NEUROPHYSIOLOGY PROBLEM SET:

GUIDE Questions Part I (Essay) and Part II (MCQs) are separate Moodle quizzes that can be done
between May 18 (8 am) to May 22 (5 pm).

1. Patient C.H., music professor, 57-years old, and a right-handed man, accompanied by his wife ,
was admitted to the hospital three days earlier after he suddenly had difficulty speaking, and
exhibiting weakness of his right side of the body (right hemiparesis).
2. At the time of admission, he also had difficulty lifting his right arm and right leg.
3. While his lower right facial muscles exhibited weakness, his right forehead muscles were
spared.
4. Somatosensory sensations were only mildly impaired for the right side.
5. His deep tendon reflexes for his upper and lower extremities on both sides were tested, showing
right hyperreflexia particularly for his knee jerk test.
6. Babinski sign for the right foot were also present.
7. On the third day of hospitalization, C.H. had regained some speech. Patient C.H.’s speech is
nonfluent, as he struggled to say a few words, with one-or-two word phrases. Speech
comprehension was normal when tested with yes-no questions or with simple commands to
point to objects with his left hand though he was unable to do so with his paralyzed right hand.
8. The same motor signs persisted on the third day of hospitalization, with C.H. still unable to move
his right hand and his right leg upon command, with deep tendon reflex tests for upper and
lower extremities showing hyperreflexia, and right-sided Babinski sign .
9. His attending neurologist, Dr. Khan, had known the patient 7 years ago when he was
hospitalized for acute viral encephalitis for which he suffered severe bilateral hippocampal
damage.
10. Dr Khan had ordered a CT scan at the time of admission three days ago. The findings would
reveal bilateral hippocampal damage incurred in the past. What was new was the discovery of
infarcts in the territory supplied by the superior division of the middle cerebral artery.

Task:

Download this problem set separately. Your integrated learning from neuroanatomy and
neurophysiology will help you answer the following assessments.

Do Neuro Module Assessment Part I. Essay Guide Questions. – answered online within one day when
you decide to start the 12-point , 3-item quiz within the 5-day period. The quiz closes at 5 pm May 22.
This is a separate quiz from Neuro Module Assessment Part II. Questions are related to the downloaded
problem set.

1. What effect does bilateral hippocampal damage have on declarative memories (explicit) and
non-declarative memories (implicit)? Answer briefly in two to five sentences

- Bilateral hippocampal damage, lesion or removal have more effect on declarative memory more than
non-declarative memories. Patients with damage in these area can no longer store declarative types of
memory in long term memory and develop anterograde amnesia. Short term memory and long term
memory prior to surgery will be remained but establishment of new long term memories will be
impaired after surgery. Such patients, however, can still learn some task because they retain procedural
memory which is a type of implicit memory.

2. Discuss briefly the role of glutamate, glycine, and the various post-synaptic glutamate receptors in the
Early Phase of Long-Term Potentiation (LTP) in the hippocampus. Answer briefly in 2 to 5 sentences. (4)

Glutamate released from the presynaptic neuron binds to AMPA and NMDA receptors (which is also
activated by Glycine) in the membrane of the postsynaptic neuron. The depolarization triggered by
activation of

the AMPA receptors relieves the Mg 2+ block in the NMDA receptor channel, and Ca 2+ enters the
neuron with Na + . The increase in cytoplasmic Ca 2+ activates Ca 2+ /calmodulin kinase, protein kinase
C, and tyrosine kinase which together induce LTP.

3. Briefly differentiate Late phase of LTP from Early Phase of LTP. Answer briefly in 2 to 5 sentences. (4)

Late phase of LTP is dependent in gene expression and protein synthesis in the postsynaptic neuron
which results in an increase in the number of AMPA receptors. Early phase LTP involves increased
sensitivity of the synapse without any gene expression nor protein synthesis. Early phase LTP depends
on the neurotransmitter.

Do Neuro module Assessment Part II. Multiple Choice Questions - answered online within one day when
you decide to start the quiz within the 5-day period. The 25-point quiz closes at 5 pm May 22. This is a
separate quiz from Neuro Module Assessment Part I. Questions may be directly or indirectly related to
the Problem SET. Other additional questions covering somatosensory and motor neurophysiology, along
with hemispheric specialization, sleep and temperature regulation are also included.