USMLE step 1 neuro – Flashcards
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high NE
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anxiety
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low NE
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depression
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high DA
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schozphrenia
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low DA
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parkinson's and depression
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low seratonin
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anxiety and depression
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low Ach
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Alzheimer's huntington, REM sleep
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low gaba
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anxiety, huntington
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glutamine + vit b6
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GABA
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NE synth location
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locus cerules/reticular formation/solitary tract
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DA synth formation
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ventral tegmentum, SNc
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seratonin synth location
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raphae nucleus
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ACh synth location
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basal nucleus of meynert
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GABA synth location
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nucleus accumbens
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DA ptwy: mesocotical block
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ventral tegmentum of MB to cortex. blocked: increase positive Sx of schizophrenia
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Da ptwy: mesolimbic
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ventral tegmentum of MB to limbic system. blocked: relief of pschosis (+Sx)
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DA ptwy: nigrostriatal
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substantia nigra par compacta to striatum (caudate and putamen). blocked: parkinson dz/ stimulation: extrapyramidal a/e
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DA pwty: tuberoinfendibular:
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arcuate nucleus of hypoth to pituitary blocked: increases prolactin- sx: amnorrhea, gynecomastia, galactorrhea
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reticualr acivating system
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locus cerelus, reticular formation and raphae nuclei. Mediates cosciousness and alertness bc synth 5ht,NE. Damge: coma.
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free nerve ending
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pain and temp. a-delta and c-fiber
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c-fibers
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free nerve ending. slow unmyelinated. warm temp
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A delta fibers
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free nerver ending. fast, meylinated, cold temp
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meissner's corpuscle
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large, meylinated. hairless skin (superficial skin) position and dynamic touch fast adapting
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pacinan corpuscle
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lg, meylinated (deep skin), ligaments, joints. fast adapting vibration and pressure
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merckle's disk
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hair follicle.(superficial skin)/ slow adapting position, static touch-edges, textures
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ruffini
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encapsulated/ slow adapting/ deep layers. sole of foot
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BBB composition
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1. tight junctions b/w NON-fenestrated capillary endothelial cells (destruction- vasogenic edema) 2. BM 3. astrocyte processes
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BBB permeability
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glucose and AA cross via carriers- slow lipid-soluable and non-polar- fast via diffusion
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non BBB, fenestrated capillaries in brain
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1. area postrema- vomiting after chemo (CZT at medulla) 2. OVLT- osmotic sensing 3. neurosecretory products- ex: ADH
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supra optic nucleus
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hypothalamus nuclei- makes ADH
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paraventricular nucleus-
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hypothalamus nuclei- makes oxytocin
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lateral area of hypothalamus
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FN- hunger. Inhibited by leptin destructionn- anorexia, failure to thrive (infants) zap lateral you shrink laterally
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ventromedial area of hypothalamus
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FN- satiety. stimulated by leptin destruction by craniopharyngioma- hyperphagia zap ventromedial you grow ventral and medial
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antetior hypothalamus
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cooling, parasymp. A/C- anterior cooling
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posterior hypothalamus
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heating, symp
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suprachiasmatic nucleus
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circadian rhythm
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thalamus: VPL
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input: spinothalmic / dorsal coums and medial lemniscus info: pain and temp (from body) output: primary somatosensory cortex.
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thalamus: body sensation
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VPL
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thalamus: VPM
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input: trigeminal and gustatory ptwy info: face sensation and taste output: primary somatosensory cortex
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thalamus LGN
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input: CN II info: vision output: calcarine sulcus (occipital lobe)
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thalamus: MGN
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input: superior olive and inferior colliculus of pons info: hearing output: auditory cortex (temporal lobe)
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thalamus: communication w/ prefrontal cortex . damage?
