1 / 68

Let’s break this down

Let’s break this down. Neuroscience: 20/180 Geriatrics + Ethics + immunology: 60/180 Faster to learn Straightforward What is 1 MEQ then? 20/180 =0.11 0.11/2*100 = 5.56 (assuming MEQ is 50%) 5.56*60/100 = 3.33 MARKS for THEORY MD2140. So….

galia
Download Presentation

Let’s break this down

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Let’s break this down • Neuroscience: 20/180 • Geriatrics + Ethics + immunology: 60/180 • Faster to learn • Straightforward • What is 1 MEQ then? • 20/180 =0.11 • 0.11/2*100 = 5.56 (assuming MEQ is 50%) • 5.56*60/100 = 3.33 MARKS for THEORY MD2140

  2. So…. • If you haven’t finish stuff like systemic patho or pharmaco, and have no time to do neuroscience • Ditch it • Or just study stroke and hope you luck out • Go learn why old people are prone to falls

  3. However… • If you got spare time and are already ethical • Neuroscience is FUN • It’s more understanding and less memorizing • If you are memorizing more than you understand, you are doing it wrong • I’m NOT talking about the ‘HOW DO YOU _____’ lectures • It forms the corner-stone of every neuro-exam you gonna have in clinical years. • It’s gonna be super important in future. But maybe not for M2 pros.

  4. Drugs Used in CNS

  5. PharmaQns • Mode of Action • Indications • Side Effects

  6. Drug Types • Anxiolytic + hypnotic • Anti-depressant • Anti-psychotic • Examples?

  7. Anxiolytic + Hypnotic • Benzodiazepine (BZD) • Short acting: Midazolam • Intermediate acting: Lorazepam, Alprazolam • Long Acting: Diazepam

  8. Benzodiazepine (BZD) • Mode of Action?

  9. Benzodiazepine (BZD) • Mode of Action • Binds to specific BZD sites in the CNS and potentiates GABA (an inhibitory neurotransmitter) action by increasing frequency of chloride channel opening • Increase Cl- Influx • Increase neuron hyperpolarization • Sedation • Drug action dependent on GABA • OD doesn’t kill

  10. Benzodiazepine (BZD) • Indications? • Think of 3

  11. Benzodiazepine (BZD) • Indications • Convulsion, seizure (IV) • Anxiety disorder • Insomnia • ‘Date-rape’

  12. Benzodiazepine (BZD) • Side Effect? • Think of 3 classes and some examples

  13. Benzodiazepine (BZD) • Side Effect • CNS: • increase sedation • decrease motor skills • slower reaction time • Anterograde Amnesia (esp with IV) • CVS • Decrease BP, decrease respiration rate • Paradoxical symptoms • Hallucination, irritability, violent tendency, excitement • Floppy Child syndrome (contra-indicated in pregnancy) • TOLERANCE, DEPENDENCE, WITHDRAWAL

  14. Non-BZD hypnotics • Zolpidem, Zopiclone

  15. Depression • Theory for Depression: • Deficiency in monoamines in the synaptic cleft • Deficiency of neurotransmitters to effect it’s action on the post synaptic membrane

  16. Anti-depressants • 2 types?

  17. SSRI • MOA? • Related to the name

  18. SSRI • MOA: • Binds to serotonin reuptake transporter in the presynaptic cell membrane • Increase concentration of serotonin in the synaptic cleft • Name: Fluoxetine, escitalopram • OD WILL NOT DIE!!!

  19. SSRI • Adverse Effect? • Think of 3

  20. SSRI • Adverse Effect: • Anxiety • Weight loss/gain • Headache • Sexual dysfunction

  21. TCA –amitriptyline, imipramine • TCA blocks both serotonin reuptake transporter and norepinephrine reuptake transporter • Gold standard treatment • BUT OD can lead to death • Depressed people tend to want to die more • Easy way to commit suicide

  22. TCA • Side Effect: • Cardiac rhythm: Tachycardia, arrhythmia • Postural hypotension • Anticholinergic effects • CNS: sedation, fatigue

  23. Antipsychotics • Broad classes? • Mode of action?

  24. Antipsychotic - Haloperidol • Typical antipsychotic • Blocks: • Dopaminergic receptors • Serotonic receptors • Histaminic receptors • Cholinergic receptors • Alpha adrenergic

  25. Haloperidol • Side effects?

  26. Haloperidol • Side effect: • Extrapyramidal side effects: • Acute dystonia • Parkinsonism • Akathisia • Malignant syndrome • Tardive dyskinesia

  27. CNS Pathology

  28. Quick Start • What’s the mean ICP? • 7 to 15 mmHg • How much blood does the brain need? • 150ml/100g/min • What can cause acute rise in ICP? (think of 2) • Hemorrhagic stroke, Intracranial Hemorrhage

  29. Quick Start • What can cause gradual focal deficits and also increase in ICP? (Think of 2) • Tumor, infection • What are the 2 different types of hydrocephalus? Name 2 etiology of each. • Non-communicating vs communicating • NC: SOL(medulloblastoma), meningitis (TB meningitis, scarring), congenital (Arnold Chiari malformation) • C: Subarachnoid hemorrhage, NPH, meningitis • What are the presentations and complications of raised ICP? • Papilloedema, headache, nausea, HERNIATION (most dangerous form of herniation is?)

