March 16th, 2012 - Gross Brain Practical Exam for Friday, March 23rd
The Gross Brain Practical will cover slide material from the Gross Brain lab as well as integrative questions from the lectures on Introduction to the Nervous System, Blood Brain Barrier, and Development that apply to the slides. The exam will consist of answering multiple choice questions on a scantron.
THE FORMAT FOR THE PRACTICAL WILL BE:
YOU WILL BE ALLOWED 45 SECONDS TO ANSWER QUESTIONS 1 10, EACH OF WHICH IS WORTH ONE POINT FOR BASIC IDENTIFICATION QUESTIONS.
YOU WILL BE ALLOWED 90 SECONDS TO ANSWER QUESTIONS 11 20, EACH OF WHICH IS WORTH 2 POINTS FOR INTEGRATIVE OR COMPLEX VISUALIZATION QUESTIONS.
YOU WILL THEN SEE EACH SLIDE ONE MORE TIME FOR 10 SECONDS, FOR REVIEW FOLLOWED BY 5 MIN WITHOUT SLIDES TO BE SURE OF YOUR ANSWERS
March 16th, 2012 - Answers to Review Questions at the End of the Handout on Neurohistology
1a. retrograde filling of cells in locations 4,6
anterograde filling of terminals at locations 3,4
Note: location 2 would not be labelled because the terminals from cell 2 are not visible in this plane.
1b. retrograde filling of cells in location 6
anterograde filling of terminals at locations 3
2a. anterograde labelling of terminals in location 3
2b. anterograde labelling of terminals in locations 3,4
3. chromatolysis at location 1,3 and 4
axonal degeneration at location 2,4
4. labelling in locations 3,4
5. symptoms ipsilaterally, because none of the neurons injured cross the midline.
6. sensory symptoms would be ipsilateral loss of light touch and contralateral loss of pain and temperature
7. stimulate appropriate dermatomes with a) pin prick for pain and b) wisp of cotton for light touch or tuning fork for vibration.
April 16th, 2012 - IFM MEDICAL NEUROSCIENCE - GROSS BRAIN PRACTICAL EXAM ANSWER KEY – MARCH 23, 2012
1. C
2. B
3. B
4. A
5. B and E
6. B
7. D
8. E
9. D
10. A
11. D
12. C
13. C
14. C
15. A
16. D
17. E
18. D
19. C
20. D
April 16th, 2012
The GSW Module Written exam will cover all Med Neuro material presented in the module. The GSW Practical exam will focus on new material using the slides from the Spinal Cord lab and Neurohistology lecture, but may also ask questions on the new material on slides from the Gross Brain lab or from slides never seen before. We will assume that you still know material that was previously tested in the Gross Brian Practical exam.
April 16th, 2012
ANSWERS TO SPINAL CORD LAB QUESTIONS
-- H1:
Medial
a) dorsal column, clarke's, lamina VII lamina V/VI, lamina IX
b) clarke's, lamina VII lamina III/IV proprius V/VI, lamina IX
c) Proprioception and fine touch
d) Ia monosynaptic stretch, Ia and Ib inhibitory, II tonic stretch
e) Dorsal column to DCN to medial lemniscus
Lateral
a) Lissauer's tract
b) lamina 1 II, dendrites of V
c) pain and temperature
d) protective flexion, scratch
e) spinothalamic ALS
-- H2: e
-- H3: crushing of anterior white commissure and medial alpha motoneurons by
syrinx
-- H4: b, e, g
-- H5: LCST,MRST, RuST, PRST, VST, VCST
-- H6: STT, ALS, Fasciculus Gracilis
-- H7: No, not present
-- H8 Horner's syndrome results, ptosis, miosis and anhydrosis due to sympathetic
losses
-- H9: Control of trunk and posture uses VST
CASES
-- I1: Poliomyelitis : MN loss
-- I2: Brown sequard: lesion at L2 on the left
-- I3: The Medial part of fasciculus gracilis on the right is spared, everything else is gone as a result of the injury.
April 24th, 2012
Brainstem Practical on 4/30/12
This practical will cover material from the Brainstem Lectures, the Brainstem Laboratories, and the tutorials for Brainstem Anatomy and Brainstem Cranial Nerves. The emphasis will be on knowing brainstem related structures and their functions, as well as where they send axons and what happens when they are lesioned. The remaining Brainstem tutorial is also useful to see where we are headed, but its material will be emphasized on the SND mid module exam.
April 27th, 2012
IFM MEDICAL NEUROSCIENCE - PRACTICAL EXAM - ANSWER KEY – 04/18/2012
* Note the answers in red indicate that less than 67% of the class answered correctly.
