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1
Q

a) Name 6 parts/tests in a basic neurological exam (6)

A
  1. Level of consciousness
  2. Speech
  3. Mental state and cognitive function
  4. Sensory function
  5. Motor function
  6. Cranial nerve function
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2
Q

a) Explain briefly what an EEG looks at/measures (1)

A

Electroencephalography measures the electrical potentials measured at scalp generated by underlying neurones

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3
Q

a) In what condition would an EEG be used as a major diagnostic tool? (1)

A

Epilepsy and coma

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4
Q

Give 2 ways in which the differences between MRI and CT scans might lead to using one in favour of the other in neurological diagnosis (2)

A
  • MRI has greater soft tissue detail, while CT has greater hard tissue detail.
  • MRI has no radiation while CT uses ionising radiation.
  • CT is quicker and more available in more hospitals + less expensive than MRI.
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5
Q

What parts of the brain would you find:

a) in the anterior cranial fossa?
b) The posterior fossa?
c) The middle fossa? (3)

A

Frontal lobe

Cerebellum

Temporal lobe

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6
Q

Where would you find (5):

a) the corpus callosum
b) the pons
c) the cerebellum
d) a basal ganglion
e) a dorsal horn

A

a) the corpus callosum – between the cerebral hemispheres
b) the pons is in the hindbrain (or middle part of brainstem)
c) the cerebellum is in the hindbrain
d) a basal ganglion is in the cerebral hemisphere
e) a dorsal horn is in the spinal cord

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7
Q

e) Explain what the difference between a primary and association cortex is (2)

A

Primary cortex = area that controls voluntary movement; it is the main processing centre for sensory information.

Association cortex = the brain integrates information and relates these to past experiences before a decision is made. Meaningful perception of the world enabling us to interact effectively. Involved in the higher functions of the brain.

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8
Q

b) Describe the function of the dorsal ganglia (2)

A
  • The dorsal root ganglia contains the cell bodies of the sensory neurons which are coming from the sensory receptors in the effector organ towards the spinal cord.
  • Relays somatosensory information from the afferent sensory neurons to the dorsal horn of the grey matter within the spinal cord.
  • Nerve endings have a role in detecting pain/chemo/mechanoceptors.
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9
Q

What are the regions of the association cortex?

A
  • Broca’s area – involved in producing intelligible speech

* Wernicke’s area – involved in comprehension of language

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10
Q

c) Indicate the direction of the roots and nerve of the spinal cord (3)

A

Dorsal roots – towards spinal cord (afferent)

Ventral – towards effector (efferent)

Spinal nerve – both directions. (Both afferent and efferent)

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11
Q

d) Between which vertebrae would you do a lumbar puncture? (2)

Why is this?

A

Between L3 and L4 or L4 and L5. This is because the spinal cord terminates at L2 before it reaches the end of the vertebral column and therefore no risk of damage to the spinal cord.

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12
Q

a) Describe the function of (i) dendrites and (ii) axons, and talk about characteristic features they have (2 x 3 marks)

A

i) Dendrites (Major area of reception of incoming information) – receives incoming signals from other neurons via synapses – neuronal input
• Branch frequently (greatly increases the surface area of the neuron)
• Often covered in spines which receive the majority of synapses from other neurons. They can integrate signals from multiple sources

ii) Axons (Conduct impulses away from cell body) – neuronal output
• Usually only one axon per cell
• Contain abundant neurofilaments and microtubules
• Can be myelinated or unmyelinated
• Emerges at axon hillock

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13
Q

b) Describe two ultrastructure features of neurones indicating that they’re metabolically active, highly organised cells (2)

A
  • Large nucleus
  • Prominent nucleolus
  • Abundant rough ER
  • Well-developed golgi apparatus
  • Abundant mitochondria
  • Highly organised cytoskeleton
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14
Q

a) Name a disease caused by death of neurones, and one caused by neuronal dysfunction (2)

A

Death – Parkinsons’s disease, Alzheimer’s disease

Neuronal dysfunction – Multiple Sclerosis, Epilepsy

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15
Q

a) Label the parts of the plane in a saggital plane of the brain. It was in a practical with the brainstem. (4)

A

Aqueduct, Third ventricle, fourth ventricle, cerebral hemisphere, infundibulum, pons, midbrain, spinal cord, medulla oblongata.

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16
Q

a) Give the functions of the Microglia?

