26

white matter

Front 27

Which cells in the central nervous system look like fried eggs on H&E staining?

Back 27

oligodendrocytes

Front 28

_____ (Oligodendrocytes/Schwann cells) are found in the central nervous systme and myelinate _____ (1/up to 30) axons, while _____ (oligodendrocytes/Schwann cells) are found in the peripheral nervous system and myelinate _____ (1/up to 30) axons.

Back 28

Oligodendrocytes; up to 30; Schwann cells; 1

Front 29

What type of cells promote axonal regeneration in the peripheral nervous system?

Back 29

schwann cells

Front 30

An acoustic neuroma is a type of _______, a tumor derived of the cell type that provides myelin to neurons in the peripheral nervous system.

Back 30

schwannoma

Front 31

Where are acoustic neuromas commonly found?

Back 31

In the internal acoustic meatus

Front 32

Schwannomas in the internal auditory meatus often affect which cranial nerve?

Back 32

CNVIII (vestibulocochlear)

Front 33

Schwann cells are derived from what early cell type?

Back 33

neural crest cells

Front 34

Which syndrome is characterized by desctruction of Schwann cells?

Back 34

Guillain-Barré- ascending paralysis

Front 35

What are the four sensory corpuscles?

Back 35

Meissner's corpuscles, Pacinian corpuscles, Merkel's corpuscles, and free nerve endings

Front 36

What kind of corpuscles are involved in dynamic fine touch (e.g., manipulation)?

Back 36

Meissner's corpuscles; these are quickly-adapting receptors

Front 37

What kind of corpuscles are located in glabrous (hairless) skin?

Back 37

Meissner's corpuscles

Front 38

What kind of corpuscles are located in deep skin layers?

Back 38

Pacinian corpuscles

Front 39

Ligaments and joint capsules contain what type of sensory corpuscles?

Back 39

Pacinian corpuscles

Front 40

What kind of corpuscles transduce sensations of vibration and pressure?

Back 40

Pacinian corpuscles

Front 41

What kind of corpuscles are involved in dynamic fine touch (e.g., manipulation)?

Back 41

Meissner's corpuscles; these are quickly-adapting receptors

Front 42

What kind of corpuscles are located in glabrous (hairless) skin?

Back 42

Meissner's corpuscles

Front 43

What kind of corpuscles are located in deep skin layers?

Back 43

Pacinian corpuscles

Front 44

Ligaments and joint capsules contain what type of sensory corpuscles?

Back 44

Pacinian corpuscles

Front 45

What kind of corpuscles transduce sensations of vibration and pressure?

Back 45

Pacinian corpuscles

Front 46

What kind of corpuscles are located in hair follicles?

Back 46

Merkel's disks

Front 47

What type of touch do Merkel's corpuscles sense?

Back 47

Static touch (e.g., shapes, edges, textures); these are slowly adapting receptors

Front 48

What type of sensory corpuscles can be found through out the skin and in some viscera?

Back 48

free nerve endings

Front 49

Free nerve endings are made up of what two types of fibers?

Back 49

C (slow unmyelinated) and Aδ (fast, myelinated) fibers

Front 50

Pain and temperature are sensed by what type of sensory corpuscles?

Back 50

free nerve endings

Front 51

Single nerve fibers are invested in the _____.

Back 51

endoneurium; the prefix endo- means "inner"

Front 52

Each fascicle of the nerve fibers is surrounded by a permeability barrier called the _____.

Back 52

Perineurium (Remember Perineurium and Permeability barrier)

Front 53

What dense connective tissue surrounds the entire nerve, including the fascicles and the blood vessels?

Back 53

The epineurium; the prefix epi- means ‘outer’

Front 54

During a limb reattachment, what nerve layer must be rejoined for the operation to be successful?

Back 54

The perineurium; the prefix peri- means "around"

Front 55

Where in the brain is norepinephrine synthesized?

Back 55

locus ceruleus

Front 56

Where in the brain is dopamine synthesized?

Back 56

ventral tegmentum and substantia nigra pars compacta (SNc)

Front 57

Where in the brain is serotonin synthesized?

Back 57

raphe nucleus

Front 58

Where in the brain is acetylcholine synthesized?

Back 58

the basal nucleus of Meynert

Front 59

Norepinephrine is _____ (increased/decreased) in anxiety.

Back 59

increased

Front 60

In depression, which two neurotransmitters are decreased?

Back 60

norepinepherine and serotonin

Front 61

True or False: Both NE and 5-HT are decreased in anxiety.

Back 61

False; only 5-HT is decreased in anxiety; NE is increased

Front 62

In which psychiatric condition is dopamine increased?

Back 62

schizophrenia

Front 63

In Alzheimer's and Huntington's diseases, which neurotransmitter is decreased?

Back 63

Acetylcholine

Front 64

Which neurotransmitter is involved in the pathogenesis of Parkinson's disease?

Back 64

dopamine

Front 65

The blood-brain barrier is formed by what three structures?

Back 65

tight junctions between nonfenestrated endothelial cells, astrocyte foot processes, basement membranes

Front 66

What two substances cross the blood-brain barrier slowly by a carrier-mediated transport mechanism?

Back 66

amino acids and glucose

Front 67

What property of a molecule allows it to diffuse across the blood-brain barrier?

Back 67

nonpolar and lipid soluble substances

Front 68

Name the three blood barriers in the body.

Back 68

The blood-brain barrier, the blood-testis barrier, and the maternal-fetal blood barrier of the placenta

Front 69

Name three specialized brain regions with fenestrated capillaries and no blood-brain barrier.

Back 69

The area postrema (responsible for vomiting with chemotherapy), the OVLT (osmotic sensing) and the neurohypophysis (responsible for ADH release)

Front 70

Infarction destroys endothelial cell tight junctions in the blood-brain barrier, leading to leakage of fluid into the brain from damaged blood vessels causing _____ _______.

Back 70

vasogenic edema

Front 71

Central control for thirst and water balance is found in what part of the brain?

Back 71

hypothalamus (the supraoptic nucleus)

Front 72

Destruction of the lateral nucleus of the hypothalamus would produce what disorder?

Back 72

anorexia (lateral nucleus of the hypothalamus is responsible for hunger)
(If you zap your lateral nucleus, you shrink laterally)

Front 73

(If you zap your lateral nucleus, you shrink laterally)

Back 73

the ventral medial nucleus of the hypothalamus (responsible for satiety)
If you zap your ventromedial nucleus, you grow ventrally and medially)

Front 74

Parasympathetic activity is regulated by the _____ (anterior/posterior) hypothalamus.

Back 74

Anterior (Remember: pArasympathetic, Anterior)

Front 75

Sympathetic activity is regulated by the _____ (anterior/posterior) hypothalamus.

Back 75

posterior

Front 76

Circadian rhythms are predominantly regulated by which part of the hypothalamus?

Back 76

suprachiasmatic nucleus (You need sleep to be charismatic (chiasmatic)

Front 77

A patient presents with the inability to regulate heat conservation and production. What part of the brain is injured?

Back 77

posterior hypothalamus
(it is hot in the posterior/back of the bus)
(Remember: if you zap your Posterior hypothalamus, you become a Poikilotherm (cool, like a snake))

Front 78

What area of the brain coordinates the cooling of the body in hot temperatures?

Back 78

anterior hypothalamus (Remember A/C = anterior cooling)

Front 79

What region of the brain regulates sexual urges and emotions?

Back 79

septal nucleus of the hypothalamus

Front 80

How does the mnemonic TAN HATS describe the functions of the hypothalamus?

Back 80

TAN HATS: Thirst and water balance, Adenohypophysis control, Neurohypophysis releases hormones from hypothalamus, Hunger, Autonomic regulation, Temperature regulation, Sexual urges

Front 81

Which area of the hypothalamus responds to emetics?

Back 81

area postrema
(The area postrema (responsible for vomiting with chemotherapy) and the neurohypophysis (responsible for ADH release))

Front 82

Leptin stimulates the _____ (ventromedial/lateral) area, mediating _____ (hunger/satiety).

Back 82

Ventromedial; satiety

Front 83

Leptin-mediated inhibition of the _____ (ventromedial/lateral) area leads to _____ (hunger/satiety).

Back 83

lateral; satiety

Front 84

The posterior pituitary receives axonal projections from the _____ and _____ nuclei of the hypothalamus.

Back 84

supraoptic (ADH) and paraventricular (oxytocin)

Front 85

The posterior pituitary secretes which two hormones?

Back 85

ADH (vasopressin) and oxytocin

Front 86

The supraoptic nucleus produces which hormone?

Back 86

ADH (vasopressin)

Front 87

Oxytocin is produced in the _____ nucleus.

Back 87

paraventricular

Front 88

What structure is the major relay for sensory information ascending to the cortex?

Back 88

thalamus

Front 89

The ablation of the lateral geniculate nucleus would produce what kind of deficits?

Back 89

visual (Lateral for Light)

Front 90

The medial geniculate nucleus is responsible for the relay of what type of stimuli to the cortex?

Back 90

Auditory (Medial for Music)

Front 91

The medial geniculate nucleus is responsible for the relay of what type of stimuli to the cortex?

Back 91

lateral part of the ventral posterior nucleus of the hypothalamus (VPL) - sensation from body

Front 92

Sensory stimuli from the spinothalamic tract are relayed to the cortex via what part of the thalamus?

Back 92

lateral part of the ventral posterior nucleus of the thalamus (VPL)

Front 93

Sensory stimuli from cranial nerve V reaches the cortex via relay through what part of the thalamus?

Back 93

medial part of the posterior nucleus of the thalamus (VPM) (Remember you put Makeup on your face and the sensory info is relayed through the VPM)

Front 94

The ventral anterior/lateral nuclei are responsible for the relay of what kind of information?

Back 94

motor (motor is anterior to sensation just like in the cortex)

Front 95

True or False: The blood supply to the thalamus comes from the posterior communicating, posterior cerebral, and anterior choroidal arteries.

Back 95

True (anterior choroidal arteries are a branch of the internal carotid artery)

Front 96

Motor information is relayed through which two areas in the thalamus?

Back 96

the ventral anterior and ventral lateral nuclei

Front 97

Sensation, including touch, pressure, pain, and proprioception, is relayed through which area in the thalamus?

Back 97

lateral part of the posterior nucleus of the thalamus (VPL)--sensation is posterior to motor just like it is in the cortex

Front 98

Sensation information from the face is relayed through which area in the thalamus?

Back 98

medial part of the posterior nucleus of the thalamus (VPM)
VPM- Makeup on your face

Front 99

What are the four components of the limbic system?

Back 99

cingulate gyrus, fornix, hippocampus and mammillary bodies

Front 100

What are the five functions of the limbic system?

Back 100

Fighting, Fleeing, Feeling, Feeding and Fucking/sex (the five Fs)

Front 101

What are the output neurons of the cerebellum?

Back 101

purkinje fibers

Front 102

What are two types of neurons provide input to the cerebellum?

Back 102

climbing and mossy fibers

Front 103

From lateral to medial, name the four deep nuclei of the cerebellum.

Back 103

Dentate, Emboliform, Globose, Fastigial ("Don't Eat Greasy Foods")

Front 104

What is the role of the lateral cerebellum?

Back 104

Voluntary movement of the extremities

Front 105

What two functions does the medial cerebellum serve?

Back 105

Balance and truncal coordiation

Front 106

The cerebellum provides stimulatory feedback to the _____ (contralateral/ipsilateral) cortex.

Back 106

contralateral: serves to modulate movement of the ipsilateral side of the body (since the contralateral cortex will control that side)

Front 107

The cerebellum receives _____ (contralateral/ipsilateral) input via the middle cerebellar peduncle.

Back 107

contralateral

Front 108

Ipsilateral proprioceptive information reaches the cerebellum via the _____ (inferior/middle) cerebellar peduncle.

Back 108

inferior

Front 109

True or False: The basal ganglia are important in voluntary movement and postural adjustments.

Back 109

True

Front 110

A patient presents with cog-wheel rigidity. This symptom is likely the result of decreased input from what structure?

Back 110

the substantia nigra (dopamine)

Front 111

Decreased input to the substantia nigra leads to _____ (increased/decreased) stimulation to the direct pathway and _____ (increased/decreased) inhibition of the indirect pathway.

Back 111

Decreased; increased

Front 112

True or False: The direct pathway of the basal ganglia facilitates movement.

Back 112

True

Front 113

True or False: The direct pathway of the basal ganglia inhibits movement.

Back 113

False; the indirect pathway inhibits movement

Front 114

Decreased input to the substantia nigra occurs in what disease?

Back 114

Parkinson's disease

Front 115

True or False: The direct pathway of the basal ganglia projects from the putamen to the globus pallidus internus.

Back 115

True

Front 116

The globus pallidus externus receives input from the putamen via what pathway of the basal ganglia?

Back 116

indirect/inhibitory pathway

Front 117

The putamen receives stimulatory and inhibitory information from what structure?

Back 117

substantia nigra pars compacta (dopamine acting on D1 and D2 receptors)

Front 118

What dopamine receptors in the putamen send stimulatory information via the direct pathway?

Back 118

D1 receptors

Front 119

What are the principle receptors for inhibitory signals within the putamen?

Back 119

D2 receptors

Front 120

The loss of dopamine in Parkinson's disease _____ (inhibits/disinhibits) the excitatory pathway and _____ (inhibits/disinhibits) the inhibitory pathway.

Back 120

inhibits; disinhibits

Front 121

The STN is in which pathway?

Back 121

the indirect/inhibitory pathway
STN= subthalamic nucleus

Front 122

How does the mnemonic TRAP help to remember the signs of Parkinson's disease?

Back 122

TRAP: Tremor (at rest), cogwheel Rigidity, Akinesia, and Postural instability (you are TRAPped in your body)

Front 123

Parkinson's disease is associated with depigmentation of which region of the brain?

Back 123

Substantia nigra pars compacta

Front 124

What composes Lewy bodies?

Back 124

alpha-synuclein

Front 125

Illicit street drugs contaminated with _____ have rarely been linked to development of Parkinson's disease.

Back 125

MPTP (can be produced when trying to make synthetic opiods)

Front 126

Neurons using which neurotransmitter are affected in Parkinson's disease?

Back 126

dopamine

Front 127

True or False: Hemiballismus is the sudden, wild flailing of both arms.

Back 127

False; hemiballismus involves one arm +/- leg (one side of the body- contralateral to the STN injury)

Front 128

Hemiballismus is the result of loss of inhibition of which part of the brain?

Back 128

Loss of inhibition of the thalamus leads to excess motor stimulation of contralateral arm (via STN, GPi--inhibitory pathway)

Front 129

Hemiballismus is the characteristic result of a lesion of which part of the brain?

Back 129

contralateral subthalamic nucleus (STN)

Front 130

What is the mode of inheritance for Huntington's disease?

Back 130

autosomal dominant

Front 131

In Huntington's disease, which type of neurons are lost secondary to atrophy of the caudate nucleus?

Back 131

GABAergic

Front 132

What are the CT findings of Huntington's disease?

Back 132

Enlarged lateral ventricles (from caudate atrophy)

Front 133

Which chromosome is associated with Huntington's disease?

Back 133

chromosome 4

Front 134

What three symptoms are associated with Huntington's disease?

Back 134

chorea, depression and progressive dementia

Front 135

What type of mutation underlies Huntington's disease?

Back 135

trinucleotide repeat

Front 136

What is the trinucelotide repeat expansion found in Huntington's disease?

Back 136

CAG (Caudate loses Ach and GABA)

Front 137

Between what ages does Huntington's disease manifest?

Back 137

20-50

Front 138

Sudden, jerky, purposeless movements are characteristic of lesions in which part of the brain?

Back 138

basal ganglia

Front 139

What is chorea?

Back 139

Sudden, jerky, purposeless movements

Front 140

What is athetosis?

Back 140

Slow, writhing movements, especially of fingers

Front 141

Athetosis is characteristic of lesions in which part of the brain?

Back 141

basal ganglia

Front 142

What effect does alcohol have on essential tremor?

Back 142

Decreases tremor

Front 143

Which tremor is associated with cerebellar dysyfunction?

Back 143

Intention tremor

Front 144

How is essential tremor treated?

Back 144

β-blockers

Front 145

Resting tremor is most noticeable _____ (proximally/distally).

Back 145

distally

Front 146

Pill-rolling tremor is a _____ (resting/intention) tremor associated with Parkinson's disease.

Back 146

resting

Front 147

A patient presents with a slow, zigzag motion when s/he points at a target. What type of tremor is this?

Back 147

intention tremor

Front 148

What is the mode of inheritance for essential/postural tremor?

Back 148

autosomal dominant

Front 149

Essential tremor is a _____ (action/intention/resting) tremor.