1. B
2. C
3. A
4. C
5. C
6. B
7. E
8. D
9. E
10. C
11. C
12. A
13. C
14. E
15. C
16. C
17. D
18. E
19. E
20. C
April 27th - Answers to questions in Medical Neuroscience Lab Manual (pp42-45)
REVIEW QUESTIONS FOR CRANIAL NERVES (Lab Manual pp45):
1. If the Xllth nerve were destroyed by a vascular lesion:
a) What blood vessel would probably be responsible?
ANTERIOR SPINAL ARTERY
b) What other major structure would be likely to be destroyed concomitantly?
MEDULLARY PYRAMID CONTAINING CORTICOSPINAL FIBERS
c) If this patient showed paralysis of the tongue and of the body would the 2 paralyses be on the same side or on opposite sides?
OPPOSITE SIDES
d) If the patient died 10-14 days later, how would you expect the cells of the hypoglossal nucleus to look?
CHROMATOLYTIC
2. How would you examine a patient to test for possible damage to the Xl nerve?
SHRUG SHOULDERS/ TURN HEAD TO OPPOSITE SIDE
3. If a patient had decreased pain and temperature sensation on one side of the face and some difficulty in speaking (phonation) and in swallowing, where would you expect the lesion to be?
LATERAL MEDULLA AT EXIT POINT OF VAGUS NERVE INCLUDING SPINAL NUCLEUS OF V (and ALS)
4. If a patient underwent thyroidectomy and, due to inadvertent damage suffered from permanent hoarseness, what nerve will have been involved?
RECURRENT LARYNGEAL OF X
What cranial nerve nucleus would show retrograde chromatolysis?
NUCLEUS AMBIGUUS
5. If a patient showed paralysis of the left side of the body but couldn't look to the right with the right eye, where would his\her lesion be?
CORTICOSPINAL TRACT RIGHT SIDE AND EXITING FIBERS OF RIGHT ABDUCENS NERVE VENTROMEDIAL CAUDAL PONS
6. What lesion would cause, on one side, a facial paralysis with auditory and vestibular symptoms and loss of taste in the anterior 2/3 of the tongue, plus loss of pain and temperature on the opposite side of the body?
POINT OF EXIT OF VII AND VIII AT PONS MEDULLARY JUNCTION. FACIAL NERVE (TOTAL PARALYSIS INCLUDING LOSS OF TASTE)
HEARING/BALANCE PROBLEMS (VIII) AND ANTEROLATERAL SYSTEM NEARBY INVOLVED.
7. If a patient showed a paralysis on the left side of the face, and an inability to look to the left with the left eye, where would the lesion be?
There might be symptoms of cerebellar dysfunction-too - Why?
LEFT GENU OF FACIAL NERVE AND LEFT ABDUCENS NUCLEUS IN FLOOR OF FOURTH VENTRICLE.
INFERIOR CEREBELLAR PEDUNCLE MIGHT ALSO BE AFFECTED WITH VESTIBULAR NUCLEI
8. What sort of lesion would cause a disturbance in eye movements, of both eyes and in all directions?
ONE IN THE MLF- THE VESTIBULO-OCULAR EXPRESSWAY
9. If a patient with a brainstem lesion complained of double vision (diplopia) when looking down to the right, in what nucleus and on which side of the brain would the lesion be found?
SUPERIOR OBLIQUE CAUSES THE EYE TO LOOK DOWN AND OUT; IT DEPRESSES AND ABDUCTS THE EYE.
DIPLOPIA LOOKING DOWN AND TO THE RIGHT INVOLVES THE RIGHT SUPERIOR OBLIQUE OF THE RIGHT EYE AND THE RIGHT TROCHLEAR NERVE.
AND IF THE LESION WERE IN THE MIDBRAIN, THE LEFT TROCHLEAR NUCLEUS BECAUSE IV IS THE ONLY COMPLETELY CROSSED CRANIAL NERVE
PATIENT COMPLAINS OF DIFFICULTY GOING DOWN STAIRS.
10. What lesion would cause a paralysis of left medial eye movement, an enlargement of the left pupil (mydriasis) and a drooping of the left eyelid? If there was also para!ysis of the right side of the body as well, where would the lesion be?
LEFT MEDIAL EYE MOVEMENT- LEFT EYE CANNOT BE ADDUCTED - IIIRD NERVE OR OCULOMOTOR NUCLEUS
DILATED PUPIL LEFT EYE- IIIRD NERVE OR EDINGER WESTPHAL NUCLEUS LEFT PTOSIS (EYELID DROOP)- IIIRD NERVE
LESION OF VENTRAL MIDBRAIN ON LEFT
Answers to Case Study questions on page 42 Medical Neuroscience Lab Manual
Acoustic Neuroma
Structures Involved:
1. LEFT TRIGEMINAL NERVE HYPESTHESIA MEANS REDUCED SENSATIONS- ALL SENSATIONS
2. BLINK REFLEX LOSS COULD BE LEFT V OR VII, BUT DRY AND RED EYE IMPLICATES VII
3. LEFT VII NERVE OR CORTICOBULBAR FIBERS?
4. LEFT VII NERVE
5. LEFT VIII NERVE OR COCHLEAR NUCLEUS
6. CEREBELLAR PEDUNCLE OR VIIITH NERVE
7. LEFT V NERVE
Brainstem Lab Review Quiz Answers on page 43 Medical Neuroscience Lab Manual
1) Where are the cell bodies of the axons which terminate in the right nucleus gracilis?
