Qbank - Neurology

Front 1

craniopharyngioma visual defects - what do you expect?

Back 1

bitemporal hemianopsia
tumors of the sella turcica (craniopharyngiomas, pituitary adenomas) apply pressure to the optic chiasm

Front 2

what are craniopharyngiomas?

Back 2

suprasellar tumors arising from remnants of Rathke's pouch
present in 2nd-3rd decade w/headaches, papilledema, signs of pituitary failure, cranial nerve dysfxn

Front 3

small posterior fossa, caudal displacement of medulla, hydrocephalus, lumbar myelomeningocele?

Back 3

Arnold-chiari malformation
downward displacement of elongated cerebellar tonsils thru foramen magnum

Front 4

pt w/multiple brown spots on body since birth develops 2 soft, flesh colored, non tender papules on upper chest - are they malignant? What are they composed of?

Back 4

pt has NF-1
these are benign neurofibromas, growth of Schwann cells & other neural elements

Front 5

how do you explain a child NF1 whose biological parents do not exhibit signs?

Back 5

germline mosaicism/new mutation - NF1 is AD 100% penetrant, but does have variable expressivity

Front 6

what kind of vision impairment do macular lesions cause?

Back 6

central scotoma
note - neural fibers transmitted macular vision go to different area of the cortex than peripheral vision

Front 7

65 yo w/bilateral visual difficulty progressing over last year
fundoscopy --> "small yellow retinal lesions clustered in the macula"

Back 7

Macular Degeneration
progressive loss of central vision due to deposition of fatty tissue (drusen) behind retina (dry MD) and neovascularization of the retina (wet MD)

Front 8

MCC blindness in ppl over 50?

Back 8

macular degeneration

Front 9

46 yo female w/subarrachnoid hemorrhage
few days later develops weakness in rt arm & leg?

Back 9

vasospasm
occurs 4-12 days after subarrachnoid hemorrhage, causes cerebral ischemia - new onset confusion, FOCAL DEFICITS
tx w/nimodipine
distinguish from rebleed - rebleed CT would show bleeding, focal deficits are characteristic of ischemic insult
vasospasm more common than rebleeding

Front 10

9 yo girl w/complex partial seizures, prescribed med, 3 mos later has bone marrow suppression - what med? What MOA? What other adverse effects?

Back 10

Carbamazepine (used for - simple partial, complex partial - generalized tonic-clonic seizures)
blocks voltage gated Na+ channels in neuronal membranes
can cause: bone marrow suppression, hepatotoxicity, siADH

Front 11

elevated acetylcholinesterase levels on 25 week amniocentesis?

Back 11

Neural Tube defect (4th week)
also alpha-fetoprtns are raised

Front 12

light microscopy shows neurons w/shrunken nuclei, no detectable nissl substance, & intensely eosinophilic cytoplasms
these findings indicate?

Back 12

irreversible damage
this is a red neuron (12-24 hours) characterized by: -shrinkage of the cell body, -pyknosis of the nucleus, -loss of Nissl substance, and -eosinophilic cytoplasm

Front 13

pt in status epilepticus, IV benzos started
what is started IV concurrently to prevent recurrence?

Back 13

phenytoin

Front 14

8 yo male w/hx recurrent pulm infections has unsteady gait, "eyes don't move steadily", has numerous superficial blanching nests of distended capillaries on sun-exposed areas, gene defect?

Back 14

Ataxia telangiectasia
ATM gene involved in DNA break repair, immunodeficiency relates to IgA
classic triad: -cerebellar ataxia, telangiectasia, increased sinopulmonary infections

Front 15

MC location of acoustic neuroma? Sx of unilateral CN V & VII involved?

Back 15

cerebellopontine angle
between cerebellum & lateral pons

Front 16

where (physically identify) is post-chemo nausea mediated?

Back 16

chemoreceptor trigger zone
area postrema of the dorsal medulla, near the 4th ventricle

Front 17

what nerve innervates salivary secretion from submandibular & sublingual gland?

Back 17

parasympathetics from superior salivatory nucleus
carried on CN VII via chorda tympani (taste)

Front 18

what nerve innervates salivary secretion from parotid gland?

Back 18

CN IX

Front 19

what is the space constant? What changes it?

Back 19

measure of ability of impulse to travel down an axon, low space constant decreases length impulse will travel
decreased by demyelination

Front 20

med recommended for motion sickness prevention? Main SE?

