BB EOYS11 Flashcards
DBS has NICE approval (NHS funded) for which three diseases? [3]
- Parkinson’s disease (Hypokinetic movement disorder)
- Essential Tremor (Hyperkinetic movement disorder)
- Dystonia (Hyperkinetic movement disorder)
Criteria in DBS for Parkinson’s disease
What type of PD makes you elligible for DBS? [1]
What are the 4 classic symptoms for this? [4]
Idiopathic PD: with 4 classical symptoms: tremor, bradykinesia, rigidity, postural instability.
DBS for PD
DBS directly impacts which two symptoms? [2]
DBS improves which symptom due to less drug being required? [1]
Directly decreases bradykinesia and rigidity
Improves dyskinesia as less L-DOPA required.
Reduced but not totally eliminated
Brain regions for DBS
Which areas of the brain targeted for tremor? [3]
Which areas of the brain targeted for Dystonia? [1]
Tremor:
* Zona incerta
* Subthalamic nucleus
* GPin
Dystonia:
* GPin
Which type of tremor indicates Parkinsons Disease unless proven otherwise?
Reemergent tremor
Resting tremor
Intentional tremor
Postural tremor
Which type of tremor indicates Parkinsons Disease unless proven otherwise?
Reemergent tremor
Resting tremor
Intentional tremor
Postural tremor
Which structures are the arrows pointing to? [5]
Label A-C
A: PAG
B: substantia nigra
C: red nucleus
Name 3 risks of DBS
- 2-3% risk of brain haemorrhage
- small risk of cerebrospinal fluid leakage
- 15% risk of temporary problems with transplantation (e.g. infection, allergy to implant).
Mechanisms of DBS
Explain the inhibition hypothesis [2]
Theory: PD due to overactive basal ganglia neurons in the STN and/or GPi.
DBS can block this and remove spontaneous discharge from GPi neurones
Mechanisms of DBS
Explain the excitation hypothesis [2]
DBS can excite afferent axons antidromically resulting in ‘jamming’ the spontaneous activity
DBS inhibits the local neuronal firing removing the spontaneous discharge from subthalamic nucleus
Mechanisms of DBS
Explain the disruption hypothesis
DBS in GPi can activate axon terminals causing extensive release of NTs (i.e. GABA & glutamate)
DBS dissociates inputs and outputs in the stimulated nucleus, thus disrupting/blocking the abnormal information flow through the GPi.
DBS disrupts abnormal information flow through the GPi
Targeting which area of the brain may help Tourette Syndrome?
Brodmann area 25 (Subcallosal cingulate)
Hypothalamus
Thalamic centromedian/parafascicular complex
Nucleus Accumbens
Anterior of the fornix
Targeting which area of the brain may help Tourette Syndrome?
Brodmann area 25 (Subcallosal cingulate)
Hypothalamus
Thalamic centromedian/parafascicular complex
Nucleus Accumbens
Anterior of the fornix
Which potential mechansim for DBS is depicted by the figure?
1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis
3- Disruption hypothesis
DBS activates axon terminals in the stimulated nucleus, induces extensive release of neurotransmitters, such as GABA and glutamate (Glu), and dissociates inputs and outputs in the stimulated nucleus
‘Deep brain stimulation also excites afferent axons antidromically’
Which of the following best describes this theory of how DBS works
1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis
‘Deep brain stimulation also excites afferent axons antidromically’
Which of the following best describes this theory of how DBS works
1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis
Which drug classes are current treatments for insomnia? [2]
Benzodiazepine - short acting
Z drugs
Name drugs & the drug class they belong to, to treat short term [2]& long term insomina [2]
Short-term use:
* lorazepam (benzo)
* temazepam (benzo)
Long-term use:
* eszopiclone (benzo)
* Zolpidem (Z-drug)
Name a drug that used for epilepsy that has recent use for insomnia [1]
Pregabalin
GABA & Galanin neurons project from which nucleus?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Pre-optic nucleus
Supraoptic nucleus
GABA & Galanin neurons project from which nucleus?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Ventrolateral Pre-optic nucleus
Supraoptic nucleus
Which sleep stage does this EEG show?
Beta
REM
Theta
Alpha
Delta
Which sleep stage does this EEG show?
Beta
REM
Theta
Alpha Alpha waves arise from the occipital lobe during wakeful relaxation with eyes closed.
Delta
What are 5 side effects of using benzodiazepines used as hypnotics? [5]
- Change in sleep patterns (suppress deep sleep and REM sleep - which is the period you become most rested in)
- Daytime sedation
- Rebound insomnia
- Tolerance
- Dependence
Which NTs are involve in anxiety?
