http://dentalbooks-drbassam.blogspot.com/ RULE SUL sais MajorTopic [Abbreviation] Major Topic __| Abbreviat Arteries Art [Muscles Ms Blood Bld [Nerves Nry Bone Bn___| Nervous system Nev S cen Celt [Periodontal PavG ligament/Gingiva Embryology Emb _ | Reproductive system RprS. Endocrine system EndrS _ [Respiratory system RspS Foramens For _| Tissue Tis Gastrointestinal GIS | Tooth T system Heart Hrt | Tooth histology ‘Tih Hist Joints Jnts__ [Urinary system Urn § Lymphatic sysiem Lym S _ | Veins Vas Miscellaneous Mise.http://dentalbooks-drbassam.blogspot.com/ ANATOMIC SCIENCES LymS ‘Which of the following structures leave each individual lymph node at the hilus? + Afferent vessels + Efferent vessels + Tonsillar tissue + Lymphatic ducts Cony © 20002010 Dena Packs ANATOMIC SCIENCES Lym S All of the following statements concerning the lymphatic system ) are true EXCEPT one. Which one is the EXCEPTION? ‘+ The main function is to collect and transport tissue fluids from the intercellular spaces im all the tissues of the body back to the veins in the blood system + Lymph is a transparent, usually slightly yellow, often opalescent liquid found in the lymphatic vessels * Itconsists of the bone marrow, spleen, thymus gland, lymph nodes, tonsils, appendix, Peyer's patches, Iymph, and lymphatic vessels + Just like the circulatory system, the lymphati to pump lymph throughout the lymph vessels stem has a central “heart-like” organ * The chief characteristic commen to all lymphatic organs isthe presence of lymphocytes 1,2 Coit © 20002910 Dena Decksas Lymph nodes are small oval bodies enclosed in fibrous capsules, Lymph nodes contain Phagocytic cortical tissue (reticular tissue) adapted to filter lymph, Specialized bands of connective tissue, called trabeculae, divide the lymph node, Afferent lymphatic vessels carry lymph into the node, where the lymph is circulated through the cortical sinuses. It is herein the sinuses that the lymph is cleansed by macrophages, lymphocytes, and plas- sa cells, The filtered lymph leaves the node through the efferent lymphatic vessels, Which merge through the coneave hilum and transport the lymph into efferent eallect- ing vessels, which converge into larger vessels called lymph trunks (there are five ‘major lymph trunks in the body). These lymph trunks, in tum, empty into either the tho- racic duet or the right lymphatie duct. Important: The thoracic duct drains most of the body and transports lymph to the left subclavian vein. The rigit iymphatic duct drains the right upper portion of the body and transports lymph to the right subclavian vein, |. The afferent lymphatic vessels enter on the convex surface of the node. Notes) 2, There ae fewer efferent vessel than alTeren: vessels associated with anode, stat! 3. The spleen, thymus, palatine, and pharyngeal tonsils da not have numerous afferent vessels entering them as do tymph nodes. aa ee co h vessels ‘** This is false; unlike the circulatery system, the Iymphstie system does not have a pump (heart) to propel lymph throughout the lymph vessels, Instead, the lymphatic system depends on the contractions of skeletal muscles, the presence of valves in lymphatic vessels (similar to those in veins), breathing, and simple gravity to move fluid throughout the body. Functions ofthe lymphatic system: + Returns tissue fluid to the bloodstream; when this uid entecs lymph capillaries its called lymph, Lymph is returned to the venous system vis two large lymph dusts ~- the thoracic duct and the right lymphatic duct * Transports absorbed fats: within the vill in the small intestine, lymph capillaries, called lacteals, transport the products of fat absorption away from the GI tract and eventually ino the circulatory system + Provides immunological defenses against disease-causing agents; lymph filters through lymph nodes, which filter out microorganisms (och as bacteria) and foreign substances 1. Lymph coniains tiquid ponion that resembles blood plasma, as well as 'Noteg| white blood cells (mostly lymphocytes) and a few red blood cells. See! 2. Lymph is absorbed fiom the tissue spaces by the lymphatic capillaries (which fs a system of closed tubes) and eventually retumed 10 the venous cicculation by {he lymphatic vessels, after lymph flows through the filtering systema (lymph nodes). £m the upper limb, fallnatk of lymphatic vesels i that they follow the veins.ANATOMIC SCIENCES Which of the following develops immature T cells into. immunocompetent T cells? + Spleen, + Bone marrow + Thymus + Lymph nodes 3 Copyright © 2092910 Dena Decks ANATOMIC SCIENCES LymS ++ Facial nodes + Occipital nodes + Deep cervical nodes + Sugulodigastric nodes 4 ‘Cong © 200-2010 Den Dscksior mediastinum that has no ies. The min function of the thymus is 19 develop immature T calls into {immunocompetent T cells. The thymus is relatively large in newborns, continues to grow until puberty, and then regresses in adults. Note; in the adult thymus, ihe bod supply is isolated fiom the parenchyma (which ts the flwctiontg portion of the gland as distinguished from the connective sue ar stroma), This is sometimes referred 1 28 We blood thymus barrier. fi he child thymus, the blood supply s not as rolated fioxn the purenchytt ‘Thespleen is forme by reticular ana Iymphaie tissue and isthe largest lymph organ, The spleen, ies in the left hypochondriae region ofthe abdominal eavity between the fundus ofthe soanscls sand the digphrapm. The spleen # purplish in color and varies in size im different individuals. The spleen is slightly oval ia shape with the hilum on the lower mpediel border, The anerior suriace is ‘covered with peritoneum, 1s enclosed ina fbrrelastie capsule that dips into the organ, forming. trabeculae, The cellular material, consisting of ymapheeytes and mscrophages, is called splenie pulp, and it lies between the rabeculte, ‘Thespleen is the largest sinyle mass of lymphoid tissuein ihe body, The spleen can be considered 2 (wo orguns in one, i filters the blood and cemmaves abnormal cells (ich as old and defective ‘red blood cels), apd it rakes disease-fighting components of the irumune system (inchudng anuibodies and fimphoovtes). The body oF the spleen appears red and pulpy, surrounded by a ‘ough capsule, The red pulp consists of loud vessels (iplente simusolds) interwoven. with connective tise (splenic cords). Tue red pulp “ilters he blood and removes old and defective blocd cells. I isthe site of erytbropotesis (hlood formation) ym 8 fetus and an infant. The white pulp is inside the red pulp, and eovsist: of File lamps of lyzaphoid tissae, Antibodies are made ‘nite the white pal. Bone marrow contains stem cells, which may develop into any of several different cell types (called pluripotent), Some stem cells destined to produce immune system cells serve as sources {or lymphoeytes, whereas others develop into phagocytes. Those that bevome Iymahooytes are Aiferentisted to become either B eels (which mature in the Bone narrow) or'T cells (which eravel fo the tymus and mature there) or ir The desp cervical lymph nodes are located ulong the length of the interna jugular vein on exch side ofthe netk, deep to the stérnoclsidamasterd muscle. The deep cervical nodes extend trun the base of the skal to the foot ofthe neck, adjacent the pharynx, ecophagus, and trachea, The deep cervical nodes ate further clussified as 10 their relationship tothe sternoclsidemstoid muscle a5 being superior or inferior The deep cervical lymph nodes are responsible for the drainage of most of the circular chain of nodes, and receive direct efferents from the salivary and thyroid glands, the tongve, the tonsil, the nose, the pharyex, and the larynx. All these vescels join together to form the jugular lymph trunk This vessel drains into either the thoracie duct on the left, the right ymphutie duct on the right, or independently drains ints either the iteral jugular, subclavian, or brachiocephalic veins. Some regional groups of Iymph nods: * Parotid lymph nodes - receive lyaph from stip of Sep sbove the parotid salivary gland, ‘tom the anterior wall ofthe estemal auditory meatus, and from the lateral pats of the eyelids anid st. The etfereat lymph vessels dratn into te deep eervieat nodes + SubnandibolarIymyps aodes~ located between te submuaitaar ginal the mand; receive lymph from the font ef the scalp, the nose, and adjacent check; the upper ip and lower ip (excopt the comer part: he perarasal sinuses; the maxillary and mandibular leet (xezpt the mandibular incisors); the anterie two-thirds of the tone xcept hep) hs lr of the ‘oul end vestibule; ard the gingiva, Th eiferentIysnph vessels dain into th deup eervieal nodes ubmental lymph nodes - locted behind the chin and onthe ralchiyid muscle; receive lymph om the tip of the tongue, the Moor of the mouth benesth the (ip of the tongue, the mandibular incisor teeth and associated wingiva, he center part of the lower lip, and he shin over the ebin. ‘The efferent lymph vessels drain into the submandibilar and deep cervical nodesANATOMIC SCIENCES Lym S ‘When antigen recognition occurs by a lymphocyte, B cells are a migrate to which area of the lymph node? + Inner medullary region + Medullary cords + Medullary sinuses + Germinal centers 5 a ‘Cop © 2002010 Dental Desks ANATOMIC SCIENCES Lym S Left internal jugular vein + Left subelavian vein ‘Junction of the left internal jugular and subclavian veins + Superior vena cava + Junction of the right internal jugular and subclavian veins an 6 Comrigat © 20002010 Dental DicksLymph nodes are small, round specialized dilations of lymphatic tissue that are permeated by lymphatic channels. Their function is primarily to act as filters. They help remave and destroy antigens that circulate in the blood and lymph. For this purpose, lymph nodes contain a lot of macrophages. Lymphoid tissue in the nodes also produces antibodies and stores lymphocytes. Note: The nodes generally occur in elusters along the connecting lymphatic vessels particularly in the armpits, the groin, the lower abdomen, and the sides of the neck. Each lymph node is enclosed in a fibrous capsule with internal trabeculae (connective tissue) supporting lympioid tissue and lymph sinuses. ‘The node consists of: * Onter cortical region - contains separate masses of lymphoid tissue called germinal centers (nodules), which are a source of lymphocytes. Also contains ‘Subseapular and cortical sinuses + Inner medullary region - lymphoid tissue here is arranged in medullary cord which are a source of plasma cells (they secrete antiborties). Also contains medull ary sinuses Lymph nodes can be classified as primary or secondary. Lymph from a particular region drains into a primary node or regional node, Primary nodes, in tum, drain into secondary node or central node. The thoracic duct is the main duct of the Iymphatic system and is Toeated posterior mediastinum. It begins below in the abdomen as dilated sac, the cisterna chyli (at the level of the T12 vertebra) and ascens through the thoracie cavity in front of the spinal column. Its the common trunk of all she lymphatic vessels ofthe body, and rains the Iymph from the majority of the body (legs, abdomen, left side of hoad, left ‘arm, and left thorax). Note: The tight lymphatic duct drains much less of the body lymph (only the lymph from the right erm, right thorax, and right side ofthe head). Important: The thoracie duct empties into the junction ofthe left internal jugular and loft subclavian veins (which is actually the beginning ofthe left brachiocephalic vein). |. The thoracic duct ascends through the aortic opening in the diaphragm, on ‘Notes the right side of the descending aorta. “Sis! 2. The thoracic duct contains valves and ascends between the aorta and the zzygos vein in the thorax. # Lymphatic duct is the right sided equivalent of the thoracie duct and drains the right side of the head and nec, the right upper limb, and the right side of the thorax. ‘The right lymphatic duct empties into the junetion of the right internal jugular and right subelavian veins (which ix actually she beginning of he right brachiocephalic vein).\TOMIC SCIENCES LymS A.25-year-old car accident vietim is brought into the emergency room complaining of severe abdominal pain radiating into the left scapula. Low hematocrit, marked hypotension, and a grossly bloody peritoneal tap all indicate a ruptured spleen. A splenectomy will be performed, and the surgeon must remove the spleen from: * The right inguinal region of the abdominal cavity + The right hypochond:ium of the abdominal cavity between the stomach and the diaphragm + The left hypochondrium of the abdominal cavity between the stomach and the diaphragm + The hypogestriun of the abdominal cavity just below the liver 1 Cori © 206-2010 Deol Decks ANATOMIC SCIENCES high fever, sore throat, earache, and greenish sputum. Enlarged tonsils, areas of pus, and the inflammation indicate tonsillitis. The girl also is breathing through her mouth; the swelling of which tonsils (also known as adenoids when enlarged) caused the obstruction of the nasopharyngeal isthmus? + Lingual consils + Palatine tonsils + Pharyngeal tonsils e ‘Cops © 206.2810 Den Decks‘The spleen is an ovoid organ roughly the size ofa fist. The spleen contains white and red pulp. The white pulp contains compact masses of lymphocytes surounding branches of the splenic artery, The red pulp consis of @ network of blood-flled sinusoids, along with lymphocytes, macrophages, plasma cells, and monocytes (phagocytic white blood eels) There are three major functions of the spleen, and these are handled by three different Uussues within the spleen * Reticuloendothelial tise: concemed with phagocytosis of erythrocytes and cell debris ftom the bloodsiveam, This same tise may prodtce foci of hemopoiesis When RECs sre needed + Venous sinusoids: along with the power of the spleen to contract, provides 2 method for expelling the contained blood to meet increased cixeulatory demands + White pulp: provides lymphocytes and source of plasma cells and henge antibodies for the cellular und humoral sperifis immune defeases Blood enters the spleen at the hilum through the splenic artery and is drained by the splenic vein, which joins the superior mesenteric vein to form the hepatic portal vein to the liver. The merves to the spleen accompany the splenic artery and are derived from the celiac plexus, Note: Like the thymus, the spleen possesses only efferent lymphatic vessels, Remember: The spleen does not develop fiom the primitive gut, as do the Lungs, liver, pancreas, gallbladder, stomach, esophagus, and intestines. ‘The spleen develops from mesenchymal cells of the mesentery attached (o the primitive stomach. Ens ‘The tonsils are lymphatic organs that He under the surface ining of the mouth and throat, ‘They ate considered part ofthe secondary immune system. They sit-in the respiratory snd alimentary tracts in position to be exposed to inspire or ingested antigens from air or food. When sufficient antigen is present, this stimulates the B cells in the geminal zone of the lymphoid follicle to differentiate ant produce antibodies. The tonsils are involved in the production of mostly secretory Te, which is trausported to the surface, providing local immue protection, There are three sets of tonsils, named according ‘o their position. ‘The pharyngeal tonsils are located on the posterior wall of the msopharynx. They are at their peak of development during childhood, and when enlarged, they are referred to as adenolds, They are surrounded rary by connective tissue and partly by ciliated pseudostratified columnar epitheliam (respiraiory epithelium), They contain no erypts. ‘The palatine tonsils are located om the posterolateral walls of the throat, one on each side. They reach their maximum size during early childhood, bat after puberty diminish considerably in size, These are the tonsils that are noticeably enlarged when « person stfers fom a “sore throat.” They contain many erypts, lymphoid follicles, but no sinuses, The palatine tonsils are surrounded partly by connective tissue and partly by non-keratinized sre smaller and more numerous, They are a collection of lytrphoid follicles on the posterior portion of the dorsum of the tongue, Each has a single crypt. They surrounded by now-Keratinized stratified squamous epithelium. Remember: Peyer's patehes are similar jn structure and funusion to the tonsils (Peyer's ‘patches form “intestinal tonsils"), Located in the small intestine (ypecifically, the Meum), they serve to destroy the abundant bacteria, which would otherwise thrive in the moist environment of the intestine. Note; Peyer's patches and tonsils ure considered subepithelial and non-encapsulated lymphoid tissues,ANATOMIC SCIENCES Bid In which of the following locations would one most likely find yellow bone marrow? + Head of long bones * Center of long bones *Ribs * Cranial bones + Vertebrae ° Conga © 20182010 Dena Decks ANATOMIC SCIENCE: Bid ‘Which leukocyte is the predominant cell type in pus, and is known as the hallmark of acute inflammation because of its fast immune response? * Basophil + Eosinophil + Monocyte + Lymphocyte ‘+ Neutrophil 10 Cony © 200.2010 Den Decks+#* Yellow bone marrow functions primarily as a site for fat storage and is found in the center of long bones, The bones are not solid structures. Cavities in the cranial bones, vertebrae, ribs, stemum, and the ends of long bones contain red bone marrow. This blood-forming tissue pro= duces erythrocytes, leukocytes, and thrombocytes within bones by a process called hemopoicsis. —— 1. Before birth, tne formed elements are also produced in a number of other ‘Notes! locations, including the liver, spleen, and lymph nodes. Ss 2. Erythropoiesis refers specifically to the production of erythrocytes. The red bone marrow contains precursor cells called hemocytoblasts (pluripotent stem cells) that give tise to all of the formed elements of the blood. The hemocytoblasts give rise to verious committed progenitor cells, which give rise to the different types of formed elements. For example, the erythrocytes develop from proerythroblasts: the platelets develop from large cells called megakaryocytes. When a child is 7 years of age, yellow marrow begins to appear in the distal bones of the limbs. This replacement of marrow gradually moves proximally, so that by the time the person becomes an adult, the red matrow is restricted to the bones of the skull, the vertebral column, the thorecic cage, the girdle bones, and the head of the humerus and femur Formed | Avg. No/mm? Element Description Funetion Eeaiwoares [5 millon [Biconcave, anvekaied sell [Transport oxygen Plates 130,000-400000 [Smal sellla fagments | Hemosasis [Leukeewies 10,000 IGranstorytes: Dire 5.400 |Lokednnctews, fine gratules | part of the mm sytem (phageeyosi) + Eosinopits 275 {Coed micous, red yellow | May phagocytze Ab-An aranntes complexes Besos 35 |Obseuremacteus, tient purple | Release histaine, rants Yepain. and serotonin JAaramatocytes: + Monosytes 340 | Kidney-shaped maces Phagocytosis + tymapioeres | 2.750 | Roundauceus,itleeyioplesm | Prosuce AB, destoy speciicargetcels,ANATOMIC SCIENCES Bid Under the microscope, erythrocytes (red blood cells) appear as: _) * Oval discs with multi-lobed nuclei * Circular discs with centrally located nuclei + Biconcave discs without nuclei * Circular dises with several nuclei " ‘Cop © 200.2010 Deal Desks ANATOMIC SCIENCES Bid Which leukocytes (white blood ceils) are the least abun ‘+ Neutrophils ‘+ Monocytes + Eosinophils * Basophils + Lymphocytes 2 Cong © 200.2010 Den DecksThe process of erythrocyte production is called erythropoiesis. The homone that stimulates erythropoiesis is called erythropoietin and is produced in the kidney. The average life span of a red blood cell is 120 Erythrocytes, or red blood cells, make up the largest population of blood cells, sumbering from 4.5 million to 6 million per cubic millimeter of blood, Their principal function is to transport oxygen and carbon dioxide. The hemoglobin molecules in erythrocytes combine with oxygen in the lungs to form exyhemoglebin. The oxygen is transported in this state to the tissucs of the body. In the tissues, the oxygen is released to diffuse into the interstitial fluid, Within the tissues, carbon dioxide is combined with the hemoglobin molecules to form earbaminohemoglobin, which is transported to the lungs. Note: About 70% of carbon dioxide, however, is transported by the blood plasma as bicarbonate ions (11C0;). Remember: (1) The proportion of erythrocytes in a sample of blood is called the hematocrit - usually around 46% for males and 40% for females, (2) The precursor cell found in the red bone marrow that gives rise to all of the formed elements of the blood is the hematocytoblast (‘hese are pluripotent siem cells), which gives rise to various committed progenitor cells, which then give rise to the different types of formed elements, Note: Granulocyte Colony-stimulating factor (G-CSF) is the hormone that stimulates precursor cells in the bone marrow to differentiate into white blood cells (leukocytes) BLOOD LEUKOCYTE FORMED woot MENTS ‘body YOLUME (number per cubic mn) ‘Neutrophils wap 070 Plasma Liniegte , [Le| tere arosties || "sve $.000 10000 sao, Momayies: Temp = Formed | ,| _riaciss 2% se Blements 250,800-400,000 Eosinophils ae Te witer73s sera sasopits To7.8 455.mlon ot Important: The mnemonic “Never Let Monkeys Kat Bananas” identifies the order of abundance of the leukocytes. http://dentalbooks drbassam.blogspot.comBid Guillain-Barre syndrome, myasthenia gravis, Wegener’s granulomatosis, and Goodpasture syndrome all have one treatment option in common. This involves taking whole blood and separating out the liquid portion and then returning this liquid portion back into blood circulation. The liquid portion of the blood is called: + Formed elements * Cerebrospinal fluid * Plasma sLymph a criti © 20910 Denl ess ANATOMIC SCIENCES Bid Platelets are best describe + Giant, multinucleated cells * Cytoplasmic fragments of cells + Immature leukocytes + Lymphoid cells 1“ Cepyrig © 200.2910 Den DeksPlasma is approximately 91% waters the other portion is made up of various materials (see chart below). The portion of the blood that is not plasma consists of formed clemeats, which includes erythrocytes (red blood cells), leukocytes (white blood cells), and cell fragments called platelets, Note: Serum = blood plasma without fibrinogen (after coagulation) BLOOD r ‘Albumins: 55% | oF Globotins body VOLUME 38% weight Z| rewire | L| —rubrtaogen Plasma ™% ™% 4to6titers |, | 55% Water “Ter Formed 91% Metabolic end products | a8" Fiements Food materials 4% Other Solutes Respiratory gases pH of 7235 1.0% Hormones, et T0745 ri Note: The ueaument described on the front of the card is called plasmapheresis. *#* Although platelets are ofien classified as blood cells, platelets are actually fragments of large bone marrow cells called megakaryocytes. Platelets are minute, irregularly shaped, disc-like cytoplasmic bodies found in blood plasma that promote blood clotting and have no definite nucleus, no DNA, and mo hemoglobin Normal blood contains 250,000 to 400,000 platelets per cubic mm. Their life span is 7-10 days they are removed in the spleen and the liver. Note: Thrombopoietin (a glycoprotein hormone) is synthesized and secreted by the liver. Thrombopoietin stimulates precursor cells in the bone marrow to ciffereatiste into megakaryocytes. Mezakaryocytes give rise to platelets. Remember: Platelets stop blood loss by forming a platelet plug. They contain many secretory vesicles (granules), which contain chemicals that promote clotting, When platelets adhere to collagen, they release ADP and other chemicals from their secretory vesicles. Many of these chemicals, including ADP, induce changes in the platelet surface that cause the surface to become “sticky.” As a result, additional platelets adhere to the original platelets and form a ‘plug.’ Important: Thromboxane Ay (TX), produced by activated platelets, has prothrom= botic properties, stimulating activation of new platelets as well as increasing platelet aggregation,\TOMIC SCIENCES Jnts {A 61-year-old male comes to the family physician complaining of sharp aches \) and a burning sensation in his hips and knees. The pain gradually gets worse throughout the day, and although the knees seem enlarged, there is minimal inflammation. The physician notes slight grating and crackling sounds (crepitus)| and diagnoses osteoarthritis. The cause of the signs and symptoms of osteoarthritis is the degradation of which of the following structures in load bearing joint * Synovial membrane + Bursa + Articular cartilage ; 15 ‘Con © 206.2010 Dent Decks ANATOMIC SCIENCES Jnts «Joint permitting slight mobility + Immovable joint + Freely movable joint 6 Cong © 200.2010 Dena DecksSynovial j freely movable (diarthrodial), with moverient limited only by joint surfaces, ligaments, muscles, or tendons. ‘They are characterized by four features 1 Articular cartilage ~ thin layer of hyaline ewtlage that covers the smooth anicular bone surfaces, This layer coniains no blood vessels or serves. Note: The temporomandibyar joint contains fibrocartlage, aot hyaline cartilage. 