Physiology PDF

**Physiology**  **[Acidosis vs. Alkalosis]** - Acidosis = Increased \[H+\], \[CO2\], decreased \[O2\] - Alkalosis = Decrease \[H+\], \[CO2\], increased \[O2\] +-------------+-------------+-------------+-------------+-------------+ | | Respiratory | Respirato...

**Physiology**  **[Acidosis vs. Alkalosis]** - Acidosis = Increased \[H+\], \[CO2\], decreased \[O2\] - Alkalosis = Decrease \[H+\], \[CO2\], increased \[O2\] +-------------+-------------+-------------+-------------+-------------+ | | Respiratory | Respiratory | Metabolic | Metabolic | | | Acidosis | Alkalosis | Acidosis | Alkalosis | +=============+=============+=============+=============+=============+ | Causes | Decrease | Increase | Non-lung | Non-lung | | | Ventilation | Ventilation | acidosis | alkalosis | +-------------+-------------+-------------+-------------+-------------+ | Examples | Hold | Hyperventil | Diarrhea | Bulimia: | | | breath, | ation | (loss | loss of HCl | | | consolidati | | HCO3-) | | | | on | | Diabetes | Diuretics: | | | (pneumonia) | | Mellitus: | Lose H+ | | | | | Ketoacidosi | | | | | | s | | +-------------+-------------+-------------+-------------+-------------+ | How to fix: | Urinate | Bag over | Hyperventil | Slow | | Exact | NH4+ out | head and/or | ation | breathing | | Opposite | | excrete | to blow off | | | | | bicarbonate | CO2 (If DM, | | | | | (NaCO3) | smell | | | | | | ketones) | | +-------------+-------------+-------------+-------------+-------------+ **[Blood Fluid Volume Control]** **Physical blood fluid volume control** - The macula densa (located in the DCT), is sensitive to sodium concentration. - When the macula dense detects a decrease in sodium in interprets it as decreased blood pressure - It then fires onto the afferent arteriole causing vasodilation. When the afferent arteriole dilates, the juxtaglomerular cells, which wrap around the afferent arteriole, are stimulated and release renin into the blood. - Renin combines with angiotensinogen (made in the liver) to form angiotensin I. - Angiotensin I goes to the lung, through an ACE converting enzyme, it turns into Angiotensin II: THE MOST POWERFUL VASOCONSTRICTER KNOWN TO HUMANKIND. - Angiotensin II will have its greatest effect on the efferent arteriole, causing vasoconstriction. Thus we open up the artery coming into the glomerulus and close off the artery leaving the glomerulus to increase pressure mechanically. **The Hormonal effects of blood-fluid volume control:** - Angiotensin II will go to the zona glomerulosa of the adrenal cortex to secrete aldosterone, which affects the distal convoluted tubules, saving sodium and excreting potassium. - When sodium levels rise in the blood, they are picked up by the supraoptic nucleus of the hypothalamus, which causes the release of ADH/Vasopressin - ADH will have its greatest effect on the collecting ducts, which are normally impermeable to water, making them permeable to water - As the water leaks out, it is picked up by the oncotic pressure of the peritubular capillaries and return to the blood. The water then dilutes the sodium concentration, shutting off ADH  **Urine Production** - In the absence of ADH, we will make urine. The fluid in the collecting ducts will leave by way of the papilla and enter the renal pyramid. - It will go through the minor calyx to the major calyx, passing through an opening called the renal sinus, into the renal pelvis. - Fluid will leave the renal pyramids via the ureter and into the posterior bladder, which is anterior to the psoas major. - It will leave the bladder by the way of the urethra, and in the males the urethra, and in the males the urethra is broken up into 4 segments. - 1^st^ segment = Periprostatic urethra before it enters the prostate - 2^nd^ segment = Prostatic urethra as it passed through the prostate - 3^rd^ segment = membranous urethra as it passes through the urogenital diaphragm which is in the deep perineal pouch - 4^th^ segment = spongy urethra AKA penile urethra as it passes through the corpus spongiosum of the penis - Pathology: - Epispadias = when the penile urethra comes out on the top of the penis - Hypospadias = when the penile urethra comes out on the bottom of the penis - Starts at the crux of the penis. - Erection = Parasympathetic - Ejaculation = Sympathetic - Muscle that voids the bladder = Detrusor Aldosterone ADH ------------------------ -------------------------------- ---------------------------------------------------------------------------- What triggers release? Angiotensin II Increase Na+ Osmolality Where does it act? Distal convoluted tubule (DCT) Collecting duct Action Saving Na+, Excrete K+ Allows reabsorption of water by making collecting ducts permeable to water **[Nephron absorption]** - Distal convoluted tubule absorbs Na+ under influence of aldosterone. - Everything else is absorbed in the Proximal convoluted tubule. **[Kidney Anatomy ]** - Renal pyramids: 8-12/kidney - Cortex = nephron, PCT, DCT & Glomerulus - Medulla = Loop of Henle, collecting ducts - Renal columns = Between renal pyramids - Podocytes: foot-like process in the kidneys - Located in Bowman's capsule for filtration. **[Hormones & Glands]** **Pineal Gland/**Epithalamus: Produces melatonin (tryptophan serotonin melatonin); required for sleep. **Hypothalamus** communicated with anterior pituitary via releasing factors, posterior pituitary via direct axonal connection. +-----------------------+-----------------------+-----------------------+ | | **Adenohypophysis | **Neurohyophysis** | | | "stimulating | | | | factors"** | | +=======================+=======================+=======================+ | **Portion of | Anterior Pituitary | Posterior Pituitary | | pituitary** | | | +-----------------------+-----------------------+-----------------------+ | **Embryology** | Rathke's pouch (aka | Neural tube ectoderm | | | surface/oral | diencephalon | | | ectoderm) | hypothalamus neural | | | | stalk | +-----------------------+-----------------------+-----------------------+ | **Connection of | Hypophyseal portal | Infundibulum (neural | | hypothalamus** | system (transported | stalk) covering -- | | | through blood) | dorsum sellae | +-----------------------+-----------------------+-----------------------+ | **Location** | Sella Turcica (on the | Sella Turcica (on the | | | sphenoid bone) | sphenoid bone) | +-----------------------+-----------------------+-----------------------+ | **Hormones** | 1. ACTH | 1. ADH (controls H2O | | | | balance) | | | 2. FSH | | | | | Origin: | | | 3. GH | supraoptic | | | | nucleus | | | 4. LH | | | | | 2. Oxytocin | | | 5. MSH | | | | | Origin: | | | 6. Prolactin | Paraventricular | | | | nucleus | | | 7. TSH | | | | | Function: Milk | | | | let down & | | | | uterine | | | | contraction | | | | | | | | Target organ = | | | | myometrium of the | | | | uterus | +-----------------------+-----------------------+-----------------------+ +-------------+-------------+-------------+-------------+-------------+ | **Hormones* | **Target | **Effect** | **Excess** | **Deficienc | | * | Organ** | | | y** | +=============+=============+=============+=============+=============+ | ACTH | Adrenal | Cause | **Cushing's | **Addison's | | | cortex, | adrenal | :** | :** | | | Zona | cortex to | Moon face, | Low blood | | | fasciculata | secrete | buffalo | pressure. | | | | Cortisol | hump, | Hyper-pigme | | | | (glucocorti | pendulous | nted | | | | coid) | abdomen & | mouth &face | | | | and | purple | | | | | aldosterone | striae | | | | | (mineraloco | | | | | | rticoid) | | | | | | Shuts down | | | | | | immune | | | | | | system | | | +-------------+-------------+-------------+-------------+-------------+ | FSH (must | Ovary | Females: 1. | Multiple | Infertility | | be actively | | Releases | oocytes | | | inhibited | Testes | follicle 2. | | | | by Inhibin) | | Release | | | | | | estrogen | | | | | | (inhibin in | | | | | | made by the | | | | | | corpus | | | | | | leuteum) | | | | | | | | | | | | Males: | | | | | | stimulates | | | | | | spermatogen | | | | | | esis | | | | | | (Inhibin | | | | | | made by | | | | | | Sertoli | | | | | | cells) | | | | | | (Note: FSH | | | | | | produces | | | | | | germ cells) | | | +-------------+-------------+-------------+-------------+-------------+ | Growth | All tissues | Somatostati | Gigantism = | Dwarfism | | Hormone | except | n | before | (MC=achondr | | (GH) AKA | cartilage | released | growth | oplasia) | | somatotropi | | triggered | centers | | | n | | by | close | | | | | hypothalamu | | | | | | s. | Acromegaly | | | | | Shuts off | = after | | | | | somatotropi | they close | | | | | n | | | | | | Note: | | | | | | Somatomedin | | | | | | from liver | | | | | | mediates | | | | | | "growth | | | | | | hormone" | | | | | | for | | | | | | cartilage | | | +-------------+-------------+-------------+-------------+-------------+ | Luteinizing | Ovary | Female: 1. | Forms | Degenerates | | Hormone | | Ovulation | corpus | corpus | | (LH) | Testes | 2. Forms | luteum when | luteum when | | | | corpus | levels are | levels are | | | | luteum to | up | down | | | | make | | | | | | progesteron | | | | | | e | | | | | | secretory | | | | | | phase | | | | | | | | | | | | Male: | | | | | | Testosteron | | | | | | e | | | | | | (Interstiti | | | | | | al | | | | | | cells of | | | | | | Leydig = | | | | | | ICoL) | | | +-------------+-------------+-------------+-------------+-------------+ | MSH | Melanocytes | In basement | Hyper-pigme | Albinism | | (secreted | | layer of | ntation | | | from pars | | epidermis | | | | intermedia) | | Phenylalani | | | | | | ne | | | | | | Tyrosine | | | | | | L-Dopa | | | | | | Melanin | | | | | | | | | | | | Stimulated | | | | | | by UV light | | | +-------------+-------------+-------------+-------------+-------------+ | Prolactin | Mammaries | Makes milk | Too much | Too little | | | | (must be | milk | milk | | | | actively | | | | | | inhibited | | | | | | by | | | | | | Dopamine/pr | | | | | | ogesterone) | | | +-------------+-------------+-------------+-------------+-------------+ | TSH | Follicular | Produce | Hyperthyroi | Myxedema | | | cells of | Thyroxin | dism; | aka | | | Thyroid | (T4) and | Graves, | hypo-thyroi | | | | Triiodothyr | Thin | dism | | | | onine | bulging | Hashimoto's | | | | (T3) to | eyes, | = | | | | maintain | exopthalmos | Autoimmune | | | | BMR. T3 is | es | Cretinism | | | | made from | | in children | | | | T4 (T4 is | | = | | | | activated | | Autoimmune | | | | in the cell | | | | | | to become | | | | | | T3) | | | | | | Maintains | | | | | | BMR | | | +-------------+-------------+-------------+-------------+-------------+ **[Hormonal control of calcium, adrenals, ovaries, testes, menstrual cycle, Spermatogenesis]** - Calcium function = controls sodium gates to keep them closed - Elevated levels = muscular weakness - Deficient levels = constant nerve depolarization (tetany) - Kept in balance by Parathyroid Hormone & Calcitonin Parathyroid Hormone, AKA PTH/Parathormone Calcitonin ---------- ---------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- Produced Parathyroid Glands (4 posterior of thyroid) Parafollicular Cells of Thyroid Effect Takes Ca2+ out of bone and puts into blood. Decreases phosphorus in blood, increase intestinal calcium Pulls Ca2+ out of blood puts in bone. Increases phosphorus in blood Excess Hyperparathyroidism: S/Sx = kidney stones, osteopenia, Brown's tumor, Rugger Jersey Spine, Salt & Pepper skull Tetany: e.g. Chvostek's sign **[Adrenals]** +-----------------------------------+-----------------------------------+ | Adrenal Cortex (GFR) = mesoderm | Adrenal medulla = Neural Crest | | | Cell | +===================================+===================================+ | Zona glomerulosa = Aldosterone | Post-ganglionic sympathetic | | | | | Zona fasciculate = cortisol | Chromaffin cells secrete | | | norepinephrine & epinephrine. | | Zona Resticularis = sex hormones | | | | Tumor = pheochromocytoma "Gray | | | Cell Tumor" | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | Ovaries | Testes | +===================================+===================================+ | Estrogen: Secondary sex | Testosterone: Secondary sex | | characteristics (Proliferative | characteristics | | phase: builds endometrial lining) | | | Progesterone: secretory phase | Made by Interstitial cells of | | nourish embryo | Leydig | +-----------------------------------+-----------------------------------+  **[Digestion Summary]** **[Mouth]** 1) **Ptyalin (Salivary amylase)** starts the breakdown of starch 2\) **Sublingual lipase** starts the breakdown of fat **[Stomach]** - **Gastric glands** give rise to **parietal cells (oxyntic cells)** & **chief cells (Peptic cells)** - **Chief/peptic cells** produce **Pepsinogen:** (later converted by HCL into Pepsin) - **Parietal/oxyntic cells make** 1) **HCL** converts **pepsinogen into pepsin** 2\) **Intrinsic factor** for **B12 absorption in terminal ileum** - Mucous neck cells aka cardiac gastric cells make mucous. - **Pyloric glands** gives rise to **gastric cells:** produce **gastrin** which **increase gastric secretions & motility & mucous** - Brunner's glands = mucous secreting glands (bicarbonate risk (alkaline)) in duodenum. Buffers chyme - Secretin triggers from the pancreas: 1) Bicarbonate -- buffers acid chyme from stomach 2\) Water -- helps cause release of pancreatic enzymes Small Intestines - Cholecystokinin -- produces most of the pancreatic enzymes in response to polypeptides in the stomach - Causes production of **pancreatic amylases** to break down **starch** - Causes production of **pancreatic lipase** to break down **fats (lipids)** - Causes production of **Trypsinogen** to break down **proteins** - **Closes pyloric sphincter** in response to **fats (lipids)** - **Inhibins** action of **Gastrin** in the stomach - Causes gallbladder to release bile (increases surface area of fats to be acted on) - Bile creates micelles which carry digested fat to the microvilli of the lacteal glands for absorption into the lymphatics in the form of chylomicrons. - Long chain fatty acids will be absorbed in the lymphatic's. - Medium chains may go through either the portal system or the lymphatic's - Small chain fatty acids go directly through the portal system to the liver. - **Enterogastrone:** Also helps **closed pyloric sphincter** in response of fats (lipids) - **Enterokinase:** Converts **trypsinogen into trypsin** for breakdown of protein - Once trypsin is made, **trypsin will activate all other proteolytic enzymes** - The crypts of Lieberkunn have enterocytes, which are the brush borders of the microvilli. - Release aminopolypeptidase & dipeptidase to breakdown poly- and dipeptides into amino acids. - Goblet cells produce mucous - **Pancreatic amylase:** Break down **polysaccharides into disaccharides** - Individual disaccharide enzymes will break down the disaccharides into monosaccharides - **Lactase** breaks down lactose into **glucose + galactose** - **Surcrase** breaks down sucrose into **glucose + fructose** - **Maltase** breaks down maltose into **glucose + glucose** **\*\*\*B12\*\*\*** (mineral of B12 = cobalt) - Cyanocobalamin or methylcobalamin needs intrinsic factor to be absorbed in the terminal ileum - If decreased intrinsic factor Pernicious anemia (macrocytic, normochromic anemia) - Untreated posterolateral sclerosis of the spinal cord (aka combined systems disease) - Fish tapeworm (Diphyllobothrium latum) in ileum can stop the B12 absorption B12 deficiency **[Liver:]** Lobes, ligaments & ducts **Anterior:** 1. R& L lobes are separated by the falciform ligament. Round ligament (Ligamentum teres) = free border of falciform ligament. Round ligament = remnant of umbilical vein. 2. Triangular ligaments attach liver to diaphragm superior/lateral 3. Coronary ligament attaches the majority of the liver to the diaphragm **Posterior lobes:** R& L, Caudate (can't be palpated) & quadrate **Ducts:** R+ L Hepatic duct Common hepatic duct. Cystic duct from GB+ common hepatic common bile duct. Common bite duct + pancreatic duct (duct of Wirsung) = ampulla vater. Empties into 2^nd^ part of duodenum at the summit of the major duodena papilla (sphincter of oddi). Liver \| Functions, Diseases & Treatments \| Britannica **[Edema:]** 4 possibilities 1. Increased venous pressure = increase hydrostatic pressure. E.g. left heart failure pitting edema 2. Decrease protein in blood = decreased oncotic/osmotic pressure. Protein (albumin) in blood pulls water out of the interstitial/extracellular fluid. Decrease protein = decrease pull of water (Notes: Kwashiorkor = protein malnutrition vs. Marasmus = complete caloric malnutrition). 