GENERAL Flashcards
What is the difference between the autonomic and somatic peripheral nervous system?
autonomic = involuntary so does not require dendrites to give that information so it is a unipolar neurone.
somatic = voluntary so requires afferent (sensory) and efferent (motor) neurones
Which neurotransmitters are used in the
a) parasympathetic
b) sympathetic
arms of the autonomic nervous system?
a) ACH
b) preganglionic = ACH
postganglionic = noradrenaline (because this will target the fight/flight response on to the organ)
Where are cell bodies found in the autonomic NS?
Pre-ganglionic = grey matter of CNS
- usually parasympathetic in the brain, sympathetic in
the spinal cord
Post-ganglionic = autonomic ganglia in the PNS
What is a glial cell?
A glial cell is a non-neuronal cell found in CNS and PNS. They help to maintain homeostasis by supporting neurones
Name some glial cells found in the CNS
- astrocytes (blood brain barrier)
- oligodendrocytes (produce myelin)
- microglia (immune monitoring)
Name some glial cells found in the PNS
- Schwann cells (produce myelin)
- satellite cells (Regulate external chemical environment same as astrocytes do in CNS)
What is found in the white matter of the brain?
axons
What is found in the grey matter of the brain?
neuronal cell bodies
What does dorsal mean?
posterior ( like the back of your hand)
What does ventral mean?
anterior
Which rami is sensory and which is motor?
dorsal = sensory
ventral = motor
What is the pyramidal system?
system of voluntary movement
Give some pyramidal signs
spasticity
hyperactive reflexes
loss of fine hand movements
extensor plantar response (Babinski sign)
What are the important tracts of the pyramidal system?
lateral and anterior corticospinal
corticobulbar
Where are the majority of UMN contained?
lateral corticospinal tract
When does
a) lateral
b) anterior
corticospinal tract cross?
a) at the medulla
b) at the spinal level it synapses at
Cerebellar signs
DANISH dysdiadochokinesia ataxia nystagmus intention tremor scanning dysarthria hyporeflexia
What is stereognosis?
the ability to recognise an object by touch
What is myoclonus?
sudden, involuntary focal/general muscle jerks
What is clonus?
a series of involuntary, rhythmic, muscular contractions and relaxations
–> sign of UMN lesion
prophylactic treatment for cluster headaches
verapamil
At what spinal levels can spinal cord injury cause autonomic dysreflexia?
above T6
Treatment of trigeminal neuralgia
carbamazepine
syringomyelia causes sensory dysfunction in which distribution
cape-like loss of pain and temperature due to involvement with spinothalamic tract
acute treatment of cluster headache
o2 + triptan
Is GABA or glutamate inhibitory?
GABA
How do you manage myasthenia gravis?
pyridostigmine (anticholinesterase inhibitor) + prednisolone
treat drug-induced parkinsonism
antimuscarinics eg procyclidine
What nerve can be injured by fracture to surgical neck of humerus?
axillary nerve
What nerve can be injured by fracture to humeral shaft?
radial nerve
treat delirium in parkinsons
lorazepam
Cause of
a) unilateral high-stepping gait
b) bilateral high-stepping gait
cause = foot drop
a) common peroneal nerve lesion
b) peripheral neuropathy
l4/5 disc herniation compressing l5
treat nausea in parkinson’s
domperidone
When shingles affects facial nerve
Ramsay Hunt syndrome
- vesicular rash around ear
Features of CRPS
- disproportiante symptoms
- allodynia
- temperature and skin colur changes
- oedema and swelling
- motor dysfunction
How does
a) Klumpe’s palsy
b) Erb’s palsy
present?
a) weak intrinsic hand muscles
b) waiter’s tip: elbow flexion and forearm supination lost
What nerve roots does
a) Klumpe’s palsy
b) Erb’s palsy
affect?
a) C8-T1
b) C5-6
In which type of meningitis are steroids used? Why?
bacterial to reduce inflammation which is a major cause of morbidity
True or false
“There is no effective vaccine against some of the common strains of meningococcal infection seen in the UK”
false
Which of the following statements is TRUE?
A. Aciclovir is useful for treating most causes of viral meningitis
B. Listeria is a small Gram negative bacillus
C. Gentamicin has good penetration into CSF and is useful for treating
some types of meningitis
D. Listeria infection is associated with the consumption of soft cheese
E. Listeria meningitis is commonest in older children and young adults
D
Why is ceftriaxone chosen for empirical treatment for
suspected bacterial meningitis instead of penicillin?
A. Ceftriaxone has a longer half-life than penicillin
B. Ceftriaxone penetrates better than penicillin into CSF
C. Most bacteria that cause meningitis are now penicillin resistant.
D. Resistance is less likely to emerge during therapy if ceftriaxone if
used
E. Ceftriaxone also has activity against Listeria infection
A: more effective to give a less amount of times
Which area of the brain is responsible for nominal aphasia?
suggests an inferior parietal lesion, and area known as the angular gyrus.
