Maryland State Department of Education
Academy of Health Professions
Course 1: Foundations of Medicine and Health Science
Unit 2: Medical Assessment
Section 4: Nervous System
ANSWER KEY AND RUBRICS
UNIT 2: INTRODUCTION
Many different fields of biology, chemistry, and physics converge in the application of
medical diagnostics, where a combination of chemical tests, physical evaluations, and
advanced imaging techniques are used to assess body functions, and detect possible
abnormalities. Many of these techniques are used in routine preventative care, but are
also an essential part of the tools used to identify injuries in emergency room situations.
In this unit, you will investigate different methods of evaluating body function, as well as
learning basic anatomy, and the structure and function of selected body systems.
Contents
2.4 Nervous System
2.4.1 Cranial Nerve Function
2.4.2 Neurological Assessment
2.4.3 Sheep Brain Dissection
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Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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Name:_____________________________
2.4.1. WORKSHEET 15: CRANIAL NERVES – ANSWER KEY
Table 1. The Names and Function of the Twelve Cranial Nerves
Cranial
Nerve
Cranial Nerve Name
Function
Number
I
Olfactory Nerve
Smell
II
Optic Nerve
Vision
III
Oculomotor Nerve
IV
Trochlear
Inferior and lateral movement of the eyeball.
V
Trigeminal Nerve
Main sensory nerve of the face. Responds to
touch, pain, temperature.
VI
Abducens Nerve
Lateral movement of the eye.
VII
Facial Nerve
VIII
Vestibulocochlear
Nerve
IX
Glossopharyngeal
X
Vagus Nerve
XI
Accessory Nerve
XII
Hypoglossal Nerve
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Eye movements, opening of eyelid, constriction
of pupil, focusing.
Major motor nerve of facial expressions,
autonomic control of tear glands, nasal glands,
salivary glands, and sense of taste.
Hearing and equilibrium.
Swallowing, gag reflex, salivation, regulation of
blood pressure and respiration, sensations of
touch, pressure, taste, and pain from the tongue,
sensations of pain, touch and temperature from
the external ear.
Speech, swallowing, regulation of pulmonary,
cardiovascular and gastrointestinal function.
Sensations of hunger, fullness, and intestinal
discomfort.
Swallowing, movements of the head, neck, and
shoulders.
Tongue movements during speech, food
manipulation, and swallowing.
Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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2.4.2 Glasgow Coma Scale - Student Role Play Cards
Patient 1
Patient 2
 You will open your eyes and look at
 You will have your eyes open and
the person examining you.
look at the person examining you.
 You will speak normally and
 You will speak normally, but you
answer questions appropriately
are confused. You don’t know
where you are, and give the wrong
 You will be able to squeeze the
month and year when asked.
examiner’s hands and stick your
tongue out.
 You will be slow to follow the
verbal commands, but will be able
to do what is asked.
Patient 3
Patient 4
 Your eyes will be closed even if
 You will keep your eyes closed,
someone pinches you.
even if someone pinches you.
 You will make no sound, even if
 You will groan in response to being
someone pinches you.
pinched, but will not say any
recognizable words.
 You will not respond to verbal
commands at all, even if pinched.
 You will not follow commands, but
if someone pinches you, you will
try to push his or her hand away.
Patient 5
Patient 6
 Your eyes will be closed, even if
 Your eyes will be open and you will
someone calls you loudly. You will
be looking around you with an
open them if pinched.
anxious expression on your face.
 You will say “Don’t!” or “Stop!”
 You will not answer questions at
when pinched, but do not speak
all. If pinched you will groan, but
whole sentences and do not answer
do not say any recognizable words.
any questions.
 You will not follow commands, but
if someone touches you (including
 You will not squeeze the
examiner’s hands or stick out your
to pinch you) you will grab hold of
tongue, but you will quickly push
his or her hand with both of yours.
his or her hand away if pinched.
Don’t let go easily.
Patient 7
Patient 8
 Your eyes will be closed, even if
 Your eyes will be closed, but you
someone pinches you.
will open them briefly if anyone
calls loudly.
 You will make no sound, even if
someone pinches you.
 You will not answer questions. If
anyone pinches you, you will groan
 You will not follow commands.
or yell, but not say any recognizable
 You will lie in a position where
words.
your closed fists are lying beside
 You will not follow commands, but
one another at the top of your chest
if someone pinches you, you will
(decorticate posturing) and will not
quickly push his or her hand away.
move from this position.
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Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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Patient 9
 Your eyes will be closed, but you
will open them if someone speaks
to you.
 You will speak normally, but you
are confused. You don’t remember
exactly what happened to you, and
you give the wrong month if asked.
 You will be slow to follow
commands like, “show me two
fingers,” but you will be able to do
so.
