neuro endo questions

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EUROPOS SJUNGA

Europos Socialinis Fondas

The Program of Medicine studies

Module

NEURAL AND ENDOCRINE REGULATION

Third course

Fifth semester

Faculty of Medicine

Kaunas University of Medicine


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Contents

1. GENERAL INFORMATION .................................................................................................. 4

2. GENERAL CONTENT OF THE MODULE ........................................................................... 4

3. AIM AND OBJECTIVES OF THE MODULE ....................................................................... 44. TUTORIALS .......................................................................................................................... 5

4.1. Case 1. Difficulty to move without having muscular strength. ......................................... 5

4.2. Case 2. Healthy people do not fall out of bed. .................................................................. 8

4.3. Case 3. Walking disorder. .............................................................................................. 12

4.4. Case 4. The concern of the manager. ............................................................................. 14

4.5. Case 5. The concern of the teacher. ................................................................................ 17

5. Lectures ................................................................................................................................ 20

5.1. Histology of the nervous system its formation ............................................................... 20

5.2. Histophysiology of endocrine glands and skin .................................................................... 20

5.3. Functional anatomy of spinal cord and brain stem .............................................................. 20

5.4. Structural organization of the somatomotor neurofunctional system ................................... 205.5. Functional anatomy of the autonomic nervous system ........................................................ 20

5.6. The neuroendocrine regulation ........................................................................................... 225.7. Hypothalamusthe thyroid neuroendocrine axis ................................................................ 225.8. Signal transmission in the nervous system .......................................................................... 225.9. Spinal cord and the brain stem motor functions. Efferent control of the motor functions.

Disorder of the motor functions of the central nervous system ................................................... 225.10. Fundamental activity of the autonomic nervous system. Stress and the pathophysiology of

general adaptation syndrome ..................................................................................................... 23

5.11. Pathological physiology of the endocrine system (2 hours) ............................................... 23

5.12. Pathological anatomy of the nervous and endocrine regulation disorders .......................... 23

5.13. Methods of the nervous system radiological analysis. Radiological diagnostics of thedemyelinating pathology. Radiological diagnostics of the degenerative brain change ................ 23

5.14. Spinal cord and the brain regional anatomy. Radiological diagnostics of CNS blood

circulation and CSF pathology .................................................................................................. 23

5.15. Radiological diagnostics of the brain congenital abnormalities ......................................... 24

5.16. Radiological diagnostics of pituitary and adrenal glands pathology................................... 24

5.17. Cholinoreceptor- blocking drugs and other antiparkinson drugs (2 hours) ......................... 24

5.18. Cholinomimetics, cholinoreceptor-blocking drugs, adrenomimetics, adrenoreceptor-bloking

drugs and antisympathicotonic drugs ......................................................................................... 24

5.19. Fundamental of the nervous system clinical examination .................................................. 245.20. Clinical evaluation of the endocrine system ...................................................................... 24

6. PRACTICALS ...................................................................................................................... 256.1. Principles of the histological structure of the peripheral and central nervous system

components histological structure ............................................................................................. 256.2. Histological structure of the endocrine glands and skin ....................................................... 26

6.3. Regional anatomy of effector structures of the spinal cord and brain stem .......................... 28

6.4. Anatomy of effector structures of diencephalon and telencephalon ..................................... 29

6.5. Anatomy of the peripheral nervous system ......................................................................... 30

6.6. Potential of action and the spread in the nerves ................................................................... 31

6.7. Motor spinal cord reflexes .................................................................................................. 31

6.8. Pathology of the neural and endocrine regulation disorders (3 hours) ................................. 31

6.9. Cholinomimetics, cholinoreceptor-blocking drugs, adrenomimetics, antiadrenergic agents . 336.10. Outline of the motor system (upper and lower motor neuron) examination and assessment33


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6.11. Clinical examination and assessment of gait, coordination, smooth movements ................ 33

6.12. Clinical analysis of the endocrine system .......................................................................... 34

7. Seminars ............................................................................................................................... 34

7.1. Cytology of nervous tissue, the structural principles of the interneuronal chemical relations34

7.2. Functional anatomy of blood supply of the brain and CSF circulation................................. 34

7.3. Anatomy of the endocrine glands ....................................................................................... 357.4. Features of biochemical structure and metabolism of nervous tissue ................................... 357.5. Disorders of the endocrine glands functions ....................................................................... 35

7.6. Antiparkinson drugs ........................................................................................................... 367.7. Thyroid hormones, antithyroid drugs and iodine ................................................................. 36

8. EXAMINATION QUESTIONS OF THE MODULE ............................................................ 37

8.1. Histology ........................................................................................................................... 37

8.2. Anatomy ............................................................................................................................ 38

8.3. Biochemistry ...................................................................................................................... 38

8.4. Physiology ......................................................................................................................... 39

8.5. Pathological physiology ..................................................................................................... 39

8.6. Pathological anatomy ......................................................................................................... 408.7. Pharmacology .................................................................................................................... 40

8.8. Radiology ........................................................................................................................... 41

8.9. Essentials of medical diagnosis .......................................................................................... 41


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1.GENERAL INFORMATIONSupervisor of the module: Prof. habil. dr. Rimvydas Stropus, Institute of anatomy

([email protected])

Coordinator of the module: lect. Igor Korotkich, Department of physiology ([email protected])

Divisions:

1. Institute of anatomy2. Department of histology and embryology3. Department of physiology4. Department of biochemistry5. Department of theoretical and clinical pharmacology6. Clinic of pathological anatomy7. Clinic of internal diseases8. Clinic of radiology

2.GENERAL CONTENT OF THE MODULEWhile analysing the problem of the module, a student obtains new information and embodies it

into these spheres:

Nervous tissue structural and functional organization in cellular neurobiologys level and theapplication value of neuroscience achievements;Anatomy and histology of the nervous and endocrine system effector functions (somatomotor

and autonomic);

Functional organization of the nervous and endocrine system effector working;

Pathogenesis of the disorders of the neuroendocrine functions, symptoms and syndromes and

essentials of their origin;

Fundamentals of clinic analysis of the impared effector functions of the nervous system and

the endocrine gland functions;

Principles of pharmacological correction of the impared neuroendocrine effector functions.

3.AIM AND OBJECTIVES OF THE MODULETo establish students with conditions under which they obtain knowledge about structural and

functional organization of the nervous and the endocrine system effector regulation, the pathogenesisof the repeated disorders, clinical expression and pharmacology correction. To acquire ability to

apply knowledge while analysing and annotating the symptoms of clinical situations, pathological

phenomena and their origin ground, terminology and treatment principles. While pursuing this goal,

a student must acquire new knowledge about:

Principles of the nervous system structural and functional organization at cellularneurobiologys level and their application value in pathology;
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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Structure and function of the motor system of spinal cord and brain stem, the pathogenesisand clinical expression of this system lesions;

Structural and functional organization of central motor system (cortex, basal ganglia andcerebellum), the pathogenesis of central motor disorders, their clinical expression principles of

pharmacological correction;

Structural and functional organization of the interactions between neural and endocrineregulation;

Morphology and physiology of autonomic regulation of the organs functions, its disorders,symptoms, syndromes, principles of pharmacological correction;

Hierarchy of the endocrine regulation, the clinical expression of its disorders and principles

of pharmacological correction.

4.TUTORIALS4.1. Case 1. Difficulty to move without having muscular strength.

Mrs. Mielina, a 37-year-old woman, having a committal of the family doctor applied for aneurologist for the left arm and leg weakness that suddenly appeared. However, she felt alright till

this moment: did not have a temperature, did not experience any injury. Having the results ofanamneses, it is known that woman had an optical disorder within the right eye two and a half year

ago she saw as if through the mist, however, optical acuity recovered fully in two weeks.Furthermore, the right leg was numb and had weakened at the same time but the symptoms passed

away in few weeks and later on the woman did not consult doctors.

Having a general medical examination done, no changes were found.

Having neurological inspection done, it was determined that perception and orientation were

unchanged, no cephalic nerve function changes found. Muscle strength in the left side of arms and

legs was lesser3-4 points (due to the system of 5 points), when the stretching arms forward the leftone droops down. Tendon and periosteum reflexes are much stronger on the left side rather than on

the right. There is no abdomen and normal right foot metatarsus reflex. Both arms have pathological

flexor reflexes; however, the left leg has pathological Babinski reflex. Superficial and deep senses

are weak on the left side of the body. Performance of coordination samples: coordination of finger-

nose and heel-knee is well done. She can walk 500 metres on her own though the left leg gets tired,

she walks with a limp. Urinates and evacuates normally.

Performed analysis:

Oculist examination: optical acuity 1.0 within both eyes, visual nerve discs were of pink colour,

with clear margins in the fundus of eyeballs.

Neurophysiologic analysis: Acoustic induced potentials examination: aural lateral loop capacity

is not disordered. Optical induced potentials examination: optical lateral loop capacity is notdisordered.

MRI: in both cerebral hemispheres periventricular white matter, in the corpus callosum there areapparent several, small, having oval form small, hyperintense foci on T2W/FLAIR images. Several

similar focuses are apparent in the mesencephalon and pons basis and in tegmentum part. Changesare typical to demyelinization case.


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On what purpose was the examination of optical and aural induced potentials performed?

What pathomorphological cerebrum tissue variation could determine MRI findings?

How can one explain whether to associate MRI findings in the brain stem within the disorders of

an arm, leg and abdomen reflexes and senses?Does the left side leg weakness and melting as well as optical disorder two years ago relate to

the present Mielinas ailment?

Concept of the problem: structural and functional mechanisms of the neurons and neuroglia

interaction as well as their disorder consequences.

