AP-Chapter-10-Part-2 - McLaren

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ESSENTIALS OF A&P
FOR EMERGENCY CARE
CHAPTER
10
The Nervous System:
Part Two: The Traffic
Control Center
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
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Introduction
• In this chapter we will focus on the main
control of the nervous system – the brain.
• Then, we will put the whole system
together to show the big picture of how the
nervous system functions.
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Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
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Learning Objectives
• Organize the hierarchy of the nervous
system.
• Locate and define the internal and external
structures and their corresponding
functions of the brain.
• List and describe the cranial nerves and
their functions.
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Learning Objectives
• Describe the sensory and motor functions
of the brain with related structures.
• Contrast the parasympathetic and
sympathetic branches of the autonomic
nervous system.
• Discuss some representative diseases of
the nervous system.
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Pronunciation Guide
Click on the megaphone icon before each item to hear the pronunciation.
anterior commissure (an TEE ree or KAHM ih
shoorz)
basal nuclei (BAY sal noo KLEE eye)
cerebellum (ser eh BELL um)
cerebrum (ser EE brum)
corpus callosum (KOR pus kah LOH sum)
diencephalon (DYE in SEFF ah lon)
fornix (FOR niks)
gyri (JIE rie)
hypothalamus (high poh THAL ah mus)
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Pronunciation Guide
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limbic system (LIM bick)
medulla oblongata (meh DULL ah OB long GA ta)
occipital lobe (awk SIP eh tal)
parietal lobe (pah RYE eh tal)
pineal body (PIN ee al)
subarachnoid space (sub ah RACK noyd)
sulcus (SULL cus)
thalamus (THAL ah mus)
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The Brain and Cranial Nerves
• The brain and cranial nerves represent the
major controls of the nervous system.
• The brain acts more as the main
processor and director of the entire
system.
• The cranial nerves leave the brain and go
mainly to the head where they receive
information and send it back to the brain
(sensory) and the brain sends back
instructions to move (motor).
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The Brain
• At the top of the spinal cord, beginning at
the level of the foramen magnum and
filling the skull, is the brain.
• The brain can be divided into several
anatomical and functional sections.
• External anatomy
– Cerebrum
– Cerebellum
– Brain stem
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Cerebrum
• The cerebrum is the largest part of the
brain.
• It is divided into the right and left
hemisphere by the longitudinal fissure and
divided from the cerebellum by the
transverse fissure.
• The surface of the cerebrum is not
smooth, but broken by ridges (gyri) and
grooves (sulci) collectively known as
convolutions.
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Cerebrum
• These convolutions serve a very important
purpose by increasing the surface area of
the brain, so you can pack more brain in a
smaller space.
• Most of the sulci are extremely variable in
their locations among humans, but a few
are in basically the same place in every
brain. These divide the brain into lobes.
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Lobes of the Brain
• The lobes are named for the skull bones
that cover them and occur in pairs, one in
each hemisphere.
• The most anterior lobes, separated from
the rest of the brain by the central sulci are
the frontal lobes. The frontal lobes are
responsible for motor activities, conscious
thought, and speech.
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Lobes of the Brain
• Posterior to the frontal lobe are the parietal
lobes. The parietal lobes are involved with
body sense perception and language
comprehension.
• Posterior to the parietal lobes are the
occipital lobes, which are responsible for
vision.
• The most inferior lobes, separated by the
lateral sulci, are the temporal lobes, which
are involved in hearing and integration of
emotions.
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Lobes of the Brain
• There is a section of the brain, the insula,
deep inside the temporal lobes that is
often listed as the fifth lobe, but is not
visible on the surface of the cerebrum.
• Much of the information coming into your
brain is contralateral, meaning that the
right side of your body is controlled by the
left side of your cerebral cortex and the left
side of your body is controlled by the right
side of your cerebral cortex.
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Specific Regions of Cerebrum
• On either side of the central sulcus are two
gyri named for their locations: the
precentral gyrus, anterior to the central
sulcus, and the postcentral gyrus,
posterior to the central sulcus.
• The frontal lobe also contains Broca’s
area, which controls motor output for
speech.
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Specific Regions of Cerebrum
• In the parietal lobe is Wernicke’s area.