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mediodorsal (MD) nucleus dmaage: memory loss
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thalamus: cerebellum (dentate n.) and basal ganglia
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VL
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thalamus: VA
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basal ganglia to prefrontal, premotor, and orbital cortices
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thalamus: anterior nuclear group
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mamillothalmic tract to cingulate gyrus part of papez circuit
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thalamus: pulvinar
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integration of vision, auditory, and somesthetic input
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cerebellum input
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contralateral cortex via middle cerebellar peduncle ipsilateral proprioception via inferior cerebellar peduncle nerves: climbing and mossy fiber
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cerebellum output
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contralateral cortex via superior cerebellar peduncle nerves: purkinje fibers modulates movement
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spinocerebellum
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vermis and paravermis via fastigial and interposed nuclei interposed n = globise and emboliform
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vestibulocerebellum
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flocculonodular lobe and vermis via fastigial nuclei
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cerebrocerebellum
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lateral hemispheres via dentate
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cerebellum nuclei
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lateral to medial: dont eat greasy food dentate, emboliform, globose, fastigial
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lateral cerebellum
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voluntary movement of extremities
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medial cerebellum
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balance, truncal coordination, ataxia injury: ipsilateral - falls to injured side bc info crosses twice
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basal ganglia: direct ptwy
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NT: dopamine receptor: D2R SNc + , + striatum, - GPi, + thalamus = movement
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basal ganglia: indirect ptwy
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NT: dopamine receptor D2R +SNc, - striatum, +GPe, -Subthalmic n.& Gpi, +thalamus = movement
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basal ganglia: GPi
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decrease/inh mov
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basal ganglia: GPe
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inhibits STN and Gpi = increases movement
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basal ganglia: STN
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stimulated GPi = inhibits movement
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basal ganglia and PD
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loss of DA= less direct ptwy , more indirect ptwy = less motion
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basal ganglia and HD
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neuronal death via NMDA-R : glutamate toxicity atrophy of striatal nuclei (main inh of mov)
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multiple sysmtem atrophy:
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parkison-like, autonomic dysFN, ataxia inclusion w/ alpha synuclein in oligodendroglia cells
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paramedian pontie reticular formation (PPRF) lesion
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eyes look away from lesion
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frontal eye fields lesion
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eyes look towards lesion
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cerebellar hemisphere lesion
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intention tremor, limb ataxia, ipsilateral
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cerebellar vermis lesion
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TRUCAL ataxia, dysarthia
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reticular activating system (MB) lesion
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reduced levels of arousal and wakefulness = coma
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superior colliculi lesion
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paralysis of upward gaze
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left parietal lobe lesion
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gerstman syndrome- agraphia, acalculia, finger agnosia, left and right disorientation
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bilateral amygdale lesion
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kluber-bucy syndrome: hyperorality, hypersexuality, disinhited behavior
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central pointine myelinosis
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acaute paralysis, dipliopia, loss consciousness. bc rapid correction of HYPO-natremia
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broca's aphasia
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nonfluent aphasia but understands INFERIOR frontral gyrus
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wernecke's apahsia
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fluent aphasia, but impaired comphrehension SUPERIOR temporal gyrus
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global apahsia
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nonfluent and impair comprehension. both broca and wernecke
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conduction aphasia
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poor repetition. pt understands and is able to speak but no connection. At arcuate fasciculus
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non-dominant broca aphasia
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expressive dysprosody- can't express emotions/inflection on speech "monotone"
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non-dominant wernecke apahsia
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receptive dysprosody- inability to comphrehend emotion or inflectionin speech
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weber's syndrome
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midbrain infarct occlusion of paramedian branches PCA contralateral hemiparesis (CST) & oculomotors CN III palsy
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CN 3
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rostral midbrain. levator palpebrae, superior, inferiorm, and medial rectus. inferior oblique/ pupillary sphincter- ciliary muscle
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Cn 4
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caudal midbrain- superior oblique
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CN 6
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caudal pons- lateral rectus
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anterior spinal art
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contralat- hemiparesis (LE), ipsilateral paralysis of CN9 pain and temp are ok
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PICA/ lateral medullary/wallenberg
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contralat- pain and temp in BODY ipsilat- dysphagia, decrease gag reflex, dipliopia, nystagmus, horner's, facial tmep and pain, ataxia
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AICA/ lateral inferior pontine synd
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ipsilateral facial paralysis (cn7), cochlear n. & nystagmus (cn8), facial pain & temp
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PCA
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contralat- hemianopoa w/ MACULAR SPARING
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MCA
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contralat- face, arm paralysis/sensation, apahsia(dominant), left side neglect (non-dominant)
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ACA
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contralat- leg-foot motor and sensory
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anterior communicating art
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MC site of berry aneurysm. visual problems- bitemporal hemianopsia
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posterior communicating art
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CN 3 palsy- down and out
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lateral striate
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from MCA. pure motor hemiparesis (arms & legs) internal capsule, caudate, putamen, GP. "arteries of stroke"
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watershed zone
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b/w ACA and MCA or MCA and PCA HYPOtension,upper leg + arms weakness, high order visual process
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basilar art
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locked in syndrome. only CN3 is intact!
