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BRS 1b > neurology > Flashcards

neurology Flashcards

1
Q

layers of the cerebral cortex

A

molecular layer
external granular layer
external pyramidal layer
internal granular layer
internal pyramidal layer
multiform layer

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2
Q

risk factors for stroke

A

age
hypertension
smoking
diabetes mellitus
cardiac disease

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3
Q

which type of stroke happens when an aneurysm ruptures

A

subarachnoid

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4
Q

which stroke is due to hypertension

A

intracerebral

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5
Q

effects of stroke involving anterior cerebral artery

A

paralysis of contralateral structure - leg
abulia - disturbances in intellect, judgement and executive function
loss of appropriate social behaviour

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6
Q

effects of stroke involving middle cerebral artery

A

hemiplegia of contralateral structure - arm
contralateral hemisensory deficits
hemianopia
aphasia (left sided lesion)
- expressive - broca’s area
- receptive - wernicke’s area

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7
Q

effects of stroke involving posterior cerebral artery

A

visual problems
- homonymous hemianopia
- visual agnosia

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8
Q

name 3 basal ganglia diseases

A

parkinsons
huntingtons
ballism

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9
Q

what is ballism

A

contralateral uncontrolled swinging of the extremities due to stroke affecting subthalamic nucleus

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10
Q

role of vestibulospinal tract

A

stabilises head during body movements
coordinates head and eye movements
mediates postural adjustments

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11
Q

role of reticulospinal tract

A

from medulla to pons
changes muscle tone associated with voluntary movements
postural stability

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12
Q

role of rubrospinal tract

A

from red nucleus of midbrain
innervates lower motor neurones which go to the flexors of the upper limb

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13
Q

role of tectospinal tract

A

from superior colliculus of midbrain
orientates head and neck during eye movements

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14
Q

what are the positive and negative signs of an upper motor neuron lesion

A

negative:
loss of voluntary movements (paresis)
plegia

positive:
clonus (involuntary rhythmic muscle contractions)
babinski’s sign (when bottom of foot is stroked big toe is dorsiflexed)
spasticity (stiffness - can cause jerky movements such as clonus)
hyper-reflexia

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15
Q

what are the signs of a lower motor neurone lesion

A

weakness
hyporeflxia
hypotonia
fasciculations
fibrillations

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16
Q

what and where is the supplementary motor area

A

anterior and medial to the primary motor area
involved in planning complex and internally cued movements

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17
Q

what and where is the premotor area

A

anterior to the primary motor cortex
involved in planning externally cued movements

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18
Q

what is the primary motor cortex

A

in the precentral gyrus, anterior to the central sulcus
involved in fine discrete voluntary movements

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19
Q

what is apraxia

A

disorder of skilled movements
happens when there is a lesion in frontal lobe or inferior parietal lobe
common causes are stroke and dementia

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20
Q

what is ataxia

A

poor muscle control that causes clumsy voluntary movements

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21
Q

what is dysmetria

A

inaproporiate force and distance for target-directed movements

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22
Q

what is scanning speech

A

staccato

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23
Q

what is disdiadochokinesia

A

inability to perform rapidly alternating movements

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24
Q

what is intention tremor

A

increasingly oscillatory trajectory of a limb in a target directed movement

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25
Q

5 main signs of cerebellar dysfunction

A

dysdiadochokinesia
intention tremor
dysmetria
scanning speech
ataxia

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26
Q

what does motor neurone pool contain

A

all the alpha motor neurones innervating a single muscle

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27
Q

describe the size of responses to an action potential by the different types of motor units

A

1) slow - type 1 –> smallest reponse
2) fast fatigue resistant - type 2a —> larger response
3) fast fatiguable - 2b –> largest response

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28
Q

what is the jendrassik manoeuvre

A

when you clench your teeth, make a fist, or try to pull apart locked fingers during your patella tendon being tapped, the reflex is larger

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29
Q

list tests for assessing cortical structure and function

A

structure: DTI (diffusion tensor imaging)

function: fMRI, PET, EEG, MEG, TMS, tDCS

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30
Q

functions of the prefrontal cortex

A

attention, adjusting social behaviour, planning, personality expression, decision making

