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Medicine MBBS year 2 > Neurology > Flashcards

Neurology Flashcards

1
Q

What is Horner syndrome? - PAM is Horny

A

When sympathetic supply to the eye is affected

Sympathetic system can’t perform function of dilating the eye and opening the eye wide.

Ptosis, anhidrosis, miosis

usually underlying problem like stroke, tumour, spinal cord lesion

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2
Q

state and describe headache red flags

A

Onset - thunderclap, acute, subacute

Meningism - photophobia, phonophobia, stiff neck, vomiting

Systemic symptoms - fever, rash, weight loss

Neurological or focal signs - visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema

Orthostatic-better lying down

Strictly unilateral

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3
Q

state some vascular and circulatory causes of headaches

A
  1. subarachoid hemorrhage
  2. acute intracerebral bleed (fatal hemorrhage due to coning)
  3. chronic subdural hemorrhage
  4. carotid and vertebral artery dissections
  5. temporal arteritis
  6. central venous thrombosis
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4
Q

what are some symptoms of a subarachnoid hemorrhage?

what are causes?

A

Thunderclap headache
meningism - stiff neck and photophobia
Usually occipital

Most caused by a ruptured aneurysm
Few caused by arteriovenous malformations, some unexplained

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5
Q

how do you treat and monitor a subarachnoid hemorrhage

A

Nimodipine (to reduce vasospasm and resulting ischemic infarct). And BP control
Diagnose with CT, Lumbar puncture (bloody or yellow) and MRA, angiogram
Treat aneurysms with platinum coiling

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6
Q

State some symptoms of a carotid and vertebral artery dissection

A

Headache and neck pain
Mean age 40, carotid > vertebral
Vertebral - occipital headache, Carotid - eye and forehead

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7
Q

How do you diagnose and treat carotid and vertebral dissections?

A

MRI/MRA, Doppler, Angiogram

Aspirin or anticoagulation

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8
Q

features of chronic subdural hemorrhage?

A

Bleeding Veins
Dark blood on scan in comparison to white blood on subarachnoid scan. Darkness shows the blood has already begun to decay
Common in old people

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9
Q

what is temporal arteritis?

what are the features?

A

Inflammation of temporal arteries
More common in females over 55
Constant unilateral headache, scalp tenderness, jaw claudication
25% Polymyalgia Rheumatica- proximal muscle tenderness
Blindness - if involvement of posterior ciliary arteries

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10
Q

how do you diagnose temporal arteritis?

A

biopsy (shows disruption of the internal elastic lamina and giant cells with nuclei)

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11
Q

what are some causes of central venous thrombosis?

A

Thrombophilia, pregnancy, dehydration and Behcets are causes

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12
Q

Optic disc swelling due to raised ICP is ___

A

papilleodema

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13
Q

What are the symptoms of meningitis?

A

Headache, Fever, Stiff neck, photophobia. Sometimes rash

confusion, alteration of consciousness

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14
Q

Treatment and diagnosis for meningitis?

A

antibiotics
blood urine culture
lumbar puncture after CT and MRI

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15
Q

Hemorrhagic changes in the temporal lobe can occur after meningitis infection with which virus?

A

Herpes Simplex

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16
Q

features of sinusitis?

A

(Malaise, headache, fever)

  • Loss of vocal resonance, anosmia, catarrh, local pain and tenderness
  • Opacification of paranasal sinus - blocked nasal passages
  • Frontal pain 1-2 hours of waking and clears in afternoon
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17
Q

state 2 infective causes of headaches

A
  1. meningitis

2. sinusitis

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18
Q

state raised intracranial pressure causes of headaches

A
  1. brain tumour -e.g. glioblastoma multiforme
  2. Idiopathic intracranial hypertension
  3. chiari malformation
  4. sleep apnoea
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19
Q

How does IHH appear on imaging.

what are the risk factors for IHH?

A

cerebral oedema with effacement of ventricles and sulci but no mass lesion.

female sex, obesity

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20
Q

what are the symptoms of IHH

A

Tinnitus, Headache + various visual symptoms - visual obscurations, diplopia, papilloedema, visual field loss.

Associated with central venous sinus stenosis

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21
Q

treatment for IHH?

A

Weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting to treat dural venous sinus stenosis.

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22
Q

Why does sleep apnoea cause a headache?

How do you treat it?

A

Hypoxia, C02 retention causes vasodilation of brain blood vessels

sleep study, nocturnal NIV

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23
Q

What is the cause of a low pressure headache?

A

These are caused by low CSF pressure or volume

Spontaneous or provoked (e.g. tear in dura during spinal anaesthesia, after lumbar puncture)

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24
Q

How do you diagnose and treat a low pressure headache?

A

MRI scan + contrast agent - this will give you characteristic meningeal enhancement
Rehydration, caffeine, blood patch

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25
Q

state 2 facial pain causes of headaches

A

trigeminal nerve neuralgia

atypical facial pain

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26
Q

what is trigeminal nerve neuralgia?

how do you treat it?

A

Electric shock like pain in the distribution of a sensory nerve. can be a symptom of MS

carbamazepine, posterior fossa decompression

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27
Q

What are the features of atypical facial pain?

how do you treat it?

A

Common in middle aged depressed or anxious women
Daily, constant poorly localized deep aching or burning in facial or jaw bones, may extend to neck, ear or throat
No sensory loss
Pathology in teeth, temporomandibular joints, eye, nasopharynx and sinuses must be excluded.

tricyclics

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28
Q

How do you treat post traumatic headache

A

NSAIDS, tricyclics antidepressants

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29
Q

Narrowing of joint space due to worn disc
Usually bilateral
Occipital pain can radiate forwards to the frontal region
Steady pain, worsened by moving the neck

these are features of what condition?

