6.05 Amy, Chris, Gem, Cel: Things Regarding The Brain

Front 1

Based on cytoarchitecture, how many distinct layers are there in most of the cerebral cortex?

Back 1

6

Front 2

How many Brodmanns’ areas are there based of difference in cell architecture (shape, size, density, lamina thickness)?
a. 65
b. 47
c. 13
d. 8
e. 13 000

Back 2

b. 47 (although LT says 52…)

Front 3

Which of the following about the primary cortical areas is incorrect?
a. It is topographically organized
b. A unilateral disturbance of a primary area usually causes disruption on the ipsilateral side
c. Receives raw information and deals with the thalamus
d. The primary motor cortex rives rise to fibres of the corticospinal tract and is involved in voluntary fine motor control
e. the primary somatosensory cortex encompasses the postcentral gyrus

Back 3

b is incorrect. Disruption on the contralateral side

Front 4

What do the secondary cortical areas do?

Back 4

Process info from the primary areas and add a layer of complexity

Front 5

What are the three major regions of higher order cortex?

Back 5

Parietal, limbic, prefrontal

Front 6

The sulcus immediately anterior the above shaded area is what?

Back 6

The central sulcus

Front 7

Choose the correct response.
a. The primary visual cortex encompasses the cingulate sulcus
b. The calcarine sulcus is located towards the anterior end of the brain
c. VI receives visual input from the lateral geniculate nucleus of the thalamus
d. The primary auditory cortex is located in the frontal lobe on the transverse gyrus of Heschl’s
e. Heschl’s is easy to say

Back 7

For a), the primary visual cortex encompasses the calcarine sulcus
For b), the calcarine sulcus is located posteriorly
For d) the primary auditory cortex is located in the temporal
For e)….

Front 8

The primary gustatory cortex is located adjacent to which other cortex?

Back 8

Insula

Front 9

Choose the correct response.
a. The prefrontal association cortex lies immediately anterior to the secondary motor region
b. The parietal association cortex allows us to respond to stimuli that are not particular important
c. The prefrontal association cortex lies around the corpus callosum
d. The linguila tract connects the Broca’s and Wernicke’s areas
e. Chris’ new haircut is too short for the size of his head

Back 9

The correct response is a).
For b), the parietal association cortex allows us to respond to stimuli that are significant
For c), the limbic association cortex lies around the corpus callosum
For d), it’s the arcuate tract

Front 10

The central sulcus divides which two lobes?

Back 10

Frontal and parietal

Front 11

What are the two major classes of neurons present in the cerebral cortex?

Back 11

Pyramidal (triangular and have an apical and basal dendrite and a projecting axon) and nonpyramidal (smaller and may act as an interneuron [if don’t have projecting axon])

Front 12

True or false: a lesion to the primary motor cortex would show upper motor neuron lesion signs such as weakness, increased tone and +ve Babinski

Back 12

True. The primary motor cortex is involved in contralateral motor control

Front 13

True or false: a destructive lesion (such as stroke) to the frontal eye fields will result in eyes deviating away from the site of the lesion, whereas a seizure will result in the eyes deviating towards the side of the lesion

Back 13

False. (I’ve put this explanation in words that I understand so I hope it makes sense…)
A destructive lesion will lead to a loss of function of the bad side and since the good side is still working, the eyes will deviate towards the side of the lesion.
A seizure is an excitatory lesion and hence there is a gain of function on the bad side, meaning it’s ‘stronger’ and pushes the eyes away from the bad side.

Front 14

Determine where the lesion is likely to be in each scenario based on the following: A man who has lost his ability to plan, has lost his get up and go (abulia) and who exhibits primitive reflexes such as grasping and pursing lips such as for suckling

Back 14

Prefrontal cortex

Front 15

Determine where the lesion is likely to be in each scenario based on the following: A woman who will not stop talking, but it’s all gibberish

Back 15

Wernicke’s area

Front 16

Determine where the lesion is likely to be in each scenario based on the following: A woman who has amnestic memory deficits

Back 16

Hippocampus, entorhinal cortex, cingulated cortex, parietal cortex
‘amnestic’ = can’t lay down new memories

Front 17

Determine where the lesion is likely to be in each scenario based on the following: A man who is asterognosic and dysgraphaesthesia and who cannot discriminate between two points

Back 17

Primary somatosensory cortex. (Dysgraphaesthesia : write on someone’s hand and they can’t work out what you’ve written on cos they can’t feel it. Asterognosia: can’t work out object in their hand by touch alone)