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31
Q

function of supplementary motor area

A

complex movements - internally cued

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32
Q

function of premotor area

A

externally cued movements

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33
Q

examples of commissural fibres

A

corpus callosum, anterior commissure

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34
Q

where/how do projection fibres travel

A

radiate as the corona radiata through internal capsule between thalamus and basal ganglia

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35
Q

limbic lobe functions

A

learning
emotions
memory
motivation
reward

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36
Q

insular cortex functions

A

visceral sensations, autonomic control, auditory processing, visual-vestibular integration, interoception

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37
Q

describe the microscopic organisation of the cerebral cortex

A

into columns —> cortical columns
and
into layers —> molecular, external granular, external pyramidal, internal granular, internal pyramidal, multiform

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38
Q

3 types of white matter tracts

A

association fibres, commissural fibres, projection fibres

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39
Q

5 types of association fibres

A

superior longitudinal fasciculus
inferior longitudinal fasciculus
arcuate fasciculus
uncinate fasciculus
short fibres

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40
Q

where does the corona radiata converge through from cortex to lower brain structures

A

converges through internal capsule between thalamus and basal ganglia

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41
Q

difference between primary and secondary cortices

A

primary: function is predictable, organised topographically, is symmetrical

secondary: function is less predictable, not organised topographically, weak/absent symmetry

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42
Q

consequences of temporal lobe lesion

A

agnosia (inability to recognise)
anterograde amnesia (inability to form new memories)

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43
Q

consequence of lesion in primary visual cortex of occipital lobe

A

blindness in corresponding visual field

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44
Q

what are the symptoms of MS

A

blurred vision, fatigue, difficulty walking, paraesthesia, muscle spams and stiffness

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45
Q

how do you find TMCT (total motor conduction time)

A

brain stimulation: find MEP latency - the time for stimulus to travel from brain to muscle

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46
Q

how does Brain stimulation and peripheral nerve stimulation prove that MS is a central ns issue

A

by brain stimulation, can find TMCT - which is longer than normal - shows that there is a problem with either upper or lower motor neurones

by peripheral nerve stimulation, can find F latency - which is normal - shows that there is no problem with peripheral nerves

so problem is with central nerves —> autoimmune demyelination of central nerves

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47
Q

what are the 3 waves produced by peripheral nerve stimualtion

A

M wave: motor axon stimulated, fast response causing muscle to twitch

H wave: sensory axon stimulated, impulse travels to spinal cord, activating the LMN in the spinal cord and causing muscle to twitch - reflex activation of muscle

F wave: strong impulse causes signal to travel antichromically up the motor neurone to spinal cord, activating the LMN in the spinal cord (not a reflex)

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48
Q

what is the response of brain stimulation on an MEG

A

MEP (motor evoked potential)

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49
Q

how to calculated PMCT

A

(M latency + F latency - 1) / 2

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50
Q

what can you get from a middle cerebral artery stroke if it causes a left sided lesion

A

Aphasia

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51
Q

a stroke in which part of the brain causes “clumsy, wobbly, drunk - like” symptoms

A

cerebellum eg intracerebellar haemorrhage

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52
Q

list the phases of a migraine

A

premonitory, aura, headache, resolution, recovery

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53
Q

describe the premonitory phase of a migraine

A

neck pain
concentration difficulty
irritability
mood disturbances
polyuria
photophobia
yawning

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54
Q

describe the recovery phase of a migraine

A

food intolerance
mood disturbance
“hungover” like

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55
Q

which medications should be avoided for pharmacological management of migraines

A

mixed analgesics
opiate-based medication

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56
Q

pharmacological management for migraines

A

NSAIDs
pro kinetics
triptans
paracetamol

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57
Q

acute and long term treatment of cluster headache

A

acute:
triptan
high flow oxygen

long term:
verapamil (used for grater occipital nerve, get ECG first)
greater occipital nerve block