Wernicke’s area was long thought to
control sensory aspects of language,
including understanding. This area is a
general interpretive area for many types of
sensory information and may integrate
much of the sensory information coming to
the cerebral cortex.
• In most people, Broca’s and Wernicke’s
areas are in the left hemisphere.
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The Cerebellum
• The cerebellum is posterior to the cerebrum.
• It too is divided into hemispheres by a raised
ridge called the vermis.
• The surface is convoluted like that of the
cerebrum.
• From its external appearance it is easy to see
why the cerebellum is called the little brain.
• The cerebellum is involved in sensory and
motor coordination and balance.
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Figure 10-1 External brain anatomy and lobes.
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Figure 10-1 (continued) External brain anatomy and lobes.
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Figure 10-1 (continued) External brain anatomy and lobes.
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Table 10-1 Cerebral Lobes and Cerebellum.
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The Brain Stem
• The brain stem is a stalk-like structure
inferior to, and partially covered by, the
cerebrum.
• The brain stem is divided into three
sections.
– The medulla oblongata is continuous with the
spinal cord. Responsible for control of
heartbeat, respiration, and blood vessel
diameter.
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The Brain Stem
• The brain stem is divided into three
sections.
– The pons is just superior to the medulla
oblongata and plays a role in respiration.
– The midbrain is the most superior portion of
the brain stem and is completely covered by
the cerebrum. The midbrain is a pathway to
relay visual and auditory impulses and other
information to the cerebrum.
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The Brain Stem
• The brain stem receives sensory
information and contains control systems
for vital processes such as blood pressure,
heart rate, and ventilation.
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Figure 10-2 (A) The brain stem.
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Figure 10-2 (continued) (B) The meninges.
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Table 10-2 The Brain Stem.
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From the Streets:
Nervous System Infections
• Infections of the nervous system can be
life-threatening.
• Meningitis
– The most common NS infection.
– Infection of the meninges
– Types
 Bacterial
 Viral
 Fungi
 Parasites
 Prions
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From the Streets:
Nervous System Infections
• Meningitis
– Causes
– Signs and symptoms
– Brudinski’s sign
– Kernig’s sign
– Diagnostic tests
– Treatment
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Internal Anatomy of the Brain
• The inside of the brain has white and gray
matter, along with hollow cavities containing
CSF.
• The white matter of the brain is surrounded by
the gray matter.
• The layer of gray matter surrounding the white
matter is called the cortex. In the cerebrum it is
called the cerebral cortex and in the cerebellum
it is called the cerebellar cortex.
• Deep islands of gray matter are nuclei.
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Internal Anatomy of the Brain
• Ventricles – the cavities in the brain. They are
continuous with the central canal of the spinal
cord and the subarachnoid space of both the
brain and the spinal cord.
• The lateral ventricles (ventricle 1 and 2) are in
the cerebrum, the third ventricle is in the
diencephalon (a region between the cerebrum
and brain stem) and the fourth ventricle is in the
inferior part of the brain between the medulla
oblongata and the cerebellum.
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From the Streets:
Burr Holes
• An epidural hematoma may result from
head trauma causing bleeding in the
epidural space.
• This causes rapid swelling and
compression of the brain.
• A physician may drill burr holes over the
hematoma to relieve pressure.
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Figure 10-3 (A) Superior sectional view of the brain.
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Figure 10-3 (continued)
(B) Sagittal sectional view of the brain.
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Figure 10-3 (continued) (C) Frontal sectional view of the brain.
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Clinical Application: CSF Circulation
and Hydrocephalus
• The ventricles of the brain, the central
canal of the spinal cord, and the
subarachnoid space surrounding both the
brain and spinal cord are filled with CSF.
The CSF is filtered from blood in the
ventricles by tissue called choroid plexus.
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Clinical Application: CSF Circulation
and Hydrocephalus
• CSF made in the lateral ventricles flows
through a tiny opening into the third
ventricle and then through another
opening into the fourth ventricle. CSF
flows into the central canal of the spinal
cord and the subarachnoid space. CSF is
returned to the blood via special “ports”
between subarachnoid space and blood
spaces in the dura mater.
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Clinical Application: CSF Circulation
and Hydrocephalus
• The balance of CSF made and CSF
reabsorbed by the blood is very important.
