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Questions and Answers

Where do the superior and inferior eyelids join together?

  • Lacrimal glands
  • Palpebral commissures (correct)
  • Tarsal plate
  • Orbital septum

What is the name of the triangle of conjunctiva exposed at the level of the palpebral commissures?

  • Lacrimal sac
  • Orbital septum
  • Tarsal plate
  • Lakes / canthi (correct)

In what location are the mimic muscles hosted in the face?

  • Orbital septum
  • Lacrimal gland
  • Tarsal plate
  • SMAS (correct)

Which muscle makes possible the movement of the skin that is lining the frontal bone?

<p>Frontal muscle (C)</p> Signup and view all the answers

What structure is like a large surface of dense connective tissue and merges with one of the levator palpebrae superioris tendons?

<p>Levator aponeurosis (A)</p> Signup and view all the answers

What is the name of the second posterior tendon that continues independently from the levator aponeurosis?

<p>Muller's muscle (A)</p> Signup and view all the answers

What is the structure that separates the skin and subcutaneous tissue from the orbital fat pad?

<p>Orbital septum (D)</p> Signup and view all the answers

What type of tissue primarily composes the orbital fat pad?

<p>White adipose tissue (D)</p> Signup and view all the answers

Which glands are sebaceous glands associated with eyelashes?

<p>Glands of Zeis (D)</p> Signup and view all the answers

Which glands are a huge collection of sebaceous glands not associated with hair follicles?

<p>Meibomian glands (B)</p> Signup and view all the answers

What is the approximate size of the orbital cavity?

<p>30 ml (A)</p> Signup and view all the answers

The six muscles of the eye have their origin connected by what structure?

<p>Anulus of Zinn (D)</p> Signup and view all the answers

What is the name for muscles which make possible the movements of the eye?

<p>Extrinsic muscles (B)</p> Signup and view all the answers

What is the primary component of the orbital fat that fills the spaces around the eye?

<p>White adipose tissue (B)</p> Signup and view all the answers

Which structure primarily suspends the eyeball vertically?

<p>Lockwood ligament (B)</p> Signup and view all the answers

Which muscle is responsible for moving the eyeball inferiorly?

<p>Inferior rectus muscle (D)</p> Signup and view all the answers

What type of movement does the medial rectus muscle produce?

<p>Adduction (B)</p> Signup and view all the answers

What is the transparent part of the fibrous tunic called?

<p>Cornea (D)</p> Signup and view all the answers

Which structure is the location of stem cells for the corneal epithelium?

<p>Limbus (C)</p> Signup and view all the answers

What is the condition called where the iris is fully extended and the pupil becomes a tiny opening, typically in bright light?

<p>Myosis (B)</p> Signup and view all the answers

What is the main function of the sphincter pupillae muscle?

<p>To constrict the pupil (A)</p> Signup and view all the answers

What is the name given to the process of pupil dilation?

<p>Mydriasis (B)</p> Signup and view all the answers

What structure connects the ciliary body to the lens?

<p>The zonular fibers (D)</p> Signup and view all the answers

What is a key characteristic of zonular fibers?

<p>They are inextensible (A)</p> Signup and view all the answers

Which layer of the eye is highly vascular and located between the retina and the sclera?

<p>The choroid (D)</p> Signup and view all the answers

What is the function of the ciliary processes?

<p>To secrete aqueous humor (B)</p> Signup and view all the answers

What is the most common location for melanoma to develop, other than the skin?

<p>The choroid (B)</p> Signup and view all the answers

What part of the ciliary body has folds with a radial orientation?

<p>Pars plicata (C)</p> Signup and view all the answers

Which layer is responsible for focusing light on the retina?

<p>The lens (C)</p> Signup and view all the answers

What is the name of the area where the visual retina begins?

<p>Ora serrata (A)</p> Signup and view all the answers

How many main layers comprise the retina?

<p>10 Layers (B)</p> Signup and view all the answers

Which layer of the retina is the most superficial?

<p>Retinal Pigmented Epithelium (RPE) (B)</p> Signup and view all the answers

Which type of cells primarily compose the retinal pigmented epithelium (RPE)?

<p>Glial Cells (B)</p> Signup and view all the answers

In which retinal layer are the nuclei of photoreceptors located?

<p>Layer 4 (A)</p> Signup and view all the answers

Which layer of the retina contains axons of ganglion cells?

<p>Nerve Fiber Layer (D)</p> Signup and view all the answers

What is the primary function of the retinal pigmented epithelium (RPE)?

<p>Absorb light and support photoreceptors. (B)</p> Signup and view all the answers

What is the approximate number of axons of ganglionic cells in the nerve fibers layer?

<p>1 Million (D)</p> Signup and view all the answers

What condition is caused by vascular endothelial growth factor prompting the proliferation of endothelial cells in the choriocapillary layer?

<p>Macular Degeneration (A)</p> Signup and view all the answers

What is the name of the barrier that prevents glutamate, aspartate and glycine from entering the retina?

<p>Blood-Retinal Barrier (BRB) (A)</p> Signup and view all the answers

What is the name of the location in the retina where retinal detachment often starts?

<p>Ora Serrata (C)</p> Signup and view all the answers

Which cells are considered the most important glial cells in the retina?

<p>Muller Cells (D)</p> Signup and view all the answers

What structure connects the inner and outer segments of photoreceptors?

<p>Axoneme (D)</p> Signup and view all the answers

What is the name of the synaptic button found in rods?

<p>Spherule (C)</p> Signup and view all the answers

What type of photoreceptors are best suited for black and white vision?

<p>Rods (B)</p> Signup and view all the answers

During darkness, what neurotransmitter is released by photoreceptors?

<p>Glutamate (A)</p> Signup and view all the answers

How many main layers are used to describe the retina by ophthalmologists?

<p>10 layers (A)</p> Signup and view all the answers

In which layer of the retina are the nuclei of photoreceptors located?

<p>Layer 4 (B)</p> Signup and view all the answers

What is the estimated number of axons in the nerve fibers layer?

<p>1 million (B)</p> Signup and view all the answers

Which vitamin is captured and manipulated by cells of the retinal pigmented epithelium?

<p>Vitamin A (B)</p> Signup and view all the answers

What is the name of the barrier that prevents glycine, aspartate, and glutamate from entering the retina?

<p>Blood-retinal barrier (C)</p> Signup and view all the answers

Where does retinal detachment typically begin?

<p>Ora serrata (A)</p> Signup and view all the answers

What type of photoreceptors are responsible for black and white vision?

<p>Rods (A)</p> Signup and view all the answers

What type of cell connects photoreceptors to ganglion cells?

<p>Bipolar cell (C)</p> Signup and view all the answers

At what angle are the centrioles arranged in the organelle connecting the outer and inner segments of photoreceptors?

<p>90 degrees (A)</p> Signup and view all the answers

Where are the soma of ganglion cells located?

<p>Ganglionic cell layer (B)</p> Signup and view all the answers

Into which layer do the dendrites of ganglion cells extend?

<p>Inner plexiform layer (C)</p> Signup and view all the answers

Where do the axons of ganglion cells extend?

<p>Nerve fiber layer (A)</p> Signup and view all the answers

Which order of neurons are ganglion cells in the visual pathways?

<p>Third-order (D)</p> Signup and view all the answers

At which location do ganglion cell axons exit the eye?

<p>Optic disc (D)</p> Signup and view all the answers

Towards which part of the retina do ganglion cells appear later during differentiation?

<p>Peripheral retina (D)</p> Signup and view all the answers

What type of inputs do ganglion cells receive?

<p>From bipolar and amacrine cells (B)</p> Signup and view all the answers

What are the specialized synaptic structures in pre-synaptic bipolar cell terminals called?

<p>Ribbons (A)</p> Signup and view all the answers

What are the two post-synaptic processes opposing each ribbon in the IPL called?

<p>Dyads (D)</p> Signup and view all the answers

What is one of the typical sources that connect ganglion cells?

<p>Bipolar cells (A)</p> Signup and view all the answers

What is the purpose of dividing the IPL into two functionally discreet subliminae?

<p>To keep the on and off channels separate (D)</p> Signup and view all the answers

In the IPL, where is sublamina 'a' primarily located?

<p>Below the amacrine cell bodies (B)</p> Signup and view all the answers

Which layers does sublamina 'b' stretch to in the IPL?

<p>Amacrine cell bodies to ganglion cell body (D)</p> Signup and view all the answers

What type of bipolar cells interact primarily within sublamina a?

<p>Basal contacting cone bipolar (C)</p> Signup and view all the answers

What is the function of horizontal cells?

<p>To connect together adjacent photoreceptors (D)</p> Signup and view all the answers

In what direction do horizontal cells transfer information?

<p>Horizontally parallel to the retinal surface (C)</p> Signup and view all the answers

What type of cell synapse does one type of horizontal cell make?

<p>A cone pedicle (C)</p> Signup and view all the answers

What is released by photoreceptors in the dark based on the video transcription?

<p>Glutamate (D)</p> Signup and view all the answers

What neurotransmitter is released by horizontal cells that hyperpolarizes photoreceptors?

<p>GABA (C)</p> Signup and view all the answers

In the described horizontal cell circuitry, what causes an ON-bipolar cell to become depolarized?

<p>Lack of neurotransmitter release (B)</p> Signup and view all the answers

What type of receptor fields do RGC's have?

<p>Two concentric circles (C)</p> Signup and view all the answers

When is firing at a maximum in RGC's with an ON-center/OFF-surround receptive field?

<p>When a light spot coincides with the ON-center (C)</p> Signup and view all the answers

What kind of cells are amacrine cells?

<p>Large cells with a cell process (C)</p> Signup and view all the answers

What type of cells release and have both presynaptic and postsynaptic endings?

<p>Amacrine cells (A)</p> Signup and view all the answers

What is the function of interplexiform neurons?

<p>Communicate between horizontal and amacrine cells (A)</p> Signup and view all the answers

What type of junction makes up an adherens junction?

<p>Zonula adherens (A)</p> Signup and view all the answers

Which type of cells form the inner limiting membrane?

<p>Müller cells (C)</p> Signup and view all the answers

If there is damage of photoreceptors, outer nuclear layer, bipolar cell layer, outer plexiform layer, or plexiform layer (4) all these layers will be replaced by the proliferation of which type of cell?

<p>Müller cells (B)</p> Signup and view all the answers

General speaking, which cell have an important role in host defence against invading microorganisms in the initiation of inflammatory...

<p>Microglial cells (C)</p> Signup and view all the answers

What is the main purpose of the external acoustic meatus?

<p>To concentrate sound onto the eardrum (C)</p> Signup and view all the answers

What type of cartilage forms the auricle (pinna) of the ear?

<p>Elastic cartilage (C)</p> Signup and view all the answers

Ceruminous glands are only associated with which part of the external acoustic meatus?

<p>The cartilaginous 2/3 (C)</p> Signup and view all the answers

What instrument is used to inspect the eardrum?

<p>Otoscope (D)</p> Signup and view all the answers

Which of these is a division for the ear?

<p>Internal ear (B)</p> Signup and view all the answers

Which of the following structures is the inferior tip of the malleus/hammer?

<p>Umbo (D)</p> Signup and view all the answers

Which part of the eardrum primarily contributes to the transfer of acoustic waves?

<p>Pars tensa (C)</p> Signup and view all the answers

What is the superior wall of the tympanic cavity called?

<p>Epitympanic recess (C)</p> Signup and view all the answers

What passes lateral to the long limb of the anvil and medial to the handle of the hammer in the tympanic cavity?

<p>Chorda tympani (A)</p> Signup and view all the answers

Which muscle's primary function is to limit the movements of the stapes?

<p>Stapedius (C)</p> Signup and view all the answers

Which part of the ear is embedded within the temporal bone?

<p>Inner ear (B)</p> Signup and view all the answers

What are the names of the two fluids found within the inner ear?

<p>Perilymph and endolymph (B)</p> Signup and view all the answers

Which of the following is a component of the bony labyrinth?

<p>Cochlea (C)</p> Signup and view all the answers

What type of stimuli are the vestibule and semicircular canals sensitive to?

<p>Linear and angular acceleration (D)</p> Signup and view all the answers

Where are the cristae ampullaris located?

<p>Semicircular ducts (A)</p> Signup and view all the answers

What structure contains the receptor organs for hearing?

