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Y2 Practice Qs > CNS > Flashcards

CNS Flashcards

1
Q

A lady with albinism finds it difficult to go outside due to finding the sunlight too bright. In which structure is she lacking melanin? Why is this difficult for her?

A

Retinal pigmented epithelium

Albinism causes loss of pigmentation
Melanin in the retinal pigment epithelium prevents reflections within the eyeball
Loss of melanin in the RPE will cause reflections and everything will appear bright in bright light

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2
Q

pt presents with right sided hemianaesthesia. Which lobe has most likely been affected to cause this finding?

A

Left parietal lobe

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3
Q

Name one disorder that causes excessive movement

A

Huntingtons disease, stroke in subthalamic nucleus,

cerebellar lesion, Sydenham’s chorea

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4
Q

Name one condition other than Parkinson’s disease that causes paucity of movement

A

Stroke of motor cortex, myasthenia gravis, motor

neurone disease, coma, brainstem herniation

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5
Q

A stroke affected a pts posterior cerebral artery. Which other artery is involved to ensure that macular vision is preserved?

A

MCA (middle cerebral artery)

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6
Q

technique to increase chance of eliciting tendon reflexes?

A

Jendrassik manouevre (clench teeth, interlock fingers and pull arms apart)

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7
Q

Why do you get macular sparing after a stroke?

A

⇒ Stroke can affect the posterior cerebral artery

⇒ Most of occipital lobe will be lost

⇒ Middle cerebral artery supplies the occipital pole (represents the macula)

⇒ Macular function (central vision) will be spared

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8
Q

How does the facial motor nucleus function?

A
  • The part of the facial motor nucleus that supplies the upper half of the face receives UMNs from both hemispheres
  • The part of the facial motor nucleus that supplies the lower face only receives a contralateral UMN input
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9
Q

How do UMN lesions involving the face and facial nerve palsies differ?

A
  • UMN lesions involving the face will spare the forehead

- True facial nerve palsies will affect all of the muscles of facial expression

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10
Q

Differentiate between meningocoele, meningomylocoele and myeolocoele

A

Menigocoele = open bubble of just CSF, no spinal cord involvement

Meningomyelocoele- CSF AND spinal cord involved- Cystic lesion protrudes out through defect in the dorsal arches

Myeolocoele= spinal cord completely open due to incomplete vertebral arch
- Rachischisis

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11
Q

What does the presence of xanthocromia in CSF suggest?

A

SAH occurred over 12 hours ago

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12
Q

PCA aneurysms can compress which cranial nerve?

A

Oculomotor - it runs parallel to the PCA

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13
Q

Damage where causes inferior quadrantanopias?

A

Damage to the superior optic radiations which run in the parietal lobe

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14
Q

Damage where causes superior quadrantanopias?

A

Damage to the inferior optic radiations in the temporal lobe

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15
Q

Where would you find a lesion that causes a contralateral homonymous hemianopia with macular sparing?

A

The PCA in the occipital lobe

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16
Q

What is the other name for the inferior optic radiations?

A

Meyer’s loop

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17
Q

Other name for absence seizures?

A

Petit mal

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18
Q

Symptoms of temporal lobe seizures?

A

Olfactory hallucinations and deja vu

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19
Q

Commonest cause of excessive daytime sleepiness?

A

Sleep apnoea - narcolepsy is rare!!

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20
Q

What is amaurosis fugax? What artery is most commonly involved?

A

Transient blindness due to hypoxia of the retina caused by blockage of the central retinal artery

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21
Q

What structure does the superior cerebellar artery supply in addition to the cerebellum?

A

Midbrain

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22
Q

Thalamoperforator arteries are branches of which main artery?

A

Posterior cerebral

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23
Q

Where do the lenticulostriate arteries take their origin?

A

Middle cerebral artery - they branch off of the MCA to supply the basal ganglia and internal capsule

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24
Q

The cuneate fasciculus contains fibres from which body region?

A

C1-T6

The gracile fasciculus contains information from the LOWER part of the body

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25
Q

The raphe nuclei in the brainstem produce which neurotransmitter?

A

5HT- serotonin

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26
Q

Where is noradrenaline produced?

A

The locus coreuleus

27
Q

What is the consequence of blockage of the arachnoid granulations e.g. in SAH?

A

CSF accumulates and causes raised ICP ( CSF usually drains through granulations

28
Q

Define tract, fasciculus and funinculus

A

Tract - distinct white matter pathway running between two regions that contains axons travelling in ONE DIRECTION ONLY

Fasciculus - a subdivision of a tract

A funinculus - kinda funny because it contains axons travelling IN TWO DIFFERENT DIRECTIONS

29
Q

What can you not use long term for anxiety tx?

A

Benzos- addictive, severe side effects, can be used in suicide attempts

30
Q

Tx for anxiety?

A
  • SSRIs (mainstay) / pregabalin (GABA analogue)

- Cognitive behavioural therapy

31
Q

Describe the epidemiology of OCD

A

Young people, 75% experience symptoms before 30, M:F 1:1, 2% of the population

32
Q

What structure is commonly enlarged in schizophrenia?

A

Ventricles

33
Q

Describe distribution of D2 receptors in the brain

A

Rich in striatum and midbrain, lower in cortex

34
Q

Which dopamine pathway is overactive in schizophrenia?

