Sunday, November 05, 2006

10:54 AM

UCC Pathology (includes Diaz-olivo questions)

o
Typical form of multiple sclerosis: recurrent-remittent

Areas where MS predominantly affects ANS: optic nerve

white matter, cerebellum, spinal cord
o
Diagnose: recent or old plaques at the level of the corpus
callosum
o
Who is more likely to develop MS? Women (I did not verify
this), People in Venezuela or NY? NY
o
Longitudinal gradient from equator to north: Washington or
Main? Gradient west to east, Main is more east. California or
Switzerland? Switzerland because it is more the east and up
o
The three parameters of MS in the spinal fluid: IgG
synthesis, basic myelin proteins and oligoclonal bands
o
3 cycles per secondspike and wave: typical absence
seizure, how long do the convulsions last? Less than 10
seconds
o
In what phase of tonic-clonic does the yell occur? At the
beginning of the tonic phase
o
What happens at the end of the clonic phase: respiration
and relaxation of the sphincters
o
Duration of 70 to 200 ms in an EEG: sharp wave
o
Wave of 13 per second: Beta
o
Typical waves found in deep sleep phase: Theta and Delta
o
Massage: alpha
o
Old person in nursing home, bacterial meningitis: anything
gram (-): Pseudomonas, Klebsiella, Proteus, Serratia
o
Patient with encephalitis, with changes in memory and
personality, how does the CSF appear? Chromic with 10
cells, predominantly lymphocytic = viral
o
And if the changes are mental with alteration in states of
consciousness, changes in behavior, what is it more likely,
encephalitis or meningitis? Encephalitis
o
What usually causes encephalitis? Herpes Simplex
o
Minimal score on Glasgow: 3
o
Parameters of the scale, what is measured: verbal
response, motor response, vision
o
Brown-Sequard: hemisection of the spinal cord
o
Blow on opposite side: countrecoup
o
Where do we usually see trauma? Frontal and temporal.
Unilateral or bilateral? Bilateral or orbito-frontal and
temporal because these are the areas that are closer to the
bone

o
o

o
o
o
o
o

o
o

o
o

Cerebral Perfusion Pressure: Average arterial pressure intracranial pressure (know the formula)
Hypertensive encephalitis. To which side is the curve?
Right, when we lose the autoregulation mechanism over
150, a value in the pressure.(does not make sense)
Ischemic encephalopathy? Low, lower than 50
Alteration of the BBB with exudation of proteins in white
matter? Vasogenic edema
Where is vasogenic edema commonly seen? Tumors, also
seen in abscesses
Kernohan-notch is seen with what type of herniation? Uncal
What occurs in an uncal herniation? We have a mass that
displaces laterally the uncus and so it is initially affected
what structure? It is in the brainstem, it was not medulla but
higher and mesencephalic. What structure in the
mesencephalic? The oculomotor
What causes oculomotor paralysis? We have ptosis,
midriasis, problems with medial ocular movement and
upward and downward. If this mass keeps growing, what is
compressed against the tentorial and shows up on the
contralateral side? The cerebral peduncle on the opposite
side. What does this show up as? In a paralysis, an ipsilateral
hemiparalysis due to corticospinals. This is what they call
the Kernohan-notch, when the contralateral cerebral
peduncle is compressed against the tenetorium due to uncal
herniation. It is contralateral and thus you would get signs of
ipsilateral corticospinals in the lesion. You would think since
the compression is contralateral that the signs would also be
contralateral, but the pressure is against the cerebral
peduncle of the opposite side and so we see ipsilateral signs
as well.
Ischemic penumbra - a potentially salvable tissue, an area
of ischemia but it still has the ability to electrically conduct
neurotransmission. It also has a certain metabolic
component.
Principle bacterial organisms - streptococcus and
anaerobes = metronidazole accompanied with a
cephalosporin of 3rd generation
Fourth cause of meningitis in the general population:
Listeria
Meningitis in neonates: E. Coli and streptococcus group B.
what do you give them? A mix of amipicillin and an
aminoglycoside
Young man with unilateral headache, that smokes and
drinks a lot, has peptic ulcers = cluster headache
Indomethacin = chronic paroxysmal hemicranium