<p>Cochlea (D)</p> Signup and view all the answers

What is the name given to the shared opening of the anterior and posterior semicircular canals?

<p>Common crus (C)</p> Signup and view all the answers

The utricle and saccule both contain which structure?

<p>Macula (A)</p> Signup and view all the answers

What type of cell is a hair cell?

<p>Neuron (B)</p> Signup and view all the answers

What structure covers the apical surface of hair cells and is not directly exposed to the endolymph?

<p>Cupula (C)</p> Signup and view all the answers

What is the name of the elliptical recess located on the medial wall of the vestibule?

<p>Utricle (B)</p> Signup and view all the answers

Which structure of the inner ear is described as a hollow, bony spiral?

<p>Cochlea (C)</p> Signup and view all the answers

Which cranial nerve does the internal acoustic meatus contain?

<p>Cranial nerve VII (D)</p> Signup and view all the answers

What two structures merge to form the vestibular part of cranial nerve VIII?

<p>Saccular nerve and utricular nerve (B)</p> Signup and view all the answers

What is another name for cranial nerve VIII?

<p>Statoacoustic nerve (C)</p> Signup and view all the answers

What geometric shape best describes the shape of the cochlea?

<p>Cone (C)</p> Signup and view all the answers

What is the name for the shared opening of the anterior and posterior semicircular canals?

<p>Crus commune (C)</p> Signup and view all the answers

Which structure receives all the semicircular ducts?

<p>Utricle (C)</p> Signup and view all the answers

What duct connects the utricle and saccule with the endolymphatic sac?

<p>Utriculosaccular duct (A)</p> Signup and view all the answers

Which structure is the equivalent of cristae ampullares, but found in the utricle and saccule?

<p>Macula (D)</p> Signup and view all the answers

What is the term for the part of the central nervous system (CNS) located within the cranial cavity?

<p>Brain or encephalon (D)</p> Signup and view all the answers

What are aggregations of neurons in the peripheral nervous system (PNS) called?

<p>Ganglia (B)</p> Signup and view all the answers

What is the equivalent of ganglia in the peripheral nervous system (PNS) within the central nervous system (CNS)?

<p>Nuclei (B)</p> Signup and view all the answers

From which embryonic structure are most neurons in the peripheral nervous system derived?

<p>Neuroectoderm (B)</p> Signup and view all the answers

What structure do axons in the PNS form?

<p>Nerves (C)</p> Signup and view all the answers

What is the term for pathways carrying information toward the central nervous system (CNS)?

<p>Afferent pathways (D)</p> Signup and view all the answers

What type of cells protect axons in both the peripheral nervous system (PNS) and central nervous system (CNS)?

<p>Glial cells (B)</p> Signup and view all the answers

What is the connective tissue that wraps each single nerve fiber in the peripheral nervous system?

<p>Endoneurium (D)</p> Signup and view all the answers

What staining agent is used to visualize myelin sheaths?

<p>Osmium tetroxide (B)</p> Signup and view all the answers

What can the compression of a peripheral nerve cause?

<p>Pain and paresthesia (B)</p> Signup and view all the answers

What name is given to inflammatory diseases that arise if the peripheral blood barrier is broken?

<p>Neuritis (D)</p> Signup and view all the answers

Which cells are located around the periphery of the soma in ganglia?

<p>Satellite cells (A)</p> Signup and view all the answers

How many pairs do the cranial nerves come in?

<p>12 (A)</p> Signup and view all the answers

Through what structure do the axons of the olfactory primary neurons pass?

<p>Cribriform plate (A)</p> Signup and view all the answers

What structures contain the secondary olfactory neurons?

<p>Olfactory bulbs (B)</p> Signup and view all the answers

What is another name for the primary olfactory cortex?

<p>Area enthorhinalis dorsalis (B)</p> Signup and view all the answers

Which Brodmann area corresponds to the secondary olfactory cortex?

<p>Area 28 (B)</p> Signup and view all the answers

What is the main function associated with the secondary olfactory cortex?

<p>Short-term memory function (D)</p> Signup and view all the answers

Which Brodmann area is the primary olfactory cortex?

<p>Area 34 (B)</p> Signup and view all the answers

What is another name for the optic nerve?

<p>Cranial nerve II (C)</p> Signup and view all the answers

What is the shape of the optic disc?

<p>Doughnut (B)</p> Signup and view all the answers

What is the name of the central white depression in the optic disc?

<p>Physiologic cup (B)</p> Signup and view all the answers

Which retinal area looks slightly darker than the surrounding retina due to increased pigment?

<p>Fovea (B)</p> Signup and view all the answers

Relative to veins, what is a characteristic of arteries in the retina?

<p>Brighter and narrower (C)</p> Signup and view all the answers

What cells myelinate the optic nerve after it passes through the sclera?

<p>Oligodendrocytes (D)</p> Signup and view all the answers

The optic nerve travels to the orbital cavity through what structure?

<p>Optic nerve canal (D)</p> Signup and view all the answers

What structure is formed by the merging of the optic nerves?

<p>Optic chiasm (A)</p> Signup and view all the answers

What is the name of the area where CN II exit from the eyeball?

<p>Fundus oculi (A)</p> Signup and view all the answers

Which Brodmann area is considered the primary visual cortex?

<p>Area 17 (C)</p> Signup and view all the answers

Damage to the inferior radiation of the lateral geniculate nucleus can cause what condition?

<p>Superior homonymous quadrantanopia (B)</p> Signup and view all the answers

What symptom is commonly associated with a defect in cranial nerve III, causing a patient to seek medical attention?

<p>Diplopia (A)</p> Signup and view all the answers

What visual defect, aside from diplopia, can result from defects in cranial nerve III?

<p>Asymmetry in the height of the two superior eyelids (C)</p> Signup and view all the answers

What term describes a patient's inability to read due to a sudden issue with focusing?

<p>Lack of accommodation (B)</p> Signup and view all the answers

In cases of abducens nerve (cranial nerve VI) defects, which muscle's function is primarily affected?

<p>Lateral rectus muscle (D)</p> Signup and view all the answers

Which cranial nerve possesses both sensory and motor components but lacks a visceral component?

<p>Cranial Nerve V (A)</p> Signup and view all the answers

The mesencephalic nucleus of the trigeminus nerve is devoted to which function?

<p>Proprioception of the organs of the masticatory system (D)</p> Signup and view all the answers

What type of neurons are contained in the spinal nucleus of the trigeminus nerve?

<p>Secondary sensory neurons of all somatosensory cranial nerves (C)</p> Signup and view all the answers

What is the sensory distribution pattern called which is associated with central lesions of the cranial nerve V?

<p>Onion-skin pattern (A)</p> Signup and view all the answers

What is the name of the ganglion in which the somatosensory lateral root expands to form?

<p>Gasserian Ganglion (C)</p> Signup and view all the answers

From which nerve does the lacrimal nerve originate?

<p>Frontal nerve (B)</p> Signup and view all the answers

Which nerves pass superior to the annulus of Zinn?

<p>Frontal and lacrimal nerves (C)</p> Signup and view all the answers

What canal does the frontal nerve pass into?

<p>Supraorbital canal (D)</p> Signup and view all the answers

The frontal and lacrimal nerves are what type of nerves?

<p>Sensory (D)</p> Signup and view all the answers

Through which structure does the nasociliary nerve enter the superior orbital fissure?

<p>Annulus of Zinn (C)</p> Signup and view all the answers

What is the name of the nerve that is depicted as originating from the sensory root of the ciliary ganglion?

<p>Long ciliary nerve (A)</p> Signup and view all the answers

Which nerve provides innervation to the vestibule of the nasal cavity?

<p>Anterior ethmoidal nerve (D)</p> Signup and view all the answers

What foramina does the anterior ethmoidal nerve passes through in order to get access to the vestibule?

<p>Anterior ethmoidal foramina (B)</p> Signup and view all the answers

The nasociliary nerve becomes which nerve at the level of the tendon pulley of the superior oblique muscle?

<p>Supratrochlear or infratrochlear nerve (B)</p> Signup and view all the answers

What is the name of the nerve that is also known as tentorial nerve of Arnold?

<p>Recurrent meningeal nerve (A)</p> Signup and view all the answers

The ciliary ganglion is associated to which cranial nerve?

<p>Cranial nerve III (D)</p> Signup and view all the answers

What type of root the ciliary ganglion is NOT associated with?

<p>Motor root (D)</p> Signup and view all the answers

Which branch in the trigeminal nerve is associated with the Gasserian ganglion?

<p>Ophthalmic nerve (D)</p> Signup and view all the answers

What is another name for Trigeminal ganglion?

<p>Gasserian ganglion (A)</p> Signup and view all the answers

Which of these is a part innervated by the meningeal branch of the maxillary nerve?

<p>The superior orbital fissure (B)</p> Signup and view all the answers

What passes on top of the inferior orbital fissure?

<p>The meningeal nerve (A)</p> Signup and view all the answers

Where is located the pterygopalatine fossa?

<p>Outside the orbital cavity (D)</p> Signup and view all the answers

If you damage one of the teeth, you make a felony in which country?

<p>Italy (D)</p> Signup and view all the answers

Foramens called supraorbital, infraorbital, and mental are what type of relationship to each other?

<p>Aligned (A)</p> Signup and view all the answers

What nerve reenters inside the scalp through the foramen spinosum?

<p>Spinous nerve (A)</p> Signup and view all the answers

What is the name of the third branch of the cranial nerve V that innervates the masticatory muscles?

<p>Mandibular nerve (B)</p> Signup and view all the answers

Which nerve provides visceromotor innervation for the parotid gland?

<p>Auriculotemporal nerve (B)</p> Signup and view all the answers

Which artery does the auriculotemporal nerve form a hook or ring around?

<p>Middle meningeal artery (D)</p> Signup and view all the answers

What is the name for a disease that causes episodes of intense facial pain on the maxillary and mandibular areas?

<p>Tic Douloureux (D)</p> Signup and view all the answers

Which nerve is running close to the apex of molar and premolar teeth?

<p>Inferior alveolar nerve (D)</p> Signup and view all the answers

What provides a complete understanding of the situation when the inferior alveolar nerve is running close to the apex of molar and premolar teeth?

<p>Cone Beam Computed Tomography (C)</p> Signup and view all the answers

Which nerve provides the entire innervation of the alveoli of the teeth belonging to the inferior quadrants?

<p>Inferior alveolar nerve (C)</p> Signup and view all the answers

How many components does the facial nerve have?

<p>Four (B)</p> Signup and view all the answers

Which muscles are controlled by the facial somatomotor nucleus?

<p>Mimic muscles (A)</p> Signup and view all the answers

What is the name for the paralysis resulted by peripheral defect of CN VII?

<p>Bell's palsy (B)</p> Signup and view all the answers

After exiting the neurocranium, cranial nerve VII divides into which two main branches?

<p>Temporofacial and cervicofacial nerves (A)</p> Signup and view all the answers

Which muscle in the neck is innervated by the facial nerve?

<p>Platysma (B)</p> Signup and view all the answers

Which muscles are innervated by the temporal branches of the facial nerve?

<p>Frontal muscles and the superior portion of the orbicularis oculi (B)</p> Signup and view all the answers

What area does the glossopharyngeal nerve collect somatosensory information from?

<p>Oropharynx and posterior 1/3 of the tongue (D)</p> Signup and view all the answers

Which of the following nerves provides the parasympathetic route to the otic ganglion?

<p>Lesser petrosal nerve (A)</p> Signup and view all the answers

Where are the neurons' soma located for the stretch receptors affected by carotid sinus syndrome?

<p>Petrous ganglion (B)</p> Signup and view all the answers

Which of the following is a somatomotor nerve that innervates the sternocleidomastoid and trapezius muscles?

<p>Accessory nerve (XI) (B)</p> Signup and view all the answers

Which action would be most affected by a defect in cranial nerve XI?

<p>Arm elevation past 60 degrees (C)</p> Signup and view all the answers

Which cranial nerve can cause dysphagia if there is a defect causing inability to swallow correctly?

<p>Glossopharyngeal nerve (IX) (A)</p> Signup and view all the answers

Which of these structures does the glossopharyngeal nerve NOT innervate?

<p>Anterior 2/3 of tongue (C)</p> Signup and view all the answers

If there is no innervation of the parotid gland, which of the following would happen?