2. Joint cavity - small Muid-filled space separating the ends of adjoining bones 3. Articular (joint) eapsule - doubie-layered: outer layer of fibrous connective tissue that encloses the joint 4, Synovial membrane - produces synovial fluid. Found on both bursa and articular cartilage. Note: Mos joints of the body are synovial joints. They are classified functionally as diarthros- 5 (means freely movable), in addition to the features above, some synovial joints have articular dises (TM and sternoclavicular joit). These dises consist of fibrocartilage: They divide the cav- ity into two separate cavities. ‘Synovial fd isa clear, thick luid secreted by the synovial membrane, which fils the joint esp- sule and lubricates the articular cartilage al the ends ofthe articulating bones. ‘Supporting ligaments (capsular, extracapsular, and intracapsular ligaments) inainiain the nor- nal position ofthe bones, ‘Ten percent of synovial joints have a washer-like stucture heiween bore ends called the menis- ‘us. Its purpose isto absor® shock, to stabilize the joint, and to spread synovial fluid, The menis- ‘as is made out of fibrocartilage, but the meniscus also has no blood supply, no nerves, and no lymphatic chennels. Biologically, the meniscus can't heal itself The knee meniscus is the most famous and most injured meniscus inthe body ‘Note: A bursa is a Muid-soe tha is lined with synovial membrane, The function of bursa fst reduce friction, For example, a bursa may be located between a tendon and a bone to reduce the [ition of the tendon passing over the bone when the tendon’s muscle contracts, Inflammation of the lining of a bursa is referred to as bursitis. Articulations (joints) are the structures where bones connect. There are three main class- es of articulations based on the amount of motion thoy allow: 1. Synarthrosis ~ immovable joint (fibrous joint), Sutures found between the flat bones of the skull are of this type. ‘Note: Gomphosis isan example of a synarthross. It isthe joint that binds the teeth to the bony sockets (dental alveolt) in the mandible and maxilla. 2, Amphiarthrosis- slightly movable joint (cartilaginous joint). One example is the symphysis pubis, where the two 0s coxa bones join anteriorly. 3. Diarthrasis - freely movable joint (synovial joint), Joints can also be classified based on the type of associated connective tissue; + Fibrous (joined by fibrous connective tissue) - two types: sutures (of sul) and sym- desmoses (between radius and uina) + Cartilaginous (joined by flbrocartilage or hyaline cartilage) ~1wo types: synehon= droves, which ae joined by hyaline eartlage (epiphyseal plates within long bone), and symphyses, which are joined by a plate of fibrocantilage (pubic symphysis) ‘mmovial Goint capsule containing a synovial membrane that secretes synovial Pluid) ~ most joints, suchas the temporomanibular joints, are synovialANATOMIC SCIENCES Ints An 18-month-old boy diagnosed with Crouzon’s syndrome needs to have Surgery to treat the prematurely fused cranial bones. The joints in the flat ‘bones of the fused cranium are classified as which of the following? * Sutures * Symphyses * Synchondroses + Syndesmoses 9,10 Coy 200 Des ANATOMIC SCIENCES Jnts The paramedics arrive at the scene of a minor motor vehicle collision. One driver claims to have experienced whiplash and is having trouble shaking her | head in a“NO* motion. She is fine with nodding her head in a “YES” manner. ‘Which of the following joints allows maximum rotational movement of the head about its vertical axis (saying “NO")? + Intervertebral joint * Atlantoaxial joint + Atlanto-oceipital joint + Costovertebral joint 6 Copyright © 208-2010 Deal DecksSutur ‘ons are places of union between two or more bones, Joins are classified on the basis oftheir structural features into fibrous, cartilaginous, snd synovial types, Fibrous joints (synarthroses): are barely movable or non-movable and are found in these forms: + Sutures are connected by fibrous connective tissue and are found between the fat bones of the skull ‘+ Syndesmoses are connected by fibrous connective tissue and occur asthe inferior tibiofibu- lar and tympanosapedial syndesmoses Cartilaginous joints (amphiarihroses): + Synchondreses (primary caritaginous joins) are united by hyaline cartilage and permit no ‘ovement but growth in the lenglh of the bone. These include epiphyseal cartilage plates and the first rib and sternum + Symphyses (secondary cartilaginous joists) ate joined by a plate of fibrocartilage and are slightly mavable joints. These include the pubic symphysis and the intervertebral dises Synovial joints (diarthrodial joints) Pemit a great degree of free movernent. They arc charaetcrized by four features: joint (syn- ovia)) cavity, articular cartilage, synovial membrane, and articular eapsule, These joints ae classified according to axes of movernent int: + Gliding (plane): include those joints found in the carpal bones of the wrist and the tarsal bones of the ankle the elbow and knee joins are examples joint such as is found between atles (C1) and axis (C2) of the vertebral column + Ellipsoidal (condyloid): found between the distal suriaces of the forearm bones (radius cand ulna) and the adjacent campal bones + Saddle: found where the metscampal of the thumb meets the trapezium of the carpus (wri) Ball ‘socket: examples include the shoulder joint and the hip joint NIT in This joint is the synovial articulation between the inferior articulating facets of the atlas (first cervical vertebra) and the superior articulating facets of the axis (second cervical vertebra), +*% Remember the movements of the head as in saying “NO.” its rocking or nodding movements ofthe head Joint is the synovial articulation between the superior articulating facets of the atlas (first cervical vertebra) and the ozeipital condyles of the skull‘TOMIC SCIENCES ASl-year-old male telemarketer has had a history of nephrolithiasis (kidney stones). 4 calciam oxalate buildup in the renal papilla would directly block filtrate flow into the: + Major calyx + Renal columns + Minor calyx *Ureter + Renal pyramid ¥ 8 ‘Contig © 208-2910 Dena Decks ANATOMIC SCIENCES UmsS ‘Name the following structures of the nephron in the order they are encountered from blood to urine: * Distal convoluted tubule Bowman's capsule * Collecting duct *Glomerulus ‘+ Loop of Henle + Proximal convoluted tubule 20 Conrih © 20.2010 Dena DecksThe kidneys are located at the back of the abdomen, one on each side of the spine, at the level of the Jower rits. They are a pair of reddish, bean-shaped organs that are highly vascularized and perform two essential fctions of the urinary system: (1) forming urine and (2) maintaining homeostasis. The kidneys. are located on either side of the larmbar spine, They lie retroperitoneally (exiernal to the peritoneal lining of the abdominal cavity) in from of the muscles attached to the vertebral column. Internal features of kidney: * Cortex - outer ight brown layer (glomerutt and proximal and distal convatated tb ules are located here), Site of blood fltzation + Medulla ~ inner datk-brown layer, contains cone-like structures called renal pyra- ‘mids that are separated by renal columns + Renal columns ~ extensions of renal cortex: * Renal pelvis ~a hollow inner stnictre that joins with the ureters (the aches dhat con duct urine to the bladder), Receives urine through the calyces + Reaal papilla - apex of pyramids, here the eolleeting ducts pour into minor calyces + Renal calyx - extension of the renal pelvis. Minor ealyces unite to form major celyces, which urine is empiied into [-—~ |. The right kidney Hes slightly tower than the left kidney due to the large Notes) size of the right lobe of the liver. Sais! 2. Bach kidney is surrounded by 4 fibrous renal eapsule anc is supported by the adipose capsole. 5. Bach kidney hes an indentation, the hilum, on the medial border, through which the ureters, renal vessels, and nerves enter of leave, 4. Bach Kidaey receives tis blood supply from a renal artery, a branch of the abdominal aorta, ret oluied tubule > Calk ors fr ‘The subunit of w kidney that purifies blood and maintains a safe balanes of solutes ad water is the nephron; it isthe functional unitof dhe human excretory system. About one million nephrons are in the cortex of each kidney, and each one is a long tubule with a closed ene, called the Bowmtan’s capsule, ‘Components of the nepfron include: + Renal corpuscle: which consists of» glomerulus (rervork of poral capillaries) and a double-walled cup, te Bovman’s capsule which surrounds the glomerulus end collects fle tute The renal corpusce isthe ste of filtration; this nomlly produces proteia-free and cell five Citrate that passes into the proximal convoluted tubules. +The tubular portion: has four main regions Fillraie fom the Bownnan's capsule frst pass- sito the proximal convoluted tubule i the cortex, Here, zlucose, amino acids, metabo- Jes, ani eleowoytes are reabsorbed from slate anc retured to circulation, Nex, the filtrate cater the loop of Henle, frst throug its descending Limb and then through its ascending Fimb, Hore, to filtrate is concentrated drcugh elecilyte exchange and reabsorption t0 pid duce skyperoemolar fli. This loop extends deep into the medulla From there, fluid enters the distal convoluted tubule also inthe cortex. Here, som i eebsorbed under he inf ‘ence of aldosterone. From the distal convohted tubule, filtrate eners the collecting duct, Which i the distal end ofthe nephron. This isthe site of Final conceatretion of ilrater Whish then emties into papillary duets deep within the medulla After filtraion, uid in the tnbules of the nephrons endergoes two mare processes, botk itwoly= {ng the peritubular capillaries: tubular reabsorption and tubular secretion. Same blood is not filtered and passes ita the efferent vesicle and periubular capillaries, Many substonces that ere filtered ae returned to the peritubular capillaries from the tubules by reabsorption, often at high ites (ex, woter ghicese,sodiun), Waste products are retained and emptied ito » collecting tubule, which is discharged tothe uretersANATOMIC SCIENCE! UmS ‘Name the following structures of the urinary system in the order they are ‘encountered from systemic circulation to excretion from the body: ++ Urinary blodder + Ureter + Urethra + Kidney a g Cops © 206-2010 Dena Decks ANATOMIC SCIENCES Um S Which statement concerning urine is false * Adults pass about a quart anda half of urine each dey, depending on the fluids and foods consumed * The volume of urine formed at night is about half that formed in the daytime + Normal urine is sterile, It contains fluids, salts, and waste products, but is free of bacteria, viruses, and fungi + The tissues of the bladder are isolated from urine and toxic substances by a coating ‘that discourages bacteria from altaching and growing on the bladder wall * Urine formation is the result of three processes: glomerular filtration, tubular reabsorption, and tubular secretion * The ureters regulate reabsorption and secretion, thus determining the composition of excreted urine 2 ‘Cosrigh © 208-2010 Dena Decksie Ene The urinary system consists of the kidneys, the ureters, the urinary bladder, and the lwrethrs, This system filters the blood and maintains the volume and chemical composition of the blood The kidneys are paired organs, which contain extensive vascularity and millions of neplions within the renal cortex and renal medulla. The kidneys filter blood and regulate the volume and composition of body fluids during the formation of urine. ‘The ureters ae long, slendet, fibromusculartubes that transport urine from the pelvis of the kidney to the base of the urinary bladder. Because the left kidney is higher than the right, the left ureter is usually slightly longer than the right, The ureters are narrowest where they originate, at the renal pelvis (ureteropelvic junction), Note: Filling of the bladder constrict the ureters ut the ureteroyesical junction, where they eter the blade. Peristaltic waves, occurring abou one to five times each minute, move urine through the ureters ‘The urethra is a fibromuscular tube that carries urine from the urinary bladder to the outside of the body. In males, the urethra carries semen as well us urine Note: The portion of the male urethra that passes through the urogenital diaphragm is called the membranous urethra, ‘The urinary bladder is a distensible sac that is situated in the pelvic eavity posterior to the symphysis pubis, The urinary bladder is slightly lower in the female than in the male. 1 concentrates and serves as 4 reservoir for urine, which the bladder receives from the kidneys through the ureters and discharges through the urethra Corry: ‘#** This is false; the kidneys regulate reabsorption and seeretion, this determining the ‘composition of exereted urine. Urine is continually produced by the kidneys and stored in the bladder. When full, he blad- der sends & message fo the reflex center inthe saeral par ofthe spinal cord, where it riggers Areflex contraction of the rmiscle of the bladder and causes the neek ofthe bladder to relax ‘This reflex is suppressed until there is an opportunity to relieve the bladder The urinary system excretes the waste products of metabolism and maintains the balance of water and electrolytes inthe blood. The system removes nicrogenous waste as urea from the blood. Urea is produced when foods containing protein, such as meat, are broken down in the body. ‘The kidneys remove urea trom the blood through tiny filtering units called nephrons. Utes, together with water and other waste substances, forms the urine as it passes through the ‘nephrons and dov the renal tubules of the kidney. Remember: Pressure from the blood in the glomerulus causes fluid to filter into the Bowman’s capsule, From there, fluid flows tothe proximal convoluted tubule, the loop of | Henle, and then to the distal convoluted tubule. Within this system, water, glucose, and sodium are reabsorbed into the blood. Waste products are retained and emptied into collecting tubule, which is discharged tothe ureters. ~, |. The urinary system is lined with transitional epithelium, ‘Note! 2.The genital and urinary systemis are supplied with parasympathetic fibers from “ss the pelvic splanchaie nerves, 3. The kicneys, ureters, and urinary bladder are all located retroperitoneslly. This, means they are located behind the peritoneum, which isthe serous membrane lining the walls ofthe abdominal und pelvie cavities and enclosing the viscera.ANATOMIC SCIENCES For A.26-year-old female has been previously diagnosed with McCune-Albright syndrome, There is bony fibrous dysplasia of the anterior cranial base leading to the encasement and narrowing of the optic canal, Although her vision is normal, there is concern that there will be compression of the optic nerve and which of the following other structure(s)? + Ophthalmic nerve (CN V-1) + Cranial nerves IIL, IV, and VI + Ophthalmic artery + Ophthalmic veins a ‘Copy © 200-2010 Den Desks ANATOMIC SCIENCES For {A 62-year-old female visits the family physician with complaints of right-sided \) || hearing loss, ringing in the right ear (tinnitus), numbness over the right half of hher face, and dizziness. The physician diagnoses her with an acoustic schwanno- ma that is occluding her right internal acoustic meatus. The internal acoustic ‘meatus pierces the posterior surface of the petrons part of the temporal bone. ‘The internal acoustic meatus transmits which two structures? + Trigeminal nerve (CN V) + Facial nerve (CN Vi) + Vestibulocochlear nerve (CN VII) ** Vagus nerve (CN X) 2 Copyrih ©2009-2010 Dena Des‘The optic eanalis located posteriorly inthe lesser wing of the sphenoid. It communicates with the middle cranial fossa, It transmits the optic nerve and the ophthalmic artery ‘Bony Opening Location (Bone) Contents Crbrifommplae vith foramina [Ethmoid othctory nerves Hypogiosal canal occipital ypogosal vane Carotid cana FFemport ternal eat artery arial anal Masitiaand lacrimal | Naslasinal oy) duck eros orbital Gssure Sphenoid and maxilla |infaoiilal ard aypomatc nerves rom V2, infaorital artery, ard ophitainc vein Superior ombibl fssire Sphenod [Ocatomotor voctesr. and sbicent perves; lacrimal, ronal and nasoctary branches of ophitalnsic nerve (V1) lophamic vein; synpatiete fibers fom Jemermucplesve Optic canal and ramen Sphencid bone [optic nerve and uphinaimicurery Stvlomstoid foramen Temporal Facial nerve ‘The vestibulocochlear nerve eaters the internal acoustie meatus and remains within the temporal bone, to the cochlear duct (hearing), semicircular ducts, and maculae (balance) ‘The facial nerve enters the internal acoustic meatus, the facial canal in the temporal bone, and emerges from the stylomastold foramen, The stylomastoid foramen lies between the styloid and mastoid processes of the temporal bone, After the main trunk of the facial nerve exits from the stylomastoid foramen, it ‘enters into the substance of the parotid gland. It is here that it gives off five main branches that will supply motor innervation to the muscles of facial expression, 1. If you inadvertently deposit anesthetic solution in the parotid gland Noted’ when giving @ mandibuler block, the patient will develop paralysis of the SSE muscles of facial expression. 2. An acoustic neuroma is a tumor involving the vestibulocochlear nerve as it exits the cranial cavity, Because this tumor compresses surrounding structures or invades nearby tissues, in addition to hearing loss and equilibrium problems, @ patient would most likely also demonstrate ipsilateral (same-sided) facial paralysis,(ATOMIC SCIENCE: For A fourth-year dental student is getting to perform operative work on a ‘mandibular molar. He is ready to provide an inferior alveolar nerve block. ‘Thinking of his old anatomy exams, he reminds himself that this nerve enters the mandibular foramen. In relationship to the occlusal plane of the mandibular molars, the mandibular foramen is locatet ‘+ At or slightly above the occlusal plane and anterior to the molars ‘+ Ator slightly below the occlusal plane and anterior to the molars * At or slightly below the occlusal plane and posterior to the molars ‘+ Ator slightly above the occlusal plane and posterior to the molars © 2s opyrh © 209.2910 Den Decks ANATOMIC SCIENCES For Which of the following allows for the exit of the spinal accessory nerve from the eranial cavity? + Foramen magnum + Jugular foramen + Foramen rotundum + Foramen ovale 16,17. 26 Copii © 29.210 Det Des‘The mandibular foramen is located on the medial surface of the ramus of the mandible just below the linguls, midway between the anterior and posterior borders of the ramus. The foramen leads into the mandibular canal, which opens on the lateral surface of the body of the mandible at the mental foramen. Note: The lingula isa tongue-shaped projection of bone that serves as the attachment for the sphenomandibular ligament. Immediately behind the incisor teeth is the ineisive foramen. In this foramen are two lateral apertures, the openings of the incisive canals (forwmina of Stenson), which transmit branches of the sphenopalatine artery, and the nasopalatine nerves, Occasionally, two additional canals are present in the incisive foramen; they are termed the foramina of Scarpa and are situated in the middle line; when present, they transmit the nasopalatine nerves. Remember: The inferior alveolar nerve (branch of V-3), artery, and vein travel through the mandibular foramen. At the mental foramen, the inferior alveolar nerve ends by dividing into (1) the mental nerve, which supplies the skin of the mental region and mucous membrane and (2) the incisive branch thai supplies the pulp chambers of the anterior teeth and adjacent mucous membrane, ‘The jugular foramen lies between the lower border of the petrous part of the temporal bone and the condylar part of the occipital bone, The jugualr foramen transmits the following structures: the internal jugular vein, and the glossopharyngeal, vagus and spiral accessory nerves. Bony Opening | Location Contents Gone) Foramer retundum |Sphenoid | Maxillary nerve (V-2) FForames ovate |Sphenoid | Mandibular nerve (V-3) Foramen magnum [Occipital | Spinal pond, vertebral artevies, and al aeeessory nerve Foraien spinesumi |Sphenoid | Middle meningeal artery Mental foramen |Mandibie | Mental nerve, artery, and vein [Gresierpalatine Palatine [Greater palatinenecve, anery, and vein foramen, [Lesser palaime [Palatine [Lesser palatine nerve, artery, and vein foramen treisiveforamen |Maxilla Nasopalatine nerve and branches of the sphenopalatine artery ugular [Occipital and | tiemal jugular vein and glossopharyngeal, temporal __} vagus, and spinal accessory nervesANATOMIC SCIENCES For ‘The cranial nerves that supply motor innervation to the muscles that ‘move the eyeball all enter the orbit through the: * Supraorbital foramen + Superior orbital fissure + Infraorbital foramen + Petrotympanie fissure 2 ‘Copy © 2098-2910 Dena Decks ANATOMIC SCIENCES Rsp S During a baseball game, a collision between the catcher and the runner into home plate resulted in fractures of the catcher’s ribs, leading to a pneumothoras| Of the left Iung. A pneumothorax is the presence of air into which space? *Cardiae notch *Hilum, + Pleural cavity + Lingula * Mediastinum, 2 Coys © 203.2010 Den DecksSe The superior orbital fissure is located posteriorly between the wreater and lesser wings of the sphe- noid bone, The superior orbital fissure communicates with the middle cranial fossa. At transmits the: « superior and inferior divisions of the oculomotor nerve (CN III) + trochlear nerve (CNIV) ‘lacrimal, frontal, and nasoziiary brenches of the ophthalmic nerve (CN V1) + abducent nerve (CN VI) + superior and inferior divisions ofthe ophtkalmie vein + sympathetic fibers fiom the eaverions plexus Bony Opening | Location (Bone) Contents Mandibular foramen | Vandiie Tnferioralveolar nerve, arteryand Vein Petcoyrmpanic [Temporal /Chorda tyrapeni nerve fissure Formentacerim —|Sphenoid, occipital, | Nerve of perygord canal (greaser and deep and temporal netrosal nerves). and arery of pterygoid eznal Superbad foramen |Prowal | Suproovbial eve, arery, and vein and canal fitisorbital foramen | Sphenoid and maxilla | Intsorbital nerve arery, and vein and canal Prerygoideanal | Sphenoid ‘Area nerves and vestels internal acoustic [Temporal Facial and yestibulozochlear nerves meatus Temporal (Opening to tympanic caviny A penetration wound of the chest wall can lead to 2 pneamothorax (air in the pleural cavity) or a hhemothorax (blood inthe pleural cavity. In both of these sinuzions, the surface tension that hinds the hngs tothe chest wall i eliminated, andthe lung will instantly shrink wo the size of. tennis ball The lungs fill the pleural divisions of the thorscic cavity: they extend from the root of the neck to the diaphragm. The lungs are the main component of the respiratory system: they distibete air end exchange gases. The right and left langs are separated by the mediastinum, which contains the hear, blood vessels, and other midline structures; fissures divide each lung into lobes. Each primey bronchus enters its respective lung atthe his, an incentation on the mediastinal suriace, The bronchi and pulmonary blood vessels wre bound together by connective issue to tort the root of ‘the lung. The base, the inferior surface of the lang, rests on the diaphragm. The apen, the most superior portion of the lang, projects above the clavicle, Right lang: + Has three lobes (superior mide, and inferior) and three secondary (lobar) bronchi + Contains ten bronchial segments (corresponding to the tertiary brane) + Usually receives one bronchial ariery + Has a slightly larger capacity thar the let lang Left lun ‘+ Has two labes (superior and inferior) and two secondary (Iebar) bronchi * Contins eight bronchial segments (ccrresponding io the tertiary bronchi) Contains @ cardiae notch (on is superior lobe), which is an indentation providing rocen for the heart Usually receives two bronchial arteries Contains a lingula, wisich is vongue-shaped portion of iis superior lobe that corresponds to the middle lobe ofthe right lung Exch lung is enclosed in a double-layered pleural sac. One layer is called the vseeral pleura; the ther is called the parietal pleura. Between the two layers isthe pleural eavity, which is fled With serous NuitANATOMIC SCIENCES RspS ‘The trachea bifurcates into right and left primary bronchi at the level of the: ) + Firstsib + Seventh cervical vertebra + Xiphoid process + Plane of the sternal angle + Suprasternal (or jugular) noich 2 ‘coy © 20092010 Dena Deks ANATOMIC SCIENCES Rsp S ‘Emphysema is 2 pulmonary disease ofthe lung characterized by destruction of the supporting structures ofthe alveoli. This leads to increased elasticity of lung|| tissue and a pathologic increase in the sizeof the air spaces. What final division | ‘of the bronchioles within the respiratory tree contains alveoli and fist permits ‘gaseous exchange with the blood? ‘+ Tertiary bronchioles + Primary bronchioles + Respiratory bronchioles + Terminal bronchioles 8 0 ‘Cong © 206-2010 Dental DecksRare ‘The trachea is u membranous tube that begins beloW the cricoid cartilage (at the level of the 6th cervical vertebra) of the larynx and ends at the level of the sternal angle (she Sth thoracic vertebra). A series of C-shaped rings of hyaline cartilage strengthen the trachea and preveat it from collapsing during inspiration. The trachea is lined with eil- ated pseudestratified columnar epithelium aad mucous-seereting goblet cells, which teap inhaled debris, Citiary action moves debris toward the pharynx far removal by coughing, The exchange of oxygen and carbon dioxide between the air and the blood occurs