Neurology Study Notes

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What is the primary function of the frontal lobe?

Motor control and concentration

What is the purpose of the tone test in neurological exams?

To evaluate resistance to passive movement of a joint

What is meant by decussation of the cranial and spinal nerves?

The right side of the body is controlled by the left side of the brain

What type of stroke is caused by a blocked blood supply?

Ischemic stroke Signup and view all the answers

What is the purpose of the AVPU scale?

To assess the level of consciousness in a patient Signup and view all the answers

What is the role of the parietal lobe?

Touch and pressure, body awareness Signup and view all the answers

What does the 'F' in the FAST acronym stand for?

Face asymmetry Signup and view all the answers

What is the most common type of stroke?

Ischemic stroke Signup and view all the answers

What is a transient ischemic attack (TIA)?

A temporary focal neurological deficit Signup and view all the answers

What is a risk factor for stroke?

Diabetes Signup and view all the answers

What is the treatment for ischemic stroke?

Thrombolysis Signup and view all the answers

What is the cause of an ischemic stroke?

An obstruction blocking the flow of blood in a part of the brain Signup and view all the answers

What is a subarachnoid haemorrhage?

A type of haemorrhagic stroke Signup and view all the answers

What is a symptom of a subarachnoid haemorrhage?

Thunderclap headache Signup and view all the answers

What is the treatment for a subarachnoid haemorrhage?

Nimodipine Signup and view all the answers

What is an extra dural haematoma?

A collection of blood in the space between the skull and the brain Signup and view all the answers

What is the definition of epilepsy?

A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions. Signup and view all the answers

What are Tonic-Clonic seizures also referred to as?

Grand-Mal seizures Signup and view all the answers

What is an absence seizure?

A seizure that causes loss of awareness of surroundings for a short time. Signup and view all the answers

What is a myoclonic seizure?

A seizure that causes body stiffness and then twitches. Signup and view all the answers

What is a tonic seizure?

A seizure that causes all muscles to become stiff. Signup and view all the answers

What is the main treatment for epilepsy?

Anti-epileptic drugs (AEDs) Signup and view all the answers

What percentage of people with epilepsy use AEDs to control their seizures?

70% Signup and view all the answers

What is the purpose of an EEG investigation in diagnosing epilepsy?

To see if different parts of the brain are functioning. Signup and view all the answers

What is a key requirement for the use of AEDs?

They must be used every day. Signup and view all the answers

What is the definition of status epilepticus?

A seizure that lasts a long time. Signup and view all the answers

What are the two characteristics of trigeminal neuralgia?

Recurrent, brief, lancing pain lasting approx. 30 seconds and trigger zones on the skin from wind and shaving. Signup and view all the answers

What is a potential cause of trigeminal neuralgia?

Multiple Sclerosis Signup and view all the answers

What is the primary area of the body affected by glossopharyngeal neuralgia?

All of the above Signup and view all the answers

What is post-herpetic neuralgia characterised by?

Erythema and typical herpetiform rash Signup and view all the answers

What is the primary area of the body affected by trigeminal autonomic cephalgia?

Eyes Signup and view all the answers

What is used to treat burning mouth syndrome?

Difflam mouthwash and Lidocaine gels Signup and view all the answers

What is a potential side effect of Phenytoin on oral health?

Gingival hyperplasia Signup and view all the answers

What is the main characteristic of multiple sclerosis?

Areas of demyelination in the CNS Signup and view all the answers

What is a common symptom of multiple sclerosis?

Chronic fatigue Signup and view all the answers

What is the primary reason for taking a pain history in identifying facial pains?

To identify the source of the pain Signup and view all the answers

What is the most common source of facial pain?

Dental pain Signup and view all the answers

What is the term for pain from a normally non-painful stimulus?

Allodynia Signup and view all the answers

What is the term for an increased response to a normally painful stimulus?

Hyperalgesia Signup and view all the answers

What is the term for an unpleasant sensation that is either spontaneous or evoked?

Dysaesthesia Signup and view all the answers

What is the dental relevance of multiple sclerosis?

People living with MS may be at increased risk of dental diseases due to various factors Signup and view all the answers

What is topiramate, and what is its potential effect on pregnant women?

A type of anti-epileptic drug, and it can cause birth defects Signup and view all the answers

What is the role of cyclin D in the cell cycle?

It phosphorylates the retinoblastoma tumour suppressor gene Signup and view all the answers

What is a characteristic of neoplasia?

