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What is going on when Nissl substance gets pushed to neuron periphery?
Wallerian regeneration
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Phagocytic cells of the CNS
Microglia (of mesoderm origin)
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Cells that promote axonal regeneration
Schwann cells
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Pacinian corpuscules
Transmit information about vibration and position from the deep skin layers, ligaments, and joints
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Meissner's corpuscules
Transmit fine touch sensation from hairless skin
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Where is NE synthesized?
Locus ceruleus
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Where is DA synthesized?
Ventral tegmentum and pars compacta of the substantia nigra
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Where is serotonin synthesized?
Raphe nucleus
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Where is ACh synthesized?
Basal nucleus of Meynert
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Where is GABA synthesized?
Nucleus accumbens
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Where are hunger and satiety mediated?
- Lateral area of hypothalamus mediates hunger
- Ventromedial area of hypothalamus mediates satiety
- Leptin inhibits the lateral area and activates the ventromedial area
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What mediates the circadian rhythm?
Suprachiasmatic nucleus of hypothalamus
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Function of thalamus
Relay station for sensory information heading to cerebral cortex
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VPL nucleus of thalamus
Mediates sensation from the body
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VPM of thalamus
Mediates sensation from the face
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Alpha synuclein inclusion bodies seen in...
Parkinson's and Lewy body dementia
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What does hemiballismus indicate?
- Loss of thalamic inhibition through the globus pallidus (i.e. contralateral subthalamic nucleus lesion)
- Can be due to lacunar stroke in a patient with HTN
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Atrophy of caudate seen in...?
Huntington's
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Myoclonus v. dystonia
- Myoclonus--sudden, brief muscle contration (e.g. hiccups)
- Dystonia--sustained involuntary muscle contraction (e.g. torticollis, writer's cramp)
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What decreases an essential tremor?
Alcohol (or beta blockers)
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Recurrent laryngeal nerve injury
Loss of all laryngeal muscles except cricothyroid, which is innervated by the superior laryngeal nerve
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Non-fluent aphasia with normal comprehension
Broca's aphasia, usually due to a L MCA stroke, affecting the inferior frontal gyrus
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Fluent aphasia with impaired comprehension
Wernicke's aphasia, usually due to a left MCA stroke, affecting the superior temporal gyrus
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What do the vertebral arteries branch off of?
Subclavians
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What do the MCAs branch off of?
Internal carotids
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Most common location for a Berry aneurysm
Anterior communicating artery
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Charcot-Bouchard microaneurysms
Affects small vessels, associated with chronic hypertension
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What does the middle meningeal artery branch off of?
Maxillary artery
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Most likely cause of a subarachnoid hemorrhage in the cerebral hemispheres
AVM
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What is amyloid angiopathy associated with?
Recurrent hemorrhagic strokes
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Regions of the brain most vulnerable to ischemia
Hippocampus, neocortex, cerebellum, watershed regions (between ACA and MCA, give rise to wedge-shaped infarcts, with proximal muscle weakness)
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What does the superior ophthalmic vein drain into?
The cavernous sinus
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What connects the lateral ventricles to the third ventricle?
Foramen of Monro
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What connects the third ventricle to the fourth ventrical?
