NEUROSCIENCES

Question 1

Where is the prion gene located and what is is called?

Answer 1

Chromosome 20, called PrPc

Question 2

What is the cellular prion protein?

Answer 2

Expressed in CNS
Has 0, 1 or 2 glycosyl residues (unglycosylated, mono or diglycosylated)
Expressed to lesser extent in lymphoid system, peripheral nerves and muscles

Question 3

Function/roles of prion proteins (4)

Answer 3

Copper binding
Cell signalling
Promoting neuronal growth and survival
Regulating synapses, receptors, and circadian rhythms

Question 4

What is the pathological prion protein?

Answer 4

PrPSc
Formed by conformational conversion of normal prion protein
Contains fewer alpha-helices and more beta-sheets
Can be endogenous or from environment
Can self-propagate
Aggregate into large extracellular deposits
Deposits trigger neurodegeneration
Resistant to breakdown by proteases

Question 5

Histological features of prion disease (4)

Answer 5

Vaculoation in all grey matter areas - spongiform encephalopathy
Synaptic dysfunction
Loss of dendrites
Atypical brain inflammation

Question 6

Advanced pathology of prion disease (3)

Answer 6

Neuronal loss
Gliosis
Severe brain atrophy

Question 7

Histological changes in variant CJD

Answer 7

Visible spongiform changes
Multiple amyloid plaques (cluster plaques) surrounded by small vacuoles - ‘florid plaque’
Stellate astrocytes

Question 8

Histological changes in sporadic CJD

Answer 8

Fine spongiform changes
Fine, disseminated vacuoles
Diffuse prior protein deposition
Occasional aggregates of dense coarse microplaques

Question 9

Mechanism of pathogenesis of sporadic CJD

Answer 9

somatic mutation or spontaneous conversion of PrPc to PrPSc

Question 10

Mechanism of pathogenesis of sporadic fatal insomnia

Answer 10

somatic mutation or spontaneous conversion of PrPc to PrPSc

Question 11

Mechanism of pathogenesis of familial CJD

Answer 11

Germline mutations in C-terminal PRNP (Codon 200)

Question 12

Somatic human prion diseases

Answer 12

sporadic CJD
Sporadic fatal insomnia

Question 13

Heritable human prior diseases

Answer 13

Familial CJD

Question 14

Infective human prion diseases (3)

Answer 14

KURU
Iatrogenic CJD
Variant CJD

Question 15

Infective animal prion diseases (5)

Answer 15

Scrapie - affects sheep
Bovine spongiform encephalopathy (BSE)
Transmissible mink encephalopathy (TME)
Chronic wasting disease (CWD) - deer, elk, moose
Feline spongiform encephalopathy (FSE)

Question 16

Mechanism of pathogenesis of kuru

Answer 16

Infection through ritualistic cannibalism

Question 17

Mechanism of pathogenesis of iatrogenic CJD

Answer 17

Infection from dura mater transplants, prion-contaminated human growth hormone, contaminated medical equipment and other medical procedures

Question 18

Mechanism of pathogenesis of variant CJD

Answer 18

transmission of bovine prions through the food chain

Question 19

Mechanism of pathogenesis of scrapie

Answer 19

infection, possible vertical

Question 20

Mechanism of pathogenesis of BSE

Answer 20

infection or sporadic

Question 21

Mechanism of pathogenesis of TME

Answer 21

infection with prions from sheep or cattle

Question 22

Mechanism of pathogenesis of CWD

Answer 22

infection

Question 23

Mechanism of pathogenesis of FSE

Answer 23

infection with prion-contaminated bovine tissues or MBM

Question 24

sporadic CJD

Answer 24

Divided into cognitive and ataxic subtypes
Cognitive - MM1 and MV1 are most common (cog impairment, cortical visual disturbance, ataxia, myoclonus)
Ataxic - VV2 and MV2 approx 1/3 of sCJD (primary symptom is ataxia, but cog imp often evident
For both, dementia and death within months

Question 25

Presenting features of sCJD and fCJD (4)

Answer 25

Cognitive impairment and psych changes (80-83%) Cerebellar signs (43-55%) Visual signs (19%) Myoclonic jerks (12%)

Question 26

Late developing signs sCJD and fCJD (4)

Answer 26

Dementia (100%) Myoclonus (73%) Cerebellar signs (79%) Seizures (40%)

Question 27

Distinguishing signs between sCJD and fCJD

Answer 27

Peripheral neuropathy frequent in E200K-129M phenotype, but rare in sporadic CJD MM1

Question 28

Sporadic fatal insomnia features

Answer 28

Rarest sporadic prion disease Average age of onset is middle of 4th decade Features mimic familial form - Marked sleep disturbance - Progressive reduction in hours of sleep - Sympathetic over-activity - Cognitive impairment - Ataxia

Question 29

Sporadic fatal insomnia histology

Answer 29

Distinct atrophy of the thalamus, often with mild and localised cortical degeneration

Question 30

Main types of inherited prion disease (3)

Answer 30

Familial CJD Gerstmann-Straussler-Scheinker (GSS) syndrome Fatal familial insomnia (FFI) MOST cases are autosomal dominant

Question 31

Familial CJD

Answer 31

Usually between 45-75 years (mean 60y) Rapid progression, average duration 5 months Spongiform changes, astrogliosis, variable neuronal loss WITHOUT amyloid plaques Lesions preferentially involve the cerebral cortex, striatum, medial thalamus and cerebellum

Question 32

Gersman-Straussler-Scheinker (GSS) syndrome

Answer 32

Most common PRNP mutation are P102L and G131V Typically present in 3rd or 4th decade Chronic cerebellar ataxia and pyramidal features Longer course than CJD Dementia develops later Average duration 5 years

Question 33

Fatal familial insomnia mutation

Answer 33

Mutation in PRNP at codon 178, and another variant at position 129 (methionine codon)

Question 34

variant CJD

Answer 34

Average age of onset 28 years Slower progression than sCJD Average 14 months duration

Question 35

Investigations for prion disease (6)

Answer 35

EEG CSF 14-3-3 examination MRI Tonsil biopsy Genetic testing Histology

Question 36

HIV-1 vs HIV-2

Answer 36

HIV-1 more virulent and infectious HIV-2 less readily transmitted and slower progression

Question 37

How does HIV work

Answer 37

Uses CD4 receptors on T cells Uses chemokine receptors to help the virus attach to the cell Membrane of virus and host cell fuse, allowing viral material in Host cell produces dsDNA from the HIV RNA, allowing viral component parts to be assembles

Question 38

What do CD4 cells do

Answer 38

Helper T cells have a CD4 glycoprotein on their surface Assist other WBCs and in activation of cytotoxic T cells and macrophages

Question 39

What do CD8 cells do?

Answer 39

Cytotoxic T cells have a CD8 glycoprotein on their surface, fighting off invaders by destroying infected and cancerous cells. Identify targets by binding to antigens.

Question 40

HIV seroconversion syndrome

Answer 40

Represents exponential increase in viral load and inflammatory response Fever, lymphadenopathy, sore throat, rash, much and joint pain, headaches

Question 41

Viral set point in HIV

Answer 41

Where viral replication and host immune response reach equilibrium When the immune system has develops specific T cells to fight against the virus, and viral load stops increasing Lasts few weeks to 3 months Symptoms often mild and short lived, similar to flu

Question 42

AIDS

Answer 42

CD4 cell count below 200 (normal is 500-1600) Development of >1 characteristics or 'AIDS-defining' infections Without antiretroviral therapy, survival is around 3 years

Question 43

HIV clinical latency stage

Answer 43

No/only mild symptoms Low level viral reproduction Can last several decades Risk of transmission reduced but not absent

Question 44

CNS effects of HIV

Answer 44

Depression Short term memory impairment Poor concentration Behaviour/personality changes Leg weakness, slow hand movement, gait changes HAND - HIV-associated neurocognitive disorder

Question 45

How does HIV get into the brain

Answer 45

Tight junctions in BBB dysregulated Perijunctional proteins lost BBB more permeable

Question 46

Histological signs of brain HIV infection

Answer 46

Multinucleated giant cells (thought to be infected monocytes that have differentiated into macrophages, or infected microglia that have fused)

Question 47

Complications of HIV-induced neuroinflammation (6)

Answer 47

Axonal damage Atrophy of dendrites Reduced neurogenesis Impaired potentiation Cognitive - memory and executive function Behave/physiological - sustained sickness, depression, exaggerated weight loss

Question 48

Risk factors for HANDs in HIV (8)

Answer 48

Comorbid Hep C infection Parenteral illicit substance use Low CD4 count Female Increasing age High viral set point early in course of infection Anaomia Low BMI

Question 49

HAND (HIV) investigations

Answer 49

CSF analysis Neuroimaging - MRI or CT

Question 50

Cerebral cortex

Answer 50

Surface of cerebrum

Question 51

Cerebellar cortex

Answer 51

Surface of cerebellum

Question 52

Within the brainstem (4)

Answer 52

Substantia nigra Red nucleus Olivary nuclei Cranial nerve nuclei

Question 53

Primary motor cortex

Answer 53

Precentral sulcus Initiating motor movements

Question 54

Anterior to primary motor cortex

Answer 54

Premotor cortex (lateral) Supplementary motor cortex (medial)

Question 55

Premotor cortex

Answer 55

Planning and initiation of movements on the basis of past experience

Question 56

Supplementary motor cortex

Answer 56

Regulation of posture by communicating the best position for each movement to the motor cortex

Question 57

Frontal gyrus

Answer 57

Dominant (usually left) - Broca's area (Brodmann 44 and 45) Superior frontal gyrus has role in working memory

Question 58

Parietal lobe - association somatosensory area (Brodmann 5 and 7)

Answer 58

Involved in recognising objected by touch. Damage: tactile agnosia or asterognosis

Question 59

Parietal lobe - right posterior non-dominant inferior parietal lobe

Answer 59

RIGHT: Distribution of attention to both sides of the body - esp angular gyrus LEFT: seems to only pay attention to right side of the world Damage: hemineglect

Question 60

Parietal lobe - angular gyrus

Answer 60

Brodmann 39 Semantic processing Number processing, work reading and comprehension Memory retrieval, attention and spatial cognition Reasoning and social cognitionS

Question 61

Parietal lobe - supramarginal gyrus

Answer 61

Brodmann 40 Phonological processing

Question 62

Parietal lobe - precuneus

Answer 62

Integrated tasks Visuospatial mental imagery Deliberate shifts of attention Recollection of past episodes Self-processing operations eg reflection

Question 63

Superior temporal gyrus

Answer 63

Processing sound through primary auditory area in transverse temporal gyri (Heschl's gyri), within lateral sulcus Social cognition

Question 64

Superior frontal gyrus

Answer 64

Picks up spatial arrangement of sounds of different frequencies from medial geniculate nucleus

Question 65

Middle and inferior temporal gyri

Answer 65

Visual perception (inferior) Language and semantic memory processing (middle) Multisensory integration

Question 66

Fusiform gyrus

Answer 66

In temporal lobe Colour information Face and body recognition Word recognition Number recognition Within-category identification

Question 67

Left fusiform gyrus lesion

Answer 67

word finding difficulty semantic paraphrasias

Question 68

Right or left fusiform lesion

Answer 68

Prosopagnosia

Question 69

Primary visual cortex formed of

Answer 69

cortical aspects of cuneate and lingual gyri on each bank of calcarine fissure, known collectively as the striate cortex/calcarine cortex

Question 70

Frontal eye fields located in

Answer 70

Precentral sulcus at caudal end of superior frontal gyrus and middle frontal gyrus

Question 71

Frontal eye fields are responsible for

Answer 71

Voluntary saccadic eye movements

Question 72

Primary auditory area located in

Answer 72

Heschl's gyrus

Question 73

Frontal lobe functions (10)

Answer 73

Motor movement Executive function Decision making Working memory Attention/concentration Language (motor expression) Inhibition Personality/emotions Social appropriateness Saccadic eye movements

Question 74

Gerstmann's Syndrome

Answer 74

Lesions in left inferior parietal lobe around angular gyrus - agraphia - acalculia - finger agnosia - left right disorientation

