Neurosensory

COURSE OBJECTIVES

Students will be able to

identify and explain the nature of abnormalities seen in common neurosensory s/stem diseases in relation to normal structure and functions.
Correlate the normal structure and functions of neurosensory system to the signs, symptoms patho-physiological states, diagnosis and management of the following common conditions: Headache, Meningitis, Encephalitis, Paralysis, Convulsion, Involuntary movements, Psychosis, Insomnia, Organophosphorus poisoning, Ear discharge (otitis media), Cataract, Conjunctivitis & Squint.

ANATOMY

Students will be able to

define a neuron and classify them on the basis of their structure and function; list Tie different connective tissue cells of nervous system and their important Unction.
divide the N.S. into Central Nervous System (CNS), Peripheral Nervous System (PNS) and Autonomic Nervous System (ANS).
list the different parts of CNS, PNS AND ANS; explain the different terminologies jsed in nervous system, e.g., nuclei, tracts and etc.
mention the different stages of development of nervous system.
mention the extent, gross anatomy and blood supply of spinal cord; correlate the segments of spinal cord to the vertebral column; describe the formation, course, fate and distribution of a typical spinal nerve.
describe the formation, distribution and branches of different nerve plexuses- cervical, brachial, lumbar and sacral and correlate the anomalies related to their njuries.
draw well labeled diagrams of cross sections of spinal cord at different levels.
mention the extent of brain stem and its different parts, their gross structure and oiood supply; locate the attachments of cranial nerves.
draw well labeled diagrams of medulla, pons and midbrain to locate the nuclei, the ascending and descending tracts and reticular formation.
mention the location of diencephalon; list different parts of diencephalon.
explain different nuclei, connections and functions of hypothalamus.
explain different nuclei, connections and functions of thalamus.
mention the location, parts, microscopic anatomy, nuclei and their connections of cerebellum; mention the blood supply of cerebellum.
list the different lobes, surfaces, borders, sulci and gyri of cerebrum and important functional areas; mention the microscopic anatomy of cerebrum.
explain the white matter, corpus callosum and internal capsule, explain the blood supply of internal capsule and the consequence of ischaemia of internal capsule.
Mention the blood supply of brain and correlate the clinical conditions (syndromes) related to the loss of blood supply to different parts of brain.
list the coverings of CNS and foldings of dura mater; explain the formation, composition and absorption of cerebrospinal fluid (CSF).
list the cranial nerves and mention their functional components.
list the ascending and descending tracts; explain the fasciculus gracilis and cuneatus, spinothalamic tracts, and spinocerebellar tracts.
explain the corticospinal tract, cortico bulbar tracts, reticulospinal tract and vestibulospinal tracts.
explain the normal anatomy of an eyeball.
explain the course of optic nerve and visual pathway.
explain the development of eye
explain the development of branchial arches, and their derivatives.
explain the development of face, lips and palate; correlate with developmental anomalies such as cleft lip, cleft palate and facial cleft.
explain the normal anatomy of external ear, middle ear and inner ear.
describe the course, relation and branches of facial nerve and correlate with the facial nerve palsy.
explain the development of ear.

CLINICAL PHYSIOLOGY

Division and organization of the nervous system:

Students will be able to

recall the following divisions of the nervous system: central nervous system, peripheral nervous system, brain/spinal cord, autonomic nervous system, somatic nervous system, ascending tracts, descending tracts, motor function, sensory function, gray matter, white matter, higher functions, reflex activity, and segmental division of the spinal cord.

Neuron and Synaptic transmission

Students will be able to

describe the structure of a neuron, different types of neurons, difference between myelinated and unmyelinated neurons,
describe the structure of a synapse, synaptic transmission, synaptic inhibition, neurotransmitters.
describe resting membrane potential and action potential in a neuron, propagation of action potential.

Autonomic Nervous System:

Students will be able to

distinguish between Sympathetic and Para sympathetic nervous systems with reference to outflow from the central nervous system, organization of pre- and post-ganglionic fibers, neurotransmitters, and overall function.
draw a diagram of the sympathetic outflow from the central nervous system and the sympathetic ganglia.
describe the sympathetic plexuses of the body and the distribution of the sympathetic nerves.
describe the relationship of the sympathetic system to the adrenal medulla.
describe the effects of sympathetic stimulation on alpha and beta receptors in smooth muscle.
describe the effects of sympathetic stimulation on cardiac muscle and blood vessels.
describe the outflow and distribution of parasympathetic nerves.
describe the action of parasympathetic stimulation on salivary glands.
show by means of a table how the opposing actions of the sympathetic and parasympathetic systems achieve control of pupillary size, airway resistance, heart rate, digestive tract activity, defecation and micturition.
describe the effects of the following drugs on the ANS: Catecholamines, alpha and beta blocking agents, ganglion blockers, anti-cholinergics.

