Chapter 39

Question 1

1. The initiation of movements by the basal motor nuclei depends on projections from the ______________ ________ to the striatum (putamen and caudate).

Answer 1

substantia nigra

Question 2

2. If the neurons in the substantia nigra die, it will be extremely difficult to __________ _____________.

Answer 2

initiate movements

Question 3

3. Death of neurons in the substantia nigra makes it so hard to ___________ movement in the facial muscles that the patient doesn’t move the facial muscles.

Answer 3

initiate

Question 4

4. Immobility of the ________ __________ creates the mask-like face typical of Parkinson’s disease.

Answer 4

facial muscles

Question 5

5. Parkinson’s disease is due to death of neurons in the ______________ _________.

Answer 5

substantia nigra

Question 6

6. Exposure to broad-spectrum herbicides such as paraquat injures neurons in the substantia nigra and increases the risk of ________________ _______.

Answer 6

Parkinson’s disease

Question 7

7. Several ______________, of which the most widely used is paraquat, cause Parkinson’s disease in susceptible individuals.

Answer 7

herbicides

Question 8

8. Caffeine and estrogen protect neurons in the substantia nigra so that male _________ drinkers have half as much risk of Parkinson’s disease as non-drinkers.

Answer 8

coffee

Question 9

9. Caffeine, certainly, and other components of _________, probably, protect the substantia nigra.

Answer 9

coffee

Question 10

10. The __________ in ________ and ______ has a neuroprotective effect that halves the risk of getting Parkinson’s disease.

Answer 10

caffeine
coffee
tea

Question 11

11. The performance of dying, but not dead, neurons in the _____________ ________ can be improved by supplying them with l-dihydroxyphenylalanine (L-DOPA), the immediate precursor of dopamine

Answer 11

substantia nigra

Question 12

12. The immediate precursor of dopamine is _____________.

Answer 12

L-DOPA (or l-dihydroxyphenylalanine

Question 13

13. Death of neurons in the substantia nigra eliminates the ________ pathway through the lenticular nucleus and allows the ___________ pathway to become overactive.

Answer 13

direct

indirect

Question 14

14. The overactive indirect pathway causes the medial globus pallidus to inhibit the stimulation of the premotor cortex by the _________ ___________ _________ of the ___________.

Answer 14

ventral anterior nucleus thalamus

Question 15

15. The symptoms of Parkinson’s disease are due to an overactive ________ ________ ___________.

Answer 15

medial globus pallidus

Question 16

16. The symptoms of Parkinson’s disease can be lessened by deep brain stimulation which uses implanted electrodes to decrease the activity of the _________ ________ ___________.

Answer 16

medial globus pallidus

Question 17

17. The most common treatments for Parkinson’s disease are _______ _________ _____________ and _________ .

Answer 17

deep brain stimulation

L-DOPA

Question 18

18. Activity of the medial globus pallidus reduces the output of the ventral anterior nucleus to the ___________ ________.

Answer 18

premotor cortex

Question 19

19. It is very difficult for the primary motor cortex (Brodmann area 4) to _________ movement without input from the premotor cortex (Brodmann area 6).

Answer 19

initiate

Question 20

20. Death of neurons in the substantia nigra makes it an effort to ________ each step when walking.

Answer 20

start (or initiate

Question 21

21. The delay between steps in _______________ disease leads to the upper body getting ahead of the feet, a symptom called anterograde walking.

Answer 21

Parkinson’s

Question 22

22. Walking with a pronounced forward lean is called _______________ walking.

Answer 22

anterograde

Question 23

23. Anterograde walking and mask-like face are symptoms of ________________ ___________.

Answer 23

Parkinson’s disease

Question 24

24. There is a lack of activity in the ventral anterior nucleus leads to a lack of activity in the ___________ ________ and ___________ ________ _________.

