[qwiz style=”width: auto !important; min-height: auto !important; border-width: 4px !important; border-color: #0099cc !important; ” align=”center”]
[h] Neurology System Flashcards
[i] Master this session in just 5 minutes.
[q] The notochord (mesodermal) induces thickening of the overlying ectoderm through a transcription factor called ……….. to form the neural plate (neuroectoderm).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHNvbmljIGhlZGdlaG9nLg==
Cg==Jm5ic3A7
Cg==[Qq]
[q] ……… becomes the nucleus pulposus of intervertebral disc in adults.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5vdG9jaG9yZC4=[Qq]
[q] Microglia is the CNS macrophages but are derived from …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqBNZXNvZGVybS4=[Qq]
[q] ………. occurs due to failure of rostral (cranial) neuropore to close. There was a history of polyhydramnios during prenatal screening with elevated alpha-feto protein and acetyl choline esterase during amniocentesis.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFuZW5jZXBoYWx5Lg==
Cg==Jm5ic3A7
Cg==[Qq]
[q] ………. occurs due to failure of the embryonic forebrain (prosencephalon) to separate into 2 cerebral hemispheres and may be related to mutations in sonic hedgehog signaling pathway. MRI reveals monoventricle and fusion of basal ganglia (star in the figure).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEhvbG9wcm9zZW5jZXBoYWx5Lg==[Qq]
[q] Holoprosencephaly is usually associated with other midline defects. Moderate form has cleft lip/palate; most severe form results in cyclopia. It is an example of a ………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGRldmVsb3BtZW50YWwgZmllbGQgZGVmZWN0Lg==[Qq]
[q] ………. results from failure of neuronal migration resulting in a “smooth brain” that lacks sulci and gyri. May be associated with microcephaly, ventriculomegaly.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExpc3NlbmNlcGhhbHku
Cg==Jm5ic3A7
Cg==[Qq]
[q] ……… is the mildest form of spina bifida that occurs due to failure of neural tube to form vertebral arches without cystic protrusion. Usually missed with prenatal ultrasound with normal serum alpha feto protein.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNwaW5hIGJpZmlkYSBvY2N1bHRhLg==
Cg==Jm5ic3A7
Cg==[Qq]
[q] …………. is a cyst like protrusion at the site of the missing spinous processes with elevated serum maternal alpha feto protein. If the cyst contains only CSF lined by dura and arachnoid (Herniation of meninges only), it is called —> …………?. If the cyst contains CSF and displaced spinal cord lined by dura and arachnoid (Herniation of meninges and spinal cord), it is called —-> ………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNwaW5hIGJpZmlkYSBjeXN0aWNhLCBtZW5pbmdvY2VsZSwgbWVuaW5nb215ZWxvY2VsZS4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] ………. occurs due to failure of caudal neuropore to close that leads to exposed, unfused neural tissue without skin/meningeal covering. There is increase in both AFP and Acetyl choline esterase.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNwaW5hIGJpZmlkYSB3aXRoIG15ZWxvc2NoaXNpcy4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] Alpha-feto protein isn’t specific for open neural tube defects because alpha-feto protein is elevated in any body wall defect either dorsal body wall defect (open neural tube defects) or ventral body wall defect (omphalocel and gastrschisis). On the other hand, ………… is specific for neural tube defects (elevated with open neural defects only).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGFjZXR5bCBjaG9saW5lIGVzdGVyYXNlLg==[Qq]
[q] ………… occurs due to downward displacement of cerebellar tonsils through the foramen magnum. Usually asymptomatic in childhood, manifests in adulthood with headaches and cerebellar symptoms. Associated with spinal cavitations (syringomyelia).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFR5cGUgSSBBcm5vbGQgY2hpYXJpIG1hbGZvcm1hdGlvbi4=
Cg==Cg==[Qq]
[q] ………… occurs due to downward displacement of cerebellar vermis and tonsils (2 structures) through foramen magnum. Associated with noncommunicating hydrocephalus due to aqueductal stenosis, and lumbosacral meningomyelocele.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFR5cGUgSUkgQXJub2xkIGNoaWFyaSBtYWxmb3JtYXRpb24u[Qq]
[q] ……….. occurs due to agenesis of cerebellar vermis (red arrow) leading to cystic enlargement of 4th ventricle (blue arrow) that fills the enlarged posterior fossa with failure of foramina of Luschka and Magendie to open –> noncommunicating hydrocephalus.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERhbmR5IHdhbGtlciBtYWxmb3JtYXRpb24u[Qq]
[q] Name the following labels:
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==MS4gVGVsZW5jZXBoYWxvbi4=
Cg==Mi4gRGllbmNlcGhhbG9uLg==
[Qq]3. Metencephalon.
4. Myelencephalon.
[q] Lesions of UMN (corticospinal tract) before the pyramidal decussation results in muscle weakness seen in muscles on the (ipsilateral or contralateral) side of the body (at the level or below the level of the lesion).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbnRyYWxhdGVyYWwsIGJlbG93IHRoZSBsZXZlbCBvZiB0aGUgbGVzaW9uLg==
Cg==Cg==[Qq][q] Lesions of UMN (corticospinal tract) after the pyramidal decussation results in muscle weakness seen in muscles on the (ipsilateral or contralateral) side of the body (at the level or below the level of the lesion).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGlwc2lsYXRlcmFsLCBiZWxvdyB0aGUgbGV2ZWwgb2YgdGhlIGxlc2lvbi4=[Qq]
[q] A lesion to any part of a lower motor neuron will result in an (ipsilateral or contralateral) muscle weakness (at the level or below the level of the lesion).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGlwc2lsYXRlcmFsLCBhdCB0aGUgbGV2ZWwgb2YgdGhlIGxlc2lvbi4=[Qq]
[q] Hypertonia in pyramidal tract lesion (UMNL) is called ……….., but hypertonia in extrapyramidal lesion (basal ganglia lesion) is called ………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHNwYXN0aWNpdHksIHJpZ2lkaXR5Lg==
Cg==Cg==[Qq][q] Lesion of (upper motor neuron or lower motor neuron) leads to decreased muscle tone (flaccidity) at the level of the lesion, with wasting of the muscles.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExNTkwu
Cg==Cg==[Qq][q] Lesion of (upper motor neuron or lower motor neuron) leads to exaggeration of deep reflexes (hyperreflexia) below the level of the lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFVNTkwu[Qq]
[q] Lesion of (upper motor neuron or lower motor neuron) leads to diminution of deep reflexes (hyporeflexia) at the level of the lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExNTkwu[Qq]
[q] What are the spinal segments that is most likely affected in case of absent biceps reflex?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEM1LCBDNi4=
Cg==Cg==[Qq][q] What are the spinal segments that is most likely affected in case of absent Triceps reflex?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEM2LCBDNywgQzgu
Cg==Cg==[Qq][q] What are the spinal segments that is most likely affected in case of absent Patellar reflex?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEwyLCBMMywgTDQu
Cg==Cg==[Qq][q] What are the spinal segments that is most likely affected in case of absent Achilles reflex?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFMxLCBTMi4=
Cg==Cg==[Qq][q] + Babinski sign (dorsiflexion of the big toe and fanning of the other toes) is seen in cases of (upper motor neuron lesion or lower motor neuron lesion).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHVwcGVyIG1vdG9yIG5ldXJvbiBsZXNpb24u
Cg==Jm5ic3A7
Cg==[Qq]
[q] Lesion of the dorsal column – medial lemniscus pathway in any part along the entire length of the spinal cord will result in (ipsilateral or contralateral) loss of vibratory and proprioceptive sensation and below the lesion, while lesion in brain stem or above (after the 2nd order neuron crosses) will result in (ipsilateral or contralateral) loss below the level of the lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGlwc2lsYXRlcmFsLCBjb250cmFsYXRlcmFsLg==
Cg==Cg==[Qq][q] Lesions of spinothalamic tract in the spinal cord or brain stem will result in (ipsilateral or contralateral) loss of pain and temperature because the 2nd order neuron crosses almost as soon as it enters the spinal cord.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbnRyYWxhdGVyYWwu
Cg==Cg==[Qq][q] Thoracic and early lumbar sections contain ………, which are made up of sympathetic preganglionic neurons.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGxhdGVyYWwgaG9ybnMu
Cg==Cg==[Qq][q] 4. Gracile and cuneate fasciculi are present above ………., whereas only the gracile fasciculus is present below this level.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBUNyBzcGluYWwgbGV2ZWwu
Cg==Cg==[Qq][q] Hornor syndrome is always (ipsilateral or contralateral) and is presented by …………., ………….. and ………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGlwc2lsYXRlcmFsLCBwdG9zaXMsIG1pb3NpcyBhbmQgYW5oeWRyb3Npcy4=[Qq]
[q] What is the most likely diagnosis?
25 years old male who was involved in a fight at the bar and received a penetrating wound injury in his neck presenting with ipsilateral paralysis and loss of tactile, vibration, proprioception sense below level of lesion, contralateral pain and temperature loss below level of lesion, and ipsilateral Horner syndrome?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJyb3duIHNlcXVhcmQgc3luZHJvbWUu
Cg==Cg==[Qq][q] What is the most likely diagnosis?
18 years old male patient presenting with Malaise, headache, fever, nausea, Flaccid paralysis, hypotonia, hyporeflexia, fasciculation, muscle atrophy + CSF Findings: ++ WBCs, slight increase of protein with no change in glucose level?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBvbGlvbXllbGl0aXMu
Cg==Cg==[Qq][q] What is the most likely diagnosis?
2 years old child presenting with his mother with marked hypotonia (Floppy baby), tongue fasciculations, and delayed development of his developmental motor milestone?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNwaW5hbCBtdXNjdWxhciBhdHJvcGh5IChXZXJkaW5nIOKAkyBIb2ZmbWFuIGRpc2Vhc2UpLg==[Qq]
[q] What is the most likely diagnosis?
30 years old male presenting with sensory ataxia, Tabetic gait (the person’s feet slap the ground as they strike the floor due to loss of proprioception), the patient can keep his balance with eyes open but sways with the eye closed, Absence of DTRs, and the patients pupils reduce in size when the patient focuses on a near object, but do not constrict when exposed to bright light?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRhYmVzIGRvcnNhbGlzLg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
24 years old patient presenting with flaccid paralysis, fasciculation, hyporeflexia of upper limb and spastic paralysis, hyperreflexia in lower limb without any sensory or bowel/bladder deficits?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFteW90cm9waGljIGxhdGVyYWwgc2NsZXJvc2lzIChsb3UgR2Vocmln4oCZcyBkaXNlYXNlKS4=
Cg==Cg==[Qq][q] What is the most likely diagnosis?
24 years old patient presenting with flaccid paralysis, fasciculation, hyporeflexia of upper limb and spastic paralysis, hyperreflexia in lower limb with loss of pain & temperature below level of the lesion although intact touch, vibration, and proprioception after aortic aneurysm repair surgery?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFudGVyaW9yIHNwaW5hbCBhcnRlcnkgKCBBU0EgKSBvY2NsdXNpb24u
Cg==Cg==[Qq][q] What is the most likely diagnosis?
27 years old female presenting with easy fatigability sensory ataxia, spastic muscle weakness in lower limb, and impaired vibratory and proprioception sensation + lab findings shows : HB: 7.1 and MCV: 110, high homocystine and methymalony coA + peripheral blood smear shows hypersegmented neutrophils?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1YmFjdXRlIGNvbWJpbmVkIGRlZ2VuZXJhdGlvbiAoU0NEKS4=
Cg==Cg==[Qq][q] What is the most likely diagnosis?
28 years old female patient presenting with frequent burns in both of her hands while cooking or while picking up her cup of tea or coffee due to loss of pain and temperature in cape-like distribution (in the hands and forearm) + MRI of the patient is show below?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN5cmluZ29teWVsaWEu
Cg==Cg==[Qq][q] lumbar puncture is usually performed between ………….. to avoid injury of the spinal cord. The L4 vertebral body lies on a line drawn between the highest points of ……….., which can be visually identified and confirmed by palpation.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEwzLDQgT1IgTDQsNS4gdGhlIGlsaWFjIGNyZXN0cy4=
Cg==Cg==[Qq][q] What is the most likely diagnosis?