o
o

o
o

o
o
o
o
o
o
o
o
o
o

o
o
o
o

Bilateral oppressive and continuous headache = tension

type
Aura - in epilepsy, but can also present in migraines

The aura in seizures is part of the seizure itself but

before the patient loses consciousness that manifests
as a partial phenomenon or is a motor, sensory or
autonomic symptom. It is the seizure itself, just that
the patient has not lost consciousness. When in a
migraine it usually begins with visual symptoms such
as stars and points of light that last 5-10 minutes and
afterwards you have headache that is continuous and
pulsating.
Interferon Beta 1 B - MS to prevent recurrence. The prof
said it is administered subcutaneously every other day. It is
an IFN used after 1993 called Betazeron.
Steroids are for acute phases.
Hemorrhagic infarct: Embolism. It blocks the circulation,
but eventually it fragments, and in the time it is being
degraded it damages the inside of the epithelium of the
endothelium so you get extravasation of blood that causes a
hemorrhagic infarct. (in other words, emboli are the usual
cause of hemorrhagic infarcts)
Where do they usually occur? Carotid artery and mural
thrombi that come from the heart
At what age do atheromatous plaques begin? Adolescence
Charcot-Bouchard aneurysms - microaneurysm caused by
hypertension
What type of infarct? Lacunar infarct
What mechanism? Fibrinoid necrosis at the level of the
vessel, hyalonosis type
Non-traumatic subarachnoid hemorrhage? Berry aneurysm
In what area: Circle of Willis
Where? At the bifurcations
Second common cause of subarachnoid hemorrhage?
Arteriovascular malformation
What are the complications of a subarachnoid
hemorrhage? Vasopasm, hydrocephalus, retardation reperfusion
Cell associated with hepatic encephalopathy = alzheimer
type II
PMLE - know symptoms and that caused by JC virus: know
pics 1301,1303,1311,1327,1331,1351,1353,1281
Multiform glioblastoma = crosses hemispheres, presents as
seizures
Carniopharyngioma: stunted growth, caclifications

Schwannomas have Verocay bodies

CJD - prion, normal presentation
Holoprosencephaly - cyclopia and arrhinencephaly, p 1300
Herpes Simplex Encephalitis = temporal lobe, cowdry type

o
o
o
o

A
o
o
o
o
o
o
o
o
o

o
o
o

o
o
o

Ring-like lesion after trip to Florida = Lyme Disease

(Borrelia Burgdorferi)
Alzheimer's disease Vignette
Ethanol effects on cerebellum - atrophy of anterior vermis
Pilocytic astrocytoma = rosenthal fibers
Tiny writing? Parkinsons
Why do bacterial and fungal meningitis have
hypoglycorragia? All of them use glucose
What type of edema is associated with ischemic
encephalopathy? Cytotoxic edema
What edema gets better with steroids? Vasogenic edema
Four structures that function as mass effect and can
increase intracranial pressure? = infarcts, hemorrhage,
tumors, abscess
Which of these cause vasogenic edema? Tumors,
abscesses
The organisms usually implicated are? Anaerobics, strep
and staph
If they are anaerobic what would you give? Metronidazole
and if staph? Napcilina and if fungal meningitis? Cocktail of
amphotericin B with fluocitocina for 2 weeks and fluconazole
when they get better
Ipsarrhythmia? Chaotic with very many slow waves, many
spikes, associated with a certain age and once the
convulsions start you see another type
4-6 cycles per second? Juvenile or myoclonus
Less than 3 cycles per second? Lenoch-gasteau
West syndrome is characterized by predominantly spasms
of flexor muscles generalized and you see ipsarrhythmia on
EEG. What do you treat it with? ACTH
Difference between a spike and a sharp wave? Spike is
70ms and wave is 70-120 ms

Checklist 2

Saber identificar en una foto los daos causados por el JC virus

Aneurisma Charcot-Bouchard y su asociacin a hipertensin
Caso clnico de una mujer que no puede peinarse Polimiocitis
En los neurofibratomas saber diferenciar entre el 1 y 2
Saber describir, o mejor dicho, dada la descripcin saber reconocer un
ependimoma Perivascular Pseudorossetes
Qu se afecta en Huntington Corea? Caudate
Un caso clnico en donde describen algo que tiene apariencia de SALT and
Pepper. - Meduloblastoma
Frmaco que se da en epilepsia de Ausencia Ethosuximide, Valproic Acid
Aprenderse bien la sobre dosis de herona
Progressive Supranuclear Palsy: Mickey Mouse appearence pierde la substancia
nigra
Tourets Putamen
Basal Ganglia problems OCD
Cyclosporine: Cause Hepatotoxicidad Renal Hypertension
Lithium Neprhogenic diabetes insipidus
Benzodiazepine (diazepam) GABA-A y Baclofen GABA-B
Meningioma Samonma Bodies Se suple de la External Carotid
Guillian Barre Campilobacter jejuni
Mc Ardles ID sntomas y la enzima que es Glycogen Phosphorylase
Werding Hoffman Pgina 1336 (Creo que hay un dibujo...mralo)
Mutacin en Holopronsencephaly
Anterior Communicating el lugar ms comn para que Aneurisma
Thiamine Deficiency en Alcohlicos y que tiene que ver con el WernickeKorsakoff
En frmaco una condicin que no responde a esteroides y si se dan podra agravar
la condicin
Primer Slide de la pgina 39 del primer handout de frmaco
Lamber Eaton Myasthenic Syndrome IgG against voltage gated calcium
channels
De la pregunta anterior que beneficios hay con el tratamiento con IVIG