Question 1.
Intermuscluar injections are often given in the gluteal region but not just anywhere in the gluteal region. In order to avoid the sciatic nerve and larger gluteal blood vessels, the nurse will put the needle about 2 inches below the iliac crest in the upper outer quadrant of the gluteal region. which muscle is the needle most likely to hit?
a piriformis
b hamstring group
c quadricep group
d gluteus medius
e gluteus maximus

Question 2.
If someone had a new genetic disease that prevented the formation of ependymal cells specifically, which of the following would be true of someone who has this disease?
a no myelination in the PNS
b no myelination in the CNS
c chronic infections in the brain
d less than normal levels of CSF
e lack of a blood – brain barrier

Question 3.
When someone gets lumbar epidural anesthesia, where does the physician put the needle?
a deep to the pia mater
b deep to the arachnoid mater
c deep to the dura mater
d in the subarachnoid space
e superficial to the dura mater

Question 4.
If someone fractured their L5 vertebae, does that mean they also damaged their spinal cord?
a yes
b no

Question 5.
If someone had food poisoning from botulism toxin, what type of symptoms might they exhibit?
a muscle spasms
b "lockjaw"
c difficulty breathing due to spasms in the respiratory muscles
d droopy eyelid
e spasming facial muscles

Question 6.
Which of the following is innervated by a somatic efferent neuron?
a smooth muscle around the stomach
b cardiac muscle
c pain receptor in skin
d touch receptor in skin
e hamstring muscle

Question 7.
All dendrites and axons in the PNS are myelinated.
a true
b False

Question 8.
In the brain, white matter is composed of nerve fibers that are myelinated by oligodendrocytes. In the spinal cord, white matter is composed of nerve fibers that are myelinated by Schwann cells.
a true
b False

Question 9.
A woman was stabbed in her back and the knife damaged one of her posterior (dorsal) rami on the right side of her body. which of the following is a result of her injury?
a flaccid paralysis of some of her back muscles
b numbness in a small area of her back
c spastic paralysis of some of her back muscles
d flaccid paralysis of some of her back muscles and numbness in a small area of her back
e spastic paralysis of some of her back muscles and numbness in a small area of her back

Question 10.
A man has a brain tumor in his right primary motor cortex which specifically damages the upper motor neurons of the lateral corticospinal tract. which of the following is TRUE?
a he will have spastic paralysis on the right side of his body
b he will have flaccid paralysis on the right side of his body
c he will have spastic paralysis on the left side of his body
d he will have flaccid paralysis on the left side of his body
e he will have no pain sensation from the left side of his body

1…gluteus maximus…why …it has a lot of mass …..lots of surface area.. which is important in intermuscular injection…other likable choice is the deltoid or your vastus lateralis…this doesnt pose any major risk in terms of nerve damage …you only have cutaneus supply with vastus lateralis
….you cannot hit the piriformis muscle …..the sciatic nerve travels below the priformis muscle …when u sit too long …you get wht is called sciatica which is when the piriformis muscle compress the sciatic nerve….also know as pain in the buttocks

2 d…ependymal cells produce CSF

3 d…my guess..we only use spidural anesthesia in the sacral hiatus …..a little confuse with the wording ….spinal tap is wht you do in the lumbar region …in the region of L4/L5
4b no….spinal cord ends at L2 in adult and L3 in kids …which is why spinal tap is done btw the region of L4/L5…conus medullaris is the termination of spinal cord which is at L2

5 the major effect will be a …it affects your neuromuscular junction primarily …also it is important to realize it is a complete blockage…so respiratory problems is also a likable choice ……people with botulism poison will suffer respiratory arrest leading to death

6 e..motor ….musle is primarily more motor
7 a…which is wht schwann cell is for
8 b…..oligo is for the CNS( brain and spinal cord)….PNS is scwann
9 d
10c

This is the third and last blog in the Parkinson’s Disease series. You can find the two previous posts here: the symptoms (#1) and neuroscience (#2).

