1. Briefly explain the possible physiological basis of referred pain.

(50 marks)
 Irritation of a visceral organ or deep somatic pain structure
 Produces pain in a somatic structure some distance away
 Dermatomal rule
 Explains that pain is generally referred to somatic structure that has originated from the
same embryological dermatome
 Nerves from viscera (autonomic) and somatic nerves
 Enters spinal cord at the same level
 And synapse with the same second order neuron in the spinothalamic tract
 As second order neurons are fewer in number
 This is convergence
 As somatic pain is more common than visceral pain
 Brain has learned to interpret stimulation of that second order neuron to be somatic
pain
 This is due to cortical plasticity
 Prolonged discharge of visceral neuron
 Facilitates discharge of somatic fibres/ facilitates peripheral endings
 Past experience of pain plays a role
 E.g- pain is referred to surgical scars

2. Explain the physiological principle of the knee jerk using a clearly labeled diagram.
(60 marks)
 This involves stretch reflex which is monosynaptic.
 When hammer hits patellar ligament extension of the knee joint occurs.
 Sensory organ is the muscle spindle.
 Which consists of intrafusal fibres of two types,
 Nuclear bag fibres
 Nuclear chain fibres
 The stretch of the muscle acts as the stimulus and causes stretch of the tendon
 It results in stretch of extrafusal fibres
 As the intrafusal fibres are attached at their endings to the extrafusal fibres or the
tendons
 Muscle spindle is stretched distorting the sensory endings
 Receptor potentials are generated in the muscle spindle
 Action potentials travels through Ia afferents
 It is integrated at the spinal cord
 Sensory fibres synapses with alpha motor neurons
 Leading to contraction of the quadriceps femoris muscle
 In reciprocal innervation some collateral fibres passing from Ia fibres synapse with an
inhibiting interneuron which synapses with the lower motor neuron supplying the
antagonists/ flexor muscles/ hamstrings
 In feedback mechanism spindle afferents stop firing because stretching of spindle ceases
with muscle shortening
 When gamma efferents discharge increases, α-δ linkage causes increased muscle
contraction, increasing muscle sensitivity.

3. Explain why a person stepping on a nail withdraws the foot without falling. (25)
  This is withdrawal reflex
 Which is a polysynaptic reflex
 A noxious stimulus like stepping on a nail
 Stimulate free nerve endings that carry pain afferents
 Via Aδ and C fibres
 Enter the interdigitating area in the spinal cord
 Many neurons synapse within the spinal cord
 And synapse on the α motor neuron
 Supplying the flexors of the leg concerned
 Flexors contract and the foot is withdrawn
 Extensors are inhibited
 Through inhibitory interneurons
 A single stimulus causes a prolonged response.
 If the stimulus is very strong
 A crossed extensor response occurs
 The extensors of the opposite side contracts
 To maintain the balance of the body.

4. How the location, intensity and quality of sensory stimuli are coded. (40)
 Location is obtained by the law of projection.
 No matter where a particular sensory pathway is stimulated, along its course to the
cortex, the conscious sensation produced is referred to the location of the receptor
 Quality (modality) is explained by the doctrine of specific nerve energies and adequate
stimulus
 There are specific receptors, specific sensory pathways and specific sensory areas in
brain. (If a pathway from a touch receptor is stimulated along its course sensation
evoked is touch)
 Magnitude of the generator potential is proportionate to the intensity of the stimulus
 Frequency of the AP depends on the magnitude, but this relationship is not linear.
Frequency of action potentials

Magnitude of stimulus

 Receptors have different threshold values.

 Weak stimuli activate receptors with lower threshold
 Strong stimuli activate receptors with higher threshold
 Some of the receptors activated are part of the same sensory unit and therefore impulse
frequency of the unit increases. (frequency coding)
 Due to overlapping/ interdigitation of one unit with another and tendency of strong
stimuli to spread over a large area, receptors of other units are also stimulated
 So temporal and spatial summation occur
 When the magnitude of the stimulus is much higher, it activates other receptors that
normally do not involve in carrying that sensation
 More units fire and more afferent pathways are activated
 Then the brain intercepts it as an increase in intensity of sensation