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85 Cards in this Set
- Front
- Back
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How many families of serotonin receptors are there, and which one is the 'fast' one?
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Seven. 5HT3 is the fast one
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What is the receptor for ATP?
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P2X is the receptor for ATP
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Blockade of sodium channel transport has what effect on neurons?
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Blocking a sodium channels hyperpolarizes, or inhibits, a neuron. Likewise when blocking calcium channels.
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What is the net effect of GABA-B receptors on pre- and post-synaptic neurons?
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On presynaptic neurons, GABA-B activates potassium channels, thereby inhibiting the cell; on post-synaptic neurons, calcium channels are inhibited.
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What myotome is tested with biceps? Triceps?
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Bicep - C5/6. Tricep - C7
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At what spinal level would an insult impair sympathetics to the heart?
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At T5/6, resulting in dysreflexia.
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At what level would spinal cord injury impair bladder function?
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At S2-4 (pudendal nerve, to external sphincter)
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What is AUTONOMIC dysreflexia? How is it treated?
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Discrepancy between ANS stimulation above/below a spinal cord injury. Sympathetic stimulation below injury causes increased vasocontriction. Baroreceptors in the brain stimulate parasympathetic compensation, resulting in vasoconstriction and bradycardia. Treat by decreasing BP.
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What are the two cell types that produce CSF?
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Choroid plexus and Ependymal cells.
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What is normal CSF pressure?
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15mmHg (+/- 3mmHg)
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What electrolyte is higher in CSF than plasma?
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Chloride
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What are the two layers of the dura mater?
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Endosteal and meningeal
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At what body temperature does cardiac fibrillation occur?
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About 27-29 degrees C
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Why do individuals with cardiac failure have problems regulating body temperature?
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Failure to distribute blood, impairs ability to redistribute heat
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What are the two main hormones that affect metabolic rate, and hence heat production?
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T3 (tri-iodothyroxine) and adrenalin
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What two nuclei does the preoptic area project to in order to exert thermoregulation?
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To the dorsomedial hypothalamus, which then projects to the raphe nucleus
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What cells are typically affected in primary demyelination?
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Oligodendrocytes or myelin
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What acute treatment should be given to improve the outcome of spinal shock?
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High dose steroids, within 8 hours
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Where does loss of sensation/movement occur, in relation to a complete lesion?
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Three segments below the lesion
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What spinal cord injury has the best prognosis?
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Brown-Sequard Syndrome, a hemisection of the spinal cord. 90% regain mobility
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What is the most common spinal cord injury? What is the prognosis with it?
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Central cord syndrome. 50% regain lower limb function.
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How does anterior cord syndrome present?
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Bilateral paraplegia, pain/temp loss; sphincter dysfunction; proprioception preserved. Worst prognosis of spinal cord syndromes
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How does posterior cord syndrome present?
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Motor function and pain/temp preserved; proprioception and fine touch lost below lesion
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What is the most common cause of coma, if no macroscopic findings are present? What is the basic mechanism of the pathology?
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Diffuse axonal injury. Disrupted membranes allow influx of calcium, which disrupts microtubular transport and allows buildup of toxic products
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Punk Drunk Syndrome resembles what dementia? Cases are commonly associated with what trauma?
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Alzheimer's disease. Commonly found with Subdural Haemorrhages
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What causes progressive damage in spinal cord injury?
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Glutamate release, which causes excitotoxicity. Free radicals and oxidative damage also may contribute.
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What percent of severe brain trauma results in epilepsy?
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5%
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What is the most common region injuries occur, in the spinal cord?
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Cervical (60%)
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Spinal cord injury: What are some predictors of outcome/recovery?
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Predictors: age, extent, location, degree of deficit.
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At what day of development does the anterior neuropore close? Posterior?
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Day 25/26, then day 27/28.
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Embryology: When is the male brain exposed to large amounts of testosterone?
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Weeks 8-20.
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Embryology: When do neurons of the cortex form?
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Week 7-16
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Embryology: What cells guide the migration of neurons from the ventricular zone?
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Radial glial cells.
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Embryology: What are three factors that interfere with neuronal mitosis and can lead to microencephaly?
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Excessive X-ray exposure, maternal rubella infection (1st trimester), and anti-cancer treatment (in first/second trimester)
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Embryology: What are the seven basic stages of CNS development?
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Proliferation, migration, differentiation, synaptogenesis, pruning, synaptic rearrangement, myelination
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Embryology: At what age does neuronal death begin, and how many cells are eliminated?
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Begins at age 2, and between 40-75% of cells are eliminated
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Embryology: Loss of ability to hear sounds that one has not been exposed to is an example of what process?
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Synaptic rearrangment
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Embryology: At what age does myelination of the brain begin?
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3 months of age
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Infection: What is Brudzinski's sign?
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Passive flexion of the neck (forward) causes involuntary flexion of hips/knees. Used in diagnosis of meningitis
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What antibiotics are given to adults with meningitis, and what else is given?
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Vancomycin & Ceftriaxone & ampicillin. Dexamethasone
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How many episodes are required, fulfilling 'migraine requirements' to be diagnoses?
