1. TUTORIAL - EXTRA PYRAMIDAL SYSTEM - UMN/LMN
Lecture 6

2. Q1. Name the extra pyramidal tract.
Rubrospinal tract = arise Red nucleus
Vestibulospinal tract = arise Vestibular nuclei
Reticulospinal tract = arise Reticular formation
Tectospinal tract = arise superior colliculus
Q2. From where extra pyramidal tract arise and where they end?
End anterior horn motor neurons
Q3. What are the functions of extra pyramidal system? 1- POSTURE MOVEMENT TONE

3. Q4. What is the overall effect of extra pyramidal system or γ motor neuron in anterior horn cell? inhibitory effect over Gamma Q5. What will be effect of extra pyramidal lesions? Select one: a). Hypotonia b). Hypertonia

4. Q6. Give 3 differences between pyramidal and extra pyramidal system.
PYRAMIDAL TRACTS
- Lateral corticospinal
- ventral corticospinal
- Corticobulbar
located in precentral gyrus.
descend directly from cerebral cortex to spinal cord.
80% cross in medulla 20% cross in spinal cord.
Function:
Lateral : fine movement:
Eg: needle work
Ventral: Postural movement
EXTRA PYRAMIDAL TRACTS
-Rubrospinal
-Vestibulospinal
-Reticulospinal
-Tectospinal
originate in brainstem nuclei
No direct control of motor cortex
3- all of them cross except Vestibulospinal
Function:
- Control of body posture
- involuntary movements muscle

5. Q7.What is i). Upper motor neuron From motor cortex to anterior horn cell of spinal cord ii). Lower motor neuron from anterior horn cell and ends on muscle Q8. What will happen to the following in UMN/LMN lesion? i). Size (bulk of muscle) ii). Tone iii). Power iv). Tendon reflexes v). Planter reflex
UMN lesion
- not change
Increased tone (Spasticity
Loss of power
Increased reflexes Clonus
Babinski sign +ve
LMN lesion
Wasting
- Flaccidity. ( hypotonic )
partial loss of power
absent
- Babinski sign -ve

6. Q11. What is brown sequard syndrome?
Q9. What is the difference between hemiplegia and hemiparesis? Where is the lesion?
Hemiplegia – Paralysis (loss of power) of half side of the body Lesion “ UMN “ ( Cortex )
Hemiparesis – Partial loss of power of half side of the body Lesion “ LMN “ ( ? )
Q10. What is paraplegia? Where is the lesion?
Paralysis in both legs Lesion “ Lumber or lower thoracic ”
Q11. What is brown sequard syndrome?
Hemicord lesion = right transcection or complete transection
dorsal columns lesion : loss of sensory
lateral corticospinal tract lesion : loss of motor
lateral spinothalamic tract lesion : loss of pain & temp

7. Q12. If there is hemisection of spinal cord at L1 on right side a)
Q12. If there is hemisection of spinal cord at L1 on right side a). What impairment will occur on right side? Loss of Sensory : light touch vibration position Loss of Motor : UMN = below site of lesion ( hypertonia – spastic – hyper reflexia clonus – Babinski sign – paralysis Monoplegia ) b). What impairment will occur on left side? Loss of Pain + temperature

8. TUTORIAL Brain Stem
Lecture 7

9. Q1. What are the components of brain stem?
a). Midbrain b). pons c). medulla
Q2. What are the functions of brain stem?
Origin of majority of peripheral cranial nerves
Cardiovascular, respiratory, and digestive control centers
Regulation of muscle reflexes involved with equilibrium and posture
arousal and activation of cerebral cortex
Role in sleep wake cycle
Q3. What cranial nerve arise from the brainstem
a). Midbrain : 3+4
b). Pons :
c). Medulla :

10. Q5. What are vegetative functions of brain stem?
Q4. Which cranial nerve causes Pupillary constriction when we put light in the eye?
Oculomotor
Q5. What are vegetative functions of brain stem?
respiration, circulation, and digestion
involuntary functions performed unconsciously
Q6. What is vegetative life?
loss of higher brain functions, lower brain levels, inconjunction with supportive therapy that is providing adequate nourishment can sustain life but person has no awareness or control of life.

