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Flashcards in BB physiology Deck (102):
1

Structural changes in epilepsy

Loss of CA2 and 3 cells in the hippocampus
Temporal lobe and hippocampal sclerosis

2

Causes of secondary epilepsy

Craniotomy
Brain injury
Stroke
Aneurysm
Tumour
CNS infection

3

Cellular mechanisms of epilepsy

Abnormal neuronal excitability
Increased excitation
Decreased inhibition

4

What is the paroxysmal depolarising shift?

Depolarisation of the membrane causes a sustained burst of action potentials involving activation of NMDA receptors

5

Which drugs are used for tonic clonic seizures?

Carbamazepine
Soldium valporate
Lamotrigine

6

Which drugs are used for absence seizures?

Ethosuzimide
Sodium valprotate

7

Which drugs are used for myoclonic seizures?

Sodium valprotate
Clonazepam
Levatiracetam

8

Which area is used for DBS in epilepsy?

Anterior nucleus of the thalamus

9

What diet can be used for epilepsy?

Ketogenic diet

10

What is optic neuritis?

Inflammation of the optic nerve
Seen in MS

11

What is internuclear ophthalmoplegia?

Damage to the MLF resulting in impaired adduction of the eye during head rotation
Seen in MS

12

What is Lhermitte's symptom?

Electric shock sensation down the back of the leg

13

What is Uhthoff's phenomenon?

Worsening of neurological symptoms in increased temperature due to increased velocity of nerve conduction

14

Where are MS lesions commonly found?

Corpus callosum
Periventricular
Cervical spinal cord
Optic nerve
Brainstem and cerebellar connections

15

MS lesions enhance with what?

Gadolinium

16

What does the McDonald's criteria state for MS diagnosis?

Presence of neurological symptoms
Dissemination in time
Dissemnination in space
Exclusion of other causes

17

HLA molecule implicated in MS

HLA-DRB1

18

No evidence of disease activity in MS

No relapses
No increase in disability
No new or active lesions on MRI

19

Which artery is most commonly occluded in the posterior circulation?

PCA

20

3 layers of the cerebellar grey matter?

Outer molecular layer = axons and densrites
Single middle Purkinje cell layer
Inner thick granule layer

21

What is within the SCPs?

Output fibres to the thalamus and cortex

22

What is within the MCPs?

Input fibres from the contralateral cerebral cortex and cranial nerve nuclei

23

What is within the ICPs?

Input fibres from the spinocerebellar tract

24

Ventral SCT

State of reflexes and interneurones
Decussates twice

25

Dorsal SCT

Proprioception
No decussation

26

Where is the fastigial nucleus found?

Vermis

27

Where is the interpose nucleus found?

Anterior lobe

28

What males up the interpose nuclei

Globose
Emboliform

29

Where is the dentate nucleus found?

Posterior lobe

30

What is the nucleus for the flocculonodular lobe?

Lateral vestibular nucleus

31

What tracts does the spinocerebellum use?

Lateral vestibulospinal
Reticulospinal

32

Which lobe is the spinocerebellum?

Anterior lobe
Vermis

33

Which lobe is the cerebrocerebellum?

Posterior

34

Which lobe is the vestibulocerebellum?

FN

35

What are the inputs and outputs of the cerebrocerebellum?

Input = MCP
Output = SCP

36

Medial vs lateral vestibulospinal tracts

Medial = head and neck
Lateral = postural muscles

37

What does medulloblastoma commonly cause?

FN syndrome

38

Symptoms of FN syndrome

Nystagmus
Ataxic gait
Fall towards side of lesion
Axial hypotonia

39

Symptoms of anterior lobe syndrome

Incoordination of the limbs
Ataxic gait
Hypotonia
Dysdiadochokinesia
Altered reflexes

40

Neocerebellar syndrome symptoms

Dysmetrria
Intention tremor
Slurred speech
Loss of eye scanning

41

Which cerebellar syndrome does alcoholism cause?

Anterior lobe syndrome

42

What does the premotor cortex do?

Integrates information from the more anterior parts of the frontal lobe and forms motor programs that are sent to the primary motor cortex

43

What does damage to the premotor cortex cause?

Apraxia

44

What does damage to the FEFs produce?

Problems with cognitive eye movements
Saccades, smooth pursuit, vergence

45

What does the dorsalprefrontal cortex do?

Planning of movements where we evaluate possible actions
Executive function

46

What does the orbitofrontal cortex do?

Inhibition of motor responses associated with the limbic system

47

Where does the CST decussate?

Spino-medullary junction

48

What does the reticulospinal tract drive?

Sympathetic preganglionic neurones
Phrenic nerve

49

Where does the rubrospinal tract originate from?

Red nucleus

50

Where does the tectospinal tract originate from?

Superior colliculus

51

What does the tectospinal tract control?

