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Block coordinators: Dr Jean-Leigh Kruger/Dr Shathani Nkhwa Year - 2023

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Faculty of Medicine
MBBS Programme

Phase 1 – Year 2 (Semester 2)

SOM 307 – NERVOUS SYSTEM AND SPECIAL SENSES

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Welcome to SOM 307 Nervous System and Special Senses. This course builds on work you
have done last year and earlier this year, particularly in SOM 206 Musculoskeletal and
Nervous Systems, but also in other courses, where you were introduced to the nervous
system and briefly to the special senses.

Although diseases of the special senses and central nervous system are perhaps not as
common as those of some other body systems, they are in many ways more distressing,
since they affect who we are – our personalities, characters and the way we interact with
the outside world. The PBL cases and supporting classes in this course hopefully bring this
alive in a graphic way.

The conveners of this course are Dr. Jean-Leigh Kruger (krugerj@ub.ac.bw) and Dr Shathani
Nkhwa (nkhwas@ub.ac.bw)

Course Overview

Week 1 – Vision and hearing

Week 2 – Cranial nerves
Vascular and traumatic brain injuries
Week 3 – Altered memory and consciousness.

Teaching Staff

This course is taught entirely by School of Medicine staff, identified on the timetable by
initials as follows:

Dr. Ernest Segwagwe BES Dr. George Mokone GM

Dr. Stephane Tshitenge ST Dr. Mooketsi Molefi MM
Dr. Goabaone Rainier GR Dr. Cassandra Ocampo CO
Dr. Maikutlo Kebaetse MK Dr. Farai Madzimbamuto FM
Prof Wallace Miller WM Dr. Rankgoane-Pono RP
Dr. Naledi Mannathoko NM Dr. Mmoloki Molwantwa MmM
Dr. Jean-Leigh Kruger JLK Dr. Sajini Souda SS
Dr. Jemal Shifa JS Dr. Ludo Badlangana LB
Dr. Nkhabe Chinyepi NC

Assessment

Continuous assessment coursework: There will be three pieces of coursework each

contributing to the overall course mark totaling 40% with weights as detailed below. These
will be:
Coursework 1: The mark for performance in the PBL group – 20%
Coursework 2 : The mark for performance in the assignments – 20%
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EBT: 60% - Tuesday 25 April 2023

LEARNING OUTCOMES FROM YEAR 1 (SOM 206) AND SEMESTER 1 (SOM 303) RELEVANT
TO SOM 307

The second year course builds on the first, and you should constantly make connections
with information already acquired. However, some material forms a fundamental
background for the block, and knowledge of this will be assumed. It may be helpful to use
the earlier course outcomes listed below to remind yourself of that material.

THEME A: Medical and Related Science

1. Describe the cellular components of the nervous system.

2. Describe the physiology of nerve conduction and synaptic transmission.
3. Outline the structure and function of the spinal cord, brain stem, cerebrum,
cerebellum and the meninges.
4. Outline the anatomy and physiology of the autonomic nervous system (ANS)
5. Understand the mechanisms of memory.
6. Outline the pathophysiology of spinal cord injury.
7. Outline the pathophysiology of common movement disorders.
8. Describe the pharmacology of the ANS.
9. The child with blindness.
10. The child with deafness.

THEME B: Physician – Patient Relationships

1. Take a history from patients with musculoskeletal disorders

2. Take a history from patients with central nervous system (CNS) problems
3. Examine for motor power, reflexes and sensation
4. Examine the spine
5. Recognise the impact of impairment and disability on the individual and society.
6. Understand the social and medical models of impairment disability and handicap.
7. Testing hearing in children.

THEME C: Public Health and Medicine

1. Outline the rationale and design of a randomised controlled tri

2. Outline the current pattern of disability in Botswana.
3. Identify the implications of statistical power in interpreting research findings.
4. Describe the range of resources available to provide continuing care in the
community.
5. Describe the features of good and poor team working.
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SOM 307: Nervous System and Special Senses

Week 1: Vision and hearing
Time Wednesday Thursday Friday Monday Tuesday
05 April 06 April 07 April 10 April 11 April

7.00 - 7.50 SDL SDL SDL

Anatomy of
8.00-8.50 the eye and Physiology of
related the eye
structures. JS Clinical
LB Placement
Anatomy of Visual fields,
9.00-9.50 the ear and pathways,
related cortical areas.
structures. Glaucoma.
LB JS

