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Medicine Year 2 > Scenario 24 > Flashcards

Scenario 24 Flashcards

1
Q

In an EEG what is delta?

A

Deep sleep

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2
Q

In an EEG what is Theta?

A

Sleep states (non rem)

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3
Q

In an EEG what is alpha?

A

Quiet, awake

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4
Q

In an EEG what is beta?

A

Activated cortex (intense mental activity, REM sleep) >13 Hz

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5
Q

What can a CAT scan do?

A

Show brain in cross sections

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6
Q

Along which axis are the major CNS divisions?

A

Rostrocaudal axis

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7
Q

Which nerves exit spinal cord?

A

Sympathetic preganglionic motor neurons

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8
Q

Which nerves mostly exit brainstem?

A

Parasympathetic preganglionic motor neurons

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9
Q

What is the role of the cerebellum?

A

Involved in regulating motor coordination and motor learning using proprioceptive inputs- damage causes ataxia

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10
Q

What is the role of the midbrain?

A

Contains ventrally occulomotor nuclei and dopaminergic neurons of the substantia nigra. Dorsal superior and inferior colliculi process visual and auditory inputs to regulate subconscious attentional motor responses to the environment

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11
Q

What is contained within the forebrain?

A

Cortex and diencephalon (thalamus, subthalamus, hypothalamus, epithalamus)

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12
Q

What is the role of the thalamus?

A

Relays all sensory information to the cortex and receives huge cortical input

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13
Q

In what areas are thalamic responses to cortical input modified by basal ganglia (and cerebellum)?

A

Non sensory cortical areas

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14
Q

What diseases show a link to abnormalities in basal ganglia output?

A

Parkinsons and HD

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15
Q

Where are the executive motor and primary sensory areas of the brain?

A

Either side of the central sulcus (motor in front)

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16
Q

What is the frontal area of the brain related to?

A

Association and personality

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17
Q

What is Brocas area function?

A

Language and speech (side near front)

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18
Q

What creates the electrically polarised membranes of neurons?

A

Sodium being pumped out

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19
Q

How is information carried in dendrites?

A

Graded potential changes which decay over 1-2mm in all directions (de-polarising, exciting!)

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20
Q

Are axons myelinated in white or grey matter?

A

White

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21
Q

What is grey matter made up of?

A

Cell bodies, dendrites, axons

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22
Q

In the spinal cord what is the arrangement of the white and grey matter?

A

White matter outside (stains black), grey matter core

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23
Q

Where in the spinal cord is there more grey matter and why?

A

at cervical and lumbar regions (motor output to the limbs)

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24
Q

What is the arrangement of white and grey matter in the brain?

A

white matter core and grey matter outside

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25
Q

What are projection neurone?

A

Excitatory lond neurons fro layer 5 of the cortex with large cell bodies

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26
Q

Why do projection neurons have large cell bodies?

A

need to supply the long axons with ATP proteins etc

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27
Q

Which division of cells in development makes glial cells?

A

Last

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28
Q

What are the 4 main roles of glial cells

A

Supply neurons with nutrients and oxygen
Surround neurons and hold them in place
Insulate one neuron from another
Destroy pathogens and remove dead neurons

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29
Q

What is the role of astrocytes?

A

To maintain the chemical environment for neuronal signalling (link to vasculature, uptake of NTs, regulation of EC K

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30
Q

What is the role of oligodendricytes?

A

Lay down myelin in CNS

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31
Q

What is the role of microglial cells?

A

Immune cells of the CNS, remove debris and cleanse ECF

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32
Q

What is the role of ependymal cells?

A

Line ventricles and central canal of spinal cord and have microvilli with create directional CSF movement also make up the BBB

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33
Q

What is the synaptic cleft distance in an electronic synapse?

A

3nm

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34
Q

What is the synaptic cleft distance in a chemical synapse?

A

30-50nm

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35
Q

Which synapse type has a larger delay?

A

Chemical

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36
Q

Is an electronic synapse typically unidirectional or bidirectional?

