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MBChB - year 2 > HNN PBL 5 > Flashcards

HNN PBL 5 Flashcards

1
Q

What is the most common thing to go wrong in movement disorders?

A

The basal ganglia

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2
Q

What are the roles of the basal ganglia?

A
  • Initiation of voluntary movement
  • Maintaining posture
  • Eye movement control
  • Social behaviour and decision making
  • Executive functions – higher function that help in terms of planning etc / working memory
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3
Q

Where are the basal ganglia located?

A

The inferior part of the cerebral hemisphere

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4
Q

What are the basal ganglia?

A

A set of deep nuclear structures that are closely intertwined with lots and lots of pathways between them

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5
Q

Is the direct pathway the “stop” or “go” pathway?

A

GO

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6
Q

Is the indirect pathway the “stop” or “go” pathway?

A

STOP

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7
Q

What is linked by the direct pathway?

A

The striatum and the GPi

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8
Q

What does activity in the direct pathway do?

A

Increases cortical activity

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9
Q

What is linked by the indirect pathway?

A

the striatum and GPi via the GPe (Globus pallidus externa) and the STN (Subthalamic nucleus)

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10
Q

What does activity in the indirect pathway do?

A

Decreases cortical activity

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11
Q

Where is the cerebellum located?

A

the posterior fossa of the cranium

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12
Q

What connects the cerebellum to the brainstem?

A

three cerebellar peduncles (superior, middle, and inferior)

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13
Q

What is the Nigrostriatal pathway responsible for?

A

Movement and sensory stimuli

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14
Q

What is the mesolimbic pathway responsible for?

A

Pleasure and reward seeking behaviours, addiction, emotion, perception

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15
Q

What is the Mesocortical pathway responsible for?

A

Cognition, memory, attention, emotional behaviour and learning

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16
Q

What is the Tuberoinfundibular pathway responsible for?

A

Control of the hypothalamic pituitary endocrine system, inhibition of prolactin secretions

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17
Q

What happens to the dopamine producing cells in Parkinson’s disease?

A

There is a loss of dopaminergic neurones within substantia nigra

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18
Q

What is made as a side effect of dopamine production?

A

Melanin

19
Q

What does less dark staining in the subthalamic nucleus mean?

A

Less production of melanin –> less dopaminergic stimulation

20
Q

What forms inside the surviving neurones?

A

Lewy bodies

21
Q

What are Lewy bodies?

A

Intracytoplasmic inclusion bodies

22
Q

When does Parkinson’s disease begin to manifest clinically?

A

After approximately 50% of dopaminergic neurones are lost

23
Q

What does the loss of cells within the substantia nigra result in?

A

Reduced activity in the direct pathway and increased activity in the indirect pathway.
This leads to an overactive STN and GPI which overall inhibits the thalamus.

24
Q

What is the general rule relating to proteins in neurodegenerative disorders?

A

proteins get misfolded and its these misfolded proteins that accumulate in the cells and can be neurotoxic

25
Q

How many stages are in the Braak staging system?

A

6 stages

26
Q

What happens in stages 1-2 of the Braak staging system?

A

virtually confined to the medulla oblongata and often the anterior olfactory nucleus – these were identified in incidental cases without a PD diagnosis. (no symptoms but may have lost their sense of smell)

27
Q

What happens in stages 3-4 of the Braak staging system?

A

Lewy bodies extend into the mid brain and substantia nigra. Most in stage 3 have a PD diagnosis

28
Q

What happens by the time a patient reaches stage 5-6 of the Braak staging system?

A

widespread distribution of Lewy bodies and this is consistent with Parkinson’s dementia.

29
Q

What symptoms may a patient with Parkinson’s disease have before they present clinically?

A

Disturbed sleep, bladder issues and constipation

30
Q

What are the key symptoms for a diagnosis of Parkinson’s disease?

A

tremor, rigidity and bradykinesia

31
Q

What symptoms develop as Parkinson’s disease progresses?

A

Patients will get worsening of symptoms at first on one side but it then moves to the other side. They then get balance problems, then cognitive difficulties

32
Q

What is bradykinesia?

A

slowness in initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive actions (repeated finger taps or arm movements)

33
Q

What is the pharmacological aim of Parkinson’s disease treatment?

A

To improve motor symptoms/improve quality of life (no evidence for neuroprotection so don’t impact the long term outcome of the disease)

34
Q

What are the classes of drugs used to treat Parkinson’s disease?

A

L-dopa
Dopamine agonists
MAO-B inhibitors
COMT inhibitors

35
Q

What are the ways L-dopa can be prepared?

A

L-dopa + carbidopa = Sinemet

L-dopa + benserazide = Madopar

36
Q

Why does L-dopa have to be combined with another substance to be administered?

A

Carbidopa and benserazide both acts to prevent L-dopa being metabolized peripherally and the side effects that would come with that

37
Q

What are the common adverse effects of L-dopa treatment?

A
  • Peripheral: nausea, vomiting, postural hypotension

- Central: confusion, hallucinations

38
Q

What is the half life and efficacy of dopamine agonists like compared to L-dopa?

A

Longer half-life

less efficacious

39
Q

What are the side effects of dopamine agonists?

A

Dopaminergic side effects, Daytime somnolence and Impulse control disorders (e.g. pathological gambling, hypersexuality)

40
Q

What are the two types of Enzyme inhibitors used to treat Parkinson’s disease?

A

MAO-B inhibitors e.g. selegiline, rasagiline

COMT inhibitors e.g. Entacapone, Opicapaone

41
Q

When in the progression of Parkinson’s disease are MAO-B inhibitors used?

A

Either in early disease or alongside L-dopa later on.

42
Q

When in the progression of Parkinson’s disease are COMT inhibitors used?

A

Usually prescribed in later disease

43
Q

What are treatment options for advanced PD?

A

Apomorphine (dopamine agonist subcutaneous needle – gives smooth dopamine profile) pen injections or subcutaneous pump, Intrajejunal duodopa infusion, Deep brain stimulation surgery

MBChB - year 2 (25 decks)

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