Patient 11
 Your eyes will be closed, even if
someone talks to you or pinches
you.
 You will answer questions
correctly. Mention that your head
hurts.
 If anyone asks you to open your
eyes, refuse and say "the light
makes my head hurt really bad."
 Follow commands appropriately,
but don't open your eyes
Patient 13
 Your eyes will be open.
 Your speech won’t make much
sense. In answer to a question like,
“what month is this?” you will say
something like, “he, umm, he . . .
My jacket. I don't . . . You will not
follow commands, but if someone
pinches you quickly push his or her
hand away.
©
Patient 10
 Your eyes will be closed, even if
someone pinches you.
 The only sound you make will be a
weak groan when someone pinches
you.
 You will not follow commands, but
if someone pinches you, you will
try to pull away or turn away from
the pain.
Patient 12
 Your eyes will be closed, but you
will open them if anyone pinches
you.
 Your speech will be fairly clear
when you are aroused by a painful
stimulus, such as a pinch, but you
will only say, “leave me alone" or
"what are you doing?" and soon go
back to sleep.
 If someone asks you a question
while you are still awake, you'll
say, “I don’t know,” and go back to
sleep.
 You will not follow commands, but
if someone pinches you, you will
quickly push his or her hand away.
Patient 14
 Your eyes will be closed, even if
someone pinches you.
 You will not make any sound, even
if someone pinches you.
 You will not follow commands. If
someone pinches you, put your
arms rigidly at your side
(decerebrate posturing).
Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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Patient 15
Patient 16
 Your eyes will be closed, even if
 Your eyes will be closed at first, but
someone pinches you.
you will open them if someone calls
you loudly.(3)
 You will keep repeating some
meaningless phrase like, "I want my
 You will not say any recognizable
bunny slippers, I want my bunny
words. If someone asks you a
slippers, I want . . ." Keep it up
question, look confused and say,
continually, and if someone pinches
"mmm ? " without opening your
you, just say it louder.
mouth.(2)
 You will sit up and rock
 You will not follow commands. If
continually. You will not follow
someone pinches you, pull away.(4)
commands. If someone pinches
you, push or slap the hand away.
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Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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2.4.2 Glasgow Coma Scale - Student Role Play Cards – Teacher Version
Teaching Note: The total Glasgow Coma Scale (GCS) score is given, and the scores for
each individual assessment are given in parentheses.
Patient 1
Patient 2
 You will open your eyes and look at
 You will have your eyes open and
the person examining you. (4)
look at the person examining you.
(4)
 You will speak normally and
answer questions appropriately. (5)
 You will speak normally, but you
are confused. You don’t know
 You will be able to squeeze the
where you are, and give the wrong
examiner’s hands and stick your
month and year when asked. (4)
tongue out. (6)
 You will be slow to follow the
verbal commands, but will be able
to do what is asked. (6)
GCS SCORE: 15
Patient is fully oriented.
GCS SCORE: 14
Patient loses 1 point for disorientation.
Patient 3
Patient 4
 Your eyes will be closed even if
 You will keep your eyes closed,
someone pinches you. (1)
even if someone pinches you. (1)
 You will make no sound, even if
 You will groan in response to being
someone pinches you. (1)
pinched, but will not say any
recognizable words. (2)
 You will not respond to verbal
commands at all, even if pinched.
 You will not follow commands, but
(1)
if someone pinches you, you will
try to push his or her hand away.
(5)
GCS SCORE: 3
Completely unresponsive patients still
score a 3 on this scale.
©
GCS SCORE: 8
Score of 5 given for motor response as
patient is able to localize source of pain.
Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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Patient 5
 Your eyes will be closed, even if
someone calls you loudly. You will
open them if pinched. (2)
 You will say “Don’t!” or “Stop!”
when pinched, but do not speak
whole sentences and do not answer
any questions. (3)
 You will not squeeze the
examiner’s hands or stick out your
tongue, but you will quickly push
his or her hand away if pinched. (5)
GCS SCORE: 10
Score of 5 given for motor response as
patient is able to localize source of pain.
Although “Don’t!” or “Stop!” are
appropriate responses to pain, the patient
is still not able to form a whole sentence
and so scores a 3 for verbal response.
Patient 7
 Your eyes will be closed, even if
someone pinches you. (1)
 You will make no sound, even if
someone pinches you. (1)
 You will not follow commands.
Patient 7
 Your eyes will be closed, even if
someone pinches you.
 You will make no sound, even if
someone pinches you.
 You will not follow commands.
 You will lie in a position where
your closed fists are lying beside
one another at the top of your chest
(decorticate posturing) and will not
move from this position.. (3)
Patient 6
 Your eyes will be open and you
will be looking around you with an
anxious expression on your face.
