Solutions To Exercises Lesson

The Peripheral Neuropathy Solution

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1. Two types of nervous tissues are neurons (nerve cells) and gjia (neuroglia). The neuron is the basic structural unit of the nervous system. The glia are cells of supporting tissue for the nervous system. (para 11-1)

2. Nervous tissues are specialized to:

a. Receive stimuli.

b. Transmit information.

c. Store information. (para 11 -2)

3. A neuron is a nerve cell body and all of its processes. (para 11 -3)

4. A dendrite carries impulses toward the cell body. (para 11 -5a)

5. An axon is a neuron process which transmits information from the cell body to the next unit. (para 11 -5b)

6. More than two poles: multipolar neuron. Two poles: bipolar neuron.

One pole: unipolar neuron. (para 11 -6a)

8. From receptor organs to the CNS: sensory neurons. From the CNS to muscles and glands: motor neurons. From one neuron to another: interneurons. (para 11 -6c)

9. The term "continuity without contact" refers to the fact that neurons do not actually touch. Thus, there is no electrical transmission of impulses from one neuron to the next. In fact, information is transferred across the synaptic cleft by chemicals called neurotransmitters. (para 11 -7)

10. A synapse is a "connection" between two neurons. An axon terminates in tiny branches. At the end of each branch is a terminal bulb. Neurotransmitters are stored in bundles called synaptic vesicles located within each terminal bulb. The presynaptic membrane is the thickened layer of the terminal bulb which faces the synaptic cleft and through which pass the neurotransmitters before entering the synaptic cleft. The synaptic cleft is the space between the terminal bulb of the first neuron and the dendrite or cell body of the second neuron. The postsynaptic membrane is that portion of the membrane of the second neuron which lies near the terminal bulb of the first neuron. (para 11 -7a)

11. A neuromuscular junction is a "connection" between the terminal of a motor neuron and a muscular fiber. Comparison: The neuromuscular junction has an organization identical to a synapse. However, the bulb is larger and protrudes into the surface of the muscle fiber. The postsynaptic membrane is also larger and has foldings. (para 11 -7b)

12. The major divisions of the human nervous system are the central nervous system (CNS), the peripheral nervous system (PNS), and the autonomic nervous system (ANS). The CNS is made up of the brain and the spinal cord. (para 11-8)

13. The three major subdivisions of the human brain are the brainstem, the cerebellum, and the cerebrum. The brainstem is that part of the brain remaining after removal of the cerebrum and cerebellum. It is the basal portion. Together with the spinal cord, it is known as the neuraxis. (para 11 -9a)

14. The cerebellum is a spherical mass of nervous tissue attached to and covering the hindbrainstem. Its three major parts are the vermis and right and left cerebellar hemispheres. In addition, the cerebellum has three pairs of stem-like connecting parts called peduncles. The outer cortex is composed of gray matter, which is the cell bodies of neurons. More central is the white matter, which is the myelinated processes of neurons. The cerebellum is the primary coordinator/ integrator of motor actions of the body. (para 11 -9b)

15. The cerebrum consists of two very much enlarged hemispheres connected to each other by a special structure called the corpus callosum. Each cerebral hemisphere is connected to the brainstem by a cerebral peduncle. The surface of each cerebral hemisphere is subdivided into areas known as lobes. The names of the four lobes are frontal, parietal, occipital, and temporal. (para 11 -9c)

16. The space separating the two cerebral hemispheres is called the longitudinal fissure. The shallow grooves in the surface of the cerebrum are called sulci. The ridges outlined by the sulci are called gyri. (para 11 -9c(1))

17. The gray outer layer of each hemisphere is the cerebral cortex. Deeper within the cerebral hemispheres, the tissue is colored white. The "gray matter" represents the cell bodies of the neurons. The "white matter" represents the axons.