A

Bidirectional

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37
Q

What are the main features of a gray type I synapse?

A

Round vesicles, wide cleft, dense BM end on shaft or spine

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38
Q

What are the main features of a gray type II synapse?

A

Flattened vesicles, narrow cleft, modest BM end on soma

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39
Q

At a chemical synapse what ion goes into the presynaptic terminal to cause transmitter release?

A

Ca

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40
Q

How is acetylcholine action terminated?

A

Broken down by an enzyme

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41
Q

How is glutamate action teminated?

A

Reuptake or into glia

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42
Q

How is 5-HT and dopamine action terminated?

A

Combination of being broken down and reuptake

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43
Q

What drugs act on GABA receptors?

A

hypnotics, anticonvulsants, anaesthetics

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44
Q

What drugs act on Serotonin receptors?

A

antidepressants, stimulants, hallucinogens

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45
Q

What drugs act on NA receptors?

A

Anti depressants

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46
Q

What drugs act on dopamine receptors?

A

anti-Parkinson drugs, stimulants

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47
Q

What drugs act on peptide receptors?

A

Analgesics

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48
Q

What drugs act on glutamate receptors

A

Anti-ischaemics, anti-convulsants

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49
Q

What drugs act on acetylcholine receptors?

A

Anti dementia

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50
Q

Why do we need a BBB?

A

Maintain a stable internal environment for cell signalling, protective against neurotoxic substances in the blood, avoid cell death

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51
Q

Which ventricles secrete CSF?

A

Lateral and 4th ventricles

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52
Q

How is the plasma monitored?

A

By circumventricular organs

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53
Q

Is the K higher in plasma or CSF?

A

Plasma (4.6 compared to 2.9)

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54
Q

Is Mg higher in plasma or CSF?

A

CSF (stabilises receptor pot)

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55
Q

Is HCO3 higher in plasma or CSF?

A

Plasma

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56
Q

Is glucose higher in plasma or CSF?

A

Plasma

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57
Q

Is calcium in CSF bound or free?

A

free

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58
Q

Which glucose transporter is present at BBB and microglia?

A

GLUT1 at BBB and GLUT5 at microglia

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59
Q

Where is CSF produced?

A

Choroid plexus

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60
Q

Where does CSF drain?

A

Arachnoid granulations

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61
Q

What is communicating hydrocephalus?

A

Obstruction in sub-arachnoid space or villi

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62
Q

What is non communicating hydrocephalus?

A

Blockage of aqueduct of Sylvius

63
Q

What is a phasic response?

A

An adapting response that usually signals a change of state

64
Q

What is a tonic response?

A

A sustained response that usually encodes information about the status quo

65
Q

What does the TRVP1 channel respond to?

A

Noxious heat, low pH and chemical stimuli (chilli)

66
Q

What is the role of a generator potential (GP)

A

Initiate an AP

67
Q

What channels are GP linked to

A

non specific cation channels

68
Q

Do GP have graded potentials?

A

yes

69
Q

What are the strengths of GP?

A

localised and graded

70
Q

What are the weaknesses of GPs?

A

dont contain modality specific information

71
Q

What is the role of APs?

A

Carry signal along an axon

72
Q

What channels are APs related to?

A

Voltage gated Na and K channels

73
Q

How long is an AP

A

brief (2-5ms)

74
Q

Is an AP graded?

A

no- all or nothing

75
Q

What are the strengths of APs?

A

signal size maintained, very versatile information coding (frequency, pattern etc)

76
Q

What are the weaknesses of APs?

A

Membrane must be hyperpolarised to start and reprimed after use

77
Q

What is the role of ESPSs and ISPSs?

A

Contribute/ prevent to the somatic depolarisation leading to generation of AP at axon hillock of neuron

78
Q

Is an ESPS/ISPSs graded or all or nothing?

A

Graded

79
Q

What is the speed of an ESPS and ISPS?

A

Fast 10-500 ms due to activation of ligand gated non specific ion channels

80
Q

Strengths of ISPS and ESPSs?

