Ninja PRITE Part 1
Low CSF levels of this neurotransmitter metabolites is associated with suicidality?
5-HYDROXYINDOLE ACETIC ACID (5-HIAA)
Ninety-five percent of right-handed people develop left hemispheric dominance for language. What percentage of left handed people develop left hemispheric dominance for language?
75%
5 y/o presents w/ sudden onset of slurred speech and gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria and extensor plantar responses. Recent h/o measles. MRI, UA, blood work unremarkable. Dx?
ACUTE CEREBELLITIS
Prostaglandin D2 increases extracellular levels of...
ADENOSINE
Lesions in mammalary bodies will produce what symptom?
AMNESIA, CONFABULATION, LACK OF INSIGHT
threatening objects produce startle response prior to person becoming consciously aware. Connection of thalamus to what?
AMYGDALA
Akinetic mutism can result from bilateral infarctions of which of the following structures:
ANTERIOR CINGULATE GYRUS
The uncinated fasciculus connects which of the following brain areas?
ANTERIOR TEMPORAL AND VENTRAL PRE-FRONTAL REGIONS
Inability to carry out motor activites on verbal command despite intact comprehension & motor function indicates?
APRAXIA
Adult LP with opening pressure 190, protein 110, glucose 27, leukocytes 5,000. Dx?
BACTERIAL MENINGITIS
Visual problem in pituitary tumor compressing optic chiasm (10x)
BITEMPORAL HEMIANOPSIA
Characteristics of Ach receptors in cerebral cortex
BOTH INHIBITORY AND EXCITATORY
Which lesion causes bilateral coarse nystagmus worsening with visual fixation and present with horizontal and vertical gaze?
BRAINSTEM
70 y/o develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria without other cranial nerve involvement. Sensory exam is limited but grossly normal, DTR's are symmetric, and cognition is intact. Likely dx: (X2)
CENTRAL PONTINE MYELINOLYSIS
70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure. Lab reveals serum sodium of 95mEq/L. This is most likely a complication of excessively rapid correction of which metabolic problem?
CENTRAL PONTINE MYELINOLYSIS
Elderly pt with confusion, lethargy, generalized tonic- clonic seizure & serum sodium 95 mEq/L may develop this complication if excessively correcting metabolic problem.
CENTRAL PONTINE MYELINOLYSIS
Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with lurching broad- based gait. (8x)
CEREBELLAR DEGENERATION (ALCOHOLIC)
Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the end of reaching movements: (2x)
CEREBELLAR TUMOR
26 y.o. w/HA and R-hand clumsiness for weeks. Exam shows difficulty w/rapid alternating movements of hand, overt intention tremor on finger-to-nose, and mildly dysmetric finger tamping. CNS intact and no papilledema. Where will damage show on MRI?
CEREBELLUM
26 y/o w HA, clumsiness of right hand x weeks. Struggles with rapid alternating movements of R hand, overt intention tremor w finger-to-nose, mildly dysmetric finger-tapping. CNs nml, no papilledema. Damage to what is seen on MRI? (3x
CEREBELLUM
Abnormal emotional expressions such as pathological laughter or crying caused by lesions affecting cortical- subcortical circuits linking frontal cortex, pons and what?
CEREBELLUM
Inability to name obj held in left hand, but not in right hand, indicates lesion in?
CORPUS CALLOSUM
Etiology of meningitis assoc with fever, HA, CSF pleocytosis with lymphocyte predominance, slightly elevated CSF protein, and normal CSF glucose
COXSACKIE VIRUS
52 y/o pt with EtOH dependence present with several days of severe headache, nausea, and low grade fever. Physical exam reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. A head CT is unrevealing. LP: 55/mm3 leukocytes (mostly lymphocytes), 45 mg/dl glucose, protein: 43 mg/dl, and presence of occasional gram positive spherical cells. The most likely causative organism is:
CRYPTOCOCCUS NEOFORMANS
Histology consistent with Jakob-Creutzfeldt disease
CYTOSOLIC VACUOLATION OF NEURONS AND GLIA WITH PRION INCLUSIONS
Neural plasticity largely mediated through the capacity to rapidly change in number and morphology which fo the following?