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58
Q

what makes a tension headache different from a migrain

A

tension is
always bilateral
shorter, only lasts around 30 mins
no nausea/vomiting
not aggravated by movement
no photophobia/phonophobia

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59
Q

describe the symptoms of aura

A

visual
- elemental visual disturbance
- expanding C’s

sensory
- numbness
- paraesthesia

  • weakness
  • speech arrest
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60
Q

is cluster headache aggravated by movement

A

no

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61
Q

associated symptoms of a cluster headache

A

facial sweating
miosis (contracted pupils)
ptosis (drooping eyelids)
restlessness/agitation

ipsilaterally
- nasal congestion/rhinorrhea
- conjunctival redness/lacrimation
- eyelid oedema

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62
Q

which medications should you not offer for cluster headaches

A

NSAIDs, opioids, ORAL triptans, ergots, paracetamol

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63
Q

what are the roles of high and low order areas of the motor system

A

High order areas - programme and coordinate movements
low order areas - execute movements

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64
Q

describe how the motor system is organised

A

hierarchical segregation: high order and low order areas

functional segregation: different parts control different aspects fo movements

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65
Q

is ballism ipsilateral or contralateral

A

contralateral

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66
Q

pathology behind Parkinson’s

A

degeneration of dopamingeric neurones from subtstantia nigra to striatum

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67
Q

pathology behind Huntignton’s

A

degeneration of GABAergic neurons in caudate, striatum and putamen
due to CAG repeat

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68
Q

symptoms of Huntington’s

A

unstable gait
choreic movements
uncontrolled jerking
swallowing difficulty
speech impairment
cognitive decline

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69
Q

cause of Ballism

A

stroke affecting subthalamic nucleus

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70
Q

causes of sensineural hearing loss

A

inner ear: prescubysis, noise, ototoxicity

nerve: acoustic neuroma aka vestibular schwannoma

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71
Q

causes of conductive hearing loss

A

outer ear: foreign body, wax (cerumen impaction)

middle ear: otitis, otosclerosis

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72
Q

what is the difference between outer and inner hair cells

A

outer: arranged in 3 rows, carry efferent signals from the brain - modulate the sensitivity of the response from the brain

inner: arranged in single row, carry afferent signals to the brain - transduction of sound

73
Q

which nerve are the outer and inner hair cells connected to

A

auditory nerve

74
Q

what is the order of nerves/nuclei in the auditory pathway

A

cochlea –> vestibular cochlear nerve –> cochlea nucleus –> superior olive –> inferior colliculus –> medial geniculate body –> auditory cortex

75
Q

what are the two clinical hearing tests using a tuning fork

A

weber test: place tuning fork on top of head
Rinne test: place tuning fork in air in front of ear, and on mastoid behind ear

76
Q

what is an audiogram used for

A

to test hearing thresholds to see if there is hearing loss or not

77
Q

What are OAE’s, how are they produced and what are they measured for

A

Otoacoustic emissions
low frequency sounds produced by the cochlea when the outer hair cells expand and contract

they are measured as part of newborn hearing test and hearing loss monitoring

78
Q

what is contained within the maculae of the utricle and saccule

A

hair cells, gelatinous matrix, otoliths (carbonate crystals)

79
Q

which direction is the macula placed in the utricle and saccule, and therefore which kind of movement do the utricle and saccule detect

A

utricle: macula is placed horizontally - detects horizontal linear movement
saccule: macula is placed vertically - detects vertical linear movement

80
Q

which liquid fills the semi circular canals

A

endolymph

81
Q

describe the composition of the ampulla of the semi circular canals

A

contain ampullary crista on base to which the hair cells are attached
then top of hair cells are attached to cupula which helps with transmitting the motion of the fluid (endolymph)

82
Q

which is located next to the cochlea, utricle or saccule

A

saccule

83
Q

name the two vestibular reflexes

A

vestibulo ocular reflex
vestibulo spinal reflex

84
Q

describe the vestibulo ocular reflex

A

keeps images fixed on retina
eye moves in opposite direction to head but at same velocity and amplitude
connection between vestibular nuclei and oculomotor nuclei

