RUSM2X- Mini 3- TIME FOR A 90!!!!

Which artery supplies the optic tract, some choroid plexus, part of the cerebral peduncle, and portions of the internal capsule, thalamus and hippocampus?

Anterior Choroidal Artery ** a branch of the internal carotid artery ** it targets the lateral ventricle

Bulbourethral Glands (Cowper's Glands)

Empty into the urethra - tubuloalveolar glands lined with mucus-secreting simple cuboidal epithelium - they are surrounded by a fibroelastic capsule containing smooth and skeletal muscle - they empty their viscous, slipper secretions into the lumen of the membranous urethra to lubricate it just prior to the emission of semen ** NOTE: bulbourethral glands cell stain grey with a foamy appearance characteristic of mucus-secreting cells

Dysconjugate Gaze

Eyes do NOT move together Strabismus: congenital weakness of eye muscles that can result in decreased vision in one eye (amblyopia) Esotropia: Abnormal medial deviation of the eye Exotropia: Abnormal lateral deviation of the eye Hypertropia: Abnormal elevation of the eye Diplopia: double vision Anisocoria: pupil asymmetry Nystagmus: reflex eye movement in one direction interupted by fast, saccad-like movement in the opposite direction

Hearing Loss

Conduction Deafness (in middle ear) Sensorineural Deafness - inner ear or cochlea, cochlear nerve, or central auditory pathway Hearing Tests: - Rinne test - Weber test

Testicular function is tightly regulated by the

Hypothalamic-Pituitary-Testicular (HPT) axis **Hypothalamus secretes GnRH--> stimulates the Anterior Pituitary to secrete FSH and LH - FSH acts on Sertoli cells to stimulate spermatogenesis and Inhibin B secretion (Inhibin B feeds back NEGATIVELY to the anteiror pituitary to inhibit FSH release) - LH acts on the Leydig cells to stimulate testosterone secretion -- Testosterone and its metabolites, DiHydrotestosterone (DHT) and estrogen, feedback NEGATIVELY to the anterior pituitary to inhibit LH release and to the hypothalamus to inhibit GnRH secretion NOTE: there is NO positive feedback of steroid hromone to the hypothalamus and pituitary in males as occurs in the females

Name Cranial Nerves I-XII

I- Olfactory II- Optic III- Oculomotor IV- Trochlear V- Trigeminal VI- Abducent VII- Facial VIII- Vestibulocochlear IX- Glossopharyngeal X- Vagus XI- Accessory XII- Hypoglossal

Dural Venous Sinuses

Found between layers of dura mater - receive blood from veins of the brain - receive CSF from the subarachnoid space ** Ultimately drain into the internal jugular vein Four Major Sinuses: 1- Superior Sagittal Sinus 2- Straight sinus 3- Transverse sinus 4- Sigmoid sinus Four Minor Sinuses: 5- Inferior Sagittal Sinus 6- Occipital Sinus 7- Inferior Petrosal Sinus (left and right) 8- Superior Petrosal Sinus (left and right) Other: 9- Cavernous Sinus 10- Sphenoparietal Sinus 11- Confluence of Sinuses

Parathyroid Gland

Four disc-shaped glands, embedded in the posterior aspect of the thyroid gland Produces hormones: - Parathyroid hormone (PTH): controls metabolism of calcium and phosphorus in the blood

Le Forte Fractures

Fractures of Anterior Skull (can be due to car accidents or other trauma) - 3 types Type 1: Horizontal fractures superior to the maxillary alveolar process (where the teeth insert!) crossing the nasal bony septum and may affect the pterygoid plates - results in a "floating", separated plate Type II: Fracture of maxillary sinuses through the infraorbital foramina, lacrimal or ethmoid bones to the nasion - central part of the face is separated from the cranium - results in a "floating", separated maxilla Type III: Horizontal fractures through the superior orbital fissures, ethmoid and nasal bones; laterally through the greater wings of the sphenoid, the frontozygomatic sutures and zygomatic arches - Viscerocranium separates from neurocranium

Structures that give rise to External genitalia in males

Genital tubercle --> Glans penis, corpus cavernosum, corpus spongiosum Urogenital sinus --> Bulbourethral glands, prostate gland Urogenital folds --> Ventral shaft of penis (penile urethra) Labioscrotal swelling--> Scrotum

Most common causes of Primary Amenorrhea

1st: Gonadal Dysgenesis 2nd: Mullerian Agenesis 3rd: Constitutional Delay of Puberty

Where in the brainstem are the each CN found?

3,4- Mibrain 5,6,7- Pons 8,9,10- Medulla

Cells migrating dorsal to the sulcus limitans form the

Alar plate (sensory neurons)

The hip bones are connected anteriorly and posteriorly by?

Anteriorly at the pubic symphysis Posteriorly by the sacrum

Drugs to treat Nociceptive Pain

Anti-inflammatories and atypical: NSAIDS - Aspirin - Ibuprogen Atypical - Acetaminophen Opiods: - Morphine - Codeine

BA for Primary Auditory Cortex

BA 41, 42 ** Auditory association cortex, BA= 22

CN I

CN I- Olfactory Nerve - Nerve has only 1 modality because it only has one function= smell 1- Special Visceral Afferent (SVA)

If fertilization/pregnancy does NOT occur..

Corpus luteum will begin to break down about 2 weeks after ovulation; CL cells cease hormone production and undergo apoptosis - decreased progesterone- onset of menstruation - remnants from CL regression are phagocytosed by macrophages, after which fibroblasts invade the area and produce a scar of dense CT called a corpus albicans

CN VI

CN VI- Abducens Nerve has only 1 axon modality: 1- General Somatic Efferent (GSE) ** Voluntary Motor to Lateral Rectus "SO4LR6AO3"

How do we diagnose psychological disorders?

DSM-5 (diagnostic manual used by health-care providers for mental disorders) 1. Diagnostic Criteria (symptom types and amounts- need 5/9 criteria to meet depression ) 2. ** Timing (i.e. 1 month, 6 month, chronic, child vs adult onset, etc) this matters - acute stress dx vs PTSD - schizophreniform vs. schizophrenia 3. *** Impact - Distress to self/others - impairment of functioning (i.e. adaptic functioning, social, occupational, self-care) 4. Exclusions (i.e, due to a mediacal condition or medication SE, etc)

Benedikts Syndrome

Damage to the ventral and lateral tegmental regions of the midbrain caused by occlusion of the posterior cerebral/basilar artereies ** Results in oculomotor palsy, contralateral hemiplegia. Ataxia, tremor and involuntary movements also exist (damaged red nucleus and superior cerebellar peduncle)

Muscles of facial expression are innervated by

CNVII

Major causes of erectile dysfunction (ED)

Cardiovascular disease, hypertension, and diabetes ** Prevalence of ED increases with advancing age & certain medical conditions (diabetes, CVD, hypertension) ** ED is a clinical marker/predictor of underlying CVD, with onser typically 2-5 yrs before a cardiovascular event

Cauliflower Ear

Cartilage of the ear is injured in trauma and blood supply is disrupted - Hematoma around the cartilage deforms the shape of the ear, compromising the blood supply - Results in fibrosis in the overlying skin ** Common in sports such as rugby, boxing & martial arts Fibrosis= wound healing, a reparative response- development of CT in response to damage or injury - replaces normal parenchymal tissue, but can occur in excess, leading to tissue remodeling and formation of permanent scar tissue

Chiari Malformation

Cerebellar tissues (tonsils) are forced downwards into the foramen magnum/spinal canal because of abnormal development or lack of space in cranial vault - several types that increase in severity and may affect the brainstem * Type II (Arnold- Chiari): cerebellar vermal displacement along the hydrocephalus and possible spina bifida

Production of Aqueous Humor

Ciliary processes produce a watery fluid called aqueous humor that circulates in the POSTERIOR AND ANTERIOR chambers - Aqueous humor similar in ionic composition to plasma BUT contains less than 0.1% protein (compared with 7% protein in plasma) NOTE: Aqueous humor provides oxygen and nutrients for the avascular cornea and lens- it MUST keep circulating! NOTE: Ciliary process in section show their double layer of pigmented and nonpigmented epithelial cells - outer non-pigmented layer (facing posterior chamber) transports a protein poor plasma from fenestrated capillaries into posterior chamber of eye - lined with (rare) stratified cuboidal/columnar epithelium ** NOTE also there is a core of CT containing fenestrated capillaries

Glutamatergic Neurotransmission

Complicated recycling pathway ** taken up by astrocytes converted to glutamine and shuttled to pre-synaptic and made back into glutamate Post-synaptic Receptors: - **Ionotropic receptors (AKA ligand-gated ion channels) : AMPA, NMDA and Kainate - Metabotropic (GPCR) receptors: mGluRs

Circle of Willis

" The connector" * Anterior Cerebral, Internal carotid Artery & Posterior cerebral arteries of BOTH sides are connected creating a structure called the "Circle of Willis" ** there is normally no flow around this circle, but it provides critical anastomotic means of flow in case any of the vessels become occluded

Parotid Region (Fossa)

Comprises the parotid gland, parotid bed (which includes muscles and part of the skull), and neurovasculature passing through the region Boundaries of Parotid Region: - Anteriorly: anterior border of masseter muscle - Posteriorly: external ear, anterior border of sternocleidomastoid muscle - Superiorly: zygomatic arch - Inferiorly: angle and inferior border of mandible - Medially: ramus of the mandible (found behind the masseter muscle)

Holoprosencephaly

* A Neural Tube Defect - Failure of the prosencephalon (embryonic forebrain) to divide into two cerebral hemispheres - Results in a single-lobed brain structure, skull and facial defects ***Associated with: mutations in sonic hedgehod (SHH) signaling, dis-regulated choleserol biosynthesis, chromosomal abnormalities (Ch13), and fetal alcohol syndrome

Extrinsic Muscles of the Tongue

** Are ALL innervated by Hypoglossal nerve (CNXII) EXCEPT for Palatoglossus *** Palatoglossus is innervated by Pharyngeal branch of Vagus (CNX) * The Extrinsic muscles of the tongue connect the tongue to the surrounding structures: the soft palate and the bones (mandible, hyoid bone, styloid process)and provide voluntary movement of the tongue - Genioglossus: protrudes tongue; depresses center of tongue - Hyoglossus: depresses tongue - Styloglossus: elevates and retracts tongue - Palatoglossus: depresses palate; moves palatoglossal fold toward midline; elevates back of the tongue

Venous drainage of the rectum

** NOTE the extensive venous drainage for the rectum- there is also the same extensive arterial supply for this organ - Superior Rectal Vein: drains into the portal system (portal vein) via the inferior mesenteric vein - Middle Rectal Vein: drains into the caval system (IVC) via the internal iliac vein - Infeiror Rectal vein: drains into the internal pudendal vein and then into the internal iliac vein to get to the caval system (IVC)

Anterior and Dorsomedial Nuclei

** are diencephalic components of the limbic system - Anterior region of the thalamus: contains only ONE large nucleus (ANTERIOR NUCLEUS) - Medial refion of the thalamus: contains only ONE large nucleus (DORSOMEDIAL NUCLEUS)

Serotonergic drug targets

- 5-HT1A receptor partial agonist: anxiety - 5-HT1b/1d receptor agonist: pre-synatpic autoreceptors and anti-migraine - 5-HT3 receptor competitive antagonists: anti-emetic

How to choose the right hormonal contraceptive?

- Adherence/compliance: choose the option that is most suited to the pts lifestyle and maximizes compliance -Adverse effects/Comorbid conditions: does the pt have a condition that could be made worse or be potentially fatal if they use hormonal contraceptives? Is there an inconvenient side effect (not serious), that may reduce compliance? (ex. headache, break-through bleeding etc) - Return to fertility time: does the pt want to be pregnant in the near (months) or long term (yrs) - pills and patches can return to fertility next cycle once stopping

The floor of the cranial vault is divided into

- Anterior Cranial Fossa - Middle Cranial Fossa - Posterior Cranial Fossa

Physiological effects of estrogen in males

- Bone growth, epiphyseal closure - Masculinization of the brain during development - Regulation of fluid in the ejaculate

Monoamine Neurotransmitters

- Dopamine - Serotonin - Norepinephrine

Physiological effects of DHT in males

- Embryonic differentiation of the scrotum, penis & prostate - Pubertal development of facial & body hair, penis growth, differentiation & activation of the prostate, sebaceous gland activity - Male-pattern hair distribution & balding

What Symptoms would be present in an Upper Motor Neuron (UMN) Lesion?

- Everything goes "up" - Produces spastic paralysis - Weakness of muscles paresis - Hyperreflexia - Hypertonia with spasticity - Babinski sign is present Ex: If corticospinal tract is damaged this will lead to Hemiplegia on R side & spastic paralysis bc inhibition signal (usually presnt from the brain to tell the LMN to calm down)- is not present so the LMN is overeacting and this is what yields hyper-reflexia and spasticity

Sleep-Related Hypoventilation

- Increased arterial pCO2, compared to waking - Diaphragm weakness - Headaches in morning - May coexist with sleep apnea - Sustained oxygen desaturation key for differential *** persistent decrease can even thoughout the day (so low level of O2 saturation even when not sleeping)

Anatomical position of the Urinary bladder in Male Pelvis

- Posterior to pubic symphysis - Superior to urethera - Superior to prostate gland - Anterior to rectum NOTE: - the bladder wall is made of smooth muscle fibers called the Detrusor muscle (detrudere= latin word for thrust out) - ureters open into the bladder from the posterior aspect

Joints of the pelvic girdle include

- Sacroiliac joint= articulation between sacrum and ilium - Lumbosacral joint= L5 vertebrae + sacrum - Sacro-coccygeal join= sacrum + coccyx - * Pubic symphysis= articulation between the two pubic bones connected by fibrocartilage

What develops from the Mesencephalon (midbrain)?

- Tectum (superior and inferior colliculi) *** Superior colliculi= visual and motor system *** Inferior colliculi= auditory system - Cerebral peduncle - Pretectum/tegmentum - Cerebral aqueduct ** tectum= roof, tegmentum= covering

By the 6th week of development, 5 prominences can be seen; which are

- Two Mandibular (1st pharyngeal arch, caudal to the stomodeum) - Two Maxillary (dorsal part of 1st pharyngeal arch, lateral to the stomodeum) - One large Frontonasal (cranial to the stomodeum)

What are the derivatives of the 1st pharyngeal pouch?

- Tympanic (middle ear) cavity - Auditory (eustachian) tube

Force inspiration- the larynx is

- Vocal folds abducts and rima glottidis wide open - Vestibule open

Anatomical position of the Prostate Gland in the male pelvis

- inferior to bladder - posterior to pubic symphysis - anterior to rectum - prostate surrounds the prostatic urethra Prostate gland is a ... - fibromuscular glandular organ (2/3rd glandular, 1/3rd firbomuscular) - produces fluid for semen, which transports sperm during the male orgasm

Digestive organs in the pelvis region

- parts of colon - rectum - anal canal

Function of the Reticular Formation?

- sensory - sleep/wakefulness - consciousness - regulation of emotion/behavior - autonomic - motor Everything! "every breath you take, every move you make, every bond you break, every step you take- I'll be watching you"

Urinary organs

- ureter - urinary bladder - urethra

Proper placement technique of urinary catheter

- urethral catheterization is done to remove urine from a person who is unable to micturate - it is also performed to irrigate the bladder and to obtain an uncontaminated sample of urine- when inserting catheters, the curves of the male urethra must be considered

Reduced penetrance for AD: AD gene, 80% penetrance- What would be the risk of an offspring for having the disease?

0.4 (0.5 for getting gene x 0.8 for showing the gene= 0.4)

Principles of Cerebellar Function

1- Functions are IPSILATERAL - if an afferent input to the cerebellum arises from on side of the body or "world", it terminates in the SAME SIDE of the cerebellum 2- Architecture/circuitry of the cerebellar cortex is CONSTANT - different functions of the different lobes are a result of afferent/efferent projections 3- Cerebellar Dysfunction: - Lesions limited to the cerebellum DO NOT produce paralysis (plegia).. they produce disequilibrium, ataxia, dysmetria and changes in muscle tone

What is found in the preoptic area of the hypothalamus?

1- Medial preoptic nucleus: contains sexually dimorphic nuclei (the nuclei in the preoptic area are larger in males than females)- this is the center of male-typical sexual behavior - one of the areas that release gonadotropic hormones 2- Lateral preoptic nucleus- may regulate REM and non-REM sleep 3- median preoptic nucleus- generates thirst 4- preoptic periventricular nucleus- helps suprchiasmatic in sleep

Nuclei of CN X- Vagus

1- Nucleus Ambiguus (BE) 2- Dorsal Motor Nucleus of X (GVE) 3- Nucleus Solitarius- Caudal (GVA) 4- Nucleus Solitarius- Rostral (SVA) 5- Main Sensory & Spinal Nucleus of V (GSA) Axon Modalities: BE, GVE, GVA, SVA, GSA

Where two regions of the CNS give rise to the sympathetic and parasympathetic Nervous systems?

1- Sympathetic= Thoracolumbar (Pre-ganglionic cell bodies located in the lateral horn of thoracic & lumbar regions (T1-L2)) 2- Parasympathetic= Craniosacral (Pre-ganglionic cell bodies located in cranial nerves III, VII, IX, X and in cell bodies in S2-S4 in the spinal cord ** Each system has a 2 neuron chain from either the spinal cord or cranial nerve nuclei located in the brainstem

3 components are required to produce a "voice"

1. Generator: force provided by air moving from lungs 2. Vibration: when air rushes past, the vocal folds vibrate 3. Resonance: sound can be modulated by cavities *** Normal voice production requires the vocal folds to meet completely in the midline (controlled by intrinsic laryngeal muscles)

Neuroectoderm divides into

1. Neural Crest Cells - Peripheral Nervous system: schwann cells, neuroglial cells, sympathetic nervous system, parasympathetic nervous system - Adrenal medulla - Melanocytes - Facial cartilage - Dentine of teeth 2. Neural Tube - Brain* - Neural Pituitary - Spinal cord* - Motor neurons - Retina

Neuronal cell bodies in the PNS are in

Ganglia - Dorsal Root ganglia - Cranial nerve ganglia - Autonomic ganglia

GVA

General Visceral Afferent - fibers that carry visceral sensation

GVE

General Visceral Efferent - motor fibers to smooth muscle, glands, viscera

Aromatase inhibitors

Letrozole

Limbic cortex loop of Basal ganglia

Limbic cortex ---> nucleus accumbens--> ventral pallidum--> dorsomedial nucleus of thalamus--> limbic cortex

Gait

Manner or style of walking

How can you see an image with your eyes?

Photoreceptor cells in the retina of the eye detect light intensity and color, and encode these parameters into electrical impulses for transmission to the brain via the OPTIC NERVE

What substrates must be supplied to the palcenta from the fetus and mother in order for the placenta to produce estrogens and progesterone?

Placenta needs: - Cholesterol from mom to make progesterone - DHEA-Sulfate from fetus adrenal gland to make estrone and estradiol - 16alpha-OH-DHEA-sulfate from fetus liver to make Estriol

Nuclei of CN VI and Motor Nucleus of VII are in the

Pons

How does renal blood flow change during pregnancy?

Renal blood flow increases by 70-80% above non-pregnancy levels- this results in increased solute delivery and thus, increased GFR

SNc (Substantia Nigra Pars Compacta)

Sends modulatory information to the striatum

Sensorimotor cortex loop of Basal Ganglia

Sensorimotor cortex--> putamen--> globus pallidus --> ventral anterior and ventral lateral nuclei of thalamus --> sensorimotor cortex ** for movement

Donepezil

Site of action: - Acetylcholinesterase Action: - inhibition

Dantrolene

Site of action: Ryanodine receptor Action: - antagonist

Botulinium toxin

Site of action: SNARE-mediated vesicular relase Action: - inhibition

SSA

Special Somatic Afferent - vision & hearing

Which muscle arises from the III pharyngeal arch?

Stylopharyngeus ** Common carotid artery & proximal part of the internal carotid artery ** CN IX (CN 9)

Sound localization occurs in the

Superior Olivary Complex - Interaural time delay (ITD): time difference for sound to reach each ear - Interaural intensity difference (IID): sound level difference between each ear, when sound is of high frequency (caused by sound-shadowing effect of head) ** Together ITD and IID= Duplex Theory of Sound Localization - interaural time delay: 20-2000Hz - interaural intensity difference: 2000-20000 Hz (higher freq)

Stridor

a high pitch (musical) sound resulting from disrupted or obstructed airflow through the larynx bc the vocal cords are stuck in a para-median position

Akinesia

absence (or poor) movement

The external ear is all

cartilaginous (elastic)

Prostaglandin E2 can induce

cervical ripening and myometrial contractions at any gestational stage - Blocking the effects of PGE2 could inhibit further progression of preterm labor ** Administration of oxytocin, progesterone blocker, PGF2alpha would be more likely to promote labor *** Corticosteroids and LH would have NO effect on labor progression, BUT corticosteroids would be indicated in order to promote fetal lung surfactant production

Nuclei of CN XI are in the

cervical spinal cord

Fiber pathways (Tracts)

change names at each synapse and sometimes when they cross the midline

Depletion of follicles from the ovaries would lead to

decreased estradiol --> NO negative feedback therefore FSH and LH levels would be high

Dystonia

disordered tonicity of muscle

Epiblast 3 layered disc can form into the

ectoderm mesoderm endoderm

In the 3rd week of development, primordial germ cells appear among the

endoderm cells in the wall of the yolk sac - the cells then migrate along the dorsal mesentery of the hindgut In the 6th week, cells invade the genital ridges aka the primitive gonads *** If the primordial cells FAIL to reach the genital ridges, gonads will NOT form

Thyroid Gland originates as an

epithelial proliferation in the floor of the pharynx at the location of the foramen cecum - In week 7 the thyroglossal duct runs from the base of the tongue at the foramen cecum and the thyroid descends and migrates to a final postion anterior to the trachea ** Normally, the thyroglossal duct will disappear - HOWEVER, a thyroglossal duct cyst may be present anywhere along the migratory pathway near the MIDLINE of the neck (remmebr cervical cysts/fistulas were more along the sternocleidomastoid muscle) --> most are near the hyoid bone (65% are located infrahyoidal, 20% suprahyoidal and 15% at the level of the hyoid), although others may be found at the base of the tongue or near the thyroid cartilage

The luteal-placental shift is markes by an increase in

estriol secretion (estriol is NOT secreted by the corpus luteum) and by reduction of 17-hydroxy-progesterone secretion (17-OH-progesterone is secreted by the corpus luteum and not the placenta).

If fertilization occurs, the corpus luteum

fails to regress and instead enlarged in response to stimulation by hCG secreted by the syncytiotrophoblast cells- this ensures continued progesterone secretion by the corpus luteum, which is essential for maintenance of pregnancy. The pituitary does NOT secrete hCG; the placenta does NOT secrete FSH or LH. Placental function is not related to prolactin- the corpus luteum does not secrete hPL

The PCO2 of the umbilical vein is greater than the PCO2 of the uterine vein. T or F?

false Uterine Vein PCO2= 45 mmHg Umbilical Vein PCO2= 40 mmHg ** Favors CO2 from fetus to mother

When looking at images such as CT images or MRI images- Axial section are viewed from the

feet of the patient - Dorsal is "behing the image, ventral is the side you see, ride side of the image is the left side Coronal Sections are viewed as if standing facing the paritent - dorsal is the "top", right side of image is the left side of patient

Ovarian follicles represent the basic functional unit of the

female reproductive system ** On the most basic level, the ovary functions to: - produce mature, fertilizable oocytes - secrete hormones ** A follicle consists of a single oocyte completely surrounded by a cluster of endocrine cells (granulosa & theca cells) - One follcile ovulates in each cycle (apprx. monthly) releasing a mature fertilizable oocyte-- the remnants of the follicle become the corpus luteum, which after a finite period of time degenerates forming the corpus albicans

Dyskinesia

fragmentary or incomplete movements

Neural crest cells, from certain _____, migrate to form the pharyngeal arches

from certain rhombomeres NOTE: Pharyngeal arches (AKA branchial arches) - in 4th and 5th week of development the pharyngeal arches begin to appear - the arches are bars of mesenchyme separated by cleft (grooves) externally and pouches internally

Dysdiadochokinesia

impairement of ability to perform rapid alternating movements

Lambda

location where the lambdoid suture meets the sagittal suture

Nuclei for CN V is in the

midbrain, pons, and medulla

In the brain stem, motor is ___, sensory is ___

motor- medial sensory- lateral

Neurons arise from

neuroepithelial cells from neuroectoderm to "build" the neocortex

During quiet respiration the larynx is

open and relaxing to get air in - vocal fold and vestibular fold are open

Erection is primarily under

parasympathetic control - parasympathetic stimulatin of the penile endothelial cells increases NO production and sitmulation of cGMP and ultimately relaxation of penile vascular smooth muscle cells - Sildenafil inhibits phosphodiesterase type 5 (PDE5) and thus inhibits breakdown of cGMP--> this action permits erection to be maintained ** PDE5 inhibitors do NOT increase NO production by endothelial cells ** Cavernous (post-ganglionic parasympathetic) nerves which facilitate penile erection are susceptible to injury following prostatectomy

The appearance of the offspring depends on who

the father and mother were

Sagittal suture connects the

two parietal bones

Following GnRH stimulation of gonadotropes, LH & FSH are released into the circulation & transported

unbound to plasma proteins to the testes - LH & FSH are both glycoprotein hormones comprising alpha and beta subunits - Beta subunit confers hormone specificity & function, while the alpha subunit is common to LH, FSH, human chorionic gonadotropin (hCG) & thyroid-stimulating hormone (TSH) - Functional activity of these hormones requires the presence of both subunits

H- Test

utilized when testing the function of each of the extraocular muscles * when carrying out the H-Test, the muscles of BOTH eyes are tested at the same time Ex: Looking to the right is testing BOTH the lateral rectus muscle in the right eye (abduction) and the medial rectus muscle in the left eye (adduction)

Disinhibition of the thalamus, EXCITATION to the cortex occurs in the

Direct Pathway of the Basal Ganglia

Dysphonia

Disorder of the voice

What is the primary stimulus for the increase in PRL secretion during pregnancy?

Estrogen stimulates prolactin production directly and indirectly (via inhibition of dopamine)- mammogenesis and negative feedback to anterior pituitary inhibiting LH and FSH secretion- inhibits ovulation

In times of stress, just like in lack of pulsatile secretion of GnRH

FSH and LH levels would be decreased

A 39 pt who underwent ovarian surgery 1 year ago presents to you complaining of spontaneous menses and infertility. What do you suspect

Premature Ovarian Insufficieny - High FSH and LH Primary Ovarian Insufficiency: Ovarian "failure" before 40 yrs of age: present as infertility patient: check karyotype and fragile X screening < 44 CGG repeats= normal 45-54 CGG repeats= Intermediate "gray zone" 55-200 CGG repeats= premutation carriers >200 CGG repeats= Fragile X syndrome Frequent intermittent ovarian function and spontaneous menses - Increased risk of Autoimmune adrenal insufficieny.. potentially fatal (Addisons: 300-fold greater than general population) and other atuoimmune diseases..polyglandular failure, hypothyroidism, myasthenia gravis, Sjogren Syndrome, lupus Risk factors: previous ovarian surgery, chemotherpay, radiation

Golgi Tendon Organs are

Proprioceptive Sensory Organs that detect changes in muscle tension - composed of a network of collagen fibers inside a CT capsule with sensory axons winding around the collagen * located at the origins and insertions of skeletal muscle fibers into the tendons of skeletal muscle ** Innervated by Ib sensory neurons ** firing of the Ib afferent fibers increases when the tendon organ is sterteched, with greater output for active contraction rather than passive stretching ** Ib axons branch extensively in the spinal cord and synapse on several interneurons in the ventral horn ** Some make inhibitory sysnapses with alpha motor neurons

Reflex Tears

Protective in nature - Its why we "tear-up" when we get a piece of dirt or other irritant in the eye or why someone criws when they cut onions - The cornea detects the irritates, sends that information to the brainstem and then a efferent signal is sent to the lacrimal gland

Fractures of the Pterion

Pterion is a region of the skull where the temporal, sphenoid, parietal and frontal bones meet - it is the thinnest and WEAKEST part of the skull (just behind the temple) ** Deep to the Pterion lies the middle meningeal artery, which can be ruptured by an injury to this region ** Rupture of the middle meningeal artery leads to an EPIDURAL HEMATOMA (blood trapped between the skull and dura)

Internal Pudendal Artery & its branches

Internal pudendal artery follows SAME path as the pudendal nerve to reach the perineum * branch names for internal pudendal artery are similar to the pudendal nerve branches - Inferior rectal artery - Perineal artery - Dorsal artery of penis or Dorsal artery of clitoris (M/F)

Frontal Sinus

Left and right sinuses drain into the middle meatus through the frontonasal duct and the semilunar hiatus ** innervated by branches of the supraorbital nerve from CNV1

Hemispheric Specialization (Handedness)

Lefties (~10%)- favor the left hand (right hemispheric specialization) <1% are ambidextrous Righties (~90%)- favor the right hand (left hemispheric specialization)

Decerebrate Rigidity

Lesion is AT the midbrain--> red nucleus is thus damaged ** decerebrate= "removing the cerebellum" - inhibitory input from the cortex on the medial reticulospinal and lateral vestibulospinal has been removed and the red nucleus, rubrospinal tract, is DAMAGED--> allows for the upper limbs to extend as the tract is NOT working so flexion CAN NOT occur * ALL limbs are extended

Mesencephalic Components

Limbic Midbrain area - consists of the ventral tegmental area (dopamine), raphe nuclei (serotonin) and locus coeruleus (norepinephrine) - Ventral tegmental area neruons --> serve several functions in the reward, motivation, and addiction systems (** cocaine blocks dopamine) ** this area is important in communicating with other limbic system structures such as the hypothalamus, amygdala, frontal cortex, hippocampus ** Ventral tegmental area and associated nucleus accumbens also seem to be important in emotional states relating to intense love and the obsessive behaviors that may accompany rejected partners/friends ** Nucleus accumbens helps to calculate the gains and loses of a situation ** All related to the survival of a species

Central control of Eye movements: Saccades

Saccades are under cortical control- through areas of cortex called the frontal, parietal and supplementary eye fields - the frontal eye field (BA8) is the major initiatory of saccades- stimulation causes horizontal conjugate gaze to the contralateral side - The movement is mediated by connections ot the superior colliculus and then the PPRF ** Damage to the frontal eye field of one hemisphere results in the inability to look voluntarily to the contralateral side ** Vertical movements and the vestibulo-ocular reflex (VOR) will remain intact- the muscles are NOT affected! Whats interesting is that recovery can occur within several days if the lesion is unilateral - Bilateral disrupiton of the cerebral region or superior colliculi cause severe deficits in generating saccades ** REMEMBER MLF is important for conjugate gaze- CN 6 on one side needs to talk to CN 3 on the other ALL THE TIME

Intellectual Quotient (IQ)

Mean= 100, SD=15 - intellectual disability <70 (2 SD from the mean- well below average) NOTE: we also have - verbal IQ - performance IQ - full sclae IQ ** index scores based on combinations of subsests

2-Point Discrimination

Measures the minimum distance at which two stimuli can be noted as different or distint - 2mm on the hand... 10 mm on the palm.. 40mm on the arm *** greatest discriminative capacity is on the fingertips - Spacing of mechanoreceptors: closer together on the fingers that allow for 2-pt discrimination- receptors are father apart on the back, so discriminating between two points is more difficult - Need smaller and more discriminative receptor fields on hands, fingertips and face to identify stimuli - Threshold for receptor activation is lower in the area of the hands and face

Dopamine only acts via

Metabotropic (GPCR) receptors 5 separate receptors (individual genes) D1 through D5 Also classified into 2 two groups pharmacologically - D1-like family (D1 and D5) - D2-like family (D2, D3, D4) * Pre- and post-synaptic locations D1-like family: (stimulatory) - Gs, sitmulates adenylyl cyclase, increases cAMP, PKA, etc D2-like family (inhibitory) - Gi, inhibits adenylyl cyclase, decreases cAMP, PKA etc - reduces Ca2+ channel actiivty - activates K+ channel ** D1 and D2 receptos most abundant

Temporomandibular Joint (TMJ)

Modified hinge type of Synovial Joint Movements include: - gliding (translation) - small degree of rotation (pivoting) - flexion (elevation) - extension (depression) Bony articular surfaces involved: - Mandibular fossa and articular tubercle of temporal bone - Condylar process of mandible ** The articular surfaces of the temporal bone and mandible are separated by a fibrocartilage articular disc

4th step of neurotransmission= Metabolism- what drugs work on here?

