Neuroscience II Exam 3

2 types of non-associative learning

1. Habituation

2. Sensitization

2 types of sleep

NREM and REM

3 primary forms of neurologic infections of the CNS

1. meningitis

2. encephalitis

3. brain abscesses

4 major classes of CNS tumors

1. Glioma

2. Medulloblastoma

3. Primary CNS lymphoma

4. Meningioma

A 21-year-old patient presents with fever, headache, and nausea which have developed over the past 24 hours. He denies any recent or past head trauma. His cervical AROM and PROM are very limited, and he involuntarily flexes his knees when his neck is passively flexed. Which condition is this patient most likely suffering from? a) chronic traumatic encephalopathy (CTE) b) acute pyogenic meningitis c) subarachnoid hemorrhage d) transient ischemic attack (TIA)

b) acute pyogenic meningitis

A 52-year-old patient presents with a headache of one week duration. She first noticed the headache the day she returned from a skiing vacation. She admits to falling while skiing on the last day of her trip. She also complains of occasional nausea and difficulty concentrating at work. She reports good health prior to the onset of these symptoms. The fundoscopic exam reveals edema of the optic discs bilaterally. Neurological exam and vital signs are within normal limits. Which of the following diagnoses best accounts for this patient's presentation? a) subdural hemorrhage b) Alzheimer disease c) Creutzfeldt-Jakob disease d) frontotemporal dementi

a) subdural hemorrhage

A 70-year-old patient with hypertension presents with memory deficits that has been increasing in severity over the past few years. No other symptoms are present. Which of the following conditions is this patient most likely suffering from? a) dementia with Lewy bodies b) frontotemporal dementia c) vascular dementia d) subarachnoid hemorrhage

c) vascular dementia

A lesion of which vessel would result in motor aphasia?

A lesion of the left middle cerebral artery

A lesion of which vessel would result in Sensory (aka receptive or Wernicke's aphasia)

left middle cerebral artery

A patient presents with a severe headache and shows signs of meningeal irritation such as Brudzinski's sign and Kernig's sign. Both findings can be indicative of which conditions?

1. Alzheimer disease

2. subarachnoid hemorrhage

3. meningitis

4. epidural hemorrhage Select one: a. 1, 2, & 3 b. 1 & 3 c. 2 & 3 d. 1, 2, 3, & 4

c. 2 & 3

A patient presents with the inability to speak fluently and chooses incorrect words when trying to communicate. They are able to follow verbal and written commands. This patient is displaying which of the following language disturbances? a. conduction aphasia b. dysphagia c. motor aphasia d. dysarthria

c. motor aphasia

A patient reports loss of sensation on the right side of the pelvic area along with urinary incontinence and paresis of the right leg. No other symptoms are reported. A branch of which cerebral artery is likely affected in this patient? a) left middle cerebral artery b) left anterior cerebral artery c) right posterior cerebral artery d) right middle cerebral artery

b) left anterior cerebral artery

A patient who can comprehend language and produce speech with some errors but cannot repeat phrases most likely has: a. Broca's (motor) aphasia b. Wernicke's (sensory) aphasia c. global aphasia d. conduction aphasia

d. conduction aphasia

A patient with bilateral amygdala lesions would most likely exhibit which of the following? a. inability to learn how to play a new sport. b. inability to navigate in a familiar neighbourhood. c. inability to form new declarative memories. d. inability to respond appropriately to a fear-provoking stimulus.

d. inability to respond appropriately to a fear-provoking stimulus.

A unilateral occlusion of the posterior cerebral artery would result in what visual deficit?

A contralateral homonymous hemianopsia

a) How much of the spinal cord does posterior spinal arteries supply? b) What parts

a) Posterior 1/3 of spinal cord b) majority of dorsal horn, dorsal funiculus

a) What are grid cells b) Where are grid cells located? c) When do they fire

a) neurons in a hexagonal arrangement b) entorhinal cortex c) when an organism navigates an area

a) What are place cells b) Where are they located c) How are they activated

a) neurons that encode spatial memories b) hippocampus c) activated when an organism is in a particular location

a) What is a brain laceration? b) What can it result in

a) injury due to penetrating and tearing of parenchymal tissues b) hemorrhage, swelling, and edema

a) What is a primary CNS tumor? b) What is the m/c form?

a) a tumor that originates in the CNS b) glial cell tumours

a) What is a secondary CNS tumor? b) What is the m/c orginate

a) a tumor that results from metastasis from an external site b) melanoma or carcinoma

a) What is Aphasia? b) What does it result from?

