The document discusses the plantar reflex test, which assesses neurological function. A normal flexor plantar reflex involves flexion of the toes when the sole of the foot is stroked. An abnormal extensor plantar reflex, or Babinski sign, involves extension of the big toe. The technique, causes, variants, and fallacies in interpreting the plantar reflex test are described. Alternative methods to elicit the plantar reflex response involving stroking or applying pressure to different areas of the foot and leg are also mentioned.
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
Reflex activity is the response to a peripheral stimulation that occurs without our consciousness.
Is an involuntary response to a stimulus.
It is a type of protective mechanism.
Reflex activity is the response to a peripheral stimulation that occurs without our consciousness.
Is an involuntary response to a stimulus.
It is a type of protective mechanism.
The plantar reflex is a nociceptive segmental spinal reflex that serves the purpose of protecting the sole of the foot. The clinical significance lies in the fact that the abnormal response reliably indicates metabolic or structural abnormality in the corticospinal system upstream from the segmental reflex.
result
receptor
effector
PATELLAR REFLEX
a stretch reflex
Golgi tendon organ in quadriceps femoris
quadriceps femoris & hamstrings
Hitting the patellar tendon with a reflex sledge just underneath the patella extends the muscle
axle in the quadriceps muscle. This creates a flag which heads out back to the spinal line and
neural connections (without interneurons) at the level of L4 in the spinal line, totally autonomous
of higher focuses. From that point, an alpha engine neuron leads an efferent motivation back to
the quadriceps femoris muscle, activating withdrawal. This withdrawal, composed with the
unwinding of the opposing flexor hamstring muscle causes the leg to kick. This is a reflex of
proprioception which keeps up stance and adjust, permitting to keep one\'s adjust with little
exertion or cognizant thought.
The patellar reflex is a clinical and exemplary case of the monosynaptic reflex curve. There is no
interneuron in the pathway prompting to withdrawal of the quadriceps muscle. Rather the bipolar
tactile neuron neurotransmitters specifically on an engine neuron in the spinal string. Be that as it
may, there is an inhibitory interneuron used to unwind the hostile hamstring muscle (Reciprocal
innervation).
This trial of an essential programmed reflex might be impacted by the patient intentionally
hindering or overstating the reaction; the specialist may utilize the Jendrassik move as a
diversion or redirection so as to guarantee a more legitimate reflex test.
ACHILLES REFLEX
stretch reflex
muscle spindle
gastrocnemius
The lower leg jolt reflex, otherwise called the Achilles reflex, happens when the Achilles
ligament is tapped while the foot is dorsi-flexed. A positive result would be the twitching of the
foot towards its plantar surface. Being a profound ligament reflex, it is monosynaptic. It is
likewise an extend reflex. These are monosynaptic spinal segmental reflexes. When they are in
place, uprightness of the accompanying is affirmed: cutaneous innervation, engine supply, and
cortical contribution to the relating spinal fragment.
Lower leg of the patient is casual. It is useful to bolster the bundle of the foot at any rate to some
degree to put nearly strain in the Achilles ligament, however don\'t totally dorsiflex the lower
leg. A little strike is given on the Achilles ligament utilizing an elastic mallet to evoke the
reaction. In the event that you are not ready to evoke a reaction, a Jendrassik move can be
attempted by having the patient container their fingers on every hand and attempt to pull the
hands separated. A positive reaction is set apart by an energetic plantarflexion of the foot. The
reaction is additionally evaluated into Grade 1-4 as indicated by the reflex reviewing framework
plantar reflex
reflex elicited
downward response of the hallux
upward response (extension) of the hallux
The plantar reflex is a reflex inspired when the sole of the foot is invigorated with a limit
instrument. The reflex can take one of two.
LOWER LIMB EXAMINATION ,INSPECTION,PALPATION,TONE ,POWER, The neurologic examination is typically divided into eight components: mental status; skull, spine and meninges; cranial nerves; motor examination; sensory examination; coordination; reflexes; and gait and station.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Plantar Reflex
1. Ref-1- The History, Physical, and Laboratory Examinations. 3rd edition.Walker HK, Hall WD, Hurst JW, 2 - Journal, Indian Academy of Clinical Medicine Vol. 6 July-
September, 2005 Geeta akhwaja BY CHERIAN THMPY(FINAL YEAR PG) 9791197781
Plantar reflex
Definition
Stroking the lateral part of the sole of the foot with a fairly sharp
object produces plantar flexion of the big toe; often there is also
flexion and adduction of the other toes. This normal response is
termed the flexor plantar reflex.
In some patients, stroking the sole produces extension (dorsiflexion) of
the big toe, often with extension and abduction ("fanning") of the other
toes. This abnormal response is termed the extensor plantar reflex,
or Babinski reflex.
Technique
Place the patient in a supine position and tell him or her that you are
going to scratch the foot, first gently and then more vigorously. Fixate
the foot by grasping the ankle or medial surface with the examiner's
hand that will be closest to the midline of the patient: examiner's left
hand when the patient's left foot is being tested, and vice versa with
the right foot. Begin with light stroking, using your finger; then use a
blunt object such as the point of a key. The reason for the graded
stimulus (1) Light touch, as with a finger, frequently obtains the reflex
without causing a withdrawal response that on occasion makes
interpretation of the response difficult; (2) one cannot conclude the
response is normal until a noxious stimulus is indeed used, since the
reflex is a cutaneous nociceptive reflex.
