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Neurology Flashcards

0
Q

What maintains the polarised resting potential in nerves?

A

Na/K pump

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1
Q

What is a ganglion?

A

A group of lots of neuronal cell bodies

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2
Q

What is the resting potential of nerves?

A

Around -65mV

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3
Q

What are the 2 types of channels in nerves?

A

Ligand-gated: open/close in response to ligands

Voltage-gated: open/close in response to membrane potential changes

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4
Q

What ion influx causes depolarisation of the nerve thus triggering an action potential? And is it voltage- or ligand-gated?

A

Na+, ligand-gated.

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5
Q

What is myelin made of in the CNS?

A

Oligodendrocytes

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6
Q

What is myelin sheath made from in the PNS?

A

Schwann cells

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7
Q

What diseases can result from demyelination?

A

Multiple sclerosis- demyelination of the CNS
Guillain-Barré syndrome- inflammatory demyelination of the PNS
Charcot Marie- tooth- genetic mutation of schwann cells

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8
Q

How is an AP transmitted between synapses?

A

Voltage-gated Ca2+ channels open when AP arrives at presynaptic terminal. This cause NT release via vesicles.. these cross the synapse and bind to ligand-gated ion channels depolarising the postsynaptic nerve.

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9
Q

What are the 2 types of receptor in the autonomic nervous system?

A

Ionotropic- holes ions travel through when ions bind.

Metabotropic- not ion channels: connect to others eg. GPCR.

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10
Q

What is the PNS divided into?

A

Somatic and autonomic

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11
Q

What is the sympathetic system and where does it arise from?

A

‘Fight or flight’ part of the autonomic nervous system. It arises from T1- L2 in the ganglia in the sympathetic chain.

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12
Q

What is the parasympatheric system?

A

‘Rest and digest’ part of the autonomic NS and is ‘craniosacral’ i.e. arises from the brainstem and the sacrum.

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13
Q

Where are the sympathetic chains?

A

They run the entire length of the spinal cord. Sympathetic preganglions in the lateral horn of T1-L2.

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14
Q

What are the NT and receptors of the sympathetic NS?

A

Preganglionic neurones release Ach to nicotinic receptors, unmyelinated neurones release noradrenaline to a & b receptors.

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15
Q

What are the NT and receptors for the parasympathetic system?

A

Bothe pre and postgangionic neurones produce Ach, but pregangionic receptor is to a nicotinic receptor and postganglionic to muscarinic receptor.

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16
Q

What is the main NT of the autonomic NS?

A

Acytylcholine

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17
Q

What are the 2 receptor types of Ach?

A

Nicotinic- ligand-gated, excitatory. Found on postganglionic neurones and NMJ.

Muscarinic- metabotropic and are found on effectors

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18
Q

An example of a nicotinic receptor agonist and its action?

A

Nicotine: Increases HR & BP

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19
Q

An example of a nicotinic receptor antagonist?

A

Succinlcholine

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20
Q

What are the muscarinic receptors and where are they found?

A

M1- CNS
M2- myocardium, smooth muscle
M3- exocrine glands, vessels and iris sphincter muscles
M4 & 5- CNS

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21
Q

Example of an agonist and an antagonist of muscarinic receptors?

A 
Agonist= muscarine
Antagonist= atropine
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22
Q

Where are alpha 1 receptors found?

A

Vascular smooth muscle, heart, pupillary dilator muscles

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23
Q

alpha 1 agonist and antagonist examples?

A

Agonist- phenylephrine

Antagonist- Doxazocin

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24
Q

Where are alpha 2 receptors found?

A

CNS, platelets, adrenergiic and cholinergic nerve terminals

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25
Q

What are the beta receptors and where are they found?

A

beta 1- heart
beta 2- Resp, uterine, vasc smooth muscle, skeletal muscle, liver
beta 3- fat cells

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26
Q

Examples of beta agonists?

A

Isoproterenol- increases HR & contractile force

Salbutamol- b2 agonist- asthma.

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27
Q

Examples of beta antagonists (beta blockers)?

A

Timolol- glaucoma
Propranolol- reduces HR and contractile force
Bisoprolol & atenolol are selective B1 antagonists

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28
Q

What are NANC transmitters?

A

Non- adrenergic, non-cholinergic, so not adrenaline or ach.

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29
Q

What is glutamate?

A

Main excitatory NT of the CNS and has both ionotropic and metabotropic receptors.

30
Q

What are the 3 ionotropic receptors to glutamate?

A

AMPA- permeable to Na+
NMDA- Ca2+ and Na+
Kainate- permeable to Ca2+ and Na+

31
Q

What is GABA?

A

Main inhibitory NT of the CNS and has 2 receptors- GABA1 and GABA2.

32
Q

What drugs act on GABA?

A

BZP e.g. lorazepam

33
Q

Where is serotonin synthesised?

A

Raphe nuclei.

These project into the cortex, medulla, thalamus, hippocampus, spinal cord

34
Q

Where is the majority of serotonin stored?

A

Enterochromaffin cells of the GI tract. Excess release can cause D&V. They are very sensitive to radio- and chemotherapy.

35
Q

Where is Ach produced?

A

Basal forebrain and the brain stem tegmentum.