Question 75

Balint Syndrome

Answer 75

Bilateral damage to posterior parietal lobe - optic ataxia - ocular apraxia -simultanagnosia

Question 76

Parietal lobe functions (10)

Answer 76

Perception and processing of sensory information Visuospatial processing Praxis (dressing, constructional, ideomotor) Somatognosia (awareness of own body) Calculation ability Reading Writing Naming Left right orientation Visual field

Question 77

Temporal lobe functions (9)

Answer 77

Memory (working memory, encoding, retrieval, selective attention) Deductive reasoning Language comprehension Auditory perception Affective prosody Music comprehension Face recognition Visual field processing (superior) Olfactory perception

Question 78

Kluver-Bucy Syndrome

Answer 78

Bilateral lesions of anterior temporal lobe, including amygdaloid nucleus. Hyperorality Placidity Visual agnosia Prosopagnosia Psychic blindness Indiscriminate hypersexuality Hypermetamorphosis Memory loss Seizures

Question 79

Occipital lobe functions

Answer 79

Perception of visual sensation

Question 80

Anton-Babinski Syndrome

Answer 80

Injury of occipital lobe from stroke or brain injury Denial of blindness (anosognosia) despite objective evidence of visual loss Confabulation to fill in missing sensory input

Question 81

Optic nerve lesions

Answer 81

Monocular visual loss

Question 82

Optic chiasm lesion

Answer 82

Bitemporal hemianopia

Question 83

Optic tract lesion

Answer 83

Homonymous hemianopia

Question 84

LEFT Upper/lower Optic radiation lesion

Answer 84

Upper/lower (superior/inferior) left homonymous quadrantonopia (vice versa for right lesion)

Question 85

Lesion of both optic radiations on one side

Answer 85

Homonymous hemianopia with central sparing

Question 86

Functions of limbic system

Answer 86

Emotion processing Encoding and retrieval of memory Autonomic functions Role in reward and addiction

Question 87

Areas included in limbic system

Answer 87

CEREBRAL CORTEX: hippocampus, insular cortex, orbital frontal cortex, subcallosal gyrus, cingulate gyrus, parahippocampal gyrus (collectively the limbic lobe) SUBCORTICAL STRUCTURES: olfactory bulb, hypothalamus, amygdala, septal nuclei, some thalamic nuclei including anterior nucleus and possibly the dorsomedial nucleus

Question 88

Cingulate gyrus

Answer 88

Part of limbic system Role in sensory, motor, visceral, emotional, motivation, memory and cognitive adaptability. Posterior cingulate cortex: supporting autobiographical memories, future planning, focusing attention Abnormalities seen in depression, schizophrenia, autism, ADHD, Alzheimers and ageing.

Question 89

Parahippocampal gyrus

Answer 89

Part of limbic system. General memory creation and recall, specific recollection of visual scenes.

Question 90

Anterior part of parahippocampal gyrus includes

Answer 90

Perihinal and entorhinal cortices

Question 91

Functions of hippocampus (3)

Answer 91

Declarative memory (encoding, retrieval) Visuospatial orientation Regulation of the hypothalamo-pituitary-adrenal axis

Question 92

Amygdala functions

Answer 92

processing of emotions acquisition and expression of fear conditioning

Question 93

Nucleus accumbens

Answer 93

With ventral tegmental area, central link in reward circuit Amount of dopamine in Na increases on frequent drug use, explaining drive to seek more Over stimulation of its neurons leads to decreased number of dopamine receptors

Question 94

4 subdivisions of the diencephalon

Answer 94

hypothalamus subthalamic nucleus epithalamus (habenula, habenular commissure, stria medullaris, pineal body) thalamus

Question 95

Role of the thalamus

Answer 95

Switchboard regulating and relaying the information to and from the brain almost all sensory input and motor output goes via thalamus plays a role in regulating sleep and wakefulness spatial memory and spatial sensory data, crucial for episodic memory

Question 96

Symptoms following thalamus lesions

Answer 96

Contralateral hemianesthesia Hyperalgesia and causalgia Contralateral homonymous hemianopia Movement disorders

Question 97

Wernicke-Korsakoff's syndrome

Answer 97

Caused by thiamine deficiency Malnutrition, alcohol dependence, prolonged diarrhoea Acute: nystagmus, opthalmoplegia, mental confusion, ataxia reversible if treated quickly, otherwise progresses into chronic Korsakoff's syndrome - profound anterograde amnesia. may also be retrograde amnesia. confabulation.

Question 98

Functions of hypothalamus (5)

Answer 98

Control of pituitary hormone release Temperature regulation Management of food and water intake Sexual behaviour and reproduction Mediation of the emotional response

Question 99

3 main groups of white matter tracts

Answer 99

commissural fibres association fibres projection fibres

Question 100

white matter tracts function

Answer 100

role in learning, cognition and psychiatric diseases

Question 101

what is myelin

Answer 101

mixture of proteins and phospholipids that insulates the neuronal fibres

Question 102

What do commissural / transverse fibres do

Answer 102

Connect the corresponding areas between two brain hemispheres

Question 103

Examples of commissural/transverse fibres (5)

Answer 103

Transverse fibres of corpus callosum Anterior commissure Posterior commissure Hippocampal commissure or commissure of fornix Habenular commissure

Question 104

Corpus callosum

Answer 104

Connects cortices of the 2 hemispheres Divided into the rostrum, genu, body/trunk and splenium Mainly myelinated axons

Question 105

Course of the corpus callosum

Answer 105

Fibres of genu cure into frontal lobe: FORCEPS MINOR Fibres of body and some of splenium extend laterlly as the RADIATION OF THE CORPUS CALLOSUM. Running across these are the INTERDIGITATE FIBRES OF CORONA RADIATA. Fibres from the splenium run backwards into the occipital lobe forming the FORCEPS MAJOR.

Question 106

Marchiafava-Bignami disease

Answer 106

Rare condition in chronic alcoholism Demyelinating processes affecting the corpus callosum Radiological diagnosis - clinical features variable and non-specific

Question 107

Anterior commissure

Answer 107

In anterior wall of third ventricle at upper end of the lamina terminalis. Key role in nociceptive sensation to contralateral side of brain in lateral spinothalamic tracts. Contains decussating fibres form the olfactory tracts and connects tow amygdala and other parts of temporal lobe contributing to olfaction, memory, emotion, speech and hearing. Implicated in sexual orientation.

Question 108

Posterior commissure

Answer 108

Interconnects the pretectal nuclei, which in turn receive the afferents from the optic tract, mediating the consensual pupillary light reflect and taking the fibres to the Edinger Westphal nuclei of the occulomotor nerve

Question 109

Association fibres

Answer 109

Connect regions within same hemisphere of the brain Bundles include: the cingulum the superior longitudinal fasciculus and arcuate fasciculus inferior longitudinal fasciculus inferior frontooccipital fasciculus and uncinate fasciculus fornix of the hippocampi

Question 110

The cingulum

Answer 110

Forms the core of the cingulate gyrus Connects regions of the frontal lobe, precuneus, posterior cingulate cortex, parahippocampal gyrus and the uncus of the temporal lobe

Question 111

Superior longitudinal fasciculus

Answer 111

longest interhemispheric fibre tract connects the frontal, parietal, temporal and occipital lobes

Question 112

Arcuate fasciculus

Answer 112

most notable subdivision of superiod longitudinal fasciculus Connects the caudal temporal cortex and inferior parietal cortex to locations in the frontal lobe and plays a major role in language use and comprehension

Question 113

Uncinate fasciculus

Answer 113

Component of the inferior frontoccipital fasciculus connecting the middle, inferior and orbital frontal gyri to the anterior temporal pole and curving around the lateral sulcus

Question 114

abnormalities in uncinate fasciculus

Answer 114

social anxiety alzheimers bipolar disorder violent behaviour affected in Phineas Gage

Question 115

Projection fibres

Answer 115

connect the cerebral cortex with brainstem and spinal cord both afferent and efferent internal capsule is a concentration of projection fibres

Question 116

internal capsule lesions - anterior limb

Answer 116

movement disorders (corticospinal or corticonuclear motor tracts) somatosensory losses (thalamocortical projections)

Question 117

internal capsule lesions - THE GENU

Answer 117

UMN deficits of cranial nerves especially VII and XII (corticobulbar tracts)

Question 118

internal capsule lesions - POSTERIOR LIMB

Answer 118

contralateral hemiplegia affecting upper and lower extremities hemianesthesia on same side as the weakness

Question 119

GABAergic inhibitory parts of basal ganglia

Answer 119

striatopallidal -between striatum and globus pallidum striatonigral - between striatum and SNr

Question 120

dopaminergic mixed effect areas of basal ganglia

Answer 120

nigrostriatal - between substantia nigra and striatum

Question 121

Role of basal ganglia

Answer 121

Enable practiced motor acts, gating the voluntary movements initiate din motor cortex and suppressing inappropriate motor commands. Role in cognitive function, implicit memory tasks, executive and emotional programmes.

Question 122

Psychiatric disorders with basal ganglia involvement

Answer 122

OCD - overactive caudate nucleus ADHD - underactive caudate Tourette syndrome - putamen Athymhormic syndrome or PAP syndrome - cortico-striatal complex (lack of motivation and urgency)

Question 123

Motor disorders affecting basal ganglia

Answer 123

Huntington's disease and parkinsonism

Question 124

Huntington's disease

Answer 124

Hereditory, progressive neurodegenerative disorder CAG expansion repeat - malformationof huntingtin protein Neurophysical and neuropsychiatric disturbances Personality and behaviour changes, mood changes, psychosis.

Question 125

Parts of the brain stem

Answer 125

Medulla oblongata Pons Midbrain

Question 126

Brain stem function

Answer 126

Regulates cardiac and respiratory functions Key role in sleep cycle regulation Maintaining consciousness Assist with reticular formation

Question 127

Midbrain - inferior colliculus

Answer 127

Received auditory impulses from the cochlear nuclei

Question 128

Midbrain - superior colliculi

Answer 128

Received visual information from teh retina and the visual cortex, directing the movements of the eyes toward a visual, auditory or tactile signal

Question 129

The red ucleus

Answer 129

High iron content, very vascular Part of extrapyramidal system Relays superior cerebral peduncle fibres Transmits descending motor information from the cortex to spinal cord via corticorubrospinal tract and cranial nerves to coordinate muscle tone and body position

Question 130

Substantia nigra

Answer 130

darker in colour - presence of melanin (by-product of dopamine) Two parts: - pars compacta - mainly dopaminergic neurons - pars reticulata - maining GABAergic neurons

Question 131

Cause of parkinson symptoms

Answer 131

Degeneration of the dopamine cells in the pars compacta of the substantia nigra, leading to depletion of dopamine in the nigrostriatal pathway

Question 132

Pars divided into

Answer 132

Pontine tegmentum - dorsally Basilar pons - ventrally

Question 133

Reticular formation

Answer 133

Area in the brain stem Regulates sleep wake cycle / consciousness Filtering incoming information to differential irrelevant background stimuli

Question 134

medulla oblongata roles (5)

Answer 134

Respiration - chemoreceptors Heart function - sympathetic and parasympathetic Vasomotor centres - baroreceptors Digestion Reflex centres of vomiting, coughing, sneezing, swallowing

Question 135

Olfactory nerve

Answer 135

CN I Smell

Question 136

Optic nerve

Answer 136

CN II Vision

Question 137

Oculomotor nerve

Answer 137

CN III Eye movements sup/inf/med recture inf oblique levator palpabrae pupillary constriction

Question 138

Trochlear nerve

Answer 138

CN IV Downward and medial movement of eye - sup oblique

Question 139

Trigeminal nerve

Answer 139

CN V General sensory sensation of face, scalp, oral and nasal cavity Corneal reflex Muscles of mastication

Question 140

Abducens nerve

Answer 140

CN VI Lateral movement of eyeball

Question 141

Facial nerve

Answer 141

CN VII Taste sensation of anterior 2/3 of tongue Muscles of facial expression

Question 142

Auditory / vistibulo

Answer 142

CN VIII Hearing and proprioception of head and balance

Question 143

Glosso-pharyngeal nerve

Answer 143

CN IX General sensation of middle ear, pharynx and taste of posterior third of the tongue Swallowing

