Medical Neuroscience explores the functional organization and neurophysiology of the human central nervous system, while providing a neurobiological framework for understanding human behavior. In this course, you will discover the organization of the neural systems in the brain and spinal cord that mediate sensation, motivate bodily action, and integrate sensorimotor signals with memory, emotion and related faculties of cognition. The overall goal of this course is to provide the foundation for understanding the impairments of sensation, action and cognition that accompany injury, disease or dysfunction in the central nervous system. The course will build upon knowledge acquired through prior studies of cell and molecular biology, general physiology and human anatomy, as we focus primarily on the central nervous system. This online course is designed to include all of the core concepts in neurophysiology and clinical neuroanatomy that would be presented in most first-year neuroscience courses in schools of medicine. However, there are some topics (e.g., biological psychiatry) and several learning experiences (e.g., hands-on brain dissection) that we provide in the corresponding course offered in the Duke University School of Medicine on campus that we are not attempting to reproduce in Medical Neuroscience online. Nevertheless, our aim is to faithfully present in scope and rigor a medical school caliber course experience. This course comprises six units of content organized into 12 weeks, with an additional week for a comprehensive final exam: - Unit 1 Neuroanatomy (weeks 1-2). This unit covers the surface anatomy of the human brain, its internal structure, and the overall organization of sensory and motor systems in the brainstem and spinal cord. - Unit 2 Neural signaling (weeks 3-4). This unit addresses the fundamental mechanisms of neuronal excitability, signal generation and propagation, synaptic transmission, post synaptic mechanisms of signal integration, and neural plasticity. - Unit 3 Sensory systems (weeks 5-7). Here, you will learn the overall organization and function of the sensory systems that contribute to our sense of self relative to the world around us: somatic sensory systems, proprioception, vision, audition, and balance senses. - Unit 4 Motor systems (weeks 8-9). In this unit, we will examine the organization and function of the brain and spinal mechanisms that govern bodily movement. - Unit 5 Brain Development (week 10). Next, we turn our attention to the neurobiological mechanisms for building the nervous system in embryonic development and in early postnatal life; we will also consider how the brain changes across the lifespan. - Unit 6 Cognition (weeks 11-12). The course concludes with a survey of the association systems of the cerebral hemispheres, with an emphasis on cortical networks that integrate perception, memory and emotion in organizing behavior and planning for the future; we will also consider brain systems for maintaining homeostasis and regulating brain state.
Preparing for the Comprehensive Final Exam
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From the course by Duke University
Medical Neuroscience
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From the lesson
Comprehensive Final Exam
This module contains materials that will help you prepare for the final challenge in Medical Neuroscience: our clinical case-based, Comprehensive Final Exam.
Meet the Instructors
Leonard E. White, Ph.D.Associate Professor
Department of Neurology, Department of Neurobiology, Duke University School of Medicine; Department of Psychology & Neuroscience, Trinity College of Arts & Sciences; Director of Education, Duke Institute for Brain Sciences; Duke University
[BLANK_AUDIO]. Welcome back to Medical Neuroscience.
I wanted to spend just a few minutes with you today giving you a sense of how to
prepare for our final examination that we have in Medical Neuroscience.
it is a comprehensive examination. It is an attempt to stretch both your
learning and your application of that knowledge in more of a clinical direction
than where we've gone this far in the course.
So I think it would be helpful if I spoke to you for a few minutes to prepare you
for this last learning experience in the course.
So what to expect on our final examination?
Well, in terms of the logistics, you can expect there to be 43 multiple-choice
questions. that number may change a little bit as we
finalize things, but that's The way it's shaping up at the present
time. So ti will be a multiple choice
examination. Now, what's going to be a bit different
than most of the assessments you've seen so far in the course is that these
questions will be organized around clinical case vignettes.
yes, in our unit quizzes, we have had opportunity to think about clinical cases
and challenge your understanding of functional neuroanatomy and we've done
that in the neuroanatomy exam as well. But here in this exam, my goal is to ask
you a series of questions that really can pertain to just about any aspect of the
content of the course we've covered so far, but as they pertain to a particular
case history. So I want you to recognize the questions
I'm asking you pertain to the description of this person and the neurological
issues that they present. So just be prepared to think that way and
I'll give you some guidance in just a few minutes as to how to begin to mobilize
your knowledge and put it into more of these kinds of clinical contexts that I
think will really help you apply the learning that you've done throughout the
course. And the questions that I present for you
will be organized around our six major themes.
