MRCPsych Flashcards
Where do Microglia originate from?
Mesodermal in origin
For the gag reflex what is the sensory and motor components?
Sensory component is - glossopharyngeal (IX)
Motor component - vagus nerve (X)
Other ones to remember:
- Corneal reflex - sensory (V) and motor. (VII)
- Jaw jerk reflex - both sensory and motor are trigeminal (V)
- Pupillary light and accommodation - sensory optic (II) motor oculi motor (III)
- Vestibuloocular - sensory vestibular ocular (VIII) and motor (oculomotor, abducens and trochlear)
Is Nitrus Oxide involved in the pathogenesis of depresssion?
Maybe - NO synthase inhibitors have Anti-depressant properties
What MRI finding is presented in vCJD and sporadic CJD
Variant - Increased signal in the pulinar nucleus of the thalamus (EEG shows general slowing)
Sporadic - high anterior basal ganglia signal bilaterally (EEG biphasic and triphasic waves 1-2 per second)
What condition are balloon cells seen in?
Pick’s disease
Do intranasal drugs bypass the BBB?
Yes
Other things to know:
- High charged, large and water soluble molecules struggle to pass
- At circumventricular organs the BBB is fenestrated to allow neurosecretory products to enter the blood (posterior pituitary, pineal gland, median eminence, lamina terminalis, subfornical organ, area postrema)
If Brocas or Wernickes aphasia arises which is the likely origin of the stroke?
Middle cerebral artery
Outline the different types of dysarthria?
Flaccid - LMN - breathy voice with imprecise consonants (Myasthenia gravis or tumour)
Spastic - UMN - explosive, forceful and at a slow rate. Pseduobulbar palsy, spastic hemiplegia.
Hypokinetic - EPSE - Parkinson’s - slow quiet with a tremor
Hyperkinetic - variable rate, inappropriate stoppages with strained quality - EPSE - Huntington’s disease, Sydenham’s chorea, tardive dyskinesia
Ataxic - rapid, mono pitched and slurred - Cerebellar - Friedrichs ataxia or alcohol abuse
What does normal aging show on EEG
Focal slowing in temporal region
What is limb kinetic apraxia?
Inability to make fine or delicate movements
What is ideomotor apraxia?
If given a hair brush can’t use - known object but can’t carry out learned task
What is ideational apraxia?
Inability to follow a sequence of actions in the correct order
What is an equine gait?
Also known as stepping or neuropathic gait, an equine gait is high stepping to prevent scrapping of the toe on the ground. It is associated with foot drop
What are Lewy bodies?
Eosinophilic cytoplasmic neuronal inclusion bodies which is made of alpha synucelein
What is serotonin broken down to and by which enzyme?
broken down to 5-Hydroxyindoleacetic acid (5-HIAA)
By MAO and aldehyde dehydrogenase
Where does constructional apraxia arise from?
Non-dominant parietal lobe dysfunction
- inability to copy a drawing (intersecting pentagons) or combine parts of a whole to make one image
What is the manual groping behaviour?
Where a persons hand and eyes may follow an action in a magnetic fashion - after tactile stimulation the person may repeat the action again and again
Alien hand signs - person repeats may elicit strange hand actions for which they repeat no control over
How may Huntingoton’s disease present and what are the EEG findings?
Low voltage EEG (attenuated trace)
Dysarthria, stiffness, a slow ataxic gait
MRI - general cerebral and cerebellar atrophy and small caudate nucleus
What are the EEG findings in delirium?
Increased theta/detla, decreased alpha and generalised slowing
What Broadman area is Wernicke’s area
BA 22 (temporal lobe - superior temporal gyrus)
Hakim’s triad is made up of BLANK and refers to the condition BLANK
Urinary incontinence
Dementia
Ataxia - gait instability
Normal pressure hydrocephalus (commonly arises from communicating hydrocephalus - poor villi circulation)
What is the lingual gyrus involved in?
Dreaming
What is pronator drift associated with?
Spasticity and other UMN signs
What is the function of the vestibulocerebellum?
Controls balance and spatial orientation
The other functional areas are:
- Spinocerebellum (fine-tune body movements)
- Cerebrocerebellum (planning movement and the conscious assessment of movement)
- Cerebellum is divided by tentorium cerebelli and is connected to the brainstem by the cerebellar peduncles
Outline the types of sensation by the following afferent axons:
A-alpha
A-beta
A-delta
C
A-alpha –> proprioreception
A-beta –> touch
A-delta –> heat and pain
C –> (pain, temperature and itch)
How does Kluver-Bucy Syndrome present?
Bilateral medial temporal lobe dysfunciton (Amygdala):
- Hypersexuality
- Hyperorality
- Docility
- Visual agnosia
- Dietary changes
Causes:
- Late stage Alzheimer’s
- Herpes simplex
- Trauma
- Frontotemporal dementia
What is the presentation of sarcoidosis?