A

cervical spondylosis

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30
Q

inflammation of meninges caused by viral or bacterial infection is _____

___ is inflammation of the brain caused by infection or autoimmunity - see wbcs around vessels

___ ___ inflammation of blood vessel walls/angiitis

____ is infection of the spinal cord known as?

A

meningitis

encephalitis

cerebral vasculitis

myelitis

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31
Q

Symptoms of encephalitis?

A 
Initially flu like symptoms (headache, fever, aches, fatigue) 
Altered mental status 
Altered behaviour and personality 
speech/movement disorders 
Seizures
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32
Q

What types of infections can cause encephalitis and meningitis?

A

Mainly viral for encephalitis and bacterial for meningitis

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33
Q

What diagnostic tests can be performed for Encephalitis?

A

CT scan, MRI scan, lumbar puncture, EEG

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34
Q

Features of Multiple Sclerosis?

A

autoimmune demyelination of CNS (brain and spinal cord)

MRI shows white periventricular plaques.

Perivascular cuffing - t cells and B cells
Leptomeningeal inflammation

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35
Q

what are the phases of a migraine

A

Prodrome: Changes in mood, urination, fluid retention, food craving, yawning

Aura: Visual, sensory (numbness/paraesthesia), weakness, speech arrest

Headache: Head and body pain, nausea, photophobia,phonophobia

Resolution: rest and sleep

Recovery: mood disturbed, food intolerance, feeling hungover
4-72 hours

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36
Q

How do you treat an acute migraine attack?

A

Non-steroidals and paracetamol and metoclopramide (anti-emetic) to prevent nausea

Triptans-tablets (vasoconstrictors) - Synergise with

NSAIDS

A short nap, TMS

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37
Q

What does Migraine prophylaxis for people with chronic migraines (more than 14 a month) involve?

A

Over-the-counter preparations: feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide

Tricyclic antidepressants
Beta-blockers 
Serotonin antagonists
Calcium channel blockers
Anticonvulsants
Greater occipital nerve blocks
Botox: crown of thorns
Suppress ovulation (progesterone only pill or implant/injection)
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38
Q

what are the 3 forms of migraine attacks?

A

Pain
Pain and focal symptoms
Focal symptoms

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39
Q

How is Erenumab used in migraine prophylaxis?:

A

An anti-CGRP Monoclonal antibody

disables calcitonin gene-related peptide or its receptor (CGRP mAbs)

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40
Q

What is a Tension type headache?

treatment?

A

Tight muscles around head and neck bilaterally
No photophobia, phonophobia or aura
>30 minutes. Constant

Acute - NSAIDs
Prophylaxis - Tricyclic antidepressants - Amitriptyline

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41
Q

Extreme unilateral periorbital pain lasting 15-180 minutes untreated. And repetitive

May present with horner syndrome - “PAM” symptoms

At least one of the following, ipsilaterally:

  • Conjunctival redness and/or lacrimation
  • Nasal congestion and/or rhinorrhoea
  • Eyelid oedema

this describes what type of headache?

A

cluster

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42
Q

how do you treat a cluster headache

A

Acute - Inhaled oxygen, S/C or Nasal Sumatriptan

Prophylaxis - verapamil

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43
Q

what are some key features of a migraine?

A
  • pulsatile
  • unilateral
  • nausea
  • sensitivity to light and sound
  • prodrome & aura
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44
Q

how do you treat dementia?

A
  • acetylcholinesterase inhibitors - not a cure
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45
Q

what are some reversible causes of dementia?

A

Depression, alcohol related brain damage, hypothyroidism, B1/B2/B12 deficiency, benign tumors

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46
Q

what tests are carried out for dementia and what are potential findings?

A

neurological examination(MoCA, ACE) + focused tests

(MMSE)

bloods

MRI (narrower gyri, wider sulci, ventricles enlarged, medial temporal volume loss, hippocampal volume loss and replacement with CSF)

PET (for B-amyloid)

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47
Q

___ dementia can manifest as behaviour variant or primary progressive aphasia

A

fronto-temporal

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48
Q

____ ____ dementia can manifest as visual haLEWYcinations, fluctuating cognition, REM sleep disorder. cognitive impairment before or within one year of Parkinsonian symptoms

A

Lewy Body

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49
Q

___ dementia is related to CVD and shows a step-wise deterioration

A

Vascular dementia

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50
Q

what causes lewy body dementia?

what do tests show?

A

Caused by aggregation of alpha-synuclein, leading to deposition of lewy bodies

  • preserved hippocampal and temporal volume
  • DAT scan - decreased availability of dopamine transporter in caudate and putamen
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51
Q

what are the histological/gross findings in Alzheimer’s?

A
  • widespread cortical atrophy especially in hippocampus -> impairment of episodic memory
  • Alpha beta amyloid deposits
  • phosphorylated tau
  • narrowing of gyri, widening of sulci
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52
Q

what are the histological/gross findings in Alzheimer’s?

A

fronto-temporal lobe degeneration

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53
Q

What are the different types of generalised seizures?

A

Absence - blank stare
Myoclonic - quick, repetitive jerks
Tonic-clonic - patient contracts muscles (stiffening), followed by rhythmic jerking. Urinary incontinence, tongue biting may occur. post-ictal confusion. classic seizure.
Tonic - muscle stiffening, fall - usually backwards
Atonic - muscle relaxation. Drop seizures. fall- usually forwards

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54
Q

What are the different types of Partial (focal) Seizures?

