Anatomy Final

Vasculature of the external ear

Arterial supply: branches of ECA Venous drainage External jugular vein Superficial temporal vein Pterygoid venous plexus

Capillary circulation

Arterioles bring blood in. Note, smooth muscle common. Precapillary sphincters regulate blood flow to capillaries. Fluid leaks out of capillaries in early parts of capillary bed. Most fluid returns in later parts of capillaries, and early veinules. Blood begins its return trip in the veinules.

The stapedius muscle is innervated by what?

CN VII

The Internal Jugular vein runs within the carotid sheath along with carotid artery and

CN X (vagus nerve)

Vertical dural infolding Inferior to tenotorium cerebelli Separates cerebellar hemispheres Separates cerebellar hemispheres

Falx cerebelli

Largest dural infolding Lies in the longitudinal cerebral fissure Separates right and left cerebral hemispheres Attached to crest Galli anteriorly, and internal occipital protuberance posteriorly

Falx cerebri

Chordae tendinae

Fibers (heart strings) attatched to the tricuspid and mitral valve which pull it closed when papillary muscles contract, preventing back flow of blood

Pterygium

Fibrovascular, triangular over-growth of bulbar conjunctiva Onto cornea usually progressive Induces astigmatism and vision change (drop in UCVA, BCVA) As it progresses onto cornea, it damages the corneal epithelium as well as bowman's layer is compromised

Integral protein

Globular protein

Complicated Nerve GE VE GA SA VA

Glossopharyngeal Nerve

Emerges from the brainstem from the lateral aspect of the rostral medulla

Glossopharyngeal Nerve

Exits cranial cavity via the jugular foramen

Glossopharyngeal Nerve

Unicellular

Goblet cells

Bony extrusion that form lower bony compartment of the TMJ

Condylar process

Dilated space at internal occipital protuberance

Confluence of sinuses

Creates route for venous blood from superficial face into infra temporal fossa Can spread superficial infections to the pterygoid venous sinus, which has emissary veins to the cavernous sinus

Deep facial vein

Asteroid Hyalosis

Degenerative process Calcium-Lipid complexes collect in the vitreous humor

though thick external fibrous layer Consists of two layers Periosteal: pressed closely against cranial bones Meningeal Innervated mostly by CN V Very well vascularized

Dura mater

Three connective tissue layers of the cranial meninges

Dura mater Arachnoid mater Pia mater

Lined with endothelium Located between periosteal and meningeal dural folds Drain all cranial contents via the internal jugular veins Collect venous blood from Cerebral veins Cerebral veins Veins draining the brainstem Diploid veins: located between internal and external compact bone Emissary veins: venous located outside the cranial activity

Dural Venous Sinuses

Precapillary sphincter

-Cuff of smooth muscle that surrounds each true capillary -Regulates blood flow into the capillary

Which Eyelid Ligaments? attach to superior and inferior tarsal plates

Medial and lateral cantonal ligaments

supplies medial eyelid

Medial palpebral

Function of the two different parts

Medulla secretes epinephrine, which acts on nerve, muscle, and gland cells just as the sympathetic neurotransmitter—but this is spread to all tissues simultaneously via the blood. The medulla can be considered as an enlarged sympathetic ganglion that secretes to the blood stream. Cortex produces steroid hormones; Cortisol does a lot, but is known clinically as a powerful anti-immune and anti-inflammatory hormone. Also known as "stress hormone." Aldosterone acts on the kidney, sweat glands, colon, etc., to conserve sodium, and therefore conserve water in blood. This increases blood pressure.

The brainstem of the central nervous system consists of which structures?

Medulla, pons, and midbrain

What branch of the mandibular nerve: GA enters of the MCF via foramen spinous with middle meningeal artery?

Meningeal branch

In close contact with arachnoid mater Continuous with spinal cord meningeal dural covering

Meningeal layer

opening that transmits the mental nerve (branch of V3)

Mental foramen

aka eminence landmark where two halves of mandible fuses during development usually more prominent in females

Mental protuberance

External features of the mandible

Mental protuberance Mental tubercles

More prominent in males and give a square appearance

Mental tubercles

What nerve carries preganglionic parasympathetic and postganglionic sympathetic fibers?

Nerve of the pterygoid Canal

Choroidal stroma

Pigmented vascularized, loose CT layer, containing melanocytes, fibroblasts, macrophages, lymphocytes and mast cells Haller's layer: outer with large lumina vessels Sattler's layer: medium sized vessels The venues join to become four large cortex veins

Aka hypophysis

Pituitary gland

Transverse Plane

Plane at right angle to both median and frontal plane (cross section)

carina

Point at which the trachea bifurcates (divides) into the left and right mainstem bronchi.

Contains several cranial nerve nuclei contains nuclei that relay signal from the forebrain to the cerebellum Contains nuclei that deal with sleep, respiration, swallowing, bladder control

Pons

contains cranial nerve nuclei, (pons), motor tracts, fourth ventricle

Pons & cerebellum

What fossa consists of the temporal, sphenoid, parietal, and frontal bones?

Temporal fossa

What fossa is superior to infra temporal fossa, which lies inferior to the zygomatic arch?

Temporal fossa

Understanding language Hearing Memory

Temporal lobe

Wernicke's area

Temporal lobe

What joint allows movement of the mandible?

Temporomandibular Joint

What joint articulates with the mandible with the skull by the mandibular condyle and zygomatic part of temporal bone?

Temporomandibular Joint

What joint is medial to the parotid gland?

Temporomandibular Joint

Muscles of the middle ear (2)

Tensor tympani Stapedius

Second largest dural infolding Separates occipital lobes rom the cerebellum Attachments Anterior crinoid process Petrous part of temporal bone Internal surface of occipital bone

Tentorium cerebelli

Paired structure located on lateral aspects of the third ventricle

Thalamus

Diencephalon is made up of?

Thalamus and hypothalamus

Relay information to appropriate brain centers for processing Control pituitary hormones Control hunger, thirst, sleep, sexual response Aka diencephalon

Thalamus and hypothalamus

Iris structure

The size of the pupil regulates the amount of light entering the eye and dependent on the state of the contraction of the intrinsic pupillary muscles the dilator and sphincter pupilae Center of pupil is slightly nasal and inferior

Iris

The lens equator is only 0.5 mm away from the ciliary processes of the pars plicata

Lens and Zonules

The lens is encased in a capsular bag and suspended within the eye by zones (or zonular fibers) Accommodation: the lens changes shape to focus for close up or distance vision

LPI revisited

The risk factors for developing primary angle-closure glaucoma are: • increasing age • increasing lens thickness • female gender • hyperopia • ethnicity (Eskimo, East Asian) Acute angle-closure glaucoma is characterized by rapid increase in IOP. •A patient suffering from acute angle closure will usually present with •severe pain, tearing, photophobia, •blurry vision, halos around lights, •corneal edema, a fixed mid-dilated pupil •IOP of 50-70 mmHg.

Mittendorf's dot

The remnant of the hyaloid vasculature system within the annulus of the ligamentum hyaloideacapsulare

Aortic valve

The semilunar valve separating the aorta from the left ventricle that prevents blood from flowing back into the left ventricle.

Afferent arteriole

The small artery that carries blood toward the capillaries of the glomerulus.

Course of the V2: Maxillary Nerve

Trigeminal ganglion Lateral wall of cavernous sinus Foramen rotundum Pterygopalatine fossa Branches out into several divisions

Passes into orbit outside the common tendinous ring GA innervation to Lacrimal glands Conjunctiva Lateral eyelid Receives hitchhiking post-ganglionic parasympathetic fibers from ptergopalatine ganglio VE innervation to lacrimal gland via greater petrosal branch of CN VII

Trigeminal n. -> Ophthalmic n. -> lacrimal n.

Largest cranial nerve

Trigeminal nerve (CN V)

Most of the scalp is supplied by what nerve?

Trigeminal nerve (CN V)

Sensory root: large root in the pons, part of midbrain, and part of medulla Motor root: separate from the sensory root in the pons?

Trigeminal nerve (CN V)

Large sensory nucleus spans length of brainstem; motor nucleus located in the pons Emerges from brainstem at the lateral aspect of the ponds Suspends four parasympathetic ganglia within the head - its branches will carry hitchhiking post-ganglionic parasympathetic fibers to their target organs Ciliary ganglion Pterygopalatine ganglion Otic ganglion Submandibular ganglion

Trigeminal nerve - CN V

Provides sensory information to the CNS from most head head and neck structures

Trigeminal nerve - CN V

Tympanic cavity

air-filled space within the temporal bone that extends from the tympanic membrane (eardrum) to the lateral wall of the inner ear (located within the petrous part of temporal bone)

True or false In hearing deficits for mechanical bone conduction is still present

True

True or false Two layer of dura are closely associated in all areas except venous sinuses and dural infoldings

True

carry information back to CNS from target organ (sensory)

afferent

The middle ear is filled with ____ and lined with _______

air muscosa

Frontal sinus

air cavity within the frontal bone that is lined with mucus membrane and drains into the nasal cavity via the frontal nasal duct

Emerges from the brainstem inferior to CN IX in the upper medulla

Vagus Nerve - CN X

Exits cranial cavity via jugular foramen (with CN IX)

Vagus Nerve - CN X

Provides VE innervation to many visceral organs below the neck

Vagus Nerve - CN X

complicated nerve GE VE

Vagus Nerve - CN X

Which of the following anatomic names is also used for cranial nerve X?

Vagus nerve

Prevents back flow of nasal fluids

Valve of hasner

Valve attachments-cardiac skeleton

Valve rings-semilunar valves: Pulmonary Aortic Trigone Valve rings-AV Mitral Tricuspid

The cavernous sinus is connected by _________ and ________ intravenous sinuses

anterior and posterior

Ophthalmic artery branches nasal cavity

anterior and posterior ethmoidal arteries

projections of arachnoid mater into the superior sagittal and transverse sinuses for CSF return to the venous system

arachnoid granulations

Thin, avascular membrane Filled with a "web" of collagen - shock absorber Only enters the longitudinal fissure, otherwise not present in any other sulk or fissures Contains cerebrospinal fluid in the subarachnoid space

arachnoid mater

renal hilum

area in the midportion of the kidney where the renal vessels and ureter enter and exit

renal column

area of cortical tissue running between the medullary pyramids

Trigeminal depression

area where the trigeminal ganglion rests on the temporal bone

Eyelid blood supply: ECA Facial artery

arises at the angle of the mandible Terminal branch: angular artery to the medial canthus

coronal suture

articulation with frontal bone

Parietalmastoid suture

articulation with mastoid process of temporal bone

Lambdoidal suture

articulation with occipital bone

sagittal bone

articulation with opposite parietal bone

Sphenoparietal suture

articulation with sphenoid bone

Squamosal suture

articulation with temporal bone

Basal surface

attaches to underlying connective tissue.

In TMJ disorder the pain is carried mainly in what nerve?

auriculotemporal nerve (branch of V3)

Inferior or caudal

away from head

Lateral

away from midline

distal

away from point of origin

An efferent nerve with the nervous system is known to carry information

away from the brain or spinal cord to the periphery of the body

Glomerular (Bowman's) capsule

blind, cup-shaped end of a renal tubule that completely surrounds the glomerulus

renal vein

blood vessel that carries blood away from the kidney and toward the heart

Renal artery

blood vessel that carries blood to the kidney

A venous sinus within the vascular system is a?

blood-filled space between two tissue layers

iridodialysis

blunt trauma to head or eye can cause iris root to tear away

central mass of a bone

body

frontal crest crista galli cribriform plate

bony features of the anterior cranial fossa

Limbus

border between cornea and sclera

Iris stroma and Sphincter

Pigmented (melanocytes) and non-pigmented cells (fibroblast, lymphocytes, macrophages) The sphincter muscle lies within the storm, 1 mm wide, encircling the pupil

The role of caudate nucleus

cognitive processing

The role of the auricle in the external ear

collects sound

Anterior border layer

composed of fibroblast and pigmented melanocytes The number of melanin granules within melanocytes and area they occupy contributes to iris color Brown -> Grey -> Blue -> Green as pigment density decreases

carbohydrate

compound made up of carbon, hydrogen, and oxygen atoms; major source of energy for the human body

What is the curled bone in the lateral wall of the nasal cavity?

conchae

The role of the external acoustic meatus and canal in the external ear

conduct sound to the tympanic membrane

projection of bone located at articulation points

condyle

COST

cones outer segment tips line or IZ- interdigitation zone

Dislocation of lens: ectopic lentis

congenital, developmental, or acquired displacement for the crystalline lens; may be incomplete (subluxation) or complete (luxation) dislocation of the lens into the anterior chamber or vitreous

thin vascularized membrane that covers sclera

conjunctiva

Four types of tissues

connective tissue epithelial tissue muscle tissue nervous tissue

Fibro-fatty layer Contains nerves Blood vessels tightly attached to dense fibrous tissue Wounds bleed profusely due to lack of vasospasm Bleeding is stopped by applying pressure against the bone Firmly attached to overlying skin and underlying aponeurotic layer

connective tissue (dense)

Nucleoulus

contains DNA that controls synthesis of ribosomal RNA

dorsal root ganglion

contains cell bodies of sensory neurons

transparent bulge on the front part of the eye to allow light to enter the eye

cornea

Posterior view

cornea appears circular H and V diameter: 11.7 mm

Keratoconus

corneal dystrophy due to localized disruptions of Bowman's layer, storm thins and weakens and intraocular pressure causes the cornea to bulge and take shape of a cone

Krukenberg's Spindle

corneal endothelium Posterior iris rubbing against zones due to high concavity of peripheral iris Higher risk of secondary glaucoma

Sympathetic

deals with "fight or flight" and fear. Terminal neurotransmitter is Epinephrine. Speeds up heartrate, more blood to muscles, slows down digestion.

Parasympathetic

deals with "rest and digest." Terminal neurotransmitter: Acetylcholine. Slows down heart rate, less blood to muscles, speeds up digestion.

catecholamines

epinephrine fight or flight

Sinus infections can spread via what vein?

ethmoidal vein

Hypoglossal canal

exit for hypoglossal nerve from cranial cavity

Stylomastoid foramen

exit for motor branch of the facial nerve

To visualize the Hippocampus, take a ________ cut from the brain through the temporal lobe

coronal the hippocampus is located in the part of the temporal love that appears to be curled in on itself

unites frontal and parietal bones

coronal suture

Glucocorticoids

cortisol stress hormone; anti-inflammatory

costal parietal pleura

covers internal surface of thoracic wall. Separated from thoracic cavity by endothoracic fascia

Role of the conchae in the lateral wall of the nasal cavity

create turbulence in the inspired air Warms and humidifies inhaled air

perforated by many foramina to allow passage of olfactory nerves into nasal cavity

cribriform plate

thick ridge of bone that projects and serves to anchor flax cerebri

crista galli

Occipital condyles

curved and smooth projections that articulate with the cervical vertebra

Superior and inferior nuchal lines

curved ridges for muscle attachment (SCM, trapezius, occipitals)

Clivus

curved wall of foveal depression leading to foveola

What is the role of Cerebrospinal fluid?

cushions brain and absorbs shocks from blunt trauma nourishes the CNS Removes metabolites from the CNS

Bregma

intersection of coronal and sagittal sutures

Vitreous Base

extends 2 mm anterior to ora serrata and 3 mm posterior 2-3 um thick Collagen extends at the right angle to vitreous base but runs parallel to retina and pars plane and embed firmly in the ILM of the retina Vitreous has its strongest attachment at the vitreous base

Anterior Cortex

extends anterior to the vitreous base and is adjacent to the ciliary body, posterior chamber, and lens

Ciliary zone

extends from collarette to iris root

Posterior Cortex

extends posterior to the vitreous base and is in contact with the ILM of the retina

Which of the following features on temporal bone?

external acoustic meatus

external opening into the auditory canal

external acoustic meatus

ELM

external limiting membrane

prominence of bone at center of occipital lobe, overlies the confluence of sinuses

external occipital protuberance

nephrons

filtering units of the kidney that remove wastes from the blood and produce urine examples of nephrons; Two cortical One Juxtamedullary Note the following—the nephron will include: Renal Corpuscle (Glomerulus with capsule) Proximal convoluted tubule (PCT) Loop of the Nephron (of Henle) Distal convoluted tubule (DCT) DCT's will empty into a collecting duct! (CD not part of the nephron)

How does the Infratemporal fossa communicate with the cranial cavity?

forament ovale and spinosum

Orbital part of the orbiculares oculi muscle that causes eye closure

forceful closure

How does the Infratemporal fossa communicate with the orbit?

inferior orbital fissure

IVC

inferior vena cava

Fetal Nucleus

formed before birth. Contains the Y sutures. Does not increase in size

thoracoabdominal diaphragm

forms partition that separates thoracic cavity from abdominal cavity

shallow depression on the surface of the bone

fossa

irregular space inferior and deep to the zygomatic arch and the ramus of the mandible located posterior to the maxilla contains important neurovascular structures that we will discuss later in the course

infra temporal fossa

The cerebrum is composed of _____ major divisions (lobes)

four

Basilar part

four-sided plate anterior to foramen magnum that articulates with the sphenoid bone

divides body into anterior and posterior parts

frontal

List of all seven pneumatized bones

frontal ethmoid sphenoid maxilla (paired) temporal (paired)

median bony extension that contain foramen cecum

frontal crest

Pyloris of stomach

funnel shaped end that terminates at the pyloric sphincter

Aldosterone

increase blood pressure

Microvilli

increases the surface area of a cell The number and shape correlate with its absorptive capacity

Cerebellar fossa

indentation in occipital bone where the cerebellar lobe lies

Cerebral fossa

indentation in occipital bone where the occipital lobe lies

Jugular Notch

indentation/gap in temporal bone that forms jugular foramen when paired with jugular notch of occipital bone

inward away from body surface

deep

Ophthalmic artery branches top of the nasal bones; anastomoses with angular artery

dorsal nasal branch

Trabecular meshwork

mesh-like structure in the anterior chamber that filters the aqueous humor as it flows into the canal of Schlemm

Filaments of cytoskeleton

microfilaments, intermediate filaments, microtubules

Spindle fibers are

microtubules

Anaphase

microtubules (spindle fibers) pull the chromosomes apart.

apical

microvilli cilia

Surface Modifications

microvilli: 0.1 µm diameter; function—increase surface area - Microvilli are loaded up with proteins to attach to any number of things, that will be picked up and carried into (and through) the cell. Are found on many organs, most notably small intestine (enterocytes) and kidney (proximal tubules). Note, too small to be seen individually by light microscope, but they can be seen collectively. Cilia; 0.25 µm diameter. Function; move mucus along surface of epithelium. - Big enough to be seen individually by light microscopy. Its' center has microtubules which slide against each other to allow them to move back and forth. Purpose to move things along which happen to be in lumen, e.g. Trachea, Uterine (Fallopian) tube.

contains cranial nerve nuclei, cerebral peduncle, cerebral aqueduct

midbrain

separated from anterior cranial fossa by sphenoid crests bounded posteriorly by superior border of petrous part of temporal bones formed by: greater wings of sphenoid bone body of sphenoid bone part of temporal bone part of parietal bone

middle cranial fossa

GE of Vagus Nerve - CN X

motor muscles of pharynx, larynx, uvula, soft palate, superior esophagus (efferent limb of gag reflex)

Abduction

movement away from the median plane

Adduction

movement toward the median plane

goblet cells secrete

mucus

Iris Rubeosis

neovascularization of the iris or AC angle, Seen with ocular ischemia, proliferative diabetic retinopathy. May cause secondary-angle closure glaucoma due to occlusion of the trabecular meshwork

contains the primary visual cortex that allows for vision to occur

occipital lobe

unpaired, located in lambdoidal suture

occipital/posterior

lateral

occluding junctions adhering junctions communicating jcts

Trabecular meshwork (TM)

occupy inner aspect of internal scleral sulcus, triangular shape with Apex at Descemet's membrane (Schwalbe's line) and Base at Scleral spur. • Inner face borders anterior chamber• Outer side faces corneal stroma, sclera, schlemm's canal

vitreous detachment

occurs as aging causes the vitreous gel to slowly shrink

Inhalation

occurs when the diaphragm pulls downward, thus increasing the size of the pleural cavity, requiring air to enter the lungs. When you breathe in, the diaphragm pulls down and the lung expands

Simusitis pain may be misinterpreted as what type of pain?

ocular pain

Meibomian glands

oil glands found in the upper and lower edges of the eyelids that help lubricate the eye

Petrous portion of temporal bone

one of the strongest parts of the skull that houses the inner ear structures

Exhalation

only requires relaxing the diaphragm; elastic forces inside the lung (Water surface tension in the alveoli and elastic fibers in the interstitium of the lung) will collapse the lung and cause you to exhale. The lungs will collapse until the elastic forces of the diaphragm are strong enough to counteract the elastic forces of the lung and stops further exhalation. When the diaphragm relaxes, then the elastic forces in the lung cause it to collapse, and you have exhalation.

Which eyelid layer? Mucus membrane with non-keratinized squamous epithelium Epithelial layer Stratified outer protective layer Contains goblet cells that produce the mucin layer of tear film Stroma Contains accessory lacrimal glands, nerves, and blood vessels

palpebral conjunctiva

Emmetropia

parallel light comes to a focus on the retina

air filled chambers within bone extensions of the respiratory part of the nasal cavity into pneumatized bones named after the bones within which they are located increase in size with age

paranasal sinuses

rest and digest

parasympathetic

VE of Vagus Nerve - CN X

parasympathetic innervation to smooth muscles of trachea, bronchi, digestive tract, cardiac muscle

Where does the inferior petrosal sinus drain?

junction between sigmoid sinus and internal jugular vein

Microtubules

made of multiple subunits of α-tubulin and β-tubulin Microtubules are made of alternating spiral rows of alpha and beta tubulin. Many organelles (particularly vesicles) move along microtubules. The microtubule acts as a curtain rod to direct motion; the molecules Dynein and Kinesin attach to the vesicles and pull them along the microtubule. Colchicine, a drug that prevents microtubule assembly, was once used to treat Gout by preventing exocytosis of proteolytic enzymes from macrophages.

Body of stomach

main central region of stomach

cuboidal

just as tall as it is wide

Ophthalmic artery branches lacrimal gland

lacrimal artery

Located within lacrimal fossa of the frontal bone Palpebral and orbital portions divided by tendon of levator palbebrae superioris (LPS) muscle

lacrimal gland

unites the parietal and occipital bones

lambdoid suture

Location of articulation of the parietal bones and occipital bone

lambdoidal suture

superior mesenteric artery

large abdominal artery; feed large and small intestine The superior mesenteric A. supplies Jejunum, Ileum, cecum, ascending colon, transverse colon.

Crypts of Fuchs

large defects in the anterior border layer are commonly seen

Foramen magnum

large opening for neurovascular structures (medulla oblongata, CN XI, vertebral arteries)

right primary bronchus

larger in diameter than the left and descends at a steeper angle note more vertical aspect

The ears are ________ to the nose.

lateral

What is used to describe an area of the body that is further from the pmedian lane?

lateral

temporal fossa infra temporal fossa

lateral skull landmarks (2)

Pupillary light reflex (PLR) Afferent limb

light on retina -> optic nerve -> brain

functions of the paranasal sinuses

lighten skull weight provide mucus epithelium

Palpebral conjunctiva

lines the eyelids

Melanin pigment

manufactured by melanocytes in the skin, and is found in retinal pigment epithelium. Brown to black color blocks light. Inclusion

Unmyelinated axons are still covered with Schwann cells

many axons covered by each cell.

Simple Cuboidal Epithelium

involved in tubules (which absorb salts and water) and in ducts of various glands Simple cuboidal cells lining kidney tubules Simple cuboidal cells lining ducts of parotid gland

Structures that are on the same side

ipsilateral

colored part of the muffle layer of the eyeball

iris

thin, contractile diaphragm anterior to lens - vascular, pigmented, and muscular

iris

Chromatin

is DNA and portein

Nuclear envelope

is a double membrane that separates the nucleus from the cytoplasm

Inner plexiform layer

is composed go the dendrites of the retinal ganglion cells and the axons of bipolar cells is where the bipolar cells make their synaptic connections with ganglion cells

Upper respiratory tract

is easy to observe, but commonly affected by simple diseases (colds, sinus infections, strep throat, etc.)

Lower respiratory tract

is hard to visualize (need to use auscultation, X-ray or bronchoscope to analyze it) and occasionally prone to problems both major and minor. Major problems are often fatal (pneumonia, cancer, etc.).

Exocytosis

is releasing of vesicle contents that were manufactured within the cell. The body uses small vesicles as the go-between to carry the molecules.

