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161 Cards in this Set
- Front
- Back
Brain tumor associated with NF2:
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* Meningioma
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Brain tumor associated with NF1, looks like hair:
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* Pilocytic astrocytoma (occurs in the cerebellum)
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Low grade glial tumor that has a "fried egg" appearance histologically:
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* Oligodendroglioma
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Cauliflower looking tumor that occurs in the 4th ventricle and spinal cord:
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* Ependymoma (causes hydrocephalus)
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Common category 1 CNS tumor:
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* Medulloblastoma (embryonal origin)
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Category 2 CNS tumors arise from what components:
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* Glial and choroid plexus (astrocytomas, gangliomas)
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Category 3 CNS tumors have features of:
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* Leptomeninges and mesenchymal tissue (meningiomas)
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A secondary brain tumor due to metastasis from another site would be what category?
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* Category 5 (secondary tumors)
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Category 4 CNS neoplasia are what type of tumors:
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* Germ cell tumors
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Blue cell tumor seen in kids that is seen often in the cerebellum:
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* Medulloblastoma
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Highly malignant tumor seen in kids that infiltrates the leptomeninges and has features of epithelium:
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* Medulloepithelioma
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Complication seen with medulloblastomas:
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* Hydrocephalus
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Retinoblastoma is due to deletion of:
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* The RB1 gene
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Most common type of glial (astrocytoma) tumor:
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* Glioblastoma
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A pt with a constant gait ataxia probably has a lesion where?
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* Cerebellum
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Differential for someone with "vertigo":
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* BPPV, vestibular neuritis, CN 8 lesion, drug toxicity (aminoglycosides, chemo), meniere syndrome
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Most common cause of vertigo:
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* BPPV (benign paroxysmal positional vertigo)
Sx: No N&V, symptoms occur with head movement, vertigo less than 1 minute |
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What causes BPPV:
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* Endolymph debris-- loose otoconia (treat using the dix-hallpike maneuver)
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Management of BPPV:
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* Epley maneuver and Brandt exercises
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What causes meniere's diseae?
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* Idiopathic endolymphatic hydrops (Tx with Acetazolamide, HCTZ, or surgery)
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A pt with episodic vertigo, tinnutis, and hearing loss along with N&V probably has:
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* Meniere's disease
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A very miserable pt with vertigo, prominent N&V and might have tinnitus or hearing loss:
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* Vestibular neuritis or Labrynthitis (if they have tinnitus/hearing loss)
TX: Benzo's, steroids, antihistamines |
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Common cause of recurrent vertigo with PHOTOPHOBIA, headache, and N&V:
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* Central vertigo = basilar migraine
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When you lose the 4 features of consciousness (arousal, wakefulness, responsiveness, and awareness to self/environment) you are in:
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* A Coma
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What brain system controls arousal and when damaged you are in a true coma?
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* Ascending reticular activating system
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A pt with episodic vertigo, tinnutis, and hearing loss along with N&V probably has:
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* Meniere's disease
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A very miserable pt with vertigo, prominent N&V and might have tinnitus or hearing loss:
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* Vestibular neuritis or Labrynthitis (if they have tinnitus/hearing loss)
TX: Benzo's, steroids, antihistamines |
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Common cause of recurrent vertigo with PHOTOPHOBIA, headache, and N&V:
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* Central vertigo = basilar migraine
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When you lose the 4 features of consciousness (arousal, wakefulness, responsiveness, and awareness to self/environment) you are in:
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* A Coma
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What brain system controls arousal and when damaged you are in a true coma?
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* Ascending reticular activating system (ascends through the periaqueductal gray)
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If you have a lesion in the pons, what body part will be affected?
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* The eyes
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A glasgow coma scale of 8 or less means:
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* Coma
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What is decorticate positioning?
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* Arms flexed, legs extended (this would be supratentorial damage)
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A pt with both arms and legs extended has a lesion where?
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* Decerebrate positioning-- lesions is at the midbrain or lower (infratentorial)
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How do you tell if a lesion is UMN or LMN?
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* UMN has reflexes, LMN doesn't
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Pt with normal (reactive) pupils, cheyne-stokes resp, decorticate, eyes look toward lesion and away from paresis has a lesion where?
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* Cortex
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Pt with small (but reactive) pupils, cheyne-stokes, decorticate, and eyes look toward lesion and away from paresis has a lesion where?
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* Thalamus
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Pt with dilated/unreactive pupils, dysconjugate gaze, abduction paralysis, decerebrate, apneustic resp?
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* Midbrain
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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?
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* Pons
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What is the big give-away with a midbrain lesion localization?