BREAK
Histology of Eye infections
10.00- the eye NM
10.50 BES

Anatomy and GOOD EASTER Clinical

11.00- histology lab: Ear infections FRIDAY MONDAY Placement
13.00 The eye and NM
ear
BES Physiology of
LB the ear
GM

L U N C H

14.00-15.30 PBL - 1 SDL

Posture and
balance
MK
(2 to 4 pm)
Clinical skills PBL – 2
15.30-17.00 Examination
of the eye
JS
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SOM 307: Nervous System and Special Senses

Week 2: Cranial nerves. Vascular and traumatic brain injuries
Time Wednesday Thursday Friday Monday Tuesday
12 April 13 April 14 April 17 April 18 April

7.00 - 7.50 SDL SDL SDL SDL

Responses of Posture and
8.00-8.50 the brain to SDL balance Clinical
SDL traumas MK Placement
NC
Implementing
9.00-9.50 CNS infections SDL evidence in
SS practice
MM

BREAK

10.00-11.30 Practical:
Review of Prevention of Testing vision PBL- 2
cranial nerves stroke. and hearing
JLK GR GM

Clinical
Placement
11.30-13.00 Anatomy Lab: Radiology
Cranial nerves Workshop SDL
JLK Imaging of the SDL
skull and brain
WM

L U N C H

14.00-15.30 PBL-1
Clinical skills: Clinical
SDL SDL Use of the Placement
Clinical skills: otoscope
15.30-17.00 Testing cranial
nerves
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SOM 307: Nervous System and Special Senses

Week 3: Altered Memory and Consciousness
Time Wednesday Thursday Friday Monday Tuesday
19 April 20 April 21 April 24 April 25 April

7.00 – 7.50 SDL SDL SDL SDL

End of Block
Test
Clinical Dementia SDL
8.00-8.50 aspects of CO (9 – 11am)
stroke
CO
Approaches
9.00-9.50 to patient
with CNS Epilepsy
disorders CO
CO
BREAK

10.00-11.30 Anaesthesia Living with

FM chronic PBL 2 SDL
neurological
disease.
ST

11.30-13.00 SDL SDL

LUNCH

14.00-15.30
PBL-1

SDL SDL

15-17.00 Clinical skills:

Full CNS
examination
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Week 1: Learning Outcomes

Anatomy of the Eye and Related Structures
 Describe the anatomy of the eye and related structures

Visual fields, pathways, cortical areas

 Describe visual receptive fields.
 Describe the parvo-cellular and magno-cellular pathways.
 Describe the extrastriate visual areas.

Physiology of vision
 Describe visual processing in primary striate cortex.
 Describe the ventral and dorsal visual pathways.

Anatomy of the Ear

 Describe the important features of the three parts of the ear.
 Describe the important relations of the ear.

Physiology of Hearing
 Describe how sound is transmitted to the cochlea.
 Outline the mechanisms of hearing and balance.
 Outline common ear pathologies.
 Describe how to test hearing and how to distinguish nerve from conduction
deafness.
 Describe how to test for vestibular function.

Posture and balance

 Be able to give a definition of posture.
 Explain the role of the brainstem in posture and balance with reference to
descending pathways and transection studies.
 Be able to draw a flow diagram which illustrates the main motor and sensory
components of postural control.
 Describe the structure and function of the vestibular apparatus: semicircular
canals, the utricle/saccule and hair cells.
 Outline the role of the vestibulo-ocular reflex in posture.
 Outline some of the posture reflexes.
 Outline the concept of anticipatory postural control.
 Describe diseases which are associated with vestibular damage such as Ménière’
s syndrome.
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Eye and Ear Infections

 Describe the normal flora of upper respiratory tract, ear and eye.
 Outline the common URTI.
 Discuss the microbial causes, of sore throat, tonsillitis, acute and chronic
suppurative otitis media, otitis externa, sinusitis, conjunctivitis, keratitis,
keratoconjunctivitis, endophthalmitis orbital cellulitis and choroidoretitnitis
(chorioretinitis), and outline their clinical features, complications and principles
of management.

Week 2: Learning outcomes

Overview of Cranial Nerves

 List and describe the principal functions of each cranial nerve.

Prevention of stroke
 Discuss the principles of Primary and Secondary prevention, especially in relation to
stroke disease.
 Discuss the common subtypes of stroke (ischaemic and haemorrhagic) and the
relative incidence of these.
 Discuss the incidence and prevalence of stroke and stroke related disability in the
community.
 Outline the common modifiable and non-modifiable risk factors for stroke
emphasizing hypertension, atrial fibrillation, smoking and diabetes.
 Briefly outline lifestyle and pharmaceutical interventions available for each.
 Discuss the problems of initiating medical therapies for conditions such as
hypertension, with no obvious symptoms.