18. Groups of related functions are associated with specific areas of the cerebral cortex. For example, centers of speech and hearing are located along the lateral sulcus. Vision is centered in the occipital lobe. Sensory and motor functions are located along the central sulcus. (para 11 -9c(3))

19. The ventricles of the brain are interconnected hollow spaces filled with CSF. The right and left lateral ventricles are found in the cerebral hemispheres. The lateral ventricles are connected to the third ventricle by the interventricular foramen. The third ventricle is located in the forebrainstem. The third and fourth ventricles are connected by the cerebral aqueduct. The fourth ventricle is located in the hindbrainstem. The fourth ventricle is continuous with the part of the spinal cord known as the central canal. (para 11 -9d)

20. The spinal cord, located within the spinal canal, is continuous with the brainstem. The spinal cord has two enlargements. One, associated with nerves for the upper members, is called the cervical enlargement. The other, associated with nerves for the lower members, is called the lumbosacral enlargement. Nerves arising from the spinal cord are called spinal nerves. There are 31 pairs of spinal nerves. (para 11-10a)

21. In the cross section of the spinal cord, one can see a central region of gray matter shaped like an H. Each arm of this figure is called a horn. The connecting link is called the gray commissure. These horns are actually sections of the gray columns. Since a column of white matter is a large bundle of processes, it is called a funiculus. (para 11-10b)

22. The skeletal covering for the brain is provided by bones of the cranium. The overall skeletal structure covering the spinal cord is the vertebral column (spine). (para 11-11a)

23. The brain and spinal cord have three different membranes surrounding them called meninges. The tough outer covering for the CNS is the dura mater. Beneath it is the subdural space. The fine second membrane is called the arachnoid mater. Beneath it is the subarachnoid space, which is filled with CSF. The delicate membrane applied directly to the surface of the brain and spinal cord is called the pia mater. (para 11-11b)

24. The two main pairs of arteries supplying oxygenated blood to the brain are the internal carotid and the vertebral arteries. Beneath the brain, branches of these arteries join to form a circle, called the cerebral circle (of Willis). The main pair of veins carrying blood back toward the heart is the internal jugular veins. The blood supply of the spinal cord is by way of a combination of three longitudinal arteries running along its length and reinforced by segmental arteries from the sides. (para 11-12)

25. Found in the cavities of the CNS is a clear fluid called cerebrospinal fluid (CSF). This fluid is found in the ventricles of the brain, the subarachnoid space, and the spinal cord's central canal. Special collections of arterial capillaries found in the roofs of the third and fourth ventricles are called choroid plexuses. These structures continuously produce CSF from the plasma of the blood. (para 11-13)

26. As CSF is produced by the choroid plexuses, it flows into all four ventricles. CSF from the lateral ventricles flows into the third ventricle and then through the cerebral aqueduct into the fourth ventricle. By passing through three small holes in the roof of the fourth ventricle, CSF enters the subarachnoid space. From here, the CSF is transported through the arachnoid viNi into the venous sinuses.

27. The peripheral nervous system is that portion of the nervous system which generally provides commands for skeletal muscles and other striated muscles and carries sensory information from the periphery of the body. A nerve is a collection of neuron processes, together and outside the CNS. (para 11 -14a)

28. The 12 pairs of nerves attached to the right and left sides of the brainstem are called cranial nerves. Each such nerve is identified by a Roman numeral in order from I to XII and an individual name. Attached to the sides of the spinal cord are 31 pairs of spinal nerves. For each, the region is designated by a letter; within each region, a nerve pair is identified by an Arabic numeral. (para 11 -14c)

29. Like a tree, a typical spinal nerve has roots, a trunk, and branches (called rami). Coming off of the posterior and anterior sides of the spinal cord are the posterior and anterior roots of the spinal nerve. An enlargement on the posterior root is the posterior root ganglion. A ganglion is a collection of neuron cell bodies, together, outside the CNS. Laterally, the posterior and anterior roots of the spinal nerve join to form the spinal nerve trunk. The spinal nerve trunk of each spinal nerve is located in the corresponding intervertebral foramen of the vertebral column. As the nerve trunk emerges laterally, it divides into the anterior and posterior rami. (para 11-15a)

30. If it carries information from the periphery to the CNS, it is an afferent (sensory) neuron. If it carries information from the CNS to a muscle or gland, it is an efferent (motor) neuron. (para 11 -15b)

31. An automatic reaction to a stimulus is referred to as a reflex. The pathway from the receptor organ to the reacting muscle is called the reflex arc. (para 11 -15c(1))

