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Elizabeth Boger Foreman, MD

• Resident, Department of Neurology
• University of North Carolina School of Medicine
• Chapel Hill, North Carolina

Amphi-Atlantic diabetic ketoacidosis occurs when emt order 2.5 mg micronase otc, tropical and subtropical diabetes symptoms and diagnosis purchase micronase now, associated with nerito-oceanic diabete wiki generic 5 mg micronase with mastercard, near-slope waters diabetes eye test charges buy generic micronase pills. Enoploteuthidae 501 Abraliopsis atlantica Nesis, 1982 Frequent synonyms / misidentifications: Abraliopsis morisii Chun, 1910 (part) / None. Photophores (light organs) on ventral side of mantle arranged in distinct isolated longitudinal rows. Depth between 97 and 786 m, larvae and early juveniles in 20 to 50 m, mainly in the thermocline at 25 to 35 m, at least 80 km from shore. Distribution: Equatorial East Atlantic, Gulf of Guinea, west of Liberia, northern Namibia; South Africa; Caribbean Sea and Gulf of Mexico. Arms with 2 rows of very sharp, slender, strongly curved hooks, which become extremely minute distally and are followed immediately by minute suckers in 2 rows. Trabeculae of protective membrane of ventral view dorsal view left ventral arm of male elongated and thickened but not joined by a wide membrane. In central part of tentacular club (manus) there are 3 or 4 small hooks on the dorsal side and 4 large (2 to 3 times longer than the width of the club) hooks on ventral side. The dactylus of the club is very short and has about 12 transverse rows of suckers in 4 longitudinal rows. Eight rows of photophores on the ventral side of the head arranged on a linear longitudinal pattern, the median one consisting of 2 parallel rows. The 5 round and reddish brown in colour photophores on the eyeball are located on the ventral periphery. The right ventral arm is hectocotylized in males and is composed of 3 subequal-sized offset crest. Habitat, biology, and fisheries: Mesopelagic and mesobathypelagic species at night ascending into epipelagic zone. Feeds mainly copepods, and to a lesser extent on euphausiids and hyperiid amphipods. In the central South Pacific, all were immature in April, maturing in July, the majority mature or spent in September. The seminal receptacles in this species are the anterior pockets under collar on sides of nuchal cartilage and in a median pocket on inner mantle. Not of interest to fisheries but possibly an important prey item for larger oceanic species. Enoploteuthidae 503 Abraliopsis morisii (Verany, 1839) Frequent synonyms/ misidentifications: Abraliopsis pfefferi Joubin, 1896; Compsoteuthis lonnbergi Pfeffer, 1900; Abralia (Compsoteuthis) jattai Pfeffer, 1912 / None. Tentacular clubs with 9 or 10 different-sized hooks in 2 rows on manus, a carpal flap and distinct aboral keel. Hectocotylus with 2 flaps of different sizes: a long narrow proximal flap and a short distal one; modified portion of arm with hooks. Habitat, biology, and fisheries: A meso and bathypelagic species, rising to epipelagic zone at night. Spawns in summer off Delaware Bay and undergoes vertical migration, mainly at 0 to 100 m at night but dispersed throughout a wide depth range, 0 to 1 000 m with apparent concentrations at 500 to 600 m and 800 to 900m, by day. Four rows of distinct light organs on ventral side of the mantle, with the medial row free of light organs (photophores) along its entire length. Right ventral arm hectocotylized, the ventral protective membrane weakly developed, the dorsal one with an enlarged flap in the zone that bears hooks; 2 rows of hooks on the two-thirds of the arm, distal part of the arm devoid of hooks and suckers; tip of the arm with small suckers. Habitat, biology, and fisheries: Widely distributed in the tropical to warm temperate Atlantic, 0 to 200 m at night. Probably limited to mesopelagic and upper bathypelagic zones, migrating to the surface at night; depth range from 0 to 2 000 m. Distribution: Morocco, Madeira, Mauritania, central Atlantic and southeast of St Helena; western Atlantic from Straits of Florida to the Caribbean, Gulf of Mexico and Brazil east of Rio de Janeiro. Enoploteuthidae 505 Enoploteuthis leptura leptura (Leach, 1817) Frequent synonyms / misidentifications: None / None. Seven distinct light organs rows on ventral side of the mantle, single midline row merges with first lateral row on