30 years old male patient presenting with lower back pain with radicular pain radiating to both legs, Saddle anesthesia, Motor weakness of both lower limb, Loss of ano-cutaneous reflex, and urinary incontinence + MRI showed disk herniation?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENhdWRhIEVxdWluYSBTeW5kcm9tZS4=
Cg==Cg==[Qq][q] Sensory dermatome at the nipple is ………… and at the umbilicus is …………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFQ0LCBUMTAu[Qq]
[q] Lesion of Corticospinal tract (pyramidal tract) in brain stem will results in (contralateral or ipsilateral) spastic weakness or paralysis below the level of the lesion?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbnRyYWxhdGVyYWwu
Cg==Jm5ic3A7
Cg==[Qq]
[q] Lesion of medial lemniscus anywhere in the brain stem will result in
(contralateral or ipsilateral) loss of vibratory and proprioceptive sensation below the level of the lesion
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbnRyYWxhdGVyYWwu
Cg==Jm5ic3A7
Cg==[Qq]
[q] lesion of spinothalamic tract anywhere in the brain stem will result in
(contralateral or ipsilateral) loss of pain and temperature below the level of the lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbnRyYWxhdGVyYWwu
Cg==Jm5ic3A7
Cg==[Qq]
[q] Corticospinal and corticobulbar tracts are always ……… in brainstem, while Spinothalamic tract and descending hypothalamic fibers are always ……….., but ……….. changes its position as it goes through brain stem from Medial to Lateral.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lZGlhbCwgTGF0ZXJhbCwgTWVkaWFsIGxlbW5pc2N1cy4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] The purely Motor cranial nerves (III, IV, VI, XII) are entering or exiting from the (Medial or lateral) part of brain stem?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lZGlhbC4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] Pure sensory and Mixed cranial nerves (V, VII, IX, X) are entering or exiting from the (Medial or lateral) part of brain stem.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGxhdGVyYWwu
Cg==Jm5ic3A7
Cg==[Qq]
[q] The corticobulbar innervation of cranial nerve lower motoneurons is predominantly (bilateral or unilateral) except the lower 1/2 of the facial nucleus & the hypoglossal nucleus which are supplied from ………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGJpbGF0ZXJhbCwgdGhlIGNvbnRyYWxhdGVyYWwgc2lkZSAodW5pbGF0ZXJhbCBpbm5lcnZhdGlvbiku
Cg==Jm5ic3A7
Cg==[Qq]
[q] Mention the cranial nerves present in the following cut section?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFVwcGVyIE1pZGJyYWluIChJSUkpLg==
Cg==Cg==[Qq][q] Mention the cranial nerves present in the following cut section?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExvd2VyIE1pZGJyYWluIChDTiBJViku
Cg==Cg==[Qq][q] Mention the cranial nerves present in the following cut section?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1pZGRsZSBwb25zIChDTiBWKS4=
Cg==Cg==[Qq][q] Mention the cranial nerves present in the following cut section?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExvd2VyIHBvbnMgKDEuIENOIFZJLCAyLiBWSUkpLg==
Cg==VGhlIGZpYmVycyBvZiBmYWNpYWwgbmVydmUgbG9vcHMgb3ZlciB0aGUgYWJkdWNlbnMgbnVjbGV1cyBhcyB0aGV5IGxlYXZlIHRoZSBmYWNpYWwgbnVjbGV1cywgdGhhdCYjODIxNztzIHdoeSBhIGxlc2lvbiBvZiBhYmR1Y2VucyBudWNsZXVzIHdpbGwgYWxzbyBpbmp1cmUgdGhlIGZhY2lhbCBuZXJ2ZSBmaWJlcnMgdGhhdCBpcyBsb29waW5nIG92ZXIgaXQu
Cg==[Qq]
[q] Mention the cranial nerves present in the following cut section?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9wZW4gTWVkdWxsYSAoMi4gQ04gSVgsIFgsIDEuIFhJSSku
Cg==Cg==[Qq][q] …………….. is the only sensory cranial nerve without thalamic relay to cortex.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgSSAoT2xmYWN0b3J5IE5lcnZlKS4=[Qq]
[q] Describe the following visual field defects?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==Cg==[Qq][q] Paradoxical dilation of both eyes while swinging of light on both eyes although intact oculomotor nerve in multiple sclerosis patient is characteristic for ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1hcmN1cyBndW5uIHB1cGlsIChSZWxhdGl2ZSBBZmZlcmVudCBwdXBpbGxhcnkgRGVmZWN0KS4=
Cg==Cg==[Qq][q] Diplopia, down and out eye position, ptosis, and loss of light and coomodation reflex are characteristic for …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9jdWxvbW90b3IgbmVydmUgbGVzaW9uLg==[Qq]
[q] ……….. is considered a unilateral Argyl Robertson pupil (the affected pupil reacts sluggishly to light, but better to accommodation) due to lesion of ciliary ganglion on the same side of the lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFkaWXigJlzIHB1cGlsLg==[Qq]
[q] …………. is affected primarily by vascular disease (diabetes
mellitus) due to ↓ diffusion of oxygen and nutrients to the interior fibers from compromised vasculature that resides on outside of oculomotor nerve.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1vdG9yIGZpYmVycy4=
Cg==Cg==[Qq][q] Diplopia (double vision) only when the patient looking downwards (going downstairs or reading) and head tilting to contralateral/unaffected side to compensate for lack of intortion in affected eye is characteristic for …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgSVYgKFRyb2NobGVhciBOZXJ2ZSwgU080KS4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] ………… carry general sensation (touch, pain and temperature) of scalp, forehead, cornea, and work as the afferent (sensory) limb of blinking reflex so, its lesion will result in —> loss of general sensation in skin of forehead and scalp and loss of blinking reflex.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9waHRoYWxtaWMgYnJhbmNoIG9mIHRyaWdpbWluYWwgbmVydmUgKFYxKS4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] …………. carry general sensation of palate, nasal cavity, maxillary face and maxillary teeth, so, its lesion will result in —> loss of general sensation in skin over maxilla and maxillary teeth.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1heGlsbGFyeSBicmFuY2ggb2YgdHJpZ2ltaW5hbCBuZXJ2ZSAoVjIpLg==
Cg==Cg==[Qq][q] …………. carry general sensation of anterior two thirds of tongue, mandibular face and mandibular teeth, so, its lesion will result in loss of general sensation in skin over mandible, mandibular teeth and tongue.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1hbmRpYnVsYXIgYnJhbmNoIG9mIHRyaWdpbWluYWwgbmVydmUgKFYzKS4=
Cg==Cg==[Qq][q] The ………… nucleus → receives information about pain and temperature of the ipsilateral face, so, its lesion will result in loss of pain & temperature of the ipsilateral face.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHNwaW5hbCB0cmlnZW1pbmFsLg==
Cg==Cg==[Qq][q] The ………. nucleus → receives information about proprioception of the face (the feeling of position of the muscles).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG1lc2VuY2VwaGFsaWMu
Cg==Cg==[Qq][q] The ………… nucleus → receives information about touch and vibratory sensation of the face.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNoaWVmIChtYWluKSBzZW5zb3J5Lg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
27 years old female presenting with severe attacks of unilateral pain along the distribution of the trigeminal nerve, the patient describes the pain as “a knife stabbing my face”. The attacks are precipitated by movement of the jaw as laughing, brushing of the teeth, mastication and last several days or weeks. The patient’s symptoms improved significantly after using Carbamazepine?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRyaWdlbWluYWwgbmV1cmFsZ2lhLg==[Qq]
[q] The lesion of motor division of trigeminal nerve will result in —> deviation of the jaw (towards or away from) the side of the lesion?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRvd2FyZC4=[Qq]
[q] ……… innervate only one extraocular muscle, lateral rectus (LR6) which abduct the eyeball, so, lesion of abducens nerve will result in (diplopia & internal strabismus).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgVkkgKEFiZHVjZW5zIE5lcnZlLCBMUjYpLg==[Qq]
[q] ………… give motor innervation to Stapedius muscle, receives taste sensations from the anterior 2/3 of the tongue, and supplies the lacrimal gland as well as the submaxillary and sublingual salivary glands.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgVklJIChGYWNpYWwgbmVydmUpLg==[Qq]
[q] ………….. courses through the parotid gland, but doesn’t innervate it, so it’s liable for injury in parotid surgery or compression by parotid gland tumors (usually malignant).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRoZSBmYWNpYWwgbmVydmUu
Cg==Jm5ic3A7
Cg==[Qq]
[q] Lesion A will result in ………………….., while lesion B will result in …………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==74KnIExlc2lvbiBBOiBMZXNpb24gb2YgYWxsIHVwcGVyIG1vdG9yIG5ldXJvbnMgb2YgZmFjaWFsIG5lcnZlIHdpbGwgcmVzdWx0IGluICYjODIxMjsmIzgyMTE7Jmd0OyBjb250cmFsYXRlcmFsIGxvd2VyIGZhY2Ugd2Vha25lc3MgKG11c2NsZXMgb2YgdGhlIG5vc2UgYW5kIG1vdXRoKSwgYnV0IHVwcGVyIGZhY2UgaXMgaW50YWN0IChtdXNjbGVzIG9mIGZvcmVoZWFkIGFuZCBleWVsaWQpIGJlY2F1c2UgaXQmIzgyMTc7cyBiaWxhdGVyYWxseSBpbm5lcnZhdGVkIChjb3J0aWNvYnVsYmFyIHRyYWN0cyBvZiBib3RoIHNpZGVzKS4=
Cg==[Qq] Lesion B: Lesion of all lower motor neurons of facial nerve (lesion of facial nucleus or facial nerve fibers) will result in —> ipsilateral complete facial palsy (Bell’s palsy).
In addition to unilateral facial paralysis, patient with Bell’s palsy may experience decreased tearing, hyperacusis, and loss of taste sensation over the anterior 2/3 of the tongue.
[q] Low frequency sound is best detected at …………, but high frequency sound is best detected at ……………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBhcGV4IG9mIHRoZSBjb2NobGVhIG5lYXIgdGhlIGhlbGljb3RyZW1hLCB0aGUgYmFzZSBvZiB0aGUgY29jaGxlYSBuZWFyIHRoZSBvdmFsIGFuZCByb3VuZCB3aW5kb3dzLg==
Cg==Cg==[Qq][q] Tympanic membrane (external ear) and Ossicles (middle ear) function is to amplify (conduct) sound through the air. That’s why any lesion of external (wax accumulation) or middle ear (otitis media, otosclerosis) → cause (conductive or sensorineural) hearing loss?. But lesion of hair cells in the inner ear or cranial nerve VIII will result in → (conductive or sensorineural) hearing loss?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbmR1Y3RpdmUsIHNlbnNvcmluZXVyYWwu[Qq]
[q] Otosclerosis is abnormal growth of bone near the middle ear —> (conductive or sensorineural) hearing loss.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbmR1Y3RpdmUu[Qq]
[q] Noise-induced hearing loss in a rock musician who has spent a lot of time in his studio recently results from damage to ………..?. ………… is lost first, regardless of the frequency of the sound causing the damage?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBzdGVyZW9jaWxpYXRlZCBoYWlyIGNlbGxzIG9mIHRoZSBvcmdhbiBvZiBDb3J0aSwgSGlnaC1mcmVxdWVuY3kgaGVhcmluZy4=[Qq]
[q] Lesion A will result in …………., but lesion B will result in ………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==TGVzaW9uIEEuIExlc2lvbnMgYmVmb3JlIHRyYXBlem9pZCBib2R5IChzaXRlIG9mIGNyb3NzaW5nKTogTGVzaW9uIG9mIGNvY2hsZWFyIHBhcnQgb2YgdGhlIGVpZ2h0aCBjcmFuaWFsIG5lcnZlIG9yIGNvY2hsZWFyIG51Y2xldXMgJiM4MjEyOyZndDsgcHJvZm91bmQgc2Vuc29yaW5ldXJhbCBoZWFyaW5nIGxvc3Mgd2hpY2ggd2lsbCBiZSB1bmlsYXRlcmFsIChhZmZlY3Qgb25lIHNpZGUpLCBpcHNpbGF0ZXJhbCAoaGVhcmluZyBsb3NzIHdpbGwgYmUgYXQgdGhlIHNhbWUgc2lkZSBvZiB0aGUgbGVzaW9uKSBiZWNhdXNlIHRoZXJlIHN0aWxsIG5vIGNyb3NzaW5nLg==
Cg==[Qq]Lesion B. Lesions after trapezoid body: Lesion of the superior olivary nucleus, lateral lemniscus, inferior colliculus, medial geniculate body or primary auditory cortex —> slight sensorineural hearing loss which will be bilateral (both sides) and decreased ability to localize sounds.
[q] In (Conductive or Sensorineural) hearing loss: there is abnormal Rinne test (in affected ear) and weber test localizes to affected ear?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENvbmR1Y3RpdmUu
Cg==Cg==[Qq][q] In (Conductive or Sensorineural) hearing loss (air conduction > bone conduction): there is normal Rinne test and weber test localizes to unaffected ear?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNlbnNvcmluZXVyYWwu
Cg==Cg==[Qq][q] …………. is overgrowth of desquamated keratin debris within middle ear space —> may erode ossicles & mastoid air cells —> conductive hearing. Often presents with painless otorrhea. loss.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENob2xlc3RlYXRvbWEu[Qq]
[q] ………….. is Age related bilateral/symmetric sensorineural hearing loss mostly to high pitched sounds due to loss of hair cells at the base of the chochlea (preserved low-frequency hearing at apex).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByZXNieWN1c2lzLg==[Qq]
[q] …………… is increased sensitivity to loud sounds due lesion of the facial nerve in the brain stem (weakness of the stapedius muscle that protects inner ear from loud sounds). Patients will typically complain of increased sensitivity to everyday sounds (shutting doors, ringing phones, traffic) and will often withdraw socially as a result.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh5cGVyYWN1c2lzLg==
Cg==Cg==[Qq][q] ……….. is the way that your brain moves your eyes to keep them focused on the stimulus of interest when there is a change in your head position.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZlc3RpYnVsby1vY3VsYXIgUmVmbGV4Lg==
Cg==Cg==[Qq][q] Introduction of cool water into the external ear mimics a lesion, it (inhibits or stimulates) the semicircular duct activity on the same side, and the opposite vestibular nuclei moves the eyes slowly (toward or away) the cool-water ear. The corrective or fast phase of the nystagmus moves the eyes quickly (toward or away) from the ear where the cool water was introduced. o If there is no fast correction phase, this means there is a lesion of ………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGluaGliaXRzLCB0b3dhcmQsIGF3YXksIGNlcmVicmFsIGNvcnRleC4gQ09XUw==ICg=[Qq]Cold Opposite, Warm Same)
[q] 60 years old patient with history of DM, hypertension presenting with vertigo, acute onset headache, and contralateral muscle weakness. These symptoms are suggestive of (central or peripheral) vertigo?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENlbnRyYWwgdmVydGlnby4=[Qq]
[q] What is the most likely diagnosis?
25 years old patient presenting with spinning/vertigo sensation, this sensation is triggered as the patient quickly lies back into a supine position with the head rotated 45 degrees?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJlbmlnbiBwYXJveHlzbWFsIHBvc2l0aW9uYWwgdmVydGlnbyAoQlBQViku[Qq]
[q] ……….. is a disorder of the inner ear characterized by an increased volume of endolymph due to defective absorption of endolymph. It is characterized by the triad of tinnitus, vertigo, and sensorineural hearing loss.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE3DqW5pw6hyZSBkaXNlYXNlLg==[Qq]
[q] …………… is a Viral or post-viral inflammation of the vestibular nerve. Presents with sudden onset of severe vertigo that lasts for several days without hearing loss. The disease frequently follows an upper respiratory tract infection.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhYnlyaW50aGl0aXMu[Qq]
[q] Describe the abnormalities in horizontal gaze 1, 2, 3, and 4?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==Cg==[Qq][q] ……….. give motor innervation to stylopharyngeus muscle, and receive all sensation of posterior one-third of the tongue (General sensation & Taste sensation), inner surface of tympanic membrane, Eustachian tube, tonsillar region, and upper pharynx. Its lesion will result in loss of all sensation of posterior one-third of the tongue and loss of gag reflex.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgSVggKEdsb3Nzb3BoYXJ5bmdlYWwgTmVydmUpLg==[Qq]
[q] …………. give motor innervation to muscles of palate, larynx, pharynx, receives sensory innervation from the thoracic & abdominal viscera, and is the major parasympathatic supply to the heart, the GIT glands in foregut and midgut. Its lesion will results in nasal speech & nasal regurgitation, Hoarseness, Dysphagia & palatal droop, Uvula pointing away from affected side, and Loss of gag and cough reflex.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgWCAoVmFndXMgTmVydmUpLg==[Qq]
[q] Bulbar and pseudobulbar palsy present with dysphagia, Dysarthria, Dysphonia, and Nasal regurgitation. Lower motor neuron signs (atrophy and fasciculations of the tongue, absent gag reflex) are characteristic for ……….. in contrast to ………. which presents with upper motor neuron signs (spastic tongue, exaggerated gag, and jaw jerk reflexes).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGJ1bGJhciBwYWxzeSwgcHNldWRvYnVsYmFyIHBhbHN5Lg==[Qq]
[q] Inspection of patient by inserting an otoscope speculum into the external auditory meatus in close contact with its posterior wall –> a vasovagal syncope will result leading to a decrease in blood pressure and heart rate because vagus nerve provides some cutaneous sensation to the posterior external auditory canal via ………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGF1cmljdWxhciBicmFuY2gu
Cg==Cg==[Qq][q] Foreign bodies (chicken or fish bones) can become lodged in the piriform recess and may cause damage to ……….. impairing the cough reflex?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGludGVybmFsIGxhcnluZ2VhbCBuZXJ2ZSAoYnJhbmNoIG9mIHN1cGVyaW9yIGxhcnluZ2VhbCBuZXJ2ZSku
Cg==Cg==[Qq][q] ………… is a purely motor nerve that supplies 2 muscles: Sternomastoid that rotate the head to the opposite side, and Trapezius that elevates the shoulder. Its lesion will results in weakness in turning head to opposite side and shoulder droop.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgVkkgKEFjY2Vzc29yeSBOZXJ2ZSku[Qq]
[q] ………… is a purely motor nerve that supplies all muscles of the tongue except palatoglossus (X). Its lesion will result in —> deviation of the tongue toward the side of the lesion on protrusion (tongue licks the lesion) due to weakened tongue muscles on affected side.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pYWwgTmVydmUgVklJIChIeXBvZ2xvc3NhbCBOZXJ2ZSku[Qq]
[q] …………… which is a branch from vertebral artery supplies the ventromedial part of the medulla.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFudGVyaW9yIHNwaW5hbCBhcnRlcnkgKEFTQSku
Cg==Jm5ic3A7
Cg==[Qq]
[q] …………… which is a branch from vertebral artery supplies the dorsolateral part of the medulla.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBvc3RlcmlvciBpbmZlcmlvciBjZXJlYmVsbGFyIGFydGVyeSAoUElDQSku
Cg==Jm5ic3A7
Cg==[Qq]
[q] …………… which is a branch from basilar artery supplies the medial pons.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBhcmFtZWRpYW4gYXJ0ZXJpZXMgKG5lYXIgdGhlIG1pZGxpbmUpLg==
Cg==Jm5ic3A7
Cg==[Qq]
[q] ………….. which is a branch from basilar artery supplies lateral part of rostral pons (upper pons).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1cGVyaW9yIGNlcmViZWxsYXIgYXJ0ZXJ5Lg==
Cg==Jm5ic3A7
Cg==[Qq]
[q] ………….. which is a branch from basilar artery supplies lateral part of the caudal pons (lower pons).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFudGVyaW9yIGluZmVyaW9yIGNlcmViZWxsYXIgYXJ0ZXJ5IChBSUNBKS4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] Branches of the …………. give different branches that supply medial and lateral midbrain.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHBvc3RlcmlvciBjZXJlYnJhbCBhcnRlcnku
Cg==Jm5ic3A7
Cg==[Qq]
[q] Lesions in the brain stem to any of the long tracts except for the descending hypothalamic fibers will result in a (contralateral or ipsilateral) deficit?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbnRyYWxhdGVyYWwu[Qq]
[q] What is the most likely diagnosis?
