BB EOYS13 Flashcards
Which part of the brain has decreased activation in schizophrenia?
Orbitofrontal prefrontal
Dorsolateral prefrontal
Medial prefrontal
Posterior parietal
Which part of the brain has decreased activation in schizophrenia?
Orbitofrontal prefrontal
Dorsolateral prefrontal
Medial prefrontal
Posterior parietal
Patients with schizophrenia have reduced number of which cells
Microglial
Astrocytes
Ependymal
Oligodendrocytes
Schwann cells
Oligodendrocytes:
Key molecules regulating myelination are differentially expressed in SCH (e.g. neuregulin 1 – which is also a genetic hit)
Describe the histopathological changes that occur in MS [3]
- Perivenular inflammation
- Demyelination: ingested by macrophages
- Gliosis (axons replaced by scar tissue)
Describe the signs and symptoms of MS [8]
Motor - spasticity, weakness and gait abnormalities.
Sensory - positive (pins & needles) and negative sensory phenomena (loss of sensation).
Cerebellum - inco-ordination and unsteady gait.
Brain Stem - diplopia, vertigo, nystagmus, dysarthria
Optic Nerves - optic neuritis (blurred vision)
Bladder and Bowel - incontinence
Higher Functions - depression, poor concentration, forgetfulness, etc.
Fatigue
All patients present differently. Not going to be all of them
Describe the different clinical subtypes of MS [3]
Primary progressive MS:
* Steady increase in disability without attacks
Relapsing-remitting MS
* Unpredicatable attacks which may or maynot leave permanent deficits followed by periods of remission
Secondary progressive MS
* Initial relapsing-remitting MS that suddenly begins to have a decline without periods of remission
Describe the approaches of treatment for MS [2]
Immunomodulatory/immunosuppressant:
* Mainstay of traditional treatment
* dampens down the immune system
Induction therapy
* “Reset” the immune system
* Higher risk (in the short term)
* Long-lasting disease remission off treatment
genetic pathophysiology of schizophrenia
Name three genes that are strongly implicated with schizophrenia [3]
Schizophrenia is a complex polygenic disorder:
- Dysbindin
- Neuregelin I
- DISC 1
- BDNF (brain derived neurotrophic factor)
- COMT (catechol-O –methyltransferase)
- DAOA (D-amino acid oxidase activator)
genes associated with schizophrenia
Describe the role of neuregulin 1, DISC 1 and dysbindin [3]
Neuregulin 1 – involved in synaptic plasticity and myelination
Dysbindin – may affect dopamine D2 receptor levels and glutamate and GABA transmission
DISC1 – associated with neurodevelopment and also signalling in corticolimbic areas
Describe the structural changes of brain in schizophrenia patients [3]
Larger ventricles and
smaller mesial temporal lobe structures:
- Ventricular enlargement is around 25%
- Overall reduction in brain volume of around 2%
- Greater reduction in grey matter compared to normal populations
Schizophrenic patients often have a decreased activation in which part of the brain? [1]
Decreased activation mainly in dorsolateral prefrontal area
What is the name of this test [1]
Wisconsin Card Sorting Test
Failure to properly pass the Wisconsin Card Sorting Test would indicate dysfunction of which brain lobe? [1]
What does Wisconsin Card Sorting Test test? [1]
Frontal lobe dysfunction
assess preservation and abstract thinking in subjects
Pathophysiology of schizophrenia
Describe the impact of schizophrenia on synaptic pathways [2]
Neurodevelopmental link:
Associated with decreased synaptic spines and decreased dendritic complexity in the cortex
This occurs due to abnormalities in the formation and maturation of brain circuits
C
Pathophysiology of schizophrenia
Describe the link between schizophrenia and neuroinflammation:
- During pregnancy? [2]
- In specific areas of the brain? [1]
- Which cell types become activated in SCH patients? [1]
During pregnancy:
* Prenatal viral infection and increased level of cytokines during pregenacny increase risk of SCH in offspring
- Pro-inflammatory cytokines are elevated in the prefrontal cortex of SCH patients
- Activated microglia are present in the brains of SCH patients within a few years of the disease onset
Schizophrenia, white matter and myelination
Describe the relationship between SCH and white matter myelination in the brain [2]
Reduced oligodendrocyte density in SCH
Key molecules regulating myelination are differentially expressed in SCH (e.g. neuregulin 1 – which is also a genetic hit)
Dopaminergic pathways in the central nervous system
Describe the effect of SCH on mesocortical and mesolimbic patients
Mesolimbic is hyperactive
Mesocortical is hypoactive
A 30-year-old female presents to the clinic complaining of irregular menses. She has been having irregular menstrual cycles for the past two years. The patient has a history of schizophrenia but has been stable on her current antipsychotic medication. She discontinued oral contraceptives and has abstained from both alcohol and nicotine for approximately one year as she and her husband are planning to start a family. The physical exam is unremarkable and the patient denies suicidal or homicidal ideations, denies auditory or visual hallucinations, cognition and judgment are intact. What is the most likely hormonal abnormality causing this patient’s symptoms?
A. Increased gonadotropin hormone secretion
B. Decreased human growth hormone secretion
C. Increased prolactin secretion
D. Decreased thyroid hormone production
A 30-year-old female presents to the clinic complaining of irregular menses. She has been having irregular menstrual cycles for the past two years. The patient has a history of schizophrenia but has been stable on her current antipsychotic medication. She discontinued oral contraceptives and has abstained from both alcohol and nicotine for approximately one year as she and her husband are planning to start a family. The physical exam is unremarkable and the patient denies suicidal or homicidal ideations, denies auditory or visual hallucinations, cognition and judgment are intact. What is the most likely hormonal abnormality causing this patient’s symptoms?
