BALES [27Q]

1. [CST]: cortex-corona-PLIC-crus-basis pedunculi-pontine basis-medullary pyramid/decuss--> LCST

2. POSITIVE BABINSKI = UMN lesion (hyperreflexia, Spastic, NO atrophy); dorsiflex 1st toe, 2-5 flare
3. DeCORtication [lesion above Red Nuc] vs DeCERebration [lesions rubrospinal, no upper flex, inc lower ext
4. [E-W NUCLEUS] LESION @ rostral midbrain = Blown Pupil
5. OCULOMOTOR LESION: UNCUS herniation or PCA Aneurysm = CN III Compression = 1st Paras Blown Pupil, then ABD eye out
6. [FACIAL MOTOR NUC]: caudal pons VII fibers LOOP over VI. Stylohyoid/STAPEDIUS/Post Digastric/Face Muscles. UPPER
symmetrical; LOWER CONTRALATERAL paralysis.
7. [DORSAL MOTOR NUC X]: PICA, Parasympathetic "Vagal Fibers" slow HR
8. [TONSIL] VESTIBULOCEREBELL; (PICA)/if herniates-compresses medulla = resp/cardiac dysfunction & fatality occurs BEFORE
unsteady gait/uncoord head w ocular m/falling to side of lesion
9. [VERMIS]= FASTIGIAL Nuc/SPINOCEREBELL/SCP (SCA anteriorly)--> Gait/Truncal Posture & Balance
10. Medial --> Lateral: FASTIGIAL (Verm)- INTERPOSED (Paraverm) - DENTATE (Ponto)
11. SCP = Interposed/Dentate Eff. & Spinocerebellar Aff; MCP = Pontocerebellar Eff; ICP = Vestibulocerebell Aff & Cortico-olivary fibers
12. PURKINJES: mossy/climbing EXCITE; stellate/basket INHIBIT;
13. INHIBITORY GOLGI CELLS in GRANULAR layer INHIBIT GRANULAR CELL from interacting w mossy fibers
14. DIRECT PATHWAY: (D1) Cortex (+) CP (-) all 3 -GPM/-GPL/-SNpr which DISINHIBITS THALAMUS, which is free to Excite (+)
Motor Cortex --> Movement!
15. INDIRECT: (D2) Cortex (+)CP (-)GPL (-)STN (+)GPM which (-)Thalamus & Cortex remains inhib; (STN inhibited the disinhibition)
16. [CAUDATE HEAD] blood supply = Recurr Art. of Heubner br of ACA; if OCCLUDED = compromise basal ganglia/NA/ALIC/genu
17. VESTIBULOOCULAR REFLEX- when head turns L; Both eyes turn R (III/VI/MLF/VESTIBULAR NUCLEI & GANGLIA)
18. LEFT NYSTAGMUS (Rules: Turning LEFT, endolymph moves opposite way TOWARD Left Utricle - utricopedal/depolarization/Left
Fast Phase/WARM same)
19. [VISUAL PATH LESION] _________________
20. BILATERALITY OF COCHLEAR Dorsal/Ventral Coch nuclei Superior Olivary Nuclei/Trapezoid body/Lat Lemn
21. [HESCHL'S BA 41] input from Auditory Radiations in PLIC (which came from MGN/branchium/Inf Colliculus/Lateral Lemniscus)
22. Transverse Temporal Gyri sound frequency somatotopy: HIGH FREQ @ POSTEROMEDIAL Gyri
23. [OCCIPITAL CORTEX] visual field/retina projections _______________________
24. [OPTIC NERVE LESION] = MARCUS-GUNN PUPIL (afferent limb of light reflex gone=no direct light constriction but
consensual/indirect is spared) & COMPLETE BLINDNESS in that eye.