Monoamine oxidase B (MAO) is an enzyme that metabolizes amine neurotransmitters (dopamine, norepinephrine, serotonin) MAO inhibition increases neurotransmitter levels (more will be available to be packed in vesicles and released) ** Selegilline= a MAO type B inhibitor that is used in treatment of parkinsons disease- increases dopamin levels in the brain

Muscles of Facial Expression that are found in the Nasal Region:

Nasalis: I: CN VII- BE axons Fx: Compresses the nasal cartilages (flare the nostrils) Procerus: I: CN VII- BE axons Fx: Depresses skin between the eyebrows

Interneuron

Neurons that transmit impulses between other nuerons (usually sensory and motor), especially as apart of a reflex action - can be either excitatory or inhibitory

Chronic Pain Disorders can include

Neuropathic Pain (CNS/PNS) - Peripheral neuropathies (diabetes, HIV) - Postherpetic neuralgia - Trigeminal neuralgia - Central post-stroke pain - Spinal cord injury - Neuropathic low back pain Mixed Pain - Migraine and chronic daily headache - Fibromyalgia - Phantom limb pain - Complex regional pain syndrome - Multiple sclerosis - Low back pain - Myofascial pain syndrome - Skeletal muscle pain Nociceptive Pain - Mechanical low back pain - Rheumatic arthritis - Osteoarthritis - Chronic inflammatory conditions - Somatoform pain disorder - Postoperative pain - Sickle cell crisis - Sports/exercise injury

Neuronal cell bodies in the CNS are called

Nuclei and are scattered throughout the cortex and brainstem levels

What is the exit site for the optic nerve?

Optic Disk - it contains NO Photoreceptor cells and is called the "blind spot" of the retina ** Lamina Cribosa= region of the sclera that contains opening through whcih optic nerve passes through to brain

Symptoms of Upper Motor Lesion Vs Lower Motor Neuron lesion

Paralysis: UMNL- Spastic, LMNL- Flaccid Reflexs: UMNL- Hyper-reflexia, LMNL- Areflexia/Hyporeflexia Muscle tone: UMNL- Increased, LMNL- reduced with fasciculations "twitching" Muscle power: UMNL- weak, LMNL- very weak Atrophy: UMNL- disuse, LMNL- pronounced Speed of movemnt: UMNL- decreased, LMNL- lost Area of coverage: UMNL- large, LMNL- localized Babinski reflex: UMNL- present, LMNL- absent

Pontocerebellum

Phylogenetic Classification: Neocerebellum Anatomical Classification: Posterior lobe, hemispheres Connections/Functions: - Main input from sensory and motor cortices - Coordinates planning, programming of movements (with motor cortices) * works with corticospinal Deficit Symptoms: - Dysmetria and hypermetria (positive rebound) - Intention tremor - Nystagmus - Decreased muscle tone

Basal ganglia communicated with

UMNs via the thalamus

What fetal derived cells are involved in spiral artery remodeling?

VSMC apoptosis, ECM degeneration & insertion of TROPHOBLAST cells into the vessel wall increases vessel size creating a high flow, low-resistance remodled spiral artery **** During sprial artery remodeling, the vessel structure changes with loss of vascular cells (apoptosis of VSMCs and generation of the vessel ECM) and replacement by trophoblasts embedded in a fibrinoid material (of trophoblast origin). Subsequent re-endothelialization occurs later in pregnancy. Maternal immune cells (natural killer cells and macropahges) located in the decidua orchestrate these changes

Nuclei and Modality of CN II- Optic

Various Nuclei- (SSA- vision)

Nuclei and Modality of CN I- Olfactory

Various Nuclei- (SVA- smell)

Structures passing through the root of the neck

Vasculature: - Common Carotid artery - Subclavian artery and branches - Internal Jugular vein - Subcalvian vein and tributaries Nerves: - Phrenic nerves - Vagus nerves -> Recurrent Laryngeal nerve - Cervical part of sympathetic trunk --> Cervical ganglia Other structures: - Trachea - Esophagus - Cervical parietal pleura (dome/ cupula of pleura) - Apex of lung - Muscles: anterior, middle, and posterior scalenes

Ventral Horn- Grey Mater of the Spinal Cord

Ventral Horn (Basal Plate) contains mainly motor neurons called alpha and gamma motorneurons - Alpha motorneurons supply SKELETAL MUSCLES (extrafusal fibers) - Gamma motorneurons supply MUSCLE SPINDLES

Branches of the Trigeminal Nerve Mandibular Division CNV3

Voluntary Motor-BE axons in the following branches: - Medial Pterygoid Nerve - Lateral Pterygoid Nerve - Masseteric Nerve - Deep Temporal Nerve Somatosensory- GSA axons in the following branches: - Meningeal branch - Buccal Nerve - Auriculotemporal nerve - Lingual Nerve *** Inferior alveolar Nerve is mixed it has voluntary motor-BE axons via the (nerve to mylohyoid) and it has somatosensory GSA axons (via the mental nerve) NOTE: the mandibular nerve passes through the foramen ovale and into the infratemporal fossa

Addiction

drug use problem/substance use disorder--> linked to psychological dependence (drug seeking behavior) ** DSM-5 has criteria to diagnose substance use - Physical Dependence: defined by tolerance (dose that used to produce effect is now not able to produce same effect- more drug needed to get same effect) and Withdrawal (body accustomed to drug- without it have physiological symptoms- sweating, chills, goose bumps, vomiting) ** seen with alot of drugs not just drugs of abuse- this is not necessarily part of addiction- (i.e. pts with epilepsy- advised to NOT stop taking all of a sudden bc may evoke siezure activity) - Cross-tolerance: tolerance to one drug, possible tolerance to other related one (i.e. alcohol + diazepam both act on GABAa receptors- may req higher dose of diazepam if you usually drink alcohol) - Pharmacoresistance

Bifid Tongue

due to failure of fusion of the left/right lateral lingual swellings from the 1st pharyngeal arch

Memory can be divided into

Short- term or Long- Term Short-term - Working memory Long- term I. Declarative - Episodic - Semantic II. Non-Declarative - Procedural

Haloperidol

Site of action: Dopamine D2 receptor Action: Antagonist

Diazepam

Site of action: GABA-A receptor Action: positive allosteric modulator

Intrafusal Muscle fibers

Skeletal muscle fibers that serve as special sensory organs, which detect the amount and rate of change in the stretch and length of a muscle ** these are found in muscle spindles

Carotid Body

Small, oval mass of tissue located within the septum on the medial side of the bifurcation of the common carotid artery in close relation to the carotid sinus - supplied primarily by the glossopharyngeal nerve (CNIX) with some input from the vagus nerve (CNX) (GVA axons) **** Chemoreceptor: stimulated by low O2 levels initiating a reflex that increases rate and depth of respiration, cardiac rate, and blood pressure

Subacute combined degeneration

Spinal cord lesions that occur because of a B12 deficiency- either pernicious anemia, other malabsoprtive disorders, malnutrition, etc *** B12 is important for the maintenance and synthesis of myelin- the actual mechanism by while myelin damage occurs is unclear Clinical Features: 1- Bilateral spastic paralysis (from lateral corticospinal axon degeneration) 2- Bilateral loss of discriminative touch, vibration & position sense (from dorsal column degeneration) ** Note: Ex- the "white" signal changes in the dorsal columns in this MRI- pt had reduced vibration & position sense and Romberg Sign (Romberg sign is a test of dorsal column function)

Adverse effects of local anesthetics

Systemic toxicity: - if injected into blood - CNS toxicity: seizures, treated with diazepam - Cardiotoxicity: hypotension--> leading to arrhythmias at toxic doses ***Bupivacaine is the worst for Cardiotoxicity ** Cocaine can cause hypertension ** pts will be asked if tongue numbness or visual auditory hallucinations or muscle twitching --> drug into vasculature and may be getting systemic rather than local affects that were intended --> can progress to seizure, coma and resp arrest if too large dose Localized toxicity ex. injection into nerve (normally it should be NEAR the nerve, not INTO nerve) Hypersensitivity ** particularly the esters - allergic dermatitis Hematological toxicity - methemoglobinemia--> treated with methylene blue (EXCEPT if pts is glucose-6-phosphate dehydrogenase deficient)

Major connections of the Striatum

Striatum= Caudate+ Putamen + Nucleus Accumbens Striatum: - Recieves excitatory information from the cortex to the thalamus - Send inhibitory information to Globus pallidus (externa and interna), substantia nigra (pars compacta and pars reticulata - Receives modulatory dopaminergic input from substantia nigra pars compacta

Brain herniations following injury

Supratentorial (structures above tentorial notch): 1- central (transtentorial) 2- uncal (transtentorial)- can result in coma/death 3- cingulate (subfalcine) 4- transcalvarial Infratentorial (structures below tentorial notch): 1- upward cerebellar (transtentorial) 2- downward cerebellar- tonsillar (transtentorial)-rapidly fatal

9th step of neurotransmission= Post-synaptic effects- what drugs work here?

Things that may occur: - increase in Ca2+, Na+, Cl- - decrease in K+ - activation of enzymes ex. kinases - change in gene expression - excitation or inhibition of post-synaptic neuron ** Dantrolene is a ryanodine receptor anatagonist (which is usually activated by IP3) and inhibits calcium-induced calcium release from endoplasmic reticulum (decreases levels of intracellular calcium)

Trigeminal System

Touch, pressure, vibration, proprioception from the face Levels of 1st order cell body? - Trigeminal Ganglion in pons Where do fibers cross the neuroaxis? - directly upon entering the pons Deficits? - Lesion of the principal sensory nucleus or trigeminal tract resuls in IPSILATERAL deficits in touch, pressure, vibration from face, teeth, anterior 2/3 of tongue & palate (all structure from the trigeminal peripheral nerve maps that have GSA axons from them!) - Lesion of Trigemino-Thalamic tract (trigeminal leminiscus) results in CONTRALATERAL deficits

Human placental lactogen (hPL) is produced by which cell type?

hPL is secreted by the syncytiotrophoblast cells (STs)- it is detectable in maternal serum from week 4-5 of gestation and levels rise exponetntially throughout pregnancy co-incident with the increase in placental mass - Levels of hPL in fetal circulation remain low throughout gestation (300-fold lower concentration than maternal circulation) *** detectable from gestation week4-5 and functions to alter maternal glucose metabolism to ensure a constant supply of nutrients to the developing fetus - it is NOT essential for fetal development or pregnancy maintenance-

Ileocecal valve

separates the terminal ileum from the cecum and regulates flow between these two structures - important to visualize the ileocecal valve to ensure you viewed the entire large intestine (ex. when giving a barium enema)

During puberty, testis cords acquire a

lumen and become seminiferous tubules - like the kidney, the testis has a hilum - testis cords break up at the thilum into a network of tubules called the rete testis (rete=network) ** In the 4th month, testis cords become horse-shoe shaped- testis cords are continuous with rete testis

Anterograde Amnesia

the inability to form new memories - bilateral medial temporal lobe damage

The cavities, or spaces, within the head include

the nasal cavity and sinuses, oral cavity and also the pharynx

Once the placenta takes over as the primary source of esrtogen and progesterone at around weeks 7-9 of gestation,

the ovary can be removed and pregnancy can be maintained

The root of the penis consists of

the two crura, which are proximal parts of the corpora cavernosa attached to the pubic arch, and the bulb of penis, which is the proximal part of the corpus spongiosum anchored to the perineal membrane

Pupillary constriction is under

parasympathetic control ** Pupillary Light Reflex: shining a light into one eye causes the pupil of that eye to constrict (direct light reflex) and causes constriction of the pupil in the other eye (consensual light reflex)

Mean

where most people will be performing - 68% ppl within 1SD of the mean (68% rule) - 95% rule: ppl in 2 SD of mean - 99.7% rule: ppl in 3 SD of mean ** important in diagnosing disorders that have cutt offs (1.5-2 SD below mean for intellecutal disability)

Venous Drainage of Nasal Cavity

* remember, veins follow arteries, so naming is essentially the same! - Veins (labial and nasal) from anterior regions of the nasal cavities join the facial veins - Veins (sphenopalatine and greater palatine) that pass with branches that ultimately originate from the maxillary artery drain into the pterygoid plexus of veins in the infratemporal fossa - Veins (ethmoidal veins) that drain into the ophthalmic veins drain into the cavernous sinus *** Remember "Danger Area" of the face and cavernous sinus infections!

Encephalocele

** A Neural Tube Defect - Rostral neuropore fails to close - Protrusion of the brain/neural tissue, meninges and spinal fluid can occur - Treatment: neurosurgical, based on case (i.e. how small, large etc)

Anencephaly

** A neural tube defect Rostral neuropore fails to close - Partial or complete absence of the brain along with defects in the cranial vault and scalp - Neural tissue degenrates - Brainstem and spinal cord are often malformed - Reflex activity may be present as reflexes do not require supraspinal/cortical control - associated with low maternal folate intake and materaly type 1 diabetes- folate is important for synthesis of verious amino acids- low levels may prevent cell turnover at the time of neural tube closure- pregnant women should take higher than normal amounts of folic acid ** Anencephaly is NOT compatible with life

Marcus Gunn Pupil (RAPD- Relative Afferent Pupillary Defect)

** Affects optic nerve Is a defect in the direct response subserved by the optic nerve ** Optic neuritis or retinal disease is a common cause ** Remember: complete CN II lesion--> there would be NO constriction whatsoever (blind) - In Marcus Gunn, we have an afferent defect, or a defect to SOME of the fibers within the optic nerve or extensions from the retina, such as in multiple sclerosis ** This is an afferent pupillary defect- meaning that some of the afferent fibers are compromised- either from the retina or along the optic nerve ** Dilation occurs in the eye with the afferent defect bc the pupil responds as if the light shone in that eye was dimmer--> this produces less bilateral constriction, so the eyes are MORE DILATED compared to when light is shone in the normal eye--> if you continue to swing the light, the pupils will BOTH CONSTRICT when light is shone in the normal and dilate when light is shone in the abnormal eye

Mood Assessment

- Anxiety (i.e. Beck anxiety inventory; BAI) - Depression (i.e, Beck Depression Inventory; BDI) - Suicide/risk - Structures interviewws - Self- and informant- reports - Largely bases on DSM-5 criteria

3 smaller Paired Cartilages in the Larynx

- Arytenoid - Corniculate - Cuneiform

Facial Nerve has 4 major modalities

- BE/SVE - SVA - GVE - GSA However, remember the 3 most important and think: 1. BE/SVE axons to muscles of facial expression (is there Bells Palsy?) 2. SVA axons (taste) from anterior 2/3rds of the tongue and some taste from the palate (is there loss of taste?) 3. GVE axons to the submandibular, sublingual and lacrimal glands (is there dry mouth or dry eye?

Damage to the anterior spinal artery (occlusion at the level of the spinal cord) may lead to

- Bilateral loss of pain and temperature sense (bc of spinothalamic axon disruption) - Bilateral paralysis (bc of lateral corticospinal tract disruption) - No changes in touch, proprioception, pressure, or vibration sense

What artery and CN supply structures that arise from the II (hyoid) pharyngeal arch?

- Corticotympanic & Stapedial arteries - CNVII (CN 7- facial nerve)

Parts of a Neuron

- Dendrites (information receiving end) - Cell body - Nucleus - Axon - Schwann cell - Node of Ranvier - Axon terminal (synaptic end- infomration transfer)

Types of nociceptive fibers

1. A Delta fibers - faster, weakly myelinated - sharp, intense pain - "first pain".. OW! 2. C fiber - slower, unmyelinated - throbbing, burning - second pain, AH!

Testes (Paired Organ) what are its functions?

1. To produe hormones (primarily testosterone) 2. To produce spermatozoa - Body temperature 37*C - Temperature of testes is ~35*C (outside body, heat exchange by veins keeps the testes cooler) ** At 35*C sperm develop NORMALLY ** At 37*C sperm that develop are STERILE NOTE: - Testis (singular) - Testes (plural) Testis= testicle (either of two oval structures in the scrotum that secrete spermatazoa)

What are the 3 functional zones of the cerebellum

1. Vestibulocerebellum 2. Spinocerebellum 3. Pontocerebellum

AMH (Anti mullerian hormone)= MIS (mullerian inhibiting substance)

Dimeric glycoprotein involved in regulation of follicle growth initiation & follicle sensitivity to FSH AMH is secreted from GCs of growing follicles at levels measurable in serum - proportional to number of developing follicles in the ovaries - AMH--> marker of ovarian reserve & reproductive lifespan - Quantitatic test: does NOT give any informaiton about egg quality NOTE: AMH is also secreted from sertoli cells and has a prominent role in mullerian duct regression in male fetal sex differentiation ( DOES NOT FX LIKE THIS IN FEMALES)

Drugs targeting dopaminergic neurotransmission

Dopamine D2 competitive anatgonists - "typical" atnipsychotics (ex. haloperidol) for schizophrenia Dopamine Agonists: L-DOPA, prodrug for Parkinsons Disease - crosses the blood-brain barrier - Is a substrate for dopamine synthesis (increases dopamina levels to treat sxs of parkinsons)

Nuclei and Modality of CN X- Vagus

Dorsal Motor Nucleus of X --> (GVE- Visceral motor) Nucleus Solitarius --> (SVA-taste & GVA- visceral afferent) Nucleus Ambiguus --> (BE- voluntary motor) Main sensory & Spinal nucleus of V --> (GSA- Touch & pain)

In the neurocranium the top of the head is

Dorsal bottom is ventral Front is rostral, back is caudal BUT ONCE IN BRIANSTEM - Top is rostral, bottom is caudal - Front is ventral, back is dorsal

Nicotine

Drug class: A stimulant; classified as drug of abuse MOA: - agonist of nicotinic acetylcholine receptors (Nn and Nm): ligand gated ion channels (ionotropic receptors) Pharmacological effects: - cardiac stimulation, increased alertness - toxis; at high doses it causes depolarization blockade and paralysis of diaphragm Psychological dependence: drug craving Physical dependence - Tolerance- pharmacodynamics: tolerance to stimulating effects - Withdrawal: fatigue, headache, sedation, nausea, irritability

Sulcus Limitans in Spinal Cord

During proliferation of neurocytes, a groove forms at the midpoint along the lateral sides of the tube- this indendation is called the sulcus limitans and is important in delineating functional regions as follows: - Cells migrating dorsal to the sulcus limitans form the Alar plate (sensory neurons) - Cells migrating ventral to the sulcus limitans form the Basal plate (motor neurons) ** at 4 weeks the neuroepithelial cells form from neural ectoderm ** 6 weeks- the ventral root will only have motor, and the dorsal root will only have sensory and this is delineated by the sulcus limitans *** Sulcus limitans is a groove separating sensory and motor structures in the future spinal cord and brainstem - the dorsal (sensory)- ventral (motor) arrangement in the spinal cord becomes a lateral-medial arrangement in the brainstem

The larynx is highly moble and can be moved up and down and forward and backward by the action of several

EXTRINSIC muscles that attach either to the larynx itself or to the hyoid bone

The nervous system develops from

Ectoderm ** How cells differentiate depend upon their position in the embryo (medial/lateral/ventral/dorsal) and what type of signals, transcription factors, receptors and molecules are present

What happens during the latent phase of Stage 1 of labor?

Effacement and dilation to 3cm (8hr) - contracting uterus gradually pushes the babies head into the cervix

10th step of Neurotransmission- Retrograde signaling- what drugs work here?

Endogenous CANNABINOIDS (produced by body- ex. 2-AG) are synthesized in post-synaptic neurons and diffuse to pre-synaptic neurons where cannabinoid CB1 receptors are located (they activate CB1 receptor) ** active ingredient in marijuanana THC bind to CB1 and CB2

Spaces in the Cranial Meninges

Epidural Space: Potential space between dura and skull Subdural Space: Potential space in innermost dural layer, near dura-arachnoid interface Subarachnoid Space: Normally present, CSF-filled space; enlarged in cisterns **NOTE: bleeding can open up potential meningeal spaces

Tongue Development

Epithelium and Glands are derived from arch endoderm Muscles are from occipital myotomes/ somites that migrate with the hypoglossal nerve (CN XII) Anterior 2/3rds: - Derived from the 1st pharyngeal arch so associated with trigeminal (CN V) - GSA is carried on Lingual Nerve (mandibular division of the trigeminal (V3)) - SVA (taste) is carried from V3 to the chorda tympani nerve of CN VII (CN7) ** GSA= touch, pain, sensation Posterior 1/3rds: - Derived from 3rd arch so is associated with the Glossopharyngeal (IX) nerve (CN9) - GSA and SVA (taste) is carried on Lingual Branch of IX Epiglottic Region: - Derived from the 4th arch so associated with that nerve, which is superior laryngeal nerve of Vagus (CNX)

Local Anesthetics

Esters: - Benzocaine - Chloroprocaine - Tetracaine - [Cocaine]*: not used as local anesthetics but did in ear, nose and throat bc vasoconstrictor bc blocks NE transporter and increases NE- important for local anesthetic and vasoconstrictor which is helpful for procedures Amides: - Articane - Bupivacaine - Lidocaine - Prilocaine - Ropivacane ** All the other drugs on this list other than cocaine will cause hypotension

Estrogen Deficiency vs. Excess

Estrogen Deficiency: Cause: Hypothalamic/pituitary/ovarian failure, menopause Consequences: - delayed puberty, no secondary sex development - vulvovaginal atrophy, dryness, increased pH (dyspareunia, sexual dysfunction) - vasomotor: hot flashes/flushes, increased cardiovascular risk - decreased bone density (osteopenia), osteoporosis Treatment: - treat the cause: ex. estrogen for delayed puberty - treat the sxs: ex. vaginal estrogen for vaginal dryness/pain; systemic estrogen therapy (ET) for hot flashes' bisphosonates for bone loss Estrogen Excess: Cause: Hypothalamic/pituitary/ovarian tumor, obesity (excess aromatase activity), exogenous estrogen therapy Consequences: - precocious pubert - increased endometrial proliferation, hyperplasia - increased risk of endometrial cancer - increased risk of breast cancer - increased venous thromboembolic events Treatment: - treat the cause: ex; continuous GnRH agonist to inhibit pituitary & ovarian stimulation, aromatase inhibiting drugs, dietary modifications, administer progestins with estrogen in menopausal HRT

In relation to sexual response cycle, the refractory period is longer in women then in men. T or F

FALSE! There is NO refractory period in women- they can have repeat orgasms

Inotropic Glutamate receptors

Fast synaptic excitatory neurotransmission - EPSPs, neuronal depolarization Three types: NMDA, AMPA, kainate - AMPA/kainate activation is depolarizing*** - Depolarization leads to release of Mg2+ block of NMDA receptor - NMDA receptor is activated (requires a co-agonist glycine or D-serine) - further depolarization can lead to opening of sodium voltage-gated ion channels and action potential Structural, pharmacologial and functional classifaction - NMDA: Na+, Ca2+ (this calcium important in excitotoxicity) - ** AMPA: Na+, (Ca2+) - ** Kainate: Na+ - All have 4 subunits

Middle Cranial Fossa

Formed by temporal and sphenoid (greater wings) bones - houses the temporal lobes of the brain and pituitary gland It contains 7 foramen with structures passing through: - Optic canal: Optic nerve (CN II), ophthalmic artery - Superior Orbital Fissure: Oculomotor nerve (CN III), Trochlear nerve (CN IV), Opthalmic division of trigeminal nerve (CNV1), Abducens nerve (CN VI), ophtalmic veins - Foramen Rotundum: Maxillary division of the trigeminal nerve (CNV2) - Foramen Ovale: Mandibular division of trigeminal nerve (CNV3); lesser petrosal nerve - Foramen Spinosum: Middle meningeal artery - Hiatus for the greater petrosal nerve: greater petrosal nerve - Hiatus for the lesser petrosal nerve: lesser petrosal nerve

Blood supply to the hypothalamus

From circle of willis - anterior cerebral artery and anterior communicating artery have branches that form the anteromedial group (AM) of perforating arteries, which supply the anterior groups of hypothalamic nuclei - posterior cerebral artery and posterior communicating artery have branches that form the posteromedial group (PM) of perforating arteries, which supply the tuberal and posterior groups of hypothalamic nuclei - middle cerebral artery branches from the anterolateral (AL) group of perforating arteries, which supply the lateral hypothalamic nuclei

Fast inhibitory neurotransmisson

GABA (gamma-aminobutyric acid) - major inhibitory neurotransmitter - acts via GABAa or GABAb receptors GABAa receptors - Ionotropic: Cl- influx, which leads to hyperpolarization of the neuron

Complete Androgen Insensitivity Syndrome (CAIS)

Genetic male (46, XY) with NON-functioning AR - Y chromosome= functional testes= MIS & testosterone secreted In utero, MIS= regression of Mullerian ducts - - NO AR= NO androgenic (testosterone or DHT) actions--> no masculinization of external genitalia (no penis, no scrotum, testes DO NOT descend), also no male differentiation of Wollfian ducts Birth: female external genitalia, phenotypic female Puberty: testosterone --> estrogen= female breast development Presentation: amenorrha, scant pubic & axillary hair, blind-ended vagina, no uterus or cervix, undescended testes, male testosterone and DHT levels

Structures that give rise to External genitalia in Females

Genital tubercle--> Glans clitoris, vestibular bulbs Urogenital sinus--> Greater vestibular glands, urethral and paraurehtral glands Urogenital folds--> Labia minora Labioscrotal swelling --> Labia majora

Gonadotropin-related Drugs

GnRH agonists - Leuprolide GnRH antagonists - Degarelix Follicle stimulating hormone (FSH) Human menopausal gonadotropins (hMG) Leutinizing hormone (LH) Human chorionc gonadotropin (hCG)

What is the concentration of Hb in fetal blood?

Hb concentration in the fetus increases during the first hald of gestation and is ~15g/dL by midgestation

Athetosis

Hyperkinetic disorder (unwanted/involuntary, increased movement) Clinical features: - Irregular, slow movement; especially seen in the fingers ** Just like in Huntigtons Disease: Degeneration of indirect pathway --> increased excitation to the cortex--> slow writhing movements (chorea)

Sensory & motor functions for ONE side of the body/world are CONNECTED WITH the

IPSILATERAL CEREBELLUM

Acetylcholine in health and disease

In CNS: cortical activation, synaptic plasticity, cognitive functioning, REM sleep, motor coordination - numerous imporationt peripheral effects DIsease (CNS) - Alzheimers disease (AD): loss of central muscarinic cholinergic neurons, important in cog. symptoms of AD - Addiciton: Nicotine (major drug of abuds)- agonist primarily at ganglionis and specific CNS nicotinic acetylcholine receptor subtypes

Suprachiasmatic Nucleus

In anterior area of the hypothalamus - "master clock" drives sleep- wake cycle - free-runnning period ~25hrs - receives input from retina that entrians cycle to 24 hrs - projects indirectly to pineal gland via spinal cord - controls pineal gland synthesis of melatonin ** Getting info about light to the suprachiasmatic nucleus--> pineal gland --> melatonin will be decreased with light and increased with darkness ** Melatonin is highest during sleep ** You need SLEEP to be CHARISMATIC!

Constructional Apraxia

Inability to accurately copy drawings or three-dimensional constructions Ex. pt copy of image not exact- pt is not spatially aware

Which hormone is primarily responsible for enhance uterine blood flow during pregnancy?

Increased blood flow in the uterine artery is primarily mediated by estrogens, which have a potent vasodilatory effect on the uterine artery - Increased estrogen levels during pregnancy (particularly in the third trimester) correlate well with increased uretine blood flow *** At term the uterus receives ~12% of cardiac output

Input and outputs of the SNc (Subtantia nigra pars compacta)

Input: Striatum Output: Widespread; especially to striatum ** Output: MODULATORY**

What is the placenta?

