1.Jackie V., age 17, has enjoyed riding horses in competitions since early childhood. In recent months, she has been practicing many hours with Fletcher, thebeautiful stallion with whom she hopes to share glory at the Olympic Games. Jackie is galloping around the track on Fletcher preparing for the next jump, whenFletcher stumbles on a rock, causing Jackie to fall to the ground and land on her head. She knows right away that she is in trouble. She loses all feeling from theneck down and is unable to move her arms or legs.A. What part of the spinal cord is likely to be injured?B. What is the name of the condition wherein there is a loss of use of both the arms and the legs?2.A bystander calls emergency medical technicians to the scene. The EMTs stabilize her neck in a cervical collar before moving her. Jackie is carried in the supineposition and attention is given to keeping her airways open. She is given a high concentration of oxygen and ventilated through a mask on the way to thehospital.She arrives at the hospital within an hour of her fall. At the hospital, X- rays show fracture of the C1-C2 vertebra. To reduce inflammation, an injectionof methylprednisolone (MP) is given. Smaller doses of the same corticosteroid drug are administered over the next 24 hours.A. Why were the paramedics so careful to stabilize the neck?B. Why might breathing difficulties be expected with this kind of injury?C. What are the names of the C1 and C2 vertebra?D. Why is a corticosteroid such as methyprednisolone important in treating this kind of disorder?3.Within 24 hours, Jackie has more motor and sensory function and is diagnosed with an incomplete transection of the spinal cord at the C 2 vertebrae. She has somebreathing difficulties and continues to receive oxygen through fiber-optic nasopharyngeal intubation. Her neck is immobilized by traction. Jackie is moved in herbed frequently in an effort to avoid respiratory infection, pressure sores on her skin, and joint contracture.A. What is an incomplete transection?B. What effects in the body are expected from a C-2 injury? C. Explain what organ systems other than the nervous system are critically impacted?D. Why would Jackie be prone to respiratory infections4.Jackie's physician, Dr. Stringer, tells her and her family that recovery will be slow while the bone and soft tissues heal. She will not offer a prognosis atthis time and tells Jackie that she is in "spinal shock." Dr. Stringer tells Jackie's family that many options are available for treatment of spinal cord injuriesthat were not available a few years ago. Depending of the course of Jackie's recovery, a choice of treatment will be made.A. What is spinal shock?B. Until a few ago, regeneration of tissue in the adult cord was thought to be an impossibility. Why was this the case?5.Over the next two weeks, Jackie begins to have muscle spasms, but breathing becomes easier for her. Her body temperature tends to fluctuate, and she continues tohave gastrointestinal, cardiovascular, and urinary problems. She has neither bladder, nor bowel control, and her heart rate and blood pressure are low. Her somaticand visceral reflexes are intact. Jackie remains in the hospital for ninety days.A. Why would temperature regulation be impaired?B. Why are sympathetic effects inhibited in this type of cord injury?6. Jim, 65 years old, visits his new physician on Friday afternoon. Jim has a headache that will not go away. He and his wife retired and moved into a new homeabout 3 months ago. A week ago, he was looking for their cat, Oscar, which he found under the steps to the porch. When backing out from beneath the porch, Jimbanged his head. Jim thinks the headache started either at that time or shortly thereafter, during an argument with his wife. Jim wants to get rid of Oscar becausehe thinks he is too much trouble, but his wife won't consider it. Their arguments have been heated, and he has often developed mild headaches afterward.A. List the possible causes of headaches that match Jim’s history:7. Jim describes his current headache as continuous, all over his head, and extending into his posterior neck muscles. His neck muscles are tight. His vision andhearing are normal, and he has no nausea. Tylenol and ibuprofen have helped slightly. He hasn't been sleeping well and remains upset about the cats.A. What is the significance of these symptoms?B. Does the lack of substantial pain relief with these drugs suggest anything about the nature of the problem?8.On physical examination, Jim is alert and oriented, and his vital signs are normal. His neck is supple and has normal range of motion. The skull is normal onpalpation, and there are no signs of abnormal cranial nerve function. His tympanic membranes are normal, as are his optic reflexes and retinae. His gait and deeptendon reflexes are also normal. The physician reaches a preliminary diagnosis of a muscle tension headache and gives Jim a mild sedative/muscle relaxant/painmedication. Jim has instructions to call or return if the headache does not improve.A. What is the significance of these findings? What possible problems were ruled out in the course of this examination?9.On Monday, Jim calls the physician's office to report that the headache is worse. The physician sees him that morning at 11 A.M. Jim's appearance and manner havechanged markedly over the weekend. He could not drive, so his wife brought him to the office. He seems drowsy (which he attributes to the medication), and hisheadache is worse. It is a throbbing pain that increases if he lies down, presses against his head, or flexes his neck. His vision is still normal. Although he isnot vomiting, he has not wanted to eat today.A. What is the significance of these symptoms?10.On physical examination, Jim still has normal vital signs, and he has no fever. However, his blood pressure is 140/90, up from 120/80 on Friday. His neck motionis normal, but flexion increases the severity of the headache. His cranial nerve, optic, and gait/balance tests are normal and symmetrical. The skull remainstender to the touch.A. Why is it important that these results are symmetrical? What would be the implications if they had been asymmetrical?11.Because there has been no