MT2

Question 1

Cranial nerve assessment:
1. Glossopharyngeal nerve
2. Vagus nerve
3. Accessory nerve
4. Hypoglossal nerve

Answer 1

1. Provides sensation to the posterior third of the palate, perform gag reflex test by touching palate
2. Motor supply to pharynx for swallowing, test by asking patient to speak
3. Motor supply to the SCM and traps, test by turning head against resistance and shrug shoulders against resistance
4. Motor supply to the tongue, stick tongue out, deviations suggest weakness

Question 2

Ms. Smith case study
1. Overview
2. Past medical history
3. Cerebral angiogram
4. Lumbar puncture and CSF analysis
5. Treating headache, depression, and obesity
6. Diagnosis

Answer 2

1. Middle aged woman with history of chronic headaches and acute consent of double vision and right eyelid droopiness
2. History of depression, no hypertension or depression
3. Insert catheter with dye into femoral artery, dye will move into BV of head making them visible, test patient for aneurysm (weak spot on BV that bulges out and fills with blood, can rupture and cause serious internal bleeding
4. Spinal tap, assess opening pressure (pressure CSF revoked with) and CSF protein conc; opening pressure elevated in bacterial inflection, normal in viral, variable in fungal and tubercular; certain protein conc can indicate certain disorders
5. Given naproxen which is anti inflammatory, if ineffective then use narcotic analgesia; if cerebral angiogram and lumbar puncture negative then can undergo dihydroergotamine treatment to narrow BV in head and block release of substances that cause headaches, continue Zoloft (SSRI) for depression; referral to dietitican for obesity
6. 3rd nerve plasy, 3rd nerve control movement of eye and eye muscle, constriction of pupil, and focus of eye; complete palsy causes closed eyelid and deviation of eye; partial affects any function

Question 3

Neuroanatomy overview
1. Allen Institute for Brain Science
2. Cerebral security
3. Ventricles
4. Blood brain barrier
5. circulation of the brain

Answer 3

1. map the brain, make research and knowledge equitable by using open science practices
2. 4 different forms of protection mechanisms from injury and infection for the CNS; skull and vertebrae enclose CNS; meninges are membranes below the bone that enclose the brain and sp cd, dura mater is tough double layer enclosing brain, arachnoid mater is the thin web following contours of brain, pia mater is tough tissue on surface of brain
3. between pia mater and arachnoid mater is the subarachnoid space, blood from capillaries enter subarachnoid space, filter through choroid plexus in lat ventricle underlying cortex to become CSF to third ventricle, cerebral aqueduct connect to fourth ventricle, draining into circulation; CSF cushions CNS from shock and change in pressure
4. BV in CNS have tightly packed layer of astroglial cells forming BBB which selectively allows certain molecules through (small) into brain
5. 1. blood supplied by internal carotid arteries running on anterior side of C spine and vertebral arteries along C spine; four merging into circle of Willis at base of brain which allows for different paths for blood to travel in event of stroke; cerebral arteries branch into smaller arteries supplying brainstem and cerebellum and split into ant (middle and dorsal), middle (lateral surface), and post (ventral and posterior surface) cerebral arteries supplying forebrain

Question 4

Sp cd
1. Sp cd and nerves
2. Dermatomes
3. SCI level
4. SCI types
5. SCI stats

Answer 4

1. sp cd is extension of brainstem, relays info from PNS to brain and facilitate reflexes; 31 spinal nerves C1-8, T1-12, L1-5, S1-5, coccygeal nerve
2. area of skin innervated by a single nerve; if rash or pain in whole dermatome then indicated problem with specific nerve
3. affects all parts of spinal cord below level of injury; sacral affect bowel and bladder control, sexual function, lumbar impairs movement in lower extremity, thoracic causes difficulties breathing and digestion, cervical impairs function from neck down such as swallowing, speech, movement of upper extremity
4. complete or incomplete, complete is dmg across whole width resulting in complete loss of sensation and motor control, incomple is injury across part of sp cd thus retain some motor and sensory function
5. many people living with SCI in Canada, expected number cases per year increasing, occurring most commonly in males between ages 20-29 and increase due to falls as pop ages

