Dog shit extra slides that shouldn't fucking exist Flashcards
Describe how NMJ functions
- Action potential reaches neuron terminus
- This activates voltage gated calcium channels
- ACH is released and attaches to nicotinic-ACH receptors on postsynaptic surface
- Stimulates Muscle contraction
How does Botulinum Toxin stop NMJ?
Stops ACH from being released from the end motor neuron
What is used to treat Myasthenia Gravis
Acetylcholinesterase Inhibitors
and
Immunosuppressants
What is the occurrence of individuals with respiratory failure who also have Myasthenic crisis?
20%
In NCS motor studies, what gives rise to Amplitude and Conduction?
Axons - Amplitude
Conduction - Myelin
What are used to treat Guillain Barre syndrome?
IVIG, Analgesia, and ventilatory support
Describe Relapsing Remitting MS (1/4)
85% of MS cases
Acute periods of relapse then recovery
Symptoms don’t worsen during recovery phase
Can progress into Progressive MS
Describe Secondary Progressive MS (2/4)
Relapsing Remitting may progress to this
Symptoms steadily worsen
Describe Primary Progressive MS (3/4)
Most severe type of MS
10-15% of MS patients
Must never have had relapse
Describe Progressive Relapsing MS (4/4)
Steady progression of disease with periods of acute relapse
What are the Input (afferents) to the Neocortex?
Ascending info from Thalamus
Ascending info from Sub-cortical structures
(Hypothalamus, basal ganglia, brainstem)
Commissural and Association fibres from pyramidal neurons
What are the Output (efferents) from the Neocortex?
Always excitatory via pyramidal cells
Thalamus
Basal ggl.
Brainstem nuc.
Spinal cord
Contralateral hemisphere
Ipsilateral hemisphere
Where is the Olfactory cortex found?
Anterior Temporal Lobe
What are some Visual Agnosias?
-
Optic Ataxia - struggle to locate objects in space (grab objects)
What-Where pathway disorientation - Prosopagnosia - can’t recognise faces
What are some Auditory Agnosias?
Wernicke’s and Broca’s aphasias
Amusia - difficulty detecting pitch or recalling music
What are the 3 layers of the Cerebellar cortex from external to internal?
Molecular
Purkinje Cell
Granule Cell
What are some notable traits about Purkinje cells?
Only found in Cerebellum
Inhibitory Neurons
Can be damaged by alcohol and lithium
Loss found in autistic children
Crista Galli is a part of what bone?
Ethmoid
What may be caused by a lesion of one of the somatosensory association cortexs?
Amorphosynthesis
(Unilateral inattention to sensory input)
What are the 3 compensatory responses?
Muscle proprioceptors
(detect changes in muscle length and tension)
Sense of balance
(detect movement of head ie. falling)
Visual inputs
(detect movement in visula field)
How many days are needed to wash out MOAI’s before using other antidepressants?
14 days
What is the name of a reversible MAOI
AND
how does it work?
Moclobeminde
Reversible inhibition of MAO type A
What is the relation between Tricyclic Antidepressants and ACH receptors?
Tricyclics have antimuscarinic activity that blocks activity of the muscarinic ACH receptor so reduce intestinal mobility
Name a drug related to Tricyclics
Trazodone
What is the most toxic SSRI for overdoses?
Citalopram
Name some common SNRI’s
Duloxetine
Venlafaxine
Name a common presynaptic alpha2-adrenoreceptor antagonist
AND
what is it used for?
Mirtazapine
Depression, anxiety, PTSD
(antidepressant)
What are the side effects of Mirtazapine in Low and High doses?
LOW doses - Drowsiness
HIGH doses - Stimulant effect
Name an antipsychotic that has some antidepressant properties
Risperidone
How do tricyclics help with pain management?
Block re-uptake of Noradrenaline and Serotonin into the nerve endings and increase their levels in the pain control pathway
What are 3 commonly used antidepressants?
Amitriptyline (Tricyclic)
Nortriptyline (Tricyclic)
Duloxetine (SNRI)
What is Duloxetine also licensed for?
Diabetic Neuropathy
What are some symptoms of Depression?
Lowered appetite
Insomnia
Low energy
Loss of libido
Social withdrawal
What are some examples of early life experiences that may increase a person’s vulnerability later in life?