A

Simple partial(consciousness intact) - motor, sensory, autonomic, psychic

Complex partial(impaired consciousness)

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55
Q

What type of seizure is characterised by motor or sensory abnormalities in 1 muscle group?

A

partial seizure

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56
Q

Most Epilepsy drugs are sodium channel ___ or GABA receptor ___

A

Blockers

Agonists

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57
Q

What is the mechanism of Lamotrigine? Name a serious side effect

A

blocks voltage gated Na+ channels

SJS

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58
Q

What is the mechanism of Sodium Valproate? Name two serious side effects

A

blocks sodium channels
Inhibits GABA transaminase so increases GABA
Hepatotoxicity. Neural tube defects.

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59
Q

What is the mechanism of Levetiracetam?

A

SV2A receptor blocker - prevents vesicle exocytosis and glutamate release

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60
Q

What is the mechanism of Benzodiazepines

A

increases GABA action

Diazepam increased frequency of Cl- channel opening - increased chloride ion influx

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61
Q

which drug can decrease the concentration on lamotrigine and therefore decrease seizure control?

A

OCP

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62
Q

Essie, who takes lamotrigine, noted that she had more seizures during the second and third week of the 4-week contraceptive cycle. Why?

how do you solve this problem?

A

4th week = placebo
earlier weeks = active pill

increase dose of lamotrigine in weeks 2-3

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63
Q

what is status epilepticus?

what is the 1st line treatment?

A

seizures for >5min or recurring seizures

benzodiazepines.
1st line = IV Lorazepam
2nd line = IV diazepam or buccal midazolam

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64
Q

Effect of oestrogen and progesterone on seizures?

A

Oestrogens are seizure promoting and progesterone is seizure inhibiting.

Many women have an increased frequency of seizures during days 10-13 (periovulatory estrogen peak)

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65
Q

when a patient is on lamotrigine, what is an alternative to OCP?

A

progesterone implant

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66
Q

Effect of pregnancy on seizures?

A

Increasing seizure frequency - changes in liver metabolism of lamotrigine

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67
Q

What are saccadic eye movements? State the different types

A

short fast burst,
•Reflexive saccade to external stimuli
•Scanning saccade
•Predictive saccade to track objects, Memory-guided saccade

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68
Q

What are Smooth Pursuit eye movements? What causes this?

A

Slow movement – up to 60°/s - Driven by motion of a moving target across the retina.

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69
Q

What are the major actions of the eye muscles?

A

Lateral rectus - lateral movement
Medial rectus - medial movement
Superior rectus - elevation
Inferior rectus - depression
Superior oblique - depresses and intorts the eye
Inferior oblique - elevates and extorts the eye

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70
Q

Describe the innervation of the muscles of the eye

A

LR6SO4R3
Lateral rectus - abducens
Superior oblique - trochlear
Rest - oculomotor nerve - nerve also raises eyelid and constricts pupil

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71
Q

What are the findings in a 3rd nerve palsy?

A

Down and out eye

Ptosis

Pupillary may be dilated:

  • Dilation shows parasympathetic nerves running on outside of CN3 have been damaged. E.g compression by mass like PComm Aneurysm (headache present)
  • Absence of dilation suggest ischemia as cause (common in diabetics)
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72
Q

What happens in a 6th nerve palsy?

A

Eye displaced medially

Double vision worsens on gazing to the affected side

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73
Q

Function of optokinetic nystagmus reflex test?

A

useful in testing visual acuity in pre-verbal children

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74
Q

In the eye, Crossed Fibres originate from __ __ and are responsible for ___ visual field

A

Nasal retina

Temporal

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75
Q

In the eye, uncrossed Fibres originate from ____ ____ and are responsible for __ visual field

A

Temporal retina

Nasal

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76
Q

What does a lesion to the optic nerve or retina result in?

A

Anopia in that eye

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77
Q

What is the effect of lesion to the RIGHT optic tract or RIGHT occipital lobe?

A

LEFT homonymous hemianopia

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78
Q

What is the main cause of a homonymous hemianopia?

A

stroke

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79
Q

Main cause of horizontal vs vertical field defect?

A

Vertical - neurological

Horizontal - eye condition

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80
Q

when would you get a right nasal hemianopia?

A

Only right eye affected

When only the uncrossed fibres in the optic tract are affected.

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81
Q

___ causes constriction of the pupil and innervation is parasympathetic

A

miosis

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82
Q

__ causes Dilation of the pupil and innervation is sympathetic

A

myDriasis

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83
Q

Describe the pupillary reaction to light/ miosis

A

1st neuron = Edinger-Westphal nucleus -> ciliary ganglion via CN III
2nd neuron = short ciliary nerves -> pupillary sphincter

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84
Q

Describe the pupillary reaction to light/ miosis

A

1st neuron = Edinger-Westphal nucleus -> ciliary ganglion via CN III

2nd neuron = short ciliary nerves -> pupillary sphincter

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85
Q

Describe the pupillary reaction to darkness/ mydriasis

A

Sympathetic stimulation causes radial muscles to contract

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86
Q

What happens when you shine light in one eye?

A

pupils constrict bilaterally

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87
Q

What causes holmes adies pupil? What are the key findings?

A

Blocked parasympathetic innervation due to damage to damage to ciliary ganglion

Dilated pupil unresponsive to light.
Absent reflex and impaired sweating may occur if there is damage to dorsal root ganglion in spinal cord
No findings consistent with CN3 palsy

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88
Q

Pilocarpine is a drug that acts on ___ receptors in iris sphincter muscle and brings about ____

A

muscarinic

miosis

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89
Q

What is light near dissociation? Name a condition that can cause it.

