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61 Cards in this Set
- Front
- Back
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Injury to which tract causes loss of vibration sense in the right leg?
A. Right spinothalamic tract B. Right fasciculus gracilis C. Right fasciculus cuneatus D. Right lateral corticospinal tract |
B. Right fasciculus gracilis
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Which tract was injured to cause right leg weakness?
A. Right fasciculus gracilis B. Right fasciculus cuneatus C. Right spinothalamic tract D. Right lateral corticospinal tract E. Left lateral corticospinal tract |
D. Right lateral corticospinal tract
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Who were Brown and Sequard?
A. 2 famous composers B. 2 neurologists interested in the spinal cord C. 2 tennis players with spinal cord injuries D. 2 places where research on the spinal cord is done E. None of the above |
E. None of the above
A single person! Was the son of an American sea captain and a French woman. He was born in Mauritius. |
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A 16 year old with hereditary multiple osteochondromas presents with insidious leg weakness, spasticity, urinary incontinence and back pain over 3 months. He has no symptoms in upper extremities. Neuroimaging of his spine is obtained.
What would you not expect to see on neurological examination? A. Arm weakness B. Presence of Babinski signs C. Loss of vibration sense in the legs D. Loss of proprioception in the legs E. Increased DTR’s in the legs |
A. Arm weakness
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A 55 year old man with diabetes mellitus presents with a one year history of loss of vibration sense and loss of pain and temperature in both feet only. The most likely etiology for this is:
A. Bilateral involvement of the spinothalamic tracts B. Bilateral involvement of the posterior columns C. Syringomyelia D. Myelitis (inflammation of the spinal cord) E. Peripheral nerve involvement (neuropathy) |
E. Peripheral nerve involvement (neuropathy)
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Which mode of sensory signals reach the cerebral cortex without going through the thalamus?
A. Conscious proprioception B. Taste C. Vision D. Smell E. Hearing |
D. Smell
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Spinocerebellar Pathways for Unconscious Proprioception
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"Anterior is Superior (Cerebellar Peduncles), all others are Inferior (Cerebellar Peduncles)"
Three Pathways: 1) Anterior Spinocerebellar 2) Posterior Spinocerebellar 3) Cuneocerebellar |
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A patient presents with slowly progressive difficulty with ambulation. She sways when standing whether her eyes are open or closed. Which pathway is most likely involved?
A. Spinothalamic tracts B. Posterior columns C. Peripheral nerve D. Spinocerebellar tracts |
D. Spinocerebellar tracts
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How do we test the following systems:
1) Spinothalamic 2) Dorsal Column 3) Spinocerebellar |
1) Spinothalamic
-Light Touch -Pin Prick -Temperature 2) Dorsal Column -Vibration -Proprioception -2 Point Discrimination -Stereognosis 3) Spinocerebellar -Unconscious movements |
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1) Paresthesia =
2) Dysesthesia = |
1) Paresthesia = Tingling
2) Dysesthesia = Feels Weird |
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1) Functional Neuroimaging:
2) Structural Neuroimaging: |
1) Functional Neuroimaging:
-MEG -SPECT -PET 2) Structural Neuroimaging: -Ultrasound -Angiography -CT -MRI |
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MEG
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Measures neuronal activity by detecting magnetic flux generated by intracellular currents in large neuronal aggregates
Good for: 1) Presurgical mapping for EPILEPSY surgery 2) Identifying Somatosensory, Motor, and Language Areas |
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When is CT the preferable form of Neuroimaging?
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Preferable to visualize:
1) Bone 2) Calcium 3) Acute Blood |
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When is MRI the preferable form of Neuroimaging?
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Preferable to visualize:
1) High Resolution Images of SMALL Brain Structures such as: -Cranial Nerves -Areas such as Cerebellopontine Angle |
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Cerebral Angiography
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Gold standard for imaging of bloods vessels
Catheter put into Femoral Artery, thus a small (1%) chance of morbidity associates X-Rays then taken |
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When is contrast material (Gadolinium) used w/ MRIs?
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To detect areas of breakdown of the BBB (due to Tumors, Meningitis, AVM, etc.)