Spastic paresis, loss of touch, vibration and proprioception on the right side of the body with flaccid paralysis of tongue with tongue deviation to left side of the lesion on protrusion?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGxlZnQgbWVkaWFsIG1lZHVsbGFyeSBzeW5kcm9tZSAoQSkgZHVlIHRvIG9jY2x1c2lvbiBvZiB0aGUgYW50ZXJpb3Igc3BpbmFsIGFydGVyeSAoQVNBKS4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] What is the most likely diagnosis?
Loss of pain & temperature of the right side of the body and left side of the face, left side miosis, ptosis and anhydrosis, limb ataxia, dysarthria, dysphagia, loss of gag reflex and diminished or absent gag reflex?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhdGVyYWwgbWVkdWxsYXJ5IChXYWxsZW5iZXJnKSBzeW5kcm9tZSAoQikgZHVlIHRvIG9jY2x1c2lvbiBvZiB0aGUgcG9zdGVyaW9yIGluZmVyaW9yIGNlcmViZWxsYXIgYXJ0ZXJ5IChQSUNBKSBvciB2YXNjdWxhciBkaXNzZWN0aW9uIG9mIHRoZSB2ZXJ0ZWJyYWwgYXJ0ZXJ5Lg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
Spastic paresis, loss of touch, vibration and proprioception on the left side of the body, and medial strabismus & diplobia of the right eye?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lZGlhbCBwb250aW5lIHN5bmRyb21lIChBKSBkdWUgdG8gb2NjbHVzaW9uIG9mIHRoZSBwYXJhbWVkaWFuIGJyYW5jaGVzIG9mIEJhc2lsYXIgYXJ0ZXJpZXMu
Cg==Cg==[Qq][q] What is the most likely diagnosis?
Loss of pain & temperature of the right side of the body and left side of the face, left side miosis, ptosis and anhydrosis, limb ataxia, left side facial paralysis, loss of taste (anterior two third of tongue), lacrimation, salivation, corneal reflex, and hyperacusis and left side hearing loss?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhdGVyYWwgcG9udGluZSBzeW5kcm9tZSAoQikgZHVlIHRvIG9jY2x1c2lvbiBvZiBhbnRlcmlvciBpbmZlcmlvciBjZXJlYmVsbGFyIGFydGVyeSAoQUlDQSku
Cg==Cg==[Qq][q] What is the most likely diagnosis?
35 years old patient presenting with paralysis of upward gaze, light-near dissociation (pupils that react to accommodation but not to light), and noncommunicating hydrocephalus (papilledema, headache, and vomiting). Pathology of ……… is the most likely cause of this patient’s symptoms?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEMu
Cg==Cg==[Qq][q] CN II, ophthalmic artery, central retinal vein pass through …….. in middle cranial fossa?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9wdGljIGNhbmFsLg==
Cg==Cg==[Qq][q] CN III, IV, VI, V1, ophthalmic vein, sympathetic fibers pass through ………… in middle cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1cGVyaW9yIG9yYml0YWwgZmlzc3VyZS4=
Cg==Cg==[Qq][q] CN V2 of trigiminal nerve pass through ………… in middle cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEZvcmFtZW4gUm90dW5kdW0u[Qq]
[q] CN V3 of trigiminal nerve pass through ………… in middle cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEZvcmFtZW4gT3ZhbGUu[Qq]
[q] Middle meningeal artery pass through ………… in middle cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEZvcmFtZW4gc3Bpbm9zdW0u[Qq]
[q] CN VII, VIII pass through ………… in posterior cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEludGVybmFsIGF1ZGl0b3J5IG1lYXR1cy4=
Cg==Cg==[Qq][q] CN IX, X, XI, jugular vein pass through ………… in posterior cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEp1Z3VsYXIgZm9yYW1lbi4=
Cg==Cg==[Qq][q] CN XII pass through ………… in posterior cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh5cG9nbG9zc2FsIGNhbmFsLg==[Qq]
[q] Spinal roots of CN XI, brain stem, vertebral arteries pass through ………… in posterior cranial fossa.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEZvcmFtZW4gbWFnbnVtLg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
70 years old patient with history of prostatic cancer presenting with dysphagia, Dysphonia/hoarseness, Loss of taste from the posterior 1/3 of the tongue, Loss of gag reflex and sternocleidomastoid and trapezius muscle paresis. The patient tongue is normal without atrophy or fasciculation or deviation?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEp1Z3VsYXIgZm9yYW1lbiAoVmVybmV0KSBzeW5kcm9tZS4=
Cg==Cg==[Qq][q] What is the most likely diagnosis?
35 years old patient presenting with loss of smell associated with ageusia (loss of taste) and inability to recognise flavor of many food and beverages after head trauma in car accident?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEF2dWxzaW9uIG9mIHRoZSBvbGZhY3RvcnkgbmVydmUgcm9vdGxldHMgYXMgdGhleSB0cmFuc3ZlcnNlIHRoZSBjcmlicmlmb3JtIHBsYXRlIGR1ZSB0byBBY2NlbGVyYXRpb24tZGVjZWxlcmF0aW9uIGZvcmNlcy4=
Cg==Cg==[Qq][q] …………….. are most susceptible to injury in case of cavernous sinus syndrome because they are more medial
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENOIFZJIGFuZCBpbnRlcm5hbCBjYXJvdGlkIGFydGVyeS4=
Cg==Cg==[Qq][q] Symptoms that mimic cavernous sinus syndrome without pituitary tumor or spreading infection to cavernous sinus is most likely due to ……………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENhdmVybm91cyBjYXJvdGlkIGFuZXVyeXNtLg==
Cg==Cg==[Qq][q] ………… controls the axial and proximal musculature of the limbs.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRoZSB2ZXJtaXMu
Cg==Cg==[Qq][q] …………. controls distal musculature of the limbs.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRoZSBpbnRlcm1lZGlhdGUgcGFydCBvZiBjZXJlYmVsbGFyIGhlbWlzcGhlcmUu
Cg==Jm5ic3A7
Cg==[Qq]
[q] …………. is the part of cerebellum is involved in motor planning.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRoZSBsYXRlcmFsIHBhcnQgb2YgY2VyZWJlbGxhciBoZW1pc3BoZXJlLg==
Cg==Jm5ic3A7
Cg==[Qq]
[q] ……….. is involved in control of balance and eye movement.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRoZSBmbG9jY3Vsb25vZHVsYXIgbG9iZS4=
Cg==Jm5ic3A7
Cg==[Qq]
[q] The symptoms associated with cerebellar lesions will be (ipsilateral or contralateral)? and why?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGlwc2lsYXRlcmFsIGR1ZSB0byBkb3VibGUgY3Jvc3Npbmcu
Cg==Cg==[Qq][q] Ipsilateral ataxic gait, Scanning speech, intention Tremors, Dysmetria, Dysdiadochokinesia, and nystagmus are characteristic for (Medial or lateral) cerebellar lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhdGVyYWwgbGVzaW9ucyAobGVzaW9ucyB0aGF0IGluY2x1ZGUgdGhlIGhlbWlzcGhlcmUpLg==[Qq]
[q] Truncal ataxia (wide-based cerebellar ataxic gait) is characteristic for (Medial or lateral) cerebellar lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lZGlhbCBsZXNpb25zIChsZXNpb25zIHRoYXQgaW5jbHVkZSB0aGUgdmVybWlzKS4=[Qq]
[q] How to differentiate ataxic gait in patient with vermal lesion from those with a lesion of the dorsal column?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]ICYjODIxMTsgQnkgUm9tYmVyZyBzaWduOg==
Cg==wqBJbiBjZXJlYmVsbGFyIGxlc2lvbnMg4oaSIHBhdGllbnRzIHdpbGwgc3dheSBvciBsb3NlIHRoZWlyIGJhbGFuY2Ugd2l0aCB0aGVpciBleWVzIG9wZW4gb3IgY2xvc2Uu
Cg==[Qq]In dorsal column lesion → patients sway with their eyes closed only (+ Romberg sign).
[q] What is the most likely diagnosis?
15 years old patient presenting with muscle weakness in the arms and legs, gait ataxia, staggering gait, frequent fall, nystagmus and dysarthria (slurred speech) with loss of vibratory and proprioception sense + kyphoscoliosis, pes cavus, and hammer toes?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEZyaWVkcmVpY2ggQXRheGlhLg==
Cg==Cg==[Qq][q] ………… is an autosomal recessive trinucleotide repeat disorder (expansion of the GAA triplet repeat) on chromosome 9 in gene that codes farataxin protein.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEZyaWVkcmVpY2ggQXRheGlhLg==
Cg==Cg==[Qq][q] The most common cause of death in Friedreich Ataxia is ………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGh5cGVydHJvcGhpYyBjYXJkaW9teW9wYXRoeS4=
Cg==Cg==[Qq][q] ………….. symptoms closely mimic Friedreich ataxia because many of the same areas of the CNS are affected?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHZpdGFtaW4gRSBkZWZpY2llbmN5Lg==[Qq]
[q] The net effect of the disinhibition in the direct pathway results in an (decreased or increased) level of cortical excitation and the (initiation or inhibition) of movement.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGluY3JlYXNlZCwgaW5pdGlhdGlvbi4=
Cg==Cg==[Qq][q] The net effect of the disinhibition in the indirect pathway results in (decreased or increased) level of cortical excitation and the (initiation or inhibition) of unwanted movement.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGRlY3JlYXNlZCwgaW5oaWJpdGlvbi4=
Cg==Cg==[Qq][q] Dopaminergic neurons in the substania nigra which project to striatum. Dopamine (excites or inhibits) the direct pathway through D1 receptors and (excites or inhibits) the indirect pathway through D2 receptors?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGV4Y2l0ZXMsIGluaGliaXRzLg==[Qq]
[q] Where do you expect the signs of right basal ganglia lesion will be?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9uIHRoZSBsZWZ0LsKgSXQgd2lsbCBpbmZsdWVuY2UgdGhlIGluaXRpYXRpb24gb2YgbW92ZW1lbnQgb24gdGhlIGNvbnRyYWxhdGVyYWwgc2lkZS4gQmVjYXVzZSB0aGUgUmlnaHQgYmFzYWwgZ2FuZ2xpYSBwcm9qZWN0cyB0byB0aGUgcmlnaHQgbW90b3IgY29ydGV4IHRoYXQgaW5uZXJ2YXRlcyB0aGUgbGVmdCBzaWRlIG9mIHRoZSBib2R5IGJlY2F1c2UgY29ydGljb3NwaW5hbCB0cmFjdCAoVU1OKSBjcm9zc2VzIGluIGxvd2VyIG1lZHVsbGEu[Qq]
[q] What is the most likely diagnosis?
63 years old patient presenting with bradykinesia, cogwheel rigidity, pill-rolling resting tremors and shuffling gate + Brain Biochemical change of the patient showed low level of dopamine in substania nigra?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBhcmtpbnNvbiBkaXNlYXNlLg==
Cg==Cg==[Qq][q] Patients with medically intractable symptoms of Parkinson disease may benefit from high-frequency deep brain stimulation of the globus pallidus internus or ………….. as it promotes thalamo-cortical disinhibition with improved mobility.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHN1YnRoYWxhbWljIG51Y2xldXMu[Qq]
[q] ………….. is autosomal dominant trinucleotide repeat disorder on chromosome 4 (CAG) —> degeneration of GABAnergic neurons in neostriatum (mainly caudate nucleus) —> leading to atrophy of caudate nucleus → enlargement of the frontal horns of the lateral ventricles.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh1bnRpbmd0b24gZGlzZWFzZS4=[Qq]
[q] What is the most likely diagnosis?
45 years old patient presenting with sudden, jerky, purposeless movement with writhing, snake like movement + relatives also noticed the patient lately have severe depression and become so aggressive + Brain Biochemical change of the patient showed low level of GABA and ACH?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh1bnRpbmd0b24gZGlzZWFzZS4=[Qq]
[q] What is the most likely diagnosis?
40 years old patient with history of liver cirrhosis presenting with bradykinesai, sudden, jerky, purposeless movement, and eye examination showed ring at the edges of the cornea?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFdpbHNvbiBkaXNlYXNlIChoZXBhdG9sZW50aWN1bGFyIGRlZ2VuZXJhdGlvbiku[Qq]
[q] Wilson disease (hepatolenticular degeneration) is characterized by degeneration of …………….?. But Huntington disease cause degeneration of …………………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEQgKFB1dGFtZW4pLCBBIChjYXVkYXRlKS4=
Cg==Cg==[Qq][q] Damage of the …………… which play an important role in the modulation of basal ganglia output, most commonly from a lacunar stroke cause Contralateral Wild, flinging movement of limbs.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHN1YnRoYWxhbWljIG51Y2xldXMu[Qq]
[q] ………. is is the most common diagnosed movement disorder that is inherited in an autosomal dominant fashion. Patients experience a slowly progressive symmetric postural and/or kinetic tremor that most commonly affects the upper extremities and improves with alcohol consumption.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEVzc2VudGlhbCB0cmVtb3JzLg==[Qq]
[q] First line treatment of Essential tremors is …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBub25zcGVjaWZpYyBiZXRhIGJsb2NrZXJzIGFzIHByb3ByYW5vbG9sLg==[Qq]
[q] ……………. nucleus of the thalamus receive sensory input from Spinothalamic and dorsal column/medial lemniscus that is responsible for Vibration, Pain, Pressure, Proprioception, Light touch, and Temperature?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZlbnRyYWwgUG9zdGVyby1MYXRlcmFsIE51Y2xldXMgKFZQTCku
Cg==Cg==[Qq][q] ……………. nucleus of the thalamus receive sensory input from Trigeminal and gustatory pathway that is responsible for Face sensation, taste?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZlbnRyby1Qb3N0ZXJvLU1lZGlhbCBudWNsZXVzIChWUE0pLg==
Cg==Cg==[Qq][q] ……………. nucleus of the thalamus receive sensory input from CN II that is responsible for Vision?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhdGVyYWwgR2VuaWN1bGF0ZSBudWNsZXVzIChMR04pLiBMYXRlcmFsIGZvciBMaWdodC4=
Cg==Cg==[Qq][q] ……………. nucleus of the thalamus receive sensory input from Superior olive and inferior colliculus of tectum that is responsible for Hearing?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lZGlhbCBnZW5pY3VsYXRlIG51Y2xldXMgKE1HTikuIE1lZGlhbCBmb3IgTXVzaWMu[Qq]
[q] …………… necleus of the thalamus receive motor input from Basal ganglia & cerebellum before projection to motor cortex.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZlbnRyYWwsIGxhdGVyYWwgTnVjbGV1cyAoVkwp[Qq]
[q] What is the most likely diagnosis?