Motor Systems and Neuromuscular Junction

Students will be able to

draw a diagram of the neuromuscular junction and show how acetylcholine acts as a chemical transmitter for striated muscle.
describe the effect of cholinesterase at the neuromuscular junction,
describe the effects of anticholinesterases, muscle relaxants, succinyl choline.
define and describe the motor unit.
define spastic and flaccid status in muscle.
define ‘twitch”, ‘clonus’ and ‘tetanus’ in muscle and show how they are determined by the rate of discharge in the motor unit.
describe the corticospinal tracts (pyramidal tracts) and their role in control of movement, other descending tracts (reticulospinal, vestibulospinal, rubrospinal, tectospinal).
distinguish between upper motor neurons and lower motor neurons
trace the passage of a nerve impulse from the motor cortex to skeletal muscle fibre.
show how the lower motor neuron acts as a ‘ final common pathway’ and its response is a summation of influences from several descending tracts.
define and classify reflexes, properties of reflexes and their clinical significance.
describe a reflex arc and the role of ‘stretch reflex’ in muscle tone.

Sensory System

Students will be able to

describe sensory receptors: definition, classification, and properties.
make a list of modalities of sensations transmitted by peripheral nerves and the special senses of the cranial nerves.
distinguish position sense (proprioception) from external sensation
describe the muscle spindles and show how they supply proprioceptive information.
describe the spinothalamic tracts and the sensations carried by them from the periphery to the center.
describe the dorsal column- medial lemniscus pathway and the sensations carried by this pathway.
describe the physiology of pain and central analgesia system; explain referred pain.

Maintenance of Posture and Reticular formation

Students will be able to

describe the vestibular apparatus and how it assists in the maintenance of posture.
describe the part played by muscle spindles and stretch reflexes in the maintenance of posture.
describe the mechanisms of tendon reflexes and ‘reinforcement’ technique of tendon reflex and its use.
describe the connections and functions of the reticular formation including consciousness and sleep.

Brain

Students will be able to

recall the anatomy of the cerebrum, cerebellum, thalamus and brainstem (midbrain, pons, medulla).
draw a diagram of the cerebrum showing the areas associated with motor function (motor homunculus), sensory function (sensory homunculus), speech and language, vision, hearing, smell.
describe the connections and functions of the thalamus.
describe the formation, composition, circulation, and functions of the CSF.
describe the blood brain barrier and its clinical significance.
describe the clinical significance of lumbar puncture.
describe the connections and functions of the prefrontal lobe and the effects of its lesions.
describe the higher cortical functions: learning and memory, language.
describe the connections and functions of the hypothalamus.
describe the connections and functions of the cerebellum.
describe the basal ganglia and their connections and extra pyramidal control of movement.
describe the components, connections and functions of the limbic system.

Disordered Function of the Nervous System

Students will be able to

describe the effects of a complete transverse section of the spinal cord at the mid- thoracic level
explain the physiological basis of: Brown-Sequard syndrome, syringomyelia, dissociated anesthesia, hemiplegia, paraplegia, quadriplegia, Parkinson’s disease, resting tremors, intentional tremors, tetanus, epilepsy, myasthenia gravis, Horner’s syndrome, neurological effects of cervical spondylosis, sensory loss in leprosy, motor and sensory aphasia, Romberg’s sign.
describe the effects of upper and lower motor neuron lesions and explain the physiological basis of the effects.

EYE

Students will be able to:

recall the anatomy of the cornea, lens, ciliary body and retina.
describe with diagrams the refractive media of the eye and show how light is focused and an image is produced on the retina.
describe how the shape of the lens is altered to focus objects at near and far distance and how this focusing is controlled.
define diopter, near point, far point.
describe pupillary reaction to light and its autonomic control (pathway for light reflex).
describe the accommodation reflex and its pathway.
describe the production, circulation, and re-absorption of the aqueous humor.
describe the vitreous humor.
describe the organization of the retina and optic nerve and the function of the rods and cones.
describe the probable mechanism of color vision.
describe dark adaptation and the function of rods and role of Vitamin A in night vision.
give the reason for a ‘ blind spot ‘ in each eye, and show how its effect is neutralized by binocular vision.
describe with a diagram the optic pathway from the retina to the visual cortex.