A permanent alteration in growth pattern Signup and view all the answers

What is a hallmark of cancer?

Insensitivity to growth inhibition Signup and view all the answers

What can slow down the cell cycle?

Inactivation of proto-oncogenes Signup and view all the answers

What is the role of an oncogene?

To cause the cell to grow autonomously Signup and view all the answers

What is a characteristic of a tumour?

An abnormal mass of tissue with uncoordinated growth Signup and view all the answers

What is the result of DNA damage that hasn't been repaired?

Genomic mutations Signup and view all the answers

What are the three steps in carcinogenesis?

Normal, initiation, promotion Signup and view all the answers

What does tumour heterogeneity describe?

All of the above Signup and view all the answers

What are the two suppressor genes that are mutated in 50% of breast cancer patients?

BRCA and Rad51 Signup and view all the answers

What is the importance of Xeroderma Pigmentosum in DNA repair?

It is involved in the repair of damaged DNA Signup and view all the answers

What is the consequence of Xeroderma Pigmentosum?

Extreme sensitivity to sunlight and UV light Signup and view all the answers

What is the name of the hypothesis that explains the development of retinoblastoma?

Knudson's Two Hit Hypothesis Signup and view all the answers

What is the function of the p53 tumour suppressor gene when DNA is damaged?

It activates p21 to arrest the cell cycle Signup and view all the answers

What is the name of the syndrome characterized by germline mutations in p53?

Li-Fraumeni syndrome Signup and view all the answers

What is the function of the APC/Beta-catenin gene?

Inhibition of signal transduction Signup and view all the answers

What is the process by which cancer cells evade the immune system?

Immune evasion Signup and view all the answers

What is the name of the immunotherapy drug approved by NICE in 2017 for management in head and neck cancer?

Nivolumab Signup and view all the answers

What is the term for the process by which cancer cells adapt to more glycolytic pathways of metabolism?

Wahlberg effect Signup and view all the answers

What is the name of the virus that causes kaposi sarcoma?

HHV-8 Signup and view all the answers

What is the term for the process by which a tumour outgrows its own blood supply and induces its own blood supply?

Sustained angiogenesis Signup and view all the answers

What is the name of the protein that enables DNA damage repair?

Rad51 Signup and view all the answers

What type of signaling occurs when a ligand binds to a receptor on the same cell?

Autocrine signaling Signup and view all the answers

Which oncogene, when overexpressed, can cause breast cancer?

HER2 Signup and view all the answers

What is the mechanism of action of Ras?

Binding to GDP and propagating a signal Signup and view all the answers

What is the result of gene amplification?

Over-expression of a proto-oncogene Signup and view all the answers

What type of genes regulate cellular proliferation and can be inactivated in neoplasia?

Tumor suppressor genes Signup and view all the answers

What is the role of E2 in the cell cycle?

To help the cell cycle progress to the S phase Signup and view all the answers

What is retinoblastoma?

A type of eye cancer Signup and view all the answers

What is the result of a gene translocation?

Activation of an oncogene Signup and view all the answers

What is the mechanism of action of cetuximab?

By binding to EGFR, it blocks EGF from binding Signup and view all the answers

What is the percentage of pancreatic cancer tumors with Ras point mutations?

90% Signup and view all the answers

Where do B lymphocytes originate and mature?

Bone marrow Signup and view all the answers

What is the process to form a mature naive B cell?

Pluripotent haemoatopoietic stem cell → Pro-B cell → Mature naive B cell Signup and view all the answers

What is the role of the Fab region of an antibody?

Binding to antigens Signup and view all the answers

What are the two polypeptide chains that make up an antibody?

Two identical polypeptides of Mr 50K and two identical polypeptides of Mr 25K Signup and view all the answers

What is the role of antibodies?

Binding to infectious microorganisms and preventing infection Signup and view all the answers

What are the two domains of the antibody that form the binding site for antigens?

Adjacent N-terminal VL and VH domains Signup and view all the answers

What is the primary function of B cells in the bone marrow?

To assemble cell surface forms of IgM and IgD Signup and view all the answers

What determines the outcomes of B cells in the bone marrow?

Recognition of self-antigens Signup and view all the answers

What is the function of Fc receptors in B cell activation?

To deliver signal 1 Signup and view all the answers

What is the function of Th cells in B cell activation?

To produce cytokines Signup and view all the answers

What is the result of class switching in B cells?

Production of antibodies of different classes Signup and view all the answers

What is the role of Activation Induced Cytidine Deaminase (AID) in B cells?