<p>Dry mouth (C)</p> Signup and view all the answers

Which opening in the skull do cranial nerves IX, X, and XI pass through?

<p>Jugular foramen (C)</p> Signup and view all the answers

What structure is located close to the internal carotid and external carotid?

<p>Carotid sinus (B)</p> Signup and view all the answers

Damage to which nerve affecting stylopharyngeus exclusively is possible to be tested by electromyography?

<p>Cranial nerve IX, the glossopharyngeal nerve (C)</p> Signup and view all the answers

In which case one would lose an activity that is fundamental for our life and not replaceable if damaged bilaterally?

<p>If the carotid body and carotid sinus function is lost (B)</p> Signup and view all the answers

What type of nerve is the hypoglossal nerve?

<p>Somatomotor (C)</p> Signup and view all the answers

The hypoglossal trigone is located on the floor of which ventricle?

<p>Fourth ventricle (B)</p> Signup and view all the answers

The fibers of the hypoglossal nerve pass between the anterior paraolivary nuclei and which other structure?

<p>Olivary nucleus of the bulb (A)</p> Signup and view all the answers

Where does the hypoglossal nerve exit from the neuroaxis?

<p>Preolivary sulcus (B)</p> Signup and view all the answers

The preolivary sulcus is continuous with which structure in the spinal cord?

<p>Anterolateral sulcus (D)</p> Signup and view all the answers

Through which structure does the hypoglossal nerve enter after the rootlets merge?

<p>Hypoglossal canal (A)</p> Signup and view all the answers

What opening is very close to the hypoglossal canal?

<p>Jugular foramen (D)</p> Signup and view all the answers

Which artery is located close to the region where the horizontal sigmoid sinus becomes vertical?

<p>Vertebral artery (B)</p> Signup and view all the answers

Which muscle has its origin close to the jugular tubercle?

<p>Rectus capitis lateralis (B)</p> Signup and view all the answers

The hypoglossal nerve passes anterior to which artery?

<p>Occipital artery (C)</p> Signup and view all the answers

What artery does the hypoglossal nerve pass anterior to?

<p>Internal and external carotid arteries (D)</p> Signup and view all the answers

The hypoglossal nerve is responsible for innervating which muscles of the tongue?

<p>Intrinsic tongue muscles only (D)</p> Signup and view all the answers

Which cranial nerve innervates the palatoglossus muscle?

<p>Vagus nerve (X) (A)</p> Signup and view all the answers

All of which muscle is innervated by cranial nerve XII?

<p>Hyoglossus (D)</p> Signup and view all the answers

Which of the following nerves contains fibers originating from the C1 neuromere?

<p>Hypoglossal nerve (A)</p> Signup and view all the answers

From which structures does the longissimus capitis muscle originate?

<p>Transverse processes of C4-T4 (A)</p> Signup and view all the answers

Where does the anterior scalene muscle insert?

<p>Costal angle-scalene tubercle of the first rib (A)</p> Signup and view all the answers

From what structures does the middle scalene muscle originate?

<p>Transverse processes of C2-C7 (C)</p> Signup and view all the answers

The roots of what structure are located between the anterior and middle scalene muscles?

<p>Cervical and brachial plexuses (C)</p> Signup and view all the answers

What vertebrae is also known as the prominent vertebra?

<p>C7 (C)</p> Signup and view all the answers

What nerve innervates the mastoid process, skin posterior to the auricle, and lobule of the ear?

<p>Greater Auricular Nerve (C)</p> Signup and view all the answers

Which nerve is composed of C2?

<p>Lesser Occipital Nerve (B)</p> Signup and view all the answers

What type of information do the transverse cervical nerves (TCN) provide?

<p>Sensory information of the skin of the neck region (C)</p> Signup and view all the answers

Which nerve is the only nerve providing motor innervation to the diaphragm?

<p>Phrenic Nerve (A)</p> Signup and view all the answers

The Supraclavicular nerves are contributed by what vertebral nerves?

<p>C3 and C4 (D)</p> Signup and view all the answers

Which muscle is NOT innervated by the musculocutaneous nerve?

<p>Triceps brachii (C)</p> Signup and view all the answers

What joints receive proprioception and sensory innervation from the musculocutaneous nerve?

<p>Shoulder and elbow (C)</p> Signup and view all the answers

Into what does the musculocutaneous nerve change its name at the level of the humeral protrusions?

<p>Lateral cutaneous nerve of forearm (D)</p> Signup and view all the answers

The right subclavian artery originates from which major vessel?

<p>Brachiocephalic trunk (C)</p> Signup and view all the answers

Which artery does the subclavian artery directly give rise to?

<p>Axillary artery (B)</p> Signup and view all the answers

What anatomical landmark marks the medial border of the first portion of the subclavian artery?

<p>Anterior scalene muscle (B)</p> Signup and view all the answers

Which portion of the subclavian artery is located posterior to the anterior scalene muscle?

<p>Second portion (C)</p> Signup and view all the answers

Which of the following is included in the first portion of the subclavian artery?

<p>Vertebral artery (A)</p> Signup and view all the answers

Which of the following arteries is fundamental for brain blood supply?

<p>Vertebral artery (D)</p> Signup and view all the answers

The costocervical trunk arises from which portion of the subclavian artery?

<p>Second portion (C)</p> Signup and view all the answers

Which artery supplies the pectoralis minor and major muscles?

<p>Superior thoracic artery (A)</p> Signup and view all the answers

The thoracoacromial artery runs over which muscle?

<p>Pectoralis minor (D)</p> Signup and view all the answers

What are the lateral and posterior cords of the brachial plexus related to?

<p>First part of the axillary artery (D)</p> Signup and view all the answers

To which muscles does the Axillary nerve distribute?

<p>Infraspinatus, teres minor, and deltoid (D)</p> Signup and view all the answers

What nerve innervates all muscles in the forearm's posterior compartment?

<p>Radial nerve (D)</p> Signup and view all the answers

The somatic nervous system is associated with what type of movements?

<p>Voluntary movements (C)</p> Signup and view all the answers

What is the primary response associated with sympathetic activation?

<p>Fight, flight, or fright (C)</p> Signup and view all the answers

Which bodily function is typically increased during parasympathetic activation?

<p>Digestive activity (D)</p> Signup and view all the answers

The sympathetic division is also known as what?

<p>Thoracolumbar division (A)</p> Signup and view all the answers

In what regions of the spinal cord do preganglionic neurons of the sympathetic nervous system originate?

<p>T1 to L2 (or C8 to L3) (C)</p> Signup and view all the answers

Where are the preganglionic neurons of the parasympathetic nervous system located?

<p>In the brainstem and sacral region of the spinal cord (C)</p> Signup and view all the answers

Which cranial nerves contain parasympathetic fibers?

<p>CN III, VII, IX, X (C)</p> Signup and view all the answers

What is the diameter range of preganglionic fibers?

<p>Less than 3 microns but more than 1 micron (A)</p> Signup and view all the answers

Which neurotransmitter is released by the second motor neuron in the parasympathetic nervous system?

<p>Acetylcholine (D)</p> Signup and view all the answers

What neurotransmitter is released by the second motor neuron in the orthosympathetic nervous system?

<p>Norepinephrine or Adrenaline (B)</p> Signup and view all the answers

What is the typical neurotransmitter found in synapses with clear round vesicles in the PNS?

<p>Acetylcholine (A)</p> Signup and view all the answers

What is the main function of sympathetic innervation in the salivary glands?

<p>Vasoconstriction (C)</p> Signup and view all the answers

Which type of fibers are contained in the white communicating rami?

<p>Myelinated preganglionic fibers (A)</p> Signup and view all the answers

Activation of what nerve produces mydriasis?

<p>Oculomotor (A)</p> Signup and view all the answers

How many cervical sympathetic cardiac nerves are there?

<p>3 (C)</p> Signup and view all the answers

What type of fibers are contained in the cardiac nerves that innervate the heart?

<p>Postganglionic efferent fibers and somatosensory fibers (B)</p> Signup and view all the answers

During a heart attack, where is the pain typically projected?

<p>Superior limb on the left side, possibly on the right (B)</p> Signup and view all the answers

What type of reaction occurs when the heart starts to slow down due to an infarct?

<p>Vagal reaction (B)</p> Signup and view all the answers

What is the function of the vagal action in response to ischemic pain?

<p>Protects and slows down the heart (A)</p> Signup and view all the answers

Where are the soma of the viscerosensory neurons collected that are responsible for vagal reactions?

<p>Inferior vagal ganglion (D)</p> Signup and view all the answers

What is the role of noradrenaline when the heart rate increases?

<p>Activates alpha1 and beta2 receptors in coronary arteries (C)</p> Signup and view all the answers

In Prinzmetal angina, what occurs in the small coronary arteries?

<p>They constrict as a result of exercise (D)</p> Signup and view all the answers

At what heart rate do we typically experience the first signs of hypoxia during exercise?

<p>180 bpm (C)</p> Signup and view all the answers

What nerve collects the somatosensory information related to dust entering the bronchi?

<p>Vagus nerve (A)</p> Signup and view all the answers

Which nerve collects somatosensory information from the larynx when a bone enters the airways?

<p>Superior laryngeal nerve (C)</p> Signup and view all the answers

What muscle is innervated by the superior laryngeal nerve?

<p>Cricothyroid muscle (C)</p> Signup and view all the answers

What is the function of noradrenaline on the airways?

<p>Bronchodilation (D)</p> Signup and view all the answers

What three nerves merge to form the greater thoracic splanchnic nerve?

<p>T6-T9 (D)</p> Signup and view all the answers

What is the vertebral level of the celiac ganglia?

<p>Top celiac trunk (A)</p> Signup and view all the answers

What is the origin of the sacral parasympathetic nervous system fibers?

<p>Anterior ramus of spinal nerves S2-3-4 (C)</p> Signup and view all the answers

What structure do the pelvic splanchnic nerves reach?

<p>Inferior hypogastric plexus (C)</p> Signup and view all the answers

What type of fibers does the pudendal nerve carry?

<p>Somatic sensory and motor fibers (C)</p> Signup and view all the answers

From where does the sympathetic NS system fibers reach the female genital tract ?

<p>Greater splanchnic nerve (C)</p> Signup and view all the answers

Through which plexus do preganglionic fibers pass?

<p>Celiac plexus (C)</p> Signup and view all the answers

What receptors increase in levels due to the effect of oestrogen stimulation during pregnancy of the uterus?

<p>Alpha1 receptors (B)</p> Signup and view all the answers

What replaces alpha1 receptors at the end of pregnancy?

<p>Beta2 receptors (C)</p> Signup and view all the answers

What is 'tocolysis'?

<p>Relaxation of smooth muscles (A)</p> Signup and view all the answers

The visceral information from the uterus, tuba, and ovary are carried by?

<p>Sympathetic afferents (A)</p> Signup and view all the answers

Which information does the pudendal nerve NOT receive?

<p>Viscerosensory information (A)</p> Signup and view all the answers

Which nerves provide sympathetic innervation to the male genital tract in addition to the lumbar splanchnic nerves?

<p>Lesser and least thoracic splanchnic nerves (D)</p> Signup and view all the answers

Through which nerves the parasympathetic innervation is provided?

<p>Pelvic splanchnic nerves (A)</p> Signup and view all the answers

Erection depends on which nervous system?

<p>Parasympathetic nervous system (B)</p> Signup and view all the answers

The inferior hypogastric plexus receives which fibers?

<p>Both sympathetic and parasympathetic (B)</p> Signup and view all the answers

What occurs with the autonomic fibers which act on M3 receptors?

<p>Triggers the contraction of the detrusor vesicae and muscles of the trigone of the bladder. (C)</p> Signup and view all the answers

Which spinal nerves primarily compose the lumbar plexus?

<p>L1-L5 (D)</p> Signup and view all the answers

From what structures do the fibers that compose any plexus derive?

<p>Anterior rami of spinal nerves (C)</p> Signup and view all the answers

Which of the following nerves is found within the anterior ramus of the lumbar plexus' divisions?

<p>Obturator nerve (C)</p> Signup and view all the answers

The iliohypogastric and ilioinguinal nerves receive major contributions from which spinal nerves?

<p>T12 and L1 (B)</p> Signup and view all the answers

Which spinal nerves primarily contribute to the genitofemoral nerve?

