BB EOYS3 Flashcards by patrick ellis

Which drug is used to treat muscle spasticity in conditions such as multiple sclerosis, cerebral palsy and spinal cord injuries? [1]

Baclofen: GABA agonist

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Which tract are the motor commands from the spinocerebellum are sent down?

reticulospinal tract
rubrospinal tract
corticospinal tract
corticobulbar tract

Which tract are the motor commands from the spinocerebellum are sent down?

reticulospinal tract
rubrospinal tract
corticospinal tract
corticobulbar tract

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Label A&B of the closed loop of the cerebrocerebellum

A: relay nuclei
B: thalamus

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What is the most common type of CNS tumour in children?

Neuroblastoma
Medulloblastoma
Glioblastoma
Schwannoma

What is the most common type of CNS tumour in children?

Neuroblastoma
Medulloblastoma
Glioblastoma
Schwannoma

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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+

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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Baclofen is an agonist to which of the following

Ca2+
AMPA glutamate receptor
Amines
GABA
NMDA Glutamate receptor

Baclofen is an agonist to which of the following

Ca2+
AMPA glutamate receptor
Amines
GABA
NMDA Glutamate receptor

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Label A-E

A: Floccus
B: cerebellar tonsil
C: vermis
D: superior cerebellar peduncle
E: 4th ventricle

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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

Superior cerebellar peduncle has output fibres only. This is mainly going up to the motor thalamus
Middle cerebellar peduncle (largest of the 3) contains input fibres from the contralateral cerebral cortex and cranial nerves
Inferior cerebellar peduncle has input fibres from the spinal cord

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Describe the course of the spinocerebellar tract (dorsal and ventral spinocerebellar tracts)

first order neuron transmits sensation along the spinal nerve and travels via dorsal root in the spinal cord
Dorsal (posterior) spinocerebellar tract: is wholly ipsilateral. Second order neuron stays on same side and enters cerebellum at inferior cerebellar peduncle on same side
Ventral (anterior) spinocerebellar tract: is contralateral: Second order neuron crosses over, ascends and enters cerebellum where it crosses back over (terminate in the ipsilateral cerebellum.The fibres decussate twice – and so terminate in the ipsilateral cerebellum.

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Name the 4 deep cerebellar nuclei [4]
What is their overall collective function? [1]

“Don’t Eat Greasy Food”

Dentate
Emboliform
Globos
Fastigial

Overall: Relay nuclei which information to the cerebellum passes through

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Cerebellum function

State and describe the location of the three functional zones of the cerebellum

Also state which cerebellar nuclei related to each zone [4]

Vestibulocerebellum comprises the flocculonodular lobe and its connections to the lateral vestibular nucleus of the pons
Spinocerebellum comprises the anterior lobe and vermis, connected to the fastigial, globose and emboliform nuclei
Cerebrocerebellum is comprised of the posterior lobe (cerebellar hemispheres) controlled by the dentate nucleus

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State the function of the spinocerebellum [1]

Via which tract are motor commands from the spinocerebellum sent down? [1]

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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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]

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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What is the function of the vestibulocerebellum? [2]

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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Cerebellar pathologies:

Why do tumours from ependymal cells specifically compress the cerebellum? [1]

What is the name for these types of tumours? [1]

Medulloblastoma:

Tumours which grow from the ependymal cells grows in the 4th ventricle, and it tends to grow in the midline so very specifically compresses the nodulus of the cerebellum.

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What is the most common type of CNS tumour in children? [1]

Medulloblastoma: tumours arising from cerebellum

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What are the symptoms of flocculonodular syndrome? [3]

little control of axial muscles, wide based ataxic gait with reeling and swaying

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Why do alcoholics often suffer from anterior lobe syndrome? [1]

brain needs B12 for myelin generation and the cerebellum has a higher turnover than most parts of the brain meaning it needs more, so if depleted in alcoholics it causes problems

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What are the characteristics of anterior lobe syndrome? [4]

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)

Neocerebellar syndrome occurs due to damage to which functional part of the cerebellum? [1]

What are characterisitic features of neocerebellar syndrome? [5]

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

Name 6 characteristics of cerebellar stroke

Dysdiadochokinesia: is the inability to perform rapid alternating muscle movements
Ataxia (gait and posture)
Nystagmus
Intention tremor
Slurred, staccato speech
Hypotonia/heel-shin test

. Headache, vertigo, nausea, vomiting
. Eye changes (nystagmus, ptosis)
. Dysarthria and dysphagia (Dysarthria is a motor disorder of speech weakening the muscles of the mouth, face and respiratory system)
. Ataxia
. Arm weakness and incoordination

Label A & B

A: inferior cerebellar peduncle
B: Vestibular nuclei

interposed nuclei comprise the [] nucleus and the [] nucleus

interposed nuclei comprise the emboliform nucleus and the globose nucleus

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]

Dentate nucleus:

Connected to cerebrocerebellum
Sends information to the contralateral red nucleus and the ventrolateral (VL) thalamic nucleus.

