Brain and Spinal Chord anat
a) Name the meninges
b) What the infection of the meninges called
c) what are the clinical features
Dura mater, Arachnoid mater, Pia mater
Meningitis
Fever, neck stiffness, photophobia, confusion, headache
What are the three main divisions of the autonomic nervous system, and what are some examples of their functions?
Sympathetic, parasympathetic, Enteric
S - Fight or flight - raise heart rate suppressed digestion, dilate, pupils and airways.
PS - Rest digest - SLUDGE
Enteric - GI track
What are confabulations
Confabulations are false or inaccurate memories that a person genuinely believes are true. The person isn't deliberately lying.
Virchows Triade
Endothelial Injury
Stasis/turbulence
hypercoagulability
FATS!
Name each of the major lipoproteins and what they do
Chylomicrons
VLDL
LDL
HDL
Name each lobes of the brain and their functions
Frontal, Parietal, temporal, occipital
F - Executive function Personality voluntary motor control Broca Area = Speech
P - somatosensory processing and spatial awareness
T - Hearing Memory Wernicke Area = Language comprehension
O - Vison
A patient develops loss of vibration and proprioception on the right side of the body below the level of a spinal cord lesion, while pain and temperature are preserved. Which tract is most likely damaged?
Dorsal column (medial lemniscus pathway)
what type of amnesia refers to the inability to form new memories after a brain injury, and is a key feature of Korsakoff syndrome.
anterograde amnesia
A patient present with facial weakness, facial drooping and weakness in her arm on the right side.
- What artery is effected
- What side of the brain
Left sided MCA
Beck's triad is a raised JVP, muffled heart sounds and hypotension - indicates what?
Cardiac tamponade
Explain the difference between the sympathetic nervous system and the parasympathetic nervous system in each:
-pre and post ganglions
-neruotransmitters
-the skin
-Ganglia are close to the spinal cord VS Ganglia are close to or inside
-Acetylcholine (ACh) is released before the ganglion; noradrenaline (NE) is usually released at the organ VS Acetylcholine (ACh) is released both before and after the ganglion
Skin is the only expectation: part of the sympathetic pathways, it should release noradrenaline, as its post ganglion neurotransmitter, however it releases ACh
A patient develops hoarseness and difficulty producing a normal voice after thyroid surgery
a) what nerve is likely damaged?
b) what muscles are affected?
a) recurrent laryngeal nerve
b) All intrinsic laryngeal muscles except the cricothyroid
Main Brain structures effected in Wernicke encephalopathy
Mammillary bodies - associated with memory
Medial thalamus - memory and cognition
Thunderclap headache/ worst head ache of my life is likely to be what?
Subarachoid hemorrhage (ouch)
In Hypertension explain
a) Primary hypertension
b) Secondary hypertension
c) complications of hypertension
a) Multifactorial
Age, Obesity, high salt intake, Alcohol, inactivity
b) Renal disease, renal artery stenosis, Hyperadrenalism, cushing's disease, thyroid disease, medications
c) myocardial infection, Stroke, heart failure, chronic kidney disease, retinopathy
a) Where is CSF produced
b) Name the ventricles in the brain and what they do
c) What is the cerebral aqueduct
a) choroid plexuses
b) Lateral, third and fourth - Store and Circulate the CSF
c) Canal in the midbrain and acts as a conduit for CSF
A patient has ptosis, a dilated pupil, and the eye positioned “down and out.” Which cranial nerve is most likely damaged, and why does this occur?
CN III – oculomotor nerve
The remaining innovative muscles include the lateral rectus and the superior oblique which pull the eye 'down and out'
Name the illness/symptoms associated with each B Vitamin
B1 B3 B6 B9/12
B1 - Wernickes
B3 4 D's (derm, diarrhoea, dementia, death)
B6 - Hair, skin and Nails
B9/12 - Megaloblastic Anaemia
On top of the pons sits which artery in the circle of willis
The Basilar Artery
a) Explain the lung hilum L & R Pulmonary art.
b) What is the cause of the most common type of pulmonary hypertension.
a) RALS
- Pulmonary artery right anterior and Left superior
b) Left sided heart failure - impaired left pumping = right side failure and backflow into lungs - Because the veins and capillaries are congested, blood from the pulmonary arteries faces heavy resistance :(
a) What is the rule of 4's in relation to the crainal nerves and their structures
b) Where do each CN exit?
a)
Above the pons (Midbrain): 4 nerves total. Cranial nerves I and II are higher up, while nerves III and IV are right in the midbrain.
In the pons: 4 cranial nerves: V, VI, VII, and VIII.
In the medulla: 4 cranial nerves: IX, X, XI, and XII.
b)
Cranial Nerves Exits:
Cribiform plate - 1 and Optic canal - 2
3,4,5,6 - S. Orbital fissure
7,8 Acoustic meatus
9,10,11 - Jular Formen
12 - hypoglossal canal
Cranial nerve V
Ophthalmic Nerve V1 - Exits S. Orbital Fissure
Maxillary Nerve V2 - Exits Foramen rotundum
Mandibular V3 - Foramen Ovale
What is the name of the process where a nerve impulse “jumps” from one Node of Ranvier to the next along a myelinated axon?And what is the purspose
Saltatory conduction
The purpose of saltatory conduction is to speed up the transmission of nerve impulses along a myelinated axon.
Why do we have to give thamine before glucose?
Reduced B1 causes low TPP (active B1 form) which causes pyruvate dehydrogenase activity ineffective = no acetyl-CoA and reduced ATP production causing brain cell injury.
Pyruvate dehydrogenase (PDH): links glycolysis to the TCA cycle.
α-Ketoglutarate dehydrogenase: works inside the TCA cycle.
Giving glucose to someone who is severely thiamine-deficient can increase metabolic demand when they lack the cofactor needed for normal energy production.
a) A 35 year old patient develops shortness of breath, chest pain after a long flight - What is wrong with her?
b) An echocardiogram shows a patent foramen ovale, she then develops weakness in her arm, and slurred speech.
Explain the process of what has happened
Paradoxical embolism:
The DVT travels through the venous circulation and, because of the PFO, crosses from the right atrium to the left atrium, bypassing the lungs. It then enters the systemic circulation and can travel to the brain, causing an ischaemic stroke.
Name 4 Left to right shunts (in the heart)
Patent foreman Oval
Patent ductus arteriosus
atrial septal defects
ventricle septal defect
intra ventricular septal defect