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Yr 2 EOYS ^2 > BBEOYS2 > Flashcards

BBEOYS2 Flashcards

1
Q

State and explain why medullablastoma patients often present with a specific symptom [2]

A

Truncal ataxia: compresses the vermis; but interrupts the pathway between the vermis and lateral vestibular nucleus

Thus, the truncal ataxia reflects the malfunction of the lateral vestibular nucleus and lateral vestibulospinal tract

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2
Q

Alcoholics have disease of which lobe of the cerebellum? [1]

A

Anterior lobe

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3
Q

Dysdiadochokinesia and dysmetria arise from abnormal function of which lobe of the cerebellum [1], cerebellar nuclei [1] or cerebellar peduncle? [1]

A

Neocerebellar cortex (cerebrocerebellum)

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4
Q

Which drug is used to treat muscle spasticity in conditions such as multiple sclerosis, cerebral palsy and spinal cord injuries? [1]

A

Baclofen: GABA agonist

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5
Q

Which tract are the motor commands from the spinocerebellum are sent down?

reticulospinal tract
rubrospinal tract
corticospinal tract
corticobulbar tract

A

Which tract are the motor commands from the spinocerebellum are sent down?

reticulospinal tract
rubrospinal tract
corticospinal tract
corticobulbar tract

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6
Q

Label A&B of the closed loop of the cerebrocerebellum

A

A: relay nuclei
B: thalamus

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7
Q

Morphine has what effect after binding to Mu receptor:

Increases K+ and Ca2+
Increases K+ and decreases Ca2+
Decreases K+ and Ca2+
Decreases K+ and increases Ca2+

A

Morphine has what effect after binding to Mu receptor:

Increases K+ and Ca2+
Increases K+ and decreases Ca2+
Decreases K+ and Ca2+
Decreases K+ and increases Ca2+

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8
Q

Label A-E

A

A: Floccus
B: cerebellar tonsil
C: vermis
D: superior cerebellar peduncle
E: 4th ventricle

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9
Q

State if the following contain input or output fibres [3]
State where the fibres go to / come from

Superior cerebellar peduncle
Middle cerebellar peduncle
Inferior cerebellar peduncle

A
  1. Superior cerebellar peduncle has output fibres only. This is mainly going up to the motor thalamus
  2. Middle cerebellar peduncle (largest of the 3) contains input fibres from the contralateral cerebral cortex and cranial nerves
  3. Inferior cerebellar peduncle has input fibres from the spinal cord
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10
Q

State the function of the spinocerebellum [1]

Via which tract are motor commands from the spinocerebellum sent down? [1]

A

The spinocerebellum (anterior lobe and vermis) controls locomotion and limb coordination, and balancing your body the ground

It sends motor commands down the reticulospinal tracts to coordinate postural and locomotor movements: i.e. when you run, walk, lean over to grab something, you don’t lose balance and fall over.

(This is a more dynamic balance when compared to the vestibulocerebellum which is more of a static balance)

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11
Q

State the function of the cerebrocerebellum [1]

From where do the inputs for the cerebrocerebellum come from in the brain [1] & the cerebellum? [1]
From where do the outputs for the cerebrocerebellum go to in the brain [1] & the cerebellum? [1]

Which deep nuclei is involved with the cerebrocerebellum? [1]

A

Cerebrocerebellum: coordinates movements initiated by the motor cortex. This includes speech, voluntary movements of hands, arms, and hand-eye coordination. It is also involved in speech coordination

Input = from cerebral cortex via middle cerebellar peduncle
Output: To motor thalamus via superior cerebellar peduncle
Deep nuclei involved = dentate

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12
Q

What is the function of the vestibulocerebellum? [2]

A
  • coordinates head and eye movements to ensure the stability of gaze.
  • It controls balance of the head on the body via the medial vestibulospinal tract and helps balance of the body on the ground via the lateral vestibulospinal tract
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13
Q

What are the characteristics of anterior lobe syndrome? [4]

A
  • incoordinaion of the limbs (especially legs)
  • ataxic gait (walks in a wide platform so they don’t fall over, this overlaps with flocculonodular syndrome).
  • hypotonia
  • reflexes appear depressed or pendular (UMN lesion)
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14
Q

Neocerebellar syndrome occurs due to damage to which functional part of the cerebellum? [1]

What are characterisitic features of neocerebellar syndrome? [5]

A

Damage to the cerebrocerebellum

Characterisitc features:
* Loss of hand-eye coordination.
* Dysmetria (inaccurate reaching with intention tremor)
* Dysdiadochokinesis (the irregular performance of rapid alternating movements of the hands)
* Intention tremors occur on an attempt to touch an object
* Loss of good speech articulation/slurred speech which is due to a loss of coordination of muscles involved in speech production

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15
Q

Which functional zone of the cerebellum is the dentate nucleus connected to? [1]

Which areas of the brain does this tract connected to the dentate nucleus send to after connecting to the dentate nucleus? [2]

A

Dentate nucleus:

  • Connected to cerebrocerebellum
  • Sends information to the contralateral red nucleus and the ventrolateral (VL) thalamic nucleus.
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16
Q

