Usmle Neuro Questions

Front 1

Brain tumor associated with NF2:

Back 1

* Meningioma

Front 2

Brain tumor associated with NF1, looks like hair:

Back 2

* Pilocytic astrocytoma (occurs in the cerebellum)

Front 3

Low grade glial tumor that has a "fried egg" appearance histologically:

Back 3

* Oligodendroglioma

Front 4

Cauliflower looking tumor that occurs in the 4th ventricle and spinal cord:

Back 4

* Ependymoma (causes hydrocephalus)

Front 5

Common category 1 CNS tumor:

Back 5

* Medulloblastoma (embryonal origin)

Front 6

Category 2 CNS tumors arise from what components:

Back 6

* Glial and choroid plexus (astrocytomas, gangliomas)

Front 7

Category 3 CNS tumors have features of:

Back 7

* Leptomeninges and mesenchymal tissue (meningiomas)

Front 8

A secondary brain tumor due to metastasis from another site would be what category?

Back 8

* Category 5 (secondary tumors)

Front 9

Category 4 CNS neoplasia are what type of tumors:

Back 9

* Germ cell tumors

Front 10

Blue cell tumor seen in kids that is seen often in the cerebellum:

Back 10

* Medulloblastoma

Front 11

Highly malignant tumor seen in kids that infiltrates the leptomeninges and has features of epithelium:

Back 11

* Medulloepithelioma

Front 12

Complication seen with medulloblastomas:

Back 12

* Hydrocephalus

Front 13

Retinoblastoma is due to deletion of:

Back 13

* The RB1 gene

Front 14

Most common type of glial (astrocytoma) tumor:

Back 14

* Glioblastoma

Front 15

A pt with a constant gait ataxia probably has a lesion where?

Back 15

* Cerebellum

Front 16

Differential for someone with "vertigo":

Back 16

* BPPV, vestibular neuritis, CN 8 lesion, drug toxicity (aminoglycosides, chemo), meniere syndrome

Front 17

Most common cause of vertigo:

Back 17

* BPPV (benign paroxysmal positional vertigo)

Sx: No N&V, symptoms occur with head movement, vertigo less than 1 minute

Front 18

What causes BPPV:

Back 18

* Endolymph debris-- loose otoconia (treat using the dix-hallpike maneuver)

Front 19

Management of BPPV:

Back 19

* Epley maneuver and Brandt exercises

Front 20

What causes meniere's diseae?

Back 20

* Idiopathic endolymphatic hydrops (Tx with Acetazolamide, HCTZ, or surgery)

Front 21

A pt with episodic vertigo, tinnutis, and hearing loss along with N&V probably has:

Back 21

* Meniere's disease

Front 22

A very miserable pt with vertigo, prominent N&V and might have tinnitus or hearing loss:

Back 22

* Vestibular neuritis or Labrynthitis (if they have tinnitus/hearing loss)

TX: Benzo's, steroids, antihistamines

Front 23

Common cause of recurrent vertigo with PHOTOPHOBIA, headache, and N&V:

Back 23

* Central vertigo = basilar migraine

Front 24

When you lose the 4 features of consciousness (arousal, wakefulness, responsiveness, and awareness to self/environment) you are in:

Back 24

* A Coma

Front 25

What brain system controls arousal and when damaged you are in a true coma?

Back 25

* Ascending reticular activating system

Front 26

A pt with episodic vertigo, tinnutis, and hearing loss along with N&V probably has:

Back 26

* Meniere's disease

Front 27

A very miserable pt with vertigo, prominent N&V and might have tinnitus or hearing loss:

Back 27

* Vestibular neuritis or Labrynthitis (if they have tinnitus/hearing loss)

TX: Benzo's, steroids, antihistamines

Front 28

Common cause of recurrent vertigo with PHOTOPHOBIA, headache, and N&V:

Back 28

* Central vertigo = basilar migraine

Front 29

When you lose the 4 features of consciousness (arousal, wakefulness, responsiveness, and awareness to self/environment) you are in:

Back 29

* A Coma

Front 30

What brain system controls arousal and when damaged you are in a true coma?

Back 30

* Ascending reticular activating system (ascends through the periaqueductal gray)

Front 31

If you have a lesion in the pons, what body part will be affected?

Back 31

* The eyes

Front 32

A glasgow coma scale of 8 or less means:

Back 32

* Coma

Front 33

What is decorticate positioning?

Back 33

* Arms flexed, legs extended (this would be supratentorial damage)

Front 34

A pt with both arms and legs extended has a lesion where?