Inner fiber

is the axon of the photoreceptor. Extends from cell body and forms specialized ending, the synaptic terminal

Ileum

is the caudal part of the small intestine but still crainial to the colon

jejunum

is the cranial part of the small intestine

External occipital protuberance

protrusion on posterior aspect of the occipital bone at the site of the confluence of sinuses

rounded elevation of the surface of a bone

protuberance

H-shaped formation of sutures that unite the frontal, sphenoid, temporal, and parietal bones vulnerable to fracture from blunt trauma overlies middle meningeal artery on its internal surface, which can lead to epidural hematoma in cases of trauma

pterion

The Corpus callosum connects what?

right and left cerebral hemispheres

orbital plate

roof of the orbit

Orbital Plate

roof of the orbit, supports frontal lobes of the brain

The role of the Tympanic membrane in the external ear

separates external and middle ear Covered with thick skin externally and mucus membrane internally Moves in response to sound vibrations

Trochlear fovea

small depression in medial wall where trochlea of the superior oblique muscle attaches to the frontal bone

Jugular notch

small indentation in the occipital bone that makes up the jugular foramen with the jugular notch of the temporal bone

Internal occipital protuberance

small protrusion on internal surface of the occipital bone

Detrussor muscle

smooth muscle of the urinary bladder sympathetic: relax (fill) parasymp: constrict (empty)

Visceral/autonomic is made up of

smooth muscles cardiac muscle glands striated muscle from branchial arch origin

Parasympathetic visceral efferents of the ANS structures

smooth muscles and glands of head and neck via CN III, VII, IX, and X

Air conduction

sound waves -> external ear -> ossicular chain -> cochlear duct

pleural cavity

space between the folds of the pleura

Accommodation

spasm, excess, in facility (transient blur, slow responsive accommodation)

vision, hearing, balance, taste, smell (special senses)

special afferent (SA)

Basal membrane

specialization of RPE

Lateral membrane

specialization of RPE

Group of contiguous subcortical structures including Caudate nucleus Putamen Nucleus Accumbens

striatum

loose vascularized connective tissue

stroma

Nasal mucosa warms and humidifies inspired air by increasing blood flow through the mucosa causing a

stuffy nose

site of muscle attachment for the stylohyoid muscle

styloid process of temporal bone

Through which of the following foramina foes the facial nerve pass through the skull?

stylomastoid foramen

GE of the Glossopharyngeal Nerve

stylopharyngeus muscle for swallowing and speech

The Cerebrospinal fluid circulates through what space?

subarachnoid

Vertebral arteries branch off of what arteries?

subclavian arteries

Potential space between meningeal layer of dura and the arachnoid Caused by tearing of a bridging vein secondary to blunt trauma: bridging veins are sheared during acceleration-decerlation of the head Usually located on the opposite side of trauma

subdural hemorrhage

unites parietal and temporal bones

squamosal suture

The stapes is pulled by what muscle to dampen vibrations into oval window?

stapedius muscle

Damage to basal ganglia results in difficulty

starting, stopping, or sustaining movement (Parkinsonism)

Radius of curvature

steeper in center, flatter near periphery

Irregular astigmatism

steepest and flattest meridian are not 90 degree apart (uncommon)

regular astigmatism

steepest and flattest meridians lies 90 degrees apart

Against the rule astigmatism

steepest curvature is in H-meridian (not common, WTR -> ATR-> in old age due to lens change

With the rule astigmatism

steepest curvature lies in V-meridian and the flattest curvature lies in H-meridian

Nucleus

storage of DNA and all of its functions

sphenofrontal suture

the junction between the sphenoid and frontal bones

Iridectomy

surgically a wedge shape full thickness iris tissue is removed

Intracellular lipid

surrounded by a single phospholipid layer, NOT a bilayer as in organelles. Inclusion

sphenoparietal suture

suture between sphenoid and parietal bones

Nasomaxillary suture

suture connecting the nasal bones with the maxillary bone

fight or flight

sympathetic

Nerves of the eyelids VE

sympathetic innervation of Muller's muscle

Internal sphincter muscle

sympathetic: constrict (close) parasympathetic: relax (open)

The outer plexiform layer is where the photoreceptor cells make their

synaptic connections with bipolar cells

S Phase

synthesis phase DNA replication

Phagocytosis

taking in large objects e.g. bacteria the mechanism whereby cells take in large objects. Example; a macrophage taking in a bacteria it encounters near a cut in the skin.

columnar

taller than wide

Arteries carry oxygenated blood to

target organs

SA of Glossopharyngeal Nerve

taste from posterior 1/3 of tongue

Accessory Organs

teeth, tongue, salivary glands, liver, gallbladder, pancreas

The inferior petrosal sinus runs in groove between petrous aspect of __________ bone and basilar part of ________ bone

temporal occipital

Sigmoid sinus forms deep S-shaped grooves in what bones?

temporal and occipital bones

shallow depression on lateral aspect of skull bounded by: superior temporal line, inferior temporal line, frontal bones, zygomatic bone, zygomatic arch contains the pterion

temporal fossa

Where is the amygdala located?

temporal lobe

The aorta arises directly from the heart and descends through the ________ into the abdomen

thorax

How does the Infratemporal fossa communicate with the temporal fossa?

through gap deep to zygomatic arch

The carotid pulse can be palpated by emergency medical service personnel at the level of the?

thyroid cartilage

Primary role of the lymphatic system

transport lymph, which is a clear fluid containing infection-fighting white blood cells

Horizontal section

transverse

Vertebral arteries pass through ______________ of the spinal column

transverse foramina

Where does the superior petrosal sinus drain?

transverse sinus

Name the muscles of mastication

temporalis masseter medial pterygoid lateral pterygoid

Central relay station of sensory impulses from the body to the cerebral cortex

thalamus

Receptor-mediated endocytosis

the cell contains receptors for large molecules and they are endocytose; hormones ,LDL, etc.

Retinal neurons

the cells in the retina of the eye that convert light into images

Posterior Vitreous Detachment

the condition where the vitreous separates from the back of the inner wall of the eye Weiss ring

Cruciform eminence

the cross-like feature where the two transverse sulk and sagittal sulcus meet

Middle meningeal artery: largest supplier of blood Anterior meningeal arteries: branches from ethmoidal arteries Accessory meningeal artery: branch of maxillary artery

vascular supply

Lymphatic system typically follows the course of the

veins

What branches directly from the subclavian arteries on each side?

vertebral arteries

Intercellular junctions Adhering

zonula adherens desmosome Hemidesmosome

Intercellular junctions Occluding

zonula occludens

What is the inferior boundary of the Temporal fossa?

zygomatic arch

formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone, which are united by the zygomaticotemporal suture commonly known as the cheek bone

zygomatic arch

VE of Glossopharyngeal Nerve

parotid gland secretion

Middle ear: infections can spread from the nasal cavity via the

pharyngotympanic tube

Thin, delicate membrane Completely lines all fissures and sulk of the brain Highly vascularized Location of all intercerebrayl hemorrhages Tightly adherent to brain surface cranial nerve roots Tearing/rupturing of pail vasculature leads to intracranial hemorrhage (aka cerebrovascular accident)

pia mater

Pigment dispersion syndrome

pigment granules shed from posterior iris and dispersed into the anterior chamber. If deposit in TM may affect aqueous outflow (pigmentary glaucoma)

The thalamus works closely with the __________ to modulate endocrine activity.

pituitary gland

The Pituitary gland is attached to hypothalamus by the

pituitary stalk

aka infundibulum

pituitary stalk

contact lens effect

pleomorphism and polymegathism was documented after 6- years of GP lens or soft lens wear (cell density remain normal

bones that contain air spaces in the form of air cells or large sinuses in order to decrease the wight of the bone volume of air spaces increases with age seven pneumatized bones are located in the skull

pneumatized bones

Nasion

point of intersection of the frontal bone and inter-nasal suture

Descending colon

portion of the colon that extends downward from the transverse colon

The eye: compartments Vitreous chamber

posterior 5/6 of eyeball, from lens to retina

Its branches will supply the following: superficial ear muscles scalp behind the ear parotid gland tympanic cavity

posterior auricular artery

Somatic is made up of

skin skeletal muscle

Sympathetic visceral efferents of the ANS structures

skin of face and anterior scalp Smooth muscles and glands Blood vessels

Lens zonules

small collagen fibrils arising from the ciliary body that attach to the equator of the lens, securing the lens' position within the eye

Anterior horizontal diameter of cornea

12 mm

Average width of Iris

12 mm

The choroid accounts for

85% of blood flowing through the eye

Area below each concha in the lateral wall of the nasal cavity?

Meatus

Eyelashes (cilia)

Nerve endings of follicles initiate reflex blinking

Articulations of the Zygomatic bone

Temporal Maxillary Sphenoid Frontal

Largest endocrine gland

Thyroid gland

Primary function of choroid

nourishes outer layers of the retina

Parasympathetic fibers originate in

nuclei of specific cranial nerves

Single narrow medial cavity beneath corpus callosum

third ventricle

Incus

"anvil" shaped, located in the middle of the chain

Endothelium

(lines blood vessels), mesothelium (lines body cavities), Type I cells (lines alveoli of lung)

Malleus

"hammer" shaped, the first ossicle in the chain that is attached to the tympanic membrane

Stapes

"stirrup" shaped, located at the end of the chain and attached to the oval window

Optic nerve can be divided into the following regions:

(1) intraocular (prelaminar & laminar) (2) intraorbital(3) intracanalicular (4) intracranial

External Sphincter Muscle

(Skeletal M.) Somatic M. Controlled by α-motor neurons in spinal cord.) This sphincter keeps the urethra closed until you are ready to empty it.

Eyelid Myokymia

(eye twitching): lack of sleep, stress, high caffeine intake, dry eyes (orbiculares oculi muscle)

Cranial Nerve 2

- Axons of the retinal ganglion cells - ~1.2 million myelinated axons make up the optic nerve - ~ 4 cm in length - Passes through optic canal of the lesser wing of the sphenoid bone - Nerve fiber tract of the CNS - Nerve fibers are enveloped by myelin sheath derived from oligodendrocytes (CNS) - Prone to many diseases of the CNS because it is a tract of the CNS

Optic Nerve Atrophy

- A tumor of the pituitary gland will put pressure on the nasal fibers crossing at the chiasm. - This will cause compression atrophy of the nerve fibers, which will cause a whitening of the optic nerve in these areas.

Enveloped by three meningeal sheaths

- Increased CSF pressure in the subarachnoid space can lead to papilledema (causes lamina cribrosa to bulge inward). - The CRV and CRA cross the subarachnoid space (SAS) 12 mm posterior to the eyeball. If CSF is too high, may compress central vein and appear as venous engorgement • Pial sheath sends in septa to support the nerve fasciles as well as the central artery and vein At the apex of the orbit, the optic nerve lies within the muscle cone formed by the four recti muscles and their tendinous origins Pain upon movement with optic neuritis? Intracanalicular portion is 5 mm and travels through the optic canal (optic foramen) formed by the optic struts of the lesser wing of the sphenoid bone with the ophthalmic artery Intracranial portion is 10 mm. After leaving the optic canal, the optic nerve passes within the subarachnoid space of the brain where it will merge with the optic chiasm.

Venous Drainage

- Primarily via the central retinal vein - Some collateral flow through the vortex veins.

Corneal layers: Endothelium

-5 microns thick -Innermost layer of cornea -Hexagonal cells covering the entire posterior cornea -Endothelial cells do not divide or replicate, stretch to cover a defect -The barrier is slightly leaky: allows nutrient flow from aqueous humor e.g. glucose, amino acids as well as water -Excess water needs to be moved out by active metabolic endothelial pump (Na-K-ATPase pump) -Endothelial cells density 1000-2000 cells/ mm sq at 80 years 3000-4000 cells/ mm sq in children 1500-3000 cells/ mm sq in adult 400-700 cells/mm sq needed for function

Corneal layers: Descemet's membrane

-5-15 microns thick, in children 5 microns and thickens to 15 microns -true membrane with an ability to regenerate (PAS +ive) -It terminates at limbus and forms an important circular structure in angles called "Schwalbe's line -Weakens attachments to the neighboring structures (storm and endothelium) Can be detached easily

Corneal layers: stroma

-500 microns thick or 90% of corneal thickness -composed of collagen fibrils, keratocytes, extracellular matrix Keratocytes: maintain stroma by synthesizing collagen and extracellular matrix Other cells: WBC, Macrophage, lymphocytes, PMNs -Fibril bundles form lamellae, which are regularly spaced, runs limbus to limbus, parallel to the corneal surface -Glycosaminoglycans (GAGs): carbs molecules, hydrophilic, attract and bind water (cornea has 78% water)

Vibration of cochlear duct receptors

-> cochlear component of VIII -> brain

Bone conduction

-> cochlear duct

Iris

-Anterior extension of the uvea -Separates the anterior and posterior chambers -Regulates how much light enters the retina -Permits the flow of aqueous humor between posterior. anterior chambers -Clinical evaluation of the iris very important especially in diabetes and glaucoma patients -Provides eye color, it's imprint is unique to each person, used as Biometric ID -Iris divide the space between cornea and lens into the anterior and posterior chamber

Intraorbital Post-Laminar

-The nerve fibers posterior to the globe become myelinated •Oligodendrocytes form the myelin sheath •The myelination, which is completed after birth, causes the optic nerve to approximately triple in size. •Allow for faster neuronal impulses -multiple sclerosis affects vision due to de-myelination of the optic nerve, slowing visual transmission 25 mm in length from posterior eye to optic canal 6 mm longer than distance between posterior surface of eye and optic canal (slack for movement)

Palisades of Vogt

-radial projections of fiber-vascular tissue in spoke like fashion around corneal periphery The interpalisafe region contain thickened epithelium, limbal stem cells reside here Limbal stem cell deficiency Loss of stem cells leading to corneal neovascularization and corneal opacity

Phototherapeutic Keratectomy (PTK)

-uses a laser to treat various ocular disorders by removing tissue from the cornea -allows the removal of superficial corneal opacities and surface irregularities -A number of disorders affecting the corneal surface may be successfully treated by taking advantage of the excimer laser's ability to meticulously remove superficial corneal tissue -treats corneal pathology in the anterior one-third of the cornea (ideally, top 10 to 20 percent -has been approved to treat up to one-third of the cornea, but one-third is pretty deep for PTK

Iris is thickest in the "collarette" region and thinnest at the base

0.5 mm

Central corneal thickness (CCT)

0.53 mm or 530 micron

Peripheral corneal thickness

0.71 mm or 710 micron

How much mucous is produced by the nasal cavity each day?

1 Liter

Cloquet's canal

1-2 mm wide channel running through the center of the vitreous body Contained the hyaloid vasculature during embryonic development It is a differentiated gel devoid of collagen filaments Extends anteroposteriorly from the retrolental space behind the lens to a funnel-shaped area over the optic nerve head (area of Martegani)

The inner nuclear layer contains nuclei of 5 basic types of neural cells

1. Amacrine cells -intermediate synaptic connections between the bipolar and ganglion cells (transfer signal parallel) 2. Horizontal cells -intermediate synaptic connection between bipolar and photoreceptor cells 3. Bipolar cells -Dendrites synapses with PR and horizontal cells, Axon synapses with ganglion and amacrine cells 4. Muller cells -extends throughout retinal layers, supportive role and structure 5. Interplexiform cells -Synapse to Amacrine cells and bipolar cells, provide feedback from inner to outer layers of the retina

Layers of Iris

1. Anterior border layer 2. Iris stroma and Sphincter (not visible) 3. Anterior epithelium and dilator 4. Posterior pigment epithelium

Division of the Lens

1. Anterior lens capsule 2. Anterior Epithelium 3. Anterior surface of adult nucleus 4. Anterior surface of fetal nucleus 5. Inner layer of anterior half of fetal nucleus (Y suture) 6. Inner layer of posterior half fetal nucleus (Y suture upside-down) 7. Post surf fetal nucleus 8. Post surf adult nucleus 9. Posterior line of disjunction 10. Posterior capsule

Cornea has 5 distinguished layers

1. Epithelium 2. Bowman's layer 3. Stroma 4. Descemet's membrane 5. Endothelium

Manufacture of protein on Rough Endoplasmic Reticulum (RER). Note, end result is proteins that fall into one of the following categories:

1. Intrinsic membrane proteins; e.g., cell membrane. 2. Proteins for secretion; e.g., Mucus, digestive enzymes 3. Protein enzymes for lysosomes; as during phagocytosis

Four major functions of eyelids

1. cover the globe for protection 2. Move tears towards drainage at medial canthus upon closure 3. Spread tear film over the anterior surface of the eye upon opening 4. Contain structures that produce the tear film

Three layers of the eye

1. fibrous tunic -Cornea -Sclera 2. Vascular tunic (uvea) -Iris -Ciliary body -Choroid 3. Neural tunic -Retina

Histology of Retina

10 Layers Sensory vs. Neural retina The outermost 10th layer is the retinal pigment epithelium (RPE) Many cell types are located in the retina (photoreceptors, horizontal cells, bipolar cells, amacrine cells, interplexiform cells, ganglion cells and Muller cells)

Eyelid layers

1. skin 2. Subcutaneous areolar layer 3. Orbicularis 4. Sub-muscular areolar fissure 5. Orbital septum 6. Posterior muscular system i. LPS ii. Muller's Muscle (aka superior tarsal muscle) 7. Tarsal plate 8. Palpebral conjunctiva

Anterior vertical diameter of cornea

11 mm

Cone

5-6 million cones Bright illumination (photopic) and color Contain 1 of 3 photopigments (conospins) stored in the disc membrane that are sensitive to different wavelengths of light Cone OS is shorter and more stout than those of rods Cones discs are shed at end of the day and are phagocytosed by RPE The outer segment of cones is enclosed by Plasmalemma as in Rods but it is continuous with membrane-forming most discs

Corneal layers: Epithelium

5-7 cell layers thick, approx. 50 micron Apical (superficial layer) 2-3 layers of flattened, squamous 2-3 layers of "wing" cells: Attach to each other by desmosomes and gap junctions A single layer of columnar basal cells The basal layer cells are the only cell of the corneal epithelium that undergo mitotic division

Posterior central cornea

6.5 mm

How many vertebrae make up the cervical spine?

7

Anterior central cornea

7.8 mm

Corneal layers: Bowman's layer

8-14 micron thick Transition layer to storm, not a true membrane (PAS -ive) It's an acellular membrane Bowman's layer is rigid and provides shape to cornea Resistant to damage by penetrating injury or infection Non-regenerative: if injured ir is replaced by epithelium (PRK) or stromal scar tissue

Rods

92-120 million rods Dim light vision (scotopic) All contain same photo pigment, rhodopsin, which is located in the disc membrane Peak density in a ring 4.5 nm outside the fovea THERE ARE NO RODS IN THE FOVEA Rod OS contains 600-1000 discs Each disc membrane is separate from the plasma membrane, except at the base where the intrados space is continuous with the extracellular space

Vitreous Humor: composition

99% water It is a dilution of salts, soluble proteins, and hyaluronic acid contained within a meshwork of collagen fibers Long non-branching collagen fibers are suspended in a network of hyaluronic acid, which stabilizes the gel structure and conformation of the collagen fibrils The combination of hyaluronic acid and collagen gives it viscoelastic properties (shock absorber) Hyaluronic acid is believed to maintain the wide spacing between the collagen fibrils

The cell membrane

A critical unit of the cell—it keeps the cell contents in place while allowing the cell to interact with its surroundings. This is the EXTERNAL membrane; there are also membrane-bounded organelles inside the cell.

ureter

A duct leading from the kidney to the urinary bladder.

Nerve to stapedius (VII) Nerve to tensor tympani (V3)

GE

Gallbladder

A muscular sac attached to the liver that secretes bile and stores it until needed for digestion Receives bile produced in liver. Concentrates bile by removing water (with some sodium). Stores bile for release. At appropriate signal, secretes bile, through common bile duct, into duodenum for emulsification of fats.

Glycogen

A polymer of glucose, a way to store up sugar for future use. Inclusion

Naming of epithelial cell types

A simple epithelium has only one layer and is named for the cells in that layer: squamous is flat, cuboidal is cube-shaped, and columnar is taller than wide. A stratified epithelium is more than one layer and is named for the layer on top. Stratified squamous has squamous cells on top but a bottom layer of cuboidal cells; stratified columnar has columnar cells on top and cuboidal cells on the bottom.

appendix

A small, fingerlike extension of the vertebrate cecum; contains a mass of white blood cells that contribute to immunity.

lacrimal lake

A triangular space at the medial angle of the eye where tears collect

Hepatic portal vein

A vein connecting the capillary bed of the intestines with the capillary bed of the liver. This allows amino acids and gluocse absorbed from the intestines to be delivered first to the liver for processing before being transported throughout the circulatory system.

Inferior vena cava

A vein that is the largest vein in the human body and returns blood to the right atrium of the heart from bodily parts below the diaphragm.

Bitemporal hemianopia

A visual field defect affecting the temporal half of the field of both eyes.

Inferior mesenteric

A. Left colic A. Sigmoid arteries Superior Rectal A. The inferior mesenteric A. supplies descending colon, sigmoid colon, and branches to the rectum.

Nasal cavity pathways

ACF via cribriform plate Paranasal sinuses Orbit via lacrimal apparatus (nasolacrimal duct) and thin orbital plates of ethmoid bone

Contains only (GE) fibers Innervated lateral rectus muscle Nucleus is located in dorsal pons Emerges from brainstem at junction of pons and medulla (aka pontomedullary junction) Exits cranial activity via superior orbital fissure

Abducens Nerve - CN VI

Main functions of lymph

Absorption of fatty acids from digestive tract Transportation of old leukocytes from lymph nodes to bones Transportation of antigen-presenting cells to lymph nodes to trigger immune response

RPE functions

Absorption of stray light Protection against toxic and oxidative damage Blood-retina-barrier Selective transport of substances to and from the retina Elimination of metabolic waste Processing Vitamin A metabolites

Cilium

Act to move OS towards direct path of light

Web of actin filaments in the cell, often at or near the surface of the cell; change of cell shape.

Actin filaments slide along Myosin molecules to allow motion. They can be used to change overall cell shape, or move proteins in the cell membrane. Filamin interconnects individual actin filalments organizing them into a network. Actin and myosin are the things that make muscle contract.

Orbicularis oris

Acts to pucker lips and shut them tightly Innervated by CN VII

Aka Cranium Composed of 22 bones 21 immovable nones + mandible 21 bones are connected by immovable sutures that ossify during adulthood

Adult skull

To what division of the nervous system does a nerve cell belong if it leads from the eye to the brain carrying visual information?

Afferent nervous system

Mastoid process

Air-filled projection of bone: air cells help equalize pressure in the middle ear Projects downward behind the external acoustic foramen/meatus \Attachment site for the posterior belly of digastric and sternocleidomastoid muscles

bronchioles

Airways in the lungs that lead from the bronchi to the alveoli. no cartilage ciliated columnar epithelium

Ultrafiltrate examples: Does not contain

Albumen Immunoglobins Platelets Blood cells

Cardiac conducting system

All cardiac cells are interconnected. Starting of the heartbeat is self-generated, at a place called the 'cardiac pacemaker' or SA node This is located where the SVC meets the Rt. Atrium. It propagates through the atrium to the AV node, which is in the cardiac skeleton near the septal cusp of the tricuspid valve. The AV node sends the signal to the Bundle of His, in the interventricular septum, and from there to the left and right bundle branches, ending in ventricular muscle and causeing ventricular contraction.

Blockage of portal vein

All veins of the GI tract drain ONLY to the liver. In cirrhosis, the liver is dying, and blood can't get through. In this event, the gut veins have no place to drain to They eventually back up into small anastomoses that lead to the IVC or even SVC.

Mesentary

Allow the organ to be free for motion (e.g. peristalsis) Carry arteries, veins, nerves, and lymphatics

Protein channel (transport protein)

Allows ions in and out

Buccinator

Allows one to puff the cheeks Compresses cheek against teeth to aid in chewing Innervated by CN VII

Houses mandibular teeth

Alveolar process

Problem: getting air into an alveolus

Alveoli are tiny— ½ to ¼ millimeter diameter. Water is held by surface tension, and usually droplets are around 2-3 mm or greater in diameter. To get air into the alveolus, we need to decrease surface tension. The lung does this with an endogenously produced detergent—Surfactant! This decreases surface tension and allows a thinner layer of fluid. Note, there has to be some fluid on the inside of the alveoli, or they will dry out and cease to function properly.

What determines size of cup

Amount of regression of glial tissue surrounding hyaloid vasculature Size of posterior scleral foraman Meniscus of Kuhnt (glial plaque - astrocytes) Inner limiting membrane of Elschnig (astrocytes) ILM of Retina (Muller cell footplates) Where the ILM of the retina meets the ILM of Elschnig is the site of firm adhesion of the posterior vitreous as well as outlines the area of Martegiani • Excessive intermediary tissue of Kuhnt (glial plaque - astrocytes) may give rise to Bergmeister's Papilla

Carbohydrate digestion

Amylase breaks down starch into small di-and tri-saccharides of glucose (e.g., maltose) Maltase enzyme (on microvilli) break maltose into glucose; absorbed. Sucrase enzyme (also on microvilli) break sucrose into glucose and fructose. Lactase enzyme (also on microvilli) break lactose into glucose and galactose. Absence of enzyme is cause of lactose intolerance. End result is monosaccharide (glucose or fructose) which is absorbed through the epithelial cells into underlying capillaries.