To initiate somatic hypermutation Signup and view all the answers

What is the result of somatic hypermutation in B cells?

Diversity in antigen receptors Signup and view all the answers

What is the role of Th1 response in class switching?

Activation of IgG1 and IgG3 Signup and view all the answers

What cytokine blocks IgA activation?

IL-4 Signup and view all the answers

What is the result of simultaneous class switching and somatic hypermutation?

Evolution of memory B cells Signup and view all the answers

What is the primary function of the hinge region of an antibody?

To increase the flexibility of the antibody to bind to multiple antigens Signup and view all the answers

What is the role of the C-terminal region of the heavy chain?

To mediate functions such as activation of complement and enhancement of phagocytosis Signup and view all the answers

What is an epitope?

A specific site on an antigen that binds to an antibody Signup and view all the answers

How can individual antigens bind to different antibodies of different specificities?

Because antigens have multiple epitopes Signup and view all the answers

What is an immune complex?

An antigen bound to an antibody Signup and view all the answers

How are antibodies bound to antigens?

Through the Fab region Signup and view all the answers

What is the role of the Fc region?

To mediate effector functions Signup and view all the answers

What are the two main effector functions of antibodies?

Activation of complement and enhancement of phagocytosis Signup and view all the answers

What is the role of IgE antibodies?

To mediate allergic reactions Signup and view all the answers

What is the primary function of IgA antibodies?

To prevent the entry of pathogens Signup and view all the answers

What contributes to the diversity of antibodies?

All of the above Signup and view all the answers

What is the primary characteristic of neoplasia?

A tissue state characterized by a permanently altered growth pattern Signup and view all the answers

What is the term for a change from one to another normal differentiated cell type within a tissue?

Metaplasia Signup and view all the answers

What is the term for an increase in the size of cells in a tissue?

Hypertrophy Signup and view all the answers

What is the term for a state in some tissues which denotes an increased risk of malignant change?

Dysplasia Signup and view all the answers

What is the term for a swelling, generally without inflammation, caused by an abnormal growth of tissue whether benign or malignant?

Tumour Signup and view all the answers

What are the two behaviours of tumours?

Benign and malignant Signup and view all the answers

What is the primary reason for an increased risk of squamous cell carcinoma in individuals over 50 years old?

Accumulation of sun damage over time Signup and view all the answers

What is the term for the process by which cancer spreads from the primary tumour to distant organs or lymph nodes?

Metastasis Signup and view all the answers

What is the primary difference between well-differentiated and poorly differentiated tumours?

The ease of identifying the tissue of origin Signup and view all the answers

What is the purpose of the TNM staging system for cancer?

To classify the tumour based on size, lymph node involvement, and distant metastasis Signup and view all the answers

What is the term for the secretion of hormones or other substances by a tumour that would not normally be produced by that particular tumour cell type?

Paraneoplastic phenomenon Signup and view all the answers

What is the primary difference between subjective and objective observations concerning prognosis?

The extent of invasion versus the degree of atypia Signup and view all the answers

What is the term for the systematic search for cancer in people who have no signs or symptoms of cancer?

Screening Signup and view all the answers

What is the primary purpose of radiology in diagnosing a tumour?

To define the size, extent, and structures involved Signup and view all the answers

What is the term for the formation of new blood vessels that can support tumour growth?

Angiogenesis Signup and view all the answers

What are the three well-established cancer screening programmes?

Cervical, breast, and colorectal Signup and view all the answers

What is an example of metaplasia?

Barrett's oesophagus Signup and view all the answers

What is the main difference between benign and malignant tumours?

Benign tumours do not metastasise, malignant tumours can undergo regional and distant metastasis Signup and view all the answers

What is the suffix '-oma' typically associated with?

Benign tumours Signup and view all the answers

What type of tissue can undergo cancer?

Epithelial and mesenchymal tissues Signup and view all the answers

What is a lymphoma?

A tumour of the lymphoid system Signup and view all the answers

What is the name of the virus associated with oropharyngeal squamous cell carcinoma?

HPV Signup and view all the answers

What is the role of squamous epithelium in the mouth?

Forms the lining of oral mucosa and acts as a barrier by laying down keratin Signup and view all the answers

What is the most common cancer of the mouth?

Squamous cell carcinoma Signup and view all the answers

What is the result of DNA damage that hasn't been repaired?

Carcinogenesis Signup and view all the answers

What is an example of dysplasia?

