Revision CNS Module PDF

‫هذا العمل التطىعي‬ ‫ليس مجهىد فرد واحد‬ ‫بل مجهىد جماعي من‬ ‫سىايسة طب السىيس‬ ‫‪0202/0202‬‬ ‫بالتىفيق للجميع‬ ‫‪BY: SUEZIANS‬‬  REVISION CNS MODULE 1) Mechanism of release of neurotransmitters in synaptic cleft is Exocytosis MECHANISM OF SY...

‫هذا العمل التطىعي‬ ‫ليس مجهىد فرد واحد‬ ‫بل مجهىد جماعي من‬ ‫سىايسة طب السىيس‬ ‫‪0202/0202‬‬ ‫بالتىفيق للجميع‬ ‫‪BY: SUEZIANS‬‬  REVISION CNS MODULE 1) Mechanism of release of neurotransmitters in synaptic cleft is Exocytosis MECHANISM OF SYNAPTIC TRANSMISSION - Action potential travels down an axon to the terminal buttons Depolarization. - Opening of voltage gated calcium channels, this leads to calcium influx. - This stimulates synaptic vesicles which contains the neurotransmitter, to Migrate to the active zone and fusion between V snare and T snare. - Neurotransmitter release by exocytosis. - Ca ions are pumped out again. - Neurotransmitter diffuse in the synaptic cleft and bind to specific receptor on the postsynaptic neuron. - The receptor sites are ligand-gated ion channels. - These channels cause sodium or calcium influx , Depolarization, Generation of excitatory postsynaptic action potential. Or cause Potassium efflux and chloride influx, Hyperpolarization, Generation of inhibitory postsynaptic action potential. - Then, Removal of chemical transmitter by : 1- Diffuse away in synaptic cleft. 2- Active reuptake by the presynaptic knob. 3- Deactivation by enzymes. 4- Removal by microglial cells. 2) Drug of choice in absence seizures is Ethosuximide 3) Occlusion of anterior cerebral artery Ant cerebral a. Middle cerebral a. Post cerebral a. - Runs in Callosal - Runs over insula in - Runs in the anterior sulcus. lateral sulcus. part of calcarine - Arises from ICA below - Arises from ICA below sulcus. ant. Perforated anterior perforated - Arises at the upper substance as the substance as the larger pole of the pons as 2 smaller terminal terminal branches. terminal branches of branches. basilar artery. CORTICAL CORTICAL CORTICAL BRANCHES BRANCHES BRANCHES - Supply the medial - Supply the lateral - Supply Tentorial surface of the cerebral surface of cerebral surface. hemisphere except hemisphere except: - Supply occipital lobe. occipital lobe & upper 1- Occipital lobe. - Supply the lower inch one inch on the lateral 2- Strip on the lat. of the temporal lobe on surface & medial 1/2 of Surface of the temporal the lateral surface. the orbital surface of lobe near to the inf. the frontal lobe. border. - Supply temporal pole and insula. - Supply lat. 1/2 of  orbital surface. CENTRAL BRANCHES CENTRAL BRANCHES CENTRAL BRANCHES - Pierce the ant. - Branches called - Short med. Group : Perforated substance STRIATE ARTERIOLES supply cerebral and lamina terminalis to - penetrate the ant. peduncles, mammillary supply: Perforated substance bodies, the 1- Ant. Part of corpus to supply: subthalamic region & striatum. 1- Corpus striatum ant. Part of the 2- Ant. Part of ant. Limb (lentiform+caudate) thalamus. of internal capsule. 2- Post 1/2 of the ant. - Long lat. Group : 3- The septal region Limb, genu & the ant. Supply geniculate including the septum Part of the post limb of bodies, post part of the lucidum. the internal capsule. thalamus& pineal body. (medial surface ‫)علي ال‬ - The largest central CALLOSAL BRANCHES branch is charcots Supply all parts of artery (MOST corpus callosum SUSCEPTIBLE (medial surface ‫(علي ال‬ ARTERY IN BRAIN TO RAPTURE) OCCLUSION OCCLUSION OCCLUSION - Contralateral loss of - Contralateral loss of - Contalateral sensation in lower limb. sensation in upper homonymous - Contralateral paralysis limbs, trunk and face. hemianopia. of muscles of lower - Contralateral limb. paralysis of muscles of face, trunk and upper limbs. - Partial deafness. - Motor and sensory aphasia. 