RP

An autosomal dominant retinal dystrophy Progressive loss of RPE and PR function Apoptosis: rods and cones Rods: functional in peripheral retina Cones: functional in the fovea "Tunnel vision" Bone-spicule pattern: RPE degenerates and pigment migrates and deposits around blood vessels

PSC

An opaque spot in the posterior pole of the cortex under the posterior capsule of the lens

Pancreas

An organ of dual function Exocrine gland: produces substances that secrete substances to duodenum as part of the digestive process: Bicarbonate --Trypsin Amylase --Lipase Endocrine gland: Hormones produced in small spherical islets (of Langerhans) scattered throughout pancreas. Produces insulin and glucagon for blood sugar control Produces somatostatin for control of hormones it produces

Open vs. closed angle

Angle structures (posterior to anterior) CBB (ciliary body band) SS (scleral spur) TM (trabecular meshwork) Schwalbe's line: Descemet's membrane terminates at limbus and forms "Schwalbe's line" Open angles: If all the structures are visible Closed angles: if TM and posterior structures are not visible

Venous drainage of the eyelid Superior ophthalmic vein

Angular + supraorbital veins _> SOV -> cavernous sinus

Iris blood supply

Anterior Ciliary arteries Long ciliary arteries Major arterial circle Radial blood vessel Minor arterial circle

What are the two boundaries of the cavernous sinus?

Anterior and posterior boundary

What are the accessory muscles of mastication that are innervated by V3?

Anterior belly of digastric Mylohyoid

Systemic Arteries

Arise from Aorta Have high arterial pressure (120/80 mm Hg) Supply all parts of the body Maintains high arterial oxygen pressure (pO2 ~ 100) There are tiny branches to the lung, but the lungs also have their own arteries—Pulmonary AA—that the lung supplies air to.

Anatomical boundaries

Anterior boundaries: Posterior surface of the lens and Retrozonular portion of the posterior chamber (Canal of Petit) Peripherally and Posteriorly: Pars plane, retina, and optic nerve Weigert's Ligament (retrolental ligament) Annular attachment between the posterior lens capsule and anterior vitreous face. Firm attachment, but weakens with age Space of Berger Potential space within the center of Weigert's ligament because the vitreous and lens are juxtaposed rather than joined

Two branches of the Retromandibular vein

Anterior branch: unites with facial vein and drains into internal jugular vein Posterior branch: unites with posterior auricular vein and forms the external jugular vein

Compartments of the eye

Anterior chamber Filled with aqueous humor (200 ul) Posterior chamber Filled with aqueous humor (50 ul) Vitreous chamber Filled with the gel-like vitreous body

part of lesser wing of sphenoid, attachment site for diaphragms sellae

Anterior clinoid process

Internal features of the Sphenoid

Anterior clinoid process Posterior clinoid process Sella turcica Sphenoid sinus Medial and Lateral Pterygoid process

Boundaries of the scalp

Anterior: superciliary arches Posterior:external occipital protuberance Lateral: zygomatic arch & external auditory meatus

What is the source of all the arteries of the head and neck?

Aorta

Aortic valve sound R 2nd intercostal space just lateral to sternum.

Aortic valve sound at heart apex; 5th intercostal space at midclavicular line

Diagram of the aqueous outflow pathway

Apex of the TM is at the Schwalbe's line and is 3-5 layers The base is 12-20 layers that extend into the ciliary body, iris, and scleral spur

Tough layer of dense fibrous tissue Must be stitched if cut because anchoring of superficial layers is lost Fans out and bless into frontal and occipitals (innervated by CN VII) Potential sub-aponeurotic: scalp bleeds will pool underneath the aponeurotic layer into the loose areolar layer

Aponeurotic layer

pseudo-stratified epithelium

Appears greater than one cell which, but all cells make contact with basement membrane

Compartments of the eye

Aqueous chamber: anterior 1/6 of eyeball from cornea to lens Anterior chamber: anterior to iris Posterior chamber: posterior to iris

clear fluid that nourishes the avascular cornea and lens

Aqueous humor

Eyelid secretions Glands of Krause

Aqueous layer Located in fornix

Eyelid secretions Glands of Wolfrig

Aqueous layer Located near tarsal plates

thin intermediate layer

Arachnoid mater

Thin strands of connective tissue Extend down and become continuous with Pia mater Loosely connect the arachnoid and Pia layers

Arachnoid trabeculae

Upper Extremity

Arm (brachium) Shoulder Elbow & Cubit Forearm (Antebrachium) Wrist Hand Digits Pollex (=thumb) Fingers Palmar

Lens-sutures

As the lens increases in size, the lens fibers are unable to stretch the anteroposterior distance, so that progressively more complicated suture pattern are formed

Functions of cardiac skeleton

Attachment of valves Attachment of cardiac muscles Electric isolation of atria and ventricles note-perforated by AV node

External parts of the ear (4)

Auricle External acoustic/auditory meatus Auditory canal Tympanic membrane

Nerve? GA from: skin of temple and ear, TMJ

Auriculotemporal nerve

What nerve of the mandibular nerve: GA carries hitchhiking VE fibers to the parotid gland?

Auriculotemporal nerve

Gonioscopy: Open vs. closed angle

Availability of anterior chamber angle structures is clinically important because angle is the location of exit for aqueous humor, which must be able to flow freely from the anterior chamber. If this exit is blocked, pressure within the eye will increase. The width of the angle can be estimated and graded using slit lamp and a Gonio lens to determine whether the angle appears wide enough to provide easy access to the trabecular

Process and adjust movement information from the cortex

Basal ganglia

subcortical tructures found deep within the brain Consist of five pairs of nuclei that receives information from the cortex about upcoming movement in order to fine-tune movement

Basal ganglia

Located along the cloves in between two layers of dura

Basilar venous plexus

connects the inferior petrosal sinuses that drain the cavernous sinus

Basilar venous plexus

aka mastoid ecchymosis Extravasation of blood underneath the aponeurotic layer, usually along the path of the posterior auricular artery Caused by basal skull injuries Occurs 2-3 days after injury

Battle's sign

Changes in epithelium as you go down the tube.

Below the tracheal bifurcation, the bronchi, like the trachea, have cartilage, pseudostratified ciliated epithelium, and mucous cells. When the tubes become too small to support cartilage, they are called bronchioles. Bronchioles have simple cuboidal ciliated epithelium; the farther down you go (terminal bronchioles) they are very few of them.

Transitional epithelium

Bladder empty, looks like stratified cuboidalWhen bladder full, it's stretched out and it looks like stratified squamous. Bladder, ureter

Arterial distribution within the kidney.

Blood flow into kidney is: Renal A Segmental A. Interlobar A. Arcuate A. Interlobular A. ___ Afferent Arterioles Glomerulus Efferent Arterioles Veinules/Vasa Recta Veins (reverse order above) Interlobular arteries -> afferent arteries -> glomerular capillaries (note filtration!) -> efferent arterioles -> peritubular capillaries and vasa recta

Eye vasculature

Blood supply: ICA -> ophthalmic artery Central retinal artery: pierces CN II Short posterior ciliary arteries: supply the choroid Long posterior ciliary arteries Supply the ciliary and iris Anastomose with anterior ciliary arteries

Branches of the right side of the aorta?

Brachiocephalic artery Common Carotid Subclavian

master organ of the CNS

Brain

The central nervous system consists of which two of the following structures?

Brain and spinal cord alone

Control center for basic bodily functions: respiration cardiac rhythm urination and bowel movements Sexual functions

Brainstem

Information channel between brain and spinal cord Composed of midbrain, pons, and medulla Contains most of the cranial nerve nuclei Produces many of the brain's neurotransmitters

Brainstem

Involuntary reflexes Crucial basic life functions Heart rate Breathing Blood pressure

Brainstem

Corneal touch reflex Efferent

Brainstem -> facial n. -> orbicularis oculi

Eyelid blood supply: ECA Maxillary Artery

Branches in infratemporal fossa Enters orbit through IOF as infraorbital artery Supplies lower eyelid and lacrimal sac Joins angular (ECA) and dorsal nasal (ICA) arteries

GA innervations of nasal cavity

Branches of V1 and V2

ascending aorta

Branches off the left ventricle; carries oxygen rich blood to parts of the body above the heart

arch of aorta

Branches to head, neck, and upper extremities

formation of words

Broca's area

Choroid layers (inner to outer)

Bruch's membrane Choriocapillaris (Capillary layer) Choroidal stroma (Vessel layer) Suprachoroid lamina

compound

Brunner's glands Pancreas Submandibular gland

What are the accessory muscles of mastication that is innervated by VII?

Buccinator Posterior belly of digastric

Atlas

C1

What are the distinctive cervical vertebrae?

C1, C2, and C7

Axis

C2

SA innervations of nasal cavity

CN 1: olfaction

intercranial aneurysm

CN III palsy

Ophthalmic artery branches Eye

CRA Long posterior ciliary Short posterior ciliary

All chambers of the cerebral ventricles are connected to allow flow of what?

CSF inter ventricular foramina

Neurocranium

Calvarium: skullcap, protects the brain Cranial base: skull floor, supports weight of the brain

The role of the pharyngotympanic tube?

Equalizes pressure in the middle ear Drains mucus from middle ear and mastoid air cells

Layers of the lens

Capsule: thin outer membrane Cortex: soft Nucleus: hard center

Major arteries of the body:

Carotid arteries to Head Subclavian artery to shoulder and upper limb. Aorta distributes blood to all other arteries. Common iliac artery to pelvis and lower limb. Femoral artery to lower limb.

Small structure embedded in the vessel wall at the bifurcation of the ECA and ICA Chemoreceptor: detects changes in oxygen and carbon dioxide levels in the blood Innervated by CN IX

Carotid body

Two important structures at the bifurcation of the internal and external carotid arteries

Carotid body Carotid sinus

Visceral afferents of the ANS

Carotid body and sinus (CN IX)

Slight dilation at the bottom of the ICA Baroreceptor: monitors blood pressure Innervated by CN IX

Carotid sinus

Components of the basal ganglia

Caudate nucleus putamen globus pallidus: cerebrum subthalamic nucleus substantia nigra: midbrain

Pseudoexfoliation syndrome

Characterized by ring-like deposits on the anterior lens located at the pupillary margin A flaky material peels off the outer layer of the lens of the eye Onset sixth decade and often presents unilaterally, but may eventually affect the other eye Debris can accumulate in the trabecular meshwork resulting in an increase in IOP for 50% of affected eyes Higher risk of secondary glaucoma

Angiotension II

Causes massive selective vasoconstriction of blood vessels and relocates blood flow to kidneys and stimulates the release of aldosterone (when the sodium is low)

Large Intestine

Cecum—small sac (1 to 6 inches), closed-end, rudimentary fermentation sac. Empties into ascending colon. Appendix—narrow tube, several inches long, serves for accumulation of lymphocytes. Empties into cecum. Colon—long tube, with four parts: ascending, transverse, descending, sigmoid. Serves for water/electrolyte absorption. Empties into rectum. Rectum—usually empty; holds feces until elimination. Empties into anal canal.

Cell Cycle

Cell division cycle: some cells never divide, some divide only when needed to, and some are in constant division.Note, cancers occur most often in cells with frequent cell division, and only very rarely in cells that don't divide. 1. Growth in size, synthesis of mRNA and protein (NB, Histone proteins) 2. Replication of DNA; the need to double DNA to divide 3. Cell growth, protein manufacture. 4. Cells complete mitosis; start over again. Cells that are in more or less constant division have specific hourly timetables that they cycle on.Such cells include bone marrow precursors to red and white blood cells, epithelial cells in gut, and skin cells.

Foveola

Center of the fovea 0.35 mm in diameter Cone concentration is highest here Only outer retinal layers present Foveal reflex

Central region of the retina

Central retina is designed for high visual acuity Has certain structural modifications from the peripheral retina Contains: Macula Fovea Foveola

Branches of the ophthalmic artery within the orbit

Central retinal (CRA) Lacrimal Supraorbital Supratrochlear Anterior ethmoidal Posterior ethmoidal Medial palpebral Long posterior ciliary Short posterior ciliary Muscular branches

Coordinate muscle movement Controls balance Lies beneath tentorium cerebelli in the posterior cranial fossa

Cerebellum

Posture and balance Coordination Skill formation

Cerebellum

ICA: supports most of the cerebrum Vertebral arteries: brainstem, cerebellum, posterior cerebellum

Cerebral vascular supply

The cavernous sinus receives blood from (3)

Cerebral veins Superior and inferior ophthalmic veins Sphenoparietal sinuses

Clear, colorless fluid

Cerebrospinal fluid

Back

Cervical Thoracic Lumbar Sacral

What provides the support for the neck and protects the route of the vertebral arteries and the spinal cord

Cervical spine

Posterior nasal apertures Divided by the vomer Open into the nasopharynx

Choanae

The trigeminal nerve suspends 4 parasympathetic ganglia. What are they?

Ciliary ganglion Pterygopalatine ganglion Otic ganglion Submandibular ganglion

Anastomosis between ICA and vertebrobasilar system

Circle of Willis

extremely important vascular structure at the base of the brain Anastomosis between ICA and ECA Location of an intracranial aneurysm that causes oculomotor nerve palsy

Circle of Willis

Vitreous Humor

Clear, gel-like substance that fills the eye between the lens and the retina Volume 4 mL = 80% of the volume of the eye It is the largest structure of the eye Storage area of metabolites for the retina and lens Provides a medium for movement of metabolites Acts as a shock-absorber due to its viscoelastic properties Transmits and refracts lights

can cause blood to pool underneath the aponeurotic layer into the loose areolar layer Blood will settle in the eyelids and behind the ears

Closed-head trauma

Stratified Squamous Epithelium

Comes in non-keratinized form (esophagus, inner mouth) or keratinized (soft keratin =skin, hard keratin = hair and nails) acts as a barrier, protects against abrasion. Stratified squamous keratinized epithelium of thin skin Stratified squamous keratinized epithelium of thick skin Stratified squamous non-keratinized epithelium of esophagus.

Branches of the left side of the aorta?

Common carotid Subclavian

Pseudounipolar Neurons

Common primary sensory neurons; found in peripheral ganglia (e.g., dorsal root ganglia, trigeminal ganglion, etc.) Peripheral process picks up sensory stimulus, will bypass the actual neuron cell body, and will proceed to the central process to then synapse in the CNS.

Anterior epithelium and dilator

Composed of myoepitheilial cells 3-5 layers of dilator muscle arranged radially ( extends from iris root to midpoint of iris sphincter muscle)

Nasalis

Compresses bridge of the nose Depresses tip of the nose Elevates corners of nostrils Innervated by CN VII

Benign, Bear tracking of RPE

Congenital hypertrophy of the retinal pigmented epithelium (CHRPE) lesions are typically solitary, flat, well-demarcated, hyper pigmented lesions of the retina, seen in a grouped configuration like "bear tracks". Both solitary lesions and "bear tracks" are benign. However, multiple, bilateral lesions can be associated with Gardner's syndrome, an autosomal dominant disease which invariably results in colon cancer by the fifth decade of life

renal pyramid

Conical mass of tissue within renal medulla

light reflex

Consensual reflex Involved circuit in one side )left_ is represented • Retina (visual information) • Visual info is fed to area 17 • Optic tract fibers with direct projection to pretectal nucleus are activated • Pretectum nucleus projects to Edinger-Westphal nucleus bilaterally • E-W nucleus gives rise to preganglionic parasympathetic neurons that synapse in the ciliary ganglion • Postganglionic fibers to sphincter pupillae.

inner segment

Consists of an ellipsoid region. (mitochondria) near the cilium and a hyoid region (endoplasmic reticulum and Golgi apparatus) near outer fiber

Does the medial wall of the nasal cavity consist of bones or cartilage?

Consists of both bone and cartilage

Nervous system cells

Consists of highly irritable cells (nerve cells) in an environment stabilized by an extensive network of support (glial) cells. Basic cells are discussed here. More of these will be discussed with head and neck and ocular anatomy.

Orbicularis oculi

Consists of two parts Causes eye closure Innervated by CN VII

Intermediate zones

Contains fibers that are unbranched, run anteroposteriorly. Fibers arise at the vitreous base that extend and insert into the posterior cortex

Capillary

Continuous capillary—has complete layer of epithelium (endothelium) around it—no gaps or holes. Brain exclusively has continuous capillaries (also called 'entire' or 'nonfenestrated'). Also in muscle, skin, exocrine glands. Fenestrated capillaries have small holes (fenestrate) to increase rate of diffusion of small molecules, such as glucose and amino acids. Found in endocrine glands, intestines, kidney. Capillaries have about the same diameter as red blood cells, forcing them to squeeze through one at a time.

Pyloric sphincter

Controls passage of food from stomach to small intestine

Sutures of the parietal bon

Coronal Sagittal Lambdoidal Squamosal Sphenoparietal Parietalmastoid

Shark-fin shaped feature anterior to mandibular notch

Coronoid process

C-shaped nerve fiber bundle

Corpus callosum

Forms majority of the rood of the lateral ventricles

Corpus callosum

Where is the largest collection of white matter tissue in the brain?

Corpus callosum

The outermost covering go the brain Consist of three connective tissue membranes that envelop the brain and spinal cord Membranes lie between the nervous tissue and bone Primary function is to protect the CNS Form a supporting framework for arteries, veins, and venous sinuses Enclose the subarachnoid space, which is vital for the normal function of the brain

Cranial Meninges

Dorsal body cavities (nervous system)

Cranial cavity—Brain & Brainstem Spinal canal—Spinal Cord

What makes up the PNS?

Cranial nerves Spinal nerves Ganglia

Accessory organs of digestion

Cranial: Salivary glands (Discussed with Head and Neck) Caudal: 3 major organs with multiple functions Liver Gallbladder Pancreas

Head

Cranium Face Orbit Auricle Temporal Oral region

barrier between nasal cavity and anterior cranial fossa, contains a small foramina for the passage of the olfactory bulbs into the nasal cavity

Cribriform plate

Which of the following bony plates is perforated to allow the passage of the olfactory nerves for the sense of smell?

Cribriform plate of the ethmoid bone

Encircles the larynx 360 Attached to inferior aspect of thyroid cartilage via the cricothyroid ligament Attaches to trachea on its inferior aspect Holds upper and lower respiratory tracts together In cases of choking, an emergency procedure is performed that pierces through the cricothyroid ligament to access the trachea and intubate the patient

Cricoid Cartilage

located in the anterior cranial fossa and serves as anchor for the flax cerebri

Crista galli

Medial view of the ethmoid bone

Crista galli Cribriform plate Perpendicular plate

Frontal nerve branches role Supratrochlear

Curves around superomedial margin of orbit Innervates conjunctive, medial eyelid, forehead

Dermatomes

Cutaneous distribution of each spinal nerve. In this position, the details of the dermatomes line up; you can see the logic in how they are arranged.

Coronal (=Frontal) plane

Cuts a vertical section, but this time from left to right; it cuts the body in to front and back halves; view is facing you. As before, superior is on top and inferior is on bottom. Typically left is to your right and right is to your left.

infection of the lacrimal sac, usually due to obstruction of nasolacrimal duct

Dacryocystitis

What is the role of the stapedius muscle?

Dampens oscillations of stapes

What is the role of the tensor tympani muscle?

Dampens vibrations of tympanic membrane

Flow of blood in all tributaries of cavernous sinus is reversible

Danger triangle of face

Spread of infection from superficial face to deep intracranial venous structures is possible

Danger triangle of face

Receive lymph from superficial nodes Conduct lymph back to venous system,

Deep Lymph Nodes

Depressor Anguli Oris

Depresses angle of mouth Innervated by CN VII

Depressor Labii Inferioris

Depresses lower lip Innervated by CN VII

Frown muscles

Depressor Anguli Oris Depressor Labii Inferioris Mentalis

Smallest dural infolding Suspended between anterior and posterior crinoid process Forms roof over hyophysial fossa

Diaphragma sellae

small, valveless veins that channel through the skull bone

Diploid veins

What is the purpose of the medial wall of the nasal cavity?

Divides nasal cavity into right and left halves

supplies side on nose and lacrimal sac

Dorsal nasal

Ophthalmic artery branches Other

Dorsal nasal: lateral nose and lacrimal sac Muscular branches: EOMs Anterior & posterior ethmoidal: nasal cavity

Zygomaticus major

Draws corner of mouth backward, upward, and outward Elevates upper lip Innervated by CN VII

Corrugator Supercilli

Draws eyebrows down and medially Produces vertical wrinkles on the forehead One muscle of frowning Lies deep to orbicularis oculi muscle Innervated by CN VII

Procerus

Draws median angle of eyebrow downward Produces horizontal wrinkles over the bridge of the nose Innervated by CN VII

Risorius

Draws the angle of the mouth back Allows you to make a smile that doesn't involve midface and eyes Innervated by CN VII

accessory duct of pancreas

Duct of Santorini

main duct of pancreas

Duct of Wirsung

RPE phagocytes shed PR discs

Each RPE cell faces 30-40 photoreceptors Rod discs are shed in the early morning Cone discs are shed during evening

Crystalline Lens: three parts

Elastic Capsule Thickest in the body (20 microns thick anteriorly) Lens Epithelium Lens fibers

Anatomic Position

Erect, facing forwards Palms forward Thumb lateral Anterior to front Posterior to back Ventral (= anterior above the knee) Dorsal (= posterior above the knee)

Mentalis

Elevates and protrudes lower lip (as in pouting) Raises chin Innervated by CN VII

Levator Anguli Oris

Elevates angle of mouth Innervated by CN VII

Levator Labii Superioris

Elevates upper lip Innervated by CN VII

What is the role of the Temporalis muscle?

Elevation of mandible

Renal System Function

Elimination of waste products Regulation of blood electrolytes and pH balance. Regulation of blood volume and thereby blood pressure. Hormone production.

Which of the following vascular lesions may result when a clot on the inner blood vessel wall becomes dislodged and travels in the vessel?

Embolus

Lens division

Embryonic Nucleus Fetal Nucleus Adult Nucleus Lens Cortex

Course of the ureter; note points where Kidney Stones get stuck.

End of renal pelvis; ureter posterior to renal A & V. ** Ureter here is anterior to psoas major Ureter passes posterior to gonadal vessels. Ureter crossing over the pelvic brim **, and is adjacent to gonadal vessels. Ureter ends by entering bladder ** from behind. ** indicates places where renal stones frequently get stuck.

simple squamous epithelium

Endothelium Lines heart, blood vessels, and lymphatic vessels Mesothelium Lines body cavities and covers all organs that project inro these cavities

Parasympathetic visceral efferents of the ANS role

Energy conservation Preganglionics: CN III, VII, IX, X Synapse: 4 cranial parasympathetic ganglia or directly on targets Postganglionics: distributed via branches of CN V Salivation, lacrimation, mucous secretion, vasodilation, pupil constriction, accommodation

Sympathetic visceral efferents of the ANS role

Energy expenditure Preganglionics: T1-2 Synapse: cervical sympathetic ganglia Postganglionics: arterial plexuses of ICA and ECA Goosebumps, sweating, vasoconstriction thickening of saliva, pupil dilation

Eyelid blood supply: ICA

Enters through petrous portion of temporal bone Courses through cavernous sinus

AKA epiglottis Located on posterior surface of the larynx Elastic cartilage that looks like a leaf When oral contents are swallowed, it closes over the laryngeal inlet Located between the hyoid bone and the dorsal aspect of the tongue

Epiglottic cartilage

Forms anteromedial floor of the cranium Forms the roof of the nasal cavity and makes up part of the nasal septum Forms part of the medial orbital wall Contains ethmoidal air cells: network of air pockets within the bone that make up the ethmoid sinus Contains superior and middle conchae Narrow curled bones that warm and humidify air Protrude into the breathing passages

Ethmoid

Which bone forms both the superior and middle nasal conchae?

Ethmoid

Flexion Abduction Eversion Pronation Protrusion Elevation Plantarflexion Lateral rotation Circumduction

Extension Adduction Inversion Supination Retraction Depression Dorsiflexion Medial rotation

Begins near angle of the mandible Drains into the subclavian vein Formed by joining of posterior auricular and posterior branch of retromandibular veins

External Jugular Veins

Branch of the common carotid Provides oxygenated blood to the superficial neck, face, and scalp

External carotid artery

Blood supply of the nasal cavity

External carotid artery Maxillary artery Facial Artery Internal carotid artery Ophthalmic artery Anterior and posterior ethmoid artery

Scalp blood supply

External carotid artery Superficial temporal Posterior auricular Occipital Internal carotid artery Supratrochlear Supraorbital

The pathway of sound waves through the ear

External ear Auditory canal Vibrate tympanic membrane Move handle and head of meatus Move incus Push stapes into oval window

Supraorbital notch/foramen Orbital plate Lacrimal fossa Trochlear fovea

External features of the neurocranium frontal bone

External portion that projects from the face Mainly cartilaginous Nares/nostrils anterior opening into the nasal cavity

External nose

Parts of the nose

External nose Nasal cavity

External features of the occipital bone

External occipital protuberance Occipital condyles Foramen magnum Jugular notch Superior and Inferior nuchal lines

Potential space between periosteal layer of dura and skull Typically due to bleeding from blunt heard trauma Herniation can occur within hours if hemorrhage is not evacuated Classical presentation: brief loss of consciousness after injury, followed by lucid period, followed by loss of consciousness, followed by death

Extradural / epidural

signs of CN III palsy

Eye is down and out Complete ptosis Pupil is dilated and non-reactive to light

Originate in two or three irregular rows

Eyelashes

Emerges from brainstem at the pontomedullary junction, lateral to CN VI Has multiple nuclei that are located in the caudal pons Exits cranial cavity via internal acoustic meatus, travels within the facial canal of the petrous part of the temporal bone

Facial Nerve - CN VII

Which of the following cranial nerves is DIRECTLY involved in Bell palsy?