3. Myxedema = hypothyroidism 4. Anaphylaxis = Type 1 Hypersensitivity reaction, Histamine release, e.g. eating, allergies, injuries Note: Generalized Edema = Anasarca \*Nephrotic syndrome: "Pre-eclampsia" = "HEP" =Hypertension, Edema, massive proteinurea **[Muscle Anatomy:]** Functional unit of a muscle -- alpha motor neuron + all muscle fibers it innervates. - **Function unit of a muscle fiber = Sarcomere** - Between Z-bands, Z-lines or Z-Discs - **A** Band = "Anionotropic" = light doesn't pass through - Myosin (slight action overlap) - Remains same with contraction - I Band = "Isotropic" = light passes through - Actin only (thin) - Shortens with contraction. - H Band = only myosin, No overlap with actin & shortens with contraction Fascial Coverings (Fascial is made by fibroblasts) - Endomysium -- covering of a muscle fiber - Perimysium -- covering of a muscle fascicle - Epimysium -- covers entire muscle **[Skeletal Muscle contraction & Pathology:]** For a muscle contraction to take place Actin & Myosin must bind. Before contraction: - The actin binding site is hidden by the Tropomyosin portion of Troponin-Tropomyosin complex. - ATP is bound of Myosin - Contraction process: - Calcium from the presynaptic knob is released, which releases ACH (acetylcholine) performed inside the synaptic knob. - ACH is released & crosses the synapses into the muscle, which is then picked up by T-Tubules. ACH goes to the sarcoplasmic reticulum to release intramuscular calcium. - Calcium binds with troponin, freeing up the actin binding sit - Calcium converts ATP to ADP, readying myosin - The heads of the Myosin crossbridge bind to Actin's active site. By conformational/stearic change, the Myosin heads cock in a power stroke allowing actin filaments to slide, causing muscle contraction. ACH breakdown after contraction: - Primary breakdown of ACH = presynaptic uptake - Secondary breakdown of ACH = acetylcholinesterase **[Types of Contractions:]** - Isometric = contraction, no joint movement - Isotonic = contraction + joint movement w/ constant weight - Isokinetic = contraction w/ constant speed and variable resistance **[Muscle Pathology]** - Clostridium botulinum = Botox - Botulism toxin prevents release of AcH form pre-synaptic terminal = no depolarization of muscle = muscle weakness "floppy baby syndrome" (1^st^ sign = diplopia 2^nd^= death) - Myasthenia Gravis - Autoimmune disorder creates antibodies against acH receptors prevents binding of AcH = no depolarization of muscle = muscle weakness Diplopia, jaw weakness & hand weakness - Clostridium Tetanae - Tetanus toxin prevents released of inhibitory neurotransmitter GABA (brain) and Glycine (spine) - No inhibition constant depolarization tetany of muscle **[Smooth Muscle Contraction]** - Actin attaches to dense bodies from one cell to another - Calcium binds with calmodulin - **There is no troponin in smooth muscle** - Joins with Myosin Kinase activates regulatory light chain - Smooth muscle relaxation - Uses Myosin phosphatase/Calcium pump to break contraction Skeletal Muscle Smooth Muscle ---------------------------------------- ------------------------ ------------------------------------------------------------------------------------------------------- Activation Faster Slower Strength Weaker Stronger Energy required to sustain contraction More Less\*: smooth muscle at full contraction required 1/300 energy of skeletal muscle = "latch mechanism Calcium channels Less Involved More involved Sodium More Involved Less involved Relaxation Acetylcholine-esterase Myosin phosphatase & Calcium pump Troponin YES NO Calmodulin NO YES **[Slow Twitch vs. Fast Twitch]** Slow Twitch Fast Twitch ----------------------------- --------------------------- Endurance/steady power Explosive Power Red color due to myoglobin White, lack of myoglobin Aerobic glycolysis Anaerobic glycolysis More mitochondria Less mitochondria Less glycolytic enzymes More glycolytic enzymes Postural muscles, endurance Muscle, Faitgable Fight gravity Fight or Flee (sprint) Marathon Runner Weight lifters, sprinters **[Heat:]** - Conduction = Loss of temperature through contact - Convection = air waves cool object - Radiation = how you normally give off heat - Evaporation = perspiration = "sudomotor activity" **[Sensory Innervation of Muscle Spindles:]** Primary Receptors Secondary Receptors --------------------------------------------- ------------------------------------ ---------------------- Endings Annulospiral Flower spray Stimulated by which intrafusal muscle fiber Nuclear chain and/or nuclear bag Nuclear Chain only Response Static response & dynamic response Static response only Note: Gamma motor neuron = cerebellum, intrafusal fibers, set tone of muscle Alpha motor neuron = cortex, extrafusal fibers, for voluntary movement Note: Muscle Spindles = Sensory organ in muscle tissue that monitors stretch of muscle and speed of muscle contraction. **[Diffusion & Transports]** Passive diffusion follows the concentration gradient Facilitated diffusion = uses a carrier protein 1. Voltage gates 2. Ligand gating -- binds a chemical with a protein Primary active transport = requires ATP Secondary active transport = co-transport (sodium) A high sodium concentration gradient will carry molecules (e.g. amino acids & glucose) into the cell **[Transmission of impulses:]** CNS: excitatory = AcH, Nor- / epinephrine, glutamate, dopamine, serotonin Inhibitory = glycine (spine), GABA (brain) PNS: 1. Neuromuscular junction = AcH 2. Autonomic nervous system = AcH & Norepinephrine AcH activates 2 receptors 1. Muscarinic = effector cells of parasympathetics 2. Nicotinic = skeletal muscle fibers, pre-ganglionic sympathetic and parasympathetic **Spinal Anatomy** **[Embryology]** +-----------------------+-----------------------+-----------------------+ | Germinal layer | Subgroup | Derivatives | +=======================+=======================+=======================+ | Endoderm | Endoderm | Organs, gut, | | | | respiratory tract | | | | "tubular structures" | +-----------------------+-----------------------+-----------------------+ | Mesoderm | Paraxial Somatic | MSK: muscle, ligame | | | ------------------- | nt, tendons | | 1. Paraxial | -- | ------------------- | | | Paraxial Splanchnic | --------------- | | 2. Intermediate | Intermediate | Smooth muscle of or | | | Head | gans | | 3. Head | Lateral | Urogenital system & | | | |. Kidneys | | 4. Lateral plate | | Skull muscles & den | | | | tine of teeth | | | | CT, cardiovascular | | | | & lymph | +-----------------------+-----------------------+-----------------------+ | Ectoderm | +------------------+ | Epidermis, ant. | | | | Surface ectoderm | | Pituitary, lens of | | "Nerves & Skin" | +==================+ | eye, skin, enamel, | | | | Neuroectoderm | | hair | | | | | | | | | | 1. Neural Tube | | +--------+--------+ | | | | | | | N. | Pos. | | | | | 2. Neural Crest | | | Tube | Pituit | | | | +------------------+ | | | ary, | | | | | | | retina | | | | | | | , | | | | | | | CNS, | | | | | | | olgode | | | | | | | ndrocy | | | | | | | tes | | | | | +========+========+ | | | | | CNS | Brain | | | | | | | & | | | | | | Outsid | Spinal | | | | | | e | Cord | | | | | | CNS | | | | | | | | Sympat | | | | | | | hetic | | | | | | | chain | | | | | | | gangli | | | | | | | on, | | | | | | | DRG, | | | | | | | ANS, | | | | | | | PNS, | | | | | | | Schwan | | | | | | | n | | | | | | | cells, | | | | | | | Parafo | | | | | | | llicul | | | | | | | ar | | | | | | | cells | | | | | | | of | | | | | | | thyroi | | | | | | | d, | | | | | | | Adrena | | | | | | | l | | | | | | | Medull | | | | | | | a | | | | | +--------+--------+ | +-----------------------+-----------------------+-----------------------+ **[CNS Pathology derived from neural tube]** Spinal bifida occulta Lamina fail to fuse. Tuft of hair growth over site (Fawn's beard) ------------------------------- ------------------------------------------------------------------------ Meningocele Meninges protrude out Myelocele Spinal cord protrudes out because meninges are not developed properly Meningomyelocele Spinal cord + meninges protruding out Arnold Chiari Syndrome Type 1 Cerebellar peduncles come below foramen magnum Arnold Chiari Syndrome Type 2 Type 1 + meningomyelocele (usually in lumbar spine) Cleft palate Failure of maxillary and palatine bones to fuse Anencephaly Absence of a major portion of the brain, skull & s scalp (most severe) **Note: Vitamin that prevents these pathologies = B8/Folic Acid/methyl folate/tetrahydrofolate** **[Embryological stages of development]** - Mesodermal 1. Notochord persists as nucleus pulposus 2. 