Question 144

Vagus nerve

Answer 144

CN X General sensations of pharynx, larynx, oesophagus, external ear and viscera Speech and swallowing Control of GI, CVS and resp systems

Question 145

Accessory nerve

Answer 145

CN XI Movement of head and shoulders through trapezius and sternocleidomastoid muscle

Question 146

Hypoglossal nerve

Answer 146

CN XII Movement of tongue

Question 147

Cerebellum

Answer 147

Fibre bundles: superior, middle and inferior cerebellar peduncles Acts as a quality controlled, correcting errors - esp motor Received info regarding proprioception and balance Connections to and from the rest of the cortex

Question 148

Anterior lobe of cerebellum

Answer 148

Receives proprioception information from muscles and joints about our position in space, information on muscle tone is relayed in the spinocerebellar tract

Question 149

Posterior lobe of cerebellum

Answer 149

Received motor information from the cortex, which is processed and streamlined in the posterior lobe. it is then conveyed back to the thalamus and cerebral cortex

Question 150

Flocculonodular lobe of cerebellum

Answer 150

receives information from the vestibular nuclei and coordinates balance

Question 151

Vermis of cerebellum

Answer 151

Coordinates truncal musculature stability

Question 152

Cerebellar symptoms

Answer 152

Dysmetria Dysdiadokinesia Hypotonia Intention tremor Scanning and staccato speech Nystagmus Ataxia Pendular knee-jerk

Question 153

Spinal cord functions (4)

Answer 153

Receiving multimodal sensory afferents from the body Relaying descending motor efferents to the trunk and limbs Integrating autonomic functions for most of the viscera, including bladder and bowel functions Plays a vital role in maintaining muscle tone and initiating reflex movements

Question 154

Spinal meninges layers (6)

Answer 154

Pia mater - innermost layer Subarachnoid space - CSF here Arachnoid mater - surrounds cord like a sheath Subdural space - potential space between arachnoid and dura mater Dura mater - outermost covering, tough and fibrous Epidural space - separates dura mater from bone wall of vertebrae, contains fat, lymphatics and vasculature

Question 155

Ascending spinal tracts

Answer 155

Carry info on pain, heat, touch and proprioception Some reaches consciousness, some unconscious

Question 156

Dorsal columns function

Answer 156

Proprioception, fine touch and vibration IPSILATERAL

Question 157

Spinothalamic tracts function

Answer 157

Pain, temperature, deep touch and pressure CONTRALATERAL

Question 158

Spinocerebellar tracts

Answer 158

Control of posture and coordination of movement IPSILATERAL

Question 159

Spino-olivary tract function

Answer 159

Unconscious proprioception and is involved in balance CONTRALATERAL

Question 160

Types of descending spinal tracts (5)

Answer 160

corticospinal rubrospinal tectospinal vestivulospinal reticulospinal

Question 161

Corticospinal tracts function

Answer 161

voluntary, discrete, skilled movements

Question 162

Rubrospinal tracts function

Answer 162

Affects the tone of the limb and fine hand movements CONTRALATERAL

Question 163

Tectospinal tracts function

Answer 163

Mediates movement of the head in response to visual stimuli CONTRALATERAL

Question 164

Vestibulospinal tract function

Answer 164

Control extensor muscle tone in the anti-gravity position IPSILATERAL

Question 165

Reticulospinal tract function

Answer 165

Influence voluntary movement, reflex activity and muscle tone IPSILATERAL

Question 166

5 parts of basal ganglia

Answer 166

caudate putamen globus pallidus subthalamic nucleus substantia nigra

Question 167

is basal ganglia grey or white matter

Answer 167

grey

Question 168

ventral division of basal ganglia

Answer 168

emotional behaviours substantia innominata, nucleus accumbens, olfactory tubercle

Question 169

dorsal division of basal ganglia

Answer 169

motor function globus pallidus, caudate nucleus and putamen

Question 170

Globus pallidus

Answer 170

Forms part of the lentiform nucleus with the putamen two segments: medial (internal) and lateral (external) Both segments contain 'tonically active' GABAergic inhibitory neurons, that can be decreased by striatum signals. This is part of the direct pathway of the basal ganglia.

Question 171

subthalamus strokes/tumours

Answer 171

contralateral hemiballismus continuous, repetitive involuntary movements can cause significant disability lack of muscle tone in affected limbs

Question 172

how do antipsychotics cause EPSEs

Answer 172

block D2 receptors substantia nigra

Question 173

nucleus accumbens

Answer 173

'limbic motor interface' - flow of information from various limbic structures to areas associated with motor processing part of reward system, linked with dopamine

Question 174

Nucleus basalis of Meynert (nbM)

Answer 174

'open' nucleus with no distinct boundaries contains large amounts of acetylcholine and choline acetyltransferase deficiency of cholinergic neurons - dementia symptoms in Alz and PD

Question 175

ventral tegmental area

Answer 175

part of reward circuit - high percentage of dopamine within midbrain parallel functions to the pars compacta of substantia nigra implicated in influencing newly learned behaviour through a rewards process

Question 176

skeletomotor circuit of basal ganglia

Answer 176

most strongly linked with motor dysfunctions movement is expedited via the direct pathway when neurons from the ventrolateral thalamus are disinhibited

Question 177

Three common attributes displayed by cerebral cortical neurons affected by the basal ganglia

Answer 177

- receive +++ sensory input - react to motivational stimuli - part of premovement activities Lesions in these cortical areas result in attentional deficits and defective movements

Question 178

eye movement control

Answer 178

oculomotor circuit superior colliculus - closely linked with basal ganglia

Question 179

3 behavioural circuits linked with prefrontal cortex

Answer 179

executive dysfunction - dorsolateral prefrontal circuit apathy - anterior cingulate circuit disinhibition - orbitofrontal circuit

Question 180

dorsolateral prefrontal circuit

Answer 180

EXECUTIVE DYSFUNCTION > dorsolateral prefrontal > caudate nucleus > globus pallidus, substantia nigra > thalamus PROBLEMS: dysexecutive syndrome unable to recall memories lack of verbal and non-verbal fluency

Question 181

anterior cingulate circuit

Answer 181

APATHY / MOTIVATION > medial frontal cortex > nucleus accumbens > globus pallidus, substantia nigra > thalamus PROBLEMS: extreme state of apathy - akinetic mutism lack of mental or physical initiative unresponsiveness

Question 182

orbitofrontal circuit

Answer 182

DISINHIBITION > orbitofrontal cortex > caudate nucleus > globus pallidus, substantia nigra > thalamus PROBLEMS: Huntington's disease behavioural disinhibition general irritability

Question 183

conditions related to dorsolateral prefrontal cortex dysfunction

Answer 183

parkinsons huntingtons PSP wilsons neuroacanthocytosis

Question 184

what does the limbic striatum ventral striatum consist of?

Answer 184

ventral putamen ventromedial caudate olfactory tubercle nucleus accumbens

Question 185

side effects of DBS for parkinsons (7)

Answer 185

cognitive defects - including verbal fluency profound hypersexuality mental confusion extreme tiredness loss of visual fields memory damage

Question 186

psychiatric manifestations of parkinsons disease (6)

Answer 186

cognitive impairment and dementia depression psychosis impulsivity pathological gambling

Question 187

atypical parkinsonism (5)

Answer 187

tendency to fall over backwards difficulty looking downwards or blurring/double vision dystonia in torso and neck dysarthria cognitive impairment

Question 188

PSP

Answer 188

usually starts in 50s rapid deterioration death within 5-10 years apathy and disinhibition bradykinesia depression personality and behaviour change emotional lability impaired judgement deficits in learning ability

Question 189

huntingtons disease pathology

Answer 189

neurodegenerative, AD disorder CAG repeat expansion >35 deterioration and loss of function in caudate nucleus and striatum further decline in frontal cortex and selective loss of GABAergic neurons

Question 190

huntingtons features

Answer 190

onset usually between 35-50y chorea dystonia - rigidity and contracture slow or abnormal eye movements impaired gait, posture, balance difficulty with speech or swallowing plus psychiatric and personality changes

Question 191

PANDAS

Answer 191

paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections appears between 3y - puberty

Question 192

OCD brain changes

Answer 192

hyperactivity of orbitofrontal cortex - increase projections from caudate nucleus lowers thalamus inhibition, makes it hyperactive this further intensifies orbitofrontal cortex hyperactivity imbalance within the direct/indirect pathways - my be underlying cause for development of OCD

Question 193

brain areas relevant to the dopamine pathways (8)

Answer 193

ventral tegmental area nucleus accumbens prefrontal cortex substantia nigra striatum hypothalamus pituitary thalamus

Question 194

brain areas relevant to serotonin pathways (9)

Answer 194

raphe nuclei prefrontal cortex thalamus hypothalamus amygdala hippocampus striatum nucleus accumbens cerebellum

Question 195

brain areas relevant to the acetylcholine pathways (7)

Answer 195

brainstem nucleus basalis of meynert prefrontal cortex thalamus hypothalamus amygdala hippocampus

Question 196

brain areas relevant to the histamine pathways (6)

Answer 196

tuberomammillary nucleus (in hypothalamus) prefrontal cortex thalamus amygdala hippocampus striatum

Question 197

brain areas relevant to the glutamate pathways (5)

Answer 197

prefrontal cortex brainstem striatum nucleus accumbens thalamus

Question 198

brain area associated with compulsions

Answer 198

prefrontal cortex

Question 199

4 major dopamine pathways

Answer 199

mesolimbic mesocortical nigrostriatal tuberoinfundibular

Question 200

mesolimbic dopamine pathway

Answer 200

VTE to NA overactivity - psychosis associated with motivation, pleasure, reward - addiction

Question 201

mesocortical dopamine pathway

Answer 201

VTE to prefrontal cortex hypoactivity - negative symptoms of Scz cognition, executive function - dorsolateral prefrontal cortex emotion and affect - ventromedial prefrontal cortex

Question 202

nigrostriatal dopamine pathway

Answer 202

substantia nigra to striatum hypoactivity - parkinsonism, akathisia, dystonia overactivity - chorea, dyskinesias, ticks

Question 203

tuberoinfundibular dopamine pathway

Answer 203

hypothalamus to anterior pituitary gland hypoactivity - hyperprolactinaemia

Question 204

thalamic dopamine pathway

Answer 204

from multiple brain regions to the thalamus function unclear ?sleep and arousal

Question 205

2 major noradrenaline pathways

Answer 205

ASCENDING: locus coeruleus to hypothalamus, thalamus, hypothalamus, amygdala, hippocampus and cerebellum > regulates mood, arousal, cognition, sexual behaviour DESCENDING: from brainstem down spinal cord > regulates pain pathways

Question 206

two major serotonin pathways

Answer 206

ASCENDING: raphe nuclei to, prefrontal cortex, thalamus, hypothalamus, amygdala, hippocampus, striatum, nucleus accumbens, cerebellum > mood, anxiety, sleep, wakefulness DESCENDING: brainstem down spinal cord > pain pathways

Question 207

two major acetylcholine pathways

Answer 207

- pathway from the brainstem: arousal cognition, otehr functions - pathway from the basal forebrain: memory, implicated in Alzheimers

Question 208

histamine pathway

Answer 208

from tuberomammillary nucleus to prefrontal cortex, thalamus, amygdala, hippocampus, striatum regulates arousal, sleep, wakefulness

Question 209

5 key glutamate pathways

Answer 209

- cortical brainstem glutamate pathway: hypoactive in scz - corticostriatal glutamate pathway: emotion, impulsivity, compulsivity, motor - thalamocortical pathway: fails in scz and info goes back to cortex causing positive and neg sx - corticothalamic pathway: some sensory info to thalamus - cortico-cortical pathway: dysregulation in negative sx scz

Question 210

dopamine pathway associated with positive sx of scz

Answer 210

mesolimbic

Question 211

structure associated with alz

Answer 211

nucleus basalis of meynert

Question 212

glutamate pathway that acts as a brake on mesolimbic dopamine pathway

Answer 212

cortical brainstem pathway

Question 213

parts of a neuron

Answer 213

cell body/'soma' dendrites axon

Question 214

what is the axon hillock

Answer 214

initial segment of the axon as it moves down from the soma

Question 215

role of golgi apparatus in neuron

Answer 215

modifies, sorts and packages proteins (including neurotransmitters) for secretion

Question 216

role of nissl substance in neuron

Answer 216

contains RER and ribosomes site of protein synthesis

Question 217

role of lysosomes in neuron

Answer 217

contain enzymes that break down cellular debris

Question 218

role of microfilaments and tubules in neuron

Answer 218

provide structural support and transportation within the cell

Question 219

how can neurons be classified

Answer 219

functional classification: sensory, motor or interneurons structural classification: unipolar, bipolar or multipolar

Question 220

sensory/afferent neurons

Answer 220

conduct nerve impulses to CNS uni and bipolar neurons are sensory in function

Question 221

motor/efferent neurons

Answer 221

convey impulses outwards from the brain these are the largest neurons

Question 222

interneurons / association neurons

Answer 222

found entirely within the CNS enable communication between CNS and other neurons

Question 223

glial cells

Answer 223

provide a supportive function in maintaining the action of neurons smaller than neurons, lack axons and dendritesa

Question 224

astrocytes (7)

Answer 224

derived from neural tube ectoderm star shaped largest of glial cells aid BBB formation structural support repair processes regulate oxidised K+ conc in extracellular fluid

Question 225

gliosis/astrocytosis

Answer 225

when brain tissue is damaged, astrocytes proliferate and fill the gap by forming a dense network termed a glial scar

Question 226

oligodendrocytes

Answer 226

derived from neural tube ectoderm responsible for formation and maintenance of myelin sheath in CNS mainly found in white matter

Question 227

microglia

Answer 227

mesenchymal origin primary immune cells of CNS scavengers of the nervous system aid phagocytosis

Question 228

ependymal cell derived from...

