🤔 MEDIUM

The hypothalamus has been described as an orchestra conductor, the master regulator … and a nightmare for medical students to learn.  Basically, the brain wants to do something, it goes (for a lot of life) through its “fixer” the hypothalamus to get it done.  Test your knowledge on “the fixer” below – good luck! 

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Neuroendocrinology

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Question 1

Stem 1 of 5

A patient, recently prescribed haloperidol for schizoaffective disorder, presents deeply alarmed to see white secretions from his breasts.
Which dopaminergic pathway is indicated in the above presentation?
A
Tuberoinfundibular
B
Mesolimbic
C
Mesocortical
D
Mesostriatal
E
All of the above
Question 2

Stem 2 of 5

It would be reasonable to say that the positive symptoms of this patient's condition are ameliorated by action on which pathway?
A
Mesocortical
B
Mesolimbic
C
Tuberoinfundibular
D
Nigrostriatal
E
All of the above
Question 2 Explanation: 
The mesolimbic pathway has projection of ventral tegmental (basically the middle of the anterior midbrain) area to the limbic system diffusely. When this is deranged, the result are the positive symptoms of schizoid disorders.
Question 3

Stem 3 of 5

What is the role of dopamine in the hypothalamus?
A
To activate the preoptic nucleus
B
To initiate circadian rhythm in the tuberal nuclei
C
To halt the secretion of the anterior pituitary gland
D
To activate the secretions of the posterior pituitary gland
E
None of the above
Question 3 Explanation: 
Dopamine from the arcuate nucleus prevents prolactin release from the anterior pituitary gland. But this dopamine is antagonised by haloperidol in this patient, hence lactation has occurred.
Question 4

Stem 4 of 5

The hypothalamic nuclei implicated in this patient's condition receives which blood supply?  Select all that apply.
A
Anterior cerebral artery
B
Anterior communicating artery
C
Middle cerebral artery
D
Posterior communicating artery
E
Posterior cerebral artery
Question 4 Explanation: 
The middle region of nuclei are supplied by the PCA and PComm
Question 5

Stem 5 of 5

Which of the following nuclei are implicated in memory formation?
A
Preoptic
B
Supraoptic
C
Paraventricualr
D
Mammillary bodies
E
Supraorbital
Question 5 Explanation: 
The MB connect directly to the hippocampus via the fornix.
Question 6
A patient presents with hyperorality and profound weight gain due to a lack of satiety. A tumour is found to be growing within his hypothalamic region. Which of the following nuclei are likely involved in his presentation?
A
Ventromedial
B
Dorsomedial
C
Arcuate
D
Paraventricular
E
Supraorbital
Question 7
A patient presents with autonomic dysregulation and bitemporal hemianopsia.  Given your knowledge of the cause of the visual field defect, which three of the below hypothalamic nuclei are most likely to be impinged by the adenoma?
A
Suprachiasmatic
B
Supraoptic
C
Supratrochlear
D
Paraventricular
E
Arcuate
Question 8
A chronic alcoholic with anterograde amnesia, ataxia and ocular defects presents. Which deficient vitamin is likely responsible for the cluster of his symptoms?
A
B1
B
B6
C
B9
D
B12
E
All of the above
Question 8 Explanation: 
The patient has Wernicke-Korsakoff syndrome which is an amalgam of Korsakoff's syndrome and Wernicke's encephalopathy. This is due to B1 deficiency (thiamine).
Question 9
The patient in the previous question is known to insert falsehoods into his narrative when discussing points - for instance he told the nurse this morning that he was a multi-millionaire. What is the term for this commonly recognised feature of his disease process?
A
Confabulation
B
Lying
C
Hallucination
D
Delusion
E
None of the above
Question 9 Explanation: 
Confabulation is a subconscious process whereby the patient is unaware that due to profound memory loss, they insert false memories into their stream of consciousness.
Question 10
Occlusion of which of the following arteries is least likely to cause hypothalamus ischaemia?
A
Anterior cerebral
B
Anterior communicating
C
Middle cerebral
D
Posterior cerebral
E
Posterior communicating
Question 10 Explanation: 
ACA, AComm, PCA, PComm supply the hypothalamus. There is not classically a supply from MCA for this structure.
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