Clinical symptoms: repeated muscle strength weakness for a young woman, temporal optical

disorder.

Objective

To obtain knowledge and know how to apply it while analysing neuroglia significance and

myelinisation and demyelinisation processes, biochemical structure peculiarities of myelin sheath,

the significance of the morphological structure for nerve fibre conduction. With reference to the

pathomorphological peculiarities of this disease, a student has to know how to explain and annotate

clinical studies purposes, their findings, the relation of disease progress peculiarities within the

demyelinisation and myelinisation processes and neurological symptomatics connection within the

pathological focuses localisation.

Learning objectives and content

Completed with the problem analysis, a student must know:

Microstructure of nerve tissue; the function and distribution of structural elements of the

nerve tissue. Subjecthistology and embryologyDepartment of Histology and Embryology

References:1. Junquiera L.C., Carneiro J. Basic histology. Text & atlas. McGraw-Hill, 2005, p. 153-181.

Histological structure of nerve tissue; function and distribution of structural elements of the

nerve tissue.SubjectanatomyInstitute of Anatomy

References:

1. FitzGerald M.J.T, Folan-Curan J. Clinical Neuroanatomy and Related Neuroscience.Saunders; 2002. p. 55-71.

Supplementary readings:

1. Nadeau S.E., Ferguson T.S., Valenstein E. et al. Medical Neuroscience. Saunders, 2004. p.117-136.

2. Poritsky R. Neuroanatomy To Color and Study. Hanley&Belfus, 2004. p. 2, 5-9.3. Grays anatomy.Elsevier Churchill Livingstone, 39 th ed., 2005. p. 43-55.


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Action potential, its origin and phases. Al-or-None law. Phases of the action potential andtheir ionic mechanisms

Changes of excitability during the action potential. Refractory, its physiologicalimportance.

Spread of electrotonic potential. Local response. Membrane length and time constants.

Propagation of action potential along nerve fibers. Factors affecting conduction velocity ofthe action potential. Compound action potentials, measurement of their propagation velocity.

Classification of nerve fibers.

Synaptic signal transfer in the central nervous system and regulation of secretion of

neurotransmitters.

Ionotropic and metabotropic receptors. Excitatory and inhibitory postsynaptic potentials,their ionic mechanisms. Inhibition in the CNS.

Signal transmission in the neurons. Temporal and spatial summation.

SubjectphysiologyDepartment of Physiology

References:1. Ganong WF. Review of medical physiology. 23rd ed. New York: Lange Medical Books /McGraw-Hill; 2010. Ch.2 (p. 54-61), Ch. 4 (p. 79-89, 115-124, 140-142).

2. Guyton AC, Hall JE. Textbook of medical physiology. 11th ed. Philadelphia: ElsevierSaunders; 2006, Ch. 5 (p. 57-71), Ch. 45 (p. 555-571).


1. Zxc Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books/ McGraw-Hill; 2005. Ch.2 (p. 54-61), Ch. 4 (p. 85-98, 107-111, 116).

Features of nervous tissue biochemical structure and metabolismSubjectbiochemistry

Department of BiochemistryReferences

1. Smith C., Marks A., Lieberman M. Marks Basic Medical Biochemistry. A ClinicalApproach. 2nd ed. Lippincott Williams&Wilkins, 2005, p. 881-904.

Pathological anatomy of nervous system demyelinised and degenerated diseases andconsequences

Subjectpathological anatomyClinic of Pathological Anatomy

References:1. Pathologic basis of Disease. Eds I.L. Robbins, R.S. Cotran. 7 th ed. 2005, p. 1177-1280; 1326-

1333.

Methods of the nervous system radiological analysis

Radiological diagnostics of demyelinised pathologySubjectradiologyClinic of Radiology

References:

1. Lectures2. Grossman R.I., Yousem D. M., Neuroradiology. The Requisites, Mosby, 2003, p. 331-369.3. Osborn A. G. Diagnostic neuroradiology, Mosby; 1994, p.716-747.4.

Osborn A. G. et all. Diagnostic imaging. Brain. Vol. I, Amirsys; 2004, section 8, p. 74-83.Supplementary readings:


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1. Osborn A. G,. Blaser S. I, Salzman K. L. Pocket radiologist Brain Top 100 diagnoses,Amyrsis, 2003, p. 255-257

Neurological evaluation of motor reflexes and movement disorders

SubjectEssentials of medical diagnosisClinic of Internal Diseases

References:

1. Epstein P. et al. Clinical examination. London: Mosby; 1997, p. 348-356.Supplementary readings:

1. Tomas J, Monaghan T. Oxford Handbook of Clinical Examination and Practical Skills.Oxford: University Press; 2007, p.330-334, 346-349.

2. Bickley L. S. Bates Guide to Physical Examination and History Taking. Philadephia:Lippincott Williams & Wilkins; 2007, p. 633-641.

4.2. Case 2. Healthy people do not fall out of bed.A 56-year-old Mr. Kraujalis liked to confine himself to a regular daily routine. Every morning he

used to get up at 6 oclock, to have breakfast with family at 6:45 and then go to work. OneWednesday morning this daily routine was disturbed he did not get up at 7 oclock. Mr. Kraujalishad myocardial infarction 5 years ago and was operated the coronary revascularisation performed.After myocardial infarction the man had a heart rhythm disorder, therefore, he constantly took

Digoxin and Orpharin. Having fear of another heart attack, family members went to see why

Kraujalis did not get up. They found him fallen out of bed, unable to move his left hand and leg. He

had diplopia, felt the left side of the body melting. A careful glance to his face told about the rightcheek side being set. Family members called for an ambulance immediately and took Mr. Kraujalis

to an emergency room.Duty doctor that worked at the emergency room called a neurologist for an immediate

consultation. A medical examination was performed on Kraujalis in the emergency room until theneurologist came:

Electrocardiogram: atrial fibrillation, tachisistolic form. Scar changes in myocardium heartanteroseptal part.

Extracranial neck arterial echoscopy: lumens of carotid arteries are within the norm, in the leftcarotid artery cerebral part there is an atherosclerotic plate, narrowing the lumen to 50% but which is

insignificant hemodynamically.

The consultant performed neurological analysis, concisely drew up the analysis results and thepatient was told to do a CT of brain.

Neurological screening findings: conscious, able to orient, able to understand and execute

commands, speaks intelligibly, symmetric pupils, does not pull the right eye to the lateral side, have

diplopia when takes a look to the right, does not contract the right forehead, closes the right eye

incompletely, the wright nose-lips corner is set, tongue in the middle line as well, other cranial nerve

function is not disordered, determines superficial and deep sense disorders on the left side of the

body, does not move the left arm and leg, tendons reflexes on the left side strengthened, muscle

tonicity was increased in the left limbs, pathological flexor reflex in the left arm, pathological

extensor symptom in the left leg, no meningitis symptoms found, pelvic organ functions are not

disordered.

What structures and how do they participate in the examined (motor) functions execution


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performed by the neurologist?

What are the mechanisms of the examined reflexes?

What neurophysiologic mechanisms do determine tendons reflexes and muscle tonicity changes?

After half an hour computer-based tomography findings were received. The neurologist looked

through the photos carefully and just took a glance to the description. Well, lets take him to thehospital unit - he said and put an appropriate record down to the case-record. Arranging thedocumentary of the patient taken to the neurologic unit, the emergency room doctor read the record

of a radiologist.CT: on the right cerebral pedunculi, pons and the right cerebellar hemisphere there is a

hypodense zone, with a slight perifocal oedema, the fourth ventricle is narrower, however, the

system of lateral ventricles is not dislocated.

What affection could cause such CT changes?

What functions can this violation disorder?

Referring to CT, give neuroanatomic basis on motor disorders on the right side of the patient face

and on the left side limbs.

Concept of the problem: structural and functional mechanisms of the spinal cord and brain stem

reflex and motor function, their disorder correlation with brain stem blood supply pathology.

Clinical symptoms: the peculiarities of disease anamnesis, neurological features of motor

disorders, findings of CT analysis.


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AIM

To obtain knowledge about structural and functional organization of the spinal cord and brain

stem reflex and motor function, the peculiarities of brain stem regional blood supply, pathogenesis of

motor functioning disorders and radiological diagnostics. To know how to apply information while

analysing and annotating the pathogenesis of patient Kraujalis, neurological symptoms andechoscopic and CT findings.

Learning objectives and contentCompleted with the problem analysis, a student must know:

Structural peculiarities of the spinal cord and the brain stem (the medulla oblongata, pons,

the mesencephalon.Subjecthistology and embryologyDepartment of Histology and Embryology

References:

1. Junquiera L.C., Carneiro J. Basic histology. Text & atlas. McGraw-Hill, 11th ed. 2005, p.153-181.

Grey matter of spinal cord: topography and functions of nuclei and laminae (in longitudinal

and transverse sections). White matter of spinal cord: topography and function of propriospinal

fibers, funiculs and tracts. Segmental structure of spinal cord and pathways of motor fibres toperiphery. Blood supply of spinal cord.

Internal structure of rhombencephalon and mesencephalon (in longitudinal and transverse

sections). Motor and autonomic nuclei of the brain stem and pathways of their fibers to innervedregions.

Structure and location of inferior and superior olivary complexes, reticular formation nuclei,substantia nigra and red nucleus, their connections with other efferent system structures.

Topography and function of descending motor tracts and association fibers in brain stem;

Blood supply of the brain stem;

Neuroanatomy of the tendon reflex arches frequently used in neurology;

SubjectanatomyInstitute of Anatomy

References:1. Drake R. L, Vogl W, Mitchel A.W.M. Grays Anatomy for Students. Philadelphia: Elsevier,

Churchil Livingstone; 2005, p. 62-67, 787-799.