Cerebral aqueduct of Sylvius
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Location of lumbar puncture
Between L3-5
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Ligaments pierced in lumbar puncture
Supraspinus, interspinus, ligamentum flavum
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Decussation of lateral corticospinal tract
Caudal medulla
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Decussation of spinothalamic tract
Anterior white commisure fibers in spinal cord
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Decusation of dorsal columns
Medulla
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Fasciculation indications
LMN lesion
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Werdnig-Hoffman disease
- Destruction of LMNs in anterior horns of spinal cord
- Floppy baby syndrome
- Tongue fasciculations are an early sign
- AR
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ALS
- Combined UMN and LMN defects, with no sensory defects
- Can be due to a mutation in SOD I
- Exacerbated by betel nut ingestion
- Commonly presents with fasciculations (LMN sign)
- Treat with riluzole
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Friederich's ataxia
- AR trinucleotide expansion disorder that leads to impaired mitochondrial function
- Presents with ataxia, nystagmus, dysarthria, pes cavus, HCM, kyphoscoliosis
- Similar presentation to B12 and vitamin E deficiency
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Level of C4 dermatome
Shirt collar
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Level of T4 dermatome
Nipples
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Level of T7 dermatome
Xiphoid process
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Level of T10 dermatome
Umbilicus
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Level of L1 dermatome
Inguinal ligament
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Level of L4 dermatome
Kneecaps
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Only cranial nerve that decussates immediately
Trochlear
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Parinaud syndrome
Paralysis of the conjugate vertical gaze, due to superior colliculus lesion (e.g. pineal gland tumor)
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Cranial nerve nuclei in the midbrain
III and IV
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Cranial nerve nuclei in the pons
V, VI, VII, and VIII
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Cranial nerve nuclei in the medulla
IX, X, XI, and XII
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3 nuclei of the vagal nerve
- Nucleus solitarius mediates visceral sensory information (taste, baroreceptors, gut distension)
- Nucleus ambiguus mediates motor innervation of the pharynx, larynx, and upper esophagus
- Dorsal motor nucleus sends autonomic innervation to the heart, lungs, and upper GI tract
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What passes through the foramen spinosum?
Middle meningeal artery
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What passes through the optic canal?
CN II, ophthalmic artery, central retinal vein
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What passes through the superior orbital fissure?
CN III, IV, V1, and VI, the ophthalmic vein, and sympathetic fibers to the eye
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Which CN is most susceptible to damage in the cavernous sinus?
CN VI, becuase it is free floating, and thin
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Muscle that opens the jaw is called ____ and is innervated by CN ____
Lateral pterygoid, innervated by CN V3
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What innervates the tensor veli palatini?
V3
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What happens to the macula if the retinal artery is occluded?
It turns cherry red, because it has its own blood supply from the choroid artery
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Actions of the superior oblique
- Abducts the eye
- Intorts and depresses when the eye is adducted
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Medial longitudinal fasisculus lesion
- Medial rectus palsy on lateral gaze
- Nystagmus is abducting eye
- Common in MS
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What does left hemianopia with macular sparing indicate?
PCA stroke, lesioning visual cortex in occipital lobe
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What is apoE4 associated with?
Late onset alzheimer's
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What gene has a protective effect against alzheimer's?
ApoE2
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Labs show increased IgG in the CSF with oligoclonal bands on electrophoresis--what is the diagnosis?
MS
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Virus that typically infects temporal lobes
Herpes
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Brief, unilateral headache associated with periorbital pain, lacrimation, and rinorrhea
- Cluster headache
- Treat with sumatriptan
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Most likely cause of brain tumor at the grey-white junction
Mets
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Tumor in cerebral hemispheres that stains positive for GFAP with histology that shows pleomorphic tumor cells surrounding areas of central necrosis and hemorrage
Glioblastoma multiforme
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Tumor in parasaggital region with psammoma bodies
Meningioma
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S-100 positive tumor found at angle between cerebellum and pons
Schwannoma
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What disease are bilateral schwannomas associated with?
NF-2
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Tumor in frontal lobe with chicken wire capilllary pattern and fried egg cells
Oligodendroglioma
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Cerebellar tumor with rosette pattern and small blue cells on histology--what's it called, and how do you treat it?
Medulloblastoma. Treat with radiation.
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Tumor found in fourth ventricle with perivascular pseudorosettes on histology
Ependymoma
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Px presents with a cerebellar tumor, retinal angiomas, and polycythemia
Von Hippel Lindau syndrome
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Tumor in an immunocompromised patient that stains positive for CD20
Primary B cell lymphoma, probably due to EBV infection
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Duret hemorrhages
Caused by rupture of the paramedian artery, due to caudal displacement of the brainstem
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