Disordered Function

Students will be able to

state the mechanisms of myopia, hypermetropia, presbyopia, astigmatism.
explain the phenomenon of Argyll- Robertson pupil.
appreciate the importance of a unilateral dilating pupil in head injury.
describe the effects of the following eye drops on the pupil and on focusing: atropine, phenylepinephrine, sympathomimetics and pilocarpine.
describe the effects of the following medications on the eye: ingested or injected atropine derivatives, ingested or injected morphine derivatives.
recognize squint (strabismus).
describe the patho- physiology of glaucoma.
describe the common forms of color blindness.
describe the effects on vision of a lesion on each of the following sites: optic nerve, optic chiasma, optic tract, and optic radiation/ visual cortex.

EAR

Students will be able to

review the anatomy of the external ear, tympanic membrane and middle ear.
state the importance of the Eustachian tube and the functions of the middle ear including impedance matching.
describe the structure of the inner ear, especially relationship of the scala vestibuli, scala tympani, scala media, oval window and round window, location and composition of endolymph and perilymph, basilar membrane, tectorial membrane and hair cells.
describe how the basilar membrane and nerve cells respond to sound vibrations of varying frequency (different theories), mechanism of hearing.
describe the nerve pathway from the cochlea to the auditory cortex.

Disordered Function

Students will be able to

explain the patho- physiology of conduction deafness and nerve deafness and the use of Rinne’s and Weber’s tests to distinguish these two types of deafness.
describe the mechanism of otosclerosis, Menniere’s disease, transient deafness on change of altitude.
describe the masking effect of blockage of air conduction upon bone conduction.

TASTE AND SMELL

Students will be able to:

describe the receptors for taste and smell sensations.
describe the pathways for taste and smell.
recognize common disorders of taste and smell.

CLINICAL BIOCHEMISTRY

Students will be able to

recall the structure of neuron.
list the nervous tissue lipids and proteins.
describe the functions of Na-K ATPase.
describe carbohydrate amino acid and nucleic acid metabolism in the brain and their special adaptation and metabolic control.
explain biochemical reasoning in multiple sclerosis and myelin destruction.
define synapses, presynaptic membrane, post synaptic membrane, synaptic vesicle, neurotransmitter and neurotransmitter receptor.
explain opening and closing of ion channels in plasma membrane and propagation of nerve impulses.
define depolarisation, hyperpolarization, threshold voltage, and action potential.
explain competitive inhibitory action of neurotoxins at Na-channel gate.
describe the function of acetylcholine and acetylcholinesterase and inhibitory function of snake venom.

PATHOLOGY

Neurosensory system

Students will be able to

apply the principle of inflammation in nervous system.
describe the etiopathogenesis, gross and microscopic features of pyogenic, viral, and tuberculous meningitis and tuberculoma.
differentiate between different types of meningitis.
describe briefly about different types of encephalitis.
explain hydrocephalus and its complications.
Describe the etiology, pathogenesis, and morphological features of cerebrovascular disease and its complications.
state the classification of the tumors of central nervous system.
Describe the pathological features of astrocytoma, oligodendroglioma, ependymoma, medulloblastoma, meningioma, neurofibroma and schwannoma.
list the causes and types of peripheral neuropathies.
Describe the gross and microscopic features of schwannoma and neurofibroma.
list common investigations used in the diagnosis of nervous system diseases

EYE

Students will be able to

describe the etiology, pathological features and complications of conjunctivitis, keratitis, and uveitis.
classify tumors of eye.
identify the gross and microscopic features of retinoblastoma and melanoma.

Ear, Nose and Throat

Students will be able to

describe the etiology, pathological features, and complications of rhinitis, sinusitis, tonsillitis, pharyngitis, and laryngitis.
describe the gross and microscopic features of nasal polyp.
list the tumors of the nose, sinuses, nasopharynx and ear.
describe the pathological features of common tumors of nose, nasopharynx, ear, and larynx.
describe the etiology and morphological features of vocal cord nodule.
describe the etiology, gross and microscopic features of nasopharyngeal carcinoma and squamous cell carcinoma of larynx.
describe otitis media and cholesteatoma.
identify the microscopical features of rhinitis, otitis media, nasal polyp, rhinosporidiosis, nasopharyngeal carcinoma, papilloma, vocal cord polyp and squamous cell carcinoma of larynx.