The brain is a very delicate organ captured
between the liquid CSF and the bones of
the skull. If there is too much CSF,
pressure inside the skull will rise and
eventually crush brain tissue.
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Clinical Application: CSF Circulation
and Hydrocephalus
• This condition, in which there is too much
CSF, is called hydrocephalus (water on
the brain). Hydrocephalus can be caused
by blockage of the narrow passages due
to trauma, a birth defect, tumor, or
decreased reabsorption of CSF. It can be
treated by medication or, more commonly,
a shunt is surgically placed to drain fluid to
the heart or abdominal cavity.
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Figure 10-4 Typical appearance of a infant with hydrocephalus.
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The Cerebrum
• The inside of the cerebrum reflects the
external anatomy. The lobes (frontal,
parietal, temporal, and occipital) are
clearly visible.
• The right and left hemispheres are
connected by several white matter
pathways surrounding the lateral ventricles
called the corpus callosum, the fornix, and
the anterior commissure.
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The Cerebrum
• Several prominent cerebral nuclei are also
involved in motor coordination, sensation,
and motor control.
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The Diencephalon
• Inferior to the cerebrum is a section of the
brain, that is not visible from the exterior,
called the diencephalon.
• Consists of several parts including the
thalamus, hypothalamus, pineal body, and
the pituitary gland which interface with the
endocrine system.
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The Diencephalon
• The diencephalon contains the third
ventricle and a number of nuclei.
– Basal nuclei and limbic system
– Nuclei responsible for controlling hormone
levels, hunger and thirst, body temperature,
sleep-wake cycles, and for coordination of the
flow of information around the brain
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Table 10-3 Diencephalon.
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The Cerebellum
• The external similarities between the cerebellum
and cerebrum are also obvious internally.
• The cerebellum has a gray matter cortex and a
white matter center, known as the arbor vitae
(tree of life).
• The cerebellum also has nuclei that coordinate
motor and sensory activity.
• Essentially, the cerebellum fine tunes voluntary
skeletal muscle activity and helps in the
maintenance of balance.
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Cranial Nerves
• In order for the CNS to function, it must be
connected to the outside world via nerves of
the PNS.
• Like the spinal cord has spinal nerves the
brain has nerves called cranial nerves.
• Cranial nerves are like spinal nerves in that
they are the input and output pathways for
the brain.
• There are only 12 pairs of cranial nerves, all
but two of which arise from the brain stem.
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Cranial Nerves
• Cranial nerves are not all mixed nerves
like the spinal nerves. Some are mainly
sensory and others are mainly motor, and
some are mixed nerves.
• Cranial nerves are much more specialized
than spinal nerves.
• Cranial nerves carry sensory and motor
information for the head, face, and neck,
as well as visual, auditory, smell, or taste
sensations.
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Figure 10-5 Cranial nerves.
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Table 10-4 Cranial Nerves and Functions.
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The Somatic Sensory System
• The somatic sensory system provides
sensory input for your nervous system and
allows you to feel the world around you.
• Somatic sensation includes fine touch, crude
touch, vibration, pain, temperature, and body
position.
• Information for somatic sensation comes into
both the brain and the spinal cord.
• To attach meaning to the sensation, it must
get to the brain for interpretation.
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Figure 10-6
Nervous system flowchart highlighting our current location.
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The Somatic Sensory System
• In reflex, somatic sensory information
comes into the spinal cord via the dorsal
root and synapse with a motor neuron in
the ventral horn.
• The same axon that carries information to
the motor neuron further carries the
sensory information to your brain via tracts
in the white matter of the spinal cord, so
you feel the pain.
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Somatic Sensory Pathways
• Three pathways carry somatic sensory
information to your spinal cord and then to
your brain.
– The dorsal column tract carries fine touch and
vibration information to the cerebral cortex.
– The spinothalmic tract carries temperature,
pain, and crude touch information to the
cerebral cortex.
– The spinocerebellar tract carries information
about posture and position to the cerebellum.
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Table 10-5 Spinal Cord Pathways for Sensory Information.
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Primary Somatic Sensory Cortex
• The sensory information coming into the
brain from the dorsal column and
spinothalmic tracts both provide sensory
information from your skin and joints to a
portion of the cerebrum known as the
primary somatic sensory cortex.
