Ninja PRITE Part 1

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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)