CLINICAL MICROBIOLOGY

Students will be able to

list and describe important pathogens affecting Neurosensory system;
describe the morphology, pathogenesis, laboratory diagnosis, transmission and prevention of the following organisms:

Bacteria: Neisseria meningitides
Viruses : Polio virus, Rabies virus, Japanese encephalitis virus
describe laboratory diagnosis of meningitis

CLINICAL PHARMACOLOGY

General considerations of autonomic nervous system

Students will be able to

state the meaning of autonomic nervous system.
describe how this system regulates the different functions in the body.

Parasympathomimetics

Students will be able to

differentiate the muscarinic and nicotinic effects and describe the salient features of parasmpathomimetics with their uses and adverse reactions.
Describe the management of organophosphorus and carbamate poisoning.

Sympathomimetics

Students will be able to

differentiate various types of adrenergic receptors and describe the importance of these receptors in therapy.
classify the sympathomimetics clinically and list the basis for their use in therapy.
list the important adverse reactions and contraindications of sympathomimetic drugs.

Antiadrenergic

Students will be able to

name the alpha and beta adrenergic receptor blocking agents; list important therapeutic indications, contraindications and adverse effects.

Nicotine

Students will be able to

describe the pharmacology of nicotine and the hazards of nicotine with special reference to smoking.

Drugs used in treatment of pain

Students will be able to

Name the opiate analgesics; explain their pharmacological actions and mechanism of action.
specify the main therapeutic uses of these agents.
compare and contrast the pharmacological actions of morphine to the actions of pethidine, pentazocine, buprenorphine and dextropropoxyphene,
list the important adverse reactions and contraindications of the opiate analgesics.

Drugs used in treatment of fever

Students will be able to

list the antipyretic analgesics.
describe the mechanism of action, therapeutic uses and adverse reactions of these drugs.

Alcohol

Students will be able to

describe the pharmacological actions of alcohol,
list pharmacological agents that are used in alcohol detoxification, state their indications.
describe the effect of disulfiram on the metabolism of alcohol, the toxic produc which builds up and the symptoms induced by this toxic product.
describe the long term toxicity associated with chronic alcohol abuse.

Drugs used in insomnia

Students should be able to

name sedative-hypnotic drugs and state their salient features and describe the major sleep pattern alteration induced by the continued use of most sedative hypnotic drugs.
list use and misuse of these drugs.

Drugs used in psychosis

Students will be able to

define the objectives of treatment of psychosis
list antipsychotic drugs.
describe current hypothesis for the mechanism of action of antipsychotics.
differentiate the phenothiazine derivatives on the basis of use, potency ant frequency of adverse effects.
state the salient features of other antipsychotic agents including atypics antipsychotics.

Drugs used in anxiety

Students will be able to

define the objectives of treatment of anxiety
name the antianxiety drugs.
explain the place of antianxiety agents in the management of anxiety;
name the adverse effects and contraindications of antianxiety drugs.

Drugs used in depression

Students will be able to

define the objectives of treatment of depression
list antidepressants.
describe the mechanism of action, contraindications and adverse effects c antidepressants.
list the drugs used in manic-depressive illness

Drugs used in convulsive disorders and Analeptic agents

Students will be able to

list antiepiieptic drugs
describe the mechanism of action of antiepileptics.
list their adverse effects and contraindications.
name the drugs used in status epilepticus.
name analeptic agents and give their therapeutic uses and limitations,

Local and General anaesthetics

Students will be able to

name the local anaesthetic agents.
give the mechanism of action, important difference, use and adverse reactions. sat e the stages of general anaesthesia.
list the general anaesthetic agents.
describe preanaesthetic medication and its importance.

Parkinsonian drugs

Students will be able to

define the objectives of treatment of parkinsonism
List the neurohumoral agents suggested to be involved in parkinsonism,
Classify the anti — parkinsonian agents and describe the suggested mechanism of action.
give their important adverse reactions and contraindications,

Drugs used to reduce appetite

Students will be able to

list the drugs that have been used in the treatment of obesity and their potential for misuse.

Drugs for eye diseases

Students will be able to

name the miotics and list their uses,
classify the mydriatics.
differentiate mydriatics of atropine group from adrenaline group.
give the indications and contraindications of these drugs.
list the drugs for common eye problems; conjunctivitis, trachoma, glaucoma.

Drugs for ENT diseases

Students will be able to

state uses of drugs for common ENT problems, e.g vertigo, rhinitis, pharyngitis, tonsillitis and ear infection.