BB EOYS4 Flashcards

1
Q

A disorder exclusively causing slurred speech would be classified as

Drunk
Dysarthria
Dysphonia
Dysarthrophonia

A

A disorder exclusively causing slurred speech would be classified as

Drunk
Dysarthria
Dysphonia: voice disorder (voice might be weak / distorted)
Dysarthrophonia: both

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2
Q

PEN-2 & (PEN-1) code for the production of

α-secretase
β-secretase
γ-secretase
δ-secretase

A

PEN-2 & (PEN-1) code for the production of

α-secretase
β-secretase
γ-secretase
δ-secretase

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3
Q

Focal seizures most commonly start in which lobe

Frontal
Occipital
Temporal
Parietal
.

A

Focal seizures most commonly start in which lobe

Frontal
Occipital
Temporal
Parietal
.

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4
Q

Pathogenesis of Alzeimers DIsease (AD)

Name the genes [3] and proteins [3] that are critical for early onset AD [3]

A

Genes for early onset AD (not common). caused by the following genes
* Amyloid precursor protein (APP)
* Presenellin 1 (PSEN1)
* Presenellin (PSEN2)

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5
Q

Which molecule is APOE involved in the metabolism of? [1]

What are the three isoforms of APOE? [3]
Which is the greatest risk for AD and why? [2]

A

Involved in cholesterol metabolism

APOE2; APOE3 & APOE4

APOE4 has greatest risk factor and decreases clearance of extracellular Aβ.

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6
Q

Which gene encodes tau? [1]

Are mutations to this gene linked to familial AD? [1]

A

MAPT gene

NOT linked to familial AD; instead to frontotemporal dementia (FTD) and several other Tauopathies.

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7
Q

Treatment strategies in AD

Name the drug class [1] and 3 drug examples you prescribe for mild - moderate AD? [3]

Name the drug class [1] and 3 drug examples you prescribe for severe AD? [1]

A

Mild-Moderate AD:
* Acetylcholinesterase inhibitors(e.g. donepezil, galantamine and rivastigmine)

Severe AD:
* NMDA receptor antagonists (e.g. memantine)

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8
Q

Presenilin 1 & 2 are responsible for making which secretase? [1]

A

Presenilin 1 & 2 proteins is one part (subunit) of a complex called gamma- (γ-) secretase.

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9
Q

Describe the inflammatory response caused by familial forms of AD pathogenesis (from early AD genes) [2]

Describe the effect of amyloid plaques within neurons (caused by familial forms of AD pathogenesis) [2]

A

Inflammatory response:
* Microglial activation - inability to clear AP causes chronic inflammation of microglia
* Astrocytosis (increase in amount) and acute phase protein release

Progressive neuritic injury within amyloid plaques
* Disruption of neuronal metabolism and ionic homeostasis:
* Oxidative Stress

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10
Q

Which posttranslational modification does the microtubule-binding protein, tau undergo which contributes to Alzheimer’s pathology? [1]

Which amino acids can undergo this specific post translational modification? [3]

A

Hyperphosphorylation.

Tyrosine, serine and threonine.

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11
Q

Define:
Dysarthria [1]
Dysphonia [1]
Dysarthrophonia [1]

What stays the same throughout each of the above? [1]

A

Dysarthria: disorder affecting articulation (slurred / unclear speech)
Dysphonia voice disorder (voice might be weak / distorted)
Dysarthrophonia: voice and articulation disoder

Language and cognition is normal

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12
Q

What is the name for saying the wrong words? [1]

A

Paraphasias

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13
Q

What is telegrammatism? [1]

A

Difficulty forming sentences

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14
Q

TBI injury mechanism:

What are the 3 causes of TBI? [3]

A

Penetrating injury
* Foreign object (e.g. bullet) enters into brain causing focal damage.

Closed head injury:
* Blow to the head (e.g. road traffic accident).

Blast injury
* Explosion (e.g. bomb) create fast moving pressure wave that passes through the brain and damages axons and vasculature.