either side well short ventral view dorsal view of anterior mantle margin; third lateral (all illustrations from Roper, 1966) pair extends shortly posterior to mantle margin. Ten more or less distinct light organ rows on ventral head surface; ventral middle line of head entirely devoid of light organs. Tentacles short, only a little longer than the arms; tentacular club long but not expanded; the carpal cluster is a raised, long structure consisting in a series of 4 or 5 suckers and knobs each with interconnecting ridges and grooves; manus not broad with 6 or 7 large hooks in ventral row and 4 or 5 smaller hooks in the dorsal row; dactylus with 2 rows of 10 to 15 minute suckers. Right ventral arm hectocotylized, the ventral protective membrane extremely narrow, the dorsal one with an enlarged flap; 2 rows of hooks extend along the arm; there is not a zone of the arm devoid of hooks and suckers; tip of the arm with small suckers. In the Gulf of Guinea small numbers of larvae were collected, both by day and night, in the upper 20 m in the South Tradewind current, juveniles of 20 to 40 mm near the frontal zone of the South Tradewind current and subtropical waters, adults mainly in subtropical waters. Growth is relatively fast and maturation relatively early, lasting only a short period; males usually mature earlier (at 45 to 60 days) than females (at 80 to 90 days). Size and age at maturity: 50 mm mantle length and 70 days in males, 60 to 70 mm mantle length and 80 to 90 days in females. Maximum age is 153 days in mature males of 72 mm mantle length and 143 days in mature females of 92 mm mantle length. Distribution: Madeira, Morocco, Mauritania, Cape Verde Islands, Gulf of Guinea, Ghana and Sao Tome and Principe, southwestern Africa; western Atlantic from Bermuda and the Caribbean to Brazil. Ventral surfaces of mantle, head and arms with anteriorly directed light organs with red colour filters. A straight or slightly curved and slightly broad, simple, funnel locking cartilage. Some species appear to be found most frequently near continental slopes and islands. This family represents an important component of the diet of many oceanic toothed whales. Subsequently, different interpretations have been introduced that depart from the earlier classification (see Young and Vecchione, 2000, 2008a, b, c). Similar families occurring in the area Enoploteuthidae: have hooks rather than normal suckers on arms. Light organs large, arranged in widely to moderately widely spaced pattern on anterior one-third to half of ventral surface of mantle; circlet around right eye composed of 16 or 17 (rarely 18 or 15) large light organs 4b. Light organs intermixed large and small, arranged in moderately dense pattern on ventral surface of mantle; circlet around right eye composed of 17 large and 1 small light organs 5a. Light organs in widely spaced pattern on ventral surface of mantle; dorsal pad of funnel organ with 2 lateral flaps; skin conspicuously papillated (except in small juveniles) 5b. Light organs in moderately widely spaced pattern on ventral surface of mantle; dorsal pad of funnel organ unsculptured; skin not papillated 6a. Terminal group of light organs on arms absent; suckers in median 2 or 3 rows of club manus larger than the marginal ones List of species occurring in the area the symbol % is given when species accounts are included. Cephalopoda in the diet of sperm whales of the Southern Hemisphere and their bearing on sperm whale biology. The importance of cephalopods as prey for hake and other groundfish in South African waters. Publication for the 40 Anniversary of the Foundation of National Cooperative Association of Squid Processors, Tokyo, 253 pp. The cephalopod family Histioteuthidae (Oegopsida): Systematics, Biology, and Biogeography. Diagnostic characters: Suckers of the manus of the tentacle in rows of 5 to 7, with strong dissimilarity in size; dorsal pad of funnel organ sculptured with median ridge down each arm; distal portion of median ridge on arms of dorsal pad funnel organ expanded into distinct flap; outer web conspicuously developed up to depth of 14% of length of longest arm; large atypical light organs not present; light organs on ventral surface of mantle and head mostly large, no densely set; 17 large light organs in circle around margin of right eyelid. Size: Maximum mantle length 204 mm; mature females 176 to 204 mm, mature males 72 to 125 mm.

