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Part 2 ISQ Club - Neuroanatomy/physiology

22 posts in this topic

MRCPsych Part 2 ISQs will be posted regularly. You are encouraged to post a reply in the thread, stating whether you think an ISQ is true or false and why (eg. a short explanation, with reference to the textbook you used). Please only deal with one ISQ in each post and include the question as the first line of your post. Posts not following this rule may be removed without warning.

You can download these questions and others on the same topic by clicking here.

1. In homonymous hemianopia it is sometimes possible for patients to point to objects in their blind field.

2. Anosognosia is more likely to occur with right-sided hemiparesis than left.

3. Recognition of facial expression occurs in the fusiform gyrus.

4. The globus pallidus is part of the limbic system.

5. The planum temporale is the primary auditory cortex.

6. There is an increased incidence of gait disturbance in patients with leukoariosis and subcortical white matter lesions.

7. Phrase lengh is shortened in broca's aphasia.

8. In aphasia following a stroke, primary languages are affected more than second languages.

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Q5 = False:

The planum temporale, part of the superior temporal

gyrus, is a lateralized neocortical language region of

possible relevance to two major symptoms of schizophrenia,

auditory hallucinations (3, 8) and thought disorder

(4, 7). Dipole modeling supports the location of

a source generator for the normal P300 wave in the region

of the planum temporale (33); this evoked potential

is aberrant in schizophrenia. The planum temporale

is normally an asymmetric structure (14), and Crow

(15) and others (16) have emphasized the importance

of disturbed asymmetries in schizophrenia. Finally, the

planum temporale is one part of the heteromodal association

neocortical network (34), which has been proposed

to be especially affected in schizophrenia (35[ch8211]37).

http://ajp.psychiatryonline.org/cgi/reprint/154/5/661

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Q4 = False.

From http://en.wikipedia.org/wiki/Limbic_lobe#Anatomy

Anatomy

The limbic system includes many different cortical and subcortical brain structures that differ depending upon which book is referenced. For ease of interpretation, this is a list of all the regions generally considered to be part of the limbic system:

Amygdala: Involved in aggression and fear;

Cingulate gyrus: Autonomic functions regulating heart rate and blood pressure as well as cognitive and attentional processing;

Fornicate gyrus: Region encompassing the cingulate, hippocampus, and parahippocampal gyrus;

Hippocampus: Required for the formation of long-term memories;

Hypothalamus: Regulates the autonomic nervous system via hormone production and release. Affects and regulates blood pressure, heart rate, hunger, thirst, sexual arousal, and the sleep/wake cycle;

Mammilary body: Important for the formation of memory;

Nucleus accumbens: Involved in reward, pleasure, and addiction;

Orbitofrontal cortex: Required for decision making;

Parahippocampal gyrus: Plays a role in the formation of spatial memory.

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Q.4 Globus pallidus is part of limbic system.

I think it's FALSE. If memory serves me right it is part of the corpus striatum/basal ganglia - where it is involved in the inhibiton of movement. lesions cause dyskinesias/Huntington's chorea etc. Phew!....blast from the past.

Source: trickcyclists.

For those revising neuroanatomy - trickcyclists is great. It's 43 pages, but you only need to read about half of it, in terms of relevant material. Good Luck!!

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Q)4

THE GLOBUS PALLIDUS IS PART OF THE LIMBIC SYSTEM- FALSE

THE GLOBUS PALLIDUS IS PART OF THE MOTOR CIRCUIT IN THE NEUROANATOMY CHAPTER OF COMPANION TO PSYCH STUDIES.

THE LIMBIC SYSTEM IS ASSOCIATED WITH MEMORY AND EMOTION, BUT IS CONSTANTLY BEING REFINED IN TERMS OF BOTH STRUCTURE AND FUNCTION AND IS NO LONGER GOOD FOR MCQS AND THERE HAVE BEEN CALLS FOR IT TO BE ABOLISHED.

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Q)2

ANOSOGNOSIA IS MORE LIKELY TO OCCUR WITH RIGHT SIDED HEMIPARESIS THAN LEFT ?

TRUE

IT OCCURS MORE FREQUENTLY WITH WITH RIGHT SIDED LESIONS, PARTICULARLY IN MIDDLE CEREBRAL ARTERY TERRITORY

FROM COMPANION TO PSYCH STUDIES PAGE 349 IN 7TH EDITION

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Q) 1

IN HOMONYMOUS HEMIANOPIA IT IS SOMETIMES POSSIBLE FOR THE PATIENT TO POINT TO OBJECTS IN THE BLIND ? SPOT ?

?? FALSE

WHEN LESIONS ARE BEHIND THE OPTIC CHIASMA FIELD DEFECTS ARE BILATERAL, ACUITY TENDS NOT TO BE IMPAIRED (ALTHOUGH OBJECTS IN THE AFFECTED FIELD CANNOT BE SEEN ) AND THE BOUNDRIES ARE IN THE VERTICAL MERIDIAN .

FROM OXFORD HANDBOOK OF CLINICAL SPECIALITIES 2ND EDITION

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RECOGNITION OF FACIAL EXPRESSION OCCURS IN THE FUSIFORM GYRUS ?

? TRUE

FACE PERCEPTION- BRAIN IMAGING STUDIES SHOW A GREAT DEAL OF ACTIVITY IN AN AREA OF THE TEMPORAL LOBE KNOWN AS THE FUSIFORM GYRUS, AN AREA ALSO KNOWN TO CAUSE PROSOPAGNOSIA WHEN DAMAGED, PARTICULARLY WHEN THIS DAMAGE IS ON BOTH SIDES.