Answer 228

neural tube ectoderm

Question 229

columnar epithelial cells

Answer 229

line ventricles of brain and central canal of spinal cord form specialised choroid plexus epithelium that secretes the CSF

Question 230

schwann cells

Answer 230

from neural crest myelination of PNS

Question 231

satellite cells

Answer 231

from neural crest provide supportive role

Question 232

allocortex consists of

Answer 232

paleocortex: includes entorhinal cortex and piriform lobe archicortex: consists of hippocampus

Question 233

neocortex

Answer 233

more than 90% of cerebral cortex two main cell types: pyramidal cells and stellate cells

Question 234

fusiform cells

Answer 234

spindle shaped cells places at right angles to surface in deep layer of cortex

Question 235

horizontal cells of Cajal

Answer 235

spindle shaped cells orientated horizontally in cortex

Question 236

cells of Martinotti

Answer 236

small multipolar cells found in layers 3-6 of cortex in almost all layers of the cortex

Question 237

6 layers of the neocortex

Answer 237

1. plexiform / molecular level 2. outer granular level 3. outer pyramidal level 4. inner granular level 5. inner granular level 6. multiform cell level

Question 238

pyramidal cells

Answer 238

75% of cortical neurons principal output neurons layers 2-5 of neocortex largest pyramidal cells and Betz cells

Question 239

Betz cells

Answer 239

largest pyramidal cells in layer 5 of motor cortex

Question 240

stellate cells

Answer 240

aka granular cells star shaped, small, multipolar neurons prominent in layer 6 main interneurons in neocortex - pass on signals between cells of the same region short axons do not leave the cortex

Question 241

spiny vs smooth stellate cells

Answer 241

spiny: excitatory smooth: inhibitory

Question 242

molecular / outermost layer of cortex

Answer 242

axons of granule cells dendrites of Purkinje cells stellate and basket cells

Question 243

purkinje / middle layer of cortex

Answer 243

single layer or cell bodies of Purkinje cells large neurons with a single axon extending deep into the cerebellum and multiple dendrites extending into the molecular level

Question 244

granular / innermost layer of the cortex

Answer 244

contains granule cells, small neurons whose axons extend into the molecular layer, and golgi cells, types of interneurons

Question 245

purkinje cells

Answer 245

uniquely found in cerebellum only source of output from cerebellar cortex type of inhibitory neuron, use GABA

Question 246

granule cells

Answer 246

most numerous type of neuron in the cerebellum only excitatory neurons in the cerebellum (use glutamate) excite the purkinje cells via axonal branches called 'mossy fibres'

Question 247

inhibitory interneurons

Answer 247

stellate, basket and golgi cells

Question 248

hippocampus layers

Answer 248

polymorphic layer - contains nerve fibres and small cell bodies of interneurons pyramidal layer - contains hippocampal pyramidal cells molecular layer - contains dendrites of the pyramidal cells

Question 249

principle cells of the hippocampus

Answer 249

pyramidal cells

Question 250

most abundant cell in the nervous system

Answer 250

glial cells

Question 251

ependymal cells

Answer 251

epithelial cells that line the ventricles and cover the choroid plexus. contribute to production and directional flow of CSF

Question 252

nodes of ranvier

Answer 252

small gaps between sections of myelin sheath which allow passage of ions, so propagating the electrical signal

Question 253

resting membrane potential

Answer 253

-60 to -75 mV

Question 254

how is resting membrane potential sustained

Answer 254

selective permeability of cell membrane to K+ ions at rest, K+ allowed to leak out of the neuron, leaving negative charge on inner surface of the membrane

Question 255

how does depolarisation happen

Answer 255

Na channels open briefly in response to excitators NTs lots of small depolarisations raise membrane potential by around 10mV - beyond AP Na rushes in making more +ve charged up to 100mV, Na channels then close triggers opening of L+ channels, allowing K+ out - this is repolarisation

Question 256

refractory period

Answer 256

immediately after an AP, open K+ channels cause membrane potential to repolarise and briefly drop below resting potential to about -80mV K+ then close, returning membrane to its resting potential limits the rate at which neurons can fire, and prevents AP being propagated in the wrong direction

Question 257

saltatory conduction

Answer 257

speed of AP propagation usually related to size of axon bigger diameter, faster transmission

Question 258

3 types of synapses

Answer 258

chemical electrical conjoint

Question 259

chemical synapses

Answer 259

NT diffuses across synaptic cleft and binds to post-synaptic receptors leads to change in permeability of the membrane reuptake by active transport

Question 260

electrical synapses

Answer 260

direct membranous contact between neurons neuron directly influenced by voltage changes in the other areas: retina, vestibular nucleus, nucleus of 5th cranial nurse

Question 261

conjoint synapses

Answer 261

properties in common with chemical and electrical synapses rarer found in lateral vestibular nucleus

Question 262

gap junctions

Answer 262

collections of protein channels in cell membranes allowing intercellular connections

Question 263

enhaptic transmission

Answer 263

form of communication between cells in nervous system, different to electrical synapses when electrical activity of one neuron alters the excitability of nearby neurons retinal photoreceptors, olfactory system, between cardiac cells

Question 264

excitatory NTs (7)

Answer 264

acetylcholine aspartate dopamine histamine noradrenaline adrenaline glutamate

Question 265

inhibitory NTs (3)

Answer 265

GABA serotonin glycine

Question 266

monoamines

Answer 266

serotonin, dopamine, noradrenaline, adrenaline

Question 267

acetylcholine derived from

Answer 267

choline

Question 268

serotonin derived from

Answer 268

tryptophan

Question 269

dopamine derived from

Answer 269

tyrosine

Question 270

noradrenaline derived from

Answer 270

tyrosine

Question 271

adrenaline derived from

Answer 271

tyrosine

Question 272

GABA derived from

Answer 272

glutamate

Question 273

glutamate derived from

Answer 273

dietary

Question 274

histamine derived from

Answer 274

histadine

Question 275

ionotropic receptors mechanism

Answer 275

act immediately last around 10-20ms open transmembrane channel allowing passage of ions

Question 276

ionotropic receptor examples (5)

Answer 276

glutamate rec NMDA rec GABAa rec 5-HT3 rec nicotinic rec

Question 277

metabotropic receptors mechanism

Answer 277

take up to 30ms to start last up to around 1s initiation of a metabolic change by stimulating the membrane bound G proteins via series of reaction, initiating the change in the cell

Question 278

metabotropic receptor examples (3)

Answer 278

dopamine D1-D5 rec serotonin rec (except 5-HT3) muscarinic M1-M3 rec

Question 279

D1 group of dopamine receptors

Answer 279

D1 and D5 GPCR increase intracellular conc of cAMP

Question 280

D2 group dopamine recptors

Answer 280

D2, 3 and 4 GPCR decreases intracellular conc of cAMP

Question 281

which of the serotonin recptors if NOT GPCR

Answer 281

5-HT3 - this is ligand gated ion channel receptor

Question 282

2 types of noradrenaline receptors

Answer 282

alpha (1 and 2) beta (1 and 2) all are GPCR a1 and b1 are excitatory a2 and b2 are inhibitory

Question 283

divisions of acetylcholine receptors

Answer 283

muscarinic - GPCR nicotinic - ion channel rec

Question 284

neuromodulator

Answer 284

acts some distance from site of release, and/or has long lasting effects, and/or is released by glia

Question 285

neurotrophic factor

Answer 285

substance which promotes neuronal differentiation and survival

Question 286

amino acid examples (4)

Answer 286

glutamate GABA glycine aspartate

Question 287

monoamine examples (6)

Answer 287

noradrenaline adrenaline dopamine serotonin melatonin histamine

Question 288

Purine examples (2)

Answer 288

adenosine ATP

Question 289

neuropeptide examples (2)

Answer 289

cholecystokinin endorphins

Question 290

what ion causes NT release

Answer 290

calcium

Question 291

pregabalin MOA

Answer 291

inhibits some types of voltage gated calcium channels, reducing release of many types of NT

Question 292

gabapentin MOA

Answer 292

inhibits some types of voltage gated calcium channels, reducing release of many types of NT

Question 293

amphetamine MOA

Answer 293

displaces noradrenaline from vesicles. causes noradrenaline's conc in nerve terminal to increase, causing its transporter to operate in reverse, allowing it out into the synaptic cleft

Question 294

enzyme involved in glutamate to GABA

Answer 294

glutamic acid decarboxylase

Question 295

levodopa MOA

Answer 295

increases the availability of precursors for dopamine synthesis

Question 296

moclobemide MOA

Answer 296

reversibly inhibits a key enzyme for the degradation of noradrenaline, dopamine and serotonin

Question 297

selegiline MOA

Answer 297

irreversibly inhibits a key enzyme for the degradation of dopamine

Question 298

MAOI cheese reaction

Answer 298

tyramine is a dietary amine can trigger the release of noradrenaline

Question 299

enzyme for choline to acetylcholine

Answer 299

choline acetyltransferase

Question 300

enzyme that degrades acetylcholine to choline and acetate

Answer 300

acetylcholinesterase or butytylcholinesterase

Question 301

donepezil MOA

Answer 301

inhibits acetylcholinesterase only

Question 302

rivastigmine MOA

Answer 302

inhibits acetylcholinesterase and butyrylcholinesterase

Question 303

galantamine MOA

Answer 303

inhibits acetylcholinesterase and allosterically modulates nicotinic cholinergic receptors

Question 304

autoreceptors

Answer 304

presynaptic receptors on the same neuron that inhibit further NT release via negative feedback

Question 305

heteroreceptors

Answer 305

located on presynaptic receptor terminals and respond to neurochemicals released from other neurons

Question 306

tachyphylaxis

Answer 306

sudden decrease in the effects produced by a drug or substance that may occur during continuous use or continuous repeated administration

Question 307

noradrenaline metabolism

Answer 307

metabolised by MAO-A and COMT to VMA and MPHG

Question 308

serotonin metabolism

Answer 308

degraded by MAO-A to 5HIAA

Question 309

which serotonin receptor can have antimigraine effect when stimulated

Answer 309

5-HT1D

Question 310

which serotonin receptor can cause anxiety, agitation, insomnia and sexual dysfunction when stimulated?