Supplementary readings:1. FitzGerald M.J.T, Folan-Curran J. Clinical Neuroanatomy and Related Neuroscience.

Edinburgh: Saunders; 2002, p. 123-134; 135-154, 296.

2. Nadeau St.E, Ferguson T.S, Valenstein E. et al. Medical Neuroscience. Saunders; 2004, p.245-263; 155-186.

3. Poritsky R. Neuroanatomy To Color and Study. Hanley&Belfus, 2004. p. 52.4. Grays anatomy.Elsevier Churchill Livingstone, 39th ed., 2005. p.307-314, 320-323, 327-345,

295-305.

Role of spinal cord in motor control. Mechanisms of stretch and Golgi tendon reflexes.

Polysynaptic reflexes;

Role of spinal cord in locomotion and other stereotypic movements;


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Associative (Renshaw) neuron and descending tractus correlation with motor neuronmechanisms;

Control mechanisms of stereotypic movements operated by the brain stem (swallowing,chewing, respiration, locomotion etc.);

The role of the brain stem descending pathways in the spinal cord motor functions.

SubjectphysiologyDepartment of Physiology

References:1. Ganong WF. Review of medical physiology. 23rd ed. New York: Lange Medical Books /

McGraw-Hill; 2010. Ch.9 (p. 157-165), Ch. 16 (p. 241-242, 247-250).2. Guyton AC, Hall JE. Textbook of medical physiology. 11th ed. Philadelphia: Elsevier

Saunders; 2006, Ch. 54 (p. 673-684), Ch. 55 (p. 691-692, 697).


3. Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books /McGraw-Hill; 2005. Ch.6 (p. 129-137), Ch. 12 (p. 202-203, 206-212).

Radiological diagnostics of the spinal cord and brain stem pathologySubjectradiologyClinic of Radiology

References:

1. Lectures2. Grossman R. I, Yousem D. M.. Neuroradiology, The Requisites, Mosby, 2003, p.183-197.3. Baseviius A., Lukoeviius S., Kiudelis J.ir kt. Radiologijos pagrindai, Kaunas, 2005, p.

108-116; 141-162.

4. Osborn A. G. Diagnostic Neuroradiology. Brain, Mosby, 1994, p. 333-367, 834-836.5.

Osborn A. G. et all. Diagnostic imaging. Brain. Amirsys, 2004, I, section 4, p. 4-107.Supplementary readings:

1. Osborn A. G., Blaser S. I., Salzman K. L., Pocket radiologist Brain Top 100diagnoses,Amyrsis, 2003, p. 84-90.

Pathogenesis of the motor disorders of the central origin;Subjectpathological physiologyDepartment of Physiology

References:

1. Stephen J. McPhee, William F. Ganong. Pathophysiology of Disease. An introduction toclinical medicine.5th ed. Lange 2006.p. 181-186.

2. Kathryn L. Mccance Sue E. Huether. Pathophysiology. The Biologic Basis for Disease inAdults and Children. 5th ed. Elsevier Mosby; 2006. p. 527-533.

The analysis methods of motor functions disorder. Clinical diagnostics of central origin

motor functions disorders.

SubjectEssentials of medical diagnosisClinic of Internal Diseases

References:1. Epstein P. et al. Clinical examination. London: Mosby; 1997, p. 356-363.Supplementary readings:1. Tomas J, Monaghan T. Oxford Handbook of Clinical Examination and PracticalSkills.

Oxford: University Press; 2007, p. 324-329, 344-345, 350-351.

2. Bickley L.S. Bates Guide to Physical Examination and History Taking. Philadephia:Lippincott Williams & Wilkins; 2007, p. 616-629.


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4.3. Case 3. Walking disorder.A 53-year-old Parkinnas having a committal of the family doctor applied for a neurologist for

the left shoulder joint pain, movement limitation and the disorder of left leg movement he feels theleft leg constraint and quicker tiredness while walking. All these ailments have troubled him for

around half a year. He took anaesthetics, muscle relaxing medicine but did not notice improvement.He as well noted that he has to walk more carefully, he can not stop when starting to move, falls

forward and can not change movement direction quickly.

Doctor neurologist examined Parkinnas:Neurological examination findings: orientated, critical, hypomimic face expression, symmetric

pupils, eye movements to either side are not disordered, symmetric face, the tongue in the middle

line. Rigid muscle tonicity is increased in the left hand, movement softness and threading gearphenomenon while flexing elbow joint, moderation of the left leg movement amplitude and softness

while walking, threading gear phenomenon is noticed while flexing tarsus joint. The manner ofpatient walking is different as he now walks in small steps. No other changes are noticed.

Performed analysis:

General analysis of blood: without pathological changes. Rheumatoid factor, C-reactive protein

and ESR (the erythrocyte sedimentation rate) are within the norm.

CT: clear foci changes of brain density were not noticed; a slight increase of brain ventricles and

subarachnoidal space enlargement.

MRI: bilaterally in frontotemporal white matter there are some hyperintense non-specific

lesions. Diminution of black matter layer is seen in the mesencephalon.

Why does the walking of Parkinnas got disordered, why does he fall? What does the performed radiological analysis determine? What is the correlation between the

changes of determined analysis and the health disorders of Parkinnas? What are the principles of treatment of these disorders?

Concept of the problem: Higher motor centres participating in movement control, structural and

functional mechanisms and the consequences of their activity disorder.Clinical symptoms: slow disease progress, hypomimic face, constraint of limbs, slow motions,

gait changes, echoscopy, findings of CT and MRI.

AIM

To obtain knowledge about structural and functional organization of somatomotor system higher

centres (motor and premotor cortex, basal ganglia, subthalamus, cerebellum) and know how to apply

while analysing the reason of Parkinnas disease, its neurological symptomatics, MRI findings andtreatment principles.



Structure of the cerebellar cortex; Cyto- and myeloarchitectonics of the cerebral cortex; Histophysiological peculiarities of substantia nigra of mesencephalon.


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Subjecthistology and embryologyDepartment of Histology and Embryology

References:1. Junquiera L.C., Carneiro J. Basic histology. Text & atlas. McGraw-Hill, 11th ed. 2005, p.

153-181.

Anatomy of motor cortex (projection and association centres); Basal nuclei: location, structure and functional organization; Location of thalamus, subthalamus and their nuclei related to motor functions Grey and white matter of cerebellum, anatomy of its afferent and efferent pathways; Structure of descending pathways from higher somatomotor centres to the brain stem and

spinal cord.

SubjectanatomyInstitute of Anatomy

References:

1. Fitz Gerald M.J.T., Folan-Curran J. Clinical Neuroanatomy and Related Neuroscience.Edinburgh: Saunders; 2002, p. 207-215, 225-228, 250-253; 265-273.


1. Nadeau St.E, Ferguson T.S, Valenstein E. et al. Medical Neuroscience. Saunders; 2004, p.267-297.

2. Poritsky R. Neuroanatomy To Color and Study. Hanley&Belfus, 2004, p. 37, 38, 45, 106-116, 131-134.

3. Grays anatomy. Elsevier Churchill Livingstone, 39th ed., 2005. p. 396-398, 419-427, 371,372, 383, 353-356, 363-366.

Somatotopic organization of the cortical motor functions; Functional organization of the pyramidal pathway; Role of motor cortex in voluntary movements; Functional organization of the basal ganglia and related structures; Neurotransmitters of the basal ganglia; Neuronal circuit and microphysiology of the cerebellum; Functional organization of the cerebellar connections;SubjectphysiologyDepartment of Physiology

References:

1. Ganong WF. Review of medical physiology. 23rd ed. New York: Lange Medical Books /McGraw-Hill; 2010. Ch. 16 (p. 242-247, 250-259).2. Guyton AC, Hall JE. Textbook of medical physiology. 11th ed. Philadelphia: ElsevierSaunders; 2006, Ch. 55 (p. 685-691), Ch. 56 (p. 698-713).

Supplementary readings:1. Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books /

McGraw-Hill; 2005. Ch. 12 (p. 203-207, 211-222).

Pharmacological correction of central origin motor disordersSubjectpharmacologyDepartment of Theoretical and Clinical pharmacology

References:

1. Bertram G. Katzung. Bendroji ir klinikin farmakologija(Basic and Clinical Pharmacology).(Vertimas lietuvi kalb.) Charibd, 2007, p. 443-457.


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2. Mycek M. J. Champe P.C. et al. Lippincott's Illustrated Reviews: Pharmacology, 3rd ed.Philaelphia: Lippincott Williams & Wilkins; 2006. p. 91-102.

3. Rang H.P. Dale M.M. et al. Pharmacology. 5th ed. Edinburgh: Churchil Livingstone; 2003. p.490-502.


1. Basic & Clinical Pharmacology, 9th ed/ ed. by B.G.Katzung, 2004, p. 447-461; 109-121.4.4. Case 4. The concern of the manager.

Mr. Stresunas, a 32-year-old head manager of a middle-sized trade network, applied to health

care centre for impairment of general health state, insomnia, heartbeat and anxiety attacks.

After a consultation with his doctor the fact appeared that the mentioned symptoms have

bothered him for about 2-3 months, however, he did not pay attention to that due to his great

occupation. The patient also mentioned frequent headaches and disordered activity of the digestive

tract: lack of appetite, frequent constipations, heartburn, pain in the upper part of abdomen appearing

after having not eaten food for a long time or in the morning. The patient does not smoke, consumes

alcohol rarely and his ailments connect to job matter. He has been managing to a high-level project

during last 6 months. He often has to take complex decisions, to go on business trips and work

overtime.