<p>L1 and L2 (B)</p> Signup and view all the answers

The obturator nerve is mainly formed by which spinal nerves?

<p>L2-L4 (D)</p> Signup and view all the answers

What approximate percentage of individuals possess an accessory obturator nerve?

<p>25% (A)</p> Signup and view all the answers

To which neuromere does the subcostal nerve belong?

<p>T12 (C)</p> Signup and view all the answers

Which of the following passes through the psoas major?

<p>Genitofemoral nerve (C)</p> Signup and view all the answers

The iliohypogastric nerve originates from which spinal nerve(s)?

<p>T12 and L1 (A)</p> Signup and view all the answers

What is the function of the iliohypogastric nerve?

<p>Mixed: sensory and motor (C)</p> Signup and view all the answers

The iliohypogastric nerve innervates the transverse abdominal muscle and the:

<p>Internal oblique muscle (D)</p> Signup and view all the answers

What does the ilioinguinal nerve innervate?

<p>Root of the penis and scrotum in males (C)</p> Signup and view all the answers

Which muscle is innervated by the genitofemoral nerve?

<p>Cremasteric muscle (C)</p> Signup and view all the answers

What nerve brings some sensory fibers to the central part of the femoral triangle?

<p>Genitofemoral nerve (C)</p> Signup and view all the answers

Flashcards

Palpebral Commissures

The point where the superior and inferior eyelids meet.

Lacunae/Cunthus

The triangle of conjunctiva exposed at the level of the palpebral commissures

SMAS

Location in the face where the mimic muscles are hosted and facilitates the movement of the skin lining the frontal bone.

Orbital Septum

Deep fascia detaching from the periosteum attaching to the levator aponeurosis, separates skin and subcutaneous tissue from the orbital fat pad.

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Orbital Fat Pad

White adipose tissue in the orbital cavity, occupying most of the space.

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Glands of Zeis

Sebaceous glands associated with eyelashes.

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Meibomian Glands

Huge sebaceous glands in the tarsal plate; not associated with hair follicles.

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Glands of Moll

Tiny sebaceous glands located between the glands of Zeis and Meibomian glands.

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Lacrimal Glands

Serous glands located that are serous secreting.

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Chalazion

Inflammation due to Meibomian gland excretory duct closure.

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Muscles of Zinn

Six muscles originating around the eye; responsible for eye movement.

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Anulus of Zinn

Fibrous ring at the origin of the extrinsic eye muscles.

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Orbital Fat

White adipose tissue filling the empty space in the orbital cavity

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Tendon's Capsule

The capsule that holds the eye in place.

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Check Ligaments

Eye ligaments suspending the eyeball horizontally.

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Lockwood Ligament

Ligament suspending the eyeball vertically.

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Fibrous Tunic

Outer layer of the eyeball comprised of the cornea and sclera.

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Vascular Tunic/Uvea

Middle layer of the eyeball; contains the iris, ciliary body, and choroid layer.

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Nervous Tunic

Innermost layer of the eyeball that contains the visual and non-visual retina.

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Anterior chamber

Transports aqueous humor from the posterior to the anterior chamber.

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Stroma (iris)

Part of the iris making a barrier anterior to the aqueous humor.

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Sphincter pupillae muscle

Circularly arranged fibers in the iris controlled by acetylcholine; cause pupil constriction.

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Dilator pupillae muscle

Epithelioid layer in the iris; its contraction increases pupil diameter.

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Mydriasis

The increase in pupil diameter caused by contraction of the dilator pupillae muscle.

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Ciliary Body

Organ extending from the iris root to the serrated line, shaping like a donut.

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En passant synaptic buttons

Noradrenaline is released by these to produce mydriasis.

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Pars plicata

Anterior portion of the ciliary body with folds, close to the iris.

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Pars plana

Posterior smooth part of the ciliary body.

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Aqueous humor

Ciliary processes secrete this and exert traction to give lens attachment.

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Ora serrata

The place where visual retina begins

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Retina

The retina has 10 layers and is a piece of the telencephalic vessel located inside a peripheral organ.

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Cytoarchitectonic

Classification of cortices into groups based on the number of layers of nuclei.

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Archicortices

Cortices with at least 3 layers of nuclei, phylogenetically old.

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Paleocortices/Mesocortices

Cortices with 4-5 layers of nuclei.

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Neocortices

Cortices with 6 layers of nuclei; most evolved.

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Retinal Pigmented Epithelium (RPE)

The most superficial layer of the retina; is not composed of cells that have anything to do with neurons, RPE are glial cells.

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Photoreceptor Layer

Contains photoreceptors corresponding to dendrites of photoreceptors.

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Outer Limiting Layer

Layer of the retina related to specific glial cells inside the retina, called Muller cells.

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External Nuclear Layer

Layer of the retina comprised to the nuclei of the soma of the photoreceptors; being the most external one

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Outer Plexiform Layer

Layer of the retina that contains axons of photoreceptors and dendrites of bipolar cells.

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Ganglionic Cell Layer

The third nuclear layer of the retina containing axons of ganglionic cells.

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Nerve Fibers Layer

Contains axons of ganglionic cells ending in the lateral geniculate nucleus; composed of non-myelinated axons.

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Inner Limiting Layer

The 10th layer of the retina that is related to specific glial cells inside the retina, called Muller cells

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Retinal pigmented epithelium

It is the layer of the visual retina that is endowed with multiple melanosomes in all individuals but albino people.

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Blood-Retinal Barrier (BRB)

The blood-retinal barrier prevents certain substances that would inhibit activity from entering the retina.

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Retinal Vessels

Vessels entering and exiting the retina, visible by ophthalmoscopy

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RPE Functions

A layer in the retina containing photoreceptors, controlling ion concentrations, and absorbing light.

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Renewal of Photoreceptors

The process by which RPE cells ingest external segments of photoreceptors, promoting photoreceptor renewal.

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RPE secreted cytokines

Secretion of these paracrine-acting substances from the RPE contributes to photoreceptor tropism, vessel development.

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Macular Degeneration

Pathological condition involving blood vessel growth toward the retina due to VEGF secretion.

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Bruck's Membrane

Structure separating the retinal pigmented epithelium from fenestrated capillaries in Layer 1 of the choroid.

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Blood-brain barrier

This structure is composed of tight junctions sealing capillaries.

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Optic Disc

Area that shows the axons of ganglionic cells connecting together to form cranial nerve II

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Roles of Rods and Cones

Composed of an outer and inner segment; responsible for spectral vision and black/white vision, respectively.

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Primary Cilium in Photoreceptors

Organelle connecting the outer and inner segments of photoreceptors, composed of 2 centrioles.

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Ribbon Synapses

Specialized synapse in photoreceptors and bipolar cells, characterized by ribbons that hold numerous vesicles.

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ON and OFF Bipolar Cells

ON or OFF, dependent on axon length, these modulate photoreceptor signals that are being transfered to the CNS

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Layers of Retina

RPE, Photoreceptors, external lamina, nuclear/plexiform layers and ganglionic cells

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Ganglion Cells

Neurons in the retina that convey visual information to the rest of the brain; axons form the optic nerve.

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Sublamina a and b

A region of the inner plexiform layer divided into two functional segments to separate the on and off channels to the brain.

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ON-OFF Ganglion Cells

ON-OFF directionally selective ganglion cells respond to both increases and decreases in light intensity and react to motion in a specific direction.

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ON directionally selective ganglion cells

Ganglion cells that are directionally selective but respond only to increases in stimuli.

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Lateral Geniculate Nucleus (LGN)

A number of cells that project from the retina to different layers of the lateral geniculate nucleus.

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Parvocellular Layers

Small neurons located in the LGN that handle color vision.

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M type ganglion cells

Fast conduction velocity, respond to low contrast stimuli, not colour sensitive, terminate in LGN.

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K type ganglion cells

These connect to B cones and transduce the blue/yellow colour linked information, terminate in the konicellular layer of the LGN.

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Horizontal cells

These connect adjacent photoreceptors.

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Type I horizontal cells

Connect red and green cones and change their electrical activity based on the retina's total illumination.

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Type II horizontal cells

Devoted to the opposition of green/red and blue/yellow.Connecting cones only.

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Amacrine cells

Connect together nearby bipolar and ganglion cells, creating a second layer of opposition.

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Interplexiform neurons

Found that horizontal cells can actually communicate with amacrine cells by means of neurons that join together those two horizontally arranged cells.

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Optic Tract

Relays information from the optic chiasma to the ipsilateral LGN, pretectal nuclei, and superior colliculus.

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Superior orbital fissure

Where both ophthalmic veins go through before reaching the cavernous sinuses.

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1st Ophthalmic Artery

The first branch is usually a common trunk of the ophthalmic artery for the medial posterior ciliary artery and the central retinal artery.

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Diaphragma sellae

Membrane that closes the apical part of the turkish chair in 70-85% of patients.

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Central Retinal Artery

The most critical branch of the ophthalmic artery is this, that vascularizes the inner layers of the retina.

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Posterior ciliary arteries

Originate from the straight portion that is between the two angles of the S-curve, from the Opthalmic artery.

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External Ear

Anything external to the tympanic membrane. Includes the auricle and external acoustic meatus.

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External Acoustic Meatus

Canal leading from the auricle to the tympanic membrane. Amplifies sound and protects the eardrum.

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Ceruminous Glands

Glands in the external acoustic meatus that secrete earwax, only in cartilaginous 2/3.

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Acute Otitis Externa

Inflammatory infectious disease of the glands in the external acoustic meatus, leading to swelling.

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Otoscope

Instrument used to inspect the eardrum and external acoustic meatus. Projects light and magnifies the view.

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Tympanic Membrane

Membrane separating the external and middle ear. Vibrates in response to sound waves.

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Umbo

Tiny protrusion at the center of the eardrum. Tip of the malleus.

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Pars Tensa

Part of the eardrum below the malleolar folds, transfering sound waves.

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Middle Ear

Cavity between the external and inner ear containing ossicles. Transmits and amplifies sound.

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Ossicles

Three small bones in the middle ear (malleus, incus, stapes) that transmit sound.

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Temporal Bone

The inner ear is located inside this bone.

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Bony Labyrinth

Bony, encasing structure of the inner ear.

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Membranous Labyrinth

The membranous structure contained within the bony labyrinth.

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Perilymph

Fluid between bony and membranous labyrinths.

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Endolymph

Fluid inside the membranous labyrinth.

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Vestibule

Organs sensitive to linear acceleration.

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Semicircular Canals

Organs sensitive to angular acceleration.

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Organ of Corti

Receptor organ for hearing inside the cochlea.

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Macula

Contains the receptor cells of the vestibule, important for balance.

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Crista Ampullaris

Sensory receptors within the semicircular canals that detect angular acceleration.

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Cochlea

Hollow, bony spiral in the inner ear around the modiolus.

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Modiolus

Central bony column in the cochlea around which it turns.

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Facial Nerve Canal

Canal containing cranial nerve VII, located anterior to the internal acoustic meatus.

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Vestibular Nerve

Nerve formed by the juncture of saccular and utricular nerves.

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Cranial Nerve VIII

Combined nerve, including both vestibular and acoustic functions.

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Tractus Spiralis Foraminosus

The base of the modiolus forms this structure.

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Striola

The virtual line dividing the utricle and saccule according to the kinocilium orientation.

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Otoliths

Tiny crystals of calcium carbonate in the macula.

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Helicotrema

Structure that opens to allow communication between the scala vestibuli and the scala tympani.

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Cranial Nerve

Nerve fibers exiting from the cranial cavity.

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Spinal Nerve

Nerve fibers exiting from the spinal cord bony cavity.

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Ganglion

A collection of neuron cell bodies in the PNS.

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Nucleus (Nervous System)

A collection of neuron cell bodies in the CNS.

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Fascicles (CNS)

Axons in the CNS connecting different nuclei.

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Nerves (PNS)

Axons in the PNS composed of connective tissue, Schwann cells, and axons (not soma).

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Sensory Pathway

Afferent pathways reaching the CNS.

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Motor Pathway

Efferent pathways exiting from the CNS.

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Endoneurium

Loose connective tissue wrapping a single nerve fiber in the PNS.

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Perineurium

Layer wrapping myelinated and non-myelinated fibers in the PNS.

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Osmium Tetroxide Stain

Highlights myelin sheaths; stains them black/brown.