It is a fetomaternal organ - the placenta and the umbilical cord are a transport system for substances (beneficial and potentially harmful) between the mother and the fetus **Placenta Previa= when the placenta blocks the birth canal 2 components of the placenta: 1. Fetal part: develops from the chorionic plate 2. Materanal part: derived from the endometrium (more precisely the decidua basalis) ** The decidua is the functional layer of the endometrium that is separated from the remainder of the uterus during childbirth

Each ejaculate contains spermatozoa suspended in seminal fluid

Just after erection: - bulbourethral glands release fluid that lubricates urethra Just before ejaculation: - prostate gland discharges secretions into urethra - spermatozoa from the ampullae of the two ductus defferentes are released into the ejaculator ducts - last and final secretion added is fructose-rich fluid released from the seminal vesicles (~70% of the fluid portion of semen is from seminal vesicles)

The fourth ventricle goes to the quadrigeminal cistern (superior cistern/cistern of the great cerebral vein) via the

Lateral aperture- left & right- (AKA Foramen of Luschka)

Neck Muscles

Longus capitis- C1-C3 Longus colli- C2-C6 Rectus capitis ant. & lat.- C1,C2 Splenius capitus- C3/C4 (dorsal rami) Levator scapulae- C3/C4 and dorsal Scapular nerve (C4,C5) Anterior scalene- C4-C6 Middle scalene- C3-C8 Posterior scalene- C3-C8 Trapezius- CNXI Sternocleidomastoid- CNXI Platysma- VII

Degarelix

MOA: - GnRH ANTAGONIST- bind to GnRH receptor in the anterior pituitary and inhibits the secretion of LH and FSH Clinical use: - advanced prostate cancer Adverse effects: - Hot flushes and sweats, edema, weight gain, decreased libido, decreased hematocrit, reduced bone density, reduced muscle mass/strength

Genital organs

Male: - vas deferens - testis - epididymis - seminal vesicles - prostate gland - penis Female: - vulva - clitoris - vagina - uterine tube - uterus - cervix - ovary

What cartilage/skeletal structures come from the I (mandibular) pharyngeal/branchial arch?

Maxillary process: - maxilla - zygomatic - temporal (squamous portion) - meckels cartilage Mandibular process: - mandible - malleus - incus - sphenomandibular ligament - anterior ligament of malleus ** served by Maxillary artery and CNV3

Dopamine in health and disease

Mediates a large number of brain functions: - motor planning and execution, reward, cognition, attention, memory, motivation, mood, prolactin production, chemoreceptor trigger zone function, etc Disease: Neurodegenrative - Parkinsons disease: loss of dopaminergic neruons in the substantia nigra Neurodevelopmental Disorders - Schizoprenia *** Haloperidol is a dopamine D2 receptor antagonist used to treat psychosis - Attention deficity hyperactivity disorders Drug abuse - Dopamine plays a key role in the "reward" center

Serotonin in health and disease

Multiple functions: - Appetite, mood, neuroendocrine function, circadian rhythm - some are direct effects some are modulatory - ex. 5-HT2A- hallucinations (LSD is an agonist for thes 5-HT2A) 5-HT2c- anorexiant Disease: - Depression - Anxiety: "antidepressant" useful in treating anxiety disorders - Schizoprenia

Adrenergic drug targets

NET- many antidepressant inhibit NET - most are non-selective and also inhibit SERT - serotonin norepinephrin reuptake inhibitors (SNRIs) - cocain clocks NET and DAT Alpha1 inhibition is a common site causing adverse effects: - orthostatic hypotension, sexual dysfunciton Monoamine oxidase (MAO): older antidepressants Increase NE release: amphetamine *** Deplete NE: Tetrabenazine

Acetylcholine receptors

Nicotinic acetylcholine receptors - Ionotropic receptos; LGIC (target for nicotine) - peripheral: neuromuscular junction - CNS: same superfamily as GABAa receptors- pentameric homomers and heteromers Muscarinic receptors: Metabotropic; GPCRs - M1 to M5 - Distinct signaling pathways (as for 5-HT receptors - Peripheeral and CNS distribution

Corneal (blink) Reflexes

Occur whenever there is a stimulus that disrupts the cornea- usually occurs from "something in ones eye" such as dirt, particles or another foreign substance ** they also occur in the presence of bright light- think about walking out into the sunshine from a movie theater- your eye automatically will "squint" ** remember that general sensory afferent from the cornea are carried on the long ciliary nerves (branches of nasociliary nerve) of the ophthalamic division of the trigeminal nerve - Efferent action is controlled by the facial nerve, particularly orbicularis oculi, which causes contraction of the muscle fibers around the eye *** In case of bright light, the optic nerve (CN II) is the afferent pathway ** A cotton wisp can be used to test the corneal reflex

Stimulation of which prostaglandin receptor mediates smooth muscle relaxation?

PGE2 stimulates relaxation via EP2 and EP4

Oculomotor Nerve Palsy

Paralysis of Superior Rectus, Inferior Rectus, Medial Rectus, Inferior Oblique, & Levator Palpebrae superioris Common causes: - Diabetic neuropathy, aneurysm, trauma - Increased intracranial pressure - Cavernous sinus pathologies ** eye is "down & out" position at rest.. why? bc which two muscles are functioning? lateral rectus (abducts the eye) and superior oblique (which abducts, depresses and medially rotaties the eye)- so the eye takes on a "down and out" position *** Pupil is dilated and unresponsive... why? bc parasympathetic fibers for constrction of the pupil are traveling on the oculomotor nerve -- so disruption of those fibers causes the pupil to slightly dilate ** Paralysis of levatore palpebrae superioris (innervated by CNIII) will cause the eye to be closed (complete ptosis)

Secretomotor Innervation (GVE axons) to Nasal Cvity

Parasympathetic path: Facial nerve (CNVII)--> Greater petrosal nerve (CNVII) --> Nerve of the pterygoid canal --> pterygopalatine ganglion (synapse) --> nasal branches *** Parasympathetic= control of mucosal secretion Sympathetic path: Superior cervical ganglion --> internal carotid plexus--> deep petrosal nerve --> nerve of the pterygoid canal --> fibers pass through pterygopalatine ganglion --> nasal branches *** Sympathetic= causes blood vessels of the mucosa to constrict

Maternal gestational diabetes can be explained by the

Pederson Hypothesis which describes how maternal hyperglycemia causes fetal hyperglycemia leading to complications of fetal growth and development (large for gestational age infant/macrosoma) - Such infants are typically born premature and are at an increased risk of neonatl hypoglycemia

CN VIII spans the

Pons and Medulla

A pt presents to you with no menses by the age of 13 in absence of secondary sexual characteristics or A pt presents to you with no menses by the age of 15 in the presence of normal gorwth and secondary sexual characteristics

Primary Amenorrhea

Retinal Pigmented Epithelium (RPE)

Primary function is to serve as support cells to the metabolically active photoreceptors - helps supply nutrients to the photoreceptors - helps remove waste ** - phagocytose older outer segments of the photoreceptors - absorb scatter light and heat **- Vitamin A cycle --> Vit A makes Retinal NOTE: it is estimated that each RPE cell is capable of phagocytosing and disposing of about 7,500 discs per day

Which hormone stimulates milk production?

Prolactin - the major lactogenic hormone - synthesized and released from anterior pituitary lactotropes - release is tonically inhibited by dopamine - estrogen stimulates PRL secretion during pregnancy - estrogen and progesterone BLOCK PRL action at breast

Clinical application of knowing the anatomy of the Bladder & Urethra

Proper performance of medical examinations/procedures - correlating patient signs and symptoms to illness, infection, or malignancy Ex: - urinary catheterization - ultrasonography of bladder - insert a cytoscope into the urethra to enter the bladder to evaluate mucosa

Drugs to reduce androngen activity

Receptor Inhibitors - Flutamide 5 alpha reductase Inhibitors - Finasteride

Accommodation Reflex

Reflex is active when the eye has to focus from a distant object to a near one The reflex consists of the following 3 events: 1-Convergence of the eyes: medial recti muscle contract, which cause the eyes to move toward each other on the nerve stimulus 2-Constriction of the pupil: necessary to focus on near objects- results from parasympathetic pathway from pretectal nuclei to the ciliary ganglion then on to the sphincter pupillae 3-Rounder (convex) lens for near vision: fibers from the ciliary ganglion also synapse on the ciliary body and contraction of the ciliary muscle fibers reduces tension on the suspensory ligament, aloowing the lens to become more convex

The loop involved with pineal gland function originates in the

Retina --> suprachiasmatic nucleus (then to paracentricular nucleus) (hypothalamus)--> reticular formation in ventrolateral medulla --> intermediolateral (preganglionic) neurons of spinal cord --> superior cervical ganglion --> pineal gland *** in humans, the light/dark cycles are detected by retinas and the signal travels to the pineal gland via a circuitous loop

Boundaries of the Nasal Cavity

Roof: Nasal, frontal, ethmoidal and sphenoidal bones Floor: palatine process of the maxilla, horizontal plate of the palatine bone Medial wall: nasal septum, which is composed of cartilage, ethmoid bone and vomer Lateral wall: 3 nasal conchae (superior, middle, inferior concha) NOTE: if you remove the septum you can see into the nasal cavity and view the lateral wall

Types of Ocular Movements

Saccades (scanning): rapid horizontal and vertical eye movements- used to redirect gase so a different image falls on the fovea- saccades are what is used all the time in everyday life- scanning the environment, reading, watching a movie or lecture Smooth-pursuit movements (tracking): the eyes follow a moving object to keep the image stationary on the fovea without moving the head Vergences: the axes of fixation converge when an object moves toward the eye, or diverge when it moves away Convergence- accomodation, pupillary constication Reflex eye movements: (1) Optokinetic response (combination of saccades and smooth pursuit)- following a moving object and when it moves out of the visual fiels, the eye will "saccade" back to the original position (2) Vestibulo-ocular reflex: slow eye movement in the opposite direction of head rotation, followed by a rapid (saccadic) movement of the eyes in the direction the head is turning

Ascending Reticular Activating System (ARAS) in the Reticular Formation

Sensory inputs into the reticular formation can modulate cortical neurons, cortical excitability and states of consciousness. Arousal & alertness! Sensory Pathways: - sources of input include ascending sensory tracts, sensory cranial nerves, cerebellum and feedback from cerebral cortex Reticular Formation: - receives input from sensory pathways - comprises diffuse aggreggation of cells in central brainstem Thalamus: - receives input from sensory pathways/reticular formation - comprises intralaminar, midline, and reticular nuclei (nonspecific thalamic nuclei) Cerebral Cortex - receives input from thalamus - "consciousness" poorly localized in cortex HOW the ARAS works: - Monotonous stimuli, darkness, boring lecture --> get bored and go to sleep - New stimulus! like a Pop quiz --> immediately arouses the Ascending Reticular activating system --> Alarm/pay attention

Selegiline

Site of action: Monoamine oxidase B Action: -inhibition

non-REM: Stage N2

"Light sleep" Characterized by: - Sleep spindles - K-complexes Subjects experience: - Decreased muscular activity - No conscious awareness of external environment NREM-2 accounts for 40-55% of total sleep time in adults

Benzodiazepines (DIAZEPAM)- therapeutic uses

- Anxiety - Epilepsy - Agitation - Insomnia - Muscle spasms - Pre-anesthesia sedatic Problems of tolerance and dependence-- so use drug acutely with short term treatment (up to 2 weeks) only - long term therapy the diazepam would only be used for short time then swtiched to something else bc risk of tolerance and dependance

Amide Local Anesthetics

- Articaine - Bupivacaine - Prilocaine - Ropivacane - Lidocaine ** Articaine has ester and amide groups but is classified with the amides

Ester Local Anesthetics

- Benzocaine - Cocaine - Procane ** Chloroprocaine has a Cl atom on C2 - Tetracane ** benzene ring with ester unit

Pts/Reproductive System Disorders

- Contraception - Menopause - Hypogonadism - Infertility - Medical abortion - Polycystic ovarian syndrome (PCOS) - Endometriosis - Leiomyomas (uterine fibroids) - Breast cancer ** Similar to what we saw with male reproductive disorders, most female reproductive disorders are caused by deficiency/imabalnce in sex hromones or inappropriate growth of tissue that is hormone dependent

Planes of Section include

- Coronal (frontal section) - Mid-sagittal (medial section) - Horizontal section (AKA axial) - Transverese section through brainstem or spinal cord

Contents of the Temporal Fossa

- Deep temporal arteries and veins - Superficial temporal artery and vein - Auriculotemporal nerve (CNV3) - Deep temporal nerves (CNV3) - Zygomaticotemporal nerve (CNV2) - Temporalis muscle ** Temporalis muscle originates at the temporal lines of the parietal and sphenoid bones and inserts into the coronoid process of the mandible- it is innervated by the Deep Temporal Nerves (CNV3) and it functions in elevation and retraction of the mandible - Temporal fascia

Drugs of Neuropharmacology

- Ethanol/alcohol - Caffeine - Nicotine - Cocaine - Amphetamine

Foramina associated with CN IX- Glossopharyngeal

- Hiatus for Lesser Petrosal Nerve - Jugular Foramen - Foramen Ovale

Adverse Effects of Testosterone administration as drug

- If administered to achieve plasam concentration in normal range- there are NO additional side effects when compared to endogenouslt secreted testosterone (may have acne!) - 17alpha-alkylated compouns can cause LIVER DAMAGE- many synthetic anabolic steroids that are abused are 17alpha-alkylated compounds (oral) - Masculizining effects on woman (excessive body hair, acne, clitoral enlargement, amenorrhea and deepening of the voice) - In pregnant women, testosterone can cause masculinization or undermasculinization of the external genitalia in the female and male fetus respectively (pregnant women should NOT be exposed to testosterone- if partner given testosteron as gel must be careful to not rub off on pregnant pt) - accelerates epiphyseal maturation and then epihphyseal closure and cessation of linear growth (timing and growth status monitoring is important when testosterone is administered to children) - Androgens suppress gonadotropic secretion, which suppresses testicular function (decreased testosterone and sperm production resulting in decreased fertility- this is issue in steroid use) - Sodium retention and edema, especially significant in older patients with heart and kidney disease

Mesenchyme for formation of the head region come from

- Lateral plate mesoderm--> laryngeal cartilages (arytenoid and cricoid) and CT in laryngeal region - Paraxial mesoderm (somites & somitomeres)--> membranous & cartilaginous components of the skull (neurocranium) and all voluntary muscles of the craniofacial region- the dermis and CT in the dorsal region of the head, meninges caudal to the prosencephalon (forebrain) -**Neural crest cells--> form the face (viscerocranium) and parts of the membranous and cartilaginous regions of the skull (neurocranium). Also form cartilage, bone, dentin, tendon, dermis, pia and arachnoid in this region, sensory neurons, ganglia, sympathetic and enteric neurons, schwann cells, cells of the adrenal medulla and glandular CT - Ectodermal (neurogenic) placodes--> form, with neural crest cells, sensory neurons and ganglia of V, VII, IX and X and special senses (hearing, equilibrium, vision, and olfaction)

Causes of Prader-Willi or Angelman

- Most often a de novo deletion (70-80% of cases) - The most common deletions are 3-4mb in size - Similar sequences --> unequal crossing over I= Imprinted (inactive when coming from a parent) - each person needs one copy of those genes that are NOT imprinted to protect from the disease - if only the inactive copy of a gene (imprinted) is present there is NO protection against a certain disease

Vestigial Structures in the region of the Male genital ducts

- Paragenital tubules persist as the paradidymis - Cranial part of the mesonephric duct persists as the appendix epididymis - Paramesonephric duct (Mullerian) female genital duct persists in the males as the appendix testis and the utriculus prostaticua (prostatic utricle)

Contraindications for Androgen Replacement

- Pregnant women or women who may become pregnant - Male patients with carcinoma of the prostate or breast (increased tumors with estrogen and androgens) - Renal or cardiac disease predisposed to edema ** Testosterone preparations are readily absorbed through all epithelial surfaces- Pts undergoind treatment with testosterone should be careful to wash hands and cover application surfaces to avoid transfer of the drug, especially to female contacts or young children

BA numbers

- Primary Motor (4) - Primary Somatosensory (3,1,2) - Primary Visual (17) - Primary Auditory (41,42)

Progestins

- Progesterone is the most important endogenous progestin - It is highly lipophilic and is well absorbed from the GI, skin and mucus membranes - Oral progesterone is ineffective bc of the significant first-pass metabolism - Synthetic progestins used as drugs are modified to have oral bioavailability Progestin Drugs: Medroxyprogesterone - half life of 40-50 days when administered IM or SubQ (one injection provides contraception for 3 months- androgen receptor agonist) Norethindrone and Levonorgesterel: - Androgen receptor agonist (structural similarity to testosterone) can cause acne and hirsutism Norgestimate: - less androgenic progestin- good for pts with PCOS Drospirenone: - antiandrogenic- good for pts with PCOS- may raise serum potassium due to mineralcorticoid activity (drospirenone is derived from spironolactone, an aldosterone receptor anatagonist) Clinical Uses: - Prevention of endometrial hyperplasia (+ estrogen) - Contraception - Amenorrhea due to hromonal deficieny/imabalance - Abdnormal uterine bleeding due to hormonal imablance -Endometriosis Adverse Effects: - Amenorrhea (some women may find this beneficial)- if given at high doses over long term (i.e IUD and Injections) - Irregular bleeding/spotting (breakthrough bleeding) - Depression - Weight gain

Sleep declines with age

- REM makes up 20% till 80 then declines with older age - Children have increased REM

What actions do drugs have on their targets?

- Receptor: agonist/ antagonist - Enzyme: substrate, inhibitor - Channel: increase/decrease acitivty - Channel or transporter: block or inhibit *** It is important to compare and contrast receptors/enzymes/channels/transporters/ion pumps ** It is important to compare and contrast ligan-gated and voltage-gated ion channels - Voltage-gated: when membrane potential changes it opens the channel - Ligand-gated ion channel: when ligand binds to channel it induces conformational change and opens channel and allows ions to flow - GPCR: activated by a ligand which cause conformational change and GPCR interacts with G protein (alpha,beta,gamma) -> alpha dissociates and they each interact with their targets and intiates signal transduction - Ion pump: depends on hydrolysis of ATP to energize pump and cause movements of ions in opposition to conc. gradient (i.e Na+-K+ ATPase) - Transporter: (i.e. NET- transmits NE from one side of membrane to other) (i.e. VMAT: NT from cytosol of neuron into synaptic vesicle)

What makes up the borders of the Infratemporal Fossa?

- Roof: Inferior surface of temporal bone and greater wing of sphenoid bone- continuous with temporal fossa - Medial Wall: Lateral pterygoid plate, and posteriorly by muscles of the pharynx and palate - Lateral Wall: Ramus of mandible - Anterior Wall: Maxilla *NOTE: the temporal fossa is superior to the infratemporal fossa and they communicate through the space between the zygomatic arch and the medial aspect of the cranium

Which artery and CN serve the structures that arise from the VI pharyngeal arch?

- Roots of definitive pulmonary arteries and ductus arteriosus - CNX (recurrent laryngeal branch of the vagus nerve)

Silver- Russell Syndrome (aka Russell-Silver Syndrome)

- Severe pre- and post-natal growth restriction - Triangular face (prominent forehead, downturn at corner of mouth) - Hemihyertrophy - Mechanizm opposite of Beckwith-Weidemann Syndrome (BWS)- ex; Disomy would be maternal

Narcolepsy

- Sleep attacks (going instantly into REM- in under 15 min- normally should take 90min--> need atleast 3 episodes every week for 3 months) Plus (at least one) - Cataplexy (less than 10sec- predicted by laughing/smiling) - Hypocretin deficiency (orexin)- decreased 1/3 CSF linked to diencephalon - Rapid REM onset May have: - sleep paralysis (60%) - hypnagogic hallucinations - excessive daytime sleeping

Reasons for Androgen Suppression

- Some diseases/ condtions arise bc of the deleterious effects of androgens on some tissues - Cause benign prostatic hyperplasia (BPH), frequently seen in older men cause urinary problems - Caused prostatic hyperplasia can also lead to prostate cancer - can contribute to androgenetic alopecia/baldness (bc of DHT)

What develops from the prosencephalon (Forebrain)?

- Telencephalon (Cerebral hemispheres) - Diencephalon & Pituitary gland - Retina (note the optic cups (vesicles)) - Olfactory system - Basal Ganglia - Internal Capsule & Commissures - Medial Temporal Lobe (hippocampus, amygdala) - Lateral Ventricles

What are the 5 levels in the spinal cord that each have a specific morphology?

1- Cervical 2- Thoracic 3- Lumbar 4- Sacral 5- Coccygeal

Swallowing

1. Oral phase: tongue pushes food posteriorly, soft palate raises to close opening to nasopharynx (palatopharyngeus plays a role) 2. Pharyngeal phase: food enters oropharynx, epiglottis blocks the laryngeal inlet 3. Esophageal phase: food enters esophagus and peristalsis moves food bolus to the stomach *** Remember that all the muscles of the pharynx and palate are innervated by CNX EXCEPT - Tensor veli palatini (CNV3) - Stylopharyngeus (CNIX) ** SO, if there is an issue with CNX or its branches, patients may have dysphagia (difficulty or an inibility to swallow)

Male Reproductive System consists of:

1. Testes - produces hormones and sperm 2. Genital ducts/Genital glands - produce secretions that conduct and nourish sperm during their movement towards the exterior of the body - sperm + these secretions make up= semen (latin seed) 3. Penis - introduces semen into female reproductive tract

Observations vs. Pathology

10-15 min with pt is not represenative of how they always are - ask what is normal for the patient (i.e. if someone speaking fast- it may be normal for them) MSE is a "snapshot" at a point in time Think about what will be useful for another provider (or you) at a future appointment

Vitamin A and RPE cells in Vision

11-cis-retinal CANNOT be synthesized de novo by humans, BUT must be converted from vitamin A (** in RPE) - Deficiency in VitA can lead to night blindness * NOTE: the large amount of smooth ER in the RPE cell FYI: In the RPE, at least 3 enzymes associated with smooth endoplasmic reticulum convert all-trans retinol to 11-cis retinal ** Bruch's Membrane (BM) - this is a thick basal lamina secreted by RPE - separates RPE from choroid

Olfactory System Pathway

1st order cell body= Olfactor Receptor Cells - these are BIPOLAR neurons - single dendrite terminated in olfatory mucosa as expanded olfactory knob - single unmyelinated axon (first order axon) penetrates cribriform plate (these axons do NOT form a single nerve! 2nd order cell body= Mitral & tufted cells - form the olfactory tract, which contain the axons of the 2nd order neuron 3rd order cell body= Primary olfactory (piriform) cortex ** remember- the olfactory systen does NOT relay through the thalamus ------- Steps 1. odorants bind to receptors 2. olfactory receptor cells are activated and send electric signals 3. the signals are relayed in glomeruli 4. signals are transmitted to higher regions of the brain

Serotonin Receptors

7 families - 5-HT1 to 5-HT7 - Some of these families have subtypes - All are expressed in CNS, but also peripherally - Some inhibitory, some excitatiory Metabotropic serotonin receptors - 5-HT1, 5-HT2, 5-HT4, 5HT5, 5HT6, and 5HT7 (and subtypes) - linked to various G proteins signaling systems - increased cAMP, decrease cAMP, increase phsopholipase C Ionotropic serotonin receptors: - 5-HT3 : Na+, K+ and Ca2+

Carotid Sinus

A dilation at the base of the internal carotid artery - innervated primarily by the glossopharyngeal nerve (CNIX) through the carotid sinus nerve (GVA axons) *** Baroreceptor: reacts to changes in arterial blood pressure

Pharmacoresistance

A drug that was previously effective becomes less and less effective (ex. ppl taking epilepsy drugs) P-glycoprotein (P-gp) is key efflux transporter that removes drugs and other molecules from the brain (BBB has changed!) - it is a multi-drug transporter, many similar transporters have been identified - Drugs are transported from brain parenchyma to endothelial cells and then to blood ** High P-gp pushes drug out of brain before it has chance to accumulate- so decreased amount in brain (i.e. less control of epileptic seizures because of this)

Specialized priamry afferent axons for Proprioception of skeletal muscle:

A-alpha fibers - LARGE myelinated fibers that transmit proprioceptive information from skeletal muscles- these are the 1a and 1b fibers associated with muscle spindles and golgi tendon organs

Specialized primary afferent axons for Mechanoreceptors of the skin

A-beta fibers - MEDIUM myelinated fibers that transmit mechanoreceptive information from the skin

Nuclei and Modality of CN XI- Accessory

Accessory nucleus --> (GSE- voluntary motor)

The reticulospinal tracts are NOT only involved in motor posturing, but also provide a pathway by which sympathetic and parasympathetic outflow is controlled- explain.

Afferents to the Cardiovascular Centers (medulla): - Chemoreceptors, baroreceptors- GVA input from CN IX and X through the solitary pathway - Hypothalamus and higher cortical regions Efferents from the Cardiovascular Centers (medulla): - Dorsal motor nucleus of X (parasympathetic) - Reticulospinal tracts (sympathetic) ** Two descending systems: inhibitory and excitatory, which modulate blood pressure, heart rate, stroke volume

Lesions to premotor cortex

Apraxia- difficulty performing complex motor tasks such as tying shoelaces despite intact motor and sensory tracts

A pt comes to you with slow, writhing movements, most pronounced on the hands and fingers-what might they have?

Athetosis - Affects the striatum - Cause: lesions of striatum

Anterior Corticospinal Pathway

Axons terminate mainly in cervical and upper thoracic cord for bilateral control of axial & girdle muscles... axons DO NOT bcross at the decussation of the pyramids - pathway ends in the mid thoracic region - Most of the axons cross at the level of the spinal cord that they will innervate, but some project ipsilaterally- the CONTRALATERAL projection is more dense UMN (1st order cell body): - in motor cortex - axons travel via the internal capsule through the cerebral peduncle and pons to cervical spinal cord levels LMN (2nd order cell body): - in ventral horn of the spinal cord - BILATERAL output to axial and girdle musculature *** Bilateral innervation- a Lesion one one side would produce possible PARESIS (weakness) and NOT paralysis- this is because the other side has a bilateral innervation as well

Conductive hearing loss in Rinne Test

BC > AC

Bony Pelvis (Pelvic Girdle)

Basin-shaped Bony ring formed by: - 2 Hip Bones - Sacrum - Coccyx Function: - Pelvic girdle attaches the axial skeleton to lower limbs - Contains and supports intestines, urinary bladder, internal sex organs

External Features of Urinary Bladder

Bladder is pyramid-shaped wen empy and spherical-shaped when full - urine enters the bladder via the ureters and urine exits the bladder through the urethra - Apex of bladder is pointed toward the pubic bone (attached to anterior abd wall and umbilicus by median umbilical ligament (remnant of fetal urachus)) - Fundus (base): in close proximity to uterus and vagina- it receives the ureters - Superior surface: completely covered by peritoneum and domes into abdominal cavity as bladder fills with urine

Craniosynostosis

Bones of the skull fuse prematurely before the brain has grown and fully formed - the resulting growth pattern provides space for the brain to grow, but results in an abnormal head shape and facial features - can also cause increased intracranial pressure (bc brain is growing and it has no where to go!)

Deep Temporal Nerves

Branches of the Mandibular Division of Trigeminal Nerve (CNV3) - Deep temporal nerves provide voluntary motor (BE/SVE) innervation to the temporalis muscle from its deep aspect

Trigeminal Neuralgia

Brief attacks of excrutiating pain - triggered by moving the mandible, smiling, yawning, tactile stimulation ** May be caused by demyelination due to pressure from small aberrant arteries Treatment: - Carbamazepine - Surgical removal of arterial compression

Krause End Bulbs

Bulbous capsules, which respond to touch, but ALSO act as thermoreceptors sensitive to cold and activated by temperatures less than 20 degrees celsius ** Found in mucous membranes of the tongue and lips, conjunctive of the eye, synovial membrane of joints in fingers, epineurium of nerves and genitals

Thyroid Gland

Butterfly shaped endocrine gland located at C5-T1 vertebral level in the neck - deep to the sternothyroid and sternohyoid muscles - R and L lobes are connected by an isthmus over the trachea- A pyramidal lobe is a variant and may be present in 10-30% of people Function: - produces thyroid hormones (T3/T4) and calcitonin

Rule #1: Parasympathetic (GVE) fibers reside ONLY in Cranial Nerves

CN III (3) CN VII (7) CN IX (9) CN X (10) ** These nerves have associated ganglion- For the parasympathetic system, the 2-neuron chain starts from the brainstem, so pre-ganglionic axons synapse in the ganglion and post-ganglionic axons arise from the cell bodies located in the ganglion: - CN III= Ciliary Ganglion - CN VII= Pterygopalatine & Submandibular Ganglion - CN IX= Otic Ganglion - CN X= Ganglion near visceral organs

CN V1

CN V1 (Ophthalmic) Pathway Travels under the dura to the superior orbital fissure where it branches into: - frontal nerve - lacrimal nerve - nasociliary nerve

CN V3

CN V3 (Mandibular) Pathway ** Mandibular nerve travels under the dura to the foramen ovale- branches also leave through the mandibular foramen and mental foramen ** Mandibular division provides BE/SVE axons to the muscles of mastication and GSA axons from various regions

Which cranial nerve serves BE fibers to MOST of the skeletal muscles of the larynx, pharynx, and palate?

CN X- Vagus ** NOTE: Uvula will deviate to the OPPOSITE side of a Nucleus Ambiguus lesion ** If a lesion is on the R side- Either the Nucleus Ambiguus or R peripheral nerves, so the intace muscles on the Left side pull the soft palate up, back & laterally

Lingual nerve is a branch of

CNV3 ** it is located in the infratemporal fossa

The Spinal Nucleus of V (GSA- pain axons terminate here) is nicely seen in the

Caudal Medulla ** can span into the pons

Leprosy

Caused by a bacterium called Myobacterium leprae which causes disfiguration of the body or skin ** Eventually causes peripheral neurological damage which causes sensory loss in the skin and muscle weakness ** People with long-term leprosy may lose the use of their hands or feet due to repeated injury resulting from lack of sensation

How does the consistency of the cervical mucus change during the periovulatory period?