Front 18

Determine where the lesion is likely to be in each scenario based on the following: A man who is a left/right unco, who is having trouble writing (dysgraphia) and doing sums (dyscalculia) and who is apraxic

Back 18

Dominant parietal lobe

Front 19

Determine where the lesion is likely to be in each scenario based on the following: A woman who has difficulty recognizing faces, will only draw half a cat that’s been shown to her and puts her pants on her head

Back 19

Non-dominant parietal lobe.
faces = agnosia, cat = neglect, dressing = dressing apraxia

Front 20

Determine where the lesion is likely to be in each scenario based on the following: A woman who has superior homonymous quadrantanopia

Back 20

Temporal visual field

Front 21

What is the normal rang for ICP?

Back 21

10-15mmHg

Front 22

At what level would ICP reach before treatment is required?

Back 22

30mmHg

Front 23

What are the symptoms of raised ICP?

Back 23

Diffuse headache, N&V, VI CN palsy, papilloedema, coma, death

Front 24

When is a headache caused by raised ICP worse?

Back 24

Morning, Coughing, straining

Front 25

Which of the following is incorrect?
a. A negative MRI essentially rules out a brain tumour
b. CT can miss some tumours
c. Diagnosis of brain tumour must be confirmed with a biopsy
d. A glioblastoma multiforme tumour typically metastasises to the lungs
e. A glioblastoma multiforme tumour appears as a necrotic, haemorrhagic, infiltrating mass

Back 25

The incorrect response is d. A glioblastoma multiforme almost never metastasises outside the head, despite its high malignancy

Front 26

Name the following brain tumour. Is it benign or malignant? Where is it attached to? What cells does it arise from?

Back 26

Meningioma. Benign, attached to dura overlying the brain. Arises from subarachnoid cells

Front 27

Which of the following is incorrect?
a. A common site for Schwannoma is the cerebellopontine angle
b. Low grade astrocytomas show distinct borders and can be removed surgically
c. Schwannoma often presents with tinnitus or hearing difficulties due to its pressing on the VIII cranial nerve
d. The three most common sources of metastatic brain tumours are lung, breast and skin (melanoma)
e. Clinical features of brain tumours include raised ICP, epilepsy and evolving neurological deficits

Back 27

b) is incorrect and it therefore the correct response. Low grade astrocytomas show distinct borders on MRI but in fact histologically, they don’t. They therefore can’t be removed surgically

Front 28

True or false: Glioblastoma multiforme (GBM) have a median survival of only one year and are essentially incurable

Back 28

True

Front 29

True or false: GMB should be treated surgically followed by radiotherapy/chemotherapy.

Back 29

True

Front 30

True/False: A person may experience an aura without a headache following it

Back 30

True- termed migraine equivalents

Front 31

What are the common triggers for migraine?

Back 31

'ChOCOLATE'
o Cheese
o Oral contraceptive
o Caffeine
o alcohOL
o Anxiety
o Travel
o Exercise
o Some others: chocolate itself, extreme heat, menstruation, lack of sleep, hypoglycaemia, orgasm, food allergy

Front 32

What are the four subtypes of migranes, which one is associated with an aura?

Back 32

o Complicated: features a persistent neurological deficit after the pain has gone
o Uncomplicated: neuro features disappear with the pain
o Common: 70% of migraines, not preceded by aura
o Classical: always preceded by and aura

Front 33

Red Flags for headaches: Something the patient tells you, like?

Back 33

 Worst headache of my life/different than any other headache
 Neck stiffness

Front 34

Red Flags for headaches: Part of the history, like?

Back 34

 History of head trauma
 Anticoagulant use

Front 35

Red Flags for headaches: What you observe in the patient, like?

Back 35

 Decreased consciousness
 Confusion
 Seizures
 fever

Front 36

Red Flags for headaches: Use an ophthalmoscope for this, like?

Back 36

papilledema

Front 37

Red Flags for headaches: General sign related to this block, like?

Back 37

Focal neurological deficit, eg hemiparesis, numbness, weakness (could still be a migraine but is still an important sign)

Front 38

What are the two commonest headache syndromes?

Back 38

Tension type and migraine

Front 39

T/F: People with depression are less likely to suffer migraine.

Back 39

False- migrainers have more depression and depressed people have more migraines.