25. Accomodation-Convergence Reaction (1) adduct (2) lens bulges (3) pupil constriction; *Loss of Convergence
26. PARASYMP LIGHT REFLEX (pretectal nuc B/L - E-W nuc B/L, Ciliary Ganglion, Sphincter pupillae M. *ARGYLLROBERTSON/Neurosyphilis IMPAIRS B/L Light Reflex @ retinotectal path (but Accomodation still intact)
27. MLF + VI lesion = ONE & A HALF SYNDROME (Paramedian br) = contralateral eye looks AWAY from lesion (contralateral LR is
spared)
CLARK [16Q]
1. [PIC] VASCULAR IMAGING - PICA branches off VERTEBRAL As before they form BASILAR
2. HYPERTENSIVE HEMORRHAGE @ DEEP GRAY basal nuclei/thalamus/cerebellum/pons; pushes on brainstem, may herniate; tx BP
control; Sx decrompress
3. CEREBRAL METASTATIC LESIONS occur @ Gray/White Junctions
4. SUBARACHNOID HEMORRHAGE "thunderclap headache"; complications=death/re-bleed/seizure/communicating
hydrocephalus/vasospasm/pulm edema/arrythm/hyponatremia
5. PITUITARY APOPLEXY: infarct/hemorrhage @ pituitary
6. MEDICATION OVERUSE HEADACHE >3 months of >2-3 days/wk using acetaminophen, NSAID, opiates, triptans.
7. PICA DISSECTION: Lateral medullary sundrome; horner's (anisocoria)
8. ALEXIA WITHOUT AGRAPHIA - splenium of CC (disconnection bw R occipital visual area and L Broca's area)
9. R PCA INFARCT = left occipital OR temporal lobe lesion "pie in the sky" sign; vertigo/diplopia/ataxia/weak/numbness
10. IDIOPATHIC INTRACRANIAL HYPERTENSION: papilledema; do imaging before LP. Complications =HA and Blindness
11. PAPILLEDEMA: increased ICP, B/L optic N swelling. Pulse Syncronous Tinnitus, visual obscurations, N/V, Postural Headache, CN VI
palsy/diplopia. Peripheral vision is first to go, blindness if untreated.
12. GIANT CELL/TEMPORAL ARTERITIS: tx = PREDNISON 60-80mg STAT; blood work, BIOPSY vessels for lymphocyte infiltration
of intima
13. TEMPORAL ARTERITIS Lab values = increased ESR, increased CRP, increased Platelets
14. Hollendorst Plaque--seen in retinal exam. (infarct to retina due to a plaque goober -- "embolic phenomenon going into the eye"; can
determine visual field defect based on its location
15. MRI (DWI sequence can show an ACUTE STROKE up to 2 weeks after; will appear bright)
16. tPA within 3 hrs of STROKE; converts plasimogen into plasmin = degrades thrombin/lyses clot
MARTIN [14Q]
1. Inner Hair Cells recieve afferent from VIII; Outer Hair Cells recieve efferent
2. Fourier Analysis: breaking down complex sounds into signals that brain can interpret
3. PLACE CODING depents on cochlear tonotopy (for higher frequencies! therefore esp at base of cochlea); If we damage hair cells @ BASE
of cochlea deficit in hearing high freq sound.
4. VOLLEY CODING requires a group of cells firing impulses such that the summation of impulses is equal to the Hz (only up to 2000 Hz)

5. TRICHROMAT: DEUTERANOMALY = can't see green-wavelengths due to DEFECT in cones; vs Dichromats have Deuteranopia = NO
green cones at all
6. SPHERICAL ABBERATION- property of all convex lenses where light hitting the edge of the lens is refracted more that light hitting near
the center; Corneas flatter near edge & pupils restrict the incoming light to center w least spherical aberration
7. LIGHT hits RODS: 11-cis to all-trans retinal -->transducin--> PDE--> dec cGMP --> closes Na channel --> hyperpolarizes
8. Dorsal Strem: Doing. Object orientation/action response to what u see; vs Ventral Stream = visual memory and object recognition
9. DECREASES SLEEP: Older age, Modafinil drug (narcolepsy tx), Dec2 gene mutation
10. MELATONIN PRODUCTION: Dark - retinal ganglion hyperpolarizes - SCN - NE - Pinealocytes - Synthesis of Melatonin from
Tryptophan
11. REM: EEG has high freq, low amplitude (Opposite on EOG); increases HR, RR, dreams and boners; decreases muscle tone