A

More meiosis due to accommodation than due to light

Adies pupil - damage to ciliary ganglion

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90
Q

Anisocoria (difference in pupil size) can be seen in what 3 conditions?

A

Horner - small

Adies pupil and CN3 palsy - larger

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91
Q

What happens if there is a Right Afferent Defect? E.g. damage to optic nerve

A

No pupil constriction in both eyes when right eye is stimulated with light

Normal pupil constriction in both eyes when left eye is stimulated with light

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92
Q

What happens if there is a Right Efferent Defect? e.g. damage to right 3rd nerve

A

No pupil constriction in the right eye when the right eye is stimulated. Pupil constriction in left

Pupil constriction in left eye when stimulated. No pupil constriction in right

Causes include CN 3 palsy with pupil involvement, holmes adie pupil

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93
Q

Describe the two types of lens

A

Convex - takes light rays and bring to a point - e.g. eyes and camera

ConCave - takes light and spreads them out

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94
Q

What is emmetropia?

A

Adequate correlation between axial length and refractive power
Parallel light rays fall on retina - no need for accommodation

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95
Q

What is ametropia?

Give examples of conditions with ametropia

A

Miss-match between axial length and refractive power

Parallel rays don’t fall on the retina

  • near-sightedness (Myopia)
  • Hyperopia Farsightedness
  • Astigmatism
  • Presbyopia
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96
Q

What happens in myopia? How do you treat it?

A

Eye too long for refractive power of cornea and lens - axial myopia

OR excessive refractive power - refractive myopia

Light focused in front of the retina

Correct with concave lens

Need Medical Doctors - Near Sightedness is the same as Myopia and requires a Diverging lens

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97
Q

What happens in hyperopia? How do you treat it?

A

Eye too short for refractive power of cornea and lens - axial hyperopia

Or insufficient refractive bower - refractive hyperopia

Light focused behind retina

Correct with convex lens

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98
Q

symptoms of Hyperopia?

A

Blurring close up , Eye pain, headache in frontal region, burning sensation in eyes, blepharoconjuctivitis

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99
Q

ambylopia

A

___ is uncorrected hyperopia in one eye

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100
Q

What happens in astigmatism? How do you treat it?

A

Abnormal curvature of the cornea - different refractive power at different axes. -

Parallel rays focus in 2 focal lines
“circle of least confusion”- least loss of image definition

Cylindrical lens

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101
Q

symptoms of astigmatism

A

Headache, eye pain
Blurred vision,

distortion of vision,

head tilting and turning

102
Q

What happens in presbyopia and how do you correct it?

A

Aging-related impaired accommodation (focusing on near objects)

Due to decrease in lens elasticity, changes in lens curvature, decrease in strength of ciliary muscle

Reading glasses.

103
Q

state and describe the near response triad

A
  1. Accommodation - circular ciliary muscle contract, relaxation of zonules and increased refractive power. Lens thicken, increase curvature
  2. Convergence
  3. Pupillary miosis
104
Q

Describe the innervation of the lacrimal system

A

Afferent - cornea, V1 cranial nerve

Efferent - parasympathetic (acetylcholine)

105
Q

Describe the production and drainage of tears

A

Produced by lacrimal gland

Drain through two puncta into superior and inferior canaliculi

Gather in tear sac and exit through tear duct into nasal cavity

106
Q

what are the functions of the tear film?

A

Oxygen supply to the cornea,

Removal of debris,
Bactericide,

Maintains smooth cornea air surface

107
Q

State the layers of the tear film and their functions

A

Mucus layer - maintains surface wetting

Middle water layer

Upper lipid layer - reduces tear film evaporation

108
Q

___ is the white of your eye

A

sclera

109
Q

___ is the clear dome that covers the iris

A

cornea

110
Q

___ is the thin transparent tissue that covers the entire front of your eye (except for the cornea) and lines the inside of the eyelids.

A

conjuctiva

111
Q

on an image of the eye, label:

  • iris
  • pupil
  • cornea
  • lens
  • ciliary body
  • suspensory ligament
  • fovea
  • sclera, choroid, retina (3 layers of the eye)
A

image in notes

112
Q

function of the cornea?

A

refraction. focusing of light (2/3)

113
Q

what happens if you hydrate the cornea?

A

it becomes white

114
Q

State the 3 parts of the uvea.

Where does it lie?

A

Iris, Ciliary body, Choroid - highly vascular and lies between sclera and retina

115
Q

function of the lens?

A

1/3 of focusing power

116
Q

the visible part of the optic nerve is known as the ___ ___

A

optic disc/blind spot

117
Q

___ is located in the centre of the retina and is responsible for detailed central vision

A

macula

118
Q

___ is located in the centre of the ____. it has a high concentration of ___ and low concentration of ____

A

fovea
macula
cones
rods

119
Q

what is the role of your central vision?