58 years old patient with history of DM, Hypertension presenting with total sensory loss on the left side of the body and face (pure hemisensory loss) without any motor affection for 8 months + the patient recently complains of severe paroxysmal burning pain over the affected area and is classically exacerbated by light touch?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==
Cg==[Qq][f]IFRoYWxhbWljIHN5bmRyb21lLg==[Qq]
[q] ………… nucleus of hypothalamus function as the feeding centre and its lesion results in Anorexia, failure to thrive.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhdGVyYWwgbnVjbGV1cy4gTGF0ZXJhbCBpbmp1cnkgbWFrZXMgeW91IExlYW4u
Cg==Cg==[Qq][q] ………… nucleus of hypothalamus function as the Satiety centre and its lesion in craniopharyngioma —> Hyperphagia, obesity.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZlbnRyb01lZGlhbCBudWNsZXVzLiBWZW50cm9NZWRpYWwgaW5qdXJ5IG1ha2VzIHlvdSBWZXJ5IE1hc3NpdmUu
Cg==Cg==[Qq][q] ………… nucleus of hypothalamus function as the Cooling centre, stimulate the parasympathetic nervous system centre and its lesion results in Hyperthermia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcsKg[Qq]
[f]IEFudGVyaW9yIG51Y2xldXMuIEEvQyA9IEFudGVyaW9yIENvb2xpbmcu
Cg==Cg==[Qq][q] ……….. nucleus of hypothalamus function as the Heating centre, stimulate the sympathetic nervous system centre and its lesion results in Poikliothermia (hypothermia).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBvc3RlcmlvciBudWNsZXVzLg==
Cg==Cg==[Qq][q] ……….. nuclei of hypothalamus Synthesize ADH and oxytocin and its lesion results in Diabetes insipidus (characterized by polydipsia and polyuria)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1cHJhLW9wdGljIGFuZCBwYXJhdmVudHJpY3VsYXIu
Cg==Cg==[Qq][q] ……….. nucleus of hypothalamus regulates circadian rhythms by receiving direct visual input and become disturbed in jet lag insomnia?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1cHJhY2hpYXNtYXRpYyBudWNsZXVzLg==
Cg==Cg==[Qq][q] ……….. nucleus of hypothalamus produces hypothalamic releasing and inhibiting factors that regulates anterior pituitary gland, has neurons that produce dopamine (prolactin inhibiting factor)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFyY3VhdGUu
Cg==Cg==[Qq][q] ………. nucleus of hypothalamus is important for thermoregulation, sexual behavior, Releases GnRH.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByZW9wdGljIGFyZWEu
Cg==Cg==[Qq][q] ………… contains choroid epithelial cells and is in the lateral, third, and fourth ventricles and secretes CSF into all ventricles, but …………. is responsible for CSF absorption and then drains into Dural venous sinuses.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENob3JvaWQgcGxleHVzLCBhcmFjaG5vaWQgZ3JhbnVsYXRpb24gLg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
51 years old patient presenting with headache, blurry vision, and vomiting + MRI shows brain tumor with increased pressure and ventricular dilatation in lateral and third ventricles, but the fourth ventricle is normal sized?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5vbmNvbW11bmljYXRpbmcgKE9ic3RydWN0aXZlKSBoeWRyb2NlcGhhbHVzIGR1ZSB0byBvYnN0cnVjdGlvbiBvZiBjZXJlYnJhbCBhcXVlZHVjdCBvZiBzeWx2aXVzLg==[Qq]
[q] What is the most likely diagnosis?
51 years old patient with history of intraventricular hemorrhage presenting with headache, blurry vision, and vomiting + MRI shows global dilatation of all brain ventricle?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENvbW11bmljYXRpbmcgaHlkcm9jZXBoYWx1cy4gSXQgdXN1YWxseSByZXN1bHRzIGZyb20gaW1wYWlyZWQgQ1NGIGFic29ycHRpb24gYnkgdGhlIGFyYWNobm9pZCBncmFudWxhdGlvbiAobm8gZHJhaW5hZ2UpLg==[Qq]
[q] What is the most likely diagnosis?
51 years old patient with history of Communicating hydrocephalus presenting with urinary incontinence, Apraxic (magnetic) gait, and Dementia + MRI is shown below and lumbar puncture shows normal ICP?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5vcm1hbCBwcmVzc3VyIGh5ZHJvY2VwaGFsdXMu[Qq]
[q] What is the most likely diagnosis?
51 years old patient with history of advanced HIV presenting with diffuse brain atrophy and dilated ventricles although normal ICP?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh5ZHJvY2VwaGFsdXMgZXggdmFjdW8u[Qq]
[q] Long term sequelae of hydrocephalus include lower extremity spasticity and hyperreflexia due to stretching of the …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHBlcml2ZW50cmljdWxhciBweXJhbWlkYWwgdHJhY3Qu[Qq]
[q] What is the most likely diagnosis?
21 years old obese female on vitamin A derivative for treatment of sever acne presenting with headache, nausea, vomiting, papilledema + MRI is negative + lumbar puncture shows normal ICP with relive of symptoms after lumbar puncture?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBzZXVkb3R1bW9yIGNlcmVicmku[Qq]
[q] ………… is the most significant complication of Pseudotumor cerebri.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGJsaW5kbmVzc8KgIGR1ZSB0byBvcHRpYyBuZXJ2ZSBjb21wcmVzc2lvbi4=[Qq]
[q] Our body is represented in the primary motor cortex and the primary somatosensory cortex upside down , the head is represented on the (lateral or medial) aspect of hemisphere then the regions for the neck, upper limb, and trunk. But on the (lateral or medial) aspect of the hemisphere the representation for the pelvis and lower limb.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGxhdGVyYWwsIG1lZGlhbC4=
Cg==Cg==[Qq][q] Lesion of motor cortex on the lateral hemisphere results in ……….., while lesion on the medial hemisphere results in ………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENvbnRyYWxhdGVyYWwgc3Bhc3RpYyBwYXJlc2lzIG9mIHVwcGVyIGxpbXAgYW5kIGZhY2UsIENvbnRyYWxhdGVyYWwgc3Bhc3RpYyBwYXJlc2lzIG9mIGxvd2VyIGxpbXAu
Cg==Cg==[Qq][q] Lesion of ……… leads to inability to make conjugate voluntary eye movement toward the right side with slow deviation of the eyes toward the left side.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExlZnTCoEZyb250YWwgZXllIGZpZWxkIChhcmVhIDgpLg==
Cg==Cg==[Qq][q] Lesion of ………….. leads to poor judgment, difficulty concentrating and problem solving, apathy (severe emotional indifference), inappropriate social behavior and the emergence of infantile suckling or grasp reflexes that are suppressed in adults (disinhibtion).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByZWZyb250YWwgY29ydGV4Lg==[Qq]
[q] There are three language centers on the lateral aspect of the left hemisphere in the vascular territory of the left middle cerebral artery:
1- …………….. is located in frontal lobe, and is the center for motor speech (make motor plan to say something).
2- ……………. is located in temporal and parietal lobe, and is the center for comprhension of spoken and written language.
3- …………… is located in parietal lobe, its significance is in transferring visual information to Wernicke’s area, in order to make meaning out of visually perceived words).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJyb2NhJiM4MjE3O3MgYXJlYSwgV2Vybmlja2UgYXJlYSwgQW5ndWxhciBneXJ1cy4=[Qq]
[q] In …………., there is difficulty in piecing together words to produce expressive speech with impaired repetition and intact comprehension (can understand written and spoken language but say almost nothing). Patients are aware of and frustrated by their problem.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJyb2NhJiM4MjE3O3MgKEV4cHJlc3NpdmUsIG5vbi1mbHVlbnQpIGFwaGFzaWEu[Qq]
[q] Lesion of …………… presents with apraxia (disruption of the patterning and execution of learned motor movement), and astereognosia (inability to recognize objects by touch).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1cGVyaW9yIHBhcmlldGFsIGxvYnVsZSAoYXJlYSA1LCA3KS4=[Qq]
[q] ………….. presents with unawareness or neglect of the left side of the body, patients may deny that the left arm or left leg belongs to them, patients may shave only the right side of their face, comb the right side of their hair, and ignore the subject located in the left side of a space. Asking a patient to fill in the numbers of a clock is a typical test that is used to detect hemi-neglect syndrome.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEhlbWlzcGF0aWFsIG5lZ2xlY3Qgc3luZHJvbWUgKGFzb21hdG9nbm9zaWEpLg==
Cg==Cg==[Qq][q] Hemispatial neglect syndrome (asomatognosia) occurs due to lesion in …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBub25kb21pbmFudCByaWdodCBwYXJpZXRhbCBsb2JlLg==[Qq]
[q] ………….. presents with alexia with agraphia, acalculia (loss of the ability to perform simple mathematical tasks), finger Agnosia (inability to recognize one’s fingers), and right – left disorientation.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqBHZXJzdG1hbm4gc3luZHJvbWUu
Cg==Cg==[Qq][q] Gerstmann syndrome occurs due to lesion in ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBhbmd1bGFyIGd5cnVzIGluIHRoZSBkb21pbmFudCBwYXJpZXRhbCBsb2JlLg==[Qq]
[q] Lesion affecting ………………. that connects Wernicke’s areas in the temporal and parietal lobe with broca’s area in the frontal lobe cause conduction aphasia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBhcmN1YXRlIGZhc2NpY3VsdXMu
Cg==Cg==[Qq][q] In …………., there is a stroke knocking out frontal lobe around Broca’s area, but Broca’s area and the arcuate fasciculus are spared. The patient presents with nonfluent aphasia with good comprehension and intact repetition.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRyYW5zY29ydGljYWwgbW90b3IgYXBoYXNpYS4=
Cg==Cg==[Qq][q] In …………., there is a stroke knocking out temporal lobe around Wernicke area, but Wernicke area and the arcuate fasciculus are spared.
The patient presents with poor comprehension with fluent speech and intact repetition.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRyYW5zY29ydGljYWwgc2Vuc29yeSBhcGhhc2lhLg==
Cg==Cg==[Qq][q] Stroke in ………… presents with left homonymous hemianopia with macular sparing and alexia without Agraphia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHJpZ2h0IHBvc3RlcmlvciBjZXJlYnJhbCBhcnRlcnku
Cg==Cg==[Qq][q] The most common aneurysm site in the circle of Willis is ………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHdoZXJlIHRoZSBhbnRlcmlvciBjb21tdW5pY2F0aW5nIGFydGVyeSBqb2lucyBhbiBhbnRlcmlvciBjZXJlYnJhbCBhcnRlcnku
Cg==Cg==[Qq][q] Posterior limb of internal capsule and genu are supplied by …………, while anterior limb is supplied by ………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExlbnRpY3Vsb3N0cmlhdGUgYnJhbmNoIG9mIG1pZGRsZSBjZXJlYnJhbCBhcnRlcnksIE1lZGlhbCBzdHJpYXRlIGJyYW5jaCBvZiBhbnRlcmlvciBjZXJlYnJhbCBhcnRlcnku
Cg==Cg==[Qq][q] Contralateral paralysis and sensory loss of the lower limb, and urinary incontinence is characteristic for stroke in ……………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFudGVyaW9yIGNlcmVicmFsIGFydGVyeS4=[Qq]
[q] Contralateral paralysis and sensory loss of the face and upper limb, nonfluent aphasia is characteristic for stroke in ……………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1pZGRsZSBjZXJlYnJhbCBhcnRlcnku[Qq]
[q] Quadriplegia; loss of voluntary facial, mouth, and tongue movements, Loss of horizontal, with preserved vertical eye movements and consciousness is characteristic for stroke in ……………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJhc2lsYXIgYXJ0ZXJ5Lg==[Qq]
[q] ………… strokes occur due to microatheroma formation and lipohyalinosis in the small penetrating arteries of the brain.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhY3VuYXIu
Cg==Cg==[Qq][q] Acute unilateral motor weakness without sensory deficits or higher cortical dysfunction (pure motor hemiparesis) is suggestive of a lacunar stroke affecting the …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHBvc3RlcmlvciBsaW1iIG9mIHRoZSBpbnRlcm5hbCBjYXBzdWxlLg==
Cg==Cg==[Qq][q] Bilateral damage to the medial temporal lobes including the ………….. results in a profound loss of the ability to acquire new information.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGhpcHBvY2FtcHVzLg==[Qq]
[q] In korsakoff syndrome there is hemorrhagic necrosis of …………. due to thiamine deficiency.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG1hbW1pbGxhcnkgYm9kaWVzLg==
Cg==Cg==[Qq][q] Confusion, Ataxia, Ophthalmoplegia in alcholic patient form the triad of ……………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFdlcm5pY2tlIGVuY2VwaGFsb3BhdGh5Lg==[Qq]
[q] The chronic effects of thiamine deficiency lead to …………… syndrome which is characterized by anterograde and retrograde amnesia, confabulation (they fill the memory gap with a fabricated story that themselves believe to be true), apathy and lack of insight.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEtvcnNha29mZi4=[Qq]
[q] Bilateral lesion of the ……….. results in disinhibited behavior (hyperphagia, hypersexuality, hyperorality).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqAgYW15Z2RhbGEu[Qq]
[q] ……………. is a part of the brainstem that plays an important role in sleep, alertness and consciousness, SO, its lesion will result in reduced level of arousal and wakefulness (Coma).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFJldGljdWxhciBhY3RpdmF0aW5nIHN5c3RlbS4=[Qq]
[q] Damage to neural structures above the red nucleus (cerebral hemispheres, internal capsule) typically results in (decorticate or decerebrate) posturing with hyperflexion of the upper limb and hyperextension of the lower limb.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGRlY29ydGljYXRlLg==
Cg==Cg==[Qq][q] Damage to the brainstem at or below the level of the red nucleus (midbrain tegmentum, pons) usually causes(decorticate or decerebrate) posturing with hyperextension of the the upper limb and lower limb.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGRlY2VyZWJyYXRlLg==
Cg==Cg==[Qq][q] There are two main type of cells that make up the nervous system → …….. and ……..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG5ldXJvbnMgYW5kIGdsaWFsIGNlbGxzLg==[Qq]
[q] ………… is a signal-transmitting cells of the nervous system and tumors arising from it are synaptophysin positive.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5ldXJvbnMu
Cg==Cg==[Qq][q] ………… is the most common glial cell type in CNS, important for repair after cerebral infarction by forming glial scar, derived from neuroectoderm, its foot processes participate in forming blood brain barrier, and tumors arising from it are GFAP (glial fibrillary acid protein) positive.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFzdHJvY3l0ZXMu
Cg==Cg==[Qq][q] …………….. is the phagocytic scavenger cells of CNS and is derived from mesodermal origin, and when infected by HIV —> it fuse to form multinucleated giant cells in CNS seen in HIV-associated dementia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1pY3JvZ2xpYS4=
Cg==Cg==[Qq][q] ………… is a ciliated simple columnar glial cells line the ventricles and central canal of spinal cord that have a role in CSF formation, circulation and absorption.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEVwZW5keW1hbCBjZWxscy4=[Qq]
[q] Demyelination of the axons in demyelinating diseases (increases or decreases) length constant (a measure of how long the depolarization signal can propagate) and (increases or decreases) time constant (time needed to propagate the action potential)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGRlY3JlYXNlcywgaW5jcmVhc2VzLg==[Qq]
[q] …………. is the cells that myelinate of axons of neurons in PNS, each schwann cell myelinates only 1 PNS axon, derived from neural crest, and may be injured in Guillain-Barre syndrome.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNjaHdhbm4gY2VsbHMu[Qq]
[q] …………. is the cells that myelinate axons of neurons in CNS, each cell can myelinate many axons, derived from neuroectoderm, and may be injured in multiple sclerosis, progressive multifocal leukoencephalopathy (PML), leukodystrophy.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9saWdvZGVuZHJvY3l0ZXMu[Qq]
[q] When the neuronal cell body become edematous and rounded, nissel substance become fine, granular and dispersed throughout the cytoplasm, with the nucleus displaced to the periphery in response to axonal injury, theses changes are called ………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNocm9tYXRvbHlzaXMu
Cg==Cg==[Qq][q] The possibilty of axonal regeneration when the axon is severed is better in (CNS or PNS)? and why?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBOUy4=
Cg==Cg==JiM4MjExOyBQTlM6IFNjaHdhbm4gY2VsbHMgc2Vuc2UgdGhlIGF4b25hbCBkZWdlbmVyYXRpb24gYW5kIGJlZ2luIHRvIHNlY3JldGUgY3l0b2tpbmVzIGFuZCBjaGVtb2tpbmVzIHRoYXQgcmVjcnVpdCBtYWNyb3BoYWdlcy4gVGhpcyBhbGxvd3MgZWZmZWN0aXZlIGNsZWFyYW5jZSBvZiBteWVsaW4gZGVicmlzIHdoaWNoLCBhbG9uZyB3aXRoIHRyb3BoaWMgZmFjdG9yIHNlY3JldGlvbiBieSBTY2h3YW5uIGNlbGxzLCBzdGltdWxhdGVzIGZvcm1hdGlvbiBvZiBhIGdyb3d0aCBjb25lIGZyb20gdGhlIHN0dW1wIG9mIHRoZSBwcm94aW1hbCBheG9uIGFuZCBmYWNpbGl0YXRlcyBuZXJ2ZSByZWdlbmVyYXRpb24u
[Qq]
– CNS: Myelin-producing oligodendrocytes become inactive or undergo apoptosis and do not assist with phagocytosis. Phagocytic macrophages/microglia are recruited more slowly because of the blood-brain barrier. This slows removal of the myelin debris, which can persist for years in the degenerating tracts and suppress axonal growth via myelin-associated inhibitory factors. Astrocytes also release inhibitory molecules and proliferate forming a glial scar that acts as a barrier to axon regeneration.
