Usmle Step 1 Dit: Neuro

Front 1

ACA supplies blood to what area of the brain?

Back 1

anteromedial surface

Front 2

MCA supplies blood to what area of the brain?

Back 2

lateral surface

Front 3

PCA supplies blood to what area of the brain?

Back 3

occipital lobe

Front 4

ACA infarct will result in:

Back 4

decreased sensory and motor functions to leg and foot

Front 5

MCA infarct will result in:

Back 5

decreased sensory or motor in face, speech (brocas area), hands

Front 6

PCS infarct will result in:

Back 6

visual defects (bc it supplies occipital lobe)

Front 7

What kind of aphasia has difficulty forming sentences, words come out in the wrong order or are omited, and has intact comprehension.

Back 7

Broca = Nonfluent aphasia

Front 8

What kind of aphasia forms words correctly but says words that don't make sense, and has impaired comprehension.

Back 8

Wernicke= Fluent aphasia

Front 9

What kind of aphasia is nonfluent with impaired comprehension?

Back 9

Global = both broca and wernicke are affected

Front 10

What kind of aphasia has poor repetition, fluent speech and intact comprehension?

Back 10

Conduction aphasia = due to affected arcuate fascilatus. Can understand well, can speak well but can't respond or repeat well.

Front 11

What aphasia has an inability to express emotion or inflection of speech?

Back 11

Non-dominant broca

Front 12

What aphasia has an inability to comprehend emotion or inflection of speech?

Back 12

Non-dominant wernicke

Front 13

Hyperorality, hypersexuality, dissability behavior

Back 13

Kluver-Bucy Syndrome = Lesion of bilateral Amygdala, associated to HSV-1

Front 14

Disinhibition and deficit in concentration, orientation and judgement; may have reemergence of primitive reflexes.

Back 14

Frontal lobe lesion

Front 15

Neglect one side of their body (spatial neglect)

Back 15

Non-dominant parietal cortex lesion (usually right side)

Front 16

Agraphia, acalculia, finger agnosia, and left-right disorientation

Back 16

Gerstmann sx = dominant parietal cortex (left) lesion

Front 17

Reduced levels of arrousal, and wakefulnes

Back 17

Reticular activating system (midbrain) lesion

Front 18

Confusion, oftalmoplegia, ataxia, memory loss (anterograde and retrogade amnesia), confabulation, personality change.

"can't remember so they lie"

Back 18

Wernicke-Korsakoff syndrome: Wernicke problems come in a CAN of beer

Mammillary body lesion, associated to thiamine deficiency, excess ethanol

Confusion, ataxia, nistagmus

Hint 18

Wernicke problems come in a CAN of beer

Front 19

Chorea, athetosis

Back 19

Basal ganglia lesion= huntingtons disease

Front 20

Tremor at rest

Back 20

Basal ganglia lesion= parkingsons disease

Front 21

Intentional tremor, limp ataxia and loss of balance. Damage to cerebellum results in ipsilateral deficit falls towards side of the lesion.

Back 21

Cerebellar hemisphere lesion

Hint 21

cerebellar hemispheres are laterally located - affect lateral limbs

Front 22

Truncal ataxia, dysarthia

Back 22

vermis is centrally located -affects central body

cerebellar vermis lesion

Hint 22

vermis is centrally located-affects central body

Front 23

Contralateral hemibllisimus (involuntary flaring of the arms and legs)

Back 23

Sub-talamic lesion

Front 24

Anterograde amnesia-inability to make new memories

Back 24

hypocampus (bilateral) lesion

Front 25

Eyes look away from the site of the lesion

Back 25

Paramedian pontine reticular formation lesion

Front 26

Eyes look towards the lesion

Back 26

Frontal eye fields lesion

Front 27

Paralysis of upward gaze

Back 27

Parinauds syndrome=superior colliculi

Front 28

What is central pontine myelinolysis?

Back 28

Its due to a rapid correction on hyponatremia, usually the doctors fault.

MRI: increased signal intensity in the pons

Front 29

What are the symptoms of central pontine myelinolysis?

Back 29

Acute paralysis, dysarthia, dysphagia, diplopia, loss of consciousness

Front 30

If the right vagus nerve or nuclei is damaged, then to which side will the uvula deviate?

Back 30

Since the muscles of the left soft palate raise the palate, and muscles of the right are not, the uvula will deviate to the left. (opposite to the lesion)

Front 31

A patient said "AH" and the uvula deviated to the right. why did this happen?

Back 31

muscles of the right palate are working but not the muscles of the left palate.

Front 32

What innervates the left soft palate?

Back 32

Left vagal nerve, left nucleus ambiguus, right corticobulbar tract, soft palate portion of the right cortex

Front 33

If the right hypoglossal nerve or nuclei is damaged, then to which side will the tongue deviate when sticking out?