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Cotyledon blood glucose for newborn discount 2.5mg micronase fast delivery, the fetal portion of the placentome blood sugar yoga purchase micronase 2.5 mg without a prescription, is listed in Nomina Embryologica Veterinaria diabetes belt order 2.5 mg micronase with amex. The human vestibule is so shallow that it is included with the external genitalia in the N diabetes type 1 celebrities discount micronase. In domestic mammals, where it is much longer, it is not an external organ and is therefore not included in the Pudendum femininum. In the mare the Frenulum clitoridis is represented by an adhesion of the dorsal surface of the Glans to the vestibular wall of the Preputium. The median sinus occupies the central part of the Glans, whereas the lateral sinuses are shallow and inconstant. The Perineum is the part of the body wall that covers the Apertura pelvis caudalis and surrounds the anal and urogenital canals. The Centrum tendineum perinei is the fibromuscular node in the median plane between the anus and the vulva or the bulb of the penis, where the following muscles converge and are attached: M. This is a general term for the striated muscle covering the bulbourethral glands, whether it is derived from M. The Pars rectalis, inconstant in the dog, is well developed only in the horse where it was formerly called the suspensory ligament of the anus or ventrale Mastdarmschleife. The first consists of fine fibers that extend from the anus to the vulva just under the skin. It is the lesser peritoneal sac, which communicates with the greater peritoneal sac through the omental foramen. It extends between the diaphragm and the liver and between the esophagus and the caudal vena cava. The passage between the vestibule and the caudal recess is the Aditus ad recessum caudalem. This sagittal membrane, which occurs in Carnivora, connects Paries profundus of Omentum majus with the left surface of Mesocolon descendens. The Mesovarium proximale extends from the body wall to the Mesosalpinx; the Mesovarium distale extends from the Mesosalpinx to the ovary and forms part of the wall of the Bursa ovarica. Ramus auricularis lateralis meningea media Ramus auricularis intermedius Ramus anastomoticus cum a. It occurs in Ruminantia and has a spleen-like organization containing lymphatic tissue, in the sinuses of which erythrocytes normally occur. The so-called hemolymph node is a lymph node that has erythrocytes in its sinuses as a result of hemorrhage in its tributary field. In this nomenclature of the heart, the terms dexter and sinister refer to the cavities of the heart and not to the sides of the body. Facies auricularis designates the former left side of the heart of the domestic mammals, the side that is marked by the tips of the auricles and corresponds more or less to the Facies sternocostalis of the N. The first term designates the former Sulcus longitudinalis sinister of veterinary textbooks. Sulcus interventricularis subsinuosus designates the former Sulcus longitudinalis dexter. The term Valvula is used only for the parts of the Valva aortae and Valva trunci pulmonalis. This term replaces the former terms: Truncus brachiocephalicus communis of Ruminantia and the horse, A. In accordance with the principle of homology-homonymy, a vessel can only be designated Arteria masseterica if it passes through the Incisura mandibulae. It has no direct connection with the rostral rete, which is formed in this species by branches of A. The Ramus anastomoticus and the part of Ramus descendens proximal to its origin correspond to the vessel formerly designated A. In the ox this artery is a branch of the Rete mirabile epidurale rostrale through the Rete chiasmaticum. When abaxial digital arteries are present on the most medial or lateral digits, they come from some other source and are called Aa. Because the distal artery corresponds to the greater part, it has been designated simply A. Its Ramus superficialis extends to the Arcus palmaris superficialis and is continued as A. It may be paired or single, or Ramus bronchalis and Ramus esophageus may arise independently. The branches of this artery are listed in the order of the segments of the intestine supplied. The term Rami colici dextri designates the branches supplying the last Gyrus centrifugalis which is closely related to the Jejunum in sheep and goats. Rami colici occur in Ruminantia, supply the Ansa proximalis and Gyri centripetales, and are homologous to Ramus colicus of other domestic mammals and to A. These arteries arise by a common trunk in the pig and horse, and by a common trunk with A. In the horse the latter consists only of the proximal segment and the Ramus descendens, formerly termed together A. When the annotation for an artery is applicable to the corresponding vein, reference is made to the note on the artery. Small venous branches (Rami) that accompany arterial branches of the same name are not listed. The latter occurs in Carnivora, Ruminantia, and the horse, and sometimes in the pig. The first term designates the vein that passes through the intervertebral foramen. It gives off the Rami interarcuales, which penetrate the Ligamenta flava; the Rami spinales, which join the Vv. The venous trunk which was previously indicated by this term is actually the cranialmost segment of V. It is absent in the sheep and goat, and the veins listed hereunder are branches of the V. A lymphocentrum is a lymph node or a group of lymph nodes that occurs in the same region of the body and receives afferent vessels from approximately the same region in most domestic mammals. The first nodes, which occur in the ox and sheep, and send efferent vessels to the Lnn. To this center belong two groups of lymph nodes by virtue of their position: the Lnn. In the Ruminants these lymph nodes are closely adjacent and not clearly distinguishable from one another. The revised nomenclature of these lymph nodes refers directly to their anatomical position and to the organs that are drained by them. In sheep and goats they are located directly against the intestinal wall, whereas in pigs they are situated within the Mesoileum and the most proximal part of the Mesocolon. They are only present in the horse and extend along Tenia lateralis, Tenia medialis and Tenia dorsalis of the cecum. The previous synonym Lymphocentrum inguinale profundum is deleted, because many of the lymph nodes of this lymphocenter lie not in the inguinal region but at the entrance of the pelvic cavity along A. The previous alternative term Lymphocentrum inguinale superficiale is deleted because several lymph nodes of this lymphocenter are remote from the proper inguinal region. The term was introduced in the second edition for some of the lymph nodes that were formerly listed under Lymphocentrum sacrale. These are the parts of the spinal cord which give origin to the sacral and caudal nerves. These terms remain valid in all species, regardless of the actual caudal extent of the Medulla spinalis. This Sulcus corresponds to the line of implantation of the ventral roots of the spinal nerves. In many mammals, it is less distinct than the Sulcus lateralis dorsalis, or even absent.