[q] Free nerve endings have fast Aδ myelinated fibers that is responsible for sensation of …………., and slow C unmyelinated fibers that is responsible for sensation of ………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBhaW4sIHRlbXBlcmF0dXJlLg==
Cg==Cg==[Qq][q] …………. is located in Glabrous (hairless) skin, adapt quickly, and is responsible for sensation of Fine/light touch, low-frequency vibration.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1laXNzbmVyIGNvcnB1c2NsZXMu
Cg==Cg==[Qq][q] …………. is located in Fingertips, adapt slowly, and is responsible for sensation of Deep static touch.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lcmtlbCBkaXNjcy4=
Cg==Cg==[Qq][q] …………. is located in Deep skin layers, ligaments, joints, adapt quickly, and is responsible for sensation of Pressure, High-frequency vibration.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBhY2luaWFuIGNvcnB1c2NsZXMu
Cg==Cg==[Qq][q] …………. is located in Fingertips, adapt slowly, and is responsible for sensation of Pressure.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFJ1ZmZpbmkgY29ycHVzY2xlcy4=
Cg==Cg==[Qq][q] The locus ceruleus is a paired brainstem nucleus located in the posterior rostral pons near the lateral floor of the fourth ventricle and functions as the principal site for …………. synthesis in the brain.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG5vcmVwaW5lcGhyaW5lLg==
Cg==Cg==[Qq][q] Serotonin-releasing neurons in the central nervous system (CNS) are located in the …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHJhcGhlIG51Y2xlaS4=
Cg==Cg==[Qq][q] Dopamine-releasing neurons in the central nervous system (CNS) are located in the …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZlbnRyYWwgdGVnbWVudHVtLCBTdWJzdGFuaWEgbmlncmEsIEh5cG90aGFsYW11cy4=
Cg==Cg==[Qq][q] Acetylcholine-releasing neurons in the central nervous system (CNS) are located in the …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJhc2FsIG51Y2xldXMgb2YgTWV5bmVydC4=
Cg==Cg==[Qq][q] GABA-releasing neurons in the central nervous system (CNS) are located in the …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE51Y2xldXMgYWNjdW1iZW5zLg==
Cg==Cg==[Qq][q] ………… is the thick outer meningeal layer closest to skull and derived from mesoderm.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IER1cmEgbWF0ZXIu
Cg==Cg==[Qq][q] ………….. is the middle meningeal layer, contains web-like connections and derived from neural crest.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFyYWNobm9pZCBtYXRlci4=
Cg==Cg==[Qq][q] ………….. is the thin, fibrous inner meningeal layer that firmly adheres to brain and spinal cord and derived from neural crest.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBpYSBtYXRlci4=
Cg==Cg==[Qq][q] Blood-brain barrier is formed by 3 structures which are ………, …………., and …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==MS0gVGlnaHQganVuY3Rpb25zIGJldHdlZW4gbm9uZmVuZXN0cmF0ZWQgY2FwaWxsYXJ5IGVuZG90aGVsaWFsIGNlbGxzLg==
CjItIEJhc2VtZW50IG1lbWJyYW5lLg==
CjMtIEFzdHJvY3l0ZSBmb290IHByb2Nlc3Nlcy4=[Qq]
[q] Dopamine hyperactivity in the ……….. pathway is associated with positive psychotic symptoms (hallucinations, delusions)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG1lc29saW1iaWMu
Cg==Cg==[Qq][q] The …………. pathway connects the hypothalamus to the pituitary gland and is responsible for the tonic inhibition of prolactin secretion. Antipsychotics can interrupt this pathway, causing increased blood prolactin levels (hyperprolactinemia), which may lead to galactorrhea (milky nipple discharge unrelated to pregnancy/breastfeeding) and menstrual irregularities (amenorrhea).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHR1YmVyb2luZnVuZGlidWxhci4=
Cg==Cg==[Qq][q] ………….. relies on a pressure gradient between mean arterial pressure (MAP) and intracranial pressure (ICP).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENlcmVicmFsIHBlcmZ1c2lvbiBwcmVzc3VyZSAoQ1BQKS4=[Qq]
[q] The most important regulator of cerebral perfusion is …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBDTzIu
Cg==Cg==[Qq][q] Why therapeutic hyperventilation may be used in acute cerebral edema (stroke, trauma) to ↓ intracranial pressure (ICP)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRoZXJhcGV1dGljIEh5cGVydmVudGlsYXRpb24gJiM4MjExOyZndDsg4oaTIFBDTzIgJiM4MjExOyZndDsgdmFzb2NvbnN0cmljdGlvbiBvZiBjZXJlYnJhbCB2ZXNzZWxzICYjODIxMTsmZ3Q7IOKGkyBjZXJlYnJhbCBibG9vZCBmbG93ICYjODIxMTsmZ3Q7IOKGkyBjZXJlYnJhbCBibG9vZCB2b2x1bWUsIGFuZCBJQ1AgYW5kIGhlbHAgcHJldmVudCBicmFpbiBoZXJuaWF0aW9uLg==
Cg==Cg==[Qq][q] In panic attacks, there is hyperventilation (↓ PCO2) —-> (increase or decrease) cerebral blood flow, which explains fainting in panic attacks?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGRlY3JlYXNlLg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
70 years old female patient presenting with her husband complaining of repetitive loss in her neighbourhood, word finding difficulty, trouble performing everyday tasks like shopping, cooking + MRI shows diffuse brain atrophy that is most prominent in Hippocampus + Biochemical changes in her brain shows decline in acetylcholine levels is most notable in basal nucleus of meynert (participates in memory & cognition) and hippocampus?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFsemhlaW1lciBkaXNlYXNlLg==
Cg==Cg==[Qq][q] Advanced Alzheimer’s disease is associated with diffuse brain atrophy. …………. is evident even in the early stages of the disease and can be detected by brain MRI?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRoZSBoaXBwb2NhbXB1cyAoQSkgaXMgdGhlIGFyZWEgb2YgdGhlIGJyYWluIGRlbW9uc3RyYXRpbmcgdGhlIGdyZWF0ZXN0IGRlZ3JlZSBvZiBhdHJvcGh5IGluIEFsemhlaW1lcuKAmXMgZGlzZWFzZS4=[Qq]
[q] In Alzheimer disease, tau protein is disturbed and hyperphosphorylated, causing microtubule structures to collapse into …………… that contribute to global neuronal dysfunction.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5ldXJvZmlicmlsbGFyeSB0YW5nbGVzLg==
Cg==Cg==[Qq][q] In Alzheimer disease, amyloid precursor protein (APP) is not properly cleared and forms amyloid fragments, these then harden into insoluble plaques and accumulate in brain tissue forming ……………. , and vessel wall causing ………………. which ↑ Risk of spontaneous lobar hemorrhage, particularly in the elderly. The most common sites of hemorrhage include the occipital and parietal lobes.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEHOsiAoQW15bG9pZCDOsikgcGxhcXVlcywgYW15bG9pZCBhbmdpb3BhdGh5Lg==
Cg==Cg==[Qq][q] All amyloids form extracellular deposits that stain with Congo red. When seen under polarized light, it gives ……………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGFwcGxlLWdyZWVuIGJpcmVmcmluZ2VuY2Uu
Cg==Cg==[Qq][q] Early onset familial Alzheimer disease (onset < 60 years old) is associated with mutation in ……………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==MS0gQW15bG9pZCBwcmVjdXJzb3IgcHJvdGVpbiAoQVBQKSBnZW5lIG9uIGNocm9tb3NvbWUgMjEu
CjItIFByZXNlbmlsaW4gMSBnZW5lIG9uIGNocm9tb3NvbWUgMTQu
CjMtIFByZXNlbmlsaW4gMiBnZW5lIG9uIGNocm9tb3NvbWUgMS4=[Qq]
[q] Apolipoprotein E4 genotype is thought to (decrease or increase) the risk of Sporadic Alzheimer disease, but ApoE2 (decrease or increase) Risk.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGluY3JlYXNlLCBkZWNyZWFzZS4=[Qq]
[q] What is the most likely diagnosis?
55 years old patient presenting with disinhibited behaviour, change in personality, poor judgement, non-fluent aphasia + MRI shows pronounced atrophy of frontal and temporal lobes + Brain biopsy shows cytoplasmic inclusions of hyperphosphorylated microtubule associated tau protein?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEZyb250b3RlbXBvcmFsIGRlbWVudGlhIChwaWNr4oCZcyBkaXNlYXNlKS4=
Cg==Cg==[Qq][q] What is the most likely diagnosis?
57 years old patient presenting with dementia and visual hallucinations, dyskinesia, and rigidity. It started with dementia followed by parkinsonian features after a few months + brain biopsy shows eosinophilic intracytoplasmic inclusions representing accumulations of alpha synuclein protein in the cortex?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExld3kgYm9keSBkZW1lbnRpYS4=[Qq]
[q] What is the most likely diagnosis?
54 years old patient presenting with ) dementia with myoclonus (startle myoclonus), CSF showing high level of 14-3-3 protein + the patient after a few days of admission, postmortem brain autopsy shows spongiform transformation of the gray matter?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyZXV0emZlbGR0LWpha29iIGRpc2Vhc2Uu
Cg==Cg==[Qq][q] …………. is the 2nd most common cause of dementia in elderly.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE11bHRpLVZhc2N1bGFyIGluZmFyY3RzIGRlbWVudGlhLg==
Cg==Jm5ic3A7
Cg==[Qq]
[q] What is the most likely diagnosis?
25 years old female presenting with unilateral visual loss associated, pain with ocular movement, diplopia, intension tremor, scanning speech, ataxia, vertigo, hemiparesis, spasticity, and hemisensory loss + she feel particularly fatigued after taking hot shower or after strenuous activity in heated environments + CSF gel electrophoresis shows oligoclonal bands + MRI shows periventricular white plaques?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE11bHRpcGxlIFNjbGVyb3Npcy4=[Qq]
[q] ………….. is a chronic autoimmune demyelinating disease affecting the white matter of the central nervous system (brain and spinal cord), most often affects women in their 20s and 30s, and it should be suspected in a patient with neurological deficits that cannot be explained by a single lesion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE11bHRpcGxlIFNjbGVyb3Npcy4=[Qq]
[q] ………… is characterized by perivenular inflammatory infiltrates made up primarily of autoreactive T lymphocytes and macrophages directed against myelin components and depletion of oligodendrocytes with patchy demyelination and glial scarring.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE11bHRpcGxlIFNjbGVyb3Npcy4=
Cg==Cg==[Qq][q]…………….. is highly myelinated fiber bundle, it is affected in MS leading to internuclear ophthalmoplegia
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lZGlhbCBsb25naXR1ZGluYWwgZmFzY2ljdWx1cyAoTUxGKS4=[Qq]
[q] What is the most likely diagnosis?
26 years old patient presenting with symmetric ascending flaccid muscle weakness and + loss of reflexes that starts after recovery of gastroenteritis + CSF finding: ↑ CSF protein with normal cell count (albuminocytologic dissociation)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEd1aWxsYW4tQmFycmUgc3luZHJvbWUu[Qq]
[q] ………… is characterized by segmental demyelination and endoneural inflammatory infiltrate are seen on the light microscopy of motor fibers, sensory fibers, peripheral nerves.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEd1aWxsYW4tQmFycmUgc3luZHJvbWUu
Cg==Cg==[Qq][q] …………. results from rapid correction of chronic hyponatremia osmotic demyelination of the axons in the central part of the pons. The typical clinical features include quadriplegia (due to demyelination of corticospinal tracts) and pseudobulbar palsy (due to demyelination of the corticobulbar tracts of CN IX, X, XI).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNlbnRyYWwgcG9udGluZSBteWVsaW5vbHlzaXMu
Cg==Cg==[Qq][q] …………… is multifocal periventricular inflammation and demyelination after infection (commonly measles or varicella zoster virus) or certain vaccinations (rabies, smallpox). Occurs usually in children. Presents with rapidly progressive multifocal neurologic symptoms, altered mental status.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFjdXRlIGRpc3NlbWluYXRlZCAocG9zdGluZmVjdGlvdXMpIGVuY2VwaGFsb215ZWxpdGlzLg==[Qq]
[q] What is the most likely diagnosis?
9 years old immigrant child presenting with seizures, myoclonus, spasticity + MRI shows inflammation, demyelination, gliosis in many cerebral areas + CSF finding: shows RNA virus in CSF?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1YmFjdXRlIHNjbGVyb3NpbmcgcGFuZW5jZXBoYWxpdGlzLg==[Qq]
[q] What is the most likely diagnosis?
32 years old child presenting with aphasia, olfactory hallucination, and personality change + Macroscopic brain examination reveals edema and hemorrhagic necrosis of the temporal lobes + CSF finding: viral DNA in CSF?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEhTViAxIGVuY2VwaGFsaXRpcy4=[Qq]
[q] What is the most likely diagnosis?
HIV positive patient with CD count less than 50 presenting with progressive dementia, motor deficits, and visual impairment + CSF finding: JC virus DNA in CSF?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByb2dyZXNzaXZlIG11bHRpZm9jYWwgbGV1a29lbmNlcGhhbG9wYXRoeSAoUE1MKS4=[Qq]
[q] What is the most likely diagnosis?
10 years old child presenting with distal weakness and sensory loss, wasting in the legs. The legs look like inverted champagne bottles, decreased deep tendon reflexes, foot drop, pes cavus, and hammer toe?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqBDaGFyY290LU1hcmllLVRvb3RoIGRpc2Vhc2Uu
Cg==Cg==[Qq][q] ……………. is an accumulation of blood between the skull bone and dura mater due to fracture of the temporal bone and subsequent rupture or tear of the middle meningeal artery (branch of Maxillary artery). Presents with Lucid interval, followed by Loss of consciousness. CT without contrast reveals hyperdense biconvex mass located between the brain and the skull not crossing suture lines.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEVwaWR1cmFsIGhlbWF0b21hLg==
Cg==Cg==[Qq][q] ………….. is an accumulation of blood between the dura mater and arachnoid due to shearing stress of cortical bridging veins after acceleration – deceleration injury. Presents with gradual onset of headache and slow decline in mental function. CT without contrast reveals crescent-shaped hemorrhage that crosses suture lines.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1YmR1cmFsIGhlbWF0b21hLg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
44 years old patient presenting with severe headache, the patient describes it as “the worst headache in my life”, confusion, fever, and nuchal rigidity + CT scan without contrast is shown below + Lumbar puncture reveals gross blood or xanthochromia?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1YmFyYWNobm9pZCBoZW1vcnJoYWdlIChTQUgpLg==[Qq]
[q] …………… occurs due to rupture of saccular (berry) aneurysm or arteriovenous malformation.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1YmFyYWNobm9pZCBoZW1vcnJoYWdlIChTQUgpLg==[Qq]
[q] More than half of the Subarachnoid hemorrhage patients develop in the vessels surrounding the ruptured aneurysm most probably due to impaired brain autoregulation, this vasospasm causes cerebral ischemia, which presents as new-onset confusion and focal neurological deficits 4-12 days after the initial insult. ……………… is often prescribed to prevent this vasospasm?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5pbW9kaXBpbmUsIGEgc2VsZWN0aXZlIGNhbGNpdW0gY2hhbm5lbCBibG9ja2VyLg==[Qq]
[q] ………… is the most common cause of intraparenchymal hemorrhage due to rupture of ……………… charcot-Bouchard microaneurysms. Hypertensive hemorrhages (Charcot-Bouchard microaneurysm) most often occur in ………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh5cGVydGVuc2lvbiwgcHV0YW1lbiBvZiBiYXNhbCBnYW5nbGlhLg==
Cg==Cg==[Qq][q] …………… causes recurrent lobar hemorrhagic stroke in Alzheimer patient especially parietal and occipital lobes.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFteWxvaWQgYW5naW9wYXRoeS4=[Qq]
[q] What is the most likely diagnosis?