Facial nerve

Structures passing through the parotid gland?

Facial plexus (motor branches of CN VII) External carotid artery: branches into maxillary and superficial temporal arteries within the parotid gland Retromandibular vein

Drains most structures of the face Continuation of angular vein Drains directly into the internal jugular vein Can drain posteriorly into the pterygoid venous plexus via deep facial vein

Facial vein

Lung sounds

Faint sounds, require practice to recognize Superior thorax—apical part of superior lobes Anterior thorax Right--superior and middle lobes, divided by 4th rib. Left—superior lobe and lingula. Note sounds in lingula may be obscured by heart sounds. Lateral and posterior thorax—easiest to hear inferior lobe.

Small intestine

First 10 inches- Duodenum Second part (~2/5 of small gut) Jejunum Tallest villi, tallest plicae, most of digestion occurs here Third part (~3/5 of small gut) Ileum Shorter villi, plicae; Peyer's patches (lymphoid tissue).

Eyebrows

First body hairs produced during embryological development Facial expressions Innervation : facial n. CN VII

Which of the following structures is a short window like opening found in healthy bone?

Fissure

Levator Labii Superiors Alaeque Nasi

Flares nostril and elevates the upper lip Innervated by CN VII

Upper surface of hard palate Palatine process of maxilla Horizontal plate of palatine bone

Floor of nasal cavity

What forms the roof of the mouth?

Floor of nasal cavity

"soft spot" that allows for molding to occur

Fontanelle

Partially covered by cartilage Formed between the sphenoid, temporal, and occipital bones Transmits the nerves to the pterygoid canal

Foramen Lacerum

entrance for middle meningeal artery into the skull

Foramen Spinosum

ovoid in shape, transmits the mandibular nerve (CN V3)

Foramen ovale

most medial foramen on either side of the sphenoid, transmits the maxillary nerve (CN V2)

Foramen rotundum

characteristics of epithelial tissues

Form surface-parallel sheets Rest on basement membrane Sheet, and individual cells, are polarized Cells tightly apposed to each other Avascular Dynamic

zonula occludens (tight junction)

Forms complete encircling girdles around the cell

Small triangular chamber between pons and cerebellum Connects to central canal and runs down the spinal cord

Fourth ventricle

OCT of Retina

From left to right RPE COST EPIS or IS/OS ELM

Articulations of the Nasal

Frontal Maxilla Ethmoid Opposite Nasal

4 branches posterior ro superior orbital fissure in V1: Ophthalmic nerve

Frontal Nasociliary Lacrimal Tentorial nerve to the meninges

Articulations of the sphenoid bone

Frontal Occipital Ethmoid Vomer Parietal (2) Temporal (2) Palatine (2) Zygomatic (2) Maxillae (2)

Main area of inhibition of impulsive behavios Primary motor cortex Broca's area

Frontal lobe

Personality, behavior, emotion Judgment, planning, problem solving Intelligence, concentration, self-awareness Movement (motor cortex)

Frontal lobe

Aka metric suture fibrous joint that divides two halves of frontal bone in infants fuses between 3-9 months of age sometimes the suture may remain in adults, but has not clinical significance

Frontal suture

unpaired, diamond shaped, located in coronal suture

Frontal/anterior

External ear innervation

GA

Innervations of nasal cavity (3)

GA SA VE

What fibers make up the second major division of CN V

GA only

Trigeminal Nerve (CN V) fibers

GA: sensation from most of head and neck GE: motor innervation Muscles of mastication Tensor tympani

Biliary tree

Gall bladder R. hepatic duct L. hepatic duct Common hepatic duct Cystic duct Common bile duct Hepatopancreatic duct Main pancreatic duct Filling Phase Occurs normally during the course of the day, when you aren't eating The liver produces bile, which travels down the hepatic ducts And then goes up the cystic duct to fill the gallbladder. Emptying phase After eating a meal, the gallbladder empties bile into the small intestine to aid in digestion of lipids. The gallbladder contracts as the main duct relaxes, allowing bile to flow down the main bile duct.

Nodes of Ranvier

Gaps in the myelin sheath to which voltage-gated sodium channels are confined.

conscious sensation from skin, skeletal mucosa, and gland mucosa

General afferent (GA)

Components of a nerve

General somatic efferent—skeletal motor axons (cholinergic axons going to skeletal muscle). General somatic afferent—sensory (numerous types, including pressure, vibration, pain (nociception), thermal, Proprioceptive (muscle spindle & Golgi tendon organ), etc. General visceral efferent—sympathetic (autonomic, fight or flight—sweat glands and blood vessels) or Parasympathetic. Note, these autonomics are classified with motor components. General visceral afferent—from internal organs; pain, pressure (baroreception), chemical

Cranial landmarks of the Neurocranium: Frontal bone

Glabella Bregma Nasion

Peripheral Iridotomy

Glc Sx for angle closure or high risk shallow ages -creates an opening in the iris tissue that equalizes the pressure gradient between the posterior and anterior chambers -allows aq H to flow freely into the AC -causes the iris to move away from the angle What happens to the outflow facility of the TM and Uveoscleral route when the pupils are dilated and when they are constricted?

Groove that runs between eyelashes and pores of meibomian glands Most anterior part of Muscle of Riolan Palpebral part of orbiculares oculi Keeps lid margins apposed to globe Surgical division of anterior and posterior portions fo the eyelid

Gray line of the eyelashes

Nerve of pterygoid canal is a union of

Greater petrosal nerve: branch of CN VII Deep petrosal nerve: ICA plexus

Grey or white matter? Nerve cell bodies Dendrites Axon

Grey matter

Through with plane of the body in anatomical position is a midsagittal section taken?

Medial

attachment site for muscles of mastication

Medial and Lateral Pterygoid process

Does the nucleus have a lot of nuclei?

Has many nuclei

Muscular Arteries

Have a conspicuous internal elastic lamina—maintaining pressure when the heart is not contracting at the time. Similarly, the tunica media—smooth muscle layer—holds pressure up and keeps the vessel intact under pressure. Tunica Intima: Endothelial cells Internal Elastic Lamina Tunica Media: Smooth Muscle Tunica Adventitia: Dense irregular C.T.

Vessel Walls—

Have three different layers: Tunica Intima—inner layer, with endothelium (a simple squamous epithelium) and an internal elastic layer. - Endothelilum, internal elastic lamins Tunica media—which is the smooth muscle and maintains pressure. - Smooth muscle and elastic fibers. Note elastic fibers made by smooth muscle cells. Tunica adventitia—which connects the tunica media to the underlying connective tissue.

Anatomic position

Head, gaze, and toes facing forward Arms relaxed at side with palms facing forward Lower limbs close together with feet parallel

Which of the following vascular lesions results in a small amount of blood escaping into the surrounding tissue and clotting?

Hematoma

Located in the middle meatus Crescent shaped groove in lateral wall of nasal cavity Drainage site for: Frontal sinus via frontonasal duct Maxillary sinus

Hiatus semilunaris

Lower Extremity

Hip Gluteal region Thigh Knee (& Popliteal fossa) Leg & Ankle Foot Sole Hallux (=great toe)

Involved in the formation of new memories - one site in the brain where new neurons are made from adult stem cells

Hippocampus

Structures that make up the limbic system

Hippocampus Amygdala Thalamus Hypothalamus Basal Ganglia Cingulate gyrus

General features of the alimentary canal

Hollow tubular structures Most are held in place by mesenteries Mesenteries consist of parietal peritoneum, arteries, veins, lymph ducts, autonomic nerves A few of the organs are affixed to body wall, that is they are retroperitoneal (e.g., ascending and descending colon, duodenum). Contains own nervous system, the enteric nervous system.

Plica semilunaris

Homologous to the nictitating membrane or third eyelid of lower Mammals Allows lateral movements of the eyelid

General Overview

Human visual system is comprised of the: Retina optic nerves optic chiasm optic tracts lateral geniculate nuclei geniculostriate radiations striate (visual) cortex visual association areas & related interhemispheral connections. Vision may be considered the dominant sense considering that the number of axons devoted to the optic nerve alone is 1 million to 2.2 million vs. acoustic nerve that has ~31,000

Collagen of vitreous base

Hyalocytes synthesize hyaluronic acid, proteins, and act as phagocytes. Most numerous at vitreous base Fibroblasts synthesize collagen fibers in the vitreous

Excess CSF in the cerebral hemisphere due to obstruction of CSF fringe or CSF absorption Excess CSF dilates ventricles and thins the cerebral cortex In infants, it results in expansion of the brain and calvaria

Hydrocephalus

U-shaped bone that is formed by fusion of 5 separate components Body Greater Horn (2) Lesser Horn (2) Lies in anterior part of the neck at the level of C3 between the mandible and thyroid cartilage Suspended in the neck from the styloid process by stylohyoid ligaments Forms the base of the tongue and the larynx In the event of strangulation, this bone is most frequently broken

Hyoid Bone

Contains only GE fibers for motor innervation of the tongue

Hypoglossal Nerve - CN XII

Emerges from brainstem on the lateral aspect of the medulla Exits cranial cavity via hypoglossal canal

Hypoglossal Nerve - CN XII

Maintains homeostasis, hormonal regulation, autonomic control, and instinctual drives

Hypothalamus

Fovea

Hz dia 1.5 mm Highest conc. of cones in retina (199,000-300,000/sq mm) Capillary free zone (0.4-0.5mm): allow light to pass through unobstructed into photoreceptor outer segment

Hollow bone that lies in the lateral wall of the nasal cavity Independent bone that arises from the maxilla Purpose is to warm and humidify air Covered with a mucus membrane that produces mucus in certain situations

Inferior Nasal Concha

Corneal nerve architecture

Important role Reflex tearing blink response Maintaining healthy epithelium Important consideration for making LASIK flap Damaged during PRK and LASIK Nerves regenerated from 3 to 9 months after refractive surgery Diabetes patients may have reduced corneal nerves

Osmolarity in loop

In descending loop, starts at 300 mOsM Increases to 1200 mOsM at bottom of loop as water passes out through osmosis. Decreases to ~100 mOsM by top of ascending loop, as sodium and chloride is pumped out.

Lens Capsule

In direct contact with anterior lens epithelium Anteriorly, the capsule is secreted by the anterior lens epithelium Posteriorly, there is no epithelium. So the lens fibers secrete the posterior lens capsule (3 microns thick) Composed of Collagen Type IV embedded in matric of glycoproteins and sulfated proteoglycans (allows the lens to stretch up to 60% of its circumference without tearing NO ELASTIC fibers in the capsule Anterior capsule increases with age 1/3 larger by age 65 2 Main functions 1. Diffusion barrier freely permeable low-molecular-weight compounds (metabolites from aqueous H) 2. Makes the lens pliable to pull of zonular fibers during accommodation

Tear Secretion Reflex

In response to irritants Secreted rapidly to flush the cornea Afferent limb: CN V1; effent limb: CN VII

Golgi apparatus

Incoming vesicles bring in proteins made in RER. The Golgi apparatus adds sugars to proteins manufactured in the rough ER. This directs the cell system to move the proteins to the correct location.

Lagopthalmos

Incomplete closure of eyelids

Superior Cranial Anterior Ventral Medial Proximal Superficial Central Parietal Somatic

Inferior Caudal Posterior Dorsal Lateral Distal Deep Peripheral Visceral

Venous drainage of the eyelid Inferior ophthalmic vein

Inferior ophthalmic vein -> pterygoid venous plexus OR cavernous sinus

located between greater wing of sphenoid and orbital plat of maxilla, transmits the following: Zygomatic and infraorbital nerves (branches of CN V2) Inferior ophthalmic vein

Inferior orbital fissure

What are the foramina of the sphenoid bone?

Inferior orbital fissure Foramen rotundum Foramen ovale Foramen Spinosum Foramen Lacerum

eyelid skin is tethered to underlying periosteum

Inferior palpebral sulcus

Much smaller than the superior sagittal sinus Runs in the inferior concave free border of the fall cerebri Ends at the straight sinus

Inferior sagittal sinus

cristae

Infoldings of the inner membrane of a mitochondrion that houses the electon transport chain and the enzyme catalyzing the synthesis of ATP.

Venous drainage of the eyelid Infraorbital vein

Infraorbital vein -> pterygoid venous plexus

What fossa communicates with all of the following: Temporal fossa Cranial cavity Orbit Pterygopalatine fossa

Infratemporal fossa

What fossa is bounded by mastoid process of temporal bone posteriorly?

Infratemporal fossa

What fossa is bounded by maxilla anteriorly?

Infratemporal fossa

What fossa is concealed behind parotid gland, masseter, and ramus of mandible?

Infratemporal fossa

Nasociliary nerve branches

Infratrochlear Long ciliary Short ciliary

What nasociliary nerve branch reaches these? Conjunctiva Eyelid Lacrimal sac Caruncle Side of nose

Infratrochlear nasociliary nerve branch

Digestion in small gut

Initial digestion in lumen from pancreatic enzymes Lipids—Bile emulsifies fats: Pancreatic lipase breaks down Triglyceride into a monoglyceride and free fatty acids, which diffuse through membrane and are reconstituted as triglyceride in the smooth ER of the epithelial cells. This will be reabsorbed as chylomicrons via the lymphatic system.

Cellular interrelations

Intercellular space Intercellular junctions Lateral cell surface Apical cell surface Basal cell surface Space between two cells ~ 150 angstroms

Bifurcates from common carotid at the level of the thyroid cartilage Enters cranial cavity through the carotid canal of the temporal bone

Internal Carotid Artery (ICA)

Originates at the jugular foramen Largest vein of the neck

Internal Jugular vein

Internal features of the Temporal bone

Internal acoustic/auditory meatus Jugular notch Carotid foramen Trigeminal depression Petrous portion of temporal bone

Branches off the common carotid Enters skull via carotid canal Passes through cavernous sinus Gives off: Ophthalmic artery Posterior communicating artery Anterior cerebral artery Middle cerebral artery

Internal carotid artery

anterior cranial fossa middle cranial fossa posterior cranial fossa

Internal cranial fossae (3)

Frontal crest Foramen cecum Orbital Plate Frontal sinus

Internal features of the neurocranium frontal bone

Internal features of the occipital bone

Internal occipital protuberance Cruciform eminence Hypoglossal canal Sigmoid sulcus Cerebral fossa Cerebellar fossa Basilar part

structures of anterior chamber angle

Internal scleral sulcus: located at internal "corneoscleral junction", house structures eg TM, SC, SS which facilitate aqueous drainage, also known as filtration apparatus Schwalbe's line: anterior most structure, formed by Descemet's membrane Trabecular meshwork (TM): occupy inner aspect of internal scleral sulcus, triangular shape with Apex at Descemet's membrane (Schwalbe's line) and Base at Scleral spur. • Inner face borders anterior chamber• Outer side faces corneal stroma, sclera, schlemm's canal Schlemm's Canal (SC): circular vessel, outer to TM and anterior to SS Scleral Spur (SS): posterior edge of internal scleral sulcus

Optic Nerve

Intraocular Regions Pre-laminar (seen as the optic nerve head clinically) Laminar - the portion that passes through the lamina cribrosa(LC) Intraocular Region Fibers are unmyelinated. However, if myelinated is of no visual consequence. Just makes it more difficult to evaluate the ONH Bigger blind spot Intraocular Region Disc is 1.9 mm Height, 1.5 mm Wide Cup is slightly displaced temporally

Distal Tubule and Collecting Duct.

Involved in final stage of sodium and water recovery. Both DCT & CD; some Na+/K+/Cl- transport; reabsorbs bicarbonate & excretes H+. Collecting Ducts are the terminal sodium/water reabsorption system. Sodium reabsorption from the tubules is dependent on Aldosterone from the adrenal gland. Water pores are dependent on Vasopressin secreted from the pituitary, regulating how much water is lost from the body.

The vascular layer is composed of three structures

Iris (anteriorly) Ciliary body Choroid (Posteriorly)

The barrier between the alveolar lumen and the capillary lumen is as small as is biologically possible, hence it is called a 'minimum barrier'

It consists of only the type I simple squamous cell of the alveolus, and the endothelial cell of the capillary.

Pseudostratified Ciliated Epithelium

It pretends to be stratified but it's not, the poser! e.g., trachea, bronchi Basal cells do not reach surface All ciliated cells reach base

If corneal injury goes into Bowman's later or deeper

It will heal with a scar

Cholesterol

Keeps membrane fluid

What is the point of mucous production in the nasal cavity?

Keeps respiratory tract clean and moist

keratinized epithelium

Keratinization protects against abrasion, desiccation, and microbial invasion Clinical correlation: Ocular cicatrices pemphigoid (OCP)

Organs involved in the renal system

Kidneys Ureters Bladder Urethra

Bbr. Of right coronary A. posteriorly.

L. Ventricular bbr. Right coronary A. Posterior interventricular A. (same as posterior descending A.) Note, pattern of PIA being supplied by the right coronary A. is by far the most common, but is referred to by most physicians as "right dominant."

Paired Smallest bone of the skull Located between frontal process of maxilla and orbital plate of ethmoid Makes up part of the medial orbital plate

Lacrimal

Depression formed by lacrimal grooves of the lacrimal and maxillary bones that houses the lacrimal sac

Lacrimal fossa

Nasolacrimal drainage system

Lacrimal puncta Canaliculi Lacrimal sac

Lies within fossa formed by maxillary and lacrimal bones Located anterior to the orbital septum Dacryocystitis

Lacrimal sac

Golgi Type 1

Large Pyramidal cell Purkinje cell Alpha Motor Neurons 1º Motor or projection

Cephalic vein

Large vein on the outermost side of the upper arm most lateral

Diaphragm

Large, flat muscle at the bottom of the chest cavity that helps with breathing

Atrioventricular valves

Large, floppy valve leaflets connect to papillary muscles by chordae tendineae The chordae tendineae and valves act like parachutes With ventricle relaxed (diastole), blood coming from atria above pushes the leaflets open With ventricle contracting (systole), pressure within ventricle forces valves closed like a parachute.

Anterior papillary muscle

Largest and most constant papillary muscle; arises from anterior wall of ventricle

Most superior part of the respiratory tract and acts as the voice box Surrounds and protects the vocal cords and entrance into the trachea, thus preventing food and fluid from entering the lungs Cartilages of the larynx make up its skeleton Total of 9 cartilages; 3 are paired and 3 are unpaired

Larynx

Terminal bronchiole

Last part of nonrepiratory conducting airway which then subdivides into respiratory bronchioles

supplies lateral eyelid

Lateral palpebral

Eyelid blood supply: ECA Arteries

Lateral palpebral Medial palpebral Dorsal nasal Supraorbital Supratrochlear

Ophthalmic artery branches Eyelid

Lateral palpebral Medial palpebral Supraorbital

What are the muscles of mastication for the Infratemporal fossa?

Lateral pterygoid Medial pterygoid

The occipital condyles are located _______ and _______ to the foramen magnum

Lateral, anterior

Pathway of Oculomotor Nerve (CN III)

Leaves midbrain Travels lateral to posterior communicating artery Enters cavernous sinus wall Divides into superior and inferior divisions to cavernous sinus Enters SOF and passes through annulus of Zinn

Uveoscleral outflow pathway

Leaves through the anterior face of ciliary body in the AC angle Pressure independent Flows between muscle fibers to supraciliary space Exits via sclera and vortex veins Mostly all glaucoma drugs target this pathway to increase outflow

Left coronary A. and branches

Left Coronary A. Circumflex A. L. Marginal A. Anterior interventriacular A. (same as L. Anterior descending A. or LAD) Lateral (Diagonal) Branch of AIA.

Liver, anatomic lobes

Left external (anatomic) lobe Falicform ligament Right external (anatomic) lobe Gall bladder

Internal (physiologic) lobes of liver

Left internal (physiologic) lobe of liver Cantlie's line Right internal (physiologic) lobe of liver

focuses light onto the retina Biconvex Transparent Elastic Made of water and proteins

Lens

Crystalline Lens: Power facts

Lens accounts for + 15-20 D of the total +60 D of the eye Range of Dioptric power is reduced to + 8 D by age 40 (hence onset of presbyopia) +1 to +2 D at age 60 Non uniform index of refraction Due to non uniform distribution of crystalline proteins in the lens fibers

Lens fibers

Lens fibers that lose nuclei then detach from the capsule and are compacted on older fibers towards the center Each fiber is about 10mm long and U-shaped Ends of the fibers meet ends of fibers from the other side of the lens at SUTURES

Passing through nerves of the middle ear

Lesser petrosal Branch of tympanic plexus (IX) to otic ganglion Chorda tympani Branch of VII to submandibular ganglion

Smile muscles

Levator Labii Superiors Alaeque Nasi Levator Labii Superioris Risorius Levator Anguli Oris

Which eyelid layer? Retractor of the upper eyelid Innervated by superior division of CN III Originates on the sphenoid bone Inserts onto the tarsal plates and the skin of the eyelid as levator aponeurosis Fan-shaped tendinous expansion posterior to the orbital septum Fibers penetrate the septum and attach to the tarsal plate and eyelid Divides lacrimal gland into orbital and palpebral lobes

Levator palpebral superioris

External Limiting Membrane

Lies next to the outer edge of the outer nuclear layer Appears a dark line, but actually represents a series of zonula adherent between photoreceptors and between Muller Cells Acts as a barrier to the passage of large molecules Contains Rids and Cons cell bodies IMPORTANT: Cone cell bodies lie in a single layer close to ELM Cell bodies of Rods are arranged in several rows inner to the cone cell body ONL is thickest in the Fovea (10 layers of cone nuclei)

Limbus

Limbal conjunctiva (A) is formed by epithelium (1) and loose connective tissue stroma (2) Tenon's capsule (B) forms a thin, poorly defined connective tissue layer over episclera (C) Limbal stroma occupies the area (D) and is composed of scleral and corneal tissues that merge in this region. Conjunctival stromal vessels are also seen (a). They form peripheral corneal arcades (b), which extend anteriorly to termination of Bowman's layer (arrow). Episcleral vessels (c) are cut in different planes. Vessels forming intrascleral (d) and deep scleral plexus (e) are shown within limbal stroma. Scleral spur has coarse and dense collagen fibers (f). Anterior part of longitudinal portion of ciliary muscle (g) merges with scleral spur and trabecular meshwork. Lumen of Schlemm's canal (h) and loose tissues of its wall are seen clearly. Sheets of the trabecular meshwork (i) are outer to cords of uveal meshwork (j) Iris process (k) is seen to arise from iris surface and join trabecular meshwork at level of anterior portion of scleral spur. Descemet's membrane terminates (double arrows) within anterior portion of the triangle, outlining aqueous outflow system.

Group of brain structures responsible for emotions and memory

Limbic system

Middle parts of the ear (2) Cavity within petrous part of temporal bone

Lined with mucosa Contains ear ossicles

Epithelium

Lines surfaces -Keeps fluid compartments separate from underlying tissues -Can carry water, ions, proteins, etc. from apical membrane to basal surface. -Includes glands, which secrete substances General characteristics -Apical surface -Basal and lateral surfaces -Basal lamina (basement membrane) -Complex junctions connecting cells.

Nerve? GA from: anterior 2/3 of tongue and floor of mouth Suspends submandibular ganglion Carries hitchhiking VE and SA taste fibers from chords tympani

Lingual nerve

Liver functions

Liver functions are related to portal vein and its relationship to the liver and other organs: Manufacture of most blood proteins. Manufacture of bile, in part using billiruben from spleen (byproduct of RBC breakdown). Regulation of blood sugar in correlation with Pancreas. Detoxification of ingested poisons.

Cells are the basic unit of life

Living things can only be described on a cellular basis. Cells have to be tiny (on the scale of 10 µm in diameter or so); too large and their nutritional needs can not be met by diffusion. Cells require water as their solvent. The water from the inside of the cell must be distinct from that outside of the cell; this is the job of the cell membrane.

Where are the muscles of mastication located in?