A

versatile- different transmitters act on same cell

81
Q

Weaknesses of ISPSs and ESPSs?

A

Metabolically expensive and vulnerable to chemical attack

82
Q

What is convergence?

A

If an AP occurs depending on the adding of the current ISPSs and ESPSs acting

83
Q

What is divergence?

A

Controlled by interneurons causing acuity of sensation due to surround inhibition (feedback inhibition)

84
Q

What information is stored in dorsal horns (back)

A

Sensory information

85
Q

What information is stored in ventral horns (front)

A

Motor information

86
Q

Where are ventral horns enlarged?

A

Limbs

87
Q

Where is CSF?

A

Sub arachnoid space

88
Q

What is in the dorsal root ganglion?

A

Cell bodies of primary sensory neurons

89
Q

What are the unconscious tracts calles?

A

Spinocerebellar

90
Q

What are the conscious tracts called?

A

Spinothalamic and DCML

91
Q

What information does the DCML pathway carry

A

Fine touch, vibration and proprioception

92
Q

Where do the signals from the lower limb travel in the DCML?

A

Fasciculus gracilis (more medial) and synapse in gracile nucleus of the medulla oblongata

93
Q

Where do signals from the upper limb travel in the DCML?

A

Fasciculus cuneatus (more lateral) and synapse in gracile nucleus of MO

94
Q

At what spinal level do DCML neurons enter?

A

Above T6

95
Q

At what level do DCML fibres decussate?

A

At the MO

96
Q

Where does the second order neuron of the DCML travel?

A

Contralateral medial lemniscus

97
Q

Where does the 2nd order DCML neuron synapse with the 3rd order?

A

In the thalamus (ventral posterolateral nucleus)

98
Q

Does the 3rd order neuron pass through the internal capsule?

A

Yes

99
Q

Where do the DCML fibres terminate?

A

Sensory cortex

100
Q

What are the two tracts of the spinothalamic pathway and what information do they carry?

A

Anterior- crude touch and pressure

Lateral-pain and temperature

101
Q

When do ST neurons decussate?

A

Immediately in the spinal cord

102
Q

Where do the ST 1st order neurons travel?

A

From entry into spinal cord to substantia gelatinosa (tip of dorsal horn) up 1/2 vert levels

103
Q

Where do ST 2nd order neurons travel?

A

anterior and lateral ST tracts on contralateral side to the synapse at the thalamus

104
Q

Where do the ST 3rd order neurons take the information to?

A

Primary sensory cortex of the brain from the VPL nucleus

105
Q

What is the purpose of the spinocerebellar tracts?

A

Carry unconscious proprioceptive information for coordination of motor movements

106
Q

Where does the SC tract lead to?

A

Cerebellum

107
Q

Where do the SC fibres travel in the spinal cord?

A

Laterally

108
Q

Do the SC neurons decussate?

A

Posterior (dorsal) dont, ventral do in spinal cord but most re cross back over in cerebellum so mostly ipsilateral

109
Q

How many neurons synapse in SC tract?

A

Only 2- synapse in dorsal horn and then cerebellum

110
Q

What would an injury to the DCML pathway cause?

A

Loss of proprioception and fine touch but small number of tactile neurons in ST pathway so may still be able to do tactile movements

111
Q

Will the injury to the DCML pathway be ipsilateral or contralateral?

A

If in spinal cord ipsilateral (more common)

112
Q

When do DCML pathway injuries occur?

A

Vit B12 deficiency and Tabes Dorsalis

113
Q

What would an injury to the ST pathway cause?

A

Loss of pain and temperature sensation

114
Q

Would injury to the ST pathway be contralateral or ipsilateral?

A

Contralateral

115
Q

What is Brown Sequard syndrome and what are the consequences?

A

hemisection of the spinal cord leading to ipsilateral loss of prioprioception and tactile sensation (DCML) and contralateral loss of pain and temp sensation (ST) also the descending tracts so ipsilateral hemiparesis

116
Q

What does lesion of SC tract cause?

A

Ipsilateral loss of muscle coordination but usually with motor damage too

117
Q

Which tracts are pyramidal?