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aneurysm causes
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APKD, marfan, ehlers danlos
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charcot bouchard microaneurysm
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ass w/ chronic HTN- small vessel in basal ganglia and thalamus
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stroke at thalamus
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only sensory loss in cotralateral side both arms and legs. no motor defecit. but difficult to walk bc loss of proprioception
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nimidipine
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CCB used after aneurysm to decrease risk of vasospam
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parenchymal hematoma
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HTN, amyloid angiopathy- lobar stroke, DB, CA at basal ganglia and internal capsule
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intraventricular hemorrhage
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PREMES < 32 wks , low birth wgt < 1500
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ischemic stroke
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emboli. a-fib, carotid dissection, patent foramen ovale, endocarditis, lacunar stroke-HTN. cystic cavity w/ reactive gliosis.
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TIA
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reversible. < 24 hrs
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dural venous sinus
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superior sagital sinus (main location of CSF return) --> confluence of the sinus --> transverse sinus--> sigmoid sinus --> int. jugular v.
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where does the sigmoid sinus become IJV
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jugular foramen
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foramen of monro
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latreal ventricle to 3rd ventricle
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cerebral aqueduct
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3rd to 4th ventricle
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CSF
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made in choroid plexus/ reabsorbe by choroid sinus
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foramen of luschka
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4th ventricle to subarachnoid space. LATERAL
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foramen of magendie
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4th ventricle to subarachnoid space. MEDIAL
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normal pressure hydrocephalus
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wet, wobbly, wacky. NO increase in volume. dementia, ataxia, urinary incontinence
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pseudotumorcerebri
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young, obese female w/ daily HA worse in AM and papilledema N- ventricles, no tumor/masses. but HIGH csf press. tx- lose wgt, acetozolamide
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fasciculus cuneatus
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dorsal column- upper extremities
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fasciculus gracilis
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dorsal column- lower extremities. (more medial)
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lateral CST
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arms are medial, legs are lateral
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polio & werdnig hoffmann dz
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LMN lesion - destructoin anterior horns- flaccid paralysis
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anterior spinal art and cord
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lose everything but dorsal columns and tract of lissauer. (proprioception, touch and temp ok)
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3 syphilis
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DRG and dorsal column lesion
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vit b12, vit E def, friedreich ataxia
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dorsal coumn, lateral CST, spinocerebellar tract ataxia, hyperreflexia, impair vibration. ok temp & pain
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polio CSF
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lymphocytic pleocytosis no protein.
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SOD1
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ALS- UMN and LMN
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friedreich ataxia
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AR. repeat dz- GAA. frataxin protein. inpaired mitochondria. freq falling, nystagmus, dysarthia, hypertrophic CMP, kid- kyphoscoliosis. loss of CN8, 10, 12, cerebellum
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brown sequad syndrome
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hemisecition. ipsilateral- UMN. tactile, vibration, sensation, LMN contralat- pain and temp below lesion
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C2
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posterior half of skull
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C3
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turtle neck shirt
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C4
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clavicle region. low collar shirt
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T4
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nipple
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T7
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xiphoid process
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t10
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umbiicus
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L1
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inguinal lig
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L4
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kneecaps "down in all fours"
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S2,3,4
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erection and sensation of penile and anal zone
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reflex s1,2
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achilles
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reflex L3,4
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patella
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reflex C5.6
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bicep
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reflex C7,8
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tricep
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moro reflex "hang on for life"
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baby opens arms when thinks is falling backwards
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CN that lie medial in brain stem
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CN 3-MB, CN 6- pons, CN 12- medulla.