(4)
 You will not answer questions at
all. If pinched you will groan, but
do not say any recognizable words.
(2)
 You will not follow commands, but
if someone touches you (including
pinching you) you will grab hold of
his or her hand with both of yours.
Don’t let go easily. (5)
GCS SCORE: 11
Score of 5 given for motor response as
patient is demonstrating ability to localize
source of pain by grabbing the teacher’s
hands.
Patient 8
 Your eyes will be closed, but you
will open them briefly if anyone
calls loudly.(3)
 You will not answer questions. If
anyone pinches you, you will groan
or yell, but not say any
recognizable words. (2)
 You will not follow commands, but
if someone pinches you, you will
quickly push his or her hand away.
(5)
GCS SCORE: 10
GCS SCORE: 5
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Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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Patient 9
 Your eyes will be closed, but you
will open them if someone speaks
to you. (3)
 You will speak normally, but you
are confused. You don’t remember
exactly what happened to you, and
you give the wrong month if asked.
(4)
 You will be slow to follow
commands like, “show me two
fingers,” but you will be able to do
so. (6)
GCS SCORE: 13
Patient 11
 Your eyes will be closed, even if
someone talks to you or pinches
you. (1)
 You will answer questions
correctly. Mention that your head
hurts. If anyone asks you to open
your eyes, refuse and say "the light
makes my head hurt really bad." (5)
 Follow commands appropriately,
but don't open your eyes. (6)
GCS SCORE: 12
This patient is oriented, but cannot open
his eyes due to pain, not because he is
unconscious.
Patient 10
 Your eyes will be closed, even if
someone pinches you. (1)
 The only sound you make will be a
weak groan when someone pinches
you. (2)
 You will not follow commands, but
if someone pinches you, you will
try to pull away or turn away from
the pain. (4)
GCS SCORE: 7
Patient 12
 Your eyes will be closed, but you
will open them if anyone pinches
you. (2)
 Your speech will be fairly clear
when you are aroused by a painful
stimulus, such as a pinch, but you
will only say, “leave me alone" or
"what are you doing?" and soon go
back to sleep. (4)
 If someone asks you a question
while you are still awake, you'll
say, “I don’t know,” and go back to
sleep. (4)
 You will not follow commands, but
if someone pinches you, you will
quickly push his or her hand away.
(5)
GCS SCORE: 15
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Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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Patient 13
 Your eyes will be open. (4)
 Your speech won’t make much
sense. In answer to a question like,
“what month is this?” you will say
something like, “he, umm, he . . .
My jacket. I don't . . .(3)
 You will not follow commands, but
if someone pinches you quickly
push his or her hand away. (5)
Patient 14
 Your eyes will be closed, even if
someone pinches you. (1)
 You will not make any sound, even
if someone pinches you. (1)
 You will not follow commands. If
someone pinches you, put your
arms rigidly at your side.(2)
GCS SCORE: 4
This patient only scores 2 for motor
response as she is exhibiting decerebrate
GCS SCORE: 12
posturing.
Patient 15
Patient 16
 Your eyes will be closed, even if
 Your eyes will be closed at first, but
someone pinches you. (1)
you will open them if someone calls
you loudly.(3)
 You will keep repeating some
meaningless phrase like, "I want my
 You will not say any recognizable
bunny slippers, I want my bunny
words. If someone asks you a
slippers, I want . . ." Keep it up
question, look confused and say,
continually, and if someone pinches
"mmm ? " without opening your
you, just say it louder. (3)
mouth.(2)
 You will sit up and rock
 You will not follow commands. If
continually. You will not follow
someone pinches you, pull away.(4)
commands. If someone pinches
you, push or slap the hand away. (5)
GCS SCORE: 9
Although the patient is speaking in
complete sentences, the responses are not
appropriate.
©
GCS SCORE: 9
Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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Student’s Name: _______________________
2.4.3 WORKSHEET 16: SHEEP BRAIN DISSECTION – ANSWER KEY
(www.brainu.org)
I. Characteristics of a brain
Write down 5 physical characteristics of your sheep brain? (e.g. how the brain feels,
color of the brain, etc)
”Jello-like”
.
“Slick”
.
III.
“Slippery”
.
IV.
“Spongy”
.
“Convoluted”
.
I.
II.
V.
II. Identifying brain regions
Body directions to use when talking about the brain.
Lateral = towards the side
Medial = towards the middle
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a. Draw the LATERAL (outer side) view of your sheep brain (include the cerebellum
and brainstem). Label the different lobes. You can peel the covering halfway back.
b. Looking at your drawing, find the different lobes of the brain on your sheep brain.
List the functions of each lobe.