Treatment of PD

Currently, there is no real cure for Parkinson’s. There are medications that fight the symptoms, but not the disease itself. Simply put, there is no way to restore the cells that died within the substantia nigra (see the neuroscience post).

Most patients with PD are prescribed Levadopa (L-DOPA). Other drugs are used in PD treatment as well, but L-DOPA is the most widely used one. This medication is converted into dopamine in dopaminergic neurons, which causes relief from many of the motor symptoms (it barely helps with the psychiatric symptoms though). However, only 5-10% of the L-DOPA passes the blood-brain barrier (a sort of filter for our brain). Because of that, most of the medicine is processed elsewhere, which causes many side-effects.

It’s pretty much an endless list of side-effects, among which nausea, increased anxiety, hair loss, vivid dreams and/or insomnia, gastrointestinal bleeding are prominent. Chronic users of L-DOPA, basically all PD patients, show more and more serious side-effects of the L-DOPA. They can even become resistant to the drug at one point.

The use of L-DOPA and hallucinations

One of the side-effects I didn’t mention yet is hallucination. in the previous blog post (on neuroscience) I mentioned that schizophrenia and PD are in a way closely related. L-DOPA becomes dopamine in the brain, but when those levels are elevated too much, PD patients become psychotic. Schizophrenia is caused by elevated dopamine levels according to the dopamine theory. PD patients can experience visual and auditory hallucinations.

These hallucinations can be as dangerous to a PD patient as to a schizophrenic. For instance, I remember very well when my grandmother started to have hallucinations for the first time. she wanted to wash her hands, but instead of turning on the cold water, she was washing her hands with boiling hot water. she didn’t feel it during the hallucination, but later on she did. (She also loved to cook and she often saw flying chicken breasts. Luckily this hallucination wasn’t as harmful as the other one).

To remedy these hallucinations, they get anti-psychotics. and you guessed it – these lower the dopamine levels again. Which causes the motor symptoms to show up again. and so they get more L-DOPA again. It’s pretty much a vicious circle at that. and don’t forget all the horrible side-effects of the anti-psychotics.

Interestingly, schizophrenics often show something called “Parkinsonism” – in this case drug-induced Parkinson’s, due to the use of anti-psychotics.

Deep Brain Stimulation (DBS)

Brain surgery such as DBS was once much more common. Ever since the invention of L-DOPA, surgery to treat PD came to a standstill. Recently, however, it has become more common again. As I mentioned, many chronic users of L-DOPA become resistant to it, and DBS has proven to be a very successful treatment. DBS mostly resolves the motor symptoms of the disease, much like L-DOPA.

Basically, DBS is the implantation of a “brain pacemaker”. this tiny device sends electrical impulses to specific parts of the brain. It changes brain activity in a very controlled way, and it’s reversible, unlike lesioning techniques that surgeons used to perform.

Note, though, that this isn’t a cure for Parkinson’s. It is a symptom fighter like L-DOPA but a more successful one at that.

It has proven to be helpful for people with chronic pain, Tourettes Syndrome and major depression, as well.

Clinical Research

Currently, researchers are asking themselves the questions “what causes the cells in the substantia nigra to die, and how can this be prevented?” and “how can we replace the dead cells?”.

There are ongoing gene trials, where they try to prevent the disease from coming into being by using non-infectious virus cells. Successful results have been announced, read more about it here.

Stem cell research has been a target as well, but it is highly controversial and has not yet shown any real results in humans. There has been some success in animals, as they survived more often and showed less behavioral abnormalities.

As you can tell, we’re still far away from finding a real cure for Parkinson’s Disease. I sincerely hope that our brilliant brain researchers will find a cure some time soon.

Thanks for reading and I hope I have been able to shed some light on this illness.

Friday, I’ll continue where we  left – sanity vs. insanity!