Answer 310

5-HT2

Question 311

which serotonin receptor is associated with antipsychotic weight gain

Answer 311

5-HT2C

Question 312

which serotonin receptor when stimulated can cause nausea, diarrhoea and headache

Answer 312

5-HT3 ondansetron is a 5-HT3 antagonist

Question 313

which serotonin receptor is involve din circadian rhythm regulation

Answer 313

5-HT7

Question 314

nicotinic receptors

Answer 314

ionotropic fast acting excitatory thalamus and cortex

Question 315

muscarinic (M1-M5) receptors

Answer 315

metabotropic G-protein mediated inhibitory or excitatory medicate the anticholinergic effect of drugs

Question 316

GABA-A ion channel

Answer 316

5 subunits shaped like a rosette binding sites for: GABA benzos barbiturates neurosteroids

Question 317

AMPA receptors

Answer 317

glutamate receptor subtype mainly postsynaptic ionotropic fast excitatory neurotransmission

Question 318

kainate receptors

Answer 318

glutamate receptor subtype ionotropic mainly presynaptic regulate release of glutamate mainly found in hippocampus

Question 319

principle site of noradrenaline synthesis

Answer 319

locus coerulus

Question 320

principle site of serotonin release

Answer 320

raphe nucleus

Question 321

4 dopamine pathways

Answer 321

nigrostriatal mesolimbic mesocortical tuberoinfundibular

Question 322

where does acetylcholine arise form in the brain

Answer 322

nucelus basalis of Meynert

Question 323

2 inhibitors NTs

Answer 323

GABA glycine

Question 324

CRH

Answer 324

released in hypothalamus stimulates noradrenergic activity controlled by glucocorticoid and ACTH levels reduced appetite and sexual drive excess - depression, anxiety, addictions

Question 325

CCK

Answer 325

gut peptide also found in brain implicated in anxiety and pain may inhibit feeding

Question 326

substance P

Answer 326

found in sensory neurons, spinal cord and brain associated with pain implicated in depression

Question 327

3 opioid receptor subtypes

Answer 327

mu - analgesia, addiction, resp depression kappa - dysphoria delta - reinforcement

Question 328

corticosteroids secreted from

Answer 328

adrenal glands

Question 329

corticosteroid subdivisions

Answer 329

glucocorticoids mineralocorticoids sex hormones

Question 330

neuropeptide Y

Answer 330

involved in feeding behaviour and anxiety

Question 331

vasopressin

Answer 331

role in memory

Question 332

typical antipsychotic receptor action

Answer 332

antagonism of postsynaptic D2 receptors

Question 333

atypical antipsychotics receptor action

Answer 333

block D2 and 5HT2 receptors

Question 334

clozapine receptor action

Answer 334

higher affinity for D4 and D1 rec

Question 335

aripiprazole mechanism

Answer 335

5HT2A antagonist and partial 5HT1A receptor

Question 336

memantine mechanism

Answer 336

specific uncompetitive NMDA antagonist

Question 337

phencyclidine mechanism

Answer 337

NMDA antagonist

Question 338

acamprosate mechanism

Answer 338

GABA analogue, stimulates GABA inhibiting transmission

Question 339

what is white matter composed of

Answer 339

glial cells and myelinated axons

Question 340

imaging - DTI

Answer 340

form of MRI that uses diffusion of water molecules alone the length of the nerve bundles facilitates the measurement, orientation and location of the white matter pathways

Question 341

functions of white matter pathways

Answer 341

higher aspects of motor functioning visual perception and related functions auditory information and related functions language funtions pain perception

Question 342

white matter pathways - association tracts

Answer 342

connect cortical areas within the same hemisphere

Question 343

white matter pathways - commissural tracts

Answer 343

connect cortical regions between the two hemispheres

Question 344

white matter pathways - projection tracts

Answer 344

bidirectional pathways arising the the cortex and terminating in the sub-cortical centres

Question 345

long association fibres

Answer 345

bidirectional connections through deep white matter

Question 346

short association fibres

Answer 346

for connections with nearby gyri subcortical, referred to as 'u fibres'

Question 347

largest white matter tract in the limbic system

Answer 347

cingulum

Question 348

corpus callosum function

Answer 348

integrates perceptual information both early and higher level cognitive processing coordinates bimanual tasks and bilateral axial movements during learning stages role in lateralisation or asymmetry of the brain inhibitory and excitatory role over both hemispheres

Question 349

corpus callosum stroke

Answer 349

Left ideomotor apraxia left hand anomia and left colour anomia associative visual agnosia left visual field dyslexia left hand agraphia right hand constructional apraxia left hemispatial neglect left motor neglect callosal alien hand syndrome delay in visuomotor responses optic ataxia

Question 350

lateral pain system

Answer 350

S1 and S2 arising from lateral thalamus discriminates the location and intensity of painful stimuli

Question 351

medial pain system (ACC)

Answer 351

arises from medial thalamus mediated affective cognitive-evaluative (psychological) component of the stimulus

Question 352

ascending pain pathway

Answer 352

pain signals travel via contralateral spinothalamic tract to medulla and brainstem

Question 353

type 1 delta fibres

Answer 353

fast adapting high threshold for activity

Question 354

type 2 delta fibres

Answer 354

slow adapting low threshold for activity

Question 355

C pain fibres

Answer 355

unmyelinated slow conducting burning sensation

Question 356

descending pain pathways

Answer 356

limbic cortical areas plus autonomic information from the brainstem

Question 357

most common dementia

Answer 357

alzheimers 62%

Question 358

cortical dementia 4 A's

Answer 358

amnesia aphasia apraxia agnosia

Question 359

subcortical dementia sx

Answer 359

bradyphrenia frontal executive dysfunction personality/mood changes

Question 360

tauopathies (5)

Answer 360

picks disease corticobasal degeneration (CBD) PSP MAPT multiple system atrophy (MSA)

Question 361

synucleinopathies (4)

Answer 361

lewy body dementia parkinsons dementia pure autonomic failure (PDD) pure autonomic failure (PAF) various subtypes of MSA

Question 361

ubiquitinopathies (3)

Answer 361

FTLD-TDP FTDP-17 (PGRN) PTLD-FUS

Question 362

gross anatomical features of alzheimers

Answer 362

generalised brain atrophy focal atrophy of medial temporal lobe dilatation of lateral ventricles

Question 363

stains for senile plaques

Answer 363

silver congo red thioflavin S

Question 363

histopathological features of alzheimers

Answer 363

senile/neuritic plaques - beta amyloid neurofibrillary tangles - hyperphosphorylated tau

Question 364

what is amyloid precursor protein (APP) cleaved by

Answer 364

initially - beta secretase then - gamma secretase

Question 365

hirano bodies seen in

Answer 365

alzheimers FTLD CJD

Question 366

3 stages of alzheimers NIA-AA criteria

Answer 366

preclinical mild cognitive impairment dementia

Question 367

what does CERAD criteria for Alz use

Answer 367

neuropathological and clinical components uses senile plaques definite/probable/possible/normal

Question 368

braak and braak staging system of Alz

Answer 368

purely neuropathological criterion

Question 369

multi infarct dementia

Answer 369

series of tiny strokes

Question 370

SVD with dementia

Answer 370

pathology in small arteries, arterioles, capillaries, venules

Question 371

strategic infarct dementia

Answer 371

single ischaemic lesion affecting parts of the brain invovled in cognition and behaviour

Question 372

Binswanger's disease

Answer 372

subcortical arteriosclerotic leukoencephalopathy deep white matter damaged due to arteriosclerosis

Question 373

cerebral amyloid angiopathy (CAA)

Answer 373

presence of beta amyloid in middle and outer layers of small and medium arteries in the brain

Question 373

CADASIL

Answer 373

cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy most common genetic form for vascular dementia AD mutations of notch 3 gene on Ch 19

Question 374

hypoperfusive dementia

Answer 374

ischaemic hypoxic dementia hypotension and hypoperdusion watershed zones, wedge shaped related to COPD and surgical procedures

Question 375

haemorrhagic dementia

Answer 375

bleed in the brain SAH, subdural

Question 376

common causes of CVD

Answer 376

atherosclerosis arteriosclerosis hypertensive arteriopathy CAA

Question 377

histopathology of FTLD

Answer 377

tauopathies ubiquitinopathies

Question 378

gross anatomical features of FTLD

Answer 378

atrophy of frontal and temporal lobes

Question 379

FTLD tauopathies (5)

Answer 379

Picks disease corticobasal degeneration (CBD) PSP FTDP-17 (MAPT) MSA

Question 380

FTLD ubiquitinopathies (3)

Answer 380

FTLD-TDP FTDP-17 (PGRN) FTLD-FUS

Question 381

picks disease gross anatomical features

Answer 381

knife blade atrophy

Question 382

histopathological features of picks disease (5)

Answer 382

pick bodies pick cells neuronal loss gliosis microvacuolation

Question 383

pick bodies

Answer 383

cytoplasmic neuronal inclusions contain tau

Question 384

histopathological features of lewy body dementia

Answer 384

lewy neurites cortical senile plaques gliosis loss of neurons in substantia nigra - depigmentation

Question 385

pick cells

Answer 385

swollen neurons with eccentrically displaced nuclei 'ballooned' neurons

Question 386

EEQ delta wave

Answer 386

<4 Hz prominent during sleep, not waking adults frontal - adults posterior - children

Question 387

EEG theta wave

Answer 387

4-8 Hz any age, usually during sleep common in children to age 13 abnormal in waking adults

Question 388

EEG alpha wave

Answer 388

8-13 Hz all ages, most commonly adults diminish with concentration/focus

Question 389

EEG beta wave

Answer 389

14-40 Hz all ages usually anterior drugs - barbituates, benzos

Question 390

EEG gamma wave

Answer 390

>40 Hz disappear during anaesthesia

Question 391

EEG - evoked responses/potentials

Answer 391

measure the electrophysiological response to various stimuli - visual evoked potential - brainstem auditory evoked potential - somatosensory evoked potential

Question 392

West syndrome

Answer 392

infantile spasms developmental retardation hypsarrhythmia typically presents between 6-18 months

Question 393

childhood absence epilepsy - EEG

Answer 393

3Hz generalised spike and wave discharged with normal background for age

Question 394

Lennox Gestaut Syndrome

Answer 394

childhood epileptic encephalopathy onset 3-5 y atonic, tonic and atypical absense seizures LD slow background activity and diffuse slow spike and wave <2.5Hz

Question 395

encephalopathies EEG

Answer 395

diffuse generalised abnormal patterns

Question 396

hepatic encephalopathy EEG

Answer 396

bifrontal triphasic waves positive sharp waves followed by negative waves with relatively low amplitude

Question 397

subacute sclerosing panencephalitis (SSPE) EEG

Answer 397

periodic complexes appear bilaterally symmetrical and synchronous between hemispheres high voltage polyphasic stereotyped delta waves

Question 398

herpes encephalitis EEG

Answer 398

generalised slowing fronto temporal predominance discharges high amplitude

Question 399

HIV EEG

Answer 399

mild EEG slowing

Question 400

CJD EEG

Answer 400

predominantly anterior frequency 0.5-2/sec stop in sleep low voltage slowing

Question 401

REM sleep EEG

Answer 401

fast, low voltage activity

Question 402

NREM sleep EEG

Answer 402

Stage 1 - mixed frequencies Stage 2 - sleep spindles, K complexed, reduced prominence of slow waves Stage 3 - delta, frontal predominence, sleep spindles, vertex waves, k complexes Stage 4 - slow delta, frontal predominance

Question 403

narcolepsy

Answer 403

shortened REM latency

Question 404

lewy body EEG

Answer 404

significant slowing

Question 405

EEG schizophrenia

Answer 405

70% normal abnormalities in catatonic scz

Question 406

EEG affective disorders

Answer 406

mostly normal bipolar - generalised increased delta and theta, decreased alpha

Question 407

EEG anxiety disorders

Answer 407

low voltages diminished alpha increased beta

Question 408

EEG personality disorders

Answer 408

increased cortical slow activity in violent offenders / antisocial

Question 409

EEG lithium

Answer 409

may produce marked slow wave changes even at therapeutic levels

Question 410

Sylvian fissure

Answer 410

separates temporal lobe from frontal and parietal lobes aka lateral sulcus

Question 411

Insula

Answer 411

cerebral cortex covering the sylvian fissure role in production of speech, processing social emotions, pain, temp, taste, olfaction, auditory, vestibular and visceral perceptions role in additction receives afferent fibres from sensory thalamic nuclei link with schizophrenia, FTD

