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Central and Peripheral Nervous Systems

The neurological exam is a way to link the structure and function of the nervous system to clinical relevant situations.

Brandon Poe

on 27 April 2016

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Transcript of Central and Peripheral Nervous Systems

The Neurological Exam
Mental Status
Cranial Nerves
The Neurological Exam is a series of clinical assesments that test the functions of all the different parts of the central nervous system. In performing this assesment, the peripheral connections are required to see what is going on in the CNS. Deficits found through any of the sub-tests of the Neurological Exam may be the result of a lesion to the central system or the peripheral connections. Though the results may not be decisive, they do limit the scope of where further testing is needed.
The Mental Status Exam is directed at the forebrain (cerebrum and diencphalon), by looking at functions ranging from primary sensory perception to cognitive functions like memory, language, and emotion. If deficits are found in a function such as language, the underlying structures which produce language (larynx, pharynx, tongue, etc.) need to be tested in more depth. But, usually, language deficits based on mental status sub-tests will be at the cognitive level (e.g. aphasia).
The Coordination Exam tests the function of motor systems that rely on the cerebellum. Because of its position on the posterior brainstem, it is situated to compare executive commands and sensory feedback for ongoing movements and to make corrections to those motor commands. Several aspects of the Coordination Exam are known more commonly in the Field Sobriety Test, since the cerebellum is acutely sensitive to the affects of alcohol.
The Sensory Exam, like the Motor Exam, highlights the functions of the spinal cord. Sensory information in the spinal cord travels in one of two major tracts, the Dorsal Column or Spinothalamic tract. The roles of those tracts can be separated based on the functions each serve.
The Cranial Nerve Exams test all the functions of the twelve cranial nerves. Though some of these functions may seem trivial, when one shows a deficit that is not more global (such as eye movements under control of the Trochlear Nerve) it may suggest an underlying trauma in that area of the CNS (for this example, that would be the posterior midbrain). When symptoms are that limited they are likely to be from a circulatory problem (e.g. stroke, aneurysm) than to a global problem (e.g. blunt force trauma or infection).
The Motor Exam is direccted mostly at the central nervous system control of skeletal muscles. Some deficits can be attributed to Upper Motor Neurons, while others are attributed to Lower Motor Neurons. The assesment of muscle tone, strength, volition, and reflexes will help separate the locus of trauma. This simple division of Upper and Lower motor neurons simplifies things a bit, as there are cerebral and brainstem control centers with specific relations to motor behavior.
Sensory structures in the spinal cord are posterior.
Motor structures in the spinal cord are anterior.
Regions of the CNS
Surface Anatomy of the Brain
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The Spinal Cord
The Basal Nuclei
The meninges
Cerebrospinal Fluid (CSF) and the Ventricles

Ascending and Descending Tracts
What happens when a cell membrane reaches threshold?

A) Neurotransmitter binds to the receptor
B) Potassium channels open
C) Voltage-gated sodium channels are activated
D) The G-protein hydrolyzes GTP
Which neurotransmitter is an amino acid that is also used to make proteins?

A) Serotonin
B) Dopamine
D) Glutamate
What type of cell is responsible for making cerebrospinal fluid?

A) Astrocyte
B) Microglia
C) Multipolar Neuron
D) Ependymal cell
Which layer of the meninges is directly adjacent to the gray matter of the brain?

A) Pia Mater
B) Arachnoid Membrane
C) Choroid Plexus
D) Dura Mater
What pathway is an axon carrying temperature information from the left leg going to be traveling through?

A) Right Dorsal Column
B) Right Spinothalamic
C) Left Dorsal Column
D) Left Corticospinal
Which ion is moving across the membrane during depolarization?

A) Chloride
B) Sodium
C) Potassium
D) Phosphate
What component of the cytoplasm is largely responsible for the negative charge inside the cell?

A) Sodium
B) Phospholipids
C) Voltage-gated calcium channels
D) Anions (proteins and phosphates)
What region of the CNS do tests of coordination target?

A) Cerebrum
B) Brainstem
C) Cerebellum
D) Spinal Cord
What region of the CNS do tests of memory target?

A) Cerebrum
B) Brainstem
C) Cerebellum
D) Spinal Cord
What region of the central nervous system is responsible (and required) for relaying sensory information to the cerebral cortex?

A) Thalamus
B) Cerebellum
C) Medulla
D) Hypothalamus
What part of the brain is the target of the Coordination Exam?

A) Cerebrum
B) Diencephalon
C) Brain Stem
D) Cerebellum
How many words starting with the same letter should a normal person be able to generate in a minute?
Which of the following neurotransmitters is always associated with hyperpolarization?

A) Acetylcholine
B) Glutamate
C) Dopamine
D) Serotonin
What channel has an inactivation gate and an activation gate?

A) Voltage-gated sodium channel
B) Ligand-gated cation channel
C) Mechanically gated cation channel
D) Voltage-gated calcium channel
Cranial Nerves
Brain stem
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