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* Dysconjugate gaze (one eye straight while one eye looks at the wall)
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A person in a coma but has a normal neuro exam probably is in:
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* Metabolic state induced coma
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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?
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* Central herniation
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Classic sign of transtentorial (uncal) herniation:
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* Ipsilateral CN III (oculomoter) paralysis
The ipsilateral pupil is dilated and unreactive |
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A pt with tonsillar herniation will have what signs:
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* Paralysis of lateral eye movement, the pressure on the medulla will eventually cause death (they will be decerebrate and then become flaccid)
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What is a duret hemorrhage?
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* Complete uncal herniation-- too late at this point
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Causes the brain damage seen in car accidents:
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* Torque on the brainstem
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2 classic signs of skull fracture:
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* Coons eyes and battle signs
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Being unable to recall the period of time after a brain injury is called:
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* Anterograde amnesia
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Where is CSF produced and absorbed?
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* Produced by choroid and absorbed by arachnoid villi
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Triad of symptoms seen with hydrocephalus (arachnoid villi aren't plugged/scarred):
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* Wet, wacky, wobbly
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If someone reaches out to touch a doorknob and they begin to have a tremor this is called ___ and the dysfunction is where?
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* Called an intention tremor and is IPSILATERAL cerebellar dysfunction
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Where is the dysfunction in a resting tremor?
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* CONTRALATERAL basal ganglia
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What is dementia and is it a clinical dx?
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* Progressive decline in intellectual function and it is NOT a clinical dx
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A pt with dementia and gait disturbance has problems where in the brain?
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* Frontal lobe
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Classic brain finding seen with Alzheimers:
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* Neurofibrillary tangles (plaques aren't as important)
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Where is atrophy most prominent in Alzheimers?
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* Medial temporal limbic areas
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How do you tell if a pt's dementia is d/t to Pick's disease?
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* Only one lobe atrophies (focal)
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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?
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* Left frontotemporal
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Main treatment for Alzheimers:
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* Acetylcholinesterase inhibitors (you want to increase ACh in the brain)
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A pt who has loss of language and social skills, coldness, and enhanced artistic realization has problems where in the brain?
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* Bitemporal
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Characteristic tremor seen in Parkinsons:
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* Resting tremor
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A tremor that begins anytime someone starts to move is:
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* Essential tremor (give them some EtOH and the tremor will slow down)
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What causes Huntington's Chorea?
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* Increased CAG repeats on chromosome 4 (AD disease) need at least 36 repeats for the disease
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Where does degeneration occur in the brain of someone with Huntingtons?
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* The caudate head
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A person on metaclopromide/haldol who always looks like their chewing gum when they aren't (abnormal mouth movements) has:
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* Tardive dyskinesia
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Toxic-metabolic disorder than can cause myoclonus:
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* CJD
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Hepatic encephalopathy can cause this "flapping tremor":
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* Asterixis
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A pt with hemiballism on the right has damage where in the brain?
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* Left (contralateral) subthalamic nucleus
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Dopa cells are lost where in pt's with Parkinsons?
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* Substantia nigra pars compacta
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Most effective management of neuropathic pain:
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* Antidepressants and antiepileptics
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Most common trigger for migraine:
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* Adrenaline (due to stress let downs)
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Only NSAID that can prevent migraine:
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* Naproxen (Triptans are the best abortive agents)
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Best way to differentiate a migraine from a cluster headache (aka trigeminal autonomic cephalgia):
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* Migraines make you want to sleep
Cluster = CAN'T sleep |
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2 neurotransmitters involved in seizure:
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* Too much glutamate (excitatory) or not enough GABA (inhibitory)
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What is seen on an EEG with seizure?
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* Spikes and waves
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Describe a typical grand mal seizure (generalized tonic-clonic seizure):
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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
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5 or more minutes of continued seizure activity is termed:
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* Status epilepticus
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CSF with WBC's, low glucose, and elevated protein has what type of meningitis?
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* Bacterial (WBC to 5k) or Fungal (WBC to 10k)
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How would you differentiate bacterial from viral meningitis?
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* With Viral the glucose is NORMAL (50 - 80mg/dl or 65% or serum glucose)
Bacterial/Fungal the glucose is low |
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Organism that causes most general bacterial meningitis:
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* Strep pneumonia
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Most common cause of sporadic viral encphalitis:
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* Herpes simplex (goes to medial temporal lobes)
Tx: Acyclovir |
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Familial prion disease:
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* Gestermann-Strausller (on chrom 20)
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Most common cause of meningitis in neonates:
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* H. influenzae
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Why does hydrocephalus occur as a complication of meningitis?
