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Basic Neurosciences - MRCPsych A > MRCPsych > Flashcards

MRCPsych Flashcards

1
Q

Where do Microglia originate from?

A

Mesodermal in origin

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2
Q

For the gag reflex what is the sensory and motor components?

A

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)
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3
Q

Is Nitrus Oxide involved in the pathogenesis of depresssion?

A

Maybe - NO synthase inhibitors have Anti-depressant properties

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4
Q

What MRI finding is presented in vCJD and sporadic CJD

A

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)

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5
Q

What condition are balloon cells seen in?

A

Pick’s disease

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6
Q

Do intranasal drugs bypass the BBB?

A

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)

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7
Q

If Brocas or Wernickes aphasia arises which is the likely origin of the stroke?

A

Middle cerebral artery

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8
Q

Outline the different types of dysarthria?

A

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

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9
Q

What does normal aging show on EEG

A

Focal slowing in temporal region

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10
Q

What is limb kinetic apraxia?

A

Inability to make fine or delicate movements

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11
Q

What is ideomotor apraxia?

A

If given a hair brush can’t use - known object but can’t carry out learned task

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12
Q

What is ideational apraxia?

A

Inability to follow a sequence of actions in the correct order

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13
Q

What is an equine gait?

A

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

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14
Q

What are Lewy bodies?

A

Eosinophilic cytoplasmic neuronal inclusion bodies which is made of alpha synucelein

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15
Q

What is serotonin broken down to and by which enzyme?

A

broken down to 5-Hydroxyindoleacetic acid (5-HIAA)

By MAO and aldehyde dehydrogenase

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16
Q

Where does constructional apraxia arise from?

A

Non-dominant parietal lobe dysfunction

  • inability to copy a drawing (intersecting pentagons) or combine parts of a whole to make one image
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17
Q

What is the manual groping behaviour?

A

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

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18
Q

How may Huntingoton’s disease present and what are the EEG findings?

A

Low voltage EEG (attenuated trace)
Dysarthria, stiffness, a slow ataxic gait
MRI - general cerebral and cerebellar atrophy and small caudate nucleus

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19
Q

What are the EEG findings in delirium?

A

Increased theta/detla, decreased alpha and generalised slowing

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20
Q

What Broadman area is Wernicke’s area

A

BA 22 (temporal lobe - superior temporal gyrus)

21
Q

Hakim’s triad is made up of BLANK and refers to the condition BLANK

A

Urinary incontinence
Dementia
Ataxia - gait instability

Normal pressure hydrocephalus (commonly arises from communicating hydrocephalus - poor villi circulation)

22
Q

What is the lingual gyrus involved in?

A

Dreaming

23
Q

What is pronator drift associated with?

A

Spasticity and other UMN signs

24
Q

What is the function of the vestibulocerebellum?

A

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
25
Q

Outline the types of sensation by the following afferent axons:

A-alpha
A-beta
A-delta
C

A

A-alpha –> proprioreception

A-beta –> touch

A-delta –> heat and pain

C –> (pain, temperature and itch)

26
Q

How does Kluver-Bucy Syndrome present?

A

Bilateral medial temporal lobe dysfunciton (Amygdala):

  • Hypersexuality
  • Hyperorality
  • Docility
  • Visual agnosia
  • Dietary changes

Causes:
- Late stage Alzheimer’s
- Herpes simplex
- Trauma
- Frontotemporal dementia

27
Q

What is the presentation of sarcoidosis?

A

SOB (granulomas)

Rashes - erythema nodosum

Dry eyes

Weight loss

Fatigue

Psychiatric presentations - 20% inc. depression and psychosis

28
Q

In Parkinson’s disease where is there loss of dopaminergic neurons?

A

Pars compacta (region of the substantia nigra)

29
Q

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

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

30
Q

How does multi system atrophy present?

A

Parkinsonism —> striatonigral degeneration
Cerebellar ataxia —> olivipontocerebellar atrophy
Autonomic failure —> shy stager syndrome

31
Q

Name some macro and microscopic features of multisystem atrophy

A

Macro:
- Cerebellar atrophy
- Substantial Nigra pallor
- Green putamen

Micro:
- Papp-Lantos bodies (alpha synuclein bodies in oligodendrocytes of cerebellum, substantia nigra and basal ganglia)

32
Q

What is asteroagnosia?

A

The inability to recognise objects by touch

33
Q

What is autopagnosia?

A

The inability to recognise parts of the body

34
Q

Low CSF HIAA is associated with what?

A

Depression and suicidality

35
Q

Histamine receptors are classified as?

A

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

36
Q

What is the most common brain tumours in adults?

A

1) Mets
2) Glioblastoma
3) Anaplastic astrocytoma
4) Meningioma

In children:
1) Astrocytoma
2) Medulloblastoma
3) Ependymoma

37
Q

How is tyrosine converted to L-DOPA (dihydroxyphenylalanine)

A

By tyrosine hydroxylase. From here L-DOPA is made to dopamine by dopamine decarboxylase

38
Q

What brain areas make up the diencephalon?

A

Thalamus
Hypothalamus and pituitary
Pineal gland
Mammilary bodies

39
Q

What are hirano bodies made from?

A

Actin

40
Q

Myasthenia gravis causes flaccid dysarthria how does this sound?

A

Breathy and nasal voice with imprecise consonants - it is affects LMN

41
Q

Where is the primary auditory cortex located?

A

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

42
Q

How does conduction aphasia present?

A

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

43
Q

How does transcortical sensory aphasia compare to Wernicke’s aphasia?

A

Same but in transcortical sensory aphasia repetition is not impaired

44
Q

How does transcortical motor aphasia present?

A

Non-fluent, halting spontaneous speech BUT repetition is fine as is reading outloud

45
Q

Compare and contrast alexia with and without agraphia?

A

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)

46
Q

What do cannabinoid agonist do to striatal dopamine?

A

Increase striatal dopamine release

47
Q

Acetylcholine receptors are classified as?

A

Nicototinic - ionotropic (rosette)
Muscarainic - metabotropic

48
Q

What effects do L and R frontal lesions show?

A

L - depression
R - disinhibition, impulsivity

Basic Neurosciences - MRCPsych A (8 decks)

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