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Yr 2 EOYS ^2 > BBEOYS2 > Flashcards

BBEOYS2 Flashcards

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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
# Local anaesthetics Name 3 examples [3] MoA? [1]
**lignocaine, bupivacaine, prilocaine** (all end in -caine) **Block Na channels**
26
Name some inhaled anaesthetics [2] and IV anaesthetics [2]
**Inhaled:** [end with -ane] Halothane Enflurane Isoflurane Nitrous oxide **Intravenous anaesthetics**: Propofol Thiopental Etomidate Ketamine Midazolam
27
Treatment for trigeminal neuralgia? [5]
**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
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
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
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
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
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
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
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
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
Which anti-epileptic treatment is teratogenic Sodium Valproate Ethosuximide Lamotrigine Levetiracetam Lorazepam
Which anti-epileptic treatment is teratogenic **Sodium Valproate** Ethosuximide Lamotrigine Levetiracetam Lorazepam
33
Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones Sodium Valproate Ethosuximide Lamotrigine Levetiracetam Lorazepam
Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones Sodium Valproate Ethosuximide Lamotrigine **Levetiracetam** Lorazepam
34
Which anti-epileptic treatment would be used to treat status epilepticus Sodium Valproate Ethosuximide Lamotrigine Levetiracetam Lorazepam
Which anti-epileptic treatment would be used to treat status epilepticus Sodium Valproate Ethosuximide Lamotrigine Levetiracetam **Lorazepam** & **Diazepam**
35
Which drug can be used as a prophylasix for cluster headaches if used at high dose nifedipine diltiazem amlodipine verapamil
Which drug can be used as a prophylasix for cluster headaches if used at high dose nifedipine diltiazem amlodipine **verapamil**
36
Triptans bind to which serotonin receptors? [2] Are triptans agonists or antagonists? [1] | Learn
**Agonists** of **5-HT1B** and **5-HT1D**
37
Ditans bind to which serotonin receptors? [1] Are they agonists or antagonists [1]
**Agonists** of **5-HT1F**
38
Ditans are anti-migraine treatment that are agonists at which receptor: 5-HT1B 5-HT1C 5-HT1D 5-HT1E 5-HT1F
Ditans are anti-migraine treatment that are agonists at which receptor: 5-HT1B 5-HT1C 5-HT1D 5-HT1E **5-HT1F**
39
Triptans are anti-migraine treatment that are agonists at which receptors [2] 5-HT1B 5-HT1C 5-HT1D 5-HT1E 5-HT1F
Triptans are anti-migraine treatment that are agonists at which receptors [2] **5-HT1B** 5-HT1C **5-HT1D** 5-HT1E 5-HT1F
40
Which anti-epileptics should not be used in absence seizures, as they may exacerbate these types of seizures? [2]
Phenytoin Carbamazepine
41
# Antiepileptic drugs: Name three calcium channels that are used as anti-epileptic drugs [3]
**Ethosuximide** **Gabapentin** / **pregabalin** (in the PBL)
42
# AEDs Which drug inhibits GABA metabolism? [1]
**Vigabatrin**
43
What is the MoA of Levetiracetam? [1]
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
Name a drug that predominately blocks Na+ channels, but also acts on Ca2+ channels and causes the presynaptic inhibition of glutamate release.
**Lamotrigine** (hint: tri gated?)
45
# AEDs Focal Seizures Treatment: First line: [] or [] Second line: [] or []
First line: **carbamazepine** or **lamotrigine** Second line: **sodium valproate** or **levetiracetam**
46
Management of tonic-clonic seizures is with: First line: [] Second line: [] or []
Management of tonic-clonic seizures is with: First line: **sodium valproate** Second line: **lamotrigine or carbamazepine**
47
Which drugs are used for absence seizures? [2]
**ethosuximide**, **sodium valproate**
48
Myoclonic seizures: First line: [1] Other options: [3]
First line: **sodium valproate** Other options: **lamotrigine, levetiracetam or topiramate**
49
Explain MoA of Sodium valproate [3]
Potentiates GABA receptor; Stops breakdown of GABA Blocks voltage gated sodium channels and T-type calcium channels
50
# 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
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
Describe the effects of PCA stroke [3]
* **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
Which arteries are commonly affected during extradural (epidural) hematoma? [2]
**Middle meningeal Artery**(temperoparital area, pterion) **Ant. Ethmoidal A.** (frontal)
53
Which cranial nerve is commonly effected by extradural (epidural) hematoma [1] What happens to visual field? [1] What happens to feelings of extremities? [1]
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
Name acute [2] and prophylactic [1] treatment for cluster headaches
**Acute**: * **oxygen** (15L/min 100% through non-rebreather mask – acts as vasoconstrictor); * -**triptans** **Prophylactic** * : has to be quick. High dose of **verapamil**
55
What are the 5 stages of migraine? [5]
Premonitory Aura Heachache Resolution Recovery
56
Describe the pathophysiology of aura of migraine
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
Describe the trigeminovascular pathways that causes migraine
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
What drug classes are used to acutely treat migraine? [3]
**Triptans**: (**5HT1D**/B **agonists**) * Vasoconstrictive Agents **Ditans** (5HT1F agonists) * Neurally Active Anti-Migraine Agent **Gepants**: small molecule CGRP receptor antagonists
59
Describe the difference between peripheral and central sensitisation that occurs during migraine pathophysiology [2] come back x
**Peripheral sensitisation:** * Sensitization of peripheral **trigeminovascular neurons** in the **trigeminal ganglion** **mediates the throbbing pain**
60
Label the type of visual field defect present [5]

Yr 2 EOYS ^2 (42 decks)

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