Answer 24

premotor cortex

primary motor cortex

Question 25

25. Lack of stimulation of the premotor cortex by the _________ ____________ _________ causes bradykinesia (Greek: brady=slow, kinesia=movement).

Answer 25

ventral anterior nucleus

Question 26

26. Bradykinesia is a symptom of _______________ _________.

Answer 26

Parkinson's disease

Question 27

27. Greatly reduced input from the __________ _______ ________ leads to spontaneous activity in lower motor neurons, especially in the region of the brachial plexus.

Answer 27

primary motor cortex

Question 28

28. Spontaneous activity in the ________ _______ __________ of the brachial plexus causes a fidgeting movement of the fingers called "pill rolling."

Answer 28

lower motor neurons

Question 29

29. "Pill rolling" is a symptom of ________________ __________.

Answer 29

Parkinson's disease

Question 30

30. James Parkinson called the disease he described "paralysis agitans" because it combined near ______________ of the facial muscles with _______ ____________ of the fingers.

Answer 30

paralysis ] | "pill-rolling"

Question 31

31. In addition to "pill rolling" and _______-like face, Parkinson's disease includes _________________ and _______________ walking.

Answer 31

mask bradykinesis anterograde

Question 32

32. Just as excess activity of the medial globus pallidus inhibits desired movement, insufficient activity of the medial globus pallidus causes ____________ ______________.

Answer 32

unwanted movement

Question 33

33. The activity of the medial globus pallidus would be most sharply decreased by removal of all stimulation by a stroke in the ______________ __________.

Answer 33

subthalamic nucleus

Question 34

34. A stroke in the _____________ _________ causes large-scale unwanted movements called hemiballismus.

Answer 34

subthalamic nucleus

Question 35

35. Because the basal motor nuclei modulate the activity of the motor cortex whose output crosses in the lower medulla, a stroke in the subthalamic nucleus causes _______________ in the ______________ limbs.

Answer 35

hemiballismus | contralateral (or opposite)

Question 36

36. The net effect of release of dopamine at synapses in the putamen is to ____________ movement.

Answer 36

facilitate

Question 37

37. An overdose of DOPA is liable to cause ____________ ____________.

Answer 37

unwanted movement

Question 38

38. Unwanted movement caused by treating Parkinson's disease with ________ is called Parkinson's dyskinesia. (Greek: dys=bad, kinesia=movement.)

Answer 38

L-DOPA

Question 39

39. Unwanted movement due to an overdose of L-DOPA is ________________ _____________.

Answer 39

Parkinson's dyskinesia

Question 40

40. Blocking too many dopamine receptors in the putamen with dopamine receptor blocking tranquillizers would have the same effect as loss of neurons in the _____________ ________.

Answer 40

substantia nigra

Question 41

41. An overdose of a dopamine-receptor-blocking tranquillizer causes symptoms similar to those of ________________ _________.

Answer 41

Parkinson's disease

Question 42

42. The bradykinesia, anterograde walk, and immobile face caused by antipsychotic ____________ ___________ __________ are called "drug induced Parkinsonism."

Answer 42

dopamaine receptor blockers

Question 43

43. Neurons respond to overstimulation and understimulation by seeking their basal activity by deleting receptors from their cell membranes during prolonged ___________________ and adding receptors to their cell membranes during prolonged ____________________.

Answer 43

inactivity | activity

Question 44

44. Neurons in the putamen respond to the prolonged inactivity induced by dopamine-receptor-blocking tranquilizers by __________ dopamine receptors.

Answer 44

adding

Question 45

45. After prolonged use of dopamine-receptor-blocking tranquillizers, neurons in the putamen have so many _______________ _____________that they are hypersensitive to _______________ from the substantia nigra.

Answer 45

dopamine receptors | dopamine

Question 46

46. Hypersensitivity to endogenous dopamine causes _____________ ____________.

Answer 46

unwanted movement

Question 47

47. Unwanted movement due to __________________ to endogenous ______________ as a result of prolonged use of dopamine-receptor-blocking tranquillizers is called “tardive dyskinesia.” (Greek: tardive=delayed.)