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at least 5
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What is the most common type of headache?
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Tension headaches
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T/F - one does not need photophobia, phonophobia, nausea or vomiting for diagnosis of migraine?
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False. Either N/V, or photophobia/phonophobia must be present
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T/F - aura must precede a headache for diagnosis of migraine?
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False. Only 1/3 of migrainers experience aura
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What is used to treat severe migraines?
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Ergot alkaloids or sumatriptan
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What are given for prophylaxis for migraines?
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Antihypertensives, anticonvulsants, ergot preparations, NSAIDs, prednisone, MAOIs
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Headaches associated with watery eyes, nasal congestion, unilateral orbital-temporal pain, at predictable time of day is called?
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Cluster headaches
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What two substances are released in association with pain experienced from trigeminal stimulation?
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Calcitonin gene-related peptide (CGRP) and Substance P (SP)
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What visual information is process by magnocellular cells of the LGN? Parvocellular?
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Motion. Colour and detail
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What is the name of the pathway that the optic radiation takes through the temporal lobe?
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Meyer's loop
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The Band of Genarri refers to what?
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Striate Cortex
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What cortical regions processes texture and depth? For visual movement? Colour?
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V2 and V3. V5. V4.
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Pretectal area (pretectum) is responsible for what function?
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Pupillary light reflex, mediated by the Edinger-Westphal nuclei
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What visual centre orients one to salient information?
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Superior colliculi
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Vestibulo-occular reflex from the vestibular nuclei, is mediated through which tract, and to what nuclei?
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Through the medial longitudinal fasciculus to the contralateral abducent nucleus, allowing abduction of the eye
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What is the number one cause of seizure?
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Idiopathic (60-70%)
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What region of the brain is seen to have rhythmical voltage fluctuations with the cortex?
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The thalamus
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When does a seizure qualify as 'status epilepticus'? When should an ambulance be contacted, and what is the concern?
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When it exceeds 30 min OR a series of attacks where consciousness regained between them. Ambulance should be contacted if exceeds 5 min, as ventilation becomes impaired
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Genetic mutation of what receptor may contribute to the disorder
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GABAA (gamma-2 subunit)
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If one has a seizure that arises from the temporal lobe of one hemisphere, but retains conscious, it is what type?
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Simple (conscious) partial (only a portion of the brain involved)
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What type of seizure is it if if one hemisphere is involved, the person loses consciousness, and has amnesia?
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Complex partial.
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What are the semi-purposeful movement that are seen during seizures, called?
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'automatisms'
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Another name for Absence seizure is? And what is first line treatment for it?
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Petit Mal seizure. Tx: Ethosuximide
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Myoclonic and tonic can both occur as Tonic-clonic seizures. What is another name for this and what is first line treatment?
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Grand Mal seizure. Tx: valproic acid
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What type of seizure is often mistaken for fainting?
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Atonic, the 'drop seizure' where people simply fall to the floor
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When does a seizure warrant a hospital transfer?
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First seizure, multiples or pregnant.
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Why might a lumbar puncture be performed on someone with a first seizure?
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If meningitis is suspected.
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If interictal EEG appears normal, despite a first seizure, what should be done for further investigation?
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Repeat the EEG after sleep deprivation
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What is the primary targets of anti-epileptic drugs?
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GABA receptors and Sodium channels
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Why should serum be measured regularly?
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Both to monitor compliance and because of interindividual metabolism
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T or F: most epilepsy can be well controlled?
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True. 70% actually. 10% are controlled poorly. The remainder have breakthrough seizures despite compliance
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When are benzos indicated for seizure?
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Status epilepticus
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Which AEDs should be avoided during pregnancy?
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Valproate, carbamazepine, phenytoin (in general, most)
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Why do expanding lesions initially not increase ICP?
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Fluids are initially displaced out of the head, until compensation is exhausted at which point ICP increases exponentially
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What is the normal ICP in an adult? In a child?
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(adult) <15mmHg, (child) <3-7mmHg
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At what ICP should one consider therapy? How is it measured?
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20-25 mmHg. By lumbar puncture or intraventricular catheter
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How does hypoventilation raise ICP?
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Increase in pCO2 (dec pO2) causes vasodilation
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What is a false localizing sign?
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When increased ICP compresses structures elsewhere in the cranium (ie CN VI) suggesting the lesion is elsewhere
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What eye signs can be seen on fundoscopy?
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Papilloedema
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What time of day will chronic raised ICP present with headache?
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In the morning, as pCO2 rises with recumbency
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What is coning, and why can it be rapidly fatal?
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Tonsillar herniation of the cerebellum, through the foramen magnum. It may compress the medulla's respiratory and cardiac centre
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What is the classic triad of symptoms with hydrocephalus?
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Gait disturbance (ataxia, apraxia), urinary incontinence, dementia
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What is non-obstructive hydrocephalus?
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When CSF absorption is blocked, but no obstructions are found in circulation (communicating)
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What is hydrocephalus ex vacuo?
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A function of normal aging, as ventricles and sulci enlarge and CSF increases
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Sunset eyes are caused by what?
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CN VI palsy, impairing the upward gaze
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