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MBChB - year 2 > Week 5 HNN lectures > Flashcards

Week 5 HNN lectures Flashcards

1
Q

What is attention?

A
  • A global (superordinate) cognitive process encompassing multiple sensory modalities, operating across sensory domains
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2
Q

What components can attention be divided into?

A

Arousal, vigilance, divided attention and selective attention

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3
Q

What is arousal?

A

a general state of wakefulness and responsivity

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4
Q

What is vigilance?

A

capacity to maintain attention over prolonged periods of time

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5
Q

What is divided attention?

A

The ability to respond to more than one task at once

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6
Q

What is selective attention?

A

The ability to focus on one stimulus while suppressing competing stimuli (e.g. you are studying in a café and there is music on the radio but you wouldn’t even be able to say what song is playing because you are just completely ignoring it.)

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7
Q

What happens when there is impaired arousal?

A

Patient may be drowsy

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8
Q

What happens when there is impaired Vigilance?

A

Impersistence - The ability to sustain attention over a period of time is impaired

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9
Q

What happens when there is impaired divided and selective attention?

A

Patient is ‘Distractable’

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10
Q

What is the most common disturbance of mental status seen by doctors?

A

Delirium

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11
Q

What happens in delirium?

A

Patients are disorientated and have memory impairments

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12
Q

What is domain-specific attention?

A

Attention relating to a specific sense

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13
Q

What can happen in the breakdown of domain specific attention?

A

Visual inattention, sensory inattention, neglect

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14
Q

What is neglect?

A

When one part of the visual field is ignored

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15
Q

How can neglect be tested for?

A

If a patient is asked to draw a clock on the wall they may either miss off the numbers on one side or they might bunch all numbers onto one side of the drawing.

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16
Q

What are the three main systems involved in attention?

A

The ascending reticular activating system, the top down attention modulation system and bottom up attentional competition

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17
Q

What is the ascending reticular activating system?

A

It is responsible for sleeping and wakefulness. It is a very global system and allows us to even pay attention

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18
Q

What does top down attention modulation allow?

A

The ability to pay attention to something while ignoring other thing that are going on around you

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19
Q

Where does the top down attention modulation occur?

A

In the frontal, parietal and limbic cortices

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20
Q

What else will be impaired if a patient has impaired arousal?

A

Impaired attention as these two things are related

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21
Q

If a patient has impaired attention will they have impaired arousal?

A

Not necessarily

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22
Q

What can hyperarousal impair?

A

Attention

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23
Q

What part of the brain can downregulate attention?

A

The amygdala if we feel pain or upset

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24
Q

What part of the attention system is impaired if a patient has drowsiness, delirium or is in a coma?

A

The arousal mechanisms

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25
Q

What part of the attention system is impaired if a patient has inattention or neglect?

A

Top down attention modulation

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26
Q

How can attention be tested in clinical practice?

A

Orientation in time and place, Serial 7s, Digit span and digits backwards, Months of the year or days of the week in reverse order, Alternation tasks, e.g. ‘Trails B’, Stroop test, Star cancellation test

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27
Q

Where does information you pay attention to go?

A

Into short term memory

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28
Q

How long does information last in short term memory?

A

About 30 seconds

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29
Q

What happens to information that isn’t rehearsed?

A

It is lost from memory

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30
Q

What happens when people study?

A

We try to put the information into short term memory and then rehearse it so it moves into long term memory

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31
Q

How long can information that is used regularly be stored for?

A

Can be kept indefinitely

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32
Q

What is the storage of long term memory known as?

A

Encoding

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33
Q

What is taking information out of long term memory known as?

A

Retrieval

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34
Q

What is short term (working) memory?

A

An active storage process as it requires maintenance and manipulation of information

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35
Q

How many elements can be held in short term memory?

A

7 +/- 2 elements

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36
Q

What are the four different systems within working memory?

A
  • Visual spatial sketchpad
  • phonological loop
  • central executive systems
  • Episodic buffer
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37
Q

What is the visual spatial sketchbook?

A

This is where we can visualize or imagine visual information

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38
Q

What is the phonological loop?

A

This is where we process what we hear

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39
Q

What is the central executive system?

A

This controls and coordinates the systems of short term memory

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40
Q

What is the episodic buffer?