What is the mode of inheritance in
a) Wilson’s disease?
b) Becker’s muscular dystrophy?
c) Myoclonic epilepsy with ragged red fibers?
a) autosomal recessive
b) x-linked recessive
c) mitochondrial
When do you see xanthochromic CSF?
sub-arachnoid haemorrhage
What does CSF look like in
a) viral meningitis?
b) bacterial meningitis?
a) clear
b) cloudy
When is protein most raised in CSF?
viral meningitis
In which case would CSF have low glucose and increased neutrophils?
bacterial meningitis
What is the first area of the brain affected by Alzheimer’s?
The nucleus basalis of Meynert (main source of cholinergic projections)
MOA of lamotrigine
Lamotrigine antagonises voltage sensitive sodium channels and this reduces the release of glutamate, the main excitatory neurotransmitter.
First-line management of Alzheimers
acetylcholinesterase inhibitor
eg. rivastigmine, donezapil and galantamine
When can memantine be used?
add-on therapy in moderate alzheimer’s
monotherapy in severe
What is memantine?
NMDA receptor blocker
Weber test in
a) sensorineural hearing loss
b) conductive
a) localises to contralateral side
b) localises to same side
Is bell’s palsy an UMN or LMN lesion ?
LMN so forehead not involved
In which type of meningitis do you see a rash?
meningococcal (bacteria)
What is the empirical treatment for bacterial meningitis?
IV ceftriaxone and dexamethasone
Features of Bell’s palsy
paralysis of facial muscles
loss of lacrimation
hyperacusis
Is sensation affected in Bell’s palsy?
no
sensory fibres carried by trigeminal nerve
Which nerve is injured in wrist drop?
radial
numb superior upper arm and weak shoulder abduction
axillary nerve
first 15 degrees of shoulder abduction is done by which muscle?
supraspinatous
Which cranial nerve supplies laryngeal muscles eg cricothyroid?
vagus
acute, ascending paralysis with glove and stocking weakness
guillain-barre
Lesion in a spinal tract would cause an UMN or LMN sign?
UMN
Which blood test is raised in temporal arteritis?
ESR
Signs of spinal injury
mixed UMN and LMN signs above the lesion
UMN signs below the lesion
Psychiatric disorder + cerebellar dysfunction + parkinsonism
Wilson’s disease
Which organism is Guillain-Barre particularly associated with?
Campylobacter jejuni
Alcoholic encephalopathy is caused by deficiency of what?
vitamin B1 (thiamine)
bilateral leg weakness, pes cavus + high-stepping gait
Charcot-Marie-Tooth
A 60yr old woman has difficulty with speech. Her sentences are fluid but don’t make sense and she is unaware of this. She can follow simple commands.
Receptive aphasia –> Wernicke’s area (Superior temporal gyrus)
A 70yr old man with slow speech and frequent pauses while he tries to remember words. He often resorts to saying “ the thing”
Expressive aphasia –> Broca’s area (Inferior frontal gyrus)
Which medications cause impulsiveness in Parkinson’s treatment?
dopamine agonists eg ropinorole
Stroke in which territory of the brain would cause weakness and sensory deficit for
a) lower limbs?
b) upper limbs?
c) both?
a) medial frontal and parietal lobes - forebrain - anterior cerebral artery
b) lateral frontal, parietal and temporal lobes - middle cerebral artery
c) occipital lobe - posterior cerebral artery
Which cranial nerve is carried through the cavernous venous sinus?
ophthalmic division of trigeminal (V1)
causes of Bell’s palsy
idiopathic mononeuritis multiplex parotid inflammation herpes zoster pontine tumour or stroke
What is Creutzfeldt-Jakob disease?
a fatal, degenerative brain disease where prion proteins (misfolded) cause degeneration and death of brain tissue resulting in a spongiform brain
How is Creutzfeldt-Jakob disease transmitted?
exposure to infected brain tissue eg. cannibalism
rarely Autosomal dominant inheritance
How does Creutzfeldt-Jacob disease present?
rapid onset dementia
myoclonus
personality changes
hallucinations
What is mononeuritis multiplex?
a peripheral nerve disorder that affects 2+ random nerves
How does mononeuritis multiplex present?
painful, asymmetrical sensory and motor features
What causes mononeuritis multiplex?
axons are damaged by a systemic process eg. diabetes mellitus, rheumatoid arthritis, vasculitis
Diagnose delirium
acute onset
inattention with fluctuating course
plus one of: disorganised thinking or altered level of consciousness
Which type of chorea is caused by GBS infection in children?
synderham’s
Which drug can slow progression of MND?
mechanism?
riluzole
anti-glutamate
How does wilsons disease present in
a) children?
b) young adults?
a) liver problems
b) CNS problems eg. ataxia, tremor, slow movement, inc tone
Differentiate multi system atrophy from other causes of Parkinsonism
early autonomic disturbance
eg. bladder/bowel problems, postural hypotension, erectile dysfunction
Which cause of Parkinsonism presents with eye problems?
progressive supranuclear palsy
treat SAH
nimodipine and surgical clipping
what causes holmes tremor?
demyelination in the mid-brain
What organism causes meningitis in neonates?
Group B strep
What organism causes meningitis in children over 3 months + adults?
neisseria meningitidis
What organism causes meningitis in >60?
listeria meningitis
Which lobe is responsible for short term memory?
temporal