12. WAKEFULNESS: Orexin, Histamines, rostral pons-midbrain cholinergic nuclei, Tuberomammillary nuc, Locus Coreolus
13. SOUR Type III presynaptic Cell --> Ca2+ influx --> NE and Serotinin NT release on neighboring cells & AFFERENT nerves; also get
excited by ATP from neighboring Type II receptors of bitter/sweet/umami
14. ODORANTS activate GPCR/adenylate cyclase/ATP --> cAMP REGULATED
WILLARD [9Q]
1. SPINAL FACILITATION: chronic = too much Ca2+; kills inhibitory interneurons to mask pain
2. ALLODYNIA= chronic facilitation - unapposed pain fibers bc large fibers take over without the inhibiting interneurons
3. HPA AXIS: CRH - ACTH - Cortisol
4. SMALL FIBER SYSTEM locations/SENSITIZATION/Freq/Slower/unmyelinated
5. PERIPHERAL SENSITIZATION: inc receptive field, inc firing, dec activation threshold; TART changes,HYPERALGESIA
6. NEUROPEPTIDES: SP, CGRP, Somatostatin
7. AROUSAL SYSTEM: emotional/sensory stim-amygdala/ant cingulate-NorEpi-HPA activ-CORTISOL/cytokines-sympathetics
8. NEUROGENIC INFLAMM. CYCLE (feed forward; allostasis)
9. GAMMA LOOP HYPOTHESIS (doesn't explain tension/spasm/SD)
KISBY [8Q]
1. LA SENSITIVITY = small fibers, actively firing, unmyelinated, mantle, NON-acidic environment (less infection)
2. LA ESTERS (Coc/Pro/Tetra; PABA derm rxn) vs AMIDES (Lido/Prilo [MetHb]/Ropiv & Bupiv [CV])
3. GA - MALIGNANT HYPERTHERMIA from halogenated (-fluranes) & succinylcholine. ANTIDOTE = DANTROLENE
4. GA - INHALED factors contributing to potency & induction:
5. NON-SELECTIVE NSAID Adverse effects (eg Indomethicin) = ULCERS via Acid back diffusion, COX-1 and COX-2 & Epithelial
Damage (need all 3 for GI injury)
6. ADVERSE SALICYLATE RXN = REYE'S SYNDROME: AVOID giving salicylates to <15 yrs w Flu/Chickenpox = MITO dmge =
hepatic injury & Encephalopathy
7. ACETAMINOPHEN: hepatotoxic metabolite uses up all Glutathione
8. CELECOXIB = ONLY selective COX-2 Inhibitor. (CYP2C9) Advantage= NO platelet inhib, fewer GI probs, may dec risk of colon CA.
CAUTION = may be PRO-THROMBOTIC (adverse CV effects)
BABBEL [4Q]
1. Pathology near CAVERNOUS SINUS can effect CN's III, IV, V, VI
2. MENINGIOMA on T1 MRI without contrast: iso-intense with brain, in extra-axial space, abuts dura
3. PROSTHETIC DEVICES are SAFE (generally) in MRI
4. T3 MRI is strongest magnet & produces best image/fastest/highest resolution
AVERSANO [4Q]
1. GLASGOW COMA SCALE: EYES 1-5, VERBAL 1-5, MOTOR 1-5; Score of 3=deep unconsciousness; 14/15=full consciousness
2. BATTLE'S SIGN: Ecchymosis behind ear = Basal Skull Fracture
3. HORNER'S SYNDROME: may effect hypothalamospinal tract. ptosos, miosis, anhydrosis
4. CHRONIC SUBDURAL HEMATOMA: bridging veins b/w arachnoid & dura.
REDDING [2Q]
1. SPINAL FACILITATION: Maintenance of a neuron pool (in 1 or more spinal segments) in a state of partial excitation or subthreshold
excitation = LESS afferent stimulation is required to trigger APs
2. CLINICAL FEATURES: Trigeminal Sensory Nucleus @ midbrain to C4. unilateral, stabbing, recurrent, paroxysms w refractory period
KRAATZ [2Q]
1. Taste to cortex: 1' afferents thru CN 7,9,10 --> cell bodies @ respective ganglia --> Medulla Solitary Track --> synapse @ SOLITARY
NUCLEUS --> 2' to VPM thalamus & synapse --> 3' to Primary Gustatory Cortex
2. Smell to cortex: environment odor-->cilia -->knob--> olfactory epith--> bulb --> synapse @ MITRAL/tufted/periglom --> CN I --> anterior
olf nuc/trigone --> diverges: Lateral stria (Efferent to bulb) or Medial stria (PIRIFORM, ENTORHINA, Amygd)
SAFAOUI [2Q]
1. Budapest Criteria: (1) Continuing pain that is disproportionate to any inciting event; (2) 1 symptom of the following sensory, vasomotor,
sudomotor, and motor; (3) 1 sign in those categories; (4) no other diagnosis to explain pain
2. It hurts.