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Ischemic vs Hemorrhagic Stroke
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Determined via CT
Ischemic = Give tPA Hemorrhagic = do NOT give tPA |
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1) External Ionizing Radiation:
2) Internal Ionizing Radiation: |
1) External Ionizing Radiation:
-CT -Angiogram -X-Ray 2) Internal Ionizing Radiation: -PET -SPECT |
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MRI Contraindications
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When Patient has FERROUS METAL (Titanium is NOT Ferrous) in Body!
ALways a concern w/ Cochlear Implants |
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T1 of MRI
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Good for visualizing NORMAL anatomy
Not DIRECTLY Detectable Longitudinal Magnetization- M Parallel to B GROWS BACK |
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T2 of MRI
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Good for visualizing PATHOLOGY - Water Content - White Matter Abnormalities - Multiple Sclerosis
DIRECTLY Detectable Transverse Magnetization- M Perpendicular to B SHRINKS |
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fMRI
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BOLD
Blood Oxygenation Level Dependent Signal = INDIRECT measure of Neural Activity |
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What is the best way to evaluate hearing?
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Basic Audiometry!
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Audiometry Equation
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A = B + C
A = Air Conduction = All Around System = THE WHOLE SYSTEM B = Bone Conduction C = Conduction System |
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Retrocochlear Hearing Loss
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Poor word discrimination with good pure tone audiometry
Example: Acoustic Neuroma - Behind ear between cochlea/brain, thus should actually be called a Vestibular Schwannoma |
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Which state of matter is compressible?
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Solid and Gas!
Liquid is NOT compressible! |
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Tympanometry yielding a Type B, FLAT LINE
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Flat Line = NO Movement of Tympanic Membrane
Otitis Media most likely cause Tympanic Membrane Perforation IF there is ALSO a larger than normal canal volume! |
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Acoustic Neuroma
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Affects Vestibular Nerve (NOT the Auditory Nerve)
Has NOTHING to do with the Conduction System! Arises from Schwann Cells, NOT the Nerve! Most common tumor of Cerebellopontine Angle! |
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Temporal Bone Fractures
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90% are Longitudinal --> Associated w/ CONDUCTIVE Hearing Loss --> 10% have Facial Paralysis
10% are Transverse --> Associated with SENSORY NEURAL Hearing Loss --> 50% have Facial Paralysis Overall, Facial Paralysis is more common due to longitudinal fractures because they take place so much more often! |
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Where is the Lateral Horn present/what is its role?
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T1 - L3
Cell Bodies of preganglionic SYMPATHETIC Nerve Fibers! |
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Where is the Dorsal Nucleus of Clarke present/what is its role?
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C8 - L3
Involved w/ Posterior Spinocerebellar Tract |
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Taste Buds Innvervated by:
1) Chorda Tympani of CN VII 2) Greater Superficial Petrosal Branch of CN VII 3) Lingual Branch of CN IX 4) Superior Laryngeal Branch of CN X |
1) Anterior 2/3 of Tongue
2) Palate 3) Posterior 1/3 of Tongue and Pharynx 4) Epiglottis and Esophagus |
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What will compression of CNIII via hemorrhage cause?
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BLown Pupils (dilated pupils)!
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What is the 1st treatment for Aneurysms?
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Barbiturates!
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Cerebral Perfusion Pressure (CPP)
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CPP = MAP - ICP
MAP < 50 mmHg = Slowing EEG MAP < 20 mmHg = Flat EEG and IRREVERSIBLE Tissue Damage Net pressure gradient that caused blood flow to the brain! |
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Relationship b/w Arterial pCO2 and Cerebral Blood Flow (CBF)
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Increase Arterial pCO2 = Increase Vasodilation = Increase CBF
***pO2 does not significantly affect CBF*** |
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Propofol
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Decreases Cerebral Metabolic Rate in a mechanism involving GABA
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Barbiturates
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Act on Reticular Activating System in mechanism associated with GABA
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Opioids
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Produce analgesia via decreasing Neurotransmission, mainly by affecting ACh
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Tension-Type Headaches
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Most common type!