Back 33

The right side is damaged, therefor the left side (functional) will push it towards the right.

(towards the side of the lesion)

Front 34

If the portion of the right motor cortex that innervates the tongue is damages, to which side will the tongue deviate?

Back 34

since tongue fibers from the right motor cortex travel to the left hypoglossal nucleus, the tongue will deviate to the left. (away from the lesion).

Front 35

A patient stuck out his tongue and it deviated to the left. Why is this happening?

Back 35

left deviation means the muscles of the right tongue are pushing the unfunctional left muscles.

(towards the lesion)

Front 36

What innervates the left tongue?

Back 36

- left hypoglossal nerve (CN XII)

- left hypoglossal nucleus (ASA->vertebral a.)

- right corticobulbar tract

- tongue portion of the right motor cortex

Front 37

What will cause a paralysis of contralateral side of the face?

Back 37

lesion in cortical motor face region

Front 38

What will cause a paralysis of the ipsilateral side of the entire face?

Back 38

lesion of facial or nucleus

Front 39

What name is given to a collection of symptoms indicative of a lesion of the facial nerve or nucleus?

Back 39

Bells palsy

Front 40

If a patient presents with drooping of the lower face, where is the site of lesion?

Back 40

Lesion of motor cortex, STROKE

Front 41

If a patient presents with drooping of the upper face (+forehead), where is the site of lesion?

Back 41

Lesion to facial nerve (bells palsy?

Front 42

What disease might have bell's palsy as a complication?

Back 42

Lyme disease, herpes zoster, AIDS, sarcoidosis, tumors, diabetes

Hint 42

My Lovely Bella Had an STD

Front 43

what artery supplies the medial lemniscus and medullary pyramid of the medulla?

Back 43

arterior spinal artery

Front 44

where does the corticospinal tract decussate in the brainstem ?

Back 44

caudal medulla prior to medullary pyramids

Front 45

where does the dorsal column medial lemniscal pathway decussate?

Back 45

medulla then ascends as medial lemniscus

Front 46

what artery supplies the spinal thalamic tract?

Back 46

posterior inferior cerebellar artery (PICA)

Front 47

what artery supplies the inferior cerebellar peduncle?

Back 47

posterior inferior cerebellar artery (PICA)

Front 48

what artery supplies the nucleus ambiguus?

Back 48

posterior inferior cerebellar artery (PICA)

Front 49

what artery supplies the spinothalamic tract?

Back 49

posterior inferior cerebellar artery (PICA)

Front 50

how do the symptoms of a lesion to the cortical motor region of the face differ from a lesion of the facial nerve or the facial nerve or nucleus?

Back 50

lesion in cortical motor face region present sx in contralateral side whereas lesion of facial nerve or nucleus present sx in the ipsilateral side.

Front 51

A patient has leftward deviation of the tongue on protrusion and has a right sided spastic paralysis. where is the lesion?

Back 51

Left medulla at the level of the pyramid

Front 52

What is the dorsal column's function?

Back 52

Ascends: pressure,vibration,fine touch and proprioception

Front 53

Where does the dorsal column decussate?

Back 53

In the medulla and ascends contralaterally in medial lemniscus

Front 54

What is the spinothalamic tract function?

Back 54

Ascends

lateral: pain,temperature

anterior: crude touch, pressure.

Front 55

Where does the spinothalamic tract decussate?

Back 55

Anterior white commissure & ascends contralaterally.

Front 56

What are the functions of the lateral corticospinal tract?

Back 56

Descends: voluntary movement of contralateral limbs

Front 57

What are the functions of the lateral corticospinal tract?

Back 57

Descends: voluntary movement of contralateral limbs

Front 58

Where does the lateral corticospinal tract decussate?

Back 58

At the caudal medulla and descends contralaterally

Front 59

What is the hallmark sign of a general brainstem lesion?

Back 59

alternating syndromes:with long tract symptoms on one side (hemiparalysis) and cranial nerve symptoms on the other

Front 60

What is the causes of Weber syndrome?

Back 60

Midbrain infarction resulting from occlusion of the paramedian branches of the posterior cerebral artery

Front 61

What are the symtoms of Weber syndrome?

Back 61

Cerebral peduncle lesion: contralateral spastic paralysis (AKA contralateral hemiparesis)

Oculomotor nerve (CN III) palsy: ipsilateral ptosis, pupillary dilation, and lateral strabismus (eye looks down and out)

Front 62

What are the possible causes of locked-in syndrome?

Back 62

- Basilar artery stroke

- Lesion in superior pons

- Hyponatremia corrected too quickly, leading to central pontine myelinolysis.