Question 5

herinated disc
1. Overview
2. Risk factors
3. Treatment

Answer 5

1. result of tear in outer layer (annulus fibrosis) of disc, disks absorb shock; most common in lumbar and cervical region
2. common occurrence in all ages, risk factors are high weight, occupation, and genetics
3. surgery to remove protruding portion, medicate with OTC pain meds, narcotics, anticonvulsants, muscle relaxers, and cortisone injections

Question 6

Glial cells and neurons
1. Neurons and glial cells
2. Types of glial cells
3. differentiation of nerve cells
4. types of neurons

Answer 6

1. 100 bil neurons, thought to be many glial cells but new tech show less than 1:1 ratio of glial to neurons
2. ependymal cells line ventricles and produce CSF by filtering blood, astrocyte nourish and structurally support neurons, microglial derived from mesoderm def, oligodendroglial cells forms myelin in CNS, Schwann cell forms myelin in PNS
3. glial and neurons begin as undifferentiated self-renewing multipotent neural stem cells, convert into progenitor cells which act as precursor cells, converting into nondiving primitive neuroblasts or glialblasts; neuroblasts specialized into interneurons or projecting neurons; glialblasts differentiate into oligodendroglia or astrocytes
4. sensory neurons with direct dendrite axon connection such as bipolar neurons of the retina or somatosensory neurons sent afferent info to CNS; interneurons with large web of dendrites such as stellate cells of thalamus, pyramidal cells of cortex, and purkinje cells of cerebellum receive info from sensory neurons and formulate response to send to motor neurons; motor neurons wth complex branches and long axons send efferent signals to muscles

Question 7

evolution of CNS
1. vertebrate brain
2. mammal brain
3. human brain

Answer 7

1. three part brain consisting prosencephalon responsible for olfactionn, mesencephalon for vis and aud, and rhombencephalon for movment and balance
2. anterior prosencephalon dev into cerebral hemispheres calledd telencephalon, posterior prosencephalon called diencephalon includes thalamus, rhobencephalon div into metencephalon (cerebellum) and myelencephlaon (lower region of brainstem)
3. three parts, forebrain for cog progessing, brainstem for reg func, and sp cd for reflexive motor func

Question 8

Brain stem: hindbrain
1. cerebellum
2. medulla oblongata
3. reticular formation
4. pons

Answer 8

1. coordinates movement, motor learning, posture, balance and plays role in cog such as language processing, working memory, and social cog
2. regulate essential functions such as breathing, HR, coughing, sneezing, etc; dmg is fatal
3. network reg circadian rhyth, general arousal, and relay info between brain and sp cd, stim area in anesthetized cats produce waking pattern of electrical activity
4. control essential functions and relay info between brain and sp cd

Question 9

Brain stem: midbrain
1. tectum
2. tegmentum

Answer 9

1. lower sensory part consisting of superior colliculus recieving vis input and inferior colliculus recieving aud input
2. upper motor part consisting of red nucleus for limb movement, substantial nigra connecting to forebrain for reward and avoidance behaviour, PAG surrounding cerebral aqueduct for species-specific behaviour and mod pain response

Question 10

brainstem: diencephalon
1. thalamus
2. epithalamus
3. hypothalmus

Answer 10

1. largest structure in diencephalon acts as relay centre for sensation, sends sensory input to appropriate part of brain for processing, contains 20 nuclei; lateral geniculate body receive vis projection, medial geniculate body receive aud projection, ventrolateral posterior nuclei for touch, pain, pressure, and temp (somatosensory)
2. small, contains pineal gland which secretes melatonin to produce sleepiness to reg circadian rhythm and habenula reg hunger and thirst
3. regulate motivational behaviours such as hunger, thirst, body temp, sex drive, etc. and interacts with pituitary gland to control endocrine func

Question 11

neurological assessment
1. olfactory nerve
2. optic nerve
3. fundus
4. photoreceptor

Answer 11

1. nerve I, responsible for sense of smell, test using something familiar with strong scent (coffee, orange peel)
2. nerve II, responsible for vision, test visual acuity using Snellen charts, colour vision tested with Ishihara plates, visual fields (peripheral vis) tested by having patient look straight ahead while moving fingers in each quadrant, visual inattention can be tested by moving both fingers at same time, visual field decrease with age; test pupil reflex by blocking light from one eye and shining light into other, if functioning well then both pupils with constrict
3. the interior surface of the eye including retina, optic disc, macula, and fovea, and posterior pole (space between optic disk and macula), optic disk is blind spot where optic nerve attaches to retina
4. convert photons into AP interpreted as vis info, macula is highly specialized with many photoreceptor for fine detail, fovea is high conc of photoreceptor for highest visual acuity