32. The pathway of a general reflex arc involves a minimum of five structures. The stimulus is received by a receptor organ. The information is transmitted to the CNS by the afferent (sensory) neuron. Within the spinal cord, there is a special neuron connecting the afferent neuron to the efferent neuron; this special connecting neuron is called the interneuron (or internuncial neuron). Carrying the appropriate command from the spinal cord to the reacting muscle is efferent (motor) neuron. The reacting muscle is called the effector organ. (para 11-15c(2))

33. The autonomic nervous system is that portion of the nervous system generally concerned with commands for smooth muscle, cardiac muscle, and glands. (para 11-16)

34. In the ANS, the number of neurons connecting the CNS with a visceral organ is always two. The cell bodies of the second neurons form a collection outside the CNS, called a ganglion. The first neuron extends from the CNS to the ganglion and is therefore called the preganglionic neuron. Cell bodies of the second neurons make up the ganglion. The second neuron's processes extend from the ganglion to the visceral organ. Thus, the second neuron is called the postganglionic neuron. (para 11 -16b)

35. The efferent pathways of the ANS fall into two major divisions. The one most active during a "fight-or-flight" reaction is the thoraco- lumbar outflow (sympathetic nervous system). The other is the cranio- sacral outflow (parasympathetic nervous system). (para 11 -16c)

36. The intermediolateral gray columns from the T-1 to the L-2 levels of the spinal cord are made up of the cell bodies of the preganglionic sympathetic neurons. The sympathetic ganglia are made up of the post- ganglionic sympathetic neurons. The sympathetic NS activates those visceral organs needed to mobilize energy for action. It deactivates those which are not needed. (para 11-17)

37. Four pairs of nuclei in the brainstem and the intermediolateral gray columns at the S-2 through S-4 levels of the spinal cord are made up of the cell bodies of the preganglionic parasympathetic neurons. The intramural ganglia within the walls of the central visceral organs are made up of the cell bodies of the post-ganglionic parasympathetic neurons. As compared to that of the sympathetic NS, the parasympathetic NS has the opposite effect on visceral organs. (para 11-18)

38. A pathway is the series of nervous structures utilized in the transmission of an item of information. (para 11 -19a(1))

39. The neuraxis is the brainstem and the spinal cord, considered together as one structure. (para 11-19a(2))

40. A sensory pathway is a series of nervous structures used to transmit information from the body to the CNS. (para 11 -19b(1))

41. A motor pathway is a series of nervous structures used to transmit information from the CNS to the body. (para 11-19b(2))

42. The human nervous system has several levels of control. The lowest level is the simple reflex arc. The highest level is the conscious level. Between, there are several progressively higher levels. All information input and all information output are monitored and evaluated. (para 11 -19c)43.The right half of the brain controls the left side of the body. The left half of the brain controls the right side of the body. (para 11 -20)

44. A pyramidal motor pathway is primarily concerned with volitional (voluntary) control of body parts, particularly the fine movements of hands. These pathways are called pyramidal because their neuron processes help to make up structures in the base of the brain called pyramids. (para 11 -20a)

45. An extrapyramidal pathway is primarily concerned with automatic (nonvolitional) control of body parts for purposes of coordination. (para 11 -20b)

46. Examples of general senses are:

b. Temperature (warm and cold).

d. Proprioception ("body sense"). (para 11 -21c)

47. Examples of special senses are:

a. Smell (olfaction).

b. Taste (gustation).

c. Vision.

d. Hearing (auditory).

e. Equilibrium. (para 11-21d)

48. The general sensory pathway is from the receptor organ, via the PNS nerves, to the CNS. This general pathway then ascends fiber tracts in the neuraxis. The pathway ends in the central area of the opposite cerebral hemisphere.

49. The receptors for the sense of smell are special hair cells called chemoreceptors. These are found in the olfactory epithelium, high in the nasal chambers in the head. The information received is transmitted by way of the olfactory nerves to the olfactory bulbs and then into the opposite cerebral hemisphere.

