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Medical Studies 2A > LIs For Mid-Semester Test Consolidation > Flashcards

LIs For Mid-Semester Test Consolidation Flashcards

1
Q

Encephalitis causes

A
  • Infective (viral, bacterial, parasitic, fungal). Most are viral: herpes, Ross River, Murray River, rabies
  • Autoimmune (aetiology unknown)
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2
Q

Infectious encephalitis clinical features, over time

A
  • Initially, flu like: headache, fever, fatigue
  • Later: stiff neck, confusion, seizures, loss of consciousness
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3
Q

Autoimmune encephalitis clinical features

A
  • Memory loss
  • Seizures (like infectious)
  • Personality changes
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4
Q

Encephalitis investigations

A
  • Brain imaging
  • Lumbar puncture
  • EEG
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5
Q

Encephalitis complications

A

For months/years+ afterward:
- Memory problems
- Persistent fatigue
- Hearing/vision problems

Can also result in coma and death.

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6
Q

Cerebral abscess causes (what kinds of infection?)

A
  • Bacterial
  • Fungal
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7
Q

Cerebral abscess clinical features

A
  • Headache
  • Fever
  • Loss of consciousness
  • Seizures
  • Nausea/vomiting
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8
Q

Cerebral abscess investigations

A
  • CT/MRI
  • Blood tests for infection (CBC, ESR, CRP)
  • Biopsy (rarer)
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9
Q

Cerebral abscess complications

A

Longer term:
- Neurological problems (e.g. memory, sensory, motor loss)

Can also result in death.

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10
Q

Stage vs grade of tumour — basic definitions

A
  • Grade: appearance of the tumour cells; how well differentiated?
  • Stage: size, location, and degree of spread.
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11
Q

What is the common grading system for tumour staging?

A
  • TNM; Tumour, Nodes, Metastases
  • Size/extent of tumour?
  • Presence/extent of lymph node involvement?
  • Presence/absence of metastases?
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12
Q

Recall the pnemonic for the different types of seizures

A

M CASTING (for mid-level actors):

M: Metabolic
C: Cortical malformation
A: Autoimmune
S: Stroke/vascular
T: Tumour
I: Infectious
N: Neurodegeneration
G: Genetic

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13
Q

Describe the vascular supply of the spinal cord. Where do each of these arteries originate?

A
  • Anterior spinal: originates from two vertebral arteries, near their join
  • Posterior spinal (2x): originates lower down the vertebral arteries
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14
Q

Which area of the spinal cord is supplied blood by which arteries?

A

Anterior 2/3: Anterior spinal artery
Posterior 1/3: Posterior spinal arteries

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15
Q

Explain how descending pathways from the brain can modulate spinal reflexes

A
  • Can modulate directly, or indirectly (i.e. by altering interneuron activity)
  • For instance, it can move your hand away from a hot object faster, or can inhibit reflexes when fine motor control is needed
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16
Q

How can proprioceptive feedback modulate reflexes?

A
  • Golgi tendons/muscle spindles have their own reflexes, remember?
  • They directly alter the activity of alpha motor neurons, influencing extrafusal muscle fibre contraction
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17
Q

What are the different kinds of intraocular muscle?

A
  • Pupillary sphincter
  • Pupillary dilator
  • Ciliary muscle
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18
Q

CN III anatomical course

A

Exits brainstem ventrally, just caudal to the mammillary bodies. Heads up to eye, exiting skull through superior orbital fissure.

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19
Q

CN IV anatomical course

A
  • Exits brainstem just caudal to the inferior colliculi
  • Decussates, and heads up the ventral aspect of the brainstem
  • Enters orbit via superior orbital fissure
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20
Q

CN VI anatomical course

A
  • Emerges from pons, and travels up the ventral aspect of the brainstem
  • Enters orbit through superior orbital fissure
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21
Q

CN V anatomical course

A
  • Exits brainstem at mid-pons level
  • Forms trigeminal ganglion, before branching off into V1, V2, and V3
  • V1: Opthalmic (superior orbital fissure)
  • V2: Maxillary (foramen rotunda)
  • V3: Mandibular (fossa ovalis)

(Note: motor components joins V3, which is why it is bigger and hence oval shaped)

(Three nuclei: mesencephalic, pontine, spinal)

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22
Q

CN VII anatomical course

A
  • Many, many brainstem nuclei
  • Emerges at pontomedullary junction
  • Exit skull via internal auditory meatus
  • Sensory and para. exit facial canal
  • Motor exits via stylomastoid foramen (what are its areas of the face?)
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23
Q

CN III function

A

Motor: Extraocular muscles (incl. levator palpebrae superioris; minus sup. oblique and lateral rectus)

Parasympathetic: Pupillary sphincter muscle (inner). Accommodation (ciliary muscle)

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24
Q

CN IV function

A

Motor: Controls contralateral superior oblique

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25
Q

CN V Function

A

Motor: pterygoid, temporalis, mandible (mastication)

Sensory: touch, temperature, pain, and proprioception of face, mouth, nasal cavity, and cranial dura

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26
Q

CN VI function

A

Motor: ipsilateral lateral rectus

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27
Q

CN VII function

A

Motor: muscles of facial expression (what are the five branches?)