A
  • detail day vision
  • colour vision
  • reading and facial recognition
  • assessed using visual acuity assessment
120
Q

what is the role of your peripheral vison

A
  • shape, movement, night vision, navigation

- assessed using visual field assessment

121
Q

what is the role of your peripheral vision

A
  • shape, movement, night vision, navigation

- assessed using visual field assessment

122
Q

Describe the layers of the retina and cells that make them up

A
  1. Outer layer - photoreceptors (rods and cones) - first order neurons
  2. Middle layer - bipolar cells - regulate sensitivity - second order
  3. Inner layer - retinal ganglion cells - transmission to brain -third order
123
Q

distinguish between the functions of rods and cones

A

Rods - scotopic vision
More sensitive to light than cones, Slow response to light
Responsible for peripheral and night vision and spatial vision
More common

Cones - photopic vision
less sensitive to light, Faster response
Responsible for central and day vision
Recognizes detail and color

124
Q

How are cones classified? State the different types

A

By wavelength
S-cones - blue
M-cones - green
L-cones - red

125
Q

what is dueteranomaly?

A

Colour blindness where you don’t perceive red

126
Q

what is achromatopsia?

A

Full colour blindness where you see the world in black and white

127
Q

what is the colour blindness test called?

A

Ishihara test

128
Q

main function of parietal lobe?

A

sensation - touch pain

spatial orientation

129
Q

main function of frontal lobe?

A

motor function, planning movements

130
Q

main function of occipital lobe?

A

visual information

131
Q

main functions of temporal lobe

A

auditory information

memories

132
Q

Amygdala, hippocampus, mammillary body, Cingulate gyrus are all components of what?

A

limbic system

133
Q

functions of the limbic system?

A

Feeding (satiety & hunger)

Forgetting (memory) - Important

Fighting (emotional response)

Family (sexual reproduction and maternal instincts)

Fornicating (sexual arousal)- important

134
Q

insular cortex function?

A

Lies deep within lateral fissure

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

135
Q

What are the functions of white matter tracts? Name the different types

A

Connect cortical areas

  1. Association fibers - connect areas within the same hemisphere
  2. Commissural fibers - connect homologous structures in left and right hemispheres
  3. Projection fibers - connect cortex with lower brain structures e.g. thalamus, brain stem and spinal cord
136
Q

Identify some association fibres and state their functions

A

superior Longitudinal Fasciculus - connects frontal and occipital lobes

Arcuate Fasciculus - connects frontal and temporal lobe. Connects brocas and wernickes

Inferior Longitudinal Fasciculus - connects temporal and occipital lobes

Uncinate Fasciculus - connects anterior frontal and temporal lobes

137
Q

Identify two commissural fibres from an image

A

Corpus callosum - top red

Anterior commissure - bottom red

138
Q

Projection fibres radiate as the __ ___. They are also congregated into the __ ___ when passing through the thalamus and basal ganglia

A

corona radiata

internal capsule

139
Q

Effect of frontal lobe lesion?

A

Changes in personality, inappropriate behavior

140
Q

Effect of frontal lobe lesion?

A

Changes in personality, inappropriate behaviour

141
Q

effect of parietal lobe lesion?

A

A lesion in right hemisphere will cause contralateral neglect

142
Q

effect of temporal lobe lesion?

A

agnosia - inability to recognize

anterograde amnesia (damage to hippocampus)

143
Q

Effect of lesion to Broca’s ?

which region of the brain is it located?

A

Expressive aphasia - broken speech, stuttering, stopping

Frontal lobe

144
Q

Effect of lesion to wernickes?

Which region of the brain is it located?

A

Receptive aphasia - fluent but meaningless speech

Temporal

145
Q

Effect of lesion in primary visual cortex?

A

blindness in the corresponding part of the visual field

146
Q

Effect of lesion in visual association area?

A

prosopagnosia: inability to recognise familiar faces or learn new faces (face blindness)

147
Q

State applications of TMS in the medical field

A

Depression, epilepsy, migraine, tinnitus

148
Q

State applications of TDCS in the medical field

A

depression, epilepsy, pain

149
Q

___ __ is an autoimmune condition. Resulting in the loss of myelin from neurons of the CNS

A

multiple sclerosis

150
Q

what are some of the main symptoms of MS?

A

Blurred vision, fatigue, difficulty walking, numbness/tingling, muscle stiffness and balance

151
Q

in peripheral nerve stimulation, what is an M wave?

A

Activation of motor axons causing AP to travel down in nerve to muscle and cause contraction/twitch

Fast response

Recorded on an EMG

152
Q

in peripheral nerve stimulation, what is an H reflex?

A

Stimulus activates sensory neurons which then travel to spinal cord & activate lower motor neurons

Twitch but also feeling of response

Reflex activation, takes
longer than M wave

153
Q

in peripheral nerve stimulation, what is an F wave?

A

Large electrical stimulation of Motor neuron can cause them to conduct antidromically
goes from motor neuron to spinal cord (wrong way) then back to motor neuron

Contraction/twitch

Not reflex

154
Q

in peripheral nerve stimulation, what type of waves are activated with varying stimulus?

A

Low stimulus - sensory nerves only activated - h reflex and absent m wave

Higher stimulus - sensory and motor neuron activation

Very high - can cause an f wave

155
Q

What does TMS of the motor cortex activate?

A

Activate upper motor neurons which cause AP to travel to lower motor neurons and cause contraction

Can measure a motor evoked potential (MEP)

Total motor conduction time (TMCT) = time from brain to muscle = MEP latency

156
Q

How do you calculate peripheral motor conduction time?

A

It is the time from spinal cord to muscle
Can be calculated using

PMCT = (M latency + F latency -1)/2

-1 = time taken for action potentials arriving at the lower motor neuron to turn around

157
Q

How do you calculate central motor conduction time? CMCT

A

Time taken to travel from brain to spinal cord

CMCT = TMCT - PMCT

158
Q

Describe the effect of Multiple sclerosis on brain stimulation and peripheral nerve stimulation

A

Brain stimulation - TMCT is delayed - problem can be along upper or lower motor neurons or both.

peripheral nerve stimulation is normal. problem is in the CNS

159
Q

what blood vessels supply the brain?

