6.09

Front 1

Name the structures that are part of the 'limbic system'

Back 1

Hippocampus
Amygdala
Fornix
Anterior thalamus
Limbic cortex (anterior cingulate, ventral prefrontal, orbitofrontal (P Gage), insula, temporal)

Front 2

What is Kluver-Bucy syndrome? What are the symptoms?

Back 2

Bilateral lesion of the amygdala

May cause:
problems remembering emotional stimuli,
reduced aggression,
reduced inhibition,
over-friendliness and
hypersexuality

Front 3

Characterise the input and outputs to the amygdala

Back 3

Massive sensory input

Outputs to:
Hypothalamus (SNA)
DMX (PSNA)
CNV (fear look)
BRF
medulla (reflexes)

Front 4

What are the results of stimulation or lesion of the ventral prefrontal cortex (part of limbic cortex)?

Back 4

The ventral prefrontal cortex causes happiness when stimulated and the opposite when lesioned.

Front 5

What is the function of the anterior cingulate cortex (part of limbic cortex)?

Back 5

The anterior cingulate is important for the awareness of self and recognition of pain (may be important in depression)

Front 6

Which of the following is NOT conflicting with the idea of dualism:
1) Issue of influence
2) Brain damage
3) Plasiticity
4) Evolution of consciousness

Back 6

Plasticity

The idea of neural plasticity is conflicting with the central dogma of the identity theory (i.e. brain state is responsible for mind state)

Front 7

Define functionalism (a branch of materialism) in the context of the mind-body problem

Back 7

That the mind state is the result of inputs, outputs and other mental states

Front 8

Define eliminative materialism in the context of the mind-body problem

Back 8

That what we understand (folk pyschology) about the mind state/mind-body problem doesn't currently account for many of the questions posed, but that continuing investigation will produce answers.

Front 9

Describe the ascending monoamine pathway for noradrenaline

Back 9

Locus coeruleus
Hypothalamus
Cortex
Hippocampus/Amygdala

NLHCHA

Front 10

Describe the ascending monoamine pathway for serotonin

Back 10

Raphe nucleus
Hypothalamus
Thalamus
Cortex
Hippocampus/Amygdala

SRHTCHA

Front 11

Cite two pieces of pharmacological evidence that go against the monoamine theory of depression

Back 11

1. Cocaine (inhibs reuptake of 5HT and NAd) has no therapeutic effect on depressive patients
2. Amphetamine (stims release of 5HT and NAd and inhibs reuptake of 5HT and NAd) has no therapeutic effect on depressive patients
3. Plasma response to pharmacotherapy is near instant but therapeutic effect takes up to 8 weeks
4. Some therapeutics have no effect on monoamines

Front 12

How do MAOI's work?

Back 12

Inhibit the metabolism of 5HT and NAd thereby increasing plasma concentration

Front 13

T/F Monoamines and their metabolites may be found in reduced levels in urine, CSF and brainstem of depressed patients

Back 13

True (not a good diagnostic though)

This is a strong piece of biochemical evidence for the monoamine hypothesis of depression

Front 14

Neuronal loss in which areas may be associated with chronic depression?

Back 14

Hippocampus
Prefrontal cortex

Front 15

What is the mechanism of action of tricyclic antidepressants in depression? Give two examples

Back 15

TCAs inhibit the reuptake of serotonin (via 5HT transporter) and noradrenaline (via uptake 1 transporter).

e.g. imipramine, amitriptyline, doxepin

Front 16

Name three unwanted side effects of tricyclic antidepressants

Back 16

Autonomic (constipation, dry mouth, blurred vision, tachycardia)
Postural hypotension
Sexual dysfunction
Cardiac arrhythmias (K+ cycling)
Seizures

Front 17

What is the mechanism of action of MAOIs in depression? Give one example

Back 17

They prevent the conversion 5HT/Nad/Da to inactive metabolites in the presynaptic site

e.g. phenelzine, moclebemide

Front 18

Name two unwanted effects that may occur with MAOI use

Back 18

Postural hypotension
Weight gain
The 'Cheese Reaction': reaction to cheese, beer, game, wine,

Front 19

What is the mechanism of SSRIs in depression? Give two examples

Back 19

They selectively inhibit the reuptake of serotonin via the 5HT transporter.

e.g. citalopram, sertraline, fluoexitine

Front 20

What is the reason for the current preference for SSRIs over TCAs?

