Q.

1: KEY: PRIMARY MOTOR CORTEX There is topographical (parts by parts) representation of body & contralateral as well as upside down representation. By joining these parts, a figure of the body is formed: MOTOR HOMUNCULUS. Parts of body concerned with precise, fine & skilled movements, are represented by much larger area. (0.5) It is concerned with controlling muscles of hands & muscles of speech. Coordinated movement of contra-lateral parts of body. (0.5) (0.5)

PREMOTOR AREA In this area there is also topographical representation of different parts of body & pattern is similar to that in primary motor area. (0.5) When pre motor area is stimulated there are movements involving contraction of groups of muscle. (0.5) This area programs the activity of primary motor area with the help of patterns already stored in brain. (0.5) Anterior part first develops a Motor image of the total muscle movement that is to be performed. (0.5) Posterior premotor cortex, excites each successive pattern of muscle activity required to achieve the image. This posterior part of the premotor cortex sends its signals either directly to the primary motor cortex to excite specific muscles or, often, (0.5)

Supplementary Motor Area When it is stimulated, there is movement of limbs or other parts on both sides (bilateral movement). Bilateral grasping movement. (0.5)
It controls the attitudinal, positional or fixation movements, e.g, background posture required for climbing up. It supplements finer motor control areas (pre motor & primary motor) by positional movements of head, eyes etc. (0.5

Q.2 What are the BASAL GANGLIA? Mention their connections and functions along with their lesion in man. Key Basal ganglia is an accessory motor system, that functions in close association with Cerebral Cortex and corticospinal motor control system. Masses of grey matter present in white matter of cerebral hemisphere Includes 5 nuclei: CAUDATE PUTAMAN GLOBUS PALLIDUS SUBSTANTIA NIGRA & SUB THALAMIC NUCLEUS Connections: a. Putamen circuit: RECIEVES FIBERS FROM: Pre motor area Supplementary motor area & Somatic sensory areas

(1)

(0.5)

SENDS FIBERS TO: Globus pallidus V.A.T.N. & V.L.T.N (ventro-anterior & ventro-lateral thalamic nuclei) Primary motor area, supplementary motor area & pre motor areas. Fibers from putaman Globus pallidus SUBSTANTIA NIGRA THALAMIC NUCLEI CEREBRAL CORTEX. Some fibers from putaman GLOBUS PALLIDUS SUBTHALAMIC NUCLEUS THALAMIC NUCLEI CEREBRAL CORTEX. Some fibers from putaman GLOBUS PALLIDUS SUBTHALAMIC NUCLEUS BACK TO PUTAMAN (0.5) b. Caudate circuit: RECIEVES FIBERS FROM: Cerebral cortex (including: pre motor & supplementary motor area) (0.5) SENDS FIBERS TO: GLOBUS PALLIDUS V.A.T.N. & V.L.T.N. pre motor & supplementary motor areas & to pre-frontal cortex. * NO FIBER FROM THIS CIRCUIT PRIMARY MOTOR AREA (0.5)

OR DIAGRAMS OF PUTAMEN & CAUDATE CIRCUITS

(1+1)

Functions: 1) Control of complex skilled motor activity with the help of cerebral cortex & corticospinal system. 2) Control of extent & timing of movements 3) Congnitive control of motor activity.

(1)

Lesion: (1) 1) Athetosis: Continuous, slow writhing movements affecting hand, arm, face or may be neck. It is due to damage to GLOBUS PALLIDUS. 2) Hemiballismus: Continuous, violent movement affecting 1 side of body / 1 limb. Here is damage to SUBTHALAMIC NUCLEUS. 3) Chorea: Rapid dancing movement affecting hand, arm or some other part of body. Damage is in CAUDATE & PUTAMAN 4) Parkinsons Disease: Degeneration of DOPAMINE secreting neurons in PARS COMPACTA of SUBSTANTIA NIGRA

DOPAMINE deficiency in CAUDATE & PUTAMAN ( by 50% or even less) No release of DOPAMINE from NIGRO STRIATE fibers. Akinesia: Inability to initiate movement or patient is very slow to initiate movement Rigidity: Cog wheel or Lead-pipe rigidity Pill-rolling tremors Due to rigidity, back is flexed, arms are flexed & adducted & knees are bent Short steps. Unable to stop the movement Loss of facial expression Decreased associative movements Tendon jerks are difficult to be elicited due to rigidity