Back 149

action

Front 150

What are the four lobes of the brain?

Back 150

frontal, parietal, occipital, temporal

Front 151

What area of the brain is responsible for speech (motor)?

Back 151

Broca's area

Front 152

A patient with Pick's disease presents with a lack of social judgment. The function of what lobe may have been affected?

Back 152

the frontal lobe

Front 153

A patient presents with unintelligible yet fluid speech. This patient most likely has a defect in what area of the brain?

Back 153

Wernicke's area

Front 154

What type of functions may be localized to the frontal lobe?

Back 154

executive functions

Front 155

In what lobe is the primary visual cortex found?

Back 155

occipital lobe

Front 156

In what lobe is Broca's area found?

Back 156

frontal lobe

Front 157

In what lobe is Wernicke's area found?

Back 157

temporal lobe

Front 158

The central sulcus divides which two lobes?

Back 158

frontal and parietal

Front 159

Broca's and Wernicke's areas are located in the _____ hemisphere.

Back 159

dominant

Front 160

In which lobe are the principal sensory areas located?

Back 160

parietal lobe

Front 161

Broca's and Wernicke's areas are connected via the _____ _____.

Back 161

Arcuate fasciculus

Front 162

The associative auditory cortex is also known as _____ (Broca's/Wernicke's area).

Back 162

Wernicke's area

Front 163

Which fissure divides the temporal from the frontal lobe?

Back 163

sylvian fissure

Front 164

The principal motor area is next to which sulcus?

Back 164

central sulcus

Front 165

A child presents with difficulty planning, concentrating, and inhibiting impulses. The origin of these deficits may attributed to what lobe of the brain?

Back 165

frontal lobe

Front 166

What is the name of the topographic representation of the sensory and motor areas in the cerebral cortex?

Back 166

Homunculus

Front 167

A lower extremity deficit in sensation or movement may indicate the occlusion of what artery?

Back 167

anterior cerebral artery (ACA)

Front 168

Motor input to which part of the body originates from the cortex within the Sylvian fissure?

Back 168

tongue and throat

Front 169

A lesion in what area of the brain may result in motor (nonfluent/expressive) aphasia with good comprehension?

Back 169

broca's area (Broca's = broken speech--nonfluent)

Front 170

A lesion in what area of the brain may result in sensory (fluent/receptive) aphasia with poor comprehension?

Back 170

Wernicke's area (Wernicke's is Wordy but makes no sense)

Front 171

A lesion in what area of the brain may result in a conduction aphasia, poor repetition with good comprehension, and fluent speech?

Back 171

The arcuate fasciculus

Front 172

A lesion in what area of the brain may result in hyperorality, hypersexuality, and disinhibited behavior?

Back 172

bilateral amygdala (Klüver-Bucy syndrome)

Front 173

A lesion in what area of the brain may cause personality changes and deficits in concentration, orientation, and judgment?

Back 173

The frontal lobe

Front 174

A lesion in what area of the brain may result in spatial neglect syndrome (agnosia of the contralateral side of the world)?

Back 174

right parietal lobe (left-sided hemineglect)

Front 175

True or False: A lesion in the reticular activating system may result in reduced levels of arousal and wakefulness (eg, coma).

Back 175

true

Front 176

A patient with Wernicke-Korsakoff syndrome likely has a lesion in what area of the brain?

Back 176

mamillary bodies

Front 177

Tremor at rest, chorea, or athetosis may indicate a lesion in what area of the brain?

Back 177

basal ganglia

Front 178

Intention tremor and limb ataxia may indicate a lesion in what area of the brain?

Back 178

cerebellar hemispheres (Cerebellar hemispheres are laterally located--affect lateral limbs)

Front 179

Damage to the cerebellum results in _____ (ipsilateral/contralateral) deficits.

Back 179

ipsilateral

Front 180

Truncal ataxia may indicate a lesion in what area of the brain?

Back 180

cerebellar vermis (Vermis is centrally located--affects central body)

Front 181

Contralateral hemiballismus may indicate a lesion in what area of the brain?

Back 181

subthalamic nucleus

Front 182

Anterograde amnesia (the inability to make new memories) may indicate a lesion of what area of the brain?

Back 182

The hippocampus

Front 183

In a lesion of the paramedian pontine reticular formation, the eyes look _____ (away from/toward) the side of the lesion.

Back 183

away from

Front 184

In a lesion of the frontal eye fields, the eyes look _____ (away from/toward) the lesion.

Back 184

toward

Front 185

Dysarthria may be indicative of a lesion in which part of the cerebellum?

Back 185

Cerebellar vermis

Front 186

What is Broca's aphasia?

Back 186

nofluent aphasia with intact comprehension

Front 187

What part of the brain is located in the inferior frontal gyrus and involved in the production of language?

Back 187

broca's area

Front 188

A patient with aphasia indicates that he can comprehend what the physician is saying, but he is unable to respond in spoken words. In what part of the brain is this lesion likely located?

Back 188

broca's area- the inferior frontal gyrus

Front 189

What is Wernicke's aphasia?

Back 189

fluent aphasia with impaired comprehension

Front 190

What is dysarthria?

Back 190

Motor inability to speak

Front 191

What is the difference between aphasia and dysarthria?

Back 191

Aphasia is a higher-order inability to speak whereas dysarthria is a motor inability to speak

Front 192

Which areas are affected in global aphasia?

Back 192

broken/nonfluent speech with impaired comprehension = broca's + wernicke's areas

Front 193

Poor repetition but fluent speech with intact comprehension is characteristic of _____ (global/conduction) aphasia.

Back 193

conduction

Front 194

Conduction aphasia is manifest as a result of damage to which area of the brain?

Back 194

Arcuate fasciculus

Front 195

A patient presents with fluent aphasia and impaired comprehension. In what part of the brain is the lesion likely located?

Back 195

superior temporal gyrus (Wernicke's area)

Front 196

Which artery supplies the anteromedial surface of the brain?

Back 196

anterior cerebral artery

Front 197

The middle cerebral artery supplies which surface of the brain?

Back 197

lateral surface

Front 198

The posterior cerebral artery supplies the _____ and _____ surfaces of the brain.

Back 198

posterior and inferior

Front 199

A patient presents with symptoms consistent with those of an acute stroke: he is unable to move his leg or foot. What artery in the brain may be occluded?

Back 199

The anterior cerebral artery; the contralateral medial surface of the frontal cortex is infarcted

Front 200

A patient presents with symptoms that are consistent with those of an acute stroke: he is unable to feel or move one arm and half of his face. What artery in the brain may be occluded?

Back 200

The middle cerebral artery

Front 201

What artery supplies both Wernicke's and Broca's speech areas?

Back 201

The middle cerebral artery

Front 202

What is the most common aneurysm of the circle of Willis?

Back 202

An aneurysm in the anterior communicating artery (can cause visual field defects)

Front 203

An aneurysm in what artery may cause visual field deficits?

Back 203

anterior communicating artery

Front 204

An aneurysm in what artery of the Circle of Willis may cause cranial nerve III palsy?

Back 204

posterior communicating artery

Front 205

What arteries supply the internal capsule, the caudate, the putamen, and the globus pallidus?

Back 205

The lateral striate

Front 206

The divisions of which artery make up the lateral striate?

Back 206

middle cerebral artery

Front 207

A stroke patient with aphasia, sensory and/or motor dysfunction likely has a stroke affecting an artery of the the _____ (anterior/posterior) circle of Willis.

Back 207

anterior circle

Front 208

A stroke patient with coma, vertigo, visual field deficits, and/or ataxia likely has a stroke affecting an artery of the the _____ (anterior/posterior) circle of Willis.

Back 208

posterior circle (affecting cranial nerves)

Front 209

The anterior cerebral artery supplies which surface of the brain: medial or lateral?

Back 209

medial

Front 210

The middle cerebral artery supplies which surface of the brain: medial or lateral?

Back 210

lateral

Front 211

What artery in the circle of Willis is the most common location for an aneurysm?

Back 211

anterior communicating artery (may cause visual field defects)

Front 212

Stroke involving the PICA results in which syndrome, characterized by nausea, vomiting, nystagmus, ipsilateral ataxia and Horner's syndrome?

Back 212

Lateral medullary (Wallenberg's) syndrome

Front 213

Which syndrome is associated with stroke involving the basilar artery?

Back 213

locked-in-syndrome (aware and awake but completely paralyzed with the exception of eye movements)

Front 214

Where are the two watershed zones in the brain?

Back 214

Between the anterior cerebral/middle cerebral arteries, and between the posterior cerebral/middle cerebral arteries

Front 215

Which areas, damaged during in hypotensive episodes, result in upper leg and upper arm weakness, and defects in higher-order visual processing?

Back 215

Watershed zones (upper leg and upper arm- anterior/middle) (higher-order visual processing-- middle/posterior)

Front 216

infarction of which artery would lead to contralateral hemiparesis (lower extremities), medial lemniscus (dec contralateral proprioception), and ipsilateral paralysis of hypoglossal nerve?

Back 216

anterior inferior cerebellar artery (AICA)- medial medullary syndrome

Front 217

Where do berry aneurysms frequently occur?

Back 217

The bifurcations of the circle of Willis (most common in bifurcation of the anterior communicating artery)

Front 218

Where is the most common site to find berry aneurysms?

Back 218

bifurcation of the anterior communicating artery

Front 219

What are the neurological sequelae of a ruptured aneurysm?

Back 219

subarachnoid hemorrhage/hemorrhagic stroke (sudden onset of the worst headache of my life)

Front 220

What type of aneurysm is associated with chronic hypertension?

Back 220

Charcot-Bouchard microaneurysms (lacunar infarcts)

Front 221

Adult polycystic kidney disease is associated with which type of aneurysm?

Back 221

berry aneurysms

Front 222

Which two connective tissue diseases are associated with berry aneurysm formation?

Back 222

marfan's syndrome and ehlers danlos syndrome

Front 223

True or False: Charcot-Bouchard microaneurysms affect all sizes of vessels.

Back 223

False; Charcot-Bouchard microaneurysms affect small vessels such as those found in the basal ganglia and thalamus

Front 224

What are four important risk factors for aneurysm formation?

Back 224

hypertension, smoking, advanced age, and race (black > white)

Front 225

What three diseases are associated with an increased risk of berry aneurysm formation?

Back 225

ehlers danlos, marfans, and Autosomal Dominant Polycystic Kidney Disease

Front 226

What type of hematoma is associated with a lucid interval?

Back 226

epidural hematoma

Front 227

What type of hematoma is commonly the result of rupture of the middle meningeal artery after temporal bone fracture?

Back 227

epidural hematoma

Front 228

What type of hematoma is usually the result of the rupture of bridging veins?

Back 228

subdural hematoma

Front 229

What type of hematoma usually occurs in elderly patients with a delayed onset of symptoms and has predisposing factors that include brain atrophy, shaking, and whiplash?

Back 229

subdural hematoma (stretching/breaking of the bridging veins)

Front 230

A patient presents with a complaint of the worst headache of her life. She has a bloody spinal tap and dies within minutes of presentation. What type of hemorrhage does this patient have?

Back 230

subarachnoid hemorrhage

Front 231

A rupture of a cerebral arteriovenous malformation typically results in what type of hemorrhage?

Back 231

subarachnoid hemorrhage

Front 232

A patient presents after falling from a window on the fourth floor of a building. CT shows biconvex disks that do not cross suture lines. What type of intracranial hemorrhage does this patient have?

Back 232

epidural hematoma

Front 233

What type of cerebral hematoma is associated with diabetes mellitus, amyloid angiopathy, and tumor?

Back 233

parenchymal hematoma

Front 234

On CT, what type of hematoma commonly presents as a crescent-shaped hemorrhage that crosses suture lines?

Back 234

subdural hematoma

Front 235

Calcium channel blockers are used to prevent which sequela of subarachnoid hemorrhage?

Back 235

vasospasm from blood breakdown products irritating vessels (2-3 days after subarachnoid hemorrhage)

Front 236

Xanthochromic spinal tap means there is evidence of what in the CNS?

Back 236

blood-- possible subarachnoid hemorrhage (or traumatic tap)

Front 237

Where in the brain do parenchymal hematomas commonly occur?

Back 237

basal ganglia and internal capsule

Front 238

Stroke appears _____ (bright/dark) on diffusion-weighted MRI 3-30 minutes after occurrence and _____ (bright/dark) on CT after 24 hours.

Back 238

Stroke is bright on diffusion-weighted MRI and dark on CT

Front 239

When emboli block large vessels, this may produce _____ (hemorrhagic/ischemic) stroke

Back 239

ischemic

Front 240

True or False: Hemorrhagic stroke may occur after ischemic stroke.

Back 240

true- may be due to reperfusion through vessels weakened during an ischemic stroke

Front 241

Which type of stroke involves small vessels and are due to hypertension?

Back 241

Lacunar strokes

Front 242

Which type of stroke may be caused by aneurysm rupture?

Back 242

hemorrhagic stroke (subarachnoid hemorrhage)

Front 243

What is the treatment for ischemic stroke?

Back 243

tPA (must be administered within 3 hours)

Front 244

Atrial fibrillation, carotid dissection, patent foramen ovale and endocarditis may cause ______ (hemorrhagic/ischemic) stroke.

Back 244

ischemic stroke

Front 245

What is a TIA?

Back 245

transient ischemic attack ("mini stroke")- a brief, reversible episode of neurologic dysfunction due to focal ischemia- symptoms last for less than 24 hours

Front 246

What structures run in the dura mater where its meningeal and periosteal layers separate?

Back 246

the venous sinuses

Front 247

All venous sinuses ultimately drain into the vein that courses through the jugular foramen, which is called what?

Back 247

internal jugular vein

Front 248

True or False: The cerebral veins feed into the venous sinuses.

Back 248

true

Front 249

What is the main location of cerebrospinal fluid return to the venous circulation via arachnoid granulations?

Back 249

superior sagittal sinus

Front 250

The lateral ventricles communicate with the third ventricle via what structure?

Back 250

foramen of monro

Front 251

The third ventricle communicates with the fourth ventricle via what structure?

Back 251

cerebral aqueduct (of Sylvius)

Front 252

The fourth ventricle communicates with the subarachnoid space via what structures laterally and medially?

Back 252

The foramen of Luschka laterally and the foramen of Magendie medially

Front 253

Cerebrospinal fluid is made by _____ cells lining the ventricles.

Back 253

ependymal

Front 254

Cerebrospinal fluid is reabsorbed by venous sinus _____ _____ in the ventricular system.

Back 254

arachnoid granulations

Front 255

True or False: Hydrocephalus is caused by the accumulation of blood in the ventricular system.

Back 255

False; hydrocephalus is caused by the accumulation of excess cerebrospinal fluid in the ventricular system

Front 256

What condition can be caused by impaired flow or reabsorption of cerebrospinal fluid in the ventricular system, choroid tumor, or ependymoma?

Back 256

hydrocephalus

Front 257

What are the four types of hydrocephalus?

Back 257

1. communicating
2. noncommunicating/obstructive
3. normal pressure
4. hydrocephalus ex vacuo (appearance of inc CSF with brain atrophy)

Front 258

What is the classic triad of symptoms in normal pressure hydrocephalus?

Back 258

ataxia, dementia, and urinary incontinence
(wobbly, wacky, and wet)

Front 259

What is the cause of normal pressure hydrocephalus?

Back 259

enlarged ventricles due to impaired reabsorption of CSF via arachnoid granulations- NO inc subarachnoid space volume, normal opening pressure

Front 260

In normal pressure hydrocephalus, ventricles are _____ (enlarged/normal size/small) and opening pressure is ______ (low/normal/high).

Back 260

enlarged; normal

Front 261

What is the cause of obstructive hydrocephalus?

Back 261

Structural blockage of cerebrospinal fluid circulation within the ventricular system

Front 262

What type of hydrocephalus is caused by impaired absorption of cerebrospinal fluid by arachnoid granulations, normal pressure or obstructive?

Back 262

normal pressure

Front 263

What type of hydrocephalus is caused by stenosis of the aqueduct of Sylvius, normal pressure or obstructive?

Back 263

obstructive

Front 264

What is hydrocephalus ex vacuo?

Back 264

Appearance of increased CSF secondary to brain atrophy (as seen in Alzheimer's, Pick disease, advanced HIV)

Front 265

How many spinal nerves do humans have? how many cervical? thoracic? lumbar? saccral? coccygeal?

Back 265

31
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

Front 266

What is the most common location for a vertebral disk herniation (between which two spinous processes)?

Back 266

L5 and S1

Front 267

Which nerves exit intervertebral foramina above the corresponding vertebrae?

Back 267

C1-C7

Front 268

Which nerves exit intervertebral foramina below the corresponding vertebrae?

Back 268

C8 and below

Front 269

Where is the lower border of the spinal cord in adults?