Cervical screening Signup and view all the answers

Study Notes

Here are the study notes in detailed bullet points:

Neurology

Neurology refers to the branch of medicine or biology that deals with the anatomy, functions, and organic disorders of nerves and the nervous system.
Cranial and spinal nerves decussate, meaning the right side of the body is controlled by the left side of the brain.

Brain Function

The brain has 5 areas with specific roles:
- Frontal lobe: motor control, concentration, planning, problem-solving, speech, and smell
- Parietal lobe: touch and pressure, taste, and body awareness
- Temporal lobe: hearing and facial recognition
- Occipital lobe: vision
- Cerebellum: coordination

Neurological Pathologies

Stroke:
- A focal neurological deficit that lasts longer than 24 hours, resulting from a vascular lesion
- Can be ischemic (80%) or hemorrhagic (20%)
- Ischemic stroke caused by a blockage in blood supply, treated with thrombolysis
- Hemorrhagic stroke caused by bleeding in the brain, no specific treatment
Transient ischemic attack (TIA):
- Focal neurological deficit that lasts less than 24 hours, resulting from a vascular lesion
- Temporary, as the deficit fully resolves
Risk factors for stroke:
- Diabetes, smoking, obesity, oestrogen OCP, excess EtOH, polycythaemia, atheroma, hereditary nature, and hypertension

Stroke Diagnosis and Treatment

The FAST acronym to identify stroke:
- F - Face: asymmetry of the face
- A - Arm: weakness in the arms
- S - Speech: slurring of speech
- T - Time: time to phone for help
Symptoms of stroke:
- Palsy
- Sudden severe headache with no known cause
- Confusion, trouble speaking or understanding speech
- Sudden trouble seeing in one or both eyes
- Ataxia, trouble walking, dizziness, loss of balance, or lack of coordination
Treatment and risk reduction:
- Ischemic stroke: thrombolysis
- Hemorrhagic stroke: no specific treatment
- Chronic stroke: NG feeding, rehabilitation, occupational therapy, and secondary risk factor management

Epilepsy

Definition: a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain
Layman's terms: temporary bursts of electrical activity in the brain that affects how the brain works
Duration and management: lifelong, managed with anti-convulsants
Types of seizures:
- Tonic-clonic (Grand-Mal)
- Simple partial
- Complex partial
- Absence
- Myoclonic
- Clonic
- Tonic
- Atonic
- Status epilepticus
Triggers: stress, fatigue, lights, alcohol, missing medication, coffee, and nicotine
Investigations: CT scan, MRI, EEG, and blood tests
Treatments: anti-epileptic drugs, surgery, electrical devices, ketogenic diet, and avoiding triggers

Multiple Sclerosis

Definition: areas of demyelination in the CNS
Pathology: peri-venular plaques of demyelination known as perineural oedemas
Predilection areas: optic nerves, brainstem and cerebellar connections, and cervical spinal cord
Symptoms: chronic fatigue, axonal blockade, and optic neuritis
Investigations: MRI of the brain and spinal cord, and electrophysiology
Types of MS: primary progressive, secondary progressive, and benign
Dental relevance: people living with MS may be at increased risk of dental diseases due to reduced manual dexterity and side effects of medications

Pain

Allodynia: pain from normally non-painful stimuli
Hyperalgesia: increased response to normally painful stimuli
Dysaesthesia: unpleasant sensation that is either spontaneous or evoked
Paraesthesia: abnormal sensation that is either spontaneous or evoked but not unpleasant
Hypoalgesia: diminished pain response to painful stimuli
Anaesthesia: no pain from painful stimuli
Neuralgia: nerve distribution pain
Neuropathic pain: nerve pathology/damage pain
Neuropathy: nerve function/damage/pathology pain
Sources of facial pain:
- Dental pain
- Trigeminal neuralgia
- Trigeminal neuropathic pain
- Trigeminal autonomic cephalgia
- Post-herpetic neuralgia
Importance of taking a pain history in identifying facial pains

Trigeminal Neuralgia

Recurrent, brief, lancing pain lasting approximately 30 seconds
Trigger zones on the skin from wind and shaving
Potential cause: MS
Treatments: anti-convulsants, LA injections, nerve ablation, and vascular decompression

Glossopharyngeal Neuralgia

Pain in the ear, base of tongue, tonsillar fossa, and angle of jaw
Triggered by chewing, swallowing, talking, yawning, and coughing
Affects the sensory areas of the glossopharyngeal nerve

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