MS mysteries
What are the four major types of multiple sclerosis?
Relapsing remitting, primary progressive, secondary progressive, progressive relapsing.
A patient has fasciculations, muscle atrophy, and hyporeflexia. What type of lesion is present
LMN lesion
What androgen is responsible for growth of prostate.
DHT
What fibers make up the right visual field?
Left side of each retina.
Temporal retina of left eye (ipsilateral) --> nasal field
Nasal retina of right eye (decussate) --> temporal field
Central ___ occlusion is to blood and thunder as central ___ occlusion is to chery red spot on macula.
Dawson fingers.
Explain the difference between aphasia, dysarthria, and apraxia.
Aphasia - problem with brain’s ability to process symbols. Usually damage to left hemisphere (broca, Wernicke’s)
Apraxia - motor planning issue
Dysarthia: muscle problem
Compare the clinical presentation of cystitis and pyelonephritis.
Cystitis: dysuria, suprapubic pain, hematuria
Pyelonephritis: addition of fever, CVA tenderness, N/V, flank pain
Lesion to meyers loop, what is the presentation.
superior quadrantopia
Which type of glaucoma has a gradual, painless onset.
primary open angle glaucoma
What are the Uhthoff phenomenon and Lhermitte's sign?
Uhthoff’s phenomenon- worsening of neurological symptoms due to increase in body temperature.
Lhermitte’s sign- sudden, brief sensation that feels like an electric shock when bending neck forward.
What is neglect syndrome, and which hemisphere lesion most commonly causes it?
Condition where patient fails to attend to, respond to, or orient toward stimuli located on one side of space. Not a sensory problem, its an attentional problem.
Usually a right hemisphere lesion (non dominant)
Compare common causes of acute tubular necrosis with common causes of acute interstitial nephritis.
ATN
Ischemic vs nephrotoxic causes which lead to sloughing of cells into tubular lumen
Common nephrotoxins: aminoglycosides, cisplatin, amphotericin, lead, myoglobin,hemoglobin
AIN
5 P’s or DRAINS : pain killers, pee pills, penicillin, PPI, rifampin, Sulfa
Or secondary to infection or autoimmune disease
What is the visual pathway.
Retina → optic nerve → optic chiasm → optic tract → LGN → optic radiations → visual cortex
Compare the clinical presentation of Periorbital Cellulitis and Orbital Cellulitis.
periorbital: mild tenderness of eye lid, normal visual acuity, full EOM ROM, painless, normal pupillary response.
Orbital: severe pain, decreased acuity, opthalmoplegia, possible RAPD, proptosis (eye bulges forward)
What is the mechanism of action of natalizuamb?
Targets a 4 integrin
Integrins are adhesion molecules that aid in chemotaxis of leukocytes to sites of inflammation. A4 is expressed on all types except neutrophils.
Prevents extravasation of CD8 T cells
What is the role of all of the following tracts :
Dorsal column - Medial Lemniscus:
Lateral corticospinal:
Spinocerebellar:
Dorsal column - Medial Lemniscus: fine touch and proprioception.
Lateral corticospinal: voluntary movement of limbs.
Spinocerebellar: unconscious proprioception.
Compare the location and DRE findings of BPH vs prostate cancer,
Google doc
Pathway for pupillary light reflex.
Retina → optic n. → optic chiasm → optic tract → pretectal area —> EWP nucleus – CN III
Describe Marcus Gunn pupils. How would a lesion on right eye present.
lesion to afferent pathway, CN II issue.
Light on left eye, both pupils constrict.
Light on right eye - dilation of pupils.
Explain the significance of the blood-brain barrier in the pathogenesis and treatment of multiple sclerosis.
Highly selective semipermeable barrier of endothelial cells that prevents solutes in circulating blood from non selectively crossing into EC fluid of CNS. The development of MS begins when integrity of BBB is compromised, aggressive immune cells craw through barrier and into spinal cord. Recognize myelin sheath as foreign and attack them.
Basic functions of the following lobes: frontal, parietal, temporal, occipital
Frontal Lobe- executive function, motor control, speech production, social behavior
Parietal Lobe - somatosensory perception
Temporal Lobe- hearing, language ,memory, recognition
Occipital lobe - visual processing
Go to whiteboard: For pre-renal, intrinsic renal, post renal. What are the relative levels of BUN/creatinine, urine sodium, FeNa, Urine osmolality, and urine specific gravity?
Sorry :3
google doc
How does the ciliary muscle and lens change shape for near vs far vision (accommodation)?
Accommodation (near)- ciliary muscle contracts, lens becomes more convex to bend light more sharply onto retina.
Far vision - ciliary muscle relaxes, lens is flattened
Describe an intranuclear ophthalmoplegia.
The side of the lesion is the side of the eye that cannot adduct.
The contralateral eye develops nystagmus.