Central Nervous System

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Central Nervous System

1. A 30-year-old female has had several episodes, each separated by several months, in which she experiences brief periods of physical weakness, clumsiness of the legs and hands, visual disturbances, and mood swings. Her weakness is most prominent in her lower extremities. CT scans show evidence of multiple lesions in the white matter of the brain and spinal cord. What is the affecting this individual? What is myelin? What is its function?

2. A patient diagnosed with strychnine poisoning is admitted to an intensive care unit with seizures of CNS origin. Describe the mechanism underlying this phenomenon.

3. A patient's pseudounipolar neurons of spinal ganglions were destroyed as a result of a viral infection. Which section of the reflex arc was damaged? Please, explain why malfunctioning of one of the sections result in the loss of reaction.

4. Potassium bromide, a sedative preparation, is administered to a hyperactive patient in a clinic. Explain the mechanism for its action.

5. Ethylene chloride is used to treat strained tendons in sportsmen. It is applied to the injured area which results in cessation of pain. What section of the reflex arc does the preparation target primarily?

6. A person suffering from tetanus responds with convulsions to insignificant irritation. Explain what process does the tetanus toxin suppress in CNS? Describe its physiological role in transmitting excitation through central synapses.

7. A patient complains of loud noise and bright light amplifying a toothache. Which characteristic of the nerve center is responsible for this phenomenon?

8. A patient experiences "phantom" pains the day after leg amputation. Explain the phenomenon.

9. A patient suffering from whooping cough vomits after a long spell of cough. What physiological mechanism is responsible for this phenomenon?

10. A 19-year-old male college student is transported to an emergency department by ambulance after hitting his head in a fall from a balcony. The student had been leaning over the balcony and fell approximately a carpeted floor. Witnesses indicate that he landed on his head and shoulder and immediately lost consciousness. The first aid team was called at once and upon arrival found the student not breathing and unresponsive to verbal commands. The patient was intubated and ventilated. His head and neck were immobilized and he was transported to an emergency department. The patient is not on any medications and has no known health problems.

1. What disease is observed in the patient?

2. Analyze the action mechanisms of brain stem structures.

3. Impact of the brain stem on the activity of the spinal cord motor.

11. An 18-year-old man is brought to an emergency center by an emergency medical service after being involved in a serious motor vehicle accident. On physical examination, the patient has normal vital signs but cannot move and has no sensation in either of the lower extremities, which are flaccid and without reflexes. Magnetic resonance imaging (MRI) reveals a fracture of the lower spine with significant swelling of and injury to the spinal cord.

1. Which tracts are responsible for direct cortical control of spinal motor systems?

2. What is the muscle response during the reverse myotatic reflex?

3. What do group afferents was detected?

12. Loss of motor activity and proprioreceptive sensation in the right side of the body below the level of injury and loss of pain and temperature sensitivity in the left side of the body have been detected in a patient following a traffic accident. Injury to which section of the brain is typically responsible for the stated changes? What is the name for this state?

13. A patient diagnosed with tetanus manifests decerebrate rigidity. Which section of the brain has been damaged? Explain the mechanism for the development of decerebrate rigidity.

14. Symptoms of a spinal shock are observed in a victim of an earthquake. An X-ray examination shows injury of the spinal cord at the level of lower chest segments. Autokynesis of lower limbs partial return a year after the injury. Explain what this means and describe the spinal shock mechanism.

15. Following a traffic accident one patient does not respond with the knee-jerk reflex in the left leg and another patient does not respond with the knee-jerk reflex in both legs. Explain the possible reasons for the loss of the reflex in both patients. Draw and name each section of the knee-jerk reflex arc.

16. Significant weakening of elbow reflexes was detected in a person undergoing a preventive medical checkup. Point at the location for the spinal cord injury.

17. A postmortem examination of the spinal cord of a 70-year-old male shows spinal damage and a decrease in the number of cells of anterior horn nuclei in the cervical and thoracic sections. Explain what functions were affected when the patient was alive.

18. A 70-year-old patient is diagnosed with hemorrhage into the brain stem. Hypertonia of flexor muscles and hypotonia of extensor muscles detected during an examination. What brain structures are damaged?

19. Partial loss of autokynesis in the right side of the body and loss of sensitivity to pain and temperature in the left side of the middle and lower part of the thoracic section have been observed in a young female patient following a fall from stairs. Explain the possible reason for this state.

20. Discoordination combined with retained muscle flexion force were observed during an examination of a sportsman after intensive physical strain. Explain what could cause discoordination.
21. A 59-year-old man became depressed during several years after a business failure. He became confused and had memory lapses. His family was concerned that he might be developing Alzheimer’s disease. He experienced progressively greater difficulty in walking. On examination, he did not know the date and had difficulty with mental arithmetic. His gait was unsteady, and he tended to fall. He had signs of interruption of the voluntary motor pathways. The results of blood chemical analysis were normal. However, in the CSF, the protein level was elevated, and the white blood cell count was high, but the glucose level was low. A magnetic resonance scan showed a massively dilated ventricular system. A microbe screening demonstrated cryptococci in the CSF.