Question 12

neurological assessement
1. oculomotor nerve, trochelar nerve, and abducens nerve
2. trigeminal nerve
3. facial nerve
4. vestibulocochlear nerve

Answer 12

1. II, IV, and VI involved in movements of the eye, test by having patient look straight ahead and follow your fingers with eyes only as you move fingers in all directions
2. V involved in sensory supply to face and movement of muscles of mastication, three branches ophthalmic, maxillary, and mandibular, test sensory by using light touch such as feather to touch each part of three parts of face, test motor supply by asking patient to clench teeth, observe and feel the contraction of masseter and temporalis muscles
3. VII, responsible for movement of facial muscles, patient makes faces to test motor supply, crease forehead, close eyes against resistance, puff out cheeks, bare teeth
4. VIII responsible for hearing, Rinne test place tuning fork on mastoid process and compare to tuning fork next to ear, next to ear should be louder

Question 13

forebrain
1. limbic sys
2. basal ganglia
3. neocortex

Answer 13

1. subcortical, self regulatory processes such as emotional processing, hippocampus responsible for memory and learning, visceral and endocrine function, and emotional behaviour; amygdala for emotional learning, fear, and reward; corpus callosum connects hemispheres; cingulate gyrus spanning neocortex above cc connects various brain regions and involved in sexual behaviour; mamillary body; and fornix
2. subcortical circuit, involved in controlling and coordinating movement and habit (stimulus-response) formation to reduce effort
3. four lobes of the brain, six layers of cells, heavily wrinkled to hold greater SA for information, hemisphere separated by longitudinal fissure, frontal lobe separated from parietal lobes by central sulcus and from temporal lobe by lateral sulcus, parietal lobs separated from the temporal lobes by lat fissure, no def boundaries for the occipital lobe

Question 14

1. Huntington’s disease
2. Parkinson’s disease

Answer 14

1. autosomal dominant disease due to abnormal expression of IT-155 gene on chromosome 4 encoding for protein huntingtin, avg age 30-54, progressive death of basal ganglia cells characterized by motor, cog, and psychiatric symptoms such as impairment of involuntary (chorea) and vol movements, loss of thinking speed and flexibility and other cog skills, and depression (most common), mania, OCD, anxiety, etc
2. avg age 62, projection from substantial nigra to basal ganglia dies, tremours in limbs, rigid movements and difficulty balancing; treated using carbidopa-levodopa which is converted to dopamine in the brain, allowing it to bypass BBB, with progression of disease, benefit of levodopa is less stable

Question 15

cortical org
1. primary, secondary, and tertiary areas
2. cellular org
3. cortical connections
4. crossed brain

Answer 15

1. primary recieve projections from major sensory sys or send motor projections to muscle; secondary adj and interconnected with primary forms sensory related functions such as form, music, motion for vision and send motor input to primary; tertiary receive sensory info from secondary and mediate complex activities such as language and attention and sent to frontal tert area to formulate plan of action
2. 6 layers with diff cells and functions related to input and output; layers V and VI pyramidal neurons send axons to other brain areas and to spinal cord, prominent in motor cortex; IV comp stellate neurons in primary areas of sensation receive input from sensory and cortical areas; layers I, II, II receive input from layer IV, well dev in secondary and tertiary regions to perform integrative func
3. four type of axon projection connection neocortex regions; long connections between one lobe and another, short connections within lobe, interhemispheric commissures, connections through thalamus
4. hemisphere responds to sensory stimulation from the contralateral side sent through decussations connecting sensory and motor info across midline

Question 16

Electrical recording
1. Single cell recording
2. Electroencephalogram (EEG)
3. Event related potentials (ERP)
4. Magnetoencephalography (MEG)

