PIL NeuroLecture and Lab F.A.Q.
October 26th 2011:
The tutorial recommended to preview tomorrow information is the GrossBrain Lab tutorial
October 28th 2011:
Program for the Weekend: Get some candies for Halloween.
Read your handouts Re-do the GrossBrain Lab and the Spinal Cord tutorials to review the material.
Start the tutorial for Pathways (to prepare for next resource session, as you do this tutorial focus mostly on dorsal column, STT and corticospinal tracts).
Then start using the tutorial for the Brainstem anatomy tutorial to get familiar with the anatomy.
Use spinal cord and brainstem sections to identify where the dorsal column/medial lemniscus system, the anterolateral system (STT), and the corticospinal tracts are situated at different levels of the brainstem and spinal cord.
If you have difficulties and need some help please e-mail me (fsessler@drexelmed.edu).
A typo has been found in Dr. Waldeck' s handout: On Page 8, "length of the axon " should be replaced by "length constant".
The text should be:
The speed of conduction in an unmyelinated axon is determined by the length constant of the axon, which is depolarized by an action potential occurring at a starting point. The length constant of axon depolarized to threshold by this passive mechanism is increased if the internal resistance of the axon (Ri) is decreased or when the membrane resistance (Rm) is increased (more resistance to electrical flow out of the axon).
October 29th 2011:
By now you should all have visited the PIL Neuroscience site in Blackboard Vista and look at the resources and guides that are released for each case; they provide guidance for taking the self-assessment tests and at the same time prepare you for the coming exam.
The tutorials to start preparing for November 2nd RS are Brainstem Anatomy and Brainstem Cranial Nerves. You should also start doing the self-assessment tests in blackboard vista.
November 1st 2011: Help guide for the First PIL Neuro exam 2011-2012
Practical Exam: 35 questions (MCQs)
~14 Identification questions with multiple choice answers: identify structures in Grossbrain, spinal cord, brainstem, thalamus (only the 4 levels), hypothalamus (only the 4 levels) slides. What structure is not present in a slide? Match letter with correct structure.
~21 Indirect questions with multiple choice answers: origin and destination of fiber pathways (STT, LCST, Dorsal column-medial lemniscus), lesion in pathways. Spinal cord lesions. Brainstem nuclei, cranial nerves, organization in functional column, function, lesions.
The practical will use the following slides: GrossBrain-10, spinal cord-6, thalamus-2, brainstem-16, hypothalamus-1
Slides to study are:
Grossbrain : C1-02 to C1-11, C1-16 to C1-21, C1-22 to C1-24 and basic difference between T1 and T2 weighted MRI from Intro to CNS RS.
Spinal cord: C1-32 to C1-35, C1-37 to C1-41, C1-47
Brainstem: ventral and dorsal brainstem (Intro CNS; Brainstem RS)
for the medulla: C1-51, C1-52, C1-53, C1-56;
for the pons: C1-58, C1-59
for the midbrain: C1-62, C1-65, C1-66
Thalamus: C2-32, C2-33, C2-37, C2-39
Hypothalamus levels: (Posterior , tuberal, anterior/suprachiasmatic, preoptic: C1-71, C1-72, C1-73, C1-74)
Use the Slide Atlas on the Web to study and practice identifying structures.
Use the Practical Quiz, tutorials and self-assessment tests (blackboard vista) on the Web to train yourself.
Review the main pathways using some of the Animations on the Web
1- To answer indirect questions, you have to know which thalamic nuclei project to which cortical regions; where are the neurons at the origin of fasciculus gracilis & cuneatus? where are the neurons at the origin of medial lemniscus? where project or terminate the fibers of the above tracts? what are the effects of lesion of these tracts (ipsi or contra losses, fine touch, proprioception...), remember that below T5 there is only the fasciculus gracilis that originates from neurons in the dorsal root ganglion (DRG). Remember when you study a tract to ask yourself where the fibers are coming from, where they are going, what info is in the tract and if there is a lesion if the deficit is ipsi or contra. Know the somatotopy of the main tracts in spinal cord and brainstem.
2- You have to know the difference between lower and upper motoneuron lesions, and the symptoms going with it.
3- Know approximately the dermatomes and identify the 5 levels of the spinal cord to be able to decide if a lesion affects upper or lower limbs
4- Symptoms associated with spinothalamic tract (STT) and ventral white commissure lesions.
5- Symptoms associated with lesion of ventral horn versus descending pathways in the lateral funiculus
6- Remember where the intermediolateral cell column and the Clarke’s nucleus are and the shape of the spinal cord at thoracic level versus cervical, lumbar and sacral levels.
