Get me bodied (neuroanatomy)
Neuro (Dys)fun(ction)
Why isn't my brain working?
You've got personality [pathology]
How did we end up in the College of Pharmacy?
100
Name the three layers of the meninges, starting with the outermost layer and moving inward.
dura, arachnoid, and pia mater
100
Pt p/w progressive difficulty walking over the past 2 days along with tingling in his feet. Physical exam shows decreased strength in bilateral LE, along with absent deep tendon reflexes. Pt notes he recently had an episode of diarrhea 2 weeks ago that resolved on its own. Diagnosis and infectious agent?
Guillan Barre Syndrome (Acute inflammatory demyelinating polyneuropathy) d/t Campylobacter jejuni infection. Will see increased CSF production with normal cell counts (albuminocytologic dissociation = elevated protein levels after a week)
100
A 35 y.o. Chinese immigrant brought after wandering the streets at yelling someone's name. She is disheveled and grossly disorganized. She arrived in the U.S. several days ago and witnessed the death of her 3 y.o. son upon her arrival. In the waiting room, she responds to internal stimuli. She is suffering from this diagnosis.
brief psychotic disorder
100
Someone with this personality disorder may experience transient psychotic symptoms.
borderline personality disorder
100
What drug is a benzodiazepine antagonist?
flumazenil
200
This sensory system is the only one in which the information travels directly to cortex, without first going through a thalamic relay station.
Olfactory (CN I)
Thalamic Tracts:
VPL - spinothalamic, DC/ML - vibration, pain, pressure, propioception, temperature (goes to somatosensory cortext in parietal lobe)
VPM - trigeminal & gustatory - face sensation and taste (goes to somatosensory cortext in parietal lobe)
LGN - CN II for vision to visual cortex in occipital lobe (lateral for light)
MGN - hearing from superior olive and inferior colliculus of tectum (to temporal lobe; medial for music)
ventral anterior/lateral nuclei - motor from basal ganglia and cerebellum (goes to frontal lobe motor corticies)
200
What visual abnormality would you expect to see in a patient with a pituitary adenoma?
Bi-temporal hemianopia. Similar lesions seen with craniopharyngiomas in children.
**vision lesions
**hearing
200
Mr. S has been married for 10 years, and believes his wife has been trying to poison him to get his money. He frequently complains of stomach pains, which he believes are due to the poison in the food. His thoughts are logical and coherent. He denies hallucinations. He is suffering from this diagnosis.
delusional disorder
200
This is the most important first lab test to obtain when evaluating a patient with pressured speech, decreased need for sleep, increased goal directed behavior and increased risk taking.
drug screen
200
This medication would be most appropriate for a patient who is depressed and would like to stop smoking.
bupropion
300
Which division of CN V exits the skull through the foramen ovale?
V3 (Standing Room Only) - V1 exists through the superior orbital fissure. V2 exists through the foramen rotundum. V3 exists through foramen ovale.
300
What type of intracranial hemorrhage is associated with non-accidental trauma?
Subdural hematoma- caused by rupture of bridging veins. Produces a crescent shape hemorrhage that can cross suture lines. Can also produce a midline shift.
300
A 42-year-old woman had loss of pain and temperature sensation on the right side of her face and left side of her body. She also had hoarseness, difficulty swallowing, and nystagmus.
Occlusion of this artery could cause this presentation.
posterior inferior cerebellar artery (PICA)
Nucleus ambiguus(CNIX,X,XI) - Dysphagia, hoarseness, gag reflex, hiccups. Nucleus ambiguus effects are specific to PICA lesions.
Vestibular nuclei/Lateral spinothalamic tract, spinal trigeminal nucleus/Sympathetic fibers - Vomiting, vertigo, nystagmus pain and temperature sensation from contralateral body, ipsilateral face.
Inferior cerebellar peduncle - Ipsilateral ataxia, dysmetria. Lateral medullary (Wallenberg) syndrome.
Ipsilateral Horner syndrome.
“Don’t picka (PICA) lame (lateral medullary syndrome) horse (hoarseness) that can’t eat (dysphagia).