Located in and around infratemporal fossa

Caruncle

Located medial to plica semilunaris A highly vascular pink nodule of modified skin containing a large nest of the accessory lacrimal and sebaceous glandular tissue Covered with epithelium that contains goblet cells

Zygomaticus minor

Located medial to zygomaticus major muscle Draws corner of mouth backward, upward, and outward to aid in smiling Innervated by CN VII

Lens fibers, Y-sutures

Location where ends of lens fibers meet both anteriorly and posteriorly in the lens; cataracts can form here

Corneal touch reflex Afferent

Long ciliary n. -> nasociliary -> ophthalmic n. -> trigeminal ganglion -> brainstem

What nasociliary nerve branch reaches these? Iris Cornea

Long ciliary: GA, hitchhiking sympathetic fibers

Allow movement of first three layers over the pericranium Extends beneath the orbiculares oculists into the eyelids Bleeding anywhere under the aponeurosis will pool in the eyelids and around the eyes Relatively avascular Danger area of the scalp Blood and pus can pool here Emissary veins connect superficial scalp veins to diploid veins of skull and intracranial venous sinuses

Loose connective/areolar tissue

Binasal hemianopia

Lost nasal halves of visual field from each eye

Interstitial fluid that lubricates all soft tissue structures Can contain pathogens, hormones, and cell debris that needs to return to the venous system

Lymph

bean-shaped structures enclosed in a capsule Collect and filter lymph fluid Contain lymphocytes widely distributed throughout the body

Lymph nodes

Macula densa

Macula densa cells are a part of the tubule that is in transition from thick loop to DCT.

Macula Lutea (Macula)

Macula is 5.5 mm diameter Its center is 3.5 mm lateral to the temporal edge of the optic disc and 1 mm below the center of the disc Appears dark due to the change in RPE morphology (taller and contain more pigment) Yellow hue is often observed due to increased amounts of Xanthophyll (lutein and zexanthin) in the ganglion and bipolar cells, Antioxidant , UV protection

lateral to the optic disc, contains the highest concentration of cone photoreceptors for optimal vision

Macula lutea

Nerve Fiber Layer

Made up of unmyelinated fibers (do not acquire myelination until the axons pass through the lamina cribosa) Increases as one move towards the optic nerve head. All the fibers exit at the optic disc, this it is thicker there The central retinal vessels are located primarily in the NFL/GCL The axons of ganglion cells from the nerve fiber layer

Hydrophobic tails

Maintains the stability of the membrane

Osseous chain of the middle ear

Malleus Incus Stapes

The Incus articulates with what?

Malleus and stapes

What are the three small bones located within the tympanic cavity and that articulate with each other via synovial joints?

Malleus, Incus, stapes

Single facial bone that forms the lower jaw Only freely movable bone of the skull and does not articulate with adjacent skull bones via sutures Articulates with neurocranium at the temporalmandibular joint (TMJ) Only articulates with the temporal bone

Mandible

Which of the following nerves exits the skull through the foramen ovale?

Mandibular

What are the nervous structures for the Infratemporal fossa?

Mandibular nerve Chorda tympani Otic ganglion

What nerve enters infratemporal fossa?

Mandibular nerve (V3)

What nerve is the largest branch of CN V?

Mandibular nerve (V3)

What nerves leaves cranial cavity through foramen ovale?

Mandibular nerve (V3)

What nerve affects the following? Muscles of mastication Tensory tympani (middle ear) Anterior belly of digastric Mylohyoid Suspends parasympathetic ganglion: otic ganglion

Mandibular nerve: GE

Functions of the Digestive System

Mastication (Chewing) Deglutition (Swallowing) Peristalsis (Propulsive movement) Digestion (Chemical breakdown of nutrients) Absorption (Carrying nutrients into bloodstream) Elimination (Passage of undigested matter)

External view of the temporal bone

Mastoid Process Digastric groove Jugular Notch Carotid foramen Styloid process Stylomastoid foramen

Mucosa lined and air-filled space Reserve air supply to lighten mastoid part of temporal bone

Mastoid air cells

Forms the upper jaw Two maxillae fused together at the inter maxillary suture From the anterior view these features are visible Frontal process Orbital Plate Infraorbital foramen

Maxilla

Bones that make up the lateral wall of the nasal cavity (4)

Maxilla Conchae Perpendicular plate of the palatine bone Medial pterygoid plate

Articulations of the lacrimal

Maxilla Ethmoid Frontal

Articulations of the inferior nasal concha

Maxilla Palatine Lacrimal Ethmoid

Second major division of CN V

Maxillary Nerve

Terminal branch of the ECA Complicated artery with three main branches

Maxillary artery

Which of the following is the larger terminal branch of the external carotid artery?

Maxillary artery

What are the vessels for the Infratemporal fossa?

Maxillary artery Maxillary vein Pterygoid venous plexus

Contents of the Pterygopalatine fossa

Maxillary nerve (V2) Terminal part of maxillary artery Nerve of pterygoid canal Pterygopalatine ganglion Veins and lympatics

Hollow space within the maxillary bone Located above the superior teeth and below the cheekbone Largest of the paranasal sinuses Located inferior to the orbit

Maxillary sinus

The Pterygoid venous plexus is drained by what vein?

Maxillary vein

Microtubule Networks

Microtubules are small hollow tubules, of variable length, which are around 23-27 nm diameter. Vesicles attach to them via proteins like Dynein and Kinesin which then carry the vesicle along the microtubules; the microtubule is a vital highway through the cell.

Three main branches of the Maxillary artery

Middle meningeal Muscular branches Infraorbital

How does the maxillary artery supply most of the dura mater? (via what artery?)

Middle meningeal artery

Internal features Parietal bone

Middle meningeal sulcus Sagittal sulcus Pacchionian pits

RPE Functions

Monolayer of polarized cuboidal cells that separate photoreceptors from their underlying blood supply (choroid) Functions Absorption of stray light Protection against toxic and oxidative damage Formation of blood-retina-barrier Selective transport of substances to and from the retina Elimination of metabolic waste

Internal parts of the ear (3) Series of cavities within petrous part of temporal bone

Motion sensors Balance Conversion of mechanical signals into electrical signals for hearing

Which of the following nerves exits the foramen ovale of the sphenoid bone?

Motor root of the trigeminal nerve

Depression

Movement inferiorly

Intortion

Movement inwards toward midline

Extortion

Movement outwards away from midline

Elevation

Movement superiorly

Organization of the alimentary canal

Mucosa Epithelium with glands Lamina Propria Muscularis Mucosae Submucosa Muscularis externa Inner (circular) layer Myenteric plexus Outer (longitudinal) layer Serosa/adventitia Inner lining of the gut; this term is ubiquitous and used EVERYWHERE Muscular part; responsible for peristalsis, sphincters, and includes the primary ganglia of the enteric nervous system.

Pseudostratified ciliated epithelium

Mucus traps particulate matter, water in mucus humidifys air, decreasing size ensures air is warmed. Particulates trapped in mucus get pushed up to the pharynx by the cilia; it is then swallowed and destroyed in the stomach.

Which eyelid layer? Aka superior tarsal muscle Innervated by the sympathetic system Originates on LPS and extends into the tarsal plates Widens palpebral fissure by 2-3 mm The minor retractor of the upper lid

Muller's muscle

Muscle's mobile end Insertion can be via ligament to bone, to subcutaneous tissue, or to skin

Muscle insertion

Fixed Usually skeletal attachment Proximal and medial to muscle insertion

Muscle origin

What muscles act on the TMJ to move the mandible during mastication?

Muscles of mastication

The mandibular nerve: GE is associated with what muscles?

Muscles of mastication temporalis masseter medial pterygoid lateral pterygoid

Describe the roof of the nasal cavity

Narrow Formed by bones and cartilage

Articulations of the ethmoid bone

Nasal (2) Maxillae (2) Lacrimal (2) Palatine (2) Inferior nasal concha (2) Vomer Frontal Sphenoid

Articulations of frontal bone

Nasal (2) zygomatic (2) Lacrimal (2) Maxillae (2) Parietal (2) Sphenoid Ethmoid

Paired Forms the bridge of the nose

Nasal bone

Lined by ciliated, mucus-secreting, highly vascular mucosa

Nasal cavity

From what areas does the Pterygoid venous plexus receive blood from?

Nasal cavity Dura mater Infratemporal and pterygopalatine fossa

What does the maxillary artery which is a branch of ECA supply?

Nasal cavity Most of dura mater Infratemporal and pterygopalatine fossa

The mucous production is continuous from what?

Nasal cavity and paranasal cavity

Which of the following nerves listed below is considered part of the ophthalmic nerve?

Nasociliary nerve

15 mm long travels adjacent to maxillary sinus through nasolacrimal canal Terminates in inferior meatus

Nasolacrimal duct

Lacrimal sac to inferior nasal meatus

Nasolacrimal duct

The pharyngotympanic tube connects middle ear to what?

Nasopharynx

Contains critical features necessary for mastication, taste, hearing, and balance Composed of seven distinct parts: Squamous portion (aka body)l fan-shaped and flat Petrous portion: houses inner ear and is one of the thicket and strongest parts of the cranium; helps form cranial floor Tympanic part: associated with ear canal

Neurocranium: Temporal Bone

Motor output:

Neurons from cortex descend and synapse on alpha-motor neurons in ventral horn, which then exit via ventral root to spinal nerves and thence to muscles.

Lens Cortex

Newly formed fibers that contain nuclei and surround adult nucleus

Blind spot

No PR at optic nerve

A light micrograph of human TM

Non-filtering region Apex may serve as source of stem cells for endothelium lining trabecular beams Filtering region The amount of pigment phagocytosed by the trabecular endothelial cells in posterior or " filtering" meshwork is greater than the anterior or "non- filtering" meshwork.

Pupil diameter

Normal 3-4 mm (normal room illumination) Can vary 1-9 mm under various lighting

Intraocular Pressure (IOP) maintains eye shape and function

Normal IOP :: 15 mmHg Hypertension :: > 21 mmHg

Beating cilia propel mucous through the choanae into the nasopharynx

Normal drainage of secretions

Uppermost part of the respiratory tract

Nose

Internal gastroesophageal sphincter (smooth muscle)

Note ascending and descending leaflets of diaphragm; when damaged, stomach can herniate into mediastinum (hiatus hernia).

PCT other functions

Note, recovers bicarbonate but leaves H+ ions in presumptive urine, making urine acidic and regulating acid-base balance in blood. Secretes Penicillin and Creatinine. (note, creatinine is a derivative of creatin, a compound used in energy balance of muscle tissue). Creatinine clearance is often used as measure of kidney function, as is BUN (Blood Urea Nitrogen, the level of urea in the blood; if high, it's not being cleared by the kidney).

Trachea

Note, the esophagus is always directly behind the trachea. The Trachea consists of many hyaline cartilaginous rings—all horse-shoe shaped. These keep trachea open. On the posterior surface of the trachea is a layer of smooth muscle which allows the esophagus to expand anteriorly when swallowing.

NS...

Nuclear Cataract progression Exaggeration of normal nucleus aging change Causes increasing myopia Increasing nuclear opacification Initially yellow then brown

Epithelial classification

Number of layers simple stratified pseudostratified Cell shape Squamous cuboidal columnar Other transitional

Epithelium-fiber interface

Nutrient and Ion exchange via numerous gap junctions

Which of the following bones forms the jugular foramen along with the jugular notch of the temporal bone?

Occipital

Supplies muscles of the neck and posterior aspect of the scalp Sends meningeal branch to supply meninges of the posterior cranial fossa

Occipital artery

Vision

Occipital lobe

The posterior scalp is supplied by what nerve?

Occipital nerves

Lies in attached border of the falx cerebelli Ends in the confluence of sinuses Communicates inferiorly with internal vertebral venous plexus within the spinal cord

Occipital sinus

Intercellular junctions

Occluding adhering communicating

Nerve? GE: striated muscles of eye and eyelid VE: smooth muscles of eye

Oculomotor Nerve (CN III)

Two nuclei: located in midbrain at the level of the superior colliculi oculomotor nucleus: GE Edinger-westphal nucleus: VE

Oculomotor Nerve (CN III)

The superior orbital tissue transmits what?

Oculomotor nerve (CN III) Trochlear Nerve (CN IV) Abducens Nerve (CN VI) Ophthalmic Nerve (CN V1) Superior ophthalmic vein

Originates as two nuclei that are located in the midbrain Exits cranial cavity via the superior orbital fissure Mixed cranial nerve

Oculomotor nerve - CNIII

Microtubules, intermediate filaments, and microfilaments, all work together to form the cellular microtrabecular lattice which gives internal structure to the cells.

Often you will find junctions between cells of the same tissues; these perform specific functions in that type of tissue. Examples include tight junctions, desmosomes, and gap (communicating) junctions. We'll talk more about these when we discuss epithelia.

Eyelid secretions Meibomian glands

Oily layer Located in tarsal plates

Exits cranial activity via perforation is the cribriform plate of the ethmoid bone Contains onlu special afferent (SA) fibers for smell

Olfactory nerve - CN 1

Semilunar valves

On great artery; attached margin is arched On the great artery, the free margin is straight shape is in a 'half moon,' held down on sides by attached margin. Sinus catches blood During Systole (ventricular contraction), blood moving up pushes valves open During Diastole (ventricular relaxation), blood in great artery starts regurgitation to ventricle; blood catches in sinus, forces valve leaflets closed.

Branches of the Internal Carotid Artery

Ophthalmic Anterior cerebral Middle cerebral Posterior communicating

Nerves of the eyelids GA

Ophthalmic (V1) Frontal: supraorbital, supratrochlear Lacrimal Maxillary (V2) Infraorbital Zygomaticofacial

Three divisions of the Trigeminal nerve - CN V

Ophthalmic (V1): exits cranial cavity via superior orbital fissure Maxillary (V2): exits cranial cavity via foramen rotundum Mandibular (V3): exits cranial cavity via foramen ovale

Bifurcates from the ICA in the cranial cavity Enters orbit via optic canal

Ophthalmic Artery

Articulations of the Maxilla

Opposite maxilla Nasal Lacrimal Zygomatic Frontal Ethmoid Inferior nasal concha Palatine Vomer Sphenoid

Articulations of the Palatine

Opposite palatine Sphenoid Ethmoid Maxilla (2) Inferior nasal concha (2) Vomer

oval, a depressed area in the back of the eyeball where the optic nerve enters

Optic disc

Exits cranial cavity via optic canal Composed of axons of ganglionic cells that are located in the retina At the optic chasm, the nasal fibers from each nerve cross over into the opposite ionic tract contains only (SA) fibers for vision

Optic nerve - CNII

Which eyelid layer? Orbital portion Attaches to orbital margins Used for forced closure of eyelids Palpebral portion spontaneous and reflex blinking Muscle of Riolan: keeps lid margins apposed to globe Muscle of Horner: muscle fibers encircle canaliculi

Orbicularis layer

Ethmoid sinus: can lead to

Orbital cellulitis

Two parts of the orbiculares oculi

Orbital part: muscle encircles orbital rim Palpebral part: muscle forms fleshy eyelid

Anterior View: Ethmoid bone

Orbital plate Perpendicular plate Superior and middle conchae

Which eyelid layer? Dense connective tissue Extension of periorbita Runs from entire orbital rim to tarsal plates of eyelids Restricts fat from falling onto lid margins

Orbital septum

What ganglion fibers travel in tympanic nerve, which re-enters petrous part of temporal bone to form tympanic plexus?

Otic ganglion

What ganglion lesser petrosal nerve arises from tympanic plexus and enters MCF then leaves MCF via foramen ovale and enters same ganglion in deep infratemporal fossa?

Otic ganglion

What ganglion postganglionic fibers distributed to parotid gland via auriculotemporal nerve?

Otic ganglion

What ganglion preganglionic parasympathetics originate in CN IX?

Otic ganglion

VE hitchhikers of the Mandibular nerve

Otic ganglion Submandibular ganglion

Zonular Lamella

Outermost layer of the lens capsule to which the zones will attach

Vitreoretinal interface

Outermost portion of the posterior cortex that contains anchoring fibrils that merge with the internal limiting membrane of the retina, which consists of a basement membrane and the foot processes of the Muller cells of the retina Vitreous attachments are very firm at the VITREOUS BASE, AROUNF THE OPTIC NERVER (WEISS RING), BLOOD VESSELS, AND AREA SURROUNDING MACULA Strands pass through the ILM of the retina to surround the retinal vessels in the nerve fiber layer. This arrangement may cause the hemorrhages that occur due to vitreous-retinal traction

Vitreous Cortex

Outermost portion of vitreous (hyaloid surface) is 100 um thick Composed of densely packed collagen fibrils, cells, protein, and mucopolysaccharides Divided into anterior and posterior cortex via the vitreous base

Corneal edema

Over-hydration of cornea results in corneal edema -> loss of transparency -> corneal haze

What are the 14 bones of the viscerocranium?

Paired Maxilla Zygomatic Nasal Lacrimal Palatine Inferior nasal concha Unpaired Vomer Mandible

What are the 8 bones of the neurocranium

Paired Parietal Temporal Unpaired Frontal Ethmoid Sphenoid Occipital

Paired Located in posterior nasal cavity between the maxilla and the pterygoid plates of the sphenoid bone L-shaped bone that forms the hard palate of the mouth Consists of a vertical and horizontal process Horizontal processes join in the middle with a suture to form the roof of the mouth and articulate with the maxillary bones Vertical processes extend superiorly into the orbit to form a small part of the orbital floor

Palatine

Eyelid surface anatomy structure 28-30 mm wide 9-10 mm in height

Palpebral fissure

the elliptical open space between the eyelids. When closed, the lid margins approximate completely. When open, the upper lid covers part of the iris

Palpebral fissure

What do the leptomeninges consist of

Pia and arachnoid mater

delicate internal vascularized layer

Pia mater

Bilateral optic nerve swelling due to raised intracranial pressure Can be causes by intracranial tumor, intracranial hemorrhage, meningitis, or it can be idiopathic

Papilledema

Hyperopia

Parallel light comes to a focus behind the retina

Myopia

Parallel light comes to a focus in front of retina

Four sinuses named by location Outgrowths of nasal cavity Lined by same mucosa that is found in the nasal cavities Mucus drains from sinuses into nasal cavities

Paranasal sinuses

Site of preganglionic parasympathetics synapses from CN III, VII, IX

Parasympathetic ganglia

VE innervations of nasal cavity

Parasympathetics to mucosal glands: pterygopalatine ganglion Sympathetics for vasoconstriction

Four small glands, two on each side on the posterior aspect of the thyroid Endocrine glands: secrete parathyroid hormone directly into the bloodstream Regulates calcium and phosphorus levels Can alter function of thyroid gland if there is a disease process present Not visible or palpable on a physical exam

Parathyroid Glands

Which of the following bones of the skull is paired? Sphenoid Ethmoid Occipital Vomer Parietal

Parietal

Articulations of the parietal bone

Parietal Frontal Sphenoid Occipital Temporal

Articulations of the Temporal Bone

Parietal Sphenoid Occipital Zygomatic Mandible

Articulations of the Occipital bone

Parietal (2) via lambdoidal suture Temporal (2) via occipitomastoid suture Sphenoid C1 (atlas): articulates with occipital condyles

Sensory information: touch, temperature, pain Interpretation of visual and spatial information Interpretation of language and words

Parietal lobe

main site of visual interpretation Primary sensory cortex

Parietal lobe

Secretes saliva via ________ duct, which sources over master and pierces the buccinator

Parotid duct

What gland is the largest salivary gland?

Parotid gland

What gland is wrapped around the mandibular ramus and bounded superiorly bu the external acoustic meatus and zygomatic arch?

Parotid gland

Innervation distributed to structures in the body wall for voluntary control of body movements

Somatic

How does the transfer sinus pass from confluence of sinuses?

Passes laterally

Frontal nerve branches role Supraorbital

Passes through supraorbital notch/foramen Innervates frontal sinus, upper eyelid, forehead scalp

Periosteum of the skull Thin fibrous membrane that covers all outer bone surfaces Loosely attached to bone

Pericranium

Diastole

Period of isovolumic relaxation. Blood flowing back toward the relaxed ventricles causes the semilunar valves to close, which is the beginning of ventricular diastole Early diastole AV valves closed Semilunar valves closed. Ventricles relax, Ventricular pressure ↓ Passive ventricular filling, The AV valves open and blood flows into the relaxed ventricles, accounting for most of the ventricular filling Mid-diastole AV valves open Semilunar valves closed. Ventricles passively filling.

Firmly attached to the skull Continuous with skull periosteum at the foramen magnum

Periosteal layer

forms part of the nasal septum and makes up the medial wall of the nasal cavity

Perpendicular plate

makes up 1/3 of the nasal septum that forms the medial wall of the nasal cavity

Perpendicular plate

The middle ear is connected to nasopharynx via what tube?

Pharyngotympanic tube

The Cell Membrane—separation between water outside and inside the cell!

Phospholipids—hydrophilic heads interact with water inside and out, hydrophobic tails keep water from freely passing between the two compartments!

Choroid blood supply

Posterior choroid is supplied by 10-20 short posterior ciliary arteries (SPCA) Anterior choroid is supplied by 2 long posterior ciliary arteries (LPCA) and Anterior Ciliary Arteries (ACA) The two systems meet at the equator and are connected with each other via recurrent vessels

attachment site for diaphragma sellae

Posterior clinoid process

The eyelid margin anatomy

Posterior edge Meibomian orifices Gray line (muscle of Riolan) Lash Line Anterior edge

bony projection of the lacrimal bone that creates posterior boundary of the lacrimal fossa

Posterior lacrimal crest

Bones of the Lacrimal

Posterior lacrimal crest Lacrimal fossa

Suprachorid lamina

Potential space between sclera and choroidal vessels Contains collagen bands, fibroblast and melanocytes Can swell without causing detachment Carry LPCA and LPCN from posterior to anterior

Five groups of superficial lymph nodes form a ring around the head and are primarily responsible for lymphatic drainage of the face and scalp

Pre-auricular parotid nodes anterior to ear; drain lymph from the ocular tissues Submandibular nodes Submental nodes Occipital nodes

The Pterygopalatine ganglion contains

Preganglionic parasympathetics from greater petrosal nerve Sensory branches of V2 Postganglionic sympathetic fibers from ICA plexus

Cell Membrane

Primarily composed of phospholipids which create the actual barrier; one layer of phospholipids on the outer surface, one layer on the inner surface. Also called the "phospholipid bilayer." Embedded in the membrane are proteins that perform many functions—hormone receptors, recognition, channels for water and ions. Outside the proteins have carbohydrates added (glycocalyx). Your cells are all sugar-coated. Inside, there are a number of structural proteins attached to the membrane.

Cirrus HD OCT of Retina

Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography

choroid

Principle function: to provide blood supply to the outer layer of the retina Another function Thermoregulatory role Absorption of light by choroidal pigments aids vision by preventing unwanted light from reflecting back through the retina

cellular respiration

Process that releases energy by breaking down glucose and other food molecules in the presence of oxygen

Lens Epithelium: Functions

Proliferates at germinative zone at the equator to form lens fibers The central anterior epithelium is involved in the transport of substances from aqueous humor to lens inferior Secretes the lens capsule

Ocular signs of cavernous sinus thrombosis

Proptosis Redness Periorbital edema

Eyelids (palpebrae)

Protect globe Move tears towards puncture to drain Spread tears over ocular surface House structures that produces oily layer of tear film ( meibum)

functions of epithelial tissue

Protection Secretion Absorption Trans-cellular transport Parallel transport Selective barrier Sensory (innervation) Contraction

Viscerocranium

Protects entrance to the respiratory and digestive system

Specialized epithelium, simple

Pseudostratified epithelium of trachea

Sensory input:

Pseudounipolar neurons have sensory end in skin/muscle, and travel back to cell body in DRG. The axon then continues into dorsal horn.

How does the Infratemporal fossa communicate with the Pterygopalatine fossa?

Ptergomaxillary fissure

What are the contents of the temporal fossa?

Pterion Temporalis and fascia Superficial artery (branch of ECA) Superficial temporal vein

Bony canal opening onto posterior surface of pterygoid process COntinous with cartilaginous covering of foramen lacerum Runs through medial pterygoid plate

Pterygoid canal

Gateways of Pterygopalatine fossa

Pterygoid canal Foramen rotundum Pterygopalatine fissure Communicates with infratemporal fossa Inferior orbital fissure Communicates with floor of orbit

Collection of small anastomosing veins in the infra temporal fossa Drains directly into the maxillary vein, which drains into the retromandibular vein Communicates with cavernous sinus via emissary veins

Pterygoid venous plexus

What vein receives blood from regions supplied by the maxillary artery?

Pterygoid venous plexus

The Skeletal framework walls of what fossa?

Pterygopalatine fossa

What fossa is an inverted tear-drop shaped space?

Pterygopalatine fossa

What fossa is immediately posterior to the maxilla?

Pterygopalatine fossa

What fossa is located between bones of lateral side of the skull?

Pterygopalatine fossa

Largest of four parasympathetic ganglia in the head

Pterygopalatine ganglion

Horner's Syndrome

Pupil constriction Ptosis Redness of skin Facial Anhydrosis

Pathway of light Non-refractive media

Pupil: regulates the amount of light passing into the eye

renal corpuscle

Purpose: to filter our of plasma some water, electrolytes, and small molecules (e.g., urea, glucose, amino acids, etc.). Blood comes in via an afferent arteriole, passes through the capillary network that makes up the glomerulus, and then leaves through the efferent arteriole. Blood flows into glomerulus via afferent arteriole. In glomerulus, some of the plasma filters out of the capillaries; this is termed the Ultrafiltrate. Remaining blood flows out through the efferent arterioles. The Ultrafiltrate remains behind in the urinary space.

