BB2Revision9 Flashcards
Peak age of MS onset is between [] years.
The rate of MS in [males / females] is increasing rapidly while the [female / male] rate of MS has remained stable.
Peak age of MS onset is between 20-40 years.
The rate of MS in females is increasing rapidly while the male rate of MS has remained stable.
Deficiency in which vitamin is associated with MS? [1]
Vitamin D - theres a geographical distribution
Describe the histopathological changes that occur in MS [3]
- Perivenular inflammation
- Demyelination: ingested by macrophages
- Gliosis (axons replaced by scar tissue)
Which viral infection is assocaited with MS? [1]
Infection from Epstein-Barr Virus
(no evidence of infection means have minimal chance of MS)
What are oligoclonal bands and how are they used in the diagnosis
Oligoclonal bands:
- IgG unique to CSF: indication that there is an immune process being driven in the CNS.
- Very consistent finding for patients with MS
- Take samples from CSF (lumbar puncture) & blood and compare
The effect of which genetic region dwarfs that of any other genetic region associated with MS? [1]
HLA
(But still very multi-gene implicated)
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
A 26 year old female, with previous history of myelitis, presents with double vision on looking to the left.
Internuclear ophthalmoplegia
To meet the criteria for diagnosis of schizophrenia, the patient must have experienced at least two of the which symptoms :[5]
What else needs to occur? [1]
Two of the following:
* Delusions
* Hallucinations
* Disorganized speech
* Disorganized or catatonic behaviour
* Negative symptoms (i.e. affective flattening, avolition…)
At least one of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.
The problems reported must not be attributable to another condition.
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 what? [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
SCH management
All drugs used at present to treat SCH
act as [agonist or antagonist] at that which receptors? [2]
All drugs used at present to treat SCH
act as antagonist at that D2 receptors
Gray matter loss is widespread in adolescents with schizphrenia.
What does this mean abnormalities in? [2]
Patients have abnormalities in:
- maturation of the brain
- the stabilisation of neural networks
Explain what tardive dyskinesia is and the length of the AE [2]
Involuntary movements of the lips, jaw, face; grimacing, constant chewing, tongue thrusting; rapid involuntary limb movements
typical antipsychotics,
taken for longer than a few months/years
In some patients it may be possible to overcome it
Describe what neuroleptic malignant syndrome is a combination of [6]
Due to typical anti-psychotics
hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability
Prolonged used of typical anti-psychotics may leda to which syndrome? [1]
neuroleptic malignant syndrome
What does the yellow rectangle represent?
Caffeine
MDMA
Alcohol
Cannabis
Cocaine
What does the yellow rectangle represent?
Caffeine
MDMA
Alcohol
Cannabis
Cocaine
Which of the following is an adenosine antagonist?
Caffeine
MDMA
Alcohol
Cannabis
Cocaine
Which of the following is an adenosine antagonist?
Caffeine: adenosine promotes sleep
What are the 3 mechanisms of acton of MDMA use? [3]
3 key functions:
I. Stimulate release of catecholamines
II. Inhibit catecholamine recapture by the uptake system
III. Inhibit monoamine oxidase (MAO) activity