A

The mesolimbic - all “limbered up” ready to cause schizophrenia

Mesocortical is underactive

Tuberoinfundibular has an endicronological role

35
Q

Who coined the word schizophrenia?

A

Eugen Bleuler

36
Q

How do you differentiate between different schizophrenia subtypes ?

A

Simple - self absorbed and socially withdrawn, no hallucinations/ delusions

Paranoid - profound hallucinations/delusions

Heberphrenic- inappropriate affect, disjointed behaviour and thought disorder ( also caused disorganised schizophrenia)

37
Q

List the first rank symptoms of schizophrenia

A
  • Auditory hallucinations
  • Somatic hallucinations
  • Passivity experiences
  • Thought withdrawal, broadcast or insertion
  • Delusional perceptions
38
Q

The posterior limb of the internal capsule represents which part of the body?

A

Trunk and lower limbs

39
Q

Which part of the internal capsule represents the face?

A

The genu

40
Q

What nerve palsy is caused by herniation of the uncus?

A

CN 3

41
Q

Which midbrain structure is important for motor control?

A

The red nucleus

42
Q

Why might a stroke affecting the lateral motor cortex compromise swallowing?

A

Denervation of the cranial nerve nuclei which distribute LMNs in the vagus nerve

43
Q

Where are pattern generator neurones found?

A

In the medulla

44
Q

What does the medial lemniscus contain?

A

Decussating second order sensory fibres in the DCML

45
Q

What does the medial longitudinal fasciculus do? What can damage here cause?

A

integrates movement of the eyes by linking the 3 CNs involved in eye movements

internuclear ophthalmoplegia - an ocular movement disorder that presents as an inability to perform conjugate lateral gaze

46
Q

Which part of the brainstem lies at the level of tentorium cerebelli?

A

The midbrain

47
Q

What white matter structures in the midbrain connect the cerebral hemispheres to the brainstem?

A

Crus cerebri

48
Q

What are the superior colliculi?

A

Features of the dorsal midbrain that deal with reflex actions to visual stimuli

49
Q

Which cranial nerve emerges ventrally from the ponto-medullary junction?

A

Abducens nerve

Facial nerve emerges laterally

50
Q

CNS shares and embryological origin with which tissue?

A

Skin - ectoderm

Gut derives from endoderm and muscle from mesoderm

51
Q

Potential cause of rapid onset dementia in young people?

A

Prion disease or an aggressive brain tumour

52
Q

Describe GCS scoring

A 
Eye Opening Response
• Spontaneous 4 points
• To verbal stimuli 3 points
• To pain only  2 points
• No response 1 point
Verbal Response
• Oriented 5 points
• Confused conversation, but able to answer qs 4 points
• Inappropriate words 3 points
• Incomprehensible speech 2 points
• No response 1 point

Motor Response
• Obeys commands 6 points
• Purposeful movement to painful stimulus 5 points
• Withdraws in response to pain 4 points
• Flexion in response to pain (decorticate posturing) 3 points
• Extension response in response to pain (decerebrate posturing) 2 points
• No response 1 point

53
Q

Pt is able to point to an object when asked and can articulate well but not repeat the objects name - site of lesion?

A

Arcuate fasciculus

54
Q

Site of lesion in hemispatial neglect?

A

R parietal lobe

55
Q

How do plaques form?

A

Amyloid precursor protein repairs neurones following damage and is broken down by alpha and gamma secretase

If Beta secretase gets involved, the resulting parts of APP are no longer soluble and accumulate between neurones, reducing signal transmission

56
Q

How do tangles form?

A

Tau proteins play a role in stabilising microtubules within the neuronal cytoskeleton
• Microtubules help to mobilise nutrients around the neuron
• Beta amyloid plaques (outside the neuron) induce pathological processes within the neuron
• Results in hyperphosphorylation of Tau proteins
• Causes a change in the shape of Tau proteins

57
Q

What are the three components of the general adaptation syndrome?

A

Alarm, resistance, exhaustion

58
Q

Outcomes of proximal MCA occlusion? Specifically if left/right sided?

A

Contralateral hemiparesis
Contralateral sensory deficit (often solely face and arms)
Contralateral homonymous hemianopia

If left sided:
Aphasia

More commonly right sided:
Contralateral (i.e. left sided) hemispatial neglect

59
Q

Outcomes of PCA occlusion?

A

Contralateral homonymous hemianopia with macular sparing

Contralateral sensory loss (due to thalamic involvement)

60
Q

What is needed to classify as a TACs stroke?

A

All 3 of:

  1. Unilateral weakness (+/- sensory deficit) of the face, arm and leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction
    • Dysphasia / aphasia
    • Visuospatial disorder
61
Q

What is needed to classify as a PACs stroke?

A

Only 2 of:

  1. Unilateral weakness (+/- sensory deficit) of the face, arm and leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction
    • Dysphasia / aphasia
    • Visuospatial disorder
62
Q

What is needed to classify as a POCs stroke?

A

One of the following:

  • Cranial nerve palsy and contralateral motor/sensory deficit
  • Bilateral motor/sensory deficit
  • Conjugate eye movement disorder
  • Cerebellar dysfunction
  • Isolated homonymous hemianopia (with macular sparing)
63
Q

What is needed to classify as a LACs stroke?

A

Pure sensory deficit
Pure motor deficit
Sensory-motor deficit
Ataxic hemiparesis

Y2 Practice Qs (8 decks)

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