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* Scarring of the arachnoid villi
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Who usually gets a subdural empyema?
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* Adults after having some surgery involving the head
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This complication of neurosyphilis occurs decades after infection and atrophies the dorsal root ganglia:
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* Tabes dorsalis
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The types of fungi that cause brain abscesses are ____ while the ones that cause meningitis are ____.
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* Abscess = filaments (mucor, aspergillus)
Meningitis = yeasts (cryptococcus, histoplasmosis) |
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How does mucormycosis typically infect the brain?
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* It ascends through the cribiform plate
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The structure of a prion:
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* Beta pleated sheets
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Where does herpes enchephalitis infect the brain?
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* Temporal lobes
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Agent causing subacute sclerosing panencephalitis:
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* Measles
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Agent causing progressive multifocal leukoencephalopathy (PML):
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* the JC virus -- demyelinates the oligodendroglia
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Is muscle fasciculations UMN or LMN?
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* LMN
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Where is the damage range in the spinal cord if there is ventilator dependence?
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* C1 to C3
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Where is the damage if thereare no upper limb movement, but they can breathe on their own?
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* C4
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What causes subacute combined degeneration?
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* B12 deficiency
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What disease is characterized by gliosis of the corticospinal tracts and muscle atrophy:
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* AML -- motor neuron only!
Oculomotor muscles are the only muscles spared |
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Only drug for ALS:
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* Riluzole
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What are the signs and symptoms of transverse myelitis?
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* Rapid onset, monophasic, paraparesis, bowel/bladder dysfunction, brisk DTR’s, bilateral BABINKSI, sensory level
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Relapsing and remitting (recurrent) demyelinating disease:
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* Multiple sclerosis
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What syndrome has upper limbs weaker than lower limbs, with UMN signs in the upper limbs and LMN signs in the lower limbs?
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* Syringomyelic syndrome
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3 genetic trisomies that can be carried to term:
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* Trisomy 13, 18, and 21 (21-- Downs is the only one that lives longer than 1 year though)
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What is a neural tube malformation that is d/t failure of closure of the posterior neuropore?
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* Chiari malformations
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What is a neural tube malformation that is d/t failure of closure of the anterior neuropore?
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* Anencephaly (absent calavarium, forebrain among other things)
Early indicator = Increased AFP |
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What is common to Chiari I, Chiari II, and Chiari III malformations?
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* All have cerebellar ectopia and small posterior fossa
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In addition to cerebellar ectopia and small posterior fossa, what else characterizes Chiari II (Arnold-Chiari malformation)?
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* Brainstem malformation with BEAKED midbrain and spinal meningomyelocele
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This chiari malformation is rare and is characterized by cerebellar ectopia, small posterior fossa, inferior displacement of the brainstem, and occipito-cervical encephalocele:
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* Chiari III
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What are the characteristics of chiari IV malformation?
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* Severe cerebellar hypoplasia and meningomyelocele
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Chiari malformation with a beaked midbrain but NO meningomyelocele:
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* Chiari 1.5 (if it was beaked and had a meningomyelocele it would be chiari II)
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Chiari malformation characterized by cerebellar hypoplasia:
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* Chiari IV
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What is the deficiency in PKU?
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* Deficiency of phenylalanine hydroxylase (converts pheynlalanine to tyrosine)
AR disorder on chromosome 12 |
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Discuss Tay-Sachs:
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* AR on chrom 15, Ashkenazi Jews, beta-HEX-A deficiency, accumulation of glycosphingolipid accumulation in neurons
Imaging show macrocephaly without hydrocephaly |
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Group of disorders of the development of movement and posture causing activity limitation is:
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* Cerebral Palsy
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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:
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* Myeloschisis
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What happens in a meningomyelocele?
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* Herniation of meninges & spinal cord through the vertebra-- neural tube defect
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A protrusion of the brain through a congenital opening in the skull (80-90% are occipital) that is also associated with hypoplastic lungs is:
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* Encephalocele
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This is a terminal fixation of the conus medullaris leading to restricted upward movement of the spinal cord:
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* Tethered cord syndrome
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What maternal disease is associated with holoprosencephaly (single ventricular cavity)?
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* Maternal diabetes or EtOH consumption/abuse
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3 most constant changes in this disease are: abnormal/agenesis of cerebellar vermis, cystic dilation of 4th ventricle, and enlargement of the posterior fossa:
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* Dandy-Walker syndrome
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Widespread loss of gyri associated with a genetic defect:
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* Miller-Dieker syndrome (no gyri in the brain)
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Most common interventricular tumor in adults occuring in the midline usually (peak occurance in 3rd decade):
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* Neurocytoma
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Meningiomas (most are dural based) are associated with what disorder:
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* NF2
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Hemangioblastomas are associated with what disease?