Back 269

between L1 and L2

Front 270

When doing a spinal tap, it is important to keep the spinal needle between which two spinous processes to avoid hitting the cord?

Back 270

L3 and L5; the needle should pass through the L3-L4 or the L4-L5 interspaces

Front 271

The lower border of the subarachnoid space extends to which vertebral body?

Back 271

S2

Front 272

During a lumbar puncture, cerebrospinal fluid is obtained from which fluid space in the spine?

Back 272

the subarachnoid space

Front 273

When performing a lumbar puncture, what bony landmarks may be used to indicate the levels of L4 and L5?

Back 273

iliac crests

Front 274

Name the three ligaments that are pierced during a lumbar puncture.

Back 274

supraspinous ligament, interspinous ligament, and ligamentum flavum

Front 275

Once a needle enters the epidural space, what other structures must be passed through to enter the subarachnoid space?

Back 275

dura mater--> subdural space--> arachnoid mater--> subarachnoid space (destination-stop here!)

Front 276

Which spinal column conveys pressure, vibration, touch, and proprioception information to the brain: dorsal, lateral corticospinal, or spinothalamic?

Back 276

dorsal column-medial lemniscus pathway (DCML)

Front 277

What part of the dorsal column transmits information from the upper body and the upper extremities?

Back 277

fasciculus cuneatus

Front 278

What part of the dorsal column transmits information from the lower body and lower extremities?

Back 278

fasciculus gracilis

Front 279

What nervous system tract in the spinal cord is responsible for ascending pain and temperature sense?

Back 279

spinothalamic tract

Front 280

What spinal column is a nerve tract that conveys voluntary motor impulses from the brain to the muscles?

Back 280

lateral corticospinal tract (cortex/brain to spine)

Front 281

Which arteries perfuse the dorsal columns?

Back 281

the posterior spinal arteries

Front 282

Innervation of the legs is _____ (lateral/medial) to that of the arms in the lateral corticospinal tract.

Back 282

lateral (legs are lateral in the corticospinal and spinothalamic tracts)

Front 283

Innervation of the legs is _____ (lateral/medial) to that of the arms in the spinothalamic tract.

Back 283

lateral (legs are lateral in the corticospinal and spinothalamic tracts)

Front 284

Innervation of the legs is _____ (lateral/medial) to that of the arms in the dorsal columns?

Back 284

medial (in the dorsal columns the upper extremities/arms are lateral to (outside of) the legs which are medial (inside)-- just like the body and the brain where legs are medial (ACA distribution)

Front 285

The second-order neuron of the dorsal column/medial lemniscal decussates in the _____.

Back 285

medulla

Front 286

The second-order neuron of the dorsal column/medial lemniscal pathway ascends contralaterally from the medulla to the ventral posterior lateral nucleus in the _____ _____.

Back 286

medial lemniscus

Front 287

The dorsal column/medial lemniscal synapses in what area before reaching the sensory cortex?

Back 287

the ventral posterior lateral (VPL) nucleus of thalamus

Front 288

The spinothalamic tract synapses in what area of the thalamus before reaching the sensory cortex?

Back 288

the ventral posterior lateral (VPL) nucleus of thalamus

Front 289

The first synapse of the spinothalamic tract occurs in the _____ (ipsilateral/contralateral) _____ (white/gray) matter of the spinal cord.

Back 289

ipsilateral; gray matter

Front 290

Which spinal tract conveys voluntary movement stimuli to the contralateral limbs from the brain?

Back 290

lateral corticospinal tract

Front 291

The 1st-order neuron in the lateral corticospinal tract is a _____ (upper/lower) motor neuron.

Back 291

upper motor neuron (UMN)

Front 292

The lateral corticospinal tract decussates at the _____ decussation within the caudal medulla.

Back 292

pyramidal

Front 293

The second-order neuron of the lateral corticospinal tract leaves the spinal cord as a _____ (upper/lower) motor neuron.

Back 293

lower motor neuron (LMN)

Front 294

Where does the second synapse of the lateral corticospinal tract occur?

Back 294

neuromuscular junction (1st synapse in the anterior horn cell of the ventral/anterior spinal cord)

Front 295

The cell body of the anterior horn is the first synapse of what spinal tract?

Back 295

lateral corticospinal tract (descending voluntary motor)

Front 296

The third-order neurons of the spinothalamic tract and the dorsal column/medial lemniscal pathway terminate in which cortex?

Back 296

sensory cortex (posterior to the central sulcus)

Front 297

Ascending pressure, vibration, touch, and proprioceptive sensation are carried by which pathway within the spinal cord?

Back 297

The dorsal column/medial lemniscal pathway

Front 298

True or False: A first-order neuron of the dorsal column/medial lemniscal pathway proceeds from the sensory nerve ending to the dorsal root ganglion, enters the spinal cord, and ascends contralaterally in the dorsal column.

Back 298

False; it ascends ipsilaterally

Front 299

A-delta; and C fibers synapse on nerve fibers found in which spinal tract?

Back 299

spinothalamic tract (these are pain and temperature fibers/free nerve endings- Alpha-delta is fast, myelinated, while C is slow, unmyelinated)

Front 300

True or False: The second-order neuron of the spinothalamic tract decussates at the anterior white commissure and ascends contralaterally to the first-order neuron.

Back 300

true (the spinothalamic tract crosses over to the contralateral side via the anterior commissure at the level it enters the spinal cord)

Front 301

Which tract conveys descending voluntary movement of the contralateral limbs?

Back 301

the lateral corticospinal tract

Front 302

Weakness, Babinski's reflex, and increased reflexes and tone are indicative of what type of lesion, upper or lower motor neuron?

Back 302

upper motor neuron (UMN) lesion

Front 303

Weakness, atrophy, fasciculations, and decreased reflexes and tone are indicative of what type of lesion, upper or lower motor neuron?

Back 303

lower motor neuron lesion

Front 304

Weakness is a sign of a what type of lesion, upper or lower motor neuron?

Back 304

both upper and lower motor neuron lesions

Front 305

Atrophy is a sign of what type of lesion, upper or lower motor neuron?

Back 305

lower motor neuron lesion

Front 306

Fasciculation is a sign of what type of lesion, upper or lower motor neuron?

Back 306

lower motor neuron lesion

Front 307

Increased reflexes are a sign of what type of lesion, upper or lower motor neuron?

Back 307

upper motor neuron lesion

Front 308

Increased tone is a sign of what type of lesion, upper or lower motor neuron?

Back 308

upper motor neuron lesion

Front 309

A positive Babinski's reflex is a sign of what type of lesion, upper or lower motor neuron?

Back 309

upper motor neuron lesion

Front 310

Decreased reflexes are a sign of what type of lesion, upper or lower motor neuron?

Back 310

lower motor neuron lesion

Front 311

Decreased tone is a sign of what type of lesion, upper or lower motor neuron?

Back 311

lower motor neuron lesion

Front 312

Increased reflexes are a sign of what type of lesion, upper or lower motor neuron?

Back 312

upper motor neuron lesion

Front 313

Increased tone is a sign of what type of lesion, upper or lower motor neuron?

Back 313

upper motor neuron lesion

Front 314

A positive Babinski's reflex is a sign of what type of lesion, upper or lower motor neuron?

Back 314

upper motor neuron lesion

Front 315

Decreased reflexes are a sign of what type of lesion, upper or lower motor neuron?

Back 315

lower motor neuron lesion

Front 316

Decreased tone is a sign of what type of lesion, upper or lower motor neuron?

Back 316

lower motor neuron lesion

Front 317

How does the mnemonic "Lower motor neuron signs = everything lowered" help one to remember the important features of lower motor neuron signs? what are the symptoms of LMN lesions?

Back 317

all signs are "down"- less muscle mass (atrophy), decreased reflexes, less muscle tone, down going toes (negative babinski),

Front 318

How does the mnemonic "Upper motor neuron signs = everything up" help one to remember the important features of upper motor neuron signs?

Back 318

all signs are "up"- increased reflexes, increases muscle tone, toes going up (positive babinski)

Front 319

Spastic paralysis is a sign of what type of lesion, upper or lower motor neuron?

Back 319

upper motor neuron lesion

Front 320

When is an upgoing toe (Babinski reflex) normal?

Back 320

in infants under 15 months

Front 321

What kind of spinal cord lesion is found in poliomyelitis and Werdnig-Hoffmann disease?

Back 321

lower motor neuron lesion only, due to destruction of the anterior horns

Front 322

What type of paralysis is associated with polymyelitis?

Back 322

flaccid paralysis (LMN only)

Front 323

What kind of spinal cord lesion is found in multiple sclerosis?

Back 323

random and assymetric lesions due to demyelination

Front 324

What signs and symptoms are associated with multiple sclerosis?

Back 324

scanning speech, intention tremor, and nystagmus

Front 325

What kind of a spinal cord lesion or deficit is found in amyotrophic lateral sclerosis?

Back 325

combined upper and lower motor neuron lesions- no sensory impairment

Front 326

What symptoms or signs are associated with amyotrophic lateral sclerosis?

Back 326

both UMN and LMN signs (hyperreflexia, + babinski, inc muscle tone, atrophy, fibrillations, fasciculations etc)

Front 327

A complete occlusion of the anterior spinal artery would spare which two areas of the spinal cord?

Back 327

dorsal columns and tract of Lissauer (posterolateral tract)

Front 328

What kind of a spinal cord lesion or deficit is found in tabes dorsalis?

Back 328

degeneration of the dorsal roots and dorsal columns due to tertiary syphillis

Front 329

What signs and symptoms are associated with tabes dorsalis?

Back 329

loss of proprioception, tactile sense, vibration --> sensory ataxia, positive romberg sign

Front 330

With which infection is tabes dorsalis most closely associated?

Back 330

tertiary syphillis

Front 331

What kind of spinal cord damage is found in syringomyelia?

Back 331

damage to the anterior white commisures where the spinothalamic tract fibers cross over-- bilateral loss of pain and temperature sensation

Front 332

What signs and symptoms are associated with syringomyelia?

Back 332

bilateral loss of pain and temperature sensation at the level of the lesion

Front 333

What three areas of spinal cord are damaged in vitamin B12 neuropathy and Friedreich's ataxia?

Back 333

demyelination of the dorsal columns, lateral corticospinal tracts , and spinocerebellar tracts

Front 334

What condition is syringomyelia associated with?

Back 334

Arnold Chiari II malformation

Front 335

What four signs are asociated with vitamin B12 neuropathy and Friedreich's ataxia?

Back 335

impaired position and vibration sense, UMN signs (hyperreflexia), and ataxic gait

Front 336

Multiple sclerosis mostly affects _____ (white/gray) matter in the _____ (cervical/thoracic/lumbar) region of the spinal cord.

Back 336

white; cervical

Front 337

At what spinal level does syringomyelia most commonly occur?

Back 337

C8-T1

Front 338

By what route is polio transmitted?

Back 338

fecal-oral

Front 339

Polio replicates in what two structures before spreading through the bloodstream to the central nervous system?

Back 339

the oropharynx and the small intestine

Front 340

Muscle weakness and atrophy, fasciculations, fibrillation, and hyporeflexia are signs of _____ (lower/upper) motor neuron lesions.

Back 340

lower motor neuron

Front 341

During lumbar puncture in a patient with polio, would the protein level be increased, decreased, or unchanged?

Back 341

slightly increased

Front 342

During lumbar puncture in a patient with polio, would the glucose level be increase, decreased, or unchanged?

Back 342

unchanged

Front 343

During lumbar puncture in a patient with polio, would the WBC count show lymphocytic or granulocytic pleocytosis, or be normal?

Back 343

lymphocytic pleocytosis

Front 344

True or False: The polio virus may be cultured from blood and stool.

Back 344

false; it can be cultured from stool or throat swab (fecal = stool, oral = throat)

Front 345

What are the signs and symptoms of polio infection prior to neurological involvement?

Back 345

Malaise, fever, headache, abdominal pain, sore throat

Front 346

What is another name for Werdnig-Hoffman disease?

Back 346

infantile spinal muscular atrophy

Front 347

What is the mode of inheritance of Werdnig-Hoffman disease?

Back 347

autosomal recessive

Front 348

Which disease presents at birth as "floppy baby" with tongue fasciculations?

Back 348

Wernig-Hoffman disease - infantile spinal muscular atrophy

Front 349

True or false: Werdnig-Hoffman disease has both LMN and UMN involvement

Back 349

false; only LMNs are involved

Front 350

Werdnig-Hoffman disease is associated with degeneration of the _____ (anterior/posterior) horns.

Back 350

anterior horns (LMN only)

Front 351

What is the median age of death in Werdnig Hoffman?

Back 351

7 months

Front 352

What is the common name for ALS?

Back 352

Lou Gehrig's disease (amyotropic lateral sclerosis)

Front 353

True or False: ALS is associated with both LMN and UMN signs.

Back 353

true

Front 354

What enzyme defect is associated with ALS?

Back 354

defect in superoxide dismutase (SOD1)

Front 355

Ingestion of what may cause ALS?

Back 355

betel nuts

Front 356

True or False: Patients with ALS have sensory, cognitive and oculomotor deficits.

Back 356

False; ALS is strictly a motor disease and the EOM are spared, there are NO sensory, cognitive or oculomotor deficits

Front 357

What disease is caused by the degeneration of the dorsal columns and roots as a result of tertiary syphilis?

Back 357

tabes dorsalis

Front 358

A patient presents with pupils that are reactive to accommodation but not to light. What is this called?

Back 358

Argyll Robertson pupils - associated with tertiary syphillis (prostitute's pupils)

Front 359

True or False: Tabes dorsalis results in impaired proprioception and locomotor ataxia.

Back 359

true

Front 360

What joint pathology is sometimes associated with tabes dorsalis?

Back 360

charcot joints

Front 361

True or False: Tabes dorsalis is associated with shooting (lightning) pain.

Back 361

true

Front 362

True or False: Tabes dorsalis results in increased deep tendon reflexes.

Back 362

false; there are decreased/absent DTRs due to lack of sensation (dorsal column degeneration)

Front 363

Why are Argyll Robertson pupils also known as "prostitute's pupils."

Back 363

because the accommodate (constrict when focusing on near objects) but they do not react to light

Front 364

What is the mode of inheritance of Friedreich's ataxia?

Back 364

autosomal recessive

Front 365

Which gene is responsible for the trinucleotide repeat in Friedreich's ataxia?

Back 365

Frataxin gene

Front 366

_____ (GAA/CAG) is the trinucleotide repeat expansion in Friedreich's ataxia.

Back 366

GAA

Front 367

Which organelle's function is impaired in Friedreich's ataxia?

Back 367

mitochondria

Front 368

How does Friedreich's ataxia present clinically?

Back 368

staggering gait, frequent falls, dysarthria, nystagmus, hypertrophic cardiomyopathy

Front 369

What is the cardiac manifestation of Friedreich's ataxia?

Back 369

hypertrophic cardiomyopathy

Front 370

Friedreich's ataxia presents in _____ (childhood/adulthood) with _____ (kyphoscoliosis/lordosis).

Back 370

childhood; kyphoscoliosis

Front 371

Ipsilateral _____ (upper/lower) motor signs are usually found below the lesion in Brown-Séquard syndrome.

Back 371

upper motor neuron

Front 372

True or False: With Brown-Séquard syndrome, one experiences the contralateral loss of all sensation at the level of the lesion.

Back 372

False; at the level of the lesion there is an ipsilateral loss of ALL sensation

Front 373

With Brown-Séquard syndrome, _____ (upper/lower) motor neuron signs are seen at the level of the lesion.

Back 373

lower- flaccid paralysis

Front 374

If a Brown-Séquard-type lesion occurs above T1, it is often associated with _____ syndrome.

Back 374

Horner's syndrome

Front 375

With Brown-Séquard syndrome, there are _____ (contralateral/ipsilateral) upper motor neuron signs below the level of the lesion.

Back 375

ipsilateral

Front 376

True or False: Brown-Séquard syndrome involves a complete transection of the spinal cord.

Back 376

False; it is a hemisection of the spinal cord

Front 377

With Brown-Séquard syndrome, there is _____ (contralateral/ipsilateral) pain and temperature loss below the lesion.

Back 377

contralateral

Front 378

In Brown-Séquard syndrome, a patient has _____ (ipsilateral/contralateral) loss of tactile, vibration and proprioception _______ (below/above) the lesion.

Back 378

ipsilateral; below

Front 379

If a Brown-Séquard-type lesion occurs above T1, it is often associated with _____ syndrome.

Back 379

Horner's syndrome

Front 380

With Brown-Séquard syndrome, there are _____ (contralateral/ipsilateral) upper motor neuron signs below the level of the lesion.