A
  1. Common carotid artery
    - Arises from brachiocephalic artery
    - Divides into external carotid which feeds the face and internal carotid artery which goes up to the brain via the carotid canal
  2. Vertebral artery:
    - Main branch of subclavian artery
160
Q

How does venous blood drain in the brain cavity?

label a diagram of the venous system in the brain

A

Cerebral veins -> venous sinuses in the dura matter -> internal jugular vein

Drains via superior sagittal to the back of the head (confluence of sinuses) then drains laterally down through sigmoid sinus and into internal jugular vein

161
Q

What are the general symptoms of intracranial hemorrhage?

A

Headache, loss of consciousness, drowsiness (typical signs due to increased ICP)

162
Q

How does an extradural hematoma manifest? What are the findings on Head CT

A

trauma, immediate clinical effects (arterial, high pressure)

Biconvex blood collection, does not cross the suture lines, may cause midline shift due to high ICP. hyperdense blood. Lucid interval for patient

163
Q

How does a Subdural hematoma manifest? What are the findings on CT?

A

trauma, can be delayed clinical effects (venous, lower pressure).

Blood is between dura and arachnoid space

Crescent shaped, can cross suture lines, can cause midline shift

Acute = hyperdense CT, chronic = hypodense

164
Q

How does a subarachnoid hemorrhage manifest? What are findings on CT?

A

ruptured aneurysms

White areas in the middle of the brain brain between lobes

165
Q

What is the main cause of intraparenchymal hemorrhage?

A

Hypertension - hemorrhages due to hypertension occur in regions like Putamen, cerebellum

166
Q

What are the risk factors for stroke?

A

Age, Hypertension, Cardiac disease, Smoking, Diabetes mellitus

167
Q

symptoms of a stroke?

A

F - ace
A - rm
S - peech
T

visual field defects
loss of consciousness

168
Q

What are anterior cerebral artery stroke symptoms?

A

Paralysis of contralateral structures (leg > arm, face). Supplies the lower limbs more

Disturbance of intellect, executive function and judgement (abulia) as artery is in frontal lobe

Loss of appropriate social behaviour

169
Q

symptoms of a stroke?

A

F - ace
A - rm (paralysis of limbs)
S - peech
T

visual field defects
loss of consciousness

170
Q

What are posterior cerebral artery stroke symptoms?

A

homonymous hemianopia

Visual agnosia

171
Q

What are the major descending tracts of the spinal cord?

A

Pyramidal tracts:

  • Corticospinal tract - voluntary movement of body
  • Corticobulbar tract - voluntary movement of face

Extrapyramidal tracts: (involuntary movements of balance, posture, locomotion)

  • Vestibulospinal,
  • tectospinal,
  • reticulospinal,
  • rubrospinal
172
Q

What are some signs of an Upper Motor neuron lesion?

A 
*generally things go up 
Hyperreflexia
Spasticity (increased muscle tone) 
Clonus 
\+ve babinski's sign
*disuse atrophy
*no fasciculations
173
Q

What are some signs of a lower motor neuron lesion?

A

Hyporeflexia
Flaccidity
*denervation atrophy
*fasciculations

174
Q

State 2 symptoms that can present in both UMN and LMN lesions

A

weakness

dysphagia

175
Q

what is Apraxia?

A
  • Result of upper motor neuron lesion
  • Lesion of inferior parietal lobe, frontal lobe (premotor cortex, SMA)
  • Patients are not paralyzed but have lost information on how to perform skilled movements
  • Stroke and dementia most common cause
176
Q

What is motor neuron disease? MND/ALS

A

Progressive neurodegenerative disorder of the motor system

Affects both upper and lower motor neurons

177
Q

A ____ babinski sign occurs in UMN lesions. Toes curl ____ and fan out. This helps differentiate from a LMN lesion.

A

positive

upwards

178
Q

The putamen and globus pallidus are collectively known as ____ ___

A

lentiform nucleus

179
Q

The putamen and caudate nucleus are collectively known as the ___

A

striatum

180
Q

what is the function of the basal ganglia?

A
  • Coordinates voluntary movement
  • Receives input from motor cortex -> provides feedback to cortex to stimulate and inhibit motor activity -> complex movement
181
Q

State 3 movement disorders of the basal ganglia

A
  1. Parkinsons disease
  2. Huntingtons disease
  3. hemiballism
182
Q

State 3 movement disorders of the basal ganglia

A
  1. Parkinsons disease
  2. Huntingtons disease
  3. ballism
183
Q

what causes Parkinson’s?

A

Degeneration of dopaminergic neurons of substantia nigra pars compacta

184
Q

What are some symptoms of Parkinson’s disease?

A

Parkinson TRAPSS your body

Tremor - pill rolling at rest 
Rigidity (cogwheel) 
Akinesia or bradykineia 
Postural instability 
Shuffling gait 
Small handwriting
185
Q

What causes Huntington’s disease?

A

Degeneration of GABAergic neurons in the striatum-> atrophy of striatum

Chromosome 4, autosomal dominant.

CAG repeat

186
Q

what are some symptoms of huntingtons disease?

A

Chorea

Speech impairment,

Difficulty swallowing

Irritability, depression

Cognitive decline and dementia

187
Q

what causes ballism?

A

Lesion in subthalamic nucleus e.g stroke

188
Q

symptoms of ballism?

A

Uncontrolled flinging of extremities

Contralateral symptoms

189
Q

What is the function of the vestibulocerebellum?