in the Jungs, Air enters the moutb or nose and passes into the pharynx and the larynx, and ther into the trachea. As the trachea passes behind the arch of the sort, the trachea bifureates of divides into right and left primary or main bronchus, which leads tothe lungs. After entering each lung, the traches bifurcates into right and left primary bronchi atthe level of the two main bronchi, which branch into the five lobar bronchi (secondary bronchi), Note: The right main bronchus divides into three lobar browehi, and the loft main bronchus divides into two lobar bronchi. Exch secondary ot lobar bronchus serves one of the five lobes of the tivo lungs. Each lobar bronchus enters a lobe in each lung (hv lobes on the lef, three lobes on the right). Within its lobe, each of the secondary bronehi (lobar bronchi) beach into tertiary bronchi (segmiental bronchi), These tertiary bronchi continue to divide deeper in the lungs into tiny bronchioles, Which subdivide aay times, forming terminal bronchioles, Each of these terminal bronehioles gives rise 10 several respirator bronchioles. Each respiratory bronchiole subdivides into several alveolar ducts, which ead in clusters of small, thin-walled air spaces called alveoli. These clusters of alveoli are called alveolar snes and form the functional unit of the lung, Condueting bronchioles are smaller extensions of bronchi (litle bronchi), Those devoid of alveoli in their walls are nearer the hilum of the lung, These conducting passageways deliver air to passagsways that have alveoli. The last generations of conducting bronchioles are called terminal bronchioles, Respiratory bronchioles, continuing from terminal bronchioles, branch nearer t0 the alveolar ducis and sacs and have occasional alveoli in their walls. These bronchioles capable of respiring are the frst generation of passageways of the respiratory portion of the bronchial tree, Bronchloles are characterized by: +A diameter of one millimeter ot less “An epithelium that progresses from ciliated pseudostratified columnar to simple cuboidal (respiratory bronchiales) * Small bronchioles haye non-cilisted bronchiolar epithelial cells (Clara cells) that secrete a surface-active lipoprotein * Walls devoid of glands in the underlying connective tissue + Woven bundles of smooth muscle to regulate the bronchiolar diameter * Walls devoid of cartilage (small diameter prevents them from collapsing at end of expiration) Note: Type TI pneumocytes ate specialized cells within the alveoli of the lungs that are adapted to produce surfactant. Type I pneumocytes are extremely thin epithelial cells lining the alveoli of the respiratcry tree and permit gaseous diffusion with theANATOMIC SCIENCES Rsp S A clumsy dentist, while placing a crown, accidentally drops it into the patient’s mouth. The patient aspirates the crown. A chest x-ray will most likely reveal the crown lodged in the: + Trachea + Right primary bronchus + Left primary bronchus * Pulmonary arery + Pulmonary vein 19,20 1 Copyriht © 2000-2010 Dens Decks ANATOMIC SCIENCES RspS + The lungs lie in the mediastinum + Cantilaginous rings are found in the main bronchi + The left lung has a smaller capacity than the right lung * Clusters of alveoli called alveolar sacs form the functional unit of the lung * Ithas two major parts ~ the conducting part (a branching, tree-like set of hollow tubes) and a respiratory part (smallest tubes and thin-walled pouches in which gas exchange takes place) 3 Cepyih © 209-2010 Deal DecksImportant: When foreign objects are aspirated into the trachea, they usvally pass ino the right primaty bronchus because it is larger, straighter, and shorter than the left. It is also in a more direct line with the trachea (important in a dental chair because ff a Patient swallows an object it tends ta lodge in the right bronchus) Each Jung is shaped like a cone. It has a blunt apex, a coneave base (that sits on the diaphragm), convex costal surface, and.a concave mediastinal surface. Atthe middle of the mediastinal surface, the hilum is located, which is a depression in which the bronchi, vessels, and nerves that form the root enter and leave the lung. ‘The root of the lung contains the following structures: + Primary bronchus: the right ard left bronchi arise from the trachea and carry airto the hilum of the lung during inspiration and carry air from the lung during expiration ‘+A pulmonary artery: enters the hilum of each lung carrying oxygen-poor blood + Pulmonary vein(s): a superior and inferior pair for each ung leave the hilum car- rying oxygen-rich blood — 1. The small bronchial arteries (which are branches of the descending aorta) “Notes! also erter the hilum of each lung and deliver oxygen-rich blood to the tissues. ‘See The bronchial arteries tend to follow the broachial tree to the respiratory bron- chioles where the bronchial arteries anastomose with the pulmonary vessels. 2. Branches of the Vagus nerve also pass the hilum of each lung. + This is false; the thoracic cavity is surrounded by the ribs and chest muscles, I's subdivided into the pleural eavities, each of which coniain a tung, and the medi- astinum, The mediastinum is further divided into four areas. ‘The middle mediastinum contains the heart and pericardial sac; the anierior. posterior, and superior areas sre named according to their postions reative to the middle mediastinum, The respiratory system consists ofthe upper and lower respiratory tacts, the lungs, and the thoracic eaze, The respiratory system is designed to exchange he carbon dioxide accurnulat- ‘ein the blood for oxygen inthe airways, which enters the lungs as air froma the surtounding aumosphere Blood iravels continuously through two different circulations: the pulmonary and the sys- temic circulations, The heart pumps deoxyyensted blood from the veins of the systemic cir- ‘ulation into the arteries of the pulmonary cisculation, This blood is oxygensted by the lungs, and then flows back to the heat! to be pumped into the arteries ofthe systemic circulation. The structures of the upper respiratory tract include the nose, movth, nesopharyms, oropharynx, laryagopharyn, and larynx, Besides warming and humiifying inhaled air, these structures provide for iste, smell, and the chewing and swallowing of food. The lower respiratory tract structures are the trachea, bronchi, and lungs, Broaehi branch into bronchioles. which in tum branch into lobules. The lobule includes the terminal brexchi- oles and alveoli, A mucous membrane containing hair-like cilia Fines the lower tract Funetionally, the lower tract is subdivided into eonducting airways (the trachea and the primary, lobar, and segmental bronchi) end alveoli, the sites of yas exchangeANATOMIC SCIENCES RspS Which type of epithelium provides sensory innervation that travels on nerve bundles through the eribriform plate? * Olfactory epithelium + Squamous ciliated epithelium without goblet cells, + Transitional epithelium with goblet cells 3 opyrht © 200.2910 Dena Decks While ascending to 30,000 feet, the passengers on a commercial flight experience the sensation of their ears “popping.” The swallowing or yawning that triggers this equalizes the pressure of the middle ‘ear with the surrounding atmosphere via the eustachian (auditory) tube. The pharyngeal opening for this tube, along with the salpingopharyngeal fold, pharyngeal recess, and pharyngeal tonsils (adenoids) are all located in the: + Laryngopharyax + Oropharynx + Nasopharynx + None of the above o ‘Coprig © 206-2010 Denial DecksAir enters through the nostrils (exiernal nares) that lead to the vestibules of the nose, The bony roof of the nasal cavity is Formed by the ceibriform plate of the ethmoid bone. ‘The lateral walls have bony projections called eonchae (superion middle, and Inferior), Which are also referred 10 2s the nasal tarbinates. These conchae form shelves that have spaces (or grooves) beneath them called meatuses (superior, middle, and inferior). The paired paranasal sinuses (maxillary, frontal, ethmoidal, and sphenoidel) drain into the nasal cavity by way of these mestuses. The nasolacrimal duct, which drains tears froin the surface of the eyes, also empties into the nasal cavity by way ofthe inferior meatus. The floor is formed by the hard palate, The nasal cavity opens posteriorly into the rasopharysx via funnel-like openings called the choanae (aosterior nares) Jo |. The vestibules ate lined with nonkeratinized stratified squamous epitheli- Notes) um. Stel 2, The conchwe of the nasal fossa: are lined with pseudostratified ciliated colummar epitielium, 3. The olfactory epithelium is very prominemt in the upper medial portion of the nasal cavity. 4. The nasal cavity receives sensory innervation from the olfactory nerve for smell and from the trigeminal nerve for other sensations. The nasal cavity's blood supply is from branches of the ophthalmic and maxillary arteries, 5, The tickling sensation felt in the nasal cavity just prior to-a sneeze is carried in the maxillary division of the trigeminal nerve, 6. During a sinus attack, painful sensation from th the nasocitiary nerve, 7, Allof the paranasal sinuses drain into the middle meatus, except the sphe- ‘noid sinus, which drains aimost dirsetly down the throat, thinoid cells is carried in The pharynx (the throat) is tube thet serves as x passageway for the respiratory and digestive tracts. It extends from the mouth and nasal cavities to the larynx and esophi- 10s. The pharyax is divided into three regions: 1, Nasopharynx - is the most superior division of the pharyax. It is inferior to the sphenoid bone and lies at the level of the soft palate. The pharynx is lined with cilint- ed pseudostratitied epithelium (respiratory epithelium) The nasophiaryns: has four ‘openings: * two auditory (eustachian) tubes: each opening out of a Lateral wall and connecting with the middle ear (iympanie exvity) ‘two opeainys of the posterior nares (ehoanae) The soft palate and uvula form the anterior wall of the nasopharyny, Nate: The tensor Veli pilatini and the levator veli palatind muscles prevent food fhom entering. the agopharynx. 2. Oropharynx- the middle division of the pharynx: is continuous With the posterior oral cavity and is Tined with stratified squamous epitheliam. The uroplnuryns extends inferiorly from the soft palate 10 the hyoid bone. The opening into the oropharynx from the mouth is called the fauces. The lingual tonsils protrde into the oropharyax from the oral cavity at the base of the tongue, The anterolateral walls of the arophar- yas support the palatine tonsils, Its a food and air passageway, 3. Laryngopharynx - is the most inferior division of the pharynx; the laryngophar yax extends From the hyoid bone to the opening of the esophagus, The laryngophar- ‘ynxcis lined with stratified squarrous epithelium. extends trotn the oropharynx cbove to the larynx and esophagus, The laryngopharynx also serves asa passageway for food and air, Air entering the laryngopharynx goes fo the lacymx while food goes ta the esophanus. Note: Food entering the larynx would be expelled by violent coughing.ANATOMIC SCIENCES starts to grow warts on her larynx and respiratory tract. A tracheotomy is performed in order to allow her to breathe. Which of the following structures is not at risk during the procedure? + Recurrent laryngeal branch of the vagus nerve + Carotid artery + Interal jugular vein + Vocal cords + Thyroid gland 38 Cop © 2062010 Dens Disks ANATOMIC SCIENCES The external carotid artery terminates within the parotid gland, just behind the neck of the mandible, where the external carotid artery gives off two final branches, the and the + Superficial temporal artery + Superior thyroid artery + Posterior auricular artery + Occipital actery * Maxillary artery + Facial artery ©, 3 Copy © 20002010 Dena Decks«The vocal cords are above the incision area for tracheotomies and cricothyrotomies. Important: A cricothyrotomy is preferable to tracheostomy for non-surgeons in emergency respiratory obstructions. In this procedure, an incision is made through the skin and cricothyroid membrane for the relief of acute respiratory obstruction. ‘An emergency tracheotomy (¢rachcostomy) is most casily made by an incision through the median ericothyroid ligament, This ligament runs from the cricoid cartilage to the thytoid cartilage und is inferior to the space between the vocal cords (rim sloticlis) where aspirated objects usually get lodged. The tracheotomy allows for ait to pass between the lungs and the outside air, Importan he space entered is called the erieothyrold space, Note: A tracheotomy (tracheas‘omy) is rarely performed and is limited to patients with extensive laryngeal damage and infants with severe airway obstruction, Because of the presence of major vascular structures (carotid arteries and incernal jugular vein), the thyroid gland, nerves (recurrent laryngeal branch of the vagus nerve), the pleural cavi- ties, and the esophagus, meticulous attention to anatomical detail has to be observed. ‘The external carotid artery supplies sirucures with the neck, face, and sealp, and also supplies the maxilla and tongue. As with the internal earotid artery, the extemal caraiid artery begins at the upper border of the thyroid cartilage (.c, at the termination of the common carotid artery and the carotid sheath). ‘The extemal carotid artery terminates within the parotid gland, just behind the neck of the mandible, where the artery gives off ‘wo final branches, the superficial temporal and the maxillary arteries. Note: At its ‘origin, where pulsations can be felt, the external cavotid artery lies within the carotid triangle Branches of the external carotid: + Superior thyraid artery -suppties thyreidpland, gives off a branch tothe sternoclei- domastoid masele and superior laryngeal artery + Lingual artery -supplies the tongue + Facial artery - supplies the face, including lips and the submancibular gland + Ascending pharyngeal artery - supplies the pharyngeal wall *+ Occipital artery supolis the pharynx and suboccipital tiangle + Posterior auricular artery - supplies back of the sealp + Maxillary artery - terminal branch of extemal carotid, it gives off branches to the ‘mandible, and the middle meningeal artery before passing through the pterygomanillery fissure to enter the pterygopalatine fossa to supply the maxilla + Superficial temporal artery - terminal branch of external carotid, supplies skin over frontal and temporal regions of scalp Important: The extemal carotid artery and its branches supply the muscles of the neck and face, thyroid gland, salivary glands, scalp, tongue, jaws, and teeth.half her body--and slurred speech. At the hospital, it was discovered that therapy caused an embolus to develop into a stroke. The clot arose from an atherosclerotic plaque located at the bifurcation of the common carotid artery. At what level does the common carotid artery bifurcate? * Cricoid cartilage «Angle of the mandible ‘Jugular notch + Superior border of the thyroid cartilage a Copyright ©2009-2010 Deal Decks In carotid sinus syncope, the eardiac sinus is overly sensitive to manual stimulation and can lead to loss of consciousness. Given this, ‘which of the following statements is true? sItis ulated by changes in blood pressure + It functions as a chemoreceptor + Its innervated by the facial nerve + Itis located at the terminal end of the extemal carotid artery *Ttcommunicates freely with the cavernous sinus 8 Ey Copyright© 2082010 Deal Deeksis supplied tothe brain, face, and scalp via two major sets of vessels the right and left common earotid arteries and the right and left vertebral arteries. The right common carotid arises from the brachiocephalic trunk, while the left common carolid rises from the sortic arch directly. The common carotid lies within the carotid sheath and runs upwards in the neck tothe superior border of the thyroid cartilage. Here it divides into wo puirs ofblood vessels, the external and internal earotid arteries. The external carotid arteries supply the face and scalp with blood. The internal carotid arteries divide further in the middle cranial {ossu into the anterior and middle cerebral arteries, which supply blood to the anterior three-fifths of cerebrum, except for parts of the temporal and occipital lobes. The Vertebrobasilar arteries supply the posterior two-fifths of the cerebrum, part of the cerebellum, and the brain stem, Remember: * Four major artenes, the two vertebral and the two carotid, supply the brain with ‘oxygenated blood. The tivo Vertebral areries (which are branches af the subclavians) converge to become the basilar artery, which supplies the posterior brain, +The circle of Wills (also called the cerebral arterial circle) is formed by the posterior cerebral (branch of hasllar artery), posterior communicating (branch of internal cayctid), internal carotid, anterior cerebral, and anterior communicating (2ranch of interna! carorid) aneries. *+** This circle of Wilis forms an important means of collateral clreulation in the event of obstuction, = The intemal carotid urcery has no branches outside the skull and enters the skull through the carotid canal, Inside the skull, the internal carotid artery gives off the ophthalmic artery, which supplies the optic nerve, eye, orbit, and scalp. The artery terminates by passing through the cavemous sinus to join the eirele of Wills and supply the brain, nn “The carotid sinus is dilated portion of tae proximal part of the internal carotid ertery near the bifurcation of the common carotid artery. This is usually at the level of the ‘superior border of the thyroid cartilage. Changes in blood pressure stimulate vagal nerve endings in the wall of the carotid simu to send signals along the vagus nerve to slow the heart rate; this response is referred jo as the carotid sinus reflex. Important: The carotid sinus is innervated by the carotid sinus branch of the glossopharyngeal nerve and by a branch of the vagus nerve. Remember: The earotid body lies pesterior to the point of bifurcation of the coramon ‘carotid artery. The carotid body is innervated by the glossopharyngeal and vagus nerves and is 2 chemoreceptor, being sensitive to excess carbon dioxide and reduced ‘oxygen tersion in the blood (this Weuuld produce a rise in blood pressure and heart rate) Carotid sinus syndrome is & temporary loss of consciousness that sometimes accompanies convulsive seizures because of the intensity of the carotid sinus reflex ‘hen pressure builds in one or both carotid sinuses.ANATOMIC SCIENCES Art + Ophuhalmic artery + Anterior choroidal + Middle cerebral * Anterior choroidal e 30 Cope © 206-2010 Dena Decks ANATOMIC SCIENCES Art Alll of the following statements are true regarding hepatic sinusoids in ‘comparison to capillaries EXCEPT one. Which one is the EXCEPTION? + Sinusoids are smaller than capillaries + Simusoids have walls that consist mainly of phagocytic cells + Sinusoids are a part of the reticulozndothelial system ‘+ Both sinusoids and capillaries are composed of endothelium 40 CConyrig © 206.2010 Dena DecksIIT The middle cerebral artery is the largest branch of the internal carotid. The artery supplies « portion ofthe frontal lob: and the lateral surface of the temporal and parietal lobes, including the primary motor and sensory areas of the face, throat, hand, and acm ‘and inthe dominant hemisphere, the areas for spesch. The middle cerebral artery is the artery most often occluded in stroke Small, deep penetrating arteries known as the lenticulostriate arteries branch from the riddle cerebral artery. These arteries are often called the “arteries of stroke” because they are often involved in a stroke (also called a cerebrovascular accident) Stroke warning signs: * Sudden weakness, paralysis, or numbness of the face, arm, and leg on one or both, sides of the body + Loss of speech or difficulty speaking or understanding speech * Dimness or loss of vision, particularly in only one eye * Unexplained dizziness (especially when associated with other neurologic s ‘ams), unsteadiness, and sudden falls + Sudden severe headache and loss of consciousness A sinusoid is a small blood vessel similar to a capillary but with a discontinuous ‘endothelium. Sinasoids are found in the liver, lymphoid tissue, endocrine organs, and hematopoietic organs such as the bone marrow and the spleen. Simasoids are highly permeable, having lerger intercellular clefts fewer tight junctions, ‘and discontinuous endothelial cells (meaning that the individual endothelial cells do not overlap as in capillaries and are spread out). The level of permeability is such as to allow small- and medium-sized proteins such as albumin to enter and leave the blood- stream. Some spaces are large enovgh for blood cells to pass. Oxygen, carbon dioxide, nutrients, proteins, and wastes are exchanged through the thin walls ofthe sinusoids. Sinusoids: * Are 30 to 40 microns in diameter + Are wider and more irregular than capillaries + Have walls that consist largely of phagocytic cells * Form a part of the reticuloendothelial system, which is concemed chiefly with phagocytosis and antibody formationANATOMIC SCIENCES Art the tunica media of large arteries is the: * Skeletal muscle cells + Elastic fibers * Smooth muscle cells * Collagen fibers ze B “ ero 200Deal ets ANATOMIC SCIENCES Art nr seis oratveitta a present in which type of blood vessel that exchanges substances via diffusion? + Anteries + Anterioles + Capillaries * Venues Veins 2 \Conyigt © 206.2910 Dena Dicks+** Key: Ifthe question referred to small arteries, the answer would have been smooth muscle cells. ‘The walls of blood vessels are composed of the following tunies (layers): 1. Tunica intima - innermost layer, consists of a layer of simple squamous epitheli- tum (called endothelium) and a thin conneetive-tissue basement membrane. The ‘endothelium of this layer is the only layer present in vessels of all sizes. Note: Atherosclerosis is the emergence of plague between the basement membrane and the endothelial eells of the tunica intima, 2, Tunica media - middle layer, is usually very thick in arteries, and consists of smooth muscle fibers mixed with elastic fibers, Increases or decreases lumen diame- ter; affects blood pressure. 