Answer 47

hypersensitivity dopamine

Question 48

48. Tardive dyskinesia occurs after _____________ use of ______________ __________ ___________ _______________.

Answer 48

prolonged dopamine-receptor-blocking | tranquilizers

Question 49

49. __________ is Greek for delayed, and dyskinesia is Greek for ______ _____________.

Answer 49

Tardivebad movement

Question 50

50. The popularity of dopamine-receptor-blocking tranquillizers (haloperidol, metoclopramide, etc.) makes ___________ ______________ a common disorder of movement.

Answer 50

tardive dyskinesia

Question 51

51. Drug induced Parkinsonism, which mostly affects the limbs, is an order of magnitude less common than _________ _____________, which mostly affects the facial muscles.

Answer 51

tardive dyskinesia

Question 52

52. The first sign of tardive dyskinesia is twitching of the ________ ___________.

Answer 52

facial muscles

Question 53

53. Whereas Parkinson’s disease is caused by death of neurons in the ______________ ________, Huntington’s disease (or Huntington’s chorea) is caused by death of neurons in the putamen..

Answer 53

substantia nigra

Question 54

54. If the indirect circuit neurons (D2) in the putamen die, the neurons in the lateral globus pallidus will ___________ the neurons in the subthalamic nucleus, and the neurons in the subthalamic nucleus will not _______________ the neurons in the medial globus pallidus.

Answer 54

inhibit | stimulate

Question 55

55. If the direct circuit neurons (D1) in the putamen die, the neurons in the medial globus pallidus will ______ ____ _____________.

Answer 55

not be inhibited

Question 56

56. If the medial globus pallidus is neither stimulated nor inhibited, it will have only the very small inhibitory effect on the ________ ____________ nucleus due to its own spontaneous activity.

Answer 56

ventral anterior

Question 57

57. Thus, death of the putamen will result in a small amount of spontaneous activity in the slightly inhibited ________ ___________ _________ of the __________.

Answer 57

ventral anterior nucleus | thalamus

Question 58

58. The death of the putamen in Huntington's disease results in small unwanted ________________.

Answer 58

movement

Question 59

59. Huntington's disease caused by an autosomal dominant gene that causes death of neurons in the __________ and, much later, in the rest of the brain.

Answer 59

putamen

Question 60

60. Because the Huntington's disease gene is ______________, either parent can pass the gene on to a child of either gender.

Answer 60

autosomal

Question 61

61. The symptoms of Huntington's disease appear in middle age after one has already had a 50% chance of passing on the ____________ _____________ ________.

Answer 61

autosomal dominant gene

Question 62

62. Huntington’s disease is characterized by many ________ ____________ ______________.

Answer 62

small unwanted movements

Question 63

63. The unwanted movements in _______________ _________ are smaller in scale than the unwanted movements in hemiballismus because the net stimulatory effect of the direct circuit neurons on the ventral anterior nucleus is still present in hemiballismus.

Answer 63

Huntington's disease

Question 64

64. If the putamen is sick rather than dead, the ____________ _____________ will be smoother than in Huntington’s disease and they will disappear when the putamen ____________.

Answer 64

unwanted movements | recovers

Question 65

65. Sydenham’s chorea (Greek: chorea=dance) is temporary unwanted movement due to suppression of activity in the ____________ by scarlet fever.

Answer 65

putamen

Question 66

66. Sydenham's chorea may last for a year after a bout of __________ ________.

Answer 66

scarlet fever

Question 67

67. The unwanted movement in ______________ ________ is smooth and dance-like.

Answer 67

Sydenham's chorea

Question 68

68. Sydenham’s chorea is an uncommon sequel of _________ _______; Huntington’s disease is a rare and fatal ____¬_______ disorder.