It commonly involves the flexor carpi radialis brevis and pronator teres tendons in patients between 35 and 50 years of age (mean 45) diabetes mellitus type ii became subject to presumptive service connection generic micronase 5 mg line. This injury is typically caused by activities that involve wrist flexion/grasp and pronation as the wrist flexors contract during grasping activities to provide stability to the wrist diabetes testing supplies commercial micronase 5 mg without a prescription. There may be a partial tear of the tendon fibers at diabetic foot sores buy micronase 5 mg with visa, or near their point of insertion on the humerus diabetes 911 cheap 2.5 mg micronase free shipping. Patient History Patient History may include Patient Data Medial Epicondylitis is caused by repetitive use of flexor/pronator muscles, especially with valgus stress at the medial epicondyle. In more severe cases, decreased sensation is associated with intrinsic weakness and even intrinsic muscle atrophy may be noted. Subjective Findings Complaints of pain over the flexor-pronator origin slightly distal and anterior to the medial epicondyle. Differential Diagnoses Cervical nerve root compression May accompany lateral epicondylitis Crystalline deposition such as gout and pseudogout (Chonrocalcinosis) Acute or chronic infection Olecranon bursitis Medial ulnar collateral ligament injury Ulnar nerve entrapment Physical/Occupational Therapy Management Therapy must show measurable functional progress. Muscle Strength Mild/no loss Mild to moderate Considerable loss 783 of 937 loss 3. Patient education should focus on rest, reduction of strenuous activities, as well as identification of causative factors and correction of faulty technique. In most cases, this type of care is largely active and is typically directed by the provider and performed by the patient as a home program Expected Procedures/Modalities Such As Outcome Relief of pain and Phonophoresis chronic Friction massage inflammation Medial counterforce brace Improve flexibility Range of motion exercises of the wrist, elbow, forearm Sustained stretch to wrist and forearm muscles Improve strength Progress strength training from isometric to concentric to and endurance eccentric contraction of forearm muscles, especially the wrist flexors and elbow pronators. Increase resistance gradually General strengthening of the unaffected areas of the arm Improve postural Postural awareness of the shoulder girdle 786 of 937 control Scapular stabilization Progressive return Gradual resumption of activities relating to community, to normal function leisure and sports Functional training activities Joint stability/co-contractions using closed chain exercises Patient education Modification of job/recreational tools and or equipment and self Avoid activities that require repetitive activities management Use of counterforce brace Continue flexibility and strengthening activities Note: Not all of the above modalities are appropriate for each individual case; they require the skill and judgment of persons properly trained and licensed for safe use. Usually the elbow joint is not involved as the bursa and the joint do not communicate unless rheumatoid arthritis is present. Patient History Patient History may include Patient Data Causes: Acute trauma (eg, falling onto a hard floor or a playing field with artificial turf and landing on the olecranon process) Minor cumulative trauma, such as repetitive rubbing of the olecranon region against a desktop during writing Infection due to abrasion or laceration at the site or due to seeding from hematogenous spread by bacteremia Inflammation as part of a systemic inflammatory process (eg, rheumatoid arthritis) or crystal deposition disease (eg, gout, pseudogout) Specific Considerations Rule out red flags (require medical management). Red Flag Possible Consequence or Cause Severe trauma Fracture/ligament rupture Fever, severe pain Possible infection Cancer history Cause of symptoms (metastatic, primary or paraneoplastic), potential complications of chemotherapy Unilateral edema Upper extremity deep vein thrombosis Loss of distal pulse Compartment syndrome Immune-compromised state Infection Cold Intolerance, fatigue, Hypothyroidism constipation Multiple joint involvement, unusual Rheumatologic diseases. Need for care is proportional to the severity of the signs and symptoms of the particular case, modified by the status 793 of 937 of healing tissues. Treatment Methods the following modalities may help ease discomfort and aid in healing process: Ultrasound, Phonophoresis, Heat Cold Patient will be educated in proper protection techniques to be utilized during all activities and started on a home program. Retraining for proper positioning to avoid re-injury, and other factors in occupationally related overuse syndromes is an important component of the overall