a) disorder in which the production and/or comprehension of language is impaired b) due to a lesion of the cerebral cortex

a) What is meningitis? b) Is parenchyma affected? c) Can result due to what? d) How long is acute e) How long is chronic

a) infection of meninges & CSF b) typically no c) bacterial (pyogenic) or viral (aseptic) origin d) ≤4 weeks e) > 4 weeks

a) What is present in Frontotemporal dementia? b) What is not present

a) intracellular aggregates of tau protein & reactive gliosis b) amyloid plaques

Acute aseptic (viral) meningitis: a) CSF findings c) Primary causative viruses d) How can it resolve

a) elevated pressure & WBC count, absence of bacteria b) echovirus, coxsackie, mumps, HIV c) usually self resolves

Acute pyogenic (bacterial) meningitis: a) Characterized by what b) CSF findings c) Primary causative organisms d) When can it be fatal

a) purulent exudate within the meninges b) elevated pressure & WBC count, bacteria present c) E. coli, group B strep, S. pneumoniae, L. monocytogenes, N. meningitidis, H. influenzae d) When untreated

Allocortex: a) How many layers b) Associated with parts of what

a) 3-4 layers b) olfactory system, the hippocampus & associated structures oldest portion

An occlusion of the left anterior cerebral artery would likely result in which of the following deficits: a. motor aphasia b. spastic paralysis of muscles on the right side of the face c. slight decrease in hearing in both ears d. loss of proprioception from the right lower leg

d. loss of proprioception from the right lower leg

Anterior spinal artery: a) Where does it branch from b) How does it exit cranial vault c) Where does it descend the spinal cord?

a) vertebral artery b) as one artery via foramen magnum c) in subarachnoid space along ventral median fissure

Arterial supply to the brain arises from what arteries?

1. internal carotid arteries (paired)

2. vertebral arteries (paired)

Astrocytomas: a) M/c form of what in adults? b) Locations

a) primary brain tumor in adults b) cerebrum, cerebellum, brainstem, & spinal cord

Brain abscess: a) What is it b) What is the origin c) How can it occur d) Signs and symptoms

a) localized region of necrosis and inflammation within brain parenchyma b) bacterial origin c) direct infection, through the bloodstream, or spread from adjacent tissues d) focal neurologic deficits, signs of increased intracranial pressure

Broca's aphasia is characterized by which impairment? a) The impaired ability to hear spoken language only b) The impaired ability to comprehend language only c) The impaired ability to produce language appropriately only d) The impaired ability to both comprehend and produce language

c) The impaired ability to produce language appropriately only

Characteristics of acute cerebral infarct

a) discoloration & softening of tissue b) red neurons present

Characteristics of declarative (explicit) memory

1. "conscious"

2. memory with awareness; involves deliberate recall

3. example: facts, ideas, etc. that can be brought to conscious recollection

Characteristics of healed cerebral infarct

a) residual cavity b) surrounding astrocytic (glial) scar

Characteristics of non-declarative (implicit) memory

1. "unconscious"

2. memory without awareness or deliberate recall

3. expressed as a change in behavior or performance

Characteristics of subacute cerebral infarct

a) edema b) liquefactive necrosis c) reactive gliosis

Cognitive/psychiatric symptoms of dementia with lewy bodies?

1. marked fluctuation in cognitive function

2. visual hallucinations

3. REM sleep behavior disorder

Common causative pathogens of chronic bacterial meningitis

1. Mycobacterium tuberculosis

2. Treponemapallidum

3. Borrelia species

Conservation of energy during sleep

1. decreased body temperature during sleep reduces energy expenditure

2. glial cell glycogen stores become depleted by repeated NT release during wakefulness & is replenished throughout the night during non-REM sleep

Creutzfeldt-Jakob disease (CJD): a) Mechanism b) What leads to neuronal death c) Signs and symptoms

a) sporadic b) accumulation of proteins leads to neuronal death c) dementia, myoclonus and motor dysfunction, rapid death

Difficulty remembering events following a head injury is called __________ amnesia, while difficulty remembering events prior to the injury is called______________ amnesia. a. anterograde, retrograde b. retrograde, anterograde

a. anterograde, retrograde

Direct input from the thalamus is received by which layer within a cortical column?

layer IV

Encephalitis: a) What is it b) What is the m/c cause of sporadic case c) What may be visible on MRI d) CSF findings

a) inflammation of brain parenchyma, often following viral infection b) Herpes simplex virus (HSV) c) brain edema d) elevated WBC count, absence of bacteria

Epidural hemorrhage: a) What is it b) Frequently associated with c) What artery laceration is common d) What is lucid interval

a) blood accumulation in epidural space b) temporal bone fracture c) middle meningeal artery d) post-injury period of absence of SXs