Cervical mucus becomes watery & stretchy (like egg white) indicated ovulation *** When it is watery and egg white-like it is a good indication that ovulation is ocurring

Weber Test

Checks lateralization - Normal hearing: NO lateralization - Conductive hearing loss: louder in affected ear - Sensorineural hearing loss: louder in normal (unaffected) ear

Primary Visual Cortex has a

Columnar Organization - the columnar schemes were organized in alternating abnds of ocular dominance columns (~1mm wide) and within the ocular dominace columns there are orientation columns in which neurons will respond to lines, edges, spatial arrangements ** Ocular dominance columns and orientation columns intersect, so an area of about 1 squar millimeter of primary visual cortex will contain a complete sequence of columns ** Blobs and interblods are imporant in processing form and color

Compartments of the Hypothalamic-pituitary ovarian axis

Compartment IV: Hypothalamus Compartment III: Anterior Pituitary Compartment II: Ovary Compartment I: Uterus, cervix, vagina Clinical presentations of primary and secondary amenorrhea: - Hypothalamic (Compartment IV) and Pituitary (III) Dysfunction - Gonadal Dysgenesis: Pure and Turners (Comp II) - Premature Ovarian Insufficiency (Comp II) - Obstructuve Outflow tract (Comp I) - Mullerian Agenesis (Comp I) - Androgen Receptor Defect (Androgen Insensitivity Syndrome) - SRY Gene/ Testes Determining Factor Defect (Swyer's Syndrome) - Androgen Enzyme Defect (5 Alpha Reductase)

Stress, weight loss, excessive exercise, PRL & TRH all

DECREASE GnRH pulsatility - Decreased GnRH--> Decreased FSH/LH--> Decreased Ovarian function (hormone production, folliculogenesis, ovulation) --> there will be no ovulation or menstruation ** High TRH levels stimulate PRLL release - PRL inhibits GnRH ** Altered thryoid fx is often associated with female menstrual irregularities In premenopausal women: Hypothyroidism: - 16% has less frequent periods (oligomenorrhea) or absent (amenorrhea) - 7% heavy periods (menorrhagia) Hyperthyroidism: Can also cause menstrual disturbances bc thyroid hormones increase SHBG which effectivly reduces amount of bioavailable estrogen in hyperthyroid females, and this affects the normal processes involved with the regulation of ovulation - Amenorrhea (absent menstrual cycles) is common with severe hyperthyroidism * Menstrual abnormalities associated with hypo- and hyper- thryoidism result in decreased fertility that is often rectified when the underlying thyroid issue is dealt with

Development of the Retina

Derived from the inner and outer layers of the optic cup It consists of two basic layers: 1. Neural Retina- (the inner layer that contains the photoreceptors) (from inner cup) 2. Retinal pigemented epithelium (RPE)- (the outer layer that rests on the choroid) (from the outer cup) NOTE: the lens forms from invaginating ectoderm- pinches off --> free standing

Function of inner ear

Detect linear movement of head & gravity (using macula) - Ampulla: detects angular acceleration of the head

Sound perception and analysis

Sound: audible variations in air pressure Cycle: Distance between successive compressed patches Frequency: Number of cycles per second, units = hertz (Hz) Range: 20 Hz to 20,000 Hz Intensity: High intensity is louder than low intensity, units= decibels (dB) * Low frequency= low pitch * High frequency= high pitch * Low intensity= soft sound * High intensity= loud sound

SVA

Special Visceral Afferent - taste & smell

Some clinical problems related to the bladder & urethra

Stress urinary incontinence - urine leakage from bladder with physical activity or exertion due to weakness of urethral sphincter muscles to constrict and prevent flow of urine Urgency incontinence or overactive bladder - sudden, uncontrollable urge to urinate and may leak urine on the way to the toilet- unable to control timing of when to urinate Dysuria= painful urination Hematuria= presence of blood in the urine Bladder carcinoma (cancer of the bladder) - carcinoma of the bladder infiltrates through the bladder wall and into the vaginal wall Cystitis= inflammation of the bladder (commonly called "bladder infection") Urethritis= inflammation of the urethra

Main Components of the Basal Ganglia

Striatum: - Caudate Nucleus - Nucleus Accumbens - Putamen Lentiform Nucleus - Putamen - Globus Pallidus (Pallidium)- External segment (GPe) and Internal segment (GPi) Subthalamic Nuclei (STN) Substantia Nigra: - Pars compacta (SNc): loss of this leads to Parkinsons** - Pars reticularis (SNr)

Which branch of the basilar artery supplies the superior surface of the cerebellum and some midbrain?

Superior Cerebellar Arteries Occlusion affects: - Superior cerebellar peduncle & cerebellum --> ataxia

Cognitive difficulties after SCI

Traumatic SCI: - difficulties with attention/concentration, processing speed Non-traumatic etiologies (i.e. multiple sclerosis), or neurodegenerative disorders due to demyelination - may have specific cognitive profiles with psychitatirc disturbances (i.e. psychoses, depression, personality changes) - prevalence of cognitive difficulties between 40-70%: memory, reasoning, felxibility, attention, slowed processing, motor slowing

Hemineglect

Types of neglect: - sensory neglect - motor-intentional neglect - conceptual neglect - combination

The Vertebral-Basilar System consists of

Vertebral artery 1- Anterior Spinal Artery 2- PICA (Posterior Inferior Cerebellar Artery) 3- Posterior Spinal Artery

3rd step in Neurotransmission- Vesicular Storage- what drugs work on here?

Vesicular monoamine transporter 2 (VMAT2)-- transports dopamine, norepinephrine, serotonin from cytosol into synaptic vesicle VMAT2 inhibited by tetrabenazine- leads to reduced NT stored and released in vesicle (leads to depletion of neurotransmitters) VMAT2 ALSO inhibited by amphetamine (but additional effects lead to increased neurotransmitter levels in synapse)

Nuclei and modality of CN VIII- Vestibulocochlear

Vestibular Nuclei --> (SSA- balance and equilibrium) Cochlear Nuclei --> (SSA- hearing)

Emotional Tears

We feel emotional pain or sadness and the brain will send the signal to produce tears - Some reasearchers suggests that crying MAY make you feel beterr, physically and emotionally, as tears may release substances built up during times of stress ** Crying is also thought of as a way of human connection, non-verbal communication, and survivial (eliciting pity, mercy)

Hypothalamus

a relatively small structure which plays a very large role - autonomic control - endocrine control - limbic system functions HEAL! Homeostasis.. Endocrine.. ANS.. Limbic Widespread and complex connectivity, which can be fit into 3 general groups 1- Interconnections with limbic system structures 2- Outputs to influence pituitary gland 3- Interconnections with both visceral and somatic nuclei of the brainsteam and spinal cord

Grey Matter

areas where there is proponderance of neuronal cell bodies, dendrites, and interneurons

Nucleus ambiguus is a group of large motor neurons that give rise to

efferent voluntary motor fibers of CN X, which supply the laryngeal and pharyngeal muscles- if supply to this region is interuppted, an individual loses the swallowing, cough, and gag reflexes

Arousal is characterized by

engorgement of the pelvic area with blood - the external genitalia (i.e. vulva), in partiuclar the clitoris ar the primary organs involves in the arousal component of the sexual response cycle - Hormones such as dopamine and androgens appear to be involved in sexual desire, while genital mechanisms such as clitoral, labial, and vaginal engorgement are key to arousal ** With arousal and adequate sensory stimulation--> orgasm ultimately may occur consisting of repeated motor contraction of the pelvic floor including uterine and vaginal smooth muscle contractions - Orgasm is possible in the absence of a uterus

Paraventricular Nucleus

excellent example of how neuroendocrine anatomy within the brain is layered - even when one particular region can be characterized as separate from another region, within that region there are further subdivisions for finer distinction ** some distinctions between dif parts of the hypothalamus are constructs, such that the same regions might someday be reclassified into still more named regions ** you will find population of cells with diff function - the inputs and outputs to these control regions will be as layered as the control regions themselves, such that the most medial of the PVNc control regions exit in the most medial fashion to a capillary network known as the median eminence - axons from the more lateral but inferior regions project all the way to the posterior pituitary, as will be further explored in endocrine physiology - ares which are most superior can be further arranged by caudal-to-rostral position and have 100% motor targets within the brain stem and spinal cord

Root of the Neck is the region

immediately superior to the superior thoracic aperture - Contains structures that pass between the neck, thorac, and upper limb An extension of the throacic cavity also projects into the root of the neck: - the pleural cavity on both sides including the cervical part of the parietal pleura - the apical part of the superior lobe of each lung Boundaries of the root of the neck: Anterior: top of the manubrium and superior margin of the calvicle Lateral: superior margin of rib 1 Posterior: top of T1 vertebra and supeiror margin of scapula to coracoid process Superior throacic apertur boundaries: Anterior: top of maubrium Lateral: superior margin of rib 1 Posterior: T1 vertebra

Conjunctivitis

inflammation of the conjunctiva - usually associated with hyperemia (excess of blood in a body part) and a discharge It may be caused by: - a number of bacteral agents - viruses - allergens - parasitic organisms Bacterial conjunctivitis, commonly known as pinkeye, usually infects both eyes and produces a heavy discharge of mucus Some forms of conjunctivits are: - extremely contagious - damaging to the eye - may cause blindness if untreated NOTE: the enlarged blood vessels of the conjunctiva area responsible for moderate redness of the eye with conjunctival swelling - frequently moderate, clear (in allergic conjunctivitis) or purulent (in bacterial conjunctivitis) discharge is visible

Oral Cavity Proper

is the space between the upper and lower teeth (dental arcades) - The roof is composed of the hard and soft palate - When the mouth is closed, the tongue occupies the entire oral cavity ** The floor of the oral cavity is covered with mucous membrane- there is mucosal fold in the midline called the frenulum that connects the tongue to the floor of the mouth ** On each side of the frenulum, there is a sublingual papilla that contains the opening of the duct of the submandibular gland - there is also a sublingual fold, which indicates the position of the sublingual gland

Pelvic Ultrasound

key imaging modality for the evaulation of the contents of the female pelvis ** can identify ovary with cysts Types: - Transabdominal Pelvic Ultrasound (pt lies on back a has probe applied to pelvic area- drink liquid before so bladder filled) - Transvaginal Pelvic Ultrasound (inset probe into vagina)- used for more detail (higher mag) - Gestational Ultrasound: **ultrasound is a standard part of prenatal care- it can be used to confirm the pregnancy, date the pregnancy and to measure the fetus so that growth abnormalilities can be recognized

Electrical signal is transported from rods and cones through

layers of synapsing neurons --> to optic nerve (carries signal to brian) 1. Light entering eye triggers photochemical reaction in rods and cones at back of retina 2. Chemical reaction in tun activates bipolar cells 3. Bipolar cells then activate the ganglion cells, the axons of which converge to form the optic nerve- this nerve transmits information to the visual cortex in the brains occipital lobe

Subthalamus

location: - inferior to thalamus - lateral to hypothalamus - medial to internal capsule and cerebral peduncles Consists of: 1- Subthalamic nuclei (STN): part of the basal ganglia circuitry (motor) 2- Substantria Nigra (SN): 2 parts (pars compacta & pars reticularis) that project to the striatum and thalamus, respectively 3- Red nucleus (RN) 4- Zona Incerta (ZI): widespread connections, but function is largely unknown

Local Anesthesia

loss of sensation in a limited region of the body - can act on ANY part of the nervous system (largely in periphery in the body-PNS) and on any type of nerve fiber (can inhibit sensory, motor and autonomic nerve function) - are applied very close to their site of action (many times delivered by injection) *** The systemic circulation terminates the effect of local anesthetics by: remove drug from local area & metabolize drug (ex. esters)

Plegia:

paralysis, all volunatery movement is lost Paresis: weakness, some muscle strength is preserved

Depletion of ovarian follicles -->

reduced secretion of ALL ovarian hormones (estradiol, estrone, testosterone, androstenedione, inhibin B, AMH) --> no feedback to the HP axis --> increased GnRH--> increased gonadotropins Clinical correlation: - increased early follicular phase FSH is the earliest & most consistent clinically measurable hormone change associated with ovarian depletion - increased serum FSH and LH and decreased serum estrogen- classic hallmarks of ovarian follicle depletion (menopause/premature ovarian failure)

Argyll Robertson Pupil

A pupil that does NOT react to light, but DOES constrict during accomodation - This is called a "light-near dissociation" - Pupils can be small and irregular ** Complication in pts with syphilis (neurosyphilis, tabes dorsalis)- deficit starts unilaterally and becomes bilateral * Precise lesion location is unknown, but is belived to be in the PRETECTAL AREA (MIDBRAIN), or region near the cerebral aqueduct, where it affects fibers dorsal to the Edinger-Westphal nucleus that are responsible for pupillary constriction, but spares ventral fibers that subserve the accomodation response EX: R eye does NOT react to light, but DOES to accomodation - accomodation is quick - bilateral small pupils that DO NOT react to light - associated with neurosyphilis ARP --> "Accomodation Reflex Present" <-- "Pupillary Reflex Absent"

Cranial Nerve Nuclei in the cervical spinal cord

CN XI: Accessory Nuclei 1- Accessory nucelus (spinal root: GSE to sternocleidomastoid and trapezius) ** found at medulla/spinal cord junction

CN XII

CN XII- Hypoglossal Axon Modality: GSE * Voluntary motor to muscles of the tongue ** A lesion to the hypoglossal nerve will cause the tongue to deviate TOWARDS THE SIDE OF THE LESION!

Chorda Tympani is a branch of

CNVII ** it is located in the infratemporal fossa

All muscles of facial expression are innervated by

CNVII - Nasalis - Procerus - Orbicularis Oculi - Corrugator Supercilli - Buccinator - Depressor Anguli Oris - Depressor Labii inferioris - Levator Labii superioris - Levator Labii superioris alaeque nasi - Levator anguli oris - Mentalis - Orbicularis oris - Risorius - Zygomaticus major - Zygomaticus minor - Platysma - Auriculars

Cervical Plexus- Muscular Branches (voluntary motor innervation- GSE axons)

Ansa Cervicalis - loop of nerves from the cervical plexus (C1-C3) - innervates the infrahyoid muscles and one suprahyoid muscle (geniohyoid) - C1 is the superior root (travels with CNXII) and C2 and C3 form the inferior root ** In a cadaveric specimen, you can see the ansa cervicalis looping around the internal jugular vein- it is located on the surface of the carotid sheath

Taste buds (SVA)

Anterior 2/3 of tongue and soft palate: - facial (CN VII) ** remember there may be taste buds on the soft palate- if so, they are innervated by CN VII Posterior 1/3 of tongue: - glossopharyngeal (CN IX) Epiglottis - vagus (CN X) ------- NOTE: - lining the sides of each papilla are taste buds which are made up of taste receptor cells that contact tastants in saliva via fine projections called microvilli - each papillae > 100 taste buds - each taste bud ~ 100 taste receptor cells (around a central taste pore) - each taste cell.. synapses with a primary taste neuron (gustatory afferent axon) - contrary to popular belief, receptor for all five traditional tastes are found anywhere there are taste buds: salty, sweet, soure, bitter, umami *** rememeber, that filiform papillae are for abrasion and DO NOT have taste buds

Benign Prostatic Hyperplasia (BPH)

As men age, the prostatic stroma and mucosal and submucosal glands begin to enlarge, a condition known as benign prostatic hyperplasia - the enlarged prostate partially strangulates the lumen of the urethra, resulting in difficulties with urination ~40% of men 50 yrs of age are afflicted with this conditon, the percentage increases to 95% in 80yr old men - Some men with an enlarged prostate develop erectile dysfunction (ED) or problems with ejaculation **** Transition Zone is where most benign prostatic hyperplasia is found *** Peripheral zone (~70% of prostate- this is a major site of prostatic cancer)

Non-steroidal anti-inflammatory drugs (NSAIDS)

Aspirin (acetylsalicyclic acid), Ibuprofen MOA: - inhibition of cycoloxygenases 1 and 2 (COX-1 and COX-2) to decrease prostaglandins - Aspirin: non-selective irreversible inhibition ("suicide inhibitor) - Ibuprofen: non-selective REVERSIBLE competitive inhibition Pharmacological effects: Aspirin - Analgesic, anti-inflammation, antipyretic, antiplatelet aggregation - Dose-dependent: antiplatelet--> antipyretic/analgesic--> anti-inflammatory Ibuprogen - Analgesic, anti-inflammatory, antipyretic Therapeutic use: - Nociceptive pain (mild to moderate), inflammatory disease, fever - Aspirin: as above plus anti-platelet effects for reduction of risk of MI and TIA

Hypoglossal Nerve Leasion

Axon Modality: GSE - Voluntary motor to ALL of the muscles of the tongue (except palatoglossus) ** Unilateral trauma to CNXII will result in paralysis and atrophy of ONE SIDE of the tongue ** Tongue deviates to paralyzed side during protrusion beacuse of the action of the unaffected geniglossus muscle on the other side *** SO a lesion to the hypoglossal nerve will cause the tongue to deviate TOWARDS THE SIDE OF THE LESION!

Spina Bifida Aperta: Meningomyelocele

** A Neural Tube Defect- more severe than Meningocele A meningomyelocele is due to the - Cadual neuropore failing to close - Vertebrae fail to fuse, but now the MENINGES AND SPINAL TISSUE push out through the opening in the vertebrae, forming a sac filled with spinal fluid and neural tissue

Golgi Tendon Reflex

** Polysynaptic If the body/muscle is carrying a heavier load than it can handle, the Golgi Tendon Reflex is activated to prevent serious muscle damage Ex. If a weight lifter tries to do bicep curls using a weight that is too heavy for the individual to lift, the person is forced to drop the weight - this prevents muscle damage! Stages of the Reflex (Polysynaptic): 1. Golgi Tendon Organ signals on the Ib (afferent/sensory) neuron 2. The Ib afferent neuron synapses in the dorsal horn of the spinal cord on an inhibitory interneuron 3. The inhibitory interneuron synapses with the alpha motor neuron, in the ventral horn of the spinal cord, inhibiting muscle contraction, causing muscle relaxation and subsequent dropping of the weight/load

What are the branches of Part 1 (Mandibular) of the Maxillary Artery

** This is the origin of 2 major branches and a few smaller branches 1. Middle Meningeal Artery 2. Inferior Alveolar Artery Smaller branches are - Deep auricular artery - Anterior Tympanic artery - Accessory meningeal artery

Photocraphic (AKA Eidectic) Memory

** most scientist do NOT believe it exists - Ppl may have specialized ways of thinking about info..not any king of enhanced memory *** Mnemonics * "Method of Loci"- Mnemonics rely not only on repitition, but also on associations between easy-to-remember constructs and lists of data *** Human mind much more easily remembers data attached to personal or otherwise meaningul information that that occuring in meaningless sequences

Pterygoid Venous Plexus

** remember that veins usually accompany the arteries and have similar naming patterns - The plexus anastomoses anteriorly with the facial vein via the deep facial vein - Superiorly, the plexus anastomoses with the cavernous sinus via emissary veins/ophthalmic veins - The pterygoid plexus of veins becomes the maxillary vein that later joins the superficial temporal vein to form the retromandibular vein ** Remember that the cavernou sinus has connections with the pterygoid plexus of veins - infection can spread (mainly through facial/ophthalmic veins) and a cavernous sinus thrombosis can occur if a clot travels from the facial vein to the cavernous sinus

Spina BIfida Aperta: Meningocele

*A Neural Tube Defect - Caudal neuropore fails to close - Vertebrae still fail to fuse, but NOW THE MENINGES push out through the opening in the vertebrae, forming a sac filled with spinal fluid

Pelvic structure (Male vs. Female)

*Both optimum for upright ambulation * Female is optimum for pregnancy In males: - Iliac crest is higher (less flared) - narrow sciatic notch - 50-60 degree pubic arch - heart shaped inlet In females: - outwardly flared iliac bones - broader sciatic notch (increases passage for the fetus) - wide pubic arch (80-90 degrees) - round/wide pelvic inlet

Congenital Insensitivity to Pain

*RARE - Autodomal recessive disorder that causes mutations in the SCN9A gene, which affects voltage-gated sodium channels in neurons of the dorsal root ganglion - The channels are unable to propagate action potential carrying pain signals *** Individuals cannot feel, and have never felt pain- they are indifferent to pain stimuli and will often self-mutilate

Major connections of the Subthalamic nucleus (STN)

*STN is the ONLY excitatory basal nucleus (only excitatory nuclei of the basal ganglia) - Recieves inhibitory information from GPe - Sends excitatory information to GPe, GPi, and Substantia Nigra pars reticulata (SNr)

Adies Pupil

- "Tonic Pupil"/ "Holmes-Adie-Pupil" - Pupil witha poor pupillary light reflex ** Pupil response is "sluggish" and slow to constrict to light- Dilation of the pupil after constriction is slow and delayed- therefore they call it a "tonic" constriction or "tonic pupil" - Accomodation is slow, sluggish and prolonged - Associated with damage to postganglionic parasympathetic innervation to the pupil/pathology to the ciliary ganglion (peripheral nerve) Ex: L eye does NOT constrict despite light, L eye is "slow" to accomodate-- Damage to left ciliary/post-ganglionic fibers - response to light is poor/absent - affected pupil is initially larger than its normal fellow pupil, but becomes smaller over time and remains tonically constricted - accomodation is slow and prolonges

Female Reproductive Organs

- 2 ovaries - 2 uterine tubes - 1 uterus - 1 vagina - external genitalia - 2 mammary glands** are NOT considered reproductive organs but do undergo cyclical changes

Babinski Sign (Extensor Plantar Response)

- Abnormal "Fanning" of toes is usually a sign of Corticospinal Tract or Upper Motor Neuron (UMN) damage - Usually this reflex is inhibited by the cortex, but with damage to the corticospinal tract, the sign is present ** Normal= flexor response ** abnormal fanning (extensor) = UMN lesion NOTE: Infants will also show an extensor response - a babys smaller toes will fan out and their big toe will dorsiflex slowly- this happens bc the corticospinal pathways that run from the brain down to the spinal cord are not fully myelinated, so the reflex is not inhibited by the cortex ** the extensor response disappears and gives way to the flexor response around 12-18 months of age

What are the 3 axes which extraocular movements of the eyeball occur?

- Anterior-posterior (z-axis) - Transverse axis ( y-axis) - Vertical axis (x-axis) * Extorsion (inferior rectus and inferior oblique) and Intorsion (Superior rectus and superior oblique) occur around the antero-posterior/z-axs NOTE: extorsion and intorsion are also known as lateral and medial rotation, respectively * Elevation (Superior rectus & inferior oblique) and Depression (inferior rectus and Superior oblique) occur around the transverse/y-axis * Abduction (Lateral rectus) and Adduction (Medial Rectus) occur around the vertical/x-axis

Mood Questionnaires

- Beck Depression Inventory (BDI-II) - Beck Anxiety Inventory (BAI) - Hamilton Rating Scale for Depression (HAM-D) - Deriatric Depression Sale (GDS) ** Good for screening and useful quanitative scores BUT important to look at all the items, ask follow-up questions, and try to understand the patients experience as best you can

Injury to Anterior spinal artery (AT LEVEL OF SPINAL CORD)

- Bilateral loss of pain and temperature sense (bc of spinothalamic axon disruption) - Bilateral paralysis (bc of lateral corticospinal tract disruption) - No changes in touch, proprioception, pressure, or vibration sense

What artery and CN supply structures that arise from the III pharyngeal arch?

- Common carotid artery & proximal part of the internal carotid artery - CN IX (CN 9)

Treatments for hearing loss

- Conductive hearing loss--> can be effectively treated by surgery - Sensorineural hearing loss--> is difficult to treat. However, considerable progress has been made in treating this hearing loss with cochlear implants *** Cochlear Implants work by directly stimulating the nerve *** Hearing aids work by amplifying sound

What are the 4 paires paranasal air sinuses?

- Frontal Sinus - Ethmoid Sinus - Sphenoid Sinus - Maxillary Sinus *** They are air-filled extensions of the respiratory aspect of the nasal cavity - They are named for the bones they occupy

Anatomical position of the Urethra in Male pelvis

- Infeiror to bladder - Extends from urinary bladder, through prostate to tip of penis NOTE: - Urethra has prostatic, membranous, bulbar and spongy (penile) parts - Functions in the ejaculation of semen and excretion of urine out of the body

How do you know a section is the Rostral Medulla?

- Inferior Olivary Nucleus - Inferior cerebellar peduncle begins to appear

What are the derivatives of the 3rd pharyngeal pouch?

- Inferior parathyroid gland - Thymus

Vasculature of the Eye includes

- Internal Carotid Artery - Ophthalmic artery - Angular vein - Facial Vein - Ophthalmic vein - Cavernous Sinus

Protective factors for Suicide

- Internal: ability to cope with stress, religious beliefs, frustration tolerance - External: responsibilty to children or beloved pets, positive therapeutic relationships, social supports

Disease with late onset and phsyical exam/lab results

- Mr. Jones is offspring of a person with Huntington Disease (HD) - Mr. Jones is 38 and does not show any signs of HD - How likely is it that Mr. Jones has the gene for HD? 1/3 not affected

Circuitry of the Basal Ganglia Involves

- Multiple parallel loops that modulate cortical output - Inhibitory via thalamus - Interconnections of basal ganglia detemine the pattern of their outputs 2 main pathways: - Direct - Indirect & Modulatory function of substantia nigra pars compacta

Which prostaglandins stimulates smooth muscle contraction?

- PGF2alpha stimulates contraction via FP - PGE2 stimulates contraction via EP1 and EP3 ** PG administration during pregnancy induces myometrial contraction

What are the derivatives of the 2nd pharyngeal pouch?

- Palatine tonisls - Tonsillar fossa

Paraxial Mesoderm (Somitomeres and Somites) give rise to what structures of the skull

- Parietal bone - Occipitals - Pet. temp ** Somitomeres: 50 pairs in human embryo- first seven give rise to striated muscles of the face, jaw, and pharynx and remaining form somites ** Somites: 37 somite pairs at the end of the 5th week of development- somites give rise to the vertebral column, associated with muscles and dermis

Motor cortices in our head can signal through the brainstem via

- Reticular formation-- (reticulospinal tract- Med & lateral) --> medial white matter in spinal cord --> axial and proximal musculature - Red nucleus-- (rubrospinal tract)--> lateral white matter in spinal cord --> proximal (rubrospinal) and proximal/distal appendicular musculature (corticospinal)

Functon of Basal Ganglia

- Role in motor control - Initiates movements and stops unwanted movements "Break Hypothesis": - To sit still: put the breaks on ALL movements except those reflexes required to maintain upright posture - To move: put breaks on some postural reflexes, and release break on voluntary movement

DiGeorge Syndrome (22q11 sequence)

- Specific deletion on Chromosome 22 - Results in abnormal neural crest cell migration with underdevelopment of the 3rd and 4th pharyngeal arches as well as the third and fourth pharyngeal pouches *CATCH-22 - Cardiac and aortic malformation are characteristic, including possible Tetraology of Fallot *review - FAcial abnormalities include micrognathia (undersized mandible), ear anomalies and telecanthus (increased distance between the eyes) - Thymus also often fails to develop, leading to immune deficiency - Cleft palate is seen in most of the cases - Hypocalcemia at birth since parathryoids are often involved ** Occurs in 1/4,000 births

Lymphatic Drainage of the Pelvis and perineum

- Superior bladder--> drains to external iliac lymph nodes; Inferior bladder --> drains to internal iliac lymph nodes - Glands penis (or clitoris)--> drains to deep inguinal lymph nodes -*Ovary/uterine tube, fundus of uterus--> drains to lumbar (or aortic, or para-aortic) lymph nodes -* Prostate-->drains to internal iliac lymph nodes -* Testis--> drains to lumbar (or aortic) nodes -* Scrotum--> drains to superficial inguinal lymph nodes

What are the derivatives of the 4th pharyngeal pouch?

- Superior parathyroid gland - Ultimobranchial body (which is incorporated into the thyroid gland) *** Ultimobranchial body gives rise to parafollicular (C cells) of the thyroid gland for calcitonin secretion

What are the 6 extraocular muscles that stabilise and move the eyes?

- Superior rectus - Inferior rectus - Medial rectus - Lateral rectus - Superior Oblique - Inferior Oblique ** All of the extraocular muscles have a resting muscle tone that is designed to stabilize the eye position- during certain movements, some muscles increase their activity, while others decrease it

Development of the Male External Genitalia

- The genital tubercle elongates to form the phallus - The phallus pulls the urethral folds forward to form the lateral walls of the urethral groove - The urethral groove extends along the phallus but does NOT reach the distal part of the phallus - The epithelial lining of the groove forms the urethral plate By the end of the 3rd month, urethral folds fuse over the urethral goove to form the penile urethra - the penile urethra does NOT extend to the tip of the phallus - in the 4th month, ectodermal cells from the tip of the glans penetrate inward to form a short solid epithelial cord - The cord lateral obtains a lumen via programmed cell death --> this is called the external urethral meatus

The cartilages of the larynx need to be connected together and this is done so by extrinsic ligaments/membranes- which are known as

- Thyrohyoid membrane - Hypoepiglottic ligament - Cricotracheal ligament

Detal about the pyramidal decussation crossing

- Upper extremities cross HIGHER/ROSTRAL in the pyramidal decussation for corticospinal tracts - Lower extremities cross more CAUDAL/LOWER ** Lesion to the Rostral part of the decussation --> affects UPPER limb ** Lesion more caudally in the decussation--> affects LOWER limb

Where do drugs act in the brain?

- Voltage-gated sodium channel - Voltage-gated calcium channel - Monoamine oxidase - Acetylcholinesterase - Amino acid decarboxylase - Serotonin transporter - Vesicular monoamine transporter type 2 - Dopamine transporter - Norepinephrine transporter - NMDA receptor - GABA-A receptor - Mu opiod receptor - Serotonin 5-HT2A receptor - Adenosine receptor - Dopamine D2 receptor

Sphenoid Bone is composed of

- body - 2 greater wings - two lesser wings - bilateral medial and lateral pterygoid processes ** Sella Turcica ("Turkish Saddle"): hypophyseal fossa contains the pituitary gland ** Cavernous sinus and associated structures found bilaterally on either side of the sella turcica

The ___, that separate the pharyngeal arches on the external surface of the embryo, are located opposite the pharyngeal ___ internally.

