Neurology Exam Quiz

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Questions and Answers

Which of the following is not a cause of dementia?

Multi infarct

Post infectious

Excessive vitamin C intake (correct)

Aging

What clinical feature is primarily associated with Alzheimer's Disease?

Impairment of recent memory (correct)

Difficulty understanding visual images

Tremor at rest

Loss of pigmented neurons

Which pathological feature is associated with Alzheimer's Disease?

Decreased dopamine secretion

Neurofibrillary tangles (correct)

Increased myelin deposition

Lewy inclusion bodies

What is the primary clinical symptom of Parkinsonism?

Resting tremor Signup and view all the answers

Which of the following metabolic disorders can cause dementia?

Wilson's Disease Signup and view all the answers

Which of the following is a common feature of Multiple Sclerosis?

Episodes of neurological defects Signup and view all the answers

What is a significant pathological change seen in Parkinson's Disease?

Degeneration of basal ganglia Signup and view all the answers

What is a risk factor associated with Multiple Sclerosis?

Genetic factor HLA-DR2 Signup and view all the answers

What are the common effects of increased intracranial pressure (ICP)?

Headache, vomiting, and coma Signup and view all the answers

Which of the following is NOT a site of brain herniation?

Cervical Signup and view all the answers

Which best describes the primary mechanism of hydrocephalus?

Increased CSF production or obstruction Signup and view all the answers

What is the primary treatment for cerebral edema mentioned?

Mannitol and hypertonic saline Signup and view all the answers

How does brain edema contribute to neuronal damage?

Through vascular damage and CSF flow obstruction Signup and view all the answers

What symptom is typically observed in infants with hydrocephalus?

Increased head size Signup and view all the answers

Which of the following best describes a common cause of cerebral infarction?

Arterial narrowing due to thrombosis and atheroma Signup and view all the answers

What is the first pathological change observed after a cerebral infarction?

Swelling Signup and view all the answers

Which type of meningitis is typically caused by Group B streptococci in neonates?

Pyogenic Meningitis Signup and view all the answers

Which symptom is NOT typically associated with meningitis?

Rash with fever Signup and view all the answers

What is the primary complication associated with pyogenic meningitis?

Herniation due to cerebral edema Signup and view all the answers

What type of meningitis usually presents with clear CSF and lymphocytosis?

Viral Meningitis Signup and view all the answers

Which organism is NOT commonly associated with bacterial meningitis in adults and the elderly?

Coxsackie virus Signup and view all the answers

What is the primary diagnostic method for meningitis?

CSF examination Signup and view all the answers

What is the characteristic cell type associated with schwannomas?

Schwann cells Signup and view all the answers

Which of the following is NOT a route of infection for CNS diseases?

Airborne transmission Signup and view all the answers

Which brain tumor is most commonly associated with hydrocephalus in children?

Medulloblastoma Signup and view all the answers

In tuberculosis meningitis, which pathological feature is observed early in the disease course?

Exudates with lymphocytes and neutrophils Signup and view all the answers

Which condition is characterized by localized collection of capsulated pus in the brain?

Brain Abscess Signup and view all the answers

What type of tumor is classified as benign and characterized by psammoma bodies?

Meningioma Signup and view all the answers

What is a common viral cause of acute encephalitis?

Herpes Simplex Virus Signup and view all the answers

At what age range are ependymomas most commonly found?

Ages 20-40 years Signup and view all the answers

Which of the following is NOT a form of encephalitis?

Chronic Signup and view all the answers

What is a common feature of neurofibromatosis?

Involves the formation of tumors on nerves Signup and view all the answers

What neurological complication can result from a brain abscess?

Scar formation leading to epilepsy Signup and view all the answers

Which neural tube defect is characterized by failure of closure of the posterior vertebral arches?

Spina bifida Signup and view all the answers

Which brain tumor is known to have a better prognosis amongst the listed options?

Oligodendroglioma Signup and view all the answers

The TORCH complex includes congenital infections that can be transmitted from mother to fetus. Which of the following is NOT included in the TORCH complex?

HIV Signup and view all the answers

What is the link between neural tube defects and maternal health?

Linked to maternal folic acid deficiency Signup and view all the answers

What type of disease is caused by prions, leading to the formation of spongy degeneration in the brain?

Transmissible Spongiform Encephalopathy Signup and view all the answers

Which type of cellular damage is commonly associated with herpes simplex virus infection in acute encephalitis?

Temporal lobe necrosis Signup and view all the answers

What is the primary source of Toxoplasmosis in neonates?

Transplacental transmission from the mother Signup and view all the answers

Which condition is primarily characterized by the loss of the myelin sheath and leads to variable neurological symptoms?

Chronic inflammatory demyelinating polyneuropathy Signup and view all the answers

What is the most frequently used treatment for Guillain-Barré syndrome?

