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Clinical neuroscience > Group work questions > Flashcards

Group work questions Flashcards

1
Q

Which structures detect muscle stretch when the tendon hammer is applied to the patellar ligament?

A

stretch receptors found in muscle spindle

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2
Q

In monosynaptic reflexes like the knee jerk, where is the synapse found?

A

grey matter of spinal cord

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3
Q

Draw a labelled diagram showing the complete reflex arc.

A
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4
Q

What spinal level(s) mediate(s) the knee jerk reflex?

A

L2,L3, L4

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5
Q

Jendrassik manoeuvre

A

used to elicit reflex - prevents some unconscious inhibition

  • ask patient to clench teeth and hands and then try to elicit the reflex
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6
Q

Whilst out shopping you witness a man collapse and start having a seizure. As a medical student you attend to the man during the interval before an ambulance arrives.

You notice that the man’s seizure started in his left hand, but then progressively moved proximally through his upper limb. Why is this the case

A
  • damage to the primary motor cortex in the region controlling the hands
  • damage/ischaemia may spread to areas of the cortex near this region e.g. up the arm
  • think homonculus
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7
Q

if there are motor problems with the left hand which side of the brain is there likely to be an abnormality?

A

right side of the brain

  • primary motor cortex neruones decussate to form the cortical spinal tract at the level of the pyramidal medullas
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8
Q

how do T1 and T2 MRI scan differ

A

T1- fluid is dark and fat is white

T2- fluid is white and fat is darker

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9
Q

describe what you can see?

Why does gadolinium (Gd) enhance the lesion?

A

a tumour derived from fat/protein e.g. meiningioma

Gd acts as a contrast to amke tumours, blood vessels and organs more enhanced–> due to 7 unpaired electrons (the most possible)

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10
Q

A baby is born with a prominent lump on her back at the lumbar level. Her mother did not take folate supplements during her pregnancy. She appears to be neurologically normal. The lump is fluid filled and transilluminates very well.

What is the fluid present in the lump likely to be?

A

CSF

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11
Q

A baby is born with a prominent lump on her back at the lumbar level. Her mother did not take folate supplements during her pregnancy. She appears to be neurologically normal. The lump is fluid filled and transilluminates very well.

Why does the baby not have neurological deficit?

A

Meningocele–> spinal cord is found within normal place in the vertebra

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12
Q

Which type of spina bifida has a worse prognosis?

A

craniorachischisis

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13
Q

The arrow is pointing to part of the ventricular system which is narrowed. Which part is this

A

cerebral aqueduct (sylvius)

  • build up of CSF in the lateral and 3rd ventricle
  • compresses brain structures- hydrocephaly
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14
Q

ways of treating hydrocephaly

A
  1. shunt- which drains the CSF into the peritoneal cavity in the abdomen using a tube (tube is quite long to account for growth (ventriculoperitoneal shunt)
  2. endoscopic third ventircuolostomy- holes created so that CSF can draining into the subarachnoid space
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15
Q

You help a plaster technician to apply a cast to a patient’s leg. He complains initially of some skin irritation but when you see him in fracture clinic the following day he states he feels comfortable, with no irritation.

What is the neurophysiological mechanism for this phenomenon?

A

radidly adapating sensory neurpones

  • AP frequency goes from high to low
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16
Q

You are assisting in theatre with a resection of a brain tumour arising from the cerebral cortex. The neurosurgeon states that the patient’s sensory function in their right hand is likely to be impaired.

Ascertain as precisely as possible where in the brain the tumour is likely to be.

A

supero -lateral

17
Q

why is the hand particularly vulnerable

A

part of the primary somatosensory cortex responsible for the hand takes up a large proportion compared to other parts of the body

18
Q

v

A patient with diabetic neuropathy is found to have bilateral ‘glove and stocking’ paraesthesia in both hands and feet.

Can this pattern be explained by a single lesion affecting the sensory homunculus in the primary sensory cortex? If not, why not?

A

no- a single lesion could not explain bilateral paraesthesia in both hands and feet

  • typical od diabetes due to distal bilateral neuropathy –> metabolic disturbances (DM and alcoholism) cause neuropathy
19
Q

Further examination of the same patient reveals that they have complete sensory loss (all modalities) in the S1 dermatome on the right side as well as weakness in plantarflexion.

Which structure(s) might have been damaged to cause this isolated dermatomal loss and accompanying weakness? Draw a diagram showing these potential site(s)

A

the spinal nerve (both sensory and motor neurones)

20
Q

label this

A
21
Q

which region of the cord has been affected

A

dorsal region (more sensory)

22
Q

Subacute combined degeneration of the spinal cord what can a vegan diet cause and why

A

Subacute combined degeneration of the spinal cord - deficiency in B12

23
Q

He initially presented with sensory ataxia. What is this?

A

sensory ataxia leads to a lack of muscle coordiantion caused by a loss of the sense of where diff parts of the body are located in relation to one another (proprioception)

24
Q

A 30 year old woman presents to the neurology clinic with ‘numbness’ affecting both of her upper limbs and the upper half of her chest.

Sensory examination reveals she has bilateral loss of pinprick and temperature sensation in the totality of her C4-T2 dermatomes. Vibration, light touch and two point discrimination are preserved.

Which sensory system is affected?

A

spinothalamic system

25
Q

A 30 year old woman presents to the neurology clinic with ‘numbness’ affecting both of her upper limbs and the upper half of her chest.

Sensory examination reveals she has bilateral loss of pinprick and temperature sensation in the totality of her C4-T2 dermatomes. Vibration, light touch and two point discrimination are preserved.

Can you explain the bilateral nature of her symptoms and signs?

A

midline lesion–> where the second order neurones decussate

26
Q

A 30 year old woman presents to the neurology clinic with ‘numbness’ affecting both of her upper limbs and the upper half of her chest.

Sensory examination reveals she has bilateral loss of pinprick and temperature sensation in the totality of her C4-T2 dermatomes. Vibration, light touch and two point discrimination are preserved.

Why are there no signs at levels below T2?

A

lesion is not effecting more lateral white matter

i. e. dorsal column (lumba more mediala dn cervical most laterl)
i. e.

Spinothalamic tract projecting info from the upper and lower body (opposite to dorsal columns)

  • The second order neurones from the lower half of the body are found in the lateral region of the spinothalamic tract
  • The second order neurones from the upper half of the body are found in the medial region of the spinothalamic tract
27
Q

Are there any other (real…) causes for insensitivity to pain? Some rare causes are FAAH-OUT!

A
  • congenital insensitivity to pain
  • neuropathy due to metabolic disorders
  • FAAH-OUT mutation
28
Q

Why does rubbing a painful area of skin relive the pain?

A
  • You stub your toe
  • Pain is detected by C-fibres (nociceptive first order neurones) and carried up via the spinothalamic tract up to the somatosensory cortex of the brain- PAINNNNNNNN
  • You start rubbing the sore toe
  • Mechanoreceptors detect rubbing movement – ABeta (AB) neurones project into the dorsal horn and synapse mainly with interneuron instead of secondary neurones
  • When an interneuron is stimulated it can start inhibiting second order neurones which are sending pain signals up to the somatosensory cortex
29
Q

How can people deal with extreme pain? e.g. hypnosis and extreme trauma can reduce pain experienced

A
  • Due to descending modulation which inhibits pain pathway
    1. Hypnosis activates cortical neurones which project down to the midbrain
    2. These excitatory neurones stimulate neurones in the periaqueductal grey (PAG)
    3. These activated PAG neurones can project down into the medulla where they are able to stimulate neurones in the nucleus raphe magnus (large nucleus near the midline- part of reticular formation)
    4. NRM neurones descend down the cord where they have an inhibitory effect on the second order sensory neurone by stimulation the inhibitory interneurons
30
Q

A soldier has been shot in the back, completely destroying the right half of his C5 cord segment.

A

Brown-sequard syndrome

a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

31
Q

Damage to the right sided C5 by gunshot wound.

Predict the sensory disturbance that he is likely to suffer from. Make sure you consider the effect of Lissauer’s tract. A diagram might help.

A

spinothalamic tract (pain, temp, pressure)

  • disturbances on the contralateral side
  • preserved on ipsilateral side

Dorsal column- medial leminiscus system (vibration, fine touch, proprioception, 2 point discrimination)

  • disturbances on the ipsilateral side
  • preserved on contralateral side

At the level of the injury- total sensory loss i.e. where the bullet went in

32
Q

A soldier has been shot in the back, completely destroying the right half of his C5 cord segment.

Speculate about any other consequences that the lesion might have bar sensory losses

A
  • paralysis of the right side
    • lesion will stop spinocorticol neuroens from progressing down the spinal tract

Clinical neuroscience (30 decks)

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