Y4 Neurology Flashcards

1
Q

describe the transmission of an AP to create muscle contraction?

A
  1. Presynaptic voltage-gated Ca2+ channels open → Ca2+ influx
  2. ACh vesicles released from presynaptic terminal
  3. ACh diffuses across cleft
  4. ACh binds to nicotinic receptors on post-synaptic
    terminal
  5. → Na+ influx → depolarisation → Ca2+ release from SR
    → muscle contraction
  6. ACh is degraded by acetylcholinesterase and choline is
    taken up into presynaptic terminal.
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2
Q

what receptor does ACh bind to at the post synaptic terminal of the NMJ?

A

nicotinic

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3
Q

what blocks ACh vesicle fusion at the NMJ?

A

botulinum, LEMS

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4
Q

what blocks nicotinic ACh receptors at the NMJ?

A

Non-depolarising: atracurium, vecuronium 􏰁

Depolarising: suxamethonium

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5
Q

what three conditions are associated with dopamine pathways?

A

schizoaffective disorder
parkinsons
hyperprolactinaemia

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6
Q

what dopamine pathways in the brain are associated with schizoaffective disorder?

A

Mesocorticolimbic: SCZ

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7
Q

what dopamine pathways in the brain are associated with parkinsons ?

A

􏰀 Nigrostriatal: Parkinsonism

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8
Q

what dopamine pathways in the brain are associated with hyperprolactinaemia ?

A

􏰀 Tuberoinfundibular: Hyperprolactinaemia

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9
Q

what symptoms would you expect from a cortical lesion?

A

Hyperreflexia proximally in arm or leg

􏰀 Unexpected patterns

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10
Q

what symptoms would you expect from a cord lesion ?`

A

Quadriparesis / paraparesis

􏰀 Motor and reflex level: LMN signs at level of lesion and UMN signs below

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11
Q

what symptoms would you expect from a internal capsule lesion?

A

Contralateral hemiparesis ̄c pyramidal distribution.

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12
Q

where is the lesion with fasciculations?

A

LMN

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13
Q

where is the lesion for brown sequard syndrome?

A

hemi spinal cord

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14
Q

what are the symptoms of brown sequard syndrome ?

A

Ipsilateral loss of proprioception / vibration and UMN weakness with contralateral loss of pain

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15
Q

what symptoms are seen in cerebellar syndrome?

A

Dysdiadochokinesia
􏰀 Dysmetria: past-pointing
􏰀 Ataxia: limb / trunkal
􏰀 Nystagmus: horizontal = ipsilateral hemisphere
􏰀 Intention tremor
􏰀 Speech: slurred, staccato, scanning dysarthria
􏰀 Hypotonia

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16
Q

what are some common causes of cerebellar syndrome ?

A
Paraneoplastic: e.g. from bronchial Ca
􏰀 Alcohol: thiamine and B12 deficiency
􏰀 Sclerosis
􏰀 Tumor: e.g. CPA lesion
􏰀 Rare: MSA, Friedrich’s, Ataxia Telangiectasia
􏰀 Iatrogenic: phenytoin
􏰀 Endo: hypothyroidism
􏰀 Stroke: vertebrobasilar
17
Q

what visual disturbance is seen with posterior cerebral artery occlusion?

A

Contralateral homonymous hemianopia ̄c macula sparing.

18
Q

what is the vascular cause of lateral medullary syndrome?

A

occlusion of one of the PICA arteries

19
Q

what is ataxia?

A

The term ataxia refers to a lack of fine control of voluntary movements.

20
Q

what does lateral medullarly syndrome result in?

A
􏰁 Dysphagia
􏰁 Ataxia (ipsilateral)
􏰁 Nystagmus (ipsilateral) 􏰁 
Vertigo
􏰁 Anaesthesia
- 􏰂 Ipsilat facial numbness + absent corneal reflex
􏰂-  Contralateral pain loss
􏰁 Horner’s syndrome (ipsilateral)
21
Q

what symptoms does Millard-Gubler Syndrome have ?

A

Effects: 6th and 7th CN palsy + contralateral hemiplegia

22
Q

what causes Millard-Gubler Syndrome?

A

Pontine lesions

23
Q

what are the effects of an anterior spinal artery occlusion? (Becks syndrome)

A

Para- / quadri-paresis
􏰁 Impaired pain and temperature sensation
􏰁 Preserved touch and proprioception

24
Q

what does LEMS stand for?

A

Lambert-Eaton myasthenic syndrome

25
where does LEMS affect?
the NMJ
26
what can cause peripheral neuropathy?
DM, EtOH, uraemia
27
what can cause damage to the dorsal columns?
B12 deficiency
28
what is lost when the dorsal columns are damaged ?
proprioception