Explain the MoA of morphine [4]

A
  • Mu acts on receptors (e.g. Mu)
  • Causes activation of K+ conductance and decreased calcium conductance
  • This leads to decreased excitability (K+) and decreased release of neurotransmitters (Ca2+).
  • Inhibits cAMP formation
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17
Q

Asides from morphine, name 5 other opioids prescribed

A
  • Herion: high solubility compared to morphine
  • Dextromoramide: potent but limited prescription
  • Methadone: large half-life - so used for long dosing.
  • Meptazinol: Mu-1 produces less respiratory depression than morphine
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18
Q

Explain MoA of paracetamol [1]

A

reduces the active oxidized form of COX-2 / selective COX-2 inhibitor

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19
Q

tricylic anti-depressants work by inhbiting the reuptake of which of the following

Ca2+
AMPA glutamate receptor
Amines
GABA
NMDA Glutamate receptor

A

tricylic anti-depressants work by inhbiting the reuptake of which of the following

Amines: serotonin and norepinephrine in presynaptic terminals,

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20
Q

Carbamazepine, sodium valproate, pregabalin treat what type of pain? [2]

A

Neuropathic pain; Trigeminal neuralgia

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21
Q

Name a tricyclic antidepressant that is used to treaet neuropathic and cancer pain [1]

A

Amitriptyline

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22
Q

Explain the mechanism of action of tricylic anti-depressants [2]

A

Tricylic antidepressants inhibit the reuptake of amines (dopamine, norepinephrine, adrenaline, noradrenaline histamine, and serotonin) and also block sodium and calcium channels

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23
Q

Pain management for complex pain types

What is the MoA of baclofen? [1]

What type of pathologies is it used to treat? [2]

A

GABA receptor agonists

It’s used to relieve muscle spasms, cramping or tightness caused by conditions such as MS, cerebral palsy

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24
Q

Pain management for complex pain types

Describe the MoA of tramadol & tapentadol [2]

A

Opioid receptor agonist AND amine reuptake inhibition

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25
Q

Local anaesthetics

Name 3 examples [3]
MoA? [1]

A

lignocaine, bupivacaine, prilocaine (all end in -caine)

Block Na channels

26
Q

Name some inhaled anaesthetics [2] and IV anaesthetics [2]

A

Inhaled: [end with -ane]
Halothane
Enflurane
Isoflurane
Nitrous oxide

Intravenous anaesthetics:
Propofol
Thiopental
Etomidate
Ketamine
Midazolam

27
Q

Treatment for trigeminal neuralgia? [5]

A

carbamazepine (sodium channel blocker): 1st line
baclofen (GABAB agonist): 1st line if unresponsive
phenytoin (sodium channel blocker)
valproate (sodium channel blocker and other targets)
clonazepam (benzodiazepine)

28
Q

Which type of seizure would you not give phenytoin or carbamazepine in order to prevent worsening of symptoms

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

A

Which type of seizure would you not give phenytoin or carbamazepine in order to prevent worsening of symptoms

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

29
Q

Which type of seizure would you give carbamazepine or lamotrigine as first line treatment?

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

A

Which type of seizure would you give carbamazepine or lamotrigine as first line treatment?

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

30
Q

Which type of seizure would you give sodium valproate as first line treatment? [2]

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

A

Which type of seizure would you give sodium valproate as first line treatment?

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

31
Q

Which type of seizure would you give sodium valproate or ethosuximide as first line treatment?

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

A

Which type of seizure would you give sodium valproate or ethosuximide as first line treatment?

Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures

32
Q

Which anti-epileptic treatment is teratogenic

Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam

A

Which anti-epileptic treatment is teratogenic

Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam

33
Q

Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones

Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam

A

Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones

Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam

34
Q

Which anti-epileptic treatment would be used to treat status epilepticus

Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam

A

Which anti-epileptic treatment would be used to treat status epilepticus

Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam & Diazepam

35
Q

Which drug can be used as a prophylasix for cluster headaches if used at high dose

nifedipine
diltiazem
amlodipine
verapamil

A

Which drug can be used as a prophylasix for cluster headaches if used at high dose

nifedipine
diltiazem
amlodipine
verapamil

36
Q

Triptans bind to which serotonin receptors? [2]

Are triptans agonists or antagonists? [1]

Learn

A

Agonists of 5-HT1B and 5-HT1D

37
Q

Ditans bind to which serotonin receptors? [1]

Are they agonists or antagonists [1]

A

Agonists of 5-HT1F

38
Q

Ditans are anti-migraine treatment that are agonists at which receptor:

5-HT1B
5-HT1C
5-HT1D
5-HT1E
5-HT1F

A

Ditans are anti-migraine treatment that are agonists at which receptor:

5-HT1B
5-HT1C
5-HT1D
5-HT1E
5-HT1F

39
Q

Triptans are anti-migraine treatment that are agonists at which receptors [2]

5-HT1B
5-HT1C
5-HT1D
5-HT1E
5-HT1F

A

Triptans are anti-migraine treatment that are agonists at which receptors [2]

5-HT1B
5-HT1C
5-HT1D
5-HT1E
5-HT1F

40
Q

Which anti-epileptics should not be used in absence seizures, as they may exacerbate these types of seizures? [2]

A

Phenytoin
Carbamazepine

41
Q

Antiepileptic drugs:

Name three calcium channels that are used as anti-epileptic drugs [3]

A

Ethosuximide

Gabapentin / pregabalin (in the PBL)

42
Q

AEDs

Which drug inhibits GABA metabolism? [1]

A

Vigabatrin

43
Q

What is the MoA of Levetiracetam? [1]

A

Binds synaptic vesicle protein SV2A causing a reduction in conduction in neurones

SV2A protein is a part of secretory vesicle membranes that mediates calcium-dependent vesicular neurotransmitter release.