- clefts externally (ectoderm side) - pouch internally (endoderm side) ** membranes, consisting of ectoderm, opposed to endoderm, separate the pharyngeal clefts from the pouches

Ectoderm can give rise to

- epidermis, hair, nails, glands of skin - brain and spinal cord - **Neural crest: sensory nerve cells and some nervous structures; pigment cells; portions of skeleton; blood vessels in head and neck ** If in doubt any structure in the head- guess Neural Crest Cells *

Neural Crest Cells gives rise to what structures in the skull

- frontal bone - nasal bone - lacrimal bone - zygomatic bone - maxilla bone - incisive bone - mandible bone - sphenoid bone - sq. temp. bone - hyoids

Swallowing- the larynx is

- laryngeal inlet narrowed - epiglottis swings down to arytenoids

Mixed Nociceptive and Neuropathic Chronic pain disorders

- low back pain (can be nociceptive, neuropathic or both- so needs further investigation!) - migraine - fibromyalgia - phantom limb pain - multiple sclerosis - myofascial pain syndrome

What muscles come from the first (mandibular) pharyngeal/branchial arch

- medial pterygoid - lateral pterygoid - masseter - temporalis - tensor veli palatini - mylohyoid - anterior belly of digastric *** CN V3 (third part of trigeminal) ** Maxillary artery

What muscles come from the II (hyoid) pharyngeal/branchial arch

- muscles of facial expression - stapedius - posterior belly of digastric - stylohyoid *** Corticotympanic and stapedial arteries ** CNVII (CN 7- Facial)

Categories of Interest n DSM-5

- neurodevelopmental - psychotic - bipolar disorder - depression - anxiety - substance use - dissociative - somatic symptoms - factitious - feeding/eating - neurocognitive - gender/sexuality - personality

Clinical Application of knowing Vulva Anatomy

- proper performace of pelvic examinations/medical procedures - examining the area for infection/malignancy Ex: - examining the vulva - identification of bartholin gland cyst - inserting speculum into vestibule/vaginal canal to conduct a pap smear

Female pelvic organs

- uterine tubes - ovaries - uterus - vagina *** Important to note the location of organs and their relative positioning to one another

Phonation- the larynx is

- vocal folds adducted and stridulating as air is forced between them - vestibule open

How are taste and smell related?

- we mostly taste with our sense of smell - when we have a cold, odorante cannot reach the olfactory epithelium due to the increase in mucous in our nasal pasasges- therefore we are not able to smell and we are not able to procedd the flavor of the food ** tongus is still able to pick up major construct- salty, sweet, bitter, sour, and umami but it is the olfactory region that ties in the fine details of the experience ** temperature of the food is NOT affected - CN V and IX from the tongue epithelium are signaling the somatosensation

Ascending Spinal Cord/Brainstem Pathways

1) Dorsal Column/ Medial Lemniscus Pathway 2) Anterolateral/Spinothalamic Pathway 3) Trigeminal Pathways (3) - Touch & proprioception (proprioception also is associated with the mesencephalic nucleus) - Pain 4) Spinocerebellar Pathways (3) - Anterior Spinocerebellar Pathway - Posterior Spinocerebellar Pathway - Cuneocerebellar Pathway

Telencephalic Components of the Limbic System

1) Neocortex ** - 6 layers *** - 95% of cerebral cortex in humans **** 2) Juxtallocortex or periallocortex (4-5 layered cortex) - Entorhinal cortex - Parahippocampal gyrus - Cingulate gyrus - Orbitofrontal cortex 3) Allocortex (3 layered cortex) - Hippocampus - Olfactory 4) Subcortical (no apparent cortical layering) - Amygdala - Basal Forebrain

What are the 2nd order Nuclei of the Dorsal Column/ Medial Lemniscus System?

1) Nucleus Gracilis - "touch" from regions T7 and BELOW - relays to VPL of thalamus via the medial lemniscus axons 2) Nucleus Cuneatus - "touch" from regions T6 and ABOVE - relays to VPL of thalamus via the medial lemniscus axons IAF= Internal Arcuate Fibers (decussating axons of this system) NOTE: as the Central processes (medial lembiscus) are ascending from the caudal medulla to the thalamus- the axons somatotopy "twists" and changes as the signal ascends

All visual pigments consist of

1) an opsin - Rhodopsin in rods - Iodopsin in cones 2) the chromophore retinal - the part of the pigment that causes the shape change in response to light; derived from vitamin A ** In both rods and cones, the membranous discs are formed from reptitive transverse infolding of the plasma membrane in the regoin of the outer segment

What are the 3 Ascending Pathways of the Cerebellum?

1- Anterior (Ventral) Spinocerebellar Pathway: - Input from golgi tendon organs, muscles spindles & spinal interneurons, cutaneous receptors & fibers of descending tracts in LOWER (distal) extremities (i.e. leg).. this tract is more related to INTENDED movement 2- Posterior (Dorsal) Spinocerebellar Pathway: - Conveys signals from muscle spindles & golgi tendon organs- info about individual muscles in the LOWER (proximal) extremities (i.e. thigh) 3- Cuneocerebellar Pathway: - Conveys signals from muscle spindles & golgi tendon organs- info about individual muscles in the UPPER extremities

4 Functional Regions of the Diencephalon

1- Epithalamus 2- Subthalamus 3- Thalamus 4- Hypothalamus

Two systems that supply the brain include

1- Internal Carotid Arterial System (goes striaght to the cranial vault) 2- Vertebral/Basilar Arterial System *** These come together and anastomose

6 functions of the Hypothalamus

1. Blood pressure and electrolyte composition - thirst, salt appetite, drinking behavior, vasomotor tone, vasopressin secretion 2. Hunger, feeding and energy metabolism - hunger and feeding behavior, autonomic modulation of digestion and neuroendocrine regulation of metabolism- affecting hormones such as cortisol, growth hormone and thyroid hormone 3. Reproductive (sexual and parental) behaviors - autonomic modulation of the reproductive organs, and neuroendocrine regultiaon of the gonads 4. Body temperature - influence on thermoregulatory behavior (ex. seeking warm shelther) control of autonomic body heat conservation/loss mechanism and controls secretion of hormones that influence energy metabolism and metabolic rate 5. Defensive Behavior - regulation of the stress response and fight/flight/freeze response to threats in the environment 6. Sleep-wake cycle - location of the circadian clock in the suprachiasmatic nucleus, and levels of arousal when awake

Examples of Spinal Cord Syndromes

1. Complete cord transection 2. Brown Sequard syndrome 3. Syringomyelia 4. Friedrichs ataxia 5. Subacute combined degeneration 6. Amyotrophic lateral sclerosis 7. Tabes Dorsalis

What are the 3 layers of the wall of the eye?

1. Corneoscleral coat (outer) 2. Uvea (middle vascular layer) 3. Retina (inner photosensitive layer)

Nervous Contents of the Infratemporal Fossa

1. Mandibular nerve (CNV3) 2. Facial Nerve (CNVII)- branch= Chorda Tympani Nerve 3. Glossopharyngeal nerve (CNIX)- branch= Lesser Petrosal Nerve [IX]

What are the 3 brain vesicles that we begin with

1. Prosencephalon or forebrain 2. Mesencephalon or midbrain 3. Rhombencephalon or hindbrain ** Vesicle formation begins after anterior neuropore closure in week 4

Urogenital system can be divided into:

1. Urinary system - kidneys, ureters, urinary bladder, urethra 2. Genital system - internal and external genitalia ** Development of BOTH systems is CLOSELY LINKED as they are derived from a COMMON mesodermal ridge which is located along the posterior wall of the abdominal cavity ** Intermediate mesoderm

Functions of the Female Reproductive System

1. to produce female gametes (oocytes) 2. to provide the enviornment for fertilization 3. to hold the embryo during its complete development through the fetal stage until birth * As in the male, the femal reproductive system produces steroidal sex hormones that control organs of the reproductive system and influence other organs in the body * Reproductive system undergoes cyclic changes in structure and functional activity: - Begins at menarche (first menses) - At menopause, cyclic changes become irregular and then disappear - Post-menopausal period- slow involution of the reproductive organs ** Although the mammary glands do not belong to the genital system, they are included here bc they undergo changes directly connected to the functional state of the reproductive system

Trigeminal System for Pain and Temperature from the face

1st order cell body= Trigeminal Ganglion via descending tract of V (spinal tract of V) to.. 2nd order cell body= Spinal nucleus of V via trigemino-thalamic tract (V lemniscus) to.. 3rd Order cell body= VPM of the thalamus axons from VPM ascend to somatosensory cortex ------------ V Ganglion --> (descending tract of V) --> Spinal nucleus of V --> (trigeminothalamic tract) --> VPM --> primary somatosensory cortex (S1)

Testing for intellectual disabilty

2 components 1. Intelligence 2. Adaptive functioning: self-care, social functioning, occupational functioning - skills that are necessary for independent daily living; expectations with age - vineland II - adaptive behavior assessment system, third edition (ABAS-3) Ex. 14 yr old with trouble brushing teeth- problem with adaptive functioning

The 2 lateral ventricles are connected to the third by the

2 interventricular foramina- left and right- aka Foramen of Monro

Uterine Tubes (Fallopian tubes/ Oviducts/Salpinx)

2 uterine tuves about 10-12 cm in length open into the peritoneal cavity near the ovary Parts: - infundibulum with fimbriae - ampulla (normal site of fertilization) - isthmus - uterine or intramural part Movement of the oocyte into the uterine tube is accomplished by 3 things: Muscularis smooth muscle acitivty 1. cilitaed cell activity 2. wafting of fimbrae of the infundibulum ** The oocyte enters the tube and moves to the ampulla NOTE: A Salpingectomy: surgical removal of an oviduct Histology: Mucosa (epithelium, basal lamina, lamina propria) - simple columnar epithelium - folded, especially in the ampulla ** The simple columnar epithelium is on a lamina propria of loose CT 2 main cell types: 1. Ciliated cells: cilia sweep fluid toward the uterus 2. Peg cells: secretory (not ciliated) - non-ciliated - darker staining - can have an apical bulge into the lumen ** Secrete nutritive fluid into the lumen of oocytes, sperm Muscularis: - thick with inner circular and outer longitudinal layers of smooth muscle - inner longitudinal layer present in the isthmus and intramural parts - muscle action appears to be more important than ciliary action for the movement of oocyte and sperm Thin SEROSA covered by visceral peritoneum lined by mesothelium

How many bones are found in the skull?

22 bones which are separated into two regions: I. Neurocranium: 8 bones that enclose the brain - Occipital bone - 2 Parietal bones - Frontal bone - 2 Temporal bones - Sphenoid bone - Ethmoid bone ** Cranial bones surround and protect the brain II. Viscerocranium: 14 bones that create the face and jaw - 2 Maxillae - 2 Palatine bones - 2 Nasal bones - 2 Inferior Nasal Conchae - 2 Zygomatic bones - 2 Lacrimal bones - Vomer bone - Mandible ** Facial bones protect and support the entrances to the digestive and respiratory tracts Skull also has 7 associated bones: - 1 Hyoid Bone - 6 Auditory Ossicles enclosed in temporal bones

External Branchial Fistula is a more serious condition that can occur if the

2nd pharyngeal cleft fails to grow caudally over the 3rd and 4th clefts, leaving remnants of the 2nd and 4th clefts in contacts with the surface/tonsil by a narrow canal ** ducts of the external branchial fistula can be found anterior to the sternocleidomastoid muscle ** sometimes mucus exudate can be seen coming out

Primary Neurulation occurs in Weeks

3 and 4 Primary Neurulation is the process by which the neural tube is formed from the neural pleate ** formation of brain and rostral spinal cord - Notochord (from mesoderm) induces the formation of the neural plate by week 3 - Neural plate proliferates and widens, producing neural folds, then a neural groove invaginates by day 20/21 - Central closure occurs day 21/22 - Cranial closure- day 24/day 25 - Caudal closure- day 26/27 (forms the tube!)

What are the 5 layers of the Cornea?

3 cellular layers and 2 non-cellular layers 1. Corneal Epithelium: - NON-keratinized stratified squamous - quick turnover ~7 days - Nuclear *FERRITIN protects from UV, NOT melanin 2. Bowmans membrane: - NO cells, very thick basement membrane, some strength - Prevents spread of infections 3. Corneal Stroma: - THICKEST layer, collagen and elastiv fibers with intersepersed fibroblasts 4. Descemet's Membrane: - NO cells - Very thick basement membrane 5. Endothelium - Simple squamous epithelium - ** Secretes Descemet's Membrane

Facial & Palate Development

3 facial prominences appear derived from neural crest mesenchyme from the 1st pharyngeal arches: - frontonasal prominence - maxillary prominence - mandibular prominence * Nasal (olfactory) placodes originate on both sides of the frontonasal prominence and then invaginate to form nasal pits with lateral and medial nasal prominences on both sides * Maxillary prominences grow medially, pushing the nasal prominences medially as well and eventually they all will form the upper lip * Ectoderm in the floor of the nasolacrimal groove forms an epithelial cord, which will become canalized to form the nasolacrimal duct with the upper end widening into the lacrimal sac ** Lower lip and Jaw form from the mandibular prominences that merge across the midline

Fetal membrane in twins

3% of ALL live births in the US - Triplets: 1 in 7600 pregnancies - Quadruplets, Quintuplets: even rarer.. Dizygotic/faternal twins - result from simultaneous shedding of two occytes and fertilization by different spermatozoa - Each zygote implants individually and develops its own placenta, amnion, chorionic sac Monozygotic/Identical twins - result from splitting of the zygote at various stages of development - splitting usually occurs at early blastocyte stage - common placenta, chorionic cavity but separate amniotic cavity - strong resemblance in blood groups, fingerprints

Each cerebral hemisphere contains

4 Major lobes which are named for the skull bones which cover them: - Frontal lobe - Parietal lobe - Temporal lobe - Occipital lobe *** If you pry open the lateral sulcus you will see the gyri of the insula ! (the 5th lobe!) The insula is divided into 2 parts: 1. Anterior insular cortex, which is believed to be involved in olfactory, viscero-autonomic, gustatory and limbic (emotional) functions 2. Posterior insular cortex, which is believed to be involed in auditory, somatosensory and skeletomotor Important landmarks include: - Central Sulcus: separates frontal lobe from parietal lobe - Lateral Sulcus (AKA sylvian fissure): separates temporal lobe from frontal and parietal lobes

We know there are 6 extraocular muscles, BUT there are 7 Extrinsic Eye Muscles.. What are they?

4 Rectus Muscles: - Superior Rectus - Medial Rectus - Inferior Rectus - Lateral Rectus 2 Oblique Muscles: - Superior Oblique - Inferior Oblique 7th extrinsic Muscle? Levator Palpebrae Superioris! * It does NOT move the eyeball, but is involved in raising the eyelid!

Limbic system consists of

4 structures that overly 4 functions: - Hypothalamus --> Homeostasis - Olfactory cortex --> Olfaction - Hippocampus --> Memory - Amygdala --> Emotion Consits of anatomic substrates underlying behaviorly & emotional expression - many connections between cortical and subcortical regions in the telencephalon, diencephalon & mesencephalon Limbic system is Important in survival of a species: - functions are "ancient"- the limbic system is evolutionarily oldest portion of the cerebrum Involved in adaptive behaviors: - What is important to attend to right now - What is important to remember - Activation of fight or flight response ** Remember the 5 F's: Flight, Flee, Feel, Feed, Fornicate ** Olfactor system "ruled" and has direct connections to the hippocampus and amygdala

Spermatogonia have

46 chromosomes, 2N DNA (DNA not replicated; no sister chromatids) Primary spermatocytes (in first meiotic prophase) have 46 chromosomes and 4N DNA- At the end of this stage, homologous chromosomes separate to give secondary spermatocyte chromosomes numbers ** Prophase of first meiotic division takes 22 days (crossing over) ** Majority of spermatocytes seen in sections will be PRIMARY spermatocytes in prophase- rarely see secondar spermatocytes bc this stage happens so quickly Secondary spermatocytes have 23 chromosomes (each has 2 sister chromatids) and 2N DNA (short lived- rarely seen in section) Spermatids and spermatozoa have 23 chromosomes and 1N DNA NOTE: Myoid cell- smooth muscle- contracts and expels mature sperm

By the end of the ____ week of development, the primitive face is formed by the stomodeum (future mouth) and the first pair of pharyngeal arches, which surround the stomodeum can be seen

4th week

After the original 3 brain vesicles we progress to

5 Forebrain (prosencephalon)--> 1) Telencephalon and 2) Diencephalon Midbrain (mesencephalon) --> mesencephlon Hindbrain (rhombencephalon) --> 1) metencephalon and 2) myelencephalon ------------- Telencephalon --> cerebral hemispheres (with lateral ventricles) Diencephalon --> thalamus, hypothalamus (with 3rd ventricle) Mesencephalon --> Midbrain (with the aqueduct) Metencephalon --> Pons and Cerebellum (with upper part of fourth ventricle) Myelencephalon --> Medulla --> Lower part of fourth ventricle

MMPI-2: Medical Setting

567 true/false quesitons - identifying psychopathology that may not be reported by patients or minimized - co-ocurring somatic symptoms without clear medical explanations (i.e. conversion disorder, somatic symptom disorder) - idenity substance abuse - psycholocial effects of or risks for a medical condition

What occurs in the 6th, 7th, and 10th weeks of Facial & Palate Development?

6th Week: - palatine shelves outgrow from the maxillary prominences- at first they are obliquely oriented on each side of the tongue 7th Week: - the shelves ascend to attain a horizontal position above the tongue and fuse, forming the secondary palate - at this same time, the nasal septum grows down and joins the newly formed palate - the secondary palate fuses with the primary palate 10 weeks: - the incisive foramen is the midline landmark between the two palates (primary and secondary palate)

Orbit is created by

7 bones and contains three "holes" that allow for the passage of nerves and vessels beween the orbit and the cranial vault Formania & there contents: Superior Orbital Fissure contains: - Oculomotor nerve (CN III) - Trochlear Nerve (CNIV) - Ophthalmic Division of Trigeminal (CNV1) - Abducens Nerve (CNVI) - Ophthalmic Vein Inferior Orbital Fissure contains: - Inferior Ophthalmic Vein Optic Canal contains: - Optic Nerve (CN II) - Ophthalmic Artery

Tinnitus

A "ringing" noise in the ears - pathophysiology poorly understood - damage to the cochlear and vestibular end-organs may be responsible - some drugs induce tinnitus in toxic doses (ex. salicylates)

Medial Pterygoid

A DEEP muscle of mastication (has a superficial and deep head) Origin: 1. medial surface of lateral pterygoid plate and palatine bone 2. tuberosity of maxilla Insertion: Medial surface of mandibular Ramus Innervation: Medial pterygoid nerve (CNV3) Function: Elevation and protrusion when both muscles work together; move mandible to contralateral side when one muscle is working

Lateral Pterygoid

A DEEP muscle of mastication (has a upper and lower head) Origin: 1. Infratemporal surface of sphenoid bone 2. Lateral surface of later pterygoid plate Insertion: Upper head attaches to joint capsule of TMJ; inferior head to the neck of the condyloid process of mandible Innervation: Lateral pterygoid nerve (CNV3) Function: Depression and protrusion when both muscles work together; move mandible to contrlateral side when one muscle is working

Buccal Nerve

A branch of the Mandibular Division of the Trigeminal Nerve (CNV3) - Buccal Nerve - passes anteriorly and is involved in transmitting somatosensation (GSA) from the skin in the region of the cheek *** This buccal nerve of CNV3 is NOT to be confused with the buccal branches of the facial nerve (CNVII) that supply voluntary motor innervation to muscles of facial expression

Lacrimal Apparatus

A netwok of structures producing, secreting, and draining fluid that moistens and provides nutrients to the exopsed eye Composed of: - lacrimal gland and ducts - lacrimal puncta and canals - lacrimal sac - nasolacrimal duct Lacrimal fluid leaves the lacrimal gland through 6-10 short lacrimal ducts --> fluid then crosses the eyeball towards the lacrimal papilla (which are two elevations that are visible on the medial aspect of each eye lid) --> lacrimal fluid then passes through the lacrimal punctum (which are openings on each of the lacrimal papilla) --> then passes through the short lacrimal canaliculus (a vessel that begins at the lacrimal punctum and ends in the lacrimal sac) --> from lacrimal sac, the fluid passes down into the nasal cavity (inferior nasal meatus) through the nasolacrimal duct

Submandibular Triangle of the Anterior Triangle of the Neck

A paired traingle bounded by the mandible and anterior and posterior belliws of the digastric muscles Contents: - submandibular gland - lymph nodes - hypoglossal nerve (CNXII) - mylohyoid nerve - facial artery and vein

Muscular Triangle of the Anterior Triangle of the Neck

A paired traingle bounded by the midline of the neck, superior belly of omohyoid muscle and the stenocleidomastoid Contents: - thyrohyoid - omohyoid - sternohyoid - sternothyroid "TOSS" - thyroid and parathyroid glands - larynx - trachea

Carotid Triangle of the Anterior Triangle of the Neck

A paired triangle bounded by posterior belly of digastric, superior belly of omohyoid and sternocleidomastoid Contents: - Tributaries to common facial vein - Cervical branch of facial nerve (VII) - Common carotid artery - External and Internal carotid arteries - Superior thyroid artery - Ascending pharyngeal artery - lingual artery - facial artery - occipital artery - internal jugular vein - vagus nerve (CNX) - accessory nerve (CNXI) - hypoglossal nerve(CNXII) - superior and inferior roots of ansa cervicalis and the transverse cervical nerve

Oxytocin

A posterior pituitary hormone, stimulates ejection ("let-down") of milk from the breast by stimulating contraction of myoepithelial cells which surround the epithelial cells of the alveoli ducts - Adequate amts of GH are required to provide the nutrients that are essential for milk production by the breast tissue via PRL - Estrogen and progesterone are essential for the physical development of breast tissue during pregnancy, BUT neither are involved with milk production or ejection

Reflex

A simple, rapid motor response to a sensory stimulus - involuntary, instantaneous and protective in nature ** Somatic, spinal reflexes are modulated by supraspinal levels, but can act autonomously ** Testing the integrity of various reflexes can help identicy motor dysfunctions

Submental Triangle of the Anterior Triangle of the Neck

A single mid-line triangle bounded by the hyoid bone, anterior bellies of the digastric muscles and mandibular symphysis - the floor is the mylohyoid muscle Contents: - Submental lymph nodes and tributary veins that unite to form the anterior jugular vein

Ductus Epididymis

A single, highly coiled that carries sperm from the testes to the ductus deferens, which is the main storage depot for sperm - 4-6m in length, 20-day journey for sperm ** Lined with pseudo-stratified columnar epithelium - absorbs excess fluid - passes nutrients to immature sperm ** Surrounded by smooth muscle, whose peristaltic contractions help to move sperm along the duct ** While in the epididymis the spermatozoa gain motility- However, transport of sperm through the remainder of the male reproductive system is achieved via muscle contraction rather than by their recently acquired motility ** The highly coiled ductus epididymis- its walll is made of pseudo-stratified columnar epithelium surrounded by CT and smooth muscle ** Straight tubules --> Rete testis --> Ductuli Efferentes --> Ductus Epididymis

Ductus (Vas) Deferens

A striaght tube ~45cm in length that transports sperm from the epididymis to the ejaculatory duct in anticipation of ejaculation - narrow lumen - pseudostratified columnar epithelium with stereocilia (microvilli)- like in epididymis, these absorb excess fluid - lamina propria rich in elastic fibers - thick muscular layer consists of inner and outer layers separated by a circular layer ** Smooth muscle gives strong peristaltic contractions that expel sperm during ejaculation NOTE: After erection, sperm enters Vas Deferens from epididymis ** Straight tubules --> Rete testis --> Ductuli Efferentes --> Ductus Epididymis--> Ductus (Vas) Deferens--> Ejaculatory Duct

Waldeyers Lymphatic Ring (tonsils of the pharynx)

A tonsilar ring that surrounds the superior pharyngeal constrictor Contains: - Pharyngeal (adenoid) tonsil - 2 Tubal tonsils - 2 Palatine tonsil - Lingual tonsil ** 1 or 2 tonsils may be noted, but understand that this is a collection of tonsillar, lymphoid tissue ** Tonsillar placement forms a protective lymphatic ring that guards the nasopharynx and oropharynx (gateways for food and air intake)

Nociceptive Fiber Types (specialized primary afferent axons)

A-delta fibers: ** small myelinated fibers that transmit information about pain and temperature - fast, thinly myelinated fiber - sharp, intense pain - "first pain".. Ow!.. C fibers: ** small UN-myelinated fibers that transmit information about pain, temperature, and ITCH (a type of pain associated with noxious stimuli) - slower, unmyelinated fiber - throbbing, burning - "second pain".. Ahh..

Intellectual Disability DSM-5 Criteria

A. Deficits in intellectual functions confirmed by both clinical assessment and standardized intelligence testing (Criteria) B. Deficits in adaptive functioning that limit functioning in daily life (impact) C. Onset of intellectual and adaptiv deficits during developmental period (timing) ** missing exclusion criteria- not all diagnoses have to fit that pattern though!

Acrosin is not release until

AFTER the sperm penetrate the cumulus cells and bind to the zona pellucida

Which branch of the basilar artery supplies anterior portions of the inferior surface of the cerebellum (flocculus) & parts of the pons?

AICA (Anterior Inferior Cerebellar Artery) ** It has a branch by the name of Labyrinthe Artery which supplies the inner ear- usually comes off the AICA and is important clinically bc obstruction can cause vertigo and possible deafness

Wernickes Aphasia

AKA Receptive Aphasia or Sensory Aphasia Fluent but meaningless with excess non-informational words - Comprehension: Poor to absent ** Fluency but with meaningless words- pts think they are communication - Brocas area can still make language- but language is running arye with no interpretation ** Words Salad

Brocas Aphasia

AKA: Expressive Aphasia or Motor Aphasia Non-fluent, broken speech containing mainly informational words - Comprehension: NOT impaired ** Comprehension fine, but non-fluent (tries to describe the image in sentences but can not get the words out)

Atypical Analgesic

Acetaminophen MOA: - NOT understood, appears to inhibit a COX-1 variant in CNS and decreases prostaglandins in the brain - Central actions to decrease pain and fever Pharmacological effect: - analgesic, antipyretic (not anti-inflammatory) Therapeutic use: - Nociceptive pain: (mild to moderate, moderate to severe when combined with opiods but has adverse effects) ** can also combine with Aspirin that is acting peripherally - can combine drugs to get better pain control - Fever

7th step of neurotransmission= Degradation (extracellular)- what drugs work here?

Acetylcholine is degraded extracellularly by acetylcholine esterase (AChE) ** Donepezil is an AChE inhibitor, used in treatment of Alzheimers Disease (enhances levels of ACh and its signaling)

Fast synaptic neurotransmitters in CNS

Act via LGICs (ligand gated ion channels) Excitatory: Glutamate - Non-essential AA - Major excitatory NT in CNS (but also present in periphery) Inhibitory: GABA - NOT incorporated in proteins - MAJOR inhibitory NT in brain (but also present in spinal cord and the periphery) ALSO Glycine is inhibitory - Non-essential AA - Major inhibitory NT in spinal cord (but also present in brain and the periphery) - ALSO a co-agonist at NMDA- type glutamate receptors

Extraocular Eye muscles innervation

All are innervated by the Superior Branch (superior rectus, levator palpebrae superioris) or Inferior Branch (inferior branch, medial rectus, inferior oblique) of the Oculomotor Nerve (CNIII) EXCEPT FOR - Lateral Rectus- innervated by Abducens (CNVI) - Superior Oblique- innervated by Trochlear (CNIV)

Tongue Muscles (8)

All innervated by CN XII EXCEPT Palatoglossus which is innervated by CNX- Pharyngeal nerve - Hypoglossus - Genioglossus - Styloglossus - 4 intrinsics - Palatolglossus

5 Muscles of the palate

All innervated by CNX, EXCEPT for Tensor Veli Palatini innervated by CNV3 (Medial Pterygoid Nerve) - Levator Veli Palatini - Palatoglossus - Patalopharyngeus - Musculae uvulae - Tensor veli palatini

What muscles arise from the VI pharyngeal arch?