Front 40

T/F: An episode of headache may be preceded by strongly felt emotions

Back 40

True

Front 41

T/F: Headache is an uncommon presentation of depression

Back 41

False, this is called somatization

Front 42

T/F: Tension headaches associated with depression tend to improve as depressive illness responds to treatment

Back 42

True

Front 43

Sir Thomas Lewis (1940s) put pain into two global categories. What are the effects of each and a general example of the type of pain associated?
o Activating

o Deactivating

Back 43

o Activating
 Evoking fight or flight
 Hypertension
 Tachycardia
 General arousal
 Example: cutaneous pain
o Deactivating
 Evoking quiescence
 Loss of interest in environment
 Hypotension
 Bradycardia
 Sometimes nausea and fainting
 Example: deep chronic visceral

Front 44

Pain projecting to the _________ play a critical role in producing changes in autonomic activity associated with pain, eg crying
 Spino- and trigemino- _________ tracts

Back 44

medulla, reticular

Front 45

Projections to the _________ play roles in integrating somatic and behavioral responses to pain from different regions or following distinct time courses
Spino-/trigemino- ____________ tracts

Back 45

midbrain, mesencephalic

Front 46

Projections to ________ regions are alternative pathways, may mediate pain-associated depression.
 Spino-/trigemino- ________ tracts

Back 46

thalamic, thalamic

Front 47

Describe what happens after a lesion to the right primary motor cortex.

Back 47

Paresis to the left side of the body

Front 48

There are 3 major regions of higher order cortex that relate to an awareness of self, what are they and what would be noticed in someone that had a lesion to this area(s)?

Back 48

Prefrontal, Parietal,Limbic. Would notice a change in personality and the person wouldn’t be able to suppress inappropriate behaviors- laugh/cry inappropriately, make rude remarks (eg loss of executive inhibition, as in Phineus Gage)

Front 49

Lesion to which area would render you incapable of performing gross movement, such as turning your body and head to look in a certain direction?

Back 49

Secondary motor cortex

Front 50

Stimulation of the lateral portion of the primary somatosensory cortex would lead to?

Back 50

Tingling on the contralateral face.

Front 51

Which sensory cortex is needed for recognition of objects?

Back 51

Secondary somatosensory cortex

Front 52

Blindness is a risk of hitting which part of your head?

Back 52

Occipital lobe- location of primary visual cortex.

Front 53

Loss of low frequency sounds is a result of a lesion to which area?

Back 53

Lateral anterior of primary auditory cortex (transverse gyrus of Heschl in temporal lobe)

Front 54

Neglect syndrome is associated with what part of the cortex?

Back 54

Parietal lobe

Front 55

True/False for damage to parietal lobe: Has decreased ability for calculations with numbers

Back 55

True

Front 56

True/False for damage to parietal lobe:Is unable to recognize faces (agnosia)

Back 56

False- this results from a lesion to V5a

Front 57

True/False for damage to parietal lobe: Person can recognize different fingers

Back 57

False, will have finger agnosia

Front 58

True/False for damage to parietal lobe:They know the difference between right and left sides of body

Back 58

False

Front 59

True/False for damage to parietal lobe: Has an inability to write (agraphia)

Back 59

True

Front 60

True/False for damage to parietal lobe:Is unable to read (alexia)

Back 60

True

Front 61

What structures in the head are sensitive to pain?

Back 61

Meningeal, dural and cerebral arteries, venous sinuses, large veins ,scalp, extracranial muscles, and meninges

Front 62

What is the nerve that carries information about pain to the head?

Back 62

Trigeminal

Front 63

What cranial nerve nuclei processes information about pain in the head?

Back 63

Spinal tract of the trigeminal nerve (Vsp)

Front 64

What actions (eg vasodilation) would cause pain in blood vessels?

Back 64

Vasodilation, vasospasm, distension, stretching, local inflammation

Front 65

Is migraine an inherited condition? (Yes/No)

Back 65

Yes

Front 66

What are some common auras?

Back 66

visual, sensory, smell (not nausea, photophobia, phonophobia)

Front 67

What percentage of migraineurs get aura?

Back 67

30%

Front 68

In what part of the cortex does Aura usually start?

Back 68

Occiptal lobe

Front 69

How quickly does it spread across the cortex?

Back 69

2-3mm/minute

Front 70

In experiments, electrical stimulation leads to increased extracranial blood flow, local calcitonin gene related peptide release (CGRP) and substance P release. During migraine, increased extracranial blood flow would cause what symptom?