Back 20

Antimuscarinics & antihistamines-with antimuscarinic action are most effective
warn of dry mouth (& other such): ex - scopolamine, or meclizine & dimenhydrinate

Front 21

how does NDMA relate to morphine tolerance?

Back 21

activation of NMDA receptors by glutamate is believed to enhance morphine tolerance by increasing phosphorylation of opioid receptrs, increasing nitric oxide levels
ketamine

Front 22

how do beta blockers effect glaucoma?

Back 22

decrease aqueous humor production by CILIARY EPITHELIUM

Front 23

44 yo man recently dx w/AIDS following PCP, c/o pain in arms & legs, PE - irregular unequal pupils that do not respond to light, do constrict
romberg sign positive, DTRs absent - what is causing neuro sx?

Back 23

Tabes dorsalis
found in neurosyphillis (AIDS or immigrants) - affects dorsal columsn & dorsal roots of spinal cords - loss of position, vibration, & pain sensation
argyll-robertson pupil is characteristic

Front 24

tell me about neurosyphillus signs?

Back 24

Argyll robinson pupil
TABES DORSALIS - dorsal columns & roots of spinal cord affected - loss of position, vibration, & pain sensation

Front 25

pt w/NF1 (what is eponym for this?) found to have "rubbery cutaneous tumors on his neck", what cells comprise these? Orginiated from what embryologic tissue?

Back 25

Schwann cells, from neural crest
eponym is "von Recklinghausen's dz"

Front 26

random ass associations of carpal tunnel syndrome?

Back 26

fluid retention (renal failure, hypothyroidism, pregnancy)
diabetes mellitus, acromegaly, rheum arthritis
and ofc chronic repetitive stress

Front 27

lady on dialysis develops carpal tunnel syndrome?

Back 27

dialysis associated amyloidosis
w/long hx hemodialysis may develop beta-microglobulin deposition

Front 28

PE maneuvers useful in carpal tunnel syndrome?

Back 28

Tinel's sign - sx reproduced by tapping on flexor surface of wrist
Phalen's sign - sx occur after flexion of wrist

Front 29

seizures occuring in the morning, aggrevated by sleep deprivation
never lost conciuosness, sudden-onset arrhythmic jerking movements - type? Tx?

Back 29

Myoclonic seizures
1st line tx is Valproic acid

Front 30

24 yo male w/headache & visual changes, intracranial calcified mass on MRI, gross inspection shows cystic spaces w/thick brownish fluid rich in cholesterol?

Back 30

cranyiopharyngioma = calcified mass, young ppl, usually yellow viscous fluid filled (cholesterol crystals)

Front 31

5 yo male w/persistent food seeking behavior, obsese, sometimes aggressive/bizzarre behaviors - what part of brain is lesioned?

Back 31

Ventromedial thalamic nucleus, where satiety centers reside

Front 32

42 yo female w/bouts of spinning sensation w/nausea & ringing in left ear, diminished hearing
"feels fine" between episodes - what condition? Pathophys?

Back 32

Meniere's dz, increased volume of endolphym from defective resporption
triad - tinnitus, vertigo, sensorineural hearing loss

Front 33

total sensory loss on one side of the body & face with no motor involvement indicates lesion where?

Back 33

thalamus

Front 34

lesion of internal capsule can result in what isolated deficits?

Back 34

motor

Front 35

patient w/hx of sensory stroke affecting 1 side of the body w/no motor involvement dies of unrelated cause years later
brain shows two 5-6 mm cavities in deep structures of the brain - what are these? What pathophys explains them?

Back 35

Lacunar infarcts
occlusion of small penetrating arteries caused by small vessel lipohyalinosis & atherosclerosis
2ndary to HTN or diabetes

Front 36

foci of hemorrhage & necrosis in mamillary bodies & gray matter around 3rd & 4th ventricle? Dx by testing what enzyme?

Back 36

Wernicke syndrome
thiamine deficiency --> inbaility to utilize glucose
dx thiamine deficiency by measuring erythrocyte transketolase activity
triad -opthalmoplegia, -ataxia, -confusion

Front 37

right non-pupil-sparing 3rd nerve palsy arises from what lesion? (unilateral headache, eye pain, diplopia, dilated nonreactive pupil, ptosis w/ipsilateral eye in down & out position(

Back 37

aneurysm of right posterior or superior cerebellar arteries --> compression

Front 38

how long do baby's have a positive babinski reflex? Why?