Back 34

* Decerebrate positioning-- lesions is at the midbrain or lower (infratentorial)

Front 35

How do you tell if a lesion is UMN or LMN?

Back 35

* UMN has reflexes, LMN doesn't

Front 36

Pt with normal (reactive) pupils, cheyne-stokes resp, decorticate, eyes look toward lesion and away from paresis has a lesion where?

Back 36

* Cortex

Front 37

Pt with small (but reactive) pupils, cheyne-stokes, decorticate, and eyes look toward lesion and away from paresis has a lesion where?

Back 37

* Thalamus

Front 38

Pt with dilated/unreactive pupils, dysconjugate gaze, abduction paralysis, decerebrate, apneustic resp?

Back 38

* Midbrain

Front 39

A pt with pinpoint pupils, intact light reflex, looks away from lesion or toward paresis, paralysis of lateral eye movement, decerebrate, and apneustic resp; where is the lesion?

Back 39

* Pons

Front 40

What is the big give-away with a midbrain lesion localization?

Back 40

* Dysconjugate gaze (one eye straight while one eye looks at the wall)

Front 41

A person in a coma but has a normal neuro exam probably is in:

Back 41

* Metabolic state induced coma

Front 42

A comatose patient with bilateral dilated pupils that get bigger and bigger, bilateral medial rectus paralysis, then decorticate to decerebate and then death, has what type of herniation?

Back 42

* Central herniation

Front 43

Classic sign of transtentorial (uncal) herniation:

Back 43

* Ipsilateral CN III (oculomoter) paralysis

The ipsilateral pupil is dilated and unreactive

Front 44

A pt with tonsillar herniation will have what signs:

Back 44

* Paralysis of lateral eye movement, the pressure on the medulla will eventually cause death (they will be decerebrate and then become flaccid)

Front 45

What is a duret hemorrhage?

Back 45

* Complete uncal herniation-- too late at this point

Front 46

Causes the brain damage seen in car accidents:

Back 46

* Torque on the brainstem

Front 47

2 classic signs of skull fracture:

Back 47

* Coons eyes and battle signs

Front 48

Being unable to recall the period of time after a brain injury is called:

Back 48

* Anterograde amnesia

Front 49

Where is CSF produced and absorbed?

Back 49

* Produced by choroid and absorbed by arachnoid villi

Front 50

Triad of symptoms seen with hydrocephalus (arachnoid villi aren't plugged/scarred):

Back 50

* Wet, wacky, wobbly

Front 51

If someone reaches out to touch a doorknob and they begin to have a tremor this is called ___ and the dysfunction is where?

Back 51

* Called an intention tremor and is IPSILATERAL cerebellar dysfunction

Front 52

Where is the dysfunction in a resting tremor?

Back 52

* CONTRALATERAL basal ganglia

Front 53

What is dementia and is it a clinical dx?

Back 53

* Progressive decline in intellectual function and it is NOT a clinical dx

Front 54

A pt with dementia and gait disturbance has problems where in the brain?

Back 54

* Frontal lobe

Front 55

Classic brain finding seen with Alzheimers:

Back 55

* Neurofibrillary tangles (plaques aren't as important)

Front 56

Where is atrophy most prominent in Alzheimers?

Back 56

* Medial temporal limbic areas

Front 57

How do you tell if a pt's dementia is d/t to Pick's disease?

Back 57

* Only one lobe atrophies (focal)

Front 58

A pt with coarsening of primary-emotional behaviors, social withdrawl/negativity, aphasias, anomias, and enhanced artistic realization and muscial ability has a problem where in the brain?

Back 58

* Left frontotemporal

Front 59

Main treatment for Alzheimers:

Back 59

* Acetylcholinesterase inhibitors (you want to increase ACh in the brain)

Front 60

A pt who has loss of language and social skills, coldness, and enhanced artistic realization has problems where in the brain?

Back 60

* Bitemporal

Front 61

Characteristic tremor seen in Parkinsons:

Back 61

* Resting tremor

Front 62

A tremor that begins anytime someone starts to move is:

Back 62

* Essential tremor (give them some EtOH and the tremor will slow down)

Front 63

What causes Huntington's Chorea?

Back 63

* Increased CAG repeats on chromosome 4 (AD disease) need at least 36 repeats for the disease

Front 64

Where does degeneration occur in the brain of someone with Huntingtons?