Premature infant with low birth weight presenting with altered level of consciousness, bulging fontanelle, hypotension, and seizures + ultrasound of the head is shown below?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5lb25hdGFsIGludHJhdmVudHJpY3VsYXIgaGVtb3JyaGFnZS4=[Qq]
[q] Neonatal intraventricular hemorrhage occurs due to hemorrhage from ………………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGdlcm1pbmFsIG1hdHJpeC4=
Cg==Cg==[Qq][q] What is the most likely diagnosis?
35 years old patient presenting with coma after automobile accident followed by death, postmortem brain biopsy shows minute punctate hemorrhages with blurring of grey white interface with immunohistochemical staining of amyloid precursor, alpha-synuclein within axonal swellings at the point of injury?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERpZmZ1c2UgYXhvbmFsIGluanVyeS4=
Cg==Cg==[Qq][q] Neurologic paraneoplastic syndromes (paraneoplastic cerebellar degeneration) that happens with some types of cancers are due to ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGF1dG9pbW11bmUgcGhlbm9tZW5vbi4=[Qq]
[q] The cells most vulnerable to ischemia due to global cerebral ischemia are ………….., ……………., …………….., and …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBoaXBwb2NhbXB1cywgbmVvY29ydGV4LCBwdXJraW5qZSBjZWxscyBvZiB0aGUgY2VyZWJlbGx1bSBhbmQgd2F0ZXJzaGVkIGFyZWFzICjigJx2dWxuZXJhYmxlIGhpcHBvcyBuZWVkIHB1cmUgd2F0ZXLigJ0pLg==[Qq]
[q] If global cerebral ischemia is more profound, necrosis of the areas supplied by the most distal branches of the cerebral arteries can occur (between the zones of perfusion of the anterior, middle and posterior cerebral arteries), this is termed ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHdhdGVyc2hlZCBpbmZhcmN0aW9uLg==
Cg==Cg==[Qq][q] – The best initial test in any kind of stroke is …………. and it’s done to exclude to …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENUIHNjYW4gb2YgdGhlIGhlYWQgd2l0aG91dCBjb250cmFzdCwgaGVtb3JyaGFnZSBhcyBhIGNhdXNlIG9mIHRoZSBzdHJva2UgcHJpb3IgdG8gaW5pdGlhdGluZyB0cmVhdG1lbnQgKGJlZm9yZSB0UEEgY2FuIGJlIGdpdmVuLCBpdCB3b3JzZW5zIHRoZSBjYXNlIGluIGhlbW9ycmhhZ2ljIHN0cm9rZSku
Cg==Cg==[Qq][q] Although lethal ischemic injury in most organs results in coagulative necrosis of parenchymal cells, in the brain such injury produces a focus of …………… within 10 days of infarction?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGxpcXVlZmFjdGl2ZSBuZWNyb3NpcyAobHlzb3NvbWFsIGRpZ2VzdGlvbiBvZiB0aGUgYnJhaW4gdGlzc3VlKS4=[Qq]
[q] A neuron that is responding to irreversible injury is called ………………..? [c]IFNob3cgbWUgdG hlIGFuc3dlcg==
Cg==[Qq][f]IHJlZCBuZXVyb24u[Qq]
[q] Characteristic changes become evident 12-24 hours after irreversible neuronal injury are …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]ICYjODIxMTsgU2hyaW5rYWdlIG9mIHRoZSBjZWxsIGJvZHksIGVvc2lub3BoaWxpYSBvZiB0aGUgY3l0b3BsYXNtLCBweWtub3NpcyAoc2hyaW5raW5nKSBvZiB0aGUgbnVjbGV1cywgYW5kIGxvc3Mgb2Ygbmlzc2VsIHN1YnN0YW5jZS4=
Cg==Cg==[Qq][q] ………… is a brief, reversible episode of focal neurologic dysfunction without acute infarction (⊝ MRI), with the majority resolving in < 15 minutes deficits due to focal ischemia. It may present with transient loss of vision in one eye, known as amurosis fugax due to occlusion of ophthalmic artery (the first branch of carotid artery) → Retinal artery occlusion by embolus from dislodged atheromatous plaque in the carotid artery.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRyYW5zaWVudCBpc2NoZW1pYyBhdHRhY2sgKFRJQSku
Cg==Cg==[Qq][q] What is the most likely diagnosis?
43 years old patient presenting with claudication of the arm (coldness, tingling, muscle pain) and posterior neurologic signs (visual symptoms, equilibrium problems) when the arm is exercised + Duplex scanning is shows shows reversal of blood flow in vertebral artery?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1YmNsYXZpYW4gc3RlYWwgc3luZHJvbWUu
Cg==Cg==[Qq][q] What is the most likely diagnosis?
40 years old male patient presenting with repetitive brief headache that usually awaken him from sleep and lasts for about 30 minutes, the pain is unilateral excruciating periorbital pain with lacrimation, rhinorrhea, and meiosis?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENsdXN0ZXIgaGVhZGFjaGUu
Cg==Cg==[Qq][q] Abortive treatment of cluster headache is …………….. or …………..?. While prophylactic treatment is …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHN1bWF0cmlwdGFuLCAxMDAlIE8yLCB2ZXJhcGFtaWwu
Cg==Cg==[Qq][q] What is the most likely diagnosis?
40 years old female patient presenting with unilateral pulsating pain with nausea, photophobia, or phonophobia that is usually preceeded by visual or auditory aura + there is a family history of the same type of the headache in her mother?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1pZ3JhaW5lIGhlYWRhY2hlLg==
Cg==Cg==[Qq][q] Abortive treatment of migraine headache is …………….. or …………..?. While prophylactic treatment is …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5TQUlEcywgdHJpcHRhbnMsIGRpaHlkcm9lcmdvdGFtaW5lLiBsaWZlc3R5bGUgY2hhbmdlcyAoc2xlZXAsIGV4ZXJjaXNlLCBkaWV0KSwgzrItYmxvY2tlcnMsIGFtaXRyaXB0eWxpbmUsIHRvcGlyYW1hdGUsIHZhbHByb2F0ZSwgYm90dWxpbnVtIHRveGluIGluamVjdGlvbnMu
Cg==Cg==[Qq][q] What is the most likely diagnosis?
40 years old female patient presenting with constant steady pain in band like pattern around head that do not typically limit patient’s ability to perform daily functions?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRlbnNpb24gaGVhZGFjaGUu
Cg==Cg==[Qq][q] Abortive treatment of tension headache is …………….. or …………..?. While prophylactic treatment is …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGFuYWxnZXNpY3MsIE5TQUlEcywgYWNldGFtaW5vcGhlbi4gVENBcyAoYW1pdHJpcHR5bGluZSksIEJlaGF2aW9yYWwgdGhlcmFweS4=
Cg==Cg==[Qq][q] What is the most likely diagnosis?
20 years old soldier presenting with body temperature 40.5 C, hypotension, confusion after fainting in hot humid environment?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEhlYXQgc3Ryb2tlLg==[Qq]
[q] …………….. is present with port wine stain of the face (nevus flammeus), ipsilateral leptomeningeal angiomas causing seizures / epilepsy, intellectual disability, and episcleral hemangioma causing early onset glaucoma.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN0dXJnZS1XZWJlciBzeW5kcm9tZS4=
Cg==Cg==[Qq][q] ……….. is present with and subependymal hamartomas in the brain causing seizures and mental retardation, Cardiac rhabdomyomas, facial angiofibromas, and leaf shaped patches of skin lacking pigment, with increased risk of renal angiomyolipomas (tumor composed of blood vessels, smooth muscle, and fat).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFR1YmVyb3VzIHNjbGVyb3Npcy4=
Cg==Cg==[Qq][q] …………. is present with multiple neurofibromas, café au lait spots, Lisch nodules of the iris, and increased risk of meningiomas, gliomas, pheochromocytomas.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5ldXJvZmlicm9tYXRvc2lzIHR5cGUgMSAoVm9uIFJlY2tsaW5naGF1c2VuIGRpc2Vhc2UpLg==
Cg==Cg==[Qq][q] …………….. is presents with bilateral vestibular schwannomas, juvenile cataracts, with increased risk of meningiomas, ependymomas.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5ldXJvZmlicm9tYXRvc2lzIHR5cGUgSUku[Qq]
[q] …………….. is presents with capillary hemangioblastoma of the cerebellum, cavernous hemangiomas of the skin, and increased risk of bilateral renal cell carcinoma.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZvbiBIaXBwZWwtTGluZGF1IGRpc2Vhc2Uu[Qq]
[q] ……………… is the most common CNS primary malignancy in adults and the worst grade of astrocytoma. Its common location is white matter of cerebral hemisphere which can cross corpus callosum to the other cerebral hemisphere resembling butterfly shape. Its characteristic histopathological features are an area of necrosis surrounded by rows of neoplastic cells “pseudopalisading necrosis”.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEdsaW9ibGFzdG9tYSBtdWx0aWZvcm1lIChncmFkZSBJViBhc3Ryb2N5dG9tYSku[Qq]
[q] Most cases of glioblastoma multiforme are associated with oncogenic mutations that increase ……………… expression on the tumor cells, leading to increased transduction of growth signals that promote cellular survival and proliferation.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGVwaWRlcm1hbCBncm93dGggZmFjdG9yIHJlY2VwdG9yLg==
Cg==Cg==[Qq][q] …………. is the second most common primary CNS tumor in adults (Slowly growing, well circumscribed and benign tumors). It arise from cells of the arachnoid cells (external to brain parenchyma) and may have a dural attachment “tail”. Most often occurs in convexities of hemispheres and parasagittal region. Its characteristic histopathological features are psammoma bodies (a core of dense calcification with surrounding collagen-fiber bundles).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lbmluZ2lvbWFzLg==[Qq]
[q] ………… is a brain tumor of blood vessel origin and associated with von Hippel-Lindau syndrome. Usually arise from the cerebellum. Its characteristic histopathological features are closely arranged, thin-walled capillaries with minimal intervening parenchyma.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqBIZW1hbmdpb2JsYXN0b21hLg==[Qq]
[q] …………… is a tumor of the peripheral nervous system that arise from schwann cells (H). It is most common location is the cerebellopontine angle (G) involving CNs V, VII, and VIII, but often localized to CN VIII in internal acoustic meatus —> tinnitus, vertigo, and sensorineural hearing loss. Immunohistochemical staining is positive for S-100.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNjaHdhbm5vbWEu
Cg==Cg==[Qq][q] Bilateral acoustic neuroma is characteristic for …………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG5ldXJvZmlicm9tYXRvc2lzIHR5cGUgMi4=[Qq]
[q] ………………… is a brain tumor that arise from in the white matter of frontal lobe. Its characteristic histopathological features are round nuclei with clear cytoplasm “fried egg cells” with chicken wire capillary pattern.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9saWdvZGVuZHJvZ2xpb21hLg==[Qq]
[q] What is the most likely diagnosis?