During medical screening of the patient, there were eruptions of herpes type noticed on the lip

corners. Palpating the abdomen, the pain appeared in the upper part. HB (rate of heartbeat)85 bpm,ABP (arterial blood pressure)160/100 mmHg.

General analysis of blood:

Erythrocytes, Hb, erythrocyte sedimentation ratewithin the norm.Leucocytes 5.0 x109 l (norm 4.0-10.0 x109 l). Lymphocytes 0.9x109 /l (norm 1.2-3.0

x10

9

/l).Findings of fibrogastroduodenoscopic analysis: inflammation of stomach and duodenum.

Duodenal ulcer.

What organs and organ system activity do cause the origin of the determined symptoms and

disorders? Explain pathogenesis of these disorders.

Concept of the problem: The significance of autonomic nervous system, hypothalamus-pituitary gland and adrenal gland combined activity in adaptive function regulation of the organism.

Clinical symptoms: stress-related changes of internal organ functions.

AIM

To obtain knowledge about morphology and function of autonomic nervous system,

hypothalamus, pituitary and suprarenal gland, their correlation mechanisms and to understand an

appearance of neurohumoral regulation disorders and principles of their pharmacological correction.

Learning objectives and contentCompleted with the problem analysis, a student must know:

Histological structure of autonomic part of the PNS;

Histological structure of hypothalamus, the pituitary and adrenal gland.


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Subjecthistology and embryologyDepartment of Histology and Embryology

References:

1. Junquiera L. C., Carneiro J. Basic histology. Text & atlas. McGraw-Hill, 2005, p. 153-181;

392-407.

Anatomy of sympathetic, parasympathetic nuclei, amygdaloid nuclear complex, nuclei ofmesolimbic system their functions and neural connections;

Hypothalamus, parts, functions and neural connections; Anatomy of pituitary gland, neural connections and peculiarities of blood supply; Regional anatomy of sympathetic trunk, pathways of fibers to organs; Regional anatomy of parasympathetic ganglia, pathways of fibers to organs Regional anatomy and structure of autonomic plexuses and ganglia of internal organs; Anatomy of sympathoadrenal system; Principles of innervation of internal organs.SubjectanatomyInstitute of Anatomy

References:

1. Drake R, Vogl W, Mitchell A.W.M. Grays Anatomy for Student. Philadelphia: ChurchillLivingstone; 2005. p. 197-199; 308-314.

2. Fitz Gerald M.J.T., Folan-Curran J. Clinical Neuroanatomy and Related Neuroscience.Edinburgh: Saunders; 2002, p. 85-100, 217- 221, 285-288.

3. Nadeau St.E., Ferguson T.S., Valenstein E. et al. Medical Neuroscience. Saunders, 2004, p.496-506.

Supplementary readings:1. Poritsky R. Neuroanatomy To Color and Study. Hanley&Belfus, 2004. p. 125- 128.2. Grays anatomy.Elsevier Churchill Livingstone, 39th ed., 2005. p. 375-379, 380-383, 235-

239, 409-411.

Functional organization of the autonomic nervous system; Neuromediators and neuropeptides of the autonomic nervous system and their effects on

target organs; Functional organization of the autonomic reflexes; Control of autonomic functions by hypothalamus, brain stem, cerebral cortex;

The basic peculiarities of the endocrine regulation: hormone concept, common mechanismsof hormone action and secretion regulation;

Significance of the hypothalamicpituitary axis to the activity of the endocrine glands;SubjectphysiologyDepartment of Physiology

References:

1. Ganong WF. Review of medical physiology. 23rd ed. New York: Lange Medical Books /McGraw-Hill; 2010. Ch. 17 (p. 261-272), Ch. 18 (p. 273-276, 279-282).

2. Guyton AC, Hall JE. Textbook of medical physiology. 11th ed. Philadelphia: ElsevierSaunders; 2006, Ch. 45 (p. 556, 748-760), Ch. 74 (p. 905-930).



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1. Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books /McGraw-Hill; 2005. Ch. 13 (p. 223-231), Ch. 14 (p. 232-238, 248-249).

Hierarchy of the neuroendocrine regulation; Structure of the hypothalamus hormones, their secretion peculiarities, target cells andbiochemical significance; Structure of the pituitary gland hormones, their secretion, target cells and biochemical

significance; Hormones of adrenal cortex, their types, synthesis, secretion, target cells, molecular

mechanisms of action;SubjectbiochemistryDepartment of Biochemistry

References:

1. R.Murray, D.K. Granner, P.Mayes, V.Rodwell. Harpers Biochemistry, 23rd ed. Prentice-HallInternational, Inc. 1996, p. 509-533; 547-560.

Physiological basics of stress-related and general adaptation syndromeSubjectpathological physiologyDepartment of Physiology

References:1. Lee-Ellen C. Copstead, Jacquelyn L. Banasik. Pathophysiology. 3rd ed. Elsevier Saunders.

2005, p. 23-45.

2. Kathryn L. Mccance Sue E. Huether. Pathophysiology. The Biologic Basis for Disease inAdults and Children. 5th ed. Elsevier Mosby. 2006, p. 311-332.

Supplementary literature:

1. Lee-Ellen Copstead. Perspectives on Pathophysiology. W.B. Saunders Company. 1995,p.136-142.

Pathomorphology of the pituitary and adrenal gland and causes their disordersSubjectpathological anatomyClinic of Pathological Anatomy

References:

1. Kumar V, Abbas A.K., Fausto K.N. Robbins and Cotran Pathologic Basis of Disease, 7th ed.Elsevier Saunders, 2005, p.1156-1164; 1207-1221.

Radiological diagnostics of the pituitary and the adrenal glands pathologySubjectradiologyClinic of RadiologyReferences:

1. Lectures2. Grossman R. I., Yousem D. M., Neuroradiology. The Requisites, Mosby, 2003, p. 517-5413. Osborn A. G. Diagnostic neuroradiology, Mosby; 1994, p. 461-484.4. Prokop A. A., Galanski M. Spiral and multislice computed tomography of the body, Thieme,

2003, p. 625-637.5. Osborn A. G. et all. Diagnostic imaging. Brain. Vol. I, Amirsys; 2004, section 8, p. 2-41.Supplementary readings:1. Federle M. P., Jeffrey R. Br. Diagnostic imaging of abdomen, Amirsys, 2004, III section 2, p.

2-38.


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2. Osborn A. G., Blaser S. I., Salzman K. L. Pocket radiologist Brain Top 100 diagnoses,Amyrsis, 2003, p. 174-177, 210-213.

Vegetotropic medicine and its operating mechanisms; The principles of disordered neurohumoral regulation pharmacological correctionSubjectpharmacologyDepartment of Theoretical and Clinical Pharmacology

References:

1. Mycek M. J. Champe P.C. et al. Lippincott's Illustrated Reviews: Pharmacology, 3rd ed.Philadelphia: Lippincott Williams & Wilkins; 2006. p. 35-90; 271-280.

2. Rang H.P. Dale M.M. et al. Pharmacology. 5th ed. Edinburgh: Churchil Livingstone; 2003. p.

136-183; 404-420.


1. Basic & Clinical Pharmacology, 9th ed,/ ed. by B.G.Katzung, 2004, p. 75-159; 604-624.

Symptoms and syndromes of disordered neurohumoral regulation and chronic stress;SubjectEssentials of medical diagnosisClinic of Internal Diseases

References:

1. Naudinas A., Leiyt P., Petkeviien R.T. ir kt. Vidaus lig diagnostikos pagrindai (Basicdiagnostics of Internal Medicine), Kaunas: Vitae Litera, 2007, p. 204-220.

4.5. Case 5. The concern of the teacher.Mrs. altyt works as a teacher in a gymnasium. Constant feelings of weakness and energy lackhave bothered her for a long time. Often these feelings are followed by an unpleasant sense of cold

which becomes unbearable sometimes and forces her to dress up in warmer clothes than usually. She

slept for 8 hours; no difficulties in falling asleep were noticed. Constipations bothered her sheevacuates no more than 1-2 times a week. Work with schoolchildren is not easy and I am already 48years old, - she used to think and never took her ailment more ser iously. However, Mrs. altyt feltanxious when she found it hard to concentrate, her memory failed, she could not perform work on

time as usual and finally her professional reputation got worse. Furthermore, she noticed that she had

gained 8 kg during the last 6 months, though her appetite and ration had not changed. Eventually, shemade time and visited the family doctor.

The doctor noted that Mrs. altyt seemed sad, apathetic and her voice was deep-chested and of

low tone. The doctor examined the patient and paid attention to her tumid face, his coarsenedfeatures. Her skin had pale yellowish skin colour. It was cold, dry, reminded of dough consistencywhile touching. Stiffening of deep tissues is found in the region of the neck and throat. Body

temperature35.8 0 C, the rate of heartbeat (HR) 50 bpm, arterial blood pressure (BP) 130/80mmHg.

Why could these health disorders appear? What functions of organs or organ system did get

disturbed?

Thinking of thyroid activity disorder, the doctor told to do blood analysis. Its results:General analysis of blood is without changes.

Thyroid self-reactive antibody testaffirmative.Thyroid hormone amount in blood:


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T45.3 pmol/l (norm9-26 pmol/l);T30.7 nmol/l (norm0.9-2.6 nmol/l).

Hypothalamus thyroid-stimulating hormone (TSH) amount in blood9.0 mU/l (norm0.5-5.0 mU/l).

What is the correlation between these results and the health state and the health disorders? Whatis the mechanism of these disorders?

Concept of the problem: the significance of the thyroid hormone to the metabolic functions oforganism and thermoregulation.

