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What percent of adults report having at least one severe or disabling headache?
45%
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What percent of migranes occur in females?
70%
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What percent of cluster headaches occurs in males?
90%
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What would a sudden onset of a severe headache, headache accompanied by impaired mental status, seizures, focal neurologic signs, new headache after 50 yrs/old indicate?
Serious neurologic problem (e.g., brain tumor, brain abscess, hemorrhage, meningitis, hypertension
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What do pain receptors above the tentorium cerebelli refer pain too?
Front half of head
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Where is pain below the tentorium cerebelli referred
occipital region
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Where is headache pain in the patient with meningitis?
Over entire head
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What is the average duration of a migraine?
1 to 2 days
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What are the primary features of a migraine headache?
- scintillating lights
- transient visual loss
- throbbing unilateral pain
- photophobia
- phonophobia
- autonomic symptoms
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What mechanism of migraine involves vasoconstriction of occipital arteries and or vasodilation of extracranial arteries?
Vascular reactivity
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what is the main precipitating factor for migraine headaches?
Stress (62%)
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How does the drug propranolol help treat migraine symptoms?
Beta-adrenergic blocker
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What does the drug verapamil treat migraine headaches?
calcium channel blocker
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What neurotransmitter is secreted by the Raphe nucleus?
5-HT (serotonin)
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What neurotransmitter is secreted by the locus ceruleus?
Nor-adrenalin
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Where is a lesion on a person who is unable to contract facial muscles on the left side of the face but raising eyebrows is intact?
Right side UMNL to the facial nerve
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What is the Bell's phenomenon?
Eyeball moves superior and lateral because the eyelid cannot close all the way
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What is the mechanism behind crocodile tears?
Lesioin to proximal geniculate ganglion causes sprouting of nerves from salivatory nucleus that connects to lacrimal fibers
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What is the most common type of headache?
Tension headache
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What are the two main medications for treating tension headaches?
- Tricyclic antidepressants
- Anti-inflammatory
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What type of headache typically refers pain behind the browbone and or cheekbones?
Sinusitis headache
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Who is mainly affected by giant cell arteritis?
Women 65 to 80
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What type of headache presents with an abrupt elevation in bp, tachycardia, palpitation, sweating tremor?
Pheochromocytoma
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What would likely be found in a UA of a patient with pheochromocytoma?
increased catecholamine and their metabolites (e.g., metanephrine, normetanephrine, vanillylmandelic acid)
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What is the normal volume the vetricles of the brain?
150 ml
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How many ML of CSF is produced by the choroid plexus?
500 ml/day
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How do the lateral ventricles communicate with the 3rd ventricle?
Interventricular foramen of monroe
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What makes up the lateral wall of the anterior horn of lateral ventricle?
Caudate Nucleus
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Where is the choroid plexus of the lateral ventricle found?
- Temporal (inferior) horn
- and body
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What is the glomus and where is it found?
Glomus is a large tuft of choroid plexus found in the trigone of the lateral ventricle
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Where are the choroid plexus found in the 3rd ventricle?
Roof
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How does the 4th ventricle pass CSF?
- two lateral foramen of luschka
- One median foramen of magendie
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What is a rare neurological disorder that impairs the body's autonomic functions (e.g., bp, hr, bladder, digestion)?
Multiple system Atrophy (Shy-drager syndrome)
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What disease is autosomal dominant and causes atrophy of caudate nucleus and frontal/temporal gyri?
huntingtion's disease
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What disease causes sever degeneration of choleinergic and GABA-ergic neurons which are located in the caudate nucleus and putamen?
huntingtion's disease
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How many repeating CAG sequences must be present to suggest a person will develop huntington's disease?
40
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What is the probable mechanism of cell death in huntington's disease?
Glutamate excitotoxicity
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what type of infection can cause sydenham's chorea?
rheumatic fever
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What is the physiology of wilson's disease?
- genetic disorder of copper metabolism
- Necrotic lesions of liver from copper deposition
- renal tube damage
- lenticular degeneration
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What causes a kayser-fleischer ring?
Wilson's disease causes copper deposition in the descemet membrane of the cornea
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Where are the majority of intracranial tumors in Adults and Children respectively?
- Adults: supratentorial
- Children: infratentorial
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Where are metastatic brain tumors frequently located?
Junction of gray and white matter
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What segment of the population do gioblastoma multiforme, meningioma, and acoustic neuroma most commonly occur?
Adults
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What are the most common primary intracranial tumors in children?
- cerebellar astrocytoma
- medulloblastoma
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What ventricle is the most common site for ependymoma?
fourth ventricle
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What age group is most commonly effected by ependymoma?
child and adolescence
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What is the most common primary intracranial neoplasm?
Glioblastoma
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What is the second most common primary intracranial neoplasm?
meningioma
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in what type of tumor are psammoma bodies found
-
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Where do meningioma cells originate?
arachnoid cells
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What is the most common intracranial site for neurilemmoma (Schwannoma)?
- eighth cranial nerve (acoustic neuroma)
- Cerebellopontine angle
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What is the most common pituitary adenoma?
Prolactinoma
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What type of neurotransmitter is used by all preganglionic neurons?
Acetylcholine
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What blocks nicotinic receptors?
curare
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What block muscarinic receptors?
atropine
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What is the postganglionic receptor for parasympathetic and sympathetic cholinergic neurotransmission?
Muscarinic
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What is the postganglionic neurotransmitter for sympathetic innervation to all areas except secretory glands?
norepinepherine
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What can be used to block alpha and beta adrenergic receptors respectively?
- Alpha blocked by phenoxybenzamine
- Beta blocked by propranolol
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What preganglionic sympathetic neurotransmitter is released to the adrenal medula?
acetylcholine
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Where is the raphe nucleus located?
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Where is the locus ceruleus located and what does it secrete?
- bilaterally in midbrain and pons paraventricular area
- Norepinephrine
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Describe Kluver-Bucy syndrome?
bilateral removal of the amygdaloid nuclei results in tame behavior, oral fixation, sexually hyperactive
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Does a LMNL of CNVII result in contralateral or ipsilateral hemiparalysis?
ipsilateral
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A lesion in what pathway would cause inability of ipsilateral eye to adduct past midline with nystagmus of abducting contralateral eye?
Medial longitudinal fasciculus
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What is the most common dermatome area fro herpes zoster?
T5-T10
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