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Cranial Nerve I foramen

The point where cranial nerve I passes through the cribriform plate.

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Anterior Ethmoidal Opening

Opening for anterior ethmoidal nerve, artery, and vein.

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Optic Nerve Foramen

Opening for the cranial nerve II

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Primary Olfactory Cortex

Area enthorhinalis dorsalis, corresponds to Brodmann area 34. Receives olfactory information.

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Secondary Olfactory Cortex

Entorhinal cortex, corresponds to Brodmann area 28. Involved in memory, particularly short-term.

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Olfactory Memory

The first memory function to develop in vertebrates.

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Pyriform Cortex

Formed by the uncus (Brodmann area 34) and anterior parahippocampal gyrus (Brodmann area 28).

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Optic Nerve

Cranial nerve II, transmits visual information from the retina to the brain.

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Physiologic Cup

A doughnut-shaped area on the optic disc with a pink neuroretinal rim and central depression.

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Fovea

A 2.5 mm diameter area slightly darker than the surrounding retina; located in the center of the macular region.

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Myelination of Optic Nerve

Acquired after the sclera, carried out by oligodendrocytes

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Bitemporal Hemianopia

Loss of vision in the temporal half of the visual field for both eyes due to optic chiasm damage.

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Homonymous Hemianopia

Visual field defect affecting the same side of the visual field in both eyes due to optic tract damage.

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Superior Homonymous Quadrantanopia

A lesion of Meyer's loop axons resulting in loss of vision in the upper contralateral visual quadrants.

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Ptosis

Dropping of the superior eyelid.

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Oculomotor Nerve (CN III)

Motor nerve with somatomotor and visceral motor functions.

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Interpeduncular Fossa

Region where oculomotor fibers enter the brainstem.

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Pre-ganglionic fibers

The axons originating from the Edinger-Westphal nuclei.

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Diplopia

Double vision caused by the inability to merge images from both eyes into a single visual field.

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Ptosis of the Superior Palpebra

Drooping of the upper eyelid.

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Lack of Accommodation

Sudden inability to focus on close objects.

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Convergent Eye (Adduction)

Condition where the eyeball is rotated inward.

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Divergent Strabismus (Abduction)

Condition where the eyeball is tilted outward.

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Sölder Lines

Loss of sensitivity with concentric distribution.

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Anatomical Distribution

Sensory distribution related to peripheral lesions, following the branches of the trigeminal nerve.

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Spinal Nucleus of the Trigeminal Nerve

Largest nucleus of the trigeminal nerve, extends to cervical spinal cord, contains secondary sensory neurons.

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Trigeminal Ganglion (Gasserian Ganglion)

Contains primary sensory neurons for the trigeminal nerve.

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When is the cadaver dissection scheduled?

Third week of July (starting Monday the 17th)

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What are the terminal roots of the ophthalmic nerve?

Nasociliary, Lacrimal and Frontal nerves.

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How does the Frontal nerve pass?

Passes into a canal formed by a bony superior part and tendon part.

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Which nerves pass superior to the annulus of Zinn?

The frontal and lacrimal nerves

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The Frontal and lacrimal nerves are what kind of nerves?

The pure sensory nerves.

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What happens when the nasociliary nerve enters the superior orbital fissure?

Gives immediately rise to collateral branches.

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The nasociliary gives rise to two what?

Posterior and anterior ethmoidal nerves.

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Where does the posterior ethmoidal nerve enter?

Enters inside one of the lateral masses of the ethmoid bone.

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What does the anterior ethmoidal nerve innervate?

Vestibule of the nasal cavity.

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Where is the nerve located in relation to the nasal cartilage?

Located in perichondrium.

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What does the recurrent meningeal branch innervate?

Dura mater.

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Where does the recurring meningeal branch go?

Internal occipital protuberance.

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Nerves that pass through the superior ?

Orbital fissure.

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Recurrent nerve?

Is also called tentorial nerve of Arnold.

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What does the autonomic root include?

Includes both sympathetic and parasympathetic roots.

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Ciliary ganglion?

Is associated with cranial nerve III.

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Cranial nerve V?

Gasserian ganglion.

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How does the maxillary nerve enter the splancocranium?

Through the foramen rotundum.

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Which ganglion is connected by sensory nerves with the maxillary nerve?

Sphenopalatine ganglion.

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What canal contains the parasympathetic root of the sphenopalatine ganglion?

Vidian canal.

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Mandibular Nerve (CN V)

The third branch of the cranial nerve V; innervates mastication muscles, with the exception of the buccinator muscle, which is innovated by CN VII.

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Anterior Division (Mandibular Nerve)

Supplies motor and sensory innervation to the temporalis, lateral pterygoid, masseter muscles, and the buccinator muscle.

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Posterior Division (Mandibular Nerve)

Provides most of the sensory and visceromotor innervation of the mandibular nerve.

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Auriculotemporal Nerve

The most important nerve for salivation, providing visceromotor innervation to the parotid gland.

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Otic Ganglion

Contains the soma of post-ganglionic parasympathetic neurons; associated with the third branch of CN V.

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Cone Beam Computed Tomography (CBCT)

An imaging technique used to determine the proximity of the lingual nerve to the molar teeth.

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Submandibular Ganglion

Parasympathetic ganglion associated with the lingual nerve for the vasomotor innervation of submandibular and sublingual glands.

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Inferior Alveolar Nerve

This supplies the entire innervation of the alveoli of all the teeth belonging to the inferior quadrants, but not to the gingiva.

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Trigeminal Neuralgia

A disease very difficult to manage that affects the maxillary and mandibular branches of the trigeminal nerve.

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Cranial Nerve VII (Facial Nerve)

Arises from the neuroaxis immediately superior to the olivary nucleus; mixed cranial nerve with 5 nuclei.

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Cranial Nerve VII Divisions

Facial nerve, or cranial nerve VII, divides into temporofascial and cervicofacial nerves after exiting the neurocranium.

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Temporal Branches Innervation

Innervate the frontal muscles and superior orbicularis oculi.

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Buccal Branches Innervation

Innervate muscles between the orbicularis oculi and orbicularis oris.

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Mandibular Branch Innervation

Innervates muscles below the lower lip and the platysma.

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Mimic Muscles Innervation

Striated muscles in face and neck, exception of the buccinator which also gets innervation from cranial nerve V.

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Taste Function

The taste sensation is processed on the same side of the brain as the taste receptor.

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CN IX Modalities

Somatic motor, visceromotor, somatosensory, and visceral sensory.

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Main Motor Nucleus of IX

The most anterior nucleus and is somatic motor, is located immediately posterior to the paraolivary nuclei.

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Sensory territory of CN IX

Collecting sensory information derived from the 3rd branchial arch

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Visceral Sensory Function of CN IX

Related to the carotid sinus and carotid body; loss of function can't be replaced.

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Somatomotor Function of CN IX

The stylopharyngeus muscle responsible to elevate the larynx superiorly.

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Jugular Foramen

Foramen where IX, X, and XI exit the skull.

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Parts of Jugular Foramen

Anterior and posterior parts, landmarks used to subdivide the jugular foramen.

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Inferior Petrosal Sinus

Joins the sigmoid sinus to form the internal jugular vein where nerves IX, X, and XI pass through.

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Muscles Innervated by CN IX

Superior pharyngeal constrictor, stylopharyngeus and the styloglossus.

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Hypoglossal Nerve (CN XII)

Cranial nerve that innervates the intrinsic muscles of the tongue, responsible for tongue movement.

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Hypoglossal Nerve Function

A somatomotor nerve which emerges from the brainstem between the pyramid and olive.

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Hypoglossal Trigone

Protrusion along the midline of the floor of the 4th ventricle where the hypoglossal nucleus resides.

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Preolivary Sulcus

The exit point of the hypoglossal nerve from the brainstem, located between the pyramid and the olive.

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Hypoglossal Canal

Canal in the occipital bone through which the hypoglossal nerve passes.

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Preolivary Sulcus Continuation

The sulcus continues from spinal cord anterolateral sulcus where the motor route of the spinal nerves originates.

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Rectus Capitis Muscles

Muscles originating from the jugular tubercle and condyloid process, related to head movement.

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Descending Branch (CN XII)

Branch of the hypoglossal nerve that descends with the ansa cervicalis, innervating neck muscles.

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Muscular Branch (CN XII)

Branch of the Hypoglossal Nerve innervates the tongue muscles.

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Ansa Cervicalis Radix Superior

Superior root is C1 of the cervical plexus.

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Ansa Cervicalis

A loop of nerves in the neck formed by the cervical plexus, innervating several neck muscles.

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Occipital, Internal and External Carotid Arteries

The nerve may pass anterior to these structures in the neck.

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C3-C4

Intersections above divide at C1.

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Omojugular Lymph Node

Lymph node near the omohyoideus tendon, related to the ansa cervicalis.

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Longissimus Capitis

Muscle originating from C4-T4 transverse processes, inserting into the temporal bone's mastoid process.

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Anterior Scalene Muscle

Muscle originating from C3-C6 transverse processes, inserting into the first rib's costal angle-scalene tubercle.

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Middle Scalene Muscle

Muscle originating from C2-C7 transverse processes, inserting into the first rib's superior surface.

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Posterior Scalene Muscle

Muscle originating from C4-C7 transverse processes, inserting into the second rib's angle.

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Levator Scapulae Muscle

Muscle originating from C1-C4 transverse processes, inserting into the scapula's superior and middle borders.

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Greater Auricular Nerve (GAN)

Innervates mastoid process, pinna/auricle (posterior skin and lobule), antitragus, and intertragic notch, composed of C2 and C3.

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Transverse Cervical Nerves (TCN)

Supplies sensory information to the skin of the neck region, running between the subcutaneous tissue. Composed of three nerves.

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Supraclavicular Region Innervation

Innervates trapezius muscle and clavicle region (externally C4, internally C3) via supraclavicular nerves.

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Erb's Point

Meeting point for greater auricular, lesser occipital, transverse cervical and supraclavicular nerves, generating pain if punctured.

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Brachial Plexus

Anterior rami of C5-T1 forming roots->trunks->divisions->cords, related to superior limb's vascular supply.

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Musculocutaneous Nerve

First terminal nerve of brachial plexus; pierces/innervates coracobrachialis, short head biceps brachii, brachialis.

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Musculocutaneous Nerve Sensation

Shoulder and elbow. C6 & C7 neuromeres are probably involved.

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Musculocutaneous Nerve Change

Becomes the lateral cutaneous nerve of the forearm.

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Subclavian Artery Origin

From brachiocephalic trunk (right) or aortic arch (left).

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Right Subclavian Artery

First gives rise to the right axillary artery.

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First Portion of Subclavian Artery

Medial to anterior scalene muscle border, different on each side.

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Second Portion Subclavian Artery

Posterior to the anterior scalene muscle.

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Third Portion Subclavian Artery

Lateral to middle scalene muscle.

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Subclavian Artery First Portion Vessels

Thyrocervical trunk, vertebral artery, internal thoracic artery.

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Second Portion Subclavian Artery contents

Costocervical trunk.

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Third Portion Subclavian Artery Contents

Dorsal scapular artery.

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Axillary Artery Origin

Lateral margin of latissimus dorsi muscle.

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First part Axillary artery location

From lateral edge 1st rib to superior border pectoralis minor.

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Second Part, Axillary Artery

Runs posteriorly to pectoralis minor.

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Third Part, Axillary Artery

Inferior border pectoralis minor to inferior border teres major.

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Autonomic Nervous System

Part of the nervous system controlling involuntary movements and gland secretions.

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Sympathetic Activation

Produces the 'fight or flight' response, increasing heart rate and blood pressure.

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Parasympathetic Activation

Produces the 'rest and digest' response, decreasing heart rate and increasing digestion.

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Sympathetic Division Origin

Extends from T1 to L2 (traditionally) or C8 to L3 (anatomically), containing preganglionic neurons.

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Parasympathetic Division Origin

Located in the brainstem and sacral region (S2-S4), contains preganglionic neurons.

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Preganglionic Motor Neurons

Motor neurons smaller than those in the somatic nervous system, located in lamina 7.

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Preganglionic Fibers Classification

Fibers with a diameter less than 3 microns, speed of conduction between 3-15 m/s.

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Origin of Preganglionic Fibers

Located in lamina 7, axons pass through lamina 9 en route to the anterior root.