A

GAIT, POSTURE, equilibrium

Coordination of head movements with eye movements

190
Q

A lesion to ___ can result in gait ataxia and tendency to fall even when sitting and eyes open. It is similar to vestibular disease.

A

vestibulocerebellum

191
Q

Damage to _____ mainly affects legs (LIMB movement) it results in a wide-based gait and is associated with chronic alcoholism

A

spinocerebellum

192
Q

Damage to ___manily affects arms. It affects SKILLED movements (tremor) and speech.

A

cerebrocerebellum

193
Q

what are the main signs of cerebellar dysfunction?

A

Ataxia - impairment of coordination- disturbance of posture or gait

Dysmetria
Intention tremor

Dysdiadochokinesia - inability to perform rapidly alternating movements

Scanning Speech - staccato

194
Q

What are alpha motor neurons? What is their function?

A

Lower motor neurons of the brainstem and spinal cord

Occupy the ventral horn

Innervate the extrafusal muscle fibers - activation causes contraction

195
Q

what is the motor neuron pool?

A

All the alpha motor neurons that innervate a single muscle

196
Q

describe some properties of a slow/Type 1 motor unit

A

smallest diameter cell bodies
Small dendritic trees
Thinnest axons thus slow conduction velocity

197
Q

Describe the 2 ways in which the Brain regulates muscle force

A

Recruitment - slow fibres first

Rate coding

198
Q

describe how muscle fibres can change

A

IIB to IIA most common after training

I to II possible In severe deconditioning, spinal cord injury, microgravity

Aging causes loss of type I and II fibres but preferentially II

199
Q

state 2 pieces of evidence for inhibitory control dominating and preventing reflexes

A
  1. decerebration

2. jendrassik manoeuvre

200
Q

in the control of reflexes, what neurons innervate and alter the sensitivity of sensory neurones?

A

gamma motor neurones

201
Q

What makes up the outer ear? Function?

A

Pinna, auditory canal and tympanic membrane

Transfers sound waves via vibration of tympanic membrane

202
Q

What makes up the Middle ear? Function?

A

3 bones/ossicles: malleus, incus, stapes

Amplification of sound from tympanic membrane to inner ear - Focusing vibrations from tympanic membrane to oval window

203
Q

What makes up the Inner ear? Function

A

Cochlea
Cochlea transducers vibration into nerve impulses.
Basilar membrane vibrates -> vibration transduced by specialised hair cells -> auditory nerve signalling -> brain stem

204
Q

State and describe the compartments of the cochlea

A

Scalia vestibuli - bone structure - contains perilymph (high in Na+)
Scala Tympani - bone structure - contains perilymph
Scala Media - membranous - endolymph (high in K+) - contains the hearing organ/organ of Corti

205
Q

Where does the organ of corti lie?

A

basilar membrane

206
Q

In the basilar membrane, high frequency is heard best at the ___ which is ___ and low frequency is heard best at the ____ which is ___ .

A

Base
Thin and rigid
Apex
Wide and flexible

207
Q

What is the function of the tectorial membrane?

A

Cause Hair deflection which depolarises the cell

In contact with OHCS which then contact IHCs

208
Q

What is the function of the tectorial membrane?

A

Cause Hair deflection which depolarises the cell

209
Q

What is the function of the outer hair cells

A

Modulation of the sensitivity of response -amplifier

Carry 95% of EFFERENT info

210
Q

If OHC brings tectorial membrane closer to inner hair cell, __ of sound occurs and vice versa

A

transmission

211
Q

Describe how the hair cells bring about transduction

A
  1. Deflection of steriocillia towards the longest cilium will open K+ channels
  2. Depolarization and neurotransmitter release
  3. Higher amplitudes = greater deflection of stereocilia and K+ channel opening
212
Q

Describe how the hair cells bring about transduction

A
  1. Deflection of steriocillia towards the longest cilium will open K+ channels
  2. Depolarization and neurotransmitter release
  3. Higher amplitudes = greater deflection of stereocilia and K+ channel opening
213
Q

What happens to sound that enters the cochlea?

A

Enters as a result of vibration of tympanic membrane and ossicles and focusing onto oval window - Goes in through the oval window - vibration of the perilymph which goes around the cochlea - vibration of the basilar membrane - organ of corti lies on this - deflection of stereocilia brought about by tectorial membrane contacting hair cells - opening of K+ channels

214
Q

what happens if sound is too soft?

A

Outer hair cells will contract - shorten its length to make tectorial membrane come closer to cillia of inner hair cells

and vice versa

215
Q

the downward phase of movement of the tectorial membrane and hair cells causes ____.
The upward phase causes ____

A

hyperpolarisation

depolarisation

216
Q

Describe the auditory pathway following sound transduction

Label a diagram as well

A

Cochlea -> cochlea nerve -> cochlea nucleus (impulse crosses and is transduced bilaterally) -> superior olive -> inferior colliculus -> medial geniculate body (in thalamus) -> primary auditory cortex

217
Q

In the auditory cortex, going from front to back, the frequency of sound _____

A

increases

218
Q

what is the human range of hearing?

A

20-20,000Hz

0dB to 120 dB

219
Q

what is most commonly damaged in hearing loss?

A

OUTER hair cells

220
Q

___ is aging-related bilateral hearing loss often of ____ frequencies due to destruction of hair cells at the cochlea ____

A

presbycusis
high
base

221
Q

What 4 procedures can be carried out during hearing assessment?