DENDRITIC SPINES
Psych stress increases cortisol and prolonged cortisol is associated with bad outcomes. Stress also affects other hormones. Increase in which hormone is correlated with decreased PTSD severity most likely due to hormone's anti-glucocorticoid properties:
DHEA
25 y/o M w 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in both feet +incoordination. Involuntary choreic movements of B/L UE, apathetic, monosyllabic. Labs normal. EEG: mild diffuse slowing. CT/MRI nml. During admission develops severe akinetic mutism, seizures, dies. Brain autopsy shows:
DIFFUSE AMYLOID PLAQUES, SPONGIFORM NEURONAL DEGENERATION, AND SEVERE ASTROGLIOSIS
Sx of lesions in one cerebellar hemisphere
DISTURBANCE OF SKILLED MOVEMENTS IN THE EXTREMITIES IPSILATERAL TO THE LESION
What does the cerebellum do in the human adult brain?
DIVERSE ROLES IN MOVEMENT, BEHAVIOR, AND LEARNING
Neurotransmitter from responsible for rewarding nature of drug abuse
DOPAMINE
Drug abuse activates neuro circuits. Generates signals in the ventral tegmental area and to where?
DOPAMINE INTO THE NUCLEUS ACCUMBENS
Which is a retrograde neurotransmitter?
ENDOCANNABINOIDS
75 yo patient evaluated for progressive gait, urine incontinence, and cognitive decline. After removal of csf, there is improvement in gait and balance. What would CT show?
ENLARGEMENT OF THE FRONTAL HORNS
Most common cause of aseptic meningitis:
ENTERIC VIRUS
When does synaptogenesis peak?
FIRST 4 YEARS OF LIFE
62yo progressive personality changes, has dull emotions, lack of initiative, and apathy. An autopsy is likely to show atrophy of ...?
FRONTAL LOBE
Previously reliable, conscientious man becomes increasingly profane, irascible, irresponsible over 6 months. Sxs suggest tumor most likely to be found where?
FRONTAL LOBE
What are cortical columns?
FUNCTIONAL UNITS FOR INFORMATION PROCESSING
Huntington's disease characterised by loss of neurons producing which NT
GABA
Deep brain stimulation in which brain structure is a useful treatment for primary generalized dystonia?
GLOBUS PALLIDUS
Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning associated comas?
GLOBUS PALLIDUS
Condition most likely to account for the presence of cognitive impairment in a pt with untreated Hep C (HCV) infection and normal ammonia level who is HIV sero- negative:
HCV INFECTION OF BRAIN
Pt with several days of fever and severe headaches presents to ED b/o generalized seizure. Pt is confused and somnolent. Also reported to have been irritable and has c/o foul smells. T2 MRI displayed (hyperintensity of left temporal): (2x)
HERPES ENCEPHALITIS
Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. The most likely medical cause of this presentation is: (2x)
HERPES SIMPLEX VIRUS (HSV) INFECTION
Adult neurogenesis in which area of the brain?
HIPPOCAMPUS
Sign of UMN lesion
HYPERACTIVE DTR
Benign intracranial HTN etiology: (2x)
HYPERVITAMINOSIS A
9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6 months ago, and at Tanner stage 4. Dx? (2x)
HYPOTHALAMIC HAMARTOMA
What is an accurate statement about the brain's default mode network?
IS INVOLVED IN REPROCESSING PREVIOUSLY EXPERIENCED STIMULI
What causes progressive multifocal leukoencephalopathy? (x2)
JC VIRUS
What is the 5HT3 receptor classification?
LIGAND GATED
Which cancer has the highest likelihood of going to brain?
