Doctor’s Passport

Find your next topic

Explore the current textbook

Available drafts · Clinical review pending
Membership
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
RapidMRCPMRCS

Neurophysiology and pain pathways

Essential points for quick revision.

Saved on this device

Synopsis

Explain membrane excitability, synaptic transmission, sensory coding, motor control and nociceptive modulation, then apply them to localisation and pain mechanisms.

  • Resting potential reflects selective permeability and maintained ion gradients; threshold opens regenerative voltage-gated channels, producing an all-or-none action potential.
  • Myelin raises membrane resistance and lowers capacitance, allowing saltatory conduction between nodes; demyelination slows or blocks propagation by reducing current safety margin.
  • Chemical synapses convert presynaptic depolarisation into calcium-dependent transmitter release, receptor activation and excitatory or inhibitory postsynaptic potentials.

Reasoning priorities

01
Equilibrium-potential reasoning

Predict the voltage toward which a selective conductance drives membrane.

Use ion gradient and charge direction together; opening a channel shifts voltage toward, not necessarily all the way to, that ion's equilibrium potential.

Worked reasoning

Worked examplePredict the effect of focal demyelination

A model axon has normal ion gradients and nodal sodium channels, but one internodal segment loses myelin, increasing membrane capacitance and current leak.

  1. Recognise that local current leaving the upstream node must charge the downstream membrane to threshold.
  2. Loss of myelin increases the charge required and allows more current to escape across the exposed internode.
  3. The downstream node reaches threshold later or not at all, producing slowed conduction, temporal dispersion or block depending on safety margin.
  4. The final predicted physiological outcome is unreliable propagation despite intact upstream action-potential generation.
  5. Verify by distinguishing axonal loss: demyelination primarily disrupts conduction properties, whereas loss of axons reduces the number of conducting fibres.
Open full textbook Answer 2 questions
Sources and review status8 sources · checked 7 Sept 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 7 Sept 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom