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184 Cards in this Set
- Front
- Back
What region of the brain is supplied by the anterior cerebral artery (ACA)?
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Medial and superior surfaces and frontal lobes
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What region of the brain is supplied by the middle cerebral artery (MCA)?
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Lateral surfaces and temporal lobes
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What region of the brain is supplied by the posterior cerebral artery (PCA)?
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Inferior surfaces and occipital lobes
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What region of the brain is supplied by the basilar artery?
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Midbrain and brainstem (pons)
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What region of the brain is supplied by the anterior inferior cerebellar artery (AICA)?
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Brainstem (pons) and parts of the cerebellum
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What region of the brain is supplied by the posterior inferior cerebellar artery (PICA)?
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Brainstem (medulla) and parts of the cerebellum
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Where are the dorsal columns located in the spinal cord?
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Posterior spinal cord
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Where is the spinothalamic tract located in the spinal cord?
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Anterior spinal cord
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Where is the corticospinal tract located in the spinal cord?
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Lateral spinal cord
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Describe the first order neuron and synapse in the dorsal columns
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Enters at the ipsilateral dorsal horn, ascends in fasciculus gracilis and cuneatus, and synapses in the nucleus gracilis and cuneatus
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How is the homunculus arranged in the dorsal columns?
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Lower body and extremities medial, upper body and extremities lateral
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Describe the first order neuron and synapse in the spinothalamic tract
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Originate in the dorsal root ganglion an synapse in the dorsolateral tract of Lissauer
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Describe the first order neuron and synapse in the corticospinal tract
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Descend from the internal capsule and midbrain, decussate in the medullary pyramids, descend in the corticospinal tract and synapse in the ventral horn through interneurons
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Describe the second order neuron in the dorsal columns
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Decussate at the medulla and ascend as the medial lemniscus
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Describe the second order neuron in the spinothalamic tract
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decussate in the ventral white commissure, and ascend in the lateral spinothalamic tract
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Describe the second order neuron in the corticospinal tract
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exit the cord through the ventral horn
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Describe the function of the dorsal columns
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Two point discrimination, vibration sense, proprioception
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Describe the function of the spinothalamic tract
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Pain and temperature sensation
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Describe the function of the corticospinal tract
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voluntary movement of striated mscle
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Which parts of the cord are affected in amyotrohic lateral sclerosis?
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Corticospinal tract and ventral horn
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Which parts of the cord are affected in poliomyelitis?
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ventral horn
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Which parts of the cord are affected in tabes dorsalis?
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Dorsal columns
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Which parts of the cord are affected in Spinal artery syndrome?
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Corticospinal tract, spinothalamic tract, ventral horn, lateral gray matter
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Which parts of the cord are affected in vitamin B12 deficiency?
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Dorsal columns, corticospinal tract
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Which parts of the cord are affected by syringomyelia?
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Ventral horn, ventral white commissure
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Which parts of the cord are affected in Brown-Sequard syndrome?
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All tracts on one side of the cord
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What symptoms result from the spinal cord defect in amyotrophic lateral sclerosis?
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spastic and flaccid paralysis
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What symptoms result from the spinal cord defect in poliomyelitis?
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Flaccid paralysis
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What symptoms result from the spinal cord defect in tabes dorsalis?
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impaired proprioception and pain sensation
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What symptoms result from the spinal cord defect in spinal artery syndrome?
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Bilateral loss of pain and temperature sensation (one level below the lesion)
Bilateral spastic paresis below the lesion Bilateral flaccid paralysis at the level of the lesion |
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What symptoms result from the spinal cord defect in vitamin B12?
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Bilateral loss of vibration and discrimination
Bilateral spastic paresis affecting legs before arms |
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What symptoms result from the spinal cord defect in syringomyelia?
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Bilateral loss of pain and temperature sensation one level below the lesion
Bilateral flaccid paralysis at the level of the lesion |
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What symptoms result from the spinal cord defect in brown-sequard syndrome?
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ipsilateral loss of vibration and discrimination sensation below the lesion
Ipsilateral spastic paresis below the lesion Ipsilateral flaccid paralysis at the level of the lesion Contralateral loss of pain and temperature sensation below the lesion |
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Name of CN I
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Olfactory
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Name of CN II
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Optic
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Name of CN III
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Oculomotor
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Name of CN IV
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Trochlear
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Name of CN V
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Trigeminal
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Name of CN VI
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Abducens
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Name of CN VII
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Facial
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Name of CN VIII
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Vestibulocochlear
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Name of CN IX
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Glossopharyngeal
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Name of CN X
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Vagus
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Name of CN XI
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Accessory
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Name of CN XII
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Hypoglossal
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Function of Olfactory nerve
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Smell
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Function of Optic nerve
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Sight
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Function of oculomotor nerve
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Medial, superior, inferior rectus muscles, inferior oblique muscle, ciliary muscle, sphincter of the eye
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Function of trochlear nerve
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Superior oblique muscle
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Function of trigeminal nerve
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sensation of the face, muscles of mastication
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Function of abducens nerve
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lateral rectus muscel
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Function of facial nerve
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Taste to the anterior 2/3 of the tongue
Muscles of facial expression, stapedius, stylohyoid, and proximal belly of digastric muscles Lacrimal, submandibular and sublingual glands |
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Function of vestibulocochlear nerve
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hearing, balance
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Function of glossopharyngeal nerve
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Taste to the posterior 1/3 of the tongue
Pharyngeal sensation Stylopharyngeus muscle Parotid gland |
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Function of the vagus nerve
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Sensation of the trachea, esophagus, viscera
Laryngeal, pharyngeal muscles Visceral autonomics |
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Function of the accessory nerve
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Sternocleidomastoid and trapezius muscles
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Function of the hypoglossal nerve
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Tongue
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What is the most common cause of bacterial meningitis in the newborn period?
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Group b-streptococci
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What is the most common cause of bacterial meningitis between 1 month and 2 y.o.?
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Streptococcus pneumoniae and Neisseria meningitidis
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What is the most common cause of bacterial meningitis between the ages of 2 - 18 y.o.?
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Neisseria meningitidis
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What is the most common cause of bacterial meningitis between the ages of 18 - 60 y.o.?
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Streptococcus pneumoniae
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What is the most common cause of bacterial meningitis after the age of 60 y.o.?
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Streptococcus pneumoniae
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Area injured in Broca's aphasia
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Inferior frontal gyrus, dorsolateral frontal cortex, anterior parietal cortex
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Area injured in Wernicke's aphasia
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posterior superior temporal gyrus, inferior parietal lobe
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Area injured in conduction aphasia
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supramarginal gyrus, angular gyrus
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Area injured in global aphasia
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large infarcts of the left cerebral hemisphere
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Characteristics of Broca's aphasia
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Expressive aphasia: nonfluent, difficulty producing words. Good comprehension.
Face and arm hemiparesis, loss of oral coordination |
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Characteristics of Wernicke's aphasia
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Receptive aphasia: Fluent, with word substitutions, meningless words, meaningless phrases (word salad) and poor comprehension
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Characteristics of conduction aphasia
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Fluent speech, word substitutions, frequent attempts to correct words, word-finding pauses
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Characteristics of global aphasia
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Difficulty producing words, nonfluent speech, poor comprehension limb ataxia
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Area of involvement of a simple partial seizure
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Focal cortical region of the brain
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Area of involvement of a complex partial seizure
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Focal cortical region (most commonly temporal lobe)
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Area of involvement of generalized convulsive seizure
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Bilateral cerebral cortex
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Area of involvement of absence seizure
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Bilateral cerebral cortex
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Signs/symptoms of simple partial seizure
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Focal sensor or motor deficits, no loss of consciousness
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Signs/symptoms of complex partial seizure
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Hallucinations, automatisms, deja vu, or impaired consciousness with postictal confusion
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SIgns/symptoms of generalized convulsive seizure
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Sustained contractions, repetitive muscle contractions and relaxations, or loss of tone (or a combination of these).
Loss of consciousness, incontinence, significant postictal confusion |
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Define Todd paralysis
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Unilateral weakness lasting several hours - days after a generalized convulsive seizure
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Signs/symptoms of absence seizure
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brief impairment of consciousness, normal muscle tone, possible eye blinking. No postictal confusion
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Presentation of Argyll Robertson pupil
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Accomodation to near objects, nonreactive to light
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Presentation of Marcus Gunn pupil
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Light in affected pupil causes minimal bilateral constriction, but light in the normal pupil causes normal bilateral constriction
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What are the three most common primary CNS tumors in adults?