7- Know how to identify the cranial nerve nuclei as well as the medial lemniscus, STT, inferior colliculus, superior colliculus, in the 8 brainstem slides for this exam. Remember that pain & temperature info from the face is in the ipsilateral spinal tract and spinal nucleus of V.
8- Know the important signs of lesion of cranial nerve nuclei and know how to match cranial nerve nuclei with their functional columns.
9- Learn how to identify the thalamic nuclei in the 4 thalamic slides of C2.
10-Learn how to identify the 4 hypothalamic levels.
11-Blood supply from anterior spinal artery, PICA, AICA, SCA, PCA and paramedian branches of the Basilar artery in relation to brainstem. Clinical signs of stroke.
12-Effects of lower and upper motoneuron lesions in body and face.
13-Descending motor systems, LCST, MRST, PRST, RST, role in motor control, effects on extensor and flexor muscles, decorticate/decerebrate posture.
14-Effects of corticobulbar lesions (contralateral drooping of the corner of the mouth).
15-Know where thalamic nuclei project and their inputs.
16-What structures are or not present in the slides.
17-Recognize a T1 from a T2 weighted MRI
Written exam: 40 questions (MCQs)
-read all the resource sessions up to and including RS# 6
-The questions will be distributed the following way:
- 5 questions: Membrane, Neurotransmission, Transduction, Neuromuscular junction, Spinal mechanisms of Motor Control, Synaptic integration, LTP & LTD
- 9 questions: Spinal Cord/ Pathways
- 2 questions: Intro to CNS
- 1 question: Thalamus
- 2 questions: Transmitters
- 13 questions: Brainstem, Brainstem stroke, Cranial nerves
- 3 questions: Hypothalamus
- 2 questions: Pain
- 3 questions: Brainstem Motor pathways, Reticular formation
1- Review the action potential and how the different channels are participating in it.
2- Resting membrane potential and equilibrium potential for sodium, potassium and chloride, Nernst, Goldman, refractory period, myasthenia gravis.
3- Neurotransmitters, where they are located, neurotransmission and how transmitter exocytosis is calcium dependent
4- LTP and NMDA, receptor potential, ionic vs metabotropic receptor, location of major neurotransmitters
5- muscle receptors and cutaneous receptors, what they detect, the fibers involved, medial & lateral division. Motor unit definition. How intensity is coded in a receptor vs in a fiber. Size principle for recruitment of neurons. Intrafusal vs extrafusal fibers, Renshaw cells.
6- Rexed classification of the laminae of the spinal cord and their equivalent in term of marginal nucleus, substantia gelatinosa, N. proprius, intermediolateral cell column, Clarke's nucleus. At which levels are these nuclei present?
7- Sensory and motor tracts from receptor to cortex and all the synapses, location of 1st, 2nd and 3rd neurons of the pathways; the difference between relay and reflex circuits. Intermediolateral nucleus. Thalamic relay of main pathways. Somatotopy. Dorsal root medial division / lateral division fibers. Types of fibers and their function.
8- Lesions in the 3 most important pathway systems (anterolateral system, dorsal column – medial lemniscal system, corticospinal tracts). Where each fiber tract terminates and from where it comes from. Anterior white commissure lesions...
9- Lower and upper motoneuron signs of lesion
10- Functions of cortical gyri. Main blood supply of the brain. Ventricular system and its relation with brain regions. Cranial nerves, where they exit, what part of the brain they belong to. Anatomic features of the spinal cord.
11- Thalamus nuclei, their cortical targets, their inputs
12-Relationship between hypothalamic nuclei and function
13-Pairing of thalamic nuclei with inputs and target cortical region
14-Role of MRST, VCST, DSCT, LVST, LCST, PRST…
15-Pairing between cell of origin and tract
16-Match cranial nerve nuclei with function, and target muscles or glands…
17-Match lesion of cranial nerves and their nuclei with deficits
18-Know the blood supply of medial (anterior spinal artery) and lateral medulla (PICA), dorsal caudal pons (level of abducens and facial nerve, AICA) and ventral caudal pons (pyramids + abducens nerve, paramedian branches of basilar artery), midbrain (level of corticobulbar and oculomotor nerve, posterior cerebral artery + basilar artery); blood supply of parietal, frontal, temporal and occipital cortex, circle of Willis. Clinical signs of stroke.
19-Know which nuclei belong to which functional columns
20-Function of brainstem motor system, reticular formation (decorticate/decerebrate), corticospinal and corticobulbar systems.