LUNG
Hippocampal atrophy has been identified in all of the following disorders:
MDD, ALZHEIMER'S DISEASE, PTSD. (NOT DISSOCIATIVE AMNESIA)
Upbeating nystagmus of primary gaze. Where is the lesion?
MEDULLARY LESION
5 y/o with 4 month history of morning HA, vomiting, and recent problems with gait, falls, and diplopia: (2x)
MEDULLOBLASTOMA
Ptosis R eye, dilated R pupil, double vision, L-sided hemiparesis, no cognitive impairment. Where is lesion? (x2)
MIDBRAIN
25 y/o pt with diplopia, difficulty with balance. On R lateral gaze, weakness of L medial rectus with nystagmus of R eye. On L lateral gaze, weakness of R medial rectus with nystagmus of L eye. Mild finger to nose ataxia. What is the most likely dx? (2x)
MULTIPLE SCLEROSIS
41 y/o chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort maintenance, and irritability (MRI: hyperintensity in frontal lobe and what looks like a finger protrusion)
MULTIPLE SCLEROSIS
Acute onset of fever, sore throat, diplopia, & dysarthria. Exam reveals an inflamed throat, left adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, & mild right hemiparesis. CT is uninformative. Spinal fluid has protein of 24, 10 mononuclear cells, and glucose of 70. Dx? (2x)
MULTIPLE SCLEROSIS
Diagnosis of 32yo woman w/ vertigo and INO
MULTIPLE SCLEROSIS
Pt w/ acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and a swollen right optic disc. Pt spontaneously recovers over the next 6 wks. Likely to develop later: (3x)
MULTIPLE SCLEROSIS
The MRI of the brain of a 35yo woman w new onset L arm and L leg numbness is shown.
MULTIPLE SCLEROSIS
Most common solid tumor of the CNS in kids
NEUROBLASTOMA
75 y/o M, Korean war veteran, with gradual development of forgetfulness and cognitive deterioration, presents with very fast /slurred speech and impaired gait. A head CT shows some generalized atrophy, unusual for his age. The LP show 35 WBC, lymphocytosis and the protein level is 110mg/Dl and elevated gamma globulin. Dx:
NEUROSYPHILIS
28 y.o. hospitalized with paranoid delusions, AH, and agitation, tx w/Haldol 5, pt becomes rigid & mute, in days gets choreoform mvmt, has seizures, gets resp problems leading to ICU admit. Exam shows ovarian mass, CSF will show antibodies to:
NMDA RECEPTORS
Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or headaches are reported. Likely diagnosis? (3x)
NORMAL PRESSURE HYDROCEPHALUS
Role of glycine at NMDA receptor
OBLIGATE COAGONIST
Increased risk-taking behavior. Where is lesion?
ORBITOFRONTAL CORTEX
Neurohormone for social bonding
OXYTOCIN
Delayed neurological deterioration following carbon monoxide-induced coma is most likely manifested by:
PARKINSONISM
68 y/o pt is depressed following a hip surgery. Pt is withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, and has trouble swallowing. MRI of the head will show:
PERIVENTRICULAR WHITE MATTER DEMYELINATION
Patient is asked to do clock draw test. They show perseveration by writing numbers around the clock up from 1-18 arranged with equal spacing around a circle, and only one clock hand. Which brain region is dysfunctional?
PREFRONTAL CORTEX
Where does the neuron morphology in the brain change the most?
