Pathophysiology CNS CNS

1. This disease is known as an insidious and progressive neurologic disorder characterized by a loss of memory, cognitive impairment, and eventual dementia?

Parkinson's disease

Age-related psychosis

Alzheimers Disease

Multiple Sclerosis

Acute Hemorrhagic Meningitis

2. True or false: In early parkinsonism, Levadopa is beneficial, however this therapy does not rectify the underlying disorder, and several years later, becomes ineffective.

True

False

3. An 85 year old female patient gradual loss of memory, cognitive function, difficulty with language, and changes in behavior. What is the most likely diagnosis?

Multiple Sclerosis

Alzheimers Disease

Parkinson's Disease

Viral meningitis

4. True or False: Alzheimers Disease is restricted to patients younger than 65 years of age and already diagnosed with presenile dimentia.

True

False

Today, the term Alzheimers disease is used generically for all ages and identifies a specific morphological corollary of dementia.

Explanation

Today, the term Alzheimers disease is used generically for all ages and identifies a specific morphological corollary of dementia.

5. True or False: The Alzheimers brain loses roughly 200 gms in an interval of 3-8 years.

True

False

6. True or False: The vast majority of meningitis cases are caused by suppurative bacteria and the organsim relates to the sex of the patient.

True

False

The vast majority of meningitis cases are caused by suppurative bacteria and the organism relates to the age of the patient.

Explanation

The vast majority of meningitis cases are caused by suppurative bacteria and the organism relates to the age of the patient.

7. Which diseased is defined as a neurologic disorder characterized pathologically by the loss of neurons in the Substantia Nigra and clinically by tremors at rest, muscular rigidity, expressionless face, and emotional lability.

Bacterial Meningitis

Alzheimers Disease

Viral Meningitis

Multiple Sclerosis

Parkinsons Disease

8. True or False: H. influenza elicits a dense leukocytic exudate, which is rich in fibrin over the convexities and therefore creates a barrier to antibiotics.

True

False

9. It has been suggested that Parkinsons disease is an acceleration of normal age related changes.The changes being referred to primarily have to do with the ___________ _______ which relays information to the _______ ________ through _________ synapses.

Brain stem, sympathetic chain, adrenergic

Cerebral cortex, cranial nerves, muscarinic

Substantia Nigra, basal ganglia, dopaminergic

Prefrontal cortex, afferent neurons, cholinergic

Medulla oblongota, efferent neurons, achetylcholinestergic

10. You're 37 year old patient presents with blurred vision and loss of vision altogether in one eye. Based on the patients age and her description of exacerbations and remissions, you begin to suspect:

Alzheimers Disease

Viral Meningitis

Bacterial Meningitis

Multiple Sclerosis

Myesthenia Gravis

11. What is the most difinitive diagnostic index of meningitis?

PMN's in the CSF

PMN's in the blood

RBC's in the CSF

Purulent discharge in the ears

Elevated white count

12. An 82 year old male patient comes in to see you with a mask-like face and is slighty drooling. The paitent presents with slow voluntary movements and a muscular rigidity throughout the entire range of motion with each movement. He has "pill-rolling" of the distal extremities that is present only at rest but goes away each time he voluntarily moves. What is at the top of your differentials?

Alzheimers Disease

Multiple Sclerosis

Stroke

Parkinson's Disease

Myesthenia Gravis

13. True or false: Because the pia is so delicate, it is an ineffective barrier against the spread of infection and typically does not prevent spread to the underlying brain.

True

False

The pia, although delicate, is an effective barrier against the spread of infection and generally prevents involvement of the underlying brain.

Explanation

The pia, although delicate, is an effective barrier against the spread of infection and generally prevents involvement of the underlying brain.

14. Risk factors for MS include all of the following EXCEPT:

Tropical climates

Most common in 40 year olds (uncommon before 14 and after 60 y.o.)

Women afflicted twice as often as men

Possibly other infectious, genetic, and infectious etiology

15. True or False: Terminal bronchopneumonia is the usual cause of death in AD.

True

False

16. The classic signs of meningeal infection include all of the following EXCEPT:

Cervical rigidity

Kernig sign

Head retraction

Murphy's sign

Brudzinski sign

17. Other causes of Parkinson-like symptoms include all of the following EXCEPT:

Spider bites (black widow, tunnel spider)

Drugs (Phenothiazines, Haldol)

Poison (Carbon monoxide, Manganese)

Hydrocephalus

Tumors (Near the basal ganglia)

Also included in the list are Bilateral infarcts of basal ganglia and cerebral trauma.

Explanation

Also included in the list are Bilateral infarcts of basal ganglia and cerebral trauma.

18.