therapy consult. If a trial course is prescribed, the following conservative management is appropriate. Patient History Patient History may include Patient Data Fractures and dislocations of the phalanges occur from a variety of mechanisms. In younger patients, these injuries are more likely to be sports related, while older patients are likely to be injured by machinery or by falls. Red Flag Possible Consequence or Cause Severe trauma Ligament tear Fever, severe pain Infection Loss of distal pulse Infection, arterial occlusion Diabetes, parathesias Neuropathy, other metabolic disorders. Subjective Findings Impaired functional ability Pain Swelling Decreased flexibility of hand Muscle atrophy Objective Findings Objective Findings may include Scope of Examination Examine the musculoskeletal system for possible causes, or contributing factors to the complaint. Subacute care is characterized by a 803 of 937 combination of direct care and home management consisting of exercise, symptom management, patient education, and an emphasis on compliance. Mild conditions result from a variety of conditions, may or may not require treatment, symptoms are low-grade and generally do not affect activity of daily living tasks. Moderate conditions also result 804 of 937 from a variety of causes; pain is usually mid-range (5-6/10), may have work restrictions and may affect performance of activities of daily living. Treatment Methods Therapy program goals are to: Modalities to reduce inflammation, Normalize pain-free range of motion, Prevent muscular atrophy, Maintain proprioception, Relieve joint pain, and Increase strength so that the other objectives may be achieved. Discharge Criteria the patient is discharged when the patient/care-giver can continue management of symptoms with an independent home program. Finger Fracture Rehabilitation If patient was treated only with casting, the program below should be shortened to a total of 12 weeks only. This program illustrates the rehabilitation for those fractures requiring open reduction and fixation. Principles of Metacarpal and Phalangeal Fracture Management: A Review of Rehabilitation Concepts. Operative repair of humeral fracture is indicated when fracture is: open, associated with a nerve or vascular injury, multiple trauma, pathologic fracture or failure to maintain acceptable alignment by non-operative means. This condition is typically treated conservatively with an emphasis on controlling distal edema and stiffness and early motion at the shoulder to prevent development of arthrofibrosis secondary to prolonged immobilization. Patient History the history of the mechanism of injury is usually the result of a direct impact to the lateral shoulder or the result of an indirect mechanism, as in a fall onto the outstretched hand. Patient Data Obtain a detailed history of the mechanism of injury and associated metabolic morbidity. Indirect causes of proximal humerus fractures result in greater degrees of fracture displacement. Determine whether seizure or electrical shock was involved, as these indirect mechanisms are associated with posterior dislocations. Red Flag Possible Consequence or Cause Severe trauma Fracture, ligament/tendon rupture Sensory loss along lateral deltoid Axillary nerve injury Fever, severe pain Possible infection Cancer history Cause of symptoms (metastatic or primary) Discoloration of wrist or hand Arterial occlusion Unilateral edema Upper extremity deep vein thrombosis Immune-compromised state Infection 811 of 937 Presentation Patient may present with arm immobilized in a sling, immobilizer or a sling with an accompanying swathe. Patient may present with a surgical scar, swelling, ecchymosis, impaired range of motion, strength and pain with shoulder movements. Neurological signs: altered reflexes and/or sensations 815 of 937 Treatment frequency and duration must be based on: Severity of clinical findings, Presence of complicating factors, Natural history of condition, and Expectation for functional improvement Treatment Methods Therapy program goals are to: Minimize inflammation, Normalize pain-free range of motion, Prevent muscular atrophy, Maintain proprioception, Relieve joint pain, and Increase strength so that other objectives may be achieved. It is common for a surgeon to have a specific protocol for post-operative rehabilitation program. Referral Guidelines Refer patient to their primary care provider to explore alternative treatment options when you find: Swelling or redness without history of trauma Muscle wasting Loss of reflexes Management/Intervention Use of modalities and/or passive treatments should be limited. The following table lists the procedures for Non-Operative, Acute Phase presentation (Begins 7-10 days after fracture) (No active movements allowed for 5-8 weeks or when bony union occurs. The focus of treatment is patient self-management