Examples of arousal promoting chemicals

serotonin, dopamine, & norepinephrine

Examples of declarative memory

facts, information, events

Examples of episodic declarative memory

1. personal events

2. memory of personal experiences

3. emotional memories

Examples of Gliomas

1. Astrocytomas

2. Oligodendrogliomas

3. Ependymomas

Examples of non-declarative memory

procedures, skills, conditioning

Examples of procedural memory

motor and perceptual skills, tasks, and habit formation examples: walking, speaking, drawing, sport performance, chiropractic adjusting

Examples of semantic declarative memory

1. facts & information

2. symbolic or language based experience

3. memory of world knowledge

Features of meningioma

1. often benign

2. solitary

3. less aggressive

4. occur in individuals AFAB 2:1 AMAB

Features of primary CNS lymphoma

1. m/c tumor in immunocompromised patients

2. malignant

3. aggressive

4. m/c in individuals aged ≥40 years

Following a head injury, a patient does not immediately display symptoms; however, a CT scan shows intracranial bleeding. Which type(s) of hemorrhage could result in this presentation? a. epidural and subdural hemorrhage b. intracerebral hemorrhage c. subarachnoid and intracerebral hemorrhage d. subarachnoid hemorrhage only

a. epidural and subdural hemorrhage

Function of cerebral cortex during sleep-wake states

1. neurons in the basal forebrain release adenosine to promote sleep

2. various regions active during REM

3. acetylcholine released to promote wakefulness

Function of epithalamus during sleep

melatonin produced by pineal gland helps promote sleep

Function of hypothalamus in sleep-wake states

1. suprachiasmatic nucleus (SCN): receives visual data about light/dark cycles

2. nucleus releasing histamine promotes wakefulness

3. nucleus releasing GABA promotes sleep

Global cerebral hypoxia/ischemia: a) What is it b) Possible causes c) What does it result in

a) decreased overall cerebral perfusion or reduction in capacity of blood to transport oxygen b) cardiac arrest, shock, carbon monoxide poisoning c) 'watershed' or borderzone infarcts

Glymphatic system action during sleep

glial cells shrink during sleep which increases CSF flow for removal of metabolic waste in the brain through the glymphatic system

Habituation: a) Stimulus b) Outcome of repeated exposure c) Nervous system areas d) Mechanism e) Why is it biologically useful

a) Repeated benign stimuli b) Decreased response to a stimulus c) Sensory- motor reflex pathways d) Short-term-depression (STD): suppression of NT release from the pre- synaptic terminal e) allows the organism to ignore stimuli that have lost their novelty or meaning

How can memory be classified?

by time course (temporal) & nature (qualitative) of content

How do patients with vascular dementia present?

a) dementia b) gait disturbances c) focal neurologic deficits

How experiences change the brain, is known as a) memory b) experience c) storage d) learning

d) learning

How would a patient present with conduction aphasia?

A patient would have difficulty with tasks that require language comprehension and production at the same time. For example, reading a sentence aloud, copying a sentence, repeating spoken language, etc.

How would a patient with Motor aphasia (aka expressive or Broca's aphasia) present?

A patient would be able to comprehend language in various forms but would have difficulty producing language

How would a patient with Sensory (aka receptive or Wernicke's aphasia) present?

A patient would be unable to comprehend language and, although language production areas are unaffected, would likely also have some difficulty speaking and writing.

Immune support during sleep: a) What cells are produced during sleep b) What can sleep deprivation decrease?

1. T-cells (WBCs)

2. sleep deprivation can decrease natural killer cell activity, reduce circulating immune complexes and secondary antibody responses

Importance of REM sleep

1. high percentage of REM sleep during development

2. following sleep deprivation REM rebound occurs:

• Increase in % of time spent in REM during sleep-wake cycle

• high percentage of REM sleep during periods of intense mental activity

In the neocortex, how many layers does each cortical column contain?

6 layers

Intracerebral hemorrhage: a) What is this caused by b) Where can it occur c) What can result from it

a) blood accumulation d/t small cerebral hemorrhages from vessels within the brain parenchyma b) can occur at both coup and contrecoup injury sites c) can compress local tissues, focal neurologic symptoms may be present

Is the amygdala active during REM or NREM sleep?

REM sleep

Location of meningiomas

arise from arachnoid mater and attach to external surfaces of the brain, within ventricles

Long-term memory: a) What is it b) What is it consolidated from c) Duration

a) the retention of potentially unlimited information b) from short-term or working memory c) stored for a potentially unlimited amount of time

Medulloblastoma: a) Features b) Location c) Possible complication

a) malignant b) posterior fossa (cerebellum) c) obstructive hydrocephalus

Memory consolidation during sleep: a) What kind of memory is REM sleep implicated with? b) What kind of memory does NREM sleep aid in?