Clinical symptoms: goitre, obesity, rapidly developing tiredness, indolence, the increased

sensibility to cold.

AIM

To obtain knowledge about the structure of thyroid gland, its hormone synthesis, secretion,

physiological and biochemical bases of activity, to understand possible disorders of thyroid activityand principles of their pharmacological correction, to understand the fundamental processes of heat

production and loss as well as the neurohumoral regulation mechanisms of thermoregulation



Histophysiology of thyroid gland.;

Histological structure of skin and sweat glands.Subjecthistology and embryologyDepartment of Histology and Embryology

References:

1. Junquiera L. C., Carneiro J. Basic histology. Text & atlas. McGraw-Hill, 2005, p. 411-415;360-372.

Regional anatomy of thyroid gland, external and internal structure of thyroid gland and

peculiarities of blood supply;

Regional peculiarities of the sweat glands, blood supply and autonomic innervation of skin.SubjectanatomyInstitute of Anatomy

References:1. Fitz Gerald M.J.T., Folan-Curran J. Clinical Neuroanatomy and Related Neuroscience.

Edinburgh: Saunders; 2002, p.79-83.

2. Drake R, Vogl W, Mitchell A.W.M. Grays Anatomy for Student. Philadelphia: ChurchillLivingstone; 2005. p. 915-919.

3. Grays anatomy. Elsevier Churchill Livingstone, 39th ed., 2005. p. 157-163, 169-170, 560-565.

Regulation of the thyroid hormone secretion;

Mechanisms of body temperature regulation, heat production and lossSubjectphysiologyDepartment of PhysiologyReferences:


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1. Ganong WF. Review of medical physiology. 23rd ed. New York: Lange Medical Books /McGraw-Hill; 2010. Ch. 18 (p. 282-287), Ch. 20 (p. 301-313).

2. Guyton AC, Hall JE. Textbook of medical physiology. 11th ed. Philadelphia: ElsevierSaunders; 2006, Ch. 73 (p. 889-901), Ch. 76 (p. 931-943).


1. Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books /McGraw-Hill; 2005. Ch. 14 (p. 251-255), Ch. 18 (p. 317-332).Thyroid hormones (iodothyronines), synthesis, secretion, target cells, mechanism of

molecular working and effect on metabolism.

Changes of metabolism in organism during hypo- and hyperfunction activity of thyroid.

SubjectbiochemistryDepartment of Biochemistry

References:

Etiology of the thyroid hormone secretion disorders and pathogenesis of related functional

disorders.Subjectpathological physiologyDepartment of Physiology

References:

1. Stephen J. McPhee, William F. Ganong. Pathophysiology of Disease. An introduction toclinical medicine.5

thed. Lange 2006.p. 572-586

2. Kumar V., Abbas A.K., Fausto K.N. Robbins and Cotran Pathologic Basis of Disease, 7th ed.Elsevier Saunders, 2005, p. 1164-1183.

3. Porth CM. Pathophysiology: Concepts of Altered Health States. Lippincott Williams &Wilkins, 7th ed, 2005, p. 970-976.

Pathological anatomy of thyroid hyper- and hypofunctions and complications.Subjectpathological anatomyClinic of Pathological Anatomy

References:

1. Pathologic basis of Disease. Eds. Robbins I.L., Cotran R.S. 7th ed., 2005, pp. 1122-1125.Pharmacological correction of disordered thyroid function.

SubjectpharmacologyDepartment of Theoretical and Clinical pharmacology

References:

1. Bertram G. Katzung. Bendroji ir klinikin farmakologija(Basic and Clinical Pharmacology).(Vertimas lietuvi kalb.) Charibd, 2007, p. 620-635.2. Mycek M. J. Champe P.C. et al. Lippincott's Illustrated Reviews: Pharmacology, 3rd ed.

elphia: Lippincott Williams & Wilkins; 2006. p. 277-280.

3. Rang H.P. Dale M.M. et al. Pharmacology. 5th ed. Edinburgh: Churchil Livingstone; 2003. p.421-428.


1. Basic & Clinical Pharmacology, 9th ed,/ ed. by B.G.Katzung, 2004, p. 625-640.Symptoms and syndromes of the thyroid pathology

Subjectessentials of medical diagnosisClinic of Internal DiseasesReferences:


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1. Naudinas A., Leiyt P., Petkeviien R.T. ir kt. Vidaus lig diagnostikos pagrindai (Basicdiagnostics of Internal Medicine), Kaunas: Vitae Litera, 2007, p. 216-217.

5.Lectures5.1. Histology of the nervous system its formation

Department of Histology and Embryology

Peculiarities of the development of the central and peripheral nervous system. General principles

of the structure of brain white and grey matter. Distinctive histological features of the structure of

spinal cord, the brain stem, the diencephalon. Histological structure of the cerebellar cortex and

telencephalon. The histostructure of PNS derivations (nerves, spinal and autonomic ganglia)..

5.2. Histophysiology of endocrine glands and skin


Histophysiology of the hypothalamus, and hypophysis, thyroid, parathyroid and suprarenal

glands; their origin. Microstructure of the skin.

5.3. Functional anatomy of spinal cord and brain stem

Institute of AnatomyGrey and white matter of spinal cord (in longitudinal and transverse sections), the structures of

motor function. Peculiarities of regional anatomy and structure of somatic motor, autonomic andreticular formation nuclei and efferent pathways of brain stem.

5.4. Structural organization of the somatomotor neurofunctional system

Institute of Anatomy

Location of motor neurons and their pathways in the PNS. Structural organization of motor

control. Morphofunctional characteristics of components of somatomotor system: cortical motorareas, extrapyramidal system, reticular formation, cerebellum and tracts.

5.5. Functional anatomy of the autonomic nervous system


Structural peculiarities of efferent part of autonomic reflex arch, correlation to autonomic

innervation. Anatomy of the sympathetic trunk, connections between sympathetic ganglia and

sympathetic nuclei, pathways of postganglionic fibres to organs. Prevertebral ganglia and autonomic

plexuses. Parasympathetic ganglia, their correlation with parasympathetic nuclei, pathways ofpostganglionic fibres. Structural organisation of intraorganic (metasympathetic) nervous system.


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5.6. The neuroendocrine regulation

Department of Biochemistry

Hierarchy of the neuroendocrine regulation. Hypothalamic hormones, their structure, secretion

control, target cells and biochemical function. Hormones of anterior pituitary hormones (growthhormone, tropic hormones), their structure, secretion control, target cells and biochemical meaning.Hormones of adrenal gland (glucocorticoids and adrenalin): synthesis, secretion and its control,

target cells, molecular working mechanisms and inactivation.

5.7. Hypothalamusthe thyroid neuroendocrine axis


Thyroid hormones (iodthyronine), their synthesis and secretion, secretion control, transfer.

Iodthyronine target cells, mechanisms of action and effect to metabolism. Metabolism changes in

organism during thyroid hypo- and hyperfunctions process.

5.8. Signal transmission in the nervous system

Department of Physiology

Action potential (AP), its,origin. AP phases, their ionic mechanisms and registration. Excitability

changes during AP. Physiological significance of refractory. Spread of electronic potential.

Propogaion of action potential along the nerve fibres. Classification and characteristics of the nerve

fibres. Measurement of the nerve impulse velocity. Synaptic signal transfer in the central nervous

system (CNS). Types of neurotransmitters in the CNS, their activity, regulation of release. Ionotropic

and metabotropic receptors. Excitatory and inhibitory postsynaptic potentials. Inhibition in the CNS,its types and mechanisms. Signal transfer in neurons, spatial and temporal summation.

5.9. Spinal cord and the brain stem motor functions. Efferent control of

the motor functions. Disorders of the motor functions of the central

nervous system


General characteristics of the somatic motor system. Spinal control of movement. Proprioceptors

in muscles and tendons and their innervation. The simplest reflexes: the stretch reflex and Golgi

tendon reflex. Reciprocal inhibition. Polysynaptic reflexes (flexor, cross-extensor). Locomotion.Effects of spinal cord lesions on the motor functions. Motor control by brain stem (midbrain, pons

and medulla). The function of the motor cortex in voluntary movement. Effects of lesions of

corticospinal (pyramidal) tract. Cerebellar subdivisions and their functions. Neuronal circuit of the

cerebellar cortex. The role of cerebellum in learning of movements. Effects of cerebellar lesions on

motor performance. Basal ganglia connections and neurotransmitters. Comparison of functional

motor loops through basal ganglia and cerebellum. Effects of basal ganglia lesions on motor

performance.

Etiology and pathogenesis of nervous system motor functions disorders. Hyperkinesis,

hypokinesis, paresis and paralysis: etiology and pathogenesis. Differences of central and peripheral

paralysis.


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5.10. Fundamental activity of the autonomic nervous system. Stress and

the pathophysiology of general adaptation syndrome

Department of PhysiologyComparison of somatic and autonomic nervous system. Charactreistics of sympathetic and

parasympathetic systems. Effects on internal organs. Transmitters and receptors in autonomicnervous system. Synaptic transmission in the autonomic nervous system: direct-gating channels or

indirect action via G-proteins and second messengers. Enteric nervous system. Autonomic reflexes.Control of autonomic functions by hypothalamus and other higher centers (brain stem, cerebral

cortex).Stress and stressors. General adaptation syndrome (GAS) conception. Disorders of organism

functions. Diseases of adaptation.

5.11. Pathological physiology of the endocrine system (2 hours)

Department of PhysiologyGeneral etiology and pathogenesis of endocrine glands function disorders. Hyperfunction and

hypofunction of hypophysis, suprarenal gland, parathyroid gland, disorders of organism functions.