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Sympathetic Cord

Connect different sympathetic chain ganglia.

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Parasympathetic Pathway

Fiber longer than the postganglionic fiber.

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En passant Synapses

Synapses with no direct postsynaptic contact, releasing neurotransmitters diffusely.

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Acetylcholine Receptors

Metabotropic receptors in the PNS, with different types varying by organ.

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Sympatheric Innervation: Salivary Glands

Innervate the sublingual, submaxillary, and minor salivatory glands. Controls vasoconstriction.

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Superior Cervical Ganglion

Collecting gray spinal nerves C1-C4.

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Cardiac Nerve Function

Sympathetic cardiac nerves (3 cervical, ~4 thoracic) deliver noradrenaline and somatosensory fibers to the heart.

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Referred Pain in Heart Attack

Pain projected to the upper limb during a heart attack, collected by somatosensory fibers.

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Vagal Reaction

Slowing of the heart in response to an infarct. Collected by cardiac vagal branches.

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Viscerosensory Role in Ischemia

Viscerosensory fibers transmit ischemic pain, triggering a reflex to increase vagal action.

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Viscerosensory Neuron Soma

Collected in the inferior vagal ganglion (nodose ganglion) which is located outside of the brain.

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Rheology

Science studying the behavior of non-Newtonian fluids, especially blood flow in vessels.

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Prinzmetal Angina

Disease involving constriction of small coronary arteries during exercise, leading to heart pain.

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Heart Rate Limit

Maximum heart rate where the heart is adequately perfused; exceeding it leads to hypoxia.

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Airway Dust Sensation

Sensory information mostly collected by the vagus nerve.

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Airway Foreign Object

Sensory info is collected by neurons in the superior ganglion of the vagus nerve.

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Superior Laryngeal Nerve

Branch of the vagus nerve that collects somatosensory information from the supraglottic and laryngeal ventricle.

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Cricothyroid Muscle

Muscle innervated by the superior laryngeal nerve that increases the tension of the vocal ligament.

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Vagal Action in Airways

Preganglionic fibers release acetylcholine, causing bronchoconstriction via M3 receptors.

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Celiac Plexus

Formed by the greater, lesser, and least splanchnic nerves, composed of at least 5 peripheral ganglia.

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Vagus Nerve Fusion

Distributes along the esophagus and forms a plexus on the surface of the adventitia of the esophagus.

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Pelvic Splanchnic Nerves

Nerves arising from the anterior rami of S2-3-4 spinal nerves that carry sacral parasympathetic fibers.

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Superior hypogastric plexus

A network of fibers and ganglionic neurons located above the pelvis.

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Inferior hypogastric plexus

The plexus connected to the superior hypogastric plexus by hypogastric nerves.

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Pudendal Nerve

Nerve formed by rami from S2-3-4 sacral spinal nerves, carrying somatic sensory and motor fibers.

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Greater Splanchnic Nerve

Sympathetic nerves from the thoracic cavity ending in the celiac ganglion, superior, and inferior mesenteric ganglia.

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Lumbar splanchnic nerves

Sympathetic nerves originating in the thoracic and lumbar regions.

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Alpha1 Receptors (Uterus)

Receptors in the uterus highly expressed during pregnancy under estrogen stimulation, contributing to uterine contraction.

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Beta2 Receptors (Uterus)

The replacement of alpha1 receptors with beta2 receptors causes smooth muscle of the uterus to hyperpolarise under noradrenaline stimulation, leading to muscle relaxation.

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Tocolysis

Hyperpolarization of smooth muscles of the uterus, induced by beta2 receptors, leading to relaxation.

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Visceral Afferents

Sensory information from the uterus, fallopian tubes, and ovaries carried by sympathetic afferents.

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Lesser and Least Thoracic splanchnic Nerves

Efferent sympathetic innervation to the male genital tract.

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Bladder Parasympathetic Innervation

Ach release onto M3 receptors triggers detrusor vesicae muscles of the trigone bladder.

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Detrusor Beta 3 Adrenergic Receptors

Activation by sympathetic fibers produces relaxation of the muscle.

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Urethra Adrenergic Receptors

Stimulation produces contraction of the urethra.

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Pudendal Nerve Contraction

Nerve releases Ach acting on skeletal muscles, contracting the sphincter.

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Lumbar Plexus

A network of spinal nerve fibers formed by the anterior rami of L1-L5 and T12, giving rise to nerves innervating the lower abdomen, anterior thigh, and medial leg.

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Iliohypogastric Nerve

Nerve that originates from T12 and L1; innervates the internal oblique and transversus abdominis muscles and provides sensory innervation to the lateral gluteal region and pubis.

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Ilioinguinal Nerve

Sensory nerve that follows a similar path to the iliohypogastric nerve, innervating the root of the penis and scrotum in males and the root of the clitoris and labia in females.

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Genitofemoral Nerve

Mixed nerve (mostly motor) that innervates the cremasteric muscle in males, responsible for the cremasteric reflex, and provides sensory fibers to the central part of the femoral triangle.

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Lateral Cutaneous Nerve of Thigh

Purely sensory nerve originating from L2 and L3 that innervates the lateral margin of the thigh.

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Femoral Triangle

Area defined by the inguinal ligament superiorly, adductor longus medially, and sartorius laterally; contains femoral vessels, lymphatics, and the femoral nerve.

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Femoral Nerve

Nerve that innervates the sartorius and quadriceps femoris muscles; continues as the saphenous nerve, providing sensory innervation to the anterior thigh, medial leg, and foot.

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Saphenous Nerve

Terminal branch of the femoral nerve that runs parallel to the greater saphenous vein, providing sensory innervation to the medial leg.

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Femoral Artery

Artery that runs close to the femoral nerve, branching into the superficial and deep femoral arteries, which supply the thigh.

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Obturator Nerve

Nerve that originates from the anterior rami of L2-L4 and innervates the adductor muscles of the thigh.

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Accessory Obturator Nerve

Nerve that supplements the obturator nerve and innervates the pectineus muscle.

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Sacral Plexus

A nerve plexus formed by the intermingling of L4-Co1 spinal nerves; distributed on the piriformis muscle, it innervates the muscles of the posterior pelvic region and lower limb.

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Sciatic Nerve

Large nerve originating from L4-S3 that divides into the common peroneal and tibial nerves in the popliteal fossa; innervates muscles of the posterior thigh and leg.

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Common Peroneal Nerve

Branch of the sciatic nerve that runs laterally and divides into superficial and deep branches to innervate muscles of the anterior and lateral leg.

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Tibial Nerve

Branch of the sciatic nerve that runs posteriorly in the leg and innervates muscles of the posterior leg and plantar foot.

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Study Notes

Heart

  • The heart receives 3 cervical and roughly 4 thoracic sympathetic cardiac nerves
  • These sympathetic nerves carry postganglionic efferent fibers delivering noradrenaline
  • They also carry somatosensory fibers
  • During a heart attack, referred pain is projected to the superior limb (typically the left), which is detected by orthosympathetic somatosensory fibers
  • Heart infarcts trigger a vagal reaction mediated by viscerosensory fibers carried by cardiac vagal branches
  • This vagal reflex protects the heart by slowing it down and reducing oxygen consumption
  • Vomiting and vegetative symptoms are related to viscerosensory information collection
  • Information is gathered by two cervical vagal cardiac nerves (superior and inferior) and usually one thoracic cardiac vagal nerve branch
  • Somatosensory neuron somata are in the dorsal root ganglia
  • Viscerosensory neuron somata are in the inferior vagal ganglion (nodose ganglion), mostly outside the brain
  • Efferent fibers in cervical and thoracic cardiac nerves are mostly preganglionic
  • Postganglionic neurons are close to the pericardium and organ
  • Sympathetic cervical cardiac nerves deliver mostly, but not all, postganglionic fibers
  • Rheology studies non-Newtonian fluid behavior; blood behaves as a Newtonian fluid at a basal heart rate of 50-60 bpm
  • Increased heart rate makes blood a non-Newtonian fluid, flowing faster centrally and slower peripherally
  • Prinzmetal angina reverses typical behavior, delivery of noradrenaline activates alpha1 and beta2 receptors to constrict large and dilate small coronary arteries
  • Noradrenaline delivery prevents cavitation: linear blood flow becomes whirling at the periphery due to viscosity
  • Compensating for viscosity involves reducing large artery caliber and increasing small artery caliber for efficient red blood cell flux
  • Prinzmetal angina involves small coronary artery constriction due to exercise, causing risk of cardiac infarct and heart pain with minimal exertion
  • The physiological limit of heart beat rate is the blood flow needed to deliver O2 to cardiomyocytes
  • Hypoxia signs appear around 180 bpm, measurable by ECG during exercise
  • Contraction is limiting perfusion at this point, and pushing past this overpasses the need for O2 in the heart
  • Strong vasodilation of small arteries inside the heart occurs during exercise, while noradrenaline causes slight vasoconstriction of large arteries

Lungs and Bronchi

  • Somatosensory information (e.g., dust) entering the bronchi is collected mainly by the vagus nerve via the superior ganglion
  • Cough receptors' somata are in the inferior ganglion
  • This information, however, is viscerosensory, not somatosensory
  • Sensory data regarding foreign objects in the airways comes from neurons with somata in the vagus nerve's superior ganglion
  • Allergic reaction cough (visceral pain) is collected by neurons in the vagus nerve's inferior ganglion
  • Coughing can be triggered by somatosensory or viscerosensory stimulation
  • Somatosensory information in the heart is collected by the orthosympathetic system and vagus nerve in the airways
  • The superior laryngeal nerve (vagus branch) collects somatosensory information from the larynx (e.g., a bone in the airway)
  • The superior laryngeal nerve gathers somatosensory and viscerosensory data from the supraglottic and laryngeal ventricles of the larynx
  • The infraglottic cavity and most of the trachea send visceral and somatosensory information via the recurrent or inferior laryngeal nerve
    • The recurrent nerve is on one side
    • The inferior laryngeal nerve is on the other side
  • The vagus nerve sends many efferent branches and collects somatosensory and viscerosensory afferent fibers in the mediastinum
  • These fibers are found along the airways from the trachea to the respiratory bronchioles, being sparse in the alveoli
  • Viscerosensory fibers in the alveoli mediate the Hering-Breuer reflex

Vocal Ligament and Airways

  • The superior laryngeal nerve innervates the cricothyroid muscle, controlling vocal ligament tension
  • The inferior laryngeal nerve innervates all other laryngeal muscles
  • Some somatosensory airway fibers are collected from somatosensory fibers from the dorsal root ganglion, associated spinal ganglia being associated with posterior roots of spinal nerves
  • Vagus nerve collects most of the somatosensory and viscerosensory information
  • Sympathetic efferent fibers to the airways originate from paravertebral ganglia T1-T5, releasing noradrenaline for bronchodilation
  • The vagal nerve sends preganglionic fibers, releasing acetylcholine for bronchoconstriction
  • Bronchodilation is due to beta2 receptor activation, while bronchoconstriction occurs via M3 receptor (metabotropic acetylcholine receptor type 3) activation
  • Parasympathetic action increases mucus production dependent on M3 receptors
  • Noradrenaline activating alpha 1 receptors causes vasoconstriction and reduces secretion in the airway system
  • Secretion activation is mainly from acetylcholine action, while secretion reduction is indirectly from vasoconstriction-induced hypoxia

Thoracic Sympathetic Nervous System

  • Sympathetic thoracic nerves from T6-T12, originating from the sympathetic chain ganglia, do NOT innervate the thorax; they enter the abdomen to innervate abdominal organs
  • Ganglia T6-T9 receive gray and white rami and send rami that join to form the greater thoracic splanchnic nerve
  • Thoracic splanchnic nerve comes from T10-T11
  • T12 contributes the least splanchnic nerve independently
  • In some individuals, the T12 branch merges with fibers from T10 and T11 to form the lesser splanchnic nerve
  • Most individuals have three thoracic splanchnic nerves, while some have two

Abdominal Nerves

  • The greater and lesser splanchnic nerves pierce through the diaphragmatic pillars to enter the abdominal cavity
  • The least splanchnic nerve, if present, passes beneath the medial arcuate ligaments
  • The medial arcuate ligament passes over the origin of the psoas major and minor muscles
  • The psoas minor makes a medial groove in the psoas major, inside this is where the least splanchnic nerve passes

