Neuro Dump - AAAAH Flashcards
(87 cards)
1
Q
neurotransmitters associated with the inhibition of aggressive behavior
A
5-HT, GABA, and Glycine inhibit aggression.
Dopamine is associated with the induction of aggression.
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Q
Glutamate
A
is the major excitatory neurotransmitter in the brain and a precursor to GABA.
works on the NMDA receptor as well as four types of non-NMDA receptors
important in memory/learning
understimulation of NMDA by glutamate -> psychosis
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Q
Locations for glutamate in the brain include
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cerebellar granule cells, striatum, hippocampus, pyramidal cells of the cortex, thalamocortical projections, and corticostriatal projections.
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Q
Major inhibitory NTs ___ and ___
A
GABA and Glycine
5
Q
The neurotransmitters associated with anxiety are ___, ___, and ___
A
norepinephrine, serotonin, and GABA.
6
Q
Change in personality after TBI. Lx location?
A
Frontal lobe.
Damage to the medial frontal region leads to an apathy syndrome.
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Q
Damage to the orbitofrontal region can cause
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disinhibition, irritability, mood lability, euphoria, lack of remorse, poor judgment, and distractability.
8
Q
Damage to the dorsolateral frontal regions leads to
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extensive executive functioning deficits.
9
Q
Damage to the medial frontal region leads to
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an apathy syndrome.
10
Q
Damage to the left prefrontal region leads to
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depression – (left frontal controls happiness, therefore damage makes sadness)
11
Q
Damage to the right prefrontal region leads to
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mania – (right frontal controls sadness, therefore damage makes manic)
12
Q
brain areas characteristically dopaminergic
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The ventral tegmental area (cell bodies), substantia nigra, and nucleus accumbens are all dopaminergic areas – schizophrenia, PD, and substance use
13
Q
ligand-gated ion channel receptor
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has an ion channel as part of its structure
14
Q
tyrosine kinase receptor
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- interacts with NGF and BDNF
- play a large role in neuronal plasticity and the remodeling of synaptic associations.
15
Q
hormones and steroids
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can diffuse into the neuron and bind to cytoplasmic receptors whose effects carry to the nucleus and regulate gene expression.
16
Q
associated with violence and aggression
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- serotonin, NE, and GABA decrease aggression
- DA, testosterone, and ACh –> aggression
17
Q
Norepinephrine is made in the
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locus ceruleus, brain stem (same area also mediates the effects of opiates and opioids)
18
Q
Serotonin is made in the
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dorsal raphe nuclei. Brain stem, pons
19
Q
Dopamine is made in the
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substantia nigra.
20
Q
Acetylcholine is made in the
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nucleus basalis of Meynert.
21
Q
six biogenic amine neurotransmitters are
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DA, Epi, NE, ACh, H, and 5HT.
random: cocaine inhibits reuptake of biogenic amines
22
Q
amino acid neurotransmitter: ___
A
GABA
23
Q
List several secondary messengers:
A
IP3, cGMP, Ca2+, cAMP, DAG (diacylglycerol), NO, and CO are all common second-messenger molecules – NOT adenylyl cyclase (enzyme)
24
Q
receptor subtypes associated with the neurotransmitter glutamate (3)
A
three receptor types associated with glutamate are AMPA, kainate, and NMDA.
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receptor subtypes associated with the neurotransmitter acetylcholine (2)
nicotinic and muscarinic
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receptor subtypes associated with the neurotransmitter NE (3)
a1, a2, B receptors
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other receptor subtypes associated with the neurotransmitters
- Serotonin w/ 5-HT receptors
- GABA with GABA receptors
- Opioids with mu and delta receptors
- Dopamine with D1, D2, etc
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Excitatory neurotransmitters open
cation (+) channels --> depolarize the cell membrane --> generating an action potential.
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Inhibitory neurotransmitters open
chloride (-) channels --> hyperpolarize the cell membrane --> action potential less likely.
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Degradation of recycled neurotransmitters is done via
MAOs, with MAO-A degrading NE and serotonin and MAO-B degrading dopamine.
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Actions of Ca2+
uses the second ion channel to open during an action potential, acts as a second messenger once in the neuron, activates the release of neurotransmitter, and activates ion channels that allow for influx of other ions that halt the action potential
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adjunctive neurotransmitter for glutamate
Glycine:
- synthesized from serine.
- adjunctive neurotransmitter at the NMDA receptor that binds with glutamate.
- independent inhibitory neurotransmitter that open chloride ion channels --> hyperpolarizes.
- area of research for schizophrenia --> shows improvement in negative symptoms
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brain structures has been linked with Tourette's syndrome and the development of tics
- The caudate nucleus has many D2 receptors.