5.12. Pathological anatomy of the nervous and endocrine regulation

disorders

Clinic of Pathological Anatomy

Morphological bases of demyelinating and degenerative nervous system disorders. Morphologyand complications of the thyroid and parathyroid glands sustained and weakened function, definition

of the goitre. Morphological peculiarities and possible complications of the hypophysis andsuprarenal gland disorders, its frequent clinical syndromes.

5.13. Methods of the nervous system radiological analysis. Radiological

diagnostics of the congenital brain disorders, degenerative changes and

demyelinating pathology.

Clinic of Radiology

Brief history of radiology, computed tomography (CT), magnetic resonance (MRI),TranscranialDoplerography (TCD), positron emission tomography (PET) and single photon emission computedtomography (SPET), angiography, their working principles, indications, contraindications, contrast

media.

Congenital disorders: CT and MR diagnostics of the ventral, dorsal induction, neuronal

migration.

Demyelinating and degenerative diseases: white and grey matter diseases, congenital and

acquired diseases.

5.14. Spinal cord and the brain regional anatomy. Radiological

diagnostics of CNS blood circulation and CSF pathology


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Clinic of RadiologyRadiological topographical anatomy of the brain and the spinal cord, radiological topographical

anatomy of the blood vessels, CT and MRI diagnostics of the ischemic stroke due to time and

localisation. Radiological diagnostics of the CSF circulation disorders (occlusive and communicative

hydrocephaly).

5.15. Radiological diagnostics of hypothalamus, pituitary and adrenal glands pathology

Clinic of RadiologyRadiological anatomy of the sella, hypothalamus, normal variants, diagnostics (CT, MRI,

ultrasonic) of pathology (dysplasia, traumatic injuries, infections, tumours). Radiological anatomy ofthe adrenal gland, normal variation, diagnostics (CT, MRI, ultrasonic) of pathology (hyperplasia,

adenomas, metastases, feochromocytomas, carcinomas).

5.16. Cholinoreceptor- blocking drugs and other antiparkinson drugs (2

hours)

Department of theoretical and clinical pharmacologyCholinoreceptor-bloking drugs: classification, agents, pharmacokinetics, pharmacodynamics,

indications, contraindications, undesirable effect. Other antiparkinson medicines: agents,pharmacokinetics, pharmacodynamics, contraindications, undesirable effect.

5.17. Cholinomimetics, cholinoreceptor-blocking drugs,

adrenomimetics, adrenoreceptor-bloking drugs and

antisympathicotonic drugs

Department of theoretical and clinical pharmacology

Cholinomimetics: classification, agents, pharmacokinetics, pharmacodynamics, indications,contraindications, undesirable effect. Adrenomimetics: classification, agents, pharmacokinetics,

pharmacodynamics, indications, contraindications, undesirable effect. Adrenoreceptor-blocking

drugs and antisympathicotonic medicines: classification, agents, pharmacokinetics,pharmacodynamics, indications, contraindications, undesirable effect.

5.18. Fundamental of the nervous system clinical examination

Clinic of Internal Diseases

The purpose of neurological clinical examination. Evaluation of consciousness, mental activity

and meningitic symptoms. Evaluation and assessment principles of movements, senses, coordination

and gait. A brief scheme of neurological patient examination and description of the noticed changes.

5.19. Clinical evaluation of the endocrine system


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Clinic of Internal DiseasesClinical methods of patients examination in endocrinology. Clinical symptoms and syndromes:

acromegaly, Cushings syndrome, thyrotoxicosis, myxedema, suprarenal insufficiency.

6.PRACTICALS6.1. Principles of the histological structure of the peripheral and central

nervous system components histological structureDepartment of Histology and Embryology

While analysing the microscopic preparations, a student must know the features of the spinal

cord, the brain stem, the cortex of cerebellum, the diencephalon and the cortex of telencephalon,

ganglions and peripheral nerve histological structure.

Description of slides

1. Neural tube, tubus neuralis and brain vesicles, vesiculae cerebrales (H-E). N. 1A. In the

transversal section of the embryo, find and note the canal of the neural tube. Pay your attention to the

thickness of the neural tube wall and location of the cells. Draw three layers of the cells in the neural

tube wall: inner or ependyma, middle layer with neuroblasts and outer layer.

During the fourth week, the neural folds expand and fuse to form three primary brain vesicles: the

forebrain, or prosencephalon, the midbrain, or mesencephalon and the hindbrain, or

rhombencephalon. During the fifth week, the telecephalon, and hindbrain partly divides into themetencephalon and myelencephalon. As a result, there are five secondary brain vesicles.

By means of a small objective lens in the transversal section of the embryo, find and draw three

primary of five secondary brain vesicles.

2. Spinal ganglion, ganglion spinale (azanas arba H-E).N. 2A, 98. By means of a small objective

lens find and draw the connective tissue capsule which covers the ganglion in the transversal sectionof the spinal ganglion. Neurons of the sensory ganglia are seen to be large and arranged in groups at

the periphery of the ganglion. The groups of cells are separated by groups of myelinated nerve fibers.Fibers are mostly located in the center of the ganglion. By means of a large objective lens find

pseudounipolar neurons with large, bright nuclei. Each neuron body is surrounded by glial cells

(satellite cells). It is necessary to separate glial cells with round nuclei and the cells of the connectivetissue capsule (with oval nuclei).

3. Spinal cord,medulla spinalis (impregnation). N. 95. By means of a small objective lens find thecentral canal of the spinal cord, gray and white matter (it looks as a butterfly) in the transversalsection of spinal cord. Find the anterior (broader and shorter) and posterior horns. In the thoracic and

the first two or three lumbar segments of the cord, a lateral horn of gray matter is also to be seen on

each side of the cord. Note posterior lateral and anterior funiculi of the white matter. By means of a

large objective lens find elements of gray and white matter: neurons and glial cells. Pay attention to

the neurons in anterior, posterior and lateral horns. Note the zona spongiosa, substantia gelatinosa

and formatio reticularis in the posterior horns.

4. Cross section of the nerve, nervus (Azan). N. 99. Draw the whole view of the nerve. Find the

sheths of the nerve: the sheath of connective tissue which surrounds the one nerve fibre is called endoneurium, the fibres surrounds the perineurium and the whole nerve is surround by epineurium.


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5. Parasympathetic ganglion, ganglion autonomicum (H-E). N. 3A. By means of a small objective

lens find muscle layers in the wall of the small intestine. Find the autonomic ganglion between the

inner circular and outer longitudinal layer. Cells of the parasympathetic ganglion are brighter than

muscle cells.

6. Cerebellar cortex, cortex cerebellaris (impregnation). N. 96. By means of a small objective lensfind a superficial layer of gray matter (cortex) and the core of white matter. Draw three layers of thegray matter of the cerebellar cortex. From the surface the layers are: 1) an outer molecular layer, 2) a

central layer of Purkinje cells and 3) an inner granular layer. Pay attention to the Purkinje cells.They are quite large and their dendrites divide repeatedly in one plane, forming a sort of fan.

7. Cerebral cortex, cortex cerebralis (impregnation). N. 4A or 5A. The cerebrum, like cerebellum,

also the surface has a cortex of gray matter and a central area of white matter. Draw six layers of the

cerebral cortex. From the layers are: 1) the molecular layer consisting largely of fibers, most of

which travel parallel to the surface, and relatively few cells, 2) the outergranular layerconsisting

mainly of small cells, 3) the outer layer of pyramidal cells consisting only of a typical pyramidal

shape, 4) the inner granular layercharacterized by the presence of many small stellate cells (granule

cells), 5) the inner layer of pyramidal cells containig large pyramidal cells, but in the motor areathere are extremely large pyramidal cells called Betz cells, 6) the layer of polymorphic cells

containig cells with diverse shapes, many of which have a spindle or fusiform shape.

8. Choriod plexus, plexus choroideus (Aazan).N. 96. By means of a small obejective lens find and

draw blood vessels with loose connective tissue, covered by ependymal cells in the transversal

section of the choroid plexus. Pay attention to the ependymal cells. Ependymal cells compose the

simple cuboidal or low columnar epihelium.

9. The midbrain, substantia nigra. (Luxol/Blue). N. 7. Find the area in the midbrain substantianigra, where are a lot of neurons with melanine granules inside.

References:1. Junquiera L. C., Carneiro J. Basic histology. Text & atlas. McGraw-Hill, 2005, p. 153-181.

6.2. Histological structure of the endocrine glands and skin


While studying the microscopic preparations, a student must know the features of histologicalstructure of the hypophysis, thyroid, parathyroid glands and skin.

Description of slides

1. Hypothysis, hypophysis (Aazan). N. 21A. By means of a small objective lens findadenohypophysis, neurohypophysis and pars intermedia. Find the capsule of the hypophysis and

septa of the loose connective tissue. In adenohypophysis by means of a small objective lens find the

following cells:

1) Chromophobe cells. These cells are small, their cytoplasm stains slightly.

2) Chromophilic cells. Chromophilic cells are larger than chromophobe cells, their cytoplasm stains

intensively. There are 2 kinds of the chromophilic cells: acidophils and basophils. The cytoplasm of

the acidophilic cells is granular, it stains with acid dyes (it stains pink with eosin). The cytoplasm of


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the basophilic cells stains with basic dyes (it stains blue with hematoxylin ). Basophilic cells are

most frequent in the posterior and medial parts of the adenohypophysis.

PARS INTERMEDIA is located between the adenohypophysis and neurohypophysis. You can find a

thin layer of cells in the pars intermedia.