The vestibulocerebellum: Controls balance of the head on the body via the [] tract Helps balance of the body on the ground via the [] tract

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** Helps **balance of the body** on the ground via the **lateral vestibulospinal tract**

Purkinje cells are GABAergic/Glutaminergic?

Purkinje cells are **GABAergic**

Which spinal tract sends information about nociception? [1] (be specific) Where does the first synapse of this spinal tract occur? [1]

**Lateral spinothalamic tract** First synapse is the **dorsal horn at the spinal level**: target for targets of pain control

Desribe the pathway of the lateral spinothalamic tract [3]

**First-order neurones**" - cell bodies are in the **dorsal root ganglion** whose axons extend from peripheral receptors **Second-order neurones** - cross almost immediately via the anterior spinal commissure and form the **lateral spinothalamic tract** - Then **ascends** in the lateral funiculus. Fibres of this tract are somatotopically organised for their entire course. **Third-order VPL neurons**: - send axons through the posterior limb of the internal capsule to the somatosensory cortex (areas 3, 1, 2).

How are endogneous opioids rapidly inactivated when in circulation? [1]

Peptides are rapidly inactivated by **peptidases** in the circulation

Explain the MoA of morphine [4]

* 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**

Asides from morphine, name 5 other opioids prescribed

- 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

Explain MoA of paracetamol [1]

reduces the active oxidized form of COX-2 / **selective COX-2 inhibitor**

tricylic anti-depressants work by inhbiting the reuptake of which of the following Ca2+ AMPA glutamate receptor Amines GABA NMDA Glutamate receptor

tricylic anti-depressants work by inhbiting the reuptake of which of the following **Amines**: **serotonin and norepinephrine in presynaptic terminals,**

Ketamine works as an antagonist to which of the following? Ca2+ AMPA glutamate receptor Amines GABA NMDA Glutamate receptor

Ketamine works as an antagonist to which of the following? **NMDA Glutamate receptor**

Baclofen is an agonist to which of the following Ca2+ AMPA glutamate receptor Amines GABA NMDA Glutamate receptor

Baclofen is an agonist to which of the following Ca2+ AMPA glutamate receptor Amines **GABA** NMDA Glutamate receptor

Carbamazepine, sodium valproate, pregabalin treat what type of pain? [2]

Neuropathic pain; Trigeminal neuralgia

Name a tricyclic antidepressant that is used to treaet neuropathic and cancer pain [1]

**Amitriptyline**

Explain the mechanism of action of tricylic anti-depressants [2]

Tricylic antidepressants **inhibit** the **reuptake of amines** (dopamine, norepinephrine, adrenaline, noradrenaline histamine, and serotonin) and also **block sodium and calcium channels**

# Pain management for complex pain types Describe MoA of ketamine [1]

NMDA glutamate receptor antagonist

# Pain management for complex pain types What is the MoA of baclofen? [1] What type of pathologies is it used to treat? [2]

**GABA receptor agonists** It's used to relieve muscle spasms, cramping or tightness caused by conditions such as MS, cerebral palsy

# Pain management for complex pain types Describe the MoA of tramadol & tapentadol [2]

Opioid receptor agonist AND amine reuptake inhibition

What are the first three firstline drug classes recommended for neuropathic pain? [3]

* **SNRIs** (duloxetine) * **tricyclic antidepressants** (amitrypyline) * **calcium channel blockers** (gabapentin, pregabalin)

# Local anaesthetics Name 3 examples [3] MoA? [1]

**lignocaine, bupivacaine, prilocaine** (all end in -caine) **Block Na channels**

# General anaesthetics Mode of administration? [2] Mechanism of action? [2]

Mode of administration: **inhalational or intravenous** Mechanism of action: **activation of inhibitory receptors or inhibition of excitatory receptors**

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

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)