Reflex head movements in response to auditory and visual stimuli

52

Arms in decorticate vs decerebrate

Decorticate = arms adducted and flexed
Decerebrate = arms adducted and extended

53

Which lamina is innervated by Ad fibres?

V

54

Which lamina is innervated by C fibres?

I and some interneurones in II

55

What substances do peptidergic C fibres release?

Substance P
CGRP

56

Anterior spinothalamic pathway

Mostly Ad fibres
From lamina V and IV
Fast pain
Discrimination and localisation
Projects to VPL, VPM, VPI, CL

57

Lateral spinothalamic pathway

Mostly C fibres
From lamina I
Slow pain
Emotionally punishing aspects of pain
Projects to MDvc, POs, VMpo --> anterior cingulate cortex and insula

58

Input to BG

Cortex --> striatum
Via glutamate

59

Output from BG

GPI
SNr
--> VA/VL thalamus
Via GABA

60

Input to medium spiny neurones

Cortical via spines
SNpc --> spines, dendritic shafts, cell body

61

Cardinal signs of PD

Tremor at rest
Rigidity
Bradykinesia
Loss of postural reflexes

62

Cardinal signs of Huntingdon's

Hyperkinesis
Ballismus = jerky
Athetosis = smooth

63

APOE in AD

E4 = greatest risk
E2 = protective

64

Amyloidogenic pathway

Beta and gamma secretases

65

CSF markers of AD

Raised Tau
Decreased beta amyloid

66

Signs of subfalcine herniation

Leg weakness

67

Signs of transtentorial herniation

CN III damage
Midbrain damage
Often fatal

68

Signs of tonsillar herniation

Reduced respiratory drive
Unconscious
Death

69

Rostral vs caudal ACC

Rostral = actions in response to pain
Caudal = registers quality of pain

70

Posterior cingulate cortex function

Visuo-spatial memory

71

Orbitofrontal cortex function

What acts to take in response to pain

72

Symptoms of Wernicke-Korsakoff syndrome

Anterograde amnesia
Some retrograde amnesia
Confabulation
Apathy

73

Kluver Bucy syndrome

Bilateral removal of amygdala
Psychic blindness
Oral tendancies
Altered sexual behaviour emotional changes

74

Pre-synaptic changes in LTP

Early = increase in glutamate release in response to anterograde transmitters (NO, CO)
Late = increase in number of glutamate release sites

75

Post-synaptic changes in LTP

Early = increased number and sensitivity of AMPA receptors
Late = increased number of synapses

76

NMDA antagonists

Memantine = near to where Mg binds
Ketamine = allosteric site

77

Persistent vs permanent vegetative state

Persistent = >1 month
Permanent = >1 year

78

DBS for persistent vegetative state

Thalamus

79

Drugs for reduced consciousness

Amantadine
Zolpidem

80

Chemicals in the blood affecting sleep

Promote awake
- ghrelin
- low glucose
Promote sleep
- CCK
- adenosine

81

Where are sleep chemicals detected?

Preoptic nuclei

82

Where are diurnal rhythms detected?

Suprachiasmatic nucleus

83

Where do the preoptic and suprachiasmatic nuclei project?

Tuberomamillary nucleus

84

What does the tuberomamillary nucleus release?

Histamine

85

Where are orexins released from?

Posterior thalamus

86

Which NT system is active during REM sleep/

ACh

87

Which NT is thought to be involved in remembering dreams?

NA

88

Time limit for thrombolysis

4.5 hours

89

Percent of strokes that are ischaemic

70-80%

90

TOAST stroke classification

1 = large artery atherosclerosis
2 = cardioembolism
3 = small vessel occlusion
4 = other origin
5 = undetermined

91

ABCD2 score for TIA

Predicts risk of stroke
A = age>60 (1)
B = BP>140/90 (1)
C = clinical features --> hemiparesis (2), speech alone (1)
D = duration --> <1h (1) >1h (2)
D = diabetes (1)
Hospitalise if >4

92

Utricle

Horizontal tilting
Detect side to side movement and acceleration
High activity lying down

93

Saccule

Vertical tilting
Detect activity forwards and backwards and up and down
High activity standing up

94

Endolymph vs perilymph

Endo = high K+, low Na+
Peri = high Na+, low K+

95

What do the semicircular canals detect?

Angular acceleration

96

How is each semicircular canal activated?

Lateral = side to side rotation
Anterior/superior = neck flexion
Posterior/inferior = neck extension

97

Which was around are the striola directions in the otolithic organs?

Utricle = towards striola
Saccula = away from striola

98

What does the striola divide the otoliths into?

Utricle = medial and lateral halves
Saccule = anterior and posterior halves

99

Which direction will nystagmus occur with warm irrigation?

Same side

100

Which direction will nystagmus occur with cold irrigation?

Opposite

101

BPPV

Benign paroxysmal positional vertigo
Otoliths displaced
Can be detected by Hallpike manoeuvre

102

Meniere's disease

Dysfunctional production of endolymph
Can lead to rupture