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CN 7
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motor- facial mov, eyelid closing, stapedius muscle in ear sensory- taste ant 2/3 tongue, lacrimation, salivation
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Cn9
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sensory- taste post 1/3 tongue, salivation-parotid, monitoring carotid body & sinus-chemo R motor- swallowing, stylopharyngrus (elevates pharynx, larynx)
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Cn 10
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sensory- taste epiglottic region, aortic chemo & baro-R, motor- palate elevation, midline uvula, talking, coughing thoracoabd viscera
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corneal reflex and lacrimation
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afferent- V1 efferent- cn 7
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jaw jerk
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V3 sensory, v3 motor both via masseter
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gag reflex
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cn9 afferent, cn 9, 10 efferent
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vagal nuclei: n. solitarius
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visceral sensation- taste, baro-R, ut distantion. CN 7,9,10
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vagal nuceli: n. ambiguous
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motor innervation pharynx, larynx, upper esophagus- Cn 9, 10, 11
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dorsal motor nucleus
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vagal nuclei. sends autonomic (parasymp) fibers to heart, lung, GI
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ear: webber test
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turning fork in middle top head. n- hear it on both ears = midline conduction defect- ipsilateral sensory defect = contralateral
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ear: rinne test
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fork at mastoid then at ear. N- AC>BC conduction defect= AC<BC
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ear: webber-R Rinne LE: AC>BC, RE: BC>AC
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R- webber--> R-conduction or L- sensory rinne- LE ac>bc normal rinne-RE bc>ac conduction
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cavernous sinus
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CN 3,4,5 (V1, V2) ,6 internal carotid and post ganglionic symp
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carvernous sinus syndrome
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ophthalmoplegio, ophthalmic and maxillary sensory loss ass- w/ infections b/w nose and lip.
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uvula deviation to the left
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1. Cn 10 and nucleus ambiguous on the RIGHT 2. corticobulbal tract/motor cortex on the LEFT
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tongue deviation to the left
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1. Cn 12 Left 2. CBT / motor cortex on R
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can't turn head to left, and should droop on R
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CN 11 on R.
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palsy of lower face
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UMN lesion think of stroke. upper face is innervated by both UMN so the ipsilateral UMN still functional
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palsy entire half of face
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bell's palsy. damage at nuclei. LMN
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causes of Bell's palsy
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Lovely Bella Had An STD lyme, HSV, Aids, Sarcoidosis, Tumor, DB
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bilateral bell's
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lyme dz, guillian barre
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open angle glaucoma
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obstruction at canal of schlemn slow, oainless, bilateral
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close angle galucoma
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obstruction of flow from posterior to anterior chamber. painful, acute, rock hard eye, frontal HA, halos, raindown around lights, non-reactive pupil dont give EPI: miadriasis
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cataracts/ congenital/ risk
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opacity of lens. / congenital- rubella classical galactosemia, galactokinase def, DB
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CN 4 damage
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eye drifts upward- vertical dipliopia problems reading, going town the stairs
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CN 6 damage
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medially directed eye
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miosis
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pupilary pschincter muscle. parasymp Cn 3 from EW n. to ciliary ganglion.
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mydriasis
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radial muscle, symp. T1 preganglionic- sup cervical ganglkion- postgl. symp- long ciliary nerve.
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marcus gunn pupil
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damage in CN2. shine light in one eye- both dilated/ shine light on ok eye- both constrict. AFFERENT problem
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macular degeneration dry vs wet
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loss of central vision. dry- slow- fat deposits wet rapid. neovascularization
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damage to optic tract on R
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loss of right retina field.= loss of left visual field homonymous hemianopia
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damage to meyer's loop on R
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in temporal lobe L upper quadrant anopia.
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damage to dorsal optic radiation R
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parietal lobe MCA L lower quadrantic lesion
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INO
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lesion of MLF causes palsy of medial rectus (Cn3) when looking laterally. the normal eye moves laterally and has nystagmus. both eyes goinward on accomodation.