4) Arterial supply of cingulate gyrus is Anterior cerebral artery 5) Neurotransmitter in substantia negra is Dopamine SUBSTANTIA NEGRA IS ONE OF THE BASAL GANGLIA: Degeneration of the negrostriatal DA neurons leads to Parkinsonism. 6) Modulate pain sensation Periaqueductal grey 7) Ttt of toxicity with alprazolam by: Flumazenil Alprazolam is one of the benzodiazepines and Flumazenil is a specific antagonist to Benzodiazepines. 8) Pilocytic astrocytoma affects children - One of the gliomas. WHO grade I. Affects children. - Morphology: Well circumscribed cerebellar cystic mass with solid mural nodule. Bipolar astrocytes and Rosenthal fibers. (eosinophilic granular bodies). Fibrillary background. 9) Patient with a history of deteriorating cognitive function Alzheimer's disease. 10) Function of microglia is Phagocytosis - Neurons: Receive, Transmit and process the nerve impulses. According to morphology, There is: Bipolar cells : As in vestibular and cochlear ganglia. Unipolar cell: As in mesencephalic nucleus of trigeminal nerve. Pseudounipolar: As in dorsal root ganglia. Multipolar cells: MOST NUMEROUS IN CENTRAL NERVOUS SYSTEM - Astrocytes: Share in formation of blood brain barrier. - Microglia: Phagocytosis. - Oligodendroglia: Formation of myelin sheath around axons. - Ependymal cells: Secretion of cerebrospinal fluid. IN PERIPHERAL NERVOUS SYSTEM - Satellite cells: Support the neurons. - Schwann cells: Formation of myelin sheath around axons. 11) Acute opioid overdose is blocked by Naloxone 12) Lateral lemniscus carries Hearing impulses 4 LEMNISCI - Lateral lemniscus involved in auditory pathway. Carries hearing impulses from both ears. - Spinal lemniscus carries pain, temperature & crude touch from the opposite side of the body. - Trigeminal lemniscus: carries pain, temperature, touch & proprioception from the opposite side of the face. - Medial lemniscus: Carries fine touch and proprioception from the opposite side of the body below the face. 13) Primary motor area lies in Frontal lobe - Primary motor area (4) : lies in precentral gyrus. Supplied by MCA & ACA. Responsible for the voluntary skillful movements of opposite side of the body except the eye. Lesion is Contralateral hemiplegia. - Premotor area (6): Lies in front of area 4. Supplied by MCA & ACA. Responsible for planning complex sequence of movements & designing (programming) of movement. Lesion is Disturbed skillful movements. Reappearance of grasp reflex. Hyperreflexia. Hypertonia. - Prefrontal cortex: Lies in most of the med. Frontal gyrus on the med. Surface, orbital part of inf. surface, Rest of the frontal lobe on lat. Surface. Supplied by MCA & ACA. Responsible for behavior, learning, emotions,.. Lesion is disturbance in function. - Frontal eye field (8): Lies in the posterior of middle frontal gyus. Supplied by MCA. Responsible for voluntary eye movements to the opposite side of the body (Conjugate lateral movement of the eye). Lesion is Deviation of both eyes to the side of the lesion. - Broca's speech area (44,45): (DOMINANT HEMISPHERE) Lies in the posterior of inf. frontal gyrus. Supplied by MCA. Responsible for speech production. Lesion is motor aphasia. - Primary visual cortex (17): Lies on each side of calcarine sulcus. Supplied by PCA. Responsible for Perception of visual stimuli. Lesion is Crossed homonymous hemianopia. - Secondary visual cortex (18,19): Lies around the primary visual cortex. Supplied by PCA. Responsible for understanding the meaning of the pictures seen. Lesion is Word blindness (visual agnosia). - Primary auditory area (41,42): Lies in the middle of superior temporal gyrus. Supplied by MCA. Responsible for Perception of sounds. Lesion: Unilateral (incomplete bilateral deafness). - Secondary auditory (22): Lies in the remaining of sup. Temporal gyrus. Supplied by MCA. Responsible for understanding the meanings of sounds. Lesion is word deafness (auditory agnosia). - Wernikes area (22): (DOMINANT HEMISPHERE) Lies in post. Of the sup. And middle temporal gyri. Supplied by MCA. Resposible for comprehension of language and sensory speech center. Lesion is Sensory aphasia (wernike's aphasia). - Primary sensory area (3,2,1): Lies in the postcentral gyrus. Supplied by MCA & ACA. Responsible for sensations from opposite side of the body. Lesion is contralateral hemianasthesia. - Association sensory area (5,7): Lies in the superior parietal lobe. Supplied by MCA & ACA. Responsible for understanding and integrating sensory information & Steriognosis.  Lesion is asteriognosis. 14) In Muscle spindle which is dynamic? Nuclear bag Nuclear chain is static. 15) Regulation of ketolysis is determined by the bioavailability of Oxaloacetate 16) Brain tumor in interpeduncular fossa will affect Oculomotor nerve 17) Tolcapone is COMT inhibitor 18) Loss of muscle co-ordination is due to Damage of cerebellum 19) Rabies diagnosis Negri bodies 20) East African sleeping sickness by Trypanosoma brucei rhodesiense 21) Patient can't vocalize the words, the injury is in Broca's speech area (motor aphasia) 22) Morphine overdose leads to Respiratory depression 23) Annual follow up investigations of type 2 diabetes are Blood lipid, Fundus examination, Microalbuminuria 24) Antiepileptic drug which elevates the plasma concentration of other drugs Valporic acid 25) The cell which is responsible for myelination of the axons in PNS (peripheral nervous system) is Schwann cell 26) In Axoplasm, There is Neurofilamnets No rER, no nucleus, no Golgi apparatus. 27) Prions cause Kuru & vCJD (variant Creutzfeldt-Jakob disease) 28) Beri beri is due to deficiency of Vit B1 (Thiamine) 29) Ttt of focal seizures is Levitiracetam 30) Peripheral adverse effects of levodopa can be reduced if given with Carbidopa ( Peripheral decarboxylase inhibitor which doesn't cross the BBB but inhibit the peripheral decarboxylase enzyme, So the 1/2 life is prolonged). 31) Patient with fever, headache, neck stiffness with history of swimming in shallow water, the causative organism is Naegleria fowleri 32) Pernicious anemia is due to deficiency of Vit B12 33) Which of the followings is involved in transport of fatty acyl CoA Carnitine 34) Function of the primary motor cortex is Initiation of the voluntary movements 35) Oxidation of the palmitoyl CoA (C16) results in 8 Acetyl CoA 36) Tumor which is attached to the dura mater and characterized by the presence of psmmoma bodies Meningioma - Meningioma: Whorls, Psmmoma bodies, Females. - Astrocytoma (Pilocytic) WHO I : Cerebellum, Child, cystic, Rosenthal fibers. - Diffuse astrocytoma WHO II : Cerebrum, Adult, Protoplasmic astrocytes swollen and plumpy , pleomorphism without mitotic figures. - Anaplastic astrocytoma WHO III : Cerebrum, Pleomorphism, Mitotic figures with no necrosis. - Glioblastoma multiform: Cerebrum, Adult, Pleomorphism, Hge, necrosis, Palisade necrosis. - Oligodendroglioma WHO II & III: Rounded uniform cells lymphocyte like, with rounded nucleus. - Ependymoma WHO II &III: 4th ventricle (common), Pseudorosettes, hydrocephalus. - Medulloblastoma Grade IV: Embryonic, Primitive cells, cerebellum At midline & rare in cerebellar hemispheres, Child, Small dark cells with little cytoplasm, pseudorosettes. - Schwannoma: Cerebellopontine angle, 8th cranial nerve (acoustic), Antoni A & Antoni B, Vertigo, Hearing loss. 37) One of the basal ganglia Caudate nucleus 38) Drug inhibits both serotonin and noradrenaline reuptake Tricyclic antidepressant 39) Which of the followings causes subacute sclerosing panenchephalitis? Measles 40) The type of neurons in dorsal root ganglia Pseudounipolar neurons 41) Neurotransmitter of fast pain fibers is Glutamate Transmitter substances involved in the analgesia system are encephalin and serotonin. 