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COLLEGE OF MEDICINE CNS - 413 BLOCK (girls) Table for the guidelines/ Requirements to achieve the Intended Learning Outcomes (ILO’s) 1433-1434 [2012-2013] CNS 424 Block Educational Framework (Week 1) Requirement to achieve the ILO’s The intended learning outcomes Describe the external and internal features of the Skull and structures passing through foramina. Discuss the organization of central nervous system. Explain the gross morphology of the spinal cord. List the bones of the skull Identify the major sutures of the skull Identify the major surface marking of the skull Identify the major foramina in the skull List the major structures which pass through the foramina Describe the cranial fossa and its part Understand the base of the skull and its fracture Describe the structure of the mandible Name the components of the nervous system Identify functional differentiation between afferent and efferent divisions of PNS Describe the gross anatomical features of the spinal cord. Describe the level of the different spinal segments comparing to the level of their respective vertebrae. Identify important gross features of spinal cord, nerve roots, and spinal ganglia. Describe the internal features of spinal cord (gray matter and white matter) in the different regions. Describe gracile and cuneate tracts and pathways for conscious proprioception, touch, pressure and vibration from the limbs and trunk. Describe dorsal and ventral spinocerebellar tracts and pathways for Describe the Ascending tracts of the spinal cord. 2 Describe the Descending tracts of the spinal cord. Describe Spinal Cord Reflexes. Explain the external and internal features of the Brainstem and the connections of its different nuclei. unconscious proprioception from the limbs and trunk. Describe lateral spinothalamic tract and pathways for pain and temperature from the limbs and trunk. Describe ventral spinothalamic tract and pathways for simple touch from the limbs and trunk. Define the terms upper and lower motor neurons with examples Describe the corticospinal (pyramidal) tract and the direct motor pathways from the cortex to the trunk and limbs. Briefly describe the indirect motor pathways from the cortex to the trunk and limbs through extrapyramidal tracts such as rubrospinal and reticulospinal tracts. Describe motor pathways to the face muscles. Compare the signs and symptoms of the upper and lower motor neuron lesions. What are the components of spinal reflexes. What type of spinal cord reflexes are there. How spinal cord reflex occurs and what is their control. What abnormalities can affect the spinal cord reflex. Identify the gross features of the brainstem. Briefly describe the internal structure of the brainstems (ascending and descending pathways, sensory and motor cranial nuclei, substantia nigra, red nucleus, olivary nucleus and reticular formation). Describe the main connections of the sensory cranial nuclei. Describe the main connections of the motor cranial nuclei. Review the blood supply of the brainstem. Describe lesions in the brainstem such as medial medullary syndrome and lateral medullary syndrome. Describe the main connections of the substantia nigra and the red nucleus. 3 Explain the role of neurotransmitters in signal transduction in the central nervous system. Discuss receptors and sensory pathways. List the main neurotransmitters of the CNS List the neuronal tracts that represent the main site of action of each neurotransmitters List the main receptors activated by each neurotransmitters Complete overview of Transmitter Pharmacology in the Central Nervous System Classify the sensory receptors Enumerate the receptors found in the skin for different sensory modalities Explain the terms receptor potentials and sensory transduction Describe the sensory pathways that mediates touch, proprioception and vibration sense Describe the organization sensory cortex 4 CNS 424 Block Educational Framework (Week 2) Requirement to achieve the ILO’s The intended learning outcomes Discuss the structure of the cerebellum with its nuclei and their connections. Identify the major lobes and regions of cerebellum. Summarize the structure of the cerebellar cortex Identify the deep cerebellar nuclei and their connections. List the afferent and efferent connections of the cerebellum and their arrangement in cerebellar peduncles. Describe the major functions of the cerebellum and how each side of the cerebellum controls the ipsilateral side of the body. Explain the effects of lesions of cerebellum and motor disorder associated with cerebellar lesions. What are the components of brainstem and their function. Should know the reticular formation and its activating and inhibitory system. Role of brainstem and brain death Define pain Identify type of sensory receptor involved in pain List name and functions of nociceptors Explain the role of PGs in pain sensation Compare between fast and slow afferent pain fibers Identify pain neurotransmitters Describe the analgesic pathway Discuss the brainstem components and functions. Describe the mechanism of pain sensation and analgesia. 