All intrinsic muscles of the larynx EXCEPT cricothyroid ** Roots of definitive pulmonary arteries and ductus arteriosus ** CNX (recurrent larngeal branch of the vagus nerve)

Antidepressants for Chronic Pain

Amitriptyline, Duloxetine - Drugs with actions at NE transport sites (not just serotonin) are useful analgesics MOA: Amitriptyline- "first" generation - drug class: tricyclic antidepressant (TCA) - blocks uptake of serotonin and NE - has a number of "off target" actions Duloxetine- "second generation" - drug class: serotonin NE reuptak inhibitory (SNRI) - blocks uptake of serotonin and NE Therapeutic use: ** Neuropathic pain: FAST onset of action -Major depressive disorder: slow onset of action bc we need to increase gene expression (ex. increase brain derived neurotropic factor- increases neuronal plasticity)- reason for long lag of taking drug and onset of its effect

Before it enters the prostate, the ductus deferens dilates to form the

Ampulla, which acts as a sperm reservoir *** Until ejaculation occurs, sperm goes no further than ampulla - At the final portion of the ampulla, the seminal vesicles join the duct - From there on, the ductus deferens enters the prostate and opens into the prostatic urethra - The segment entering the prostate is called the ejaculatory duct Seminal Vesicles are: - Two Highly tortuous tubes, ~15cm in length - Folded mucosa lined with cuboidal or pseudostratified columnar epithelium rich in secretory granules - Lamina propria is rich in elastic fibers and surrounded by a thin layer of smooth muscle

Corticobulbar Tract of the Accessory Nerve (CNXI)

An exception to the bilateral with contralateral dominance rule **** Accessory has IPSILATERAL corticobulbar innervation ONLY - UMN innervates IPSILATERAL accessory motor nucleus - LMN innervates IPSILATERAL sternocleidomastoid and trapezius **Unilateral UMN Lesion AND LMN Lesion= unable to rotate head to the contralateral side upon resistance and unable to raise ipsilateral shoulder upon resistance

Testosterone is sequestered in the testes by

Androgen Binding Protein (ABP) ** ABP - production is regulated by FSH - binds testosterone with HIGH affinity - ABP-testosterone complex is an intra-testicular testosterone storage reservoir NOTE: - ABP binding to testosterone facilitates concentration of testosterone within the seminiferous tubules - The concentration of testosterone within the lumen of the seminiferous tubules is about 100 times that of plasma and this high concentration is required for normal spermatogenesis - Of interest here is that it is the Sertoli cells that have androgen receptors (AR) and not the developing sperm *** NOTE: injections of testosterone can NEVER produce a high enough concentration within the seminiferous tubules to support spermatogenesis - Thus, functioning Leydig cells and Sertoli cells are required for a normal sperm count

Tongue Epithelium (GSA- Somatosensation)

Anterior 2/3 of tongue and soft palate: - trigeminal (CNV3)- important for mouth feel (creamy, oily, texture) Posterior 1/3rd of tongue: - glossopharyngeus (CNIX) Epiglottis: - vagus (CNX)

Sensory nerve fibers which form a plexus around a hair follicle in hairy skin- they convey crude touch and pressure sensation carried on the

Anterior Spinothalamic Pathway ** Signal is triggered with movement of hair

Ethmoid Sinus

Anterior and middle cells drain into the middle meatus via the ethmoidal bulla - posterior cells drain into the superior meatus directly - the air cells and their bony framework make up the ethmoidal labyrinth ** Innervated by the ethmoidal branches of the nasociliary nerve from CNVI

Drugs to Treat Neuropathic Pain

Antidepressants: TCA - Amitriptyline SNRI: - Duloxetine Anticonvulsants: Ion channel modulators - Carbamazepine - Gabapentin General Anesthetics NMDA Receptor antagonist: - Ketamine ** agonist was glutamate

General presentation in a Mental Status Exam

Appearance - posture, grooming, appearance for age, clothing - ex: has a hunched- over posture while standing, is unshaven, appears older than chronocological age, wearing a heavy coat on hot day Behavior - mannerisms, phsycomotor, tics - ex. shows unusual facial expressions or hand movements, seems agitated or particularly slow, uses repetive, non-productive movements Attitude toward the examiner - cooperative, seductive, hostile, defensive - ex. (lacking) is not helpful, behaves in a sexually provacative fashion, seems angry, seems to take remarks personally Level of consciousness - consciousness, lethargy, sleepiness - ex; is not fully alert, seems mentally slowed down, dozes off repeatedly

Normal Connectivity of the Basal Ganglia involves

Cortex --> Basal Ganglia --> Thalamus --> Back to Cortex Involves: - Multiple parallel loops that modulate cortical output ** Limbic Cotex loop with nucleus acuumbens ** Association Cortex loop ** Sensorimotor Cortex loop - Interconnections of the Basal Ganglia detemine the pattern of their outputs Sensorimotor Cortex loop: Sensorimotor cortex- (emphasizes)-> Putamen--(emphasizes)--> Globus Pallidus --> Ventral anterior nucleus and Ventral lateral nucleus (VA and AL) --> Sensorimotor cortex Association Cortex loop: Association cortex --> Caudate--> Globus Pallidus and Substantia Nigra (pars reticulata)--> Dorsomedial nucleus--> back to association cortex Limbic Cortex Loop: Limbic cortex --> Nucleus Accumbens --> ventral pallidum--> dorsomedial nucleus--> back to limbic cortex

Epidemiology of Spinal Cord Injury (IC)

Apprx 291,000 ppl currently living with SCI in US - 17,700 new pts estimated to occur annually - alcohol has been found to play major factor in 25% of spinal cord injuries - males account for 78% of spinal cord injury patients - avg. age has increased to 43 yrs (was 29 in 1970s0 Estimated racial/ethnic distribution: - white: 60% - black/african american: 23% - hispanic: 13%

Head and Neck Vasculature:

Arch of the Aorta gives rise to: - Brachiocephalic Trunk (AKA Inominate Atery) * only on R - L/R Subclavian Arteries ** subclavin aa. give rise to L&R vertebral arteries (vertebral arteries do not supply structures in neck/head- they contribute to the arterial supply of the brain) - L/R Common Carotid Arteries ** R subclavian and R Common Carotid are branches of the Brachiocephalic trunk Common Carotid artery bifurcates into: - L/R External Carotid Arteries (to neck, face, scalp) - L/R Internal Carotid Arteries (straight into the cranium to supply the brain) *** This occurs at level of C3/C4 cervical vertebra

Vomiting Reflex

Area Postrema/Chemoreceptor Trigger Zone (CTZ) - Belong to the circumventricular system, which lack a blood brain barrier and can detect noxious stimuli (emetic toxins) - Afferent stimuli: drugs, toxins, hormones (pregnancy), alcohol, infection, vestibular stimuli - Efferent: Dorsal motor nucleus of X--> vomiting reflex ** Vomiting can be activatived by cortical, chemical, vestibular, and increased intracranial pressure - Motion sickness - Stimuli from pharynx and stomach - Chemotherapy, Anaesthetics, Opiods - Pain (anticipatory Ex. smell, sight, fear) NOTE: Other reflexes including coughing, yawning, shivering, gagging, laughing, crying, hicupping

Receptive Fileds

Area of skin within which a stimulus must occur in order to activate a receptor- Receptive field size varies with type/location of sensory receptor ** depth at which the receptor is located is also associated with the size of the receptive field - Ruffini endings and Pacinian corpuscles are found in deeper dermal layers and they both have larger, more diffuse, receptive fields - Merkels disks and Meissners Corpuscles are found in the epidermal layer and they both have a small receptive field

Vasculature of the Tonuge

Arterial Supply: - Lingual artery (from external carotid artery) - Dorsal Lingual Artery supplies the root/base of the tongue - Deep Lingual supplies the body - Sublingual supplies the floor of the mouth and sublingual gland Venous Drainage: - Tongue is drained mainly by the dorsal lingual veins and the deep lingual veins (accompany their respective arteries) - They both run posteriorly and join the sublingual vein ** ALL drain into the internal jugular vein

What role does the fetus play in stimulating the onset of labor?

As the fetus descends from the uterus towards the vagina, it stretches and distends the cervix - Sensory information regarding mechanical stretch is transmitted to the paraventricular and supraoptic nuclei of the hypothalamus stimulating the posterior pituitary to secrete oxytocin - Once released, oxytocin acts on its receptors in the myometrium to stimulate uterine contractions, further cervical stretch and further OT release - This cycle continues until after the placenta has been delivered ** This is the ferguson reflex- a neuroendocrine POSITIVE FEEDBACK LOOP that regulates labor progression

Meniere's Disease

Attacks of rotational vertigo - can be severe, incapacitating, unpredictable - last anywhere from minutes to hours Unilateral or bilateral hearing loss - fluctuating, progressive - usually in lower frequencies - may include experience of distorted sounds or unusual sensitivity to noises Unilateral or bilateral tinnitus Unilateral or bilateral sensation of pressure in ears

What happens if there is damage to the BE/SVE voluntary motor axons of CNV3?

BE/SVE axons (voluntary motor) originate in the brainstem on the same side that the axons will innervate (i.e the nuclei on the left side of the brainstem will innervate the left muscles of mastication) If they are damaged- the jaw will deviate TOWARDS the affected side ** think about the action of the pterygoids- if they are intact on one side and non-functional on the other side, the intact side wil "push" laterally toward the affected/unopposed side

Cells migrating ventral to the sulcus limitans form the

Basal plate (motor neurons)

3 regions of the decidua

Based on their relation to the implantation site: 1. Decidua basalis= part DEEP to the conceptus that forms maternal portion of the PLACENTA 2. Decidua capsularis= SUPERFICIAL part of the decidua overlying the conceptus 3. Decidua parietalis= remaining parts of the decidua

Primordial Follicles

Beginning in puberty, with the release of FSH from the pituitary, a small group of primordial follicles each month begins a process of follicular growth - up to about 20 primordial follciles are activated to begin the maturation process - located in the superficial ovarian cortex Consists of a: - primary oocyte enveloped by a single layer of squamous follicular cells - follicular cells are surrounded by the basal lamina separating the follicle and the surrounding vascularized stroma (stroma cells) - the organelles of the cytoplasm (ooplasm) are near the nucleus and include numerous mitochondria, several golgi complexes, and extensive RER (balbiani body)

The specialized pyramidal cells in layer V of the primary motor cortex of the Neocortex of the Cerebral cortex are called

Betz Cells

What is macrosomia? What are 2 major consequences of macrosomia?

Birth weight >4.5kg at term or >90th percentile for a given gestational age= large for gestational age (LGA) infant - occurs in 15-45% of diabetic pregnancies - birth injuries, shoulder dystocia, and increased risk of childhood obesity, impaired glucose tolerance and metabolic syndrome

BE/SVE

Branchial Efferent/Special Visceral Efferent - motor fibers to skeletal , voluntary muscles that developed from branchial (pharyngeal) arches

Components of the Placenta

By the beginning of month 4, the placenta has 2 components: 1. A maternal portion: decidual basalis 2. A fetal portion: chorion frondosum Starting from week 9 of development, the demands from the fetus for nutrients increase- this causes an increase in the surface area between the maternal and fetal components of the placenta - Consequently the villi on the embryonis pole continue to grow and expand to give the chorion frondosum - Villi on the aembryonic pole degenerate and by month 3, this side is smooth to give the chorion laeve

Superior Origin of the Pharynx

C-shaped origin on the base of the skull - the opening of the "C" faces anteriorly towards the back of the oral and nasal cavities and larynx - Begins at the medial pterygoid plate of the sphenoid bone and passes inferior to the pharyngotympanic tube - Passes medially to the occipital bone and joins line from opposite side at the pharyngeal tubercle

CN VIII

CN VIII- Vestibulocochlear 1- Special Somatic Afferent (SSA) - Hearing (Cochlear) and balance & equilibrium (vestibular)

CN XI

CN XI- Accessory Cranial Root (BE/SVE): - Historically thought to assist CN X in innervating muscles of the larynx, parynx & soft palate Spinal Root (GSE): - Innervates Sternocleidomastoid and Trapezius ** This has been up for debate by some anatomists about whether nerve is SVE or GSE but for this course we say that GSE is to the Sternocleidomastoid and Trapezius ** Remember what theses muscles do! - Sternocleidomastoid: rotation of head to the opposite side and flexion of the neck on the same side - Trapezius muscles (3 parts): Upper part: elevation of scapula and arm support Middle part: retraction of the scapula Lower part: depression of the scapula ** All take part in scapula rotation NOTE: Patients with DAMAGE to the accessory nerve would NOT be able to elevate the shoulder on the side of the injury against resistance- they would NOT be able to turn their head contralateral to the side of injury against resistance

CN II

CNII- Optic Nerve Nerve has only 1 axon modality: Special Somatic Afferent (SSA) - Vision

All the Intrinsic Muscles of the Larynx are innervated by

CNX (Recurrent Layrngeal branch) EXCEPT FOR - Cricothyroid muscle: innervated by CNX (External branch of superior laryngeal nerve) *** these muscles are developed from pharyngeal arch VI Muscles and their functions: - Posterior cricoarytenoid: abduction and external rotation of the arytenoid cartilage- primary abductors of the vocal folds and openers of the rima glottidis - Arytenoid oblique: sphincter of the laryngeal inlet - Transverse arytenoids: Adduction of arytenoid cartilages - Thyroarytenoid: Sphincter of vestibule and of laryngeal inlet - Cricothyroid: Forward and downward rotation of the thyroid cartilage at the cricothyroid joint - Aryepiglottic (extension of arytenoid oblique): Adducts arytenoid cartilages and acts as a sphincter on laryngeal inlet - Thyroepiglottic (extension of thyroarytenoid): Depresses the epiglottis - Vocalis: adjusts tension in vocal folds - Lateral cricoarytenoid: internal rotation of the arytenoid cartilage and adduction of vocal folds

Which CN sends GVE fibers to viscera?

CNX- Vagus ** Also remember that a collection of nuclei within the nucleus ambiguus is also cardio-inhibitory in nature (GVE) via the vagus nerve- that collection will innervate the heart in addition to the dorsal motor nucleus of X

Sensory & motor functions for ONE side of the body/world are CONNECTED WITH the

CONTRALATERAL FOREBRAIN (thalamus of the diencephalon & cortex of the telencephalon)

Choroid Plexus produces

CSF - A double-layered fold of pia mater along with ependymal tissue forms the tela choroidea, which has refions of projections called choroid plexus - Choroid plexus can be present in the lateral, 3rd, or 4th ventricles - Blood supply is from anterior choroidal artery (from internal carotid artery) and posterior choroidal arterial branches (from posterior cerebral artery).

How does CSF move from the subarachnoid space into the sinuses?

CSF passes through arachnoid villi (AKA arachnoid granulations) into the venous sinus - these villi protrude through the dura mater and act as one-way valves - CSF flows form the villus and into the venous blood by diffusion as the pressure driving the CSF is higher than that in the venous circulation An arachnoid villus showing the passage of CSF from subarachnoid space in dural venous sinus 2 theories: 1- CSF movement through large vacuoles in endothelial cells 2- Movement through the channels between cells

Anticonvulsants

Carbamazepine, Gabapentin MOA: Carbamazepine: - Use dependent blocker of voltage-gated Na+ channels - a NON-neurotransmitter system target - Voltage-dated ion channels: drug targets for epilepsy, arrhythmias, angina, hypertension, pain and local anesthesia Carbamazepine: - binds to inactivated voltage-gated sodium channels - slows the recovery from inactivation phase - inhibits repetitive neuronal firing - use-dependent block (Aka state-dependent block) - Anticonvulsant Gabapentin - Structural analogue of GABA but NO effect on GABA receptors - Inhibit presynaptic N, L, P/Q-type voltage-gated Ca2+ channels (containing alpha2delta subunit) --> inhibit calcium influx, thereby inhibiting excitatory NT release (ex. glutamate, substance P)

Serotonergic drug targets

Catabolic enzyme: - Monoamine oxidase (MAO) inhibitors- older antidepressant or Serotonin transporter - Tricyclic antidepressants- antidepressant (ex. Amitriptyline) - Selective serotonergic reuptake inhibitors (SSRIs)- antidepressants, anxiolytics ex. fluxetine***

The third and fourth ventricle are connected via the

Cerebral aqueduct (Aqueduct of Sylvius)

Lateral Cervical Cysts can occur when

Cervical Sinus (2nd to 4th Pharyngeal Clefts) fail to obliterate leaving a potential space in the anterior triangle of the neck, anterior to the upper third of the sternocleidomastoid muscle (MOST COMMON location)

There is cross-talk between gustatory and olfactory systems

Chemosensation in virtually al animals as means for determining safe/ edible vs. toxic/inedible- in some respects, these sense are most directly tied to survival - Mouth-born chemical (tastants) detected by gustatory system - Airborne chemicals (odorants) detected by olfactory system - Mastication releases chemicals/odorants that can be detected by the olfactory system Terms to know: - total ageusia: loss of all taste sensation - partial ageusia: loss of a particular taste sensation - hypogeusia: decreased taste sensation - dysgeusia: distorted perception of taste - phatogeusia: perception of taste where there is none ** Anosmia and ageusia are emerging as sxs of COVID19- smell and taste dysfunction in COVID 19- there are also disorders of taste and smell

Goals of Hormone Replacement Therapy

Children: - Primary goal is to establish normal puberty/virilization and support male secondary sex characteristics- achieved with testosterone Adults: - Support/maintain male secondary sex characteristics- achieved with testosterone - Fertility (if desired by the patient): if the problem is hypothalamic/pituitary, induce fertility with gonadotropins (LH/FSH)-- testosterone must be discontinued (remember that testosterone administration suppresses gonadotropin secretion due to negative feedback)- Fertility treatment takes time to induce spermatogenesis; avg time is 5-12 months (infertility due to primary hypogonadism CANNOT be treated with pharmacotherapy- it will do no good to stimulate damaged/unresponsive testes)

Ester Local Anesthetics

Chloroprocaine: - injected - FAST onset, short duration of action EXCEPT if given spinal has longer duration of action - infiltration, peripheal nerve block, epidural Tetracaine: - topical or injected - long duration of effect: topical eye drops, topical, spinal anesthesia Benzocaine: - topical - INSOLUBLE in water, applied directly to wounds where it remains (little systemic absorption) - for pain, itching, sunburn, insect bites, etc ** Can cause METHEMOGLOBINEMIA

Spinoreticular Tract (Paleospinothalamic Tract)

Chronic, dull pain (C-fibers) project to cingulate and somato-sensory cortex - Projections also go to the reticular formation for emotion, arousal, motivation

3 Intrinsic Muscles of the Eye

Ciliary Muscle - is a ring of smooth muscle that controls accomodation for viewing objects at varying distances- it changes the shape of the lens within the eye but does not affect the pupil or the iris Dilator Pupillae - Smooth muscle of the eye- runs radially in the iris and will contract to dilate the pupil- this widens the pupil and lets more light into the eye Sphincter Pupillae - Located in the iris of the eye and surrounds the pupil - Contraction of the muscle constrics the pupil (reduces its size) and decreases the amount of light allowed into the eye

Biological Clock

Circadian Rhythms - Physiological and biochemical process - Endogenous - Modified by environemental cues (i.e Zeitgebers- ex. Daylight) Key concepts of the biological clock: - suprachiasmatic nucleus (SCN): Controls circadian rhythms- endocrine cycles and sleep/wake cycles - pineal gland - melatonin (hormone): released from pineal gland in response to darkness **NOTE: even if in dark room all day we would have a sleep-wake cycle but 24hr period

Examples of CNS drug classification

Classified by target and/or mechanim: - SSRI (selective serotonin reuptake inhibitor) - Antimuscarinic (muscarinic receptor antagonist) - MAO (manoamine oxidase) inhibitory Classified by therapeutic use: - Antiepileptics, Antidepressants Classified by chemisty: - phenothiazined, benzodiazepines**

Estrogen Receptor Anatgonists

Clomiphene

A pt presents to you with karyotype 46XY and testes in her abdomen alonw with a short vagina, full breast developed, and low estrogen levels- what can she have

Complete Androgen Insensitivity Syndrome (Maternal X Linked Recessive Disorder) - Testes present (1/2 intra-abdominal, 1/2 inguinal canal) - Short vagina: usually managed with dilators - Testosterone --> estrogen peripherally: allows secondary sexual characteristics like breast development, even though estrogen levels are "low female" levels - Estrogen acts unopposed Physically: may be eunuchoid; tall Other physical abnormalities are rare: unlike mullerian agenesiis Treatment: Testes are predisposed to neoplasia and need to be removed - 55% neoplasia risk - 22% are malignant ** This is the ONLY exception where gonadectomy can be deferred until after complete pubertal development Pubertal development --> Gonadectomy --> Estrogen replacement

Leuprolide

Continuous (nonpulsatile) Administartion: - Gonadotropin-releasing hormone (GnRH) receptor AGONIST- binds to GnRH receptors in anterior pituitary- initially increases LH and FSH --> sustained nonpulsatile administration causes desensitization of the GnRH receptors--> this INHIBITS the release of LH and FSH Pulsatile administration (like what body does) - Binds to GnRH receptors in the anterior pituitary- INCREASES secretion of LH and FSH - Pulsatile administration is less common in the clinical setting bc of inconvenience and cost associated with the intravenous pump that is required Clinical Uses (of NON-pulsatile administration): * suppression of gonadotropin production - prostate cancer - central precocious puberty - block endogenous puberty in pubertal transgender adolescents - endometriosis - uterine fibroids ** initial 2 week surge then goes down (LH/FSH) Adverse effects: - Hot flushes and sweats, edema, weight gain, decreased libido, decreased hematocrit, reduced bone density, reduced muscle mass/strength

Describe the 1st layer of the eye

Corneoscleral Coat - the outer or fibrous layer of the eye Consists of: 1. sclera the white portion 2. cornea the transparent portion ** these two layers are continuous LIMBUS= (corneoscleral junction) is an area of transition from the transparent collagen bundles of the cornea to the white opaque fibers of the sclera

Where are memories stored?

Cortex - widespread projections from association neocortex converge on the hippocampal region - the output of the hippocampus is ultimately directed back to these same neocortical areas

Cranial vs. Spinal Meninges

Cranial Meninges: - Dura Mater: Double layered, attached to inner skull surface - Epidural space: potential space between dura mater and skull - Arachnoid: attached to inner surface of dura - Pia mater: attached to CNS surface Spinal Meninges: - Single layer, suspended in vertebral canal - Epidural space: real space between dura and vertebral periosteum - Arachnoid: attached to inner surface of dura - Pia mater: attached to CNS surface and to the dura as denticulate ligaments

Cavernous Sinuses are clinically important bc of their relationship to

Cranial Nerve III, IV, V, VI and the Internal Carotid Artery, and pathway of infection ** the Cavernous Sinuses receives venous blood from deep veins of the face and ophtalmic veins of the orbit, as well as connections with the pterygoid plexus of veins - INFECTION can spread from the facial or ophthalmic veins (lacerations, blemishes) - Cavernous sinus thrombosis can occur if a clot travels from the facial vein to the cavernous sinus (can cause meningitis!)

Is there a cure for spinal cord injuries?

Currently there is NO cure * Ongoing research to develop and test new interventions are progressing - decompression surfery, nerve cell transplantation, nerve regeneration, complex drug therapies, brain- machine interfaces, and robotic exoskeleton ** new treatments for PAIN management - cognitive behaviroaly therapy

Institue of Medicine recommendations for weight gain in pregnancy

Data showed that women who gained within the guidelines experienced better outcomes than those who did not If you are: Underweight (BMI <18.5) - should gain 12.5-18kg (28-40lb) Healthy weight (BMI 18.5-24.9) - should gain 11.5-16kg (25-35lb) Overweight (BMI 25.0-29.9) - should gain 7-11.5kg (15-25lb) Obese (BMI >/= 30.0) - should gain 5-9kg (11-20lb)

Teeth

Decidious (milk/baby) teeth= 20 these are replaced with --> Adult/Permanent teeth= 32 ** These sit in sockets within the alveolar processes Function: Primary tool of mastication (chewing, biting, grinding) 1- Incisors 2- Canines (cuspids) 3- Premolars (bicuspids) 4- Molars (4-5 cusps) NOTE: in the skull and mandible of a child the milk teeth and permanent teeth can be seen

Valsalva Manuver

Defined as the forced expiration of air AGAINST a closed airway - can be used to clear the ears, unintentionally during coughing, during a bowel movement, or as a diagnostic/treatment aid Closure of the rima glottidis (space between true vocal folds) through adduction of the vocal folds: - coughing - sneezing - straining: lifting weights in the gym/bowel movement When the rima glottidis is closed, the anterolateral abd muscls contract to: - increase the intra-abdominal pressure - increase the intra-thoracic pressure

Perineum

Diamond-shaped area between thighs - located inferior to the pelvic diaphragm - has same boundaries as the pelvic outlet ** It is subdivided into urogenital triangle and anal triangle ** Important of perineum: contains structures that support pelvic organs that play a vital role in urination, defecation, sexual intercourse and childbirth Boundaries of Perineum: Anatomical borders: defined by bony margins - Anterior border: pubic symphysis - Lateral border: ischiopubic rami and sacrotuberous ligament and ischial tuberosities - Inferior border: tip of coccyx Surface Anatomy Borders: clinically important to be aware of the surface anatomy which marks the boundaries of the perineum Boundaries of Female Perineum: - Anterior border: mons pubis - Lateral border: medial surface of thigh - Inferior border: intergluteal cleft

GABAa receptor modulators (benzodiazepine-site agonists)

Diazepam is a benzodiazepine (BZ) MOA: - bind to GABAa receptors AT A SEPARATE site to GABA- it binds to BZ-site (at the interface of an alpha and gamma subunit) **** It potentiates the actions of GABA (i.e. positive allosteric modulator- increases conc. of GABA and binds to separate site, wont open or close channel just modulates the function of that channel) --> increases hyperpolarization ** NO EFFECT- without GABA being present Modulation of receptor activity (important pharmacological concept) - Modulator binds to an allosteric binding site (diazepam binds to allosteric site) - distinct from the agonist binding site (orthosteric site- so GABA binds to the orthosteric site) - Modulator has NO intrinsic activity- requires agonist binding (at its own site for an effect to be seen

What does the limbic system consist of?

Diencephalic Components: 1) Hypothalamus & its nuclei 2) Nuclei in the Thalmus 3) Nuclei in the Epithalamus Telencephalic (Cerebral Cortex) Components: 1) Subcortical (not organized as cortex) 2) Aloocortex (3 layers) 3) Juxtallocortex or Periallocortex (4-5 layers) Mesencephalic (Midbrain) Components: 1) Limbic Midbrain Area Other inputs: 1) Sensory- Visual, Auditory & Somatic Sensation

Clinical correlation related to the Prostate

Digital Rectal exam - examination of the lower portion of the rectum, perineum and surrounding tissues using a gloved finger inserted into the anus - during examination, the examining fiber can palpate the prostate gland Benign Prostatic Hypertrophy (BPH) - BPH is an overgrowth of the prostate - Affects most older men and produces urinary problems due to the tissue hypertrophy compressing the prostatic urethra and affecting the flow of urine through the urethra Prostate cancer - majority of prostate cancers arise in the PERIPHERAL ZONE of the prostate gland.. which is palpable by digital rectal examination

Woman born without a cerebellum

Discovered at 24-years-old *** She'd had a shaky walk for most her life, and unlike most people, who learn to walk when theyre very young infants, she was only abl eto master this skill at 7 yrs old. She was also only able to speak properly from the age of six - The fact that the woman has only minor reactions to the missing part of her brain suggests how "plastic" and adaptable this organ is, and perhaps her brains cortex has been filling in the gaps in order for her to function NOTE: - a woman with cerebellar tumor lived a normal life--> only problem is if the sun is going down or there are shadows and visual input is impaired then she has trouble navigating her path

Freys or Auriculotemporal Syndrome

Disorder resulting from damage to, or near, the parotid galnds (surgery)- often involves damage to the auriculotemporal nerve - Cause is idiopathic although it is parasympathetic and sympathetic damage may be responsible Sxs: - Redness and sweating in cheek area, adjacent to the ear - Sxs may appear when person eats/ requires strong salivary production Parasympathetic: stimulates parotid galnd to produce saliva Sympathetic: stimulates sweat glands to produce sweat and causes vasodilation of blood vessels In Freys, the parasympathetic and sympathetic fibers near the parotid galnd are damaged - damaged parasympathetic nerves regenerate by growing abnormally along sympathetic pathways - parasympathetic nerves that normally tell the parotid gland to produce saliva are now instructing sweat glands to produce sweat and blood vessels to dilate Result: excessive sweating and flushing when eating food/during saliva production

Thalamus

Divided into anterior, medial and lateral regions which contain various nuclei ** remember that the thalamus is the relay station or "switchboard" of the CNS ** all the nuclei within the 3 regios project, or relay, to an area of cortex Ventral subgroup: Motor control: 1- Ventral anterior (VA) 2- Ventral lateral (VL) Sensory processing: 3- Ventral posterolateral (VPL) 4- Ventral posteromedial (VPM) Dorsal subgroup: 1- Pulvinar 2- Lateral Posterior 3- Lateral Dorsal Metathalamic Groups (sometimes referred to as part of the lateral region): 1- Lateral geniculate nucleus (LGN) 2- Medial geniculate nucleus (MGN)

Amphetamine

Drug class: a stimulant, some therapeutic uses but also a drug of abuse MOA: - accumulates in presynaptic vesicles; decreases uptake of dopamine into vesicles and causes release of dopamine and norepinephrine from vesicles - increases dopamine and norepinephrine in cytoplasm - promotes transporter-mediated release of dopamine and norepinephrine from neurons ** amphetamine causes transporters to work in opp. directon to release dopamine and NE instead Net effect: increased dopamine and norepinephrine in synaptic cleft Pharmacological effects: - psycho-motor stimulation (hyperactivity, anorexia, insomnia) - cardiovascular stimulation (HR, BP, arrhythmias), stroke, MI - similar to cocaine, but longer half-life Cautions/contraindications: - Mania, psychosis - Psychological dependence

Bias

Due to - clinician - standardization sample - language - psychosocial factors (i.e. education, neighborhood) Ex. Psychotic disorder diagnoses among african american/black pts vs. euro-american/white patients over 24 yrs without having family history

Horners Syndrome

Due to an injury, interuption or deficiency in SYMPATHETIC activity Symptoms: 1- Miosis (constricted pupil) 2- Ptosis (weak, droopy eyelid) 3- Anhydrosis (decreased sweating) The site of lesion, or issue, is ipsilateral to the side of the symptoms- Any of these can cause the clinical appearance of Horners Syndrome: 1- Central lesions that involve the hypothalamospinal fibers (transection of the cervical spinal cord)- these are the first-order neurons in the pathway 2- Disruption of preganglionic axons along the sympathetic chain- these are the second-order neurons in the pathway 3- Disruption of postganglionic axons traveling with the internal carotid artery- these are the third- order neurons in the pathway *** Partial Horners Syndrome can occur with disruptions to the third-order neuron as anhidrosis may be limited to part of the foreheard or be absent

Habenular Nuclei is part of the

Epithalmus ** A diencephalic component of the limbic system

Drug therapy targets the cardiovascular system

Erectile dysfunction

Uterine and Vaginal Malformations

Errors in Fusion and Errors in Septral Resorption Erros in Fusion: - Uterine didelphys: 2 mullerian ducts fail to fuse, duplication of the reproductive structures - Bicornuate uterus: fundus is indented, partial fusion of the mullerian ducts - Unicornuate uterus: asymmetric lateral fusion defect- one cavity usually normal, while other duct poorly developed (+/- rudimentary horn) Errors in Septal Resorption: - Septate uterus (complete or partial): normal external surface of the fundus (compared to bicornuate), incomplete resorption of the midline septum between the 2 mullerian ducts - Arcuate uterus: slight midline spetum with minimal, and often broad, fundal cavity indentation *** Renal anomalies in 25-30% of women with the above defects

Unpaired bone located between the orbits- separated the nasal cavity from the brain

Ethmoid Bone

Function of Alpha motor neurons

Extrafusal muscle fibers

Structures passing through the parotid gland

Facial Nerve (CN VII) - separates gland into superficial and deep parts - forms parotid plexus (5 terminal branches) in the gland "To Zanzibar By Motor Car" Retromandibular Vein: - formed by union of superficial temporal and maxillary veins - passes through gland superficial to external carotid artery and deep to facial nerve (CNVII) External Carotid Artery: - gives rise to posterior auricular artery and then divides into terminal branches (maxillary and superficial temporal arteries

Spinothalamic/Anterolateral System

Fast, acute, sharp pain, painful pressure, temperature & CRUDE/light touch There are 2 parts to this system: 1. Anterior Spinothalamic Tract: carries light (crude) touch informaition (in addition to the dorsal columns/medial lemniscus system) **2. Lateral Spinothalamic Tract: carries pain, temp & noxious pressure information

Where in the fallpian tube does fertilization normally occur?