3. Tunica adventitia - an outer leyer of connective tissue, containing elastic and cel- lagenous fibers, The tunica adventitia of the larger vessels is infiltrated with a system of tiny blood vessels called vasa vasorum (“vessels of the vessels”) that nourisi the ‘mote extemal tissues of the blood vessel wall Blood is carried away from the heart in large vessels called arteries, These divide into smnaller arteries, and the smaller arteries divide into arterioles. Arterioles divide into microscopic capillaries (ihe exchange area of the system). The capillaries converge to form vessels called yenules, which join to form still larger vessels called veins. Veins retum the blood to the heart, Blood is carried away from the heart in large vessels called arteries, These divide into smaller arteries, and the smaller arteries divide into arterioles, Arterioles divide into microscopic capillaries (ihe exchange area of the system). The capillaries converge to form vessels called venules, which join to form still larger vessels called veins. Veins return the blood to the beart Through capillary walls, which consist of a single layer of endothelial cells, blood and tissue cells exchange gases and metabolites. Capillaries are tiny blood vessels with extremely thin walls that consist of endothelium only; no tunica media or adventitia is present. They join arterioles and venules, These blood vessels accommodate erythrocytes one at atime. In certain structures (liver, spleen. bone marrow, and certain elond). the arterioles, rather than connecting with capillaries, empty into blood vessels called sinusoids. They have very, very thin walls that conform to the space in which they are located (farm irregular tortuous tubes). » 1: The velocity of blood flow is slowest in capillaries. Notes) 2. A decrease in vesse! diameter causes an increase in resistance to blood flow.Art * Common carotid artery + Portal artery + Hepatic artery + Splanchnic artery B 4“ Copy © 20102010 Den Decks ANATOMIC SCIENCE! Art + Anterioles to capillaries + Atteries to arterioles + Capillaries to venules + Venules to veins “4 CConright © 200-2010 Deal Decks‘The hepatic artery brings oxygenated blcod to the liver, while the hepatic portal vein brings food-laden blood from the abdominal viscera. Note: The haptic portal vein is formed by the union of the superior mesenteric vein and the splenie vein, Remember: Alll the blood supplied to the liver from the bepatic arteries and the portal vein eventually drains via the hepatic veins to the inferior vena cava. Important: The most unusual aspect of hepatic circulation is that all the blood sup- plied to the liver from the hepatic arteries and the portal vein empties into the same sinu- Soids (minwe endothelial-lined passageways in the liver lobules). which therefore con- tain a mixture of arterial and venous blood. The sinusoids of each lobule empty into a common central vein. The commen central vein of each lobule then empties into cone of three hepatic veins. These veins all empty into the inferior vena cava, which trans- pors the blood to the heart 5 pressure of circulating blood fs found in arteries, and gradual- ly drops as the blood flows through the arterioles, capillaries, venules, and veins (where it isthe lowest). The greatest drop in blood pressure occurs at the transition from arter- ies 10 arterioles, Arterioles are one of the blood vessels of the smallest branch of the arterial circulation, Blood flowing from the heart is pumped by the left ventricle to the aorta (largesi artery), which in turn branches into smaller arteries and finally into arterioles. The blood contin- ues to flow through these arterioles into capillaries, venules, and finally veins, which return the blood to the beart Arterioles have a very small diameter (<0.5 mm), small lumen, and a relatively thick tunica media that is composed almost entirely of smooth muscle, with litle elastic tis- sue. This smooth muscle constricts and dilates in response to neurochemical stimuli which in tum changes the diameter of the arterioles. This causes profound and rapid changes in peripheral resistance. This change in diameter of thearterioles regulates the flow of blood into the capillaries. Note: By affecting peripheral resistance, arterioles directly affect arterial blood pressure,ANATOMIC SCIENCES Art ‘Which of the fo + Sublingual * Submandibular + Von Ebner’s + Parotid ® 4s Cony © 200.2010 Den Dc \TOMIC SCIENCES + Inferior alveolar artery * Posterior superior alveolar artery + Lingual artery * Infraorbital artery 4 Conprig © 200.2010 Del Dickss blood to the face, tonsils, palate, labial glands, and muscles of the lips. The facial artery also supplies the submandibular gland, the sla and dorsum of the nose, and the muscies of facial expression, The facial artery originates in the external earotid artery and gives off branches that supply the neck and face. Branches of the facial artery (cervical and facial portion) include Cervieal portion: Tonsillar - to the tonsils + Ascending pharyngeal - to the pharyngeal wall * Glandular - to the submandibular gland * Submental - to the area below the chin Facial portion: * Inferior labial - to the lower lip + Superior labial - to the upper lip and vestibule of nose + Lateral nasal - to the lateral wall of the nose fouter side) + Angular - to the medial side of the eye. It is the terminal branch of the facial artery and can anastomose with the dorsal nasal branch of the ophthalmic artery Remember: The two terminal branches of the external carotid artery are the super- ficial temporal artery and the maxillary artery The lingual artery arises from the anterior surface of the external carotid artery, oppo- site the tip of the greater cormu of the hyoid bone. The lingual artery loops upward and then passes deep to the posterior border of the hyoglossus muscle io enter the sub- mandibular region, The loop is crossed superficially by the hypoglossal nerve. The loop supplies blood to the tongue, supratyoid region, sublingual gland, palatine tonsils, and floor of the mouth. Important: In the oral region, the lingual artery usually is found between the hyoglas- sus and yenioglossus muscles. Branches of the lingual artery include the suprabyoid, dorsal lingual, sublingual, and deep lingual branches. Note: The inferior alveolar vein, artery, and nerve along with the lingual nerve are found in the space between the medial pterygoid muscle and the ramus of the mandible (pterygomandibular space). Important: The injection site forthe inferior alveolar nerve block is probed with a cot ton tip applicator at the depth of the pterygomandibular space ot the medial surface of the ramus, The needle is inserted into the tissues of the plerygomandibular space until the mandible is contacted. The needle is withdrawa 1 mm from the tissues to protect the reriosteum, and then the injection is administered.In the ER, a car-accident vietim who hit his face on the steering ‘Wheel arrives bleeding profusely from the mouth and nose. Upon examination, the physician discovers that along with avulsed teeth, his hard palate is fractured and the incisive foramen is obliterated. Nope ey a : ANATOMIC SCIENCES Art Examination of a patient with an ulcerative carcinoma of the posterior third of the tongue revealed bleeding from the lesion and difficulty swallowing (dysphagia). The bleeding was seen to he arterial which of the following arteries was involved? * Deep lingual artery * Dorsal lingual artery + Tonsillar artery * Sublingual artery “ \Conyig © 204.2010 Den Decksom In the pterygopalatine fossa, the maxillary artery gives rise to the descending pala- tine artery, which travels to the palate through the pterygopalatine canal, which then ter- ‘minates in both the greater palatine artery and lesser palatine artery by way of the greater and lesser palatine formamina to supply the hard and soft palates, respectively, ‘The maxillary artery ends by becoming the sphenopalatine artery, which supplies the nasal cavity. The sphenopalatine artery gives rise to the posterior lateral nasal branches and septal branches, including a nasopalatine branch thet accompanies the nasopala- tine nerve through the ineisive foramen on the maxilla 1. The greater palatine artery supplies the mucosa of the hard palate pesteri- Notes) or 10 the maxillary canine, Sis) 2, Mucosi of the bard palate anterior to the maxillary canine is supplied by the nasopalatine artery. 3. The soft palate and tonsils are supplied by the lesser palatine artery. ‘+* The dorsal lingual artery runs on the superficial surface ofthe tongue itisa branch of the lingual artery that delivers blood to the posteriar superficial tongue. So, this artery must be the soutoe of the hemorrhage, ‘The tongue is supplied by the lingual artery, the tonsillar branch of the facial artery, and the ascending pharyngeal artery. The veins drain jato the internal jugular vein. The lingual artery arises from the exismal carotid artery atthe level of the tip of the greater ‘bom of the hyoid bone in the carotid triangle. Branches include: + dorsal lingual: supplies the base and bedy of ihe tongue (pasteriar superficial tongue) + suprahyoid: supplies the suprahyoid muscles + sublingual: supplies the mylohyoid muscle, sublingual salivary gland, and mucous mem. branes ofthe floor of the mouth * deep lingual (terminal branch: supplies the apex ofthe tongve Remember (information about the tongue) 1, Motor innervation is fm the hypoolossal newve (CN 0) 2. Sensory innervation - lingual (ranch of rigeminal CN V-3) supplies the anterior two- thirds, glossopharyngeal (C1VX) supplies the posterior one-third (inchaling vallate papillae), vagus (CN X) through the internal laryngeal nerve supplies the area near the cpiglotis. 3. Taste- facial (CIV V1) via chorda tympani supplies the anterior two-thirds: plossopharyn- ‘geal (CN 1X) supplies the posterior one-third. |The tonsillar artery isa branch of the facial artery that also supplies blood to the ‘Notes, palatine tonsil <5 2. The ascending pharyngeal artery is the smallest branch of the external carotid artery Branches include the pharyngeal and meningeal arteries, 3. The lingual artery and facial artery often aise from a common trunk of the extem= al caroid arteryANATOMIC SCIENCES Art Which branch of the maxillary artery runs through the foramen spinosum_ and is implicated in epidu I hematomas Inferior alveolar artery * Middle meningeal artery + Inttaorbital artery * Deep temporal arery 4 Capytght © 209-2910 Dena Decks ANATOMIC SCIENCES Art After a large Thanksgiving dinner, the traditional American family notices that they all are drowsy. The “food coma” is a result of oxygenated blood being restricted from the brain and being shunted to the stomach in order for digestion. All of the arteries that supply are derived directly or indirectly from the: + Splenic artery + Hepatic artery + Gastroduodenal artery * Celiac trunk (artery) 50 ‘Copia © 200-2010 Den Desksrn ‘The maxillary artery is the larger terminal branch of the external carotid artery. It begins the neck of the mandibular condyle within the parotid gland. The maxillary artery rans between the mandible and the sphenomancibular ligament anteriorly and superiorly through the infratemporal fossa. After traversing the infratemporal fossa, the maxillary artery enters the plerygopalatine fossa. Within the infiatemporal and pterygopalatine fos- sac, the maxillary artery gives off many branches. Branches inthe infratemporal fossa: + Inferior alveolar artery: follows the inferior alveolar nerve into the mandibular canal and spplies tissues ofthe chin and lower teeth + Midate meningest artery: an important artery that passes upward behind the mandibular nerve, The arteryenters the skull throuzh the foramen spinosum. This artery supplies the ‘icninges within the skull. Note: Damage results in an epidural hematoma. Small branches that supply the lining of the extemal auditory meatus and the tympanic rembrane + Numerous small muscular branches that supply the muscles of mastication ‘Branches im the pterygopalatine fossa: + Posterior superior alveolar artery: Supplies the maxillary sinus and the molar and pre ‘molar teeth “Infraorbita enters the orbital cavity throw the inferior orbital fissure + Greater palatine artery: supplies the mucosa ofthe hard palate posterior ta the maxill- ary canine + Pharyngeal branch: supplies the mucous membrane of the roof of the nasopharynx + Sphenopalatine artery: supplies the mucous membrane of the nasal cavity, Its the terminal branch of the maxillary artery, Note: Damage resuls in cpistexis (nosebleed) Note: The lateral pterygold muscle divides the maxillary artery into three sections: the mandibular, pterygoid, and pterygopalatine. All of the arteries that supply the stomach are derived directly of indirectly from the celiac trunk (celiac artery). The eeliae artery takes its origin from the abdominal aorta {ust betow the diaphragm at about the level of the welfth thoracic vertebra, [tis the artery that supplies the foregut. The celiac urtery is surrounded by the ectiac plexus and lies behind the lesser sac of peritoneum. The celiac artery has three terminal branche the splenic, let gostric, and hepatic arteries Splenic artery — to the spicen 1, Left gastroepiploic: arises fiom splenic artery atthe hilum of the spleen to supply the greater curvature of stomach. 2. Short gustries: arise from the splenic artery at the hilum of the spleen to supply the fundus of stomach, Left gastric artery — arises from the celia artery to supply the lesser curvature of stomach and the lower third ofthe esophagus. Hepatic artery ~ to the liver |, Right hepatie artery — to right lobe of live. * eystie artery ~ arises fiom righthepatic artery to supply the gallbladder. 2. Left hepatic artery —to left lobe of liver. * ight gastrie artery — arises from the hepatic artery atthe upper border of the py Joris to supply the lesser eurvature of stomach. * gastroduodenal artery — large branch of hepatic artery that supplies the pancreas ‘and duodenum, = right gastroepiploie artery: supplies greater curvature of the stomach, - superior pancreaticoduodenal artery: supplies the upper half of the ducdenurANATOMIC SCIENCES Art ‘The internal thoracic artery ends in the sixth intercostal space by dividing into the: + Anterior and posterior intercostal arteries + Subclavian and inferior epigastric arteries + Superior epigastric and musculophrenic arteries 34 © st ‘Copyright © 20902010 Dena Decks ANATOMIC SCIENCES Art The abdominal aorta terminates by dividing into the common iliac arteries \) and the middle sacral artery at what vertebral level? ) +710 oTI2 *T2 +4 Ls 82 ‘Contig © 206-2010 Deal Decks5 The internal thoracic artery supplies the anterior wall of the body from the clavicle to the umbilicus. I! isa branch of the first part of the subclavian artery in the neck: This artery descends vertically on the pleura behind the cosial cartilages, just lateral to the sternum, and endsin the sixth intercostal space by dividing into the superior epigastric and musculophrenic arteries Branches of the internal thoracic artery include: * Two anterior intercostal arteries forthe upper six intercostal spaces + Perforating arteries, which accormpeny the termianl branches of the corresponding, intercostal nerves + The pericardiacophrenie artery, which accompanies the phrenic nerve and sup- plies the pericardium * Mediastinal arteries to the contents of the anterior mediastinum, for example, the thyrnus gland * The superior epigastric artery; which enters the rectus sheath and supplies the rec tus muscle as far as the umbilicus +The museulophrenie artery, which rans around the costal margin of the diaphragm and supplies the lower intercostal spaces and the diaphragm Note: The inferior epigastric artery, « branch of the external iliac artery, anastomoses with the superior epigastric artery in the rectus sheath in the area of the umbilicus. ‘The aorta is the main trunk of a series of vessels that convey the oxygenated blood 10 the tissues of the body for their nutrition. The aorta commences at the upper par of the left ventricle, and ater ascending for a short distance, arches bickward and tothe let side, over the root of the left lung; the aorta then descends within the thorax on the left side of the vertebral column, passes into the abdominal cavity through the aortic opening of the iaphragr in front of the twelfth thoracic vertebra. The aorta descends behind the Peritoneura on the anterior surface of the bodies of the lurubar vertebree. At the level of the fourth lumbar vertebra, the aorta divides into the two common iliae arteries, Note: The characteristic feature of the aorta is that it contains a lot of elastic fibers in its tunica media (middle layer of blood vessel wall. Anatomically, the sora is traditionally divided into the ascending aorta, the corti areh, and the descending sorta. The descending aorta is, i turn, subdivided int the thoracic aorta (that descends within the chest) ancl the abdominal sorta (ihat descends within the abdomen). + Ascending aorta: a short vessel that starts at ihe aortic opening ofthe left ventricle. The ascending aort’s only branckes are the right and left coronary arteries, which supply the hear muse * Aortic arch: gives rise 10 three areal branches: the brachiocephalic, the left common carotid, and the lef subclavian, ‘These arteries furnish all of tie blood to the head, neck, and upper limbs. * Descending aorta: * Thoracic portion: extends from T4 10 T12 (lies inthe posterior mediastinun). All oF the arterial branches (posterior intercostal, subcostal arteries) from this part are small, They supply the thorax and the disphragm, Abdominal portion: extends from T12(o L4, where the descencing aorta terminates by dividing into the two common ise arteries and a stall middle sacral artery. Arier- i fom this arca supply the abdomen and pelvic region as well as the lower limbs,ANATOMIC SCIENCES Art AS a result of curiosity, a 2-year-old boy decides to stick a sharp object up hhis nose and causes a nosebleed (epistaxis) of the anteroinferior portion of the nasal septum. This bleeding involves the septal branches of the: + Ophthalmic and occipital arteries + Sphenopalatine and facial arteries + Frontal and perictal arteri + Pharyngeal and meningeal arteries 5 Cop © 2009-2010 Dena Dicks ANATOMIC SCIENCES Art ‘The upper half of the duodenum is supplied by the abranch of the gastroduodenal artery. The lower half of the duodenum is supplied by the a branch of the superior mesenteric artery. ‘+ Superior pancreaticoduodenal artery; inferior pancreaticoduodenal artery ‘Inferior pancreaticoduodenal artery; superior pancreaticoduodenal artery + Superior renal artery; inferior renal artery + Inferior renal artery; superior renal artery 5 Copy © 2009.20 Dena Deke‘The arterial blood supply to-the nasal cavity is derived maialy from branches of the maxillary artery, The most importaat btanch is the sphenopalatine artery, which enters the nasal cavity through the sphenopalaline foramen. The sphenopalatine artery anastomoses with the septal branch of the superior Iblal branch of the facfal artery in the region of the vestibule, which isa very common site of bleeding from the nose. Rementber: The sphenopalatine artery isthe terminal branch of the maxillary artery. Other small arteries that supply blood to the nasal cavity include: + The descending palatine branch of the maxillary artery * The superior labial branch of the Facial arcery + The posterior ethmoidal branch and anterior ethmoidal branch of the ophthalmic, artery Remember: 1. The ophthalmic artery is @ branch of the internal carotid artery. 2, The maxillary artery is one of the terminal arteries of the external carotid. The ‘other terminal artery of the external carotid isthe superficial temporal artery. 3. The pterygopalatine fossa is a cone-shaped paired depression deep to the infia- ‘temporal fossa. The plerygopalatine fossa located between the pterygoid process and the maxillary tuberosity, close to the apex of the orbit. This fossa contains the maxil- lary arery and nerve and their branches arising here, including the infrsorbital and, sphenopalatine arteries, the maxillary division of the ttigeminal nerve aud branches, and the pterygopalatine ganglion. The pterygopmlatine fossa communicates laterally with the infratemparal fossa through the pterygomaxiary fissure, medially with the ‘nasil cavity through the sphenopalatine foramen, superiorly with the skull through the foramen rotundum, sad anteriorly with the orbit through she infer fissure, ‘The arterial supp) ‘num aid lleum is from branches of the superior mese toric artery. The intestinal branches arise from the left side of the artery and run ia the ‘mesentery 10 reach the gut, They anasiomose with one another to form a series of arcades. The lowest past of the ileum is also supplied by the iteocolic artery ‘The large intestine extends from the Teun Wo the anus. The large intestine is divided into the cecum, the appendix, the ascending colon, the transverse colon, the descending colon, and the sigmoid colon. The blood supply to these areas is as follows = Cocum: the arterial blood supply is ffom the anterior and posterior cecal arteries, ‘which are braaches ofthe ileocolie artery, a branch of the superior mesenteric artery * Appendix: the arterial supply is by means of the appendicular artery, a branch the posterior ceeal artery * Ascending colon; the arterial! blood supply is trom the ileocolic and right colic branches ofthe superior mescateri¢ artery + Transverse colon: the arterial blood supply of the proxinial two-thirds is from the ‘middle colis artery, a branch of the superior mesenteric artery, The distal third is sup- plicd by the lef colic artery, a branch of the inferior mesenteric artery * Descending colon: the anerial bleod supply is from the left colic and sigmoid ‘branches of the inferior mesenteric artery . * Sigmoid colon: the arterial blood supply is from the sigmoid branches of the infe- or mesenteric artery Note: The arterial blood supply to the reetum is from the superior, middle, and inferior rectal arteries, The superier rectal urtery is direct continuation of the inferior mesen. toric artery. The middle rectal artery is a small branch of the internal iliac anery. The inferior rectal erteryis a branch of the intemal pudendal urtery inthe perineum, The arte ‘al blood supply to the anus (ana/ canal) is trom the superior and inferior eectal arter-ANATOMIC SCIENCES Art ‘The left subclavian, left carotid, and brachiocephalic artery are branches of the: + Extemal caroiid artery + Celige artery + Aortic arch + Common iliac artery 5s ‘cop © 208-2010 Dent Decks [All of the following statements concerning the common carotid arteries are true EXCEPT one. Which one is the EXCEPTION? * The common carotid arteries are the same in length * The common carotid arteries differ in their mode of origin * The right common carotid artery begins at the bifurcation of the innominate artery (brachiocephalic artery) bebind the sternoclavicular joint and is confined to the neck + The left common carotid artery originates from the highest part of the arch of the aorta in the superior mediastinum ané consists of a thoracic and a cervical portion 36 56 Copyright © 2019-2010 Den Decks‘The arch of the aorta is 4 cortimiation of the ascending aorta, The aortic arch lies behind the manubsrium sterni and arches upward, backward, and to the leftin front of the trachea (its main direction is backward). It then passes downward to the left of the tra- chea, and at the level of the stemal angle become continuous with the descending aorta. Branches include: +The brachiocephalic artery is an extremely short artery and is the first branch from the aortic arch, This artery passes upward and to the right of the trachea and divides into the right common carotid and right subclavian arteries behind the right sternoclavicular joint, Remember: There are mo (right and left) brachiocephalic veins but only one brachiocephalic artery. + The feft common carotid artery arises from the convex surface of the aortic arch ‘on the Ieft side of the brachiocephalic artery, The left common cerotid artery runs upward and w the left of the trachea and enters the neck behind the left sternoclavic~ ular joint. * The Jef subclavian artery arises trom the aortic arch behind the left common carotid artery, The left subclavian arery runs upward along the left side of the trachea ‘and the esophagus to enter the root of the neck. This artery arches over the apex of the left lung. Important: 1, The upper limbs are supplied by the subelavian arteries (both right and leji) 2, The head and neck are supplied by the right and left common carotid arteries. The major arteres that supply the heid and neck are the common carotid and subclavian, arteries. The origins from the heart ofthe common carctid and subclavian areries that supply he head and neck are different forthe right and lft sides ofthe body, For the right side ofthe body, the common carotid and subclavian arteries are both branches from the brachiocephalic artery. ‘The brachiocephalic artery fsa direct branch of the wort ‘The common carotid artery is branchless and travels up the néck, lateral 10 the trachea and far 4ynX, to the upper border of the thyroid cartilage, The common carotid artery travels in a sheath (Geep tothe stermocleidomsstoid muscle This sheath also contains the internal jugulat vein end the vagus nerve. The conmon carotid artery ends by dividing into the internal end exteraal ‘carotid arteries at zboat the level ofthe larynx. >The internal earotid hs no branches inthe neck, The internal carotid'sbranches supply: the structures inside the cranial cavity. The internal carotid gives rise to tbe ophthalmic artery, the major blood supply of the orbit und eve, that enters the orbit through the optic foramen (caral) wih the optic nerve. The internal carosid ends by dividing into the anterior and iddle cerebral arteries that contrbue to the great cerebral eile fof Wills). * The external carotid his eight branches that msinly supply head structures outside the cranial cavity. The branches are as follows: ‘Anterior branches: Posterior branches: 1. Superior thyroid artery 1, Ascending pharynges! artery 2, Lingual artery 2. Occipital arery 3. Favial artery 3, Posterior auricular artery 4. Maxillary artery 4. Superficial temporal artery The subclavian artery arises lateral to tbe common carotid artery. The subclavian artery gives off ‘branches to supply both intracranial ard extracranial structure, but its major destination is the upper extremity /arm), Remember: On the left side of the body, the left common carotid and left subclavian arteries arise from the arch of the aorta inthe superior riediastinum,Which artery supplies the muscles of mastication, the maxillary and mandibular teeth, the palate, and almost all of the nasal cavity? + Mandibular artery + Subclavian artery + Vertebral artery + Maxillary artery 87 Cori © 200.2010 Det Dscks ANATOMIC SCIENCES Bn ‘a basketball game left the point guard seeing double. The sician determined that the paper-thin wall that holds up the eye had collapsed and the right eye now sat lower than it should have, thus causing the diplopia. Name the projection of the ethmoid bone that c + Cribrform plete * Crista gall + Ethmoid sinus + Lamina papyracea 37,38 Capri © 2008210 Den DekeMas Females | ve et Bunche th fp leer eel era tay ack fs” in wpe sear raralvear Civesnseo (trash tt uppes fe mantic tre ae Asesirsureeraeoe [il aery [Arte frie feral arin pass enghihe for | fot te maxlny ase | ise sd it te ner enl Breast aes ct sp thr | Supplies te maxillary sinus and the anterior tet | Mitiescpeioraieair [amid arey [ay or may not te pose presen ares Fone nora nerf em sey fe Wants gh the elo see a se hermit cea Desens oe velar aa opty the mat us { ad tieplousat eerie Possrurapesiabed | Tirdparofie | Arne etre he masa any ene the enaplaine a | eit sins ral an als Macc Tet Tnfrealveer Descente flaws he rer afer ove rhe man amen oe sscond yeotr Sepp oft maa th Meat Sipps he ial iva he ane eeh Basie near aver ney [Sopp ear eth Fitting together to form a protective shel, the skull is composed of paired bones on each side, and ‘unpaired bones running through its midline, The seven unpaired bones are the frontal, ethnioid, ‘occipital, sphenoid, manclibte, vomer, and hyaid bones. The 10 paired bones are the temporal bones, including the tiny middle ear bones (ossicles) of the malleus, ineus, and sapes (hanmer, ‘anvil, and stirrup), parietal, lacrimal, nasal, zygomatic, palatine, and maxillary bones ‘The ethmoid bone is exceedinaly light and spongy, and cubical in shape; this bone i situaved at the anterior part of the base of the cranium, between