until dynamic rehabilitation is initiated). The focus of treatment is patient self management until dynamic rehab could be initiated). It is further defined by the interscalene interval, a triangle with its apex directed superiorly. This triangle is bordered anteriorly by the anterior scalene muscle, posteriorly by the middle scalene muscle, and inferiorly by the first rib. Frequently the symptoms are attributed to trauma or described as a repetitive use syndrome. Many sources believe that anatomical compression due to postural changes of the shoulder girdle is a primary cause. Soft tissue fibers compress the neurovascular structures as they change in relationship to skeletal changes. Vascular occlusions or space occupying lesions such as tumors or callus formation may also play a role. Red Flag Possible Consequence or Cause Severe trauma Fracture, ligament tear, tendon rupture Fever, severe pain Possible infection Unilateral edema Upper extremity deep vein thrombosis Immune-compromised state Infection Cancer history Cause of symptoms (metastatic or primary) Discoloration of hand/fingers Vascular occlusion, shunt emboli (dialysis patients) Exertional symptoms, history of cardiac Anginal equivalent disease 822 of 937 Presentation Pain, numbness and/or tingling, and heaviness of the involved upper extremity are common complaints reported. Subjective Findings Patient presents with neurological type symptoms of the upper extremity. Postural changes may be obvious, including the forward shoulders, forward head, excessive spinal curves, or significant leg length differences. Objective Findings Scope of Examination Examine the musculoskeletal system for possible causes, or contributing factors to the complaint. They may be helpful in determining the cause and location of the compression, thus, assisting in proper therapy treatment.

The general depolarization toward threshold of a cell membrane when excitatory synaptic activities predominate is known as (a) facultation diabetes symptoms groin purchase micronase 5 mg, (b) differentiation diabetes prevention nih discount 2.5 mg micronase fast delivery, (c) inhibition diabetes mellitus type 2 cpt code order micronase 2.5mg mastercard, (d) facilitation diabetic blisters buy micronase american express. Examples of neurotransmitters are (a) adenine and guanine, (b) thymine and cytosine, (c) acetylcholine and norepinephrine, (d) none of the preceding. The axon is the cytoplasmic neuronal extension that conducts impulses toward the cell body. A polarized nerve fiber has an abundance of sodium ions on the outside of the axon membrane. Every postsynaptic neuron has only one synaptic junction on the surface of its dendrites. A nerve impulse can travel along an axon for an indefinite distance without distortion or loss of strength. The resting potential in a nerve cell is caused by the high concentration of potassium outside the cell. Somatic motor nerves innervate skeletal muscle, and autonomic nerves innervate smooth muscle, cardiac muscle, and glands. The majority of specialized junctions that receive stimuli from other neurons are located on the and of the neuron. Only 10% of the cells in the nervous system are, and the remainder are 3. The velocity with which an action potential is transmitted down the membrane depends on the fiber and on whether or not the fiber is. On a myelinated neuron, the action potential appears to jump from one node to another. This method of propagation is called. Within the peripheral nervous system, myelin is formed by the. A junction between two neurons, where the electrical activity in the first influences the excitability of the second, is called a. The transmitter substance is stored in small membrane-enclosed in the synaptic knob. When an action potential depolarizes the synaptic knob, small quantities of transmitter substance are released into the. The interval from the onset of an action potential until repolarization is about one third complete, during which no stimulus can elicit another response, is referred to as the. With repetitive stimulation, there is a progressive decline in synaptic transmission due to depletion of the store of neurotransmitter in the axon terminal. A chronic degenerative disease that progressively destroys the myelin sheaths of neurons is called 14. A cluster of nerve cell bodies in the peripheral nervous system is referred to as a. Bipolar neuron (e) one long axon and many dendrites Answers and Explanations for Review Exercises Multiple Choice 1. The myelin sheath allows an impulse to travel by way of saltatory conduction (impulses jump from node to node). False; dendrites are usually shorter than axons, although some dendrites are as long as axons. False; the myelin sheath generally surrounds axons; some dendrites are myelinated. The gray matter consists of either nerve cell bodies and dendrites or unmyelinated