50. Special hair cells (chemoreceptors) are found in the taste buds, scattered over the tongue and the rear of the mouth. These cells, which react to dispersed or dissolved food molecules, are the sensory receptors for the special sense of taste. The information received is transmitted to the opposite side of the brain by three cranial nerves. (paras 11 -24, 11 -25)

51. The eyeball is the sense organ containing the receptor tissues for the special sense of vision. The eyeball is shaped like a bulb (or sphere).

52. The outermost layer of the eyeball is colored white and is made up of very dense FCT; it is known as the sclera, scleral coat, or fibrous tunic. Its anterior portion is called the cornea. The major focusing device for the eyeball is the cornea. (para 11-27b(1))

53. The middle layer of the wall of the eyeball is known as the choroid, choroid coat, or vascular tunic. This layer is richly supplied with blood vessels and pigmented with a black material. (para 11 -27b(2))

54. The inner layer of the wall of the eyeball is known as the retina, retinal coat, or internal tunic. The actual photoreceptor elements are located at the back and the sides. These elements are the rods and the cones. (para 11 -27b(3))

55. The elements which register colors are the cones. However, cones require more intense light than do rods. Rods register only black and white. (para 11 -27c(1)(a))

56. The fovea centralis is a small depression at the posterior end of the eyeball opposite the pupil. The macula lutea is a small yellow area of the retina where vision is sharpest. It includes the fovea centralis. (para 11-27c(1)(b))

57. The blind spot is the point of exit of the optic nerve, at the posterior end of the eyeball where there are no rods and cones. (para 11-27c(1)(c))

58. The thickening of the choroid layer around the edge of the lens is called the ciliary body. It includes radial muscle fibers making up the ciliary muscle.

59. The lens is biconvex. The anterior surface is flatter than the posterior surface. The lens is transparent and elastic. Its thickness varies with contraction or relaxation of the ciliary muscle. Accommodation is the process in which close objects are seen more clearly; it involves contraction of the ciliary muscle, reduction in pupil size, and convergence of the lines of sight. (para 11 -27c(4))

60. The space between the cornea and the iris is called the anterior chamber. The space between the iris and the lens is called the posterior chamber. Together, these make up the space between the cornea and the lens called the anterior cavity and filled with the aqueous humor. This drains into the encircling canal of Schlemm, located in the angle between the cornea and the iris. Behind the lens is a jellylike material called the vitreous body. It fills the posterior cavity of the eyeball. (para 11-27c(6), (7))

61. The orbit is the cavity in the upper facial skull which contains the eyeball and its adnexa. The orbit is shaped roughly like a cone. (para 11-28a)

Examples of the adnexa are the:

a. Extrinsic ocular muscles.

b. Eyelids.

c. Lacrimal apparatus.

d. Eyebrow.

63. Of the six extrinsic ocular muscles, four are called recti muscles. Two are oblique muscles. The lateral rectus M. is on the outer side of the eyeball. The superior rectus M. is above the eyeball. The medial rectus M. is on the inner side of the eyeball. The inferior rectus M. is below the eyeball. The superior oblique and inferior oblique muscles approach the eyeball from the medial side. (para 11 -29a)

64. Attached to the margins of the orbit are the upper and lower eyelids. These have special hairs called eyelashes. The inner lining of the eyelids is continuous with the conjunctiva, a membrane over the anterior surface of the eyeball.

65. In the upper outer corner of the orbit is a lacrimal gland, which secretes a lacrimal fluid, which is ultimately collected and delivered into the nasal chamber by the nasolacrimal duct. (para 11 -29c)

66. Neurons carry information from the photoreceptors located in the nervous retina. They leave the eyeball at the blind spot. Passing to the rear of the orbit, the neurons now belong to the optic nerve (cranial nerve Jj). The optic nerve enters the cranial cavity by passing through the optic canal. Beneath the brain, the optic nerves from both sides join to form the optic chiasma, in which half of the neurons from each optic nerve cross to the opposite side. From the optic chiasma, the right and left optic tracts proceed to the brain proper. (para 11 -29e)

67. The human ear has two major special sensory functions: hearing (auditory) and equilibrium (balance). The three parts of the human ear are the external (outer) ear, the middle ear, and the internal (inner) ear. (para 11 -30)