5 Describe Motor Cortex and Pyramidal Tracts. Define opiate and list endogenous opiates Describe the different motor areas How different part of the body are represented in motor cortex Have concept of motor homunculus Describe the functions of different motor areas with their role in voluntary movement Describe the origin and functions of pyramidal tract Histology Describe opioid analgesics and antagonists in terms of their mode of action, indication, dose, side effects and contraindication. List the main types of opioid receptors. Explain the molecular events that follow opioid receptor activation Explain the mechanism of action of opioid agonists, partial and mixed agonist/ antagonists, and antagonists. Contrast the central and the peripheral actions of morphine and related drugs. Describe the major features of the analgesic effect of opioids. Describe the actions of opioids upon different organ systems. Relate the different actions of opioids to the activation of specific receptors Describe the main features of the tolerance to the effect of opioids. Outline the main differences between morphine and other opioid drugs. List the routes of administration available for opioids. Describe the main adverse effects of opioids. Outline the main features of opioid dependence. Describe the opioid abstinence syndrome. List the main contraindications and cautions in the use of opioids.. Outline the analgesic use of opioids. Describe the main effects and therapeutic uses of opioid antagonists. 6 CNS 424 Block Educational Framework (Week 3) Requirement to achieve the ILO’s The intended learning outcomes Explain the brain topography and internal features of the brain. Describe the extrapyramidal tracts. Demarcate the major lobes, gyri and sulci of the cerebral hemisphere.. Describe the organization of the cerebral hemisphere into cerebral cortex ,white matter and nuclei Describe the types of fibers in the white matter of the cerebral hemisphere: projection (internal capsule), commissural and association fibers. Identify the basal ganglia nuclei. Identify main parts of the diencephalons and name the main functions of each part Define parts of the brainstem and briefly describe its internal structure. Identify the superficial attachments of the cranial nerves. Briefly describe the brain ventricles and meanings. Describe the organization of the cerebral cortex. (Layers and columnar organization). Locate the motor, sensory and other cortical areas. Describe the cortical areas related to the written and spoken language. Identify the structures in coronal, sagittal and horizontal sections of brain. Describe the types of fibers in the internal capsule. List the extrapyramidal tracts. Summarize the functions of extrapyramidal tracts. Define upper and lower motor neurons 7 Explain the role of cerebellum in controlling body movements. Describe Anti-seizure Drugs in terms of their mode of action, indication, dose, side effects and contraindication. Describe the structure of basal ganglia and its connections. Compare and contrast upper and lower motor neuron lesions. How cerebellum is connected to different parts of brain Describe the role of cerebellum in control of movements Know the functions of different parts of cerebellum List the main classes of anti-epileptic drugs Explain the mechanism of action , pharmacological action, pharmacokinetic and adverse effects of selected drugs in each group List the main contraindications of antiseizure drugs Outline the main therapeutic uses of antiseizure drugs Understand the anatomical and functional definition of the basal ganglia. Identify the different components of the basal ganglia. Describe the connections of the different components of the basal ganglia and the indirect pathways from the basal ganglia to the lower motor neurons. Describe signs and symptoms of lesions which affect different components of the basal ganglia. Enumerate the basal ganglia and describe their main circuits, neurotransmitters and functions Explain the following features and phenomena associated with Extrapyramidal disease: dyskinesia, dystonia, tremor, chorea, athetosis, and hemiballismus Give examples from Parkinson's disease and the choreas of Sydenham and Huntington. Describe the structure of the internal capsule Identify different areas of the internal capsule Describe the connections and functions of Basal Ganglia. Discuss the structure of internal capsule. 