• This is located in the postcentral gyrus of
the parietal lobe.
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Primary Somatic Sensory Cortex
• The axons transport information to specific
parts of the SS cortex that correspond to
parts of the body. Body is mapped on
brain surface.
• The neurons in the SS cortex are the
neurons that allow you to have conscious
sensation.
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Primary Somatic Sensory Cortex
• The map is also evident on your body
surface. The map of the body surfaces
innervated by each spinal nerve consists
of a band or region of skin supplied by a
single sensory nerve. Each band is called
a dermatome.
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Figure 10-7 Primary somatic sensory area. Notice the size of the body parts are proportional
to the amount of the sensory input provided. For example, the hands provide much more
sensory input due to touch than your neck would, and as a result, the area devoted to the
neck is much smaller. Remember that the map is contralateral.
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Figure 10-8 Dermatomes.
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Understanding Somatic Sensation
• Another area of the cerebral cortex that
allows understanding and interpretation of
somatic sensory information is located just
posterior to the SS cortex in the parietal
lobe and is known as the somatic sensory
association area.
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Understanding Somatic Sensation
• The somatic sensory system works on a
kind of hierarchy with the sensory neurons
in the spinal cord and brain stem,
collecting information and passing it to the
areas in the thalamus, cerebellum, and
cerebral cortex for processing.
• Understanding of complex sensory input
happens only after the information is
passed to the SS cortex and the SS
association area.
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From the Streets:
Seizure
• A seizure is an episode of abnormal
neurological function caused by an
abnormal electrical discharge of the brain
neurons.
• Causes
– Epilepsy-clinical syndrome of recurrent
seizures.
– Primary / idiopathic
– Secondary
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From the Streets:
Seizure
• Categories:
– Generalized tonic-clonic
 Grand mal seizures
– Partial
 Absence seizures
 Focal seizures
• Signs and symptoms
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From the Streets:
Seizure
• Assessment
– Postictal phase
• Diagnostic tests
• Treatments
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The Motor System
• The motor system is also a hierarchy,
working in parallel with the SS system,
with two obvious differences.
– Information moves in the opposite direction
from brain to spinal cord.
– Second, the motor system has two divisions,
the somatic motor system and the autonomic
nervous system.
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Figure 10-9 Our current position on the nervous system flowchart.
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Somatic Motor System
• The somatic motor system controls
voluntary movements under orders from
the cerebral cortex.
• In the frontal lobe are the premotor and
prefrontal areas which plan movements.
• The plan from these two areas is sent to
the primary motor cortex.
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Somatic Motor System
• The primary motor cortex is located in the
precentral gyrus in the frontal lobe, just
anterior to the SS cortex.
• The primary motor cortex also has a map
of the body and is contralateral. The size
of the map is proportional to the amount of
movement control. Thus the hands and
the tongue have bigger maps than the
trunk or the forearms.
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Somatic Motor System
• Like the somatic sensory cortex, the
primary motor cortex is contralateral.
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Figure 10-10 Motor areas of the brain, with homunculus.
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Subcortical Structures
• Nuclei
– Deep in the cerebrum are several areas of
gray matter. Areas of gray matter found within
the cerebrum and surrounded by white matter
are known as nuclei.
– The nuclei can be part of the basal nuclei, a
motor coordination system, or part of the
limbic system, which controls emotion and
mood.
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Subcortical Structures
• Nuclei, Thalamus, Cerebellum
– The plan for movement leaves the motor
cortex and connects with neurons in the
thalamus, located in the diencephalon.
– The thalamus, basal nuclei, and cerebellum
are part of a complicated motor coordination
loop.
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Subcortical Structures
• Nuclei, Thalamus, Cerebellum
– Here, the movement must be fine-tuned,
posture and limb positions are taken into
account, other movements are turned off, and
movement and senses are integrated.
– Patients with Parkinson’s have a disorder in
the basal nuclei, making them unable to start
some movements or turn other movements
off. They have difficulty walking, swallowing,
and have tremors when sitting still.
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Spinal Cord Pathways
• After the movement information is
processed by the thalamus and basal
nuclei, it moves to the spinal cord and
brain stem via ascending spinal cord
tracts.