The first line to be stroked begins a few centimeters distal to the heel
and is situated at the junction of the dorsal and plantar surfaces of the
foot. The line extends to a point just behind the toes and then turns
medially across the transverse arch of the foot. Stroke slowly, taking 5
or 6 seconds to complete the motion.
Causes ofan extensor plantar response
Pyramidal tract lesions
Normal children upto one year of age
Deep sleep
Coma
General Anaesthesia
Post-ictal stage of epilepsy
Electroconvulsive therapy (ECT)
Hypoglycaemia
Alchol intoxication
Narcosis
Hypnosis
Following severe physical exhaustion
Head trauma with concussion.
Variants of the Babinski Sign
True Babinski sign – includes all the components of the fully
developed extensor plantar response.
Minimal Babinski sign – is characterised by contraction of
the hamstring muscles and the tensor fasciae latae which can
be detected by palpation of the thigh.
Spontaneous Babinski sign – is encountered in patients with
extensive pyramidal tract lesions. Passive flexion of the hip
and knee or passive extension of the knee may produce a
positive Babinski sign in adults, as may foot manipulation in
infants and children.
Crossed extensor response/bilateral Babinski sign – may be
encountered in cases with bilateral cerebral or spinal cord
disease. Unilateral foot stimulation elicits a bilateral response
in such cases.
Tonic Babinski reflex – is characterised by a slow prolonged
contraction of the toe extensors. It is encountered in patients
with combined frontal lobe lesions and extrapyramidal
involvement.
Exaggerated Babinski sign – may take the form of a flexor or
extensor spasm. Flexor spasms can occur in patients with
bilateral UMN lesion at the supraspinal or spinal cord level.
Extensor spasms can occur in patients with bilateral
corticospinal tract lesion but preserved posterior column
function.
Pseudo Babinski sign -This sign may be encountered in
patients with choreoathetosis where the up going toe is a
manifestation of hyperkinesia.
Inversion ofthe plantar reflex -If the short flexors of the toe
are paralysed, or the flexor tendons have been severed, an
extensor plantar response may be obtained even in the absence
of UMN lesions and is termed inversion of the plantar reflex
of peripheral origin.
Withdrawal response -Most people tend to withdraw their
feet from a plantar stimulus as they are unable to tolerate the
sensation. This reflex withdrawal interferes with the normal
response. It is basically a voluntary movement or withdrawal
due to a ticklish or unpleasant sensation. It is encountered in
sensitive individuals or patients with plantar hyperaesthesia
due to peripheral neuritis, confused with a positive Babinski’s
sign. It is characterised by a dorsiflexion of the ankle along
with hip and knee flexion. In such a situation, it is important to
repeat the stimulus more gently and hold the foot at the ankle,
or try alternative stimuli. A true Babinski sign can be
clinically distinguished from the false Babinski by a failure to
inhibit the extensor response by pressure over the base of the
great toe. Moreover, unlike the voluntary withdrawal of the
toes, the true Babinski sign is reproducible.
Fallacies in the interpretation of the plantar response
No response to the plantar stimulus may be observed in certain
situations.
Patients with callosities of the feet
Sensory loss in the S1 dermatome may be encountered in
patients with peripheral neuropathy or tibial nerve injury
Babinski response may not be observed in UMN lesions with
complete paralysis of the extensors of the toes.In such cases,
contraction of the tensor fasciae latae may be taken as a
positive sign.
Bony deformities like ‘hallux valgus’ may prevent any
movement of the big toe.
In patients with ‘pes cavus’ it is difficult to assess the
movement of the big toe. The toe could be so retractedas to
appear to be in the extensor position to start with. In such a
situation, it is important to observe the movement at the
metatarsophalangeal joint because if the terminal joint alone is
observed, a further extension of the same may be quite
misleading.
Other methods to elicit plantar reflex
Eponym Technique
Chaddock
(1911)
The skin under and around the lateral malleolus is
stroked in a circular fashion. The stimulus may also
be carried forward from the heel to the small toe.
Bing (1915) The dorsum of the big toe is pricked with a pin. The
big toe withdraws into the pin when abnormal, as
opposed to being flexed away from the stimulus
when normal. This sign and the Chaddock sign are
perhaps the most reliable after the Babinski sign.
Oppenheim
(1902)
The thumb and index finger apply heavy pressure to
the anterior surface of the tibia, stroking down to the
ankle.
Gordon
(1904)
Compressing the calf muscles, or applying deep
pressure to them.
Schaefer
(1899)
Pinching the Achilles tendon enough to cause pain.
2. Ref-1- The History, Physical, and Laboratory Examinations. 3rd edition.Walker HK, Hall WD, Hurst JW, 2 - Journal, Indian Academy of Clinical Medicine Vol. 6 July-
September, 2005 Geeta akhwaja BY CHERIAN THMPY(FINAL YEAR PG) 9791197781