8 9 CNS 424 Block Educational Framework (Week 4) Requirement to achieve the ILO’s The intended learning outcomes Describe the location and parts of the Thalamus with its nuclei and explain the structure of Hypothalamus and Subthalamus with its nuclei and connections. Discuss Drugs of Abuse. Describe the location of the thalamus List the different parts and nuclei of the thalamus List the afferent input to different nuclei of the thalamus List the efferent output from the different nuclei of the Thalamus Describe the structure of hypothalamus, epithalamus , and subthalamus List the nuclei of the hypothalamus List the afferent connections of the hypothalamus List the efferent connections of the hypothalamus List the functions of hypothalamus General concepts Describe the main features of physical dependence Describe the main features of psychological dependence Outline the guidelines for the treatment of drug dependence Nicotine abuse and dependence Describe the main features of tobacco dependence Outline the toxicity of tobacco Describe the pharmacological treatment of nicotine dependence Cannabis abuse and dependence Describe the pharmacological actions of cannabinoids 10 Discuss the components, arrangement, distribution and functions of Autonomic nervous system. Describe the tolerance and dependence to cannabis Outline the toxicity and therapeutic uses of cannabis Hallucinogen abuse and dependence List the main classes of hallucinogenic drugs and the main representatives of each class Describe the pharmacological actions of hallucinogens Describe the tolerance and dependence to hallucinogens Outline the toxicity of hallucinogens Steroids abuse and dependence Describe the main features of steroid abuse and dependence. Psychostimulants abuse and dependence Describe the pharmacology of cocaine and amphetamines Describe the tolerance and dependence to cocaine and amphetamines Outline the toxicity of cocaine and amphetamines Describe the main aspects of xanthine abuse and dependence Abuse and dependence on hypnotics, sedative and inhalants Describe the pharmacodynamics and pharmacokinetic of ethanol Describe the tolerance and dependence to ethanol Describe the ethanol withdrawal syndrome Outline the pharmacological therapy of ethanol dependence Describe the main features of barbiturate and benzodiazepine dependence Describe the main aspects of inhalant abuse and dependence Opioids abuse and dependence Describe the main features of opioid dependence Describe the opioid withdrawal syndrome. Outline the pharmacological therapy of opioid dependence Review the subdivisions of the nervous system. Review the general arrangement and compare the sympathetic and parasympathetic parts. 11 Discuss the role and functions of Thalamus and Hypothalamus in regulation of body mechanisms. Explain the effect of drugs on autonomic nervous system in terms of their mode of action, Describe the following plans Para vertebral ganglia. Prevertebral ganglia. Parasympathetic ganglia. Splanchnic nerves. Autonomic plexuses. Map out the various plexuses in head and neck, thorax, abdomen and pelvis. Make a list of the components of the system. Review the basic structure of sympathetic trunk. Describe the source of sympathetic system in the neck and make a list of target organs. Describe the Para vertebral sympathetic ganglia in the abdomen, their locations and target organs. Discuss the relation of this system to the adrenal medulla. Discuss the sympathetic innervation of blood vessels. Make a list of the components of the system. Make a list of cranial nerves having parasympathetic activity. Describe the parasympathetic ganglia in the head and neck, their locations and target organs. Describe the sacral parasympathetic out flow. Make a list of its target organs. List the different thalamic nuclei. Appreciate the role of thalamus as a relay between subcortical areas and the cortex. List the different hypothalamic nuclei Describe the important control areas in hypothalamus Appreciate temperature related problems eg. Fever, heat stroke, hypothermia etc Recognize or describe the location and mechanism of action of nicotinic and muscarinic cholinergic receptors and the effects produced if they are stimulated 12 indication, dose, side effects and contraindication. Explain the arrangement of limbic system. Differentiate between the layers of meninges and spaces between them. or blocked. Also recognize Cholinomimetics, Cholinergic agonist and antagonist as well as anticholinesterase or cholinesterase inhibitor Explain the relative activity of epinephrine, norepinephrine, isoproterenol and other stimulants of adrenergic transmission as to their alpha1, beta1, beta2, and beta3 stimulating potential. Also understand the mechanism of action, pharmacological effects, adverse effects, contraindications and therapeutic uses of adrenergic antagonist. Define limbic system Know the different parts and functions of limbic system Describe the function of various parts of hypothalamus Describe the arrangement of the meninges and their relationship to brain and spinal cord. Explain the occurrence of epidural, subdural and subarachnoid spaces. Locate the principal subarachnoid cisterns, and arachnoid granulations. 