1st AID USMLE Step 1 Neurology and Psychiatry Pathology2

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Transmission of polio: fecal oral
polioreplication site: oropharynx and small intestine
polio pathology: destructionof anterior horn of spinal cord, lmn destruction
symptoms of polio: nonspecific flu like
LMN lesion signs
muscle weakness muscle atrophy fasciculation fibrillation hyporeflexia hypotony UMN or LMN?: LMN
lab findings in polio: CSF with lymphatosis, elev prot

virus recovered from stool or throat
1 MS 2 Progressive multifocal leukoencephalaopathy (PML)--aids 3 acute disseminated encephalomyelitis (postinfectious) 4 Metachromatic leukodystrophy (lysosomal storage 5 Guillan-Barre common pathology?: Demyelinating and dysmyelinating diseases
classic triad of MS: SIN:
Scanning speech
Intention tremor
Nystagmus
white chicks in 20's--30's
Treatment of MS: beta interferon or immusuppression
lab findings in Guillain barre: elevated CSF protein
normal cell count

*"albuminocytologic dissociation"

elevated protein -> papilledema
seizure with intact consciousnes motor, sensory, autonomic, psychic sx: simple partial
seizure with impaired consciousness; 1 area of brain: complex partial
Blank stare seizure: petite mal--generalized
seizure with quick repetitive jerks: myoclonic--generalized
seizure with alternating stiffening and movement: tonic clonic--generalized
seizure with stiffening: tonic--generalized
"drop" seizure: atonic--generalized
hematoma type from rupture of middle meningeal artery: epidural hematoma
bleeding type from rupture of bridging veins --shaken baby, trauma in elderly: subdural hematoma
bleeding type from rupture of aneurysm: subarachnoid
"worst headache of my life"

--bloody spinal tap
HTN amyloid angiopathy diabetes mellitus tumor causes of type hematoma?: parenchymal
genetic conditions associated with berry aneurysm: APKD
Ehlers Danlos
Marfans
most common primary brain tumor: glioblastoma multiforme
prognosis of glioblastoma multiforme: grave, under 1 year
staining method for glioblastoma: GFAP, it is grade IV astrocytoma
appearance of glioblastoma: pseudopalisading tumor cells--border central areas of necrosis and hemorrhage
2nd most common primary brain tumor: meningioma
tumor which most often occurs in convexivities of hemispheres and parasagittal region: meningioma
prognosis of meningioma: resectable
what cell type in meningioma: arachnoid
brain tumor with spindle cells concentrically arranged in a whorled pattern; psammoma bodies: meningioma
3rd most common primary brain tumor: schwannoma
bilateral schwannoma associated with what condition: neurofibromatosis type 2
brain tumor with "fried egg" cells round nuclei with cytoplasm often calcified: oligodendroma
brain tumor characterized by rosenthal fibers--eosinophilic corkscrew fibers: pilocytic astrocytoma
brain tumor with rosettes, or perivascular pseudorosette pattern of cells: medulloblastoma
highly malignant cerebellar tumor, form of primitive neuroctodermal tumor (PNET): medulloblastoma
brain tumor with rod shaped blepharoplasts (basal ciliary bodies) found near nucleus: Ependymoma
Brain tumor with foamy cells and high vascularity: hemangioblastoma
tumor most often cerebellar
associated with von Hippel-Lindau syndrome
****when found with retinal angiomas: hemangioblastoma
brain tumor which can cause 2ndary polycythemia: hemangioblastoma