the two orbits, at the roof of the nose, and contributes to cach of these cavities. The ethmoid bone consists of four parts: 4 horizontal or eribriform plate, forming part of the base ofthe cranium: a perpendicular plate, constituting pert of the nasal septum; and two lateral mastes or labyrinths. * Cribriform plate: Conizins many olfactory foramina. The olfactory nerves pass through these foraming. Note: Damage 10 this area typically results in the loss of sense of sone * Perpendicular plate: The crista gai isa midline projestion from the perpendicular plate that serves as an attachment forthe falx cerebri. * Lateral masses (right and let) project downward from the erbriform plate. They contain the ‘ethmoid sinuses and the orbital plate of the ethmoid bone (lamina papyracea). The lamina Dapyracea forms the paper-thin medial wall of the orbit, The superior and middle nasal conchae are serol-ike projections that extend medially from the lateral masses into the nasal J, Bach ethmoidal sinus is divided into anterior, middle, and posterior ethmoidal air Notes) cells. se 2, The superior wall or roof of the orbit is formed alnost completely by the orbital plate ofthe frontal bone. Posterory, the superior walls formed by the lesser wing of the sphencid bore,ANATOMIC SCIENCES All statements concerning the sphenoid bone are true EXCEPT one. Which one is the EXCEPTION? + The greater wing of the sphenoid bone forms the lateral wall of the orbit and the roof of the infratemporal fossa + The lesser wing of the sphenoid bone contains the optic canal (optic foramen) and helps form the superior orbital fissure and roof of the orbit + The medial pterygoid plates of the sphenoid bone provide attachment sites for two muscles of mastication * Foramina within the greater wing of the sphenoid bone provide access to both the perygopalatine and infratermporal fossa *+ The body of the sphenoid bone contains the sella turcica and the spheroidal sinuses 50 Cyr © 2038-2010 Dent Deck ANATOMIC SCIENCES Bone in the mandible develops by: ) + Endochondral ossification + Subchondral ossification ‘+ Intramembranous ossification + Primary ossification eo Copyright © 208-2910 Den Decks‘8 This is false. Remember: The lateral pterygoid plate provides the origin for both the lateral and the medial pterygoid muscles. ‘Thesphenoid bone is situated at the base of the skul in front ofthe temporal and basilar part of the occipital bone. It somewhat resembles a bat with iss wings extended, and is divided into a median portion or body, two great and ‘wo small wings extending ‘outward from the sides of the body and two pterygoid processes that projet froin the ‘bone below. + Hollow body: Contains the sella turciea, which houses the pititery gland and tae sphenoidal sinuses. + Grester wings: Help to form the lateral wall of the orbit end the roof of the intiatempors! fossa, Contain foramen rotundam: transmits maxillary nerve (¥=2), foramen ovale; ransmits mandibular nerve (V-3), and foramen spinosun: tansnits the middle meningeal vessels and nerves to the tissues covering the brain + Lesser (@mall) wings: Help to form the roof of the erbit and the superior orbital fissure; contain the optic eanal (optic foramen) that transmits the optic nerve (CN I) and ophthalmic axtery + Pterygoid processes: One on cither side, descend perpendicularly fromthe regions where the body and great wings unite, Each process consists of a medial and a lateral the upper parts of which ae fused anteriorly; a vertical sulcus, the pterygopal- groove, descends on the front ofthe line of fusion The frst evidence of bone ossification (hone formation) occurs around the eighth week of prenatal development. Bones develop either through endochondral ossification (going through «a cardlaginous stage) or through intramembranous ossification (forn- ing directly as bone). The distineticn between endochondral and intramembranous for- "ation rests on whether a cartilage model serves asthe precursor ofthe bone (endochon- deal ossification) or whether the bone is formed by a simpler method, without the inter- vention of a cartilage precursor (intramembranous ossification) Most bones are endochondral, meaning that they began as a hyaline eartilage model before they ossify, This takes place within hyaline cartilage. This type of ossification is principally responsibie for the formation of short and long bones. Bone replaces cani- lage (osteaeytes replace chondrocytes). The bones of the extremities and those pacts of the axial skeleton thet bear weight (e.2., vertebrae) develop by endochondral ossifica- tion The flat bones of the skull and face, the mandible, and the clavicle develop by intramembranous ossification. It is 50 called because it takes place within membranos of connective tissue. The mandible and mavilla are formed this way. This process con tributes to the growth of short bones and the thickening of le involves the transformation of ostecblasts to osteocytes. ig bones, This process Remember: Once bone is formed, it grows by appositional growth (growth by addi- tion of new layers on those previously formed)ANATOMIC SCIENCE: Bn During distalization of molars in bodily orthodontic movement, the alveolar bone distal to the toath must resorb, and the alveolar bone mesial to the tooth must appositionally grow. In orthodontic movement, the alveolar bone is being remodeled. This remodeling is a function of: + Osteoclasts and osteoblasts ‘+ Chondroblasts and osteoblasis + Osteoblasts and osteocytes + Chontirocytes and osteocytes ot Copyright © 209.2010 Dent Decks ANATOMIC SCIENCES Bn are functions of the skeletal system EXCEPT one. Which one is the EXCEPTION? + Lymph filtration * Mineral storage * Support * Protection * Body movement + Hemopoiesis 62 Coys © 200.2010 Dena Decks‘Osteoclasts are cells that break down and remove exhausted bone tissue. Osteoblasts build new bone tissue to replace this loss. Osteoblasts are the principal bone-building cells; they synthesize collagenous fibers and bone matrix, and promote mineralization during ossification. Once this has been accom- plished, the osteoblasts, which are tapped in their own matrin, develop into osteocytes that maintain the bone tissue. |. Osteoblasts are derived from mesenchyme (fibroblasts) and have a high ‘Notes! RNA content and stain intensely, See! 2. Osteoctasts (ivhich are derived from stem cells in the bone marrow~ the same ones that produce monceytes and macrophages) ae large multinucleated cells that coatain Iysosemes and phagocytic vacuoles. Note: A Howship’s Ineuna is a smal hollow created on the bone surface by osteoclastic activi 3. Osteoid is newly formed orgenie bone matrix that hes not undergone calsi- fication, +*** Important: Osteoid differs from bone in that osteoid does not have a mineralized matrix, Remember: Bone is hard and resists compression because of the mineralization offs extracellular matrix. When bone mattix mineralizes, inorganic hydroxyapatite crystals (Primarily calcium phosphate) axe deposited around the existing collagen foils, and the Water content of the matrix decreases. Bone derives its flexibility and tensile strength fiom its abundant collagen fibers. Functions of the skeletal system: + Support: skeleton forms a rigid framework to which are attached the softer tissues and organs ofthe bod. * Protection: the skull and vertedral column erolose the CNS; the rib eage protects the hear, ants, reat vessels, iver, and spleen; and the pelvic eavity supports the pelvic viscera, * Body movement: bonss serve as anichoring attachments for most skeletal muscles. in this capacity, the bones act as levers with the join's fimctioning as pivots when muscles contract to cause body movement. ‘+ Hemopoiesis: the red tone marrow of an adult produces red blocd ells, white blood cells, and platelets + Mineral storage: the inorgatic matrix of bone is composed primarily of the minerals calcium and phosphorus. These minerals give bone its rigidity and accotnt for approx imately two-thirds of the weight of bone. About 95% of the calcium ard 90% of the phosphorus within the body are deposited in the bones and teoth, Bone exists in two forms: Compact (appears asa solid mass) and spongy ce eanesflous bone, which consis of a branching network of trabeculae. Important: The initiation of bone mineralization involves the following (1) Holes or pores in collagen fiters, (2) The release of matrix vesicles by osteoblasts. (3) Alkaline Phosphatase activity in osteoblasts and matrix vesicles. (4) The degradation of matrix yrophosphate wo release an inorganic phosphate group. Fracture repair involves the following events: (1) Blood clot formation, (2) Bridging callus formation, (3) Perivsteal callus formation, and (4) New endochoudral bone formation.ANATOMIC SCIENCES Bn At the temporomandibular joint (TMJ), hinge movements occur between the: + Condyle and artisular eminence + Artcular dise and articular eminence + Condyle and articular dise + Asiculardiae and articular cavity + Condyle and articular cavity a ‘Const © 206-2010 Dest Decks ANATOMIC SCIENCES Bn Apatient comes into the orthodontist’s office as referred to by his general dentist. The orthodontist notes the patient’s tongue thrusts and notes that early ‘treatment could prevent skeletal problems. Soft tissue development is thought to encourage mandibular growih: * Upward and forward * Upward and backward + Downward and forward + Dowaward and backward ee Copy © 209.2910 Den DecksThe TMJ is © synovial joint with two articular cavities. Each cavity is responsible for a dif ferent movement at the joint. An aricular dise sits between the sondylar process of the nandible on its inferior side and the mandibular fossa and articular eminence of the tempo- ral bone on the superior side, This dise divides the joint into the two articular cavities, with cone cavity acting as a hinge component and the other cavity serving as x gliding campo- nent. The lower part of the joint. between the condyle and the articular disc, is the hinge component of the joint. When the joint moves, this hinge component ofthe joint moves first, to initiate mendibular opening. The upper part of the joint, between the articular dise and the mandibular fossa and articular eminence of the temporal bone, creates the gliding com- ponent. During joint movement, this gliding cavity moves after the hinge component to ter- ‘inate mandibular opening, 1. The condyle of the mandible rests in dhe mandibular fossa (also called glenoict Notes’ fossa) of the temporal bone. The fesse articulates with the condyle of the sal) “mandible to form the TMI. 2, The articalar eminence forms the anterior boundary of the fosss and helps maintain the mandible in position. This area isthe functional aud asticalar portion of the TMI. 3. Separating the mandibular fossa from the tympanic plate posteriorly is the squamotympanic fissure, through the mediel end of which (petrotmpanic fis -sur2) the chorda tympani exits from the tympanic cavity. 4. The concave area between the mandibular condyle end coronaid process is the mandibular note (also kxown as the coronoid notch). The mandibular notch sransmits arteries and nerves fo the masseter muscle 5. *** Important: The posterior slope of this eminence is lined by fibrous con- nective tissue. ‘The space between the jaws into which the tect erupt is generally considered to be pio- vided by growth at the mandibular condyles (especially she molars). The conyle is & major site of growth. Many arguments have been made about condyle function in mandibular growth, Most authorities agree that softaissue development carries the mandible forward and downward, while condylar growth fills in the resulaat spece to maintain contact with the base of the skull The bone of the alveolar process exists only’to support the teeth. Ifa tooth fails to erupt, alveolar bone never forms in that area; and if @ tooth is extracted, the alveolus resorbs after the extraction until finally the alveolar ridge completely atrophies. The position of the tooth, not the functional load placed om it, determines the shape of the alveolar ridge. Note: The long axes of the mandibular condyles intersect at the foramen magnum, ‘which indicates that these axes are directed posteromiedially.ANATOMIC SCIENCES Bn Alll of the following statements concerning the nasal cavity are true EXCEPT one. Which one is the EXCEPTION? + The lateral walls are formed primarily by the maxilla, palatine (perpendicular Plate), ethmoid, and nasal conchae (superior, middle, and inferior) + The medial wall or nasal septum is formed entirely by the yomer bone + The bridge of the nose is formed by the two nasal bones * The roof is formed by the nasal, frontal, sphenoid (ody), and ethmoid (cribriform late) bones * The floor is formed by the palatine process of the maxilla and the horizontal plate of the palatine bone 4041 ANATOMIC SCIENCES Bn + A small, rounded process + A prominent elevated ridge or border of a bone + A large, rounded, roughened process + A sharp, slender, projecting process 6 Cnsisht © 2092010 Deal Decs++ This is false; the medial wall ot nasal septum is formed by the perpendicular plate of the ethmoid bone, the vomer bone, and the sepial cartilage. The rest of the framework of the nose consists of several plates of cartilage, specifically, the lateral nasal cartilage and the greater and lesser alar cartilage. The cartilage is held together by fibrous connective tissue ‘The nasal cavity opens on the face through the nostrils or nares and communicates with the nasopharynx through two posterior openings called the ehoanae. The area below each concha (superior, middie, and inferior) Is referred to as a meatus, ‘The nasal cavity receives innervation from the olfactory nerve (CN /) and branches of the trigeminal nerve (CN ¥). The nasal cavity’s blood supply is mainly from the sphenopalatine branch of the maxillary artery. The nasal cavity also receives blood. from the anterior ethmoidal branch of the ophthalmic artery and the septal branch of the superior labial branch of the facial artery. Note: The nasopalatine nerve is a parasympathetic and sensory nerve that arises in the Pterygopalatine ganglion, passes through the sphenopalatine foramen, across the root of the nasal cavity 10 the nasal septum, and obliquely downward to and through the incisive canal, and innervates the glands and mucosa of the nasal septum and the anterior part of the hard palate Important: The communication between the pterygopalatine fossa and the nasal cav- ity is the sphenopalatine foramen, The sphenopalatine artery and the nasopalatine nerve extend through the sphenopalatine foramen, Surface Features of Bone (enlargenients and processes): + Process: the most generic term for bone projection that serves as a point for attach ‘ment of other structures. Example: Acromsion process of the scapula, transverse proc 208 of verisbrn. + Epicondyle: a projection or swelling on a condyle (or above, in some cases) Example: Medial and lateral epicondyles of femur, + Spine: 2 sharp, slender projecting process. Example: Spinous process of vertebrae, spine of the seapuls * Tubercle: a small, rounded process, Example: Greater and lesser tubercles of humerus, ‘*Tuberasity: a lage, rounded, roughened process, Example: ischium, *Trochanter: a large blunt projection for muscle attachments on the fernur Example: Greater and lesser trochanters of the femur * Crest: a prominent elevated ridge or border of a bone, Example: Iliac crest ofthe item, Linen (lino)s a small crest, usvally somewhat straighter then a crest Example: Linea aspera of formu. + Ramus: a major branch oF division of the main body of a bone. This may have its own articulations er processes. Example: The coronoid end condylar processes of the ‘mandible are subdivisions of the ramus. + Neck: a slight narrowing of the body of the bone that supports the head Example: Necks of the humerus end femur * Lamina: a very thin layer of bone. Example: The lamina of the vertebrae, Ischia tuberasity of theANATOMIC SCIENCES Bn ‘The shaft of a long bone is capped on the end by spongy bone that is surrounded by compact bone. This is called the: + Periosteum + Diaphysis + Endosteum + Epiphysis e ANATOMIC SCIENCES Bn ‘Which cranial fossa houses the cerebellum, medulla, and pons’ + Anterior cranial fossa 6 Copyright ©2009-2910 Den Decks + Middle cranial fossa + Posterior cranial fossa 6s Cong © 200-2010 Deal DesksLong bones have « tubular shaft, the diaphysts, and usually an epiphysis a each end, During he growing phase, the disphysis i separated from the epiphysis, by an epiphyseal carflage, The part of ‘he digphysis that lies adjacent to the epiphysesl cartilage is called the metaphysis. The shaft has & ‘ental marrow cavity containing bore manrow. The outer part of te shatt is camposed of compact ‘bone tit is covered by ¢ connective tissue sea, the pertosteum, A typical lang bone includes the following structures: Sree | Tocation and Function Dispysi__ [one hah colas oa elingiel be ofurbleconpectbons | pips |Caps dips: ccs of peng bone sounded compact boar ood cel an pel : tinsel fle | Between he xp hysisand he apie raion a roic vy ‘eapnsie fer lengutono one Msllinyeavly | Cnrly poston sce win dpe sonia ay yellow Pane Hite mien | Opening io dips roan ne Gr mel veseh To eT ei ela av. Aniscetag | Cops cach epiphysis composed of alle evan finns Toney nce eallny evn, comin of upprine ae oper comecive Paroneuan [vcr te stice of fone comin of me vp comerive ion, st fe liamet nl dens chen repose damensbone growth ‘Gest bo] Hard outer rer of eae tai avery pevasaun senes fr aches of mss, proves rts al pves dale sagen ‘Gaisiae | Por, hy vascular, ier ipert Now ice akan Bove Tipster an prevides sce forte sone prow Whee Hoo este ‘The internal surface ofthe base of the skull consists of thrse cranial forsue, the anterior, middle, ‘aid posterior. They increase in size and depth from anterior to posterior The anterior and mide ‘ossae are separated by the lesser wing of the sphenoid bone, and the middle and posterior fossae are separated by the petrous part ofthe temporal bone. ‘The anterior cranial fossa is adapted for reception ofthe frontal lobes ofthe brain, and is formed by portions of the frontal, ethmond, end sphenoid boxes. The erista gal, x midline process ofthe ‘thrid bone, gives attackment othe anterior end of the falx cerebri, On'each side of the crsta, gall ore the groeved exfbriform plates of tte ethmoid bone, providing numerous onfices for the delivate olfeciory nerves from the nasal mucosa to synpse in the olfactory bulbs. The middle crariat fossa is composed of the body and great wings of the sphenoid bore, the ‘squamous and petrows parts ofthe temporal bonesand the frontal angles ofthe parietal bones, This fossa isthe “busiest” ofthe cranial fossae. This fossa ecntains lalerally the temporal lobes of the ‘brain. This fossa contains the optic chiesma, optic canal, sella tueica, and the hypophyseal fossa that houses the pituitary gland. Within ihis fossa, the superior orbital issure,foremen rotundum, foramen ovale, foramen lucerum, and foramen spinosum are found. th the temporal bone, the hiatus for both the lesser and greater petrosél nerves are found. On the anterior surféce af the Petrous portion oF the ‘ermporal bone is the trigeminal impression, which lodges the trigersinal ‘ganglion (semilunar or gasserian) ofthe Fifth nerve The posterior cranial fossa, the deepest of the fossae, houses the cerebellam, medal, suet Pons. Antriorly, lhe posterior cranial fosss extends t the apex of the peirous lemporal Posteiory, itis enclosed by the occipital bone. Laterally, portions ofthe squamous ternporel etd ‘nastoid pert ofthe temporal bone form ts Walls I contains four important foramina, the internal acoustic meatus (in the petrou part of the temporal bone), the jugular foramen (benveen jhe -phenoid end occipital bones), the hypoglossal canal (tn the oecipital bone), and the foratien magnum (a large median opening in the floor of the fossa, where the medulla oblongata is ‘continous with the spinal card),‘Treacher Collins syndrome is a rare genetic disorder that presents with, many craniofacial deformities. One of the characteristic traits is downward slanting eyes, which is caused by underdevelopment of the bone that forms the substance of the cheek. Which bone is this that anchors the muscles of mastication and facial expression? Ethmoid bone + Zygomatic bone + Oveipital bone ‘Sphenoid bone eds ° Cony © 2019.2010 Dental Dicks ANATOMIC SCIENCES Bn ‘Which can be defined as a tube-like passage running through a bon« * Fovea * Meatus + Fossa + Fissure n Corsi © 206.2610 Den DeckseT ‘The zygomatic bone is situated at the upper and lateral part the prominence of the cheek, part of the lateral wall and floor of the orbit, and parts of the temporal and infratemporal fossae. The zygomatic bone presents a malar and a uur processes, the frontosphenoidal, orbital, maxillary, and temporal The zygomatic bone articulates with four bores: the frontal, sphenoidal, temporal (to form the zygomatic arch), and maxilla. Above the zygomatic arch isthe temporal fossa, which is filled with the temporalis muscle. Attached to the lower margin of the zygomatic arch is the masseter muscle. Note: The temporalis muscle passes medial to the zygomatic arch before the muscle inserts into the coronoid process of the mandible. The temporal fossa is a shallow depression on the side of the cranium bounded by the temporal lines and terminating below the level of the zygomatic arch. The infratemporal crest of the greater wing of the sphencid bone separates the iemporal fossa from the infratemporal fossa below it, Important: 1. The temporal and deep to the zygomatic arch 2. The pterygopalatine fossa communicates laterally with the infratemporal fossa through the pterygomaxillary fissure, medially with the nasal cavity through the sphenopalatine foramen, superiorly with the sill through the foramen rotundum, and anteriorly with the orbit through the inferior orbital fissure. fratemporal fossae communicate with each other ‘Surface Features of Bone Depressions: + Fissure (¢ sharp, deep groove): a sharp, narrow, cleft-like opening between the parts of a bone that allows for the passage of blood vessels and nerves Example: superior orbital fissure of the sphencid. * Sulcus (a groove, but shallower and a less abrupt cleft than a fissure): a shallow, Wide groove on the surface of a bone that allows for the passage of blood vessels, nerves, and tendons Example: Intertubercular sulcus of the humerus, altemately known as the bicipital groove. * Incisure (notch): a deep indentation on the border of a bone Example: greater sciatic incisure or notch of the os coxa + Fovea: a small, very shallow depression Example: fovea capitis on the head of the femur accepts a ligament fiom the hip socket or acetabulum * Fossa: « shallow depression. This may or may not be an articulating surface Example (of articulating surface): Glenoid fossa of the scapula or mandibular fossa of the temporal bone. Example (no-articulating surface): subscapular fossa. Openings: + Foramen: an opening through which blood vessels, nerves, or ligaments pass Example: Foramen magnum of the occipital bone, mental foramen of the mandible, * Meatus (canal): a tube-like passage running through a bone Example: the acoustic meetus of the temporal bore.ANATOMIC SCIENCES. Bn Which fossa has no bony inferior or posterfor boundary? + Pterygopalatine fossa + Infratemporal fossa + Temporal fossa n = Coorg © 2038-2010 Dent Decks ANATOMIC SCIENCES Bn All of the following are openings from the pterygopalatine fossa EXCEPT one. \ Which one is the EXCEPTION? + Sphenopalatine foramen + Foramen rotundum + Foramen lacerum + Prerygomaxillary fissure * Inferior orbital fissure n ‘Const © 208.2010 Dena Decks‘Boundaries | ‘Temperal Fowsa | infratemperal Fossa Ptecygppalatine Fosia at Foote Seperor —[fefenoriemporlfine | Greser ving oF pheond bone [aio suae& of phan poe edly [Anterior [Froniroses of | Wantary wberosy Masilcy eons zxgorate bone’ Metta | Sareoftenpgal | tateal peqaow pine ee Lateral |@jgoumiarah [Mandibular ans ed Peryavomiliy Taso ype a Inferior | Ieiiemporaler of | No boy border Peyacpline can spend bone Poster _[fnerortempirallin. [No ny bondor esi roses ofapemnd bone M Rn fratempo [Mascis [Temporal mee | Parypoid moses Blood vessels |Areabload vesele | Peryzoi plexus and macitry | Maxilany artes Gl portion an anery (second perticn) and | ranches inching itaerba wd branches incline mide | spenopaltine tenis meningel ary neror alvecir aren, and posterior super alvenlar artery Neves | Arsaneres Mandibulr rere insuding | Peppa paugionand infer aveclarandingual J mxlary nerve ‘The pterygopalatine fossa is small triangular space behind and below the orbital cavity communicates laterally with the infrotemporal foxsa through the pterygomaxillary fissure, medially with the nasal cavity through the sphenopalatine foramen, superiorly with the skull through the foramen rotundum, and anteriorly with the orbit through the inferior orbital fissure, ‘The pterygopalatine ganglion lies in the prerygopalatine fossa just below the maxillary nerve (¥-2). The plerygopalatine ganglion receives preganglionic parasympathetic fibers from the facial nerve by way of the greater pettosel nerve. The pierygopalatine ganglion sends postganglionic parasympathetic fibers o the lacrimal gland and plans in the palate and the nose: ‘Note: The maxillary nerve (V2) and the pterygopelatine pertion of the maxillary artery pss through the