improvement and the symptoms have worsened, Jim is sent for a CT scan of the head and a series of blood tests. The radiologist reportsto the family physician that the CT scan shows a large, bilateral subdural hematoma of uncertain age. A skull fracture is not indicated, and the blood tests(CBC,WBC, diff. count) are normal.A. Is it significant that the blood tests are normal? If results had been abnormal, what else could be involved?12.Jim is referred to a neurosurgeon. After discussion, Jim signs informed consent papers and is taken to the operating room. The neurosurgeon draining thesubdural hematoma reports that when the skull is pierced, blood is initially released at high pressure. After recovering from anesthesia, Jim finds that hisheadache is virtually gone. He jokes with his family physician that he's glad he didn't have to get his head shaved (he is already bald), and says he has decidedto buy a big dog.A. What does the high-pressure release tell you about the status of the hematoma?13.Myah Burk is a 24-year old female that attends university on a regular basis and has a part-time job at a small gift store. Lately Myah has been experiencingepisodes of muscle fatigue, numbness and tingling of the extremities and blurred or double vision. For the most part, these symptoms were mild and usuallydisappeared in a day or two. She attributed her fatigue and blurred vision to preparation for exam week and working evenings and weekends at her job. However, thesymptoms persisted after exam week. Myah noted that she felt weak and tired most of the time, so she decided to visit her doctor.Myah met with her family doctor and explained that she felt tired all the time and that she was having problems seeing, especially with her left eye. The doctorcarried out a routine examination and found nothing out of the ordinary so he sent her to see an ophthalmologist. The ophthalmologist noted her symptoms andordered a full neural examination including an MRI and a spinal puncture for a sample of cerebrospinal fluid (CSF).The results from her tests indicated that her extremities were slightly hyper-reflexive, she had elevated protein levels in her CSF, and her MRI showed multipleregions of demyelinated axons (plaques) that were located along the optic nerve, cerebellum, brain stem and spinal cord. The diagnosis was multiple sclerosis(MS).A. Which of the neuroglia cells is responsible for production of myelin sheaths around axons in the central nervous system:14.Myah had muscle fatigue and hyper-reflexia because of plaques on the corticospinal tract slows nerve transmission along the descending motor pathways from thecortex to the spinal motor neurons. This produces muscle weakness and hyper-reflexia.A. Why did Myah have visual problems?B. Why did Myah have numbness or tingling of the extremities?15.A 17-year-old male was working vigorously on a summer construction crew building a new section of a freeway. In the intense heat of the day, he began toexperience severe pain in the muscles of his limbs and carpopedal spasms. The cramping made his muscles feel like hard knots. The foreman of the crew instructedthe young man to drink some salt water he had available and rest a while.What caused the cramping?16. Why was the ingestion of salt and water beneficial for this patient?17.Prior to intubation for a surgical procedure, the anesthesiologist administered a single dose of the neuromuscular blocking agent, succinylcholine, to a23-year-old male to provide muscular relaxation during surgery and to facilitate the insertion of the endotracheal tube. Succinylcholine acts as a depolarizingagent that prevents repolarization of the nerve. Therefore, no further ACh is released until the drug is cleared.What typically prevents acetylcholine (ACh) from accumulating in the neuromuscular junction and causing a sustained contraction in a normal individual?18.70-year old Russell Johnson was diagnosed with Parkinson’sdisease three years ago. This disease affects motor areas of the brain, causing slowed movements, bodytremors, and gait disturbances. Parkinson’s is a progressive disease, leading to the gradual deterioration of its victims. Which type of nuclei is damaged in thispatient?19. Which type of activity does the cell bodies in the pre-central gyrus process?a. somatosensoryb. visionc. smelld. motor commands.20.Normally, the substansia nigra sends neurons to the basal nuclei. These neurons release a hormone to inhibit the basal nuclei. When the substantia nigra isdamaged, however, the inhibitory signals essential to motor integration are missing. Name the hormone that inhibits the basal nuclei.21. What structural class of neurotransmitter does the hormone from your answer in # 20 belong?22.Debra was in an automobile accident and receives trauma to the face. After X-rays, she has factures to the maxilla and the mandible. She also complains thatthey have lost sensation to her face and difficulty moving the muscles in her mouth. Which cranial nerve most likely has been damaged by this injury?23.Your next patient Mark, was in a fight and received trauma to the neck. He complains of difficulty moving several of the muscles in his neck. Which nerve mostlikely was damaged during the fight?24. Bill was stung by several bees and transported to the emergency room. He arrives and is in anaphylaxis (anaphylactic shock), life-threatening type of allergicreaction where the blood vessels dilate and blood pressure drops. Typically, the neurotransmitter, norepinephrine reverses this. Instead, you accidentallyinjectacetylcholine and he died. What happened?25.As a result of your experience with Bill, you decide to move to and practice as a nurse in Australia. In spite of its beauty, Australia is home to the top tenmost poisonous animals. Tom arrives at your emergency room, from at a local beach. He found and decided to capture a Blue Ringed Octopus. Instead, the octopus bithim. The painless bite from the octopus may seem innocuous, however the deadly neurotoxins in the animal’s saliva immediately begin working. A major component ofthe toxin is a compound called Tetrodotoxin. This toxin blocks sodium channels within a few minutes. What would this do to his motor output and respiration?