Back 380

ipsilateral

Front 381

True or False: Brown-Séquard syndrome involves a complete transection of the spinal cord.

Back 381

False; it is a hemisection of the spinal cord

Front 382

With Brown-Séquard syndrome, there is _____ (contralateral/ipsilateral) pain and temperature loss below the lesion.

Back 382

contralateral

Front 383

In Brown-Séquard syndrome, a patient has _____ (ipsilateral/contralateral) loss of tactile, vibration and proprioception _______ (below/above) the lesion.

Back 383

ipsilateral; below

Front 384

If a Brown-Séquard-type lesion occurs above T1, it is often associated with _____ syndrome.

Back 384

Horner's syndrome

Front 385

With Brown-Séquard syndrome, there are _____ (contralateral/ipsilateral) upper motor neuron signs below the level of the lesion.

Back 385

ipsilateral

Front 386

True or False: Brown-Séquard syndrome involves a complete transection of the spinal cord.

Back 386

False; it is a hemisection of the spinal cord

Front 387

With Brown-Séquard syndrome, there is _____ (contralateral/ipsilateral) pain and temperature loss below the lesion.

Back 387

contralateral

Front 388

In Brown-Séquard syndrome, a patient has _____ (ipsilateral/contralateral) loss of tactile, vibration and proprioception _______ (below/above) the lesion.

Back 388

ipsilateral; below

Front 389

With Brown-Séquard syndrome, contralateral loss of pain and temperature sense below the lesion represent a transection of the _______ (spinothalamic/corticospinal) tract.

Back 389

spinothalamic tract

Front 390

Name the three cardinal signs associated with Horner's syndrome.

Back 390

Ptosis (droopy eyelid), Miosis (constricted pupil as pupillary dilation is an action of the SNS), Anhydrosis (no sweating)

Front 391

What causes Horner's syndrome?

Back 391

sympathectomy - interruption of sympathetic innervation of the smooth muscles of the eyelid, pupil, and sweat glands of the forehead and face

Front 392

True or False: A Pancoast's tumor is an example of pathology that may cause Horner's syndrome.

Back 392

True- a Pancoast tumor is an apical lung tumor

Front 393

True or False: Hemisection is an example of pathology that may cause Horner's syndrome.

Back 393

True; Brown-Sequard syndrome-hemisection of the spinal cord is a cause of Horner's syndrome if the lesion occurs above the T1 level

Front 394

What sign of Horner's syndrome is characterized by pupillary constriction in one eye?

Back 394

miosis

Front 395

Syringomyelia may causes Horner's syndrome in its _____ (late/early) stage.

Back 395

late

Front 396

Horner's syndrome is associated with a lesion above what level of the spinal cord?

Back 396

T1

Front 397

Which pathway is interrupted to result in Horner's syndrome?

Back 397

the oculosympathetic pathway

Front 398

How many neurons comprise the oculosympathetic pathway?

Back 398

3- the pathway begins in the hypothalamus- synapses in the intermediolateral column, and then the superior cervical ganglion before innervating the face

Front 399

Where does the oculosympathetic pathway originate?

Back 399

hypothalamus

Front 400

Where does the first neuron of the oculosympathetic pathway synapse?

Back 400

the lateral horn of the intermediolateral column of the spinal cord

Front 401

Where is the second synapse in the oculosympathetic pathway?

Back 401

superior cervical ganglion

Front 402

What is the bony landmark to find when preparing for a pudendal nerve block (to relieve the pain of pregnancy)?

Back 402

ischial spine

Front 403

What disease is characterized by pain two thirds of the way from the umbilicus to the right anterior superior iliac spine?

Back 403

appendicitis (pain at McBurney's point)

Front 404

What is the bony landmark to find when performing a lumbar puncture?

Back 404

iliac crest (L4)

Front 405

Which nerve root supplies the sensory innervation to the posterior half of the skull "cap"?

Back 405

C2

Front 406

A patient presents with paresthesias on his neck in the distribution of a high turtleneck shirt. What cervical nerve root is involved?

Back 406

C3

Front 407

The nipple line is the anatomic landmark for the dermatome that is innervated by which nerve root?

Back 407

T4 ( at the teat pore)

Front 408

The xiphoid process denotes the dermatome that is innervated by which nerve root?

Back 408

T7

Front 409

A patient presents with nerve damage and he is unable to have an erection or feel his penis or anus. What three nerves could be involved in his injury?

Back 409

S2, S3, S4 (remember: "S2, 3, 4 keep the penis off the floor.")

Front 410

Pain from appendicitis causes referred pain at the umbilicus in the distribution of which nerve root?

Back 410

T10 (at the belly butTEN)

Front 411

Which spinal nerve innervates the kneecaps?

Back 411

L4 (down on L4s-- all fours)

Front 412

During acute cholecystitis, a patient has referred pain to her right shoulder. What nerve is responsible for this sensation of referred pain?

Back 412

the phrenic nerve

Front 413

True or False: Sensation at T10 may be found at the level of the umbilicus.

Back 413

True

Front 414

True or False: Sensation at L1 may be found at the level of the umbilicus.

Back 414

False; sensation for L1 may be found at the inguinal ligament (remember: L1 is IL--Inguinal Ligament)-- groin distribution

Front 415

What nerve root may be found at the same level of a low-collar shirt?

Back 415

C4

Front 416

Intrafusal stretch within a muscle stimulates what type of afferent neuron?

Back 416

Ia

Front 417

The gamma loop causes _____ (increased/decreased) sensitivity of the reflex arc.

Back 417

increased

Front 418

Which neurons cause extrafusal muscle (extrafusal) contraction?

Back 418

The α motor neurons

Front 419

With regard to spindle muscle control, the stimulation of ____ loop motor neurons promotes the contraction of intrafusal fibers.

Back 419

γ (gamma)

Front 420

What structures are parallel to the muscle fiber and monitor muscle length?

Back 420

muscle spindles

Front 421

_____ (Golgi tendon organs/Muscle spindles) monitor muscle tension, whereas _____ (Golgi tendon organs/muscle spindles) monitor muscle length.

Back 421

golgi tendon organs; muscle spindles

Front 422

True or False: A muscle spindle is at the end of muscle fiber.

Back 422

False; it runs parallel to the muscle fiber

Front 423

What structures help someone pick up a heavy suitcase when he or she does not know how heavy it is?

Back 423

muscle spindles- monitor muscle length

Front 424

If a person has been holding a heavy suitcase for too long, what structures sense the tension and may make the person drop the suitcase?

Back 424

golgi tendon organs

Front 425

The Golgi tendon organ provides _____ (inhibitory/stimulatory) feedback to _____ (alpha/gamma) motor neurons in response to tension.

Back 425

inhitory; alpha (inhibit contraction)

Front 426

Eliciting the biceps reflex tests which nerve root?

Back 426

C5

Front 427

Which nerve root is tested by the triceps reflex?

Back 427

C7

Front 428

Which nerve root is tested by the patellar reflex?

Back 428

L4

Front 429

Which nerve root is tested by the Achilles reflex?

Back 429

S1

Front 430

What reflex involves the dorsiflexion of the big toe and the fanning of the other toes?

Back 430

babinski reflex

Front 431

True or False: The Babinski reflex is a normal finding in infants during the first year of life.

Back 431

True; however, its persistence after the first year is a sign of an upper motor neuron lesion

Front 432

What reflex involves the extension of an infant's limbs when he or she is startled?

Back 432

moro reflex

Front 433

What reflex involves the infant automatically seeking its mother's nipple?

Back 433

rooting reflex

Front 434

What reflex may be elicited by placing a finger in the hand of an infant?

Back 434

palmar reflex; the infant will grasp a finger placed in the palm

Front 435

Plantar stimulation causes large toe dorsiflexion and the fanning of the toes in what reflex?

Back 435

babinski reflex

Front 436

Lesions in what lobe of the brain may cause primitive reflexes to reemerge?

Back 436

frontal lobe

Front 437

When do the primitive reflexes normally disappear?

Back 437

within the first year of life

Front 438

How does one elicit the rooting reflex?

Back 438

Stroke the cheek or mouth; if the reflex is present, the head will turn in the direction of stroking-- nipple searching

Front 439

Which cranial nerves lie medially at the brain stem?

Back 439

III, VI, XII

Front 440

The _____ _____ is responsible for melatonin secretion and circadian rhythms.

Back 440

pineal gland

Front 441

Where is the conjugate vertical gaze center located?

Back 441

superior colliculi

Front 442

Which part of the brain stem takes part in auditory processing?

Back 442

inferior colliculi

Front 443

What condition results in paralysis of the conjugate vertical gaze due to a lesion in the superior colliculi?

Back 443

parinaud syndrome

Front 444

The _____ _____ (involved with visual information) in the brain stem are located above the _____ _____ (involved with auditory information).

Back 444

superior colliculi; inferior colliculi (remember your eyes are above your ears)

Front 445

What sort of tumor may cause Parinaud syndrome?

Back 445

pinealoma (tumor of the pineal gland)

Front 446

What cranial nerve is responsible for the sense of smell?

Back 446

CN I- olfactory nerve

Front 447

What cranial nerve is the only nerve without a thalamic relay to the cortex?

Back 447

CN I- olfactory nerve

Front 448

Blindness could be the result of injury to what cranial nerve?

Back 448

CN II (optic nerve)

Front 449

What cranial nerve controls eye movement, pupil constriction, accommodation, and eyelid opening (levator palpebrae)?

Back 449

CN III (oculomotor nerve)

Front 450

Which two cranial nerves function only to control eye movement (unlike cranial nerve III)?

Back 450

CN IV (trochlear nerve- controls superior oblique-look down and in) and CN VI (abducens--controls lateral rectus)

Front 451

What cranial nerve is responsible for the muscles of mastication and facial sensation?

Back 451

CN V - trigeminal nerve

Front 452

A lesion of which cranial nerve would cause an individual to lose the sense of taste on the anterior two thirds of the tongue?

Back 452

CN VII- facial nerve

Front 453

Which cranial nerve controls the movement of the tongue?

Back 453

CN XII- hypoglossal nerve

Front 454

Which nerve contributes to the innervation of the submadibular and sublingual salivary glands?

Back 454

CN VII- facial nerve

Front 455

Without which cranial nerve would a person not be able to hear?

Back 455

CN VIII- vestibulocochlear nerve

Front 456

Which cranial nerve is responsible for taste on the posterior third of the tongue?

Back 456

CN IX- glossopharyngeal nerve

Front 457

Which cranial nerve innervates the parotid gland?

Back 457

CN IX- glossopharyngeal nerve

Front 458

Taste in the epiglottis region is mediated by which cranial nerve?

Back 458

CN X- vagus nerve

Front 459

Which cranial nerve monitors aortic arch chemoreceptors and baroreceptors?

Back 459

CN X- vagus nerve

Front 460

Which cranial nerve is important in head turning and shoulder shrugging?

Back 460

CN XI- accessory nerve-- innervates sternocleidomastoid muscle + trapezius

Front 461

What cranial nerve is responsible for tongue movement?

Back 461

CN XII- hypoglossal nerve

Front 462

What cranial nerve is responsible for lacrimation?

Back 462

CN VII- facial nerve

Front 463

Which cranial nerves are responsible for salivation from the submandibular gland, sublingual glands, and the parotid glands?

Back 463

cranial nerve VII- the facial nerve is responsible for salivation from the submandibular and sublingual glands, while cranial nerve IX- the glossopharyngeal nerve is responsible for salivation from the parotid gland

Front 464

What cranial nerve is responsible for the closing of the eye (orbicularis oculi)?

Back 464

CN VII (facial nerve- responsible for movement of all facial muscles)

Front 465

Which cranial nerves are responsible for opening and closing the eyelid?

Back 465

cranial nerve III- oculomotor opens the eyelid (levator palpebrae), and CN VII- facial nerve and closing of the eyelid (orbicularis occuli)-

Front 466

Which cranial nerves are responsible for taste?

Back 466

CN VII (facial nerve- taste on anterior 2/3 of tongue), CN IX (glossopharyngeal nerve- taste on the posterior 1/3 of tongue), cranial nerve X (vagus nerve) is responsible for taste around the epiglottis

Front 467

Which two cranial nerves are involved in swallowing?

Back 467

cranial nerves IX and X (glossopharyngeal and vagus)

Front 468

Which cranial nerves go to the tongue (both sensory and motor)?

Back 468

Cranial nerve VII (facial nerve) is responsible for taste from the anterior 2/3 of the tongue; cranial nerve IX (glossopharyngeal nerve) is responsible for taste from the posterior 1/3 of the tongue; cranial nerve XII (hypoglossal nerve) is responsible for tongue movement

Front 469

Which three cranial nerves are responsible for eye movement?

Back 469

CN III (oculomotor- SR, IR, MR, IO), CN IV (trochlear- SO)
CN VI (abducens- LR)

Front 470

What cranial nerve is responsible for innervating the stapedius muscle (dampens noises) of the ear?

Back 470

Cranial nerve VII (facial nerve)

Front 471

What cranial nerve is responsible for monitoring carotid body and sinus chemo- and baroreceptors?

Back 471

Cranial nerve IX (glossopharyngeal nerve)

Front 472

What cranial nerve innervates the stylopharyngeus (elevates pharynx and larynx)?

Back 472

CN IX (glossopharyngeal nerve)

Front 473

What nerve is responsible for facial sensation?

Back 473

trigeminal nerve (CN V- V1, V2, V3)

Front 474

What nerve is responsible for pupillary constriction?

Back 474

CN III (oculomotor nerve)

Front 475

What nerve is responsible for eye accommodation?

Back 475

CN III (oculomotor nerve)

Front 476

The nuclei of cranial nerves III and IV are located in what part of the brain?

Back 476

midbrain

Front 477

The nuclei of cranial nerves V, VI, VII, and VIII are located in which part of the brain stem?

Back 477

pons

Front 478

The nuclei of cranial nerves IX, X, XI, and XII are found in what part of the brainstem?

Back 478

medulla

Front 479

Sensory cranial nerves typically originate in which part of the brain stem?

Back 479

lateral side

Front 480

Motor cranial nerves typically originate in which part of the brain stem?

Back 480

medial side

Front 481

Where are the cranial nerve nuclei located in the central nervous system?

Back 481

brainstem (tegmentum)

Front 482

What are the afferent and efferent cranial nerves involved in the corneal reflex?

Back 482

afferent- CN V-v1- corneal sensation
Efferent- CN VII- closing eyelid

Front 483

What are the afferent and efferent cranial nerves involved in the lacrimation reflex?

Back 483

afferent CN V- v1
efferent CN VII

Front 484

What are the afferent and efferent cranial nerves involved in the jaw jerk reflex?

Back 484

afferent CNV- v3
efferent CNV -v3- muscles of masstication

Front 485

What are the afferent and efferent cranial nerves involved in the pupillary reflex?

Back 485

afferent- CN II optic nerve
efferent- CN III oculomotor nerve

Front 486

What afferent and efferent chranial nerves are involved in the gag reflex?

Back 486

afferent- CN IX glossopharyngeal nerve
efferent- CN IX and CN V- glossopharyngeal and vagus

Front 487

Cranial nerves VII, IX, and X feed into what vagal nucleus?

Back 487

nucleus solitarius (remember Solitarius for visceral Sensory Information)

Front 488

Which vagal nucleus contains visceral sensory information such as taste, gut distention, and baroreceptors?

Back 488

nucleus solitarius (remember Solitarius for visceral Sensory Information)

Front 489

Which vagal nucleus provides the motor innervation of the pharynx, the larynx, and the upper esophagus?

Back 489

nucleus aMbiguus (Motor)

Front 490

Which nucleus sends autonomic (parasympathetic) fibers to the heart, the lungs, and the upper gastrointestinal tract?

Back 490

dorsal motor nucleus

Front 491

What structure is the vagal nucleus that innervates cranial nerves IX, X, and XI?

Back 491

nucleus ambiguus

Front 492

True or False: A person with a lesion to the nucleus ambiguus would have difficulty swallowing.

Back 492

true

Front 493

True or False: A person with a lesion of the nucleus ambiguus may not be able to elevate the palate of his or her mouth.

Back 493

true

Front 494

Cranial nerve I exits the brain through what bony structure?

Back 494

cribriform plate

Front 495

Which five cranial nerves exit through the middle cranial fossa in the sphenoid bone?

Back 495

II, III, IV, V, VI

Front 496

What structure contains cranial nerve II, the ophthalmic artery, and the central retinal vein?

Back 496

optic canal

Front 497

What structure contains cranial nerves III, IV, and VI; the first division of the trigeminal nerve; and the ophthalmic vein?

Back 497

superior orbital fissure

Front 498

The second division of the trigeminal nerve exits the brain via the foramen ______ (rotundum/ovale/spinosum).