The above silver stain show bundles of paired, heliclal filaments in the cytoplasm of cortical neurons or hippocampal pyramidal cells that displace or encircle the nucleus (flame cells). These are known as:

Signet-ring cells

Senile plaques

Neurofibrillary tangles

Fire cells

19. True or false: Some patients with MS exhibit a relentless course without any exacerbations or remissions.

True

False

20. The degree of functional impairment with MS is variable, ranging from minor disability to severe incapacity. The range of symptoms include all of the following, EXCEPT:

Widespread paralysis

Severe nausea and vomiting

Dysarthria

Severe visual defects

Incontincence and dementia

21. Leptomeningitis is an inflammatory process that is localized to the interfacing surfaces of the _______ and the _________, where ______ flows.

Dura, Pia, CSF

Arachnoid, Pia, Blood

Pia, Arachnoid, CSF

Dura, Arachnoid, CSF

22. Current advances in AD include the understanding of Neurofilbrillary tangles, which are paired _______ filaments. These filaments, consist of an abnormal form of a normally occuring ___________-____________ protein. When normal, the protein is responsible for proper _________ transport.

Pleated, macrotubule-associated, lipid

Helical, microtubule-associated, axonal

Round, cytoskeletal-associated, active

Helical, macrotubule-associated, lipid

23. The following picture shows what characteristic hallmark of MS?

Plaques

Shrinking sulki

Widened gyri

Thunder bolts

24. The combination of clincal assessment and modern radiologic methods allow for acurate diagnosis in 80-90% of cases however, which of the following is necessary for a difinitive diagnosis.

Biopsy

Endoscopy

Pathologic examination of vessels in the brain

Pathologic examination of brain tissue

25. What type of infection resulting in injury (gross loss of pigmentation) to the substantia nigra occured during the infuenza pandemic of 1916-1920 which lead to the clinical expression of "postencephalitic parkinsonism."

Bacterial meningitis

Acute hepatitis

Cholelithiasis

Sinusitis

Von Economo Encephalitis

26. Which of the following is TRUE about Pachymeningitis?

Inflammation of the Pia

Usually a consequence of traumatic brain injury.

The arachnoid acts as a barrier to infection.

The inflammation is restricted to the outer surface of the brain.

Pachymeningitis is inflammatino of the dura usually a consequence of contiguous infection such as chronic sinusitis or mastoiditis. The dura is a barrier to infection therefore inflammation is restricted to the outer surface.

Explanation

Pachymeningitis is inflammatino of the dura usually a consequence of contiguous infection such as chronic sinusitis or mastoiditis. The dura is a barrier to infection therefore inflammation is restricted to the outer surface.

27. ________ are the hallmark of meningitis caused by tuberculosis, viral meningitides, and chronic fungal infections (cryptococcal meningitis).

Macrophages

Lymphocytes

Eosinohpils

Monocytes

28. Which of the following is not a clinical manifestation of Bacterial Meningitis?

Head ache

Convulsions in adults

Fever

If untreated, coma and death

Vomiting

Bacterial meningitis frequently causes convulsions in children.

Explanation

Bacterial meningitis frequently causes convulsions in children.

29. The picture displays an atrophic nerve cells which contain what?

Rod-shaped, smooth, basophilic mitochondrial inclusions.

Spherical, granular, eosinophilic cytoplasmic inclusions.

Square, gritty, lymphocytic periplasmic inclusions.

Triangular, soft, macrolytic endoplasmic inclusions.

The picture shows residual atrophic nerve cells containing spherical, granular, eosinophilic cytoplasmic inclusions called Lewy Bodies.

Explanation

The picture shows residual atrophic nerve cells containing spherical, granular, eosinophilic cytoplasmic inclusions called Lewy Bodies.

30.

Which of the following is NOT true of the gross Alzheimers brain?

Loss of neurons and neuritic processes

Narrow gyri

Widened sulci

Unilateral cortical atrophy

Atrophy in frontal, parietal, temporal, and hippocampal cortices.

31. All of the following are clinical manifestations of Parkinson's disease EXCEPT:

Depression

Hypertonia

Hypotonia

Dimentia

Akinesia

32. Which of the following is not true of Bacterial Meningitis organisms and age?

E. Coli and Group B strep are most commonly found in neonates with bacterial meningitis

Group A strep and H. Pylori are most commonly found in adolescents with bacterial meningitis.

H. influenza is usually fuond in infants 3 months-3 years old with bacterial meningitis.

Strep pneumococcus is usually found in adults with bacterial meningitis.

N. meningitidis is usually found in military barracks when bacterial meningitis is going around.

33. The following picture of microscopic AD plaques are most commonly found where?

Hyppocampus, amygdala, and cortex

Medulla, corpus colosum, hyppocampus

Cortex, brain stem, spinal cord

Frontal, temporal, parietal lobe

34. Which of the following is a feature of Alzheimers Disease?

Advances of our pathologic understanding of AD relate to alpha-protein amyloid deposition in senile plaques.

Plaques located in the spinal cord are linked to intelectual funciton and are a constant feature of AD

The pathogenisis of AD is fully understood

World wide, AD is the most common cause of dementia in the elderly accounting for half of all the cases. The cause of AD has yet to be fully understood, but recent advances show greater understanding related to beta-protein amyloid deposition leading to senile plaques located in the cerebral cortex of the brain and are related to intelectual function.