13 CNS 424 Block Educational Framework (Week 5) Requirement to achieve the ILO’s The intended learning outcomes Discuss the blood supply of the central nervous system. Discuss physiology of Speech. Describe meningitis in terms of definition, classification, causative agents and etiological factors. Explain the pathological aspects of cerebrovascular diseases. Describe the four arteries supplying the CNS. Follow up each artery to its destination. Describe the circle of Willis and its branches. Discuss the principle of end artery type of circulation. Describe venous drainage of the brain. Identify the cortical speech areas. Understand the causes of dysarthria, dysphonia and explain the different types of aphasia Define meningitis, myelitis, and encephalitis. Enlist the most common causative agents of meningitis. Identify the routes of pathogens entry to invade central nervous system. Discuss the tropism of nervous system to certain types of pathogens. Identify the mechanism of tissue destruction during meningitis. Classify meningitis according to etiology, and epidemiology. Define the abnormal components of cerebrospinal fluid and their importance as a diagnostic indicator for different types of meningitis. Differentiate between pathogens of central nervous system according to microbiological aspects. Enumerating types of intracranial hemorrhage. Describing morphological features of brain infarction. Enumerating types of cerebral aneurysms 14 Know various types of memory Role of different parts of brain involved in processing and storage of memory Role of different central mechanisms in learning &memory Discuss the physiology of learning and memory. Explain the ventricular System of the brain and formation, circulation and absorption of cerebrospinal fluid. Describe the ventricles of brain and importance of their choroids plexus. Summarize the pathway of cerebrospinal fluid (CSF) circulation Locate the safe sites for the lumbar puncture. Identify brain ventricles in CT scan, MRI and ventriculograms. Discuss the biochemical composition, sampling and analysis of cerebrospinal fluid. Recalling the main biochemical concepts of the CSF. Being oriented of the clinical aspects of CSF sampling in limited details. Discussing the utilization of CSF analysis in diagnosing many neurological diseases. 15 CNS 424 Block Educational Framework (Week 6) Requirement to achieve the ILO’s The intended learning outcomes Discuss Hydrocephalus in terms of definition, causes, morphology and complications. Describe physiology of sleep and EEG. Describe anxiolytic, sedative, and hypnotic drugs in terms of their mode of action, indication, dose, side effects and contraindication. Discuss the orbit, orbital contents, cranial nerves (III, IV and VI), eye and visual pathway. Understanding definition of hydrocephalus. Discussing causes of hydrocephalus. Describing morphological features of hydrocephalus. Being aware of the complications of hydrocephalus. What are the stages of sleep What is REM and NREM sleep What is the origin of EEG What EEG waves record is obtained and what is their classification Importance of EEG in clinical practice. Explain the mechanism of action, pharmacological effects and adverse effects of Selected drugs in each group Describe the main features of benzodiazepine pharmacokinetics Describe benzodiazepine inverse agonists and antagonists Outline the main therapeutic uses of each drug in each group Describe the location of the orbit. Make a list of structures making the orbit starting from orbital margin. Define each component. Describe openings into orbital cavity. Describe muscles of the orbit, their cone arrangement, origin, insertion, nerve supply and their function. Describe the visual pathway Discuss the central connections of the cranial nerves (III,IV,VI) 16 Describe the physiology of vision. Describe the biochemical, nutritional and clinical aspects of Vitamin A and its role in vision. Discuss the mode of action, indication, dose, side effects and contraindication of the drugs used in the treatment of Bipolar Disorders and Migraine. Describe the structure of the eye and explain how images are brought to a focus on the retina. Describe the refraction of light as it passes through the eye to the retina, identifying the eye components that account for refraction of light at the center of the eye and away from the center. Describe the process of accommodation, contrasting the refraction of light by the lens in near vision and in far vision. Describe the refractive deficits that account for myopia, hyperopia, presbyopia, and astigmatism, and their correction by eyeglasses or contact lenses. Contrast the transduction process for rods and the three types of cones, Describe the function of rhodopsin in the rods and explain how dark adaptation is achieved. Predict the visual field defects resulting from the following lesions in the visual pathway: retinal lesion, optic nerve lesion, optic chiasm, optic tract, lateral geniculate nucleus, optic radiations, primary visual cortex. Describe the topographic representation of the visual field within the primary visual cortex, including the topics of retinotopic organization, orientation selectivity, and ocular dominance. Describe the processing of information in the visual cortex, and the consequence of a lesion in the higher visual association areas. Explain the differing light sensitivities of the fovea and