Back 70

Throbbing headache

Front 71

What percentage of people who have a first time TIA will have a stroke within the next 12 months?
A. 5%
B. 15%
C. 25%
D. 35%
E. 45%

Back 71

B. 15%

Front 72

In each category, what tests would you order to assess a TIA a Stroke?
Brain
Vascular imaging:
Cardiac imaging:
Blood tests:

Back 72

In each category, what tests would you order to assess a TIA a Stroke?
Brain imaging: CT or MRI
Vascular imaging: Carotid ultrasound, CT or MRI angiography
Cardiac imaging: ECG, Echo
Blood tests: FBC, Cholesterol, glucose, PTT, ESR, EUC, LFTs

Front 73

Low dose aspirin has been shown to have a relative risk reduction of 13% in preventing secondary stroke. Which patient group would choose to use an alternative to aspirin (may be more than one answer) and what would you use?

Back 73

A. Patients who are receiving warfarin therapy: Titrate warfarin dose
B. Patients with diabetes
C. Patients older than 65
D. Patients who suffer from peptic ulceration: Clopridagril
E. Patient who have had an event while on aspirin: Clopridagril (with/without aspirin)

Front 74

In a trial of dipyridamole in secondary stroke prevention dipyridamole resulted in 16% relative risk reduction compared to placebo and aspirin resulted in 18% relative risk reduction compared to placebo. When used in combination (aspirin and dipyridamole), what was the relative risk reduction compared to placebo?
A. 16%
B. 18%
C. 26%
D. 34%
E. 37%

Back 74

E. 37%

Front 75

What patient group would benefit from using warfarin over aspirin for prevention of secondary stroke?
A. Recurrent intracerebral haemorrhage
B. Atrial fibrillation
C. Carotid thrombolic occlusion
D. Lucunar infarction
E. Berry aneurysm

Back 75

B. Atrial fibrillation

Front 76

Which statement describes the changes in blood pressure that occur after stroke?
A. Autoregulation of cerebral perfusion is lost with acute stroke
B. After acute stroke vascular resistance increases causing an increase in blood pressure as cerebral perfusion = perfusion pressure/vascular resistance
C. Blood pressure is commonly elevated above pre-stroke levels following acute stroke
D. It is important not to try to lower blood pressure unless it reaches dangerously high levels and may cause organ damage
E. All of the above

Back 76

E. All of the above

Front 77

FGF (fibroblast growth factor) provides a signal in the developing lens for lens epithelium cells to differentiate into fibre lens cells. Which statement is correct?
A. There is a high concentration of FGF in the aqueous humor
B. The low dose of FGF in the aqueous humor (compared to the high dose in the vitreous humor) causes differentiation from epithelial cells to fibre lens cells
C. There is a high concentration of FGF in the vitreous humor
D. A high dose of FGF promotes proliferation of epithelial cells
E. Epithelial cells proliferate independently of FGF

Back 77

C. There is a high concentration of FGF in the vitreous humor

Front 78

Fibre lens cells have specialized interlocking proceses holding them together. For what functional reason are these only found in the lens?

Back 78

The lens needs to remain transparent so it cannt be held together with connective tissue.

Front 79

Which statement regarding accommodation is incorrect?
A. Accommodation is a reflex involving the optic nerve as the afferent and the occulomotor nerve as the efferent
B. Sphincter ciliaris has its biggest aperture when it is relaxed
C. Increased tension of the suspensory ligaments causes the lens to become more spherical
D. When the cilary sphincter is relaxed the suspensory ligaments are more taut
E. To view closer objects the lens needs to be more spherical

Back 79

C. Increased tension of the suspensory ligaments causes the lens to become more spherical

Front 80

In an experiment to determine the way the polarity of the lens develops a lens was removed and turned around so that the epithelium was facing inward and the lens cells were facing anterior. What would happen to this lens after a few days?

Back 80

The lens starts to grow another layer of fibre cells at the back and eventully the layer of fibre cells now at the front (because of the inversion) degenrates.

Front 81

What percentage of Australian Drug taking is done by people over 65?
A. 10%
B. 25%
C. 40%
D. 50%
E. 60%

Back 81

D. 50%

Front 82

Which of the following is not a component of Pharmacokinetics?
A. Absorption
B. Distribution
C. Effect
D. Metabolism
E. Elimination

Back 82

C. Effect

Front 83

Aging has several effects on the pharmacokinetics of drugs. The mass of the liver decreases by 30-40% which decreases the amount that enzymes can metabolise drugs (first pass effect). There is also a decrease in blood flow up to 50%, which affects both liver function and ________. The clearance by the kidneys can decrease by _____%.