21-Pain: PAG, Gate control theory, fast pain slow pain, A-delta/C fibers, polymodal nociceptors, peripheral sensitization to pain, role of insula and anterior cingulate cortex in processing emotional aspect of pain, referred pain, mechanisms contributing to neuropathic pain, role of NMDA in central sensitization to pain, fast pain vs slow pain.
If you need help, contact: fsessler@drexelmed.edu or jshumsky@drexelmed.edu.
November 2nd 2011:
The tutorials recommended to preview tomorrow information are the Brainstem Vascular Lesion and Hypothalamus. You can also look at the Pathways tutorial for MRST, PRST, RST, LVST, MVST, decerebrate and decorticate posturing.
November 5th 2011:
In case you are wondering how the practical exam will be. Slides will be projected with arrows pointing at structures. There will be identification and indirect questions: about 45 secondes for identification, and about 1.4 minute for indirect questions. At the end each slide will be presented again for about 10 secondes. You will have about 5 more minutes to review your answers.
November 8th 2011:
The tutorials recommended for this case and to preview next RS information are Cerebral Cortex, Memory circuit, Emotion circuit and Reward circuit.
November 10th 2011:
The tutorials recommended for the next case and to preview next RS information are Cerebellum and Basal Ganglia..
November 16th 2011: Help guide for the Final PIL Neuro exam 2011-2012
The Practical (35) and Written (40) MCQs will be mostly about the Resource Sessions provided during the last 3 cases + a few questions about hypothalamus, spinal cord and brainstem which require some cumulative knowledge from previous RS). Also 1 question of biochemistry in the written MCQ will require reading the handout in BBvista last case.
Practical:
Will be 35 multiple choice questions (1 identification question, 34 indirect questions including lesion in visual pathways, cerebral cortex lesions, internal capsule, vestibular brainstem lesion/nystagmus, cerebellum lesion, pathways to/from cerebellum, cerebellar cortex, cerebellar white matter, lesion/pupillary reflex, layer in retina, fibers in ICP, MCP and SCP, cochlea, cerebellar cortex, lesion of MLF/INO, basal ganglia features (connection, neurotransmitters/peptides, lesions), thalamocortical projections, limbic connections, cerebellar projections), spinal cord lesion, brainstem lesion; hypothalamus levels, nuclei present, functions...
Slides to study:
Slides of spinal cord 5 levels
Slides of brainstem from pyramidal decussation to pretectal region of the midbrain (only the slides presented during lecture-lab)
Slides of the forebrain (C1-68 to C1-75).
4 thalamus levels
4 hypothalamus levels
10 horizontal sections (basal ganglia, thalamus, amygdala, hippocampus...)
1 retina
1 cochlea
1 hippocampal formation
Also sections shown in RS showing components of the basal ganglia, cerebellum, visual, auditory and balance systems and some Gross brain slides from lateral and ventral surface of brain and midsaggital and horizontal section of Gross brain. Be able to identify some components of the limbic system and some of their pathways (septum, hippocampus, amygdala, mammillary body, anterior nucleus of thalamus, nucleus accumbens, MD, cingulate gyrus, parahippocampus gyrus, fornix, anterior commissure, mammillothalamic tract)
Test Questions will be:
12 Basal ganglia + Cerebellum + Motor systems
6 Cortex + thalamus
10 Vision + Audition + Balance
3 Limbic
2 Hypothalamus
1 Spinal cord/lesion
1 Brainstem/cranial nerve
Written:
Multiple choices: 40 questions:
-2 aging
-11 basal ganglia + cerebellum + motor systems (anatomy, pathways, transmitters, cerebellar and basal ganglia clinical symptoms, intention tremor vs resting tremor, Parkinson, Huntington, hemiballism, hypotonia/hypertonia, basal ganglia diagrams, purkinje, granule cells, climbing fibers, stellate, Golgi, basket, premotor, supplementary motor, motor cortex, somatotopy, VA, VL, GABA, peptides, ICP, SCP…)
-13 vision/audition/balance (bitemporal, hemi and quadrantanopia, pupillary light reflex, direct/consensual, function of On-center and Off-center, cGMP-gated channel, dark current, P and M pathways, Meyer’s loop, calcarine sulcus, retina layers…) (basilar membrane, location of sound, bone/air conduction, stapedius, mechanically-gated cation channel, outer hair cells...) (VOR, nystagmus, COWS, MLF, rotation, post-rotation, LVST and MVST function, lesion vestibular nuclei, optokinetic nystagmus, semi circular canals, otolith organs…)
-4 cortex (cortical layers and projections, frontal eye field, alexia, agraphia, sensory and motor aphasia, aprosodia, Gerstman’s syndrome, prosopagnosia, hemineglect, hemianesthesia, alexia without agraphia…; Brodmann areas 3, 1, 2, 39, 40, 41, 42, 44, 45, 5, 7, 22, 17, 18, 19, 4, 6, 8…)
-2 sleep (stages of sleep progression, EEG, deep sleep, REM sleep, variation with age, VLPO, tuberomammillary, lesion in pons, midbrain...);
-1 growthdevelopment
-4 limbic (memory, emotion, reward circuits, fornix, amygdala, pyramidal/granule cells, Kluver-Bucy, symptoms of lesion, anterograde amnesia, role of dopamine, schizophrenia, VTA, dentate gyrus, local circuits, CA1, CA3, mossy fiber, Schaffer’s collaterals...)
