BASIC PRINCIPLES & HISTORY/EXAM

Question 1

What does the term myelopathy mean?

Answer 1

Abnormality of the spinal cord

Question 2

What does the term encephalopathy mean?

Answer 2

Abnormality of the brain

Question 3

What does the term encephalopathy mean?

Answer 3

Abnormality of the brain

Question 4

What does the term radiculopathy mean?

Answer 4

An abnormality of a single nerve root

Question 5

What does the term plexopathy mean?

Answer 5

An abnormality of a plexus e.g. brachial

Question 6

What does the term polyradiculopathy mean?

Answer 6

Abnormality of many nerve roots

Question 7

What does the term polyneuropathy mean?

Answer 7

Abnormality of multiple nerves

Question 8

What does the term mononeuropathy mean?

Answer 8

Abnormality of a single named nerve

Question 9

What does the term mononeuritis multiplex mean?

Answer 9

Abnormality of multiple named nerves

Question 10

Function of frontal lobe?

Answer 10

Primary motor cortex - voluntary motor control of the contralateral side
Premotor and supplementary motor cortex - planning, sequencing and execution of movement
Frontal eye fields - voluntary eye movement - saccade
Prefrontal cortex - management of higher cognitive functions such as Insight, control of emotions, memory, personality, planning, organising, discipline, problem-solving, self-control, decision making, motor planning
Brocas - production of speech i.e. can think of it as controlling voluntary movement of the muscles producing speech! (only in dominant hemisphere)

Question 11

Function of parietal lobe?

Answer 11

Primary somatosensory cortex & somatosensory association cortex - receives sensory information from all sensory receptors e.g. vibration, pressure, fine touch
Posterior association area - visual, auditory and sensory pathways all coalesce here e.g. Sensory visuospatial processing
On dominant hemisphere - Wernickes area is found in the supramarginal gyrus - for comprehension of written and spoken language
on non-dominant hemisphere :

Question 12

Function of temporal lobe?

Answer 12

Primary auditory cortex and auditory association cortex - for reception of auditory information and interpretation of sounds i.e. recognising sound
On dominant hemisphere - wernickes area is in the upper temporal lobe - for comprehension of written and spoken language
Most medial aspect = primary olfactory cortex - awareness of smell & recognising smell
Hippocampus & amygdala - memory, learning & regulating emotions

Question 13

Function of occipital lobe?

Answer 13

Most posteriorly - primary visual cortex - awareness of vision
More anterior - visual association cortex - analysis visual stimulus eg. Can tell you colour, angles, if its moving etc

Question 14

Function of basal ganglia?

Answer 14

Fine tunes voluntary movements as it receives impulses for upcoming movement from cerebral cortex which it processes and adjusts. They convey their instructions to the thalamus which then relates information back to the cortex

Question 15

What are the nuclei of the basal ganglia?

Answer 15

Input nuclei - caudate nucleus, putamen

Intrinsic nuclei - external globus pallidus, subthalamic nucleus, pars compacta of the substantia nigra

Output nuclei - internal globus pallidus, pars reticulata of the substantia nigra

Question 16

Function of the cerebellum?

Answer 16

Cerebrocerebellum - planning & initiating movements, coordination and motor learning
Spinocerebellum - regulating body movements by allowing for error correction, coordination and posture
Vestibulocerebellum - controls balance and ocular reflexes, mainly fixation on a target

Question 17

Function of the brainstem?

Answer 17

Midbrain - controls eye movements and integrates it with auditory input
Pons - controls movements of the body and equilibrium. Arousal and attentiveness.
Medulla oblongata - controls respiratory function, CV system, reflexes and GI activities

Important it contains…
Reticular formation - Consciousness, sleep and wake cycle, alertness and arousal levels
Cranial nerves 3-12 so has functions in facial movements sensation, hearing, taste

Question 18

Describe the main sulci in the brain?

Answer 18

Longitudinal fissure - deep furrow down the centre of the brain separating left and right hemispheres
Central sulcus - separates frontal and parietal lobe
Lateral sulcus (sylvian fisure) - separates parietal, frontal and temporal love
Parietooccipital sulcus - separates parietal and occipital lobe
Pre-occipital notch - a small fissure that’s the separation between temporal and occipital lobe

Question 19

Function of the insula?

Answer 19

Responsible for gustation (taste), being aware of visceral sensations e.g. sensations from GIT, vestibular sensations (sensations of movements)
Involved in risk-reward behaviours too e..g desires, cravings and addiction

Question 20

Where is the insula?

Answer 20

Located in both hemispheres
It forms the floor of the lateral sulcus i.e. its underneath the frontal, parietal and temporal lobes

Question 21

Outline the process of language?

Answer 21

1. Ear and auditory nerve for hearing
2. Wernickes - understanding language
3. Arcuate fasciculus - religion
4. Brocas - language production
5. Central motor output pathways: cerebellum & corticospinal tracts for articulation of speech
6. Peripheral motor output pathways: facial, hypoglossal, vagus nerves, face & tongue for articulation of speech
7. Larynx for voice production

This its important for assessing the cause of speech changes e.g. is it dysarthria caused by an issue in the motor output pathway, is it dysphonia caused by an issue in the larynx, is it fluent aphasia caused by an issue in wernickes, is it deafness caused by the auditory nerve issue or is it non-fluent aphasia caused by a lesion in Brocas

Question 22

How to assess an aphasia?

Answer 22

1. Establish pt cn hear you
2. Listen to spontaneous speech - is it fluent? Are they using words correctly?
3. Assess word finding ability e.g. how many animals can they last in 1 minute (should be >18)
4. Assess reading & writing

Question 23

What are agnosias?

Answer 23

Abnormalities of perception despite being able to demonstrate that the sensory modality is intact e.g. inability to recognise a face despite normal vision is prosopagnosia
These indicate parietal lobe lesions

Question 24

What are apraxias?

Answer 24

When an action cannot be carried out even though the necessary motor and sensory function is intact
Eg. dressing ataxia is when pt cannot organise clothes to allow dressing

These indicate a parietal lobe lesion

Question 25

How can a pts attention be assessed/,

Answer 25

By using a digit span - how many digits can the pt repeat both forward and backward (normal is 7 forward and 5 backwards)

Question 26

Outline the pathway of the pupillary light reflex?

Answer 26

Afferent limb - nerve fibres running within the optic nerve
Efferent limb - parasympathetic nerve fibres causing constriction and sympathetic nerve fibres causing dilation : found in the oculomotor nerve

Question 27

Causes of ptosis?

Answer 27

Horners syndrome
Occulomotor palsy
Myasthenia graves
Myopathies - especially myotonic dystrophy
Aponeurotic dehisence - common in elderly

Question 28

What is Aponeurotic dehisence?

Answer 28

When the tarsal plate is separated from the levator muscle = causes ptosis in elderly

Question 29

Outline causes of different types of visual field defects?

Answer 29

U/L visual field loss = optic nerve or retina
Bitemporal hemianopia - optic chiasm
Superior homonymous quadrantanopia = temporal lobe
Inferior homonymous quadrantanopia = parietal lobe
Homonymous hemianopias (visual field loss in the same halves of visual field of each eye) - occipital lobe