Back 38

up to 12 months
incomplete myelination of corticospinal tracts

Front 39

the corneal limb reflex is mediated by what nerves - afferent? Efferent?

Back 39

afferent - nasociliary branch of CN V1
efferent - temporal branch of CN VII

Front 40

ear ossicles attach to which window? Where are low frequency sounds heard?

Back 40

oval (think ossicles - oval
or think the shape of the ossicle is oval like), round window is after the sound transmits all through

low frequency best heard at apex of chochlea, near helicotrema

Front 41

cherry red macula in setting of monocular vision loss?

Back 41

retinal artery occlusion
time course will be sudden

macula has separate supply of blood from choroid artery so stays red

Front 42

"cotton wool" exudates on fundoscopic exam?

Back 42

diabetic retinopathy

Front 43

sudden brief shock-like mm contraction?

Back 43

Myoclonus
physiologic - hiccups & hypnotic jerks (while falling asleep)
pathologic - epilepsy, CJD

Front 44

what does ___ relay?

-VPL
-VPM
-lateral geniculate body
-medial geniculate body

Back 44

Thalamus relay

VPL - spinothalamic (pain & temp) and medial lemniscus (position & proprio) -to primary somatosensory cortex, brodmann 3, 1 &2

VPM - trigeminal & gustatory (to primary sensory cortex, Brodmann 1,2,3)

lateral geniculate - light (from optic nerve to optic radiations to visual cortex, calcarine sulcus)

medial geniculate - sound (from superior olivary & inferior colliculus to auditory cortex temporal lobe, Brodmann 41 & 42)

Front 45

ALS genetic implication? Clinical findings? Tx?

Back 45

Genetic - mutation of gene for copper-zink superoxide dismutase (SOD1)

LMN (dmg to anterior horns) & UMN (demyelination of tracts) sx

tx - Riluzole, decreases glutamate release

Front 46

friedrich ataxia - presentation? Associations?

Back 46

autosomal recessive, 5-15 yo
difficulty walking

hypertrophic cardiomyopathy, kyphoscoliosis,foot abnlities, diabetes mellitus

Front 47

what do you see on MRI with MS? What's going on there?

Back 47

characteristic plaques, variable distribution of the slcerotic plaques accounts for the variety of neurologic manifestations

main pathologic process is demyelination, with the following changes in the plaques

1.) axon demyelination
2.) depletion of oligodendrocytes (myelin producing cells of CNS)
3.) Accumulation of lipid-laden macrophages (phagocytize products of myelin breakdown)
4.) Fibrillyar astrocytes (astrocyte proliferation rxn to injury)
5.) infiltration by lymphocytes & monocytes

Front 48

unilateral periorbital/temporal pain w/nasal congestion, lacrimation, and ptosis?

Back 48

Cluster headache

M 7x more often than females
30min-2 hrs, around same time each day (often after going to sleep)
pain free interval of ~1 year between each series of attacks

Front 49

rehydrate an alcoholic, gets ataxia, nystagmus, ophthalmoplegia, & anterograde amnesia? What happened?

Back 49

Wernicke encephalopay, typically necrosis of mamillary body part of papez circuit, involved in cortical control of emotion & memory

alcoholics are malnourished and low thiamine
dextrose w/o prior thiamine adminstration results in acute thaimine level drop, resulting in Wernicke encephalopathy

Front 50

recurrent small lobar hemorrhages in right occipital & left parietal areas?

Back 50

cerebral amyloid angiopathy
-deposition of beta-amyloid into arterial wall

unlike HTN strokes are less severe, and located in cerebral hemispheres & involve smaller areas of brain
(HTN strokes tend to involve basal ganglia - lenticulostriate arteries)

Front 51

unilateral ptosis & "down & out" gaze - where is lesion? MC cause?

Back 51

CN III paralysis

compression (berry aneurysm, uncal herniation) or nerve ischemia (diabetes)

Front 52

15 yo male has kyphoscoliosis & high plantar arch, what will he experience? He did have a brother that died of heart failure at 25

Back 52

Friedreich ataxia (autosomal recessive)
"frataxin" gene (nl mitochondria fxn)

gat ataxia
degeneration of dorsal column & dorsal root ganglia (position & vibration)
kyphoscoliosis & foot abnormalities (pes cavus)
hypertrophic cardiomyopathy & CHF
diabetes

Front 53

hemibalismus from stroke - what brain area?