Answer 16

1. high res, measure voltage change (AP) in single cells
2. cheap, Use electrodes on surface of the skull to measure the electrical activity of summed activity of different states of consciousness; awake beta, awake but relaxed alpha, slow freq high amp waves interrupted by great AP for drowsiness, slow high amp delta sleep waves
3. cheap, change in the electrical signal in response to sensory stimulus, repeated present stimulus and avg result to find location and time of processing to show readiness potentials processing info before motor response; P component peak with processing, N component dip with detecting and distinguishing stimuli
4. Expensive, Uses magnets to detect electrical fields of neurons to create map of magnetic intensity

Question 17

Brain stimulation
1. Intracranial brain stimulation
2. Transcranial magnetic stimulation

Answer 17

1. surgically place thin electrode into target areas deep in brain, Implant neurostimulator into chest, program it to gen personalized electrical impulses to target brain regions to regulate abnormal neural activity and limit side effects of movement disorders; alleviate tremors, rigidity, and involuntary movements
2. pass current through the coil which creates magnetic field around coil, stimulate neurons to depolarize; can cause nausea

Question 18

Structural imaging
1. Conventional radiography
2. Pneumoencephalography
3. Angiography
4. Computed tomography

Answer 18

1. quick andcheap X rays well absorbed by bones, then soft tissues, and least by water; easy to id fractures and gross brain abnormalities
2. Remove small amount of CSF and replace with air, use X rays to track air as it moves through ventricles to image brain, not often used since it can be painful
3. substance absorbing X rays is injected into blood, as blood moves into brain, X rays produce image of BV
4. use X rays and computer processing to generate detailed cross sectional images of body

Question 19

dynamic/functional imaging
1. PET
2. MRI
3. fMRI
4. magnetic resonance spectroscopy
5. diffusion tensor imaging
6. optical tomography

Answer 19

1. radioactive substance injected into blood decays and releases positrons to stabilize, positrons annihilate when in contact with free e-, releasing photons detected by machine, increase blood flow with increase in neural activity; compare control and stimulation scenarios by substracting difference, mostly used in research not clinical
2. time-consuming, high quality, normally hydrogen field unaligned use strong magnetic field to align hydrogen nuclei poles in body and apply second magnetic field in a different direction, removed 2nd field and measure relaxation rate time taken to realign with original field; relaxation rate varies with tissue producing different intensities on image to differentiate between tissues
3. increase in neuron activity increase BF and oxyhemoglobin, fMRI detect difference in ratio of oxyhgb and deoxyhgb using MRI to locate areas of brain activity
4. breakdown of metabolities distinguishes nerves cells from other substances
5. cheap and portable, images nerve fibers by detecting direction water molecules move
6. fNIRS, difference between amount infrared light reflected by oxygenated and deoxy blood, measure brain’s BF and avg O2 consumption

Question 20

epliepsy
1. EEG
2. provoked seizure
3. first seizure
4. idiopathic generalized epilepsy

Answer 20

1. detect abnormal brain activity; partial seizure is when abnormal discharge restricted to few brain regions, brief loss of consciousness, sensation or emotions; generalized seizures is widespread throughout brain, convulsions, loss of muscle tone,and loss of consciousness; shows as large distinctive spikes on EEG or loss of signal and able to id region of seizure
2. specific triggered or underlying conditions such as drugs or sleep deprivation; structural abnormalities in the brain can also provoke seizure in individuals without pre-existing epilepsy diagnosis
3. usually between age 16-25, comprehensive evaluation to determine underlying cause and monitoring for future seizures
4. seizures occur without identifiable cause, commonly absence seizure where there are brief lapses in awareness

Question 21

V1
1. overview
2. structure
3. lesion

Answer 21

1. first area of processing, recieve visual input from LGN and send to extrastriate cortex areas for higher processing
2. striate cortex, laminar org most distinct in layer 4, has more than one distinct function (heterogenous); comp blobs are metabolically more active and stain deeper thus sensitive to color , pass info to V4 while interblobs are sensitive to orientation pass info to MT/V5 for motion
3. do not have conscious perception of vision but have unconscious perception for vision during locomotion due to LGN connections to V2 and from sup colliculus to thalamus

Question 22

vision
1. occipital lobe
2. visual field and visual pathway
3. other vision structures
4. cortical structure