can produce EPO
Origin of craniopharyngioma: remnants of Rathke's pouch
glioblastoma multiforme peak incidence in kids or adults?: adults
meningioma peak incidence in kids or adults?: adults
schwannoma peak incidence in kids or adults?: adults
oligodendroglioma peak incidence in kids or adults?: adults
pituitary adenoma peak incidence in kids or adults?: adults
pilocytic astrocytoma peak incidence in kids or adults?: kids
medulloblastoma peak incidence in kids or adults?: kids
ependymoma peak incidence in kids or adults?: kids
hemangioblastoma peak incidence in kids or adults?: kids
craniopharyngioma peak incidence in kids or adults?: kids
UMN lesion weakness?: yup
UMN lesion Atrophy?: no
UMN lesion fasciculations?: no
UMN lesion Reflexes up or down?: up
UMN lesion tone up or down?: up
UMN lesion Babinski?: yes
LMN lesion weakness?: yes
LMN lesion atrophy?: yes
LMN lesion fasciculation?: yes
LMN lesion reflexes up or down?: down
LMN lesion tone up or down?: down
LMN lesion babinski?: no
diseases with lower motor neuron lesions only due to destruction of anterior horns flaccid paralysis: poliomyelitis and werdnig-Hoffman disease
disease with: lesions of white matter mostly in cervical region assymetric lesions scanning speech intention tremor nystagmus: multiple sclerosis
disease with: combined upper and lower motor neuron deficits with no sensory deficit: ALS
dx? everything in spinal cord deficient but dorsal columns and tract of Lissauer: complete occlusion of ventral spinal artery
dx? degeneration of dorsal roots and dorsal columns impaired proprioception locomotor ataxia: tabes dorsalis aka 3ary syphilis
dx? bilateral loss of pain and temperature sensation: syringomyelia--crossing fibers of corticospinal tract damaged
ddx? ataxic gait hyperreflexia impaired position and vibration sense: vitamin b12 neuropathy
Friedreich's ataxia
ddx? demyelination of: dorsal columns lateral corticospinal tracts spinocerebellar tracts: vitamin b12 neuropathy
friedreich's ataxia
syringomyelia most common region: C8-T1
syringomyelia associated condition: arnold chiari malformation
dx? degeneration of dorsal columns and roots shooting pain argyll robertson pupils: tabes dorsalis aka tertiary syphilis
what is argyll robertson pupil: accomodates but does not react to light
dx? below lesion: ipsilateral umn signs ipsilateral loss of tactile, vibration, proprioception contralateral pain and temp loss LMN signs at level of lesion: brown-sequard, hemisection of spinal cord
signs of horner's, 3: ptosis
anhidrosis and flushing
miosis
1st synapse of pathway affected in horners: synapse at T1 in IML
injury at shaft of humerus expected deficit in motion?: wrist drop
**extensor carpi radialis longus
sensory deficit: posterior brachial cutaneous posterior antebrachial cutaneous likely injury site?: shaft of humerus
nerve which passes thru supinator: radial
injury at supracondyle of humerus nerve injury?: median--medial supracondyle
fracture at supracondyle of humerus vascular injury>?: brachial artery
deficient forearm pronation likely fracture site?: supracondyle of humerous
loss of sensation over lateral palm and thumb. radial 2 1/2 fingers likely fracture site?: supracondyle of humerus
what nerve passes thru pronator teres?: median
median nerve passes thru what muscle: pronator teres
radial nerve passes thru what muscle?: supinator
hand of benediction impaired wrist flexion and adduction impaired adduction of thumb and ulnar 2 fingers likely fracture site?: medial epicondyle of humerous
injury to medial epicondyle of humerus what nerve damaged?: ulnar
loss of sensation over medial palm and 1/2 fingers what nerve injury?: ulnar
ulnar nerve passes thru what muscle: flexor carpi ulnaris
what nerve passes thru flexor carpi ulnaris: ulnar
muscles innervated by musculocutaneous: coracobrachialis
biceps
brachialis
what nerve passes thru coracobrachialis: musculocutaneous
musculocutaneous passes thru what muscle: coracobrachialis
erb duchenne palsy what injured?: upper trunk of brachial plexus
C5 C6

"waiter's tip"
findings of erb duchenne palsy: "waiters tip"

*hands by side (abductors)
*medially rotated (lateral rotators)
*pronated forearm (biceps)
Consequences of injury to common peroneal nerve: Loss of dorsiflexion and eversion

PED=Peroneal Everts and Dorsiflexion

foot dropPED
Nerve roots of common peroneal nerve: L4 S2
deep peroneal innervates what compartment?: anterior
superficial peroneal innervates what compartment: lateral
lateral compartment of leg innervated by what: superficial peroneal
anterior compartment of leg innervated by what: deep peroneal
consequence of loss of tibial nerve: loss of plantar flexion

TIP=Tibial Inverts and Plantarflexes

if injured can't stand on TIP toes
tibial nerve what roots?: L4-S3
tibial nerve innervates what compartment: posterior
posterior compartment of leg innervated by what nerve: tibial
medial longitudinal fasciculus lesion what consequence?: on attempted lateral gaze:
nystagmus in abducting eye
--medial rectus palsy

*normal convergence
internuclear ophthalmoplegia associated with what condition: MS

Mlf=Ms
Anxiety neurotransmitter changes: NE up
GABA down
serotonin down
Depression neurotransmitter changes: NE down
serotonin down
Schizophrenia transmitter changes: dopamine up
Parkinson's disease neurotransmitter changes: dopamine down
NE up GABA down serotonin down what condition?: Anxiety
NE down serotonin down what condition?: Depression
dopamine up what disease?: Schizophrenia
dopamine down what disease?: Parkinson's disease

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