These are the themes that are represented in the units of medical neuroscience.
of course there will be functional neuroanatomy but not at the same level of
detail and emphasis that I asked you about in the neuroanatomy exam.
my goal there was to probe more thoroughly your knowledge of functional
human neuroanatomy. but of course we, we cannot have a
comprehensive examination. And we cannot have a cogent discussion
around clinical cases without also having a clear neuroanatomical framework that
helps you understand what might be going on in that patient.
So functional neuroanatomy will be an important component of this examination.
We'll have questions that pertain to neural signalling and plasticity of
synapses and circuits. Of course, there will be emphasis on
sensory systems and the basis of sensory perceptions.
likewise, there will be significant content pertaining to motor systems and
the control of movement and we'll have some questions in some of the cases that
pertain to your understanding of the associative functions of the cerebral
cortex among other more complex brain functions.
Now I'd like to tell you a little bit about my approach to managing this
examination. So, first of all, I want you to
understand that I see this as not just a final examination but I see this as first
and foremost the final learning experience that we get to share together
in medical neuroscience. Now I understand, of course, as you do
that this examination is essentially a take home examination.
You have multiple attempts at it. So this gives me just a little bit of
license to try to craft it less as an assessment of fact and detail, and more
of an opportunity to mobilize your knowledge and apply it in a context that,
I think, will be meaningful to you. After all, this is medical neuroscience.
We have been emphasizing the foundational neuroscience that underlies clinical
practice. But this examination is an opportunity to
begin to move that knowledge more towards the clinical context.
So, I want you to learn while you do this examination.
You might want to plan on having at least a couple of attempts at this examination,
so that you can improve your learning as you go.
I want this examination to require integrative thinking.
I want you to be confronted with a clinical case that requires you to think
about the basis of synaptic transmission in the brain and potentially the
consequences when synaptic transmission goes awry.
And I want you to be able to think at a very large scale level in terms of the
whole patient and the potential functional impairments that one might
find when a patient is, let's say, experiencing a stroke or seizure or some
other kind of disorder or dysfunction of brain activity.
So, I want you to think in an integrative way, across the scales of organization
that we've discussed in this course. From the cellular and synaptic level,
right on up through the level of human behavior.
And, of course, I want to emphasize again the importance of having an accurate
functional neuroanatomical framework for understanding what's going on in your
patient. And in the diagnoses that are common when
presented with a patient with neurological injury or dysfunction, your
principal aim is to localize the lesion. Because once you have an anatomical
picture of where the lesion is localized, then that leads you towards appropriate
intervention. for example it, it, it, does matter, it
should matter, whether the lesion that produces weakness in one side of the body
is localized to the spinal cord, and may be a neoplasm or that this weakness is
attributable to a more acute event up in the cerebral cortex.
And our approach to how we treat such a patient, how we promote rehabilitation
and optimization of health status and functional ability is going to depend
upon having that accurate neuroanatomical framework.
And I'll just encourage you and remind you that great neurology, great clinical
neuroanatomy has been in practice many, many decades prior to the invention of
the magnetic resonance imaging machine. one of my concerns for our modern
education of practitioners in the medical sciences, is that we rely perhaps a bit
too much on imaging without first relying on our capacity to take a history, to
acquire a physical examination findings, and then to build an anatomical framework
that helps us understand the localization of a lesion in the nervous system of a
patient. Prior to the time that we then explored
the anatomy of that patient with our modern imaging methods.
So, obviously we need both. We need the clinical expertise, and we
need the best technologies that can help us understand the nature of injury and
disease that afflicts the nervous system. Now how to study and learn.
Well, I'd like to just briefly remind you of some of my tips that I gave you right
at the onset of the course. And hopefully, I can reinforce them just
a bit now. And that will prepare you for making the
most of this final learning experience. So my tip number one is to follow the
path. So I've tried to give you a path.
I've tried to lay out for you a coherent curriculum through the content of this
course. you'll be the judge as to how successful
I've been in laying out that path. like this beautiful path through the
rainforest in the great Pacific Northwest of, of this continent sometimes the path
is clear. sometimes it's it's, it's not quite so
clear. and we have to blaze a trail forward.
But nevertheless I have tried to give you a path to follow and I would encourage
you to continue to follow that path through the conclusion of the course.