Back 20

The side effects of the two are similar, although SSRIs seem to cause less acute toxicity and have a lower overdose risk.

However, there is concern over the use of SSRIs in children and adolescents because of some studies showing an increase in early suicide following therapy

Front 21

Name two drugs that may be used in the treatment of depression that do not directly act on monoamines

Back 21

Lithium (mostly for bipolar)

Sodium valproate

Carbamazepine

Front 22

What is required by the DSMIV for diagnosis of bipolar disorder?

Back 22

At least one episode of mania/hypomania

Front 23

T/F The incidence of bipolar disorder is equal in males and females

Back 23

True

Front 24

Which of the following are commonly comorbid with bipolar disease:
vascular disease
substance abuse
migraine
obesity

Back 24

All

Front 25

T/F Most bipolar sufferers are asymptomatic in between episodes

Back 25

False

Front 26

What defines the difference between bipolar 1 and bipolar 2 disorders?

Back 26

Bipolar 1: at least one episode of mania

Bipolar 2: recurrent depression with at least one episode of hypomania WITHOUT an episode of mania

Front 27

What are the atypical features of bipolar depression?

Back 27

Hyperphagia
Hypersomnia
Weight gain
Anergia

Front 28

What are the common drugs used for treatment of mania and depression in bipolar disorder?

Back 28

Mania: LITHIUM, valproate/carbamazepine, atypical antipsychotics

Depression: lithium, lamotrigine, antidepressants (some refractoriness)

Best: lithium + valproate (+atypical antipsychotic?)

Front 29

Which feature of bipolar disorder is most commonly the index case

Back 29

Depression

Front 30

How is chronic stress theorised to be involved in the etiology of depression?

Back 30

Chronic cortisol
->increased NMDA activity
->Ca influx, enzyme hyperactivity, free radicals, DNA damage, downreg CREB-BDNF

Downreg BDNF: hippocampal and frontal atrophy

Front 31

How do antidepressants stimulate neurogenesis?

Back 31

serotonin/NAd
-> GPCR -> cascade
CREB-BDNF upregulation

Front 32

T/F Atrophic changes in seen in depression may be reversed by antidepressants

Back 32

True

Front 33

Name one gene that may be involved in the genesis of depression (along with environmental factors)

Back 33

COMT: catabolises dopamine. Involvement in schizophrenia also - sensitises to adolescent cannabis use.

Serotonin transporter gene:

Front 34

Which areas are most likely to be atrophied in the depressed brain?

Back 34

Hippocampus, possibly frontal lobe and hypothalamus as well

Front 35

What is the main refractive element of the eye?

Back 35

Cornea

Front 36

T/F The epithelium of the cornea is simple squamous

Back 36

False - stratified squamous

Front 37

From where does the cornea derive its nutrient supply and innervation?

Back 37

Nutrients: Cornea is avascular (unless irritated/inflamed). Therefore aqueous hum and limbic vessels

Innervation: V1

Front 38

What test might be used to diagnose a penetrating vs non-penetrating corneal injury?

Back 38

Seidel's test

Front 39

A corneal injury as deep as what layer would be expected to leave a thin white scar?

Back 39

Stroma

Front 40

What does the conjunctiva cover/lie on?

Back 40

Inner eyelid + sclera (NOT cornea)

Front 41

What is the name of the ligament that support the tarsal plates?

Back 41

medial palpebral lig

Front 42

Name the three layers of a tear film (from deep to superficial)

Back 42

Superficial oily film
Aqueous layer
Superficial lipid film

Front 43

Describe the shape of the globe in a myopic eye. Should the sufferer use + or - lenses?

Back 43

Globe is too long, causing light to bend and focus in front of the retina.

Requires negative lenses

Front 44

Describe the shape of the globe in a hyperobic eye. Should the suffer use + or - lenses?

Back 44

Globe is too short, causing light to bend too little and focus behind the retina.

Requires positive lenses

Front 45

Describe the shape of the globe in an astigmatic eye.

Should the sufferer use + or - lenses?

Back 45

Like a rugby ball

Astigmatics may require either + or - lenses

Front 46

What is arcus senilis?

Back 46

Accumulation of lipid in the stroma

Front 47

What is the name for typically symmetric, chronically red, dry eyelid margins?

Back 47

Blepharitis