42) Symptoms of neurological disease associated with cerebellum are Ataxia and dysmetria 43) Spinal cord hemisection leads to Ipsilateral loss of tactile localization, vibration & proprioception (Damage of Gracile & Cuneate) - Gracile tract receives proprioception of the lower 1/2 of the body. - Cuneate tract receives proprioception of the upper 1/2 of the body. 44) Motor decussation occurs in Upper part of medulla oblongata (UPPER CLOSED MEDULLA) 45) Manifestations of lower motor neuron lesion Hypotonia 46) A 10 year old girl develops headache, ataxia, hydrocephalus with a midline cerebellar mass, what's your diagnosis? Medulloblastoma 47) One of the association fibers Commissural fibers Association fibers Projection fibers - Corpus callosum - Cingulum - Corona radiata (Largest and main - Uncinate - Internal capsule Commissure in the - Sup. Longitudinal - Thalamic radiation, Brain. It consists of bundle. Visual, auditory Rostrum, genu, body, - Inf. Longitudinal bundle. Radiations. Splenium). - Ant. Commissure - Post. Commissure - Habenular Commissure - Hippocampal Commissure. Connects structures Connects structures in - Ascending to the of both cerebral the same cerebral Cerebral cortex hemispheres. hemisphere. From the thalamus. - Descending from The cortex to the lower Centers. BLOOD SUPPLY OF THE INTERNAL CAPSULE - ANT. LIMB Ant. 1/2 of the ant. Limb by ACA. ( ‫ فبعض‬Anterior ‫( كلهم‬ Post. 1/2 of the ant. Limb by MCA. (ICA ‫هتبقي بال‬post ‫ ما عدا اللي كلهم‬MCA ‫) الباقي بقا اي حاجة هتبقي بال‬ - GENU By MCA. - POST. LIMB Ant. 1/2 of post. Limb by MCA. Post. 1/2 of the post. Limb by ICA. - All parts of corpus callosum are supplied by ACA except the splenium which is supplied by the PCA ( occipital ‫)ناحية ال‬. 48) Site of the vital centers of the control of visceral activities is Hypothalamus 49) Responsible for formation of CSF Choroid plexus - Hydrochephalus is a chronic accumulation of CSF in the ventricular system leading to its dilatation and atrophy of the brain tissue. - TYPES: NON communicating : due to obstruction of ventricles  Communicating: DUE TO 1) Increase in the production as in choroid plexus papilloma. 2) Decrease in the absorption as in congenital aplasia of the villi, Damage of the villi, Thrombus in SSS (sup. Sagittal sinus). 3) Obstruction as in congenital cases, Due to meningitis, Tumor, Sub tentorial mass (obstruction of the subarachnoid). 50) Rabies is transported to the brain along Peipheral nerves - STREET VIRUS : in saliva of the infected animal. - FIXED VIRUS : is prepared by repeated culture in the brain of the rabbit. - MODE OF TRANSMISSION: 1) Bite of rabid animal. 2) Non-bite exposure: AEROSOLS of bats 3) corneal transplantation from an infected cadaver. 