85
Q

eye clinical test to check for problems with vestibular system

A

“skew”:
cover one eye, other pupil/irirs goes up
uncover the eye, pupil/iris goes back down

86
Q

how to differentiate between vestibular neuritis and stroke

A

HINTS exam
- Head Impulse test
- Nystagmus
- Test of skew deviation

87
Q

what are the acute vestibular balance disorders

A

vestibular neuritis
stroke

88
Q

what is the intermittent balance disorder

A

BPPV

89
Q

what are the recurrent balance disorders

A

migraine
meniere’s disease

90
Q

what is the border between the cornea and sclera called

A

limbus

91
Q

what is the lipid layer of the tear film produced by

A

Meibomian glands along the eyelid margin

92
Q

how is the conjunctiva nourished

A

has tiny blood vessels

93
Q

how is the cornea nourished

A

oxygen from the air - dissolves into aqueous layer of tear film
glucose from aqueous humour - fluid between cornea and iris

94
Q

cornea has a low water content, what happens if you hydrate it

A

it changes from transparent to white

95
Q

where does the eye’s refractions power come from

A

2/3 from the cornea
1/3 from the lens

96
Q

5 layers of the cornea

A

epithelium
bowmans membrane
stroma
descemet’s membrane
endothelium

97
Q

what is the role of the endothelium of the cornea

A

pumps fluid out of the cornea to prevent corneal oedema

98
Q

what are the 3 parts of the uvea

A

iris
choroid
ciliary bodies

99
Q

role of ciliary body

A

controls thickness of lens
clears aqueous humour

100
Q

what us it called when the lens loses elasticity with age

A

cataract

101
Q

what is the innervation of tear production

A

afferent: ophthalmic branch of trigeminal nerve - from cornea to CNS
efferent: parasympathetic fibres - from CNS to lacrimal gland
neurotransmitter: Ach

102
Q

describe how tear are drained

A
  • tears drain into superior and inferior puncta - small openings on upper and lower medial lid margins
  • drain into superior and inferior cannaliculi
  • superior and inferior cannaliculi converge to form one canaliculus
  • drains into tear sac
  • drains into tear duct
103
Q

what is the macula

A

in the centre of the retina
responsible for detailed central vision
no rod cells

104
Q

what is the fovea

A

in centre of macula
has the highest concentration of cones and the lowest concentration of rods
only place with highest enough number of cones to be able to see in detail

105
Q

what is central vision, how is it tested and what happens when it is lost

A

seeing detail in light and colour
eg reading, facial recognition
tested by visual acuity assessment
if lost, have poor visual acuity

106
Q

what is peripheral vision, how is it tested and what happens when it is lost

A

night vision, seeing shape, movement, navigating
tested by visual acuity assessment
if lost, have extensive loss of peripheral field and unable to navigate

107
Q

contrast the sensitivity, response, and vision type for rods and cones

A

rods: slower response, higher sensitivity to light, scotopic vision (ie night vision)

cones: faster response, less sensitive to light, photooptic vision (ie light vision)

108
Q

describe the layers of the retina

A

1) 1st order neurones - photoreceptors (rods and cones)
detect the light

2) 2nd order neurones - bipolar neurones
local signal processing

3) 3rd order neurones - retinal ganglion neurones
transmit signal form eye to brain

109
Q

what colours do S, M, L cones detect

A

S - blue
M - green
L -red

s-sea, l-love, m-me

110
Q

what is the most common form of colour blindness

A

deuteranomaly / daltonism –> can’t see colour red

111
Q

what is the name for complete colour blindness

A

achromatopsia

112
Q

how to calculate index of refraction

A

speed of light in vacuum / speed of light in medium

113
Q

what effects do concave/convex lenses have on light rays

A

concave: spreads the rays out
convex: converges the lenses, brings them to a point

114
Q

what is emmetropia

A

adequate correlation between axial length and refractive power

115
Q

what is ametropia and what are the 4 types

A

mismatch between axial length and refractive power
- myopia
- hyperopia
- astigmatism
- presbyopia