optic disk. Discussing the essential biochemical & nutritional aspects of vitamin A as one of the fat-soluble vitamins. Understanding the biological role of vitamin A in various cellular functions. Verify the role of vitamin A in vision. Being oriented of the clinical aspects of vitamin A deficiency & overdose with Special focus on side effects of medication by vitamin A. Explain the mechanism of action of drugs used in acute mania Explain the mechanism of action, pharmacokinetics, adverse effects, drug interactions, Contraindications and therapeutic uses of lithium. Outline the therapeutic uses of valproate, and carbamazepine in bipolar 17 Discuss the development of the nervous system. Discuss the mode of action, indication, dose, side effects and contraindication of the drugs used in local and general anesthesia. disorder. Outline the use of neuroleptics in bipolar disorder. List the drugs used to treat migraine headache Explain mechanism of action, pharmacological effects, adverse effects and Contraindications for drugs used in migraine Describe prophylaxis of migraine Describe the formation of neural tube and neural crest. Describe the development of brain and spinal cord. Describe the positional changes of spinal cord. Describe the development of the spinal nerves and their spinal ganglia. Describe the development of meninges. Describe the development of brain vesicles from the neural tube. Describe the development of the different parts of brain. Describe the development of brain ventricles and choroid plexuses Describe the development of the cranial nerves and their ganglia. Describe the congenital anomalies of brain and spinal cord. Describe general principles of surgical anesthesia Explain stages and depth of anesthesia Enumerate the mechanism of action, pharmacological effects, adverse effects, pharmacokinetics and contraindications of inhalation and parenteral anesthetics Explain mechanism of action, basic pharmacological actions, clinical pharmacology, pharmacokinetics and adverse effects of local anesthetics 18 CNS 424 Block Educational Framework (Week 7) Requirement to achieve the ILO’s The intended learning outcomes Explain the mechanism of Hearing. Discuss the mode of action, indication, dose, side effects and contraindication of the drugs used in the treatment of depressive disorders. Discuss the development of the eye and ear. Describe the functions of external, middle and inner ear Describe, how molecules in air are converted into impulses generated in hair cells in the inner ear How the impulses generated in the inner ear transmitted to auditory cortex Discuss the functions of auditory cortex Explain how pitch, loudness and timbre of sound is appreciated Describe the various type of deafness Describe the functions of vestibular apparatus Outline the amine hypothesis of mood Explain the mechanism of action of different classes of antidepressants Describe the main pharmacological effects and routes of drug administration of Antidepressants Describe the role of P450 system in the metabolism of antidepressants Differentiate the main adverse effects of different antidepressants. Outline the main drug interactions of antidepressants Outline the main contraindications of antidepressants. Describe the main therapeutic uses of antidepressants Describe the development of the optic cup, and lens, Describe the development of the retina, iris, and ciliary body Describe the development of the choroid, sclera and cornea Describe the development of the optic nerve and vitrous body 19 Explain the biochemical basis of neurotransmitters and neurological disorders. Discuss otitis media, otitis externa, eye infections and conjunctivitis in terms of definition, causative pathogens and etiological factors. List the anomalies associated with eye development Discuss the clinical bases of the above anomalies Describe the development of inner ear Describe the development of middle ear Describe the development of the external ear List the anomalies might be associated with ear development Discuss the clinical ases of the ear anomalies Recall the neurotransmitters according to their structures into nitrogencontaining neurotransmitters and neuropeptides Recognize the relationship between glucose metabolism and formation of neurotransmitters Explain the excitotoxins and other biochemical responses to ischemic brain injury Understand the therapeutic approach for treatment of brain stroke Recall an overview of neurodegenerative disorders Illustrate the overall process involved as dopamine acts as neurotransmitter and its impact to Parkinson disease Understand the biochemical basis for development of Alzheimer disease Enlist the most common pathogens of the middle ear. Identify the most common hospital acquired infection associated with ear inflammation. Enumerate the clinical specimens collected for diagnosis of ear infection. Differentiate between pathogens of otitis media and externa according to microbiological aspects. Enumerate the causative agents of eye infection and conjunctivitis. Differentiate between these pathogens according to microscopy, cultural characteristics, and other criteria. Distinguish between types of conjunctivitis according to causative agents and clinical picture. 