Fertilization usally occurs in the ampulla

Conduction Aphasia

Fluent BUT make repeated attempts at the correct word, errors increases with length and complexity of phrase - Comprehension: NOT impaired ** fluency absent, comprehension present ** pt aware they are not able to make complete sentences (connectivity lost- Brocas making words but control is scattered)

Anterior Cranial Fossa

Formed by: - frontal (orbital plate) - sphenoid (lesser wings) - ethmoid (cribriform plate) ** Anterior cranial fossa houses the frontal lobes of the brain and the olfactory bulb and tract (CN I) sit in the cribriform plate It contains 2 Foramen: - Foramen Cecum: with Emissary Veins passing through to nasal cavity ** emissary veins connect veins outside the cranium to the venous sinuses inside the cranium - Olfactory foramen in cribriform plate: with olfactory nerves (CNI) passing through

Scalp & Face Vasculature

From the Opthalmic artery: - The supraorbital artery and supratrochlear artery (from the ophtalmic artery, which originates from the internal carotid artery in the cranial vault) From the External Carotid artery: - Facial artery that terminates as the angular artery and labial vessels - Transverse facial artery and frontal/parietal branches (all branches of the superficial temporal artery) - Posterior auricular artery - Mental artery (branch of inferior alveolar from the maxillary artery) ** veins will usually follow arteries and have same names, although veins can be variable

Local circuitry and cells of the cerebellar cortex

Granule cell parallel fibers are: - excitatory on Basket, stellate, & golgi cells - excitatory on Purkinje cell dendrites in molecular layer Basket cells are: - INHIBITORY on purkinje cell some in purkinje layer Stellate cells are: - INHIBITORY on purkinje cell dendrites in molecular layer Golgi cells are: - INHIBITORY on mossy fibers in granule cell layer Purkinje cells are: - INHIBITORY on the DCN (deep cerebellar nucle)- use GABA *** MAJOR OUTPUT neuron of the cerebellar cortex

What cartilage/skeletal structures arise from the III Pharyngeal arch?

Greater horn and lower body of hyoid bone ** Common carotid artery & proximal part of the internal carotid artery ** CN IX (CN 9)

GABA in health and disease

Health: - sleep, calming, balances (quenches) excitation Disease: Epilepsy - acquired or hereditary - many GABAa receptor mutations identified Anxiety?? Sleep disorders??

Diffuse Modulatory Systems

Higher functions of the brain such as consciousness, cognition, attention, motivation and mood originate from the cerebral cortex- However, these functions are under the modulatory/regulatory control of small neurotransmitter molecules, like serotonin, dopamine, noradrenaline and ACh, which originate from restricted regions of the "old" brainstem - Many psychoactive drugs appear to act directly on these modulatory systems (cocaine, amphetamines, ecstasy) - Many psychiatric disorder appear to result from abnormal functioning of these diffuse modulatory systems (Shizophrenia, depression)

Larynx

Hollow musculo-ligamentous structure with a cartilaginous framework suspended from the hyoid bone superiorly and attached to the trachea inferiorly - Larynx is both a valve that closes the lower respiratory tract and also produces sound Composition: 3 large UNPAIRED cartilages: cricoid, thyroid, epiglottis 3 PARIS of smaller cartilages: arytenoid, corniculate, and cuneiform A fibro-elastic membrane and many intrinsic muscles ** The angle between the 2 laminae is more acute in men (90 degreed) than in women (120 degrees) so the laryngeal prominence is more apparent in men than in women ** During swallowing, the dramatic upward and forawrd movements of the larynx facilitate closing the laryngeal inlet and opening the esophagus

A pt comes to you with chorea ("dance"), gradually worsening dementia and personality changes- what might they have?

Huntingtons - Affects striatum; caudat nucleus; medium spiny neurons ** bilateral bc decreased striatum - Cause: Inherited; short arm of chromosome 4

Hemiballismus

Hyperkinetic disorder Region: Contralateral STN (ex. Lacunar stroke) Clinical features: Sudden, wild flailing of 1 arm +/- ipsilateral leg ** GPi is NO LONGER excited by STN and there is increased excitation to the cortex --> wild flailing movements

Intrinsic Muscles of the Tongue are all innervated by

Hypoglossal Nerve (CNXII) ** these function in altering the shape of the tonuge These include: - Superior longitudinal: Shortens tongue; curls apex and sides of tongue - Inferior longitudinal: Shortens tongues, UNCURLS apex and turns it downward - Transverse: Narrows and elongates tongue - Vertical: Flattens and Widens tongue ** Muscles are confined to the interior of the tongue - NO bony attachment sites - Voluntary motor, altering the shape of the tongue

Nuclei and Modality of CN XII- Hypoglossal

Hypoglossal nucleus --> (GSE- voluntary motor)

Bells Palsy

If BE axons of facial nerve are disrupted- either through parotid gland dissection/procedure, infection (viruses/bacteria) --> the voluntary motor signals to the muscles are compromised and the muscles will not work A Bells Palsy always occurs on the SAME SIDE as the nerve injury as it is affecting the peripheral nerves on the side of innervation Sxs: Dropping of the eye, mouth bc muscles are not innervated- pts may drool, have trouble speaking etc.

Sleep deprivation is associated with

Impaired - learning and memory (procedural and episodic) - cogniitve performance - metacognition - emotion regulation Sleep loss harms your health: - viral infections - weight gains - Diabetes - High blood pressure - Heart disease - Mental illness - Mortality (sleep apnea--> increases risk of dying early by 46% )

A 12 yo pt who has never had a menstrual period presents complaining of cyclic pelic pain at puberty

Imperforate Hymen - Cyclic pelvic pain at puberty - Absence of menstrual flow (primary amenorrhea) - Bulging hymen with valsalva maneuver - Hematocolpos/hemtometra May predipose to Edometriosis Treatment: a cruciate incision in the hymen allows egress of retained menstrual blood

Night terrors

In 1st third of the night - short period of terror during sleep - occurs during non-REM sleep - no memory of arousal - phsyiological sign: increased HR, rapid breathing, pupils dilated ** Most common in children and males RISKS: - stress - fever - lack of sleep - family histroy

Ovarian Steroid Hormone Biosynthesis

In Theca Cells (TCs lack aromatase): Cholesterol --desmolase--> pregenolone Progenelone --3betaHSD--> progesterone --17alphaOH--> 17-hydroxy progesterone --17,20 lyase-->Androstenedione --17betaHSD--> Testosterone Progenelone--17alphaOH--> 17-hydroxy-pregenolone--17,20lyase--> DHEA --3betaHSD--> Androstenedion --17betaHSD--> testosterone ** Without aromatase- theca cells cannot convert androgens to estrogens In Granulosa Cells (GCs lack 17alpha-OH, 17-20 lyase): Cholesterol --desmolase--> Pregenenolone --3betaHSD--> Progesterone Androstenedione --aromatase--> Estrone--17betaHSD--> estradiol Testosterone--aromatase--> Estradiol ** Without 17alphaOH and 17-20-lyase activity- Granulosa cells cannot convert pregenolone to androgen NOTE: NO single ovarian cell contains ALL the enzyme necessary for complete steroid biosynthesis- instead the GCs and TCs co-ordinate to complete the process - Androgens (mainly androstenedione, some testosterone) produced in TCs are transported to the GCs where they are aromatized to estrogens (mainly estradiol, some estrone)

Where can GSA axons from CNVII terminate depending on if the information is touch or pain?

In either the Main Sensory Nucleus of V or the Spinal Nucleus of V ** remember CN VII (facial) carries GSA from skin of the concha of the auricle near external acoustic meatus (minor contribution)

Crossed-Extensor Reflex

In many instances, the withdrawal reflex is followed by the crossed-extensor reflex Ex: Stepping on a nail with the right foot 1. Painful stimulus sends a signal through the sensory neuron to the CNS where synpases occur with multiple interneurons (polysynaptic) 2. Interneurons synapse with alpha motor neurons for right leg - Inhibit extensors (quadriceps muscles) so they relax - Stimulate flexors (hamstring muscles) so they contract 3. Interneurons synapse on other interneurons for left lef (contralateral side) - Extensors (quadriceps muslces) contract to plant the foot - Flexor relax (hamstringe muscles) 4. To maintain balance and prevent falling over, left leg which was flexing, is now extended to plant left foot (crossed-extensor reflex) 5. There is also contraction of hip and gluteal muscles on left side to support shift of bodys center over the extended left leg

Age of menarche (puberty) is correlated to nutriation & BMI

Increased BMI--> earlier that someone will get their menstrual period

Tonsillar Herniation

Increased intracranial pressure --> cerebellum pushed down and herniated into the foramen magnum --> Respiratory (cardiac) insufficency= Death

Somatosensory Innervation (GSA) of the Nasal Cavity

Innervation of nasal mucosa can be divided into 2 parts by an oblique line passing through the anterior nasal spine and the sphenoethmoidal recess - Posterioinferior portion: Maxillary Nerve (CNV2)- nasopalatine nerve to the nasal septum and posterior inferior and posterior superior lateral nasal nerves supply the lateral wall - Anterosuperior portion: Ophthalmic nerve (CNV1)- anterior and posterior ethmoidal branches of the nasociliary nerve

Glutamate in health and disease

Inotropic glutamate receptors mediate most of the fast excitatory neurotransmission in the CNS - sensory information, motor coordination, emotions and cognition, including memory - long-term potentiation (LTP): test memory formation in neurons- gluatmate is important in this Disease: Brain ischemia (stroke) - increase glutamate levels - glutamate-mediate excitotoxicity Schizophrenia? - hypothesized role of glutamate

Inputs and Outputs of GPe (Globus Pallidus Externa)

Inputs: Striatum, Subthalamic nuclei Output: widespread; to most basal ganglia including striatum, GPi, subthalamic nuceli ** Output: INHIBITORY

Input and Outputs of GPi (Globus Pallidus Interna)

Inputs: Striatum, subthalamic nuclei, GPe (globus pallidus externa) Output: thalamus ** Output: INHIBITORY

Function of Gamma motor neurons

Intrafusal muscle fibers

Innervation of the Lacrimal Gland (GVE axons)

Lacrimal gland receives BOTH parasympathetic (production of fluid) and sympathetic (reduction in secretion) innervation Parasympathetic Path: Facial Nerve (CNVII) --> greater petrosal nerve (CNVII) --> nerve of pterygoid canal --> pterygopalatine ganglion (synapse) --> zygomatic branch of maxillary nerve (CNV2) --> lacrimal nerve (CNV1) Sympathetic Path: Superior cervical ganglion --> internal carotid plexus --> deep petrosal nerve --> nerve of pterygoid canal --> fibers pass through pterygopalatine ganglion --> zygomatic nerve (CNV2) --> lacrimal nerve (CNV1)

What is the normal duration of stage 2 of labor? What events normally occur during this date of labor?

Lasts 40-60 minutes in nulliparous women and 10-15 min in multiparous women Corresponds to the time from full cervical dilation to delivery of the fetus - Associated with continuous strong frequent uterine contraction and relaxation cycles stimulated by PGs and OT - Assissted by voluntary pushing ** Ferguson Reflex

Hemispheric Specialization (Language)

Left hemisphere is dominant for language in... >90% right ~85% ambidextrous >70% left

Contralateral Superior Quadrantanopia

Lesion or disruption to the optic radiation in the temporal lobe (loop of meyer) where are terminating in the lingual gyrus ** can be caused by tumors,infarcts, demyelination EX: Lesion to Left temporal loop will result in a Right Superior Quadrantanopia

Contralateral Inferior Quadrantanopia

Lesion or disruption to the optic radiations in the parietal lobe which are terminating in the cuneus ** can be caused by tumors, infarcts, demyelination EX: lesions to the Left parietal loop will result in a right inferior quadrantanopia

Facial: Supranuclear Palsy

Lesion to axons of the Corticobulbar tract (UMNs) - Lesion will affect ONLY the lower quadrant of the face on the CONTRALATERAL SIDE ** upper quadrant is unaffected bc the dorsal component of the facial nucles, which innervates this quadrant, is bilaterally innervated by corticobulbar fibers LOWER quadrant only affected ** a lesion on the left would experience symptoms on the right

Facial: Bells Palsy

Lesion to axons of the LOWER motor neuron - this lesion affects axons originating in the ENTIRE facial nucleus, both DORSAL and VENTRAL components ** therefore, the ENTIRE ipsilateral side of the face is compromised- muscles of facial expression are NOT recieving innervation *** A lesion on the left would experience symptoms on the left

Lesion to the corticospinal (pyramidal) tract at the pyramidal decussation

Lesion to the Rostral part: - Bilateral paralysis/paresis of UPPER limbs Lesion to the Caudal part: - Bilateral paralysis/paresis of LOWER limbs

Decorticate Rigidity

Lesion: ABOVE the midbrain, so red nucleus is a-ok, bc red nucleus lives in the midbrain ** Red nucleus is part of the rubrospinal tract --> innervates flexor musculatrure of the arms ** Also this lesion above the midbrain CUTS OFF the normal inhibitory input from the cortex- it feel sleft alond and so it fires and will flex the arms - Medial reticulospinal and lateral vestibulospinal are NOT getting the messaging/inhibition from the cortex- since these pathways originate in the reticular formation and the vestibular nuclei in the brainstem caudal to the midbrain - so these tracts extend ** these tracts unconciously extend the lower limbs for balance and posturing and maintaing an upright form

GnRH Receptor Agonists

Leuprolide

Superficial Cervical Fascia

Lies between the dermis of the skin and deep cervical fascia - contains the platysma muscle, cutaneous nerves, blood vessels, lymphatics, and varying amount of fat Platysma muscle: a muscle of facial expression that is colloquially referred to as "the cords of the neck" ** the platysma is enveloped by fascia

The scalp is highly vascularized, so may bleed profusely when lacerated- which layer is designated as the DANGER ZONE?

Loose CT (Layer 4 of SCALP) is the DANGER ZONE when lacerations reach this area - this layer contains the emissary veins, which connect with the intracranial venous sinuses --> therefore, there is a risk for spreading infection to cranial structures (brain, meninges) ** Apply direct pressure to help control profuse bleeding- unless there is a possible skull fracture or deeper injury

Cataracts

Loss of transparency of the lens or lens capsule * more than half of all americans age 65 and older have a cataract NOTE: cataract is an opacity (cloud formation) of the eye lens, develops due to aging Causes: - with age, the lens can become clouded by conformational changes or cross-linking of the lens proteins Cataracts can also result from: - diseases - metabolic or hereditary conditions - trauma - exposure to a deleterious agent (such as UV radiation) Treatments: Cataracts that significantly impair vision can usually be corrected sugically by removing the lens and replacing it with an optically perfect plastic lens *** Plastic lens inserted inside lens capsule is: - still connected to zonule fibers - still controlled by ciliary muscle

Prolactin secreting pituitary adenoma

Low FSH and LH - incidence unknown - SMALL tumor commonly causes amenorrhea - only 1/3 pts develop galactorrhea (low or markedly deficient estrogen) Risks: - osteoperosis - cardiovascular disease - vaginal atrophy ....not unlike the menopausal female without HRT... MOA: Prolactin.. Hypothalamus.. Decreased pulsatile GnRh Pharmacological treatment: Most common: Dopamine agonist - Bromocriptine: parlodel - Cabergoline: Dostinex NOTE: ovaries will respond normally to FSH/LH stimulation Surgical treatment: - Transphenoidal resection: upper lip--> sphenoid sinus--> pituitary fossa--> dura --> remove tumor reconstitute anterior wall of fossa Risks: - incomplete resection - recurrence - CSF leaks - meningitis - Diabetes insipidus

CNS targets of acetylcholine neurotransmission

M1 recptors - many drugs have adverse effects due to antagonist action Acetylcholinesterase (AChE) *** Donepezil: AChE inhibitor that cross the blood-brain barrier increase Ach levels in patients with Alzhiemers disease- improves cognitive function in some patients

Flutamide

MOA - Competitve ANTAGONIST at the androgen receptor (target would be the tissues- in case of prostate cancer in prostate - also in hypothalamus and pituitary you will find andogren receptors -- increasing testosterone but androgen receptor blocked - so luprolide gived with prostate cancer to decrease testosterone) Clinical use: - prostate cancer Adverse effects: - most are predicatable consequences of androgen depravation (hot flashes, decreased libido, impotence, hepatotoxicity)

Induction of ovulation with Clomiphene

MOA: -antagonist at the estrogen receptor- increase the secretion of gonadotropins and estrogens by inhibiting the negative feedback of estradiol on the hypothalamus and anterior pituitary - stimulate ovulation in women with oligomenorrhea or amenorrhea and ovulatory dysfunction Clinical uses: - treatment of ovulatory dysfunction in women who wish to become pregnant Adverse effects: -hot flasses

Progestin Only Contraceptives

MOA: - Progestin thickens the cervical mucus and makes the endometrium less favorable for implantation. Progestin-only contraceptives do NOT reliably inhibit ovulation - When progestins are administered orally, mucus changes do not persist beyond 24 hrs- to be maximally effective, pts should take the pill at the SAME TIME daily ** Has higher failure rates that the combined hormonal contraceptive Adverse effects: - irregular bleeding/breakthrough bleeding- common reasom women choose to discontinue use - Amenorrhea after extended use - may have prolonged ovulation suppression after injectable formulations (medroxyprogesterone) are stopped *** these not good if considering pregnany in the short term - Acne- if progestin with androgen agonist activity is used - mood changes - weight gain

Cerebrospinal fluid (CSF)

Made by the choroid plexus Normally, CSF is clear, colorless, and odorless Total volume: ~150ml (adult) ~400-500ml produced and reabsorbed daily Function: 1. Mechanical Support: the brain is fully encased in CSF, which reduces the weight of the brain (1500g) to ~25g- protects against damage from brains own weight and reduces "traction" on nerves and vessels 2. Protection: from pressure changes- shock absorber!- provides a cushion to protect from trauma- and immune cells protect against pathogens 3. Metabolic: controls brain excitability by regulating ionic composition and supply nutrients and removes metabolites

Largest, strongest bone in the face, forming the lower jaw

Mandible - All lower teeth are housed in the Alveolar Process of the body (transverse part) of the mandible - The body meets the ramus (vertical part of mandible) at the mandibular angle - The ramus has a condylar process for articulation with the temporal bone and a coronoid process for attachment of the temporalis muscle ** **** Neurovasculature acess the mandibular dentitiion by passing through the mandibular foramen into the mandibular canal within the bone

Placental Circulation

Maternal Side: - highly oxygenated and nutrient rich maternal blood, flows into an intervillous space from the spiral endometrial arteries in a pulsatile manner and spurts toward the chorionic plate (CP) As the pressure dissipates, blood flows slowly over the villi to allow exchange of gases, nutrients, and metabolic products - blood, which has collected the waste products that has passed across the placental barrier from the fetus, returns through the endometrial veins to the maternal circulation

The largest branch of the External Carotid Artery

Maxillary Artery - it has 3 parts and 15 branches (some sources indicate 17 if you count a couple terminal branches off the main branches) *** it is a major source of blood supply for the nasal cavity, oral cavity, all teeth, and the dura matter in the cranial cavity *** it originates within the parotid gland and passes forward into the infratemporal fossa- it then enters the pterygopalatine fossa, where it ends in termianl branches

Maxillary Nerve (CNV2) & Pterygopalatine Fossa

Maxillary Nerve (2nd division of trigeminal nerve) is purely somatosensory (GSA) and enters the pterygopalatine fossa through the foramen rotundum - Branches into the zygomatic nerve and superior alveolar branches (posterior, middle, anterior), before terminating as the infraorbital nerve - passes anteriorly through the fossa to terminate as the infraorbital nerve **these nerves are carrying somatosensory (GSA) information from the structures of the face back to the brainstem and brain *** The maxillary nerve has branches that connect it to the pterygopalatine ganglion that lives in the fossa MAXILLARY NERVE BLOCK: - extensive dental surgery may require total nerve block of the maxillary nerve (CNV2) - the maxillary nerve in the pterygopalatine foss is most often approached intraorally via the greater palatine canal

What is the ferguson reflex

Mechanical stretch of the cervix --> Increased OT (oxytocin release)--> Increased uterine contractions---> Mechanical stretch of the cervix *** A neuroendocrine POSITIVE FEEDBACK LOOP that regulates labor progression

The Fourth ventrical goes to the cerebellomedullary cistern (cisterna magna) via the

Median aperture (foramen of magendie)

Memory Testing

Medical Populations: - temporal lobe epilepsy (pre-and post-treatment) - cardiac arrest/ hypoxic events - dementias - brain tumor - traumatic brain injury - stroke - encephalitis (ex. pt H.M - surgery to take out both hippocampi- defferentiated declarative vs. other types of memory) Wechsler Memory Scales: - Assesses important domains of memory and learning - older adolescents and adults (16-90yrs) - verbal (auditory) and visual memory (immediate, delayed, and recognition memory)

Biopsychosocial Model

Medical disorders often have a significatn behavioral/psychological component - heart disease - headaches - ulcers - rheumatic arthritis - chronic pain - genetic disorders - epilepsy

Brainstem Consists of

Midbrain Diencephalic Junction (level of tentorium cerebelli) - Midbran Pontomesencephalic Junction - Pons Pontomedullary Junction - Medulla Oblongata Cervicomedullary Junction (level of foramen magnum & pyramidal decussation) - Spinal Cord

Major Landmarks on the Ventral Aspect of the Brainstem

Midbrain: - optic chiasm - optic tract - R/L mammillary body - R/L Cerebral Peduncle (Crus Cerebri) Pons Medulla Oblongata - Olive - Pyramid - Decussation of Pyramids * Cerebellum

Which branch of the internal carotid artery travels in the lateral sulcus (AKA Sylvian Fissure) and supplies the insula and most of the lateral surface of the cerebral hemisphere?

Middle Cerebral Artery (MCA) - Lenticulostriate branches come off the MCA and supply deep structures like the basal ganglia and internal capsule

Inside-Out Lamination of cortical Neurons

Migrating neurons climb all the way to the pial surface and then drop off the radial glia "conveyer belt" - later-born neurons migrate through the layers of the earlier-born neurons and depost themselves superficially to them, thus giving rise to an "inside-out" layering scheme, with older neurons in deep layers, younger neurons in superficial layers

Monosynaptic vs. Polysnaptic Reflexes

Monosynaptic: - One synapse= RAPID - A sensory neuron synapses directly on a motor neuron - Ex; Myotatic Reflex Polysynaptic - Many synapses= SLOWER - Involves a sensory neuron, interneuron/s and motor neurons- Can produce more complex responses - Ex; Withdrawal Reflex

Straddle Injuries

More common in prepubertal children - pt straddles an object and when they fall they strike the urogenital area with the force of his or her body weight -injury caused by the compression of soft tissues against the bony margins of the pelvic outlet ** Can be viewed on CT scan

Nasal Fractures

Most common facial fracture - may result in deformation of the nose

Otitis Externa

Most common in swimmers (excessively wet ears) or due to bacterial infection (AKA "swimmers ear") - Itching and pain in the external ear are chief complaints - Pulling the auricle or putting pressure on the targus increases the pain *** Can be associated with a middle ear infections (otitis media) if the eardrum ruptures) Sxs: severe pain in and around ear, itching, swelling, pus and muffled hearing

Inferior Alveolar Nerve Block

Most common type of nerve bloock used for dental procedures and involes anesthetization of the inferior alveolar nerve (CNV3) - site of injection is around the mandibular foramen (passage for the inferior alveolar neurovasculature to enter the mandibular canal) - this process will also anesthesize the lower lip, labial alveolar mucosa, half of the chin, and the gingivae - problems can occur with "misses" into the parotid gland, facial nerve or medial pterygoid muscle

Cerebellar Outputs

Motor execution: - Fastigial Nucleus --> to medial descending systems - Interposed nucleus (Globus and Emboliform nucleus) --> to lateral descending systems Motor planning: - Dentate nucleus --> to motor and premotor cortices Balance and eye movements: - To vestibular nuclei

Corticobulbar fibers of the Vagus Nerve

NOT an exception, but has clinical significance ** Since the uvula is a small structure, you are able to observe damage, regardless of the bilateral innervation Unilateral UMN lesion= uvula will deviate TOWARDS the lesion upon phonation- muscles on contralateral side no longer receive innervation so uvula is "pulled" to ipsilateral side Unilateral LMN lesion= uvula deviates AWAY from the lesion upon phonation- muscles on ipsilateral side are no longer innervates so uvula is pulled to contralateral side ** deviates AWAY bc muscles on opposite side are working and pull uvula to opposite side of the LMN lesion

Sensitization

Nociceptors are unique in that they sensitize with frequent stimulation instead of adpating as other cutaneous receptors do - Sensory endings in inflamed tissue can be SO sensitive to stimulation that stimuli that is usually non-painful become painful (allodynia) and the perception of painful stimuli becomes more intense (hyperglesia) Wind-up theory: - In just 1965 it was discovered that when a peripheral nerve was stimulated enough to activate C-fibers, there was a progressive build up of the amplitude of the electrical response recorded in the corresponding dorsal horn neurons of the spinal cord--> they termed this phenomenon "wind-up" --> this is now believed to be crucical to understnading the problem of chronic pain

Non-specific Association and non-speficic regulator nuclei

Non-specific (association) Parietal lobe --> lateral posterior (LP) nuclei --> parietal lobe - unknown function parietal, occipital and temporal lobes --> pulvinar nuclei--> parietal,occiptal, and temporal association cortex - fx may be vision recognition or attention spinothalamic tract, amygdala and entorhinal cortex --> dorsomedial (or mediodorsal) nuclei --> prefrontal cortex - for emotional response to pain and memory Non-specific (regulators) Multiple cortical areas, reticular formation, cerebellum, basal ganglia spinothalamic tracts --> intralaminar (centromedian is part of)--> frontal and parietal lobes, caudate nucleus and putamen- may be for alertness and response to pain, affect basal ganlia and limb systems

Normal, Near-sighted, Far-sighted

Normal (ideal)= Emmetriopia Near-sighted= Myopia (1 in 4 Americans) - Far objects are blurry, close objects are clearer ** Cornea is TOO thick or eyeball is TOO long Far-sighted: Hyperopia (least common) - Near objects are blurrier than far objects NOTE: corrective lenses work by refracting light before getting to your eye

Sphenoid Sinus

Note the location of this sinus! Only a thin bone separates it from the optic nerve, optic chiasm, pituitary gland, internal carotid artery and cavernous sinus - it drains directly in the sphenoethmoidal recess - Innervated by ethmoidal branches of the nasociliary nerve from CNV1

Medial Medullary Syndrome (Inferior Alternating/ Dejerines Syndrome)

Occlusion of branches of the anterior spinal artery (at the level of the medulla) on one side or medulalry branches of the vertebral artery Affects the: - Corticospinal tract - Medial Lemniscus - Hypoglossal Nucleus (CNXII) Ex: if L side affected: - Loss of voluntary motor function onf the RIGHT (for corticospinal- fibers have yet to cross) - Loss of touch, pressure, vibratory sense on the RIGHT (for medial lemniscus) - Loss of voluntary motor function to the tongue on the LEFT (hypoglossal nucleus damage affects the IPSILATERAL side)

Basilar Skull Fractures

Occur anywhere along the base of the skull The break occurs in at least one of the following bones: - temporal - occipital - sphenoid - frontal - ethmoid (can have anterior, longitudinal, or transverse fractures) Symptoms: - Otorrhea: draining of fluids from the ear - Rhinorrhea: draining of fluids from the nose - Periorbital ecchymosis (Racoon eyes): brusing around both eyes - Postauricular ecchymosis (Battle sign): bruising over the mastoid process ** Ecchymosis= discoloration of skin caused by blood from broken vessels enter the tissue under the skin ** A bruise is always caused by trauma, whereas ecchymosis is NOT always the result of trauma

Disconnect Syndromes

Occur when the language centres of the left (dominant) hemisphere are disconnected from other cortical functional areas in the opposite hemisphere Ex: Apraxia - Ideomotor - Ideational/conceptual - Constructional Ex: Alexia withouth agraphia - cannot read, but CAN write - cannot read own writing "Pt unable to read K-E-Y and F-O-R-K, but can write a full sentence- when interuppted mid-sentence, then asked to complete the sentence, she cannot read what she had written just a moment before - Lesion in dominant (usually left) occipital cortex prevents processing of visual information from right hemifield (a right hemianopia is therefore usually present) - Information about left hemifield that has reached right occipital cortex is prevented from crossing to the language areas by the lesion in the posterior corpus callosum

Tabes Dorsalis (Tabetic Neurosyphilis)

One manifestation of neurosyphilis - Destroys large diameter dorsal root fibers and cell bodies in DRG usually in lumbosacral regions, therefore pts have absent tendon reflexes at knee & ankle, decreased vibration & position sense in the legs & feet, a Romber sign** and tabetic gait Sxs: 1- Lightning pains (not fully known, but are probably a result of incomplete dorsal root lesions at different levels) 2- Ataxia, areflexia and hypotonia (due to destruction of proprioceptive axons in the dorsal roots) 3- Bladder malfunction (deafferentation at the sacral spinal cord levels that affects parasympathetic axons and results in urine retention instead of expulsion)

What determines eye color?

Only one pigment (melanin) in eyes, and it is brown - Color variations among different irises are typically attributed to the melanin content within the iris stroma *** Fewest melanocytes= blue eyes *** Most melanocytes= brown/black eyes ** This explains why some newborn babies can be born with blue-grey eyes, but eyes develop more melanin and change color in the months after birth

Which artery travels along the optic nerve to supply the eyeball and other orbital structures?