- Regulates motor activity
--blockade of caudate D2-R --> bradykinesia
--overstimulation --> tics and Tourette's
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Alcohol, benzodiazepine sedative-hypnotic agents, and barbiturates act on ___ receptor
GABA-A α1 β2 γ2 (chloride channel)
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2 agents work on GABA-B
1. Sodium oxybate (γ-hydroxybutyrate; GHB), "date-rape" drug FDA-approved for narcolepsy and cataplexy
2. Lioresal (Baclofen) antispasmotic.
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mesolimbic pathway
Positive Sx Schizophrenia
- goes from the ventral tegmental area to the nucleus accumbens
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mesocortical pathway
cognition, negative Sx in schizophrenia
- goes from the ventral tegmental area to the frontal cortex
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Tuberoinfundibular pathway
associated with prolactin/lactation from antipsychotics
- goes from the hypothalamus to the anterior pituitary
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Nigrostriatal pathway
associated with EPS/parkinsonian effects of the antipsychotics
- goes from the substantia nigra to the basal ganglia
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Neural tube becomes
CNS
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highest rate of synapse formation in the brain takes place during what age
During gestation, peaks 2nd trimester
In total, peaks at 2yo but continues until 10yo
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Ectoderm becomes
PNS
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N-methyl-d-aspartate (NMDA) receptor
- play a role in learning and memory,
- plays a role in psychopathology.
- allows sodium, potassium, and calcium to pass
- opens when bound by 2 glutamate molecules and 1 glycine molecule at the same time.
- can be blocked by magnesium and PCP
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Emotional memory localizes to the
Amygdala, ties emotions to memories
Other important memory areas: hippocampus, diencephalic nuclei, and the basal forebrain.
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neurotransmitters localized predominantly to the basal forebrain and is responsible for memory, attention, and executive functioning
acetylcholine
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SEs from Blocking the H1 receptor
weight gain and sedation
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SEs from blocking acetylcholine receptors
dry mouth, constipation, blurry vision, urinary retention, and cognitive dysfunction.
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SEs from blocking α1 adrenergic receptors
orthostatic hypotension and drowsiness.
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SEs from blocking dopamine receptors
extrapyramidal syndrome (EPS) and elevated prolactin.
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___ lesions cause patients to appear profane, irritable, and irresponsible.
Orbitofrontal lobe
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Homozygosity for which one of the following is believed to predispose patients to Alzheimer-type dementia
Apo E4 -- has been associated with chromosome 19.
- Down's has increased APP expression --> increased β-amyloid deposition --> Alz.
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more typical of a cortical dementia, eg Alzheimer's, than of a subcortical dementia
a gradual decline in cognitive function, normal speed of cognition, and the presence of aphasia, dyspraxia, and agnosia. Depression is less common, and motor abnormalities are typically absent (unless in the terminal stages).
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Old guy in SNF with acute delirium: tx?
Lighting/open windows, calendar, companionship, low-dose haldol. NO BENZO
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Subcortical dementia, eg Parkinson's , typically presents with
dysarthria and extrapyramidal motor abnormalities; apathy and depression are common; frontal memory impairment, with recall aided by cues; speed of cognition in subcortical dementia is slow.
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psychiatric symptoms is found with AIDS?
progressive dementia, personality changes, depression, and loss of libido -- NOT heat intolerance
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patient has a stroke --> calm/hypersexual --> where's the lesion?
Klüver–Bucy syndrome results from bilateral destruction of the amygdaloid bodies and the inferior temporal cortex due to Pick's, Alzheimer's, CVA. Clinical features include hypersexuality, placidity, and hyperorality.
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example of declarative memory
Episodic memory is mediated by the medial temporal lobes, anterior thalamic nuclei, mammillary bodies, fornix, and prefrontal cortex. It involves explicit, declarative awareness. An example of episodic memory would be remembering what you ate for a meal yesterday.
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On which chromosome is the gene for amyloid precursor protein?
APP --> chrom 21 (main component of plaque)
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65yo F from SNF to ER w/ cognitive impairment, delusions, masked facies, shuffling gait, cogwheel rigidity of the extremities, visual hallucinations, and agitation -- worsening MSK rigidity w/ IM Haldol. Dx?
dementia with Lewy bodies (DLB)
-- can see low uptake in basal ganglia on fluorodopa positron-emission tomography (PET)
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most consistent with delirium
rapid onset, duration hours to weeks, attention fluctuates, recent and immediate memories impaired, speech incoherent, disruption of the sleep-wake cycle.
-- look for immediate memory in delirium and remote memory in dementia
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Semantic memory is
mediated by the inferolateral temporal lobes. It too involves explicit, declarative awareness. Examples of semantic memory include knowing who the first president of the United States was.