Responses of the brain to traumatic injury

 Describe the basic anatomy of the cranium.
 Describe the basic physiological responses to traumatic brain injury.
 Understand the concept and consequences of raised intra-cranial pressure.
 Describe the patterns of intra-cranial haemorrhage after traumatic brain injury.
 Outline the clinical assessment and investigation of the head injured patient.
 Outline the clinical management of the head injured patient.

Clinical aspects of stroke

 Define stroke and TIA.
 Outline the pathophysiology of stroke.
 Describe common clinical syndromes arising following strokes, and relating anatomy
to clinical symptoms.
 Outline the principles of stroke rehabilitation.
 Outline prognosis and outcomes following stroke.

Implementing evidence in practice

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 Outline the principles of implementing evidence-based approaches to healthcare in

practice.
 Outline the barriers to implementation.
 Outline the strategies that can lead to successful implementation in practice.

CNS Infections
 Discuss causative organisms of meningitis, encephalitis
 Understand other infections of the CNS -Rabies, Subacute sclerosing panencephalitis,
tetanus and botulism. Prion disease, Cerebral abscess, Guillain-Barre syndrome
Acute transverse myelopathy and Congenital central nervous system infection.
 Outline clinical features of CNS infections.
 Outline lab investigations and interpretation of CSF analysis.
 To be familiar with management principles of CNS infections.

Imaging the brain

 Describe why we need to be able to examine the brain by non-invasive methods.
 Discuss which methods are available.
 Describe their advantages and disadvantages.
 Describe what the techniques tell us about structure, chemistry, blood supply,
function.
 Describe non-invasive imaging in clinical practice – what is the state-of-the-art?

Clinical skills: Testing the cranial nerves

 Describe how to test for olfaction.
 Describe how to test visual acuity and visual fields.
 Outline the appearance of the normal fundus on ophthalmoscopy.
 Describe how to test for eye movements and for ptosis.
 Describe how to test for pupillary reactions.
 Describe how to test muscles of mastication.
 Describe how to test for taste.
 Describe how to test muscles of facial expression.
 Describe how to test for palatal movement.
 Describe how to test trapezius and sternomastoid movement.
 Describe how to test for tongue movement.

Week 3: Learning Outcomes

Approaches to the patient with CNS disorders:

 Be able to perform a brief clinical examination of the central nervous system.
 Be able to describe the appearance of a normal fundus of the eye.
 Identify certain cranial nerve palsies by clinical signs.
 Describe the difficulties in taking a medical history from a patient with neurological
impairment.
 Describe how pathological changes relate to clinical signs and symptoms in some
common neurological conditions.
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 Be able to distinguish between the symptomatology of subdural, subarachnoid and

extradural haemorrhage.

Dementias
 Describe what is meant by the term dementia.
 Discuss the relationship between normal ageing, minimal cognitive impairment and
dementia.
 Describe the main pathological features of the common forms of dementia, and
discuss how the pathology influences the presenting features.
 Describe the main clinical symptoms of the common conditions which lead to
dementia.
 Outline the rationale and mode of action of the currently used drug treatments for
Alzheimer’s disease.

Epilepsy
 Describe how to define and classify the epilepsies.
 Link some causes of epilepsy with embryological development of the brain.
 Describe the different ways in which epilepsy can affect the individual.
 Describe the basic pharmacology of anti-epileptic drugs.

Living with Chronic Neurological Disease

 Describe the presentation of dementia.
 Describe the impact of a diagnosis of dementia on a patient and his or her family.
 Describe the effect on the life of a patient and family relationships of the progress of
dementia.
 Consider the impact on the health of informal carers of living with dementia.
 Consider the living bereavement brought about by dementia.
 Consider the impact on society of the need to provide care for dementia sufferers.
 Consider the potential for abuse of dementia sufferers.

Anaesthesia
 Define anaesthesia.
 Describe the evolution of anaesthesia.
 Describe the different types of anaesthetic agents.
 Compare and contrast general anaesthesia with regional anaesthesia.
 Describe the principal theories of how anaesthetic agents work.
 Describe the principal induction, inhalation and neuromuscular blocking agents.
 Describe ways of monitoring the depth of anaesthesia.
 Describe the expanding role of anesthetist
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