A
  • Resident macrophage population of the CNS
  • Involved in immune surveillance
  • Present antigens to invading immune cells
  • First cells to react to infection or damage
  • Role in tissue modelling
  • Synaptic stripping
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17
Q

a) Give the functions of the Schwann cells?

A
  • Myelin producing cells of the PNS
  • Each Scwann cell produces only one myelin sheath
  • Promote axon regeneration
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18
Q

a) Give the functions of the Astrocytes?

A
  • Scaffold for neuronal migration and axon growth during development
  • Formation of blood-brain barrier
  • Transport of substances from blood to neurons
  • Segregation of neuronal processes (synapses)
  • Removal of neurotransmitters
  • Synthesis of neurotrophic factors
  • Neuronal-glial and glial neuronal signalling
  • Potassium ion buffering
  • Glial scar formation
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19
Q

a) What’s the difference in the white and grey matter? (2)

A

Grey matter contains neuronal cell bodies.

White matter comprises ascending and descending axon tracts to and from the brain.

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20
Q

What’s difference between ganglia and nuclei?

A

Ganglion - a group of neuronal cell bodies in the PNS.

Nuclei - A group of neuronal cell bodies in the CNS.

*One exception to this rule is basal ganglia.

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21
Q

a) How are motor neurons affected by Multiple Sclerosis and how does it lead to defects? (2)

A
  • Chronic inflammatory demyelinating disease of the CNS
  • Nerve conduction is slowed as there are no nodes of Ranvier and therefore salutatory conduction cannot occur. Conduction is slower via unmyelinated neurons.
  • If enough myelin is lost = nerve block/no conduction. Leads to loss of motor function i.e. inability to innervate the muscles so no voluntary movement.

MS results from inflammation and disruption of myelin in the CNS.

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22
Q

What is another example of myelin disease?

A

Another example of myelin disease – Adrenoleukodystrophy

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23
Q

b) Which ion’s equilibrium potential is the membrane potential closest to in a real neuron at rest?

A

K+ because the membrane is most permeable to K+.

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24
Q

c) Which ion’s equilibrium potential is the membrane potential closest to at the peak of the action potential?

A

Na+ because the membrane is most permeable to Na+.

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25
Q

a) Given a diagram of the brain – side-on. Draw on the borders of the 4 lobes and label them.

A

With head facing to the left:

Frontal lobe - at the front
Parietal lobe - Top, right
Temporal lobe: Bottom middle
Occipital lobe: Bottom, right (Back of head)

Cerebellum: Very bottom of the brain, under occipital lobe

26
Q

b) There is a lesion in the brain at X (primary visual cortex, occipital lobe). What is the effect and why?

A

The primary visual cortex normally receives input from retina, so lesions would cause a scotoma, or a hole in the field of vision.

27
Q

c) What structures make up the brainstem?

A

Midbrain, pons and the medulla (from superior to inferior)

28
Q

d) What is the function of the hypothalamus?

A

Involved in the coordination of homeostatic mechanisms

Interface between CNS, autonomic nervous system (ANS) and the endocrine system

Maintaining homeostasis + provides an interface between the voluntary, autonomic and neuroendocrine systems.

29
Q
  1. Blockage of CSF in the brain, describe the layers of the meninges and their functions.
A 
•	2 types of hydrocephalus
Communicating (all 4 ventricles are enlarged)
o	Block in CSF absorption or CSF flow over brain surface caused by:
o	Meningitis
o	Head injury
o	Congenital
o	Haemorrhage (sub-arachnoid)
Non-Communicating (not all ventricles enlarged)
o	Block in ventricular system caused by:
o	Aqueduct stenosis
o	Ventricular tumours
o	Paraventricular tumours
•	Signs and symptoms
o	Headache
o	Drowsiness
o	Blackouts
o	Raised intracranial pressure
o	Increased head circumference (in child)
•	Treatment
o	Remove cause, e.g. papilloma
o	Divert CSF, e.g. shunt
o	Open alternate pathway, e.g. ventriculostomy