Dorsal root ganglia from T6 down on the right
2) Will lesions to the right cuneate nucleus and right medial lemniscus produce symptoms on the same or opposite sides of the body?
Opposite
3) A lesion involving the left lower quadrant of the brainstem at the level of mid-medulla (slide 55), would cause motor symptoms.
a. Where?
Contralateral upper and lower limb
b. What Cranial nerves might be involved?
CN XII
c. What would happen if a person with such a lesion were asked to stick out his tongue, and raise both arms?
Tongue would deviate on protrusion toward the side of the lesion. One could only raise the arm ipsilateral to the side of the lesion.
4) Name some specific cranial nerve nuclei that contribute fibers to the MLF.
Vestibular nuclei, CN VI, CN IV
5) Name some of the ascending pathways that contribute to the inferior cerebellar peduncle.
Dorsal spinocerebellar tract, cuneocerebellar tract, olivocerebellar fibers, vestibulocerebellar fibers, reticulocerebellar fibers, trigeminocerebellar fibers
6) What would be a likely site of blockage giving rise to an enlargement of the IVth ventricle at the level of the open medulla?
A blockage of the foramen of Luschka or Magendie
What cranial nerves might be affected?
Any nucleus in the floor of the fourth ventricle e.g., Hypoglossal nucleus, Dorsal motor nucleus of X, Abducens nucleus, Genu of the facial nerve.
7) What symptoms would you expect from a lesion to the left facial genu?
Left side facial weakness, hyperacusis, but no sensory or parasympathetic signs.
8) After vascular damage in the region of the red nucleus, what cranial nerve would be likely to be affected at the same time?
CN III
9) Given a tumor in the cerebral aqueduct, expanding ventrally:
a. What structures would it involve (in order)?
MLF, then the trochlear nucleus in the mid midbrain, or the oculomotor nucleus and the nucleus of Edinger Westphal in the rostral midbrain.
b. What changes would you expect in the lateral and 3rd ventricles?
Enlargement; non-communicating hydrocephalus
10) Where are the cell bodies located whose axons comprise the mesencephalic tract?
In the mesencephalic nucleus
Are they considered primary or secondary afferents?
Primary
11) What symptoms would result from a unilateral lesion destroying the cerebral peduncle and IIIrd nerve?
Dilated pupil, external strabismus, ptosis, ipsilateral to the lesion side; contralateral lower face weakness and contralateral upper and lower limb spastic weakness
12) What sensory modality is served by the nucleus solitarius?
Taste from the entire tongue and chemo and baroreception from the carotid body and carotid sinus.
Which nerves send afferents to his nucleus?
CN's VII, IX, X
Would you expect the cells of the solitary nucleus to show chromatolysis following axotomy of the vagus nerve?
No, anterograde degeneration because it contains neurons that respond to sensation.
13) What muscle group does the main motor nucleus of V innervate?
Muscles of mastication (pharyngeal arch 1)
14) For what two parasympathetic functions of the eye is the Edinger-Westphal nucleus responsible?
Pupillary constriction and contraction of the ciliary muscle.
15) What sensory and motor impairments might follow section of the Vth nerve?
Anesthesia of the face, scalp, oral cavity including the anterior 2/3 of the tongue, and nasal cavity for touch, pain and temperature.
16) If you had a lesion on one side of the base of the pons, where would you find orthograde fiber degeneration?
In the ipsilateral middle cerebellar peduncle because of damage to the trasnsverse pontine fibers; in the contralateral middle cerebellar peduncle because of damage to the pontinne nuclei; in the medullary pyramid; in addition if cranial nerve VIth or VIIth is damaged there will be degeneration in the periphery.
April 30th - Brainstem Practical
We apologize. It turns out that ALL of the answers to Q18 except D are true. Since the question should have asked for the false answer we will award everyone 2pts credit regardless of your scantron answer.
May 7th - IFM MEDICAL NEUROSCIENCE
PRACTICAL EXAM
ANSWER KEY 04/30/2012
1. A
2. D
3. A
4. C
5. B
6. C (Brachium of IC is not present. CTT is indeed present, but obscured)
7. B
8. A
9. E
10. E
11. B
12. C
13. E
14. C
15. E (typo on IMS exam, so we will accept A,B,E for IMS)
16. A
17. E
18. D (accept all, we should have asked for FALSE answer)
19. B
20. B
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