Back 498

rotundum

Front 499

The third division of the trigeminal nerve exits the brain via the foramen _____ (rotundum/ovale/magnum).

Back 499

ovale

Front 500

The middle meningeal artery exits at the foramen _____ (rotundum/spinosum).

Back 500

spinosum

Front 501

Which cranial nerves exit through the posterior cranial fossa?

Back 501

VII, VIII, IX, X, XI, XII

Front 502

The internal auditory meatus contains what two cranial nerves?

Back 502

CN VII and VIII

Front 503

Which foramen contains cranial nerves IX through XI and the jugular vein?

Back 503

jugular foramen

Front 504

What cranial nerve is found in the hypoglossal canal?

Back 504

hypoglossal nerve CN XII

Front 505

The spinal cord exits the skull via the _____ _____.

Back 505

foramen magnum

Front 506

The spinal roots of cranial nerve XI and the vertebral arteries exit the brain via what opening?

Back 506

foramen magnum

Front 507

How does the mnemonic "Standing Room Only" help you remember where the trigeminal nerve exits?

Back 507

divisions of the CN V exit owing to Standing Room Only- v1- Superior orbital fissure, v2- foramen Rotundum, v3- foramen Ovale

Front 508

The cavernous sinus is a collection of venous sinuses on either side of what gland?

Back 508

pituitary gland (which sits in the sella turcica)

Front 509

Blood from the eye and the superficial cortex progresses from the cavernous sinus to what vein?

Back 509

internal jugular vein

Front 510

Which cranial nerves traverse the cavernous sinus?

Back 510

CN III, IV, V1 and V2, and VI (notice that V2 is in the cavernous sinus but not in the superior orbital fissure which contains CN III, IV, V1 and VI--key distinguishing feature)

Front 511

Which cranial nerve is "free floating" within the cavernous sinus?

Back 511

CN VI (abduccens)

Front 512

The nerves that control the extraocular muscles (plus V1 and V2) pass through what?

Back 512

cavernous sinus

Front 513

What syndrome is characterized by ophthalmoplegia and ophthalmic and mandibular sensory loss?

Back 513

cavernous sinus syndrome

Front 514

Which artery passes through the cavernous sinus?

Back 514

internal carotid artery

Front 515

A lesion of CN XII results in tongue deviation _____ (toward/away from) the side of the lesion.

Back 515

toward (lick your wounds)

Front 516

A patient's jaw deviates to the right; this indicates a lesion in which cranial nerve, and on which side?

Back 516

right CN V (mandibular V3 division- jaw deviates toward the side of the injury)

Front 517

A lesion in CN X results in uvula devation _____ (away from/toward) the lesion.

Back 517

away from

Front 518

A patient presents with left shoulder droop; on which side and in which cranial nerve is the lesion?

Back 518

left side (CN XI-accesory innervation of trapezius)

Front 519

A lesion in CN XI results in weakness turning the head to the ________ (contralateral/ipsilateral) side.

Back 519

contralateral side

Front 520

The upper face receives _____ (unilateral/bilateral) upper motor neuron innervation.

Back 520

bilateral (so if you have a unilateral UMN CN VII lesion the forehead will be spared-- can still wrinkle forehead)

Front 521

A lower motor neuron lesion results in _____ (ipsilateral/contralateral) paralysis of the upper and lower face.

Back 521

ipsilateral

Front 522

An upper moton neuron lesion results in what sort of paralysis in the lower face?

Back 522

contralateral paralysis of the lower face only

Front 523

Complete destruction of the facial nucleus or its branchial efferent fibers results in what?

Back 523

bell's palsy

Front 524

Bell's palsy is characterized by peripheral _____ (ipsilateral/contralateral) facial paralysis with inability to close _____ (eye/mouth) on affected side.

Back 524

ipsilateral; eye

Front 525

Bell's palsy is a complication of which 6 conditions?

Back 525

Lyme Disease, AIDS, Sarcoidosis, Tumors, Herpes zoster, Diabetes (LAST Heard Ding of BELL) or ALexander graHam BELL with STD.

Front 526

Without what cranial nerve would elevation of the palate be impossible?

Back 526

CN X (Kuh-kuh-kuh tests palate elevation)

Front 527

Without what cranial nerve would the sound "la" be impossible to make?

Back 527

CN XII (La-la-la tests tongue)

Front 528

To press one's lips together, what cranial nerve must be intact?

Back 528

CN VII (Mi-mi-mi tests lips)

Front 529

Name the three muscles that close the jaw.

Back 529

Masseter, teMporalis, and Medial Pterygoid (M's = Munch Muscles)

Front 530

What muscle opens the jaw?

Back 530

lateral pterygoid (Lateral Lowers jaw)

Front 531

What nerve innervates all the muscles of mastication?

Back 531

CN V- V3- mandibular branch of the trigeminal nerve

Front 532

With one exception, all muscles with the root -glossus are innervated by what nerve?

Back 532

CN XII (hypoglossal nerve)

Front 533

All muscles with the root -glossus are innervated by the hypoglossal nerve, except for which one? what is this muscle innervated by?

Back 533

palatoglossus (innervated by CN X-vagus)

Front 534

With one exception, all muscles with the root -palat are innervated by what nerve?

Back 534

CN X- vagus nerve

Front 535

All muscles with the root -palat are innervated by the vagus nerve, except for which one? what is this muscle innervated by?

Back 535

tensor veli palatini (innervated by V2/mandibular branch of the trigeminal nerve)

Front 536

In which bone is the inner ear located?

Back 536

temporal bone

Front 537

What fluid is the bony labyrinth filled with?

Back 537

perilymph

Front 538

What are the names of the three tubes within the bony labyrinth?

Back 538

cochlea, vestibule, semicircular canals

Front 539

What are the series of tubes filled with endolymph inside the bony labyrinth called?

Back 539

membranous labyrinth

Front 540

Because it is rich in sodium, perilymph is similar to which kind of fluid?

Back 540

Extracellular fluid (ECF)

Front 541

Because it is rich in potassium, endolymph is similar to which kind of fluid?

Back 541

intracellular fluid (ICF)

Front 542

Name the four elements of the membranous labyrinth.

Back 542

cochlear duct, utricle, saccule, semicircular canals

Front 543

What is the function of the hair cells in the inner ear?

Back 543

detection of sound and spatial orientation

Front 544

The vestibular apparatus is important for what?

Back 544

spatial orientation (balance)

Front 545

Does the narrow and stiff base of the cochlea pick up high- or low-frequency sound?

Back 545

high frequency sound

Front 546

What part of the cochlea picks up low-frequency sound?

Back 546

the wide, flexible apex

Front 547

Endolymph is made by what structure?

Back 547

the stria vascularis

Front 548

Within the inner ear, in what two places are maculae found?

Back 548

utricle and saccule

Front 549

Maculae are important for sensing what kind of acceleration?

Back 549

linear acceleration

Front 550

Semicircular canals contain _____, which are important for detecting angular acceleration.

Back 550

ampullae (Ampullae detect Angular acceleration)

Front 551

The progression of hearing loss in the elderly starts with ____ (high/low) -frequency sounds and progresses to ____ (high/low) -frequency sounds

Back 551

high frequency sounds and then progresses to low frequency sounds

Front 552

Conductive hearing loss is characterized by a negative Rinne test, meaning sound travels better through _____ (bone/air), as well as a Weber test that localizes to the _____ (affected/unaffected) ear.

Back 552

bone; affected

Front 553

Sensorineural hearing loss is characterized by a positive Rinne test, meaning sound travels better through _____ (bone/air), as well as a Weber test that localizes to the _____ (affected/unaffected) ear.

Back 553

air; unaffected

Front 554

A man with decreased hearing in his left ear is found to have a negative Rinne test and a Weber test that localizes to his left ear. What type of hearing loss does he have?

Back 554

conductive hearing loss

Front 555

A woman with decreased hearing in her left ear is found to have a positive Rinne test and a Weber test that localizes to her right ear. What type of hearing loss does she have?

Back 555

sensorineural hearing loss

Front 556

How does a scuba flipper help one remember the structure of the cochlear membrane?

Back 556

Like a scuba flipper, the cochlea is narrow/stiff at the base and wide/flexible at the apex

Front 557

Where is the aqueous humor absorbed?

Back 557

the trabecular meshwork

Front 558

What is the function of the canal of Schlemm?

Back 558

it collects aqueous humor from the trabecular meshwork

Front 559

Where is aqueous humor produced?

Back 559

ciliary process (under beta innervation)

Front 560

Which muscle is involved in accomodation?

Back 560

ciliary muscle

Front 561

Which muscle is involved in pupillary constriction (miosis)?

Back 561

constrictor/sphincter/circular muscle innervated by parasympathetic M3

Front 562

Which muscle mediates mydriasis?

Back 562

radial/dilator muscle (myDriasis = Dilation-- a sympathetic response innervated by alpha 1)

Front 563

The muscle mediating mydriasis receives which sort of innervation?

Back 563

sympathetic alpha 1 (myDriasis= dilation)

Front 564

What innervation does the muscle that controls miosis receive?

Back 564

parasympathetic Muscarinic 3 (miosis involves pupillary constriction)

Front 565

What is glaucoma?

Back 565

impaired flow of aqueous humor leading to increased intraocular pressure

Front 566

Increased intraocular pressure manifests as what on fundoscopy?

Back 566

optic disk atrophy with cupping

Front 567

What are the two forms of glaucoma?

Back 567

open/wide angle and closed/narrow angle

Front 568

Which type of glaucoma involves obstructed outflow through the canal of Schlemm?

Back 568

open/wide angle glaucoma

Front 569

Which type of glaucoma involves obstructed flow between the iris and the lens?

Back 569

closed/narrow angle glaucoma

Front 570

_______ (Open/closed) angle glaucoma is more common.

Back 570

open

Front 571

Open-angle glaucoma is _____ (painful/painless), whereas closed angle is _____ (painful/painless).

Back 571

painless; painful

Front 572

In which form of glaucoma is epinephrine contraindicated?

Back 572

closed/narrow angle glaucoma

Front 573

An African-American patient presents with myopia; which form of glaucoma is most likely?

Back 573

open/wide angle glaucoma

Front 574

A patient presents with progressive eye pain and decreased vision; which type of glaucoma is suspected?

Back 574

closed/narrow angle glaucoma

Front 575

What is a cataract?

Back 575

Painless, bilateral opacification of the lens leading to decreased vision

Front 576

What are the risk factors for developing cataract?

Back 576

age, sunlight, alcohol, smoking, classic galactosemia, galactokinase deficiency, diabetes (sorbitol accumulation), trauma and infection

Front 577

What are the risk factors for developing cataract?

Back 577

increased intracranial pressure

Front 578

How does papilledema manifest on fundoscopy?

Back 578

elevated/bulging optic disk with blurred margins and enlarged blind spot

Front 579

What extraocular muscle does cranial nerve VI innervate?

Back 579

lateral rectus (CN VI abducens)

Front 580

What extraocular muscle does cranial nerve IV innervate?

Back 580

superior oblique (CN IV trochlear)

Front 581

What muscle abducts, intorts and depresses the eye?

Back 581

superior oblique muscle (CN IV)

Front 582

Identify the seven extraocular muscles.

Back 582

superior rectus, medial rectus, lateral rectus, inferior rectus, superior oblique, inferior oblique, levator palpebrae superioris (upper eyelid muscle)

Front 583

What two blood vessels supply the eye?

Back 583

opthalmic artery and superior opthalmic vein

Front 584

With cranial nerve III damage, the eye would look ____ (up/down) and ____ (in/out) at rest.

Back 584

down; out (because IV pulls it down and VI pulls it out)

Front 585

With cranial nerve IV damage, the patient experiences diplopia with a defective _____ (upward/downward) gaze.

Back 585

downward

Front 586

With cranial nerve VI damage, the eye is directed _____ (medially/laterally).

Back 586

medially

Front 587

How does the "chemical formula" LR6SO4R3 help one remember the innervations of the extraocular muscles?

Back 587

CN VI innervates the Lateral Rectus; CN IV innervates the Superior Oblique; CN III innervates the Rest

Front 588

A patient's inability to follow the examiner's finger from outside toward the nose indicates a weakness in which muscle?

Back 588

medial rectus

Front 589

A patient's inability to follow the examiner's finger upward and medially indicates a weakness in which muscle?

Back 589

inferior oblique

Front 590

A patient's inability to follow the examiner's finger downward and medially indicates a weakness in which muscle?

Back 590

superior oblique

Front 591

A patien's inability to follow the examiner's finger downward and laterally indicates a weakness in which muscle?

Back 591

inferior rectus

Front 592

A patient's inability to follow the examiner's finger toward the temple indicates a weakness in which muscle?

Back 592

lateral rectus

Front 593

A patient's inability to follow the examiner's finger upward and laterally indicates a weakness in which muscle?

Back 593

superior rectus

Front 594

How does IOU help remember the test for the inferior oblique?

Back 594

To test the Inferior Oblique, have patient look Up

Front 595

What type of eye pathology features retinal necrosis + edema leading to atrophic scar formation?

Back 595

retinitis

Front 596

What is strabismus?

Back 596

misalignment of the eyes

Front 597

What is amblyopia?

Back 597

Reduction of vision due to misuse during a critical period (may be due to strabismus/misalignment of the eyes)

Front 598

True or False: Strabismus can cause amblyopia.

Back 598

true

Front 599

What are three etiologies of amblyopia?

Back 599

strabismus, deprivation, unequal refractive errors

Front 600

Miosis is _____ (constriction/dilation) of the pupil, mediated by _______ (parasympathetic/sympathetic) stimulation.

Back 600

constriction; parasympathetic

Front 601

Which cranial nerve mediates miosis?

Back 601

CNIII via the edinger westfall nucleus

Front 602

Which cranial nerve nucleus mediates miosis?

Back 602

Edinger-Westphal nucleus

Front 603

Which muscle mediates dilation (mydriasis)?

Back 603

radial muscle

Front 604

Mydriasis is mediated by ______ (parasympathetic/sympathetic) innervation.

Back 604

sympathetic (dilation)

Front 605

Innervation of the radial muscle occurs via the _____ _____ ______ by way of the superior cervical ganglion.

Back 605

long ciliary nerve

Front 606

What cranial nerve carries signals from the retina to the pretectal nuclei?

Back 606

optic nerve (CN II)

Front 607

Activation of what nuclei within the midbrain causes the pupils to contract bilaterally?

Back 607

edinger-westphal nuclei

Front 608

True or False: The Marcus Gunn phenomenon is an afferent pupillary defect (eg, due to optic nerve damage or retinal detachment)

Back 608

True- failure of pupillary constriction when light is shone into eye

Front 609

What is the consensual pupillary light reflex?

Back 609

Pupils contract bilaterally when light shines in one eye

Front 610

What is the Marcus Gunn phenomenon?

Back 610

afferent defect that leads to failure of bilateral consensual pupillary constriction to light (Lack of constriction when light shines in the affected eye, indicates a CN II lesion)

Front 611

Where in cranial nerve III are fibers controlling eye movement found, centrally or peripherally?

Back 611

centrally

Front 612

Which part of CN III is affected first by compression?

Back 612

Parasympathetic fibers/output (located Peripherally)

Front 613

Which part of CN III is affected first by vascular disease such as diabetes?

Back 613

centrally located innervation to extraocular muscles

Front 614

How does retinal detachment lead to vision loss?

Back 614

photoreceptors degenerate when the neurosensory layer of the retina is separated from the pigmented epithelium

Front 615

What are two possible causes of retinal detachment?

Back 615

trauma and diabetes

Front 616

Degeneration of the macula causes loss of _____ (central/peripheral) vision.

Back 616

central vision (macula= central part of the retina, lesions in the occipital cortex lead to macular sparing)

Front 617

What is the term for vision loss in a part of the visual field, such as the central defect seen in macular degeneration?

Back 617

scotoma

Front 618

What are the two forms of Age Related Macular Degneration (ARMD)?

Back 618

wet due to neovascularization
dry to lipid deposits and retinal atrophy

Front 619

Which form of ARMD is due to neovascularization?

Back 619

wet ARMD

Front 620

_____ (Wet/Dry) ARMD is slow, resulting from retinal atrophy.

Back 620

dry

Front 621

Transection of the optic nerve results in what type of visual field defect?

Back 621

unilateral anopia

Front 622

If a patient presents with a pituitary adenoma, he or she should be screened for what type of visual field defect?

Back 622

bitemporal hemianopia

Front 623

A lesion of the optic tract may cause what type of visual field defect?

Back 623

homonymous heminanopia

Front 624

A lesion at Meyer's loop (temporal lobe) may result in what type of visual field defect?

Back 624

upper quadrantic anopia

Front 625

A lesion of the dorsal optic radiation (parietal lobe) may result in what type of visual field defect?