31 pairs of Mesodermal somites from paraxial mesoderm a. Sclerotome = membranous vertebral column b. Myotome = muscle i. Somatic = skeletal muscles ii. Splanchnic = "visceral" smooth muscle iii. Epimere = dorsal primary rami, posterior mm, extensors iv. Hypomere = ventral primary rami, anterior mm, flexors c. Dermatomes = nerves - Ossification 1. Intramembranous/intramedullary ossification a. Mesenchymal tissue into bone b. Clavicle & all flat bones of skulls (e.g. parietal, temporal, flat bone of ilium & flat bone of mandible) 2. Enchondral ossification = performed in cartilage = ossification for all other bones Note: secondary ossification centers: tip of the spinous process, tip of the TP's, tup of the dens and mammillary process Ilium, mandible & scapula = Both Intra & Enchondral **[GI Embryology:]** Mouth = Stomodeum Foregut = back of throat to 1^st^ 1/3^rd^ duodenum Midgut = last 2/3^rd^ duodenum to 1^st^ 2/3 transverse colon Hindgut = last 1/s transverse colon to anus **@ 2/3 transverse colon = transition** 1. Midgut Hindgut 2. Vagus (CN 10) Pelvic Splanchnic (S2-S4) 3. Superior Mesenteric artery inferior mesenteric arter **[1^°^ Vesicles, 2^°^ Vesicles, Derivatives, CN \# & Ventricles ]** +-------------+-------------+-------------+-------------+-------------+ | 1^°^ | 2^°^ | Derivative | CN \# | Ventricle | | Vesicle | Vesicle | of neuraxis | | | +=============+=============+=============+=============+=============+ | Prosencepha | Telencephal | Cortices + | 1 | Lateral | | lon | on | Basal | | ventricle | | | | ganglion + | 2 | | | | Diencephalo | Cingulate | | | | | n | gyrus | | | | | | | | | | | | Thalamus | | | | | | (Hypo, Epi, | | | | | | Sub) | | | +-------------+-------------+-------------+-------------+-------------+ | Mesencephal | Mesencephal | Midbrain | 3,4 | Aqueduct of | | on | on | | | Sylvius | +-------------+-------------+-------------+-------------+-------------+ | Rhombenceph | Metencephal | Pons + | 9-12 | Floor of | | alon | on | Cerebellum | | 4^th^ | | | | | | Ventricle | | | Myelencepha | Medulla | | | | | lon | Oblongata | | Obex = Fold | | | | | | of tissue | | | | | | at floor of | | | | | | 4^th^ | | | | | | ventricle | +-------------+-------------+-------------+-------------+-------------+ Note: Foramen of Monroe connects the lateral & 3^rd^ ventricles. Just below the 4^th^ ventricles is the Cisterna Magna +-------------+-------------+-------------+-------------+-------------+ | Branchial | CN \# | Bones/Carti | Muscles | Misc | | Arch | | lage | | | +=============+=============+=============+=============+=============+ | 1^st^ : | CN V | Mandible, | Mastication | "From jaw | | Mandibular | | Malleus, | (all) | to stapes" | | | | Incus, | tensor | | | | | Tympanic | tempani, | General | | | | membrane | tensor | sensation | | | | | veli, ant | to ant 2/3 | | | | | belly of | of tongue | | | | | digastric | | +-------------+-------------+-------------+-------------+-------------+ | 2^nd^ : | CN VII | Stapes | MM of | Taste to | | Hyoid | | | facial | anterior | | | | Styloid | expression, | 2/3 of | | | | process | Stylohyoid, | tongue | | | | | stapedius, | | | | | Cornu of | post belly | | | | | hyoid | of | | | | | | digastric | | +-------------+-------------+-------------+-------------+-------------+ | 3^rd^ : | CN IX | Body of | Stylopharyn | Thymus | | Thymus | | hyoid | geus | gland. | | | | | | Taste & | | | | Greater | | general | | | | cornu | | sensation | | | | | | of post. | | | | | | 1/3 of | | | | | | tongue | +-------------+-------------+-------------+-------------+-------------+ | 4^th^ -- | CN X | Laryngeal | Cricothroid | Recurrent | | 6^th^ : | | cartilage | , | laryngeal | | Thryoid & | | | Levator | nerve of | | Cricoid | | | veli, | part of "5" | | | | | palatine, | | | | | | mm of | | | | | | larynx, | | | | | | pharynx | | +-------------+-------------+-------------+-------------+-------------+  +-------------+-------------+-------------+-------------+-------------+ | **\#** | **Name** | **Origin** | **Foramina | **Action** | | | | | / Bone** | | +=============+=============+=============+=============+=============+ | 1 | Olfactory | Frontal | Cribriform | S: Small | | | | lobe | plate / | (mitral | | | | | Ethmoid | cells) | +-------------+-------------+-------------+-------------+-------------+ | 2 | Optic | Thalamus | Optic | S: Vision | | | | | foramen / | | | | | | sphenoid | R: Afferent | | | | | | pupillary | | | | | | light | | | | | | reflex | +-------------+-------------+-------------+-------------+-------------+ | 3 | Oculomotor | Midbrain | Superior | M: "All | | | | | orbital | else 3" | | | | | fissure / | (SO4, LR6, | | | | | sphenoid | all else 3) | | | | | | | | | | | | R: | | | | | | Pupillary | | | | | | constrictio | | | | | | n | | | | | | (Edinger | | | | | | Westphal) | | | | | | | | | | | | P: Efferent | | | | | | Pupillary | | | | | | light | | | | | | reflex | +-------------+-------------+-------------+-------------+-------------+ | 4 | Trochlear | Midbrain | Superior | M: Superior | | | | | orbital | Oblique | | | | | fissure / | (SO4) | | | | | sphenoid | | +-------------+-------------+-------------+-------------+-------------+ | V1 | Ophthalmic | Pons | Superior | S: Corner | | | / | | orbital | of cantus | | | | | fissure / | to bald | | | Trigeminal | | sphenoid | spot | | | | | | | | | | | | R: Afferent | | | | | | Corneal & | | | | | | afferent | | | | | | Oculocardia | | | | | | c | +-------------+-------------+-------------+-------------+-------------+ | V2 | Maxillary | Pons | Foramen | S: Corner | | | | | Rotundum / | of canthus | | | | | sphenoid | to corner | | | | | | of mouth | +-------------+-------------+-------------+-------------+-------------+ | V3 | Mandibular | Pons | Foramen | S: Corner | | | branch of | | ovale / | of mouth to | | | Trigeminal | | sphenoid | chin, | | | | | | general | | | | | | sensation | | | | | | to tongue | | | | | | | | | | | | M: mm of | | | | | | mastication | | | | | | & tensor | | | | | | tympani | | | | | | | | | | | | R: Jaw Jerk | | | | | | ( afferent | | | | | | & efferent) | +-------------+-------------+-------------+-------------+-------------+ | 6 | Abducens | Pons | Superior | M: Lateral | | | | | orbital | rectus | | | | | fissure / | (LR6) | | | | | sphenoid | | +-------------+-------------+-------------+-------------+-------------+ | 7 | Facial AKA | Pons | Internal | S: "Chordae | | | Chordae | | auditory | tympani" | | | Tympani in | | meatus | from middle | | | middle ear | | stylomastoi | ear to ant. | | | | | d | 2/3 of | | | | | foramen / | tongue for | | | | | Temporal | taste / | | | | | | gustatory | | | | | Note: | sense | | | | | Pierces | | | | | | Parotid | M: Facial | | | | | gland | mm & | | | | | | stapedius | | | | | | | | | | | | P: | | | | | | Lacrimation | | | | | | , | | | | | | Salivation | +-------------+-------------+-------------+-------------+-------------+ | 8 | Vestibuloco | Pons | Internal | S: Balance | | | chlear | | auditory | (vestibulo) | | | | | meatus / | | | | | | Temporal | Hearing | | | | | | (cochlear) | +-------------+-------------+-------------+-------------+-------------+ | 9 | Glossophary | Medulla | Jugular | S: | | | ngeal | | Foramen / | Posterior | | | | | Temporal / | 1/3 tongue | | | | | Occipital | taste. | | | | | | Middle ear | | | | | | | | | | | | M: | | | | | | Stylopharyn | | | | | | geus | | | | | | | | | | | | R: Carotid | | | | | | afferent, | | | | | | gag | | | | | | efferent | | | | | | | | | | | | P: | | | | | | Salivation | | | | | | (parotid | | | | | | glands) | +-------------+-------------+-------------+-------------+-------------+ | 10 | Vagus | Medulla | Jugular | S: Tympanic | | | | | Foramen / | membrane | | | | | Temporal / | | | | | | Occipital | M: Palate, | | | | | | pharynx, | | | | | | larynx (via | | | | | | nucleus | | | | | | ambiguous) | | | | | | | | | | | | R: carotid | | | | | | (squeeze | | | | | | skin over | | | | | | SCM), gag & | | | | | | oculocardia | | | | | | c | | | | | | efferent | | | | | | | | | | | | P: Palate | | | | | | to 1^st^ | | | | | | 2/3 | | | | | | transverse | | | | | | colon | +-------------+-------------+-------------+-------------+-------------+ | 11 | Spinal | Medulla | Jugular | M: SCM | | | Accessory | | Foramen / | (wc2/3) = | | | | | Temporal / | contra | | | | | Occipital | rotn, ipsi | | | | | | lat flx | | | | | | | | | | | | Traps | | | | | | (wC3,4) = | | | | | | forms slope | | | | | | of neck | +-------------+-------------+-------------+-------------+-------------+ | 12 | Hypoglossal | Medulla | Hypoglossal | M: | | | | | foramen / | intrinsic | | | | | Occiput | mm of | | | | | | tongue | +-------------+-------------+-------------+-------------+-------------+ **[\*\*NOTES: "Oval Man, Rotate Max, Spin the Middle\*\*]** 1."Oval Man" = V3 foramen ovale, Mandibular division. 