11. Q7.What is brain death?
irreversible cessation of cerebral functions, both cerebral hemispheres and brain stem.
Q8. What is the difference between vegetative life and brain death?
in vegetative life Cerebral cortex is damaged While
in brain death The Cerebral cortex and brain stem is damaged irreversibly.
Q9. What happens to spinal reflexes in brain death?
They are _________ . Select one:
Present
Lost

12. TUTORIAL Cerebellum
Lecture 8

13. Q1 a. What are the functions of Cerebellum? Maintenance of balance
Enhancement of muscle tone
Coordination and planning of skilled voluntary muscle activity
b. Name three parts of cerebellum.
Vermis - Intermediate zone - Lateral zone
Q2. What are the layers of cerebellar cortex from outside to inside?
Molecular cell layer
Purkinje cell layer
Granular cell layer
Q3. What are
a). Mossy fibers Originate Vestibulo cerebellar, Spino cerebellar and Ponto cerebellar Make multiple synapses on Purkinje cells
b). Climbing fibers Originate from inferior olive in the medulla
Play role in cerebellar motor learning Make multiple synapses on Purkinje cells

14. Q5. Name the clinical signs seen in the cerebellar disease.
Q4. What cell type is responsible for cerebellar output? It is exhibitory or inhibitory?
Purkinje “ inhibitory “
Q5. Name the clinical signs seen in the cerebellar disease.
T – Tremor (intention)
A – Ataxia (Drunken gait , unsteady gait)
N – Nystagmus
D – Dysdiadokokinesia
D – Dysmetria
D – Dysarthria
Q6. What is intention tremor? oscillating movements of a limb as it approaches the object e.g. (finger nose test)

15. Q7.What is Dysdiadochokinesia?
Inability to perform rapid alternate movements smoothly e.g. doing pronation and supination of one hand on other
Q8. What happens to the gait in cerebellar disease?
Ataxia “Drunken gait - unsteady gait”
Q9. What happens to speech in cerebellar disease?
Dysarthria
Q10. Is there paralysis in cerebellar disease?
No but there is hypotonia

16. TUTORIAL Basal Ganglia
Lecture 9

17. Q1. What is difference between basal ganglia and basal nuclei?
basal nuclei = cell bode nucleus masses of gray matter in CNS
basal ganglia = in PNS
Q2. Name the 5 structures which belong to basal ganglia.
1. Caudate Nucleus
2. Putamen
3. Globus Palidus
4. Subthalamic Nuclei
5. Substantia Nigra
Q3. What are the functions of basal nuclei?
Inhibition of muscle tone
Coordination of slow, sustained movements
Suppression of useless pattern of movement

18. Q4. In basal nuclei lesion, what happens to
a). Movements: Hypokinesia or Akinesia
Tremor ( Resting )
b). Muscle tone: Increased muscle tone ( Rigidity )
Q5. In Parkinson’s disease, where is the pathology?
basal ganglia (substantia nigra)
Q6. Which neurotransmitter is lost in Parkinson's?
DOPAMINE

19. Q7. What are clinical symptoms of Parkinson’s disease?
® resting tremor
® bradykinesia (generalized slowness of movements)
® muscle rigidity
Q8. What is
a). Lead pipe rigidity
Stiffness of limb movement equal in opposing muscle.
b). Cogwheel rigidity
When stiffness is combined with tremor.
Q9. What happens to facial expression and blinking?
expressionless, mask like face - Blinking of eyelid is reduced

20. Q11. What happens to speech in Parkinsonism?
a). Posture : STOOP
b). Gait :
becomes hurrying, festinant, short and shuffling with poor arm swinging
Balance is impaired
Falls are common
Q11. What happens to speech in Parkinsonism?
monotonous, slurring dysarthria
due to combined tremor and rigidity
Q12. Is there any paralysis in Parkinsonism?
No- but slow movement ” bradykinesia “