Celiac Plexus

  • The greater, lesser, and least splanchnic nerves terminate in the celiac plexus, which has at least 5 peripheral ganglia
  • The two superior ganglia are paired and known as celiac ganglia, while the intermediate ganglia are associated with the superior mesenteric artery
  • The superior mesenteric ganglion is at the same vertebral level as the superior mesenteric artery
  • The celiac ganglia are on top of the celiac trunk
  • Since the celiac trunk is between two vertebrae, the superior one would give the answer
  • There are two aortic renal ganglia associated with the renal arteries
  • An image on the right holds information about greater, lesser and least splanchnic nerves levels but is false

Lumbar Splanchnic Nerves

  • Roughly four lumbar splanchnic nerves contribute fibers to the inferior mesenteric ganglion, associated superiorly with the inferior mesenteric artery origin
  • This ganglion contributes fibers to the superior hypogastric plexus
  • The plexus originates inferior to the inferior mesenteric artery and extends down to the aortic bifurcation into common iliac arteries
  • The aorta is covered by the superior hypogastric plexus

GI Tract - Enteric Nervous System

  • There are two aggregations of local neurons in the GI tract: the myenteric plexus (Auerbach plexus) and submucosal plexus (Meissner plexus)
  • Efferent sympathetic and parasympathetic fibers innervate both plexuses
  • Most SNS fibers are postganglionic, while all PSNS fibers are preganglionic
  • Sensory neurons collect mostly visceral and some somatosensory pain, which travels to spinal cord and through the vagus nerve up to proximal 1/3 of the colon
  • The vagus nerve (cranial nerve X) distributes along the esophagus below the tracheal bifurcation
  • At the T4 vertebral level, the right and left vagal nerves go around the esophagus and form a plexus in this area named fusion

The Vagus Nerve and Esophagus

  • Vagotomy previously the only cure for gastric ulcer involved cutting the left vagus branch (anterior on esophagus) and the right vagus branch (posterior)
  • The left vagus branches off from the esophagus
  • Anatomical Variations exist and additional branches of the vagal nerve exist making this difficult, requiring a microscope to see the anterior branches
  • Sometimes only a single anterior vagal trunk and additional posterior trunks exist
  • The ideal position for a root of the vagus would be inferior 1/3 of the esophagus, but often close to the diaphragm
  • Vagotomy would decrease the acidity, but not entirely
  • Omeprazole proton pump inhibit is effective completely suppressing Hydrochloric Acid
  • 20ml twice a day

Dorsal Medial Nucleus

  • Dorsal medial nucleus is visceromotor nucleus
  • The Superior area releases Acetylcholine and so does the inferior
  • Superior neurons release Acetylcholine and substance P where inferior release VIP, NTP and NO
  • The sympathetic nervous system mainly restricts
  • Paravertebral mainly go to the vesells to restrict perfusion to the GI
  • Prevertebral ganglia connect to the immunological system
  • Sympatehtic Postaganglionic mainly go to Immunilogical system
  • Two places that sympathetic ganglia end
    • Circulare Muscle Layer and activaite contraciton
    • Meissner Plexus which release neuropeptides
  • Para smypatheic reasease acetlycholine
  • Interneurons trigger gut with Acetylcholinr

Enterochromaffin Cells

  • Enterochromaffin cells and the CNS is done via serotonin
  • Soma is in the nodose ganglian
  • Transient receptro is called AT1
  • Olfr558 is for metaboites
  • manipulated by the release of noradrenaline

Small Large bowl ANS

  • Somatosensory, Vicerosensory, Somatomotor, Viceromotor
  • Sympathetics, parasympathetics fibers act on most the cell, making to differentiate from cateogies
  • Viscero is the vagus Nerve
  • THe sacrol Neuromere is form S2-S4

Bowel Cont.

  • Distal 2/3 the spinal innervation The lesser and small is the less innervated T10 and T12 Somatosenosy and Visecrla effernt the infereio mestenter artery
  • The soma is in the infeerior meseentric of L1 and L2

Stomach ANS

  • The stomach the sympathetic system through Celica Plexis Post ganglia come from celiac number 1 and 2 #3 the superior mestritic cella

Renal ANS

  • No proof is the Vagal Kidney
  • Pancrease and liver are true
  • Not a parasmpatheitnervated system

Sacral ANS

  • Most sacral parasympathetic NS fibers travel via the pelvic splanchnic nerves, originating from the anterior rami of S2-3-4 spinal nerves
  • Pelvic splanchnic nerves reach the inferior hypogastric plexus
  • This plexus is a network of fibers and ganglionic neurons
  • The inferior hypogastric plexus connects via left and right hypogastric nerves
  • This connection goes to the superior hypogastric plexus, an unpaired, medially located plexus of the sympathetic NS above the pelvis

Hypogastric Plexuses

  • All autonomic NS based on superior and inferior hypogastric plexuses
  • The superior plexus lies superior to the pelvic brim and tightly opposes the vertebral column, specifically the last two lumbar vertebrae and the first sacral vertebra
  • The superior hypogastric plexus sits below the inferior mesenteric ganglion
  • It connects to the inferior plexus via two hypogastric nerves
  • The inferior plexus connects to the anterior rami of S2-3-4 spinal nerves via pelvic splanchnic nerves
  • S2-3-4 sacral spinal nerves give rise to rami that form the pudendal nerve
  • The pudendal nerve carries somatic sensory and motor fibers, but not sympathetic NS fibers

Autonomic Innervation of the Female Genital Tract

  • The pudendal nerve should be considered separately from this system
  • The remaining system comprises fibers reaching the female genital tract from the sympathetic NS
  • These fibers originate from the greater splanchnic nerve (from the thoracic cavity)
  • These nerves end in the celiac, superior, and inferior mesenteric ganglia
  • Here, they give rise to postganglionic fibers reaching the reproductive tract
  • The lesser and least splanchnic nerves also contribute
  • Sympathetic NS contribution also comes from thoracic and lumbar regions via lumbar splanchnic nerves
  • Most postganglionic fibers originate from the celiac plexus, and the superior and inferior mesenteric ganglia

Reaching the Ovaries, Oviduct, Uterus, and External Genitalia

  • Sympathetic postganglionic fibers travel along the ovarian artery (originates at L2)
  • Postganglionic fibers reach the organ via the superior hypogastric plexus, hypogastric nerves, and the inferior hypogastric plexus lateral to the uterus
  • In females, the inferior hypogastric plexus resides within the loose connective tissue forming the internal part of the mesometrium
  • Preganglionic fibers pass through the celiac, superior mesenteric, and inferior mesenteric ganglia without interruption
  • They interact with the inferior hypogastric plexus where local postganglionic sympathetic neurons are located
  • These postganglionic sympathetic fibers trigger the contraction of the oviduct, uterine muscle, and smooth muscle cells of the vagina

Uterine Receptors and Pregnancy

  • The uterus expresses high levels of alpha1 receptors during pregnancy due to oestrogen stimulation
  • These fibers contribute to uterine contraction at the end of pregnancy
  • Epidural anaesthesia doesn't affect these fibers as they do not pass through the vertebral canal below the injection level
  • At the end of pregnancy, alpha1 receptors are replaced by beta2 receptors
  • Beta2 receptors hyperpolarize smooth muscles of the uterus via noradrenaline stimulation, resulting in tocolysis (muscle relaxation)

Parasympathetic Fibers in Female Genital Tract

  • Parasympathetic fibers originate from sacral neuromeres S2-4
  • These preganglionic fibers release ACh on neurons within the myometrium where the inferior hypogastric plexus is
  • These are postganglionic neurons, releasing ACh
  • Parasympathetic neurons are located in the hypogastric plexus, not in ganglia
  • Postganglionic sympathetic neurons that release noradrenaline intermingle with parasympathetic neurons that release ACh

Pelvic Splanchnic Nerves and Female Genital Tract

  • Preganglionic fibers carried by pelvic splanchnic nerves form a network in the hypogastric plexus near the vagina and uterus, mostly embedded in the myometrium.
  • Anterior rami of S2-4 give rise to spinal nerves that provide somatosensory and somatomotor fibers
  • Somatosensory fibers collect receptors in the female reproductive tract's external genitalia, running inside the pudendal nerve

Sensory Information in Female Genital Tract

  • Visceral information from the uterus, tuba, and ovary is carried by sympathetic afferents.
  • The pudendal nerve exclusively conveys somatosensory information, not viscerosensory.

Muscles of Pelvic Diaphragm and Perineal Region

  • Striated muscles in the pelvic diaphragm and perineal region are innervated by the pudendal nerve
  • Cutting the pudendal nerve results in paralysis of striated muscles in the pelvic diaphragm and perineal region, affecting sexual function, urinary and rectal control
  • The effect is more drastic in males

Visceral and Somatosensory Sensation Pathways

  • Visceral sensation travels through the hypogastric nerves, superior hypogastric plexus, lumbar splanchnic nerves, and thoracic splanchnic nerves to the CNS.
  • The pudendal nerve carries somatosensory information from external genitalia
  • It also provides motor innervation to striated muscles in the pelvic diaphragm and perineal region.

Sympathetic Innervation of Male Genital Tract

  • The male genital tract receives efferent sympathetic innervation via the lesser and least thoracic splanchnic nerves, but not the greater thoracic splanchnic nerve
  • It also receives sympathetic innervation from lumbar splanchnic nerves, similar to the female genital tract

Parasympathetic Innervation of Genital Tract

  • Parasympathetic innervation occurs via pelvic splanchnic nerves in both sexes
  • This innervation is crucial for various reproductive functions

Erection and Detumescence

  • Erection relies on the parasympathetic NS, while detumescence requires the sympathetic NS via noradrenaline
  • Damage to the pelvic splanchnic nerve in females has minor effects
  • Damage to the inferior hypogastric plexus in males significantly impacts both parasympathetic and sympathetic NS, causing defects in erection and potential ejaculation issues
  • DaVinci system endoscopic surgery has reduced iatrogenic damage to the inferior hypogastric plexus

Innervation of Male Genital Tract Continued

  • The inferior hypogastric plexus contains sympathetic and parasympathetic fibers, with a prevalence of postganglionic sympathetic fibers
  • All parasympathetic fibers are preganglionic
  • Collectively, these fibers control smooth muscle cells of organs, including bladder, prostate, and rectum, as well as involuntary sphincters

Pudendal Nerve in Males

  • The pudendal nerve provides somatomotor and somatosensory innervation to the male genital tract, external genitalia, perineal floor, and pelvic floor
  • Damage to the pudendal nerve disrupts somatomotor innervation of the bladder, rectum, and muscles relating to ejaculation
  • It also affects somatosensory information from the penis and bladder
  • Proprioceptive systems in the bladder wall, critical for continence, relay sensory input to the brain through the pudendal nerve.