Back 64

* The caudate head

Front 65

A person on metaclopromide/haldol who always looks like their chewing gum when they aren't (abnormal mouth movements) has:

Back 65

* Tardive dyskinesia

Front 66

Toxic-metabolic disorder than can cause myoclonus:

Back 66

* CJD

Front 67

Hepatic encephalopathy can cause this "flapping tremor":

Back 67

* Asterixis

Front 68

A pt with hemiballism on the right has damage where in the brain?

Back 68

* Left (contralateral) subthalamic nucleus

Front 69

Dopa cells are lost where in pt's with Parkinsons?

Back 69

* Substantia nigra pars compacta

Front 70

Most effective management of neuropathic pain:

Back 70

* Antidepressants and antiepileptics

Front 71

Most common trigger for migraine:

Back 71

* Adrenaline (due to stress let downs)

Front 72

Only NSAID that can prevent migraine:

Back 72

* Naproxen (Triptans are the best abortive agents)

Front 73

Best way to differentiate a migraine from a cluster headache (aka trigeminal autonomic cephalgia):

Back 73

* Migraines make you want to sleep
Cluster = CAN'T sleep

Front 74

2 neurotransmitters involved in seizure:

Back 74

* Too much glutamate (excitatory) or not enough GABA (inhibitory)

Front 75

What is seen on an EEG with seizure?

Back 75

* Spikes and waves

Front 76

Describe a typical grand mal seizure (generalized tonic-clonic seizure):

Back 76

Start out with a cry, get stiff all over (tonic), then become clonic (jerking), can be incontinent, unconscious, last about a minute, after jerking they are post-ictal, maybe sleepy for up to an hour

Front 77

5 or more minutes of continued seizure activity is termed:

Back 77

* Status epilepticus

Front 78

CSF with WBC's, low glucose, and elevated protein has what type of meningitis?

Back 78

* Bacterial (WBC to 5k) or Fungal (WBC to 10k)

Front 79

How would you differentiate bacterial from viral meningitis?

Back 79

* With Viral the glucose is NORMAL (50 - 80mg/dl or 65% or serum glucose)

Bacterial/Fungal the glucose is low

Front 80

Organism that causes most general bacterial meningitis:

Back 80

* Strep pneumonia

Front 81

Most common cause of sporadic viral encphalitis:

Back 81

* Herpes simplex (goes to medial temporal lobes)

Tx: Acyclovir

Front 82

Familial prion disease:

Back 82

* Gestermann-Strausller (on chrom 20)

Front 83

Most common cause of meningitis in neonates:

Back 83

* H. influenzae

Front 84

Why does hydrocephalus occur as a complication of meningitis?

Back 84

* Scarring of the arachnoid villi

Front 85

Who usually gets a subdural empyema?

Back 85

* Adults after having some surgery involving the head

Front 86

This complication of neurosyphilis occurs decades after infection and atrophies the dorsal root ganglia:

Back 86

* Tabes dorsalis

Front 87

The types of fungi that cause brain abscesses are ____ while the ones that cause meningitis are ____.

Back 87

* Abscess = filaments (mucor, aspergillus)

Meningitis = yeasts (cryptococcus, histoplasmosis)

Front 88

How does mucormycosis typically infect the brain?

Back 88

* It ascends through the cribiform plate

Front 89

The structure of a prion:

Back 89

* Beta pleated sheets

Front 90

Where does herpes enchephalitis infect the brain?

Back 90

* Temporal lobes

Front 91

Agent causing subacute sclerosing panencephalitis:

Back 91

* Measles

Front 92

Agent causing progressive multifocal leukoencephalopathy (PML):

Back 92

* the JC virus -- demyelinates the oligodendroglia

Front 93

Is muscle fasciculations UMN or LMN?

Back 93

* LMN

Front 94

Where is the damage range in the spinal cord if there is ventilator dependence?

Back 94

* C1 to C3

Front 95

Where is the damage if thereare no upper limb movement, but they can breathe on their own?

Back 95

* C4

Front 96

What causes subacute combined degeneration?

Back 96

* B12 deficiency

Front 97

What disease is characterized by gliosis of the corticospinal tracts and muscle atrophy:

Back 97

* AML -- motor neuron only!

Oculomotor muscles are the only muscles spared

Front 98

Only drug for ALS:

Back 98

* Riluzole

Front 99

What are the signs and symptoms of transverse myelitis?

Back 99

* Rapid onset, monophasic, paraparesis, bowel/bladder dysfunction, brisk DTR’s, bilateral BABINKSI, sensory level

Front 100

Relapsing and remitting (recurrent) demyelinating disease:

Back 100

* Multiple sclerosis

Front 101

What syndrome has upper limbs weaker than lower limbs, with UMN signs in the upper limbs and LMN signs in the lower limbs?