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Procedural memory is mediated by
the basal ganglia, cerebellum, and supplementary motor area. It involves either nondeclarative awareness. Examples: operating a car (explicit) or signing your name (implicit).
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___ and ___ are associated with defects in chromosome 21
Down's (trisomy) and Alzheimer's (APP --> increased amyloid), therefore Down's increased risk of Alzheimer's
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Fragile X syndrome presents with
IDD, long ears, narrow face, short stature, hyperextendable joints, arched palate, macro-orchidism, seizures, autistic features, high rate of ADHD and learning disorders. It is the second MCC of IDD; d/t mutation X chromosome.
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Autism spectrum disorder presents with
lack of ability to use/read nonverbal gestures, inappropriate peer relationships, lack of sharing enjoyment with others, lack of emotional reciprocity; communication deficits, repetitive or idiosyncratic use of language, and lack of make-believe play; repetitive or stereotyped patterns of behavior, adherence to inflexible ineffective routines, repetitive motor mannerisms, or persistent preoccupation with parts of objects. Appears before 3 years of age.
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Specific learning disorder with impairment in reading is characterized by
reading achievement substantially below what is expected for the child's age/IQ. It interferes with academic achievement and activities of daily living that require reading skills.
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A diagnosis of intellectual disability is based on
deficits in reasoning, adaptive function, and learning from experience, with onset in childhood development. -- NOT based on deficits in social-emotional reciprocity, which is more common in ASD.
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clinical picture of Wernicke's encephalopathy
clinical triad: disorientation, ophthalmoparesis, and gait ataxia, +/- tachy, sweats, nystagmus
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clinical picture of Korsakoff
disoriented, ophtalmoparesis, ataxia, psychosis, confabulation, antero/retrograde amnesia
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Subcortical white matter lesions perpendicular to the ventricles are seen in
MS/other demyelinating diseases
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Man dies of Wernicke's, brain autopsy shows
microhemorrhages in the periventricular gray matter, particularly around the aqueduct and third and fourth ventricles.
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likelihood of a patient acquiring Huntington's disease if his father is a carrier and has the illness
Carrier with illness = autosomal dominant
Aa x aa = 50% transmission
Huntington's = CAG triplet repeat
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metastatic carcinoma of the lung presents with generalized muscle weakness and is found to have improved muscle strength with minimal exercise. Dx?
Lambert–Eaton myasthenic syndrome: paraneoplastic abnormality of presynaptic acetylcholine release, in conjunction with small cell lung carcinoma. Autoimmune against calcium channels; EMG reveals a classical decrement to 3 Hz stimulation in muscles of the hands or feet.
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Postmortem studies of ALS patient's central nervous system would reveal ___
disorder of UMN and LMN --> anterior horn cells degenerate --> neuron degeneration creates MSK atropt --> can't talk, move, eat, breathe --> death in 3-5yr (except Steven Hawking, who was a hardcore champ, 55yrs, hold my beer bitches)
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Nigrostriatal depigmentation and atrophy
Frontal and temporal lobe atrophy
Corpus callosum thinning and atrophy
Dorsal column volume loss
Parkinson's Disease
Pick's / FTD
Multiple Sclerosis
B12 deficiency polyneuropathy
70
7yo w/ staring, EEG 3-per-second spike and wave failed ethosuximide. Tx?
Absence seizures:
1st ethosuximide
2nd Depakote
NOT carbamazepine (makes worse)
71
Seizure Tx
When in doubt, pick Depakote.
Tonic-clonic: carbamazepine, phenytoin, Depakote, Lamictal, gabapentin
Absence: ethosuximide, Depakote
Partial: carbamazepine, Depakote, benzo, phenytoin
Myoclonic: Valium IV or per rectum
Neuropathic pain: carbamazepine, gabapentin
Mood stabilizing: carbamazepine, Depakote
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H/o intractable seizures, MR, acne, skin depigmentation on back, blotchy patches on retina. Dx?
Tuberous sclerosis
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Rett's disorder presentation:
Developmental disorder only in girls. Deceleration of head growth from ages 5 months to 4 years, loss of purposeful hand skills and development of stereotyped hand movements between ages 5 months and 2.5 years, loss of social engagement, and acquired impairment in expressive and receptive language skills, and seizures in 75% of patients
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Williams' syndrome presentation:
autosomal dominant mental retardation syndrome that occurs by deletion of 7q11–q23; short stature, depressed nasal bridge (an upturned nose), broad forehead, widely spaced teeth, and elfin-like facies, as well as thyroid, renal, and cardiovascular anomalies. Psychiatric symptoms include anxiety, hyperactivity, and hypermusicality.
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