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medicine year 1 and 2 > case 21 > Flashcards

case 21 Flashcards

1
Q

what is ignorance?

A

a lack of knowledge or false belief

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2
Q

what is alogia?

A

(remember ur greek an, logos-without speech/words)
lack of spontaneity and flow of conversation; poverty of speech. using fewer words, answering only what’s asked directly, speaking in a vague, repetitive, or concrete way.

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3
Q

what is presbyopia?

A

difficulty with near vision (age related)

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4
Q

what is exopthalmos?

A

bulging eyeballs

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5
Q

what is hyperaemia?

A

lots of blood vessels

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6
Q

what causes ‘flashes’ in vision?

A

when vitreous gel bumps, rubs, or tugs against the retina. retina doesn’t have any nerves so whenever there’s a contact on it it can only perceive it as flashing lights.

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7
Q

which vessels supply the optic nerve head?

A

short posterior ciliary arteries

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8
Q

what are the main inhibitory neurotransmitters of the CNS?

A

gaba and glycine

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9
Q

what is the main excitatory neurotransmitter of the CNS?

A

glutamate

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10
Q

what is a structure in the temporal lobe disrupted in both schizophrenia and epilepsy?

A

hippocampus

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11
Q

how do most typical antipsychotics travel in the blood?

A

have a high level of plasma protein binding

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12
Q

where do the noradrenaline pathways start in the brain?

A

locus ceruleus

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13
Q

what’s another word for the optic radiation?

A

geniculostriate pathway

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14
Q

what’s another word for the primary visual cortex?

A

striate cortex

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15
Q

which glands contribute to the tear film?

A

lacrimal glands
meibomian glands
mucous glands

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16
Q

what is the sclera?

A

white of the eye

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17
Q

what is the first branch of the internal carotid after the cavernous sinus?

A

ophthalmic artery

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18
Q

what is the parasympathetic nucleus for CNIII (occulomotor)?

A

EWN (edwinger-westphal nucleus)

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19
Q

which branch of the facial nerves gives parasympathetic supply to the lacrimal gland?

A

greater petrosal nerve

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20
Q

what is the parasympathetic nucleus for CNVII (facial)?

A

superior salivatory nucleus

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21
Q

what are the symptoms of acute glaucoma?

A 
pupil enlarged and fixed
blurred vision, cloudy cornea
haloes
nausea and vomiting
can cause conjunctival infection
22
Q

what are the symptoms of chronic glaucoma?

A

often asymptomatic until advanced visual field loss.

23
Q

what happens in akinetopsia and what causes it?

A

patients experience an impaired perception of motion eg an object may jump from one position to another.
caused by a lesion in the V5 area.

24
Q

what causes prosopagnosia?

A

medial temporal lobes have a record of faces (usually right side dominant)-damage to the temporal lobe or ventral stream from the visual cortex can cause this condition.

25
Q

what causes blindsight?

A

damage to the primary visual cortex in the occipital lobe causes the patient to become cortically blind-no conscious awareness of sight.
but rest of visual pathway is intact and info processing can be taken over by other areas of the brain.

26
Q

what are 3 examples of visuocognitive defects?

A

akinetopsia
prosopagnosia
blindsight

27
Q

where in the brain is the VTA (ventral tegmental area)?

A

midbrain

28
Q

where in the brain is the substantia nigra?

A

midbrain

is a basal ganglia structure

29
Q

how does dopamine control lactation?

A

binds to D2 receptors, causing tonic inhibition of lactation.
does this by preventing prolactin releasing factor from stimulating prolactin release from the anterior pituatary.

30
Q

what is tonic inhibition?

A

selectively modulating the excitability and inhibition of different types of neurones

31
Q

why do some antipsychotic drugs lead to galactorrhoea and gynocomastea?

A

they also bind to the D2 receptors and can cause increased prolactin

32
Q

what is the role of noradrenaline?

A

sleep, wakefulness, arousal, attention, feeding behaviour

33
Q

where are the noradrenaline pathways in the brain found?

A

start in locus ceruleus

lead to cerebellum, cerebral cortex, thalamus, limbic system.

34
Q

what is the role of serotonin?

A

sleep and wakefulness, arousal, mood and behaviour, apetite, and interaction with dopamine pathways.

35
Q

where are the serotonin pathways found in the brain?

A

start from raphe nuclei (pons and brainstem regions)

travel to cerebellum, cerebral cortex, striatum, and hippocampus.

36
Q

what are the 2 acetylcholine pathways in the brain and where are they found?

A

1) basal forebrain pathway: starts at nuclei in the basal forebrain and projects to large parts of cortex as well as thalamus, amygdala, hippocampus
2) dorsolateral pontine/tegmental pathway: starts in nuclei here and projects to cerebellum and spinal cord as well as thalamus, hypothalamus, amygdala, and hippocampus.

37
Q

what is the main excitatory neurotransmitter of the CNS?

A

glutamate

38
Q

what can excessive release of glutamate during brain trauma lead to?

A

excitotoxic brain death

39
Q

what is the major inhibitory neurotransmitter of the CNS?

A

GABA

40
Q

where is GABA predominantly present in?

A

local interneurones

41
Q

what are the GABA pathways?

A

local interneurone circuits
purkinje cells in cerebellum
medium spiny neurones of striatum

42
Q

how does an imbalance of neurotransmitter cause schizophrenia?

A

excess of dopamine in mesolimbic pathway->positive symptoms eg hallucinations, delusions, disordered thoughts
underactivity of dopamine in mesocortical pathway-> negative symptoms eg apathy

43
Q

what is thought to cause parkinson’s?

A

excess of dopamine in nigrostriatal pathway

44
Q

what are the 3 broad domains of schizophrenia symptoms?

A

1) positive symptoms-presence of features that shouldn’t be there eg hallucinations, delusions, disordered thoughts
2) negative symptoms-lack of features that should be there eg emotions, speech, movements
3) cognitive symptoms

45
Q

how can you think of schizophrenia?

A

like a scattered and fragmented way of thinking (not split personalities!)

46
Q

what are some mechanisms thought to be involved in schizophrenia as well as just dopamine?

A

NMDA receptors controlling glutamatergic and GABAergic pathway activity
glutamate dysfunction
serotonin overactivity

47
Q

what are the classes of antipsychotic drugs?

A

1) 1st generation/typical: D2 antagonists but can also interact w histamine, cholinergic, and alpha adrenergic receptors.
block all 4 dopamine pathways
2) 2nd generation/atypical: cause transient block of D2 receptors and also block 5-HT2a receptors

48
Q

what is the approach to antipsychotic prescribing?

A

start patient on low dose and titrate up

patient should stay on medication 4-6 weeks before concluding that there is no response to treatment.

49
Q

what happens in neuroleptic malignant syndrome?

A

rare but life threatening reaction that can occur in response to antipsychotic medication. causes muscle rigidity which can lead to rhabdomyolysis which can lead to renal failure. also causes sweating, hyperthermia, tachycardia, labile blood pressure

50
Q

what does labile mean?

A

easily changed

51
Q

what is stereopsis?

A

the fusing of images from 2 eyes which allows for binocular vision

medicine year 1 and 2 (29 decks)

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