Q.3 Trace the pathway and give the significance of Attenuation reflex. What is its significance. (2.5+2.5 Marks) KEY: Pathway (2.5) Loud sounds through ossicular System CNS Stapedius muscle Pulls stapes outward Tensor tympani muscle Pulls handle of malleus Inward. These two forces oppose each other increased rigidity, decreased ossicular conduction of low frequency sound (below 1000 cycles/sec) Significance (2.5) 1. To protect cochlea from damaging vibrations by very loud sound (1.5) 2. To reduce background noise and allow a person to concentrate on sounds above 1000 cycles/sec. (1) Q.No.4: Write down the effects of sympathetic and parasympathetic stimulation on the following organs: eye, heart, gut, urinary bladder and lungs. Answer key: Eye: 1 mark. Pupil: Dilated (sympathetic) Constricted (parasympathetic). Ciliary muscle: Slight relaxation (far vision). Sympathetic Constricted (near vision) parasympathetic. Glands: Vasoconstriction and slight secretion. (sympathetic). Stimulation of copious secretion (parasympathetic). Heart: 1 mark. Muscle: Increased rate. (sympathetic)

Increased force of contraction. (sympathetic) Slowed rate. (parasympathetic). Decreased force of contraction (especially of atria). (parasympathetic). Coronaries: Dilated (b2); constricted (a). (sympathetic) Dilated. (parasympathetic). Gut: 1 mark. Lumen: Decreased peristalsis and tone. (sympathetic) Increased peristalsis and tone. (parasympathetic). Sphincter: Increased tone (most times). (sympathetic) Relaxed (most times). (parasympathetic). Urinary Bladder: 1 mark. Detrusor muiscle: Relaxed (slight). (sympathetic) Contracted. (parasympathetic). Trigone of urinary bladder: Contracted. (sympathetic) Relaxed. (parasympathetic). Lungs: 1 mark. Bronchi: Dilated. (sympathetic) Constricted. (parasympathetic). Blood vessels: Mildly constricted. (sympathetic) Dilated. (parasympathetic). Q.5 Enumerate the functions of the spinocerebellum. Key: (1 mark each = 5 marks) Face & limbs are represented here (in intermediate zone of cerebellum). Involved in coordination of movements (distal part of limbs). Acts as a comparator. Compares intended plan of movement received from motor cortex & red nucleus with actually performed movement. In case of discrepancy, corrective signals are sent. It recieves information actually performed movements from PROPRIOCEPTORS through spino-cerebellar tracts. Compared & corrected via signals through red nucleus & thalamic nuclei to motor cortex. Also controls: rate, range & direction of movement. Damping function. Prevents pendular movements & tremors (pendular knee jerk in case of disease) Also controls very rapid movements like typing (ballistic movements) & very rapid eye movement (reading & when a person in a moving vehicle, fixate the outside scene).

Guyton pg. 705 Q. No. 6: What are the types of adrenergic and cholinergic receptors present on the effector organs? Mention the function of various types of adrenergic receptors. 2+ 3 Answer key: Two principal types of cholinergic Receptors are Muscarinic and Nicotinic receptors. 1 mark. Adrenergic Receptors are Alpha and Beta Receptors. 1 mark. Function of Alpha receptors (given below in the table): 1 mark Function of Beta-1 receptors (given below in the table): 1mark Function of Beta-2 receptors (given below in the table): 1 mark

Q.7. Some second year medical students, went to Fortress Stadium to enjoy Mary go round. One boy started throwing up when the swing movement became rapid. His friends had to make a request to stop the swing in emergency. a. Give the most likely diagnosis. b. Mention the patho-physiology. (1+4 marks) Key: 7 (Reference: Guyton 11th Ed. p. 824) a. Motion Sickness. b. Pathophysiology: (1 mark)

The rapidly changing motion of the swing stimulated the receptors in vestibular labyrinth of the boys inner ear. (1 mark) From inner ear impulses were transmitted by brain stem vestibular nuclei into the cerebellum. (1 mark) Then to the chemoreceptor trigger zone for vomiting located bilaterally on the floor of 4th ventricle in the brain medulla. (1 mark) And finally to the vomiting center (that includes multiple sensory, motor & control nuclei mainly in the medullary & pontine reticular formation but also extending into the spinal cord) to cause vomiting. (1 mark)