300
Characterized by a child who is argumentative with adults, short-tempered, angry, spiteful, and refuses to comply with rules, but does not harm people or property or commit serious rule violations.
Oppositional Defiant Disorder
300
Aged meats and cheeses are discouraged with this class of medication because they can precipitate this reaction.
MonoAmineOxidase Inhibitors and Hypertensive crisis
Other antidepressant classes to know with side effects and interactions:
SSRI, SNRI, antipsychotics, TCAs, atypicals (trazodone, mirtazepine), St. John's Wort
400
Which cells produce CSF and what type of tumor is associated with these cells?
Ependymal cells A tumor of ependymal cells is called an ependymoma. It is a childhood brain tumor commonly found in the fourth ventricle and can cause hydrocephalus. It has a poor prognosis.
400
This disease is caused by aggregation of hyperphosphorylated tau proteins and can cause early personality changes or aphasia.
Frontotemporal dementia
compared to Alzheimer which also involves hyperphosphorylated tau but characterized by low ACh, slowly progressing, and widespread cortical atrophy. Rarely aphasia.
Other Dementias: Vascular (step-wise deterioration), HIV-Associated (microglial nodules with multinucleated giant cells), Lewy-Body (hallucinations), CJD (vacuolation, 14-3-3 protein)
Neurodegenerative movement disorders: Huntington, Parkinson
400
A 66-year-old man woke up one morning and could not move his right arm or hand. He had trouble trying to speak to his wife, but could understand her questions and follow her directions. At the hospital, neurological exam revealed the following abnormalities:
- paralysis of right lower face muscles (but he could wrinkle his forehead on both sides)
- paralysis and hyperreflexia of right hand and arm
- mild sensory loss (both modalities) in right hand, arm and face
- Broca's aphasia
He most likely has a lesion in this location.
left middle cerebral artery (MCA) caused by thrombosis. The lesion includes the precentral gyrus (motor strip), innervating hand, arm and face, and Broca's area. The postcentral gyrus (sensory strip) is involved to a lesser extent.
400
Someone experiencing social withdrawal, disorganized behavior, and auditory hallucinations for 5 months may be diagnosed with this.
ANSWER: schizophreniform disorder: more than 2 symptoms of schizophrenia for 1-6 months
schizophrenia: greater than or equal to 2 of the following active symptoms (delusions, hallucinations, disorganized speech, disorganized/catatonic bahavior, negative symptoms) for greater than 6 months and one month of active symptoms
schizoaffective - schizophrenia + mood disorder (more than 2 weeks of psychotic symptoms without mood symptoms)
schizotypal (cluster A personality disorder) - brief episodes
400
Nicotinic M depolarizing agent associated with malignant hyperthermia
Succinylcholine
500
What is the effect on movement of dopamine binding to D1 and D2 receptors on the direct and indirect pathways of the basal ganglia?
D1 Receptor activates the D1Rect pathway → ↑ movement; D2 receptor inhibits indirect pathway → ↑ movement (no matter the pathway, dopamine always promotes movement)
500
Nerve impulse transmission to muscle tissue is affected due to antibodies destroying or blocking these type of post-synaptic receptors in a patient with ptosis, diplopia, reduced muscle strength and a reduced capacity for repetitive muscle use.
acetylcholine. treated with pyridostigmine
500
New patient to your clinic comes in after hearing voices for the past 6 months telling him he is worthless and to kill himself. His only medication is sertraline which he has taken for two years. He is suffering from this disease.
Major depressive disorder with psychotic features
vs. Schizoaffective
vs. Schizophrenia
500
Compare the duration of symptoms in major depressive disorder (MDD), dysthymia, and cyclothymia.
Symptoms of MDD last ≥ 2 weeks; dysthymia and cyclothymia are diagnosed in adults after symptoms of > 2 years
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500
Typical antipsychotics can worsen negative symptoms because of their effect on this pathway.
mesocortical pathway
Know your dopaminergic pathways:
Nigrostriatal (movement)
Tuberoinfundibular (prolactin secretion)
Mesocortical (executive function, reward)
Mesolimbic (reward pathway)