A

This is where we can bring in information from long term memory when we need it

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41
Q

What is interference?

A

When someone tries to learn something from one category and there is other stimuli then they will be disrupted

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42
Q

What is the limit on long term memory?

A

There is no known limit

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43
Q

What is the interaction between short and long term memory like?

A

They operate independently

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44
Q

What are the tow categories of long-term memory?

A

Explicit (declarative) and implicit (procedural)

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45
Q

What are the categories of explicit (declarative) memory?

A

Episodic and semantic

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46
Q

What are the categories of implicit (procedural) memory?

A

Motor skills and classical conditioning

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47
Q

What is episodic memory?

A

A form of explicit (declarative)memory that can be accessed and reflected upon. It is personally experienced, temporally specific episodes/ events

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48
Q

What is the role of the dorsolateral prefrontal cortex in episodic memory?

A

It is responsible for the temporal organisation of memories. It also interacts with structures in the extended limbic systems

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49
Q

What is temporal organisation?

A

the ability to place events in time

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50
Q

What parts of the extended limbic system are involved in episodic memory?

A

The medial temporal lobe and the diencephalon

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51
Q

How is episodic memory tested in clinical practice?

A
  • Recall of complex verbal information (e.g. recall of stories in the Wechsler Memory scales)
  • Recall of geometric figures (e.g. Rey-Osterrieth Figure test)
  • Word-list learning (e.g. California verbal learning test)
  • Recognition of newly encountered words and faces (Warrington’s recognition memory test)
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52
Q

What is semantic memory?

A

A form of explicit (declarative memory) that is available to access and reflect on. It is made up of factual information and vocabulary.

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53
Q

Where in the brain does semantic memory occur?

A

Left hemisphere anterior temporal lobe is a key integrative region
Anterior temporal cortex (ATC) and angular gyrus (AG) integrate incoming information

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54
Q

How is semantic memory arranged in the brain?

A

Ventral (visual) to dorsolateral (non-visual); posterior (basic objects) to anterior (complex)
There seems to be a way of organizing information based on whether it is visual or not and whether it is basic or complex. These are then stored in different regions of the brain.

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55
Q

What does anterior temporal cortical destruction or atrophy present with?

A

Damage to semantic memory

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56
Q

What can cause anterior temporal cortical destruction or atrophy?

A
  • Herpes simplex encephalitis
  • Trauma
  • tumours
  • Alzheimer’s dementia or Semantic dementia (a form of frontotemporal dementia)
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57
Q

What can categorical defects in semantic memory be caused by?

A

Can be caused by Progressive right temporal lobe atrophy (a variant of frontotemporal dementia)

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58
Q

What may Progressive right temporal lobe atrophy (a variant of frontotemporal dementia) also present with?

A

prosopagnosia - behavioural disturbance

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59
Q

How can semantic memory be tested in clinical practice?

A
  • Tests of general knowledge and vocabulary (e.g. Wechsler Adult Intelligence Scale)
  • Fluency – generate exemplars from specific semantic categories (e.g. name as many animals as possible in 60secs)
  • Object naming to confrontation (e.g. Boston naming test – can they name frequently used objects)
  • Tests of verbal knowledge (e.g. What colour is a banana?)
  • Person-based tasks (e.g. naming photographs of famous people)
60
Q

What is implicit (procedural) memory?

A

There is no conscious access to these memory stores, it is the motor skills that can be built up with practice

61
Q

What are some examples of implicit (procedural) memory?

A

Learning to play a musical instrument, learning to ride a bike, learning to use a computer keyboard

62
Q

What parts of the brain are involved in implicit memory?

A

basal ganglia and the cerebellum

63
Q

What is the role of the eye?

A

detection, localisation and analysis of light in the visual field.

64
Q

Where are transmitted rays of light focused to?

A

The retina

65
Q

What do the retinal photoreceptors do with light energy?

A

Transduce it into changes in neuronal membrane potential

66
Q

How are signals transmitted from the eye to the brain?

A

Via the optic nerve

67
Q

What does the cornea do?

A

Focuses (refracts) rays of light so that they pass through the retina

68
Q

Where is the retina located?

A

The back of the eye

69
Q

What is the retina?

A

A multi-layered structure that converts light into neural impulses

70
Q

What does the deepest layer of the retina consist of?