What is the most likely reason for the patient’s changed mental state and motor difficulties?

22. A 34-year-old woman with a long-standing history of seizure disorder presents to her neurologist with difficulty walking and coordination. She has been on phenytoin for several days after having been switched from valproic acid. She states that she has had an acute change in gait, unclear speech, blurring of vision, tremor with movement, and loss of hand coordination. She has never had symptoms like this before. She denies headache and vertigo or any other com plaints. On examination, she has an unstable gait and poor hand-eye coordi nation. She is noted to have nystagmus along with a fine tremor of the hand when she is moving it. A urine drug screen is negative. She has a computed tomography (CT) scan and lumbar puncture, which are both normal. Phenytoin levels are slightly elevated. She is diagnosed with cerebellar ataxia, probably as a side effect of phenytoin.

What part of the cerebellum is responsible for planning and initiation of movement?

Is the output of the cerebellar cortex excitatory, inhibitory, or both?

What is the neurotransmitter for Purkinje cells?

23. A patient gets very tired while doing his job. He reels and doesn’t keep the balance, while standing with closed eyes. Muscle tone is reduced. Explain which part of CNS is injured.

24. A 64-year-old woman has impaired thin movements of fingers, developed muscle rigidity and tremor. She was diagnosed with Parkinson’s disease. Indicate the injured brain structures that could cause the disease.

25. A patient has movement disorders: tremor, ataxia and movement asynergia. Indicate the localization of the injury. What other symptoms could be revealed?

26. Muscle fatigue, trophic and metabolic disorders were revealed in the patient during examination. Which brain area is injured? How to define the disorder?

27. During examination movement disorders as amplitude and strength discrepancy, disproportional movements, “rooster walking” where revealed in the patient. Which brain area is injured? How to define the disorder?

28. Brain hemorrhage caused prolonged sleeping in 60-year-old man. Explain what is probable injury localization?

29. A patient was diagnosed with Parkinson’s disease. Indicate which brain mediator system could be injured?

30. After spinal cord traumatic abruption on the level of XI-XII thoracic segments total disappearing of voluntary movements under trauma level occurred. Indicate the injured tracts.

31. A patient was diagnosed with impaired sentence perception (sensory aphasia). Which brain area is injured?

32. Old patient was diagnosed with motor aphasia. Which brain area is injured?

33. Patient with decreased movement ability has tremor and increased muscle tone. Indicate the injured tracts.

34. Finger nasal probe was used during the examination of the patient. The patient didn’t touch his nose with forefinger. Which brain area is injured? What other probes could be used?
35. A 12-year-old girl is brought to the emergency room with difficulty in breathing. On examination she is found to have dyspnea with audible wheezes and is diagnosed with asthma. The patient is given an inhaled medication (albuterol), which provides immediate relief of the bronchial constrictive symptoms. Which autonomic nerve system receptors are affected by mentioned medication? What is the mechanism of stimulation of above receptors?

Which neurotransmitter activate above receptors?

36. A patient has rising heart rate, pupil dilatation, mouth mucosa dryness after the accident. Describe which regulative systems are involved in above changes and why?

37. A patient was put atropine drops into conjunctiva for better examination field. What is the drug’s effect?

38. While waiting for tooth extraction 24-year-old woman got the increasing of sympathetic nervous system tone. Describe the possible effect.

39. A patient with bronchial asthma was prescribed inhalations of 0,5% isadrin solution (adrenergic agonist). Patient felt heartache and increased heart rate after that. What was the purpose or the prescription and what are the reasons of side effects?

40. A patient with decreased heart rate, constricted bronchus, increased gut motor and secretory function. Indicate the possible reasons.

41. A patient after brain steam hemorrhage misses pupil reflex. Indicate the causing injured area.

42. A bronchus smooth muscle cramp appears in the patient. Explain which membrane receptor activators should be used to cease the attack.

43. A patient has tachycardia attack. Which membrane cytoreceptors of cardiomyocytes should be blocked to stop the attack?

44. Salivation increases and dryness of oral mucosa appears during commotion (alarm) in human. Describe the mechanisms of action.

45. After the road accident, a research participant got increased heart rate, significant increase in blood pressure, dilated pupils, dry oral mucosa. What is the reason and which system of regulation took part in these changes?

56. In order to better examine the fundus of eyeball the doctor put drops of atropine in research participant’s eye conjunctiva. Why did he use this medicine and what is the mechanism of its action?

Questions for learning:

  1. Describe the contours of biological regulation functions.

  2. Biological regulation, its’ types, shapes, adjustable parameters, the role of the feedback circuit of biological regulation.

  3. Explain the role of feedback provided by adaptive response.

  4. Explain the mechanisms of information transmission in the synapses of the central nervous system, the role of neurotransmitter and neuromodulator.