~Equal in Men/Women "Hatband" Distribution Adolescence to adulthood and old age Often provoked by STRESSFUL situation! Best Treatment = Amitriptyline + NSAID |
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Migraine Headaches
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More common in Women (70%)
70% are Unilateral, but may alternate side-to-side Childhood - 40 Occur ANYTIME, Red Wine can provoke them! Associated w/ Menstrual Cycles Best Treatment: Triptans (Selective Serotonin Agonist). EXCEPTION: PREGNANCY or Ischemic Heart Disease = Give Opioids |
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Cluster Headaches
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Least common type
Almost always in Men (>90%) Unilateral, behind eye or periorbital region 20-40 years of age Often occur at NIGHT 4-8 Week Cycles with up to 4/Day May be seasonal! If a female has this, do a work up! |
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Topiramate
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Anticonvulsant used as a Preventative (Prophylactic) Medication for MIGRAINE Headaches
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Excess endolymphatic pressure caused by INADEQUATE endolymph reuptake
Causes transient attacks of Dizziness, Nausea, Vomiting, Nystagmus, Hearing Loss |
Meniere's Syndrome
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Cervical Enlargement
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C3 --> T1
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Lumbar Enlargement
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L1 --> S2
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Inflammatory Arthritis
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Caused by Joint Nociceptors Fibers release Neuropeptides such as:
1) Substance P 2) Calcitonin Gene Related Peptide (CGRP) |
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What might the activation of Silent Nociceptors induce?
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(Justin is Silent, HAC)
1) Hyperalgesia 2) Allodynia 3) Central Sensitization |
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Aspirin Action
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Prostaglandin produced from Arachidonic Acid BLOCKS the K+ Efflux from Nociceptors following damage --> Additional Depolarization --> Nociceptors MORE Sensitive
Aspiring BLocks conversion of Arachidonic Acid --> Prostaglandin |
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Dejerive-Roussy Syndrome aka Thalamic Pain Syndrome
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Caused by lesions in Spinothalamic Tract and its Targets of Termination or Diencephalic Lesions
Experience spontaneous aching and burning pain in body regions where sensory stimuli normally do not lead to pain (brain/spinal cord, which do NOT contain nociceptors) |
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Stroke or Occlusion in Thalamogeniculate Arterty (branch of Posterior Cerebral Artery)
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Supplies Lateral Posterior Half of Thalamus
Stroke or occlusion can result in Thalamic Lesion --> Devastating Intracranial Pain in CONTRALATERAL side of the Thalamic Lesion AND Sensory Loss |
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Neglect Deficit
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Lesion in Somatosensory Association Cortex
Inattention to tactile, proprioceptive and/or visual stimuli CONTRALATERAL to lesion site |
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Pain Cortex
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1) S1
2) S2 3) Somatosensory Associated Cortex 4) Anterior Cingulate Cortex (Motivation) 5) Posterior Insula (Aversion) Gets input from VPL/VPM/IL |
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Wallenberg's Syndrome
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Infarct involving PICA --> effects Posterior Medulla
Loss of Pain/Temp on CONTRALATERAL Side of BODY (Spinothalamic Crossed) Loss of Pain/Temp on IPSILATERAL Side of FACE (Spinal Trigeminal Uncrossed) |
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Infarct in the following would affect what?
1) PICA 2) Middle Cerebral Artery 3) Anterior Spinal Artery |
1) PICA --> Spinothalamic Tract and Spinal Trigeminal Lemniscus
2) Middle Cerebral Artery --> Postcentral Gyrus and Posterior Paracentral Lobule 3) Anterior Spinal Artery --> Ventral 2/3 of Cord (Spinothalamic/Motor Roots) |
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Amyotrophic Lateral Sclerosis (ALS) AKA Lou Gehrig's Disease aka Charcot's Disease in Europe
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Neurodegenerative disease of Motor System!
Effects Pyramidal Tracts/Ventral Horn Upper Motor Neuron Signs = Babinksi SIgn, Spasticity, Hyperreactive Tendon Reflexes Lower Motor Neuron Signs = Atrophy, Fasciculations Onset is Focal and Assymetric. Becomes Diffuse. |
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Vitamin B12 Deficiency
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Subacute Combined Degeneration
Degeneration of White Matter: -First in Posterior Columms -Eventually in Lateral/Anterior Columns/Corticospinal Tracts -NOT SPINOTHALAMIC!!! |
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Shingles
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Rash associated with REACTIVATED VZV
Affects Dermatomes, Most commonly in Thoracic Region |
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Lesion in Cavernous Sinus
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Would effect CNIII, IV, V1, V2, VI and/or Carotid Artery
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Medullary Tumor
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Would affect CN VII, VIII, IX, X, XI, XII and increase intracranial pressure
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Pontine Lesion
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Would affect CN VI and CN VII
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