Intravenous immunoglobulin (IVIG) Signup and view all the answers

Which of the following is a major distinction between primary and secondary brain tumors?

Primary tumors originate in the central nervous system, while secondary tumors arise elsewhere. Signup and view all the answers

In the WHO classification of brain tumors, which category includes meningiomas?

Tumors of meninges Signup and view all the answers

Which type of glioma is recognized as the most common primary tumor in adults?

Astrocytoma Signup and view all the answers

What histological feature is indicative of higher grade gliomas?

Mitosis and necrosis Signup and view all the answers

Which statement about the subclassification of brain tumors is true?

Mixed tumors include cells from at least two different types of tissues. Signup and view all the answers

What symptom is least likely associated with brain tumors?

Increased appetite Signup and view all the answers

Study Notes

CNS Pathology

CNS pathology covers infections, routes, pyogenic meningitis, causes of meningitis, complications, meningitis pathology, aseptic (viral) meningitis, Brudzinski's and Kernig's signs, TB meningitis, diagnosis and management, brain abscess, encephalitis, acute encephalitis pathology, slow encephalitis, prion disease, toxoplasmosis, TORCH complex, increased intracranial pressure, space-occupying lesions, brain herniation, brain edema, mannitol and hypertonic saline, hydrocephalus, cerebrovascular accidents, cerebral infarction, transient ischemic attacks (TIAs), cerebral hemorrhage, head injury, extradural hematoma, subdural hematoma, intracerebral hemorrhage, degenerative diseases, and diseases of myelin.

Pathology of CNS Infections

CNS infections involve meningitis, encephalitis, brain abscess, and different types of infections (bacterial, viral, fungal, parasitic).
Routes of infection include blood (trauma), direct extension (e.g., from otitis media), and nerves (e.g., rabies and herpes).

Pyogenic Meningitis

An acute infection of the meninges.
Anatomical types include leptomeningitis (pia + arachnoid matter), and pachymeningitis (dura).

Causes of Meningitis (examples)

Neonates: Group B streptococci, E coli, Listeria monocytogenes.
Children/Teenagers: Streptococcus pneumoniae, H influenza (non-vaccinated infants)
Adults/Elderly: Streptococcus pneumoniae.
Children: Coxsackie virus (fecal-oral transmission)

Meningitis Pathology

Sub arachnoid pus
CSF organization
Turbid CSF
Hydrocephalus
Normal cortex

Aseptic (Viral) Meningitis

Usually mild, with complete recovery.
Common pathogens include HSV, CMV, enteroviruses, and mumps.
CSF characteristics: clear, lymphocytosis, normal sugar, slightly increased protein.

Brudzinski's and Kernig's Signs (Examples)

Brudzinski's sign: flexion of the hips and knees in response to neck flexion.
Kernig's sign: resistance to extension of the leg while the hip is flexed.
Used to diagnose meningitis.

Brain Abscess

Localized collection of capsulated pus.
Causes: bacterial, fungal, parasitic, tumor.
Source: direct, metastatic.
Clinical effects: similar to a space-occupying lesion, leading to increased intracranial pressure (ICP), focal neurological deficits, and potentially epilepsy and coma.

Encephalitis

Inflammation of the brain tissue (usually viral).
Forms: acute (HSV, HZV, rabies), persistent (PMLE, SSPE), slow (prions).
Clinical features: severe mental status changes, focal neurological deficits, potentially seizures and/or coma. Potentially fatal.
Pathology (examples): perivascular inflammation, glial hyperplasia, inclusion bodies, neuronal damage (e.g., temporal lobe necrosis in HSV, disseminated necrosis in CMV).

Acute Encephalitis Pathology

Perivascular inflammation
Glial hyperplasia
Inclusion bodies
Neuronal damage
HSV: Temporal lobe necrosis
CMV: Disseminated necrosis
Rabies: Negri bodies

Slow Encephalitis (Prion Diseases)

Caused by abnormal infectious proteins (prions) leading to the degeneration of brain cells.
Forms: Creutzfeldt–Jakob disease (CJD), Kuru.
Types: indigenous and exogenous (e.g., mad-cow disease).