The anatomic position

Purpose; to standardize the position of the body so we can further describe the parts in a sensible, overall manner. This is not how you typically stand or walk, but rather how the body is situated in its most basic, simple and useful form. The things that are in front (anterior) are in front, and the things that are in back (posterior) are in back. It is the standard reference for all the basic terminology to come.

Summary of the membrane-bounded vesicle system: rough ER, Golgi, secretory/membrane vesicles.

RER -> Vesicles -> Golgi apparatus -> vesicles -> Terminal location (cell membrane, lysosome, exocytosis)

RPE: dysfunction

RPE digests, recycles shed PR discs If RPE can't do this job it will dump the partially digested materials (hydrophobic) onto the Bruch' membrane - Drusen, if stars within cells = Lipofuscin (increases with age)

posterior projecting part that connects body of mandible with condylar process

Ramus

External features of the mandible

Ramus Coronoid process Condylar process Alveolar process Mental foramen

Pulmonary veins

Receives high oxygen blood from lungs.

Tear Secretion Basal

Regularly secreted to keep cornea moist and nourished Secreted by meibomian glands, sebaceous glands, and conjunctiva

Bergmeister's Papilla

Remnant of glial tissue from the hyaloid vasculature

Choroid neovascular membranes (CNVM)

Results from the break in the Bruch's membrane Due to pathological myopia, Exudative ARMD, Histoplasmosis, Choroidal rupture

Retinal cells

Retina, fovea, rods, cones, iris, cornea, macula

Inner layer of the eye

Retina: innermost layer Optic disc: oval, a depressed area in the back of the eyeball where the optic nerve enters Macula lutea: lateral to the optic disc, contains the highest concentration of cone photoreceptors for optimal vision

Formed by union of superficial temporal and maxillary veins Runs within the parotid gland posterior to the ramus of the mandible Divides into two branches as it leaves the parotid gland

Retromandibular vein

Peristalsis

Rhythmic contraction of smooth muscles causing movement of bolus.

cilia

Rhythmic, beating appendage Beating cilia move particulates parallel to cell surface

The smallest cellular organelle.

Ribosome Consists of two parts, a large subunit (60S) and a small subunit (40S). For an overall 80S. Each subunit is held together by RNA (Ribosomal RNA, or rRNA). This also interacts with mRNA and tRNA. A messenger RNA fits between the two subunits and moves along a groove; this mRNA will bind to tRNA's carrying amino acids and will catalyze the formation of proteins in a growing chain. The ribosome is really the only way one can make proteins thus they are critical in cell function. Ribosomes can be free in the cytoplasm and make cytoplasmic proteins, or attached to endoplasmic reticulum and make proteins which are associated with the membranes, intracellular and extracellular.

heart position in chest:

Right border alongside Rt. Side of sternum Left border from adjacent to chest at 3rd rib to 5th intercostal space at midclavicular line. Inferior border; sits on diaphragm, at xiphisternal junction.

Right coronary A. and branches.

Right coronary A. SA nodal A. Conus branch. Atrial branch. Right marginal A.

Optic nerve: C/D ratio

Rim = should be pink (vascularized) Between cup and outermost edge of optic disc.

Disc Shedding

Rod discs are shed in the early morning Cone discs are shed during the evening Discs are then phagocytksed by the RPE

Spectra

Rods: 500 nm Cones: 420 nm (blue) 531 nm (green) 588 nm (red)

PR Synaptic Terminals

Rods: Inner fibers five way to spherule (synapses with rod bipolar cell and process of horizontal cell) Cones: Inner fibers give way to pedicle (synapses with several interneurons)

Platysma

Runs from the neck to the mouth Superficial to most structures of the neck Raises skin of the neck Allows individual to grimace Innervated by CN VII

Surgical treatment

SLT (Selective Laser Trabeculoplasty), small laser (cold laser only absorbed by pigmented tissue) holes are made in TM to increase fluid movement Trabaculectomy, A wedge of meshwork is surgically removed and a scleral flap is made, aqueous can drain and accumulate to be absorbed into episcleral tissue Can lower IOP by 30%, 1-3 months for results to appear Endoscopic cyclophotocoagulation (ciliary body), reduces aqueous production by using laser to damage tissue of ciliary processes

Anatomic Planes

Sagittal Mid-sagittal (Median) Parasagittal Transverse (X-section, Horizontal) Coronal (frontal) Oblique In clinical practice, 'sectional' techniques such as MRI and CT will be among your most useful tools. Know the planes and how to interpret from them.

Inhalation muscles

Scalene and intercostal muscles can assist the diaphragm by increasing the diameter of the chest, making for more air inspiration.. Forcible exhalation occurs using other intercostal muscles; additionally, abdominal muscles compress abdominal viscera, forcing the diaphragm up.

Structures of the eye

Sclera Conjunctiva Cornea Iris Pupil Lens

Eyelid secretions Glands of Zeis

Sebaceous secretion Eyelash lubrication Located at base of hair follicle

Aqueous Humor

Secreted by Ciliary Body (Q = 2.5 uL/min) Flows through Pupil Flows through Outflow Pathway Enters veins on surface of eye

overlies the sphenoid sinus and houses the pituitary gland

Sella turcica

Orbital surface of the maxilla

Separated from the sphenoid bone by the inferior orbital fissure Contains the infraorbital groove/sulcus that becomes the infraorbital canal and terminates on the facial surface as the infraorbital foramen The maxilla is the weakest along the infraorbital canal

Tenon's capsule

Sheet of dense connective tissue encases the globe It lies between conjunctiva and episclera

What nasociliary nerve branch reaches these? Ciliary body Iris sphincter

Shirt ciliary: GA, hitchhiking sympathetic and parasympathetic fibers

Iris

Single Arrow = terminus of Bowman's layer Double arrows = Schwalbe's line ( Where Descemet's membrane terminates and TM originates ) f = Scleral spur( posterior margin of TM) g = longitudinal bundle of the ciliary muscle

Iris Drawing of the limbus

Single Arrow = terminus of Bowmans layer Double arrows = Schwalbe's line ( Where Descemet's membrane terminates and TM originates ) f = Scleral spur( posterior margin of TM) g = longitudinal bundle of the ciliary muscle

Smooth muscle structure and function

Single elongated cell, no striations Single nucleus Communicating junctions, external lamina Acts as a unit: when one muscle cell contracts, the entire mass contracts.

Adrenal (Suprarenal) glands

Sits on top of the kidneys, between it and vertebra. Is NOT connected otherwise to kidneys; operates as a completely separate gland. Two glands in one!!! An outer layer that produces the steroids (e.g., cortisol, aldosterone, and androgens) is called the 'cortex.' An inner layer that releases catecholamine (epinephrine) is called the 'medulla.' Other than by location, the two parts are otherwise unrelated to each other.

Small pyramidal space inferior to the orbital apex and deep to the infratemporal fossa

Skeletal framework

Which eyelid layer? Contains fine hairs, sweat glands, and sebaceous glands Thinnest skin in the body Does not contain any fat

Skin

Order of the scalp

Skin Connective tissue Aponeurosis/Galea Aponeurotica Loose connective/areolar tissue Periosteum

Pupillary aperture (pupil)

Slightly displaced inferonasally Ranges from 1-9 mm

Pinguecula

Slightly elevated mass of modified conjunctival tissue usually at 3 and 9 o'clock change in the submucosal layer of epithelium changed

Golgi Type II

Small Stellate cell Cell of Martinotti Horizontal cell Granule cell 1º Interneuro

Simple

Small and large gut Stomach sweat glands sebaceous glands

Endoplasmic Reticulum.

Smooth ER: multiple specialized functions. Often for assembly of phospholipids to make membrane. Other functions in other cells. Smooth ER lacks ribosomes Rough ER: Manufacture of membrane proteins. Ribosomes on outer surface. Ribosomes are attached to the cytosolic side of rough endoplasmic reticulum

ANS innervates what?

Smooth muscle (walls of blood vessels, muscles of iris) Cardiac muscles Glands

Glandular epithelialium

Specialize epithelium: ability to secrete bodily fluids Glands can be unicellular or multicellular gland secretion can be serous, fluid, mucoid, or combination

Choriocapillaris

Specialized capillary bed, single layer of anastomosed, fenestrated capillaries with wide lumina They are densest at the macula Unique to the choroid. contains pericytes (proved local blood flow regulation)

Supero-posterior to superior concha Opening for sphenoid sinus into nasal cavity

Sphenoethmoidal recess

Openings into nasal cavity (3)

Sphenoethmoidal recess Hiatus semilunaris Nasolacrimal duct

Large contribution to the floor of the cranium Bridging bone: unites neurocranium and viscerocranium Strengthens sides of the skill

Sphenoid

Which is a single bone located at the midline of the skull?

Sphenoid

Which of the following bones of the skull is considered a cranial bone?

Sphenoid

air-filled space within the body of the sphenoid

Sphenoid sinus

Contains GE fivers only for motor innervation of trapezius and sternocleidomastoid muscles

Spinal Accessory Nerve - CN XI

Enters skull via foramen magnum Exits skull via jugular foramen (along with CN IX and CN X)

Spinal Accessory Nerve - CN XI

Originates both within cranium and outside of skull in upper spinal cord (C1-C5)

Spinal Accessory Nerve - CN XI

Lies within vertebral Cana. deep to meninges Runs from foramen magnum to L1-L2 Gives off 31 pairs of spinal nerves

Spinal cord

Sutures of the Temporal Bone

Squamosal Occipitomastoid Sphenosquamosal Zygomaticotemporal

Which part of the temporal bone is involved in the temporomandibular joint?

Squamous

Stratified Squamous: Cuboidal: Columnar:

Squamous: Keratinized (skin) vs. Non-keratinized (wet membranes) Cuboidal: Large ducts Columnar: Large ducts

Simple Squamous: Cuboidal: Columnar:

Squamous:Endothelium Type I cells Mesothelium Cuboidal: Renal Tubules Columnar: Intestinal surface epithelium

In addition to the zygomatic bone, which of the following bones has a process that form the other part of the zygomatic arch?

Temporal bone

Outer Segment (OS)

Stack of membranous discs with photopigment in the membrane of the discs and plasma membrane of the cell. The area inside of the disc is called the intrados space, the area between the disc is the extrados space

cortical cataract

Star-Shaped opacity. Cortical cataract shows asymmetric, radial, white spokes with a black center. Through ophthalmoscope, black spokes are evident against the red reflux. Forms in the outer cortex of the lens, progressing faster than nuclear cataract.

The union of the inferior sagittal sinus and the great cerebral vein Runs along attachment between falx cerebri and tentorium cerevelli Joins the confluence of sinuses

Straight sinus

Stratified Cuboidal

Strataified cuboidal and columnar generally makes up the epithelium of various medium to large glandular ducts. Stratified cuboidal epithelium in salivary duct.

Stratified Colulmnar

Stratified Columnar epithelium in salivary duct.

Bladder Function

Stretch receptors in bladder wall & pressure receptors in the trigone tell the body when to empty it. Normal daily activities: sympathetics are in control; prevent urine flow Micturation: Parasympathetics are in control; permit urine flow

Cardiac muscle

Striated muscle for rapid contraction. Single branched cells, with a central nucleus. Attached end-to-end with desmosomes (to bind them together) and gap junctions, to carry electrical signals (ions) to adjacent cells. They do not have nerves to start the contraction, they are self-stimulated; modified muscle cells in the sinu-atrial node self-depolarize spontaneously, and these will send the signal first to the AV node then through the heart by other modified cells, the Purkinje fibers. From there, the contraction is carried from cell to cell until the whole heart is affected. They are influenced by autonomic nerves. Sympathetic nerves increase this rate of contraction, parasympathetic nerves slow it down. Your heart rate is basically the result of these two opposing forces acting on the SA node.

Basement membrane

Structural attainment: flexible and firm Compartmentalization: separation of tissues Filtration: both physical and polyanionic Tissue scaffolding Regulation and signaling (in morphogenesis, development and wound healing)

Which of the fooling processes is located just inferior and medial to the external acoustic meatus?

Styloid process

Which eyelid layer? Layer of loose connective tissue between orbiculares oculists and orbital septum Communicates with subaponeurotic (loose areolar) layer of the scalp Raccoon eyes

Sub-muscular areolar tissue

Real space between arachnoid and pia Contains CSF and blood vessels Lines surface of the brain and the gyri but does not enter the sulci of brain-like pia mater Classic presentation: sudden onset thunderclap headache with some level of confusion Often causes by rupture of intracranial aneurysm

Subarachnoid hemorrhage

Which eyelid layer? Loose connective tissue between skin and orbiculares layer Does not contain fat Blood and edema can easily pool into this layer (caused by direct blunt trauma to periorbital area)

Subcutaneous areolar layer

Fibers travel in chords tympani, then hitchhike onto the lingual nerve in the infratemporal fossa to travel to the what ganglion?

Submandibular ganglion

What ganglion is located in submandibular region?

Submandibular ganglion

What ganglion preganglionic parasympathetic fibers originate in CN VII?

Submandibular ganglion

What ganglion? Postganglionics are distributed via the lingual nerve to the sublingual and submandibular glands?

Submandibular ganglion

Eyelid secretions Glands of Moll

Sudiferous secretion Located adjacent to hair follicle base

Primary filtering stations Usually associated with an organ or small region

Superficial Lymph Nodes

Supplies: scalp over the parietal and frontal bones superior aspect of parotid gland (via transverse facial branch) masseter muscle (via transverse facial branch) temporalis muscle

Superficial temporal artery

Drains blood from the side of the scalp, temporals muscle, and external ear Joins maxillary vein to form the retromandibular vein

Superficial temporal vein

Lie in the lateral wall of the nasal cavity

Superior and Middle conchae

Which of the following landmarks serve to locate the hyoid bone during an extra oral examination on a patient?

Superior and anterior to the thyroid cartilage

Branches of the facial artery

Superior labial Inferior labial Lateral nasal Angular: terminal branch, anastomoses with branches of the internal carotid artery

Cavernous sinus communicates with the superficial face via

Superior ophthalmic vein Inferior ophthalmic vein

LPS inserts into eyelid skin to produce superior eyelid crease

Superior palpebral sulcus

Eyelid surface anatomy

Superior palpebral sulcus Inferior palpebral sulcus Lateral canthus Medial canthus Palpebral fissure

Unpaired Dural Venous Sinuses

Superior sagittal Inferior sagittal Straight Occipital Anterior intercavernous Posterior intercavenous Basilar venous plexus

Tributaries of the confluence of sinuses

Superior sagittal straight occipital

Begins at crest Galli of the ethmoid bone Terminates at confluence of sinuses Usually empties into right transverse sinus Lies in convex attached border of the fall cerebri Receives superior cerebral veins Drainage site of CSF via arachnoid granulations

Superior sagittal sinus

Branches of the External carotid artery

Superior thyroid Facial Occipital Posterior auricular Maxillary Superficial temporal

Brachial artery

Supplies arm, and all of upper limb distal to this point.

Aorta

Supplies high oxygen blood to body.

Pulmonary artery

Supplies low oxygen blood to lung.

Gonadal arteries

Supplies the ovaries or testes

Radial artery

Supplies wrist & Hand, sometimes used for coronary arterial bypass grafts.

Shallow depression on the side of the skull

Temporal fossa

What fossa communicates only with the infratemporal fossa?

Temporal fossa

Cytomusculoskeleton.

Supports cell structure, and allows for movement of structures within the cell. Filamentous elements: Microfilaments (mostly actin); 7 nm dia Intermediate filaments (many kinds; a type for each class of tissues!) 10 nm dia. Microtubules one of the most important cytoskeletal structures. 25 nm dia.

Frontal nerve divides into two nerves what are they?

Supraorbital Supratrochlear

Drains anterior of scalp and forehead Joins supraorbital vein to form the angular vein

Supratrochlear vein

Which Eyelid Ligaments? forms hammock below the eyeball to provide support encloses inferior rectus and inferior oblique muscles

Suspensory ligament of Lockwood

Eyelid Ligaments

Suspensory ligament of Lockwood Whitnall ligament Medial and lateral cantonal ligaments

Visceral efferents of ANS

Sympathetic (originates in hypothalamus) Parasympathetic

Parts common to PRs

Synaptic terminal Inner fiber Cell body Outer Fiber Inner segment (IS) Cilium (Connecting Stalk) Outer Segment (OS)

Cerebrum is made up of what?

Telencephalon

RPE

TEM of human RPE layer CC: Choriocapillaries BML Bruch's membrane SEM of the apical surface of the RPE Note the hexagonal shape and the ovoid melanin granules Cell density greatest in fovea ~5000 cells/mm2 Peripherally ~2,000 cells/mm2 RPE and PRs are arranged apex-to-apex due to embryological development. Thus, a potential space is located, the subretinal space is located between them Interphotoreceptor matrix fills the space, is very strong, but not junctions RPE basement membrane is the innermost layer of Bruch's membrane RPE extends from ora Serrata (transitions from pigmented ciliary epithelium) to just before the optic disc Microvilli at the apical end of the RPE projecting between the OS of PRs Apical membrane specializations Apical Na+/K+ ATPase pumps

Aqueous drainage pathway

TM Route (90%) of flow Pressure DependentNo Active transport involved All based on pressure gradient between intraocular pressure (IOP) and episcleral venous pressure (EVP) 15 mmHg vs 7 mmHg Uveoscleral Route (10%) of flow Pressure Independent 90% TM AC 10% ciliary body Open face of Ciliary body band allows IRIS for eggression via the space betweenthe ciliary muscle fiber bundles to thesupracilliary -> suprachoroidal space -> multiple ways out from this point

What disorder has the following symptoms? Pain in jaw and around ear? Difficulty chewing Locking of joint Headache

TMJ disorder

What disorder is the most common source of facial pain after dental pain and usually affects 20-40-year-olds?

TMJ disorder

minor calix

Takes urine from pyramid

Which eyelid layer? Dense irregular connective tissue Consists of collagen fibrils that surround meibomian glands Provides rigidity to eyelids 1 mm which, 29 mm long

Tarsal plate

Pathway of light Refractive media

Tear film Cornea Aqueous humor Lens Vitreous body

Photoreceptor

The PR layers contains the outermost portion of photoreceptors, the portion containing the photopigment PRS: specialized cells that convert light energy into a neural message (phototransduction) The outer portions of the PRs are adapted for capturing light, while their inner parts are for transmitting the signal 2 types of photoreceptors: rods and cones

RPE Na/K ATPase Pump

The RPE cell is unique, it has Na+/K+ ATPase pumps on its apical surface To regulate fluxes to keep the sensory retina (PR) adhered to the RPE

Frontalis

The anterior portion of a two-bellied muscle, the occipitofrontalis Raises eyebrows and wrinkles forehead Gives expression of surprise Innervated by CN VII

Crystalline Lens

The biconvex structure is located posterior to the iris and pupil and anterior to the vitreous body The convexity of the posterior curvature is far steeper (5-8 mm ROC) vs the anterior curvature (8-14 mm ROC) The poles are at the center of the anterior and posterior curvature Axis of the lens: a line connecting the poles The Equator of the lens: marginal circumference of the lens At birth, the lens diameter is 6.5 mm. In the adult, the lens is 10 mm in diameter and 4 mm thick in the unaccommodated state The diameter of the adult lens does not increase significantly with age; however, the thickness increases 0.02 mm/year Once fibers have lost their nuclei, the organelles of the fiber become specialized to form lens crystallins (alpha and beta) that make up the bulk of the fiber ~40% Non-uniform distribution of crystallins is thought to give the lens a non-uniform refractive index

Juxtaglomerular cells

The cells of the afferent artery at the juxtaglomerular apparatus. They are baroreceptors that secrete renin upon sensing a decrease in blood pressure. When blood pressure is low, the juxtaglomerular apparatus secretes renin, which affects Angiotensin which in turn can increase blood pressure.

Corneal Properties

The cornea is the principal refracting surface of the eye Cornea is transparent Due to smooth and regular epithelium The regular arrangement of stroll fibrils and small fibril diameter Destructive interference of light minimizes light scattering (cornea scatter less than 1% light) Cornea is avascular The peripheral cornea is continuous with conjunctiva and sclera Corneal haze: spacing of stromal fibrils is altered due to edema or due to activated fibroblast, myofibroblast cells (especially after PRK)

Lacrimal punctum

The edge of each eyelid has a tiny opening, through which tears drain.

The Heart Wall

The epicardium contains fat, pericardium—and the arteries that supply the heart, and veins that drain it. The myocardium is the muscle layer, with interconnected cells. Endocardium is the layer that lines the inside of the heart; its epithelium is an endothelium, the same cell lining as the arteries and veins.

brachiocephalic artery

The first major branch off of the aorta and the major artery to the forelimbs and head.

TEM of glomerular capillary and podicyte

The functional barrier includes; Podocyte Foot Processes Basal Lamina Fenestrated capillary Plasma fluid filters through the basal lamina and into the urinary space. Only water and other small molecules can make it—large molecules can't.

The collection of the axons from the ganglion cells

The ganglion cell to photoreceptor in the macular region is almost 1 to 1 Moving outward from the macular the ratio changes with one ganglion cell representing input from many photoreceptors

The heart

The heart is wrapped in a blanket of fibrous pericardium. It is attached at a couple of points BUT is mostly free, allowing the heart to beat without restraint. The fibrous pericardium is supplied with pain receptors from the phrenic nerve, which travels on either side of it. The phrenic nerve (C3,4,5) then continues on down to innervate the diaphragm (sensory and motor.) Pain from the pericardium is typically localized to the shoulder.

The Heartbeat

The heart operates by coordinated contraction of its muscular layer. Each cardiac muscle is an individual muscle cell, capable of its own contraction. Nonetheless, if the heart did not beat in a coordinated fashion, it would not be able to function. This is accomplished by the properties of heart muscle. Once a contraction is stimulated in one muscle cell, the contraction will be propagated by passing from cell to cell, spreading out to the entire heart until each chamber finishes contracting.

The Skeletal framework opens onto what?

The inferior orbital fissure

Bruch's membrane

The innermost layer of the choroid fuses with the retina Five layers 1. BM of RPE 2. Inner collagenous zone 3. Elastic layer 4. Outer collagenous zone 5. BM of Choriocapillaris Allow nutrients inflow to the retina and remove waste products The acellular layer containing elements of the choroid and RPE Surrounds optic disc and extends peripherally to the ora Serrata Thickest near the optic disc (2-4 microns) Thinner peripherally (~1-2 microns)

Anterior chamber angle

The junction of the cornea and the iris, from which aqueous humor leaves the eye (also called filtration angle)

First Accessory organ—Liver

The liver, a vital, life-sustaining organ, resides In the upper right quadrant of the abdomen. It is difficult to palpate because 1) it is hidden in most of its area by the ribcage. 2 It is soft (as beef or chicken livers from the grocery store). If it is hard, or can be palpated below the rib margin, than something is wrong. The liver is spread out, most of it being on the right but carrying over to the left side. It is predominantly behind right thoracic cage, under diaphragm and hidden by costal margin. Part of it in the center is not protected by the ribcage; this part is overlain by the Xiphoid process. The liver is very soft and so difficult to palpate; if it is easily palpated as a solid mass, particularly below the right margin of the ribs, good chance of something wrong, like cirrhosis Top surface conforms to diaphragm in shape. Inferior part follows inferior rib margin. At Rt. 9th costal cartilage, the liver deviates to right (this part is under Xiphoid process)—this is also where the gallbladder peeks out. Left side ends at approximately the left dome of the diaphragm. Anatomically one of the most boring organs of the body. Physiologically, it is one of the most complex.

Lymphatic System

The lymph system starts in the tissues (ALL of them. Everywhere.) The lymph capillaries start blindly in tissues, where they have open spaces between endothelial cells that let excess fluid in. These then join to form a network of lymph capillaries, like a net with interconnecting lumina. They eventually collect in lymph nodes, where lymph is filtered and passed on into more lymph ducts. Eventually it works its way through relatively large ducts (about size of small veins) to drain into the brachiocephalic veins. The lymph is actually vital to the overall function of the circulatory system. Capillaries leak small amounts of fluid into the tissues. Most of this fluid is returned to veinules. About 7% does not. If not picked up, the tissue swells. That 7% is picked up by lymph capillaries. It goes through several series of nodes where it is screened by the immune system. Sometimes bacteria and (!!) cancer cells use the lympatic system to invade the body. If they get past ALL the lymph nodes, they can then get into the venous system and general circulation.

median cubital vein

The median cubital vein is the one that is used most commonly for a simple "blood draw."

Microvilli RPE

The microvilli at the apical end of RPE projecting between the outer segments of the rods

Lens Epithelium

The monolayer of cuboidal cells No posterior epithelium Used to make primary lens fibers during development Epithelial cells proliferate throughout life at the equator (germinative zone) Cells stretch and become the columnar shape Arranged in rows to form secondary lens fibers None are discarded!! Area od active mitosis (E-cells)

Internal Limiting membrane

The most vitread of all the retinal layers. It is formed by the footplates of Muller cells, which are covered by a basement membrane Anteriorly, the ILM of the retina is continuous with the ILM of the covering the ciliary body, while posteriorly, at the optic disc, footplates of Muller cells are replaced by astrocytes that form the ILM of the optic disc Muller cells are long glial cells extend from the ILM to just below the ELM Provide support and maintain extracellular environment

Important landmarks

The pars plane portion of the ciliary body is much thinner and less vascularized than the pars plicate, making it the safest point of entry into the eye for vitreous-retinal surgical procedures

Pharynx

The pharynx ends at approximately the C-6 level (the lever of the cricoid cartilage); it continues into the thorax and abdomen as the esophagus.