• The corticospinal and corticobulbar tracts
from your motor cortex are direct
pathways, whereas others coming from
subcortical structures are considered
indirect pathways.
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Spinal Cord Pathways
• The axons synapse on motor neurons in
the ventral horn. These motor neurons
project to skeletal muscles, via the cranial
nerves or the ventral roots and spinal
nerves, sending orders to the skeletal
muscles to carry out the planned
movement and to coordinate it.
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Spinal Cord Pathways
• A second function of the motor tracts is
fine tuning of reflexes. These tracts inhibit
reflexes, making them softer than they
would be if they had no influence from the
brain.
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Table 10-6 Spinal Cord Pathways for Motor Information
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The Role of the Cerebellum
• The cerebellum has both motor and
sensory inputs and outputs from the
cerebral cortex, the thalamus, basal
nuclei, and the spinal cord.
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The Role of the Cerebellum
• The cerebellum gets information about the
planned movement and the actual
movement and compares the plan to the
actual. If the plan and the actual don’t
match, the cerebellum can adjust the
actual movement to fit the plan.
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The Role of the Cerebellum
• The function of the cerebellum is subtle
and still a bit of a mystery, but without the
cerebellum movements would be
inaccurate at best.
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From the Streets:
Headache
• Headache is a common complaint and
usually a benign symptom.
• However, sometimes it can be associated
with a serious disease.
• Types
– Migraine
– Cluster
– Tension
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From the Streets:
Headache
• Migraine
– Often caused by a trigger
– Pathophysiology
• Cluster: characterized by very severe,
unilateral pain in the orbit, forehead, or
temple.
• Tension: characterized with nonpulsating
pain on both sides of the head.
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Autonomic Nervous System
• The motor system is divided into two
systems:
– The somatic system controls skeletal muscles.
– The autonomic system controls physiological
characteristics such as blood pressure, heart
rate, respiratory rate, digestion, and sweating.
• The neurons for the autonomic system, like
the somatic motor neurons, are located in the
spinal cord and brain stem, and release the
neurotransmitter acetylcholine. This is where
similarities end.
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Autonomic Neurons
• The autonomic motor neurons are all located in
the lateral horn rather than the ventral horns and
unlike the somatic motor neurons, autonomic
neurons do not project directly to muscles.
• They make a synapse in a ganglion outside the
CNS. These are preganglionic neurons.
• Then a second motor neuron, called a
postganglionic neuron, projects to the muscle.
• There are no autonomic neurons in the cervical
spinal cord.
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Autonomic Nervous System
• The autonomic nervous system is divided
into two subdivisions:
– The sympathetic division
– The parasympathetic division
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Figure 10-11 General representation of autonomic nervous system. ACh = acetylcholine and
NE = norepinephrine.
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The Sympathetic Branch
• The sympathetic division controls the
“flight or fight” response; it is charged with
responding to emergencies.
• Sympathetic effects increase heart rate,
BP, and sweating, also causing a dry
mouth – symptoms of an adrenaline rush.
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The Sympathetic Branch
• The preganglionic neurons are located in
the thoracic and first two lumbar segments
of the spinal cord. The preganglionic
neurons, which secrete acetylcholine,
synapse with the postganglionic neurons
in the sympathetic ganglia.
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The Sympathetic Branch
• The ganglia form a pair of chain-like
structures that run parallel to the spinal
cord (paravertebral ganglia), where
neurons in the ganglia release the
neurotransmitter norepinephrine.
• Most importantly, the sympathetic system
stimulates the adrenal glands to release
the hormone epinephrine that causes the
adrenaline rush.
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The Parasympathetic Branch
• The parasympathetic division is often
called “resting and digesting” as it has the
opposite effect of the sympathetic division.
• The parasympathetic system is
responsible for everyday activities, as well
as reversing the sympathetic effects.
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The Parasympathetic Branch
• Parasympathetic effects include
decreased heart rate, respiration, and
blood pressure, and increased digestive
activity including salivation and stomach
activity.
• The neurons of the parasympathetic
system are in the brain stem and the
sacral spinal cord. The neurotransmitter
acetylcholine is released by postganglionic
neurons.
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From the Streets:
Sympathetic Nervous System
• Sympathetic nervous system results in the
release of norepinephrine from
postganglionic nerves.