HIV positive patient with CD4 count less than 30 presenting with single brain lesion in MRI?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByaW1hcnkgQ05TIGx5bXBob21hLg==[Qq]
[q] ………… is the most frequent CNS tumor in immunosuppressed patients, such as those suffering from AIDS. These tumors arise from ………… and are universally associated with ……………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByaW1hcnkgQ05TIGx5bXBob21hLCBCIGNlbGxzLCBFcHN0ZWluIEJhcnIgVmlydXMu[Qq]
[q] The most common type of benign pediatric primary brain tumor is …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHBpbG9jeXRpYyBhc3Ryb2N5dG9tYS4=
Cg==Cg==[Qq][q] The most common malignant pediatric primary brain tumor is ………………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG1lZHVsbG9ibGFzdG9tYS4=
Cg==Cg==[Qq][q] …………….. is the most common primary brain tumor in children that usually arise in posterior fossa (cerebellum). Its characteristic histopathological features are well differentiated neoplasms comprised of spindle cells with hair-like glial processes that are associated with microcysts.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBpbG9jeXRpYyAobG93LWdyYWRlKSBhc3Ryb2N5dG9tYS4=
Cg==Cg==[Qq][q] …………….. is the second most common brain tumor of childhood and most common malignant brain tumor in childhood. Present with truncal ataxia and noncommunicating hydrocephalus due to compression on cerebellar vermis and 4th ventricle. Its characteristic histopathological features are sheets of small cells with deeply basophilic nuclei and scant cytoplasm with abundant mitosis.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lZHVsbG9ibGFzdG9tYS4=
Cg==Cg==[Qq][q] ……………. is the third most common brain neoplasm in children. Most commonly found in 4th ventricle and can cause hydrocephalus. On microscopic examination, tumor cells are organized around the lumen of the ventricle and small vessels resembling rosettes “Perivascular Rosettes”.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEVwZW5keW1vbWEu
Cg==Cg==[Qq][q] …………….. is the most common childhood supratentorial tumor. Derived from remnants of Rathke pouch. Histology shows Calcification “tooth enamel like “.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENyYW5pb3BoYXJ5bmdpb21hLg==
Cg==Cg==[Qq][q] CNS tumors of (neuronal or neuroglial) origin frequently stain positively for synaptophysin on immunohistology.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5ldXJvbmFsLg==[Qq]
[q] In Cingulate (subfalcine) herniation, the cingulate gyrus herniates under the falx cerebri, potentially compressing ……………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBhbnRlcmlvciBjZXJlYnJhbCBhcnRlcnku
Cg==Cg==[Qq][q] Ipsilateral oculomotor nerve (CN III) compression, ipsilateral posterior cerebral artery compression, contralateral cerebral peduncle compression against the tentorium, are characteristic for ………….. herniation.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRyYW5zdGVudG9yaWFsIChVbmNhbCkgaGVybmlhdGlvbi4=[Qq]
[q] The most important mechanisms of the development of diabetic neuropathy are ………………. and …………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEVuZG9uZXVyYWwgYXJ0ZXJpb2xlIGh5YWxpbml6YXRpb24sIG9zbW90aWMgZGFtYWdlIHRvIGF4b25zIGFuZCBTY2h3YW5uIGNlbGxzLg==[Qq]
[q] ……………….. is caused by predominantly central nerve ischemia, which affects the central somatic nerve fibers but spares peripheral parasympathetic fibers, So, Symptoms include: ptosis, down and out gaze, but normal sized reactive pupil (normal light and accommodation reflexes).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERpYWJldGljIG9waHRoYWxtb3BsZWdpYS4=
Cg==Cg==[Qq][q] ………… is the most common cause of conjunctivitis, often due to ……………; present with red eye and sparse mucous discharge, swollen preauricular node, ↑ lacrimation; usually self-resolving.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZpcmFsIGluZmVjdGlvbiwgYWRlbm92aXJ1cy4=[Qq]
[q] ……………. occurs because the eye is too short for refractive power of cornea and lens —> light focused behind retina. Can be corrected with convex (converging) lenses.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh5cGVyb3BpYS4=
Cg==Cg==[Qq][q] ……………. occurs because the eye is too long for refractive power of cornea and lens —> light focused infront of retina. Can be corrected with concave (diverging) lenses.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE15b3BpYS4=
Cg==Cg==[Qq][q] …………….. occurs because of abnormal curvature of cornea –> different refractive power at different axes. Can be corrected with cylindrical lens.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFzdGlnbWF0aXNtLg==
Cg==Cg==[Qq][q] ………….. is aging-related impaired accommodation (focusing on near objects), primarily due to ↓ lens elasticity, changes in lens curvature, ↓ strength of the ciliary muscle.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByZXNieW9waWEu
Cg==Cg==[Qq][q] Patients with mild myopia often note improvement with age, why?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByZXNieW9waWEgY2FuIGNvbXBlbnNhdGUgZm9yIG15b3BpYSBieSBkaXNwbGFjaW5nIHRoZSBpbWFnZSBiYWNrd2FyZCwgc28gdGhhdCBpdCBmb2N1c2VzIG9uIHRoZSByZXRpbmEu
Cg==Cg==[Qq][q] ……………. is painless, often bilateral, opacification of lens, often resulting in ↓ vision. Can present with loss of red reflex in children.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENhdGFyYWN0Lg==
Cg==Cg==[Qq][q] ……………. present with cupping (thinning of outer rim of optic nerve head versus normal), usually with elevated intraocular pressure (IOP) and progressive peripheral visual field loss although normal iridocorneal angel. The most common cause is blocked trabecular meshwork from WBCs (uveitis), RBCs (vitreous hemorrhage), retinal elements (retinal detachment).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE9wZW4gYW5nbGUgZ2xhdWNvbWEu[Qq]
[q] ……………….. present with very painful, red eye [D], sudden vision loss, halos around lights, rock-hard eye, frontal headache following pupillary dilation, which may occur in darkened movie theaters, during times of stress, or due to drug intake.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFjdXRlIENsb3NlZC9uYXJyb3cgYW5nbGUgZ2xhdWNvbWEu
Cg==Cg==[Qq][q] Antimuscarinic drugs and alpha agonists are contraindicated in (closed or open) angle glaucoma.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNsb3NlZCBhbmdsZSBnbGF1Y29tYS4=
Cg==Cg==[Qq][q] ……………… ↓ aqueous humor synthesis by ciliary epithelium with no pupillary or vision changes.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IM6yIGJsb2NrZXJzIChUaW1vbG9sLCBiZXRheG9sb2wsIGNhcnRlb2xvbCku
Cg==Cg==[Qq][q] ……………….. ↓ aqueous humor synthesis via inhibition of carbonic anhydrase with no pupillary or vision changes.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERpdXJldGljcyAoQWNldGF6b2xhbWlkZSku
Cg==Cg==[Qq][q] ……………… ↑ outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork and cause miosis and cyclospasm (contraction of ciliary muscle) as side effects.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENob2xpbm9taW1ldGljczo=
Cg==MS4gRGlyZWN0IChwaWxvY2FycGluZSwgY2FyYmFjaG9sKS4=
Cg==Mi4gSW5kaXJlY3QgKHBoeXNvc3RpZ21pbmUsIGVjaG90aGlvcGhhdGUpLg==
[Qq][q] ………………. ↑ outflow of aqueous humor via ↓ resistance of flow through uveoscleral pathway and cause darkening of the color of iris (browning).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqBQcm9zdGFnbGFuZGluIChMYXRhbm9wcm9zdCwgUEdGMiku
Cg==Cg==[Qq][q] …………. is inflammation of uvea. Present with hypopyon (accumulation of pus in anterior chamber) and conjunctival redness. Associated with systemic inflammatory disorders (sarcoidosis, rheumatoid arthritis, juvenile idiopathic arthritis, HLA-B27–associated conditions).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFV2ZWl0aXMu[Qq]
[q] ……………… occurs due to deposition of yellowish extracellular material in between Bruch membrane and retinal pigment epithelium (Drusen). It causes distortion (metamorphopsia) and eventual loss of central vision (scotomas). Prevent progression with multivitamin and antioxidant supplements.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERyeSAobm9uZXh1ZGF0aXZlKSBBZ2UtcmVsYXRlZCBtYWN1bGFyIGRlZ2VuZXJhdGlvbiAoQU1EKS4=[Qq]
[q] …………………. occurs due to rapid loss of vision due to bleeding 2° to choroidal neovascularization. It causes distortion (metamorphopsia) and eventual loss of central vision (scotomas). Treat with anti-VEGF (vascular endothelial growth factor) injections (ranibizumab) or laser.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFdldCAoZXh1ZGF0aXZlKSBBZ2UtcmVsYXRlZCBtYWN1bGFyIGRlZ2VuZXJhdGlvbiAoQU1EKS4=[Qq]
[q] Diabetic retinopathy is the leading cause of blindness in the USA. Retinal damage occurs due to ………………….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNocm9uaWMgaHlwZXJnbHljZW1pYSBpbmR1Y2VkIG1pY3JvdmFzY3VsYXIgaW5qdXJ5Lg==[Qq]
[q] Dot-blot and flame-shapped hemorrhages, Hard exudates and macular edema, and cotton wool spots without neovascularization during fundoscopy of diabetic patient is characteristic for ……………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5vbnByb2xpZmVyYXRpdmUgRGlhYmV0aWMgcmV0aW5vcGF0aHku
Cg==Jm5ic3A7
Cg==[Qq]
[q] Dot-blot and flame-shapped hemorrhages, Hard exudates and macular edema, cotton wool spots, neovascularization that rupture causing vitreous hemorrhage and detachment of the retina during fundoscopy of diabetic patient is characteristic for ……………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHByb2xpZmVyYXRpdmUgZGlhYmV0aWMgcmV0aW5vcGF0aHku
Cg==Cg==[Qq][q] Thickening of the arteriolar walls (“copper or silver wiring”), compression of the associated veins (arteriovenous nicking), and small, white foci of retinal ischemia (cotton-wool spots) are characteristic for ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEh5cGVydGVuc2l2ZSByZXRpbm9wYXRoeS4=
Cg==Cg==[Qq][q] …………….. cause acute and painless monocular vision loss. Specific fundoscopic findings include a pale retina and cherry red macula.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGVudHJhbCBhcnRlcnkgb2NjbHVzaW9uLg==[Qq]
[q] ……………. is the most common cause of central artery occlusion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEVtYm9saXNtLg==[Qq]
[q] ……………. usually present with subacute monocular visual loss. The characteristic changes on funduscopic examination are sometimes referred to as the “blood and thunder” appearance and include optic disk swelling, retinal hemorrhage, dilated veins, and cotton wool spots.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENlbnRyYWwgcmV0aW5hbCB2ZWluIG9jY2x1c2lvbi4=[Qq]
[q] ………….. occurs due to separation of neurosensory layer of retina (photoreceptor layer with rods and cones) from outermost pigmented epithelium (normally shields excess light, supports retina) —> degeneration of photoreceptors —> vision loss. Often preceded by posterior vitreous detachment (“flashes” and “floaters”) and eventual monocular loss of vision like a “curtain drawn down.”
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFJldGluYWwgZGV0YWNobWVudC4=
Cg==Cg==[Qq][q] ……………. is inherited retinal degeneration. Present with painless, progressive vision loss beginning with night and peripheral blindness (rods affected first). Fundoscopy Bone spicule-shaped deposits around macula.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFJldGluaXRpcyBwaWdtZW50b3NhLg==[Qq]
[q] What is the most likely diagnosis?
HIV positive patient with CD4 count less than 30 presenting with visual disturbance + funduscopy reveals yellow-white, fluffy retinal lesions near the retinal vessels with associated hemorrhage?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENNViBSZXRpbml0aXMu[Qq]
[q] Treatment with ………………. is required to prevent blindness in CMV retinitis in HIV positive patient?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGdhbmNpY2xvdmlyLg==[Qq]
[q] ………… is optic disc swelling (usually bilateral) due to ↑ ICP (2° to mass effect). This buildup of pressure compresses the optic nerves externally, which in turn cause elevation of the optic disc with blurred disc margins.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBhcGlsbGVkZW1hLg==
Cg==Cg==[Qq][q] Every case of leukocoria in children is considered a …………….., until proven otherwise. These patients have an increased risk of secondary tumors, especially ………… later in life.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHJldGlub2JsYXN0b21hLCBvc3Rlb3NhcmNvbWFzLg==
Cg==Cg==[Qq][q] The weakest plates of bone in the orbit are …………………, are common sites of fracture. Fracture is typically evident on radiographic imaging, and fluid (blood) or herniation of the orbital contents can often be visualized in the adjacent normally air-filled sinuses.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBtZWRpYWwgYW5kIGluZmVyaW9yIHdhbGxzLg==
Cg==Cg==[Qq][q] Opioid Analgesic work on presynaptic neurons causing ……………, and on postsynaptic neurons causing ………………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==JiM4MjExOyBQcmVzeW5hcHRpYyByZWNlcHRvcnMgJiM4MjEyOyZndDsg4oaTIENhIGluZmx1eCAmIzgyMTI7Jmd0OyDihpMgc3Vic3RhbmNlIFAgcmVsZWFzZSAocGFpbiBuZXVyb3RyYW5zbWl0dGVyKS4=
Cg==JiM4MjExOyBQb3N0c3luYXB0aWMgcmVjZXB0b3JzICYjODIxMjsmZ3Q7IOKGkSBLIGVmZmx1eCAmIzgyMTI7Jmd0OyBtZW1icmFuZSBoeXBlcnBvbGFyaXphdGlvbi4=[Qq]
[q] ………… and ………. are prodrugs that is converted by the cytochrome P450 into active full opioid agonist. Cytochrome P450 inducers will increase its active form and may lead to toxicity.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENvZGVpbmUsIE1lcGVyaWRpbmUu[Qq]
[q] …………. is a full opioid agonist that increase the serotonin level and should be avoid with SSRI because it may cause serotonin syndrome. It also has antimuscarinic action (has the opposite of morphine’s smooth muscle effect), So, no miosis, no spasm of GI / GU/ Gallbladder, and tachycardia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lcGVyaWRpbmUu[Qq]
[q]……………. is a long-acting opioid drug used in maintenance of opiate addiction (opioid detoxification).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1ldGhhZG9uZS4=[Qq]
[q] ……….., ……….., and ………… shouldn’t be given to a patient on a full agonist —> it will act as antagonist —> precipitation of withdrawal.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]
Cg==MS4gQnVwcmVub3JwaGluZSAoUGFydGlhbCBhZ29uaXN0IG9waW9pZHMpLg==
Cg==Mi4gTmFsYnVwaGluZSwgcGVudGF6b2NpbmUgKG8gzrogYWdvbmlzdCBhbmQgzrwgYW50YWdvbmlzdCku
[Qq]3. Butorphanol ( o κ-opioid receptor agonist and μ-opioid receptor partial agonist).
[q] ………….. is IV opioid antagonist that is used for reversal for respiratory depression in acute opioid toxicity.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqBOYWxveG9uZS4=[Qq]
[q] …………. is per oral opioid antagonist that is used for ↓ craving for alcohol and used in opiate addiction.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]wqBOYWx0cmV4b25lLg==[Qq]
[q] …………. is opioid derivative that can be used for treatment of diarrhea.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExvcGVyYW1pZGUsIERpcGhlbm94eWxhdGUu[Qq]
[q] …………. is opioid derivative that can be used for treatment of cough.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERleHRyb21ldGhvcnBoYW4u[Qq]
[q] Morphine should be avoided in patients with pulmonary dysfunction except …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHB1bG1vbmFyeSBlZGVtYS4=[Qq]
[q] Morphine should be avoided in patients with head trauma because ………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IMKgdmFzb2RpbGF0YXRpb24gZHVlIHRvIGhpc3RhbWluZSByZWxlYXNlICYjODIxMTsmZ3Q7IGNlcmVicmFsIHZlc3NlbCBWRCAmIzgyMTE7Jmd0OyBpbmNyZWFzZWQgY2VyZWJyYWwgYmxvb2QgZmxvdyAmIzgyMTE7Jmd0OyDihpEgSUNQIChhdm9pZCBpbiBoZWFkIHRyYXVtYSku[Qq]
[q] Acute toxicity of …………. causes a classic triad of Pinpoint pupil, Respiratory depression, Coma. And should be treated with ……….?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG9waW9pZCwgU3VwcG9ydGl2ZSB0cmVhdG1lbnQgKyBJViBuYWxveG9uZS4=[Qq]
[q] In animal studies, NMDA receptors antagonists, like ………., block the actions of glutamate and effectively block morphine tolerance.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGtldGFtaW5lLg==[Qq]
[q] Tolerance to the different side effects of opioids is expected to occur. However, tolerance to ………… and ……….. does not readily occur.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNvbnN0aXBhdGlvbiBhbmQgbWlvc2lzLg==[Qq]
[q] ………… is very weak opioid agonist, also inhibits 5-HT and norepinephrine reuptake and can cause Serotonin syndrome.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRyYW1hZG9sLg==[Qq]
[q] ………… is the type of seizure that involve a localized part of the brain, no loss of consciousness and no postictal confusion.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNpbXBsZSBwYXJ0aWFsIHNlaXp1cmUu
Cg==Cg==[Qq][q] ……….. is the type of seizure that involve a localized part of the brain with impaired consciousness and postictal state are present. .
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENvbXBsZXggcGFydGlhbCBzZWl6dXJlLg==
Cg==Cg==[Qq][q] Drug of choice for both simple partial and complex partial seizures is ………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNhcmJhbWF6ZXBpbmUgKDFzdCBsaW5lKS4=[Qq]
[q] ………… is the type of seizure that presents with brief episodes of staring, but no postictal confusion and more common in children.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFic2VuY2UgKHBldGl0IG1hbCkgc2VpenVyZXMu
Cg==Cg==[Qq][q] Drug of choice for absence (petit mal) seizures is ………. and the 2nd line is ………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGV0aG9zdXhpbWlkZSAoMXN0IGxpbmUpLCB2YWxwcm9hdGUgKDJuZCBsaW5lKS4=
Cg==Cg==[Qq][q] ………… is the type of seizure that presents with generalized tonic extension of the extremities followed by colonic rhythmic movements, loss of consciousness and prolonged postictal confusion are present.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRvbmljIGNvbG9uaWMgKEdyYW5kIG1hbCkgc2VpenVyZXMu
Cg==Cg==[Qq][q] …………….. is the type of seizure that presents with brief arrhythmic jerking movements, last < 1 sec, usually occur in clusters for a few minutes, no loss of consciousness.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE15b2Nsb25pYyBzZWl6dXJlcy4=
Cg==Cg==[Qq][q] Drug of choice for myoclonic seizures is …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHZhbHByb2ljIGFjaWQgKDFzdCBsaW5lKS4=[Qq]
[q] Drug of choice for myoclonic and absence (petit mal) seizures is …………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHZhbHByb2ljIGFjaWQu[Qq]
[q] …………….. is the type of seizure that presents with stiffening of the body.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRvbmljIHNlaXp1cmUu
Cg==Cg==[Qq][q] …………….. is the type of seizure that presents with loss of tone of the body and commonly mistaken for fainting.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEF0b25pYyBzZWl6dXJlLg==
Cg==Cg==[Qq][q] ………………….. inhibits neuronal high frequency firing by reducing the ability of Na channels to recover from inactivation (blocks voltage gated Na channels in cortical neurons). They stabilize these channels in an inactivated state, therefore, fewer Na channels are available for the propagation of an abnormal action potential).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBoZW55dG9pbiwgY2FyYmFtYXplcGluZSBhbmQgdmFscHJvaWMgYWNpZC4=
Cg==Cg==[Qq][q] …………… is the 1st line for treatment of absence seizures when associated with tonic colonic or myoclonic seizures.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZhbHByb2F0ZS4=[Qq]
[q] …………. has a narrow therapeutic index with a number of potential adverse effects including gingival hyperplasia, Ataxia and nystagmus, hirsutism, coarsening of facial features and acneiform skin rash, osteomalacia, and if taken during pregnancy, it may cause fetal hydantoin syndrome, cleft lip and palate.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBoZW55dG9pbi4=[Qq]
[q] …………. is the 1st line for treatment of trigeminal neuralgia and cause bone marrow, hepatotoxicity, and SIADH as side effects.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENhcmJhbWF6ZXBpbmUu
Cg==Cg==[Qq][q] …………. is the 1st line for treatment of myoclonic seizures and cause bone marrow, hepatotoxicity, Pancreatitis, Alopecia, and SIADH as side effects.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNvZGl1bSB2YWxwcm9hdGUgKFZhbHByb2ljIGFjaWQpLg==
Cg==Cg==[Qq][q] …………… is the drug of choice for treatment of absence seizures and works by blocking T type of calcium channels in thalamic neurons causing hyperpolarization.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEV0aG9zdXhpbWlkZS4=
Cg==Cg==[Qq][q] …………. facilitate GABA action by ↑ frequency of Cl channel opening → membrane hyperpolarization. It can be used for the treatment of status epilepticus.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJlbnpvZGlhemVwaW5lcyAoTG9yYXplcGFtKS4=
Cg==Cg==[Qq][q] ………… facilitate GABA action by ↑ duration of Cl channel opening → membrane hyperpolarization. It can be used for the treatment of status epilepticus.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJhcmJpdHVyYXRlcyAoUGhlbm9iYXJiaXRhbCku
Cg==Cg==[Qq][q] ………………….. work by Blocking voltage gated Na channels and inhibits the release of glutamate. It is used mainly for the treatment of refractory partial seizures and in the treatment of bipolar disorder. It is associated with a potentially life-threatening hypersensitivity reaction (Steven Johnson syndrome) that manifests as a skin rash especially in children which requires discontinuation of the drug immediately.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExhbW90cmlnaW5lLg==
Cg==Cg==[Qq][q] …………. is an antiepileptic drug that works by inhibition of GABA reuptake.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRpYWdhYmluZS4=
Cg==Cg==[Qq][q] …………. is an antiepileptic drug that works by inhibition of GABA transaminase (the enzyme that metabolize GABA) and increase GABA concentration.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZpZ2FiYXRyaW4u
Cg==Cg==[Qq][q] …………. is an antiepileptic drug that works by increasing brain GABA concentration (analogue), used also in neuropathic pain (such as post-herpetic neuralgia).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEdhYmFwZW50aW4u
Cg==Cg==[Qq][q] …………………. are antiepileptic drugs and cytochrome P450 inducers.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFBoZW55dG9pbiwgY2FyYmFtYXplcGluZSBhbmQgcGhlbm9iYXJiaXRhbC4=[Qq]
[q] …………… is an antiepileptic that is metabolized to phenobarbital and phenylethylmalonamide (PEMA). All three compounds are active anticonvulsants.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByaW1pZG9uZS4=[Qq]
[q] …………….. is recurrent or continuous generalized tonic colonic seizures that last for ≥ 5 minutes without a return to consciousness. It is a life-threatening condition that has several systemic effects, including hypertension, tachycardia, cardiac arrhythmia, and lactic acidosis.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN0YXR1cyBFcGlsZXB0aWN1cy4=[Qq]
[q] ………………… are the first line drugs for management of status epilepticus.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExvcmF6ZXBhbSArIGZvc3BoZW55dG9pbi4=
Cg==Cg==[Qq][q] If seizures do not stop after benzodiazepines and phenytoin are administered, ……………. is indicated.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHBoZW5vYmFyYml0YWwu
Cg==Cg==[Qq][q] If still seizing after phenobarbital, ……………………..?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGludHViYXRlIGFuZCBnaXZlIE1pZGF6b2xhbSwgcHJvcG9mb2wsIG9yIGluaGFsZWQgYW5lc3RoZXRpY3MgdG8gaW5kdWNlIGEgc3RhdGUgb2YgZ2VuZXJhbCBhbmVzdGhlc2lhLg==
Cg==Cg==[Qq][q] What is the most likely diagnosis?