Poor parent-child relationship
Marital discord / divorce
Neglect
Physical and sexual abuse
The rate of depression in women, who before age 11, had lost their mother and who also experienced a severe recent loss is how much greater?
x3 higher
Depression is approximately ___ more common in patients with a chronic illness
2 to 3 times
Major depression is associated with ___ increased risk for cardiac mortality among patients hospitalised for MI
2 to 4 times
Define Penumbra
Area of salvageable damage
What are the 3 Watershed areas?
Most vulnerable to hypoperfusion
Cortical Border Zone between ACA and MCA
Internal Border Zone between LCA and MCA
Cortical Border Zone between MCA and PCA
What is an ABCD2 Assessment
AND
how do you score it?
7 point score to predict early stroke risk post TIA
Points for:
Aged 60 or above [1]
BP systolic >140 and/or diastolic >90 [1]
Unilateral weakness [2]
Speech disturbances w/o weakness [1]
Duration of symptoms in mins, >60 [2], 10-59 [1]
Diabetes [1]
What are the 5 S’s of Stroke Mimics?
Seizures
Sepsis
Syncope
SOL (tumour, subdural)
Somatisation
What are some symptoms of General Anxiety Disorder?
Restlessness
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Disturbed sleep
What are the 1st - 3rd line drug treatments for Generalised Anxiety Disorder?
1st line - SSRI e.g. sertraline
2nd line - Alternative SSRI or SNRI
3rd line - Consider Pregabalin
Define Delusions
A false, fixed, strange, or irrational belief that is firmly held. Not normally accepted by other members of the same culture or group (excuse for religion)
Define Hallucinations
Sensory perception without an appropriate stimulus
What are the 5 notable structures in the Cerebellum?
Ant. Lobe
Primary Fissure
Post. Lobe
Posterolateral Fissure
Flocculonodular Lobe
What is the function of the 3 lobes of the cerebellum?
Ant. Lobe - Spinocerebellum
Post. Lobe - Cerbrocerebellum
Flocculonodular Lobe - Vestibulocerebellum
Vestibulocerebellum receives input and sends output to where?
Input - Vestibular & Visual areas
Output - Vestibular nuc.
Spinocerebellum receives input and sends output to where?
Input - Spinocerebellar & auditory, visual, vestibular systems & sensorimotor cortex
Output - Vermis to fastiglial nuc. to vestibular & reticular formation of pons and medulla
Spinocerebellum consists of what structures?
Vermis of post. and ant. cerebellum + adjacent intermediate zones on both sides of vermis
Cerebrocerebellum receives input and sends output to where?
Input - Cerebral motor cortex & adjacent premotor & somatosensory cortices
Output - Dentate nuc. to thalamus to motor and premotor cortices
Cerebrocerebellum consists of what structures?
Lateral zones of Cerebellar hemispheres (pink/flesh)
What are the input and output neurons of the Cerebellum?
Input - Climbing & Mossy
Output - Purkinje
What are the 4 nuclei of the Cerebellum?
Dentate
Emboliform
Globose
Fastiglial
What is the primary role of the Cerebellum?
Thought to be to supplement and correlate activities of other motor areas
What are the clinical features of Cerebellar damage?
Hypotonia
Ataxia
Dysarthria
Nystagmus
Myoclonus
What are the 2 parts of the Membranous Labyrinth?
Auditory part - Cochlea
Vestibular part - Otolith organs & Semicircular canals
What cells are in the saccule?
Hair cells
What 2 structures make up the Otolithic Organs?
Saccule & Utricle
What is the difference in function between the Otolith organs and the Semicircular canals?
Otolith organs - Detect gravity & head tilt
Semicircular canals - Detect head rotation
What does the Utricle detect?
Horizontal acceleration
What does the Saccule detect?
Vertical acceleration
Describe Mechanotransduction in Hair cells
—SEE DIAGRAM—
Cilia + kinocilium provide direction info
Movement of otolithic membrane bends these structures
Movement will open hair cell cation channels
How do the semicircular canals detect angular acceleration (head rotation movements)?
Hair cells are clustered in sensory epithelium called Crista Ampullaris
These hair cells project into gelatinous Cupula, all orientated the same way
As head rotates canal moves but endolymph stays put, bending the hair cells to either excite or supress transmitter release
What is the path of axons from Otolith organs?