• Two enzymes break down norepinephrine
with the synapse:
– monamine oxidase (MAO)
– catechol-O-methyl transferase (COMT)
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Figure 10-12 Norepinephrine is the neurotransmitter of the postganglionic sympathetic
nervous system. It is taken up by the presynaptic membrane and broken down by the enzyme
monamine oxidase or catechol-O-methyl transferase.
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From the Streets:
Sympathetic Nervous System
• Four types of receptors:
– alpha 1
– alpha 2
– beta 1
– beta 2
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Table 10-7 Primary Actions and Locations of Adrenergic and Dopaminergic Receptors.
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From the Streets:
Parasympathetic Nervous System
• Acetylcholine is the neurotransmitter for
the parasympathetic NS
• Acetylcholine as short half-life
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From the Streets:
Parasympathetic Nervous System
• Parasympathetic NS has two types of
acetylcholine receptors:
– nicotinic
– muscarinic
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Figure 10-13 Acetylcholine is the neurotransmitter of the parasympathetic nervous system,
the ganglia of the sympathetic nervous system, and the somatic nervous system. It is promptly
degraded into acetic acid and choline by the enzyme acetylcholinerase, and the resultant byproducts are taken by the presynaptic membrane.
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Table 10-8 Location and Effect of Muscarinic Receptors.
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From the Streets:
Organophosphate Poisoning
• Organophosphates are a class of
insecticides used widely in agriculture.
• The principle action of organophosphates
is deactivation of the enzymes
acetylcholinerase (cholinesterase) in the
nervous system.
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From the Streets:
Organophosphate Poisoning
• Organophosphates bind to cholinesterase,
thus inactivating the enzyme.
• Signs and symptoms
• Treatment
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The Limbic System
• The limbic system is a series of nuclei in
the cerebrum, diencephalon, and superior
brain stem.
• The limbic system is involved in mood,
emotion, and memory.
• One nucleus helps attach emotion to
movement, another coordinates emotion
and your sense of smell. Still another is
responsible for storing and retrieving
information.
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The Reticular System
• The reticular system is a diffuse network of
nuclei in the brain stem that is responsible
for “waking up” your cerebral cortex.
• The reticular system activity is vital for the
maintenance of conscious awareness of
your surroundings.
• General anesthesia inhibits the reticular
system, rendering surgery patients
unconscious.
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The Reticular System
• Injury due to ischemia, trauma, or drugs
can damage the reticular system, leading
to coma.
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Common Disorders of the
Nervous System: Part II
•
•
•
•
•
•
Spastic paralysis
Flaccid paralysis
Cerebral palsy
CVA
Subdural hematoma
Huntington’s disease
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Spastic Paralysis
• Paralysis is the inability to control
voluntary movements.
• Paralysis can be spastic or flaccid.
• Spastic paralysis is characterized by
muscle rigidity or increased muscle tone
(hypertonia) and overactive reflexes
(hyperreflexia).
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Spastic Paralysis
• In spastic paralysis the muscles are rigid
and the reflexes overreactive due to
decreased communication from the brain
to the ventral horn of the motor neurons in
the spinal cord.
• Muscles contract randomly and reflexes
do not have any control signal from the
brain.
• Strokes, head injuries, and spinal cord
injury can cause spastic paralysis.
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Flaccid Paralysis
• Flaccid paralysis is characterized by floppy
muscles (hypotonia) and decreased
reflexes (hyporeflexia).
• It is caused by damage to the spinal
nerves, so impulses cannot get to the
muscles from the motor neuron.
• Flaccid paralysis occurs with peripheral
injury or disorders like polio or GuillainBarré syndrome.
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Cerebral Palsy
• Cerebral palsy (CP) is a collection of
movement disorders that are not
progressive and occur in young children.
• Signs of classic spastic paralysis are seen.
• CP is caused by improper development or
damage to the motor system of the brain.
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Cerebral Palsy
• Symptoms range from minor motor loss to
significant motor deficits, including the
inability to walk or speak.
• Intelligence may or may not be affected,
depending on the cause of CP.
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Cerebral Vascular Accident
• A cerebral vascular accident (CVA), or a
stroke, is caused by interruption of blood
flow to a portion of the brain due to
hemorrhage or a blood clot.
