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Neurology - Kaplan


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why are local anesthetics less effective in areas of infection?
they are weak bases and are only effective at penetrating tissue in the unprotonated form - abscesses have lower pH and thus lidocane, etc. becomes protonated and poor anesthesia results
transient global amnesia usually represents a variant of what?
TIA (typically in the posterior cerebral territory)
migraine and epileptic attacks have also been implicated in some cases of transient global amnesia
what level is normal for CSF glucose?
about 2/3 of the serum value
how is the hypophysis approached transnasally?
through the spenoid sinus
what becomes atrophic in tabes dorsalis?
dorsal column
to what class of drugs does phenelzine belong?
what condition is characterized by demyelination of the central pons following overly rapid correction of severe hyponatremia
central pontine myelinolysis
coagulative necrosis of brain parenchyma with macrophage-rich chronic inlammatory infiltration mixed with microscopic cysts containing bradyzoites: ring-enhancing lesions in AIDS patient
what drugs will reverse the paralysis of vercuronium?
neostigmine, edrophonium, and other cholinesterase inhibitors
what does the recurrent laryngeal nerve innervate?
all of the intrinsic laryngeal muscles except the cricothyroid
meningitis - encapsulated yeast, HIV patient, Mississippi/Missouri river beds
what type of fungus is cryptococcus?
monomorphic - encapsulated yeast form is found in both clinical specimens and in the environment as the infectious form
occlusion of what artery causes a lateral medullary syndrome characterized by deficits in pain and temperature sensation over contralateral body, ipsilateral dysphagia, hoarseness, diminished gag reflex, vertigo, diplopia, nystagmus, and vomiting, ipsila
occlusion of what artery causes ipsilateral facial paralysis, ipsilateral cochlear nucleus damage, nystagmus, and ipsilateral pain and temperature loss of face; ipsilateral dystaxia?
occlusion of what artery results in homonymous hemianopsia of the contralateral visual field?
posterior cerebral artery
fever, headache, nuchal rigidity, and low Glascow coma score along with increased neutrophils, elevated protein, and reduced glucose in the CSF indicate waht type of meningitis?
what is the most frequent organism causing meningitis in the elderly?
strep pneumo
severe ocular pain accompanied by blurred vision associated with halos around lights; eye that is red and hard; mydriasis?
acute angle-closure glaucoma
what is the treatment for acute angle-closure glaucoma?
IV acetazolamide - inhibits carbonic anhydrase, leading to reduced production of aqueous humor and a concomitant reduction in intraocular pressure; osmotic diuretics can also be used
what nerve lies in the tonsillar fossa?
glossopharyngeal nerve - general sensory innervation to the mucosa of pharynx, and general sensory and taste sensation to the mucosa of the posterior 1/3 of the tongue
what do you call the inability to recognize, despite adequate sensation?
what type of drug is amitryptiline? what are its side effects?
TCA - strong anticholinergic properties
what gyrus will be most affected in a subfalcine herniation?
cingulate gyrus - runs along the medial aspect of the cerebral hemisphere, just above the corpus callosum
what are the two active metabolites of primidione (an anticonvulsant used for the treatment of tonic-clonic, psychomotor, and focal epileptic seizures)?
phenobarbital and phenethylmalonamide (PEMA)
subacute sclerosing panencephalitis can follow infection with what virus?
what are cortical tubers?
malformed (hemartomatous) nodules of the cortex - seen in tuberous sclerosis
supendymal giant cell astrocytoma grows from the walls of the lateral ventricles and is pathognomonic for what?
tuberous sclerosis
intracytoplasmic spherules composed of paired helical filaments seen best with silver stains
Pick bodies
paralysis of upward gaze?
lesion/ compression of the superior colliculi
aneurysm of superior cerebellar artery, posterior cerebral artery, or basilar artery can all compress what nerve?
tumors of what compress the vertical gaze center?
pineal gland
what does the pineal gland manufacture from serotonin?
in what anatomic space is the middle meningeal artery located?
middle cranial fossa
lesion of what produces central scotoma?
lesion of what causes ipsilateral blindness?
optic nerve
lesion of what causes bitemporal hemianopia?
optic chiasm
lesion of what causes homonymous hemianopia?
optic tract
lesion of what auses upper homonymous quadrantanopia?
temporal optic radiations
lesion of what causes lower homonymous quadrantanopia?
parietal optic radiations
what CN is responsible for the gag reflex?
the posterior half of the ear canal receives sensory information from what?
auricular branch of vagus
naegleria fowleri crosses what to enter the brain via the olfactory nerves?