PREFRONTAL CORTEX
Which is the most reliable finding from CSF analysis for a pt with multiple sclerosis in the chronic progressive phase of the dz? (2x)
PRESENCE OF OLIGOCLONAL BANDS
Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of treatment in this case: (2x)
PREVENT BLINDNESS
65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/ labs unremarkable. Dx? (4x)
PROGRESSIVE SUPRANUCLEAR PALSY
66 y/o c/o frequent falls, several-month hx of anxiety, unwillingness to leave home. On exam, mild impairment of vertical gaze on smooth pursuit/ saccades, mild axial rigidity & minimal rigidity of upper extremities, along w mild slowness of movement on finger tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Pt is slow in arising from a chair. Most likely dx: (6x)
PROGRESSIVE SUPRANUCLEAR PALSY
A 66 yo complains of frequent falls. ON exam, the pt has difficulty with upward gaze, and has severe axial rigidity which is less apparent in upper or lower extremities. There is mild slowness of movement on finger tapping, hand opening and wrist opposition and the patient's fingers acquire cramped pastures with the effort of the task. The pt's neck posture is extended. Gait is somewhat slow, with short steps, and The pt is slow when arising from a chair. What is most likely diagnosis?
PROGRESSIVE SUPRANUCLEAR PALSY
Dx for 68yo c/o falls. PE shows upright rigid posture, stiff gait, extended knees, and pivoting while turning.
PROGRESSIVE SUPRANUCLEAR PALSY
Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty in voluntary vertical upward/ downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems with horizontal & vertical gaze. Oculocephalic reflexes normal. Involuntary saccades. (2x)
PROGRESSIVE SUPRANUCLEAR PALSY
25 y/o pt c/o severe HA and vomiting. Pain is dull and mostly in occipital region. Exam: b/l severe papilledema, otherwise WNL. LP: opening pressure: 200mmH2O, no cells, 62mg/dl glucose, 31 mg/dl protein. CT: normal. Dx?
PSEUDOTUMOR CEREBRI
Severe occipital HA, BL papilledema and no other abnormalities. Chronic acne treated with isotretinoin. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 22mg/dl protein. CT is normal. (7x)
PSEUDOTUMOR CEREBRI
60 y/o right-handed M, getting lost, only writes on right half of paper. Left-sided hemi-neglect. Where is the lesion? (8x)
RIGHT PARIETAL LOBE
Severe occipital HA, BL papilledema and vomiting. Just started birth control pills. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 31mg/dl protein, RBC 400. CT is normal.
SAGITTAL SINUS THROMBOSIS
Decreased level of what NT is most associated with depressed mood, poor sleep, and poor impulse control
SEROTONIN
79 y/o pt with a deteriorating mental state over a 3- week period has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Myoclonic jerks are also seen. Diagnosis: (5x)
SPONGIFORM ENCEPHALOPATHY
Pain by neurogenic inflammation mediated by?
SUBSTANCE P
Implantation of deep brain stimulation electrodes is an effective tx for Parkinson's. Optimal location for electrodes?
SUBTHALAMIC NUCLEUS
Exposure to light effects which brain structure?
SUPRACHIASMATIC NUCLEUS
The most likely reason that adults are superior to adolescents in abstract thinking. The brain undergoes:
SYNAPTIC PRUNING
32 y/o pt 1-month hx of worsening headaches, episodic mood swings and occasional hallucinations with visual, tactile and auditory content. CT head reveals tumor where:
TEMPORAL LOBE
Superior homonymous quadrantic defects in the visual fields result from lesions to which of the following structures? (2x)
TEMPORAL OPTIC RADIATIONS
What condition is a forerunner of MS? (2x)
TRANSVERSE MYELITIS
Mesolimbic DA pathway includes which structure?
VENTRAL STRIATUM
In addiction, dopaminergic neurons project to nucleus accumbens. Cell bodies of these neurons reside in which area of brain?
VENTRAL TEGMENTAL AREA
17y/o is evaluated for binge eating associated with a 60 lb weight gain over the past four months. CT shows a craniopharyngioma that likely disrupts what structure?
VENTROMEDIAL HYPOTHALAMUS
If an MRI of the head shows an infarct of the Left ACA, what is the deficit?
WEAKNESS OF CONTRALATERAL FOOT AND LEG
Dorsal-lateral-pre-frontal cortext plays important role in what activity?
WORKING MEMORY