• 3 layer of meninges:
o Dura mater – tough tissue membrane adheres to skull
o Arachnoid membrane – thin membrane attached to underside of the dura
o Pia mater – delicate membrane closely adherent to the surface of the brain
• Sub arachnoid space – space between arachnoid membrane and pia mater where csf circulates
• Pia mater and subarachnoid space are usually infected in meningitis.
• Bacterial meningitis (in CSF):
o High white cell count, predominantly neutrophils
o Protein conc. Increased and glucose conc. Decreased
o Bacteria may be identifiable
• Viral meningitis (in CSF)
o High white cell count, predominantly lymphocytes
o Normal protein and glucose conc.
o Viral identification is unlikely

30
Q

This question is about the parasympathetic nervous system:

a) Describe the location of pre- and post-ganglionic neurones (4)

A
  • The cell bodies of preganglionic neurones are in the CNS and its axon extends to synapse with the dendrites of a postganglionic neurone. Preganglionic neurones are long.
  • The cell bodies of postganglionic neurones are in autonomic ganglia which are close to or embedded in the target organ. Postganglionic neurones are short.
31
Q

b) Name the neurotransmitter in (2)
i) Preganglionic neurones
ii) Postganglionic neurones

A

i) Acetylcholine
ii) Acetylcholine, Adrenaline and Noradrenaline
Nicotinic in pre and muscarinic in post

32
Q

Name 3 effects of parasympathetic stimulation of the GI tract (3)

A

Sympathetic activity – inhibits peristalsis
• Generally decreases motility and tone of GI tract
• Stimulates contraction of sphincters
• Inhibits secretory activity

THEREFORE PARASYMPATHETIC IS OPPOSITE
relaxation of sphincters

33
Q

What effect would there be on the pupil if parasympathetic stimulation was cut off? (1)

A

Pupil contraction would not be able to occur because pupillary sphincter cannot contract.

(Pupil will dilate?)

34
Q

(a) What are the three most important factors that influence the passive movement of ions across a cell membrane? (3 marks)

A

Permeability of the membrane, concentration gradient and electrical gradient.

35
Q

(b) How would the resting membrane potential of a neuron change if there were an increase in the number of open potassium ion channels? (2 marks)

A

An increase in potassium ion channels would cause potassium ions to leave the cell and can hyperpolarise the cell but most of the time, the membrane potential moves back to the potassium equilibrium potential.

(more negative)

36
Q

(c) In ionic terms what is the main action of the sodium-potassium pump? What is the significance of this for the membrane potential? (3 marks)

A

Sodium potassium pump helps to maintain the resting membrane potential (-70mv), where using ATP, 3 sodium ions are pumped out of the cell whilst 2 potassium ions are pumped into the cell, against their concentration gradients.

Charge gradient – more positive charges leaving cells than entering. Means inside cells has a more negative potential than outside.

Chemical gradient – more K+ and less Na+ inside compared to outside

37
Q

What is the function of the corpus callosum?

A

Interconnects the corresponding cerebral cortices of the two hemispheres

38
Q

What is the function of the cerebellum?

A

Coordinates movement or responsible for learning motor skills
or maintains posture

39
Q

What is the function of the infundibulum? What is it also called?

A

Pituitary stalk

Stalk of pituitary/ connects the pituitary to the hypothalamus

40
Q

State what would happen to someone with Multiple Sclerosis and why this has damaging effects (2)

A

A chronic inflammatory multifocal demyelinating disease of the CNS of unknown cause, resulting in the loss of myelin, oligodendroglia and axons. Myelinated neurones have a much faster speed of conduction than unmyelinated and so a nerve impulse would take much longer to process and to react on.

41
Q

Name the principal neurotransmitter released from the post-ganglionic parasympathetic fibres and describe how it is removed from the synaptic cleft.

A

Acetycholine (1 mark). Acetylcholine is broken down in the synaptic cleft (0.5 marks) by the enzyme acetylcholinesterase (0.5 marks) into choline and acetate (0.5 marks); the choline is actively taken back into the neurone (0.5 marks).

42
Q

(b) Describe the main influence of the parasympathetic nervous system on
(i) Exocrine glands.
(ii) Intestinal smooth muscle.
(iii) Heart rate.
(iv) The penis.

A

Increased secretion (1 mark)

contraction (1 mark)

reduced heart (1 mark) and slowed A-V conduction (1 mark)

Erection

43
Q

(c) Explain briefly the mechanisms by which bright light causes the pupil to constrict.