prerygopalatine fossa Bony Opening | Location (Bone) Contents Spieropalatine foramen | Spenoid and palatine _|Sphenepalainealen and vei, easopaatine nerve Prerygoidearal Sphenoid Deep and greater petoeal nerves that formnenve of pterygoid canal, area vessels Pierysorailary Sphenoid and maxila [Posterior sipeior alveolar vin, anery and wena, fissure maxilary artery Foramen wtindum || Sphenod Maxitlry nerve (72) inieriorovbial ssure | Sphonoid and smstla [latisorbtal nd zygomate verve lnfeortfal artery, and opSthslmi win Pieryenpalatine canal | Vaxitlaand palatine [Greaterand loser palatine venn arenes and Pharyngeat cena Sphonoid and pataine | Phacyngeal ranch of =ANATOMIC SCIENCES Bn Which of the following receives the opening of the nasolacrimal duet’ + Superior meatus + Middle meatus + Inferior meatus n Copyright© 2092010 DexalDesks ANATOMIC SCIENCES Bn A prosthedontist designs his maxillary removable complete and partial dentures to engage the hamular notch behind the maxillary tuberasities. The /hamulus is a small slender hook, which extends from the medial pterygoid plate| ‘The medial pterygoid plate is a component of the pterygoid process, which is a ‘component of which bone? + Sphenoid bone + Occipital bone + Palatine bone + Temporal bone ™ Copyright © 20072610 Dent Decks‘The nasal conchae are three pairs of scroll-like, delicate shelves or projections, which ‘hang into the nasal cavity irom the lateral walls, These projections assist in increasing, the surface area within the nasal cavity for filtering, heating, and moistening the ait. The superior and middle conchae are part of the ethmoid bone; the inferior conchae are separate bones (also called the inferior turbinates). The space below each concha is referred to as a meat + Superior meatus: lies below and lateral tothe superior concha. The superior meatus receives the openings of the posterior ethmoidal sinuses. + Middle meatus: lies below and lateral to the middle concha. The middle meatus receives the openings of the frontal, maxillary, anterior, and middle etamoial sinuses The middle ethmoidal sinuses drain onto the ethmaidal bulla (rounded prominence on the lateral wall of the middle meatus). The antertor ethmoidal sinuses drain into the infundibulum (iume-lte structive thet empties ino 4 groove called the hiawes sem lunaris on the lateral wall of the middle meatus). The frontal sinuses drain into the infundibulum ot directly into the middle mestus. The maxillary sinus drains divcetly into the hiatus semilunaris; its opening (ost) is located near the top ofthe sinus * Inferior meatus: lies below snd lateral to the inferior conchae, It receives the opening of the nasolacrimal duet. The nasclacrimal duct drains lacrimal fluid from the surface of the eye into the meatus for evaporation during respiration, ‘The left and right pterygold processes project down wings within the body of the sphenoid bone. The: rasal pessage toward the paste: Each process consists ofa medial anda lateral plerygoid plate. ‘The lateral pterygold plate provides the origin for both lateral and medial pterypotd muscles. The plate slio forms the medial wall ofthe infratemporal fossa, The medial pterygoid plate forms the posterior limit of the lateral wall of the nasal cavity. The modial plat cad inferiorly su hamulus, & small, slender hook that sctsas «pulley forthe tenser vel palatnl tendon to change its direction of pull from near the juneticn oF each ofthe g processes run along the posterior portion of the fiom veal a herzaa thers tersing the soft palate Pri 6 Sa] Sc Hone aaa Se vsiarmae msn — [onand eoratasatiarn esi [Nuts — [oma er a my wc rcpt [stnaio [Tom tana enter [Mote — [fone mata ato ewan [2pm [Ronnie oa a a I [roi tems [oie perso ea ne RT Nast jromess [Tempo | Conpook atmueair els itary presese—[2veonace [Fo inform wi orion a aera oa al feos [Maina [rome ane ianl pate [raisins oss [Teapost [romsron ta TM eaadorecss —_|Sytenow | Cone onsite Ieal Neon pa Sows |enpont | Sever seaihmet ir msc an lige [Rampal press [ype | orien fava ch zygote pices [rove [Tatent wn rasa press |Nacta | Rs ral portant aeANATOMIC SCIENCE! Bn A young patient arrives in the physician’s office with unexplained symptoms for a long time. The patient has had bloody nasal discharge and painful oral lesions. A chest x-ray reveals “coin lesions”, and labs reve Ultimately, the isolation of the ANCAs - IgG antibodies - fegener’s granulomatosis. The dentist who referred this patient fo the physician ‘made a note of the necrotizing oral lesion that had perforated the hard palate into the nasal cavity, The roof of the oral cavity is formed by the: + Ethmoid and palatine bones + Maxilla and nasal bones + Maxilla and palatine bones + Nasal and yomer bones 7% = Cnyigt © 20082010 Denil Decks ANATOMIC SCIENCES Bn + Trabeculae 47,48 7 Cope © 20022010 Dent Decks*** Specifically, the palatine processes of the maxilla and the horizontal plates of the palatine bones. “The structure formed by this anion is the hard palate, The anterior two-thirds of the hard palate is formed by the palatine processes of the maxilla, and the posterior one- third is formed by the horizontal plates of the palatine bones. The hard palate forms not nly the rot oF the oral cavity proper but also the floor af the nasal cavity. Iris cov- ered with a mucous membrane and beacath the muccsa are pelatal salivary glands. The greater (anterior) palatine vein, artery, and nerve travel along the maxillary alveolar Processes anteriorly where they join the nasopalatine nerves und sphenopalatine artery and vein, exiting the nasal cavity from the incisive foramen. ‘The soft palate is continuous with the hard palate posteriorly and is “soft” because it ‘does not have & bony substrate bat contains a tough fibrous connective tissue sheet, the palatal aponeurosis, and is covered with a mucosa. Salivary glands are Found in the Underlying connective tissue, Posteriorly, the soft palate suspended in the oropharyiax ends in the midtine uvula, Remember: Most of the palatal muscles receive motor innervation from the pharyn- geal plexus of nerves, The tensor muscles of the palate receive motor branches trom the mandibular division of the trigeminal nerve (CN V3). Sensory innervation is pro- vided by the maxillary division of the trigeminal nerve (CN 2). Arterial supply is from ppart-3 (prerygopalatine portion) of the maxillary artery. There are two types of bone tissve: compact and spongy, The names imply that the two types of bone tissue differ in density, or how tightly the tissue is packed together. There are three types of cells that contribute to bone homeostasis. Osteoblasts are bone-form- ing cells, osteoclasts resorb or break down bone, and osteocytes are mature bone cells An equilibrium between osteoblasts and osteoclasts maintains bone tissue, ‘Compact bone consists of closely packed osteons or haversian systems. The haversian system consists of a central canal called the haversian canal, which is surrounded by concentric rings (lamellae) of matrix, Between the rings of matrix, the bone cells (osteo «ytes) are located in spaces called lacunae. Small channels (canaliculi) radiate from the lacunae to the haversian canal to provide passageways through the hard matrix. In come pact bone, the haversian systems are packed tightly together to form what appears to be solid mass. The haversian canals contain blood vessels that are parallel to the long axis of the bone, These blood vessels interconnect, by way of perforating cawals, with vessels on the surface of the bone Spongy (cancellous) bone is lighter and less dense than compsct bone. Spongy bone consists of plates (trabeculae) and bars of bone adjacent to small, irregular cavities that coniain red bone marrow. The canaliculi corinect to the adjacent cavities, instead of a central havessien canal, to receive their blood supply, It may appear that the trabeculae awe arranged in a haphazard manner, but they are organized to provide maximum steagth similar to braces that are sed to support a building, The trabeculae of spongy bone follow the lines of stress and can realign ifthe dir of stress changesANATOMIC SCIENCES Bn A 62-year-old female patient with osteoarthritis is having her right hip | replaced. A titanium-ceramic prosthesis will act as the head of her femur and a poly-ethylene cup will act as the socket in the hip bone. In a normal hip, this cup-shaped cavity that receives the head of the femur is called the: * Pubic tubercle + Obturator foramen + Acetabulumn + Pelvic girdle 7 Coy © 209.2010 Dena Deke TOMIC SCIENCE! Cell A young couple looking to have a baby goes to a fertility clinic. ‘The reason they are having trouble conceiving is because the man’s sperm is incompetent and are relatively non-motile. In vitro fertilization is indicated and will most likely be suecessful. What is the long, whip-like organelle that sperm use to move about? 50,51 * Centriole + Flagellum + Vacuole *Cilium 7 Consist © 20092010 Dena DecksThe os coxa oF hipbone is formed by the fusion of the ilium, isehium, and pubis on cach side of the pelvis. The os coxa articulates with the sacrum at the sacroiae joint to form the pelvle girdle, The two hip bones articulate with one another anteriorly at the symphysis pubis. * The ilium is the upper flattened part of the hip bone; the ilium possesses the iliac ‘rest, which ends in front at the anterior superior iliac spine and behind at the post- rior superior iliac spine. The ilium possesses a large notch called the greater notch. * The ischium is L-shaped with an upper thicker part (body) and a lower thinner part (rans). This part bears the weight of the body when a person is in at uptight, seated position. Features include ischial spine and ischial tuberosity, The obturator foramen is formed by the ramus of the ischium together with the pubis. * The pubis is divided into a body, a superior ramus, and an inferior ramus. The bodies of the two pubic bones articalate with each other in the midline anteriorly at the symphysis pubis. Medial to the symphysis is the pubie tuberele. The inguinal igament connects the pubic tubercle to the anterior superior iliae spine Note: The acetabulum is a cup-shaped cavity on the lateral side of the hip bone that receives the head of the femur, Its formed superiorly by the ‘lium, posteroinferiorly by the ischium, and anteromedially by the pubis, Flagelia are present in the human body only in the spermatozoa. Flagelle are similar in structure to cilia but are much longer. The action of the flagellum produces movement. ‘The cilium is a short, hair-like projection from the cell membrane, The coordinated beat- ing of many cilia produce organized movement. ‘The besic structure of flagella and cilia is the same. They resemble centrioles in having rine sets of microtubules arranged in acylinder: But unlike centrioles, cach set is a dou blet rather than a triplet of microtubules, and two singlets are present in the center of the cylinder. At the base ofthe cylinders of cilia and flagella, within the main portion of the cell, isa basal body. The basal body is essential to the functioning of the cilia and fla- sella. From the basal body, fibers project into the cytoplasm, possibly to anchor the bass body to the cell Both cilia and flagella usually function either by moving the cell or by moving liquids ‘or small particles across the surface of the cell. Flagella move with an undulating, snakedike motion. Cilia beat in coordinated waves. Both move by the contraction of the tubular proteins contained within them.ANATOMIC SCIENCES Cell ‘The inactive X chromosome in a female cell is called the: + Pineal body + Lateral body + Golgi body + Barr body 7 ‘Cong © 201.2010 Dena Decks ANATOMIC SCIENCES Cell ‘In which cellular component are glycoproteins assembled for extracellular use? * The Golgi apparatus ‘The endoplasmic reticulum The nucleus The nucleolus 0 Cong © 206.2610 Den Decks1a the female, the genctic activity of both X chromosomes is essential only during the first few weeks after conception. Later development requires just one functional X chromosome, The other X chromosome is inactivated and appears as.a dense chromatin mass salled the Barr body. This Bar body is atacked to the nuclear membrane in the cells of a normal female, In the cells of a normal male, who has only one functional X chromosome, the Barr body Is absent, Important: The Barr body's presence isthe basis of sex determination tests (for example, ‘emniocentess). 1. The sex of an embryo can be determined at about the eighth week, ‘Notes 2, Females have 45 active chromosomes and one inactive Barr body. ‘The function of the Golgi apparatus is two-fold: First, the modification of lipids and pro- teins; Second, the storage and packeging of materials that will be exported from the cell ‘The Golgi apparatus is often called the “shipping department” of the cell. The vesicles that pinch off from the Golgi apparatus move to the cell membrane, ard the material in the vesicle is relessed to the outside of the cell. Some of these pinched-off vesicles also become lysosomes. Important: The Golgi apparatus is where glycoproteins are assem- bled for extracellular use, The Golgi apparatus (sometimes cailed the Golgi body) is similar to endoplasmic retic- ‘lum (ER). It is composed of flat, membranous sacs, or eisternae, arranged in stacks like Pancakes. These stacks have two poles— the cis face, which receives materials for pro- cessing, and the rans face, through which substances are released for transport to other parts of the cell /— 1. These cisternae are located between the nucleus and the secretory surface of (Notes) 2 cell ius 2. They package, store, and modify products that are secreted from the cell 3, Procollagen filaments are formed here from amino cells. Lysosomes are cytoplasmic membrene-bound vesicles that contain a wide variety of gly~ coprotsin hydrolytic enzymes that serve 1o digest and destroy exogenous material, such as bacteriaWhich of the following is the distinctive array of microtubules in the core of cilia and flagella composed of a central pair surrounded by a sheath of nine doublet microtubules (characteristic “9 + 2” pattern)? + Centriole + Axoneme + Tubulin + Malleotus 8 Copy © 200.2010 Den Decks ANATOMIC SCIENCES Cell and is maternally transmitted? + Peroxisomes * Ribosomes * Centrosomes + Mitochondria 2 Copyright © 20.2910 Dena Decks‘An axoneme isthe core seaffold of the eukaryotic cilia and flagella. which ate projections from the cell made up of microtubules, Thus, the axoneme serves as the “skeleton” of these ‘organelles, both giving support tothe strucure and, in most cases, causing it to bend. Though dis- tinetions of function and/or length may be made between cili and flagella, the intemal stricture of the exoneme is common to both. The charactenstic feature of the exonetne is its “9 +2” arrangement of microtubules and associ- ated proteins, as shown in the image be'ow. Nine pairs of “doublet” microtubules, a component of the cellular eytoskeleton, form a ring around a “central palr” of single microtubules. Ciliry ynvin arms, the motor complexes that allow the axoneme 1 bend, are anchored to these micro tubules, The interactions between the ciliary dynein proteins and outer doublet microtubules wen- crate force by sliding the doublets parallel to each other, which bends the cilium and enables it 10 beat ‘The radial spoke, a protein complec important ia regulating the motion of the axoneme, is also ‘housed in the axoneme: it projects fem each set of outer doublets toward the central micro~ tubules. The radial spoke is 2 multi-unit protein structure found in the axonemes of exksryotic cilia and flagella. The doublets and ceniral sheaths are linked by proteins known as nexins = Be = ie a ‘Cross section of an axoneme eke Note: Centrioles are cell organelles that constitute the ventrosome and thus sid in formation of the mitotic spindle Mitochondria are thread-like structures within the cytoplasm that provide most of the body's ATP, which fuels many cellular activities, [Membranus Plas avembrane [Serves ss boundary ofthe cel minlining is integrity, prin molecule embedded n plasms membrane perfonn vciusfanctons; fe exarpe, he serve es mathers hat iat oto each ivi rap bornones snd ter moleeales and a ats mechanisms Enlopainie til | Ribosomes tached o rough I spnhysizn proteins Wat lve cols vale Gag omplex: soa ER synthesize pid ncerpoated in cellmenbrancs, steroid hommones, nd certsncarbobyuraes wed 0 frm glvcoprcin Galglapparats | Synhesvescaohydate, coming lobules oF giycopmein ee ee ih pete, and packages the products Tefonsomes | Conan enzymes th dtoify hail satanees Nitocondria [Catabolism ATP synthesis el’ "power lot” Nudes ousesthe genetic code, which in un dicatsprtsin yhoin, ony playing an essential ol in othr cl artis, namely ll mansort. meta, tad owe [Nosrnemtranous Rifesomes [itor protein ethos sls “otcin ere Gyomieeton [Actas « Gaaneworkvosuppor iheceland is orginal: unaons ins oovoueny Foes call eters (roils, gla). Nudeolig [Plage an eset le th fommion oF boomANATOMIC SCIENCES, Cell Kupffer cols in the liver area specialized ype ot, ——~—~=*&*Y + Basophil + Plasma cell + Mast cell + Macrophage 8 Coren © 200-2010 Den Decks ANATOMIC SCIENCES Cell ‘Which cell, known as the “mother cell,” is a part of the seminiferous tubule and secretes hormones and proteins that facilitate spermatogenesis? + Interstitial cells, + Endothelial cells, + Sertoli cells * Clara cells Cy Consist © 2038-2010 Dena DecksMacrop! ‘A macrophage is any phagocytic cell derived from a monoeyte (a type of blood cell), including macrophages of the liver (Kupffer cel), spleen, and loose conneciive tissue (histiocyte). enc e Celt Primary Funetion Plasina Antibody synthesis Mast Mediator of inflammation on contact with entizen ‘Schwann Forms myelin sheath around axons of the PNS Sertoli Proviuces testicular uid Leydig. Protluces testosterone Fibroblast Prosluces collagen and reticular fibers ‘Osteoblast Fonns bone mairix, gives rise fo osteveytes ‘Odontoblast Forms dentin ‘Ameloblast Forms enamel TiLymphocyies) | Cell-mediated immunity B ymphocyies) [Differentiate inv plasma cells Alpha (Pancreatic) | Produces glucagon Beta (Pancreatic) | Produccs insulin Call Primary Location Sistentaculer [internal ear (organ of Cons, taste buds, olfaciory epithelium Pyramidal) | Corsbral cortex (oorebrum) fEndotetiat [Lining blood and lymph vessels, endocardium (inner layer) Ependymal [ining the brain ventricles and spinal cord Sexot [Seminiferoustubutes ofthe testis [Gangiionic [In ganglion peripheral othe CNS [Globular Transitional epithelium (kidney, water, bladder) Pricke Strat spinosum of epidermis Fibroblast | Mest common cll of connective tissue [Chromatin [Adrenal medalta and paraganglia of SNS Purkinje Cerebellar certex (cerebeltam) [Goblet Mocous menibranes of respiratory and intestinal tracts Intersitiad [Connective taave islet Pancreas Justaglomerilar [Renal comuscle of kidney Mesenchymal | Fomdberwesn scwder and endoderm of embryosANATOMIC SCIENCE: Ce Aver spots are seen as a sign of aging and are actually lipofuscin granules pres) ent in dermal cells. Lipofuscin is a yellow-brown pigment that is Produced as a result of lysosomal digestion. What is the collective name given to lifeless substances, including lipofuscin granules, yolk, fat, and starch, that may be stored in various parts of the cytoplasm? + Protoplasm, + Nucleoplasm, + Ectoplasm, + Metaplasm. ‘In which phase of the interphase does the DNA replicate in Preparation for mitosis? *G) phase +S phase + Gy phase *Mphase 8 Copyright © 209-2010 Dena Desksot Example * Glycogen: carbohydrate storage granules in ver and muscle cells > Fat deposts + Pigment granules: deposits of colored substances 1. Ligofasen:yellowish-rown subsance tha increases m quantity as cells age 2. Melani abundant in epidermis ofthe skin and etna, Protoplasm is a viscous, translucent, watery material that is the primary component of animal cells. It contains a large percentage of water, inorganic ions (potassium, calciun, magnesium, and sodium), and naturally occurring organic compounds (such as proteins, ‘pids, and carbohydrates). Nucleoplasm, the protoplasm of the cell nucleus, plays a part in reproduction. Cytoplasm, the protoplasm of the cell body that surrounds the nucleus, converts raw materials into energy. The cytoplasm is the site of most synthesizing activities and contains cytosol (a viscous, semitransparent fluid that is 702% ‘0 90% water), organelles, and inclusions (metaplasma). A clear, thin. film of protoplasm called the cell membrane always surrounds the cytoplasm. The outer part of the cytoplasm is called the ectoplasm. ell cycle consists of interphase (iacludiag growth and synthesis) and miosis ‘+ Growth isthe increase in cellular mass as the esult of metebolism, + Synthesis isthe replication of DNA in preparation for mitosis, * Mitosis isthe splitting of the nucieus and cytoplasm that results in two diploid cells being formed. ‘The cell cycle ean be further divided into: + Interphase: the interval between successive cell divisions during which the cell is metabol- izing and the chromosomes are directing RNA synthesis, Teincludes: 1. G, phase — the frst gromth phase 2. S phase ~ DNA synthesis 3.G, phase ~the second growth phase + -M phase: mitosis (alo called karyokinesis) is the division of the nuclear perts of @ cell to form two diploid daughter cells, Cytokinesis is the division of the cyloplasm, which accompanies mitosis. ‘e) os ese 7 ‘\ “com grown ana] reer t (( paresANATOMIC SCIENCES Cell + Surrounds the cell wall and serves to protect the cell from changes in osmotic pressure +s a polysaccharide-containing structure thet functions in attachment to solid surfaces, preventing desiccation, and protection Is a non-permeable membrane enclosing the cell wall +Is.a dynamic, selectively permeable membrane enclosing the cytoplasm a7 Cong © 201.2010 Den Das ANATOMIC SCIENCES ‘What type of cell in the dental papilla adjacent to the inner enamel epithelium differentiates into odontoblasts? ‘+ Myoepithelial cell + Mesenchymal cell + Macrogiia cell * Mast cell 8s Copy ©2009-2910 Dena DecksThe plasma membrane (cell membrane) isa thin east struct 10 nanometers thick. It is located between the cell wall and the cytoplasm. Normal cell membrane Function is essential {or passive nutrient diffusion in and out of the cell, as well as for active (ie, requiring energy) ‘cansport across the membrane. The plasma membrane consists of a phospholipid bilayer contain- ing integrel and peripheral proteins. This type of membrane is called a fluid mosaic and is Found in both prokaryoric and eukaryotic cells ‘The cell wall surrounds the plasme membrane and serves to protect the cell from changes in ‘osmotis pressure, anchor flagells, mainvain cell shape, and control the transport of molevules into ‘and out of the cel. Stractares interior to the cell wall inchide the plasma membrane, he eyto- plasm, and cytoplasmic constituents such as DNA, ribosomes, and inclusions, Remember: The mitochondrion is an organelle ofthe cell eyteplasm that consists of an inner ‘membrane and an outer membrane (as does the nucleus). Mitechonadsia are the principal ener {7 source of the cell (major site of ATP production) and ace involved in all oxidative processes. They contain eyelic DNA. Phosphotpie Lcerbonyarates sphoDid ‘These cells have the potential to proliferate and differentiate into diverse types of cells (Rbroblasts, chondroblasts, odontoblasts, and osteoblasts), Mesenchymal cells form a loosely woven tissue called mesenchyme or embryonic connective tissue. Important: The mesenchymal cells in the dental papilla adjacent to the inner enamel epithelium differentiate into odontoblasts, which produce predentin that caleifies to become dentin, Mesectoderm (also called ectomexenchyme) is that part of the mesenchyme detived from ectodem, especially from the neural crest in the very young embryo, Neural crest cells give rise to spinal ganglia (dorsal root ganglia) and the ganglia of the autonomic nervous system. These cells also give rise to neurolomama cells (Schwann cells), cells of the meninges that cover the brain and spinal cord, pigment cells (melanocytes), chromaffin cells of the adrenal medulla, and several skeletal and muscular components of the bead,ANATOMIC SCIENCE: Cell On the playground at recess, a young girl is stung by a bee and immediately breaks out in hives and starts gasping for air. The teacher grabs an epinephrine Autoinjector from the first aid kit and is able to save the girl. What cells, when bound by IgE, are responsible for this anaphylactic reaction? * Mast cells ‘+ Macrophages + Platelets + Kupfer cells 80 ‘Contig © 206-2010 Dental Decks ANATOMIC SCIENCES Cell around a protein base of primarily: ) + Hydroxyapatite + Hyaluronan + Histones + Haploid 90 ‘Cosi © 205-2010 Den DeckseR Mast cells are large cells with coarse metachromatic granules containing heparin (anticoagulant), histamine (vasodilator), and other substances (.e., chemotactic factors, such as eosinophil chemotactic factor of anaphylasis and neutrophil ‘chemotactic factor). They occur in most loose connective tissue, especially along the path of blood vessels. These cells act as mediators of inflammation on contact with antigen Note: Normally, mast cells are not found in circulation, Both mast cells and basophils liberate heparin into the blood. Heparin can prevent blood. ‘coazulation as well as speed the removal of fat particles from the blood after a fatty