NBME Form 2 – Flashcards
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Conus medullaris
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The conus medullaris (latin for "medullary cone") is the tapered, lower end of the spinal cord. It occurs near lumbar vertebral levels 1 (L1) and 2 (L2).
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Toxic/ Metabolic encephalopathy aka
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Delirium
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Some common causes of SIADH include
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Meningitis, head injury (SAH), cancers (small cell lung), infections (brain abscess, pneumonia, lung abscess), GBS, drugs (FQ, cyclophosphamide, carbamazepine, MDMA, SSRI, TCA, morphine), hypoTH, sarcoid
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Temporal arteritis
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Inflamm of ICA, branches of ICA may lead to occipital headaches, CRAO!!! Blindness due to ophthalmic artery occlusion
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Audiometry to
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Eval hearing loss in kid whos not talking well...
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87 yo woman with 7 mo hx of decreasing ability to fxn independently; workup?
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MRI
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STEVENS JOHNSONS DRUGS 4
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Carbamazepine, ethosuximide, phenytoin, lamotrigine
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Urinary incontinence doesn't have to be cauda equina foo
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Can be spastic bladder, overflow incontinence, etc... UMN and LMN both possible!
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Where are genitals on homunculus map
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Falx
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Chronic n-hexane toxicity
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Extensive peripheral nervous system failure (and eventually CNS); tingling and cramps in arms and legs then general mm weakness. Mm atrophy, loss of coord, vision loss.
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Methanol poisoning
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CNS depressant like etoh. Metabolic acidosis. Vision loss. Dilated pupils with hyperemia of the optic disc and retinal edema. Optic nerve affected.
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Pallor of optic disc
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Pallor reflects replacement of dead axons in the optic nerve by glial tissue.
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Methyl ethyl ketone aka butanone
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Irritant to eyes and nose of humans
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Organophosphate poisoning
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DUMBBELSS: diarrhea, urination, miosis, bronchospasms, bradycardia, excitation of skeletal mm and CNS, lacrimation, sweating, salivation
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Parathion is a(n)
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Organophosphate
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Toluene intoxication (inhaled)
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Light-headedness, nausea, sleepiness, unconsciousness, death; GABAnergic
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Trichloroethylene
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CNS depression resulting in general anesthesia
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Neck stiffness, pain radiating from neck to left hand, urinary incontinence, unsteadiness when walking. Atrophy of LUE, increased tone in both Les. DTRs 2+ at UEs, 3+ at LEs. Babinski bilaterally present. Stiff, wide-based gait. 1 yr hx.
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Spondylotic cervical myelopathy
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Decorticate posturing: possible damage to
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Cerebral hemispheres, internal capsule, thalamus, midbrain
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Decerebrate posturing: damage to
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Brainstem, specifically below the level of the red nucleus (mid-collicular lesion). Lesions or compression in the midbrain and lesions in the cerebellum. Commonly seen in pontine strokes.
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Upward herniation
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Increased pressure in posterior fossa can cause cerebellum to move up through tentorial opening in upward, or cerebellar herniation. Midbrain is pushed through tentorial notch.
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Midbrain components
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Crus cerebri, substantia nigra, red nuclei, III, IV, superior colliculus, cerebral aqueduct, spinothalamic tract and medial lemnicus
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Acute cerebellar ataxia assoc with
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Viral infec esp chickenpox in kids
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Vitamin A excess
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Arthralgia, fatigue, headaches, skin changes, sore throat, alopecia. Teratogenic (cleft palate, cardiac abnlities)
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Phenytoin toxicities
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Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome), SLE like syndrome, cyt P450 induction, lymphadenopathy, Stevens-Johnson syndrome, osteopenia
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TORCH CMV infection
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Hearing loss, seizures, petechial rash, blueberry rash
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Most severe form of congenital CMV is referred to as
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Cytomegalic inclusion disease CID
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Cytomegalic inclusion dz sx
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characterized by intrauterine growth restriction, hepatosplenomegaly, hematological abnormalities (particularly thrombocytopenia), and various cutaneous manifestations, including petechiae and purpura (ie, blueberry muffin baby). However, the most significant manifestations of CID involve the CNS. Microcephaly, ventriculomegaly, cerebral atrophy, chorioretinitis, and sensorineural hearing loss are the most common neurological consequences of CID.
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Malignant hypertension tx
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Nitroprusside, nicardipine, clevidipine, labetalol, fenoldopam
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Nitroprusside toxicity
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Can cause cyanide toxicity (releases cyanide)
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Renal salt wasting nephropathy vs SIADH
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Key differential dx factor for salt wasting nephropathy is that affected patients present with a dehydrated state; on the other hand, SIADH is diagnosed by a hypervolemic? state
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Trigeminothalamic pathway from the R face crosses where
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Goes to pons then goes down to cervical cord where it crosses midline, then ascends all the way up on L side
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Efferent limb of the pupillary reflex crosses midline where?
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Tricked ya! NEVER CROSSES THE MIDLINE. Begins in dorsal midbrain and exits with the third nerve.
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Anisocoria that is more pronounced in the dark than in bright light indicates a
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Sympathetic lesion on the side of the smaller pupil!
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Does the sympathetic pathway cross the midline?
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Neverrr
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5th finger sensation which nerve root
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C8
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Adductor pollicis brevis which nerve root
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C8