Back 625

lower quadrantic anopia

Front 626

A lesion at the calcarine fissure of the visual cortex may result in what type of visual field defect?

Back 626

hemianopia with macular sparing

Front 627

A patient with macular degeneration may have what type of visual field defect?

Back 627

central scotoma

Front 628

A patient presents with an inability to gaze laterally with both eyes. When looking to the left, his left eye has nystagmus, but convergence is normal. What type of syndrome does this patient have?

Back 628

intranuclear opthalmoplegia (Medial longitundinal fasiculus syndrome)

Front 629

The medial longitudinal fasciculus coordinates lateral gaze by connecting which two nuclei?

Back 629

CN VI nucleus and the medial rectus subnucleus of CN III

Front 630

Medial longitudinal fasciculus syndrome is associated with what disease?

Back 630

multiple sclerosis

Front 631

True or False: The right medial longitudinal fasciculus innervates the right medial subnucleus of cranial nerve III.

Back 631

true

Front 632

when warm water is injected into the external auditory canal, what direction is the quick phase correction of nystagmus to: ipsilateral or contralateral?

Back 632

ipsilateral (COWS- Cold Opposite, Warm Same)

Front 633

when cold water is injected into the external auditory canal, what direction is the quick phase correction of nystagmus to: ipsilateral or contralateral?

Back 633

contralateral (COWS- Cold Opposite, Warm Same)

Front 634

What is the most common cause of dementia in the elderly?

Back 634

Alzheimer's disease

Front 635

Senile plaques and neurofibrillary tangles characterize what type of dementia?

Back 635

Alzheimer's disease

Front 636

True or False: The number of neurofibrillary tangles does not correlate with the degree of dementia in Alzheimer's disease.

Back 636

False; the number of neurofibraillary tangles does correlate with the degree of dementia

Front 637

Chromosomes 1, 14, 19, and 21 are associated with the familial form of what type of dementia?

Back 637

Alzheimer's disease

Front 638

What is the second most common cause of dementia in the elderly?

Back 638

multi-infarct dementia

Front 639

Alzheimer's disease may cause amyloid angiopathy, which may result in what serious complication?

Back 639

intracranial hemorrhage

Front 640

True or False: Alzheimer's disease is characterized by diffuse cortical atrophy.

Back 640

True

Front 641

What degenerative disease of the cerebral cortex affects only the frontal and temporal lobes?

Back 641

Pick's disease

Front 642

An elderly woman is increasingly socially inappropriate, inattentive, and clumsy. What type of dementia leads to this patient's decrement in executive functioning?

Back 642

Pick's disease (frontotemporal dementia)

Front 643

_____ bodies are characterized by intracellular aggregated τ proteins found in the brain.

Back 643

pick bodies

Front 644

What degenerative disease of the cerebral cortex is associated with parkinsonianism, dementia, and hallucinations?

Back 644

lewy body dementia

Front 645

What degenerative disease of the cerebral cortex is caused by an α-synuclein defect?

Back 645

lewy body dementia

Front 646

Creutzfeld-Jakob disease is caused by _____ accumulation in the brain.

Back 646

prion

Front 647

What degenerative disease of the cerebral cortex is associated with a rapidly progressive dementia (occurring over weeks to months), myoclonus, and a spongiform cortex?

Back 647

Creutzfeld-Jakob disease

Front 648

The neurofibrillary tangles found in patients with Alzheimer's disease are commonly made up of abnormally phosphorylated ____ protein.

Back 648

tau

Front 649

What is the incidence of the familial form of Alzheimer's disease?

Back 649

10%

Front 650

True or False: Alzheimer's disease is a degenerative disease of the cerebral cortex.

Back 650

true

Front 651

The familial form of Alzheimer's disease is associated with which allele?

Back 651

ApoE4

Front 652

What is the CSF finding for multiple sclerosis?

Back 652

increased protein (IgG since it is an autoimmune disease)

Front 653

A patient presents with sudden loss of vision, internuclear ophthalmoplegia, hemiparesis and bladder incontinence; what disease does she have?

Back 653

multiple sclerosis

Front 654

In multiple sclerosis, what are periventricular plaques?

Back 654

areas of oligodendrocyte loss (loss of myelin) and reactive gliosis

Front 655

How does the mnemonic SIN help you recall Charcot's classic triad of MS?

Back 655

Scanning Speech, Intention tremor, Internuclear opthalmoplegia (MLF syndrome), Incontinence of bowel/bladder, Nystagmus

Front 656

What is the treatment for MS?

Back 656

B-interferon or immunosuppressant therapy

Front 657

True or False: Axons are preserved in MS despite loss of myelin.

Back 657

True

Front 658

What demographic group is most likely to be affected by MS?

Back 658

White women in their 20s and 30s

Front 659

Which disease is defined by autoimmune inflammation and demyelination of the brain and spinal cord?

Back 659

multiple sclerosis

Front 660

Medical management of which sequelae of MS is available?

Back 660

neurogenic bladder, spasticity, and pain

Front 661

True or False: MS usually has a rapidly progressive course.

Back 661

false, it usually relapsing and remitting

Front 662

What syndrome is characterized by symmetric ascending muscle weakness that begins in the distal lower extremities and that typically occurs after or concurrent with an infection?

Back 662

Guillain-Barré syndrome

Front 663

Findings in Guillain-Barré syndrome include a(n) _____ (elevated/lowered) cerebrospinal fluid protein level with a ______ (normal/elevated) cell count.

Back 663

Elevated; normal (albuminocytologic dissociation)

Front 664

True or False: In patients with Guillain-Barré syndrome, the inflammation and demyelination of peripheral nerves and motor fibers of the ventral roots cause symmetric ascending muscle weakness that begins in the upper extremities.

Back 664

False; weakness begins in the lower extremities

Front 665

Facial paralysis occurs in what percentage of patients with Guillain-Barré syndrome?

Back 665

50%

Front 666

True or False: There is no definitive link to pathogens in cases of Guillain-Barré syndrome.

Back 666

True

Front 667

True or False: Almost all patients survive Guillain-Barré syndrome.

Back 667

True

Front 668

How is Guillan-Barré treated?

Back 668

Respiratory support, plasmapheresis, IV immune globulins

Front 669

In Guillan-Barré syndrome, what is the target of autoimmune attack?

Back 669

peripheral myelin

Front 670

What is the mechanism by which the immune system is induced to destroy myelin in Guillan-Barré syndrome?

Back 670

molecular mimicry

Front 671

True or False: It takes years for patients to regain function after being affected by Guillain-Barré.

Back 671

False; most patients recover in weeks to months

Front 672

Which rapidly progressive disease is characterized by demyelination of CNS due to destruction of oligodendrocytes?

Back 672

progressive multifocal leukoencephalopathy (PML due to JC virus)

Front 673

Which virus has been implicated in PML?

Back 673

JC virus

Front 674

In what percentage of AIDS patients is PML seen?

Back 674

2-4%

Front 675

Which demyelinating disease may occur after infections with chickenpox or measles, or with rabies and smallpox vaccinations?

Back 675

acute disseminated (postinfectious) encephalomyelitis

Front 676

Which demyelinating disease is characterized by multifocal perivenular inflammation and demyelination?

Back 676

acute disseminated (postinfectious) encephalomyelitis

Front 677

What is the mode of inheritance of metachromatic leukodystrophy?

Back 677

autosomal recessive

Front 678

In metachromatic leukodystrophy, what is the consequence of sulfatides building up?

Back 678

impaired production of the myelin sheath

Front 679

In metachromatic leukodystrophy, which enzyme is deficient?

Back 679

aryllsulfatase A

Front 680

What is another name for Charcot-Marie-Tooth disease?

Back 680

hereditary motor and sensory neuropathy (HSMN)

Front 681

Which group of hereditary nerve disorders is characterized by defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath?

Back 681

Charcot-Marie-Tooth disease

Front 682

Is the origin of a partial seizure found in one area of the brain or diffusely throughout the brain?

Back 682

one area

Front 683

During a simple partial seizure, is consciousness intact or impaired?

Back 683

consciousness is intact

Front 684

True or False: Recurrent febrile seizures qualify a patient for the diagnosis of epilepsy.

Back 684

False; febrile seizures are not considered epilepsy

Front 685

A young girl sometimes lapses into a blank stare and then resumes her conversation as if nothing had happened. What kind of seizure may this child be experiencing?

Back 685

absense seizures (ethosuxamide is first line tx)

Front 686

A spouse calls 911 and reports that her husband is on the floor thrashing with alternating stiffening and movements. What kind of seizure might the patient be experiencing?

Back 686

Tonic-clonic/ grand mal seizure

Front 687

"Drop" seizures are also called _____ seizures.

Back 687

atonic- these may be confused with syncope (fainting)

Front 688

What are possible causes of new-onset seizures in the elderly?

Back 688

stroke, tumor, trauma, metabolic abnormalities, infection

Front 689

From which part of the brain do partial seizures most commonly originate?

Back 689

mesial temporal lobe-- which contains the hippocampus and amygdala

Front 690

What is epilepsy?

Back 690

A disorder of recurrent unprovoked seizures

Front 691

How does neuronal firing differ in seizure activity as compared to normal function?

Back 691

firing is synchronized and high frequency

Front 692

What type of seizure is characterized by quick, repetitive jerks?

Back 692

myoclonic seizure

Front 693

What type of seizure is associated with stiffening (as opposed to jerking)?

Back 693

tonic seizure

Front 694

True or False: Partial seizures cannot become generalized.

Back 694

False; partial seizures may secondarily generalize

Front 695

True or False: Genetic disorders, febrile seizures, trauma-related, congenital malformations, and metabolic insults are common causes of seizures in children.

Back 695

true

Front 696

True or False: Tumors, trauma, stroke, and infection are common causes of seizures among adults.

Back 696

true

Front 697

Which type of seizure is often mistaken for fainting?

Back 697

atonic seizure

Front 698

What syndrome is a congenital disorder characterized by facial port-wine stains and ipsilateral leptomeningeal angioma?

Back 698

Sturge-Weber syndrome

Front 699

A toddler is diagnosed with seizures, mental retardation, and glaucoma. Her pediatrician notices a port-wine stain and hemiparesis. What is the most likely diagnosis?

Back 699

Sturge-Weber syndrome

Front 700

A toddler is diagnosed with seizures, mental retardation, and glaucoma. Her pediatrician notices a port-wine stain and hemiparesis. What is the associated brain lesion?

Back 700

leptomeningeal angioma

Front 701

Tuberous sclerosis is characterized by what three characteristic cutameous manifestations?

Back 701

"ash leaf spots" (hypopigmented skin spots) shagreen patches, and sebaceous adenomas

Front 702

In addition to its cutaneous manifestations, tuberous sclerosis is characterized by which findings?

Back 702

hamartomas in the CNS, cardiac rhabdomyomas, renal angiomyolipomas, mitral regurgitation, subependymal glial cell astrocytoma, seizures

Front 703

Neurofibromatosis type 1 (von Recklinghausen's disease) is characterized by what two cutaneous formations and what ocular formation?

Back 703

cafe-au-lait spots on the skin, neurofibromas in the skin, lisch nodules (pigmented iris hamartomas)

Front 704

Is von Hippel-Lindau disease an autosomal dominant or autosomal recessive disorder?

Back 704

autosomal dominant

Front 705

What neurocutaneous disorder is associated with cavernous hemangiomas in skin, mucosa, and internal organs; renal cell carcinoma; and hemangioblastoma in retina, brain stem, and cerebellum?

Back 705

von Hippel Lindau disease

Front 706

What is the inheritance pattern of tuberous sclerosis?

Back 706

autosomal dominant

Front 707

The majority of primary tumors in adults are _____ (infratentorial/supratentorial), whereas they are mostly _____ (infratentorial/supratentorial) in children.

Back 707

supratentorial; infratentorial

Front 708

What percentage of adult brain tumors are metastases, often presenting at the gray-white junction?

Back 708

50%

Front 709

What is the most common primary brain tumor in adults?

Back 709

glioblastoma multiforme (grade IV astrocytoma)

Front 710

What type of staining may help confirm the diagnosis of glioblastoma multiforme?

Back 710

glial fibrillary acidic protein staining- GFAP- marker of astrocytes

Front 711

What is the second most common primary brain tumor in adults?

Back 711

meningioma

Front 712

Bilateral schwannomas are typically found in patients with what congenital illness?

Back 712

neurofibromatosis type II

Front 713

Meningiomas arise from what type of cells that are external to the brain?

Back 713

arachnoid cells

Front 714

Pilocytic astrocytomas are associated with what histologic finding?

Back 714

Rosenthal fibers, which are eosinophilic corkscrew fibers

Front 715

Psammoma bodies are commonly found in what type of primary brain tumor?

Back 715

meningiomas

Front 716

What is the third most common primary brain tumor in adults?

Back 716

schwannoma

Front 717

Schwannomas typically affect what cranial nerve?

Back 717

CNVIII (acoustic schwannoma)

Front 718

What rare and slow-growing primary brain tumor is most often found in the frontal lobes?

Back 718

oligodendroglioma

Front 719

What rare and slow-growing primary brain tumor is characterized by "fried egg" cells (i.e., round nuclei with clear cytoplasm) and a chicken-wire capillary pattern?

Back 719

oligodendroglioma

Front 720

Pituitary adenomas most commonly secrete what hormone?

Back 720

prolactin

Front 721

A large pituitary adenoma often presents with what visual complaint?

Back 721

bitemporal hemianopia

Front 722

Most pituitary adenomas originate in the anterior pituitary, which is embryologically derived from what structure?

Back 722

rathke's pouch

Front 723

What is the prognosis for a pilocytic astrocytoma?

Back 723

Good; this is a benign, resectable tumor

Front 724

True or False: A medulloblastoma is a highly malignant primary cerebellar brain tumor that is found in children.

Back 724

true

Front 725

What primitive neuroectodermal tumor can compress the fourth ventricle and cause hydrocephalus?

Back 725

medulloblastoma

Front 726

What primary brain tumor of childhood is most commonly found in the fourth ventricle?

Back 726

ependymoma

Front 727

What is generally the prognosis for an ependymoma?

Back 727

poor

Front 728

Perivascular pseudorosettes are characteristic of what primary brain tumor?

Back 728

ependymoma

Front 729

What benign childhood tumor is often confused with pituitary adenomas because of its symptom of bitemporal hemianopsia?

Back 729

craniopharyngioma (derived from rathke's pouch)

Front 730

A craniopharyngioma is embryologically derived from the remnants of what structure?

Back 730

rathke's pouch

Front 731

True or False: Seizures, dementia, and focal lesions are symptoms of a brain tumor.

Back 731

true

Front 732

True or False: Patients with glioblastoma multiforme typically have a good prognosis.

Back 732

False; the prognosis is typically grave (less than 1 year)

Front 733

True or False: Psammoma bodies are laminated calcifications.

Back 733

True (often seen in meningiomas, also seen in papillary thyroid cancer)

Front 734

True or False: Meningiomas are nonresectable.

Back 734

False; they are resectable

Front 735

True or False: Schwannomas are nonresectable.

Back 735

False; they are resectable

Front 736

True or False: Hyper- or hypopituitarism may be the result of a pituitary adenoma.

Back 736

true

Front 737

Bitemporal hemianopia may result from what type of tumor because of increased pressure on the chiasm as a result of the anatomic location of this particular tumor?

Back 737

pituitary adenoma

Front 738

What type of brain tumor is characterized by rosettes or a perivascular pseudorosette pattern of cells?

Back 738

medulloblastoma (childhood tumor of cerebellum with poor prognosis)

Front 739

True or False: Medulloblastomas are radiosensitive.

Back 739

true

Front 740

True or False: Ependymal cell tumors arise from the lining of the ventricles.

Back 740

true

Front 741

Hemangioblastomas are most often found in what region of the brain?

Back 741

the cerebellar region

Front 742

True or False: Hemangioblastomas are associated with Von-Hippel-Lindau syndrome.

Back 742

true

Front 743

The pathologic appearance of what brain tumor involves foamy cells and high vascularity?

Back 743

hemangioblastoma

Front 744

What brain tumor may produce erythropoietin and lead to secondary polycythemia?

Back 744

hemangioblastoma

Front 745

What is the most common childhood supratentorial tumor?

Back 745

craniopharyngioma

Front 746

True or False: Glioblastoma multiforme are typically found in the cerebral hemispheres. They have a butterfly shape, and they do not cross the corpus callosum.

Back 746

False; they may cross the corpus callosum (they do have a butterfly shape and are found in the cerebral hemispheres)

Front 747

True or False: Glioblastoma multiforme are typically found in the cerebral hemispheres. They have a butterfly shape, and they do not cross the corpus callosum.