A. Increased gonadotropin hormone secretion
B. Decreased human growth hormone secretion
C. Increased prolactin secretion
D. Decreased thyroid hormone production
Which area of the brain sets the urgency with which a movement is chosen and executed?
Prefrontal cortex
Premotor cortex
Posterior parietal cortex
Primary motor cortex
Supplementary motor area
Which area of the brain sets the urgency with which a movement is chosen and executed?
Prefrontal cortex
Premotor cortex
Posterior parietal cortex
Primary motor cortex
Supplementary motor area
Parkinson’s Disease sees a particular degeneration of which of the following:
locus coeruleus
raphe nucleus
thalamus
periaqueductal gray
locus coeruleus
Hallmark of PD !
Looking at the axial CT images carefully, you see mass which has taken up the contrast and appears bright. Which of these cerebral cortical regions does this mass overlie?
Prefrontal cortex
Auditory cortex
Primary motor cortex
Visual cortex
Looking at the axial CT images carefully, you see mass which has taken up the contrast and appears bright. Which of these cerebral cortical regions does this mass overlie?
Prefrontal cortex
Auditory cortex
Primary motor cortex
Visual cortex
According to a colleague of Marina - Lydia - who witnessed the event, the seizure was preceded by abnormal, repetitive movements. Looking again at the coronal view of the CT brain (below) and recalling the motor homunculus, in which body part would these abnormal movements most likely be observed:
Right face
Left face
Right upper limb
Left upper limb
RIght lower limb
Left lower limb
According to a colleague of Marina - Lydia - who witnessed the event, the seizure was preceded by abnormal, repetitive movements. Looking again at the coronal view of the CT brain (below) and recalling the motor homunculus, in which body part would these abnormal movements most likely be observed:
Right face
Left face
Right upper limb
Left upper limb
RIght lower limb
Left lower limb
The mass is probably closest to the upper limb region of the primary motor cortex. The lower limb is represented more medially and the face is represented more laterally.
Of course, the problem is in the right hemisphere, so this will manifest on the left side peripherally.
Clinically, this phenomenon of abnormal, unprovoked sensorimotor activity is known as a focal or partial seizure, and reflects involvement of distinct funtional areas of cortex.
Which of the following is the right common carotid artery
A
B
C
D
E
F
Which of the following is the right common carotid artery
A
B
C
D
E
F
Which of the following is the left internal carotid artery
A
B
C
D
E
F
Which of the following is the left internal carotid artery
A
B
C
D
E
F
Which of the following is the left vertebral artery
A
B
C
D
E
F
Which of the following is the left vertebral artery
A
B
C
D
E
F
A 58-year-old man presents to the clinic with three months of progressively worsening headaches and balance problems. An MRI reveals a circumscribed extra-axial homogenous mass compressing the foramen shown in the image (red arrow). Which one of the following nerves passes through this foramen?
A. Glossopharyngeal
B. Vagus
C. Accessory
D. Hypoglossal
A 58-year-old man presents to the clinic with three months of progressively worsening headaches and balance problems. An MRI reveals a circumscribed extra-axial homogenous mass compressing the foramen shown in the image (red arrow). Which one of the following nerves passes through this foramen?
A. Glossopharyngeal
B. Vagus
C. Accessory
D. Hypoglossal
The epithalamus has two main components. What are they? [2]
Pineal gland
Habenular nuclei
Habenular
Which structure is the arrow pointing?
Thalamus
Global pallidus
Internal capsule
Caudate nucleus
Putamen
Which structure is the arrow pointing?
Thalamus
Global pallidus
Internal capsule
Caudate nucleus
Putamen
Which structure is the arrow pointing?
Thalamus
Global pallidus
Internal capsule
Caudate nucleus
Putamen
Which structure is the arrow pointing?
Thalamus
Global pallidus
Internal capsule
Caudate nucleus
Putamen
After the olfactory nerve rootlets have passed through the cribiform plate and synapsed in the olfactory bulb, which olfactory tracts does olfactory information travel in?
Where do these tracts travel to? [2]
Olfactory tracts divide into into lateral and medial striae
The lateral stria continues to the primary olfactory cortex, which resides within the uncus.
The medial stria carries fibres to the contralateral olfactory bulb via the anterior commissure
Hippocampal associations
Label A & B [2]
A: Dentate gyrus
B: parahippocampal gyrus
Label A-C
A: Amygdala
B: Hippocampus
C: Parahippocampal cortex
Label A-J
a, cingulum;
b, cingulum fibres entering parietal cortex;
c, corpus callosum;
d, head of caudate nucleus;
e, body of the fornix;
f, columns of the fornix;
g, mammillary body;
h, mammillothalamic tract;
i, anterior nucleus of the thalamus;
j parahippocampus
Which of the following structures looks atrophied
Thalamus
Brainstem
Amygdala
Hippocampal formation
Pituitary
Which of the following structures looks atrophied
Thalamus
Brainstem
Amygdala
Hippocampal formation
Pituitary
Which of the following is the tonsil
A
B
C
D
E
Which of the following is the tonsil
A
B
C
D
E
Which of the following is the floccus
A
B
C
D
E
Which of the following is the floccus
A
B
C
D
E