2. "Rotate Max" = V2 Foramen Rotundum Maxillary division. 3. Spin the middle = foramen spinosum Middle meningeal artery **Muscle of Mastication** Muscle Origin Insertion Action/Notes ---------------------------- --------------------------- ----------------------------------- ------------------------------------ Temporalis Temporal fossa Coronoid mandible Close jaw Masseter Zygomatic External Angel of jaw Close jaw Internal/Medial pterygoid Medial pterygoid process Internal angle of jaw Close jaw External/lateral pterygoid Lateral pterygoid process Disc of TMJ & condyle of mandible Opens/depresses jaw. Protrudes jaw **[Overview of Neurology]** Dendrites = Impulse towards cell body Axon = Impulse away from cell body Axon Hillock = Impulse originates Overview: Receptors (dendrite) Peripheral nerve Spinal cord Brainstem Cerebellum & Thalamus Thalamus Parietal lobe Wernicke's area Limbic System Motor Response NOTE: Only sensation that bypasses thalamus = semll Cerebellum receives info after impulses pass through brainstem & also from the cortex **[Action Potential]** **Resting membrane potential: Muscle = -85 - 90 mv, Neuron = -65 -- 70 mv** - Resting membrane potential: (-) inside, (+) outside - Large protein molecules create (-) inside, Sodium creates (+) charge on outside **Receptors =** Allow sodium (Na+) to leak into the cell, toward depolarization of nerve for action potential. **Dorsal Column receptors (a beta fibers)** - **Pacinion** = Vibration - **Ruffini** = Joint position sense / conscious proprioception - **Meissner's / Merkel's** = accurate touch / 2 pt. discrimination - **Free Naked endings =** pain, temperature, and crude touch **Depolarization** = Na+ rushing in the cell **Ascending limb** = Sodium leaking in towards "sodium equilibrium point" from receptor stimulation **Threshold** = enough Na+ leaks in for any portion of inner membrane to be (+) = spontaneous depolarization = "All or nothing principle" **Descending limb** = Potassium out of cell = repolarization = threshold to zero (resting membrane potential) = (+)charges inside, (-) outside = Absolute refractory period **Subnormal period**. AKA "hyperpolarized" AKA "relative refractory period". = more negative & harder to fire the nerve **Then:** Na+/K+ pumps kick in an dump 3 Na+ out, 2 K+ in **[Brain -- Simplified]** Medulla & pons = Respiratory & cardiac centers, autonomics, CN5-12 Midbrain = reflexes to light & sound, CN 3 & 4 Thalamus = Relay station, sensory fibers, Pulvinar region = Integration of sensory info - VPM = Ventral posteromedial = sensory from face - VPL = Ventral posterolateral = sensory from arms & legs - Lateral geniculate = sensory from eyes - Medial geniculate = sensory from ears Cerebrum = Intellect & association - Parietal Lobe = Localization "somesthetic cortex" & posterior central gyrus. Brodmann 1,2,3. Problem solving - Occipital Lobe = Vision, Broadman 17 - Temporal Lobe - Superior Lobe = Hearing = superior lobe. Contains petrous portion for sound. - Inferior Lobe = Long term memory, smell - Memory = hippocampal cells (Damage anterograde amnesia) - Smell = Parahippocampal cells in Uncal area - Wernicke's area (POT center) = sensory matching - Interpretation: Does this make sense? If not, it'll fire sympathetic - Destroyer by B1/Thiamin deficiency d/t alcoholism (Wernicke-Korsakoff syndrome). Develop sensory aphasia. Can't understand language. Word blindness is angular gyrus. Can read, see, but not understand. - Frontal Lobe = Corticobulbar AKA pyramidal tracts. Location of pre-central gyrus - Voluntary motor = precentral gyrus. Corticospinal tracts AKA corticobulbar AKA pyramidal tracts. Executive function. Personality. Motor aphasis = Broca's speech area in inferior frontal lobe on left. Receives blood through middle cerebral artery. Limbic System = Associated with amygdala. Pleasure or pain, Do I need to remember for survival? Basal Ganglia = inhibits thalamus (stop motor response), proved background muscle tone - Dysfunction: trivial information, elicits motor response = Parkinson's disease Aka paralysis agitans. Pill-rolling tremor, mask-like face, shuffling/propulsive gait, lead pipe rigidity. Lewy inclusion bodies. Decreased Dopamine from substantial nigra in midbrain - Caudate = secretes GABA. (genetic defect = Huntington's Chorea (fatal in males by 50)) - Striatum = putamen + caudate (Internal capsule separates caudate & putamen - Lentiform -- globus pallidus + putamen Hypothalamus = hunger, thirst, temperature regulation, sex, rage, fear Cerebellum = balance, equilibrium, involuntary coordination, unconscious proprioception **[Specialized Cells of Nervous system]** - Blood Brain Barrier = Astrocytes + tight capillary beds - Microglia = macrophages - Ependymal cells = lines ventricles, CSF (made in choroid plexus in lateral ventricles). CSF is absorbed in the sagittal sinus - Oligodendrocytes = myelin in CNS = Derived from neural tube because within the CNS - Demyelinization of CNS = MS - Schwann Cells = myelin in PNS = Derived from neural crest - Demyelinization of PNS = Ascending paralysis. Post-Vaccine, Post infection - Meissner's & Auerbach's Plexuses = Allows peristalsis -- Derived from neural crest cells - If absence of Meissner's Auerbach's = no peristalsis. Congenital megacolon AKA Hirschsprung's **[Flow of CSF]** Choroid plexus in lateral ventricles makes CSF (ependymal cells). CSF flows into the Foramen of Monroe 3^rd^ Ventricle Cerebral Aqueduct of Sylvius 4^th^ ventricle Foramen of Magendie (midline) & Foramen of Lushka (lateral) Central canal & subarachnoid space Reabsorbed in Arachnoid Villi in Superior Sagittal Sinus **[Spinal Cord Tracts:]** Overview: Receptors Peripheral n DRG Spinal Cord Brainstem Cortex [Motor Tracts/Descending Tracts] - Rubrospinal = Proximal muscle flexors of upper & lower extremity. From red nucleus of midbrain - Reticulospinal = Extensor muscles of back and arms. From reticular formation in the midbrain - Except any back muscle innervated by a plexus will be considered a Ventral primary rami - Tectospinal = Neck muscles reflex to light & sound. Form the tectum in the midbrain - Reflex to light (Superior Colliculus); Reflex to sound (Inferior Colliculus) - Vestibulospinal = Extensor muscle of back & legs. From cerebellum & vestibular nuclei; posture - From cerebellum: dentate nucleus anterior horn of spinal cord gamma motor neurons intrafusal fibers for TONE - Corticospinal (pyramidal) = Precentral gyrus of frontal lobe (giant cells of Betz) - Lateral corticospinal = Flexors of distal extremities. Decussates at medulla - Ventral corticospinal = Flexors of the trunk. Decussates at spinal level - Precentral gyrus anterior horn alpha motor neurons extrafusal fibers movement  Rexed Lamina of the Spinal cord II = Substantia Felatinosa blocks pain = Trach of Lissauer = for spinothalamic tract VII = Nucleus Dorsalis of Clark IML : T1 -- L2 sympathetic IMM: S2 -- S2 parasympathetic **[Sensory Tracts/Ascending Tracts]** **DCML = Dorsal Columns Medial Lemniscus:** - Receptors (ab fibers): **Pacinion** (Vibration), **Ruffini** (Joint position sense), **Meissner's/Merkel's** (2pt discrimination) - Legs Ab spine (fasciculus gracilis) Dorsal columns Medulla (nucleus gracilis) decussation (Medial Lemniscus) VPL of contralateral thalamus Contralateral cortex - Arms Ab fibers spine (fasciculus cuneatus) Dorsal columns Medulla (nucleus cuneatus) decussation (medial lemniscus) VPL of contralateral thalamus contralateral cortex **Spinothalamic tracts: Lateral = Pain/Temp. Ventral = crude touch/pressure** - Receptors = free naked nerve endings - Lateral spinothalamic = pain/temp synapse in posterior horn in the "tract of Lissauer AKA Rexed