FROM FACE PERCEPTION-WIKIPEDIA THE FREE ENCYCLOPEDIA

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Q6 = True.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9400551&dopt=Abstract

CONCLUSION: In our Veteran population, leukoaraiosis is an independent predictor of gait disturbance after accounting for stroke and cerebral atrophy. Although leukoaraiosis is a form of cerebrovascular disease, it appears to be most closely associated to gait disturbance in the absence of symptomatic stroke or leg deficit.

P.S. Maximus, I know part II questions are annoying, but there's no need to SHOUT all of the answers! ;)

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Q)2

ANOSOGNOSIA IS MORE LIKELY TO OCCUR WITH RIGHT SIDED HEMIPARESIS THAN LEFT ?

TRUE

IT OCCURS MORE FREQUENTLY WITH WITH RIGHT SIDED LESIONS, PARTICULARLY IN MIDDLE CEREBRAL ARTERY TERRITORY

FROM COMPANION TO PSYCH STUDIES PAGE 349 IN 7TH EDITION

uhm... :o

so that means it's FALSE cause it's a right sided hemiparesis which indicates a LEFT sided brain lesion

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you were spot on BROCA about the right sided hemiparesis signifying a left sided lesion- thanks

IN BROCA'S APHASIA PHRASE LENTH IS SHORTENED ?

? TRUE

IN BROCA'S APHASIA SPEECH IS OF A TELEGRAPHIC NATURE DUE TO DELETION AND DISTURBANCE IN WORD ORDER. MOREOVER THE REPETITION OF WORDS AND PHRASESIS IMPAIRED

FROM-WWW.VIRGINIA.EDU/

space on this site is not rationed and does not require a fee , so why not make it easy for everybody to read,especially as i ususlly come on this site whenever i am feeling tired and sleepy.

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Q2. Should be false bc a R sided lesion will result in L HEMIPAResis..........

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Q1: T

20% retain the ability to make visual saccades to an object in the blind spot

PAMBAKIAN and KENNARD 81 (4): 324. (1997) British journal of opthalmology

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Q2. Should be false bc a R sided lesion will result in L HEMIPAResis..........

I agree. The answer is False.

Anosognosia occurs in R sided lesions of the Parietal lobe, that are more likely to be accompanied by R (rather than L) lesions of Frontal lobe, which will cause L hemiparesia (and not R hemiparesia).

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3. Recognition of facial expression occurs in the fusiform gyrus.

TRUE. According to Wikipedia, There is still some dispute over the functionalities of this area, but there's relative consensus on these four:

processing of colour information

face recognition

word recognition

number recognition

The fusiform gyrus is part of the temporal lobe.

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8. In aphasia following a stroke, primary languages are affected more than second languages.

I'd say FALSE. It's not whether a language is primary or secondary that matters, but how much each language is used (the most used language will recover faster after a stroke).

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q2

Maximus, you were talking about a lesion behind the optic chiasm causing bilateral field defects, but the question is about an homonymous hemianopia. Also it refers to blind field, as opposed to blind spot (which we all have).

I think it may be

T,

but only because of the wording - 'may sometimes be able to point to' i.e. doesn't say they can see it. It could be a lucky guess...

Or am I thinking too much about lucky guesses??

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8. In aphasia following a stroke, primary languages are affected more than second languages.

I'd say FALSE. It's not whether a language is primary or secondary that matters, but how much each language is used (the most used language will recover faster after a stroke).

Not sure that's the case - especially in heads up / heads down languages (where the subject comes before or after the verb). These are set at an early stage (first 6 months) and immensly resiliant to brain damage throughout life. It is rare for someone to completely lose a mother-tongue used as a main language dduring childhood, while people more  frequently lose thhe ability to speak in local languages if the have migrated, even if the migration was decades previously and the mother tongue was not spoken.

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8. In aphasia following a stroke, primary languages are affected more than second languages.

I'd say FALSE. It's not whether a language is primary or secondary that matters, but how much each language is used (the most used language will recover faster after a stroke).

False. But do not agree with most used language dictum. Read a paper on this but cannot remember the ref. now. supposedly differential loss and subsequent recovery of primary/secondary languages was documented in early case histories in the west, in bilingual patients. There was a dictum that the most used language just prior to stroke would recover first, but this has since been disproved. Several patterns of loss/recovery have now been documented, assuming that patients are truly fluent in both languages.

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1. In homonymous hemianopia it is sometimes possible for patients to point to objects in their blind field. T 20%

2. Anosognosia is more likely to occur with right-sided hemiparesis than left.  F

3. Recognition of facial expression occurs in the fusiform gyrus. T

4. The globus pallidus is part of the limbic system. F

5. The planum temporale is the primary auditory cortex. F

6. There is an increased incidence of gait disturbance in patients with leukoariosis and subcortical white matter lesions. T

7. Phrase lengh is shortened in broca's aphasia. T

8. In aphasia following a stroke, primary languages are affected more than second languages. F

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The limbic system includes:

1.Amygdala: Involved in aggression and fear;

2.Cingulate gyrus: Autonomic functions regulating heart rate and blood pressure as well as cognitive and attentional processing;

3.Fornicate gyrus: Region encompassing the cingulate, hippocampus, and parahippocampal gyrus;

4.Hippocampus: Required for the formation of long-term memories;

5.Hypothalamus: Regulates the autonomic nervous system via hormone production and release. Affects and regulates blood pressure, heart rate, hunger, thirst, sexual arousal, and the sleep/wake cycle;

6.Mammilary body: Important for the formation of memory;

7.Nucleus accumbens: Involved in reward, pleasure, and addiction;

8.Orbitofrontal cortex: Required for decision making;

9.Parahippocampal gyrus: Plays a role in the formation of spatial memory.

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