NEUROHYPOPHYSIS consists of glial cells, pituicytes and nerve fibers. Pituicytes are highly

branched cells. Between them you can see endothelial cells of capillaries.

2. Epiphysis cerebri (pineal gland), epiphysis cerebri, (H-E). 22 A. By means of small objective

find the pia mater that covers the surface of epiphysis and septa that extend into the gland and forme

the lobules. By means of large objective within the lobule find pinealocytes chief cells of the gland.

The cells are big with large nucleus in cytoplasm contain lipid droplets. At the periphery of the

lobule find smaller cells with oval compact nuclei glial cells. In addition to these parenchymal and

glial cells, in the human pineal gland you can find calcified concretions, called brain sand or corpora

arenacea.

3. Thyroid gland, glandula thyreoidea (HBp). 23 A. By means of a small objective lens find

connective tissue capsule and septa of loose connective tissue capsule. Find follicles of the gland.

Walls of the follicles are composed of the follicular cells. Lumen of the follicle contains colloid (a

gelatinous substance). Another type of cells, the parafollicular cells, are found as part of the follicular

epitheliumIn the connective tissue between follicles there is a great number of capillaries.

4. Parathyroid gland, glandula parathyroidea (HBp). N. 24 A. By means of a small

objective lens find the capsule of the loose connective tissue. The perenchyma of the parathyroid

gland consists of 2 types of cells: the chief cells and the oxyphil cells. Chief cells are small,

polygonal with a vesicular nucleus and a pale staining, slightly acidophilic cytoplasm. They contain

secretory granules, which secrete parathyroid hormone. Oxyphil cells are polygonal also, but larger

than chief cells, nuclei are smaller and stain more densely. The cytoplasm of these cells contains

acidophilic granules. The function of the oxyphil cell is uncertain.

5. Adrenal gland,glandula suprarenalis (Azan or H-E).N. 24 A, 25 A. By means of a small

objective lens find the capsule of dense connective tissue. Find the cortical and medullar parts of the

adrenal gland. Adrenal cortex can be subdivided into 3 concentric layers: the zona glomerulosa, zona

fasciculata and the zona reticularis. Beneath the capsule is the zona glamerulosa in which the cells

are arranged in rounded or arched clusters surrounded by capillaries. In zona fasciculata the cells are

arranged in straight cords 1 and 2 cells thick. The cells are polyhedral with a great number of lipid

droplets in their cytoplasm. The zona reticularis contains cells arranged in irregular cords that form

an anastomosing network. The adrenal medulla is composed of polyhedral parenchymal cells


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arranged in cords or clumps and supported by a reticular fiber network. Between cells there is a great

number of capillaries.

6. Skin of the palm, cutis (H-Kernechtrot). N. 21. By means of a small objective lens find

epidermis, dermis and hypodermis. By means of a larger objective lens find and draw layers of the

epidermis: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum and stratum

corneum.

The junction between the dermis and epidermis is an uneven boundary. Dermis consists of

two layers: papillary and reticular. The papillary layer is constituted of numerous finger like

connective tissue protrusions into the dermis. The papillary layer consists of loose connective tissue.

It is located immediately under the epidermis and is separated from it by the basal lamina. The

reticular layer is deep to the papillary layer and consists of dense connective tissue. It considerably

thicker than the papillary layer. Hypodermis contains a variable amount of adipose tissue. In the

dermal papillae you can find Meissners corpuscles (they are touch receptors) and in deeper dermis

and hypodermisPacinian corpuscles (they are composed of a myelinated nerve ending surrounded

by a capsule and they respond to pressure and vibration).

6. Skin of the head, cutis (HBp/H-E). N. 23. By means of a small objective lens find layers

of the skin. Stratum corneum is much thinner, papillary layer is thin, reticular thick. Find

longitudinal sections of hair follicles in the dermis and hypodermis. The outermost part of the hair

follicles is a downgrowth of the epidermis external root sheeth, at deepest point there is

invagination of the connective tissue papilla. External root sheet is several cells thick, other cells

are called the matrix. Internal root sheet is a multilayered cellular covering that surrounds the deep

part of the hair. The hair consists of the medulla, cortex and cuticle. Near hair follicle find sebaceous

glands, musculus errector pili and sweat glands.

References:

1.

Junquiera L. C., Carneiro J. Basic histology. Text & atlas. McGraw-Hill, 2005, p. 411-415;360-372.

6.3. Regional anatomy of spinal cord and brain stem effector structures.

Anatomy of cerebellum

Institute of AnatomyStudents must repeat external anatomy and regional location of spinal cord, brain stem and

cerebellum effector structures (somatic, autonomic nuclei and tracts).

For neuroanatomical reasoning of first (4.1) and second (4.2) study problems student should be

able to explain:


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Segments of spinal cord: definition, number, sceletotopy, internal structure (gray and white

matter, proper fasciculi*, roots*, spinal nerve*), origin and structure of horse tail, segmental

distribution of sensory and motor fibers to dermatome, sclerotome, and myotome, their neurological

significance.

Gray matter of spinal cord in horizontal and longitudinal sections: anterior, intermediate,posterior columns*, anterior, lateral, posterior horns*- their segmental functional peculiarities(sensory, motor, autonomic) at different levels.

Effector nuclei of gray matter: somatic motor, autonomic (sympathetic, parasympathetic):

location, pathway of their fibers to periphery and lesions.

White matter of spinal cord: funiculs*, descending tracts (corticospinal*, rubrospinal*,

reticulospinal*, vestibulospinal*, tectospinal*) origin, location and function.

Brain stem*: parts, internal structure (basis* and tegmentum*), location of descending tracts.

Effector nuclei of brain stem: topography of motor somatic nuclei*, pathway of fibers, innervated

muscle groups, lesions; topography of parasympathetic nuclei*, pathway of preganglionic fibers.

Cerebellum*: parts, structure and function of gray matter (cortex and nuclei), peduncles, their

main afferentic and efferentic tracts related to somatomotor function.

Blood supply of brain stem and cerebellum.

Note.

At the end of practical work the assessment of students knowledge is carried out. Students mustanswer to 3, 4, 5, 6, 7, 8, 9, and 10 exams questions.

Additional information about these questions will be given in the lecture 5.3.

References:

1. Fitz Gerald M.J.T., Folan-Curran J. Clinical Neuroanatomy and Related Neuroscience.Edinburgh: Saunders; 2002, p. 23-32, 123-154.

2. Grays anatomy. Elsevier Churchill Livingstone, 39th ed., p. 307-322, 327-350.

6.4. Anatomy of effector structures of diencephalon and telencephalon


Students must repeat peculiarities of diencephalon and telencephalon anatomy.

For neuroanatomical reasoning of second (4.2), third (4.3), and fourth (4.4) study problems

student should be able to explain: location, structure of effectors and connections with functionally

related other parts of brain.

Diencephalon: lateral group of thalamus nuclei, nucleus of subthalamus, location, connections

with basal nuclei and motor cortex; structures of hypothalamus involved in autonomic and

neuroendocrine regulation, location, structure, neuronal and humoral interaction with hypophysis.

Basal nuclei: location of caudate and lentiform nuclei, corpus striatum and globus pallidum,connections with substantia nigra, thalamus, motor cortex, neurochemical features.


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1. Drake R, Vogl W, Mitchell A.W.M. Grays Anatomy for Student. Philadelphia: ChurchillLivingstone; 2005. p. 69-71, 87-88; 110-112; 340-343; 420-425; 494-497; 617- 621, 656-665,

800-807.

2. Grays anatomy. Elsevier Churchill Livingstone, 39th ed., 2005. p.554-559, 966-968, 1124-1126, 1364, 1365.

Supplementary readings;1. Poritsky R. Neuroanatomy To Color and Study. Hanley&Belfus, 2004. p. 17, 27, 28, 53, 56,

57, 60, 61, 79.

6.6. Action potentials in nerves


Please print Appendix 9.1 for laboratory exercise

Registration of monophasic and diphasic summated (compound) action potentials (SAP),

measurement of their propagation velocity. Refractory periods during the action potential of separate

nerve fibre and during the SAP. Inhibition of the SAP by local anaesthetic drug.

References:

1. Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books /McGraw-Hill; 2005. Ch.2 (p. 54-61).

Supplementary readings:1. Guyton AC, Hall JE. Textbook of medical physiology. 11th ed. Philadelphia: Elsevier

Saunders; 2006, Ch. 5 (p. 65-71).

6.7. Motor spinal cord reflexes


Please print Appendix 9.2 for laboratory exercise

Recording of the strech reflex and reflex induced by electrical impulses (Hoffmanns reflex),excitability changes in their reflex arch, their similarities and differences. Recruitment curve of theHoffmanns reflex.

References:1. Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books /

McGraw-Hill; 2005. Ch.6 (p. 129-134).


2. Guyton AC, Hall JE. Textbook of medical physiology. 11th ed. Philadelphia: ElsevierSaunders; 2006, Ch. 54 (p. 673-680).

6.8. Pathology of the neural and endocrine regulation disorders (3

hours)

Clinic of pathological anatomy


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6.9. Cholinomimetics, cholinoreceptor-blocking drugs, adrenomimetics,

antiadrenergic agents

Department of Theoretical and Clinical Pharmacology

While performing the practical work, a student must obtain knowledge about thepharmacokinetic, pharmacodynamic characteristics and usage of this kind of medicines,

contrindications, undesirable effect.

References:

1. Bertram G. Katzung. Bendroji ir klinikin farmakologija (Basic and Clinical Pharmacology)(Vertimas lietuvi kalb). Charibd, 2007, p. 74-120; 121-158.