Back 747

False; tooth enamel-like calcification is common in craniopharyngiomas

Front 748

True or False: Pseudopalisading tumor cells border central areas of necrosis and hemorrhage.

Back 748

true

Front 749

Pilocytic astrocytoma will stain positive for what protein?

Back 749

glial fibrillary acidic protein (GFAP)

Front 750

What are the histologic findings of glioblastoma multiforme?

Back 750

Pseudopalisading pleomorphic tumor cells with areas of central necrosis and hemorrhage

Front 751

What are the histologic findings of meningioma?

Back 751

Spindle cells in a whorled pattern; psammoma bodies

Front 752

A "butterfly glioma" has undergone what process?

Back 752

It has invaded the contralateral hemisphere through the corpus callosum

Front 753

True or False: A cingulate herniation under the falx cerebri may compress the posterior cerebral artery.

Back 753

False; it may compress the anterior cerebral artery

Front 754

True or False: Coma (but not death) results when herniations compress the brain stem.

Back 754

False; both coma and death may result from these herniations
(death may be due to compression of brainstem centers controlling drive to breathe)

Front 755

True or False: The uncus is composed of the lateral temporal lobe.

Back 755

False; it is composed the medial temporal lobe

Front 756

What structure can herniate through the foramen magnum as a result of increased intracranial pressure?

Back 756

cerebellar tonsils

Front 757

The stretching of what nerve during an uncal herniation may result in ipsilateral dilated pupils/ptosis?

Back 757

CN III- which is responsible for parasympathetic mediated pupillary constriction (absent light reflex on affected side)

Front 758

During uncal herniation, compression of the ipsilateral posterior cerebral artery may result in what visual field deficit?

Back 758

contralateral homonymous hemianopia (with macular sparing) due to compression of the Posterior Cerebral artery to the visual cortex

Front 759

During uncal herniation, ipsilateral paresis may be a result of the compression of the _____(contralateral/ipsilateral) crus cerebri.

Back 759

contralateral crus cerebri (Kernohan's notch)

Front 760

True or False: Duret hemorrhages may result from the caudal displacement of the brain stem. What are duret hemorrhages?

Back 760

True- duret hemorrhages are paramedian artery ruptures

Front 761

What is the differential diagnosis for ring enhancing lesions seen on brain imaging?

Back 761

metastasis, toxoplasmosis, AIDS lymphoma, abscesses

Front 762

What is the differential diagnosis for uniformly enhancing lesions seen on brain imaging?

Back 762

lymphoma, meningioma, metastases (although usually ring enhancing)

Front 763

What diagnosis must be considered when heterogenously enhancing lesions are seen on brain imaging?

Back 763

glioblastoma multiforme

Front 764

True or False: Headache is pain due to irritation of dura, cranial nerves, extracranial structures or brain parenchyma.

Back 764

False; headache is not due to irritation of the brain parenchyma

Front 765

A patient experiences 72 hours of unilateral pulsating pain accompanied by nausea and photophobia; which type of headache does he have?

Back 765

migraine headache

Front 766

Which disturbances may be associated with the "aura" preceding a migrane headache?

Back 766

visual, sensory, and speech disturbances

Front 767

Which cranial nerve is irritated in the etiology of migraine headaches?

Back 767

CN V- trigeminal nerve

Front 768

The release of which three substances may be implicated in the etiology of migraine headaches?

Back 768

substance P, Calcitonin Gene Related Peptide (CGRP), vasoactive peptides

Front 769

Which headache is characterized by at least 30 minutes of bilateral steady pain without aura?

Back 769

tension headache

Front 770

True or False: Both migraine and tension headaches are aggravated by light and noise.

Back 770

False; tension headaches are not aggravated by light or noise

Front 771

_____ headaches are repetitive brief headaches characterized by unilateral periorbital pain.

Back 771

cluster headaches

Front 772

Which type of headache is much more common in males?

Back 772

cluster headaches

Front 773

Cluster headache may manifest with _____ (ipsilateral/contralateral) lacrimation, rhinorrhea and Horner's syndrome.

Back 773

ipsilateral

Front 774

A patient presents with the "worst headache of his life"; what is the etiology of this headache?

Back 774

subarachnoid hemorrhage (possible berry aneurysm rupture)

Front 775

Which pathologies may result in the symptom of a headache?

Back 775

meningitis, hydrocephalus, hemorrhage, neoplasia or arteritis

Front 776

What is vertigo?

Back 776

illusion of movement (not to be confused with dizziness or lightheadedness)

Front 777

True or False: Vertigo, dizziness and lightheadedness all describe the same phenomenon

Back 777

False; vertigo is the illusion of movement

Front 778

Which is more common: peripheral or central vertigo?

Back 778

peripheral vertigo

Front 779

Which type of vertigo may be caused by semicircular canal debris, vestibular nerve infection, or Meniere's disease?

Back 779

peripheral vertigo

Front 780

A patient undergoes positional testing for vertigo and is found to have delayed horizontal nystagmus; what type of vertigo does she have?

Back 780

peripheral vertigo

Front 781

Central vertigo is the result of a lesion in what parts of the brain?

Back 781

cerebellum or brain stem

Front 782

A patient undergoes positional testing and is found to have immediate nystagmus that switches directions. He has _____ (peripheral/central) vertigo.

Back 782

central

Front 783

Which two α-agonists are used to treat glaucoma?

Back 783

epinepherine and brimonidine

Front 784

How do α-agonists treat glaucoma?

Back 784

they decrease aqueous humor synthesis (via vasoconstriction)

Front 785

Which drug is contraindicated for closed-angle glaucoma?

Back 785

epinepherine

Front 786

Which β-blockers are used to treat glaucoma?

Back 786

timodolol, betaxolol, carteolol

Front 787

How do β-blockers affect glaucoma?

Back 787

decreased secretion of aqueous humor

Front 788

What are the side effects of epinephrine in glaucoma?

Back 788

myDriasis (pupillary Dilation due to sympathetic effects) and stinging

Front 789

How does acetazolamide treat glaucoma?

Back 789

it decreases aqueous humor secretion by decreasing bicarbonate levels via inhibition of carbonic anhydrase

Front 790

Which four cholinomimetics are used to treat glaucoma?

Back 790

direct- pilocarpine, carbachol, indirect- phystostigmine, echothiophate

Front 791

Which drugs treat glaucoma by increasing outflow of aqueous humor, contracting the ciliary muscle, and opening the trabecular meshwork?

Back 791

cholinomimetics

Front 792

Which drug is used for glaucoma in emergencies?

Back 792

pilocarpine

Front 793

Which drug is most effective in opening the canal of Schlemm?

Back 793

pilocarpine

Front 794

A patient starts taking a new drug for glaucoma, and experiences miosis and cyclospasm. To which class of drugs does this belong?

Back 794

cholinomimetics (pupillary constriction is due to parasympathetic response)

Front 795

Which prostaglandin increases the outflow of aqueous humor?

Back 795

Latanoprost

Front 796

Latanoprost is an analog of which prostaglandin?

Back 796

PGF2α

Front 797

A patient's new glaucoma drug is causing browning of the iris. What is she taking?

Back 797

latanoprost (prostaglandin analog)

Front 798

Morphine, fentanyl, codeine, heroin, methadone, meperidine, and dextromethorphan are in which category of drugs?

Back 798

opiod analgesics

Front 799

Opioid analgesics act as _____ (agonists/antagonists) at the mu, delta, and kappa opioid receptors to modulate synaptic transmission.

Back 799

agonists

Front 800

Match the following substances with the opioid receptor (mu/delta/kappa) that they bind most avidly: morphine, dynorphin, enkephalin.

Back 800

morphine = mu
dynorphin = kappa
enkephalin= delta

Front 801

Which opioid agonist is used for cough suppression?

Back 801

dextromethorphan

Front 802

Which two opioid agonists are used to alleviate diarrhea?

Back 802

loperamide and diphenoxylate

Front 803

Which opioid analgesic is used for maintenance programs for heroin addicts?

Back 803

methadone

Front 804

Pain and acute pulmonary edema can both be treated with what category of medication?

Back 804

opiod analgesics

Front 805

A patient well-known to the emergency department presents with respiratory depression, constipation, and miosis. What is the most likely cause of her condition?

Back 805

opiod toxicity

Front 806

Tolerance _____ (does/does not) develop to the miosis and constipation associated with opioid toxicity.

Back 806

does not; patients will develop tolerance to other opioid effects

Front 807

Which two drugs are used to treat opioid toxicity?

Back 807

naloxone and naltrexone (opiod receptor antagonists)

Front 808

Which drug is most effective in opening the canal of Schlemm?

Back 808

pilocarpine

Front 809

A patient starts taking a new drug for glaucoma, and experiences miosis and cyclospasm. To which class of drugs does this belong?

Back 809

cholinomimetics (pupillary constriction is due to parasympathetic response)

Front 810

Which prostaglandin increases the outflow of aqueous humor?

Back 810

Latanoprost

Front 811

Latanoprost is an analog of which prostaglandin?

Back 811

PGF2α

Front 812

A patient's new glaucoma drug is causing browning of the iris. What is she taking?

Back 812

latanoprost (prostaglandin analog)

Front 813

Morphine, fentanyl, codeine, heroin, methadone, meperidine, and dextromethorphan are in which category of drugs?

Back 813

opiod analgesics

Front 814

Opioid analgesics act as _____ (agonists/antagonists) at the mu, delta, and kappa opioid receptors to modulate synaptic transmission.

Back 814

agonists

Front 815

Match the following substances with the opioid receptor (mu/delta/kappa) that they bind most avidly: morphine, dynorphin, enkephalin.

Back 815

mu = morphine
delta = enkephalin
kappa= dynorphin

Front 816

Which opioid agonist is used for cough suppression?

Back 816

dextromethorphan

Front 817

Which two opioid agonists are used to alleviate diarrhea?

Back 817

loperamide and diphenoxylate

Front 818

Which opioid analgesic is used for maintenance programs for heroin addicts?

Back 818

methadone

Front 819

Pain and acute pulmonary edema can both be treated with what category of medication?

Back 819

opiod analgesics

Front 820

A patient well-known to the emergency department presents with respiratory depression, constipation, and miosis. What is the most likely cause of her condition?

Back 820

opiod toxicity

Front 821

Tolerance _____ (does/does not) develop to the miosis and constipation associated with opioid toxicity.

Back 821

does not; patients will develop tolerance to other opiod effects

Front 822

Which two drugs are used to treat opioid toxicity?

Back 822

naloxone and naltrexone (opiod receptor antagonists)

Front 823

Butorphanol acts a partial _____ (agonist/antagonist) at opioid _____ (mu/kappa) receptors, and an _____ (agonist/antagonist) at _____ (kappa/delta) receptors.

Back 823

butorphanol is a partial agonist at mu receptors and an agonist at kappa receptors

Front 824

What is the toxicity of butorphanol?

Back 824

Withdrawal if a patient is on a full opioid agonist, due to its partial agonist activity

Front 825

Butorphanol causes _____ (more/less) respiratory depression than full agonists.

Back 825

less- thus the reason for its use!

Front 826

What is the clinical use of butorphanol?

Back 826

pain relief with less risk of respiratory depression

Front 827

Which drug is a weak opioid agonist and inhibitor of serotonin and NE uptake?

Back 827

tramadol (works on multiple neurotransmitters- "tram it all")

Front 828

What is the toxic effect of tramadol?

Back 828

decreases the seizure threshold, and effects similar to opiods (miosis, constipation, addiction, respiratory depression)

Front 829

What is the clinical use of tramadol?

Back 829

chronic pain

Front 830

Name the three first-line drugs for the treatment of generalized tonic-clonic seizures.

Back 830

phenytoin, carbamezapine, valproic acid

Front 831

Name the two drugs (one is considered a drug class) that are first-line agents for the treatment of status epilepticus.

Back 831

phenytoin = prophylaxis
benzodiazepines (lorazepem and diazapem) = acute treatment

Front 832

What is the mechanism of action of both phenytoin and carbamazepine?

Back 832

increased inactivation of Na+ channels

Front 833

What drug is used as a first-line agent for the treatment of trigeminal neuralgia?

Back 833

carbamezapine

Front 834

What epilepsy drug used to treat partial (simple and complex) and tonic-clonic seizures blocks voltage-gated sodium channels?

Back 834

lamotrigine

Front 835

What epilepsy drug also used to treat patients with peripheral neuropathy works by increasing GABA release?

Back 835

gabapentin (also used to treat bipolar disorder)

Front 836

Which epilepsy drugs used to treat partial (simple and complex) and tonic-clonic seizures increases sodium channel inactivation and also increases GABA action?

Back 836

topiramate (blocks sodium channels) and valproic acid (increases GABA concentration)

Front 837

What epilepsy drug that increases GABA action is the first-line agent used to treat pregnant patients?

Back 837

phenobarbital

Front 838

What epilepsy drug that increases sodium channel inactivation and GABA concentration is also used to treat absence and myoclonic seizures?

Back 838

valproic acid

Front 839

What class of drugs is used as first-line therapy for acute status epilepticus?

Back 839

benzodiazepines (lorazepem and diazepem)

Front 840

What is the first-line agent for the treatment of absence seizures?

Back 840

ethosuxamide

Front 841

What antiepileptic drug blocks thalamic T-type calcium channels?

Back 841

ethosuxamide

Front 842

What is the first-line agent used to prevent seizures in patients with eclampsia?

Back 842

MgSO4 (magnesium sulfate)

Front 843

If magnesium sulfate fails to prevent seizures in a patient with eclampsia, what class of drugs could also be used?

Back 843

benzodiazepines

Front 844

what anti-epileptic drug inhibits GABA reuptake and is used to treat simple and complex partial seizures?

Back 844

tiagabine

Front 845

what anti-epileptic drug irreversibly inhibits GABA transaminase, thus increasing GABA and is used to treat simple and complex partial seizures?

Back 845

viagabatrin

Front 846

Sedation, tolerance, and dependence are hallmarks of what class of drugs used to treat status epilepticus?

Back 846

benzodiazepines

Front 847

The adverse effects of what antiepileptic drug include diplopia, ataxia, blood dyscrasias, liver toxicity, teratogenesis, and the induction of cytochrome P450?

Back 847

carbamezapine (blood dyscrasias include agranulocytosis and aplastic anemia)

Front 848

What two blood dyscrasias are commonly associated with carbamazepine toxicity?

Back 848

agranulocytosis and aplastic anemia

Front 849

Which three epilepsy drugs may predispose individuals who are taking them to Stevens-Johnson syndrome?

Back 849

carbamezapine, ethosuxamide, lamotrigine

Front 850

Which antiepileptic drug may cause sedation, tolerance, and dependence in addition to inducing cytochrome P450?

Back 850

phenobarbital

Front 851

What epilepsy drug may cause lupus-like syndrome and gingival hyperplasia?

Back 851

phenytoin

Front 852

A patient with epilepsy presents with hirsutism, megaloblastic anemia, ataxia, and gingival hyperplasia. What drug may this person be taking to help treat the epilepsy?

Back 852

phenytoin

Front 853

Acute hepatotoxicity is associated with which antiepileptic drug?

Back 853

valproic acid

Front 854

Women of childbearing age who are taking what antiepileptic drug should also be using birth control because of the teratogenic risk of neural tube defects associated with the drug?

Back 854

valproic acid

Front 855

True or False: Gabapentin may cause sedation and ataxia.

Back 855

true

Front 856

Which antiepileptic drug is associated with kidney stones and weight loss?

Back 856

topiramate

Front 857

What syndrome is characterized by a prodrome of malaise and fever followed by rapid onset of erythematous and purpuric macules found on oral, ocular, and genital surfaces that eventually progress to epidermal necrosis and the sloughing of skin?

Back 857

Stevens-Johnson syndrome (associated with carbamezapine, ethosuxamide and lamotrigine -SUX to Lose your skin Cover)

Front 858

How does the mnemonic EFGH help you remember the toxicities of ethosuximide?

Back 858

EFGH- Ethosuxamide - Fatigue, GI disturbances, and headache (as well as Stevens-Johnson syndrome which sux to get)

Front 859

Which antiepileptic drug creates a use-dependent blockade of sodium channels and inhibits glutamate release from excitatory presynaptic neurons?

Back 859

phenytoin

Front 860

Which antiepileptic drug is primarily used to treat tonic-clonic seizures and is also a class IB antiarrhythmic agent?

Back 860

phenytoin

Front 861

The chronic use of which antiepileptic drug produces gingival hyperplasia in children?

Back 861

phenytoin

Front 862

True or False: A lupus-like syndrome and hirsutism are both potential adverse side effects of phenytoin.

Back 862

true

Front 863

True or False: Fetal hydantoin syndrome is a potential adverse effect of phenytoin during pregnancy.