Question 412

fusiform gyrus

Answer 412

on inferior surface of temporal and occipital lobes facial recognition - impairment causes prosopagnosia

Question 413

parahippocampal gyrus

Answer 413

anterior part includes entorhinal and perihinal cortices role in encoding and retrieving memories

Question 414

anterior cingulate cortex (ACC)

Answer 414

surrounds anterior corpus callosum role in regulation of emotions, impulse control, motivation, decision making and reward anticipation regulatory role in autonomic functions eg BP and HR dorsal - cognitive central - emotional

Question 415

error detection in the brain

Answer 415

ACC plays a role directs attention to task related stimuli responsible for managing responses to conflicting stimuli ACC function tested by stroop test affected in depression, and schizophrenia, OCD, social anxiety extreme damage to ACC - akinetic mutism

Question 416

spindle neurons / von economo neurons

Answer 416

in frontal insula, anterior cingulate cortex and dorsolateral prefrontal cortex process of transforming feelings into actions faster than other types of neurons social emotions across the whole brain begin to form at 4m, but work in 2nd year of life (shame, anger, guilt)

Question 417

area of ACC in neuromodulatory treatment in treatment resistant depression

Answer 417

anterior subgenual cingulate area (Cg25) overactive in treatment resistant depression DBS can target this area

Question 418

role of hippocampus

Answer 418

encoding, storing and retrieving memories declarative memory damage - anterograde amnesia and recent retrograde amnesia

Question 418

entorhinal cortex

Answer 418

primary olfactory cortex 4 cellular layers role in formation of declarative and spatial memories memory consolidation and optimisation take place during sleep here one of first structures affected by alzheimers - loss of volume degeneration seen in temporal lobe epilepsy

Question 418

subiculum role

Answer 418

retrieval of newly learned information role in initiation and maintenance of temporal lobe seizures

Question 418

uncus

Answer 418

covered with olfactory cortex link with temporal love epilepsy - olfactory and gustatory hallucinations preceding seizures can get uncal herniation due to mass effect - emergency decompression

Question 418

third cranial nerve palsy

Answer 418

eye down and out part of uncal herniation

Question 419

dentate gyrus

Answer 419

neurogenesis takes place role in formation of new memories, spatial orientation and addiction

Question 420

role of limbic system

Answer 420

fear, motivation, anger, memory, pleasure 'old brain' - functions for survival impact on endocrine and PNS

Question 421

amygdala

Answer 421

integrative role between emotions and motivation combine external and internal stimuli modulates reactions to events that are essential for survival related to fear and fear conditioning

Question 422

Urbach-Wiethe

Answer 422

gradual destruction of amygdala from early life due to calcium deposition absence of fear, but other emotions (anger, sadness, happiness, disgust) are present lose ability to recognise facial expressions of fear

Question 423

short fear pathway

Answer 423

thalamus-amygdala with omission of the cortex instantaneous value for survival response even to subliminally perceived threat results in secretion of norepinephrine, acetylcholine, dopamine and serotonin in the brain, and adrenalin and cortisol in the body autonomic changes for flight/fight

Question 424

long fear pathway

Answer 424

thalamus-cortex-amygdala guides perceptual search of environment to establish the cause of the aroused state

Question 425

mammillary bodies

Answer 425

round structures at end of anterior fornix pillars role in autobiographical memories damaged by thiamine deficiency - Korsakoffs

Question 426

left sided temporal lobe lesions

Answer 426

impaired repetition of words impaired recognition of words and loss of comprehension impaired memory of verbal material

Question 426

components of papez circuit

Answer 426

hippocampal formation mammillary bodies anterior thalamus cingulate cortex parahippocampal gyrus hippocampal formation

Question 426

right sided temporal lobe lesions

Answer 426

decreased recognition of tonal sequences and musical abilities loss of inhibition when talking impaired recall of non-verbal material such as much or drawings

Question 427

8 principles of functional impairment in temporal lobe lesions

Answer 427

auditory sensation and perception visual perception selective attention catergorisation of verbal material language comprehension long and short term memory personality changes altered sexual behaviour

Question 428

complex partial temporal lobe lesions

Answer 428

focal seizures - absence attacks automatism - purposeless behaviour olfactory and complex visual and auditory hallucinations disturbances of mood and memory - deja vu

Question 429

presentation of limbic encephalitis

Answer 429

headache, low grade fever, flu sx agitation, disinhibition auditory and visual hallucinations STM loss, concentration difficulties epileptic seizures or dyskinesia autonomic instability association with neoplastic illness, eg ovarian teratomas

Question 430

Kluver-Bucy syndrome

Answer 430

hyperorality sexual disinhibition visual agnosia loss of fear apathy amnesia aphasia

Question 431

hippocampus changes early stages of psychosis

Answer 431

volume decrease

Question 432

unmedicated depression amygdala change

Answer 432

volume loss

Question 433

tests to assess temporal lobe

Answer 433

semantic memory short term memory visual function visual fields auditory functions language functions stroop effect test rey-osterrieth complex figure test mooney closure test wechsler memore scale

Question 434

when does brain development start

Answer 434

week 3 in utero

Question 435

endoderm

Answer 435

gastro and resp systems

Question 436

ectoderm

Answer 436

epidermal ectoderm - skin, nails, sweat glands neuroectoderm - brain, CNS

Question 437

prosencephalon

Answer 437

forebrain gives rise to telencephalon (cerebral hemisphere) and diencephalon (thalamic structures)

Question 438

mesencephalon

Answer 438

midbrain

Question 439

rhombencephalon

Answer 439

hindbrain

Question 440

3 main modes of neuronal migration

Answer 440

radial migration tangential migration multipolar migration

Question 441

when does myelination start and finish

Answer 441

begins 5m in utero complete around 20y

Question 442

optimum language learning for phonemes

Answer 442

6-12 m

Question 443

factors that influence brain plasticity (8)

Answer 443

genetic predisposition experience (pre and post natal) hormones psychoactive drugs dietary factors aging stress brain injury or disease

Question 444

Bucharest early intervention project

Answer 444

studied impact of institutionalisation - institutionalised form birth - institutionalised at birth then foster - never institutionalised significant effect on brain development ADHD, ODD foster care helped with emotional difficulties

Question 445

anencephaly

Answer 445

neural tube fails to close breakdown in tissue incomplete skulls, large parts of brain missing rise from Zika virus

Question 446

encephalocele

Answer 446

part of brain and membranes herniate through opening in skull, usually at back of neck

Question 447

lissencephaly

Answer 447

smooth brain limited/absent sulci and gyri causes - infection, ischarmia, chromosome abnormalities

Question 448

heterotopias

Answer 448

clumps of grey matter in wrong part of brain cause seizures

Question 449

schizencephaly

Answer 449

abnormal neuronal migration results in clefts in the brain, lined with grey matter and filled with CSF

Question 450

complex neurodevelopmental disrders

Answer 450

due to combination of genetic, environmental and epigenetic factors eg autism, schizophrenia, ADHD, epilepsy

Question 451

schizophrenia risk factors

Answer 451

genetic vulnerability environmental maternal - diabetes, preeclampsia prenatal - rhesus, maternal malnutrition, infectious exposure obstetric - hypoxia, low birth wt, pre-term, brain injury childhood - drugs, trauma other - urban birth, winter birth, migration, older paternal age

Question 452

Schizophrenia genetic factors

Answer 452

COMT Dysbindin Neuregulin

Question 453

schizophrenia structural brain changes

Answer 453

reduced cerebral volume increased ventricle size reduced amygdala and hippocampal volume

Question 454

anterolateral / spinothalamic tract

Answer 454

crude touch pain and temperature

Question 455

ASD characterised by impairment in... (3)

Answer 455

receptive or expressive language as used in social communication development of selective or reciprocal social interaction functional or symbolic play

Question 456

brain areas involved in ASD

Answer 456

fusiform gyrus - hypoactivation amygdala insula - hypoactivation right AI frontoinsular and cingulate cortex - von economo neurons prefrontal cortex cerebellum

Question 456

dorsal / posterior column tract

Answer 456

vibration tactile discrimination / fine touch proprioception

Question 457

ipsilateral spinocerebellar tracts

Answer 457

muscle and tendon positions

Question 457

alpha beta fibres - pain

Answer 457

large diameter highly myelinated fast conduction low activation threshold light touch, non-noxious

Question 458

c fibres - pain

Answer 458

smallest diameter unmyelinated slower conduction high activation threshold slow, diffuse, dull pain temperature release combination of glutamate and substance P

Question 458

alpha delta fibres - pain

Answer 458

small diameter thinly myelinated medium conduction velocity high and low activation thresholds rapid, sharp, localised pain release glutamate

Question 459

pyramidal / corticospinal tract

Answer 459

control of voluntary movement

Question 460

extrapyramidal tracts

Answer 460

involuntary reflects, movement and coordination

Question 461

reticulospinal tract

Answer 461

controls somatic and visceral motor function

Question 462

extrapyramidal tracts

Answer 462

reticulospinal, vestibulospinal, rubrospinal, tectospinal control of involuntary movements and reflexes coordination indirect innervation of motor neurons

Question 462

Brown-Sequard syndrome

Answer 462

hemi section injury to the spinal cord loss of ipsilateral proprioception and 2 point discrimination loss of contralateral temp and pain sensation ipsilateral pyramidal signs causing spastic paralysis below lesion and abnormal reflexes

Question 463

pyramidal tracts

Answer 463

corticospinal and corticobulbar voluntary postural and fine movement direct innervation of motor neurons

Question 463

subacute combined degeneration of the spinal cord

Answer 463

vit B12 deficiency absent ankle jerk and upgoing planters muscle weakness that could become spastic clumsiness, unsteady gait, depression, psychosis and progression to dementia if untreated

Question 464

parts of basal ganglia (6)

Answer 464

corpus striatum claustrum nucleus accumbens septi and olfactory tubercle substantia nigra subthalamic nucleus

Question 465

where is melanin produced

Answer 465

pineal gland

Question 466

UMN deficits (4)

Answer 466

hypertonia spastic paralysis hyper-reflexia extensor (Babinski sign) plantar reflexes

Question 467

LMN deficit (7)

Answer 467

hypotonia flaccid paralysis hypo-reflexia flexor plantar reflexes muscle wasting fasciculation fibrillation

Question 468

role of limbic system (4)

Answer 468

memory emotional and behavioural expression motivation olfaction

Question 469

dorsolateral prefrontal cortex function

Answer 469

allows the organisation of information to facilitate response in major executive fuctions

Question 470

anterior cingulate function

Answer 470

has a role in motivating behaviour

Question 471

orbitofrontal lobe function

Answer 471

integration of limbic and emotional information into behavioural responses

Question 472

features of damage to dorsolateral prefrontal cortex (6)

Answer 472

poor planning impaired concentration/attention, affecting working memory perseveration and impersistence deficits in set shifting motor programming disturbances concrete thinking and poor judgement

Question 473

bilateral medial temporal lobe lesions

Answer 473

profound global amnesia problems with learning verbal material when lesions on dominant side problems with learning non-verbal material when lesions on non-dominant side

Question 474

satiety centre

Answer 474

ventromedial hypothalamus

Question 475

circadian pacemaker

Answer 475

suprachiasmatic nucleus (SCN)

Question 476

ghrelin

Answer 476

fast acting orexigenic hormone helps us start a meal secreted mainly peripherally by the gut

Question 477

leptin

Answer 477

secreted by adipose tissue long acting anorexigenic suppress appetite

Question 477

cholecystokinin

Answer 477

induce satiety in combination with pancreatic glucagon and the hypothalamus

Question 478

mirror neurons

Answer 478

discovered by rizzolatti prefrontal cortex activated when performing a task and when observing others doing it may mirror physical actions as well as emotions

Question 479

amygdala - aggression and placidity

Answer 479

stimulation - aggression destroyed - placidity

Question 480

ASD and amygdala

Answer 480

hypoactivation of amygdala while attempting to make social inferences

Question 481

postpartum mood disorder treatment options

Answer 481

antidepressants eg fluoxetine, sertraline, nortriptyline CBT interpersonal therapy