2. Mycek M. J., Champe P.C., et al. Lippincott's Illustrated Reviews: Pharmacology, 3rd ed.Philadelphia: Lippincott Williams & Wilkins; 2006, p. 35-65; 66-90.

3. Rang H.P., Dale M.M. et al. Pharmacology. 5th ed. Edinburgh: Churchil Livingstone; 2003,p. 136-160; 161-183.

Supplementary readings:1. Basic & Clinical Pharmacology, 9th ed./ ed. by B.G.Katzung, 2004, p. 75-121; 122-159.

6.10. Outline of the motor system (upper and lower motor neuron)

examination and assessment


Muscle strength examination and evaluation. More often in neurological practice used reflexes:

examination and their response evaluation within the standard and in pathology. The search and

evaluation of the pathological reflexes. The examination and evaluation of muscle tonicity. The

symptoms of upper and lower motor neuron lesions.

References:1. Epstein P. et al. Clinical Examination. London: Mosby; 1997; pp. 348-356.

Supplementary readings:1. Thomas J, Monaghan T. Oxford Handbook of Clinical Examination and Practical Skills.

Oxford: University Press; 2007, p. 330-334; 346-349.2. Bickley L.S. BatesGuide to Physical Examination and History Taking. Philadelphia:

Lippincott Williams & Wilkins; 2007, p. 633-641.

6.11. Clinical examination and assessment of gait, coordination, smooth

movements


Examination and assessment of extrapyramidal system. Examination and assessment of

coordination. Examination and evaluation of gait and posture.

References:1. Epstein P. et al. Clinical Examination. London: Mosby: 1997, p. 356-363.


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Regional anatomy of internal organs innervation (coeliac, abdominal aortic, superior andinferior hypogastric plexuses and ganglia), their structure and innervated organs. Anatomy of heart

autonomic regulation.

References:

1. Drake R, Vogl W, Mitchell A.W.M. Grays Anatomy for Student. Philadelphia: ChurchillLivingstone, 2005, p. 307-314, 179-180, 835, 998-999.

2. Grays anatomy. Elsevier Churchill Livingstone, 39th ed., 2005. p.3. FitzGerald M.J.T, Folan-Curan J. Clinical Neuroanatomy and Related Neuroscience.

Saunders; 2002, p. 85-100.


1. Poritsky R. Neuroanatomy To Color and Study. Hanley&Belfus, 2004. p. 17, 27, 28,

7.3. Anatomy of the endocrine glands

Institute of AnatomyFunctional anatomy of hypothalamus nuclei, their humoral and neural connections with pituitary

gland. Peculiarities of the regional and aging anatomy of pituitary, pineal, thyroid, parathyroid,adrenal glands. Dispersed neuroendocrine system. Anatomy of the sympathoadrenal system.

References:1. Drake R., Vogl W, Mitchell A.W.M. Grays Anatomy for Student. Philadelphia: Churchill

Livingstone, 2005, p. 327-328; 915-919.2. Grays anatomy. Elsevier Churchill Livingstone, 39th ed., 2005. p. 179- 182, 380-385, 560-

565, 1245-1249.


1. Nadeau St.E., Ferguson T.S., Valenstein E. et al. Medical Neuroscience. Saunders, 2004, p.507- 522.

7.4. Features of biochemical structure and metabolism of nervous tissue


Peculiarities of nervous tissue biochemical structure. Metabolism of carbohydrates and energy in

the nervous tissue. Metabolism of amino acids and lipids.

References:

1. Devlin T.M. Textbook of biochemistry with clinical correlation. Wiley-Liss, 6th ed. 2006, p.892-947.

7.5. Disorders of endocrine glands functions (2 hours)


Description:Slides of patients with endocrine diseases (disfunction of thyroid, adrenal, parathyroid gland,

adenohypophysis etc.), schemes of pathogenesis of endocrine glands function disorders are analysedduring the seminar.

Literature:1. Stephen J. McPhee, William F. Ganong. Pathophysiology of Disease. An introduction to

clinical medicine.5th

ed. Lange 2006. p. 493-502, 554-564, 572-584, 598-620.


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2. Porth C.M. Pathophysiology: Concepts of altered Health States. 7th ed. Lippincott Williams& Wilkins; 2005. p. 951-984.

3. Kumar V., Abbas A. K., Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed.Elsevier Saunders; 2005, p. 1155-1226.

7.6. Antiparkinson drugs

Department of Theoretical and Clinical Pharmacology

Antiparkinson drugs, classification, agents, pharmacokinetics, mechanism of action, indications,contraindications, undesirable effect.

References:

1. Bertram G. Katzung. Basic and Clinical Pharmacology. Charibde, 2007, p. 443-457.2. Mycek M. J. Champe P.C. et al. Lippincott's Illustrated Reviews: Pharmacology, 3rd ed.

Philadelphia: Lippincott Williams & Wilkins; 2006, p. 91-102.

3. Rang H.P. Dale M.M. et al. Pharmacology. 5th ed. Edinburgh: Churchil Livingstone; 2003, p.490-502.

Supplementary readings:1. Basic & Clinical Pharmacology, 9th ed/ ed. by B.G. Katzung, 2004, p. 447-461; 109-121.

7.7. Thyroid hormones, antithyroid drugs and iodine

Department of Theoretical and Clinical PharmacologyPreparations of thyroid hormones: agents, pharmacokinetics, pharmacodynamics, indications,

contraindications, undesirable effect. Antithyroid drugs: agents, pharmacokinetics,pharmacodynamics, indications, contraindications, undesirable effect. Iodine products: agents,

pharmacokinetics, pharmacodynamics, indications, contraindications, undesirable effect.

References:1. Bertram G. Katzung. Bendroji ir klinikin farmakologija (Basic and Clinical Pharmacology).

(Vertimas lietuvi kalb). Charibd, 2007, p. 621-635.2. Mycek M. J. Champe P.C. et al. Lippincott's Illustrated Reviews: Pharmacology, 3rd ed.

Philadelphia; Lippincott Williams & Wilkins; 2006. p. 277-280.

3. Rang H.P. Dale M.M. et al. Pharmacology. 5th ed. Edinburgh: Churchill Livingstone; 2003,p. 421-428.


1. Basic & Clinical Pharmacology, 9th ed./ ed. by B.G. Katzung, 2004; p. 625-640.7.8 The importance of CT and MR methods in neuroradiology. The

analysis of CT and MR imaging.

Department of RadiologyEvaluation of CT and MR tomograms: MR different sequences, topographical anatomy of the

brain in CT and MR slices, congenital disorders, demyelinating diseases, degenerative disorders,

pathology of the hipophysis and adrenal glands.

References:1. Lectures2. Grossman R. I., Yousem D. M. Neuroradiology. The Requisites, Mosby, 2003, p. 183-197 ,

331-369, 517-541

3. Osborn G. Diagnostic neuroradiology, Mosby, 1994, 3-113, 330-398, 461-484, 716-747, 834-836


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4. Prokop A. A., Galanski M. Spiral and multislice computed tomography of the body, Thieme,2003

5. Baseviius A., Lukoeviius S., Kiudelis J., Dobrovolskien L. Radiologijos pagrindai,Kaunas, 2005

6. Osborn A. G. et al. Diagnostic imaging. Brain. Vol. I, Amirsys; 2004, section 8, p. 74-83, vol.II, section 2, p. 2-41.


1. Burgener F. A., Meyers St. P., Tan R. K., Zaunbauer W. Differential diagnosis in magneticresonance imaging, Thieme, 2002.

2. Federle M. P., Jeffrey R. Br. Diagnostic imaging of abdomen, Amyrsys, 20043. Osborn A. G., Blaser S. I., Salzman K. L., Pocket radiologist Brain Top 100 diagnoses,

Amyrsis, 2003, p. 84-90, 174-177, 210-213, 255-257

8.EXAMINATION QUESTIONS OF THE MODULE8.1. Histology

1. Histological structure and distribution of grey matter of the brain and spinal cord.2. Histological structure and distribution of white matter of the brain and spinal cord.3. Histological structure of the peripheral nerve, spinal and autonomic ganglia.4. Histological structure and peculiarities of the development of spinal cord.5. Structural peculiarities of brain stem (the medulla oblongata, pons, the mesencephalon).6. Histological structure of the cerebellum (structural peculiarities and distribution of the grey

and white matter).

7. Histological structure and origin of the cortex of the telencephalon. Histologicalcharacteristics of the module of the brain cortex.

8. Connective tissue derivates in the central and peripheral nervous system.9. Basic principles of the histostructure of endocrine gland. Histophysiology of parathyroid

glands.

10.Histological structure and origin of the adenohypophysis. Functional relations betweenhypothalamus and hypophysis.

11.Histological structure and origin of the neurohypophysis. Functional relation betweenhypothalamus and hypophysis.

12.Histophysiology and origin of the thyroid gland.13.Histophysiology and the origin of the suprarenal gland.14.Histological structure of hairy skin.15.

Histological structure of nonhairy (glabrous) skin. Differences between the histologicalstructure of the hairy and glabrous skin.


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8.2. Anatomy

1. Components of neuron internal structure and their functional significance. Axoplasmic flowstructure, its biological and medical significance. Structural organization of neuroninteraction: chemical synapses, their types due to the structure and neuromediators.

2. Structural organization of neuroglia and neuron interaction: astrocytes, oligodendrocytes,neurolemocytes (Schwann cells). Biological and medical significance of neuroglia. Influenceof nerve fibre sheath structure to nerve impulse speed. Neuron degeneration and regeneration.

3. Anatomy of spinal gray matter in transverse and longitudinal sections, regional (segmental)functional peculiarities of the gray matter.

4. Somatic motor neurons of the spinal

neuro endo questions

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