Monoamerinergic systems: Noradrenaline, 5-HT
Gabanergic systems
Name a drug that acts as a benzo antagonist and can be used to treat overdose? [1]
What is administration like? [1]
Flumazenil
Has a short half-life so need continous adminsitration needed
Which nuclei controls circadian rhythm?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Pre-optic nucleus
Supraoptic nucleus
Which nuclei controls circadian rhythm?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Pre-optic nucleus
Supraoptic nucleus
[]A common feature of anxiety disorders is the []activity of limbic structures such as the [] and the inability of higher cortical structures to control this hyperactivity
A common feature of anxiety disorders is the hyperactivity of limbic structures such as the amygdala and the inability of higher cortical structures to control this hyperactivity
These are indications that [] transmission is involved in the
genetic risk for anxiety disorders
Dopamine
Glutamate
GABA
5HT
These are indications that [] transmission is involved in the
genetic risk for anxiety disorders
Dopamine
Glutamate
GABA
5HT
Name 5 classes of drugs that can act as anxiolytics [5]
SSRIs
SNRIs
Benzodiazepines
5-HT1A agonists
β-adrenoceptor antagonists
Name 3 benzodiazepines used as anxiolytics
clonazepam, alprazolam, lorazepam
Name two SNRIs and two SSRIs used as anxiolytics [4]
SSRIs
* fluoxetine, escitalopram, paroxetine
* can be used to treat panic and social phobias
SNRIs:
* venlafaxine, duloxetine
Name two 5HT-1A agonists and one B-adrenoreceptor antagonists used as anxiolytics [3]
5-HT1A agonists: buspirone ipsapirone
β-adrenoceptor antagonists: propranolol
State which muscles CN3 provides motor innervation to [5]
Motor fibres to:
Superior rectus
Inferior rectus
Medial rectus
Inferior oblique
Levator palpabrae superioris
Lesions to the oculomotor nerve result:
The pupil []
The eyelid [] because of loss of innervation to the [] muscle
Lesions to the oculomotor nerve result in a resting ‘down and out’ position of the eye
Pupil dilates due to loss of parasympathetic innervation to the pupil
Eyelid droops because of loss of innervatio to the levator palpabrae superiorsis (ptosis)
Which muscle does the trochlea nerve innervate? [1]
What movement does this cause? [1]
superior oblique muscle: downward and laterally
What is the abducens nerve commonly affected by and why? [2]
Raised ICP [1]
Due long intradural course and the** sharp bend along** the petrosal part of the temporal bone,
The opthalmic nerve divides into which nerves? [3]
Frontal nerve
Nasocilliary nerve
Lacrimal nerve
Describe the corneal (blink) reflex)
- Sensory information transmits through the ophthalmic division of the trigeminal nerve (V)
- Synapses within the spinal trigeminal nucleus in the brainstem
- The contacted nerve within the spinal trigeminal nucleus then projects to the facial nucleus and synapses with the facial nerve
- The facial nerve exits the facial nucleus activates the orbicularis oculi muscle & causes a blink
What are the two branches of the mandibular (V3) nerve? [2]
Describe the role of these nerves
Inferior alveolar nerve
* supplies the lower dentition and gives off the mental nerve which passes through the mental foramen.
Lingual nerve
* supplies somatosensory fibres to the anterior 2/3 of the tongue. The chorda tympani is a branch of the facial nerve and“hitches a lift” with the lingual nerve to supply special sensory fibres of tast to the anterior 2/3 of the tongue.
The hypoglossal nerve (CNXII) exits the skull through the []
The hypoglossal nerve (CNXII) exits the skull through the hypoglossal canal
Which is the only muscle of the tongue that is not innervated by the hypoglossal nerve? [1]
Which nerve is it innervated by? [1]
palatoglossus is the only of these muscles to be innervated by the vagus nerve (CNX).
Eva’s tongue has deviated to the left side. A lesion of the hypoglossal nerve (CNXII) would cause the tongue to deviate to which side? [1]
A lesion of CNXII would cause the tongue to deviate towards the side of the lesion.
Tongue Towards
Which way does the uvula deviate in a X nerve lesion? [1]
Uvula is deviated away from the side of the lesion
Label A-F
A: cerebral aquaduct
B: olfactory tract
C: Optic nerve and optic chiasma
D: Oculomotor nerve (n. III)
E: Substantia nigra
F: Trochlea nerve
Label A-E
A: Oculomotor nerve (n. III)
B: Trigeminal nerve (n. V)
C: Abducent nerve (n. VI)
D: Facial nerve (n. VII)
E: Vestibulocochlear nerve (n. VIII)