Additional CNS Pathologies / Neurological disorders

Toxoplasmosis: Parasitic brain infection, common in neonates (transplacental from infected mother). Infection of food contaminated with animal urine/feces, especially cat feces.
TORCH Complex: Infectious disorders, including toxoplasmosis, rubella, CMV, and herpes simplex virus. Symptoms include microcephaly, central nervous system (CNS) calcifications, petechial rash, hepatosplenomegaly, and thrombocytopenia.
Increased Intracranial Pressure (ICP): High pressure inside the skull due to space-occupying lesions (e.g., abscess or hematoma, tumors, recent infarcts, brain edema). Effects: headache, vomiting, papilledema, coma, and brain herniation, which causes further neuronal damage.
Brain Herniation: Pushing of the brain tissue due to increased intracranial pressure.
Brain Edema: Swelling of the brain tissue due to intracellular & extracellular water accumulation (vasogenic, cytotoxic). Effects: vascular damage, CSF flow obstruction, neuronal damage. Treatment using mannitol and hypertonic saline.
Hydrocephalus: Increased Cerebrospinal Fluid (CSF) volume in the cranium due to production, obstruction, or reabsorption issues. Infants: large head circumference and mental retardation. Adults: dilated ventricles and brain atrophy.
Cerebrovascular Accidents (CVA): Includes cerebral infarction (ischemia) and cerebral hemorrhage. Infarction: due to arterial narrowing (thrombosis, atheroma), shock, and increased intracranial pressure. Pathology (examples). Clinical effects. TIA: transient ischemic attacks. Cerebral hemorrhage: caused by hypertension (HT), tumors, bleeding disorders, arteriovenous malformations. Pathology: initial bleeding -> increased intracranial pressure -> death -> later cyst formation, subarachnoid hemorrhage. Xanthochromia - yellow discoloration of CSF (bilirubin).
Head Injury: Trauma causes concussion, skull fracture, contusions (Delayed onset edema and CSF leakage, hematomas - Extradural, intradural). Effects: scarring and shrinking, potentially leading to epilepsy.
Extradural Hematoma: Rupture of middle meningeal artery due to linear skull fracture. Rapid recovery phase, later elevated intracranial pressure (↑ICP), surgical draining (burr holes).
Subdural Hematoma: Rupture of small bridging veins caused by trauma. Can worsen and lead to brain herniation/coma. Potentially chronic.
Intracerebral Hemorrhage: Bleeding within the brain tissue. Common cause of sever brain injury in severely traumatic cases, potentially fatal.
Degenerative Diseases: loss of functional neurons. Examples: Alzheimer's disease, Parkinsonism.

Degenerative Diseases

Alzheimer's Disease: Progressive dementia with impaired memory, challenges with daily tasks, and confusion. Causes include genetics, lifestyle, environmental factors, but sometimes trauma and toxins.. Pathology: gross brain atrophy, senile plaques (amyloid), neurofibrillary tangles, cerebral amyloid.
Parkinsonism: Loss of pigmented neurons in the basal ganglia, ↓dopamine secretion. Causes include idiopathic PD, trauma, post-infectious states, and toxins. Clinical features: Tremor (rest), rigidity (cogwheel), bradykinesia (mask facies), festinating gait, postural instability. Pathology: degeneration of basal ganglia, reduced dopamine secretion, Lewy inclusion bodies.
Other Degenerative Diseases: Other related neurological disorders. Some can be from a variety of factors.

Diseases of Myelin

Multiple Sclerosis: Autoimmune disorder causing demyelination of white matter in the CNS. Clinical findings: progressive with relapse/remission; variable neurological symptoms (sensory and motor); loss of myelin sheath, plaque formation, and inflammatory cell response.
Other related disorders: Some types of leukodystrophy, demyelinating neuropathy examples.

Diseases Of Peripheral Nerves

Demyelinating neuropathies (e.g., Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy). Axonal neuropathies(e.g., hypertrophic neuropathies, examples of viral infections, alcoholic/drug-induced neuropathies, diabetic neuropathies).

Brain Tumors

Classification: Secondary (metastatic) or Primary. Important factors: Age and location. Benign tumors are sometimes also harmful. Malignant tumors tend to metastasize, while benign tumors are typically localized.
WHO Classification: based on neuroepithelial tissue (embryonic, glial, mixed tumors), tumors of meninges, cranial and spinal nerves, lymphomas/hematopoietic neoplasms, germ cell tumors, cysts, tumor-like lesions, sellar region, local extensions from regional tumors, and metastasis.
Gliomas (examples: astrocytoma, oligodendroglioma, ependymoma, mixed gliomas). Astrocytomas (types: fibrillary, pilocytic, anaplastic, glioblastoma multiforme).
Ependymomas: Usually benign; around the ventricles.
Oligodendrogliomas: Rare; in cerebral white matter. Better prognosis than other gliomas.
Meningiomas: from arachnoid granulations, usually benign, slow growth, often present as space-occupying lesions (SOL).
Medulloblastomas: Primitive neuroectodermal tumors in the cerebellum, can result in hydrocephalus.
Peripheral Nerve Sheath Tumors (examples: schwannomas, neurofibromas).

Neural Tube Defects

Failure of closure of the neural tube, resulting in defects of the vertebrae, skull, meninges, spinal cord, or brain, often linked to maternal folic acid deficiency. Spina bifida (types: occulta, with different degrees of spinal abnormalities).

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Test your knowledge on major neurological disorders and their features with this comprehensive quiz. Explore topics including Alzheimer's Disease, Parkinsonism, and Multiple Sclerosis. Ideal for medical students or anyone interested in neurology.