meal. They both also release histamine as well as smaller quantities of bradykinin and serotonin, Note: {t is mainly the mast cells in inflamed tissues that release these substances during inflammation, ‘The mast cells and basophils play an exceedingly important role in some types of allergic reactions because the type of antibody that causes allergic reactions (ihe [gk ‘ype) has a special propensity to become attached to mast cells and basopkils, The reaction between antigen and antibody causes the mast cell or basophil to supture and release exceedingly large quantities of histamine, bradykinin, serotonin, heparin, SRS-A (slow-reacting substance of anaphylaxis). and a number of lysosomal enzymes. This, in tur, causes local vascular and tissu reactions that eause many, if not most, of the allergic manifestations, Chromosomes are maximally condensed forms of chromatin. Chromatin consists of strands of DNA wound around a protein base of primarily histones and looks like a beaded string under en electron microscope. Chromatin occurs in two forms: euchromatin (extended) and heterochromatin (condensed). When a cell prepares to divide, the chromatin coils into compact chromosomes, Except in the gametes (germ cells), chromosomes appeut in paits. One chromosome from each pair comes from the male germ cell (sperm), the other from the female germ cell (ovum. Normal human cells coniain 23 pairs of chromosomes, which makes the diploid number 46. The diploid number is the numer of chromosomes of a nonmal cell, The haploid ‘number is the number of chromosomes in a gamete. Usually, the diploid numbers wwice the haploid number, In these cells, 22 pairs are called homologous chromosomes or ‘autosomes. These sets contain genetic information that controls the same characteristics or functions. The 23rd pair ate sex (X’ and ¥) chromosomes. The composition of these chromosomes determines gender: XX produces a genetic female; XY, a genetic male.ANATOMIC SCIENCES Cell +s. formative cel present in red bone marrow that gives rise toa specific specialized cell +Is a mature B lymphocyte that is specialized for antibody production Is a mature T lymphocyte thet is specialized for cell-mediated immunity + Is any phagocytic cell of the reticuloendothelial system ot ‘Cope © 298-2610 Denl Dicks ANATOMIC SCIENCES | | E | £ + Fibroblasts + Hepatocyte + Kupffer cell + Erythrocyte 2 Capris © 2012010 Deal DecksMN ted B cells that ure very important in the production of antibody. They are rarely found in the peripheral blood. They comprise from 0.2% to 2.8% of the bone matrow white cell count. Mature plasma cells are often oval or fan shaped, measuring 8 to 15 jum. Their appearance (on light microscopy) is quite charac~ teristic: they have basophil eytoplasm and an eccentric nucleus, in addition toa pale zone in the cytoplasm that (on electron mieroscapy) contains wn extensive Golgi apparatus. They ate found mainly in bone marrow and connective tissue, They have a short lifetime of 5t0 10 days, B calls (B lymphocytes, complete maturation in the bone marrow): produce antibody mediated immunity. They account for 20% to 30% of cireulating lymphocytes and like T lymphocytes become associated with lymphoid organs (lymph nodes, spleen, etc). AS B lymphocytes become sensitized io an antigen, metwe B cells develop into plasma calls of become memory B cells. Memory B cells are formed specific to the antipens) encountered dusing the primary immune response; able to live fora long time, these cells can respond quickly upon second exposure 10 the antigen for which they are specitio. ‘Tells (T lymphocytes or thymus-derived lymphocytes): produce cell-mediated immuni- ty. They account for 70% to 80% of circulating lymphoeytes and becorne associated with the lymph nodes, spleen, and other lymphoid tissues. Upon interacting with a specific antigen, T lymphocytes become sensitized and differentiate inio several types of daugh- ter cells. These include memory T cells, which remain inactive until futue exposure ta the same antigen; killer T cells, which combine with antigen on the surface of the fore cign cells, causing lysis of the foreign cells and the release of cytokines; and different subsets of helper T cells, which help sctivate ther T lymphocytes, ‘The liver’s functional unit, the lobule, consists of plates of hepatic cells, or hepatocytes. that encircle a central vein and radiate outward. Separating the hepatecyte plaies from each other are sinusoids, the liver’s capillary system, Hepatocyies make up 60% to 80% of the eytoplasmie mass ofthe liver. These cells are involved in protein synthesis, proiein storage and transformation of carbohydrates, synthesis of cholesterol, bile salts and phospholipids, and detoxification, modification, and excretion ofexogenous and endogenous substances. The hepatocyte also initiates the formation and secretion of bile. Hepatocytes have abundant organelles that periorm their numerous fictions. Smooth endoplasmic retiewlum produces bile salts and detoxifies poisons. Peroxisomes also detoxify poisors. Rough endoplasmic reticulum produces blood proteins, The Golgi apparatus packages bile and other secretory products of the cell. Glyeosomes store sugar. Finally, numerous mitochondria fuel cell activity Kupffer cells are reticuloendothelial macrophages, which line we sinusoids, They function to remove bacteria and toxins that have entered the blood through the Intestinal capillaries. These cells have definite cytologic characteristics such. as clear vacuoles, lysosomes, and granular endoplasmic reticulum.ANATOMIC SCIENCES Cell ‘The following is the site of synthesis of rRNA: + Endoplasmic reticulum + Ribosomes + Golgi apparatus + Nucleolus + Plasma membrane % ‘Conyngs © 200-2010 Desa Decks ANATOMIC SCIENCES Cell Im which phase of mitosis does the chromatin condense into chromosomes and the nuclear envelope break down? + Interphase + Prophase + Metaphase + Anaphase + Telophase ey Cong © 206.2910 Dent Decksis an oval body found inside the nucleus. The nucleolus consists of RNA and protein and is not bounded by a limiting membrane, The nucleolus is the site of FRNA synthesis, Ribosomes are small particles consisting of rRNA and protein, They are commonly called the “protein factories” of the cell. They are responsible for the proves of translation, or taking the information from the DNA, encoding on RNA, and Using it to create the proteins needed hy the cell ‘The endoplasmic reticulum is & membranous network through the cytoplasm. The endoplasmic reticulum is continuous with the cell and nuclear membranes, ‘There are two types of endoplasmic reticulum: 1. Smooth (ribosomes are absent) ~ steroid synthesis; intercellular transport; detoxi= fication 2. Rough (ribusomes are attached) - synthesis of proteins for use outside a cell (extraceltular use) + 1. The nucleus of a cell is surounded by two membranes and contains DNA. Notes) 2. Active cells (Rbroblasts, osteoblasts, etc.) are characterized by an Gee ebundance of rough endoplasmic reticalten. 3. RNA and DNA can be distinguished tiom one another by the Feulgen reaction, “Mitosis is the process of normal call division. Mitosis occurs whenever body eells need to produce more cells for growth or for replacement and repair. The result of mitosis is two identical daughter cells withthe same chromosomal content as the parent cl, Mitesis is part of the entre life span of the cell slso caled the call eyele. This entire cycle consista of the following stages: Interphase: the interval between successive cell divisions during which the cell is ‘metabolizing and the chromosomes are dreeting RNA synthesis. It includes: 1. Gy phase: the first growth phase 2. S phase: DNA synthesis 3. Gp phase: the second growth phase Mitosis can be divided into four principal sapes: * Prophase: The chromatin, diffuse in interphase, condenses into chromosomes. Each chromosome has duplicated and now consists of two sister chromatids. At the end of prophase, the nuclear envelope breaks down into vesicles ‘+ Metaphase: The chromosomes align at the equatorial plate and are held in place by microtubules aiteched to the mitotic spindle and to part of the centromere ‘“Anaphase: The centromeres divide, Sister chromatids seperate and move toward the cor- responding poles + Telophase: Daughter chromosomes arrive atthe poles, and the microtubules disappear. ‘The condensed chromatin expands, and the nuclear envelope reappears. The cytoplasm divides (cytokinesis), and the cell membrane pinches inwerd, ukimately producing two daughter cells ‘The turnover rate of the cell varies greatly fiom one tissue to another. For example, there is rapid tumover in the epithelium of the alimentary canal and epidermis and slow turnover in the pancreas and thyroid,ANATOMIC SCIENCES Cell 9s copy © 2009-2010 Den Decks ANATOMIC SCIENCES GIS The preferred site for vitamin By) absorption is thi 52,53 o% Copyright © 20192010 Den Deckssore complicated than mios visions in sequenee, each one of Which has strong similarities to mitsis. Meiosis 1 ihe frst ofthe tvo divisions is eften called eduetion division, since i is here thatthe ctiromasome complement is reduce from 2N (diploid) 10 IN (haploid, terphase in meiosis identical to jmierphase in mitosis and there is no way, by simply observing the cel, wo determine ‘what typeof vision the eel wll undergo when it does divide, Meiotic division wil oeeur only in cellsassoeiled with mate or female sex organs. Prophse fis virtully identical to prophase in mitesis, involving the appearance of the chromosomes, the development of the spindle ‘pparatus, and the Tweakdown of the micleur membrane (emvevope), Here is where the eiicl oscars betveen metaphase In meiosis and metaphase to moss, in the late, Fe sheomotores Fine up on the metaphuse plate in no patiulat order. In’ metaphase}, te chrontosore pairs realigned on ether id ofthe ncaa plate, ts during ths alignment tht chromatid arms ry overlap and tempera fuse (chiaemara), esting in eossovern Dusinganphase the pine iberscontact, pulling the homologous pursaway from exch other anu toward ech pole of the cll A cleavage famow (ypeally frm a this platy followed by crtokiness, ut the muclear membrane usually isnot re-formed sn the ehroraosomen do tt ‘iseppeae. At the end of telophase T, each daughter cell has single sot of chromavornes ball ‘otal number in the orginal cel where the chromosomes were presen in pits, While the onal cell was diploid, the daughter cells are now huploid. This is why meiosis Tis often called reduetion division. Méiosis 11 is quite simple in that i is simply # mitotic division of each of the haploid ces troduced in meiens I, There is no interphase between meiosis | and meiosis 1. When metosia is complete there will be a total of four daughter cells ich with half the tls! number of chromosomes as the original cell. In the ease of male sivctires, all four cells will eventually develop mt typical sperm eels. fn the case of female structures, hee of the cells will typically abort, leaving a single cell to develop into sn egg cell tha is usually much larger than atypical sperm call ‘The small intestine is the man se of shsopon of digested food, The small intestine spssalized fore ‘mpletion ofthe digestio processes ad th subsocuert absorption ofthe diyested prodtcts Ths small nsx: ‘me roms of thre rain segments the duodenum, jj and ileum, ‘Characteriele features of the small intestine inst ‘Antestinal vill, These ae finge>Hike projections ito the lumen Yeonsitine of ace epltellum ond snderdyng lad propria Theeplthelve tinny the trnen corsisg of a sete exhunmerepthsiun with goblet cel, The sal surface of the absompive epithelial coll hs ubeusb bree” resting rom an overly arranger 2flesely packed microvilli wich may name several hundred pr absoratoe cell, The mat haneion OF ‘he mterovtl isto ineease the eface wie available for absomticn #4 The lamina propria othe sal inestine 1sformed fom loss eeansctive fsb. This vont blod vessle nerves, and arg lymphatic Vosels fle of abaorpion of tp * Intestinal gad. These are simple tubular glands thet open 0 he intestinal Yumon Baan tho hase oF 1c sll. The ittstinal ghd are sometins cll the erypts of Lieherkun. Seccory cells (Panvth lls; wi lange aedophilc granules a found atthe base oF the ines ands, The fsctien of these secresry cls itil ot Sly understood, bus is how th they Reset soya, Which ha ani-tae ‘eal properiee. * Valves of Kerekrine. The lini of the small tesine ne pera folds kyon as Valves uf Kercking ‘or plicae cirutares These ae most prominent én the ejunums, These fils. soon acronopcally te ans ‘vets settions, consist of mucosa and submnicass Important: 4. Tks min distinguishing Restere of the dundenum isthe prose of gn in he subvuees. These do seal or Brunner’s plans proce skalne secretions io covert te elects of gasrs weds thal peach the sduoderu, These elas pls provide the necesiary alkaline eaVinminen fy the linetoning ofthe vaverne fneceatie serie, 2 The rain disinguishing feature ofthe fejamum the presence uf prominent valves af Rereheng ipline ‘reulan). 3: The Het is mast devotd of valves of Kerting, however large sccuilations oF Inmphatictasue, bth ods nd dense, are found in the lamina copra, These can ofien be seen wacroscopicaly 46 large White bitches and are commanly kaown as Payers palehes. The dieu s ihe prettered ate Toe vtambn BIZ absorption, Note: The leum smi int ths scum se Hevceealjuetion,ANATOMIC SCIENCES G A patient comes to the emergency room presenting with jaundice and intense \) pain in the upper abdominal and between the shoulder blades. The physician suspects choledcholithiasis that is caused hy cholesterol stones formed in which ‘organ that stores and concentrates the bile. * Appendix * Gallbladder + Pancreas * Spleen 34 7 Cony © 2009210 Dena Decks ANATOMIC SCIENCES GIS ‘Which comparison between the large intestine and smal * The lumen of the large intestine is of a greater diameter than that of the small intestine * The smooth muscle coat of the large intestine consists of three bands called taeniae coli that cause the colon to form pouches (called haustra). The small intestine lacks this characteristic * The walls of the large intestine have more villi than the small intestine * The external surface of the large intestine has small areas of fat-filled peritoneum called epiploic appendages. The small intestine lacks this characteristic * The large intestine is about one-fourth the size of the small intestine oe Conga © 206-2010 Dent Decks‘The gallbladder is a sac-shaped organ roughly 3 to 4 inches long. [tis firmly attached to the lower surface ofthe iver and lies on the right side ofthe abdomen just helow the ribs at the front. The gallbladder is joined by the eystic duet to the biliary ducts of the liver: ‘The common bile duet passes down through the head of the paneseas to drain into the duodenum at the duodenal ampulla. astbeZore the duct enters the ducdeuma, the cox son bile duct is joined by the main duct of the pancreas Note: The gallbladder's lining is folded into raga (similar to thowe in the stomach). The siddle layer consists of smaoth muscle fibers that contract to eject bile. Bile is continuously produced by the liver and drains through the hepatic ducts and bile duet to the duodenuin, When the sera intestine is empty of food. the sphineter (Odds sphincter) of the hepatopancrestic ampulla (ampulla of Vater) constvicts, and bile is forced up the cyst duct to the gallbladder for storage. Important: Secretion of the hormone cholecystokinin after u fatty meet stimulates yall- bladder comraction and relaxation of Oddi's sphincter, and the bile mixes with the chyme. —}.The sphincter (Odds sphincter) of the hepalopancreatic ampullaris is a eir- Notes! cular muscle that surounds the hepatopancreatic ampulla (ampulla of Vaier), SF 2, The gallbladder does aut contain a submucosa as do the stomach and intes- tines (leh large and smal). 3. Bile emuisifies neutral fas and absorbs fatty acids, cholesterol, and certain vitamins 4. The gallbladder receives blood from the eystie artery, « branch of the right hepatic urtery. The galtbladder is imervated by vagal fibers from the celine plexus, The lymph drains into a eystic lymph node. then into the hepatic nodes, and eventually into the celine nodes. ‘walls ofthe large ines The larg intestine consists of th colon and rect. The cab is somposed of various pit: the secu, ‘ascending colo, transverse colon, descending colon, and sigmoid colon, The append (attache to tie sssuin. The feexim i he cen 1 lst partoF the digestive tte ad le ato the last par the anus «The are stating lacks fod or vil is curactsact by many rub esis lands With linge nun bars of goblet cells This is sometimes deserbet nyu andular epltheliam * The lage sntestin isthe site of water absorptin (va colamnar ébserive ation of the feces. The secretions ofthe goblet cells provide lubvicacion Abundant ymphatic issue is comma ite anne cf the lange nestine) * Whereas the erculae smooth masse layers entiauous she fomgidinal ripe riuscle of te muscularis {inthe form of tee thick bunds, known a tavlan eo * The anal region, nice the es of the lng intestine has a eres of longitudinal folds, andthe epitheione becomes a stratified squamous epithelium The Large Intestine Is Composed af hres Parts: 1. Cecunn: the boyimning ofthe Sage Intestine, bay-ike soueture that reeves the Hew of the smal lmestne. The vermiform append is «rary, blind tube tha estends dowoward fom he eco. ‘eontairs a large anount of Iyemphoid tse. 2. Calon: parts of the colon include the ascending eolon ~ te shortest i of the lore iene tat ‘xlends upward from the eevum os the right postrir alomisal wall. The transverse colan ex tend werossthe upper sume were the colon bends downward along the left posterior abdominal val ‘asthe descending colon. Low in the axon, the eolon curves ei the pelvis tower the midline as he Ssshaped slam eolon 3. Rectum: extend fai the siempid colon th anus Ite stmight and dows not poste the tonne cat that ore present inthe rest ofthe large intestine, Th fects ens as the unl camal (7-4 om), which ‘opens tothe exterior through the agus. The anal cana is surouded by the internal aad extemal sphlner ‘cles dat contro he expulsion of comers (be! movementy) Important: Unlike those of the rest of she GE tact, longital muscles do no tinm a eonteweus Jnyer arcund the lange intestine. Instead three bats of longitu rst salled taeatae cll, su the length of the colon. Coatrustions gather the colon int kanes ‘hanna, giving the colon ite “puckered” appearmece, sd 8a the site of for the lumina surfaces Tropa (owing a the large bacterial pogulaion in the\TOMIC SCIENCES. G Tine mucus to protect the walls of the mucosa. + Peyer's patches + Glands of Kereksing + Herwvig’s glands + Brunner’s glands + Crypss of Lieberkuhn 2 Coprignt © 206-2010 Dena Decks ANATOMIC SCIENCES GIS Hearthurn or GERD is a reflux disease associated with substernal burning pain and even metaplasia where the acidic juices of the stomach enter the muscular tube that connects the pharynx to the stomach. ‘This tube is called the: * Ascending colon + Duodenum + Esophagus + Ureter 100 Cong © 206-2010 Dental Decksed dvodenel glands or submucosal glands) are small, branched, coiled, tubular glands situated deeply in the submucosa of the duodenum. These glands secrete an alksline mucus to protect the walls of the mucosa from enzymes in the intestinal juice. Note: Histologically, itis possible to distinguish the duodenum from the stomach by the presence of these submacosal glands, Remembe |, The duodenum is the first partof the small injestine and measures around 12 inches in Jength, The daodenum has a °C” shape, with the curvature of the “C” encircling the bead of the pancress, It js the shortest but widest part ofthe small intestine. 2 ‘The interior of the duodenum has a folded sueface, which increases the available surface area for absorption of sugars, fas, and amino acids 3. Itis retroperitoneal (ie behind the peritoneum). 4. Ireceives the common bile duct and panereatic duct at the duodenal papilla (ich is @ smal, rounded elevation in the wall ofthe duadenum), 5. The duodenum receives blood from the superior pancreaticoduodenal artery, a branch of the gastroduodenal artery, and the inferior pauereaticeduodenal arte branch of the superior mesenteric artery, Important: The sympathesic and parssympahetic divisions. of the autonomic nervous system control contraction of smooth rousclesin the intestinal wall. (1) Sympathetic: The splanchnic nerve passes through the celiac plexus. Postganglionic fiters innervate the small intestine, Sympathetic stinulajon slows motility of the smi intestine, (2) Parasympathetic: The vagus nerve supolies a vast distribution of parasympathetic bers. Postganglionic fibers from the celiac plexus associated with the vagus nerve innervate the small intestine. Purasympathetic stimulation of the stall intestine causes increased motility. Note: The preganglionic parasympathetic neurons to the duodenum are located in the dorsal motor nucleus of the vagus nerve. The esophagus is 10-inch collapsible muscular tube that lies dorsal to the trachea and ventral to the vertebral column, The esophagns is located behind the truchea in whe thorax. The esophagus extends from the oropharynx anterior to the Vertebral eolumu, enters the mediastinum, leaves the thomex vie the esophageal hiatus, and joins the stomach. The poitt where the esophagus ends and the stomach begins is the esophagogastric junction. The opening ticugh which the abdominal part of the esophagus enters the cardiac portion of the stomach ig called the eardiue orifice, Important: There is an abrupt change in the type of susfitce epithelium at the junction of the esophagus and stomach ~ from stratified squamous to simple eclumnat, The esophagesl wall contains four ayers, ay follows fom the lumen outwac: * mucosa - epithelium, lamina propria, snd glands ‘submucosa - connective tissue, bleod vessels, and glands * muscularis (middle layer) - upper third, stiated muscle; middle third, striated and smooth; lower thind, smooth muscle * adventitia - connective tissue that merges with connective tissue of surrounding structures: ‘The esophagus receives blood trom the inferior thyrald artery, fiom branches of the descending thoracte aorta, and from branches of the left gasttie artery, “GERD” stands for gastroesophageal reflux disease, and "Banret’s esophagus” is the ‘metaplasia, of abvormal change, in the epitheliuim of the lower end of the esophagus thought to be caused by chronic acid damage, Remember: The esophagus receives parasympathetic fibers from the esophages! branches of the vagus nerve, The esophagus receives motor fibers from the recurrent laryngeal branches of the vagus nerve ard sympathetic innervation fom the ‘sophageal plexus of nerves,ANATOMIC SCIENCES A newborn boy of Jewish ancestry has been vomiting frequently. ‘His parents bring him to the physician, who notes a narrowing (stenosis) of the opening from the stomach to the duodenum ‘due to functional hypertrophy of the surrounding muscle. What is the name of the opening from the stomach into the small intestines? + Cardiac orifice *Pyloric sphincter + Lesser omentum + Greater omentum, 401 ‘Corrs © 2082010 Den Decks Alll of the following statements concerning the liver are true EXCEPT one, Which one is the EXCEPTION? Itreceives blood ftom the hepatic artery and portal vein * Itreceives autonomic nerve fibers from the celiac plexus Its function is to store and concentrate bile It is the body's heaviest and most setive internal organ The caudate lobe of the liver is separated from the tight lobe by the inferior vena cava and from the left lobe by the fissure for the ligamentum yenosum ‘The quadrate lobe of the liver is separated from the right lobe by the gallbladder and from the left lobe by the fissure for the ligamentum teres 102 ey Cops © 20602610 Den Decksible, pouch like structure whout 10 inches long-and ezpable of holding 2 to 4 quarts Attached (othe lower end of the esophagus, the stomach lies immediately inferior to the diaphragm and extends fo the duodenal portion of the small intestine, The stomach lies inthe JeMl upper quadrant of the abdorninal cavity ‘The lateral surface of the stomusch 5 called the greater carvanures the medial surface, the lesser ‘curvature. The lesser omentum layer ofthe peritoneum extends around the stomach, and the sreater omentum is found along the greater curvature of the stomach, The interior af Whe stomach is lined with rows of folds or wrinkles, called rugae, immediately distal 0 the gastrocsophagest junction ofthe stomach and esophagus, ealangeé portion disial to the earia,Iying sbave und to the left of the gusto esophageal opening 3. Body: tbe midale or main portion of the stomch, distal to the fundus und tapering. in wie. 4. Pylorus: the lower portion, beween the body’ andthe gestrodundenal junction. The stomach has three layers oF ssnooth muscle ~ the att lonituelal, he ride ore, ane the inner oblique muscles. 