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Glioblastoma, meningioma, and schwannoma
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What are the three most common primary CNS tumors in children?
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Astrocytoma (benign), medulloblastoma (malignant), and ependymoma (may be malignant)
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Presentation of Horner syndrome
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Ptosis, miosis, anhidrosis
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Presentation of an Adie pupil
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Minimally reactive dilated pupil
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Presentation of MLF syndrome
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With lateral gaze, there is absent contralateral eye adduction
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Cause of an Argyll Robertson pupil
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Syphilis, SLE, DM
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Cause of a MArcus Gunn Pupil
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Afferent nerve defect
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Cause of Horner syndrome
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Sympathetic trunk lesion (e.g. Pancoast tumor)
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Cause of an Adie pupil
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abnormal innervation of the iris
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Cause of MLF syndrome
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Intracranial lesion, MS
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Define myopia
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Refracting power of the eye is too great, causing image focal point to be anterior to the retina
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Define hyperopia
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Refracting power of the eye is insufficient, causing image focal point to be posterior to the retina
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Define astigmatism
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asymmetric corneal surface, causing inconsistent refraction of light
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Define strabismus
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Deviation of the eye unable to be overcome by normal motor control
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Define Amblyopia
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Developmental defect in neural pathways of the eye, resulting in poor visual acuity and spatial differentiation in the affected eye
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What kind of white blood cells are found in the CSF of a patient with bacterial meningitis?
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PMNs - Neutrophils
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What kind of white blood cells are found in the CSF of a patient with fungal meningitis?
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Lymphocytes
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What kind of white blood cells are found in the CSF of a patient with tuberculous meningitis?
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Lymphocytes
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What kind of white blood cells are found in the CSF of a patient with Viral meningitis?
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Lymphocytes
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What are the three most common bacterial causes of meningitis in a patient under the age of 1 month old?
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1. Group B Streptococcus
2. E. coli 3. Listeria (occasionally) |
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Generally, what are the two most common bacterial causes of meningitis in a patient between the ages of 1 - 60 y.o.?
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1. Streptococcus Pneumoniae
2. Neisseria Meningitidis |
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What is the most common cause of bacterial meningitis between the ages of 10 - 19 y.o.?
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Neisseria meningitidis
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What additional bacterial cause of meningitis can occur in patients age 50 - 60 y.o.?
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Listeria monocytogenes
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What are the four most common bacterial causes of meningitis in patients aged 60 y.o. or older, as well as alcoholics and patients with debilitating comorbidities?
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1. Streptococcus Pneumoniae
2. Listeria Monocytogenes 3. Neisseria Meningitidis 4. Gram negative bacilli |
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What is the empiric antibiotic coverage for suspected bacterial meningitis under 1 month of age?
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1. Ampicillin +
2. Cefotaxime or Gentamycin |
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What is the empiric antibiotic coverage for suspected bacterial meningitis from 1 month of age - 60 y.o.?
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1. Cefotaxime or Ceftriazone
2. Vancomycin |
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What is the empiric antibiotic coverage for suspected bacterial meningitis over 60 y.o, as well as alcoholics and patients with debilitating comorbidities?
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1. Ampicillin
2. Cefotzxime or Ceftriaxone 3. Vancomycin |
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What medication should be added to patients over the age of 6 weeks old at the beginning of antibiotic therapy for bacterial meningitis, and what effect does it have?
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Dexamethasone
Reduces long-term neurologic sequelae in children, and reduces morbidity and mortality in adults |
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Headache that is made worse by foods containing tyramine
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Migraine headache
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Headache in an obese woman with papilledema
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Pseudotumor cerebri
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Headache with jaw muscle pain when chewing
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Temporal arteritis
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Headache associated with periorbital pain with ptosis and miosis
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Cluster headache
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Headache with photophobia and/or phonophobia
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Migraine headache
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Headache with bilateral frontal/occipital pressure
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Tension headache
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Headache with lacrimation and/or rhinorrhea
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Cluster headache
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Headache with elevated ESR
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Temporal arteritis
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Headache described as the "worst headache of my life"
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Subarachnoid hemorrhage
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Headache with extraocular muscle palsies
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Cavernous sinus thrombosis
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Headache preceded by scintilating scotomas
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Migraine headache with aura
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Headache occurring either before or after orgasm
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Post-coital cephalagia
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Headache that is responsive to 100% oxygen supplementation
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Cluster headache
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Headache beginning days after a trauma to the head, and persists for over a week
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Subdural hematoma
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Which artery is most commonly involved in an embolic ischemic stroke?