Parasympathetic: parotid glands

Sensory: external auditory meatus, tympanic membrane, and external ear (pinna)

Special sensory: taste on anterior 2/3 of tongue

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28
Q

Explain the difference in patience presentation between bells palsy and stroke

A

Bell’s Palsy: not able to move eyebrow, distal to decussation. Linked to nerve damage.

Stroke: damage occurs within brain parenchyma, upstream from decussation. Ipsilateral lower facial motor loss. Worse.

29
Q

CN III palsy

A
  • Eye is down and out (two remaining muscles)
  • Pupil is dilated (no para. input)
  • Eyelid is drooped (no levator palpebrae superioris)
30
Q

CN IV Palsy

A
  • Eye is deviated upward inward (no superior olbique)
  • Compensatory head tilt away from affected eye
31
Q

CN V Palsy

A
  • Sensory loss in face, ant 2/3 of tongue, cranial dura
  • Motor loss in muscles of mastication (what are they?)
  • When mouth is opened, jaw deviates towards affect side
32
Q

CN VI Palsy

A
  • Eye is deviated inward (no lat. rectus)
  • Diplopia
33
Q

CN VII Palsy

A
  • Motor loss in face
  • Loss of salivation/tongue sensation if proximal to splitting of CN VII (parotid is preserved)
34
Q

CN VIII Function

A

Special Sensory: Balance and hearing

35
Q

CN IX Function

A

Motor: Minor role in elevating larynx and pharynx during swallowing

Para.: Parotid glands

Sensory: Anterior 2/3 of tongue

Special Sensory: Taste of anterior 2/3 of tongue

Visceral Sensory: Carotid bodies

36
Q

CN X Function

A

Motor: Pharynx, soft palate, and larynx (speaking and swallowing)

Para: Heart, GI tract, trachea

Sensory: Larynx and laryngopharynx

Special Sensory: Taste at root of tongue

37
Q

CN XI Function

A

Motor: Upper Trapezius and SCM

38
Q

CN XII Function

A

Motor: Extrinsic (positioning) and intrinsic (movement) muscles of tongue

39
Q

CN VIII anatomical course

A
  • Arises from vestibular nuclei and cochlear nuclei (bipolar)
  • Leaves skull at internal acoustic meatus
  • Cell bodies found in spiral (hearing) and vestibular (balance) ganglia; other pole synapses on cochlea/vestibular apparatus separately
40
Q

CN IX/X anatomical course

A
  • Arise from a series of many brainstem nuclei
  • Exit skull and connect with effector after leaving the skull through the jugular foramen
41
Q

CN XI anatomical course

A
  • Spinal portion arises from C1-C5
  • Cranial portion joins CN X
  • Enters via foramen magnum; exits via jugular foramen
42
Q

CN XII anatomical course

A
  • Arises from hypoglossal nucleus in medulla
  • Exits skull via hypoglossal canal
43
Q

CN VIII palsy

A
  • Nystagmus
  • Tinnitus
  • Vertigo
  • Sensorineural hearing loss
44
Q

Which nerves control the sensory/motor arms of the gag reflex

A

Sensory: CN IX
Motor: CN X

45
Q

CN IX/X palsy

A

Uvula deviates away from affected side when (say “aah”)

46
Q

Peripheral vs central vertigo

A

Peripheral: Inner ear/vestibular nerve
Central: Brain/Brainstem

47
Q

Causes of central vertigo

A

Vascular:
- Posterior circulation stroke
- Vertebrobasilar insufficiency (usually atherosclerotic)
Other:
- Multiple sclerosis
- Tumour

48
Q

Causes of peripheral vertigo

A
  • Benign paroxysmal positional vertigo
  • Meniere’s disease (triad; vertigo, tinnitus, sensorineural hearing loss)
  • Vestibular neuronitis/labrynthitis
49
Q

What are some causes for non-vertiginous dizziness?

A

Cardio:
- MI
- Arrhythmia
- Aortic stenosis
- Pulmonary embolism

Neuro:
- Normal pressure hydrocephalus (remember the lady who fell over while gardening?)

Other:
- Hypoglycaemia
- Drug related

50
Q

Describe the presenting features of Benign paroxysmal positional vertigo

A

Recurrent, brief attacks of positional vertigo.