A

Corticospinal and corticobulbar

118
Q

What are the pyramidal tracts responsible for?

A

Voluntary control fo muscles

119
Q

Where do pyramidal tracts originate from?

A

Cerebral cortex

120
Q

What is the role of the extra pyramidal tracts?

A

involuntary and automatic control of muscles

121
Q

Where do extra pyramidal tracts originate from?

A

Brain stem

122
Q

What are neurones in the descending tracts also known as?

A

Upper motor neurones

123
Q

Are there synapsess in the desc tracts

A

NO

124
Q

What is the journey of a CS neurone to the medulla

A

Descend through internal capsule (important consideration in IC stroke) then through crus cerebri of midbrain, pons and into medulla

125
Q

After the medulla do the lateral CS neurons or anterior CS neurons decussate?

A

Lateral

126
Q

Where do the CS neurons end?

A

Ventral horn (of cervical and upper throacic levels for anterior, all for lateral)

127
Q

Where do corticobulbar (CB) tracts arise from?

A

Lateral part of primary motor cortex

128
Q

Where do the CB neurone travel?

A

Through IC to brainstem where they terminate on the motor nuclei of cranial nerves

129
Q

Do most of the fibres innervate the motor neurones bilaterally?

A

Yes

130
Q

What the exceptions to the rule that the fibres from CB innervate the motor neurones bilaterally?

A

UPN for facial nerve and hypoglossal nerve have contraleral innervation

131
Q

What are the names of the 4 extrapyramidal tracts?

A

Recticulospinal, vestibulospinal, rubrospinal, tectospinal

132
Q

Which extrapyramidal pathways deccusate?

A

Rubrospinal and tesctospinal (contralateral innervation))

133
Q

What is the role of vestibulospinal tracts?

A

Balance and posture

134
Q

What are the roles of the Retculospinal tracts?

A

Medial is from pons and facilitated voluntary movements, lateral is from the medulla and inhibits

135
Q

What is the role of the rubrospinal tract?

A

Fine control of hand movements from the red nucleus

136
Q

What is the role of the tectospinal tract?

A

Vision stimuli from the superior colliculus of the midbrain

137
Q

What are the signs of an upper motor neurone lesion? (CS)

A

Hypertonia, Hyperreflexia, clonus, babinski sign (extension of big toe) and muscle weakness- all contralateral

138
Q

What are the sigs of injury to the CB tracts

A

Due to the bilateral nature a unilateral lesion will cause mild weakness apart from hypoglossal and facial nerves

139
Q

What do Meisseners corpuscles respond to?

A

light touch and change in texture

140
Q

What do bulbous corpuscles respond to?

A

tension deep in skin and fascia

141
Q

What do merkel nerve endings respond to?

A

direct sustained pressure

142
Q

What do pancinian corpuscles respond to?

A

Rapid vibrations

143
Q

What cold sensitive fibres fire

A

small myelinated A delta

144
Q

What type of fibres are cold-nociceptors?

A

C axons

145
Q

What fibres are warm sensitive >35 degrees

A

C axons

146
Q

What type of fibres are warm nociceptors?

A

A delta axons

147
Q

What type of fibre is responsible for fast pain?

A

A delta- myelinated

148
Q

What type of fibres signal slow pain?

A

C fibres

149
Q

Where do muscle receptors lie?

A

In parallel to main muscle fibre (sensitive to small changes in length)

150
Q

What are golgi tendon organs?

A

Lie in series with main muscle fibres and detect change in muscle tension

151
Q

What type of axon is A beta?

A

Large myelinated

152
Q

How is contrast enhanced eg tactile acuity?

A

Surround inhibition by interneurons

153
Q

Where does the somatosensory information from the face come from?

A

Enters via trigeminal nerve, synapses on entering brain stem, deccusation in medial lemniscus and synapses in thalamus (VPM)

154
Q

Where do the VPL and VPM project to?

A

Postcentral cortical gyrus mostly 3b

Medicine Year 2 (19 decks)

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