Back 101

* Syringomyelic syndrome

Front 102

3 genetic trisomies that can be carried to term:

Back 102

* Trisomy 13, 18, and 21 (21-- Downs is the only one that lives longer than 1 year though)

Front 103

What is a neural tube malformation that is d/t failure of closure of the posterior neuropore?

Back 103

* Chiari malformations

Front 104

What is a neural tube malformation that is d/t failure of closure of the anterior neuropore?

Back 104

* Anencephaly (absent calavarium, forebrain among other things)

Early indicator = Increased AFP

Front 105

What is common to Chiari I, Chiari II, and Chiari III malformations?

Back 105

* All have cerebellar ectopia and small posterior fossa

Front 106

In addition to cerebellar ectopia and small posterior fossa, what else characterizes Chiari II (Arnold-Chiari malformation)?

Back 106

* Brainstem malformation with BEAKED midbrain and spinal meningomyelocele

Front 107

This chiari malformation is rare and is characterized by cerebellar ectopia, small posterior fossa, inferior displacement of the brainstem, and occipito-cervical encephalocele:

Back 107

* Chiari III

Front 108

What are the characteristics of chiari IV malformation?

Back 108

* Severe cerebellar hypoplasia and meningomyelocele

Front 109

Chiari malformation with a beaked midbrain but NO meningomyelocele:

Back 109

* Chiari 1.5 (if it was beaked and had a meningomyelocele it would be chiari II)

Front 110

Chiari malformation characterized by cerebellar hypoplasia:

Back 110

* Chiari IV

Front 111

What is the deficiency in PKU?

Back 111

* Deficiency of phenylalanine hydroxylase (converts pheynlalanine to tyrosine)

AR disorder on chromosome 12

Front 112

Discuss Tay-Sachs:

Back 112

* AR on chrom 15, Ashkenazi Jews, beta-HEX-A deficiency, accumulation of glycosphingolipid accumulation in neurons

Imaging show macrocephaly without hydrocephaly

Front 113

Group of disorders of the development of movement and posture causing activity limitation is:

Back 113

* Cerebral Palsy

Front 114

This disorder is a cleft of spinal cord result from failure of the neural folds to form the neural tube leading to an “OPEN BOOK” defect:

Back 114

* Myeloschisis

Front 115

What happens in a meningomyelocele?

Back 115

* Herniation of meninges & spinal cord through the vertebra-- neural tube defect

Front 116

A protrusion of the brain through a congenital opening in the skull (80-90% are occipital) that is also associated with hypoplastic lungs is:

Back 116

* Encephalocele

Front 117

This is a terminal fixation of the conus medullaris leading to restricted upward movement of the spinal cord:

Back 117

* Tethered cord syndrome

Front 118

What maternal disease is associated with holoprosencephaly (single ventricular cavity)?

Back 118

* Maternal diabetes or EtOH consumption/abuse

Front 119

3 most constant changes in this disease are: abnormal/agenesis of cerebellar vermis, cystic dilation of 4th ventricle, and enlargement of the posterior fossa:

Back 119

* Dandy-Walker syndrome

Front 120

Widespread loss of gyri associated with a genetic defect:

Back 120

* Miller-Dieker syndrome (no gyri in the brain)

Front 121

Most common interventricular tumor in adults occuring in the midline usually (peak occurance in 3rd decade):

Back 121

* Neurocytoma

Front 122

Meningiomas (most are dural based) are associated with what disorder:

Back 122

* NF2

Front 123

Hemangioblastomas are associated with what disease?

Back 123

* VHL (von-hippel lindau disease)

Front 124

Tumor found in the paramedian location of the cerebellum and associated with VHL:

Back 124

* Hemangioblastoma

Front 125

Tumor arising from Rathkes pouch:

Back 125

* Craniopharyngioma

Front 126

Primary CNS lymphoma is often associated with:

Back 126

* the EB virus and large diffuse B-cell tumors

Front 127

Common histo component to neuroblastomas:

Back 127

* Homer-wright rosettes

Front 128

Schwannomas most commonly occur where?

Back 128

* On the 8th crainal nerve

Front 129

Nerve that is pinched in carpal tunnel syndrome:

Back 129

* the MEDIAN nerve (become trapped underneath the flexor retinaculum)

Front 130

This muscle has weakness/wasting in carpal tunnel:

Back 130

* Abductor Pollicis Brevis (APB)

Front 131

A positive Tinnel or Phalens sign is indicative of:

Back 131

* Carpel tunnel

Front 132

What causes meralgia paresthetica?

