MBB Final Review

What does the central tegmental tract carry?

Desc. fibers from red nucleus to the ipsilateral inf. olive and asc. axons from nucelus solitarius carrying taste info to VPM nuclei of the thalamus

Dentatothalmaic tract exits the cerebellum via .

Superior cerebellar peduncle.

What is impaired in Williams syndrome?

Dorsal (where?) visual pathway

Papez circuit

Cingulate gyrus > hippocampal formation > fornix > hypothalamus/mammilary bodies > anterior thalamic nuclei > cingulate gyrus

What is rhodopsin?

Opsin and retinal

What does retinal pigmented epithelium do?

Converts all-trans rhodopsin to 11-cis rhodopsin (recycles rhodopsin so it can detect light again)

Where do the w ganglion cells synapse? (3)

Pretectal area, superior colliculus, suprachiasmatic nucleus

What provides input to the nucleus of Edinger-Westphal?

Pretectal area

What are the possible swinging flashlight test findings?

Normal Response:

Both pupils constrict equally and briskly when light is shone into either eye.

RAPD Present:

The pupil of the affected eye does not constrict as much as the other pupil when the light is swung from the unaffected eye to the affected eye.

Vestibulo-thalamo-cortical tract

Bilateral projections to VPL and VPI nuclei > areas 2v and 3a of the cerebral cortex

Haploinsufficiency

Single copy of gene is not enough to produce normal amount of gene product > phenotypic effect

What do lesions of the lateral cerebellar cortices (pontocerebellum) cause?

Disorders of speech and coordinated movement

What neurotransmitters are involved in delirium?

Imbalance of Ach and dopamine

What does the workup of ED include?

Electrolytes, EKG, and bone scan

Which symptoms do antipsychotics typically address?

Positive symptoms

D2 blockade due to antipsychotics causes _.

Decrease in positive symptoms (mesolimbic), worsening thinking/motivation (mesocortical), decreased sex drive and galactorrhea (tuberoinfundibular), and abnormal movements (nigrostriatal)

Which atypical antipsychotic is associated with histaminergic, muscarinic, and alpha side effects?

Quetiapine

Which 3 atypical antipsychotics are associated with muscarinic side effects?

Olazapine, quetiapine, and risperidone

What are the general management strategies for the violent patient?

Verbal redirection > PO meds > IM injection

What is the typical management strategy for personality disorders?

Psychotherapy

What is the key aspect of the "strange situation" paradigm?

To assess quality of infant-caregiver attachment (look @ child's reaction to return of caregiver)

What is the Erikson stage @ 0-1 years?

Trust vs. Mistrust, hope

What is the Erikson stage @ 1-3 years?

Autonomy vs. Shame/Doubt, will

What is the Erikson stage @ 3-6 years?

Initiative vs. Guilt, purpose

What is the Erikson stage @ 6-12 years?

Industry vs. Inferiority, competence

What is the Erikson stage @ 12-18 years?

Identity vs. Role Confusion, fidelity

What is the Erikson stage @ 18-40 years?

Intimacy vs. Isolation, love

What is the Erikson stage @ 40-65 years?

Generativity vs. Stagnation, care

What is the Erikson stage @ 65+ years?

Ego integrity vs. despair, wisdom

What are some brain stats?

1300g and consumes 20% of oxygen

What is Nissl material?

Rough endoplasmic reticulum

What do astrocytes form?

Fibrillary neuropil w embedded neurons

What makes up gray matter?

Neuron cell bodies, dendrites, unmyelinated axons

What makes up white matter?

Myelinated axons

What is a gemistocyte?

Reactive astrocyte that forms gliosis

What is the function of microglia?

Precursor to macrophage > clean up after injury

How does edema form?

Plasma fluid exudes from intravascular space to interstitial space

What is the most common form of edema?

Vasogenic edema

What is the gene deletion in oligodendroglioma?

1p/19q codeletion

Middle cerebral artery stroke weakness

F/A > L

Anterior cerebral artery stroke weakness

L > F/A

What can a germinal matrix (intraparenchymal) hemorrhage cause?

Spastic diplegia in neonates

Acute necrotizing hemorrhagic encephalitis

Similar to ADEM but more severe (also mostly in children and young adults)

Marchiafava-Bignami disorder

Demyelination/necrosis of corpus callosum associated with chronic alcohol abuse and malnutrition

What does the CT and MRI look like in diffuse axonal injury?

Normal CT/MRI

What percentage of adult tumors are metastatic?

50%

What is the difference between tumor and bleeding/trauma imaging?

Use contrast for tumors

What is the MOST common hemorrhagic metastasis?

Melanoma

How does diplopia occur?

Not conjugate eye movements

How does the tongue deviate in a lesion of CN XII?

Towards the lesion

Where do you commonly see axillary neuropathy?

People not using crutches correctly

What is another name for radial neuropathy?

Saturday night palsy

What is "meralgia paresthetica"?

Lateral femoral cutaneous neuropathy

Describe myoclonic seizures.

Quick, brief jerks

Describe generalized tonic-clonic seizure.

Shaking throughout the body

Describe tonic seizures.

Stiff throughout the body

Describe clonic seizures.

Jerk continuously

What is the most teratogenic anticonvulsant?

Valproid acid *DO NOT USE unless post-menopausal

What are the atypical Parkinsonian disorders? (4)

Multiple system atrophy (MSA), progressive supranuclear palsy (PSA), corticobasal degeneration (CBD), and lewy body dementia (LBD)

What are some key points of corticobasal degeneration?

Presents with asymmetrical symptoms and distinctive features like apraxia and alien limb syndrome

What should you do if ESR/CRP is elevated in a patient > 60 coming in for a headache (or jaw claudication/vision changes)?

Start treatments with steroids FIRST to prevent blindness - do not wait for temporal artery biopsy to confirm

Describe pontine gaze palsy.

Lesion in the right pons > cannot look towards the right side

Describe INO.

Lesion in right MLF > R eye cannot adduct and L eye experiences nystagmus (can look towards the right side with both eyes)

Describe one and a half syndrome.

Lesion in right PPRF and MLF > cannot look towards the right side and INO (R eye cannot adduct and L eye nystagmus) when looking towards the left

What happens in a supratentorial structural lesion?

Unilateral lesion > uncal herniation > ipsilateral dilated pupil