A
  • Tuning fork - Rinne test, Weber Test
  • Audiometry/PTA
  • Central processing assessment - sound localization, filtered speech, speech in noise
  • Tympanometry - creates variations of air pressure in the air canal - used to test the condition of the middle ear and mobility of the eardrum
222
Q

What is the implication of these graphs on a tympanogram:

  • A ?
  • B ?
  • C ?

INSERT PICTURE***

A

A:

  • normal
  • peak compliance occurs at near atmospheric pressure indicating normal pressure within the middle ear

B:

  • no sharp peak little to no variation with pressure
  • middle ear effusion, tympanic membrane perforation, occluded ear canal, eustachian tube dysfunction

C:
- negative middle ear pressure

223
Q

What are the 3 different types of hearing loss?

A
  1. conductive
  2. sensorineural
  3. mixed
224
Q

what happens in conductive hearing loss?

give examples of conditions that cause this

A
  • problem in outer or middle ear problem with conduction or amplification of sound

causes:
- wax
- otitis or otosclerosis in middle ear

225
Q

what happens in sensorineural hearing loss?

give examples of conditions that cause this

A
  • problem in inner ear or the auditory nerve. Transduction problem

causes:

  • presbycusis
  • ototoxicity in inner ear
  • VIII nerve tumor in nerve
226
Q

In conductive hearing loss, bone conduction is ____

A

Normal

bone conduction bypasses outer and middle ear and stimulates cochlea

227
Q

In sensorineural hearing loss air conduction and bone conduction are ___ affected

A

both

228
Q

How do you treat hearing loss?

A

Treat underlying cause like wax

Hearing aids, Cochlear implants, Brainstem implants

229
Q

How do cochlear implants function?

A
  • Replaces the function of the hair cells
  • Receives sounds and sends an electrical impulse directly to auditory/cochlea nerve
  • So requires functioning auditory nerve
230
Q

What treatment can be given for hearing loss due to auditory nerve damage?

A

brainstem implant

231
Q

What are the 3 main inputs of the vestibular system

A

Visual
Proprioceptive
Vestibular information

232
Q

What are the main outputs of the vestibular system?

A

ocular reflex

postural control

233
Q

where is the vestibular organ?

A

In the posterior area of the inner ear

Inner ear contains hair cells for balance as well as hearing

234
Q

State the structures that make up the vestibular organ

Label them on a diagram

A

otoliths organs - utricle and saccule

3 semi-circular canals - anterior, lateral, posterior

235
Q

what movement do semicircular canals respond to?

A

angular

236
Q

What is the function of hair cells in the vestibular organs during head movement?

A

Allows the cells to depolarize with movement of endolymph generated by movement of head.

237
Q

How are hair cells arranged in the otolith organs?

located on maculae in the otoliths organs.

A

placed horizontally in the utricle

placed vertically in the saccule

238
Q

Why are utricle and saccule called otoliths organs?

A

Have otoliths/crystals on top of the hair cells that help with hair cell movement

239
Q

state 3 substances contained in the maculae

A

Hair cells
Gelatinous matrix
Otoliths/crystals on top

240
Q

Where are hair cells located in the semicircular canal?

A

In the ampulla - Crista ampullaris

241
Q

What brings about movement of hairs in the semicircular canal?

A

Head movement - endolymph flow - Cupula displacement closes the ampulla - helping deflection of the cilia

242
Q

The vestibular nerve transmits impulses from the vestibular organ to the vestibular nucleus in the brain stem. Where do the vestibular nuclei project to?

look at diagram of the vestibular pathway to aid understanding

A

DOWN, BACK, UP AND VERY UP

  1. Down = SPINAL CORD (vestibulospinal tract) -> ends at muscles -> postural changes. lateral tract to limbs, medial to neck and back
  2. Back = CEREBELLUM -> vestibulocerebellum
  3. Up = CNVI, CN IV, CN III nuclei/ nuclei of extraocular muscles via medial longitudinal fasiculi -> Vestibulo-ocular reflex (VOR) which keeps image fixed on retina
  4. Very Up -> ventroposterior nucleus in thalamus -> vestibular cortex (awareness of sensations)
243
Q

Where is the vestibular cortex thought to be located?

A

Parieto-Insular Vestibular Cortex (PIVC). This is in the parietal lobe

244
Q

Functions of the vestibular system?

A

Postural control
Detect and inform about head movements
Keep images fixed in retina during head movement

245
Q

What type of stimulation do Otoliths organs respond to?

A

linear acceleration and tilt
Utricle - Horizontal plane movement
Saccule - Vertical

246
Q

What happens during the Vestibulo-ocular reflex?

A

Eye turns in opposite direction to head

247
Q

How do you assess the vestibular system?

A

Anamnesis , Posture and gait , Cerebellar function, Eye movements
Vestibular tests: vHIT, VEMP etc
Imaging
Symptoms and impact assessment

248
Q

What are the main symptoms of a balance disorder?

A

dizziness

vertigo

249
Q

what are peripheral vestibular disorders?

Give examples of causes

A
  • vestibular disorders of labyrinth or VIII nerve (inner ear)
  • vestibular neuritis
  • BPPV (abnormal presence of crystals in the scc canals)
  • Ménière’s disease
  • unilateral and bilateral vestibular hypofunction
250
Q

what are central vestibular disorders?

Give examples of causes

A

stroke, MS, tumour

251
Q

Distinguish balance disorders using evolution

A

Acute - vestibular neuritis, stroke
Intermittent - BPPV
Recurrent - Meniere’s Disease, Migraine
Progressive - tumour, MS

Medicine MBBS year 2 (11 decks)

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