It’s also synthsised by all motor neurones of the spinal cord

36
Q

Where is dopamine produced?

A

Ventral midbrain: substantia nigra & ventral tegmental area.

37
Q

Where is noradrenaline made?

A

locus coerulus

38
Q

What are the different types of peripheral neuropathy?

A

Motor neuropathy
Sensory neuropathy
Autonomic neuropathy

39
Q

Ulnar nerve compression at the elbow presents as?

A

hypothenar wasting, weakness of finger abduction and reduced thumb adduction.

40
Q

How does medial nerve compression present?

A

Carpel tunnel syndrome: numbness in the lateral 3 1/2 fingers, thenar wasting

41
Q

How does radial nerve palsy present?

A

wrist drop, sensory loss on thumb webbing.

42
Q

What is Guillain-Barré syndrome?

A

Autoimmune condition often triggered by an infection. causes demyelination and nerve conduction is blocked.

43
Q

What’s the classical presentation of GBS?

A

Symmetrical weakness usually beginning in the lower limbs and progressing upwards. Patients describe ‘rubbery legs’

44
Q

What is Myasthenia Gravis?

A

Antibodies vs. Ach receptors on the post-synaptic membrane.

45
Q

What are the symptoms of Myasthenia gravis?

A

Fatigueable weakness, ptosis, affects limbs proximal>distal and facial muscles.

46
Q

What is neuromyotonia?

A

Antibodies vs. voltage-gated K+ channels.

47
Q

What are the symptoms of Neuromyotonia?

A

Muscle twitching, cramps and muscle pain.

Associated with insomnia, delusions & personality changes

48
Q

What is lambert- eaton myasthenic syndrome and what is it associated with?

A

Antibodies vs. voltage-gated Ca2+ channels. Associated with small cell lung carcinoma.

49
Q

How do tricycling antidepressants work (TCAs)?

A

Inhibit reuptake of serotonin and noradrenaline.

e.g. Imipramine and amitriptyline

50
Q

What are the side effects of TCAs?

A

Long QT interval,
Arrhythmias, coma, acidosis and large pupils
weight gain, sedation and confusion

51
Q

How do monoamine oxidase inhibitors work (MAOIs)?

A

Inhibit the breakdown of monoamine NTs e.g. serotonin, dopamine, melatonin and noradrenaline.

52
Q

Side effects of MAOIs?

A 
Cheese reaction (Tyramine)- severe hypertension
- postural hypotension, restlessness, hallucinations, weight gain.
53
Q

How do SSRIs cause hyponatraemia?

A

inappropriate ADH release -> total body fluid increased so Na+ levels diluted.

54
Q

What are the 2 categories of BZPs?

A

Hypnotics- Temazepam, Zopiclone

Anxiolytics- Diazepam, Lorazepam

55
Q

Where does the lower motor neuron start?

A

The anterior horn cell

56
Q

What do renshaw cells do?

A

They are inhibitory neurones and are excited by a-motor neurone. They release glycine back which inhibits firing of the motor neurone.

57
Q

What is the function of the golgi tendon organ?

A

Prevent damage to the muscle if a load is too prolonged or heavy. Have a higher threshold than muscle spindles.

58
Q

What part of the muscle initiates a reflex?

A

Spindle

59
Q

What do gamma motor neurones do?

A

Keep the muscle spindle ready to stretch- cause it to retract maintaining tension.

60
Q

What are the descending tracts?

A

Corticobulbar, corticospinal, reticulospinal, vestibulospinal, tectospinal and rubrospinal

61
Q

What does the corticospinal tract convey?

A

Motor control

62
Q

What sensations does the spinothalamic tract convey?

A

pain, temp, touch

63
Q

What senseations do the dorsal columns convey?

A

joint position and soft touch

64
Q

What is apraxia and what are the 2 types?

A

Inability to produce a specific motor act even though sensory and motor pathways remain intact.
Ideomotor
Idiational

65
Q

What are the symptoms of an upper motor neurone lesion?

A

Paralysis, weakness, hyperreflexia, increased muscle tone, spasticity, positive babinski reflex

66
Q

What are the symptoms of a lower motor neurone lesion?

A

Hyporeflexia, fasciculations, muscle atrophy, denervation

67
Q

In what tract are pain and temperature conveyed and where do they decussate?

A

Spinothalamic tract and they decussate in the segment of origin

68
Q

Where are touch and pressure conveyed and where do they decussate?

A

Spinothalamic tract and the ascend 2-3 levels then decussate

69
Q

What is brown-sequard syndrome?

A

Hemisection of the spinal cord

70
Q

What tracts will become ischaemic if the anterior spinal artery is occluded?

A

Corticospinal and spinothalamic tracts

71
Q

What does motor neurone disease cause?

A

Wasting of the anterior horn cells. This results in both upper and lower motor neurone signs.

72
Q

What occurs in an intervertebral disk prolapse and what are the grades of severity?

A 
The nucleus pulposus herniates out through the annulus fibrosus.
1- Disk bulge
2- Dick protrusion
3- Disk extrusion
4- Disk sequestration
73
Q

What are the layers of the spinal cord?

A

Outermost is the dura mater,
Inner is arachnoid
Innermost is the Pia

Revision (12 decks)

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