Question 481

PMS treatment

Answer 481

SSRIs - either regular or anticipated and stopped several days into menstrual flow

Question 482

postpartum psychosis onset

Answer 482

abrupt onset usually within 2 weeks of delivery

Question 482

differentiating postpartum depression from baby blues

Answer 482

later onset (several weeks postpartum) longer duration (months) absence of labile mood patients with postpartum blues can go on to develop postpartum depression

Question 483

where is TRH released from

Answer 483

hypothalamus

Question 483

hyperthyroidism treatment

Answer 483

anti-thyroid drugs occasionally psychotropic medication may be needed

Question 483

Graves disease

Answer 483

Hyperthyroidism: irritability sweating anxiety exophthalmos ophthalmoplefia goitre tachycardia AF thirst D+V tremor stiffness palmar erythema proximal muscle wasting heat intolerance fatigue weight loss oligomenorrhoea

Question 484

anterior pituitary hormones (6)

Answer 484

TSH ACTH LH FSH GH prolactin

Question 485

primary hypothyroidism causes

Answer 485

90% hashimotos thyroiditis medication - lithium, amiodarone

Question 486

secondary hypothyroidism causes

Answer 486

tumours or infarction of the pituitary gland

Question 487

tertiary hypothyroidism causes

Answer 487

tumours or infarctions of the hypothalamus carbamazepine

Question 488

hypothyroidism features

Answer 488

slow reflexes dry skin cold hands bradycardia depression tired feel cold weight gain menorrhagia constipation impaired memory

Question 489

congenital hypothyroidism

Answer 489

1:2000-4000 births commonest cause is iodine deficiency heel prick test after birth untreated - learning disability

Question 490

adrenal cortex hormones (4)

Answer 490

steroid hormones glucocorticoid (cortisol) mineralocorticoid (aldosterone) sex steroids (androgens)

Question 491

hormones secreted by adrenal medulla (3)

Answer 491

catecholamines adrenaline noradrenaline

Question 492

changes to HPA function in depression

Answer 492

increased CRH in CSF failure to suppress cortisol in response to dexamethasone increased adrenal size and sensitivity to corticotropin or ACTH blunted ACTH response to CRH

Question 492

causes of cushings syndrome

Answer 492

exogenous steroid exposure long term steroid use endogenous over production of steroids (pituitary adenomas, adrenal adenoma/carcinoma, ectopic ACTH production, SCLC or bronchial tumours)

Question 493

Cushing's syndrome

Answer 493

S+S occur due to sustained hypercortisolaemia of any cause

Question 493

Cushing's disease

Answer 493

hypercortisolaemia occurs due to ACTH-secreting pituitary adenoma

Question 494

Cushing's syndrome symptoms

Answer 494

facial fullness hirsuitism acne buffalo hump cardiac hypertrophy hypertension purple striae central obesity skin atrophy peripheral oedema osteoporosis anxiety withdrawal fatigue mania and psychosis

Question 495

Tests for cushings syndrome

Answer 495

24 hour urinary free cortisol overnight low dose dex supp test salivary cortisol measurement

Question 496

cushings syndrome treatment

Answer 496

depends on cause reduce steroid dose if taking tumour resection symptomatic treatment

Question 497

Addison's disease

Answer 497

primary adrenal insufficiency deficiency in cortisol, aldosterone and adrenal androgens autoimmune commonest cause in western countries autoantibodies directed against 21-hydroxylase enzyme

Question 498

features of hypoadrenalism

Answer 498

weight loss vitiligo hyperpigmentation of palmar creases and buccal mucosa orthostatic hypotension low body temp weakness and fatigue GI symptoms anorexia muscle, joint, abdo pain postural dizziness salt craving intolerance to cold loss of libido dry skin loss of axillary and pubic hair depression memory impairment psychosis (rare)

Question 499

acute primary adrenal failure / adrenal crisis features

Answer 499

orthostatic hypotension confusion fever hypoglycaemia circulatory collapse

Question 500

diagnostic test for addisons

Answer 500

synacthen test

Question 501

treatment for adrenal insufficiency

Answer 501

large volume NaCl and 5% dextrose replace glucocorticoids with parenteral hydrocortisone or dexamethasone

Question 502

pineal gland functions

Answer 502

sleep wake cycle feeding body temp

Question 503

suprachiasmatic nucleus

Answer 503

'internal clock'

Question 504

circadian rhythm sleep disorder

Answer 504

mismatch between requirements for sleep and bodys internal clock eg social demands not synchronised with circadian rhythm, eg jet lag, shift work change in circadian rhythm eg delayed sleep phase syndrome synthetic melatonin helps reset biological clock

Question 505

seasonal affective disorder

Answer 505

clear seasonal pattern NICE - treatment same as depression ?preventative antidepressants limited evidence on light therapy

Question 506

Klinefelter presentation

Answer 506

47 XXY tall stature mild-mod LD reduced facial hair gynaecomastic obesity small testes erectile dysfunction osteoporosis

Question 507

Turner Syndrome

Answer 507

45 X or XO short stature low set ears micrognathia webbed neck high arched palate coarctation of aorta primary hypothyroidism shield chest widely spaced nipples congenital renal abnormalities peripheral lymhpoedema cubitus valgus

Question 508

hyperprolactinaemia

Answer 508

sulpride, risperidone, typical antipsychotics reduced libido amenorrhoea galactorrhoea gynaecomastia

Question 509

long term effects of hyperprolactinaemia

Answer 509

reduced bone density possible increased risk of thromboembolism possible increase in risk of breast cancer

Question 510

CATIE

Answer 510

examined effectiveness of different antipsychotic medications in over 1400 pts with Scz and included physical health indicators metabolic syndrome in >40% of pts diabetes in 11%

Question 510

GH deficiency symptoms

Answer 510

weakness and fatigue sensitivity to cold loss of libido decreased bone density increased fracture risk loss of pubic and axillary hair amenorrhoea - females impotence - males depression with irritability anergia, dullness, drowsiness apathy self neglect memory impairment

Question 511

strategies to improve memory encoding

Answer 511

chunking mnemonics imagery primacy-recency effects

Question 512

length of iconic memory

Answer 512

0.5 seconds

Question 512

length of echoic memory

Answer 512

2 seconds

Question 513

STM capacity

Answer 513

7 +/- 2 digit span

Question 514

what is chunking

Answer 514

combining units of information into chunks

Question 515

what is the brown peterson technique?

Answer 515

overcomes maintenance rehearsal hear groups of 3 letters eg S-T-B asked to repeat what they just heard, then count backwards recall better with short delays in comparison to longer delays - STM without rehearsal is short lived

Question 516

what is non-declarative memory

Answer 516

cant be accessed consciously

Question 517

modes of retrieval

Answer 517

recognition - navigating familiar routes recall - actively searching memory stores reintegration/reconstruction - however in this mode become distorted, elaborated on, falsified

Question 518

memory - central executive

Answer 518

responsible for higher cognitive processes eg planning, problem solving DORSOLATERAL PREFRONTAL LOBE capacity limited but modality free important for dual task performance part of attention system 'in charge' of slave systems - phonological loop and VSSP

Question 519

4 main components of working memory

Answer 519

central executive - represents attention phonological loop - speech based info held visuospatial sketchpad - codes visual and spatial info episodic buffer - holds and integrates info from phonologicla loops, visuospatial sketchpad and LTM

Question 520

what brain area is phonological loop associated with?

Answer 520

dominant parieto-occipital hemisphere

Question 521

about phonological loop

Answer 521

codes acoustically (sounds) verbal rehearsal loop composed of phonological store and articulatory control process that feed back into the store (silent rehearsal) causes memory traces to fade after about 2 seconds

Question 522

which brain area is visuospatial sketch pad associated with?

Answer 522

non-dominant parieto-occipital regions

Question 523

about visuospatial sketchpad

Answer 523

eg map reading and navigation spatial component and visual component

Question 524

episodic buffer - memory

Answer 524

acts as backup store, communicating with components of WM and LTM multimodal store of limited capacity thought to use chunking

Question 525

how to assess working memory

Answer 525

digit span

Question 526

causes of working memory deficit / reduced digit span

Answer 526

phonological loop damage - injury to left hemisphere leads to difficulties with word and sentence repetition and reduced digit span dorsolateral PFC injury - lesser degree

Question 527

recency effect and primacy effect

Answer 527

recency: words at end of list recalled first primacy: words at beginning recalled better than middle

Question 528

episodic memory

Answer 528

autobiographical in nature details about time and place includes flashbulb memories bilateral limbic system and temporal lobe

Question 529

semantic memory

Answer 529

factual knowledge derived from episodic memory SM stored conceptually, without reference to time and context in which info was acquired expands throughout our lives

Question 530

examples of non-declarative memory

Answer 530

complex motor skills - surfing priming classical conditioning

Question 531

schema theory

Answer 531

Bartlett proposed that memory is determined by - material presented with previous experience - knowledge an individual may already have theory argues that previous knowledge is stored as schemas, and the schemas play a role in how we represent and organise new knowledge in memory

Question 532

schema theory: accretion

Answer 532

a new example of a pre-existing schema is recorded, and added to the relevant schema in LTM

Question 533

schema theory: tuning

Answer 533

new information allows for changes to existing schema if they are not sufficient

Question 534

schema theory: restructuring

Answer 534

a new schema is formed, using information from a pre-existing schema

Question 535

forgetting curve

Answer 535

ebbinhaus curve sharp drop over first 9 hours, rate of forgetting then slows and declines little thereafter

Question 536

forgetting: decay theory

Answer 536

structural change occurs in the brain when something is learned and remembered. with time, the engram is destroyed by metabolic process, though with repetition and rehearsal it can be preserved. passage of time responsible for forgetting. a study disproved this showing that recall improved with sleep.

Question 537

forgetting: displacement theory

Answer 537

based on experimental evidence showing that once a memory system has reached capacity, old information is displaced by new information. it explains forgetting in a limited-capacity system such as STM

Question 538

forgetting: interference theory

Answer 538

events that occur before and after learning are thought to influence forgetting retroactive interference = recall of earlier learning affected by later learning proactive interference = recall of later learning affected by earlier learning strong evidence for these theories exists from laboratory studies but there is less 'real world' evidence

Question 538

forgetting: motivated forgetting (repression)

Answer 538

'unconscious forgetting of painful memories in order to protect the psyche' - Casey et al, 2009

Question 539

cure-dependent forgetting

Answer 539

Tulving's encoding-specificity principle states that recall is improved if the recall environment is the same as the learning environment cue dependent forgetting refers to both context and state dependent forgetting. context dependent forgetting occurs when related contextual or environmental clues are not present state dependent forgetting occur when physiological cues are not available

Question 540

forgetting: retrieval failure

Answer 540

theory is best illustrated by 'tip of the tongue' moments. it proposes that memories can not be retrieved because the correct cues are not available

Question 540

features of memory loss in amnesic syndromes

Answer 540

intact STM anterograde amnesia retrograde amnesia unchanged intellectual abilities unchanged implicit memory

Question 541

medial temporal lobe amnesia

Answer 541

bilateral damage to medial temporal lobe and hippocampal system limited RA no confabulation

Question 542

diencephalic amnesia

Answer 542

bilateral damage to the medial thalamic area, mammillary bodies and hypothalamic areas typically marked RA patients fill gaps with confabulation distinctly poor insight eg Korsakoff's syndrome

Question 543

post traumatic amnesia (PTA)

Answer 543

time between initial injury and memory recovery: PTA <1 hour - mild head injury PTA 1-24 hours - mod head injury PTA >24 hours - severe head injury in PTA, patients are unable to transfer information from STM to LTM

Question 544

Ribot's law

Answer 544

in retrograde amnesia following brain damage, more recently formed memories are more impaired compared to older memories

Question 545

transient global amnesia (TGA)

Answer 545

can last several hours unable to make new memories so cant recall the TGA after commonly in middle aged men cause thought to be temporary loss of function of the limbic hippocampal circuits

Question 546

transient epileptic amnesia (TEA)

Answer 546

rare by possibly underdiagnosed brief, recurring episodes of amnesia caused by underlying temporal lobe epilepsy