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* VHL (von-hippel lindau disease)
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Tumor found in the paramedian location of the cerebellum and associated with VHL:
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* Hemangioblastoma
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Tumor arising from Rathkes pouch:
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* Craniopharyngioma
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Primary CNS lymphoma is often associated with:
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* the EB virus and large diffuse B-cell tumors
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Common histo component to neuroblastomas:
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* Homer-wright rosettes
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Schwannomas most commonly occur where?
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* On the 8th crainal nerve
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Nerve that is pinched in carpal tunnel syndrome:
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* the MEDIAN nerve (become trapped underneath the flexor retinaculum)
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This muscle has weakness/wasting in carpal tunnel:
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* Abductor Pollicis Brevis (APB)
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A positive Tinnel or Phalens sign is indicative of:
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* Carpel tunnel
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What causes meralgia paresthetica?
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* Entrapment of the lateral cutaneous nerve of the thigh
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This is an immune acute aquired inflammatory demyelinating polyneuropathy:
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* Guillain-Barre Syndrome (GBS)
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What are the clinical features of GBS?
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* Progressive ascending symmetric flaccid weakness of the limbs, can eventually ascend to cranial nerves and be fatal
Tx: IV immunoglobins |
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How does ALS present?
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* Progressive weakness over months/years that generally starts in one extremity
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Hallmark of the post-synaptic NMJ disorder myasthenia gravis:
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* Fatiguable weakness -- they will have arm drift and can't sustain an upward gaze
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Drug to help dx myasthenia gravis:
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* Endrophonium
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What is the general pattern of weakness in myopathy?
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* 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 |
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Duchenne and Becker muscular dystrophy are both disorders of:
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* Dystrophin both are x-linked as well (kids with Becker live longer though)
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What area of the brain does Alzheimers affect the most?
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* Temporal lobe-- especially the hippocampus
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Prototypical frontotemporal dementia:
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* Pick's disease (have Aphasia, Apraxia, and Agnosia)
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What causes amyotrophic lateral sclerosis (ALS)?
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* Loss of motor neurons in the anterior horn of the spinal cord (LMN) as well as in the motor cortex (UMN)
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What visual field disturbance is most common with a temporal lobe tumor?
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* Superior quadrantanopsia
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Where is the tumor: cyclical vomiting, occipital headache, vertigo, nystagmus, ataxia, ipsilateral hypotonia and hyporeflexia, brainstem signs and hydrocephalus occur late:
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* Cerebellum
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Increased ICP affects this cranial nerve:
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* Abducens (CN VI)
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Cerebral edema that responds to osmotic agents, and is a failure of the ATP-dependent Na/K pump:
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* Cytotoxic cerebral edema (seen with strokes)
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Cerebral edema that is d/t to seeping of CSF into the parenchyma d/t CSF flow obstruction:
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* Interstitial cerebral edema
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Which type of cerebral edema is most common and where does it occur?
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* Vasogenic, occurs mainly in white matter, around brain tumors, abscesses or lesions, and is caused by BBB disruption with increased permeability-- responds to steroids
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A patient with early nunchal rigidity and head tilt followed by coma and respiratory arrest might have a this herniation:
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* Tonsillar herniation
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A patient with a dilated ipsilater pupil, followed by ipsilateral hemiparesis might have this herniation:
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* Uncal herniation
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Where do menengiomas arise from?
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* Arachnoid cells, develop at a dural site
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A subdural hematoma is damage to:
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* The bridging veins (pt's will show a crescent shaped blood on CT/MRI and it can be acute or a delayed presentation)
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A epidural hematoma is damage to:
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* Middle meningeal artery-- presentation is acute (hours or less)
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How do the best treatments for myasthenia gravis work?
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* The carbamylate the acetylcholinesterase enzyme (Neostigmine and Pyridostigmine)
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Pt's who OD on tricyclic antidepressants often die from:
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* Lethal arrythmias
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What are Beta waves and Delta waves associated with in relation to sleep?
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* Beta = REM or alert wakefulness
Delta = Stage 4 (deep, non-rem sleep) |
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Tabes dorsalis affects what in the spinal cord?
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* The dorsal COLUMN
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Most common complication of meningitis:
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* Hydrocephalus
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Where does the greatest amount of salt and water retention occur in cerebral edema?
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* The white matter
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Typical location for hypertensive hemorrhages:
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* Basal ganglia
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Rupture of a Berry aneurysm can lead to:
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* Subarachnoid hemorrhage
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