Back 83

kidney function, 10-20%

Front 84

Aging also affects pharmacodynamics. Most organs have age-related _______ in response to medications, which is compounded by disease. For example, in the CNS there are fewer muscarinic Cholinergic receptors than in young people. In the autonomic system there are also fewer adrenergic receptors.

Back 84

decrease

Front 85

What structures in the head are sensitive to pain?

Back 85

Meningeal, dural and cerebral arteries, venous sinuses, large veins, scalp, extracranial muscles, and meninges

Front 86

What is the nerve that carries information about pain from the head?

Back 86

Trigeminal

Front 87

What cranial nerve nuclei processes information about pain in the head?

Back 87

Spinal tract of the trigeminal nerve (Vsp)

Front 88

Is migraine an inherited condition? (Yes/No)

Back 88

Yes

Front 89

What are some common auras in migraine?

Back 89

visual, sensory, smell (not nausea, photophobia, phonophobia)

Front 90

What percentage of migraineurs get aura?

Back 90

30%

Front 91

In what part of the cortex does Aura of migraines usually start?

Back 91

occipital lobe

Front 92

How quickly does aura spread across the cortex?

Back 92

2-3mm per minute

Front 93

What percentage of people who have a first time TIA will have a stroke within the next 12 months?
A. 5%
B. 15%
C. 25%
D. 35%
E. 45%

Back 93

B

Front 94

In a trial of dipyridamole in secondary stroke prevention dipyridamole resulted in 16% relative risk reduction compared to placebo and aspirin resulted in 18% relative risk reduction compared to placebo. When used in combination (aspirin and dipyridamole), what was the relative risk reduction compared to placebo?
A. 16%
B. 18%
C. 26%
D. 34%
E. 37%

Back 94

E

Front 95

What patient group would benefit from using warfarin over aspirin for prevention of secondary stroke?
A. Recurrent intracerebral haemorrhage
B. Atrial fibrillation
C. Carotid thrombolic occlusion
D. Lucunar infarction
E. Berry aneurysm

Back 95

B

Front 96

Which statement describes the changes in blood pressure that occur after stroke?
A. Autoregulation of cerebral perfusion is lost with acute stroke
B. After acute stroke vascular resistance increases causing an increase in blood pressure as cerebral perfusion = perfusion pressure/vascular resistance
C. Blood pressure is commonly elevated above pre-stroke levels following acute stroke
D. It is important not to try to lower blood pressure unless it reaches dangerously high levels and may cause organ damage
E. All of the above

Back 96

E

Front 97

FGF (fibroblast growth factor) provides a signal in the developing lens for lens epithelium cells to differentiate into fibre lens cells. Which statement is correct?
A. There is a high concentration of FGF in the aqueous humor
B. The low dose of FGF in the aqueous humor (compared to the high dose in the vitreous humor) causes differentiation from epithelial cells to fibre lens cells
C. There is a high concentration of FGF in the vitreous humor
D. A high dose of FGF promotes proliferation of epithelial cells
E. Epithelial cells proliferate independently of FGF

Back 97

C

Front 98

Which statement regarding accommodation is incorrect?
A. Accommodation is a reflex involving the optic nerve as the afferent and the occulomotor nerve as the efferent
B. Sphincter ciliaris has its biggest aperture when it is relaxed
C. Increased tension of the suspensory ligaments causes the lens to become more spherical
D. When the cilary sphincter is relaxed the suspensory ligaments are more taut
E. To view closer objects the lens needs to be more spherical

Back 98

C

Front 99

In an experiment to determine the way the polarity of the lens develops a lens was removed and turned around so that the epithelium was facing inward and the lens cells were facing anterior. What would happen to this lens after a few days?

Back 99

The lens starts to grow another layer of fibre cells at the back and eventully the layer of fibre cells now at the front (because of the inversion) degenrates.

Front 100

What percentage of Australian Drug taking is done by people over 65?
A. 10%
B. 25%
C. 40%
D. 50%
E. 60%

Back 100

D

Front 101

Which of the following is not a component of Pharmacokinetics?
A. Absorption
B. Distribution
C. Effect
D. Metabolism
E. Elimination

Back 101

C