21. Q13. Is there any sensory loss in Parkinson’s Disease?
No sensory loss
Q14. What is Huntington’s chorea? Where is the lesion?
quick, uncontrollable movements due to decrease neurotransmitter GABA and Acetylcholine
Lesions of Striatum (Caudate nucleus and Putamen)
Q15. What is Athetosis? Where is the lesion?
spontaneous writhing ( Twisting ) movements of the hand, arm, neck, and face - Lesions of Globuspallidus
Q16. What is Hemiballismus? Where is the lesion?
sudden wild flinging movements of the half of the body. - Lesions of Subthalamic nuclei

22. TUTORIAL Thalamus / Hypothalamus
Lecture 10

23. Q1. What are the functions of thalamus?
relay sensory input Somatic, auditory, visual , visceral ( except olfactory ).
sleep- awake cycle
Q2. Can pain be localized by thalamus? No
Q3. What are the functions of Hypothalamus?
1. Controls body temperature
2. Controls thirst and urine output
3. Controls food intake(Hunger and Satiety center )
4. Controls anterior pituitary hormone secretion
5. Produces posterior pituitary hormones
6. Controls uterine contraction and milk ejection
7. Serves as major ANS coordinating center
8. Plays role in emotional and behavioral pattern
9. Participates in the sleep – wake cycle
Q4. What is normal body temperature? 98.4oF (37oC)

24. Q5. What is core temperature?
It is temperature of deep tissues of the body. It remains constant within ±1oF .
Q6. Why there is body temperature?
oxidation of metabolic fuel derived from food.
Q7. At what temperature can convulsions occur?
106oF (41oC)
Q8. Give 4 mechanisms by which heat exchange takes place by the body to maintain the body temperature.
1. Radiation = by heat waves
2. Conduction = by direct contact
3. Convection = by air currents
4. Evaporation = from the skin surface + respiratory

25. Q9. How hypothalamus regulates the body temperature?
receives afferent information about temperature through receptors called Thermoreceptors.
Q10. What is the role of posterior region of hypothalamus in temperature regulation?
Activated by Cold : to produce heat
Q11. What is the role of anterior region of hypothalamus in temperature regulation?
Activated by Heat : to produce cold

26. Q15. What is frostbite? Why tissue damage occur in frost bite?
Q12. What is heat exhaustion?
exposed to high temperature combined with increased physical activity and humidity. (dehydration 40oC fainting ↓bP)
Q13. What is heat stroke?
breakdown of thermo-regulatory mechanism in hypothalamus
Q14. What will you advise to reduce the risk of heat exhaustion and heat stroke?
Stay out of sun during hottest part of the day.
Avoid extreme physical exertion.
cold drink - Take cool shower -Keep the environment cool.
Q15. What is frostbite? Why tissue damage occur in frost bite?
excessive cooling of particular part of the body to the point where tissue in that area is damaged. Due to breaking down of hypothalamus thermostat under the 30 oC which is responsible for heat regulation.

27. TUTORIAL Limbic System
Lecture 11

28. Q1. What are the functions of Limbic System?
1. Emotion 2. Behavior
3. Motivation 4. Memory
Q2. What structures are included in the limbic system?
Amygdala
Hippocampus
Cingulate gyrus
Portions of hypothalamus
Portions of thalamus
Portions of basal nuclei
Portions of lobes of cerebral cortex [ limbic association cortex]
Q3. Define emotions.
feelings, mood, anger, happiness, fear,
and physical responses associated with these feeling e.g. laughing, crying
Q4. Where sensation of fear arises?

29. Q5. What are functions of Amgdala?
- Sociability - Fear response - Pleasure
- Post traumatic stress - Aggression - Memory
Q6. What are the functions of Hippocampus?
reward and punishment determine whether or not information will be stored as memory
If no reward or punishment, it is hardly remembered but a person learns any sensory experience that causes pain or pleasure and makes strong memory trace
hippocampus provides the drive to rehearse and consolidate these sensory experiences
Q7. In Alzheimer disease, there is memory loss. Which area is affected first? Hippocampus

30. Q8. Where is reward center?
hypothalamus = lateral & ventromedial
thalamus and Amygdala
Q9. Where is punishment center?
hypothalamus + thalamus + Amygdala and Hippocampus
Q10. Punishment has powerful effect or reward?
Punishment