And I'll give you some study tips. in just a moment that will give more
detail to that path that I think will be most productive for you.
But, tip number one is to get yourself organized for this journey even to the
finish line at the end of the course and follow this path.
My second tip is to visualize your knowledge.
I've tried to encourage you to do that via our peer assessment opportunities in
the course, but I certainly would encourage you to continue to improve your
knowledge by making it visible. And I'll say more about that, also, in
just a moment. I think we have wonderful opportunity to
learn spatially. perhaps one of my regrets in this first
iteration of medical neuroscience is that I've not encouraged you to do this more
regularly throughout the course. And in future editions of medical
neuroscience, I think I will exercise some of the spatial learning approaches
that I use here on campus with my own students.
But I just love this concept of letting our medial temporal lobe memory system
not just manage semantic symbols, but do what it has evolved to do, which is to
map our environment and our position within it.
And I love the idea of making your knowledge fill the space around you, and
physically move through that space as a way of building association and
consolidating your learning. And I love this image from an art
installation where myself and my son were embedded in this environment, this
artistic creation. And it was such a wonderful illustration.
For me of what it means to immerse oneself in the knowledge that defines
your environment. Well my final tip for you is to learn
socially. Now that's a challenge for, for many of
us, I know, especially in our global learning community.
But I am just so pleased to see so many of you come together in the discussion
forum and really lend a helping hand to one another in a positive and encouraging
way. I think that's the power of the learning
community that we can build, even in an online course such as this.
So I'm very grateful to all of you that have contributed so well and so
constructively in that process. And encourage you all to continue that,
and even to extend it to face-to-face encounters.
I think it would be wonderful to share with your friends and family some of what
you've been learning in medical neuroscience.
See, if you can't explain to a loved one the ionic basis of the action potential
or the mechanisms of synaptic plasticity that are responsible for learning, and
memory in the nervous system. Or why a particular stroke involving a
particular artery produces the functional impairments that we often see from a
clinical point of view. So learn socially, and I think you'll be
very productive. Well, I want to give a little bit more
detail to my first tip. Follow the path.
And what I want to do is to really focus on learning clinical neuroanatomy, which
gives us a wonderful framework for synthesizing and integrating our
knowledge of medical neuroscience. So, here's a bit of a strategy that I
found to be successful personally, and I know many of my students on campus feel
the same way. So let me just share with you some of
these steps in a bit more detail, and maybe you can freeze frame and capture
some of the specific tips that I'm about to provide for you as you organize
yourself for preparing for this final. So step number one study the pathway.
So know the essential elements of each pathway.
And here is basically a list of the pathways that I want you to be able to
represent in your knowledge and your drawings.
I want you to be able to accurately depict the dorsal column medial lemniscal
pathway. As well as the anterolateral pathways
that subserve mechanical sensation and pain and temperature sensation for the
post-cranial body. I'd love for you to be able to do the
same for the face via our trigeminal system.
the visual system has been very important, throughout this course, and
it's very critical that you understand the connections from the retina on up
through the visual cortical areas in the occipital lobe and into the parietal and
temporal lobe, so be familiar with the retina-geniculate striate pathway that's
responsible for visual perception. the pupillary light reflex is a very
important diagnostic reflex to know how to evaluate, how to interpret, so
familiarize yourself with that reflex. Now into the motor system.
you certainly should be quite confident in your understanding of the lateral
corticospinal tract. You should also be familiar with our
medial spinal pathways. Those pathways that set the stage for the
expression of skilled behaviors. You should be familiar with the pathways
in and out of the cerebellum, as well as the direct and indirect pathways through
the basal ganglia. Now I know this is a lot and this is a
tremendous amount of detail to master. But if you can break it down into the
systems level pathways that are responsible for sensation, for motor
control and the integrative actions of the nervous system.
Now I think you will be well on your way to mastering the essential content that
is a critical component to clinical practice, no matter what kind of a
practitioner you may be or you may aspire to become.
Well, that was more detail than will be shared in the following tips but as
you've heard from me already. I'm a firm believer in creating your own
visual representations, be it through drawings or some other means.
I want you to be able to challenge yourself to make your conceptions
visible, and as you've heard repeatedly from me, when it comes to drawing, the
bigger, the better. Another tip.
I think we spend way too much time sitting down in stable postures in front
of fixed surfaces. I think our learning and our creativity
is really mobilized when we move our body.