  5. Explain the mechanisms of excitation and inhibition.

  6. Neurotransmitters (acetylcholine, norepinephrine, dopamine, glycine, GABA, glutamate, serotonin, nitric oxide, etc.) and neuromodulator (neuropeptides, neurosteroides, etc.).

  7. Excitatory synapses and their neurotransmitters.

  8. The development of excitatory postsynaptic potential (EPSP), its parameters and physiological role.

  9. Postsynaptic inhibition, growth inhibitory postsynaptic potential (ІPSP). Presynaptic inhibition mechanisms of development. Central inhibition (I.M. Sechenov).

  10. The process of summation in central synapses: spatial summation, temporal summation. Summation of excitation and inhibition of neurons of the CNS.

  11. Summation of the role of integrative processes in the central nervous system.

  12. Nervous regulation functions.

  13. Neuron as structural and functional unit of the CNS.

  14. Types of neurons and their functions. Neural circuit.

  15. Reflex. Reflex arc, its parts, mechanisms coding and transmission links of the reflex arc. The role of receptors.

  16. Nerve centers and their physiological properties coordination reflexes principles.

  17. Types of reflexes and their physiological significance.

  18. Basic lines of the nervous adjusting of functions.

  19. Functions of neuroglia.

  20. Classification of receptors. General mechanisms of functioning receptors.

  21. A concept is about a nerve-centre. Properties of nerve-centers.

  22. Classification of mediators, their general characteristics.

  23. Description exciting and brake postsynaptic potentials.

  24. CNS synapse, their structure, mechanisms of information transfer. Features transfer excitation in the central synapses.

  25. Functions of spinal cord.

  26. Mechanisms of muscular and joint reception (proprioreceptions).

  27. Description of tonic reflexes (miotatic and neck tonic), those reflex arcs.

  28. Description of phase reflexes (tendon, leather, rhythmic, bend, cross-reflex), them reflex arcs.

  29. Neuron organization of back brain.

  30. Neuron organization of middle brain.

  31. The role of reticular formation in the implementation of motor functions. Influence of medial and lateral paths of reticulospinal motoneuron spinal cord.

  32. Functional organization and functions of basal nuclei.

  33. The functions of the cerebellum. Effects of removal or destruction of the cerebellum that occur in humans, their physiological mechanisms.

  34. Functional characteristic nuclei thalamus.

  35. Functions of hypothalamus.

  36. Levels CNS, provided their interaction with adaptive reactions.

  37. Analysis of sensory spinal cord.

  38. Actions of the spinal cord, its organization and coordination mechanisms (convergence, divergence, species inhibition of motor neurons - the opposite, reciprocal).

  39. Physiological characteristics of proprioceptors.

  40. Muscle spindles and stretch receptors, their structure and function.

  41. Stretch reflexes (myotatic), their reflex arc functions of gamma- loop.

  42. Activation of alpha and gamma motoneurons and supraspinales motor centers.

  43. The role of stretch reflexes in the regulation of tone (myotatic tone reflexes) and muscle length (myotatic phase reflexes).

  44. The clinical significance of the study of myotatic reflexes.

  45. Tendon reflexes of the receptors and their reflex arc physiological significance.

  46. Conduction functions of the spinal cord and its role in the regulation of motor functions.

  47. Up and down motor pathways, their role in regulating the activity of alpha and gamma motor neurons.

  48. Vestibular receptors bag and pestle, their role in the regulation of tone and posture.

  49. Role of midbrain in the regulation of motor functions.

  50. Motor reflexes in midbrain: static and kinetic article Reflexes straightening (labyrinthine, neck). Head turns and semicircular receptor channels and their physiological role in maintaining posture balance while moving with acceleration.

  51. The role of the midbrain in the regulation of stereotyped involuntary movements.

  52. Orienting reflex.

  53. The role of the reticular formation in the regulation of motor functions.

  54. Up, down and the rising influence of the reticular formation of the brain.

  55. The role of the basal nuclei in the regulation of motor functions.

  56. The role of motor areas of the cortex in the regulation of motor functions.

  57. The role of the cerebellum in the regulation of motor functions.

  58. The role of the cerebral cortex in the formation of the system of the organism.

  59. The role of the limbic system in the formation of the system of the organism.

  60. Explain the mechanisms of action of the autonomic nervous system in visceral functions of the body.

  61. To analyse the changes of visceral functions in the activation of sympathetic or parasympathetic nervous system.

  62. Explain the mechanisms of change in visceral function after blockade of ganglionic transmission and neuroorganic synapses of the autonomic nervous system. Basic features of humoral regulation of functions.

  63. Role of the Parasympathetic Nervous System on visceral functions.

  64. Role of the Sympathetic Nervous System on visceral functions.

  65. Enteric Nervous System, its Neurotransmitters, Receptors, impact on gastrointestinal physiology.

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