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Middle cerebral artery
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What two diseases are associated with formation of berry aneurysms?
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Autosomal dominant (adult onset) polycystic kidney disease, and Ehler's-Danlos syndrome
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What are the five most common lacunar stroke syndromes?
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1. Pure motor hemiparesis (most common)
2. Pure sensory stroke 3. Ataxic hemiparesis 4. Sensorimotor stroke 5. Dysarthria-clumsy hand syndrome |
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Define tonic seizure
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Sustained contraction of the extremities andback
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Define clonic seizure
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Repetitive muscle contraction and relaxation
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Define tonic-clonic seizure
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Brief contraction period, followed by repetitive contraction-relaxation pattern
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Define myoclonic seizure
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Brief repetitive contractions
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Define atonic seizure
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Complete loss of tone ("drop" seizures)
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What EEG pattern will be seen in an absence seizure?
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Generalized three-cycle/second spike and wave pattern
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What intracranial hemorrhage is associated with a classic "lucid interval"?
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Epidural Hematoma
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What are the two most common locations of berry aneurysms?
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Anterior communicating artery
Posterior communicating artery |
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Arterial location of a stroke presenting with contralateral extremity an trunk weakness:
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Anterior Cerebral artery
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Arterial location of a stroke presenting with contralateral face and upper extremity weakness and decreased sensation, bilateral visual abnormalities, aphasias or neglect syndromes:
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Middle Cerebral Artery
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Arterial location of a stroke presenting with Contralateral visual abnormalities or blindness:
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Posterior cerebral artery
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Arterial location of a stroke presenting with cranial nerve abnormalities, contralateral full body weakness and decreased sensation, vertigo, loss of coordination, difficulty speaking, visual abnormalities, or coma:
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Basilar artery
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Arterial location of a stroke presenting with weakness of the face, arm, and leg on one side of the body without sensory or cortical signs:
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Lacunar arteries
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Name of syndrome presenting with weakness of the face, arm, and leg on one side of the body without sensory or cortical signs:
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Pure motor hemiparesis (Lacunar stroke)
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Arterial location of a stroke presenting with sensory defect of the face, arm and leg on one side of the body without motor or cortical signs:
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Lacunar arteries
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Name of syndrome presenting with sensory defect of the face, arm and leg on one side of the body without motor or cortical signs:
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Pure sensory stroke (Lacunar Stroke)
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Arterial location of a stroke presenting with ipsilateral weakness and limb ataxia out of proportion to the motor defect, possible gait deviation to the side of the lesion without cortical signs:
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Lacunar arteries
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Name of syndrome presenting with ipsilateral weakness and limb ataxia out of proportion to the motor defect, possible gait deviation to the side of the lesion without cortical signs:
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Ataxic hemiparesis (Lacunar stroke)
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Arterial location of a stroke presenting with weakness and numbness of the face, arm and leg on one side of the body without cortical signs:
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Lacunar arteries
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Name of syndrome presenting with weakness and numbness of the face, arm and leg on one side of the body without cortical signs:
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Sensorimotor stroke (Lacunar stroke)
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Arterial location of a stroke presenting with facial weakness, dysarthria, dysphagia, and slight weakness and clumsiness of one hand without sensory or cortical signs:
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Lacunar arteries
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Name of syndrome presenting with facial weakness, dysarthria, dysphagia, and slight weakness and clumsiness of one hand without sensory or cortical signs:
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Dysarthria-clumsy hand syndrome (Lacunar stroke)
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What are the unique features of dementia caused by Pick disease?
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Behavior and personality changes
Progressive Aphasia |
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What is another name for Pick Disease?
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Frontotemporal dementia
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What are the unique features of Lewy body dementia?