4) Human to human is extremely rare. - RETROGRADE AXONAL TRANSPORT. - NEGRI BODIES - HYDROPHOBIA & AEROPHOBIA. (painful spasm in throat muscles). - CAUSE OF DEATH : CARDIAC ARREST - PRE-EXPOSURE PREVENTION (high risk, lab workers, vets): 3 doses with booster dose after 2 years. - POST-EXPOSURE PREVENTION (after bite) : 5 doses (0,3,7,28th ) or Rabies Immunoglobulins. - VACCINES: 1) HDCV (human diploid cell rabies vaccine ) 3) Purified vaccine adsorbed rabies (fetal resus monkey lung cells ) 2) Purified chicken embryo cell vaccines (virus grow on chicken fibroblast) 51) Depression accompanied by pain Tricyclic antidepressant 52) Cerebellar lesion manifested by Intention tremors 53) Characteristic for opiate withdrawal Convulsions 54) Encapsulated receptor in the skin responsible for pressure Pacinian corpuscle 55) Perineurium is Fascial layer surrounds a bundle of nerve fibers 56) Transverse section in pons will show Abducent nucleus 57) Section in the open medulla shows the presence of Hypoglossal and vestibular nuclei  OPEN MEDULLA IMPORTANT NOTES - Red nucleus appears at the level of superior colliculus. - Inf. colliculus : Center of auditory reflexes, connected with med. Geniculate body. - Sup. Colliculus : Center of visual reflexes, connected with lat. Geniculate body. - Ant. Lobe of cerebellum ( Paleocerebellum ) : Control of muscle tone. - Middle lobe of the cerebellum ( Neocerebellum ) : Coordination of muscle movement. - Folloculonodular lobe : Equilibrium. 58) Mycotic aneurysm is due to Subacute infective endocarditis - Congenital: Congenital absence of the media ….. Weakness of the wall ….. Aneurysm. - Mycotic: Polyarteritis nodosa, Subacute infective bacterial endocarditis. - Arteriovenous: Communication between ICA and cavernous sinus secondary to trauma. - Atherosclerotic: common sites are basilar a. & MCA. CEREBRAL HEMORRHAGE & THE MAIN CAUSE OF EACH TYPE - Epidural: Trauma of middle meningeal artery. - Subdural: Trauma to cortical veins. - Subarachnoid: Rapture of berry aneurysm. - Petechial: Infections, hemorrhagic blood diseases, trauma. 59) Alternative hypo and hypercellular areas is characteristic for Schwannoma 60) The last stage of death is Molecular death 61) The most accurate diagnostic procedure for primary amebic meningioenchephalitis (PAM) is CSF sample 62) Antidepressant selective on BZ1 Benzodiazepines 63) Diabetic patient with heart attack follow up Quit smoking, Life style changes, start statin, ezetimibe 64) The cause of bluish red areas on the back of dead body is Hypostasis 65) Most sedating antidepressant ( ‫) مش فاكرين االختيارات‬ Doxepin 66)Drug for depression accompanied with pain ( ‫(مش فاكرين برضو‬ Duloxetine NOTES 1- Selegiline is one of the MOAIs used in ttt of parkinsonism. 2- The only cranial nerve which is attached to the dorsal aspect of the brain stem is Trochlear nerve 3- Mode of transmission of poliomyelitis is Feco-oral transmission 4- Poliovirus causes Lower motor neuron lesion. 5- Poliovirus is inactivated When heated at 55ºC for 30 min 6- Meningitis Is the inflammation of the leptomeninges (pia&arachnoid) and the subarachnoid space. 7- Pia mater ends at the apex of conus medullaris by forming filum terminal then descends and pierces the arachnoid and dura at the level of S1 to become attached to the back of coccyx. 8- Denticulate ligaments Are extensions of the pia mater which connects the spinal cord to the dura mater. 9- Level at which the spinal cord ends At 3rd month of intrauterine life: It fills the whole vertebral canal. At birth : Level of L3. In adults: At intervertebral disc between L1 & L2. SO LUMBAR PUNCTURE SHOULD BE AT LEVEL BETWEEN L2 & L3 OR BETWEEN L3 & L4. 10- Level at which the arachnoid mater and subarachnoid space ends is S2 vertebra 11- Spinal cord shows 2 enlargements Cervical: from which brachial plexus arises. Lumbar: from which the lumbosacral plexus arises. 12- Multiple sclerosis Is an Autoimmune Demyelinating Disease. 