Back 863

true (includes group of possible sx including heart, limb, face defects, cleft lip, and MR)

Front 864

Phenytoin creates a use-dependent blockade of _____ channels and inhibits glutamate release from excitatory presynaptic neurons.

Back 864

sodium

Front 865

Phenytoin is most commonly used for to treat which type of seizure?

Back 865

tonic- clonic seizures (first line) although it can be used for partial seizures as well and prophylaxis for status epilepticus

Front 866

A patient presents with nystagmus, ataxia, diplopia, and sedation after starting an antiepileptic drug for tonic-clonic seizures. What medication was the patient most likely started on?

Back 866

phenytoin

Front 867

Phenobarbital, pentobarbital, thiopental, and secobarbital are members of which class of drugs?

Back 867

barbiturates

Front 868

Barbiturates facilitate GABAA action by increasing the _____ (duration/frequency) of chloride channel opening, thereby (increasing/decreasing) neuron firing.

Back 868

duration; decreasing

Front 869

What is the treatment for barbiturate overdose?

Back 869

supportive measures-- Assisted respiration and maintenance of blood pressure

Front 870

What type of drugs are commonly used as sedatives for treating anxiety, seizures, insomnia, and the induction of anesthesia?

Back 870

barbiturates

Front 871

True or False: Dependence is a major adverse effect of barbiturates.

Back 871

true

Front 872

What class of medications commonly used to treat anxiety is contraindicated for patients with porphyria?

Back 872

barbiturates

Front 873

True or False: Barbiturates have an additive central nervous system depression effect when combined with alcohol.

Back 873

true

Front 874

What liver enzyme do barbiturates induce?

Back 874

CYP-450

Front 875

Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, and alprazolam are members of what class of drugs?

Back 875

benzodiazepines

Front 876

Benzodiazepines facilitate GABAA action by increasing the _____ (duration/frequency) of chloride channel opening.

Back 876

Frequency (Remember, FREnzodiazepines increase FREquency)

Front 877

True or False: Most benzodiazepines have short half-lives and no active metabolites.

Back 877

False; most benzos have long half-lives and active metabolites

Front 878

Which class of drugs used for alcohol detoxification has an additive central nervous system depression effect with alcohol and may result in dependence?

Back 878

benzodiazepines-- but they have less respiratory depression than barbiturates, which also have additive CNS depression with EtOH

Front 879

With what drug should benzodiazepine overdose be treated?

Back 879

flumazenil (competitive antagonist at GABA benzodiazepine receptor )

Front 880

Flumazenil is a competitive antagonist at what type of receptor?

Back 880

GABA benzodiazepine receptor

Front 881

Compared with barbiturates, benzodiazepines involve a(n) _____ (decreased/increased) risk of respiratory depression and coma.

Back 881

decreased

Front 882

True or False: In addition to treating status epilepticus, benzodiazepines may be used to treat night terrors and sleepwalking.

Back 882

true

Front 883

True or False: Benzodiazepines are used to treat anxiety and spasticity.

Back 883

true

Front 884

True or False: Benzodiazepines are used to treat alcohol withdrawal to prevent delirium tremens.

Back 884

true

Front 885

Which are the short-acting benzodiazepines?

Back 885

Triazolam, Oxazepam, Midazolam (Remember TOM Thumb is SHORT)

Front 886

Which benzodiazepines have the highest addictive potential?

Back 886

the ones with short half-lives (triazolam, oxazepam, midazolam)

Front 887

General anesthetics that act on the central nervous system must be _____ (lipid/water) -soluble or actively transported across the blood-brain barrier.

Back 887

lipid

Front 888

Anesthetic drugs with _____ (decreased/increased) solubility in the blood have rapid induction and reduced recovery times.

Back 888

reduced

Front 889

When discussing general anesthetics, what does the acronym MAC stand for? and what does it mean?

Back 889

Minimal Alveolar Concentration- the concentration of drug needed to anesthetize 50% of people (varies with age)

Front 890

Nitrous oxide has _____ (high/low) blood and lipid solubility and thus _____ (fast/slow) induction.

Back 890

low blood and lipid solubility; fast induction

Front 891

When discussing general anesthetics, as potency increases, does the minimal alveolar concentration increase or decrease?

Back 891

decrease-- it takes less concentrated drug to achieve the desired potency

Front 892

Halothane has high lipid and blood solubility; thus, it has _____ (high/low) potency and _____ (fast/slow) induction.

Back 892

high potency, and slow induction

Front 893

When discussing general anesthetics, potency is proportional to 1/_____ _____ _____.

Back 893

minimal alveolar concentration (MAC)

Front 894

When discussing general anesthetics, the higher the lipid solubility, the _____ (higher/lower) the potency.

Back 894

higher

Front 895

Halothane, enflurane, isoflurane, and sevoflurane belong to which class of drugs?

Back 895

inhaled anesthetics

Front 896

Inhaled anesthetics may cause a(n) _____ (decrease/increase) in cerebral blood flow.

Back 896

increase

Front 897

What are four common effects of inhaled anesthetics?

Back 897

myocardial depression, respiratory depression, nausea/vomiting and increased cerebral blood flow

Front 898

What inhaled anesthetic may cause hepatotoxicity?

Back 898

Halothane (Hepatotoxicity)

Front 899

What inhaled anesthetic may cause nephrotoxicity?

Back 899

methoxyflurane

Front 900

What inhaled anesthetic is a proconvulsant?

Back 900

Enflurane (Epileptic like seizure)

Front 901

True or False: Inhaled anesthetics may cause malignant hyperthermia.

Back 901

true (tx: dantrolene)

Front 902

True or False: Inhaled anesthetics may cause myocardial depression.

Back 902

true

Front 903

True or False: Inhaled anesthetics may cause an increase in cerebral metabolic demand.

Back 903

False; they may cause a decrease in cerebral metabolic demand

Front 904

What barbiturate is commonly used for the induction of anesthesia and short surgical procedures?

Back 904

thiopental

Front 905

True or False: The effect of thiopental is terminated by its redistribution from the brain.

Back 905

True- it is redistributed into fat and tissue

Front 906

What is the most common drug used for anesthesia during endoscopy?

Back 906

midazolam (versed) a short acting benzodiazepine

Front 907

What are three common adverse effects of midazolam?

Back 907

severe post-op respiratory depression, decreased BP and amnesia (tx = flumazenil)

Front 908

_____, which is a phencyclidine analog, acts as a dissociative anesthetic.

Back 908

Ketamine (arylcyclohexylamines)

Front 909

What are three common adverse effects of ketamine?

Back 909

nightmares, hallucinations, and disorientation

Front 910

Does ketamine increase or decrease cerebral blood flow?

Back 910

increase

Front 911

True or False: Morphine and fentanyl are opiates that are used with other central nervous system depressants during general anesthesia.

Back 911

true

Front 912

What intravenous lipid-based anesthetic, which is used for rapid anesthesia induction, results in less postoperative nausea than thiopental does?

Back 912

propofol

Front 913

True or False: Thiopental is often used during the induction of anesthesia.

Back 913

true (but more likely to cause post-op nausea than propofol)

Front 914

True or False: Thiopental may cause increased cerebral blood flow.

Back 914

False; it may cause decreased cerebral blood flow

Front 915

True or False: Ketamine is the only commonly used induction agent that does not lower blood pressure.

Back 915

true

Front 916

Which IV anesthetic potentiates GABAa?

Back 916

propofol

Front 917

How does the mnemonic "B.B. King on OPIATES PROPOses FOOLishly" help you remember the classes and drugs involved in IV anesthesia?

Back 917

BB King PROPOses FOOLishly: Benzodiazepines, Barbiturates, Ketamine, Opiates, and Propofol

Front 918

Ketamine blocks which receptors?

Back 918

NMDA receptors

Front 919

Procaine, cocaine, and tetracaine are three esters that are used as _____ (inhaled/intravenous/local) anesthetics.

Back 919

local anesthetics (-aine ending)

Front 920

Lidocaine, mepivacaine, and bupivacaine are three _____ (amides/esters) used for local anesthesia.

Back 920

Amides (all of the amIdes have 2 I's in the name)

Front 921

Local anesthetics block _____ channels by binding to specific receptors on the inner portion of the channel.

Back 921

Sodium

Front 922

_____ (Primary/Secondary/Tertiary) amine local anesthetics penetrate membrane in unchanged form and then bind to ion channels in a charged form.

Back 922

Tertiary

Front 923

Local anesthetics preferentially bind to ______ (activated/inactivated) sodium channels, so they are most effective in ______ (rapidly/slowly) firing neurons.

Back 923

activated; rapidly (use dependent)

Front 924

True or False: Local anesthetic penetrates infected tissue more efficiently because of the increased acidity in the tissue.

Back 924

False; False; acidity in the tissue makes penetration by the anesthetic more difficult, and more anesthetic must be used

Front 925

When considering the order of nerve blockade, _____ (myelination/size) predominates over _____ (myelination/size).

Back 925

size predominates over myelination, therefore small myelinated fibers are anesthetized first, followed by small unmyelinated fibers, then large myelinated, and last large unmyelinated fibers

Front 926

With regard to the order of loss when using local anesthesia, what is the first sensory modality to be extinguished?

Back 926

Pain (pain then temperature then touch and last pressure)

Front 927

With regard to the order of loss when using local anesthesia, what is the last sensory modality to be extinguished?

Back 927

pressure

Front 928

True or False: With regard to local anesthesia, small-diameter fibers are blocked before large-diameter fibers.

Back 928

true

Front 929

What drug is commonly mixed with local anesthesia (except for cocaine) to enhance the local anesthesia action, to decrease bleeding, and to decrease systemic concentration?

Back 929

epinepherine (it acts through vasoconstriction, which leads to less dilution of the drug and less taken into systemic circulation so more available locally)

Front 930

What amide, which is used in local anesthesia, may cause severe cardiovascular toxicity?

Back 930

bupivacaine

Front 931

What uncommonly used local anesthetic is a commonly abused street drug that may cause cardiac arrhythmias?

Back 931

cocaine is an ester that could be used for local anesthesia--- should not be given with epinepherine

Front 932

List the order in which the following senses are lost during nerve blockade, from first to last: pain, touch, temperature, and pressure.

Back 932

pain, temperature, touch, pressure

Front 933

True or False: With regard to local anesthesia, large-diameter nerve fibers are blocked before small-diameter nerve fibers.

Back 933

False; small diameter fibers (responsible for pain and temp) are blocked first

Front 934

True or False: With regard to local anesthesia, unmyelinated fibers are blocked before myelinated fibers.

Back 934

False; myelinated fibers are blocked before unmyelinated fibers

Front 935

Accidentally injecting local anesthetics such as lidocaine into a vein may cause what cardiac abnormality?

Back 935

arrhythmia

Front 936

Succinylcholine is a _____ (depolarizing/nondepolarizing) neuromuscular blocking agent.

Back 936

depolarizing

Front 937

Neuromuscular blocking drugs that are commonly used for muscle paralysis during surgery or mechanical ventilation are selective for motor _____ receptors.

Back 937

nicotinic (use ACh)

Front 938

What is the antidote to phase I (prolonged depolarization) for succinylcholine?

Back 938

there is no antidote (uh oh)

Front 939

Phase I depolarization in neuromuscular blockade is potentiated by _____ inhibitors.

Back 939

cholinesterase inhibitors

Front 940

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, and rocuronium belong to which class of drugs?

Back 940

nondepolarizing neuromuscular blocking drugs

Front 941

Nondepolarizing neuromuscular blocking drugs compete with _____ for receptors.

Back 941

Acetylcholine

Front 942

What is an antidote for a nondepolarizing neuromuscular blocking drug?

Back 942

cholinesterase inhibitors - neostigmine and edrophonium

Front 943

Use of succinylcholine may cause what two electrolyte abnormalities?

Back 943

hypercalcemia and hyperkalemia (peaked T waves)

Front 944

What is the antidote phase II (repolarized but blocked) for succinylcholine?

Back 944

cholinesterase inhibitors - like neostigmine

Front 945

What drug is used to treat malignant hyperthermia?

Back 945

dantrolene

Front 946

What drug is used to treat neuroleptic malignant syndrome?

Back 946

dantrolene

Front 947

Dantrolene prevents the release of what substance from the sarcoplasmic reticulum of skeletal muscle as a mechanism to treat malignant hyperthermia?

Back 947

Ca2+

Front 948

The use of which two drugs may result in malignant hyperthermia?

Back 948

inhaled anesthetics and succinocholine

Front 949

Parkinsonism is a result of the loss of what kind of neurons?

Back 949

dopaminergic neurons

Front 950

True or False: Bromocriptine is a dopamine antagonist.

Back 950

False; it is an ergot alkaloid and partial dopamine agonist

Front 951

Amantadine may _____ (decrease/increase) dopamine release.

Back 951

increase

Front 952

True or False: L-dopa/carbidopa is converted to dopamine in the central nervous system.

Back 952

true (carbidopa prevents conversion in the periphery)

Front 953

What is the selective monoamine oxidase type B inhibitor that prevents the breakdown of dopamine in the central nervous system?

Back 953

selegiline

Front 954

Name two catechol-O-methyltransferase inhibitors that prevent the breakdown of dopamine in the central nervous system.

Back 954

Entacapone and tolcapone

Front 955

Patients with parkinsonism have excess activity of what neurotransmitter?

Back 955

Acetylcholine

Front 956

What antimuscarinic medication used to treat Parkinson's disease improves tremor and rigidity but has little effect on bradykinesia?

Back 956

Benztropine (Remember, decrease your tremor before you drive your Mercedes-BENZ)

Front 957

What drug used to treat Parkinson's disease is also used as an antiviral agent against influenza A and rubella?

Back 957

amantadine

Front 958

Amantadine toxicity is characterized by what symptom?

Back 958

ataxia

Front 959

What class of medication is used to treat an essential or familial tremor?

Back 959

beta-blockers

Front 960

Which five drugs/classes are used to treat Parkinson's disease?

Back 960

Remember BALSA: Bromocriptine, Amantadine, L-dopa/Carbidopa, Selegiline (and COMT inhibitors), Antimuscarinics (benztropine)

Front 961

What medication used to treat Parkinson's disease crosses the blood-brain barrier, where it is then converted into dopamine by dopa decarboxylase in the central nervous system?

Back 961

L-dopa

Front 962

L-dopa is clinically indicated for the treatment of what condition?

Back 962

Parkinson's disease

Front 963

What medication is a peripheral decarboxylase inhibitor that is given with L-dopa?

Back 963

carbidopa

Front 964

True or False: Carbidopa increases dopamine bioavailability to the brain and limits peripheral adverse effects.

Back 964

true

Front 965

True or False: When administering L-dopa, akinesia may occur after administration and dyskinesia may occur between doses.

Back 965

false; dyskinesia may occur after a dose and akinesia may occur between doses

Front 966

What effect may L-dopa have on the heart?

Back 966

arrhythmias

Front 967

How does selegiline increase availability of dopamine?

Back 967

inhibits Monoamine Oxidase-B which selectively breaks down dopamine over norepi or 5-HT

Front 968

True or False: Selegiline may increase the adverse effects of L-dopa in patients with parkinsonian conditions.

Back 968

true

Front 969

Selegiline is an adjunctive agent to what medication that is a mainstay in the treatment of Parkinson's disease?

Back 969

L-dopa/carbidopa

Front 970

True or False: Sumatriptan is a 5-hydroxytryptamine antagonist.

Back 970

false; it is a 5-HT agonist

Front 971

True or False: Sumatriptan causes vasoconstriction.

Back 971

true

Front 972

The half-life of sumatriptan is how long?

Back 972

<2 hours

Front 973

Sumatriptan is used to treat what conditions?

Back 973

acute migraine and cluster headaches

Front 974

True or False: Possible adverse effects of sumatriptan include coronary vasospasm.

Back 974

true

Front 975

Tingling is a common adverse effect of what migraine headache medication?

Back 975

sumatriptan

Front 976

True or False: Sumatriptan is contraindicated in patients with CAD or Prinzmetal's angina.

Back 976

true- as it may cause coronary vasospasm

Front 977

Which two drugs are approved to treat Alzheimer's disease?

Back 977

memantine and donepezil

Front 978

To which class of drugs does donepezil belong?

Back 978

acetylcholinesterase inhibitor

Front 979

What three side effects are associated with donepezil?

Back 979

Nausea, dizziness, insomnia

Front 980

Which drug, used for Alzheimer’s disease, acts as a NMDA receptor antagonist?

Back 980

memantine

Front 981

What are the side effects of memantine?

Back 981

Dizziness, confusion, hallucinations

Front 982

Memantine helps prevent what calcium-mediated process in Alzheimer's disease?

Back 982

Excitotoxicity