A

(c) Light directed by sensory fibres in the retina triggers a parasympathetic reflex. (0.5 mark) This involves the passage of information via afferent fibres to the brain (1 mark) and the consequent prompt activation of the efferent parasympathetic fibres which supply the circular muscle of the iris (contrictor pupillae), causing it to contract (1 mark). This is a consensual reflex – i.e. light shone in one eye causes both pupils to contract. (0.5 marks).

44
Q

i) Describe the synthesis, inactivation and breakdown of GABA (3)

A
  • GABA is synthesised from glutamateusing theenzymeL-glutamic acid decarboxylase(GAD) withvitamin B6as acofactor.
  • After GABA binding with receptors, GABA transporter (GAT) takes GABA back into nerve terminal and glial cells. In the glial cells, GABA transaminase (GABA-T) converts the GABA to Succinate semialdehyde (SSA)
  • In the nerve terminal, GABA can be repackaged into synaptic vesicles, or converted to SSA and enter the TCA cycle where it is converted back to glutamate – this is known as the GABA shunt
45
Q

i) What are the 3 ways in which drugs act to increase the activity of GABA? (3)

A
  1. Central intracerebroventricularly (i.c.v) administration of GABA
  2. Inhibition of GABA-T
  3. Potentiating central GABA mediated inhibition
  4. Slow down uptake of GABA by slowing down GAT activity
46
Q

Name two therapeutic uses for these drugs (2) (increasing the activity of GABA)

A
  • Antiepileptic
  • Anxiolytic
  • Sedative
  • Muscle relaxant
47
Q

i) Explain the mechanism of the GABAA linked receptor (3)

A
  • GABA molecules bind to the extracellular part of the receptor which triggers opening of achloride ion-selective pore.
  • Influx of Cl- ions into cells
  • The increased chlorideconductancepolarises the cell - increases themembrane potentialtowards the reversal potential of the Cl¯ ion which is about –65mVin neurons, inhibiting the firing of newaction potentials
48
Q

State the function of the cerebellum.

A

Coordinates movement (+ learning motor skills)

49
Q

d) Certain forms of signalling in neurones involve the movement of Chloride ions, through channels, across the cell membrane down their electro-chemical gradient. What does this tell us about the distribution of chloride ions at rest across the neuronal cell membrane and how is it achieved?

A

Chloride ions aren’t just subject to passive movement across the membrane, so there must be some mechanism pumping chloride ions against their electrochemical equilibrium.

50
Q

What is the central sulcus?

A

Central sulcus is between frontal and parietal. Lateral issue is between frontal and temporal lobe. Parietal-occipital sulcus between parietal and occipital lobe.

51
Q

What structures make up the brainstem?

A

Pons, medulla, midbrain

52
Q

Describe what would happen in a blockage of CSF?

A

Hydrocephalus: it can be communicating - affecting all 4 ventricles, and results from haemorrhage, be congenital, meningitis or head injury. Or it could be non-communicating - affecting only one ventricle and results from aqueduct stenosis, ventricular tumours or paraventricular tumour.

53
Q

What are the layers of the meninges?

A

From outside inwards:

Dura mater

Arachnoid membrane

Pia mater

54
Q

Name the 2 components of the autonomic nervous system.

A

Parasympathetic and sympathetic

55
Q

Certain drugs in the eye can affect the autonomic nervous system. Give one example of a sympathetic and one of the parasympathetic agonist.

A

Atropine

Pilocarpine

56
Q

b) Define 3 functional subtypes of neurons in the nervous system. (3)

A

Motor neurones

Sensory neurones

Interneurones - Interneurons create neural circuits, enabling communication between sensory or motor neurons and the central nervous system (CNS).

57
Q

b) Name the two layers between which cerebral spinal fluid flows. (1)

A

The CSF occupies the subarachnoid space (between the arachnoid mater and the pia mater) and the ventricular system around and inside the brain and spinal cord.

58
Q

c) Describe two functions of CSF. (2)

A

CSF protects brain and spinal cord from trauma.

CSF supplies nutrients to nervous system tissue.

CSF removes waste products from cerebral metabolism.

59
Q

d) State two ways in which the composition of the blood and CSF differ. (2)

A

Normally contains few cells
Much less protein
Reduced concentration of potassium and calcium ions
Higher concentration of magnesium and chloride ions

60
Q

e) What is the flow rate for CSF? (1)

A

Flow rate: approx 500 ml/day

NB: Volume: 150 ml

61
Q

f) Name a disorder caused with blocked CSF flow (1)

A

Hydrocephalus

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