First project to the Lateral Vestibular Nucleus
They then project via vestibulospinal tract to Spinal Motor neurons - POSTURE
What is the path of axons from Semicircular canals?
First project to the Medial Vestibular Nucleus
They then project via MFL to Motor nerves of trunk and neck muscles - keeps head straight as body moves
Describe the Vestibulo-Ocular reflex
Semicircular canals control eye movements
Dirrect stimulation of ampullary nerves elicits specific eye movements
What is a potential cause of Meniere’s disease?
XS accumulation of endolymph and damage to hair cells
What causes Vertigo?
Debris from otolithic membrane adhering to cupula in ampulla of post. semicircular canal
May also be due to lesions of vestibular aspect of CN VIII, or central lesions affecting brainstem vestibular nuclei
What is a risk factor for Spina Bifida
AND
how can it be minimised?
Low levels of Folic Acid in early pregnancy
Take 400 micrograms daily
What are possible complications of Spina Bifida?
Permanent spinal injury from lesion downwards
L1 lesions likely to be wheelchair bound
Sacral lesions less likely to walk
Bladder and bowel dysfunctions
Hydrocephalus + Chiari malformations
What is the difference between a Chiari 1 malformation and a Chiari 2?
Chiari 1 - Downward placement of cerebellar tonsils
Chiari 2 - Downward placement of cerebellum, brainstem, and 4th ventricle
What is a Syringolmelia?
Fluid filled cyst (syrinx) forms within the spinal cord
What leg mobility functions would be lost in an L4 spinal cord injury?
Knee flexion
Hip extension
Ankle dorsiflexion
Ankle inversion
Greater toe flexion
What is a significant risk for those who are less able to mobilise
AND
how may it be prevented?
Pressure sores
Graded 1- 4 (4 being the worst)
Regular repositioning and specialist mattresses / cushions
How may we treat Neurospaciticy?
Regular Botulinum Toxin injections to relax muscles
Splints to keep limb in more comfortable position
How may we treat Neuropathic pain?
Chronic pain medication e.g.
Gabapentin / Pregabalin / Amitriptyline / Duloxetine
Dorsal column stimulator implants can block pain signals
What is life threatening issue that may affect those with T6 or above injury
AND
what are its symptoms and managements?
Autonomic Dysreflexia
Pounding headache, flushed skin above level of SCL, HT, low HR
Give sublingual Nifedipine
What is the Disability paradox?
The assumption (made by the abled) that individuals with a disability have a lower quality of life
This is NOT true
What specifically is being tested in the Cornea reflex?
Trigeminal sensory pathway
Facial motor pathway
What are the only CN’s with and Parasympathetic function?
III, VII, IX, X
Name all brainstem nuclei
^^^
What class of drug is Metformin?
Biguanide
What are the side effects of DDP-4 inhibitors (gliptans)?
- Headache
- Dizziness
- Pancreatitis
What is HONK?
Hyper Osmolar Non-Ketotic coma
What is MALA?
Metformin Associated Lactic Acidosis
Describe what condition is present in each NCS
What are some functions of the Reticular Formation?
Describe the main features of MS
Roughly describe the 4 types of MS
What are the treatment options for MS?
What is Prosopagnosia?
Face blindness
(can’t recognise faces)
What are the 3 layers of the Cerebellum?
What are the different types of spinocerebellar tracts?
Posterior spinocerebellar tract
- proprioceptive and tactile info from lower limb
Cuneocerebellar tract
- proprioceptive and tactile info from upper limb
Anterior spinocerebellar tract
- relays ascending proprioceptive and decending motor info to the cerebellum for refined motor output
What muscles are associated with the 1st pharangeal arch?
What muscles are associated with the 2nd pharangeal arch?
What muscles are associated with the 3rd pharangeal arch?
Stylopharangeus
What muscles are associated with the 4th pharangeal arch?
What muscles are associated with the 6th pharangeal arch?
Laryngeal muscles
(except cricothyroid)
Describe Primary brain injury
Describe Secondary brain injury
When shouldn’t you discharge a TBI patient?
Name two antibiotics that can be used for UTI’s
Trimethoprim
Fosfomycin
What are two common bacteria found in urine?
E.coli
Klebsiella
What is done to treat DKA in clinical setting?