Portal vein and its critical importance

The portal vein is of critical importance to many features of the intestinal tract. Critically, the blood entering the portal vein comes from all of the veins in the digestive system and spleen. ALL veins of alimentary canal, pancreas, and spleen go to the liver! These veins coalesce into a single portal vein, which then distributes its blood TO the liver. The slightly lower oxygen of the portal venous blood mixes with high-oxygen arterial blood entering the liver.

Fovea

The portion of the retina that provides the best visual acuity Only cones are found here 1.5 mm in diameter Walls slope downward toward the fovea are called the clivus Avascular Only outer retinal layers are present The OS of the cones are elongated for maximizing packing density (150,000 - 300,000 cone cells/mm2) The inner fibers of photoreceptors found in the outer plexiform layer are horizontally orientated (vertical elsewhere in the retina). This layer in the foveal region is referred to as the Nerve Fiber Layer of Henle The foveal region is avascular. The layers of the fovea are dependent upon the underlying RPE and choriocapillaris for their metabolic support

descending thoracic aorta

The posterior intercostal arteries are parietal branches of the

Secondary bronchi

The primary bronchi split into these smaller tubes within the lungs Sup. Lobe bronchus to superior lobe Middle lobe bronchus to middle lobe Inf. Lobe bronchus to inferior lobe.

The Stomach: Bag of Acid—and its functions

The stomach receives food from esophagus and stores it, to be passed on. The stomach produces acid, primarily to eliminate bacteria. It produces the enzyme Pepsin (pH optimum ~3.0, acid) to break down proteins into smaller peptides, and a lipase, to break down triglycerides to a diglyceride and fatty acid. It produces Intrinsic Factor for absorption of vitamin B-12 (Cyanocobalium) In churns up the food, mixing it and helping to break it up somewhat. Stores gasses to be eliminated by reverse peristalsis through the esophagus (Eructation—a belch). Note: one can survive without the stomach, but you have to a) chew your food up very well, and b) take daily Vitamin B-12 shots.

Lower urinary track in female

The trigone has many pressure receptors; it what tells you when your bladder's full. Urethra is short and (relatively) wide Uterus folds over top of bladder A short, wide urethra makes the female more prone to bladder infections.

Lung volume is controlled by the pleural cavity.

The watery pleural fluid will not expand or compress; If the cavity is expanded, the only way for the chest to expand with it, is if air enters the lungs from outside. The lungs are elastic, and always have a tendency to collapse. Some negative pressure must ALWAYS be applied to the pleural space.

Pathway of aqueous humor

There are two main outflow pathway for aqueous exit from anterior chamber Unconventional outflow pathway Uveoscleral outflow (5-35% of total outflow): generally 10% • Fluid exit through uveal meshworkàciliary muscle bundles àsuprachoroidal spacesàabsorbed into sclera or anterior ciliary veins or vortex veins • Conventional outflow pathway (remaining outflow 65-95%): Trabecular outflow: generally 90% • Trabecular meshwork à corneoscleral meshwork à juxtacanlicular tissueàschelmm's canalàepiscleral veins Sustained resistance to outflow usually results in elevated IOP

Filtration Pressure

Things causing fluid to leave capillaries Capillary hydrostatic pressure (Capillary HP) Things causing fluid to return to capillaries Colloid osmotic pressure (COP) Capsule Hydrostatic Pressure (Capsule HP) Filtration pressure FP = HP(capillary)-HP(capsule)-COP 7mm Hg = 45 mmHg-10 mmHg - 28 mm Hg. FP = filtration pressure HP = hydrostatic pressure COP = vascular colloid osmotic pressure

Inclusions

Things commonly found in cells but, because they are not vital to cell function, are not called 'organelles.' Things not vital for cell function so not an organelle, but nonetheless common.

Transverse plane

This is the cross-sectional plane. It splits the body into the part above it and the part below it. Sectional view: patient's right is to the left, patient's left is to the right. Anterior is on top and posterior is on bottom.

Ganglion cell layer

This layer is generally one cell thick, but near the macula, the layers pile up Retinal Ganglion cells are the output cells of the retina that communicate with the central visual system structures The retinal ganglion cells are the primary cells affected in glaucoma Contains the cell bodies of the ganglion cells

Sagittal plane

This plane is vertical, going from anterior to posterior. View can be at the midline (mid-sagittal) or to the side of that (parasagittal), all the way to the edge of the body. It splits the body into left and right halves. Top is superior, bottom is inferior.

Pericardial cavity

This space between parietal pericardium and visceral pericardium is filled with fluid and allows the heart to beat with little friction.

Ventral body cavities

Thoracic cavities, 2 pleural (Lungs) and 1 pericardial (Heart) Abdominopelvic cavity (Liver, intestines, stomach, spleen) Retroperitoneal organs are those in abdomen but outside of the body cavity proper, e.g., Kidney, Ascending Colon, Pancreas, Duodenum.

Body Core

Thorax Chest Abdomen Pelvis

How many sinuses are in close proximity to the orbits?

Three

Trabecular Meshwork (TM)

Three regions of the TM:Uveal Trabecular Meshowrk (nearest the AC):Contains the widest spacing between beams (25-75 microns side-to-side) Only 1-3 layersOriginates from the anterior aspect of ciliary body and irisCorneoscleral Meshwork:Originates from the scleral spur (8-15 layers)Flat perforated sheetsOpenings 2-15 microns (side-to-side)Juxtacanalicular Connective Tissue (Cribriform Meshwork)Abuts the outermost corneoscleral sheetComposed of fibroblasts and ECM material, elastic fibers TM: interlamellar spaces: large 25 to 75 microns side-to- side

Vitreous Zones

Three zones: Cortex (most dense) Intermediate Zone Cloquet's canal

Where does the sigmoid sinus drain?

Through the internal jugular vein

Endocrine gland: ductless Part of the immune system: maturation site of T lymphocytes Grows from birth until puberty After puberty, gland stops growing and slowly starts to shrink (involute) Consists of right and left lobes connected by a midline isthmus Located in the thorax inferior to the thyroid gland and deep to the sternum between the lungs

Thymus Gland

Cartilages of the larynx

Thyroid (unpaired) Epiglottis (unpaired) Cricoid (unpaired)

Largest of the laryngeal cartilages Located on anterior surface of the larynx Responsible for Adam's apple due to the laryngeal prominence Thyroid membrane connects the superior aspect of the cartilage to the thyroid bone

Thyroid cartilage

Ductless: secretes thyroxine directly into the vascular system Hormone that stimulates metabolic rate of the body Consists of two lateral lobes connected anteriorly by a midline isthmus Located inferior to the thyroid cartilage at the junction of the larynx and trachea Contained within a visceral compartment along with hyoid bone, larynx, trachea, esophagus, and pharynx

Thyroid glands

Junctions holding adjacent cells together.

Tight junction Desmosome Basal Lamina

Cell Junctions in Epithelia

Tight junction prevent things from diffusing from the lumen to the underlying CT Desmosomes hold the epithelial cells together so they are a single unit, rather than isolated cells. Gap junctions connect the cells electrically so they all respond to stimuli at the same time.

RPE: Blood-retina barrier

Tight junctions (zonulae occludentes) between the RPE cells Tight junctions between the non-fenestrated endothelial cells of the retinal capillaries

RP: Treatment

To slow doen progression High doses of Vitamin A (15000 IU/day) DHA, Omega 3, Vit C 1000 mg, Lutein, Zeaxanthine (no solid evidence)

Posterior or dorsal

Towards back

Trabecular route

Trabecular meshwork Corneoscleral meshwork Juxtacanalicular meshwork (JCT) SC = Schlemm's canal CC =Collector channels e = deep scleral plexus d = intrascleral plexus c = episcleral veins

Specialized epithelium, stratified

Transitional epithelium of bladder

zonula adherens

Transmembrane proefins of the intern family link the hemidesmosome to the ECM

Paired Dural Venous Sinuses

Transverse Sigmoid Cavernous Superior petrosal Inferior petrosal

Course along posterolateral attached margins of the tentorium cerebelli

Transverse Sinus

What forms the groove in occipital bone?

Transverse sinus

Aka semilunar aka gasserian ganglion contains cell bodies of incoming GA fibers from the head and neck

Trigeminal Ganglion

Sits on petrous portion of the temporal bone in Meckel's cave aka trigeminal cave Covered by meninges Surrounded by CSF

Trigeminal Ganglion

Carries hitchhiking fibers SA: taste from anterior 2/3 of tongue and palate (chords tympani to V3) Sympathetics from internal carotid artery plexus - innervation of smooth muscles of the eye and blood vessels of the anterior structures Parasympathetics from CN III, VII, and IX

Trigeminal Nerve

Contains only general efferent (GE) fibers to the superior oblique muscle Nucleus located in the dorsal midbrain at the level of the inferior colliculi Exits midbrain from its dorsal aspect Only cranial nerve to cross over completely Exits cranial activity via superior orbital fissure Highly vulnerable to trauma due to its long intracranial course

Trochlear Nerve - CN IV

Protein digestion

Trypsin breaks proteins into small fragments (peptides): carboxypeptidase breaks them into individual amino acids or di/tri peptides. On microvilli, there are two enzymes to break down peptides into amino acids: Aminopeptidase (digest at amino end of peptide) Carboxypeptidase (digest at carboxy terminal of peptide) After digestion, amino acids and di/tri peptides are absorbed.

Stratified squamous epithelium

Two or more cell layer thick Found on surfaces where friction occurs Stratified corneal epithelium (50 u) The stratified epithelium is named from the superficial layer Surface cells (non-keratinized squamous cells) wing cells (20 u wing-like) Nasal cells (single layer columnar cells, 8-10 u)

Inner wall endothelial cells of Schlemm's canal

Two unique aspects: Giant vacuoles Pores

Auditory Ossicles

Tympanic cavity

The malleus attaches to what?

Tympanic membrane

Sympathetic ICA plexus Tympanic nerve from IX

Tympanic plexus: GA and VE (to tympanic mucosa)

Uncal herniation

Typically causes oculomotor palsy: -"Down and out"eye Caused by unopposed SO (IV) and LR (VI) - Dilated pupil Caused by unopposed sympathetic nerve - Ptosis Caused by lost innervation to LPS

Tear Secretion Emotional

Underlying mechanism is unknown In CN V lesions, reflexive tears are lost, but emotional are not

superior mediastinum

Upper compartment of the thoracic cavity Note hyaline cartilaginous rings held together by fibrous tissue. Window opened to show the smooth muscle in back.

Deep inhalation:

Upper ribs expand in A-P direction Middle and lower ribs expand in mediolateral plane. This creates Increased chest volume.

Forced exhalation

Upper ribs pull down, middle to upper ribs pull towards midline. This creates Decreased chest volume. Note, in order to breathe you MUST use the diaphragm. In quiet breathing, you ONLY use the diaphragm. In forced inhalation and exhalation, you use external muscles IN ADDITION to the diaphragm. Ergo, no diaphragm, you can't breathe.

Ureters and Bladder

Ureters arise from the renal hilum and course inferiorly, crossing over the psoas major muscle but located entirely retroperitonally. They empty into the posterior aspect of the bladder at the upper lateral extremes of the trigone. The bladder is a muscular sac that rests at the inferior extreme of the abdominopelvic cavity. From it, the urethra extends to the outside to eliminate urine.

Lower urinary track in male

Urethra is long, with several parts; relatively narrow Urethra has to penetrate Prostate, which (if enlarged—cancer or BPH) can block urine flow.

Cell Organization

Using a glandular cell as an example, we'll cover how the typical epithelial cell is organized. Of particular note: Apical surface lines a tube (gland duct, blood vessel, gut) or a surface (skin, inside of cheek) Bottom surface sits on a felt-like basal lamina, that helps attach it to the underlying tissues, keep them separate.

Cup/Disk ratio increase in primary open angle glaucoma (POAG)

Usually from high pressure in eye Glaucoma: nerve damage

Retina Detachment: RD

Usually separates at RPE and PR layer (as no intracellular junctions) RPE remain attached to choroid and can not be separated without difficulty RD separates PR from their blood supply, if not attached quickly PR cells will necrose and die Argon laser is used to produce scar at edges of RD to prevent enlargement and to reposition the layer Silicon oil (72% success rate) or gas tamponade perflutopropane (87% success) can be used to reattach the retina and prevent fluid leakage in to breaks and sub retinal space

V 1, 2 or 3 Ciliary ganglion (smooth muscle of eye)

V1

Four ganglia suspended by CN V

V1 V2 V3

Enters orbit via SOF outside the tendinous ring Passes between roof to orbit and LPS muscle

V1 -> Frontal Nerve

Passes through SOF and common tendinous ting Runs along medial wall of orbit Suspends ciliary ganglion

V1 -> Nasociliary nerve

Multiple CN palsies cavernous sinus thrombosis

V1, V2, III, IV, VI

Smallest division GA onlu Travels in lateral wall of cavernous sinus

V1: Ophthalmic Nerve

Three divisions of the Trigeminal Ganglion

V1: ophthalmic nerve V2: maxillary nerve V3: mandibular nerve

V 1, 2 or 3 pterygopalatine ganglion (lacrimal gland, mucous glands of nose and palate)

V2

Conveys hitchhiking post-ganglionic parasympathetic fivers from the pterygopalatine ganglion to the lacrimal nerve

V2 -> Zygomatic Nerve

Formed by merging of zygomatiocfacial and zygomaticotemporal nerves within the lateral aspect of the orbit

V2-> Zygomatic Nerve

Suspends pterygopalatine ganglion and carries hitchiking fibers Postganglionic parasympathetics to lacrimal gland and nasal and palatal mucosa Postganglionic sympathetics from ICA to same targets

V2: Maxillary Nerve

The Temporomandibular Joint GA nerve supply?

V3

The primary muscles of mastication are innervated by the motor branch of what V?

V3

The tensor tympani muscles is innervated by what?

V3

V 1, 2 or 3 submandibular and otic (salivary glands)

V3

Middle layer of the eye

Vascular and muscular Choroid Ciliary body Iris

Internal jugular vein

Vein located at the side of the neck to collect blood from the brain and parts of the face and neck.

Neurovascular bundle They all go to the same place, why no go together?

Veins have the same structure that arteries do, but they are thinner—less internal elastic lamina, and much less tunica media. As a result, they are typically not round, but "fill in" to available space; they also can expand and contract depending on pressure and drainage of the outgoing pipes.

Vascular adaptations

Veins: Thin-walled, they often have valves to permit blood flow only one-way. This permits blood in extremities to be pressed along by muscle action. Note, valves are found principally in veins of extremities only, and in lymphatics Arteries have smooth muscles and elastic tissue to keep pressure up even when heart is not in systole. This way, blood flow is continuous. There are frequent arteriole-to-arteriole anastomoses to bypass certain capillary beds; e.g., during extreme muscle action, the blood to the overlying skin nearly shuts down.

Pass bilaterally through transverse foramina of C1-6 Enter cranial cavity via foramen magnum Join to form basilar artery Becomes posterior cerebral artery pair Supplies brainstem, cerebellum, and posterior cerebrum

Vertebral arteries

coronal (frontal) plane

Vertical plane at a right angle to sagittal plane Anterior and posterior halves

Sagittal plane

Vertical plane parallel to median plane Right and left halves

Median Plane (midsagittal plane)

Vertical planes passing longitudinally through the body (sagittal plane through midline) Right and left halves

Fusion of vesicles with cell membrane!

Vesicle carried along microtubules to plasma membrane. At the end, the vesicle membrane fuses with the plasma membrane and opens a hole for the contents to escape.

Nuclei located in caudal pons and superior medulla Exits brainstem at pontomedullary junction inferior to CN VII Contains only (SA) fibers for hearing and balance Exits cranial cavity via internal acoustic meatus and stays within petrous portion of temporal bone (it does NOT leave the skull) Innervates inner eat structures

Vestibularcochlear Nerve - CN VIII

Two types of fibers in the ANS

Visceral Afferent Visceral Efferent

innervation of smooth muscle and glands

Visceral efferent (VE)

Visual field defects

Visual pathway is shown, as are sites of interruption of nerve fibers and resulting visual field defects. 1, Complete interruption of left optic nerve, resulting in complete loss of visual field for left eye. 2, Interruption in midline of optic chiasm, resulting in bitemporal hemianopia. 3, Interruption in right optic nerve at junction with chiasm, resulting in complete loss of visual field for right eye and superior temporal loss in field for left eye (due to anterior knees). 4, Interruption in left optic tract, causing incongruent right homonymous hemianopia. 5, Complete interruption in right optic tract, lateral geniculate nucleus, or optic radiations, resulting in total left homonymous hemianopia. 6, Interruption in left optic radiations involving Meyer's loop, causing incongruent right homonymous hemianopia. Visual pathway is shown, as are sites of interruption of nerve fibers and resulting visual field defects. 7, Interruption in optic radiations in left parietal lobe, causing incongruent right homonymous hemianopia. 8, Interruption of all left optic radiations, resulting in total right homonymous hemianopia. 9, Interruption of fibers in left anterior striate cortex, resulting in right homonymous hemianopia with macular sparing. 10, Interruption of fibers in right striate cortex, resulting in left homonymous hemianopia with macular and temporal crescent sparing. 11, Interruption of fibers in right posterior striate cortex, resulting in left macular homonymous hemianopia. 12, Interruption of fibers in right anterior striate cortex, resulting in left temporal crescent loss.

Age-related changes

Vitreous continues to shrink and collagen fibers aggregate forming floaters that float within the lacunae

corticobulbar pathway

Voluntary motor pathways: Upper motor neurons project to eye-related cranial nerve nuclei in the pons and medulla bilaterally.

Thin, flat unpaired midline facial bone Almost trapezoidal in shape Forms posterior part of the nasal septum and separates posterior nasal cavity into right and left halves

Vomer

Ultrafiltrate examples: Contains

Water Ions (sodium, potassium, chloride, calcium, etc.) Glucose Urea Bicarbonate

Grey or white matter? Myelinated axons

White matter

Which Eyelid Ligaments? Suspensory support for upper eyelid Surrounds LPS

Whitnall ligament

Which of the following cranial nerves and its moron function is involved in pathology when a patient protrudes the tongue and a deviation to the right side is noted?

XII

Is TMJ included in the infratemporal fossa?

Yes

Branches of V2: Maxillary Nerve

Zygomatic Infraorbital

Paired Aka malar bone Forms majority of the cheekbone Contributes to the wall and floor of the orbit

Zygomatic bone

Transmits zygomaticofacial nerve (branch of zygomatic nerve of V2)

Zygomaticofacial foramen

Foramina of the Zygomatic bone

Zygomaticofacial foramen Zygomaticotemporal foramen

sensation from skin of cheek

Zygomaticofacial nerve

Transmits the Zygomaticotemporal nerve (branch of the zygomatic nerve of V2)

Zygomaticotemporal foramen

prostate

a gland surrounding the neck of the bladder in male mammals and releasing prostatic fluid.

Esophagus

a muscular tube Collapsed when not in use. Same layers as rest of alimentary canal. Stratified squamous epithelium (as per inside of mouth and of pharynx) Muscular layer—first 1/3, all skeletal muscle; second 1/3, mixed; last 1/3, all smooth muscle. Sends food bolus to stomach by peristalsis.

Neuron

a nerve cell; the basic building block of the nervous system

simple

a single layer of cells

pituitary adenoma

a slow-growing benign tumor of the pituitary gland;

Lacrimal fossa

a small depression in the lateral wall where the lacrimal gland sits

Iris synechia

abnormal attachment of iris surface and another structure (lens or corneal endothelium or trabecular meshwork, TM)

pupillary dark reflex Afferent

absence of light on retina -> optic nerve -> brain

Lateral Surface

abuts another epithelial cells

Emotion center of the brain: pleasure, fear, anxiety, anger Strengthens emotional content of memories

amygdala

sigmoid colon

an S-shaped structure that continues from the descending colon above and joins with the rectum below

Cisterna chyli

an enlarged pouch on the thoracic duct that serves as a storage area for lymph moving toward its point of entry into the venous system

Frontal crest

anchor for dura mater

Receives blood from nostrils and superior ophthalmic vein Can spread infection to the cavernous sinus via the superior ophthalmic vein

angular vein

shallowest and most elevated contains anterior parts of frontal lobes of the brain formed by: frontal bone ethmoid bone body of sphenoid lesser wings of the sphenoid

anterior cranial fossa

Tricuspid valve

anterior cusp

Schwalbe's line

anterior most structure, formed by Descemet's membrane

superciliary arches glabella nasion mental proturberance

anterior skull landmarks (4)

Glabella

anterior-most post of the frontal bone

Where does the superior petrosal sinus lie?

anterograde-lateral margin of terrarium cerebelli

For the left side of the body, the common carotid and subclavian arteries arise directly from the?

aorta

Largest blood vessel in the body

aorta

large opening in the skull

aperture

Posterior boundary of the cavernous sinus location

apex of petrous temporal bone

renal papilla

apex of renal pyramid

The Cerebrospinal fluid returns to the venous system via

arachnoid granulations

Where is the cerebellum?

back of brain

semicircular canals

balance

Basal

basal lamina basal striations

Vertebral arteries join in the posterior cranial fossa to form the

basilar artery

The Internal Jugular vein merges with the subclavian vein to form the

brachiocephalic vein

What makes up the CNS?

brain brainstem: pons, medulla, midbrain Cerebellum Spinal cord

pupillary dark reflex efferent

brain -> spinal cord -> cervical sympathetic chain -> superior cervixal ganglion (synapse) -> internal carotid artery

aka hindbrain

brainstem

Pupillary light reflex (PLR) Efferent limb

brainstem -> CN II -> parasympathetic root (Edinger Westphal nucleus) -> ciliary ganglion (synapse) -> short ciliary n. -> sphincter pupillae

Alveolar duct

branches of the respiratory bronchioles that lead directly to the alveoli

Respiratory bronchiole

branches of the terminal bronchioles that subdivide into several alveolar ducts simple cuboidal epithelium

macular degeneration (MD)

breakdown of the tissues in the macula, resulting in loss of central vision Dry AMD Wet AMD

External carotid artery

brings blood to the face

capillary

brings in CO2 and takes out O2

major calix

bunch of "minors" joined

Situated in middle cranial fossa on either side of the body of the sphenoid

cavernous sinus

Formation of blood clot within the cavernous sinus Late complication of infections arising from the face or sinuses Systemic signs Fever Tachycardia Sepsis

cavernous sinus thrombosis

Outer plexiform layer (OPL)

can be thought of as having two layers A wide outer band composed of the inner fibers (aka Henle's fibers) of the rods and cones A thinner band made up of the synaptic terminals of photoreceptors, dendrites of bipolar cells, as well as horizontal cell axons and dendrites It is here that the synaptic terminals will synapse with the dendrites of bipolar and horizontal cells

connect puncta to the lacrimal sac 10 mm long (2mm vertical, 8 mm horizontal) Muscle of Horner

canaliculi

Which of the following structures is a smaller vessel that branches off an arteriole to supple blood directly to a tissue?

capillary

Common pulse points

carotid pulse radial pulse (routine)

The role of cerebral aqueduct?

carries CSF from third to fourth ventricle

striatum (basal ganglia)

caudate nucleus and putamen

elastic fibers

causes lung to contract when tension is relaxed

Pool of stagnant blood contained by dural folds

cavernous sinus

Inner nuclear layer

cell bodies of bipolar cells, horizontal cells, amacrine cells, interplexiform cells, and Muller cells are located here IMPORTANT: Understand that this layer marks the deepest penetration of blood vessels from the central retinal vasculature

Mitochondria

cell powerhouse. Sole repository for enzymes for oxidative phosphorylation. Has its own DNA, and ribosomes, so can make some (but not all) of its own enzymes—need mRNA from nuclear sources to make everything it needs. Site of oxidative phosphorylation (e.g., TCA cycle)

Pinocytosis

cell takes in smaller molecules

simple columnar epithelium

cells appear taller than wide Function to protect In stomach and digestive tract, to protect from bacteria Can secrete mucus to coat and protect Can be innervated to provide sensory input: Cornea

simple cuboidal epithelium

cells appear to look like cubes when viewed laterally retinal pigment epithelium

Foveola

center of foveal depression

Porta Hepatis

central area of the liver where the portal vein, common duct, and hepatic artery enter Hepatic portal vein Hepatic artery Hepatic bile duct The Hepatic Veins drain directly into Inferior Vena Cava.

renal pelvis

central collecting region in the kidney

Ophthalmic artery branches Retina

central retinal artery

connects 3rd and 4th ventricles

cerebral aqueduct of sylvius

cerebral cortex, white matter, basal ganglia

cerebral hemispheres

What makes up the midbrain

cerebral peduncle cerebral aqueduct

Internal cavities of the brain

cerebral ventricles

aka forebrain

cerebrum

Pleomorphism

change in cell shape

Polymegathism

change in cell size

The nasal cavity extends from the nares anteriorly to the __________ posteriorly

choanae

Located between sclera and retina Extending from ora errata to optic nerve Thickest 0.2 mm at posterior pole, thinnest 0.1 mm at ora serrata

choroid

Monolayer of polarized cuboidal cells that separate photoreceptors from their underlying blood supply

choroid

highly vascular pigmented layer between the sclera and retina

choroid

Where is Cerebrospinal fluid produced?

choroid plexus

spongy mass of capillaries in the ceiling of each ventricle

choroid plexus

Prophase

chromosomes condense, and as they do so the nuclear membrane disappears.