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Bradykinesia, Parkinsonian Gait, Cogwheel Rigidity
Visual Hallucinations |
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Cause of syncope associated with emotional stress, trauma, pain, the sight of blood, or prolonged standing:
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Vasovagal Syncope (a type of Reflex Syncope)
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Cause of syncope associated with micturition, defecation, coughing, and GI stimulation:
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Situational syncope (a type of Reflex Syncope)
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Cause of syncope associated with head-turning, shaving or a tight collar:
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Carrotid-sinus hypersensitivity
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Cause of syncope associated with exertion, palpitations, chest pain, or shortness of breath:
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Cardiogenic syncope
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Cause of syncope associated with BP medications, that will have a positive tilt table test:
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Orthostatic syncope
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Cause of syncope associated with prolonged loss of consciousness, seizures or neurologic deficits:
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Cerebrovascular syncope
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Define a Chalazion:
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Inflammation of internal Meibomian sebaceous glands resulting in the entire eyelid swelling
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Define a Hordeolum:
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Stye
Infection of external sebaceous glands of Zeiss or Mol; tender, red welling at the lid margin |
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Define anterior blepharitis:
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Infection of the eyelids and lashes secondary to seborrhea; red, swollen lid margins with dandruff on lashes
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Treatment of a chalazion:
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Usually self-limited
Surgical excision and/or intralesional steroid injection |
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Treatment of a hordeolum:
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Hot compress 3-4 times per day for 10-15 minutes
I&D if not resolved within 24 hours |
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Treatment of anterior blepharitis:
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wash lid margins daily with shampoo
Remove scales with cotton ball Antibiotic ointment daily applied to the lid margin |
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Diagnosis in a patient presenting with acute onset of vertigo, nausea, vomiting and nystagmus with preserved hearing:
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Vestibular neuritis
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Diagnosis in a patient presenting with acute onset of vertigo, nausea, vomiting and nystagmus with hearing loss:
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Acute labrynthitis
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What is the most common cause of conductive hearing loss?
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Otosclerosis
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What is the most common cause of sensorineural hearing loss?
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Presbycusis
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Describe the Rinne Test. In what type of disorder will it be abnormal?
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Tuning fork is held against the mastoid process until it is no longer head, and is then moved just outside of the ear. Normally the patient will be able to hear the fork outside the ear.
Normally, air conduction is greater than bone conduction. An abnormal Rinne test (i.e. the patient cannot hear the tuning fork when it is moved), indicating conducive hearing loss |
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What is the pathogenesis of Parkinson disease?
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Idiopathic dopamine depletion, loss of dopaminergic striated neurons in the substantia nigra and Lewy body formation, leading to abnormal cholinergic input to the cortex
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What is a Lewy body?
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Eosinophilic cytoplasmic inclusions in neurons
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Are Anterior Horn cells UMN or LMN?
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LMN
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Are corticospinal tract cells UMN or LMN?
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UMN
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What is the result of destruction of anterior horn cells?
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Flaccid paralysis
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What is the result of destruction of corticospinal tract cells?
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Spastic paralysis
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Pathophysiology of Myasthenia gravis:
|
Autoantibodies that bind to ACh receptors at the neuromuscular junction preventing normal neuromuscular transmission, resulting in easy fatigability
|
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Pathophysiology of Lambert-Eaton syndrome:
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Autoantibodies to presyntamtic calcium channels, preventing calcium release, resulting in weakness that improves with continued use
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How is Myasthenia gravis distenguished from Lambert-Eaton syndrome?
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The weakness in myasthenia gravis worsens with use, while the weakness in Lambert-Eaton syndrome improves with continued use
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What are the three most common primary CNS tumors in adults?
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Glioblastoma
Meningioma Schwannoma |
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What are the three most common primary CNS tumors in children?
|
Astrocytoma
Medulloblastoma Ependymoma |
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What is the most common malignant primary CNS tumor in children?
|
Medulloblastoma
|
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What CNS damage causes spasticity in cerebral palsy?
|
Damage to the pyramidal tracts
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What CNS damage causes dyskinesis in cerebral palsy?
|
Extrapyramidal damage
|
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What are three causes of a cherry red spot on the macula?
|
Retinal Artery occlusion
Neimman Pick Disease Tay-Sach's disease |
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What are the three most common causes of acute otitis media?
|
Streptococcus pneumoniae
Haemophilys influenzae Moraxella catarrhalis |