Front 63

What are the areas of damage in medial inferior pontine syndrome?

Back 63

-Corticospinal tract

-Medial lemniscus

-Abducens nucleus

-Abducens nerve fibers

Front 64

What are the symptoms of medial inferior pontine syndrome?

Back 64

- Contralateral spastic hemiparesis

- Contralateral loss of light touch, vibratory, kinesthetic sensation

- Paralysis of gaze to side of lesion

- Ipsilateral paralysis of lateral rectus muscle

Front 65

What are the symptoms of the locked in syndrome?

Back 65

Preserved consciousness and blinking but quadriplegia, loss of voluntary facial, mouth and tongue movements.

Front 66

Medial syndromes conserve what function?

Back 66

temperature and pain because those fibers travel laterally.

Front 67

MLF lesion

Back 67

When CN VI activates lateral rectus, CNIII doesnt get the signal and doesnt activate contralateral medial rectus.

Front 68

MCA stroke is due to lesions in what areas?

Back 68

Motor cortex: upper limb and face

sensory cortex: upper limb and face

temporal lobe (wernicke), frontal lobe (broca)

Front 69

what are the symptoms of a MCS stroke?

Back 69

contralateral paralysis of upper limb and face, contralateral loss of sensation of upper, lower limb and face.

Aphasia (if its the dominant side), and hemineglect (if in nondominant side)

Front 70

What areas are affected in an ACA stroke?

Back 70

Motor cortex: lower limb

sensory cortex: lower limb

Front 71

What are the symptoms of an ACA stroke?

Back 71

contralateral paralysis and loss of sensation (lower limb)

Front 72

Where areas are affected in a lenticulo-striate artery?

Back 72

Striatum, internal capsule

Front 73

What are the symptoms of a lentico-striate artery?

Back 73

contralateral hemiparesia and hemiplegia

Front 74

What is a common location of lacunar infarct due to unmanaged hypertension?

Back 74

Lenticulo-striate artery stroke

Front 75

What are the symptoms of an ASA stroke?

Back 75

Contralateral hemiparesis of upper and lower limbs, decreased contralateral proprioception, ipsilateral hypoglossal dysfunction (tongue deviation)

Front 76

What areas are affected in an ASA stroke?

Back 76

Lateral corticospinal tract, medial lemniscus, caudal medulla (hypoglossal nerve)

Front 77

What artery is damaged in the medial medullary sydrome?

Back 77

ASA

Front 78

What are the areas of lesion in PICA stroke?

Back 78

Lateral medulla

Front 79

What structures are in the lateral medulla?

Back 79

Vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, simpathetic fibers, inferior cerebellar penduncle

Front 80

What are the symptoms of PICA stroke?

Back 80

DONT PICA HORSE (hoarsness) THAT CANT EAT (dysfagia)

Vomit, vertigo, nistagmus, decreased pain and temperature sensation face & contralateral body, horner syndrome in ipsilateral. Dysphagia, descreased gag reflex, ataxia, dysmetria, hoarsness.

Hint 80

DONT PICA HORSE (hoarsness) THAT CANT EAT (dysfagia)

Front 81

What artery is damaged in lateral medullary (wallenberg) syndrome?

Back 81

PICA

Front 82

Ambiguus nucleus is specific to what infarct?

Back 82

PICA/wallenberg sx/lateral medullary sx

Front 83

What structures are damaged in AICA infarct?

Back 83

lateral pons, middle and inferior cerebellar penduncles

Front 84

What structures are included in the lateral pons?

Back 84

cranial nerve nuclei, vestibular nuclei, facial nuclei, spinaltrigeminal nucleus, cochlear nuclei, sympathetic fibers

Front 85

What are the symptoms of AICA infarct?

Back 85

Vomit, vertigo, nistagmus. paraylisis of face, decreased lacrimation and salivation, decreased taste of 2/3 ant tongue, decreased corneal reflex. Face: decreased pain and temp. ipsilateral decreased hearing, and horner sx.

Ataxia and dysmetria

Hint 85

facial droop means AICA pooped

Front 86

What artery is affected in lateral pontine syndome?

Back 86

AICA

Front 87

What area is lesioned in PCA infarct?

Back 87

occiptal cortex visual cortex

Front 88

What are the symptoms of PCA infarct?

Back 88

contralateral hemianopia with macular sparing

Front 89

what information is communicated at the nucleus soltarius?

Back 89

sensory information like taste, baroreceptors, sensation of gut distention

Front 90

What information is communicated at the nucleus ambiguus?

Back 90

motor innvervation to the pharynx, larynx and upper esophagus

Front 91

what information is communicated at the dorsal motor nucleus?

Back 91

autonomic information to the heart, lungs, and upper GI tract