So when you draw, I would suggest that you, you draw standing up, or you make
your drawings sufficiently large that you simply have to move.
And I think you'll find that this can be a tremendous assistance to your studying
and learning, not just in this course but in whatever endeavors you may be
pursuing. Well, step number three is to begin to
push your knowledge and your representations into the social domain of
our human relations. So discuss the pathways, verbalize orally
your understanding. So, here are some questions that you can
ask if you get a drawing in front of you that perhaps has neurons along a sensory
or motor pathway. You can point to an axon, and you can ask
yourself questions such as, where does this axon originate?
Or in other words, where are the cell bodies that grew out theses axons?
And this is one way to get to a level of detail that's critical for understanding
functional neuroanatomy. One might ask the same kind of question
in the intrograde direction. You may want to ask, where do the axons
in question terminate? Where are the synapses made by the axon
in question? Again, our focus will be on the level of
detail that is essential for localizing lesions in the central nervous system.
Now, one might also ask about cell bodies and begin there so one could identify a
cell. Let's say, it's a dorsal root ganglion
cell or perhaps a cell in oh, let's say the thalamus, and you might ask where are
the axons terminating that grew out from these cells.
Now, in all of these kinds of questions when you're talking about the anatomy of
pathways, it's so important to understand decussation, that is, where is there a
midline crossing. So one way to rehearse your knowledge of
decussation is to be as specific as you can about addressing these questions.
So for example, if you were to ask yourself or a study partner, where do the
axons in the medial meniscus originate? A great answer would be the contralateral
dorsal column nuclei. Okay?
So the concept of contralateral there emphasizes that you understand that the
decussation has happened. prior to the collection of axons that
actually form the medial lemniscus. Okay.
Step number 4 is to actually begin to explore the anatomy of the nervous system
through our digital atlases, or perhaps you have some textbooks or paper atlases
at your disposal. But actually find the pathways.
Identify the pathways and cross sections through the brain and the spinal cord.
So, identify the key elements of these pathways that you've depicted in your
drawings. The locations of axons, the location of
cell bodies and critical gray matter structures.
Now I would again be very pleased if you were to use Sylvius4 for this
exploration, but there are so many wonderful products out there.
I'm really happy for you just to dive in to some accurate representation of the
actual structure of the human brain as it's presented.
either in histological atlas or a photographic atlas.
And finally, my fifth tip is to begin to take your knowledge of these different
systems and components and build it together into a framework [SOUND] that
really defines the spaces and structures of the central nervous system.
For example, I would want you to be able to ask questions, such as, well, what
would happen if we had a stroke that involved the right vertebral artery,
which supplies brain structures in the right ventral medulla and caudal pons?
So you might want to think about well what comes together along the ventral and
medial aspect of the medulla. And that should point you towards
structures such as the medullary pyramid, the medial meniscus, maybe even a cranial
nerve that is associated with that level of the nervous system.
And then in that case, the cranial nerve in question would be the hypoglossal
nerve. So, I want you to be able to really take
advantage of your knowledge of the vascular system to put a focus on this
exercise. So I want you to be able to discuss what
happens when regions of the nervous system are injured.
And a great way to do that is to appeal to the vascular anatomy that we've
learned. And that anatomy would include knowing
the distributions of the major cerebral arteries, the middle cerebral artery, the
anterior cerebral artery, the posterior cerebral artery, including the branches
of some of these that supply deeper structures, and more posterior
structures, such as the brain stem. I'd want you to be able to understand the
penetrating or circumferential branches of the basilar and vertebral arteries,
the cerebellar arteries, and understand how they supply these sectors or wedges
of the brain stem. And the same would be true for the spinal
arteries, the posterior spinal artery and the anterior spinal artery.
So I think with this path made a little bit more clear with this guidance, you
will be successful in this final learning experience in medical neuroscience.
not only might you pass the course with the honor of distinction, but you will be
affirmed as having succeeded on, on really quite an arduous journey.
I know it's been difficult or you to follow this path that I've laid out for
you given the amount of information that I've tried to convey, and the challenge
of consolidating it all. But I hope that you find this to be an
affirming experience, as you take this journey to its end, as we approach our
final event in medical neuroscience. So with that said, I look forward to
seeing you on the other side of the final exam in one form or another.
And I trust that you'll be successful. And that you're learning and your hard
work will be validated and affirmed.
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