1. consolidation of nondeclarative (procedural) memory

2. declarative memory consolidation

Memory loss following trauma, select the best option: a) anterograde amnesia b) retrograde amnesia

a) anterograde amnesia

Mesocortex: a) How many layers b) Includes what gyri?

a) 3-6 layers b) cingulate gyrus & parahippocampal gyrus

Most common location of CNS tumour in adults

cerebral hemispheres

Most common location of CNS tumour in kids

posterior fossa

Motor symptoms of dementia with lewy bodies?

1. rigid muscles

2. bradykinesia

3. masked facies

4. resting tremor

5. shuffling gait

Neocortex: a) How many layers b) Comprises majority of what

a) 6 layers b) cerebral hemispheres

newest portion

NREM sleep: a) How many stages b) What is stage 1 c) What is stage 3 d) How long is a cycle duration e) How many cycles per night

a) 3 b) transition from wakefulness to sleep c) deepest level d) 70-90min e) 4-5

Orbitofrontal Cortex: a) Function b) What does it communicate with?

a) allows for emotional working memory b) amygdala

Patient H.M: a) What did he suffer from b) What was the procedure he did c) What was the result d) What else resulted from surgery e) What happened to declarative memory f) What happened to non-declarative memory

a) severe temporal lobe epilepsy b) bilateral medial temporal lobectomy c) seizures were all but eliminated, his intelligence and motor abilities remained intact d) devastating amnesic effects e) impaired f) intact

Patient HM was unable to form new declarative memories due to his surgery. However, he was able to form new non-declarative memories and learn new skills. This was most directly possible because which structure(s) was/were still intact? a. medial temporal lobes b. hippocampi c. basal ganglia d. thalamus

c. basal ganglia

Patient S.M with bilateral amygdala lesions was put in fearful situations, what did she report and what were the results?

1. reported minimal amounts of fear and lacked fear-related responses in provoking situations

2. displayed 'curiosity' and not avoidance behaviors

3. understood concept of fear & could identify potentially fear-producing circumstances

4. unable to perceive fear based on an individual's facial expression but could identify it through voice and body language

Possible complication of meningioma

obstructive hydrocephalus

Possible complication of primary CNS lymphomas

spread of malignant cells through ventricular system

Posterior spinal artery: a) Where does it branch from b) How does it exit cranial vault c) Where does it descend the spinal cord?

a) vertebral artery b) through foramen magnum c) in subarachnoid spaces near dorsal lateral sulcus

Prion disease: a) How can misfolding of prion protein occur? b) What does the prion protein act as? b) How does it progress

a) sporadic, genetic, or through infectious transmission b) acts as infectious agents that spread through neural tissue c) rapidly progressive, fatal

Procedural memory requires activation of what brain structures?

basal ganglia (esp. striatum) and cerebellum

Recalling that Christmas occurs on December 25th each year is an example of a(n)_______ memory, whereas recalling how one spent the holiday with family last year is an example of a(n)_______memory. a. explicit, implicit b. episodic, procedural c. semantic, episodic d. non-associative, semantic

c. semantic, episodic

Sensitization a) Stimulus b) Outcome of repeated exposure c) Nervous system areas d) Mechanism e) Why is it biologically useful

a) Repeated novel or harmful stimuli b) Increased response to a stimulus c) Sensory- motor reflex pathways d) Short-term potentiation (STP): enhanced release of NT from the pre- synaptic terminal e) cues the CNS about novel stimuli that may have important survival value

Short-term/Working memory: a) What is it? b) What kind of information c) Duration

a) the limited retention of a limited amount of information b) typically goal-directed information (inclusion & exclusion of info) c) limited duration: seconds to minutes

Sign and symptoms of alzheimers disease

1. gradual decline in cognitive function (e.g., memory disturbances, deficits in language and orientation)

2. personality changes

3. mood disturbances

4. loss of motor skills

5. often fatal within 5-10 years of diagnosis

Signs/symptoms of CNS tumours

1. headache (m/c)

2. neuro deficits

3. changes in behavior/personality

4. seizures

5. signs of increased intracranial pressure

Signs/symptoms of encephalitis

fever, headache, altered mental status, mood disturbances, seizures, focal neuro deficits, meningeal irritation may be present

Signs/symptoms of frontotemporal dementia

personality changes and language disturbances (aphasias) prior to memory deficits