The binding of levetiracetam to SV2A appears to decrease the rate of vesicle release

44
Q

Name a drug that predominately blocks Na+ channels, but also acts on Ca2+ channels and causes the presynaptic inhibition of glutamate release.

A

Lamotrigine

(hint: tri gated?)

45
Q

AEDs

Focal Seizures Treatment:

First line: [] or []
Second line: [] or []

A

First line: carbamazepine or lamotrigine
Second line: sodium valproate or levetiracetam

46
Q

Management of tonic-clonic seizures is with:

First line: []
Second line: [] or []

A

Management of tonic-clonic seizures is with:

First line: sodium valproate
Second line: lamotrigine or carbamazepine

47
Q

Which drugs are used for absence seizures? [2]

A

ethosuximide, sodium valproate

48
Q

Myoclonic seizures:

First line: [1]
Other options: [3]

A

First line: sodium valproate
Other options: lamotrigine, levetiracetam or topiramate

49
Q

Explain MoA of Sodium valproate [3]

A

Potentiates GABA receptor;
Stops breakdown of GABA
Blocks voltage gated sodium channels and T-type calcium channels

50
Q

Split brain syndrome

Describe how a patient with split brain syndrome would percieve & verbalise an object in their right visual field & their right hand

Describe how a patient with split brain syndrome would percieve & verbalise an object in their left visual field & their left hand

A

Human anatomy; the right hemisphere receives visual input from the left visual field and controls the left hand

Transfer of visual learning between the hemispheres is abolished

right visual field the patient responds correctly verbally and with his/her right hand.

Left visual field the patient verbally states that he/she saw nothing, and identifies the object accurately with the left hand only

51
Q

Describe the effects of PCA stroke [3]

A
  • Contralateral homonymous hemianopsia (a field loss deficit in the same halves of the visual field of each eye,)
  • Reading and writing deficits
  • Impaired memory
52
Q

Which arteries are commonly affected during extradural (epidural) hematoma? [2]

A

Middle meningeal Artery(temperoparital area, pterion)

Ant. Ethmoidal A. (frontal)

53
Q

Which cranial nerve is commonly effected by extradural (epidural) hematoma [1]

What happens to visual field? [1]

What happens to feelings of extremities? [1]

A

CN III damaged

Loss of visual field opposite to lesion (compress of PCA)

Weakness of extremities on opposite side of lesion (crossed pyramid pathways)

54
Q

Name acute [2] and prophylactic [1] treatment for cluster headaches

A

Acute:
* oxygen (15L/min 100% through non-rebreather mask – acts as vasoconstrictor);
* -triptans

Prophylactic
* : has to be quick. High dose of verapamil

55
Q

What are the 5 stages of migraine? [5]

A

Premonitory
Aura
Heachache
Resolution
Recovery

56
Q

Describe the pathophysiology of aura of migraine

A

A transient and local suppression (depression)
…of spontaneous electrical activity in the visual cortex (cortical)
…which moves slowly across the brain (spreading)

(Note: occurs rom visual cortex not the eyes)

57
Q

Describe the trigeminovascular pathways that causes migraine

A

Increase in serotonin causes BV on the dura to vasodilate

This causes a release of neuropeptides

This begins a cascade reaction causing further inflammation: particularly release of CGRP: potent vasodilator

CGRP activate the nerve pathways & the nerves send pain signals to the trigeminal ganglion

The trigeminal ganglion, once activated by CGRP, is what causes peripheral sensitisation which is responsible for the throbbing pain in a migraine

Trigeminal ganglion transmits pain impulses to SpV (spinal trigeminal nucleus caudalis)

SpV then relays to the thalamus and from the thalamus to the cerebral cortex where pain is decoded

58
Q

What drug classes are used to acutely treat migraine? [3]

A

Triptans: (5HT1D/B agonists)
* Vasoconstrictive Agents

Ditans (5HT1F agonists)
* Neurally Active Anti-Migraine Agent

Gepants: small molecule CGRP receptor antagonists

59
Q

Describe the difference between peripheral and central sensitisation that occurs during migraine pathophysiology [2]

come back x

A

Peripheral sensitisation:
* Sensitization of peripheral trigeminovascular neurons in the trigeminal ganglion mediates the throbbing pain

60
Q

Label the type of visual field defect present [5]

A

Yr 2 EOYS ^2 (42 decks)

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