13- Alzheimer disease is a Degenerative disease Deposition of amyloid protein Hirano bodies 14- Parkinsonism is a Degenerative disease Lewy bodies 15- Brain abscess ( source of infection ). Direct: Otitis media, Sinusitis Blood: Pyemia 16- In stretch reflex Supraspinal facilitatory area is Vestibular nucleus Inhibitory areas are Area 6,4 17- CSF Passes from 1) Lat. Ventricle to 3rd ventricle (through interventricular foramen of monro) 2) From 3rd ventricle to 4th ventricle (through cerebral aqueduct) 3) From 4th ventricle to the subarachnoid space (through 3 aperatures : Median aperature foramen of magendi and 2 lateral aperatures (of luschka). Absorbed by arachnoid villi. 18- Rabies is inactivated by Sunlight, heat (1hour at 50ºC), UV. 19- Cerebral molecular layer contains Horizontal cells of cajal 20- Chicken pox is caused by Varicella zoster virus 21- Reye's syndrome Linked with aspirin in children 22- Prevention of varicella zoster 1) Preparation of choice is varicella zoster immunoglobulin 2) live attenuated vaccine ‫جرعتين بينهم شهر‬ 3) Acyclovir to immunocompromised individuals. 23- Type of paralysis caused by poliovirus is Flaccid paralysis. 24- Meningitis in epidemics is caused by Group A of Neisseria meningitides 25- Most common causative organism of meningitis in neonates Group B streptococci 26- In children Streptococcus pneumonia 27- In adults Streptococcus pneumonia then N. meningitides 28- In pregnant or old people Listeria monocytogenes 29- Axon membrane is called Axolemma And axonal cytoplasm is called Axoplasm 30- Nerve cell doesn't have Centrioles (That's why it can't devide) 31- Positive babinski sign is in Upper motor neuron lesion 32- Section in closed medulla will show Gracile and cuneate nuclei 33- Nystagmus Is a repetitive involuntary movement of the eye. 34- Neospinothalamic tract Fast pain (N.T. is glutamate) 35- Paleospinothalamic tract Slow pain (N.T. is substance P) 36- Superior to corpus callosum there is The SSS. 37- Group of nerve cells inside the central nervous system is called Nucleus 38- Group of nerve cells outside the central nervous system is called Ganglion 39- Nissl granules Found in the dendrites and the soma and is composed of rER and ribosomes. 40- Cells line the ventricles are Ependymal cells 41- Fatty liver occurs due to deficiency of Vit B5 42- In PNS, nerve fibers are Has neurolemmal sheath and myelin sheath 43- In CNS, nerve fibers are Nerve fibers are myelinated without neurolemmal sheath 44- In autonomic nervous system & some peripheral nerves, nerve fibers are Unmyelinated with neurolemmal sheath 45- Melanin inclusion found in the neuron is characteristic to Substantia negra 46- Post. Inf. cerebellar a. (PICA) arises from Vertebral artery which is a branch from 1st part of subclavian artery, pass through foramen transversarium except 1st and 7th 47- Sup. Cerebellar a. & Ant. Inf. Cerebellar a. Basilar artery 48- Gall bladder pain radiate to Rt. Shoulder 49- Cardiac pain (angina) radiate to Lt. shoulder 50- Appendix radiate to Umbilicus 51- Gastric pain radiate to Epigastric region 52- Pancreatic or renal pain radiate to Back 53- Renal pain radiate to Back (loin pain), Testicular, inguinal. 54- Antidepressant of choice in elderly Buspirone 55- Sedative drug used in ttt of absence seizures Clonazepam SABIN SALK Live attenuated Inactivated Oral Injection OPV (ORAL) IPV (INACTIVATED) Stimulates IgA production Stimulates IgG production Is given at lower dose Safe AB titre is higher than IPV Herd immunity Used in immunocompromised SHOULDN'T be given to Can't protect GIT from immunocompromised Reinfection. because it's live attenuated.  PARASITOLOGY https://suezunivedueg.sharepoint.com/:p:/r/sites/2022-Year2- CNSNS1.2.7/Shared%20Documents/Lectures/Parasitology/CNS%20Par asitology%20Revision.pptx?d=w54b7d527ca4b43f69d6068b9bfa5acf9& csf=1&web=1&e=cp07HE ( ‫)ده اسئلة اللي الدكتور نزلتها وقتها‬ THANK YOU