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Pathophysiology > L35 and 36 > Flashcards

L35 and 36 Flashcards

1
Q

How is the basal ganglia involved in motor control?

A

Influences the output of cerebral cortex

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2
Q

Neural activity arriving to the BG may be important for the ___ and ___ in motor selection

A

what and where

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3
Q

What does the ventral division of the basal ganglia include??

A

Nucleus accumbens
Substantia innominate
Nucleus Basalis of Meynert
Olf Tubercle

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4
Q

What structure serves as the efferent pathway for the basal ganglia?

A

Parabrachial Pontine Reticular

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5
Q

What symptoms are associated with damage to the Parabrachial Pontine Reticular (PPR)

A

Postural instability
Gait abnormalities
Changes in arousal, attention

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6
Q

What are the two loops of the BG?

A

1) Cortical
2) Subcortical

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7
Q

True or False: The Cortical Loop of the BG has diffuse inputs from the BG

A

True

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8
Q

How does one get into the basal ganglia cortical loop? out of?

A

In - neo striatum (putamen/caudate)
Out - globus pallidus / sub nigra / pars reticulata / thalamus

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9
Q

The superior colliculus and the pedunculopontine nucleus are part of which loop of the basal ganglia?
A. Cortical
B. Subcortical

A

B. Subcortical

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10
Q

Which pathway begins as excitatory projection from
cerebral cortex to neostriatum?

A

Direct

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11
Q

In the direct pathway, striatum inhibits cells in ___ and ____

A

globus pallidus internal (GPint) and SNpr

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12
Q

In the direct pathway, how do the pallido-thalamic fibers (which project to the thalamus) affect the thalamic targets?

A

Tonically inhibit

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13
Q

What is the net effect of the direct pathway?

A

1) Increase activity of thalamus
2) Excite cerebral cortex

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14
Q

Which pathway includes a loop through both the GP and the SubThN + striatum activates GPex?

A

Indirect pathway

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15
Q

Which NT does the GP use?

A

GABA

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16
Q

In the indirect pathway, the globus pallidus tonically inhibits the ____, its target

A

SubThN

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17
Q

True or False: The direct pathway is associated with increased firing rates of fibers from subthalamic nuclei to GPing

A

False - this occurs in the Indirect Pathway!!

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18
Q

True or False: In the indirect pathway, GPint is naturally inhibitory to thalamus

A

True

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19
Q

What is the net effect of the indirect pathway?

A

1) Decreased activity of thalamus
2) Decreased activity of cerebral cortex

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20
Q

Dopaminergic neurons from __ project
onto striatal neurons

A

SNpc (substantia nigra - pars compacta)

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21
Q

Neostriatal neurons expressing __ receptors
give rise to the direct pathway and SNpc
projections EXCITATE the direct pathway.

Neostriatal neurons belonging to the indirect
pathway have __ receptors. When dopamine
binds to __ receptors, neurons are inhibited.
INHIBITION of the indirect pathway

A

D1; D2; D2

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22
Q

What is the effect of dopaminergic stimulation on
striatal neurons?

A

Facilitate movement via: both direct and indirect pathways

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23
Q

True or False: The “where” options in motor selection may
be modulated by dopaminergic inputs

A

False - the “when”

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24
Q

PD is caused by loss of dopamine producing cells in the ____

A

basal ganglia (substantia nigra - pars compacta)

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25
Q

True or False: The severity of one’s PD correlates well with extent of degeneration of dopaminergic neurons in the substantia nigra pars compacta

A

True

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26
Q

True or False: A large portion of SN cells may be loss before motor symptoms are evident

A

True

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27
Q

Parkinson Disease as an example of a _____ disorder
A. hyperkinetic
B. hypokinetic

A

B. hypokinetic

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28
Q

In PD, there is loss of SNpc input to striatum. What is the result of this?

A

Increased inhibition of the motor thalamus (VA, VL)

29
Q

True or False: In PD, connections between thalamus and
motor areas of the cortex are hyperactive

A

False - hypoactive

30
Q

Why is the direct pathway disengaged in PD?

A

Loss of tonic facilitation of striatal neurons
bearing D1 receptors

31
Q

In PD, there is a loss of tonic inhibition of striatal neurons
bearing D2 receptors. What is the effect of this?

A

1) Increased activity of striatal inhibitory connections
2) Disinhibition of sub-thalamic nucleus

32
Q

True or False: In PD, there’s a loss of tonic inhibition of striatal neurons bearing D2-R. As a result of this, the VA/VL of thalamus is inhibited, motor cortex/CST activity is reduced (hypokinetic
signs)

A

True

33
Q

True or False: Patients who have hypokinetic symptoms and response to levodopa have PD

A

True

34
Q

_____ is a type of PD that is relative, non-motor symptom sparing

____ is a type of PD that has more postural instability, gait difficulty (associated with worse prognosis, older onset, and mild cognitive impairement)

A

Tremor Dominant
PIGD (Akinetic)

35
Q

Which form of PD is associated with higher prevalence of freezing gait, hallucinations, daytime somnolence, and REM sleep disorder?