axons and neuroglia. It also exists as special clusters of nerve cell bodies, called nuclei, deep within the white matter. Gray matter forms the centrol point of the spinal cord, where it is surrounded by white matter. Neurons communicate with one another by means of innumerable synapses between axons and den drites. Objective B To describe the embryonic development of the brain into the forebrain, midbrain, and hindbrain, and to explain how this correlates with the division of the brain into five mature regions derived from the three initial ones. The brain begins its embryonic development as the front end of the neural tube starts to grow rap Survey idly and to differentiate. By the fourth week after conception, three distinct swellings are evident: the prosencephalon (forebrain), the mesencephalon (midbrain), and the rhombencephalon (hindbrain). Further development, during the fifth week, results in the formation of five mature regions: the telencephalon and the diencephalon derive from the forebrain, the mesencephalon remains unchanged, and the metencephalon and myelencephalon form from the hindbrain (fig. Early in embryonic development, the developing neural tube begins to establish the foundation of the new nervous system. This critical period of development is highly susceptible to disrup tion by a variety of influences. Substances consumed by a pregnant woman during the critical period of neural development may alter normal brain development. Many neural tube defects can be prevented by carefully avoiding harmful substances, such as alcohol and drugs, as well as some common pharmaceuticals. The cerebrum consists of five paired lobes within two convoluted cerebral hemispheres. The elevated folds of the convolutions are the gyri (singular gyrus), and the depressed grooves are the sulci (singular sulcus). The convolutions greatly increase the surface area of the gray matter and thus the total number of nerve cell bodies. Beneath the cerebral cortex is the thick white matter of the cerebrum known as the cerebral medulla. A sulcus is a shallow depression or groove between the gyri of the convoluted cerebral cortex. The most noted of these is the central sulcus between the precentral gyrus of the frontal lobe and the postcentral gyrus of the parietal lobe (see fig. The most obvious of these is the lon gitudinal cerebral fissure separating the cerebrum into right and left cerebral hemispheres. The lateral fissure separates the frontal lobe from the temporal lobe, and the parieto-occipital fissure separates the temporal lobe from the occipital lobe. Although sensory and motor information can be correlated to specific lobes of the cerebrum, within those lobes, specific folds, or gyri, are designated as being primary for that sensory or motor function (fig. These primary areas represent either the final output (in the case of motor) signals or the first incoming recipient area (in the case of sensory) signals to send or receive the nervous information. The primary motor area of the cerebrum is the precentral gyrus, the primary somatic motor area is found on the postcentral gyrus, and the primary visual area straddles the calcarine sulcus on the medial occipital lobe. Loss of activity in this area reduces the selective stimulation of motor centers elsewhere in the frontal lobe, which in turn eliminates coordinated muscle contraction of skeletal muscles of the pharynx, larynx, and diaphragm. Central sulcus Motor area Sensory area Parietal lobe Frontal lobe General interpretative area Motor speech area Occipital lobe Visual area Lateral sulcus Auditory area Cerebellum Interpretative and memory area Temporal lobe Brainstem Figure 10. Impulses travel not only between the lobes of a cerebral hemisphere, but also between the right and left cerebral hemispheres and to other regions of the brain. They are named on the basis of location and the direction in which they conduct impulses (fig. Association fibers are confined to a given hemisphere, where they conduct impulses between neurons in various lobes. Commissural fibers connect the neurons and gyri of one hemisphere with those of the other. Projection fibers form descending tracts, which transmit impulses from the cerebrum to other parts of the brain and spinal cord, and ascending tracts, which transmit impulses from the spinal cord and other parts of the brain to the cerebrum. Brain waves originate from the various cerebral lobes and have distinct oscillation frequencies. Alpha waves are best recorded in an awake and relaxed person whose eyes are closed. The detection of theta waves in an adult may indicate severe emotional stress and may signal an impending nervous breakdown. Delta waves are common in a person who is asleep or in one who is awake but who has brain damage; they have a low frequency of 1 to 5 Hz.

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