A

Photoreceptors called rods and cones

71
Q

SIGHT

What is the neural signal transmitted through?

A

Intermediate layers of bipolar and horizontal cells

72
Q

SIGHT

Where is the neural signal transmitted to?

A

The retinal ganglion cells

73
Q

Where are the retinal ganglion cells found?

A

The innermost surface of the retina

74
Q

Where are the cell bodies of the retinal ganglion?

A

The vitreous humour of the eye

75
Q

Where do the axons of the retinal ganglion cells exit the eye?

A

The optic disc

76
Q

What do the axons of the retinal ganglion cells form when they leave the eye?

A

The optic nerve

77
Q

SIGHT

What is the pathway that the signal takes once it leaves the eye?

A

Optic nerve–> Optic chiasm –> optic tract –> lateral geniculate nucleus –>optic radiation –> visual cortex

78
Q

What happens to the optic nerve at the optic chiasm?

A

There is partial decussation and 50-60% of the nerve fibres cross over

79
Q

What does the partial decussation of the optic nerve at the optic chiasm allow?

A

The visual cortex of both the left and right cerebral hemispheres to receive visual information from BOTH eyes and permits binocular and stereoscopic vision

80
Q

What does the optic tract contain?

A

Nerve fibres from both the left and right eyes

81
Q

Where do most nerve fibres of the optic tract project to?

A

The Lateral geniculate nucleus

82
Q

Where is the lateral geniculate nucleus?

A

In the dorsal thalamus

83
Q

What is the dorsal thalamus?

A

The relay centre of the visual pathway

84
Q

What does the dorsal thalamus do?

A

Relays sensory information from the optic nerve to the visual cortex

85
Q

How is information passed from the optic tract to the visual cortex?

A

The nerves of the optic tract terminate within the lateral geniculate nucleus and synapse with neurons located inside it. These neurons then project to the visual cortex via the optic radiations

86
Q

What is the primary visual cortex known as?

A

V1 (primary visual processing area) or the striate cortex (due to it’s striped appearance caused by a prominent band of myelinated nerve fibres which can be seen by the eye

87
Q

what is the nasal retina?

A

The part of the retina on both eyes closest to the nose

88
Q

where on the left eye is the light from the right visual field transmitted to?

A

The temporal retinal of the left eye

89
Q

What is the temporal retina?

A

The part of the retina closer to the outside of the face

90
Q

which visual cortex does the visual stimuli from the left visual field project to?

A

The right visual cortex

91
Q

which visual cortex does the visual stimuli from the right visual field project to?

A

The left visual cortex

92
Q

What does a partial optic nerve lesion cause?

A

Ipsilateral scotoma

93
Q

What is ipsilateral scotoma?

A

A small patch where you can’t see in the middle of the eye

94
Q

What does a complete optic nerve lesion cause?

A

Blindness in the affected eye

95
Q

What does a lesion of the optic chiasm cause?

A

Bitemporal hemianopia

96
Q

What is bitemporal hemianopia?

A

Blindness in the temporal visual field of both eyes

97
Q

What does a lesion of the optic tract cause?

A

Homonymous hemianopia

98
Q

What is Homonymous hemianopia?

A

Visual field loss on the same side in both eyes

99
Q

Whar does a lesion in Meyer’s loop cause?

A

Homonymous upper quadrantanopia

100
Q

What is homonymous upper quadrantanopia?

A

Loss of visual field in the upper quadrant on the same side in both eyes

101
Q

What does a lesion in the optic radiation cause?

A

Homonymous hemianopia

102
Q

What is homonymous hemianopia?

A

Loss of visual field over half of the eye on the same side in both eyes

103
Q

What does a lesion in the visual cortex cause?

A

Homonymous hemianopia

104
Q

What does a bilateral macular cortex lesion cause?

A

Bilateral central scotomas

105
Q

What are bilateral central scotomas?

A

a circular loss of vision in the middle of the visual field

106
Q

What are some causes of lesions of the optic nerve?

A
  • Acute optic neuritis
  • Indirect traumatic optic neuropathy
  • Optic atrophy
107
Q

What happens in acute optic neuritis?

A

demyelinating inflammation of the optic nerve

108
Q

What can cause optic atrophy?

A

Ischaemia or tumours which may compress the nerve

109
Q

What can cause lesions of the optic chiasm?