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15
Q

Types of traumatic brain injury injury classification

Describe the injury classifications for TBI [2]

A

Focal injury:
- Coup: at site
- Contrecoup: opposite site

Diffuse injury:
- Diffuse axonal injury

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16
Q

Diagnosis of TBI

Which scale is used to classify TBI? [1]

Which critertia is it based on? [3]
What is the maximum score for each of the criteria? [1]

A

Glasgow Coma Scale (GCS):

Based on:
- eye opening [/4]
- motor response [/5]
- verbal response [/6]

17
Q

What are mild, moderate and severe GCSs? [3]

A

Mild: 14-15
Moderate: 9-13
Severe: less than 8

18
Q

What can an MRI scan detect that a CT scan cannot? [3]

A
  • diffuse axonal injury ( the shearing (tearing) of the brain’s long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull)
  • non-haemorrhagic contusion
  • brainstem injury
19
Q

1- Pathophysiology of TBI: Increase in intracranial pressure

How do you detect ICP? [1]

A

ICP bolt

20
Q

1- Pathophysiology of TBI: Increase in intracranial pressure

Describe the Monro-Kellie Hypothesis [4]

A

Relationship between the contents of the cranium and intracranial pressure:

  • Brain is enclosed in a fixed non-expandable skull.
  • Increase in mass (e.g. haematoma) reduces CSF and cerebral blood flow in the brain.
  • Decrease in brain blood and CSF causes ischemia and then brain cell death.
  • Increase ICP can cause herniation.
21
Q

4- Pathophysiology of TBI (seizures)

What is a seizure due to? [1]

When can seizures occur post-TBI? :

How long would a early [1] and late [1] post-traumatic seizure be after a TBI?

A

Seizures are abnormal sudden electrical disturbance in the brain.

Early post-traumatic seizures: A seizure within 1st week of TBI.

Late post-traumatic seizures: A seizure after 1st week of TBI.

22
Q

5- Acute management of TBI (Mild TBI)

How would you acutely treat mild TBI? [2]

A
23
Q

5- Acute management of TBI (Severe TBI)

Which drugs can you use to start seizure prophylaxis? [2]

Which drugs can you use to induce coma? [2]

A

Start on seizure prophylaxis: phenytoin/levetiracetam

Sedation/Induce coma with propofol or benzodiazepines

24
Q

5- Acute management of TBI (Mild TBI)

How would you acutely treat moderate TBI?

A

(Moderate TBI: Experience brain changes and symptoms remains or worsen)

  • Transfer to Neurosurgical unit
  • Surgical evacuation dependent on size and type of haematoma
  • Transfer to intensive care unit (ICU) to allow brain bruising + swelling to reduce by itself.
25
Q

What size haematoma would be evacuated regardless of GCS? [1]

A

>30 cm3

26
Q

5- Acute management of TBI (Severe TBI - ICP)

How could you manage severe ICP:

Acutely [2]
Long term [1]

A

Short term:
* mannitol
* hypertonic saline
(shift of water from extravascular space to intravascular space across the BBB-controversy which therapy is better.)

Long term:
* extraventricular drain/ external ventricular drain (EVD) or ventriculostomy

27
Q

Which part of the brain undergoes structural changes during epilepsy? [1]

Which structural changes occur in this area? [4]

A

Reorganisation of the hippocampal tissue / hippocampal scleoris:
* Atrophy of CA2 and CA3 hippocampal areas
* Different tract orientation
* Compresion of layers
* Loss of neurones

28
Q

Strucutral changes in epilepsy (I)

What are the consequences of hippocampal sclerosis / degeneration in epilepsy? [1]

A

Sprouting of axons & neurogenesis- may lead of excess synaptic conduct between neurons

Aberrant circuits may be created within the hippcampus

Overtime, there is transformation within neural networks that promote excitability.

29
Q

Strucutral changes in epilepsy (II)

Name [1] and explain [2] which cell type, that if lost, can lead to epilepsy

A

GABAnergic inhibitory chandelier cells:

  • Interneuron cells which synapse onto CNS
  • Loss of inhibitory cells increases risk of abnormal excitatory activity
30
Q

Describe the phenomenon / profile of neurones in an epileptic focus [1]

Describe how this occurs [1]

A

Burst firing: aka paroxysmal depolarising shift phenomenon

  • This leads to synchronous, hyperexcitable activity within a neuronal population
  • Particularly NDMA glutamate receptor activation
31
Q

How do astrocyte abnormalities influence the development of epilepsy? [1]

A

Astrocytes:

  • contain EAAT1 and EAAT2 transporters
  • EAAT1 and EAAT2 transporters are key in synaptic glutamate uptake
  • A deficiency in EAAT1 and EAAT2 transporters leads to a decrease in glutamate reuptake
  • This means there is more glutamate in synapse and increases excitability
32
Q

Which physiological changes occur when the body undergoes EPILEPTOGENESIS to create a Hyperexcitable neuronal network in epilepsy [4]

A
  • Neuroinflammation
  • Blood- Brain-Barrier breakdown
  • Oxidative stress
  • Gliosis
  • Network and synaptic changes
33
Q

Which other major pathways may be disregulated in epilepsy? [2]

A

The mTOR pathway is a major regulator
of growth and homeostasis

The REST pathway leads to negative regulation
of the expression of many genes in the CNS