116
Q

causes of myopia

A

excessive long globe
excessive refractive power

117
Q

myopia treatment

A

use a diverging/negative lens
use contact lenses
remove eye lens to reduce refractive power

118
Q

hyperopia causes

A

excessively short globe
insufficient refractive power

119
Q

what is axial hyperopia

A

excessively short globe

120
Q

what is refractive hyperopia

A

insufficient refractive power

121
Q

symptoms of hyperopia

A

blurry vision - straight away when looking at close things OR intermittently
–> is worsened by tiredness, poor light

asthenopic symptoms:
- headache in frontal region
- eye pain
- burning eye sensation
- blepharoconjunctivitis (inflammation of eyelid margin and conjunctiva)

122
Q

symptoms of hyperopia

A

blurry vision - straight away when looking at close things OR intermittently
–> is worsened by tiredness, poor light

asthenopic symptoms:
- headache in frontal region
- eye pain
- burning eye sensation
- blepharoconjunctivitis (inflammation of eyelid margin and conjunctiva)

123
Q

what happens if hyperopia is left uncorrected

A

amblyopia - lazy eye

124
Q

what is the circle of least confusion

A

in astigmatism
the area between the focal points of the 2 meridians where the image is the least blurry

125
Q

astigmatism symptoms

A

asthenopic symptoms
blurred vision
distorted vision
head tilting and turning

126
Q

treatment for regular astigmatism

A

cylindrical lens with or without spherical lens
surgery

127
Q

treatment for irregular astigmatism

A

rigid cylindrical lens
surgery

128
Q

what is the near response triad

A

pupillary miosis
- sphincter pupillae
- increase depth of visual field

convergence
- medial recti of both eyes
- align eyes on a close object

accomodation
- circular ciliary muscles
- increase refractive power of the lens

129
Q

what is a zonule of the eye

A

the circumferential suspensory ligament that connects the lens of the eye to the ciliary body

130
Q

what is presbyopia

A

loss of accommodation when looking at close objects due to age

131
Q

treatment of presbyopia

A

convex lense to allow to see near objects - monodical or multifocal
- reading glasses
- bifocal glasses
- trifocal glasses
- progressive power glasses

132
Q

complications of contact lenses

A

infectious keratitis
giant papillary conjunctivitis
severe chronic conjunctivitis
corneal vascularisation

133
Q

what are the options for surgical correction of eyesight problems

A

keratorefractive surgery - laser

ICL (intra collated lens) implant on top of natural eye lens

clear lens extraction and IOL (intraocular lens)

134
Q

describe the process of keratorefracrive surgery

A

cut the corneal flap
flip the corneal flap
apply photo-refractive treatment
reshape corneal stroma
put corneal flap back into position

135
Q

what is the disadvantage of intraocular lenses

A

lose accommodation so will need reading glasses

136
Q

describe the signal transmission along the visual pathway from the eye to the brain

A

eye (photoreceptors, bipolar cells, ganglion cells)
optic nerve
optic chiasm
optic tract
lateral geniculate nucleus
optic radiation
visual cortex

137
Q

cause of homonymous hemianopia

A

stroke

138
Q

cause of bitemporal hemianopia

A

pituitary gland enlargement/tumour

139
Q

name for when you’re blind in only one eye

A

monocular blindness

140
Q

name for being blind in the inner field of your right eye

A

right nasal hemianopia

141
Q

name for being blind in one quadrant of each eyes visual field

A

quadrant hemianopia

142
Q

cause of contrallateral homonymous hemianopia with macula soaring

A

stroke affecting primary visual cortex
macula is not affected as has dual blood supply from posterior cerebral arteries on both sides

143
Q

difference between crossed and uncrossed fibres (their origin and which visual filed they are responsible for)