Question 547

psychogenic amnesia

Answer 547

dissociative or hysterical amnesia occurs when an individual undergoes extreme trauma loss of personal identity loss of recollection of personal events preservation of personality and social skills no loss of the ability to kaperform complex behaviours

Question 548

katathymic amnesia aka motivated forgetting/dissociative amnesia

Answer 548

forgetting that can occur after traumatic events first described by Freud 1895 if conscious - suppression if unconscious - repression

Question 549

retrospective falsificaiton

Answer 549

unintentional distortion of memory that occurs due to an individuals altered mental state feeling low in mood can paint a negative picture of past experiences

Question 550

false memory

Answer 550

when an individual remembers an event that did not happen, despite their belief that it did

Question 551

screen memory

Answer 551

when a memory in its entirety is too painful to recall, so it is remembered part truthfully and part falsely. an individual may recollect an event with different details in order to avoid a painful fact

Question 552

confabulation

Answer 552

falsification of memory in clear consciousness due to an organic pathology

Question 553

spontaneous confabulation

Answer 553

unprovoked expression of inaccurate memories these can be bizarre, yet held with firm conviction and preoccupying commonly linked with frontal lobe pathology

Question 554

provoked confabulation

Answer 554

associated with fleeting intrusion errors or distortions made in response to a challenge to memory such as a memory test not a conscious attempt to fill in memory gaps and can occur in healthy patients

Question 555

pseudologica fantastica

Answer 555

pathological lying occurs without brain pathology, usually in those with certain personality types eg antisocial or hysterical

Question 556

vorbeireden

Answer 556

'approximate answers' patient may understand the question but avoid the correct answer

Question 556

munchausen's syndrome

Answer 556

pathological lying where an individual presents with false illness can also be by proxy, usually parent and child

Question 557

cryptamnesia

Answer 557

occurs when a forgotten memory returns without being recognised as a memory, so the individual believes it to be an original thought, eg a 'new joke' that has been heard multiple times before

Question 558

perception

Answer 558

how we make sense of sensory information reaching our brain

Question 558

retrospective delusions

Answer 558

precede the start of psychosis eg individual may state that their mother 'has always been the Queen'

Question 558

hyperamnesia

Answer 558

exaggerated registration, retention and recall flashbulb memories PTSD flashbacks

Question 558

Phi phenomenon

Answer 558

animated light appearing to move but no motion

Question 559

figure ground differentiation

Answer 559

eg figure is words and ground is paper illusion pictures eg faces kissing vs vase cant hold both at the same time (multistable perception) cocktail part effect is auditory equivalent

Question 559

Gestalt laws of perception (6)

Answer 559

similarity proximity closure common fate symmetry continuity 'some psychiatrists can frighten small children'

Question 559

top down processing

Answer 559

conceptually driven processing our perceptions are the end result of 'higher up' processes, making inferences about what things are like

Question 559

bottom up processing

Answer 559

stimulus driven involved processing information in a more 'direct manner', essentially determined only by the information presented to our sensory receptors

Question 560

components of perceptual constancy

Answer 560

size constancy shape constancy colour constancy location constancy

Question 560

perceptual constancy

Answer 560

'the ability to perceive an object as unchanging, despite changes in the sensory information that reaches our eye'

Question 561

visual cues associated with depth perception

Answer 561

retinal disparity stereopsis convergence accommodation motion parallax light and shadow angular declination object overlap

Question 561

the gestault psychologists

Answer 561

koffka wertheimer kohler

Question 562

who described the perceptual set

Answer 562

allport

Question 563

structure involved in the visual pathway

Answer 563

superior colliculus lateral geniculate nucleus 'See Light'

Question 564

simultagnosia

Answer 564

inability to recognise more than one object at once

Question 564

cerebral akinetopsia

Answer 564

inability to see movement, patient sees life as a series of 'stills' - rare

Question 564

capgras syndrome

Answer 564

delusional belief that someone close to the sufferer has been replaced by an imposter

Question 564

structures involved with the auditory pathway

Answer 564

Inferior colliculus Medial geniculate nucleus (MGN) 'Interpret Music'

Question 565

amblyopia

Answer 565

reduced vision resulting from monocular deprivation

Question 566

when does visual depth perception develop

Answer 566

around 6 months cliff test

Question 567

by what age is myelination of optic nerve completed

Answer 567

by 2 years

Question 568

charles bonnet syndrome

Answer 568

vivid visual hallucinations, which typically affect older people with visual loss and no other psychological symptoms

Question 569

NTs in auditory hallucinations

Answer 569

dopamine - high in limbic system acetylcholine - low glutamate - reduced NMDA receptor function serotonin - hallucinations possible SE of SSRIs, 5HT2A agonist activity GABA-A - reduced GABAA binding

Question 569

functional imaging of auditory hllucinations

Answer 569

brocas area anterior cingulate left temporal cortices

Question 570

signal detection theory (SDT)

Answer 570

state that all information recognition takes place in the presence of some uncertainty and that processing relied on both pattern recognition and biases in responding hallucinations - difficulty deciphering which sensory inputs are real and which are not

Question 570

cho and wu - spontaneous activation model of hallucinations

Answer 570

auditory hallucinations arise from spontaneous activity in auditory and associated memory areas more of a bottom up approach

Question 570

source monitoring theory of hallucinations

Answer 570

failure of a system that normally distinguishes between internal and external events

Question 570

self monitoring theory of hallucinations

Answer 570

when there is failure of the normal predictive processes that identify actions/language as ones own an 'inner voice' is then taken to be 'non self'

Question 571

waters et al - series of steps to hallucinations

Answer 571

early traumatic insult leading to aberrant activation of the auditory network combination of hypersalient auditory signals and emotional modulation with highly personal experiences such as depression/anxiety/past memories, along with delusional ideas and reduced insight, is proposed to lead to hallucinatory beliefs

Question 572

changes in the body during sleep (6)

Answer 572

increased GH secretion changes in melatonin secretion at different points increased renal phosphate excretion skin and tissue repair maintenance of normal activity levels of CNS sympathetic activity and muscle tone increases with sleep deprivation

Question 573

five key brain areas involved in sleep

Answer 573

sleep centres reticular activating system locus coeruleus tuberomammilllary nucleus ventrolateral preoptic nucleus

Question 574

neuromodulators involved in sleep (7)

Answer 574

noradrenaline acetylcholine serotonin histamine galanin GABA orexin

Question 575

locus coeruleus

Answer 575

within posterior area of rostral pons role in physiological reactions to panic and stress noradrenaline

Question 576

orexin

Answer 576

regulates appetite arousal and wakefulness produced in lateral hypothalamic area also a role in emotion, reward and motivation

Question 576

locus coeruleus functions (7)

Answer 576

emotions and psychological stress arousal and sleep wake cycle behavioural flexibility and behavioural inhibition neuroplasticity balance and posture attention and memory cognitive control

Question 577

orexin deficiency

Answer 577

narcolepsy (plus cataplexy)

Question 577

ventrolateral preoptic nucleus

Answer 577

mainly active during sleep neurons reposnible for onset of sleep by obstructing wake promoting systems 'sleep neurons' have sudden increase at point of sleep onset

Question 578

inhibitory NTs released by ventrolateral preoptic nucleus

Answer 578

GABA galanin

Question 579

increasing frequency of EEG waves

Answer 579

Delta - <4 Hz Theta - 408 Hz Mu - 7-11 Hz Alpha - 8-13 Hz SMR - 12-15 Hz Beta - 14-40 Hz Gamma - >40 Hz

Question 579

wake promoting neurons

Answer 579

orexin serotonin histamine acetylcholine noradrenaline

Question 579

orexin action

Answer 579

increases food craving and promotes wakefulness

Question 579

stage 2 NREM EEG

Answer 579

sleep spindles k complexes

Question 580

stage 1 NREM EEG

Answer 580

alpha waves decrease in amplitude theta waves appear with frequency 4-7 Hz

Question 580

sleep spindles on EEG

Answer 580

waxing and waning 10-16Hz oscillations lasting 0.5-2s

Question 580

stage 3 NREM EEG

Answer 580

delta / slow wave sleep

Question 581

REM proportion of sleep

Answer 581

20-25% of total sleep time approx 4-6 episodes in cycles of 90-120 minutes REM episodes increase in length throughout the cycles babies more REM than elderly etc

Question 581

areas of brain most active in dreaming

Answer 581

extrastriate visual areas limbic system including hippocampus and amygdala anterior cingulate gyrus pons

Question 582

freud theory of dreaming

Answer 582

manifestation of subconscious mind's interpretation of our deepest desires and fantasies

Question 583

drugs likely to affect dreaming (4)

Answer 583

dopamine increasing drugs eg levodopa reserpine analogues various blockers centrally acting cholinergic drugs

Question 584

activation synthesis model of dreaming (Hobson and McCarley)

Answer 584

neurophysiology of dreaming genetically programmed to promote the construction and testing of neurons, circuits and pathways automatically activated forebrain synthesizes the dream by comparing information generated in specific brain stem circuits with information stored in memory

Question 585

reverse learning model of dreaming - Crick and Michison

Answer 585

unwanted or 'parasitic' models of behaviour which exist in the cerebral cortex and associated subcortical areas of the brain suggest that a reverse learning mechanisms is activated during RME sleep to get rid of these modes done by modifying individual synapses through strengthening or weakening them

Question 585

how much time in adults spent in stage 1 NREM

Answer 585

10-15%

Question 586

who found REM linked with dreaming

Answer 586

Kleitman and Aserinsky

Question 587

area of brain most active during dreaming

Answer 587

pons

Question 588

suprachiasmatic nucleus

Answer 588

main circadian pacemaker 'body clock' group of cells in hypothalamus reset daily by light input from retina

Question 589

where is melatonin secreted from

Answer 589

pineal gland

Question 590

drugs with insomnia as a side effect

Answer 590

SSRIs SNRIs beta blockers cholinesterase inhibitors some antipsychotics mood stablisers

Question 591

antidepressants - hypnotic effect

Answer 591

melatonin secretion increased by SSRIs suppression of REM sleep - this can help with mood lifting

Question 592

where is GABA found in the brain (6)

Answer 592

substantia nigra globus pallidus hippocampus hypothalamus cortex spinal grey matter

Question 593

hayflicks limits - ageing

Answer 593

cells in culture will divide about 50 times then stop due to shortening telomeres at each replication

Question 594

free radical theories of ageing

Answer 594

aerobic cellular respiration leads to the production of free radicals (eg superoxide, hydroxyl) leads to protein damage due to inappropriate oxidation and damages DNA damage is cumulative results in ageing

Question 595

genes that control ageing

Answer 595

account for approx 25% in variation of ageing between individuals generally genes associated with GH and receptors

Question 596

disposable some theory of ageing

Answer 596

animals have finite resources which can be put into maintaining the integrity of their body systems or reproduction repair mechanisms not perfect comprise on soma repair may have improved reproductive fitness the population that sacrifices some repair in favour of reproduction will be more likeyl to be naturally selected

Question 597

reduction in brain weight in normal ageing

Answer 597

20% reduction

Question 598

vision changes with age

Answer 598

13% of >75y are visually impaired less periorbital fat iris weaker pupil smaller and less reactive lenses less elastic less rhodopsin so deterioration in light reflexes

Question 599

hearing and balance changes in ageing

Answer 599

25% develop hearing loss prescyacusis 28-43% of men and 17-20% women between 60-69y increased risk of BPPV and dizziness 70% of over 70s have hearing loss that should be considered for a hearing aid

Question 600

GI changes in ageing

Answer 600

taste may change tooth decay more common salivation production reduced reduced hepatic mass and blood flow lives enzymes as effective, but reduced blood flow and mass can affect drug pharmacokinetics constipation more common

Question 600

renal changes in ageing

Answer 600

general decline from 40y GFR declines by 10% a decade after 40y and worsened by HTN and/or diabetes reduced ability to concentrate urine

Question 600

memantine excretion

Answer 600

renal

Question 601

type of memory not affected by age

Answer 601

working memory

Question 601

prevalence of depression in older adults

Answer 601

10-17%

Question 601

as per ONS which are group has highest levels of life satisfaction

Answer 601

65-69y

Question 602

5 stages of grief

Answer 602

denial anger bargaining depression acceptance