Back 53

subthalamic nucleus on contralateral side

(NOT caudate, that is Huntington's)

Front 54

long term sequelae of hydrocephalus in an infant?

Back 54

LE spasticity from stretching of periventricular pyramidal tracts

visual disturbances

learning disabilities

Front 55

66 yo man w/recently discovered lung mass develops dizziness, dysarthria, limb ataxia worsening over 2 weeks, is admitted ot the hospital but worsens and dies. Autopsy shows extensive cerebellar purkinje cell degeneration - what's going on?

Back 55

A paraneoplastic, autoimmune phenomenon where antibodies against the tumor cells are cross-reacting with the body's own healthy organs and tissues

paraneoplastic cerebellar degeneration MC seen w/cancers of lung, breast, ovary, uterus, & lymphoma

Front 56

what specific effects does B12 deficiency have on the CNS?

Back 56

abnormal myelin synthesis, with degradation of:

1.) Dorsal columns of spinal cord - bilateral loss of position & vibration sense

2.) Lateral corticospinal tracts - UMN signs, spastic paresis, hyperreflexia, pathologic reflexes (babinski)

3.) Axon degeneration of peripheral nn - numbness or paresthesias


"subacute combined degeneration" - both ascending (dorsal columns) and descennig (corticospinal tract) pathways

Front 57

Wernicke vs CPL?

Back 57

Wernicke - confusion, ataxia, ophthalmoplegia

Front 58

pure motor lacunar infarct?

Back 58

posterior limb internal capsule

Front 59

pure sensory lacunar infarct?

Back 59

VPL or VPM of thalamus

Front 60

ataxia-hemiplegia lacunar infarct?

Back 60

base of pons

Front 61

dysarthria-clumsy hand lacunar infarct?

Back 61

base of pons or genu of internal capsule

Front 62

charcot-bernard vs lacunar vs berry?

Back 62

charcot bernard - hemmorhagic, aneurysm, lenticulostriate

lacunar - ischemic, lenticulostriate

berry - hemmorhagic, weak media, circle of willis (larger than charcot bernard)

Front 63

lateral inferior pontine syndrome vs lateral medullary syndrome?

Back 63

lat infer pontine - anterior inferior cerebellar artery
-contralateral loss pain & temp
-ipsilateral deficits in CN V & VIII
-Horner's syndrome
-Cerebellar sx

Lateral medullary (wallenberg) syndrome - posterior inferior cerebellar artery (PICA)
-contralateral loss pain & temp
-ipsilateral deficits of CN V, VIII, IX, X, & XI
-Horner's syndrome

Front 64

lesion causing upward gaze palsy? Structure? Location? Name?

Back 64

pineal gland

midline structure dorsal to superior colliculus & between thalamic bodies

Parinaud syndrome - tumors of pineal gland may lesion midbrain in region of superior colliculus due to mass effect

upward gaze palsy, absent pupillary light reflex, failure of convergence & wide-based gait

damage is to oculomotor & trochlear nn, as well as Edinger-Westphal nucleus

Front 65

what can chronic alcoholism do to cerebellum?

Back 65

atrophy of anterior lobes & cerebellar vermis

results in gait ataxia, truncal instability, intention tremor, & rhythmic postural "Parkinsonian" tremor of fingers & hands

Front 66

flat affect, inappropriate sexual behavior, hyperphagia, constant food seeking? Where's the damage?

Back 66

Kluver-Bucy

bilateral dmaage to temporal lobes, particularly AMYGDALA (down in inferomedial part of lobe)

potentially caused by HSV encephalitis or traumatic brain injury

Front 67

67 yo w/hx uncontrolled HTN sudden weakness in extremities & face, loses conciousness few minutes later, has extended upper & lower extremities & pinpoint pupils, dies a few hours later - what's going on?

Back 67

Pontine hemmorhage

pinpoint pupils, loss of horizontal gaze, quadriparesis, decerebrate posturing & rapidly evolving coma culminating in death w/in hours

Front 68

in CNS tumor what is vasogenic edema?

Back 68

disruption of blood-brain barrier leading to increased vascular permability, plasma filtration into cerebral interstitium causing vasogenic edema