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2011-07-10 04:53:54

Some miscellaneous review cards for the the Neuro part of the USMLE 1
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  1. what do you see in the CSF in MS?
    increased IgG, oligoclonal bands
  2. what are two symptoms of Metachromatic Leukodystrophy?
    • 1. Motor and cognitive d/f
    • 2. Seizures
  3. what causes MLD?
    arylsufatase A deficiency (a lysosomal storage dz)
  4. Symptoms of Progressive Multifocal Leukoencenphalopathy?
    • limb weakness
    • cortical speech problems
  5. what causes PML?
    • JC virus
    • lymphohistiocytosis
    • demyelination
  6. Sx of Central Pontine Myelinolysis?
    • pseudobulbar palsy
    • spastic quadriparesis
    • mental changes
    • +/- locked-in syndrome
  7. Et of CPM?
    • focal demyelination
    • aggressive tx of hyponatremia
    • EtOHics, severely malnourished, liver dz
  8. Sx of Guillain-Barre?
    • ascending inflammatory neuropathy of PNS myelin
    • autonomic d/f
    • cranial nn involvement
    • sensory loss or pain
    • absent or decreased rflxs
  9. Et of GBS?
    • campy....2/3 of pts have respiratory or GI dz 1-3 wks bpc
    • elevated CSF protein with normal cell count: albuminocytologic dissociation
  10. the primary vesicle forebrain becomes the...
    • telencephalon and
    • diencephalon
  11. the midbrain becomes the...
  12. the hindbrain become the...
    • metencephalon and
    • myelencephalon
  13. whats in the diencephalon?
    • thalamus
    • pineal gland
    • neurohypophysis
    • hypothalamus
    • retina
  14. whats in the metencephalon?
    • pons and
    • cerebellum
  15. what protein does anterograde transport use?
    • kinesin
    • ...its fast, at 400 mm per day
  16. what protein does retrograde tpt use?
    • dynein
    • ...tpts lysosomes and recycled membrane
  17. what two features are seen in stillborn infants with oligohydramnios?
    • clubfeet
    • pulmonary hypoplasia
  18. what does the adenohypophysis derive from?
    Rathke's Pouch; an outgrowth of oral ectoderm
  19. three sx of normal pressure hydrocephalus
    • confusion
    • gait apraxia
    • urinary incontinence
  20. What is a Nissl stain/body?
    RER in neuron cell bodies
  21. What type of fibers convey proprioception?
    • 1a: spindle
    • 1b: Golgi tendon organ
  22. What type of fibers convey touch?
    II, A-beta
  23. What type of fibers convey sharp pain and cold?
    III, A-delta
  24. What fibers convey dull pain and warmth?
    4, C
  25. What is in the intermediate zone of the spinal cord from T1 to L2?
    • preganglionic sympathetic neuron cell bodies
    • the Clarke nucleus: sends unconscious proprio to cerebellum
  26. What does the corticospinal tract do?
    voluntary skeletal muscle
  27. where does the corticospinal tract originate?
    in the primary motor cortex, in the precentral gyrus of the frontal lobe
  28. Where does the corticospinal cross?
    in the brain stem, at the pyramidal decussation or the caudal medulla-spinal cord junction
  29. Where is the first synapse of the CST?
    in the ventral horn at the same level
  30. What does a lesion of the corticospinal tract above the pyrimidal decussation cause?
    contralateral weakness
  31. what does the knee stretch reflex test?
    • L2-L4
    • femoral nerve
  32. what does the ankle stretch reflex test?
    • S1
    • tibial nerve
  33. what does the biceps stretch reflex test?
    • C5-C6
    • musculocutaneous nerve
  34. what does the triceps reflex test?
    • C7-C8
    • radial nerve
  35. what is a clasp-knife reflex characteristic of?
    UMN lesion
  36. what does the the dorsal column-medial lemniscus system do?
    • sensory info for discriminative touch
    • joint position
    • vibration
    • pressure
    • ...from trunk and limbs
  37. From where does the DCML system originate, and how does it get into the cord?
    the cell bodies are in the DRG, then they enter the cord via class 2 or A-beta fibers
  38. What are the two parts of the DCML?
    • the fasciculus gracilis from the feet
    • and the fasciculus cuneatus from the arms
  39. What are the 3 receptor cell types of the DCML?
    • pacinian corpuscle
    • meissner corpuscle
    • muscle spindle
  40. Where does the DCML decussate?
    it synapses in the medulla, becomes the medial lemniscus and decussates?
  41. Where does the medial lemniscus synapse?
    in the ventroposterior-lateral nucleus of the thalamus, and then on to the post-central gyrus
  42. What do lesions of the dorsal columns cause?
    • loss of:
    • joint position sense
    • vibration
    • pressure
    • two-point discrimination
    • astereognosis: inability to identify characteristics of an object
  43. what does the spinothalamic tract do?
    pain, temperature, crude touch
  44. What is the route of the spinothalamic tract?
    receptor - DRG - tract of lissauer - synapse in dorsal horn - cross in spinal cord at the ventral commissure - synapse in the VPL -
  45. How does a lesion of the spinothalamic tract present?
    Contralateral loss of pain and temperature
  46. What does the spinocerebellar tract do?
    mostly unconscious proprioception from muscle spindles and GTOs to the cerebellum
  47. What does the dorsal spinocerebellar tract do?
    input from the lower extremities and lower trunk
  48. what does the cuneocerebellar tract do?
    proprioception from upper extremities and trunk to the cerebellumj
  49. What is the lesion and presentation of Polio?
    • deg'n of LMN of both ventral horns
    • flaccid paralysis
    • muscle atrophy
    • fasciculations
    • areflexia
  50. lesion and presentation of Tabes Dorsalis?
    • dorsal columns, pretectal nucleus
    • bilateral dorsal column signs
    • broad gait
    • pos Romberg: sways with eyes closed
    • Progressive Parasthesias Pain and Polyuria (or oligouria...)
    • Argyle Robinson pupils
  51. Pres and lesion location of ALS?
    • progressive atrophy of ventral horn - muscle atrophy
    • primary lateral sclerosis (corticospinal tract): spastic paralysis in lower limbs
    • increased tone and reflexes
    • flaccid paralysis in upper limbs
  52. Pres and lesion in Anterior Spinal Artery occlusion?
    • all but the dorsal column
    • bilateral signs
    • mid-thoracic, weakness, absence of pain and temperature
    • BUT vibration and pressure remain
  53. What is the cause and lesion in Subacute Combined Deg'n?
    • Demyelination of the dorsal columns
    • spinocerebellar tracts
    • corticocpinal tracts
  54. What is the cause, lesion, and presentation of Syringomyelia?
    • cavitation of the cord, usually cervical
    • bilateral loss of pain and temp at the level of the lesion
    • eventually, muscle weakness, then flaccid paralysis and atrophy of the upper limb muscles due to destruction of ventral horn cells