Lamina II". Connects to Rexed Lamina II two segments above and below. After synapse is Rexed Lamina II Decussates across Lamina 7 "Bar of H" travels of contralateral thalamus contralateral cortex - Pathology: Syringomyelia = dilation of central canal = cuts spinothalamic tracts (lost pain & temp in "cape & shawl-like" distribution - Ventral spinothalamic = crude touch same pathway except ascends ventral spinothalamic tract. **[Cerebellum]** +-----------------------------------+-----------------------------------+ | 3 lobes | Cerebellar Nuclei | | | | | - Flocculonodular = midline = | - Fastigial = Spine | | balance of spine | | | | - Globus = proximal joint e.g. | | - Anterior lobe = balance from | Glenohumeral | | arms & legs | | | | - Emboliform = middle joints, | | - Posterior lobe = how the | e.g. Elbow | | cerebellum talk to | | | | - Dentate = Distal joints e.g. | | cortex | Digits (Motor) | +-----------------------------------+-----------------------------------+  **[Sympathetic Nervous System: Lateral Horn T1-L2 "Fight or Flight"]** **Adrenergic receptors:** Norepinephrine & Epinephrine stimulates the breakdown of Glycogen to glucose. - Alpha receptors = **More sensitive to Norepinephrine** - Alpha 1 = Vasoconstriction of central a., dilation of pupils - Beta receptors = **More sensitive to Epinephrine** - Beta 1 = Increases Heart rate, Increase contractility **ACH receptor ALL PARASYMPATHETIC,** the following are **SYMPATHETICS** - **Muscarinic** = **ANS ONLY** = sweat glands (sudomotor activity), Pilierector tissue - **Nicotinic** = **ANS and Skeletal muscle = goes to arterioles of muscles & skin** - **Primary Neuron =** IML = Intermediolateral horn of spinal cord form T1-L2 - Post ganglionic sympathetic are responsible for the production of norepinephrine - **Cervical Chain ganglion** - Superior sympathetic chain ganglion = above C4, pupil dilation - Middle sympathetic chain ganglion = C4-5 - Inferior sympathetic chain ganglion = C6-8 - Stellate Ganglion = C8 -- T1 - Note: Disruption of Cervical chain ganglion **Horner's Syndrome** (ptosis, miosis, anhidrosis) - **Catecholamine pathway:** Phenylalanine Tyrosine L-Dopa Dopamine Norepinephrine Epinephrine **[The Eye]** Anterior Cavity - Ant. Chamber = Cornea to iris = filled w/ aqueous humor - Post. Chamber = Iris to lens = filled w/ aqueous humor Notes: Aqueous humor is made by Ciliary epithelium & drains into the Canal of Schlemm XS Aqueous humor = Glaucoma = increased intraocular pressure Cupping of the disc. Posterior Cavity - Lens to Retina = filled with vitreous humor = jelly-like that maintains the shape of the eye Sclera = Out fibrous layer of the eye Cornea = first to refract light Retina = Converts light into neural signal. Location of the blind spot Macular = visual recognition **[Embryology:]** - Lens = lens placodes (surface ectoderm) - Retina & Iris = Optic stalk gives rise to Optic Cup - Lens/Retina/Vision = Pia Mater - Vascular Portion = Choroid - Sclera = Dura Mater Fovea centralis = most acute vision - Has cones: bright light & colors - M/c/c blindness in elderly = macular degeneration = can't see in the light Rods - Bright lights hyperpolarize the rods - Glaucoma affects rode first - 1^st^ s/sx = rings around lights Pigment - Rhodopsin = purple pigment - Vitamin A (retinol/retinal) supports the rods - Deficiency = nyctalopia = night blindness - Keratomalacia = softening of cornea Optic nerve decussates at optic chiasm - Nasal tracts decussate at optic chiasm - Carry temporal fields of vision - Damage to chiasm = damage to nasal tracts - E.g. Pituitary tumor Bitemporal hemianopsia = "tunnel vision" Voluntary muscles of eye = frontal lobe - Innervates ipsilaterally b/c LMN **[Reflexes:]** In musculoskeletal system = "Myototic reflex" = "stretch reflex" = uses reflex hammer - Upper motor neuron = from Cerebral cortex to (but not including) the anterior horn cells (Alpha motor n.) - Lower motor neuron = from anterior horn cell to the muscle - Monosynaptic = strike tendon stimulates muscle spindle cells (responsible for stretch) synapses on alpha motor neuron - Other receptors (e.g. Ruffini for joint proprioception and angulation) \*Reflexed synapses directly onto the alpha motor neuron. They DO NOT synapse in the spinal cord\* **Upper Motor Neuron Lesion** **Lower Motor Neuron Lesion** ---------------------------------------------------------- ------------------------------------------------------ Clonus d/t constant firing, no inhibition Fasciculations = muscle dying & spontaneously firing Spasticity because increased firing increase muscle tone Hypotonia: lose 1b & 1a afferents for tone Hyperreflexia because muscle spindle is so tight Hyporeflexia: decrease tone on spindles Special Cells: - DRG = unipolar / pseudo-unipolar - CN 1, 2, 8 = Bipolar - Everything else = Multipolar **[The Ear:]** (2 functions = hearing & balance) - Hearing: Turns mechanical waves into fluid waves - Sound pounds the tympanic membrane Malleus Incus Stapes Oval window (contains perilymph) - Inside the oval window = hair cells AKA Organ of Corti aka spiral ganglion AKA stereocilia - Cochlear nucleus leaves via the trapezoid body (2° neurons) to brainstem superior olive in Pons via lateral lemniscus through the inferior colliculus (reflex) leaves medial geniculate body of thalamus superior gyrus in temporal lobe AKA "Gyrus of Heschl" **[Vestibular]** - Anatomy of Cochlea: - Scala media = cochlear canal - Scala vestibuli = vestibular canal - Scala Tympani = tympanic canal - Vestibular / Reissner's membrane is above the Tentorial membrane which is above the Basilar membrane - Balance - Utricle = Linear acceleration (car) - Saccular = Linear acceleration (elevator). Function part utricle - Macule = static equilibrium (standing still) - Semicircular canals = angular acceleration (roller coaster) - Crista ampularis = dilation of semicircular canals. Contains crystals **[The Nose:]** Smell pathway, limbic portion of smell, drainage of nose Smell: - Sensory neuron Cribriform plate of Ethmoid Olfactory bulb (mitral cells) olfactory radiations Uncus Note: Smell is associated with rhinencephalon. Bowman's gland produces mucosa required to smell. - Limbic Portion - Uncus of parahippocampus = Sense of smell - Dentate of hippocampus = Memory & smell - Fornix = Midline connection of hippocampus - Amygdaloid = Emotional response to smell - Drainage of nose - Superior nasal meatus = Posterior ethmoid recess - Inferior nasal meatus = Nasolacrimal duct - Middle nasal meatus = Everything else (Frontal, sphenoid, maxillary) **[Joint Classification]** **(SADISM)** **S I S**ynarthrosis = **I**mmovable = Fibrous Synostosis =Sutures of skull (e.g. sagittal & coronal sutures) Gomphosis =Teeth **A S A**mphiarthrosis **S**lightly moveable = Cartilaginous Synchondrosis = Temporary, epiphyseal plates, hyaline cartilage, sternal articulations Symphysis = IVD, Pubic symphysis, fibrocartilage Syndesmosis = Interosseous membrane (e.g. Tib/fib & radio-ulnar syndesmosis) **D M D**iarthrosis = **M**oveable (freely) = synovial Uniaxial = Hinge/Ginglymus = cubital/humeroulnar joint, mortice joint **=** Pivot/Trochoid = atlas/axis, proximal radioulnar joint Biaxial = ovoid/condlymus = Radiocarpal, MCP, TMJ, Knee (modified) = Saddle/Sellar = 1^st^ metacarpal/trapezium, SC joint Triaxial = Gliding/Plana =Facets, AC joint, intercarpal & tarsal joints = Ball & socket/spheroidal = Coxafermoral joint & glenohumeral joint Other joints: Schindylesis = perpendicular articulation of ethmoid & vomer SI joints = Atypical diarthrodial  **[Spinal Ligaments:]** 9 common ligaments of the spine 3 anterior: 1. ALL = Anterior Longitudinal Ligament = front of vertebral bodies from sacrum C2 = Anterior Atlanto-occipital = ALL from Atlas to Occiput. (limits extension) 2.PLL = Posterior Longitudinal Ligament =Back of vert. bodies (ant. Portion of Canal) - From sacrum C2. Wider in cervical, thinner in lumbar (thinnest at L5. Limits flexion) 3.IVD = Intervertebral disc = Fibrocartilage. Symphysis, 23 IVD's 25% height of 3 middle: 1. LF = Ligamentum Flavum = Lamina to Lamina (post. Portion of canal). Sacrum C2 = Posterior Atlantoaxial = Ligamentum Flavum from C2-C1 = Posterior Atlantooccipital = LF from C1 to C0. Increased calcium "Arcuate Foramen" (Vertebral a. & C1 nerve pass through). LF= highly elastic. Limits flexion. 