A

crossed
- originate in nasal retina
- responsible for temporal visual field

uncrossed
- originate in temporal retina
- responsible for nasal visual field

144
Q

consequence of damage at the optic chiasm

A

homonymous hemianopia

145
Q

consequence of damage on the left side, posterior to optic chiasm

A

right homonymous hemianopia

146
Q

consequence of damage on the right side, posterior to optic chiasm

A

left homonymous hemianopia

147
Q

are constriction/dilatation mediated by the sympathetic/parasympathetic systems

A

constriction - parasympathetic
dilatation - sympathetic

148
Q

which muscles contract in pupil constriction/dilation

A

pupil constriction - circular muscles contract
pupil dilatation - radial muscles contract

149
Q

describe the efferent pathway from the brain to the eye

A

Edinger westphal nucleus
oculomotor nerve efferent
ciliary ganglion
short posterior ciliary nerve
pupillary sphincter

150
Q

what is the pupillary constriction response with a right afferent defect

A

afferent is eye to brain
so right pupil doesn’t construct when light is shone in right eye (as can’t sense the light)
but constricts when light is shine in left eye (consensual reflex)

151
Q

what is the pupillary constriction response with a right efferent defect

A

efferent is brain to eye
so right pupil doesn’t constrict whether light is shone in left or right eye
but left pupil constricts when light is shone in either left or right eye

152
Q

how to test for relative afferent pupillary defect and results

A

swinging torch test
both pupils constrict when light is shone in undamaged eye
both pupils dilate when light is shone in damaged eye

152
Q

how to test for relative afferent pupillary defect and results

A

swinging torch test
both pupils constrict when light is shone in undamaged eye
both pupils dilate when light is shone in damaged eye

153
Q

where is the superior oblique muscle attached and how does it move the eye

A

attached high on the temporal side of the eye
moves eye down and out

154
Q

where is the inferior oblique muscle attached and how does it move the eye

A

attached low on the nasal side of the eye
moves the eye up and out

155
Q

medial rectus innervation

A

inferior branch of oculomotor

156
Q

superior rectus innervation

A

superior branch of oculomotor

157
Q

inferior oblique innervation

A

inferior branch of oculomotor

158
Q

lateral rectus innervation

A

abducens

159
Q

superior oblique innervation

A

trochlear nerve

160
Q

inferior rectus innervation

A

inferior branch of oculomotor nerve

161
Q

how to test for superior rectus

A

elevation and abduction

162
Q

how to test for inferior rectus

A

depression and abduction

163
Q

how to test for superior oblique

A

depression and adduction

164
Q

how to test for inferior oblique

A

elevation and adduction

165
Q

what is eye torsion

A

rotation of the eye around its anterior posterior axis

166
Q

what is dextroversion

A

movement of both eyes to right

167
Q

what is levoversion

A

movement fo both eyes to left

168
Q

what is the role and innervation of levator palpebrae superioris

A

raises the eye lid
superior branch of the oculomotor nerve

169
Q

how to test visual acuity in preverbal children

A

test the optokinetic nystagmus reflex

170
Q

what is optokinetic nystagmus

A

smooth pursuit followed by fast phase reset saccade

171
Q

what is nystagmus

A

oscillatory eye movement

172
Q

what are the signs of 3rd nerve palsy

A

droopy eyelid
affected eye is moved down and out

173
Q

what are the signs of 6th nerve palsy

A

affected eye deviates inwards and cannot be abdcuted

174
Q

a pts pupil is dilated and cannot constrict, which nerve is affected

A

(parasympathetic part of) inferior branch of oculomotor

175
Q

causes of third nerve palsy

A

medical causes
surgical causes eg posterior communicating artery aneurysm

176
Q

which cause of third nerve palsy is pupil sparing and why

A

medical cause
the inner portion is more affected, parasympathetic fibres are found in the outer surface of the nerve

  • in surgical causes, the aneurysm causes compression of the nerve from the outside, so it affects the parasympathetic fibres and is not pupil sparing
177
Q

what is the site if damage that causes absent knee jerk reflex and impaired sweating

A

dorsal root ganglion of spinal cord

178
Q

what is Adie’s pupil and what is the cause

A

light near dissociation (have miosis in response to acommodation but not light)
it is due to abnormal reinnervation that takes place as a result of ciliary body damage
–> the fibres target the iris instead of the ciliary body

BRS 1b (10 decks)

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