Answer 22

1. main lobe responsible for processing visual information, ability to precieve and interpret visual stimuli; contains primary visual cortex (v1) for basic visual info and other areas for complex visual processing such as visual processing and spatital awareness
2. images in the left visual field are projected onto the right side of the retina and sent electric signal down the optic nerve converging at optic chiasm to right optic tract, right lateral geniculate nucleus in thalamus down optic radiation to v1
3. vision related areas in brain make up 55% total cortex, vision is dom sense, calcarine sulculus of V1 div upper and lower visual field, lingual gyrus of temporal lobe contain V2 and ventral posterior area, fusiform gyrus of temporal lobe contain V4
4. human cortex has six layers but V1 has more than six

Question 23

V2
1. overview
2. structure
3. dorsal stream
3. ventral stream
4. STS stream

Answer 23

1. sent output to parietal lobe for dorsal stream, output to inferior temporal ventral stream, and output to superior temporal sulcus STS stream
2. thin stripes for color perception, thick stripes for form and motion perception
3. visual guidance of motion
4. object perception
5. connected to many other parts of temporal lobe such as Wernicke’s area; visuospatial function (faces, biological motion), language processing ( language and voices), and social cog (theory ofmind) and perception

Question 24

1. V3
2. V4
3. V5

Answer 24

1. receive info from V1 and V2 for dynamic form
2. info from the V2, responsible for colour, colour vision allow primates to have higher visual recognition due to its role in detection of movement, depth, and position
3. info from V1, vision and motion

Question 25

5 types of vision
1. vision for action
2. action for vision
3. recognition
4. space
5. visual attention
6. Milner-Goodale model

Answer 25

1. vision evolved for motion, using vision to direct specific motion; parietal visual area in dorsal stream; bottom up processing (using stimuli to drive cog processes)
2. consciously using eye movements to attend to distinct or important part of stimulus (vis scanning, eye movements, selective attention); top down processing (use cognitive processes to respond to stimuli, reflexive)
3. temporal lobes ventral stream, requires higher visual acuity and more complex neural processing; motion detection is faster and more accurate than object recog suggests motion processing is older evolutionarily, object recog is higher function building on motion detection
4. parietal lobes dorsal stream; vision to determine spatial location such as location of object relative to person (egocentric space) and location of object relative to another (allocentric space)
5. only attend and process important characteristics of image to not be overwhelmed by visual stim
6. V1 send info to V2 and dorsal stream consisting V5 (motion) and V3A (form); dorsal stream fuels action in parietal lobe; V2 send info to dorsal and ventral stream fueling object recog consisting of V3 (dynamic form) and V4 (colour) in temporal lob

Question 26

visual path disorders
1. monocular blindness
2. bitemporal hemianopia
3. right nasal hemianopia
4. homonymous hemianopia
5. quandrant anopia
6. macular sparing
7. scotomas

Answer 26

1. lose sight in one eye due to dmg to retina or optic nerve
2. loss of vision in both temporal fields due to tumor on pituitary gland putting pressure on optic chiasm thus info cannot cross over
3. lesion in lateral chiasm leading ot loss of vision in on nasal field
4. blindess of one visual field due to dmg in optic tract, LGN, or V1
5. blindness in one quarter of visual field due to vis cortex lesions near calcarine sulcus
6. sparing of central visual field allows for retention of high acuity, differentiates lesions of optic tract or thalamus from V1 since it only occurs after dmg to V1 as macular part of V1 receive double BF from medial and cerebral artery
7. small occipital lobe lesions resulting in small blindspots

Question 27

visual agnosia
1. overview
2. prospoagnosia
3. object agnosia
4. alexia (dyslexia)
5. visuospatial agnosia

Answer 27

1. neurological condition affecting ability to recog or interpret visual info despite normal vision
2. bilateral occipital lobe dmg, unable to recog faces
3. cannot recog object; apperceptive cannot match or id objects by shape, size, and color due to gross bilateral dmg to occipital lobe, simultagnosia is type of apperceptive which cannot processing multiple objects at once such as reading and finding objects in busy environ; associative can perceive but cannot recog objects due to inability to connect vis info with knowledge about object due to lesion from anterior temporal lobe
4. inability to read due to dmg to left fusiform and lingual areas
5. topographic disorientation (inability to find one’s way) accompanied by other visual deficits due to dmg to occipotemporal regions, medial fusiform, and lingual areas; can be symptom of dementia