Case 21 Questions 1-10

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Enjoy working thorugh the following questions. We hope they aid your learning. If you have any issues or feedback, please email [email protected]

Question 1

Which of the following is the best explanation for why second generation (atypical) antipsychotics are preferential to first generation (typical) antipsychotics?

  1. Second generation (atypical) antipsychotics do not cause any metabolic side effects
  2. First generation (typical) antipsychotics have less extra pyramidal side effects
  3. Second generation (atypical) antipsychotics have a decreased risk of extrapyramidal side effects
  4. First generation (typical) antipsychotics can cause agranulocytosis
  5. Second generation (atypical) antipsychotics do not have sedative side effects

The correct answer is option c, Second generation (atypical) antipsychotics have a decreased risk of extrapyramidal side effects

Second generation antipsychotics do have a decreased risk of extra-pyramidal side effects
Option a, Second generation antipsychotics do cause metabolic side effects
Option b, First generation antipsychotics are more likely to cause extra pyramidal side effects
Option d, Clozapine (an atypical antipsychotic) is the antipsychotic most likely to cause agranulocytosis
Option e, Both first and second generation antipsychotics can have sedative side effects

Question 2

Which receptor is involved in sexual dysfunction when targeted by second generation (atypical) antipsychotics?

  1. D1
  2. A2
  3. H1
  4. H2
  5. G6

The correct answer is option b, A2

A2 receptors are targeted by antipsychotics and sexual dysfunction is a known side effect. A2 receptor antagonism can decrease peripheral vasodilation
D1 receptors are not targeted by antipsychotics as they are hypoactive in schizophrenia
H1 receptor antagonism causes sedative effects, sexual dysfunction is not a side effect
H2 receptor antagonists are used to reduce stomach acid production. Sexual dysfunction is not a side effect
G6 is not a receptor

Question 3

Which of the following is not a dopamine pathway

  1. Mesolimbic
  2. Nigostriatal
  3. Mesocortical
  4. Tuberoinfundibular
  5. Dorsolateral pontine

The correct answer is option e, Dorsolateral pontine

Dorsolateral pontine is an area of the brain associated with cholinergic pathways
Mesolimbic is a dopamine pathway
Nigostriatal is a dopamine pathway
Mesocortical is a dopamine pathway
Tuberinfundibular is a dopamine pathway

Question 4

Which neurotransmitter has pathways from the basal forebrain nuclei to large parts of the cortex including the thalamus, amygdala and hippocampus

  1. Noradrenaline
  2. Serotonergic
  3. Cholinergic
  4. Dopamine
  5. Glutaminergic

The correct answer is option c, Cholinergic

Cholinergic pathways originate in the basal forebrain nuclei and supply large parts of the cortex including the thalamus, amygdala and hippocampus
Noradrenergic pathways originate in the locus ceruleus and supply large areas of the brain including the thalamus, cerebellum, cerebral cortex and limbic system
Serotonergic pathways originate in the Raphe Nucleus and supply the cerebellum, cerebrum, striatum and hippocampus
There are 4 dopaminergic pathways and they do not originate in the basal forebrain nuclei
Glutamate is widespread throughout the brain

Question 5

Which of the following is a symptom of schizophrenia caused by hyperactivity of D2 receptor pathways?

  1. Hallucinations
  2. Reduced speech
  3. Anhedonia
  4. Poor memory
  5. Circumlocution

The correct answer is option a, Hallucinations

Hallucinations are a positive symptoms of schizophrenia caused by hyperactivity of D2 receptors
Reduced speech is a negative symptom of schizophrenia cause by hypoactivity of D1 receptors
Anhedonia is a negative symptom of schizophrenia cause by hypoactivity of D1 receptors
Poor memory is a cognitive symptom of Schizophrenia associated with D1 hypofunction
Circumlocution is a feature of speech associated with dementia

Question 6

What is the best explanation for hyperactivity of the hippocampus in schizophrenia?

  1. Increase in excitatory input from GABAnergic neurons
  2. Increase in excitatory input from glutaminergic neurons
  3. Loss of inhibitory input from GABAnergic neurons
  4. Hypertrophy of the temporal lobe
  5. Increase in EAAT (Excitatory Amino Acid Transporter)

The correct answer is option c, Loss of inhibitory input from GABAnergic neurons

Option c, Loss of input from inhibitory GABAergic neurons
Option a, GABA is inhibitory not excitatory
Option b, It is not caused by an increase in excitatory glutaminergic activity
Option d, There is no hypertrophy of the temporal lobe, the hippocampus actually tends to be smaller in people with Schizophrenia
There may be some association between EAAT dysregulation and schizophrenia, but this is not the cause for hyperactivity of the hippocampus

Question 7

Which of the following is a neurotransmitter broken down by Monoamine Oxidase (MAO), but not catechol-o-methyl transferase (COMT)

  1. Epinephrine
  2. Dopamine
  3. 5-HT
  4. Norepinephrine
  5. GABA

The correct answer is option c, 5-HT

5-HT is broken down by MAO, but not COMT
Epinephrine is broken down by both COMT and MAO
Dopamine is broken down by both COMT and MAO
Norepinephrine is broken down by both COMT and MAO
GABA is broken down by GABAT a mitochondrial enzyme

Question 8

What is the precursor to serotonin?

  1. Tryptophan
  2. Tyrosine
  3. Phenylalanine
  4. Glutamine
  5. L-DOPA

The correct answer is option a,Tryptophan

Tryptophan is the amino acid precursor to serotonin
Tyrosine is the precursor to Dopamine, Epinephrine and Norpinephrine
Phenylalanine is a precursor to Tyrosine
Glutamine is a precursor to GABA and Glutamate
L-DOPA is a precursor to dopamine, Epinephrine and Norepineprhine used in the treatment of Parkinson’s Disease

Question 9

The fovea is thin and able to be supplied by the choroid when the central retinal artery is occluded. Which of the following findings of fundoscopy is the result of this?

  1. Flame haemorrhage
  2. Cherry red spot on macula
  3. Optic disc cupping
  4. Spontaneous venous pulsation
  5. Cotton wool spots

The correct answer is option b,Cherry red spot on macula

Cherry red spot occurs during central retinal artery occlusion as the rest of the macula is pale and ischaemic but the fovea is preserved and therefore appears red in comparison
Flame haemorrhage is an intra-retinal haemorrhage
Optic disc cupping is a common in glaucoma
Spontaneous venous pulsation is a sign of normal intracranial pressure
Cotton wool spots are ischaemic damage that appear on the retina but are not related to central retinal artery occlusion

Question 10

Which of the following is an important reason for binocular vision?

  1. Depth perception
  2. Stereopsis
  3. Diplopia
  4. Accommodation
  5. Phototransduction

The correct answer is option a, Depth perception

Depth perception is an important reason for binocular vision
Stereopsis is the fusing of images from 2 eyes which allows for binocular vision
Diplopia is retinal disparity causing double vision
Accommodation is the change of the lens shape to allow for focus on near or distant objects
Phototransduction is the sensory transduction of the visual system

Credits

  • 1-10 (SinĂ©ad Foley, 3rd year)