• If oxygen supply is disrupted long enough,
the brain cells will die.
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Cerebral Vascular Accident
• Symptoms vary depending on area
affected and can include paralysis, inability
to speak, blindness, loss of memory, or
lack of sensation.
• Symptoms appear suddenly or can be a
series of small minor strokes. These ministrokes are called transient ischemic
accidents (TIAs).
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Subdural Hematoma
• A subdural hematoma is a pool of blood
between the dura mater and arachnoid mater, in
the subdural space.
• Subdural hematomas are caused by head
injuries rupturing tiny blood vessels.
• A large, or growing, hematoma can cause brain
damage by increasing pressure in the skull.
• Some resolve themselves (small ones) while
others can require surgery to relieve the
pressure.
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Huntington’s Disease
• Huntington’s disease is a progressive,
genetic disorder causing deterioration of
neurons in the basal nuclei and, eventually,
the cerebral cortex.
• The disease begins with wide mood swings,
memory disturbances, writhing movements of
the hands or face, or clumsiness. Eventually,
difficulty swallowing, speaking, and walking
as well as memory loss, psychosis, and loss
of cognitive function will occur.
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Huntington’s Disease
• There is no cure and most patients die
from injuries, infections, or other
complications.
• Genetic testing can identify those at risk.
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From the Streets:
Extrapyramidal Motor Syndromes
• Several drugs used in emergency
medicine can cause side effects that
involve the extrapyramidal system (EPS).
• EPS side effects are similar to the effects
of Parkinson’s disease, but are reversible.
• EPS signs and symptoms include muscle
spasms of the neck, face, tongue, and
back (dystonia).
• Dystonia and akathisia
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From the Streets:
Neurologic Trauma
• Traumatic brain injury (TBI) can be
devastating and cause permanent
disability.
• Blunt trauma
– Primary injury
– Secondary injury
– Focal injuries
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Figure 10-15 In an epidural hematoma, the bleeding usually results from arterial bleeding
and can develop rapidly.
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Figure 10-16 With subdural hematomas, the bleeding is usually venous and develops much
more slowly than epidural hematomas.
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From the Streets:
Neurologic Trauma
• Diffuse injuries
• Coup and Contrecoup injuries
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Figure 10-14 Coup and contrecoup injuries.
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From the Streets:
Neurologic Trauma
• Penetrating trauma
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Figure 10-17 Postmortem specimen showing a massive missile tract through the substance
of the brain as a result of a high-velocity, high-energy gunshot.
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Snapshots from the Journey
• The nervous system is your body’s
computer system. Without it you could not
sample your environment, make decisions,
or respond to stimuli. Your CNS handles
millions of pieces of information every
minute, regulates other body systems, and
corrects problems that occur.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Snapshots from the Journey
• The brain is a hierarchical organ, divided
into compartments (lobes) with specific
functions. There are twelve cranial nerves
attached to it that can be sensory, motor,
or mixed.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Snapshots from the Journey
• The cerebrum controls your conscious
movement and sensation. Beneath the
cerebrum are the diencephalon, brain
stem, and cerebellum. Each part plays
important roles in coordinating sensory
and motor information for the cerebrum.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Snapshots from the Journey
• Other parts of the brain, called association
areas, allow you to make connections
between different types of sensory
information and to compare current
experience to memories.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Snapshots from the Journey
• There are motor and sensory maps of the
body in the cerebral cortex. Orders for
voluntary movements originate in the
primary motor cortex in the precentral
gyrus of the frontal lobe and travel down
the spinal cord via direct spinal cord tracts.
Subcortical structures coordinate this
information via indirect tracts. The somatic
sensory cortex is in the postcentral gyrus
of the parietal lobe.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Snapshots from the Journey
• Sensory information from the spinal cord
tracts eventually ends up in this part of the
cortex. When the information arrives there,
you become aware of your sense of touch.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Snapshots from the Journey
• The nervous system also controls smooth
muscle, cardiac muscle, and endocrine
glands via a part of the system known as
the autonomic nervous system. The
autonomic nervous system has two
branches. The sympathetic division
controls the flight-or-fight response, and
the parasympathetic division controls dayto-day activities.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Case Study
• A young woman finds her elderly father
lying at the bottom of the basement stairs.