cribriform plate - trauma to nose predisposes to meningoencepalitis
on what chromosome is Rb located?
perivenous microglial encephalitis with demyelination is characteristic of what?
post-infectious encephalomyelitis after measles
demyelination of white matter of cerebral hemispheres with abnormal giant oligodendrocytes?
progressive multifocal leukoencephalopathy - demyelinating disease caused by infection with JC virus, especially in immunocomprimised individuals
phagocytosis of motor neurons in spinal cord?
severe hemorrhagic and necrotizing encephalitis of the temporal lobe with eosinophilic Cowdry type A inclusion in neurons and glia
herpes encephalitis
small granulomas with central caseation in the meninges
tuberculous meningitis
how do neostigmine and pyridostigmine act?
carbamylating the acetylcholinesterase enzyme
if CSF shows increased lymphocytes, plasma cells, macrophages, and fibroblasts, what type of meningitis is it?
what is the classical cause of chronic meningitis?
what is the role of the superior laryngeal nerve?
sensory innervation to the laryngeal mucosa above the vocal folds - accompanies superior laryngeal artery (branch of superior thyroid artery)
what muscle moves the hyoid anteriorly to open the pharynx?
what innervates the geniohyoid?
ansa cervicalis branch of C1
these appear as intracytoplasmic aggregates with a typical flame shape and are composed of bundles of PHFs twisted around each other
neurofibrillary tangles
medial aspect of the temporal lobe forced under the free edge of the tentorium cerebelli?
uncal herniation - resulting compression of the oculomotor nerve
explain the Marcus-Gunn phenomenon
in the absence of adequate light entering the eye (e.g. in retinal detachment or optic neuritis), paradoxical dilation of the pupils occurs - retina receives far less light than it normally would and the pupils dilate in order to absorb as much as possible
inability to close eye - what nerve is damaged?
Patau's syndrome is associated with what congenital brain abnormality?
what is the drug of choice for specific myoclonic syndromes?
valproic acid - effective and nonsedating
brain cyst with single layer of mucin-producing columnar epithelium with a ciliated apical surface?
colloid cyst
60% of cerebellar abscesses are related to what?
middle ear infection
cataracts are located in what structure of the eye?
what cardiac finding is associated with tuberous sclerosis?
cardiac rhabdomyoma
what supplies the anterior half of the ear canal?
auriculotemporal nerve
the afferent limb of the pupillary light reflex is carried by what?
optic nerve
what is the efferent limb of the pupillary light reflex?
oculomotor nerve
embolization from infective endocarditis typically causes small abscesses in what brain region?
parietal lobe
location of the brain responsible for spatial recognition?
parietal lobe
what cardiac defect may allow emboli originating from the veins in the legs to bypass the pulmonary circulation and reach the systemic arteries, thereby producing infarcts in the brain as well as in other organs (paradoxical embolism)
spongiform change in the gray matter is the hallmark of what neurological disease?
herpes encephalitis characteristically involves what lobes?
temporal and base of frontal
cysts causing space-occupying lesions and hydrocephalus or seizures; Mexico, South Central America; Philippines, Southeast Asia
cystercercosis - parasitic infection caused by larval cysts of tapeworm Taenia solium
gliosis is found in what neurological disease?
patient unable to move facial, pharyngeal, or limb musculature - paralyzed and unable to speak after hemorrhage
'locked-in' syndrome - ventral pons
what nerve provides sensation to the radial side of the hand, including the lower part of the dorsal aspect of the thumb and all the fingers except the pinky and half of ring finger?
what is the pyriform cortex?
primary olfactory cortex
exposure to what may lead to rabies without a bite?
vampire bats found in Central America
the incidence of carotid body tumors is higher where?
in people living at high altitude
what are the prevalent secretory products of carotid body tumors?
catecholamines, especially norepinephrine
what nerve supplies the muscles of mastication?
V3 - mandibular nerve
staphylococcal meningitis occurs mostly in patients with what?
indwelling ventricular-peritoneal shunts; staph epidermidis
at what rate do nerves regenerate?
1 mm/day
rosenthal fibers
pilocytic astrocytoma
this disease is associated with an abnormally small posterior fossa, with resultant downward displacement of cerebellar vermis and medulla through the foramen magnum - leads to hydrocephalus; also lumbar myelomeningocele and syringomyelia
Arnold-Chiari type 2
what is an encephalocele?
brain herniates through the occipital bone
markedly increased lymphocytes in CSF suggests what?
acute lymphocytic meningitis (viral)
what nerve is responsible for hip abduction?
superior gluteal nerve (L4-S1)

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