Metaphase

chromosomes line up in center, guided by microtubules from spindles.

muscular and vascular, connects the choroid with the iris

ciliary body

Schlemm's Canal (SC)

circular vessel, outer to TM and anterior to SS

angoid streaks

damage to elastic layer of Bruch's Pseudoxanthoma elastic, Ehlers-danlos syndrome, pagats disease, sickle cell disease, and Idiopathic (PEPSI)

Secretion

deliberately forcing other unwanted substances into presumptive urine.

The role of cerebral peduncle?

delivers motor information from the cortex to the cerebellum and spinal cord

The scalp is firmly attached to aponeurotic layer via

dense connective tissue

Drusen

deposit of waste material from retina Between inner collagenous layer of Bruch's and BM of RPE Characteristic of ARMD

What is the role of the Lateral pterygoid muscle?

depression

Hilum

depression in an organ where blood vessels and nerves enter and leave

alimentary canal

digestive tube that extends from the mouth to the anus Continuous tube Oral Cavity --Pharynx Esophagus --Stomach Small gut --Large gut Rectum --Anal Canal

Styloid process

downward-projecting fingerlike extension; point of attachment for head and neck muscles with the word "stylo" in them

superior mesenteric vein

drains small intestines and ascending colon

Ptosis

droopy eyelid

The Internal Jugular vein drain intracranial venous blood from the

dural venous sinuses

Simple Columnar Epithelium

e.g., inner lining of stomach, small and large intestine. more specialized: in the intestine, it has lots of long microvilli for absorption of nutrients. In the uterine tube it has cilia for moving the Zygote along to the uterine cavity for implantation. Simple columnar cells of the small intestine Simple columnar cells of the uterine (Fallopian) tube.

Embryonic Nucleus

earliest mass at center of lens composed of primary lens fibers. Formed at 2 months gestation. Does not increase in size

carry information away from CNS organ (motor)

efferent

What is the role of the Masseter muscle?

elevation

What is the role of the Medial pterygoid muscle?

elevation

EPIS

ellipsoid portion of the inner segments or EZ-ellipsoid zone or IS/OS- inner segment outer segment junction line

Pupillary zone

encircle the pupil

Branches off the ECA and curves around the angle of the jaw

facial artery

Main blood supply to the face

facial artery

Perirenal fat

fatty tissue surrounding the renal capsule Pararenal fat is the fat outside the perirenal (Gerota's) fascia, Perirenal fat is the fat inside the perirenal fascia

Adult Nucleus

fibers made between birth and sexual maturation. Increases in size throughout life. Will sclerosed and become yellowish with age

connects lateral and 3rd ventricles

foramen of monro

G1 Phase

first gap phase routine metabolism

cecum

first part of the large intestine

Duodenum

first part of the small intestine First part receives acidic chyme from stomach. Acidic mucus protects first part of duodenum from acid) Second part receives: Pancreatic ducts (bicarbonate buffers acidity) Bile ducts from gall bladder. Third part goes right to left Fourth part empties into jejunum. Duodenal bulb (first part) Duodenum (second part) Greater duodenal papilla (hepatic-pancreatic duct) Jejunum

narrow, cleft-like opening between adjacent parts of a bone or bones that forms a passageway for neurovascular structure

fissure

Squamous

flat

circular or oval-shaped opening in skull bones

foramen

Vertebral arteries enter cranial cavity through

foramen magnum

Intercellular junctions Communicating

gap junction

Fast-communicating junctions

gap junctions (macular communicant) allow for intercellular communication and electrical coupling cells Low-Resistance pathway for current flow Allow fast spread of electric activity throughout organ (smooth muscle contraction)

innervation of striated muscle

general efferent (GA)

GA of Glossopharyngeal Nerve

general sensory information form tonsils, pharynx, middle ear, Eustachian tube, mastoid air cells, posterior 1/3 of tongue (afferent limb of gag reflex)

Bleeding can cause

generalized swelling of the scalp Periocular ecchymosis (aka raccoon eyes) Battle's sign

smooth, slightly depressed area between the superciliary arches point of fuse. of frontal suture that is present only in infants

glabella

Neuronal support cell

glia cells Support cells in the CNS: Astroccyte = general support Oligodendrocyte = myelin production Microglia = phagocytic cells. Ependymal cell = lines ventricles.

Is the thalamus mostly composed of grey or white matter?

grey

shallow indentation that transmits blood vessels and nerves

groove (sulcus)

Sigmoid sulcus

groove that transmits the sigmoid sinus

The scalp contains

hair follicles Sweat glands Sebaceous glands Significant arterial supply, venous drainage, and lymphatic drainage

The tensor tympani attaches to what?

handle of malleus

distal bronchus

has cartilage pseudo stratifies ciliated epithelium

Trachea and primary bronchi

have U-shaped cartilages; the cartilage is needed to keep them open. Once you get into secondary bronchi and beyond the cartilages consist of irregular plates.

Cochlea

hearing

retinitis pigmentosa

hereditary, progressive disease marked by night blindness with atrophy and retinal pigment changes

visceral efferents and special afferents carried in branches of trigeminal nerve (CN V)

hitchhiking fibers

Perirenal

holds urologic and vascular structures kidney fat

Myelinated axons:

how myelin grows in a developing axon.

Eyelid margin

identified by the 'grey line' of Meibomian gland orifices. This is an important landmark to identify when closing the eyelid surgically

Middle meningeal sulcus

impression on internal surface of parietal bone caused by the middle meningeal artery

Pacchionian pits (aka arachnoid pits)

impressions in the bone where the cerebrospinal fluid pools within arachnoid granulations

pupillary dark reflex

in the dark, the pupils automatically dilate

Medial canthus

inner corner of eye

visceral pleura

inner layer of pleura lying closer to the lung tissue

ventral ramus

innervates skeletal muscles of the limbs

hydrophilic heads

interacts with water outside and inside

ipsilateral blindness

internal carotid artery

Which of the following structures is contained within the carotid sheath?

internal jugular vein

Cervical lymph nodes

located along the sides of the neck

Internal scleral sulcus

located at internal "corneoscleral junction", house structures eg TM, SC, SS which facilitate aqueous drainage, also known as filtration apparatus

Digastric groove

located posterior to the mastoid process; the origin of the posterior belly of digastric

axillary lymph nodes

located under the arms in the armpits

Ophthalmic artery branches ciliary body and iris

long posterior ciliary arteries

Presbyopia

loss of accommodation

right kidney

lower than the left

contain lymph fluid contain valves

lymphatic vessels

controls activity of most hormone-secreting glands

master gland

site of muscle attachment (sternocleidomastoid and posterior belly6 of the digastric)

mastoid process of temporal bone

paired, located between temporal, parietal, and occipital bones

mastoid/ posterolateral

What sinuses are most commonly affected in a sinus infection?

maxilarry sinuses

The lateral wall of the nasal cavity is mainly formed by what bone?

maxilla

In what bone are both the infraorbital Forman and infraorbital canal located?

maxillae

The spaces located under the three conchae of the lateral walls of the nasal cavity are the nasal

meatuses

Primary functions of the middle ear

mechanical conduction of sound to fluid-filled inner ear

Carotid foramen

medial and anterior to the jugular notch, opening for the carotid canal

Ophthalmic artery branches eyelid

medial palpebral branches

Divides body into anatomical position R and L halves

median plane

contains cranial nerve nuclei, motor tracts, fourth ventricle

medulla oblongata

Jugular notch

meets with jugular notch of occipital bone to form the jugular foramen that transmits the glossopharyngeal, vagus, and spinal accessory nerves

Eyelashes are located anterior to pores of

meibomian glands

Inflammation of the meninges Can be causes by bacteria or viruses Most cases are viral and relatively benign Bacterial meningitis is extremely serious and fatal if not treated promptly Common symptoms Severe headache Fever Photophobia Stick neck

meningitis

Sphenoidal sinus via sphenoethmoidal recess: can lead to

meningitis or intracranial abscess

triangular bony elevation formed by fusion of two halves of mandible forms the prominence of the chin

mental protuberance

Brainstem is made up of?

mesencephalon, pons, and medulla oblongata

Uvea

middle vascular pigmented

Distal convoluted tubule

minor reabsorption.

Multipolar Neurons

most common, found in everything form motor neurons, interneurons, projection neurons, etc. Pyramidal cells of the cortex and Purkinje cells of the cerebellum are multipolar.

The role of Nucleus Accumbens

motivation

The role of Putamen

motor control

The pharyngotympanic tube is opened by what yawning and swallowing causes "popping of eardrums"

muscles of soft palate

Ophthalmic artery branches orbital muscles

muscular branches

Christmas tree cataract

myotonic dystrophy

Another name for the medial wall of the nasal cavity

nasal septum

The nasal cavity is divided into right and left halves by what

nasal septum

intersection between frontal and nasal bones known as the bridge of the nose

nasion

Centriole

near the center of the cell, is a pair of organelles which organize the microtubules throughout the cell. The centriole is the organelle at the center of the microtubule network, and the microtubules will radiate out from its ends (not shown here so the artist could concentrate on the structure of the centriole itself)

Proximal

near the point of origin

The cranium is divided into two parts, what are they?

neurocranium and viscerocranium

Enucleated eye

normal adult eye roughly a size of a quarter Diameter: 24-25 mm (1 inch) Additional 1 mm = 3 Diopters

Palebral fissure

open space between eyelids

Carotid foramen

opening for internal carotid artery

iridotomy

opening is made using laser without excising the tissue and muscle

Internal acoustic/auditory meatus

opening within the petrous part of the temporal bone that transmits the facial and vestibulocochlear nerves

Apical surface

opens to outside world, or inside of a hollow organ.

Eyelid blood supply: ECA Terminal branch

ophthalmic artery

pupillary dark reflex efferent: long ciliary

ophthalmic n. -> nasociliary n. -> long ciliary n. -> dilator pupillae muscle

pupillary dark reflex efferent: short ciliary

ophthalmic n. -> nasociliary n. -> short ciliary n. -> dilator pupillae muscle

Infection of upper lip, nose, and eyelids can spread via what vein?

ophthalmic vein

The pituitary gland is located immediately beneath the

optic chiasm

Lateral canthus

outer corner of eye

renal cortex

outer region of the kidney

Bulbar conjunctiva

overlays the eyeball, with the white sclera showing through

Lysosomes

packets of digestive enzymes active in acid pH and surrounded by a membrane

Is the sigmoid sinus paired or unpaired?

paired

Is the transverse sinus paired or unpaired?

paired

Are the lateral ventricles of the brain paired or unpaired?

paired one in each cerebral hemisphere

orbital apex composed of lesser wing go sphenoid bone and the

palatine

Aniridia

partial or complete absence of iris. High association with glaucoma (75%)

Interventricular septum

partition between the right and left ventricles (Aortic outflow tract behind mitral valve)

Filtration

passage of plasma constituents into ultrafiltrate.

Transverse colon

passes horizontally from right to left toward the spleen

Foramen cecum

pathway for emissary vein to pass between superior sagittal sinus and the nasal cavity ( potential route for spread of infections intracranially)

How big is the pituitary gland?

pea-sized

Systole

period of isovolumic contraction. Ventricular contraction causes the AV valves to close, which is the beginning of the ventricular systole. The semilunar valves were closed in the previous diastole Early systole AV valves closed Semilunar valves closed. ↑ venricular pressure, atria filling passively. Period of ejection. Continued ventricular contraction pushes blood out of the ventricles, causing the semilunar valves to open Late systole AV valves closed Semilunar valves open Ventricles pumping blood out. Atria passively filling.

largest and deepest contains cerebellum, pons, and medulla oblongata formed by: occipital bone part of parietal bone part of temporal bone

posterior cranial fossa

Scleral Spur (SS)

posterior edge of internal scleral sulcus

external acoustic meatus mastoid process of temporal bone styloid process of temporal bone zygomatic arch pterion external occipital protuberance

posterior skull landmarks (6)

Pterygopalatine ganglion of the trigeminal nerve role?

postganglionic parasympathetics to lacrimal gland

Otic ganglion of the trigeminal nerve role?

postganglionic parasympathetics to parotid gland

Ciliary ganglion of the trigeminal nerve role?

postganglionic parasympathetics to smooth muscles of eye

Submandibular ganglion of the trigeminal nerve role?

postganglionic parasympathetics to submandibular and sublingual glands (via corda tympani)

high density of melanin granules

potential for choroidal melanoma

a projection or outgrowth of a tissue from a larger area

process

located at the intersection of the frontal, parietal, temporal, and sphenoid bones The relatively weak point of the skull middle meningeal artery courses along with the cranial bones in the location of the pterion trauma to this area can fracture the cranium and result in epidural hematoma

pterion

Located in infra temporal fossa between temporals and lateral pterygoid muscles; receives many veins from superficial face and communicates with cavernous sinus via emissary veins

pterygoid venous plexus

central opening on the iris; diameter altered o control amount of light entering the eye

pupil

What makes up the medulla oblongata?

pyramidal tracts Cranial nerve nuclei Fourth ventricle

increased intracranial pressure due to poor drainage of venous blood or cerebral edema

raised/pulsating fontanelle

Bipolar cells

rare type, makes up some types of retinal, vestibuloauditory, and olfactory nerves.

Thoracic duct

receives lymph from the left side of the head, neck, chest, abdomen, left arm, and lower extremities

Loop of the Nephron

recovers 20% of sodium, 10% of water

Collecting ducts

recovers 9% of Na, 19% 0f water (variable).

Proximal convoluted tubule

recovery of 70% of water and salts, 100% of glucose and any small proteins that slip through, 60% of other things, secretes penicillin, creatinine. First tubule to come in contact with ultrafiltrate. Simple cuboidal epithelium, lined with long microvilli. Functions in reabsorption of most substances that are in the ultrafiltrate. Water and salts, 70 % Other misc solutes, 50-60 % 100% of glucose for levels up to blood concentration 200 mg/dl; above that, glucose spills into urine. 100% of amino acids and small proteins.

Reabsorption

recovery of things vital to life, e.g., water, sodium, glucose.

Palpebral part of the orbiculares oculi muscle that causes eye closure

reflex blinking

stem cells

regenerate epithelial cells

Nuclear pores

regulate movement of material into and out of the nucleus

Vein

relatively large diameter, thinner vascular wall, low pressure, lower speed of flow. The larger diameter of the vein makes up for the slower speed of flow and results in the same overall rate of blood flow as the artery, which has a smaller vascular diameter but higher pressure and higher speed of blood flow. Note, human vessels are more versatile than house pipes, because their vascular walls are elastic and can accommodate different rates while maintaining consistent pressure. Veins return blood from body to the heart; In general, veins will follow arteries. Venous pressure varies (and continuously drops) the farther you are from the heart. Veins are often called 'deoxygenated' but they are not. Normally veins have an pO2 of 40; after exercising it may drop to 20. While most veins follow arteries, there are a quite few veins, both peripheral, and in the viscera, that follow a separate course; they are unique, and do not follow the arteries. We will discuss the unique veins of the superficial upper limb and the gut veins that will be important to know.

Artery

relatively small diameter, larger vascular wall, high pressure, higher speed of flow. Blood travels in the arteries at a fast speed, but has to return to the heart at a slower speed due to lower pressure. Because the two blood flows have to balance,

Blood capillaries in the kidney

remove excess water and salts recovered, maintaining the osmotic gradients

innermost layer

retina

Which of the following veins results from the merger of the superficial temporal vein and maxillary vein?

retromandibular

Corneal nerve

richly innervated by corneal nerves that send afferent impulses through the long ciliary nerves (CN V Ophthalmic division) Within the cornea the nerves are not myelinated, they acquire a myelin sheath at the limbus Most nerves are concentrated in the anterior storma immediately beneath the Bowman's layer (sub epithelial plexus) and send branches into the epithelium (intraepithelial plexus) Descemet's membrane and the endothelium are not innervated

Sagittal sulcus

runs along the length of the sagittal surface on the international; surface of the cranial cavity

urinary bladder

saclike organ in which urine is stored before being excreted

invites the two parietal bones

sagittal suture

soft tissue that covers the calvaria of the skull

scalp

tough outer layer of the eyeball

sclera

The choroid is firmly attaches at 3 locations

scleral spur Exit of vortex veins Optic nerve

G2 Phase

second gap phase routine metabolism

VA of Glossopharyngeal Nerve

sensation from carotid body and sinus

Dorsal root

sensory

Secondary function

serves as a heat exchange

Which of the following cranial nerves is associated with the stylomastoid foramen

seventh cranial nerve

Posterior edge of the eyelid margin

sharp mucocutaneous junction

Ophthalmic artery branches choroid

short posterior ciliary arteries

Transverse sinuses become ___________ sinuses as they approach posterior aspect of petrous temporal bone

sigmoid

Continuation of transverse sinuses

sigmoid sinuses

Simple Squamous Epithelium

single layer of flattened cells needed to allow quick diffusion of nutrients/gasses into or out of an area. Endothelial cell in arteriole Type 1 cell in lung alveolus

simple squamous epithelium

single layer of flattened cells Lining cortex of kidney facilitate rapid diffusion, filtration kidney fillers about 180 liters blood/day

Posterior epithelium

single layer of heavily pigmented columnar cells

Aka sinusitis

sinus infection

Thick and hairy

skin

paired, located on either side of the skull

sphenoidal/anterolateral

Sympathetic fibers originate in the Exit spinal cord and synapse in sympathetic ganglion Postganglionic fibers hitchhike along different nerves to reach target organs

spinal cord

Lymph from the scalp, face, and neck drains into the superficial ring of lymph nodes

submental submandibular parotid mastoid occipital

dehydration. failure to thrive, poor venous blood volume or low intracranial pressure

sunken fontanelle

prominent aspect of frontal bones underneath eyebrows more prominent in males

superciliary arches

Which of the following arteries can sometimes be visible under the skin of the temporal region on a patient?

superficial temporal

towards the head

superior

The cavernous sinus drains into

superior and inferior petrosal sinuses Basilar and pterygoid sinuses via emissary veins

Anterior boundary of the cavernous sinus location

superior orbital fissure

Located between greater and lesser wings of the sphenoid

superior orbital fissure

What is the superior boundary of the Temporal fossa?

superior temporal line

The two brachiocephalic veins unite to form the

superior vena cava

Veins drain deoxygenated blood from organs to the

superior vena cava, through the heart, and ultimately to the lungs for re-oxygenation

Vertebral artery

supplies brainstem and cerebellum

left primary bronchus

supplies left lung note horizontal aspect

Intermediate filaments:

support internal structures of cell; here, they interconnect various junctions to help keep cell shape and support overall epithelial structure.

Ophthalmic artery branches skin above the orbit

supraorbital artery

The lacrimal gland is located just inside the lateral part of the

supraorbital rim

drains anterior scalp and forehead

supraorbital vein

Ophthalmic artery branches skin above the orbit

supratrochlear artery

Gastric fundus

the part of the stomach that is to the left and above the level of the entrance of the esophagus.

Gas exchange

the process of obtaining oxygen from the environment and releasing carbon dioxide

Choroid

the vascular layer of the eye (tunica vasculosa) Dark brownish color due to melanocytes Composed of blood vessels, melanocytes, and connective tissue Posterior aspect of the uveal tract Contains blood vessels, melanocytes, connective tissue, and mucinous extracellular

Subclavian vein

the vein that provides passageway from the lymphatic system to the vascular system

Guttata

thickening of DM in central corner indicative of endothelial dysfunction

Hassall-Henle bodies

thickening of Descement's membrane (DM) bulging into anterior chamber near corneal periphery (common finding increases with age)

conjunctiva

thin, translucent mucus membrane covers anterior sclera from limbus, anteriorly it lines the eye lids

What is the role of the Buccinator muscle?

tightens cheek while chewing

Alveolus

tiny air sac at the end of a bronchiole in the lungs that provides surface area for gas exchange to occur Type 1: - produces surfactant - thin walls -> gas exchange and Type 2 cell

Alveoli

tiny sacs of lung tissue specialized for the movement of gases between air and blood

Outer layer of the eye

tough, fibrous Cornea: transparent fibrous layer Sclera: opaque layer of dense connective tissue

Anterior or ventral

toward the front

Superior or cranial

towards head

Medial

towards midline

Lymphatic system helps rid the body of

toxins and waste

The eye: compartments Vitreous Body

transparent, gelatinous substance that fills the vitreous chamber - mainly water and collagen fibers

Ascending colon

travels upward from the cecum to the undersurface of the liver

Heterochromia

two iris are of different color in the same person, congenital (disruption of sympathetic innervation) or sign of uveal inflammation

Telophase

two nuclei, now restored.

stratified

two or more layers of cells

Another name for the middle ear

tympanic cavity

Caput medusa sign;

typically from liver disease resulting in blockage of blood through the liver, resulting in backup of the portal system. Here it back ups through the paraumbilical vein finding its way to the abdominal peripheral circulation. Consequences Bilirubin will remain in blood and concentrate, contributing to Jaundice (overall yellowish or even green color of skin, particularly well seen in sclera of the eye). Short-term, esophageal and rectal varices can bleed (blood loss) Intermediate term: can do a portal-caval shunt, which relieves pressure but not underlying cause. Liver failure will still result in long-term problems. Unless liver is somehow healed or replaces, the consequences will be fatal.

Image orientation on retina

upside down and backwards

Mitral valve

valve between the left atrium and the left ventricle; bicuspid valve

Pulmonary valve

valve positioned between the right ventricle and the pulmonary artery

Supraorbital notch/foramen

variable in different individuals; transmits supraorbital nerve and vessels

Astigmatism

variation in corneal curvature in various meridians

Epithelial tissue

varies in structure and function

nuclear sclerotic cataract

yellowing and opacification eventually will get brown and cause huge myopic shift

unconscious sensation from viscera and blood

visceral afferent (VA)

innervation distributed to visceral structures in body wall and cavity for (mostly) involuntary control of body functions

visceral/autonomic

physiologic cup

visualized as a light area near center or disc.inside disc where vessels enter and exit,

Functions of the nasal cavity (4)

warms, cleans, and humidifies air Olfaction Teardrainage Mucus production

Interpretation of speech

wernicke's area

Pupillary light reflex (PLR)

when light hits the eye, the pupil automatically constricts

Corneal touch reflex

when you touch the cornea, you instinctively blink

Retinal fundus

whole image

Cytokinesis

wo daughter cells split apart to begin the cycle anew.

Another distinguishing feature of macula is presence of an intraretinal pigment

xanthophyll

Nerves of the eyelids GE

zygomatic branch of CN VII to orbiculares oculi

sensation from skin of the temporal region

zygomaticotemporal

Pulmonary arterial blood pressure is low--

~25/10 mm Hg.

• The posterior chamber contains two regions,

• Canal of Hannover: the area occupied by zonules • Canal of Petit: retrozonular space, the area from most posterior zonule to anterior vitreal face (potential space)

Pupillary dilation

• Posterior hypothalamus projects to intermediolateral cell column of spinal cord C8-T2 (Ciliospinal Center of Budge) • Synapse in superior cervical ganglion • Postganglionic fibers form internal carotid plexus and follow its branch (ophthalmic plexus) • Leave the plexus and innervate dilator pupillae m.

Accommodation (near vision)

• Retina (visual information) • Visual info is fed to area 17 • Area 17 gives descending projections to area 19 • Area 19 projects to Pretectal nucleus • Pretectum nucleus projects to Edinger-Westphal nucleus bilaterally • E-W nucleus gives rise to preganglionic parasympathetic neurons that synapse in the ciliary ganglion • Postganglionic fibers to sphincter pupillae and ciliary muscle via short ciliary nerves Involved circuit in one side )left_ is represented

Blood supply to optic nerve

• The optic nerve is nourished via three arterial systems - Pial - Central retinal artery (arteriole) - Short posterior ciliary arteries (arterioles) Pre -laminar region: Both the central and peripheral portions are supplied by vessels from the surrounding choroid. Laminar region:centrally by branches from the central retinal artery peripherally by branches from the pial arterial network & Circle of Zinn Retro-laminar region:centrally by branches from the central retinal artery peripherally by branches from the pial arterial network The four sources of vessels: Branches from the central retinal artery or its branches Branches from the circle of the Zinn (representing a system of anastomoses between branches from the short posterior ciliary artery (SPCA) and the the pial arterial network) Choroidalbranches Pialbranches

Visual fields defect

•A lesion in the retina will cause a field defect that is similar in shape to the lesion and is in the corresponding location in the field • •If the lesion is in the superior nasal retina, the defect will be in the inferior temporal field.