1. The maximum capacity of the stomach is about 310 4 liters. S277 2. The stomach receives blood fom all three branches of the celiac artery, The feft astrie artery supplies the lesser curvature ofthe fundus and the body ofthe stomach, The right gastric artery isa loop thst supplies the lesser curvature and then forms an smastomsis withthe let gastic artery. The left and right gastro-omental arteries supply the greater curvature, ‘The mucosa of the stomach contains many gastric glands in the lamina propria: Parietal (oxynic) cells: located ia fundus and body, secrete HCL. + Zymogeaie (chief css: located in fundus and body; secrete pepsinogen + Enteroendocrine cells: present. throughout the stomach; produce gastrin “** This is false; the galbiadder receives bile, concentrates it by absorbing water andl salts, and sores it nil delivered 10 the duaderiam Bileis produced and excreted by hepatocytes (iver ells, which are he most versatile cells the body, Bile is secreted by the liver iato the common hepatic dict. A shor eystic duct from the gallbladder joins the common hepatic duct p form the eommen bile dc, which trenspors the bile infenoriy 10 the duodenum to help emulsify fat for digestion, Note: Kupffer ess line the Siusoids of the liver and fimesion to filer bacteria and small foreign panicles out of the blood. The liver isthe heaviest and most active imal orwtn in the body. Many of the tver's functions axe tal for life. Normally reddish brown in colo, the liver lies under te cover and protection ot the lower bs on the right side of the abdomen, Th liverhas an upper dlaphragmati) surface al ‘lower (viscera) surface; te two surfaces are separated at he front bya shap infsior border The livers attached tothe diaphragm by the faleiform, triangular, and coronary ligaments, The liver ‘salso joined tothe stomach and diodenumby the gastrohepatic and hepstoduodenal ligaments spectively. The visceral surface of the livers in contact with the gallbladder, the right Kedney, ‘partof the duodenum, te esophagus, the stornach, and the hepatic flexute ofthe colon, The porta hhepatis ~ the point where vessels and ducts enter and exit the liver — lis on the vertral surface. ‘The liver is divided ipto right, ent, caudate, anc quadrate lobes, The quadtate and cayite lobes are uetionally part of the left lobe, although they are separated from it by a fissure on the visera side sd by the Fale Higamnent on the digphragmatie side The liver receives blood from two sources: the hepatic artery, which supplies the liver with ‘oxygensted blood flow the aor, and the hepatic portal veln, which caries the produsts of tligestin to the liver for processing, This blood eventuilly diains via the hepatic veins into the inferior vena cava, which transports the blood to the bear, Remember: The liver has digestive, metabolic, and regulatory functions; ts chief digestive fimetion is producing bile, whict sets asa fat emulsitier inthe inal intestineANATOMIC SCIENCES GIS Alll of the following comparisons between the ileum and jejunum are correct EXCEPT one. Which one is the EXCEPTION? + The mesentery of the ileum contains more fat * The ileum hes mote plicae citculares (valves of Kerckring) and more villi * They are both suspended by mesentery * Less digestion and absorption of nutrients occur in the ileum 10 copyrnt ©2009-2910 Den Decks s ANATOMIC SCIENCES GIS * Stomach + Large intestine + Small intestine 104 Copyright © 2019.2010 Den DecksWicnne ‘+ This is false; the jejunum has mote plicse circulaves (vulves of Kerclring) and more vili, Note: The lower part of the ileum has no plicae citculares (aves of Kerviving), Comparison of the jejunum and ileum: Aejunum (middle portion of small intestine): extends from duodevun to the ileum 1. Thicker muscutar wall for more active peristalsis 2. Has a mucosal inner lining of greater diameter for sbsorpton, 3. Has more (ard larger) plicae circutares (valves of Kerchring) end more vill for greater absorption. Tleum (distal portion of the small intestine): extends from the jejunum to the cecum 1. More mesenteric fat. 2. More Iymphoid tissue (Peyer & patches). 3. Blood supply is more complex. 4. More goblet cells, which secrete mucus. Remember: 1. Valves of Kerelering. The lining of the small intestine has permanent folds known as valves of Kerckring or plicae circulares, These are most promineat in the Jejunum, These folds. seen macroscopically in transverse sections, consist of rucoss and submucoss, 2. Intestinal vill. These are fingerike projections int the lumen (consisting of surface epithelium and underlying lamina propria) *** The epithelium lining the lumen consiss ofa sityple columnar epithelium with gob- Jet cells. The apical surface ofthe absorptive epithelial cells has a “brush border” (result ing from an orderly arrangement of closely-packed mierovill, which may number several Jmunired per absorptive cell), The min function ofthe mierovil is to increase the surface area available for absorption, Unlike these of the rest ofthe GI tac, longitudinal muscles do not form @ continuous layer sround the larg intestine, Instead, three bands of longitudinal muscle, called taeniae coli, run the length ofthe colon. Contractions gather the colon into bands /hawsra), giving the colon its “puckered” appearence The major function ofthe large intestine (also called the colon) is the removal of water from. the material (clyme} entering it. Water is removed by absorption. Unlike the small Intestine the large intestine does not seerete enzymes into its lumen, Histologic characteristies: + Epithelium: simple columnar with microvills border to increase surface area for abserption of water from the lumen, Mucus secreted by goblet cells Jubricates dehydrating fecal mass, lnestinal gins (erypts of Lieberkuhn) invade lamina propria. The epithelium Tacks vill. * Muscularis externa: inner circle consisting of a smooth muscle layer. Comins the three bands of longitudinal muscle, called taenine coli, for peristalsis. Important: The vagus nerve supplies parasympathetic fibers to the eseéading and transverse colons, while the descending and sigmoid colon along with the restum and anas ace supplied by the pelvie splanchnic nerves.ANATOMIC SCIENCES GIS ‘Which cells, located in the crypts of Lieberkuhn, secrete an antibacterial ‘enzyme that maintains the gastrointestinal barrier? + Paneth cells + Enteroendocrine cells * Sertoli cells + Absomptive cells 105 Conrigt © 20092010 Den Decks ANATOMIC SCIENCES GIS Which of the following is not produced by the pancreas? * Lipase ‘+ Trypsinogen ‘Insulin * Cholecystokinin Glucagon + Amylase 108 = Cony © 200.2010 Den DecksCharacteristic features of the small intestine Fact * Intestinal vil. These are Fingzrlike pro and underlying lamina propria). ‘*** The epithelium lining the Inner consists ofa siple columnar epithelium with goblet ce The apical surface of the abiorpive epithelial cells fs s “brush border” (resulting from an order= arrangemem of cleseh-packed micwvilli, whch may number several hundred por désorptive «ell, The win fanetion of the mnlerovil 's(o increase the surface area svatlabe for absompton *** The lamins propria ofthe small intestine a ered fram lose cemnective tise. This contains blood vesses, nerves, and lage lymphatic vessels (alte uf abserpton of lipid) ‘Intestinal lands. These are simple tabular glands thet open to the intstnalIamen heswean tho base ofthe vit, The intestinal glands are sometimes called the erypts uf Lieherkubn. Secretary cells (Paneth cells) with large seidoptilic granules are ound at the base of the intestinal plans Their fonotion Is sil! nt Fully understood, bat i is known tha they secrete lysozyme, whish has sntisbucteriel properties and helps aiatan the gastrointestinal harrier "+ Valves of Kerekring. The lining of the small intestine has permanent folds known as Valves oF Korein or pliae eireulares, These sre most prominent ithe fejumun. These folds, seen macho ‘seopically in transverse seotions, eansitt of rmicosa and stihmucoss ‘Three types of epithelial cells line the microvill ofthe “rush burdes": |, Goblet cele: sesrete mucas, abundant fn ileue, 2 Absorptive cells parisipte in shsoeption, simple colunmar eels, 3. Enteroendocrine cells: secrete enterorastones (secrets and cholecystokinin) ints the Mood: ‘seeam. Abundant inthe duodenum. Remember: 1. Brunner's glands (also called duodenal glands or submucosal glands) are smal, brauched, ‘oils, tubular plands situted deeply inthe submucosa of the duodenu These slands secrete an alkaline mucus to protect the walls ofthe intestinal juice. 2, The Ueumn contains aggregates of mesenteric lympla andes called Peyer's patches, which inter- ‘cept and destroy bacteria before hey ave absorbed by ths digestive trace, iors nto the tumen feonsiiting of swcace epithelim The pancreas is an elongated gland lying behind the stomach and in front of the aorta and inferior vena cava. The large head of the pancreas is fanned by the C-shaped loop of the duodenum. Extending (0 the left from the head eegion are the néck, body, and tail of the pancreas, respectively. The tail meets the spleen on the left of the abdomen, Pancreatic secretions ure collected by the main pancreatic dust (and accessory pamtore= atte dect), which, together with the bile duct, enters the duodenum at the duode! ampulla (ampulla of Vater). Most ofthe digestive process takes place in the duodenum, ‘ue to the action of pancreatic enzymes, ‘The exocrine portion is formed by secretory cells aranged in small sacs called acini, which sesrete digestive cuzymes called panereatic juices into the intestine, ‘The endocrine portion consists of clisters of cells called pancreatic islets (islets of Langerhans), which are scattered among the acini. These cells produce insulin and sslueagon, hormones that promote the cellular uptake of glucose and the breakdown of ulycogen, respectively. 1. Endocrine portion (secrets inio bloodstream) the Following enzymes: pancreatic lipase, amylase, carboxypeptidase, elastase, and chtymotrypsinogen Islets of Langerhans (cell vf pancreas) + Alpha cells: secrete glucagon, which counters the action of insulin + Beta cells scerete insulin, which promotes uptake and storage of glucose 2, Exucrine portion (secretes through duet into duodenum): secretes the following snzymes: panereatic lipase, amylase, carboxypeptidase, elastase, and chymotrypsinogen. *Acinar cells produce enzymes that digest proteins, carbohydrates, and fats, Tryp- sinogen is then converted to trypsin in the small intestine Note: Cholecystokinin js produced by te duodenum and regulates pancreatic juice secretion,ANATOMIC SCIENCES Msi Which muscle separates the anterior cervical triangle from the posterior cervical triangle? + Trapezius + Omohyoid + Mylobyoid + Stemocleidomastoid 59,60,61 107 eae Ser eteieeasene ANATOMIC SCIENCES, Msi All of the longitudinal muscles of the pharynx are innervated by the vagus nerve via the pharyngeal plexus EXCEPT one. Which one is the EXCEPTION? + Stylopharyngeus + Palatopharyngeus + Salpingopharyngeus 108 Conrig © 206-2010 Deal Decksoid ‘The neck ean be further divided into triangles, the two most important being the anterior and posterior cervical triangles. The anatomic borders of the anterior cervical triangle are the medial portion of the stemocleidomestoid muscle, the lower border of the mandible, and the midline of the neck. Important structures within this triangle are the carotid arteries and jugular veins, thyroid gland, esophagus, trachea, larynx, and vagus nerve. The posterior cervical tiangle’s borders are the lateral edge of the sternocleidomastoid muscle, trapezius, and clavicle, Important structures within this region are the subclavian artery end vein, suprascapular artery, and brachial plexus. The posterior triangle of the neck can further be subdivided into. 1. Occipital triangle lying above the inferior belly ofthe omohyoid muscle. Contents includes the spinal accessory nerve (CN XJ) and the superficial cervical cutaneous branches of the cervical plexus. Part of the occipital and parts of the transverse cervical and suprascapular arteries are also found in the cecipital triangle 2. Subclavian triangle lying inferios to this muscle. Contents includes the superior, middie, and inferlor trunks of the brachial plexus, suprascapular nerve, and artery, the subclavian artery and vein as well as the external jugular vein, Important: Muscles thet usually appear in the loor ofthe posterior triangle include the megius scalene, splenius capitis, levator scapulae, and the anterior belly of the omohyoid. *** The stylopharyngeus is innervated by the glossopharyngeal nerve. Muscle Origin Insertion Action Stiopharyagexs: |Siyiid processof tempor [Late md posterior [Elevates he lary end pana bone poaryogeal alls [ring svatowing Patserbaeynacus | Poserir border orinehard | Laryngonbarynand Puls the wall fhe pharyan op pale and fom the palstn | tye entlage ard Acting together, ey pull sponeurosis he pslatophuryngea!achosto ward the mine Salgingopharyngens [Cover part of the eatiage | Fibem pass downward | Asias in clevatng he pana ortte auditory ube | and tend with fe pal phuryaes seeMsi + Fiber + Sarcolemma + Myofibril + Filament + Sarcomere 108 s Cont © 201.2010 Dena Decks ANATOMIC SCIENCES of his peers, He has read his notes meticulously but is still very shaky. After the inferior alveolar nerve injection, he gains confidence and performs the rest of the injections without a hitch. The next day, the classmate whom he performed injections on is complaining of jaw pain and the inability to open his mouth. Which muscle did the nervous student penetrate during the IAN injection, which, along with the masseter forms a sling around the mandible? + Temporalis + Medial prerygoid + Lateral prerygotd * Buceinator - + Posterior belly of the digastric 63,64 & 10 (Coprig © 206.2010 Desa DecksSarcomere Each skeletal muscle fiber is surrounded by a membrane, the sarcolemma. In the muscle fiber's cytoplasm (sarcoplasm) are tiny myofibrils, arranged lengthwise. Bach myofibril consists of two types of finer fibers called filaments (hick myusin filaments ‘nd thin actin filaments), Tae filaments are stacked in compartments called sarcomeres, the functional units of skelctal muscle. During muscle contiaction, the sarcomere shortens when thick and thin filaments slide over each other. ‘The striated pattem that is so characteristic of skeletal muscle directly results trom the structure of the contractile units of the muscle. Each fiber of the muscle is striated and made up of many myofibrils, which are also striated in the same pattern of alternating atk and light bands called the A bands ad I bands, respectively. In the center of each A band is a lighter zone called the HI zone; in the center of each I band is a dark, thin line called the Z tine. The portion of a myofibril between two Z lines constitutes a single contractile unit ered a sarcomere. Each sarcomere is composed of two sets of protein filaments. The thick myosin filaments are located in the A band, The thin actin filaments are located primarily inthe T bands but extend into the A bands, The overlap of the actin and myosin filaments causes the dark coloration of the A bands; actin’s absence fiom the center of the A bands results in the lighter H zone of each A bard. a SSS Sa SSS The angle of the mandible rests in this sling, The medial pterygoid muscle arises from the medial surface of the lateral pte-ygoid piate and inserts on the medial surface of the angle and ramus of the mandible, Important: The medial pterygoid, masseter, and temporalis (mainly anterior portion) elevate the mandible during jaw closing (biting and chewing). |. The superior origin ofthe lateral pterygoid muscle is from the inftatemporal (Notes) crest of tae greater wing of the spheroid bone, and the inferior origin is from “SE the lateral surface of the jateral pterygoid plate of sphenoid bone, Both heeds insert at the articular disc of TMI and neck of mandibular condyle, Remember: + The mandible is protruded by both the action of doth lateral Plerygoid muscles * One muscle causes lateral deviation of the mandible (shifts ‘mandible to opposite side) 2. The masseter muscle originates from the lower border and medial surface of the zygomatic arch. The muscles fibers nm downward and backward to be attached to the lateral aspect of the ramus of the mandible 3. All of the muscles of mastication are innervated by the mandibular division of the trigeminal nerve,ANATOMIC SCIENCES Ms! * Soft palate + Hard palate + Uvule * Glossopalatine arch ‘+ Pharyngopelatine arch oo Cops © 20082610 Dental Dicks ANATOMIC SCIENCES Msi ‘Which of the following muscles pulls the shoulder downward and forward? + Pectoralis major * Pectoralis minor + Teres major © Teres minor * Deltoid * Latissimus dorsi 412 ‘Cong © 2062010 Deol DecksThe palate is the roof ofthe oral cavity, consisting anteriorly of the bony hard palate and posteri- ‘rly of the soft palit, Transverse ridges, called palatal rugae, are located along the mucous menbranes of the hard palate, where they serve as friction bards agsinst which the tongue is placed during swallowing. The uyula Is suspended from the sof palate, During swallowing, the soft palate and uvula are drawn upward, closing the nasopharynx and preventing food ané fluid ‘from entering the nasal cavity. The neurovascular bundle of the soft palate is the lesser pélatine ‘vein, artery, and nerve, The pharyngeal plexus of nerves supplies the uvuler area ‘Notes! 1. The aperture by which the mouth communicates with the pharynx is called the isth= ‘mus fatcium, ft is bounded, above, by the sof pelate; below, by the dorsum of the tongue; and on either side, by the glessopalatine arch. 2. The glossopatstine (palocogiossus) arch (aaterior pilar of fauces or anterior faucial pittar) on cither side runs downward, lateralward, and forward to the side ofthe base of the tongue, and is formed by the projection of the palatoglossas muscle with its cover- ing mucous membrane. 3. The pharyngopalatine (palatopharyngeal) arch (posterior pillar of auces or poste= rior faweial pillar) is larger and projects father toward the middle Line than the anteri~ 6; the pharyngopalatine arch runs downward, lateral, and backward to the side of the Phatyns, and is formed by the projection of the palatophacyngeus muscle, covered by ‘mucous membrane. On either side, the two arches are separated below by a trisngular interval, in which the palatine tonsil is lodged. 3. The palatal salivary glands are found beneath the mucous membrane ofthe hard and soft palate. They are mostly of the mucous type and contribute tothe oral fluid 4. Bifld wvula results (rom: failure of complete fusion of the palatine shelves. A unilat- cally damaged pharyngeal plexus of nerves causes the uyla to deviate tothe opposite side, This s because the uvalar mascle shontens the uvula Wher it contracts and the mus cle on the intact side pulls the wvula toward that side $$$ Muscle Nerve supply ‘Action Pecirais major) veda and tarerel peorcal Aduets the arn and voles A medially nerves from medal snd lateral conts of brechil plexus Pesionlis minor Medial pectoral nerve fom medial | Pulls he shoulder downward and farward cord of brachial plexus atissimislorsi | Thoracodorsal nerve from posterior | Extends adducts, and medlaly cord of brachial plex rotates the arm Denoia Avilla norve (C5 wd C6) Wi he help oF he supraspinais mascie, abducts he upporlimis use shoulce joint FTerseajor | Lower subscapular nerve from Nediailyrotaes and adducts the arm posterior cond of brachial plexus Tere minor [Branch ofanilary nerve averaly rotaies tearm and vabilizes the shoulder jointANATOMIC SCIENCES Msi * Ophthalmic division (7-1) of trigeminal nerve * Maxillary division (V-2) of trigeminal nerve + Mandibular division (¥-3) of trigeminal nerve + Fecial nerve (VI) 10 = opyig © 200.2910 Deol Decks ANATOMIC SCIENCES A S-year-old boy presents to the physician with tonsillitis. As part of her exam, the physician asks the patient to stick out his tongue and say “AAAH,” in order to visualize the tonsils. Which muscle is responsible for the protraction of tongue? + Hyoglossus + Styloglossus + Palatoglossus *Genioglossus mu Const © 208-2910 Dena DassMastication is defined as the physical process of chewing food in preparation for swal- lowing and ultimately digestion. Four pairs of muscles in the mandible make chewing possible. These muscles can be grouped into two different functions. The first group includes three pairs of muscles that elevate the maadible to close the mouth. The second ‘group includes one pair of muscles that works to depress the mandible (drop the jaw), translate the jaw from side to side, and protrude the mandible forward, All are innervated by the mandibular division of the trigeminal nerve (¥-5) -- see note ‘below. They receive blood from ihe pterygoid portion of the maxillary artery. Remember: 1. The masseter, temporalis, and medial pterygoid ~- close the mouth (elevate the mandible) and hence account for the strength of the bite 2, The lateral pterygoid -- opens, shifts (rom side to side), and protrudes the mouth (or mandible), Note: There is one mot ‘aucleus, a special visceral efferent (SVE) nucleus, associated with the trigeminal nerve. Itinnervates the muscles of the first branchial arch, which consists mostly ofthe museles of mastication. They also include the tensor tympani and several other small muscles. The nucleus is located in the mid pons at the level of attach- rent of the trigeminal nerve to the brainstem. Fibers of the trigeminal motor nucleus ‘merge as a separate motor root. Paired extrinsic muscles originate on structures away from the tongue and insert onto it, causing tongue movements during speaking, manipulating food, cleansing teeth, and swallowing. Musete Origin Insertion Action Innervation Geaioglosis| Superior genial | Dorsum oftongue | Protrades apex of wngue | Hypoalons spine of aandibe rough mouth nerve Sistogiossis |Siyoid process of [Lateral sideund) | Draws tngue upward nd |iypogiosal temporal bone | dorsimoP iomgue | backward nerve Hiyoglesses || Body and greatcr | Sideat tongue | Dopreses wngue Hyposiossl emu of hyoid tone Rae Palstorlonis| Peacine Sideortongie | rattsroct of tongue upward | Phacyngeal sponeirosis rd tackwaxl sarows plexus oroptaryngealiethenaeANATOMIC SCIENCE! Msi ‘Most of the muscles that act on the shoulder girdle and upper limb Joints are supplied by branches of the brachial plexus. Which of the following is not? + Levator scapulae + Rhomboid major + Rhomboid minor + Tropezius + Serratus anterior + Pectoralis minor 6 * Subclavius 2 15 \Coprgn © 200.2010 Den Decks A.16-year-old girl who is just about to have her junior prom comes erying into the physician’s office, but is lacrimating only from her right eve. ‘The left half of her face is also paralyzed, and the physician diagnoses her with | Bell’ palsy. An oral exam reveals trauma to her buccal mucosa where her teeth | hhaye bitten her cheek. Which muscle, paralyzed in Bell’s palsy, is responsible for} keeping mucous membranes out of the plane of occlusion and food out of the buceal vestibule? *+ Medial pterygoid + Lateral pterygoid * Buccinator + Masseter + Temporals 70,7172 16 Cony © 20002610 Dental Dicks[Seratveamierior | Pull: scapula Forward and downward Long thoracic vere, whic srs from root C5, 6 and 7 of the brachial plewus Pestomlis minor | Puls the shoulder downward and forward Nediat pectoral nerve from ei contof brachial plexus Subetavis epresses the clavicle and steadis this bone | Nerve te the mabslaviva front uring movements of the shoalder gale he upper trunk the beach! plexus Tapers ‘Suspends tke shoulder gil fom the skull and the | Note fiber from the spiral ‘ertebral cluntn. The upper fibers elevate the [part ofthe ascessory neve and scapula. The middle bers pull the saul Sensory fibers for the thin! medially. The lower fibers pull the rca border [and foun crvial nerves af the seapula downward so thatthe glenoid ea faces upward aad forvaré LevaturScapilac, | Raises the medial border ofthe wcapala Thi ane arth cervical nerves and from the ders seapularnenve (C5) Romito major | Wit the rhomboid minorand levator sapulaeit | Dorsil sanular nerve (C5) slovates the medial border ofthe scape and pulls ie meally Rehomboidmiior | Wit the chomboid major and levator scapula, | Dorsal stapular nerve (eS) slovates the media bard ofthe scapule a pulls Ft medially ‘The buceinator is one ofthe muscles ofthe cheeks und lips. On exch side, the Buseinator has 2 complex origin from: * The maailla along th alveolar process superior to elveolar margin horizontally beween the anterior border ofthe first and third molars * The mandible along the oblique line of the mandible between the first and third moters + The pterygomandibular ligament * The pterygomandibular raphe: a thin, fibrous band running from the hamulus of the redial pterygoid plate down to the mandible It inserts a orbicularisoris and skin at the angle of the mouth, It is raversed by the parotid duct. iis not a prim ‘muscle of mastication ~ it does not move the jaw ~ and this is reflect- cd the buecinator’s motor ianervation from the facial nerve. However, proprioceptive fibers are derived from the buccal brench of the mandibular branch ofthe trigeminal nerve. ‘The actions of the buceinator ate to: 1. Moye boluses of food ou of the vestibule of the mouth and back towards the molar teeth, 2, Tense the checks during blowing and whistling 3, Assist with closure of the mouth — 1. The facial and maxillary arteries supply blood to buceinstor musce. ‘Notesi| 2. Food accumulating in the vestibule might suggest that the buccinator is not Stee working property. 3. I'the point of aneedie enters the parotid gland during aa inferior alveolar injec~ tion and solution is deposited in the gland, the most likely result is paralysis of the buccinator muscle. 4. Damage to the facial nerve orits branches may cause weakness or paralysis of facial muscles called Bell's palsy,