Explanation

World wide, AD is the most common cause of dementia in the elderly accounting for half of all the cases. The cause of AD has yet to be fully understood, but recent advances show greater understanding related to beta-protein amyloid deposition leading to senile plaques located in the cerebral cortex of the brain and are related to intelectual function.

35. The following picture shows what? Which type of stain? And where are they located?

Amyloid angiopathy, Congo red stain, spinal cord

Amyloid angiopathy, Congo red stain, cerebral blood vessels.

Neurofibrillary tangles, congo red stain, cerebral cortex

Senile plaque, Silver stain, cerebral blood vessels

Amyloid angiopathy, silver stain, cerebral blood vessels

36. Your 42 year old patient presents with weakness in both legs and numbness of lower extremities that bothers them intensely for 6-7 weeks and then subsides. This is the 3rd time they have been to your office because the symptoms keep coming back. You are beginning to suspect MS and expect to find what after radiologic testing?

A lesion at the optic nerve

A plaque in the brain stem

A plaque within the spinal cord

A lesion at the substantia nigra

A plaque within the basal ganglia

37. Which of the following is true of genetic and immune factors related to MS?

A familial aggregation of the disease with an increased risk in 1st degree relatives.

Dizygotic twins show a 25% concordance for MS (2% for monozygotic)

Immune factors related to perivascular lymphocytes and macrophages with numerous CD4+, CD8+, and t-cells

Direct evidence exists for the involvement of certain viruses including mumps, rubella, herpes, and measles.

JC virus has recently been studied, due to its role in preventing demyelination in the CNS.

38. Grossly, the brain discloses an exudate of PMN's and fibrin which opacifies the _________, and giving a _______or _________ white appearance, usually over the convexities as well as the base of the brain.

Pia, creamy or white

Arachnoid, yellow or purulent

Arachnoid, creamy or white

Dura, Yellow or purulent

Arachnoid, grey or cloudy

39. What are discrete spherical masses of sliver-staining neuritic processes surrounding a central amyloid core?

Lewy Bodies

Neurofibrillary tangles

Signet ring cells

Hewey Bodies

Senile (neuritic) plaques

40. Which of the following is NOT true of the "hallmark of the disease" in MS?

The plaque is the hallmark of the disease

Usually situated in the white matter, but occassionaly breech the gray-white junction

Exhibit a preference for the optic nerves and chiasm and uniformly localizes in to the periventricular white matter.

Can also involve the cerebellum, brainstem, and spinal cord.

Usually 2-4 mm in size with a jagged, irregular contour

41. Which of the following is NOT true of Parkinson's disease?

Most commonly occurs in white males

Typically effects those in the 6th-8th decade of their life.

Genetic factors do not play a role (except for a rare autosomal dominant disorder)

The vast majority of cases are idiopathic.

The disease has been recorded after viral encephalitis and after the intake of a toxic chemical (MPTP).

No sex or ratial differences are apparent in Parkinsons disease.

Explanation

No sex or ratial differences are apparent in Parkinsons disease.

42. Which of the following is not true of Multiple Sclerosis?

A chronic demyelinating disease of the CNS

Characterized by numerous patches of demyelination througout the grey matter

It is the most common demyelinating disorder (prevelence 1 in 1000)

Disease effects both sensory and motor functions

Characterized by exacerbations and remissions over a period of years.

43. All of the following are true about MS, EXCEPT:

Histologically, there is a selective loss of myelin in a region of axonal preservation.

Perivascular inflammation lymophocytes and macrophages with focal edema.

Astrocytes traverse the aging plaque and the tissue becomes dense with glial processes.

As the plaque ages, it becomes less discrete and the edema progresses.

44. Microscopically, what are the changes seen in Parkinson's disease?

Loss of pigmentation in the substantia nigra

Residual atrophic nerve cells are seen known as "Hewey Bodies"

Pigmented neurons are scarce with small extracellular deposits of melanin, from necrotic neurons.

Loss of pigmentation in the Locus Ceruleus

A and D are gross changes seen in Parkinsons. B is also wrong because the atrophic nerve cells are known as Lewy bodies.

Explanation

A and D are gross changes seen in Parkinsons. B is also wrong because the atrophic nerve cells are known as Lewy bodies.

45. True or false: In MS, patients usually die of respiratory paralysis or UTI's in terminal coma 10-15 years after the onset of symptoms.

True

False

Patient's usually die 20-30 years after the onset of symptoms.

Explanation

Patient's usually die 20-30 years after the onset of symptoms.

46. Your 37 year old patient presents with blurred vision and vertigo. Due to a history of exacerbations and remissions you begin to suspect MS. Upon radiographic studies, where do you expect to find the initial lesion?

Optic nerves

Brain Stem

Prefrontal cortex

Spinal cord

Basal ganglia