51
Q

Explain the pathophysiology of primary open angle glaucoma

A
  • Increased resistance to outflow of aqueous humour from the trabecular meshwork
  • Increased intraocular pressure
  • Retinal ganglion cell death (and therefore optic neuropathy)
52
Q

Explain the pathophysiology of acute angle closure glaucoma

A
  • “Pupillary block”
  • Lens pushes out on iris, decreasing the angle of the trabecular meshwork
  • Decreased aqueous humour outflow
  • Increased intraocular pressure
  • Ganglion cell death (and therefore optic neuropathy)
53
Q

What is the common thread amongst all “Glaucoma”s?

A

A group of diseases whereby vision is lost due to damage of the optic nerve.

54
Q

Guillain Barre symptoms

A
  • Classically: ascending weakness
  • Paraesthesia in fingers/hands/toes/feet
  • Respiratory issues (if resp muscles affected)
  • Facial weakness/sensory loss (remember: CNs are part of the peripheral nervous system)
  • Autonomic dysfunction
55
Q

What are some possible causes of GBS?

A
  • Viral infection (e.g. EBV)
  • Bacterial infection (e.g. camylobacter jejuni)
  • Vaccination
  • Surgery

(?Molecular mimicry)

56
Q

GBS investigations

A
  • Lumbar puncture
  • EMG
57
Q

GBS lumbar puncture results

A

Increased protein; normal white blood cell count.

58
Q

GBS EMG findings

A

Abnormal nerve conduction (makes sense)

59
Q

GBS treatment

A
  • Intubation/ventilation if required
  • Plasmapheresis (filter out plasma, and therefore autoantibodies)
  • IvIg; introduction of healthy antibodies to dilute autoantibodies
60
Q

Complications of GBS

A
  • Respiratory muscle paralysis (respiratory failure/pneumonia)
  • DVT leading to PE (immobilization)
61
Q

Broadly, describe prion diseases

A
  • Prions are a type of protein that can trigger normal proteins to fold abnormally.
  • Prion diseases refer to the accumulation of these prions in the brain (e.g. CJD = Mad cow disease)
62
Q

Describe the three classes of structural filaments in a neuron, and their functions

A
  • Neurofilament (main structural protein)
  • Microtubule (cellular transport pathway)
  • Actin filament (regulates neuronal shape change)
63
Q

What investigations do we perform in a patient who has lost consciousness?

A
  • Bloods (EUC/LFT, creatinine; kidney, glucose; hypoglycaemia)
  • Blood gas (check for respiratory failure)
  • CXR
  • ECG (cardiac causes)
  • CT/MRI of head (tumour/stroke/herniation/haemorrhage etc.)
  • Lumbar puncture (infection)
  • Toxicology
64
Q

Describe the role of SCI rehabilitation

A
  • Return patient to highest level of function possible
  • Help assist with activities of daily living; as independent as possible
  • Support family, make adjustments to living environment
65
Q

Only lesions proximal to the ___ can cause unilateral hearing loss. Why?

A
  • Proximal to the cochlear nuclei
  • This is because, once the nerves reach the ventral and dorsal cochlear nuclei, projections are bilateral
66
Q

What are the dorsal cochlear projections responsible for? Describe the pathway.

A
  • Responsible for quality of sound
  • Cochlear nerve synapses on dorsal cochlear nuclei
  • Crosses at pontine tegmentum, and ascends in lateral lemniscus (not medial, which is DCML)
  • Synapses on inferior colliculus
  • Passes through brachium of inferior colliculus, and heads to MGN of thalamus
  • Then to primary auditory cortex
67
Q

What are the ventral cochlear projections responsible for? Describe the pathway.

A
  • Responsible for timing of sound
  • Cochlear nerve synapses at ventral cochlear nuclei
  • Fibres continue bilaterally (some crossing at trapexoid body) to superior olivary nucleus (remember climbing fibres? they’re just downstairs in the inf. olivary nucleus)

From here, pathway is same as dorsal:

  • Lateral lemniscus to inferior colliculus
  • IC brachium to MGN of thalamus
  • Primary auditory cortex
68
Q

Draw the direct/consensual light reflex pathway

A

https://lh3.googleusercontent.com/proxy/f5wJ0AZeLB_wsTHeLiliVVh3QjE2KM35XjnUfxIqlJlz8W1GwExUEu-2eh-xyCnbOLw4r7OwSepAfbmYhoXhhL-JqvmH7GtvVMOWYcoKXz4NMyu0loP-AAiwYs3lIReq_eJKpixgzKcf4VbB

69
Q

What is another name for the piriform cortex?

A

Primary olfactory cortex!

Medical Studies 2A (108 decks)

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