He is paralyzed on his right side, but he
seems to be able to feel that side of his
body. At the hospital he is diagnosed with
a stroke.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Case Study Questions
• What part of his brain is damaged?
• How can you tell?
• What would you expect to happen to his
ability to speak and understand language?
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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From the Streets
You are called to the scene of a 3 year-old
male, who parents state, “has been shaking
all over and now won’t wake up”. You find
your patient slow to respond with hot, dry, &
moist skin. You note that he has a recent
history of a viral illness and has a rectal
temperature of 105ºF.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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From the Streets Questions
• What is the term used to describe the
“shaking all over” that the parents
observed?
• What is his most likely diagnosis?
• What is the most likely cause of the
condition?
• What is his prognosis?
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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From the Streets Questions
• What is the term used to describe the
“shaking all over” that the parents
observed? Convulsions (or clonic-tonic
activity)
• What is his most likely diagnosis? Seizure
• What is the most likely cause of the
condition? A rapid developing and high
fever is the most common cause of
pediatric seizures.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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From the Streets Questions
• What is his prognosis? He is currently
post-ictal, but will return to normal shortly.
Provide safety, oxygen, and suction if
needed.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter
Review Questions
1. One of the following brain parts is a
cortical structure. Which one?
a. Hypothalamus
b. Medulla oblongata
c. Precentral gyrus
d. Pineal body
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
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End of Chapter
Review Questions
2. This cranial nerve controls the abdominal
visceral:
a. Olfactory (I)
b. Trigeminal (V)
c. Vestibulocochlear (VIII)
d. Vagus (X)
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
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End of Chapter
Review Questions
3. The size of the map of each body part in
the postcentral gyrus is determined by
the:
a. Sensitivity of the body part
b. Size of the body part
c. Importance of the body part
d. Fine-motor control of the body part
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter
Review Questions
4. The sympathetic nervous system:
a. Causes decreased heart rate
b. Has ganglia near the organs
c. Has ganglia near the spinal cord
d. All of the above
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter
Review Questions
5. This part of the brain contains the body’s
set points and controls most of its
physiology, including blood pressure and
hunger level.
a. Thalamus
b. Hypothalamus
c. Amygdala
d. Hippocampus
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
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End of Chapter
Review Questions
6. After a severe blow to the head, Jill has
uncontrollable hunger and thirst, her
body temperature varies wildly and she
keeps passing out because her blood
pressure is not well controlled.
Neurological tests detect a hemorrhage.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter
Review Questions
6. Where is the bleed located?
a. Frontal lobe
b. Hypothalamus
c. Basal Nuclei
d. Spinal cord
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter
Review Questions
7. After having meningitis, Billy loses his
sight. What part of his nervous system
may be damaged.
a. Frontal lobe
b. Cranial Nerve
c. Spinal cord
d. Broca’s area
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter
Review Questions
8. During a party, Jim begins to feel just
awful. His heart is racing, he can’t catch
his breath and he is sweating and
beginning to panic. He suspects
somebody has spiked his drink. What
part of his nervous system is stimulated?
a. Hypothalamus
b. Parasympathetic
c. Frontal lobe
d. None of the above
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter Review Questions
1. The ______ are nuclei that coordinate
motor output.
2. The occipital lobe is responsible for this
sensation: ___.
3. The white matter of the spinal cord contains
______ tracts, which are motor, and _____
tracts, which are sensory.
4. Emotion, mood, and memory are controlled
by this collection of nuclei: ___.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter Review Questions
5. This portion of the brainstem has vital nuclei
for respiration and the cardiovascular
system: ___.
6. Bea has become very uncoordinated lately,
her movements are slow and stilted. She
can move, but not easily. A neurologist
determines that she has had a small stroke
that has damaged this part of the motor
system. ____________
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
1. List the differences between cranial and
spinal nerves.
2. List the differences between the
sympathetic and parasympathetic
nervous systems.
3. Explain how the cerebral cortex and
subcortical structures interact to produce
motor output.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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End of Chapter
Review Questions
4. Explain how somatic sensory information
travels from skin sensation to
understanding.
5. Explain the overall hierarchy of the
nervous system that exists between the
cerebral cortex, subcortical structures,
and the spinal cord.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
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