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alzheimers
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senile plaques: b-amyloid (dark cotton balls) neurofibrillary tangles- TAU phosphorylation (flame shape)
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pick's dz
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frontotemporal dementia dementia, aphasia, change in personality pick's body- ROUND tau, stains w/ silver
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lewy body dementia
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parkinson w/ dementia, VISUAL hallucinations, repeated falls, and syncope. alpha-synuclein defect (lewy body)
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MS
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oligoclonal bands (IgG to oligodendroglia cells) periventricular plaques
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guillain barre'
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motor fibers. symmetric. ascending/ autonomic dysFN CSF- high protien no WBC / papilledema ass w/ campylobacter
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PML
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AIDS+ JC virus - destruction of oligodentroglia
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acute disseminated (post inf) encephalomyelitis
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multifocal inflamm and demyelination after infection. no necrosis. ass w/ kids and chickenpox/measles
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metachromatic leukodystrophy
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AR lysosomal storage dz arylsulfatase A def. - impair production of myelin
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charcot marie-tooth dz
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hereditary- motor and sensory neuropathy def in protein ass w/ meylin. - palpable perineal n. but thin calfs constant demyelination/remyelination- onion bulb look
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seizures general
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1. absence- 3hz, no postictal confusion- blank stare 2. myoclonic- jerks 3. tonic-clonic- grand mal. stiff and jerks 4. tonic- stiff 5. atonic- drop. mistaken for fainting.
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simple vs comple sz
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simple- consciousness is intact. complex- impaired consciousness
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causes if sz by age
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kids- genetic>inf>trauma adults- tumors>trauma>stroke>inf elderly- stroke> tumor>trauma>metabolic>inf
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cluster HA
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unilatral. brief HA. every day for several wks tearing, runny nose! horner's tx/; O2 +/- sumitriptan
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tension HA
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bilateral. > 30 mins. dull pain no othe associated sx frontal-occipital region
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migraine
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unilatreal- pulsating, n/v, photophobia, phonophobia, possible aura. tx: sumitriptan for acute/ BB for prophylaxis.
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trigeminal neuralgia
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lightening pain, electrical shock like w/ min stimuli- bed sheets, wind. tx- carbamezepine,
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sturge webber syndrome
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cong. port wine stain at trigeminal region (V1) ipsilateral letomeningeal angioma pheochromocytoma
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tuberous sclerosis
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hamartomas in CNS, cadiac rhabdomyomas renal angiolypomas. ashleaf spots
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Von Hipple Lindau dz
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cavernous hemangiomas in skin, mucosa BILATERAL renal cell CA- increases epo pheocrhomocytoma, hemangioblastoma in cerebellum
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GMB
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MC 1 tumor adults GFAP+ / pesudopalisading cells hemispheres. crosses corpus callosum. / necrosis.
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meningioma
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2nd MC in adults whorled pattern. psammoma bodies - calcification rings
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schwannoma
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3rd MC in adults. resectable S-100 + bilateral aucustic schwannoma - NF2
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oligodendroglyoma
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slow growing. frontal lobes. GFAP + fried eggs cells and chicken wire capillary
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pilocytic astrocytoma
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kids. GFAP + usually at cerebellum - cyst and solid rosenthal fibers- eosinophilic corckscrew fibers
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medulloblastoma
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cerebellar tumors kids. PNET homer-wright rosettes. small blue cell Ca
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epndymoma
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at 4th ventricle. kids. hydrocephalous. perivascular pseudorosettes.(white area around BV)
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hemangioblastoma
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kids. cerebellum w/ foamy cells. ass w/ vHL syndrome. produces EPO- 2nd polycythemia
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craniopharyngioma
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benign kids. from rathke's pouch- calcification- enamel like bitemporal hemianopsia.
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uncal herniation
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ipsilateral- CN 3 palsy, paresis( compression crus cerebri-contralat) contralateral- homonymous hemianopia (comp ipsilat PCA)
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cingulate herniation
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subfalcine. under falx cerebri. compression ACA
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downward transtectorial herniation
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compression cerebral aqueduct- hydrocephalus
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cerebellar tonsil herniation
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into foramen magnum ass w/ arnol chiari