20 Explain the Trigeminal nerve (V) with its nuclei, types of fibers it carry and distribution. Explain structure of the ear, Vestibulocochlear (VIII) nerve and hearing pathway. Discuss the pathological aspects of degenerative brain diseases. Review the general anatomical features of the face and scalp. List the trigeminal nerve nuclei and their location Follow up the course of trigeminal nerve from its point of central connections, exit and down to its target areas. Describe the sensory and motor components of the trigeminal nerve Describe the structures making the external and middle ear. Discuss the features of the tympanic membrane. Describe the ossicles and related muscles. Describe the auditory tube, its openings and structure. Understand the mastoid air cells and their connection to the middle ear. Describe the structure of cochlea, semicircular canals, utricle and saccule Describe the course of vestibulocochlear nerve and its central connections Be aware of etiopathogenesis of multiple sclerosis. Recognize pathological basis of Alzheimer disease. Understanding the pathological background and clinical features of Parkinsonism. 21 CNS 424 Block Educational Framework (Week 8) Requirement to achieve the ILO’s The intended learning outcomes Discuss the mode of action, indication, dose, side effects and contraindication of the drugs used in the treatment of Neurodegenerative Diseases. Discuss the common pathogens causing acute viral encephalitis and brain abscess. Explain the mechanism of action of each drug in each group Describe the main effects of each drug on different organ systems Describe the absorption, distribution and metabolism of levodopa and carbidopa Describe the administration routes of each drug in each class Describe the main adverse effects of each drug in each class Explain the on/off effect and wearing-off effect of levodopa / carbidopa Explain the therapeutic value of combining levodopa with carbidopa in Parkinson’s disease Explain the use of dopamine agonists and antimuscarinic drugs in Parkinson’s disease Explain the use of neuroleptic and benzodiazepines in Huntington’s disease Explain the use of central cholinesterase inhibitors in Alzheimer’s disease Enlist the most common causative agents of encephalitis and brain abscess. Identify the causative agents of encephalitis according to microbiological aspects. Define the viral latency in nervous tissue and its effect on immunocompromised patients. Evaluate the clinical significance of CSF examination in diagnosis of encephalitis. Discuss the role of prophylactic passive vaccine in protection of central nervous system. 22 Discuss the Facial (VII) nerve in terms of its nuclei, types of fibers it carry and distribution. Explain the Glossopharyngeal (IX), Vagus (X), Accessory (XI) and Hypoglossal (XII) nerves with their nuclei, types of fibers they carry and distribution. Describe the nuclei of the facial nerve Follow up the course of facial nerve from its point of central connections, exit and down to its target areas. Discuss the various modalities of its fibers. Review your knowledge of its target areas Follow up the course from the central connections; exit from the brain and down to its target organs of IX, X, XI. And XII nerves Make a list of types of nerve modalities conveyed by these nerves Make note of plexuses that the vagus creates in the thorax and abdomen. Enumerate the five major taste sensation Describe the mechanism by which the basic taste sensations are appreciated Explain the physiology of Taste Sensation. Explain olfactory nerve and olfactory pathway. Describe the formation of the olfactory nerve Discuss the olfactory pathway Describe the pathological aspects of brain tumors. Discussing classification of brain tumors. Describing morphological features of glioma. Recognizing prognosis and complications of brain tumors. Describe the basic features of neural elements in the olfactory epithelium and olfactory bulb Describe the olfactory receptors and transduction mechanisms. Outline olfactory pathways. Recognizing the routes of infection to brain. Describing the gross and microscopic picture of brain abscess. Being aware of the complications of brain abscess. Explain the mechanism of smell sensation. Discuss the pathological aspects of brain abscess. 23 Describe the Neuroleptics (Anti-psychotic) drugs in terms of their mode of action, indication, dose, side effects and contraindication. Outline the dopamine hypothesis of schizophrenia. Explain the mechanism of action of each drug in each class. Describe the antipsychotic action of neuroleptics. List the main pharmacokinetic features of neuroleptics Outline the use of depot preparations of fluphenazine and haloperidol Describe the main adverse effects of neuroleptics List the main contraindications of neuroleptics Outline the main therapeutic uses of neuroleptics. 24