-2 brainstem/cranial nerve lesions
-1 biochemistry question related to the handout (last case folder in blackboard vista, will be released tomorrow)
Short answer essays: 5 (will be clinical cases and others).
-Know about the receptors and fiber types used for proprioception, fine touch, temperature and pain.
-Know the pain/temperature and fine touch/proprioception pathways from the body and from the face: from receptor to cortex (i.e. types of receptor, type of fibers, myelin/nonmyelin, velocity, cell body of 1st neuron in DRG (face->trigeminal ganglion), dorsal root division, level of crossing, 2nd and 3rd neuron locations, location of tract in spinal cord, medulla, pons, midbrain, thalamus, somatotopy, projection to cortex, somatotopy.
-Know how to explain clinical symptoms in spinal cord, lesion of tracts, upper and lower motoneuron signs....,
-Know how to explain clinical symptoms in brainstem (cranial nerve nuclei, stroke
-Know the corticospinal descending pathways. From motor cortices to corona radiata, internal capsule, cerebral peduncle, longitudinal motor pontine fibers, pyramidal tract, pyramids, decussation, location and somatotopy in spinal cord.
-Know the spinal cord at sacral, lumbar, thoracic and cervical levels. Where tracts are running within these levels, their somatotopy (for 3 of them only), what tracts are present in the lateral, dorsal and ventral funiculi and if nucleus dorsalis of Clarke and intermediolateral cell column are or not present.
Have a general idea about the location of the dermatome for the upper and lower limbs and some important myotomes.
-Cerebral cortex: know the function of each area and its Brodman number (i.e Wernicke->22,39,40; Broca->44,45; Primary and association visual->17,18,19; Auditory->41-42; lesion of 18,19,20,21; 3,1,2,39,40; 44,45,6,4; 8,6,4,3,1,2,5,7...). Effects of cortical lesions. Blood supply to the cortex (i.e. Middle, Anterior, Posterior cerebral a.). Function of right and left cerebral hemispheres.
-Cerebellum: structures, connections, effects of lesion and how it works. How is cerebellar ataxia produced. Lesion of ICP, SCP. Hypertonia, hypotonia, dysmetria, intentional tremor. Lesion of ICP, MCP, SCP.
Basal ganglia: structures, connections, effects of lesions and how it works.
Flaccid paralysis (lower motor neuron signs in body and face), spastic paralysis (upper motor neuron signs in body and face), rigidity, tremor at rest, intentional tremor, ataxia, decerebrate and decorticate posture, babinski, effects of corticobulbar lesion, alternate hemiplegia.
Effect of lesion of sympathetic fibers.
Internuclear ophthalmoplegia circuit.
Circuit for horizontal gaze (PPRF controlling abducens nucleus)
VOR circuit (how the vestibular nuclei control the abducens to produce slow pursuit movement in opposite direction to head rotation) and how to explain the nystagmus (slow phase /fast phase, rotation, postrotation, caloric, optokinetic, and clinical symptoms due to a lesion of vestibular nuclei or vestibular apparatus on one side)
Brainstem cranial nerve nuclei, blood supply and symptoms following stroke.
Match the symptoms of stroke with the correct blood vessel and the correct location. There are lateral and medial syndromes at the level of the medulla, pons and midbrain that involve different arteries (anterior spinal a., PICA, paramedian branches of basilar, AICA, circumferential branches of basilar, posterior cerebral a. and paramedian branches at top of basilar), cranial nerve nuclei and longitudinal ascending and descending systems. In the cortex know the effects of stroke of posterior, middle and anterior cerebral a. in relation to Brodmann area and deficits. Stroke of anterior choroidal artery and PCA in posterior limb of the internal capsule can result in visual, sensory and motor deficit all together.
-Know how to integrate sensory and motor systems together and illustrate how they work together to perform a task.