  30. Keep going… • What are the 4 most common tumors in children? Where are they found? • Medulloblastoma (posterior fossa/infratentorial) • Pilocytic Astrocytoma (Glioma, anywhere in the brain parenchyma) • Ependymoma (para/intra-ventricular) • Germ Cell tumor (Mid-line) • What are the presentation of a slow-growing Meningioma? • SOL • Focal deficits and raised ICP • What type of CNS tumor (that we’ve learned) cross the midline and forms a butterfly shape lesion? What grade is it? • GlioblastomaMultiforme (Grade IV)

  31. Keep going… • What must you suspect if you find primary lymphoma in the brain? • HIV • Immunosuppression • What can be the possible diagnoses when there are multiple SOL in the brain? • Lymphoma, Abscess, METASTASIS • What are the acute, chronic, and pregnant complications of drinking alcohol? (Name 1 each) • Acute: Respiratory depression -> Death • Chronic: cerebellar atrophy, cortical atrophy, Wernicke’s encephalopathy, Korsakoff syndrome • Pregnant: fetal alcohol syndrome (growth retardation)

  32. Almost there… • What histological changes of the brain can you see in Alzheimer’s disease? • Amyloid plagues / Neurofibrillary tangles (tau protein in neurons) • These cannot be digested. Leads to reactive gliosis and neuronal damage and progressive cognitive decline • Which lobe is most affect in AD – Smaller, atrophied brain? • Temporal Lobe • What are the clinical features of Parkinson’s Disease? • TRAP – asymmetric • Mask-like face • Gait abnormality • Respond to LevoDopa (for 5 to 7 years)

  33. Almost there… • What are the 2 broad groups of meningitis? • Bacterial vs Aseptic • What’s the difference in Cell/Glucose/Protein? • What are the top 3 cause of meningitis in neonates? • E coli, Listeria monocytogenes, Streptococcal agalactiae • What are the other few bacteria that cause meningitis in pediatrics? (young children) • Nisseriameningitidis, Streptococcal pneumonia, Hemophilus influenza type B • THEY ALL HAVE CAPSULE!!!!!!!!!

  34. HYPERTENSION AND IT’S ASSOCIATED HYPERTENSIVE CEREBRAL VASCULAR DISEASE IS IMPORTANT!!!!!!!

  35. Localising Lesions

  36. Revision • DCML • Spino-thalamic • Corticospinal • Spino-cerebellar • General route, Decussation, Function?

  37. UMN VS LMN • What is UMN and LMN? • How does it help in localizing the level of the lesion? • Understand: Inverted supinator jerk and Inverted knee jerk • Where is the level of the lesion?

  38. UMN vs LMN • Inverted Supinator Jerk • Weak biceps jerk (C5, 6) • Weak brachioradialis jerk (C5,6) • Brisk triceps Jerk (C7, 8) • (Brisk flexion of the fingers) • Will this guy be able to breathe? • Inverted Knee Jerk • Weak knee jerk (L3) • Brisk ankle jerk (S1)

  39. What’s wrong with this guy?

  40. Brown Sequard Syndrome • Where is the Lesion? • T2 to L2 • How to narrow down further? • Strength of Hip Flexion • Cremasteric reflex • Superficial Abdominal Reflex • What are the OTHER clinical signs? • UMN signs… WHICH SIDE? • Loss of proprioception and touch… WHICH SIDE?

  41. Brown Sequard Syndrome • Hemisection of the spinal cord • What are some SOL in the spinal cord that can cause hemicord syndrome? • Tumor (meningioma, lymphoma), Abscess • Can syringomyelia/hydromyelia cause brown sequard?

  42. Revision • What is somatotopy? • Of the Brain • Of the Spinal Cord

  43. Ascending weakness • What are the causes of ascending weakness? • Guillain-Barre syndrome • Myelopathy (compression, vascular, inflammation) • What are some microbes that can cause Guillain-Barre syndrome? • Campylobacter jejuni • CMV • Influenza • Varicella • How will a syringomyelia present? (usually grows laterally and anteriorly)

  44. Stroke • What are the 2 different type of infarct? • “An artery can either _____ or ______.” • What are the risk factors for each? (name at least 5) • What are the etiologies? (at least 2 for each)

  45. Stroke • Ischemic infarct vs hemorrhagic infarct • What are the risk factors? • Hypertension, Diabetes, hyperlipidemia, TIA, Hypercoagulable state, Atrial Fibrillation, RHD, Vascular malformations (Berry aneurysm, Charcot-Bouchard Aneurysm, AVM, moya-moya) • What are the etiologies? • Ischemic: Shock, acute plague change, thromboembolism • Hemorrhagic: Rupture of aneurysm, trauma, tumor, malignant hypertension

  46. Revision • What clinically important areas does the superior branch of the middle cerebral artery supply? • How about the inferior branch of the MCA?

  47. MCA • Superior • Frontal Lobe: Broca(left), FEF, Primary Motor Cortex(UL and Face) • Parietal lobe: Somatosensory cortex (UL and Face) • Inferior • Parietal lobe: Wernicke’s Area(left), Somatosensory cortex(UL and Face) • Parietal and Temporal Lobe: Optic Radiation(contralateral homonymous hemianopia) • Internal Capsule (lenticulostriate arteries, LL and lots of other stuff) • What about the PCA and ACA?

More Related