A
  • Tumours (pituitary adenoma, meningioma)

- aneurysms (ACA)

110
Q

What can cause lesions of the optic tract?

A
  • tumours
  • trauma
  • aneurysm of post. cerebral artery
111
Q

Where do nerve fibres that don’t go to the lateral geniculate nucleus go?

A

The superior colliculus or the pretectal area of the midbrain

112
Q

What is the superior colliculus responsible for?

A

Eye movements

113
Q

What is the pretectal area responsible for?

A

pupillary light reflex

114
Q

What are Goldmann perimetry tests used for?

A

To test the extent of the visual field

115
Q

How is the Goldmann perimetry test carried out?

A

A test light is used at the stimulus and the visual field is mapped according to the detection of light

116
Q

What nervous system is responsible for pupillary constriction?

A

both parasympathetic and sympathetic

117
Q

What is the pupil?

A

A hole surrounded by the iris that changes in size to regulate the amount of light falling on the retina

118
Q

Why does the pupil appear black?

A

because light is absorbed by the retina and other tissues in the eye

119
Q

How many muscles does the iris have?

A

two

120
Q

What are the two muscles of the iris?

A
  • sphincter pupillae

- dilator pupillae

121
Q

What is sphincter pupillae?

A

A central sphincter that constricts the pupil

122
Q

What is dilator pupillae?

A

A set of dilator muscles which dilate the pupil

123
Q

What does the size of the pupil depend on?

A

The balance between parasympathetic and sympathetic stimulation

124
Q

What type of fibres innervates sphincter pupillae?

A

Parasympathetic fibres

125
Q

What type of fibres innervates dilator pupillae?

A

Sympathetic fibres

126
Q

What does parasympathetic activity lead to in the eye?

A

Constriction of the pupil

127
Q

What does sympathetic activity lead to in the eye?

A

Dilation of the pupil

128
Q

Where does the pathway for pupillary constriction begin?

A

At the Edginer-Westphal nucleus

129
Q

Where is the Edginer-Westphal nucleus?

A

Near the oculomotor nerve nucleus

130
Q

What do the parasympathetic fibres for the eye enter the orbit with?

A

CNIII

131
Q

Where do the parasympathetic fibres in the eye synapse?

A

The ciliary ganglion - the post ganglionic fibres then supply sphincter pupillae

132
Q

What is the pathway for sympathetic innervation to the iris like?

A

It is made up of a three neuron chain

133
Q

Where does the pathway for pupillary dilation begin?

A

In the hypothalamus and travels to the cilliospinal centre

134
Q

Where is the cilliospinal centre?

A

In the spinal cord between the levels of C8 and T2

135
Q

Where do the third neuron of the pupillary dilation pathway travel?

A

Through the carotid plexus

136
Q

Where do the fibres innervating the dilatory muscles of the pupil enter the orbit?

A

The first division of the trigeminal nerve

137
Q

What is the pupillary light reflex?

A

When the pupils constrict in response to light

138
Q

What is the accommodation reflex?

A

The constriction and convergence of the eyes when looking from a distant object to a close one

139
Q

What is the purpose of the pupillary light reflex?

A

It regulates the amount of light falling on the retina in different light conditions

140
Q

What is the afferent pathway of the pupillary light reflex?

A

The optic nerve (CNII)

141
Q

What is the efferent pathway of the pupillary light reflex?

A

The oculomotor nerve (CNIII)

142
Q

How is the pupillary light reflex tested?

A

A torch is shone in each eye (separately) - the pupil should rapidly constrict

143
Q

What does the swinging flashlight test look for?

A

Can identify asymmetry of afferent input in the pupillary light reflex

144
Q

What would cause abnormal results in the swinging flashlight test?

A

Disease of the optic nerve or the retina

145
Q

What is asymmetry of afferent input in the pupillary light reflex also known as?

A

Relative afferent pupil defect (RAPD)

146
Q

What are the 3 components of the accommodation reflex?

A
  • Pupil constriction (Constrictor pupillae)
  • Lens accommodation (ciliary muscles)
  • Convergence of the eyes (contraction both medial rectus muscles)
147
Q

How is the accommodation reflex tested?

A

The patient looks at a far away image and then to a near object.

MBChB - year 2 (25 decks)

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