Back 132

* Entrapment of the lateral cutaneous nerve of the thigh

Front 133

This is an immune acute aquired inflammatory demyelinating polyneuropathy:

Back 133

* Guillain-Barre Syndrome (GBS)

Front 134

What are the clinical features of GBS?

Back 134

* Progressive ascending symmetric flaccid weakness of the limbs, can eventually ascend to cranial nerves and be fatal

Tx: IV immunoglobins

Front 135

How does ALS present?

Back 135

* Progressive weakness over months/years that generally starts in one extremity

Front 136

Hallmark of the post-synaptic NMJ disorder myasthenia gravis:

Back 136

* Fatiguable weakness -- they will have arm drift and can't sustain an upward gaze

Front 137

Drug to help dx myasthenia gravis:

Back 137

* Endrophonium

Front 138

What is the general pattern of weakness in myopathy?

Back 138

* Proximal weakness is greater than distal (getting out of a seat, climbing stairs, lifting arms above head)

Will have elevated CPK, nerve conduction is normal though

Front 139

Duchenne and Becker muscular dystrophy are both disorders of:

Back 139

* Dystrophin both are x-linked as well (kids with Becker live longer though)

Front 140

What area of the brain does Alzheimers affect the most?

Back 140

* Temporal lobe-- especially the hippocampus

Front 141

Prototypical frontotemporal dementia:

Back 141

* Pick's disease (have Aphasia, Apraxia, and Agnosia)

Front 142

What causes amyotrophic lateral sclerosis (ALS)?

Back 142

* Loss of motor neurons in the anterior horn of the spinal cord (LMN) as well as in the motor cortex (UMN)

Front 143

What visual field disturbance is most common with a temporal lobe tumor?

Back 143

* Superior quadrantanopsia

Front 144

Where is the tumor: cyclical vomiting, occipital headache, vertigo, nystagmus, ataxia, ipsilateral hypotonia and hyporeflexia, brainstem signs and hydrocephalus occur late:

Back 144

* Cerebellum

Front 145

Increased ICP affects this cranial nerve:

Back 145

* Abducens (CN VI)

Front 146

Cerebral edema that responds to osmotic agents, and is a failure of the ATP-dependent Na/K pump:

Back 146

* Cytotoxic cerebral edema (seen with strokes)

Front 147

Cerebral edema that is d/t to seeping of CSF into the parenchyma d/t CSF flow obstruction:

Back 147

* Interstitial cerebral edema

Front 148

Which type of cerebral edema is most common and where does it occur?

Back 148

* Vasogenic, occurs mainly in white matter, around brain tumors, abscesses or lesions, and is caused by BBB disruption with increased permeability-- responds to steroids

Front 149

A patient with early nunchal rigidity and head tilt followed by coma and respiratory arrest might have a this herniation:

Back 149

* Tonsillar herniation

Front 150

A patient with a dilated ipsilater pupil, followed by ipsilateral hemiparesis might have this herniation:

Back 150

* Uncal herniation

Front 151

Where do menengiomas arise from?

Back 151

* Arachnoid cells, develop at a dural site

Front 152

A subdural hematoma is damage to:

Back 152

* The bridging veins (pt's will show a crescent shaped blood on CT/MRI and it can be acute or a delayed presentation)

Front 153

A epidural hematoma is damage to:

Back 153

* Middle meningeal artery-- presentation is acute (hours or less)

Front 154

How do the best treatments for myasthenia gravis work?

Back 154

* The carbamylate the acetylcholinesterase enzyme (Neostigmine and Pyridostigmine)

Front 155

Pt's who OD on tricyclic antidepressants often die from:

Back 155

* Lethal arrythmias

Front 156

What are Beta waves and Delta waves associated with in relation to sleep?

Back 156

* Beta = REM or alert wakefulness
Delta = Stage 4 (deep, non-rem sleep)

Front 157

Tabes dorsalis affects what in the spinal cord?

Back 157

* The dorsal COLUMN

Front 158

Most common complication of meningitis:

Back 158

* Hydrocephalus

Front 159

Where does the greatest amount of salt and water retention occur in cerebral edema?

Back 159

* The white matter

Front 160

Typical location for hypertensive hemorrhages:

Back 160

* Basal ganglia

Front 161

Rupture of a Berry aneurysm can lead to:

Back 161

* Subarachnoid hemorrhage