Bladder and Urethra Innervation

  • Parasympathetic innervation of the bladder utilizes M3 receptors to contract the detrusor vesicae and muscles of the trigone
  • sympathetic fibers activate beta 3 adrenergic receptors in the detrusor vesicae, causing relaxation of the muscle
  • The urethra utilizes alpha 1 adrenergic receptors to contract the urethra
  • The parasympathetic system contracts the detrusor vesicae, causing the urethra to dilate
  • The sympathetic system stimulates beta 3 receptors to relax the detrusor vesicae, and contract the urethra
  • Thus, the sympathetic system keeps urine inside the bladder
  • The pudendal nerve innervates the external urethral sphincter, causing it to contract

Lumbo-Sacral Plexus

  • The lumbar plexus includes the four lumbar spinal nerves (L1-L5) and a contribution from T12
  • Plexuses consist of fibers from the anterior rami of related spinal nerves, forming peripheral nerves
  • The lumbar plexus comprises the anterior and the posterior rami
  • The iliohypogastric, ilioinguinal, genitofemoral, and obturator nerves are derived from the anterior ramus
  • The iliohypogastric and ilioinguinal nerves primarily originate from T12 and L1
  • The genitofemoral nerve is contributed by L1 and L2
  • The obturator nerve originates from L2-L4

Accessory Obturator Nerve

  • 25% of individuals have an accessory obturator nerve, composed of tiny fibers and not easily recognized

Nerve Pathways

  • The subcostal nerve belongs to the T12 neuromere, residing outside the lumbar plexus
  • The ilioinguinal, iliohypogastric, and lateral cutaneous nerve of the thigh pass close to the subcostal nerve
  • These three nerves, along with the femoral nerve, pass between the psoas and quadratus lumborum muscles
  • The genitofemoral nerve passes through the psoas major muscle

Iliohypogastric Nerve

  • It originates from T12 and L1 and has both sensory and motor functions
  • The iliohypogastric nerve runs between the psoas major and quadratus lumborum muscles
  • It moves laterally and downwards, running on the iliac crest posteriorly, internal to the transversus abdominis
  • In the anterior two-thirds, it pierces the transversus abdominis and runs between the transversus abdominis and internal oblique muscles
  • It innervates the internal oblique and transversus abdominal muscles (motor function)
  • Nerve defects can prevent an individual from staying upright
  • At the periphery, it consists of pain and sensory information fibers
  • Compression causes anesthesia and pain in innervated skin areas
  • It innervates the lateral gluteal region and the pubis (sensory function) in both males and females

Ilioinguinal Nerve

  • The ilioinguinal nerve moves in the same direction as the iliohypogastric nerve, piercing the transversus abdominis and running on top of the iliac crest
  • It is a sensory nerve that does not innervate any muscles
  • It innervates the root of the penis and scrotum in males
  • It innervates the root of the clitoris, labia minora, and extends to the labia majora in females

Genitofemoral Nerve

  • Mostly a motor nerve innervating the cremasteric muscle, which is absent in females
  • Absence in females means the cremasteric reflex cannot be elicited
  • The genitofemoral nerve pierces the psoas major.
  • Cremasteric reflex checks for function of the genitofemoral nerve in males via needle on the lateral scrotum, eliciting cremasteric muscle contraction and testis movement upwards
  • Absence indicates defect in the genitofemoral nerve
  • It runs between the internal spermatic fascia and the cremasteric muscle
  • The cremasteric muscle derives from the internal oblique muscle
  • The pampiniform plexus is inside the internal spermatic fascia, which derives from the transversalis fascia

Lateral Cutaneous Nerve of the Thigh

  • Located between the genitofemoral and the obturator nerve
  • It is a pure sensory nerve innervating the lateral margin of the thigh
  • Sensory information is brought to the CNS upon stimulation
  • It derives from L2 and L3 neuromeres
  • The nerve distributes to the fascia lata, mainly on the superficial fascia of the thigh
  • Veins, nerves, and lymphatic vessels are found on this layer
  • It innervates the part depicted in pink (in the image)
  • The genitofemoral nerve sometimes brings sensory fibers to the central part of the femoral triangle
  • Cutaneous nerves distribute to the superficial fascia, along with the greater and smaller saphenous veins
    • Greater saphenous vein collects blood from the thigh and delivers it to the external iliac vein
    • Smaller saphenous vein collects blood from anterior/posterior parts of the leg and feet, draining into the femoral vein

Femoral Triangle

  • Superior border: inguinal ligament (floor of the inguinal canal)
  • Medial border: adductor longus
  • Lateral border: sartorius muscle
  • It contains lymphatics, vessels, and nodes, then the vein, artery, and femoral nerve, from medial to lateral

Femoral Sheath

  • Closes the triangular fossa
  • It is pierced by the greater saphenous vein, which empties into the femoral vein at the level of the inferior border of the femoral triangle
  • Damage to the triangle may result in massive bleeding due to superficial vessels

Femoral Nerve

  • Exits the femoral triangle into different collateral branches
  • The sartorius muscle is innervated by the femoral nerve in two places: origin and insertion
  • The sartorius is the longest muscle in the body
  • The femoral nerve innervates all bellies of the quadriceps muscle: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius
  • The quadriceps and sartorius muscles are exclusively innervated by the femoral nerve
  • The pectineus is also innervated by other nerves
  • The quadriceps muscle allows leg extension over the thigh
  • The anterior branch innervates the skin on the anterior thigh (covering rectus femoris) and the antero-medial skin of the leg, including the medial foot
  • Continues with the terminal branch called the saphenous nerve
  • Origin of the saphenous nerve varies by textbook but changes its name to saphenous nerve below the sartorius
  • The saphenous nerve runs parallel but deep to the greater saphenous vein, with no relationship between them

Femoral Nerve Relationships

  • Because is covered by the sartorius muscle and runs medially to the medial margin of the vastus medialis, the femoral nerve becomes superficial after the sartorius
  • In the superficial fascia of the leg, it follows the small saphenous vein laterally

Femoral Nerve Specifics

  • The femoral artery crosses the femoral nerve immediately below the sartorius, before becoming the saphenous nerve
  • Before being crossed by the lateral circumflex femoral artery, it creates branches that innervate the pectineus, sartorius, and the skin of the anterior thigh
  • It has a relationship with the greater saphenous vein, close to the patella
  • Sensory innervation to the knee joint is provided by the infrapatellar branch, which is actually provided by the saphenous nerve
  • The iliacus and psoas major are also innervated

Femoral Artery

  • Runs close to central branches of the femoral nerve
  • Superficial lies between the sartorius and the adductor longus, then posteriorly to the femur, becoming the popliteal artery
  • At the level of the adductor longus, posterior branches creates the deep femoral artery of the thigh
  • While, the superficial femoral artery remains between the sartorius and the adductor longus, the deep is posterior to the adductor longus
  • The deep artery gives rise to two circumflex femoral arteries
  • Medial circumflex femoral artery: superior, loops around the neck of the femur and supplies the head of the femur
  • Lateral circumflex femoral artery: inferior, at the root of the greater trochanter and enters the diaphysis of the femur

Muscles of Thigh

  • Divided into three compartments: anterior, medial, and posterior
Anterior Compartment
  • Sartorius, rectus femoris, and vastus lateralis superficially
  • Vastus intermedius and vastus medialis internally
Medial Compartment
  • Adductor longus, adductor brevis, adductor magnus, and gracilis
Posterior Compartment
  • Biceps femoris, semitendinosus, and semimembranosus muscles
  • The adductor canal lies between the anterior and medial compartments, with the femoral artery, femoral vein and femoral nerve
  • Posterior to the adductor longus lies the deep femoral artery/deep artery of the thigh
  • The sartorius, gracilis, semitendinosus, and semimembranosus altogether form the Pes Anserinus

Femoral Nerve Pathology

  • Responsible for the patellar tendon reflex, and defects result the absence of it, which tests the L3-L4 spinal component
  • Injuries result in weakness of knee extension and numbness over the anterior/medial thigh, leg and foot

Obturator Nerve

  • Originates from the anterior rami of L2-L4.
  • Has a specific relationship with the obturator externus and the adductor brevis
  • Runs close to the pelvic brim and exits the obturator foramen, between the pectineus and the obturator externus
  • Then divides into anterior and posterior branches at the adductor brevis.
  • Bifurcation occurs internally to the small pelvis at the obturator externus in some people

Obturator Nerve Specifics

  • Innervates the adductor magnus, adductor longus, adductor brevis and sometimes the pectineus
  • Defects prevent adduction because muscles are compromised
  • After innervating the adductor magnus, it becomes more superficial to enter the fascia lata and changes the name to cutaneous branch of the obturator nerve
  • Responsible for innervation of a small part near the knee on the medial thigh

Obturator Nerve Branches

  • The anterior branch innervates adductor muscles
  • The posterior branch innervates the adductor magnus and obturator externus

Accessory Obturator Nerve

  • Present in 25% of individuals.
  • Takes part in motor innervation of the obturator nerve, innervating the pectineus
  • Defects don't cause issues, because the pectineus is also innervated by the femoral nerve

Sacral Plexus

  • Goes from L4 to Co1, and is intermingled with the lumbar plexus
  • Shared are L4 and L5 with lumbar plexus
  • Distributed on the epimysium of the piriformis muscle, which is posterior to the obturator internus and to the levator ani

Sacral Plexus Exit

  • Branches exit from an opening between the piriformis, obturator internus, levator ani, and coccygeal muscle
  • The coccygeal muscle is sometimes considered part of the levator ani

Greater and Lesser Sciatic Foramina

  • The greater sciatic foramen is between the greater sciatic notch, sacro-spinosus ligament and sacro-tuberosus ligament
  • The piriformis muscle divides the greater sciatic foramen into an antero-superior and postero-inferior part
  • The sciatic nerve passes through the greater sciatic foramen
  • Lesser sciatic foramen is between the sacro-tuberosus ligament and the lesser sciatic notch
  • The pudendal nerve passes through the lesser sciatic foramen to enter the smaller pelvis
  • The sciatic nerve exits the lesser pelvis in between the piriformis (below it) and the obturator internus
  • The sciatic nerve moves inferiorly and is superficial to the obturator internus, gemellus inferior, quadratus femoris, and is entirely covered by the gluteus maximus

Sacral Plexus Nerves

  • Subdivided into different positions
  • The sciatic nerve is most anterior and originates from L4-S3
  • Level S3 shares the rectum

Superior and Inferior Gluteal Nerves

  • Superior gluteal nerve originates from L4-S1.
  • Runs in between the gluteus minimus and piriformis muscle
  • Exits from the superior part of the greater sciatic notch
  • Innervates the gluteus minimus (anteriorly) and gluteus medius (posteriorly)
  • Also innervates the tensor fasciae latae, which is crucial for running
  • Inferior gluteal nerve originates from L4-S2
  • Comes from the greater sciatic notch, between the piriformis and superior gemellus muscle
  • Innervates only the gluteus maximus
  • The superior gluteal nerve is superior to the piriformis, while the inferior gluteal nerve is inferior to the piriformis

Sciatic Nerve

  • Up to the popliteal cavity it is a single nerve
  • Then it divides into the common peroneal/fibular nerve and tibial nerve
  • Vessels run far from the sciatic nerve, because the sciatic nerve is posterior

Nerves Between

  • Medial to lateral
    • Adductor magnus
    • Semimembranosus
    • Semitendinosus
    • Biceps femoris (long and short head)
  • In the gluteal region the sciatic nerve is covered by the gluteal muscles

Hamstring

  • The semitendinosus, semimembranosus, gracilis, and sartorius make this up

Sciatic Nerve Division

  • It separates into the common fibular/peroneal nerve (laterally) and tibial nerve (downwards posteriorly) once enters the popliteal cavity Nerve Levels
    • Common fibular/peroneal nerve consists of L4-S2 roots
    • Tibial nerve consists of L4-S3 neuromeres
  • In the popliteal cavity, the nerve is lateral, the popliteal vein is intermediate and the popliteal artery is medial
  • The neurovascular peduncle enters into a space between the gastrocnemius and the soleus, as well as piercing through the soleus medially
  • Nerve changes its position from lateral to separate the artery, centrally, and the vein which goes lateral
  • The artery and vein are called tibial now
  • After piercing soleus, the tibial nerve distributes to the flexor digitorum longus, tibialis posterior, flexor hallucis longus, gastrocnemius, and soleus
  • Then it turns on the medial calcaneal side to move medially and enter the foot superficial to the abductor hallucis muscle
  • There the tibial nerve divides into two terminal branches
    • Lateral plantar nerve, which distributes to the plantar skin of the last digit
    • Medial plantar nerve, which distributes to the 1st-3rd plantar skin of the fingers

Tibial Nerve Flaws

  • Defects lead to poor inversion (up to 30°) and flexion of toes, which all muscles involved are innervated by the tibial nerve only

Additional Info

  • The common peroneal/fibular nerve goes passes the fibula and the fibularis/peroneal longus muscle, and bifurcates between the fibularis and the extensor digitorum longus
Surface level and below
  • With the superficial branch, it runs the fibularis longus and extensor digitorum longus muscle, ending on the skin covering the feet With the deep branch, it's associated with the anterior tibial artery, and has less skin innervation than the superficial

Additional Notes

  • A defect in the common peroneal nerve leads to a defect in eversion (up to 20°) and extension (or dorsiflexion).
  • Stimulating the deep peroneal nerve by scratching between the first and second finger of the feet elicits a reaction
  • The triangular area between the first and second digits is exclusively innervated by the deep peroneal nerve
  • The remaining dorsum of the foot is innervated by the superficial peroneal nerve
  • The lateral part of the foot is innervated by the sural nerve

Variant Anatomy

  • There are some anatomical variants for the nerves that innervate the posterior part of the leg
  • Dermatomes must be studied with the various neuromeres

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