A

PIGD

36
Q

True or False: Men are more likely to develop PD

A

True

37
Q

A change in the SNCA gene can change the ___ ____ protein, leading to clumps of it (Lewy Bodies)

A

alpha-synuclein

38
Q

Which two environmental toxins may contribute to PD?

A
  1. MPTP
  2. MPPP
39
Q

Which factors are related to higher risk of PD?

A
  • well water
  • rural
  • head injury
  • meth use
  • melanoma
40
Q

Which factors lower one’s risk of developing PD?

A
  • cigarettes and ETOH use
  • caffeine
  • CCB
  • green and black tea
41
Q

True or False: ETOH use may elevate urate levels. Urate may be protective to dopamine-producing neurons

A

True

42
Q

What are the four cardinal features of sporatic PD?

A
  1. Tremor (resting)
  2. Rigidity
  3. Bradykinesia
  4. Postural Instability
43
Q

Which type of PD always starts unilaterally (and first side is always the more involved side)?

A

Sporadic PD

44
Q

Hyposmia may be present during which stage of PD???

A

Long, prodromal phase

45
Q

True or False: A majority of patients with PD have cognitive impairment right away

A

True

46
Q

Which three structures may be affected first in PD???

A
  1. Olfactory Bulb
  2. Enteric NS
  3. Medulla - vagus n
47
Q

Failure of voluntary vertical gaze, as well as unexplained falls early in the disease, and an extended neck posture suggests which disease?

A

Progressive Supranuclear Palsy

48
Q

What distinguishes PD from Progressive Supranuclear Palsy?

A

The latter has early
falls, problems of downward gaze,
extended neck posture, tremor
uncommon in PSP and PD drugs
are less effective in PSP

49
Q

Which distinguishes PD from Multiple System Atrophy?

A

Symmetric presentation and multi-system involvement

50
Q

How is Lewy Body Disease distinguished from PD?

A

Early cognitive involvement, symmetric deficits, and less likely to see tremor

51
Q

GPi, SubThN, and ventral intermediate nucleus (VIM) of
thalamus all involved in ___
production

A

tremor

52
Q

True or False: Cerebello – thalamo – cortical
circuit involved in amplifying
tremor

A

True

53
Q

Which symptom of PD is best described: Increase in muscle tone
manifested as a speed-independent resistance to passive movement
A. Spasticity
B. Rigidity

A

B. Rigidity

54
Q

Which cut-muscular reflex is reduced in PD?

A

I1

55
Q

_____: slowness of
movement including “sequence
effect” which is a progressive
decrease in speed and amplitude
of repetitive continuous
movements (eg, gait, writing)

A

Bradykinesia

56
Q

What does bradykinesia look like
during a simple discrete
movement?

A
  1. Decreased size of the initial agonist
    burst
  2. Movement achieved through a series
    of small agonist bursts
57
Q

In PD, one can display shorter step length, reduced foot clearance (shuffling) steps due to ____

A

bradykinesia

58
Q

_____ gait: a consequence of decreasing step length (sequence effect) and increased cadence

A

Festinating

59
Q

What is the most typical gait dysfunction in patient with advanced PD?
A. Festinating Gait
B. Freezing
C. Bradykinesia

A

B. Freezing

60
Q

Pedunculopontine nucleus may contribute to which aspect of PD?

A

Freezing of gait

61
Q

Impairments in ____ postural adjustments and loss of automatic righting and protective (stepping, grabbing) reactive postural control are seen in PD

A

anticipatory

62
Q

What is the primary therapy for PD?

A

Levodopa / carbidopa
combination to replace dopamine loss

63
Q

True or False: Carbidopa allows for more L-dopa to cross blood-
brain barrier

A

true

64
Q

True of False: There are significant side effects of taking L-dopa long term

A

True

65
Q

While Levodopa/Carbidopa improve most symptoms of PD, it does not improve ___ as much

A

balance

  • only partially useful for freezing of
    gait and falls
66
Q

DBS is an option for which patients?

A
  1. Those with sporafic PD
  2. Those with dyskinesias
67
Q

True or False: Symptoms not responsive to drugs will
likely NOT be responsive to DBS

A

True

68
Q

____ nucleus is a popular target for DBS

A

Subthalamic

Pathophysiology (26 decks)

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