1. Frontal Lobe
The executive functions of the frontal lobes involve the ability to recognize
future consequences resulting from current actions, to choose between good
and bad actions (or better and best), override and suppress unacceptable
social responses, and determine similarities and differences between things or
events. Therefore, it is involved in higher mental functions.
The frontal lobes also play an important part in retaining longer term
memories which are not task-based. These are often memories associated with
emotions derived from input from the brain's limbic system. The frontal lobe
modifies those emotions to generally fit socially acceptable norms.
2. Parietal Lobe
The parietal lobe plays important roles in integrating sensory information
from various parts of the body, knowledge of numbers and their relations, and
in the manipulation of objects. Portions of the parietal lobe are involved with
visuospatial processing.
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3. Temporal Lobe
The temporal lobe is involved in auditory processing and is home to the
primary auditory cortex. It is also heavily involved in semantics both in
speech and vision.
4. Occipital Lobe
The occipital lobe is the visual processing center of the mammalian brain
containing most of the anatomical region of the visual cortex
It is also involved with visuospatial processing, color discrimination and
motion perception.
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c. Draw the MEDIAL (inner side) view of the sheep brain. Label all of the brain
parts that you can see.
d. Look at your sheep brain and find out whether you have the right or left half
(hemisphere). I have the _______________________ half (hemisphere).
Find another group with the opposite half as yours and put both halves together.
Compare the size of the brain to the size of a known object e.g. the whole sheep brain
is as small as an apple. Write your comparison below.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
III. Coverings of the brain
The dura mater (tough mother) is a protective covering of the brain. Does your
sheep brain have a dura mater? (Hint: it looks white or purplish)
The sheep brains may or may not have a dura mater.
a.
To take the dura mater off, locate the ROSTRAL end of your sheep brain.
b. Using your thumb and index finger, peel the dura mater back towards the
CAUDAL side. You might have to use the scissors to snip part of the dura mater at
the ROSTRAL end.
c. Remove the dura mater.
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Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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d. Try pulling the dura mater apart. What do you notice? Does it rip like a piece of
paper? Describe the properties of the dura mater.
The students may describe the dura mater as tough, cannot pull apart, must cut.
IV. First dissection – Exploring the Neuron and its parts
a. Find the structure of a neuron from your textbook. Draw a neuron and label its
parts.
Diagram of neuron
National Institute on Drug Abuse (NIDA)
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b. Place your brain with the cut-side (MEDIAL) down.
c. Using your plastic knife, cut the brain about 1 inch from the rostral end (where the
dent is located).
d. Draw the inside of the cutoff piece.
White matter
Grey matter
The dark area (grey matter) contains the cell bodies of neurons
The light area (white matter) is made up of myelinated axons
Image of cut section of sheep brain http://www.exploratorium.edu/memory/braindissection
e. What do you notice about the cut surface?
There seems to be two different layers of tissue: A white inner layer (white matter)
and a darker outer layer (grey matter).
f. Using the probe stick, poke the dark area? How does it feel?
g. Using the probe stick, poke the light area? How does it feel?
h. Identify the dark and light areas.
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V. Second dissection: Memory function of the brain
What is the part of the brain that stores short term memories?
The part of the brain that stores short-term memories is the prefrontal cortex.
a. To find this brain part, slide your thumb along the outside (lateral side) of the brain
stem until it disappears under the cerebrum.
b. Keep wiggling your thumb and dig it gently under the cortex until you can’t push it
in any more.
c. Pull back the cerebrum so that you break the brain into two pieces. The memory
center is the white C-shaped band of fibers and the grey matter inside them right
around the area where the brain broke apart.
d. Try to pull it out.
i. What do you notice about it?
ii. What kinds of things does a sheep need to remember?
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VI. Comparing Sheep Brains to Human Brains
a. Label the brain parts in both the human and sheep brain picture.
MEDIAL view of the human brain
Cerebrum (frontal lobe)
Corpus callosum
CAUDAL
Cerebellum
MEDIAL view of the sheep brain
Cerebellum (occipital lobe)
Cerebellum
CAUDAL
Corpus callosum
The outer layer of the brain is called the cerebral cortex is the thin layers of worm-like
gray matter forming the surface of the hemisphere. The cortex is arranged in folds
called gyri (singular = gyrus) which are separated from one another by folds called sulci
(singular = sulcus).
b. Observe the cortex in the sheep and the human brain. What do you notice about
their relative size?
This region is more extensive in the human brain.
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c. What is the role of this region of the brain?
This region is responsible for all levels of cognition, which includes all thought and
memory.
d. Why does it differ between human and sheep?
Humans have much higher levels of cognition.
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Copyright, Stevenson University, 2009; AHP Course 1_Unit 2: Section 4_Teacher Version 2
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