30 years old patient presenting with fever, generalized lymphadenopathy, facial edema, and diffuse morbilliform skin rash that can progress to a confluent erythema with follicular accentuation + CBC shows eosinophilia and LFTs shows elevated serum alanine transaminase + hepatomegaly, jaundice during physical examination?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERydWcgcmVhY3Rpb24gd2l0aCBlb3Npbm9waGlsaWEgYW5kIHN5c3RlbWljIHN5bXB0b21zIChEUkVTUyku[Qq]
[q] Overdose treatment of barbiturates is …………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHN1cHBvcnRpdmUgKGFzc2lzdCByZXNwaXJhdGlvbiBhbmQgbWFpbnRhaW4gQlApLg==[Qq]
[q] ………………… are short acting Benzodiazepine with higher addictive potential.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFscHJhem9sYW0sIFRyaWF6b2xhbSwgT3hhemVwYW0sIGFuZCBNaWRhem9sYW0gKEFUT00pLg==[Qq]
[q] ………………………. are Benzodiazepine that can be used for those with liver disease due to minimal first-pass metabolism.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExvcmF6ZXBhbSwgT3hhemVwYW0sIGFuZCBUZW1hemVwYW0gKExPVCku[Qq]
[q] Treat Benzodiazepine overdose with ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGZsdW1hemVuaWwgKGNvbXBldGl0aXZlIGFudGFnb25pc3QgYXQgR0FCQSBiZW56b2RpYXplcGluZSByZWNlcHRvciku[Qq]
[q] All benzodiazepines should be excluded from use in conjugation with diphenhydramine and chlorpheniramine because ……………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGFkZGl0aXZlIENOUyBkZXByZXNzaW9uLg==[Qq]
[q] ………………….. is a short-acting hypnotic agent structurally unrelated to benzodiazepines. It binds to the same portion of the GABA A on the CNS (BZ1 subtype) –> sedation and hypnosis. It is used for treatment of insomnia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE5vbmJlbnpvZGlhemVwaW5lIGh5cG5vdGljcyAoWm9scGlkZW0sIFphbGVwbG9uLCBlc1pvcGljbG9uZSku[Qq]
[q] …………. is an orexin antagonist. It is used for treatment of insomnia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1dm9yZXhhbnQu[Qq]
[q] ………….. is a melatonin receptor agonist; binds MT1 and MT2 in suprachiasmatic nucleus. It is used for treatment of insomnia.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFJhbWVsdGVvbi4=[Qq]
[q] (High or low) blood/gas partition coefficient means high blood solubility which means that more anesthetics must be absorbed by the blood before it can be effectively transferred to other tissues.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEhpZ2gu
Cg==Cg==[Qq][q] (High or low) blood/gas partition coefficient means the amount of gas needed to saturate the blood is small and brain saturation occurs quickly and onset of action is (slow or fast)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGxvdywgZmFzdC4=
Cg==Cg==[Qq][q] If the arteriovenous concentration gradien of anesthetic drug is high, this means this drug has (high or low) tissue solubility. This means blood saturation will be (slow or fast) and brain saturation (slow or fast)?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGhpZ2gsIHNsb3csIHNsb3cu[Qq]
[q] The potency of the drug depends on ………….?. The more lipid soluble the anesthetic, the (higher or lower) the MAC and the (higher or lower) the potency.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBsaXBpZCBzb2x1YmlsaXR5LCBsb3dlciwgaGlnaGVyLg==[Qq]
[q] Almost all of inhaled anesthetics (increase or decrease) cerebral blood flow which is undesirable effect as it results in increased ICP. Other important effects are myocardial depression, hypotension, respiratory depression and decreased renal function.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGluY3JlYXNlLg==[Qq]
[q] Massive hepatic necrosis and malignant hyperthermia are rare but severe complication of ……….. exposure?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGhhbG90aGFuZS4=[Qq]
[q] What is the most likely diagnosis?
35 years patient presenting with with fever and muscle rigidity soon after surgery under general anesthesia + Tachycardia, hypertension, hyperkalemia, acidosis and myoglobinuria?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1hbGlnbmFudCBoeXBlcnRoZXJtaWEu[Qq]
[q] Genetic susceptibility of malignant hyperthermia may be related to mutations in ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHRoZSBnZW5lcyBlbmNvZGluZyB0aGUgcnlhbm9kaW5lIHJlY2VwdG9ycyAoY2FsY2l1bSBjaGFubmVsKSBvZiBzYXJjb3BsYXNtaWMgcmV0aWN1bHVtLg==
Cg==Cg==[Qq][q] ………….. is a muscle relaxant effective in malignant hyperthermia. It acts on ryanodine receptor —> prevents further release of Ca into the cytoplasm of muscle fibers.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERhbnRyb2xlbmUu
Cg==Cg==[Qq][q] The cause of the rapid plasma decay of thiopental was not metabolism of the drug but rather ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IHJlZGlzdHJpYnV0aW9uIG9mIHRoZSBkcnVnIHRvIG90aGVyIHRpc3N1ZXMgdGhyb3VnaG91dCB0aGUgYm9keSAoc2tlbGV0YWwgbXVzY2xlcyBhbmQgYWRpcG9zZSB0aXNzdWUpLg==
Cg==Cg==[Qq][q] ………… potentiates GABA A effect. Used for sedation in ICU, rapid anesthesia induction, short procedures with less postoperative nausea than thiopental (antiemetic).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFByb3BvZm9sLg==[Qq]
[q] …………. is a PCP analogs that work as NMDA receptors antagonist. It act as dissociative anesthetics (no sensory input). It cause disorientation, hallucination, bad dreams.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFyeWxjeWNsb2hleHlsYW1pbmVzIChLZXRhbWluZSku[Qq]
[q] ………… work by blocking of Na channels in peripheral sensory receptors by binding to specific receptors on inner portion of channel. Preferentially bind to inactivated Na channels keeping them in this inactive state.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IExvY2FsIGFuZXN0aGV0aWNzLg==
Cg==JiM4MjExOyBFc3RlcnM6IHByb2NhaW5lLCBjb2NhaW5lLCB0ZXRyYWNhaW5lIChlc3RlcnMgaGF2ZSBqdXN0IG9uZSBpIGluIHRoZWlyIG5hbWVzKSBhcmUgbWV0YWJvbGl6ZWQgYnkgcGxhc21hIGFuZCB0aXNzdWUgZXN0ZXJhc2VzLg==
Cg==JiM4MjExOyBBbWlkZXM6IGxJZG9jYUluZSwgbWVwSXZhY2FJbmUsIGJ1cEl2YWNhSW5lIChhbUlkZXMgaGF2ZSAyIEnigJlzIGluIG5hbWUpIGFyZSBtZXRhYm9saXplZCBieSBsaXZlciBhbWlkYXNlcy4=[Qq]
[q] In infected tissue (more acidic medium), alkaline anesthetics are more charged, so you will need ………………?
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IG1vcmUgYW5lc3RoZXRpYyBhbmQgbG9uZyBkdXJhdGlvbiB0byBnZXQgYW5lc3RoZXRpYyBlZmZlY3QgaW4gaW5mZWN0ZWQgdGlzc3Vlcy4=[Qq]
[q] ………….. is a strong ACh receptor agonist that produces sustained depolarization followed by desensitization and prevents muscle contraction. It causes hypercalcemia, hyperkalemia, and malignant hyperthermia as side effects.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFN1Y2NpbnlsY2hvbGluZS4=
Cg==Cg==[Qq][q] There may be a genetic defect leads to …………. —–> no metabolism of succinylcholine —-> long recovery and may need ventilator support after the operation.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGF0eXBpY2FsIHBzZXVkb2Nob2xpbmVzdGVyYXNlLg==[Qq]
[q] ………….. work as a muscle relaxant by competion with ACh for receptors.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFR1Ym9jdXJhcmluZSwgYXRyYWN1cml1bSwgbWl2YWN1cml1bSwgcGFuY3Vyb25pdW0sIHZlY3Vyb25pdW0sIHJvY3Vyb25pdW0gKG5vbmRlcG9sYXJpemluZyBkcnVncyBoYXZlIOKAnGN1cml1bSYjODIyMTsgb3Ig4oCcY29yb25pdW0mIzgyMjE7IHN1ZmZpeCku[Qq]
[q] ………………….. is used for reversal of blockade of nondepolarizing Neuromuscular blocking drugs.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFjZXR5bCBjaG9saW5lIGVzdGVyYXNlIGluaGliaXRvcnMgYXMgbmVvc3RpZ21pbmUgKG11c3QgYmUgZ2l2ZW4gd2l0aCBhdHJvcGluZSB0byBwcmV2ZW50IG11c2NhcmluaWMgZWZmZWN0cyBzdWNoIGFzIGJyYWR5Y2FyZGlhKS4=[Qq]
[q] ………, …………., and ………. are centrally acting skeletal muscle relaxant used for treatment of muscle spasticity, multiple sclerosis, ALS, cerebral palsy.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEJhY2xvZmVuLCBDeWNsb2JlbnphcHJpbmUsIFRpemFuaWRpbmUu[Qq]
[q] …………. have a chemical structure similar to the neurotransmitter dopamine and directly stimulate dopamine receptors. Can be used for treatment of Parkinson disease, hyperprolactinemia, restless leg syndrome. And cause dyskinesia and psychosis as side effects.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERvcGFtaW5lIGFnb25pc3RzOg==
CiYjODIxMTsgRXJnb3QgY29tcG91bmRzOiBCcm9tb2NyaXB0aW5lIGFuZCBwZXJnb2xpZGUu
CiYjODIxMTsgTm9uLWVyZ290IGNvbXBvdW5kczogcHJhbWlwZXhvbGUgYW5kIHJvcGluaXJvbGUu
Cg==[Qq]
[q] ………. is used for treatment of parkinsonism by ↑ dopamine release and ↓ dopamine reuptake, also used as an antiviral against influenza A and rubella.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFtYW50YWRpbmUu
Cg==Cg==[Qq][q] levodopa has tradionally been administered with ……………. to ↑ the bioavailability of L-dopa in the brain and to limit peripheral side effects (nausea & vomiting).
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IGNhcmJpZG9wYSAoYSBwZXJpcGhlcmFsIGRvcGEgZGVjYXJib3h5bGFzZSBpbmhpYml0b3IpLg==
Cg==Cg==[Qq][q] ……………….. are central effects of dopamine and are caused by L-dopa, regardless of whether carbidopa is added to levodopa treatment.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEFueGlldHksIGFnaXRhdGlvbiwgRHlza2luZXNpYSwgcHN5Y2hvc2lz[Qq]
[q] ……….. is a COMT inhibitor that primarily serves to increase the bioavailability by inhibiting peripheral methylation.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IEVudGFjYXBvbmUu
Cg==Cg==[Qq][q] …………. is another COMT inhibitor that inhibit both peripheral and central methylation. Unlike entacapone, tolcapone has been associated with hepatotoxicity.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRvbGNhcG9uZS4=
Cg==Cg==[Qq][q] ……………….. supplementation should not be taken by those on levodopa therapy, because it increases the peripheral metabolism of levodopa and decreases its effectiveness. The more peripheral conversion of levodopa, the less levodopa enters the CNS.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFZpdGFtaW4gQjYu[Qq]
[q] ……… blocks conversion of dopamine into 3-MT by selectively inhibiting MAO-B.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFNlbGVnaWxpbmUu
Cg==Cg==[Qq][q] …………. are the preferred treatment for drug-induced parkinsonism after discontinuing the offending medication.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IENlbnRyYWxseS1hY3RpbmcgYW50aW11c2NhcmluaWMgZHJ1Z3MgKHRyaWhleHlwaGVuaWR5bCwgQmVuenRyb3BpbmUpLg==
Cg==Cg==[Qq][q] …………….. are centeral AChE inhibitors and are 1st-line treatment of alzhimer patients.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IERvbmVwZXppbCwgZ2FsYW50YW1pbmUsIHJpdmFzdGlnbWluZSwgdGFjcmluZS4=[Qq]
[q] ………….. is a NMDA receptor antagonist and are used for treatment of alzhimer patients.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IE1lbWFudGluZS4=[Qq]
[q] …………….. inhibit vesicular monoamine transporter (VMAT), limit dopamine vesicle packaging and release and are used for treatment of Huntington disease.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IFRldHJhYmVuYXppbmU=[Qq]
[q] …………. directly counter the pathophysiologic mechanism of migraine headaches by inhibiting the release of vasoactive peptides —> vasoconstriction and blocking pain pathways in the brain stem. It is used for treatment of Acute migraine, cluster headache attacks. Contraindicated in patients with CAD or Prinzmetal angina or pregnancy.
[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]
[f]IDUtSFQgYWdvbmlzdHMgKFN1bWF0cmlwdGFuKS4=
Cg==Cg==[Qq][x][restart]
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