3. ILT = Intertransverse ligament = transverse process to transverse process 3 posterior: 1. ISL = Interspinous lig. = the middle of one spinous process to the next sp. 2.SSL = Supraspinous lig. = from the tip of one spinous to the top of the next spinous 3.Ligamentum nuchae = supraspinous ligament from C7 to occiput. **[Upper cervical ligaments:]** TL = Transverse ligament = holds dens in the fovea dentalis of atlas. Creates pivot joint & maintains ADI (the indent on posterior side of anterior tubercle) CL = Cruciate ligament = C0 to body of C2. Cross-shaped. Includes transverse ligament as horiz. Portion AL = Alar ligament = Sides of dens to occipital condyles. Aka "check ligament". Limits rotn of C2 AD = Apical Dental ligament = Apex of dens to anterior aspect of foramen. Limits flexion/extension of C2 **[Dentate Ligaments:]** 21 ligaments connecting the Pia to Dura along the spinal cord +-------------+-------------+-------------+-------------+-------------+ | | Oblique | Oblique | Rectus | Rectus | | | Capitus | Capitus | Capitus | Capitus | | | Superior | Inferior | Posterior | Posterior | | | | | Major | Minor | +=============+=============+=============+=============+=============+ | Origin | TP of C1 | SP of C2 | SP of C2 | Posterior | | | | | | Tubercle C1 | +-------------+-------------+-------------+-------------+-------------+ | Insert | Occiput | TP of C1 | Lateral | Below | | | above | | Nuchal Line | Nuchal Line | | | nuchal line | | | | +-------------+-------------+-------------+-------------+-------------+ | Action | Extension & | Rotation of | Extension & | Extension & | | | lateral | C1 on C2 | lateral | lateral | | | rotation of | | rotation of | rotation of | | | the head | | the head | the head | +-------------+-------------+-------------+-------------+-------------+ | Unique | 1. Lateral | 1. Inferio | 1. Medial | 1. Not | | | part of | r | part of | part of | | | triangl | part of | triangl | the | | | e | the | e | triangl | | | | triangl | | e | | | 2. Not | e | 2. Not | | | | attach | | attach | 2. Not | | | to C2 | 2. No C0 | to C1 | attach | | | | attachm | | to C2 | | | | ent | | | +-------------+-------------+-------------+-------------+-------------+ **[Spinal Curves, body shape & canal shape]** Spine Curves Body Shape Canal Shape ---------- ---------------------------- ---------------------- -------------------- Cervical 2° when baby lifts head Circular Triangular Thoracic 1° at birth Heart Oval/circular Lumbar 2° d/t psoas from crawling Kidney Triangular/Trefoil Misc. Apex of L/S curve = L3 Sacrum = 1° at birth "TOT" **[Ribs]** True vs. false vs floating ribs - Ribs 1 -- 7 (true ribs) = articulate with sternum - Ribs 8 -- 10 (false ribs) = articulate to costocartilage of 7^th^ rib - Ribs 11 & 12 = floating ribs Typical vs. atypical ribs - Ribs 3 - 9 = typical ribs - Ribs 1 -- 2, 10 -- 12 = atypical ribs - Rib 1 = short & flat, groove for subclavian artery & vein - Tubercle for anterior scalene & surface for middle scalene - Full facet and demifacet of T1 - Rib 2 = Surface for posterior scalene & serratus anterior - T10 body = full face superior demifacet on T10 - T11 & T12 = single full facet. Floating ribs MC to fracture = angle of the rib **[Ligaments]** - Radiate ligament on front of the head of the rib connecting to the body of the vertebra - Interarticular ligament on front of the rib to the body of the vertebra - Costotransverse ligaments connect the rib to the TVP **[Selected Nerve Roots]** C1 Suboccipital n. Motor to suboccipital mm. ---------- ------------------------------------------------------------------------------------- ------------------------------------------------------ C2 Greater occipital n. Medial dorsal 1° rami C2, 3 Lesser occipital n. Sensory behind ear C3 Least occipital n. 1^st^ nerve compressed by a disc C3, 4 Great auricular n. Sensory on/around ear C3, 4, 5 Phrenic n. Motor to diaphragm C5 Dorsal scapular Motor to rhomboids & levator scap. (ventral 1° rami) C5, 6 Suprascapular n., Subclavian n. Axillary, U+L subscapular C5, 6, 7 Long Thoracic n., Lateral pectoral n., musculocutaneous C6, 7, 8 Thoracodorsal n. Motor to latissimus dorsi (ventral 1° rami) C5 -- T1 Radial n., Median n. Motor to upper extremity C8, T1 Ulnar, medial pectoral, & medial antebrachial cutaneous n. T12 Subcostal n. Sensory L1 Iliohypogastric n., ilioinguinal n. Sensory L1, 2 Genitofemoral n. Afferent + efferent of cremaster reflex L2, 3 Lateral femoral cutaneous n. Sensory to lateral thigh meralgia paresthetica L2, 3, 4 Femoral n. (leg extension), Obturator N. (thigh adduction) (L2, 3, 4 pierces psoas) L4 -- S1 Superior gluteal n. Motor gluteus minimus + medius, TFL L4 - S3 Sciatic N. (pieces piriformis) Splits into Tibial (L4-S4) & Common peroneal L5 -- S2 Inferior gluteal n. Motor to gluteus maximus S1 -- S3 Posterior femoral cutaneous n. Sensory to posterior thigh S2 -- S4 Pudenal n. Erection & bowel/bladder control **[Structural Landmarks]** +-----------------------------------+-----------------------------------+ | EOP | External Occiput | +===================================+===================================+ | Axis | First palpable spinous | +-----------------------------------+-----------------------------------+ | C3 | Hyoid bone | +-----------------------------------+-----------------------------------+ | C3, 4 | Carotid Artery Bifurcation | +-----------------------------------+-----------------------------------+ | C4 | Cephalic Portion of the Thyroid | | | Cartilage | +-----------------------------------+-----------------------------------+ | C5 | Caudal Portion of the Thyroid | | | Cartilage | +-----------------------------------+-----------------------------------+ | C6 | Cricoid cartilage; Carotid | | | tubercle (TP of C6) | +-----------------------------------+-----------------------------------+ | C7 | Vertebral prominens (largest | | | spinous & transverse process in | | | the cervical spine) | +-----------------------------------+-----------------------------------+ | T2 | Episternal Notch (suprasternal | | | notch); Carina of the Trachea | +-----------------------------------+-----------------------------------+ | T3 | Spine of the Scapula | +-----------------------------------+-----------------------------------+ | T4 | Sternal Angle of Louis (2^nd^ | | | Costochondral Cartilage) | | | | | | Dermatome of the Nipple | +-----------------------------------+-----------------------------------+ | T7 | Dermatome of the Xyphoid Process | +-----------------------------------+-----------------------------------+ | T10 | Dermatome of the Umbilicus | | | | | | Vertebral Level of the Xphoid | | | Process | +-----------------------------------+-----------------------------------+ | L1 | Transpyloric Line | +-----------------------------------+-----------------------------------+ | L3 | Vertebral Level of the Umbilicus | +-----------------------------------+-----------------------------------+ | L4 | Iliac Crest; Spinous of L4 | +-----------------------------------+-----------------------------------+ | L5 | Transtubercular Line | +-----------------------------------+-----------------------------------+ | S2 | PSIS | +-----------------------------------+-----------------------------------+ **[Miscellaneous Information:]** - Trapezium makes up the slope of the neck - 2 neck muscles that have both cranial nerve and cervical innervation: trapezius CN XI Cervical 3, 4 - SCM: CN XI cervical 2, 3 - Muscle that elevates the first four ribs during inspiration: Serratus Posterior Superior, Innervation: T1 -- T4 Thoracic aka Costal Nerves - Muscle that depresses the last four ribs during exhalation: Serratus Posterior Inferior. Innervation T9 -- T12 Thoracic aka Costal Nerve **General Anatomy** **[Embryology:]** +-----------------------+-----------------------+-----------------------+ | **Germinal Later** | **Subgroup** | **Derivatives** | +=======================+=======================+=======================+ | Endoderm | Endoderm | Gut, respiratory | | | | tract. "tubular | | | | structures" | +-----------------------+-----------------------+-----------------------+ | Mesoderm | Paraxial | Gives ride to somites | | | | (31 pairs) | | 1. Paraxial | Intermediate | | | | | Urogenital system & | | 2. Intermediate | Head | kidneys | | | | | | 3. Head | Lateral Plate | Skull, muscles & | | | | connective tissue | | 4. Lateral Plate | | (CT) of head, dentine | | | | | | | | Blood & lymph cells, | | | | CT, cardiovascular & | | | | lymphatics, spleen, | | | | serous membranes of | | | | pleura & pericardium | +-----------------------+-----------------------+-----------------------+ | Ectoderm | Surface Ectoderm | Epidermis, **anterior | | | | pituitary**, **lens | | "Nerve & Skin" | Neuroectoderm | of eye**, enamel, | | | | hair, nails | | (2 types) | - Neural Tube | | | | | N. Tube \| | | | - Neural Crest | **posterior | | | | pituitary, retina of | | | | eye,** CNS, pineal | | | | body | | | | | | | | Neural Crest \| | | | | **Dorsal Root | | | | Ganglion (DRG), ANS, | | | | Parafollicular cells | | | | of thyroid, Adrenal | | | | medulla** | +-----------------------+-----------------------+-----------------------+ [**Embryological Stages of development:** Mesodermal Chondrification Ossification] - Mesodermal - Chondrification = mesoderm being replaced by cartilage - Ossification = cartilage replaces by bone (2 types) = 1° ossification = before birth = 2° ossification = after birth 1. Intramembranous/intramedullary ossification a. = mesenchymal tissue into bone b. Clavicle & all flat bones of skill (e.g. parietal) 2. Endochondral ossification = preformed in cartilage = ossification for all other bones **[GI Embryology:]** Mouth = stomodeum **[The Gubernaculum:]** Males Becomes scrotal ligament AKA gubernacular testis. Females becomes suspensory ligament of ovary, ovarian lig. & round lig. **Foramen cecum** gives rise to the thyroid. **[Limb Bud rotation:]** Arm = 90° Lateral Legs = 90° Medial **Planes of the body:** 1. Coronal/Frontal = A-P 2. Sagittal/media = R-L a. Parasagittal = elbow flexion/extension 3. Transverse/horizontal = S-I **[Stages of Mitosis:]** 1. Interphase = resting 2. Prophase = nuclear membrane disappears 3. Metaphase = chromosomes align at equator 4. Anaphase = chromosomes move toward poles 5. Telophase = separation of chromosome **[Histology & Tissues]** **Histology** +-----------------+-----------------+-----------------+-----------------+ | Epithelium | General Purpose | Location | Notes | +=================+=================+=================+=================+ | Simple Squamous | Air & Fluid | Alveoli, | Thinnest cells, | | | diffusion | capillaries, | therefore | | | | blood & lymph | easiest for | | | | vessels | diffusion | +-----------------+-----------------+-----------------+-----------------+ | Stratified | Areas of high | Keratinized = | "If you are | | Squamous | friction | skin | satisfied, then | | | | | you are | | | | Non -- | stratified" | | | | Keratinized = | | | | | oral cavity, | | | | | anal cavity, | | | | | vagina, | | | | | esophagus | | +-----------------+-----------------+-----------------+-----------------+ | Simple Cuboidal | Secretory cells | Kidney tubules, | CSF production, | | | | glands & | ependymal | | | | digestive | cells, | | | | tract, choroid | follicular & | | | | plexus | parafollicular | | | | | cells of | | | | | thyroid | +-----------------+-----------------+-----------------+-----------------+ | Stratified | Secretory | Sweat glands | | | Cuboidal | | | | +-----------------+-----------------+-----------------+-----------------+ | Transitional | Stretch -- | Urinary | Allows | | | bladder | bladder, | expansion | | | | ureters, | | | | | kidneys | | +-----------------+-----------------+-----------------+-----------------+ | Simple columnar | Absorption | Stomach, small | Easy absorption | | | | & large | | | | | intestine, | | | | | glands | | +-----------------+-----------------+-----------------+-----------------+ | Stratified | Reproductive | Uterus (not | | | columnar | tract | vagina) | | +-----------------+-----------------+-----------------+-----------------+ | Pseudostratifie | Respiratory | Entire | Cilia = Filter | | d | tract | pulmonary | | | Ciliated | | tract: Nasal | | | Columnar "PCCE" | | mucosa terminal | | | | | bronchiole | | | | | | | | | | Exception = | | | | | alveoli (simple | | | | | squamous) | | +-----------------+-----------------+-----------------+-----------------+ **[Macrophage cells:]** - Dust cells = lungs - Kupffer = liver - Microglia = brain - Langerhan = skin **[Tissue types:]** - Dense regular = tendons + ligaments - Dense irregular = dermis of skin - Elastic = blood vessels - Reticular = lymph nodes & spleen (Note: Reticular collagen fibers are Type III collagen fibers) **Skin:** **Epidermis (from superficial to deep)** Striatum corneum "Cows" Top layer; dried, non-nucleated ----------------------- --------- ------------------------------------------------------------------ Striatum lucidum "Like" Only on soles/feet & palms/hands (only found in thickened areas) Striatum granulosum "Green" Grammar layer; flattened, Oakland bodies; Keratin producing Striatum spinosum "Soft" Prickle cell layer; Melanosomes, Langerhans cells Striatum germinativum "Grass" Basal Layer -- melanin located here skin color **Melanin** -- Basement (basal) layer of epidermis. Skin color **Dermis: (superficial to deep)** Papillary dermis Reticular dermis Hypodermis AKA "subcutaneous tissue/fascia" **[Mouth: Tongue, Mm of Mastication, Tonsils]** **[Tongue:]** - **Extrinsic mm of tongue** - Palatoglossus CN X: Elevates tongue (Vagus nerve via pharyngeal plexus) - Styloglossus CN XII: Elevates, retracts tongue - Hyoglossus CN XII: depresses, retracts tongue - Genioglossus CN XII: depresses, protrudes tongue - **Intrinsic mm of tongue** (CNXII) - Muscle of each side of lingual septum - Superior longitudinal - Inferior longitudinal - Transverse muscle - Verticule muscle - **Taste Buds of tongue:** - Circumvallate = largest & fewest. Anterior to sulcus terminalis - Filiform = smallest & most numerous \*\*Note involved with taste - Fungiform = 1^st^ taste buds to experience food - Foliate = located on the sides of the tongue - **Taste on tongue** - Sweet = anterior - Salty = anterolateral - Sour = posteriorlateral - Bitter = posterior **[Rings of Waldeyer (Tonsils)]** Palatine, lingual, pharyngeal **[Adenoids:]** Pharyngeal tonsils in nasopharynx Note: Torus Tubarius = naso-pharynx opening of auditory tube (Notes: When the adenoids swell they can occlude the opening of the Eustachian tube) **Muscle of Mastication =** V3 (Mandibular) of Trigeminal Muscle Origin Insertion Action/Notes --------------------------------------------------------- --------------------------- ------------------------------------ ------------------------------------------------------ Temporalis Temporal bone Coronoid of mandible Close haw, Posterior fibers retract Masseter Zygomatic External Angle of Jaw Close jaw (1° closer) Internal/medial pterygoid Medial pterygoid process Internal Angle of jaw Close haw, lateral deviate External/lateral pterygoid (attaches to articular disc) Lateral pterygoid process Disc of TMJ & condyle of mandible. Opens/depresses jaw, Lateral deviation protrudes jaw **[Anatomical Triangles of the Neck, Laryngeal Cartilages]** +-----------------------+-----------------------+-----------------------+ | **Triangle** | **Boundaries** | **Contents** | +=======================+=======================+=======================+ | **[Anterior]{.underli | SCM, Midline/neck, | Salivary glands, | | ne}** | Inferior | larynx, thyroid | | | border/mandible | | | 4 Triangles insides: | | | | | | | | 2 above & 2 below | | | +-----------------------+-----------------------+-----------------------+ | - Carotid | SCM, Posterior | Carotid arteries | | | Digastric, Omohyoid - | | | | superior belly | Internal jugular V. | | | | | | | | Vagus | +-----------------------+-----------------------+-----------------------+ | - Submandibular AKA | Digastric m. (both | Salivary glands | | digastric | heads) | | | | | Hypoglossal N | | | Inferior | | | | border/mandible | Myohyoid N. | +-----------------------+-----------------------+-----------------------+ | - Muscular AKA | SCM | Larynx | | inferior carotid | | | | | Omohyoid -- superior | Trachea | | | belly | | | | | Thyroid | | | Midline/neck | | +-----------------------+-----------------------+-----------------------+ | - Suprahyoid AKA | Digastric m. | Muscles/floor/mouth | | submental | (anterior) | | | | | Salivary glands & | | | Hyoid bone | ducts | +-----------------------+-----------------------+-----------------------+ | **[Posterior]{.underl | SCM (lateral border) | Nerves | | ine}** | | | | | Traps (posterior | Vessels | | | bord