SOB (granulomas)
Rashes - erythema nodosum
Dry eyes
Weight loss
Fatigue
Psychiatric presentations - 20% inc. depression and psychosis
In Parkinson’s disease where is there loss of dopaminergic neurons?
Pars compacta (region of the substantia nigra)
Out of the following hypothalamic nuclei what are their functions
a) anterior
b) posterior
c) ventromedial
d) lateral
e) supraoptic
f) suprachiasmatic
g) arcuate
h) preoptic
I) paracentricular
a) hypothermia centre - parasympathetic to keep cool
b) hyperthermia centre - sympathetic to keep warm
c) ventromedial feeding centre, sexual behaviour and insulin regulation
d) lateral satiety centre
e) supraoptic - produces oxytocin and ADH for fluid balance (diabetes insipid is with lesions)
f) SCN - suprachiasmatic for circadian rhythms
g) arcuate - releases dopamine to anterior pituitary and is sensitive to leptin
h) preoptic - thermoregulation and secretes GnRH (regulates sexual behaviour and important endocrine function)
I) paraventricular - regulates oxytocin and ADH secretion and release CRH and TRH
j) dorsomedial - stimulated appetite sensitive to leptin, emotion, libido and some circadian activity
How does multi system atrophy present?
Parkinsonism —> striatonigral degeneration
Cerebellar ataxia —> olivipontocerebellar atrophy
Autonomic failure —> shy stager syndrome
Name some macro and microscopic features of multisystem atrophy
Macro:
- Cerebellar atrophy
- Substantial Nigra pallor
- Green putamen
Micro:
- Papp-Lantos bodies (alpha synuclein bodies in oligodendrocytes of cerebellum, substantia nigra and basal ganglia)
What is asteroagnosia?
The inability to recognise objects by touch
What is autopagnosia?
The inability to recognise parts of the body
Low CSF HIAA is associated with what?
Depression and suicidality
Histamine receptors are classified as?
H1 - CNS and throughout body - allergic reaction
H2 - parietal cells in stomach to secrete gastric acid
H3 - CNS - regulates to decrease the release of other neurotransmitters
H4 - basophils - for chemotaxis
What is the most common brain tumours in adults?
1) Mets
2) Glioblastoma
3) Anaplastic astrocytoma
4) Meningioma
In children:
1) Astrocytoma
2) Medulloblastoma
3) Ependymoma
How is tyrosine converted to L-DOPA (dihydroxyphenylalanine)
By tyrosine hydroxylase. From here L-DOPA is made to dopamine by dopamine decarboxylase
What brain areas make up the diencephalon?
Thalamus
Hypothalamus and pituitary
Pineal gland
Mammilary bodies
What are hirano bodies made from?
Actin
Myasthenia gravis causes flaccid dysarthria how does this sound?
Breathy and nasal voice with imprecise consonants - it is affects LMN
Where is the primary auditory cortex located?
Heschl’s gyrus (anterior transverse temporal gyrus) - this is hidden within the sylvian fissure
- Planum temporale and superior temporal gyrus are lateral to it
- Planum temporale is usually larger on L > R
- Planum temporale contains the secondary auditory cortex
How does conduction aphasia present?
Primarily a repetition difficulty:
- Comprehension is intact
- Fluent output may contain pauses and phonemic paraphasias however repetition is primarily affected
- Naming may contain paraphasias
- Sensory or motor difficulties are absent or small
- Branches of inferior/superior branches of MCA
- Due to arcuate fasciculus affected
How does transcortical sensory aphasia compare to Wernicke’s aphasia?
Same but in transcortical sensory aphasia repetition is not impaired
How does transcortical motor aphasia present?
Non-fluent, halting spontaneous speech BUT repetition is fine as is reading outloud
Compare and contrast alexia with and without agraphia?
Alexia without agraphia:
- Can’t read but can write, speak spontaneously, repeat phrases, speech is fluent and comprehension is not impaired
- Weirdly patients after a delay won’t be able to read a phrase they have wrote
- Can recognise words spelled out loud or traced into hand
- Affects L occipital love and splenium of corpus callosum therefore angular gyrus can’t access visual info
- Causes include L PCA infarction, tumour or demyelinating lesion (MS)
Alexia with agraphia:
- Can’t read and can’t write
- Spontaneous speech unaffect although may not be able to name items
- Affects dominant inferior parietal lobe (angular gyrus)
What do cannabinoid agonist do to striatal dopamine?
Increase striatal dopamine release
Acetylcholine receptors are classified as?
Nicototinic - ionotropic (rosette)
Muscarainic - metabotropic
What effects do L and R frontal lesions show?
L - depression
R - disinhibition, impulsivity