Answer 68

scarlet fever | hereditary

Question 69

69. Patients usually recover from ________________ _________, they always die from _____________ ___________.

Answer 69

Sydenham's chorea | Huntington's disease

Question 70

70. The cholinergic neurons in the putamen have the net effect of ____________ movement.

Answer 70

inhibiting

Question 71

71. A deficiency of cholinergic neurons in the putamen or caudare leads to ___________ ____________.

Answer 71

unwanted movement

Question 72

72. Tourette’s syndrome is vocal and facial tics due to a hereditary deficiency of ______________ _________ in the head of the caudate nucleus.

Answer 72

cholinergic neurons

Question 73

73. The unintended vocalizations in _______________ syndrome are due to a hereditary deficiency of cholinergic neurons in the ________ of the ___________ ___________ which controls vocalization.

Answer 73

tourettes | head of the caudate nucleus

Question 74

74. The tics in Tourette's syndrome are exacerbated by activation of the direct basal motor circuit and suppression of the indirect circuit by ________________.

Answer 74

dopamine

Question 75

75. ______________ syndrome involves tics, mostly of the facial muscles, and unwanted vocal outbursts while awake.

Answer 75

tourettes

Question 76

76. Since the coincidence of Tourette's syndrome in identical twins is only 75%, the genes that cause it require _______________ factors for expression.

Answer 76

environmental

Question 77

77. Tourette's syndrome is caused by several ________ with variable penetrance.

Answer 77

genes

Question 78

78. Restless legs syndrome (a.k.a. Willis-Ekbom disease) is the only hyperkinetic disorder of movement that is not due to malfunction of the _________ __________ ___________.

Answer 78

basal motor nuclei

Question 79

79. Restless legs syndrome is due to ________________ in the pontine reticular formation due to a common hereditary defect in the D3 receptor.

Answer 79

hyperactivity

Question 80

80. The defective ____ receptor fails to inhibit leg extensions when dopamine levels fall during sleep.

Answer 80

D3

Question 81

81. Although the defective _____ ________ is recessive, it is common enough to make restless legs the most common disorder of movement.

Answer 81

D3 gene

Question 82

82. There are 3 hereditary disorders of movement: _________________ ___________, ______________ _____________, and ____________ _______ _____________. All are hyperkinesias.

Answer 82

Tourette's syndrome, Huntington's chorea, and restless legs syndrome

Question 83

83. _________________ __________ is progressive and fatal.

Answer 83

Huntington's chorea

Question 84

84. _________________ ____________ produces facial and vocal tics while awake.

Answer 84

Tourette's syndrome

Question 85

85. ___________ ______ ____________ produces kicks during sleep.

Answer 85

Restless legs syndrome

Question 86

86. ______________ _________ is an uncommon sequela of scarlet fever.

Answer 86

Sydenham's chorea

Question 87

87. Sydenham's chorea usually disappears in about ___ _______, but antibiotics are usually given to prevent recurrence.

Answer 87

1 year

Question 88

88. Huntington's chorea and Sydenham's chorea are due to failure of a damaged ___________ to prevent _____________ ___________.

Answer 88

putamen | unwanted movement

Question 89

89. Huntington's chorea and Sydenham's chorea are due to insufficient activity of _____ neurons in the _____________.

Answer 89

D2 | putamen

Question 90

90. Parkinson's disease is due to excessive activity of _____ neurons in the ____________.

Answer 90

D2 | Putamen

Question 91

91. Parkinson's disease is due to failure of the _________________ neurons in the substantia nigra to inhibit the ____ neurons in the ____________.

Answer 91

dopaminergic D2 putamen

Question 92

92. Tardive dyskinesia is due to the _____________ receptive neurons in the ___________ becoming hypersensitive to ______________ as they habituate to _____________ receptor blockers.

Answer 92

dopamine putamen dopamine dopamine

Question 93

93. Hemiballism is usually due to a stroke affecting the _____________ __________.

Answer 93

subthalamic nucleus