68. The external flap of the ear is called the auricle (pinna). It directs airborne sound waves into the canal called the external auditory meatus, which extends into the temporal portion of the skull. (para 11-31)

69. The tympanic membrane is between the external auditory meatus and the middle ear cavity. On the medial side of the tympanic membrane, there is a space within the temporal bone called the middle ear cavity. The auditory ossicles are three very small bones linking the tympanic membrane to the medial wall of the middle ear cavity. The auditory ossicles respond to a sound stimulus by vibrating (mechanically oscillating). From the lateral to the medial ends, the names of the ossicles are: malleus, incus, and stapes. The auditory tube connects the middle ear cavity with the nasopharynx. (para 11 -32)

70. The bony labyrinth is a complex cavity within the temporal bone. It has three semi-circular canals, a vestibule (hallway), and a snail- shaped cochlear portion. The membranous labyrinth is a hollow tubular structure suspended within the bony labyrinth. (para 11 -33a)

71. The endolymph fills the space within the membranous labyrinth. The perilymph fills the space between the membranous labyrinth and the bony labyrinth. (para 11-33b)

72. The cochlea is a spiral structure associated with hearing. It has 2-1/2 turns. Its outer boundaries are formed by the snail-shaped portion of the bony labyrinth. (para 11 -33c)

73. The central column of the cochlea is called the modiolus. Extending from this central column is a spiral shelf of bone called the spiral lamina. Connecting this shelf with the outer bony wall is a fibrous membrane called the basilar membrane. This membrane forms the floor of the spiral portion of the membranous labyrinth called the cochlear duct. This contains a structure with hairs, sensory receptors of hearing; this structure is called the organ of Corti. (para 11 -33c(1))

74. Within the bony cochlea, the space above the cochlear duct is known as the scala vestibuli and the space below is known as the scala tympani. Between the middle ear cavity and the upper space is an oval window called the fenestra vestibuli. Between the middle ear cavity and the lower space is a round window called the fenestra cochleae. (para 11-33c(2), (3))

75. A sound stimulus is transferred from the stapes to the fluid perilymph of the scala vestibuli. In response, the basilar membrane of the cochlea vibrates. The hair cells of the organ of Corti are mechanically stimulated. This stimulation is transferred to the neurons of the acoustic nerve, which passes out of the modiolus into the internal auditory meatus of the temporal bone. From here, the nerve enters the cranial cavity and goes to the brain. (para 11 -33d)

76. The two sac-like portions of the membranous labyrinth are the sacculus and the utriculus. They are filled with endolymph. On the wall of each sac is a collection of special hair cells known as the macula, which serves as a receptor organ for static and linear kinetic gravitational forces. The saccular macula and the utricular macula are oriented at more or less 90° angles to each other. (para 11-35)

77. Extending from and opening into the utriculus are three hollow structures called the semicircular ducts. The utriculus completes the circles for each duct. The three ducts are all oriented at 90° angles to each other. Where it opens into the utriculus, each semicircular duct ends in an enlargement called an ampulla.

Movement of the fluid endolymph bends the hairs of the crista in specific directions. These are responses to linear and/or angular kinetic gravitational forces. (para 11 -36b)

78. Carrying the information from the maculae and the cristae to the brain is the vestibular nerve. Contained in the same fibrous sheath from the membranous labyrinth to the brain are the vestibular and auditory nerves. (para 11 -37)

79. The simplest and lowest level of control is the reflex arc. Producing wider reactions to stimuli are segmental reflexes. A number of nuclei in the hindbrain monitor and control visceral functions of the body, including respiration and heartbeat. The facilitatory and inhibitory areas of the reticular formation monitor and control general body functions, including sleep. The thalamus is a primary relay for information going to and from the cerebrum and cerebellum. One of the most important integrators of motor activity of the body is the cerebellum.

80. In humans, the highest level of control is in the cerebrum. Here, we can clearly designate three levels of control.

a. The first level is concerned with visceral activities of the body, as related to fight-or-flight, fear, and other emotions.

b. At the second level, activities of the body are standardized and repetitive in nature. An example is the sequence of muscle actions involved in walking.

c. At the third level, brand new solutions can be created. This is the volitional level.

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