Ophthalmic Artery ** it is a branch of the internal carotid artery

Phrenic Nerve

Originate from C3-5 nerve roots Mainly voluntary motor (GSE) and Sensory (GSA) fibers - voluntary motor (GSE axons) to the diphragm - somatosensory (GSA axons) to the central part of the diphragm, mediastinal pleura, and pericardium ** remember: "C3, C4, C5 keep the diaphragm alive" In the neck: the phrenic nerve runs over the anterior surface of the anterior scalene muscle, posterior to the subclavian vein, and anterior to the internal thoracic artery as it enters the thoracic cavity In the thoracic cavity: the phrenic nerve runs anterior to the root of the lung, and into the pericardium between the fibrous and parietal layers

Parasympathetic vs. Sympathetic innervation of the Bladder

Parasympathetic - stimulates urination (detrusor muscle contraction) Sympathetic nerves - INHIBIT urinartion (relaxes detrusor muscle)

Pelvic Inlet (Superior Pelvic Aperture) vs. Pelvic Outlet (Inferior Pelvic Aperture)

Pelvic Inlet (Superior Pelvic Aperture) - has same boundary as the pelvic brim Pelvic Outlet (Inferior Pelvic Aperture) - area bounded by coccyx, sacrotuberous ligaments, ischial tuberosities, ischiopubic rami, and pubic symphysis

Visceral Pain & Pelvic Pain line

Pelvic Pain Line= inferior limit of the peritoneum - this limit determines which nerves carry visceral pain sensation from an organ/structure in abdominopelvic area Structures SUPERIOR (above) the pelvic pain line --> visceral (organ) pain sensation is conveyed via sympathetic nerves (lumbar or sacral splanchnic nervese) Structures INFERIOR (below) the pelvic pain line--> visceral pain sensation converyed via PARASYMPATHETIC NERVES (pelvic splanchnic nerves)

Pelvic Rings

Pelvis is composed of a number of closed rings: - ring outside of pelvis - pelvic inlet - obturator foramen rings Significance: - A fracture or diastasis (widening of joint space) in one location in the ring will usually result in a fracture or distasis in another location in the ring Ex: car accidnet in one part must look for a fracture in the other parts

Perineal Body

Perineal Body= Central Tendon of the Perineum - A fibromuscular mass - Located in the center of the perineum between the anal canal and vagina (or bulb of the penis) Functions: - Support and attachment point for muscles of perineum and levator ani which themselves support pelvic organs - *** In women, acts as a TEAR RESISTANT structure between the vagina and the external anal sphincter an EPISOTOMY** can help prevent damage to perineal body - childbirth can lead to damage (stretching/tearing) of the perineal body and possible prolapse of pelvic viscera - this may be avoided by an episiotomy (a surgical cut in the perineum, throguh the opening of the vagina) to prevent uncontrolled tearing of the perineal body, prevent rupture of tissues and aid a difficuly birthing delivery

Lymphatic Drainage of the Pharynx and Larynx

Pharynx: - Nasopharynx--> Retropharyngeal Lymph Nodes (deep) - Oropharynx--> Jugulodigastric lymph nodes Larynx: - Lymphatic vessels SUPERIOR to the vocal folds drain to the SUPERIOR deep cervical lymph nodes - Lymphatic vessels INFERIOR to the vocal folds drain into pretracheal/paratracheal nodes then into the INFERIOR deep cervical lymph nodes ** Remember! All of the lymph will ultimately drain into the deep cervical nodes, then the jugular lymphatic trunks, and finally to the thoracic duct on the left or lymphatic duct on the right NOTE: the palatine tonisl drains through the pharyngeal wall into the jugulodigastric nodes in the region where the facial vein drains into the jugular vein

Reticular formation and its involvement in the Respiratory System

Pons: Pneumotaxic (inhibition) and apneustic centers Medulla: Dorsal (DRG) and ventral (VRG) respiratory groups Afferents to Respiratory Centers: - Aortic body from CN X and carotid body from CN IX- blood pressure and composition, partial pressures of oxygen, carbon dioxide, pH Efferents from Respiratory Centers: - Reticulospinal tract (sympathetic) targets the phenic nerve (diaphragm) and intercostal nerves (intercostal muscles) to regulate breathing - Motor brainstem nuclei for muscles of the larynx, soft palate, facial expression and other auxillary respiratoy musculature ** Dorsal and ventral respiratory groups are responsible for rhythm of respiration

Fetal Circulation

Poorly oxygenated blood leaves the fetus and passes through the umbilical arteries towards the placenta - these divide in the villi to form an extensive arterio-capillary-venous system which brings fetal venous blood close to maternal blood- thus no mixing of blood occurs - once exchange occurs across the placental barrier, highly oxygenated blood returns to the fetus via the umbilical vein

Which branch of the basilar artery supplies the medial and inferior surfaces of the occipital and temporal lobes?

Posterior Cerebral Arteries - these send branches to rostral midbrain and caudal diencephalon - gives rise to posterior choroidal arteries which supply the choroid plexus of the 3rd and lateral ventricles

Which artery joins the posterior cerebral artery to the internal carotid artery?

Posterior Communicating Artery * a branch of the internal carotid artery

Cardiac Nerves are

Postganglionic Branches of the sympathetic nervous system that originate in the cervical ganglia of the sympathetic trunk and travel to the cardiac plexus- the nerves are named after the ganglion from which they arise: - Superior Cardiac Nerve: arises by 2 or more branches from the superior cervical ganglion - Middle Cardiac Nerve (Great Cardiac Nerve): largest of the three cardiac nerves, arises from the middle cervical ganglion - Inferior Cardiac Nerve: arises from either the inferior cervical or first thoracic ganglion

Maturation sequence of Cortex

Postnatal cortical maturation involves a reduction in grey matter, relative to white matter (white matter expands due to myelination) - children lose 20 billion synapses per day between early childhood and adolescence- the process makes our mental process more streamlined and coherent as we mature ** Primary and unimodal cortical areas mature first (around puberty), while maturation of the prefrontal and parietal multimodal areas ends at ~20years

Premature vs. delayed ejaculation

Premaure: - recurrent pattern of ejaculation within 1 minute of partnered sexual activity and before the individual wishes it and causing clinically significant distress Delayed ejaculation: - recurrent pattern of delayed or absent ejaculation with partnered sexual activity and causing clinically significant distress

Association Fibers

Primarily, axons of pyramidal neurons from layers I, II, and III * Connect different cortical areas in ONE hemisphere - arcuate fibers- loop (connect adjacent gyri) - superior longitudinal fasciculus - arcuate fasciculus - uncinate fasciculus

Primary and Association Cortices

Primary Cortex (aka Idiotypic cortex, Heterotypic cortex): 1. Primary Sensory (aka Konicortex, Hypergranular cortex, Granular cortex) - primary somatosensory - visual - auditory cortex 2. Primary Motor (aka Marcopyramidal cortex, Agranular cortex) - primary motor cortex Association Cortex (aka Homotypic cortex) 1. Unimodal (aka Modality-specific association cortex) - somatosensory - visual - auditory association cortex - premotor cortex - supplementary motor area 2. Heteromodal (aka Higher-order association cortex) - Prefrontal - Parietal - Temporal heteromodal association cortex

What Broadman areas are the following areas associated with: Primary auditory cortex, primary motor cortex, primary somatosensory cortex, primary visual cortex

Primary Motor Cortex (4) Primary Auditory Cortex (41, 42) Primary Somatosensory cortex (3, 1, 2) Primary Visual Cortex (17)

Pterygopalatine Fossa

Pyramid-shaped space inferior to apex of orbit and medial to infratemporal fossa Bondaries of the pterygopalatine fossa: Anteriorly: Posterior aspect of the maxilla Medially: perpendicular plate of the palatine bone Laterally: pterygomaxillary fissure Roof: incomplete roof- medial infratemporal surface of the greater wing of the sphenoid bone Floor: palatine bone *** Pterygopalatine Fossa like a cavern and space with the pterygomaxillary fissure facing laterally towards infratemporal fossa and the sphenopalatine foramen facing the nasal cavity

Rectouterine pouch & Vesicouterine pouch

Rectouterine pouch (AKA pouch of Douglas or Cul-de-sac of Douglas) - a recess formed by a fold of peritoneum between the rectum and the uterus - is the lowest part of the peritoneal cavity and it can collect fluid - lies behind the posterior vaginal fornix Vesicouterine pouch - a peritoneal recess between the bladder and the uterus

Lesions to supplementary motor cortex

Reduced ability to coordinate actions on the two sides of the body, often akinesia- difficulty initiating movement

Accomodation Reflex

Reflex is active when the eye has to focus from a distant object to a near one Reflex consists of 3 events: 1. Convergenve of the eyes: medial recti muscles contract, which causes the eyes to move toward each otehr on the near stimulus 2. Constiction of the pupil: necessary to focus on near objects- Results from parasympathetic pathway from pretectal nuceli to the ciliary ganglion then on to sphincter pupillae 3. Rounder (convex) lens for near vision: fibers from the ciliary ganglion also synapse on the ciliary body and contraction of the ciliary muscls fibers reduces tension on the suspensory ligament, allowing the lens to become more convex

CT of the Lower Pelvis (Female)

Relationship of the uterus to the urinary bladder: Anterior to posterior: - bladder - uterus - rectum Challenges: bowel may obstruct view of the ovaries - ultrasound is the first line imaging modlity for viewing the uterus and ovaries

Interaural Intensity Difference (IID)

Relative to HIGH-frequency sound - Sound from right, casts a sound shadow on left (lower- intensity sound in left ear is a cue that sound came from right) - Sound from straight ahead, casts sound shadow behind the head (Sound reaches both ears with same intensity) - Sound from oblique angle on right will partially shadow left ear ** IID is sensed by the LATERAL SUPERIOR OLIVE (LSO)

Types of Spinal Reflexes

Remember, a reflex is a PROTECTIVE action that can act autonomously without any supraspinal control! (does NOT need the brainstem/brain) ** these reflexes have evolved to allow the body to respond quickly to threats and hazards without the time delay involved when the brain is consulted about how to respond to a stimulus There a 4 major types of spinal reflexes: 1. Myotatic reflex (Deep tendon reflex, stretch reflex, knee jerk reflex) 2. Golgi Tendon Reflex 3. Withdrawl Reflex (Flexor reflex) 4. Crossed Extensor Reflex

Inhibitory or Excitatory changes in membrane potential

Resting potential= -70mV - open Na+ (sodium into neuron= depolarizing), same with ca2+ - Cl- into cell, K+ out of cell are both hyperpolarizing events Nernst equation predicts which way ions will flow and depends on concentration gradient (depends on conc. inside and outside)

Functions of the Frontal lobes

Restraint: - judgment - foresight - perserverance - delaying gratification - inhibiting socially inappropriate responses - self-governance - concentration Initiative: - curiosite - spontaneity - motivation - drive - creativity - shifting cognitive set - mental flexibility - personality Order: - abstract reasoning - working memory - perspective taking - planning - insight - organization - sequencing - temporal order

Highly anastomotic network of epithelium-lined channels that carry sperm

Rete testis ** These epithelial cells are: - cuboidal - have mirovilli and cilia (microvilli help the rete testis to absorb excess fluid and materials, and cilia help to move sperm along tube) NOTE: the spermatozoa are immobile till they reach the epididymis this is why the cilia is needed- and the microvilli absorb excess materials including: protein and potassium, from the seminal fluids ** Straight tubules--> Rete testis --> Ductuli Efferentes

Neural Tube Defects (NTDs)

Rostrally related: - Anencephally - Encephalocele - Holoprosencephaly or can have Spina Bifida (myeloschisis) - Spina Bifida Occulta - Spina Bifida Aperta (cystica) - Meningocele - Meningomyelocele - Rachischisis & Craniorachischisis *** Neural tube defects (NTDs) can be detected by: - Ultrasound examination - Aminocentesis: checking for elevated levels of alpha-fetoprotein, which can leak into the amniotic fluid when the neural tube is not closed - this protein is a major component of fetal serum, and an open neural tube allows some to leak and ultimately reach the materal circulation, where it can also be detected- therefore, high levels can indicate a neural tube defect *** Most spinal cord defects occur in the lumosacral area, and up to 70% can be prevented by maternal use of folic acid prior to and during pregnancy

Extraocular Eye Muscles

SO4LR6AO3 CN III: inferior rectus, superior rectus, medial rectus & inferior oblique, levator palpebrae superioris CN IV: superior oblique CNVI: lateral rectus

Fibrous Tunic (External Layer of the Eye)

Sclera: - Dense Irregular CT - Supports eye shape - Protects delicate internal structures - Extrinsic eye muscle attachment site Cornea - 2 layers of epithelium with organized CT in between - Protects anterior surface of the eye - Refracts (bends) incoming light

Anabolic Steroid Abuse

Self-administration of very high doses of androgens has been used by athletes to increase performance Commonly observed adverse effects include: - acne - aggressive behavior (i.e. Roid rage) - gynecomasstia (due to androgen conversion to estrogen with aromatase) - erythrocytosis - increased LDL (bad cholesteroL) and decreased HDL (good cholesterol) - reduced testicle size (bc negative feedback- reduce natural testes production--> decreased sperm production) - reduced sperm production- decreased fertility *** usually fertility comes back once stop steroids

Trigeminal Neuralgia

Sensory disorder of CN V, which causes sharp sudden pain in the face - Maxillary (V2) nerve most frequent, then V3 and V1 - pain is triggered by touching area of skin Cause: unknown, probably blood vessel compression on a nerve Treatment: move blood vessel away or section sensory root of CNV

Carbamazepine

Site of action: - Voltage- gated sodium channel Action: - Use-dependent block

Oral Vestibule

Slit like space between the teeth, gingivae and the lips/cheeks - communicates with the exterior through the oral fissure, which we have seen is controlled by certain muscles of facial expression ** the duct of the parotid gland (near upper 2nd molar) empties into the vestibule

Rapidly-Adapting vs. Slowly- Adapating Receptors

Slowly-adapting mechanoreceptors: - respond THROUGHOUT a stimulus - as the pressure increases, the total number of action potentials discharged rises and there is higher firing rates I.e. Merkels disc (touch) & Ruffinis ending (stretch) Rapidly-adapting mechanoreceptors: - respond only at the start and end of a stimulus, signaling when it is applied and removed I.e. Pacinian (vibration) & Meissners corpuscle (touch)

Lymphatics in the Brain

Some of the brains waste products enter the CSF to be removed - the dura mater contain lymphatic vessels - these resemble blood vessels ** use of brain magnetic resonance imaging can confirm the presence of lymphatic vessels in autopsy tissue using special staining methods

Fetal descent and delivery occurs during which phase of parturition?

Stage 2 - Corresponds to the time from full cervical dilation to delivery of the fetus - associated with continuous strong frequent uterine contraction and relaxation cycles stimulated by PGs and OT - assisted by voluntary pushing - Ferguson reflex

Placental separation and expulsion occurs during which stage of labor?

Stage 3 - corresponds to the time from fetal delivery to separation and delivery of the placenta - OT and PGF2alpha mediated contractions detach and expel the placenta and decidua basalis from the uterus and compress uterine blood vessels Major complication is maternal hemorrhagin, still a major cause of maternal morbidity and mortality

Fascia of the Neck

Superficial Cervical Fascia which contains the platysma muscle Deep cervical fascia which has 4 layerd: 1. Investing layer 2. Pretracheal layer (includes infrahyoid fascia) 3. Carotid sheaths 4. Prevertebral layer (includs alar fascia) ** Each of the four compartments of the neck is surrounded and enclosed by fascia *** Fascia covering the pharyngeal constrictors and continuing onto the buccinator muscle is specifically called buccopharyngeal fascia (part of pretracheal fascia)

Lymph from the scalp and face drains into the

Superficial ring (pericervical collar) of lymph nodes: - Submental - Submandibular - Parotid, Pre-auricular - Mastoid - Occipital *** All of the lumph will ultimately drain into the deep cervical nodes --> jugular lymphatic trunks --> thoracic duct on the left or the lymphatic duct on the right **Remember: lymph is carrying excess interstitial fluid (tissue fluid) through lymph vessels to enter venous circulation - Lymph nodes fitler the lymph along the way

3 paravertebral ganglia in the cervical region

Superior Cervical Ganglion: - adjacent to C1 and C2; signals on post-ganglionic axons travel to target: (heart, head, neck) via "hitch-hiking" on the carotid arteries Middle Cervical Ganglion: - adjacent to C6; postganglionic target: heart (cardiopulmonary splanchnic), neck (peri-arterial plexus) Inferior Cervical Ganglion: - adjacent to C7; postganglionic target: heart, lower neck, arm, posterior cranial arteries- may be fused to the first thoracic ganglion to form the stellate ganglion

Total peripheral resistance falls during pregnancy but mean arterial pressure remains relatively unchanged. How?

TPR falls because of high-flow, low-resistance circuit in the uteroplacental circulation and vasodilation MAP is unchanged because it is maintained by HR and CO

Tactile Sensations- Deep Receptors

Tactile sensitivity on hairless (glabrous) skin on fingers, lips, palms & sole of foot - fingerprints contain a sense matrix of mechanoreceptors - mechanoreceptors sense changes in skin contour when an object is pressed against it Pacinian Corpuscle (Abeta) - sensitive to vibration and pressure - vibrational role may be used to detect surface texture, ex. rough vs. smooth - rapidly adapting Ruffinis Corpuscles (Abeta) - stretching of skin and sustained pressure (can also sense warmth) - monitor slippage of objects along the surface of the skin, allowing modulation of grip on an object - slowly adapting

Cervix

Tapering end of the uterus that contains two anatomical parts: 1. Endocervix: upper part - lined by simple columnar epithelium - large mucus-secreting cervical glands 2. Exocervis: continuous with the mucosal lining of the vagina - lines the cervical region around the external os where the cervix projects slightly into the upper vagina - non-keratinized stratified squamous epithelium *NOTE: the abundant, branched (unlikw uterine glands which are NOT branched) mucus-secreting cervical glands composed of a simple columnar epithelium that is continuous with the lining epithelium of the cervical canal - blockage of the openings of the mucosal glands results in the retention of their secretions, leading to formation of dilated cysts within the cervix called Nabothian cysts (these develop frequently but are clinically important only if numerous cysts produce marked enlargment of the cervix) ALSO note the transition between "transformation zone" - stratified squamous epithelium --> to simple columnar epithelium ** this transition zone is found further up in older women and lower in puberty- cervical cancer affects this area more bc it is closer to the outside

Medial Motor Systems

Target the spinal cord and control axial musculature (core!) 1- Lateral vestibulospinal tract 2- Medial vestibulospinal tract 3- Lateral reticulospinal tract 4- Medial reticulospinal tract 5- Tectospinal tract 6- Anterior Corticospinal tract

Mechanim of action of local anesthetics

Target the voltage gated sodium channel- when channel open sodium flows through- if enough sodium it can depolarize the neuron ** local anesthetic crosses cell membrane by simple diffusion bc lipophilic- but once crosses it picks up positive charge- and positive charge binds to voltage sodium channel blocking it preventing it from working - extracelluler 7.4, intracellular- 6.8pH (at higher pH there is higher proportion of local anesthetic that is unionized, at lower pH greater proportion of ionized) ** these drugs are ALL weak bases - pKa local anesthetics: 7.5-10 - Henderson-hasselbach equation: log (cationic)/(nonionized)= pka(anesthetic)- pH (body fluid) ** look at how much is ionized/ionized *pKa: the pH where concentrations of cationic and nonionized froms are equal

4 Muscles of Mastication

Temporalis Masseter Medial Pterygoid Lateral Pterygoid **These develop from the 1st pharyngeal arch, so they are innervated by the nerve associated with this arch: CNV3 ** these muscles are responsible for movements of the mandible- chewing (mastication!)

Vestigial Structures in the Region of the Female Genital Ducts

The mesonephric system persists in the female as: - Epoophoron - Paroophoron - Gartner cyst

Arachnoid Mater

Thin, delicate and avascular - attached to the dura mater - semi-transperant 1- Subarachnoid space: filled with CSF - Subarachnoid cisterns: openings in the subarachnoid space created by separation of arachnoid and pia mater, filled with CSF 2- Arachnoid Trabeculae: extend to pia mater, help to keep brain suspended 3- Arachnoid Villi: allow passage of CSF from the subarachnoid space into the dural venous sinus- large arachnoid villi are called arachnoid granulations

Mandibular Nerve (entirety of CNV3) Block

To produce a mandibular nerve block, anesthetic is injected near the mandibular nerve where it enters the infratemporal fossa - in the extraoral approach the needle passes through the mandibular notch of the ramus of the mandible into the infratemporal fossa *** The injection usually anesthesizes the auriculotemporal, buccal, lingual, and inferior alveolar nerves

During pregnancy, how are total blood volume, RBC mass and plasma volume altered?

Total blood volume= increases by 40% RBC mass/volume= increased 20-30% Plasma volume: increases 30-50%

Anterior (Ventral) Spinocerebellar

Transmits muscle spindle and golgi tendon organ AFFERENT information from DISTAL lower limbs to cerebellum 1st order cell body= DRG (GSA) - Fibers travel via Fasciculus Gracilis to.. 2nd order cell body= Spinal Border Cells (located in lumbar regions of anterior horn in laminas VII (joint afferents) - Fibers cross in Anterior white commissure (AWC) ascend via the Anterior Spinocerebellar Tract (in the anterior lateral funiculus)--> cross again in the brainstem --> pass through the SUPERIOR cerebellar peduncle (SCP) to the cerebellum ** Left information--ends up in LEFT side of cerebellum DRG-> (fasciculus gracilis)-> Spinal border cells->(Anterior spinocerebellar tract)-> thru SCP--> Cerebellum

Cuneocerebellar Tract

Transmits muscle spindle and golgi tendon organ afferent information form the upper limb & neck 1st order cell body= DRG - fibers travel via fasciculus cuneatus to.. 2nd order cell body= Lateral (external accessory) Cuneate Nucleus - Fibers travel rostrally via the Cuneocerebellar Tract and through the *INFERIOR Cerebellar Peduncle (ICP to the cerebellum DRG -> (Fasciculus Cuneatus)--> Lateral (external) Cuneate Nucleus --> (Cuneocerebellar Tract)--> Thru ICP--> Cerebellum

Posterior (Dorsal) Spinocerebellar

Transmits muscle spindle and golgi tendon organ afferent information from trunk and PROXIMAL lower limb to cerebellum 1st order cell body= DRG - fibers travel via fasciculus gracilis to.. 2nd order cell body= Clarkes Nucleus (Column) (T1-L2) - Fibers travel rostrally via the Dorsal Spinocerebellar Tract (in the lateral funiculus) through the INFERIOR** Cerebellar Peduncle (ICP) and into the cerebellum DRG-> (Fasciculus gracilis)--> Clarkes Nucleus --> (dorsal spinocerebellar tract)--> Through ICP --> Cerebellum

Middle Ear

Transmits vibrations of the tympanic membrane across the cavity of the middle ear to the internal ear - it does this through 3 interconnected, but movable, bones that bridge the space between the tympanic membrane and the inner ear These 3 bones (OSSICLES) are: - Malleus: connected to the tympanic membrane - Incus: connected to the malleus by a synovial joint - Stapes: connected to the incus by a synovial joint and attached to the lateral wall of the internal ear at the oval window (*these are the first bones to fully ossify and are mature by time of birth)

Which is the ONLY nerve to exit on the dorsal aspect of the brainstem, just caudal to the inferior colliculi?

Trochlear Nerve (IV)

Nuclei and Modality of CN IV- Trochlear

Trochlear Nucleus --> (GSE- Voluntary Motor)

If pregnancy DOES occur

Trophoblast cells of the implanted embryo produce a glycoprotein hormone called human chorionic gonadotropin (hCG) - hCG maintains and promotes further growth of the corpus luteum- stimulating secretion of progesterone to maintain the uterine mucosa ** Corpus luteum of pregnancy becomes very large and is maintained by hCG for 4-5 months -- it then degenerates and is replaced by a corpus albicans - By 4-5 months, the placenta can produce progesterone and estrogens to maintain the uterine mucosa

Seminiferous tubules form tortuous pathways through the testicular lobes and then narrow into short, straight segments, the

Tubuli Recti, which connect with the rete testis - the tubuli recti (straight ducts) - the rete testis - the ductuli efferentes ** These carry spermatozoa and liquid from the seminiferous tubules to the epididymis

Which are the largest of the 3 pairs of salivary glands?

Two Parotid Glands - The glands apex is posterior to the mandibular angle, and its base is related to the zygomatic arch - The gland has an irregular shape as it is wedged between the mandibular ramus and mastoid process ** Fatty tissue, located between lobules of the gland, enables the gland to accomdate movements of the mandible (chewing) *** Parotid bed is defined by the structures that surround and are in contact with the parotid gland

Two Cell Two Gonadotropin Theory

Two cells & Gonadotropins are necessary for steroid hormone production - LH stimulates thecal cell androgen production (mainly androstenedione and some testosterone) in theca lutein cells (Theca cell) - FSH stimulates granulosa cell estrogen production (androgens diffuse into GCs where they are aromatized to estrogen (estradiol (mainly) and some estrone) under direction of FSH). ** this is the physiological mechanism by which antral follicles produce estrogen ** Remember: this is the process or ovarian hormone biosynthesis by antral follicles during the early follicular phase of the menstrual cycle, i.e. BEFORE ovulation- the primary hromone secreted is estrogen (Estradiol)

In a normal 28-day menstrual cycle, on what day is the endometium most receptive to implantation?

Uterine receptivity to an implanting embryo is limited to a discrete period of time during the mid-secretory phase of the menstrual cycle called the "window of implantation" estimated to span from days 19-24 of the (ideal 28-day) menstrual cycle (5-10 days after ovulation)

Perinaud's Syndrome

Vertical gaze disruption resulting from lesions of the dorsal midbrain and pretectal area 4 Components of the syndrome: 1- Loss of vertical gaze: disruption to the Rostral Interstitial Nucleus of the MLF (riMLF) (the vertical gaze center) 2- Dilated, irregular pupils with light-near dissociation: may result from the disruptuon of axons to the Edinger-Westphal Nucleus and sparing the accomodation fibers 3- Collier's Sign (upper eyelid retraction) 4- Convergence-Retraction Nystagmus: attempts at upward gaze cause the eyes to pull in and the globes to retract Common causes: Pineal gland tumors, hydrocephalus, multiple sclerosis or vascular disorders in the pretectal or midbrain regions NOTE: In children with hydrocephlus, the 3rd ventricle can push on the tectum (collicular area) of the midbrain, causing a Parinauds and also affecting CNV1 resulting in a "setting-sun sing"- eyes inward and depressed

Vertigo

Verto= Whirling/spinning - Often accompanied by nausea, vomiting, and gait ataxia Caused by: - peripheral lesions that affect vestibular labyrinth of inner ear or vestibular division of CN VIII - central lesions that affect brainstem vestibular nuclei or their connections (central lesions may be accompanied by nystagmus)

Lateral Medullary Syndrome (Wallenbergs Syndrome) (occlusion of PICA/ Vertebral artery)

Wallenbergs affects: 1- Inferior cerebellar peduncle, vestibular nuclei --> ataxia, vertigo, nausea, nystagmus 2- Spinal V tract & possible spinal V nucleus --> ipsilateral pain/temp loss from face 3- Spinothalamic tract--> contralateral pain/temp loss from body 4- Descending sympathetic fibers--> Ipsilateral Horners syndrome 5- Nucleus Ambiguus--> hoarseness, dysphagia 6- Nucleus Solitarus--> ipsilateral decreased taste 7- Cochlear Nuclei --> ipsilateral hearing loss Horners Syndrome: 1- Ptosis: dropping of the eyelid 2- Miosis: impaired dilations..pt has an abnormally decreased pupil size 3- Anhydrosis: decreased sweating on the ipsi face

Imaging of the Appendix

Why? Acute appendicitis - imaging increases the specificity of diagnosing appendicitis - imagining decreases the negative appendectomy rate Imaging modalities used: - computed tomography (CT) - ultrasound Challenges of imaging of the appendix: - difficulty localizing and visualizing it **rememeber McBurney point: 1/3 of way between umbilicus and ASIS Normal Appendix on CT: - thin walled - measure less than 6mm wall-to-wall diameter - surrounded by homogenous clean, black fat - often contains intraluminal gas Advantages of evaluating the appendix with a CT scan: - highest diagnostic accuracy - lowest rate of nonvisualization of the appendix - readily available - other pathologies can be identified Imaging Features of Acute appendicitis on CT: - enlarged appendiceal wall-to-wall diameter, more than 6mm - appendiceal wall thickening (more than 2mm) - periappendiceal fat stranding - appendiceal wall enhancement - appendicolith (calcified deposit within the appendix)

Short-term: Working Memory

Without reptition, we have a limited memory span ** In 1950s, Dr. George Miller--> "maginal number 7, plus or minus 2" -- 7 elements or chuncks - span for remembering words ~5 - letters ~6 - number ~7 ** Limited storage duration due to attention/distraction ** Operates in Problem solving and planning ** Prefrontal cortex is important

Projective Personality Testing

Words/images presented to elicity a subjective "unconscious" process - Rorschach Test - Thematic Appreception Test (TAT) - Draw a House/Person - 3 wishes - Sentence Completion Test (SCT) ** Useful in psychosis and in diagnosing children

Sleep patterns

Young adults: - 90 min cycle, increased REM Elderly and residently - decreased REM Depression - going into REM too early - this is measure to see if it is going back to normal to test the efficacy of drug treating depression

Local Anesthetic must diffuse from where it is delivered to the

actually neurons with sodium channels on it- it must permeate CT structures to reach site of action which is the voltage-gated sodium channels (unmyelinated C fibers and weakly myelinated Adelta fibers that are most sensitive to the local anesthetic)

Adrenergic receptors targeted by NE

alpha 1 is a GPCR - Gq-linked; IP3, DAG signaling - many drugs have alpha1 adverse effects Alpha2 is a GPCR (inhitory) - Gi, Go-linked; decreases cAMP, increases K+ effluc and decreases Ca2+ influx - pre-synaptic alpha2 decrease NE release (Negative feedback)- agonists decrease blood pressure by actions in brain stem *** ALPHA2 IS PRE-SYNAPTIC AUTORECEPTOR (with neg feeback to inhibit NT release in this case NE) but also post-synaptic Beta1 is a GPCR - Gs-linked, increases cAMP, increase Ca2+ influx, increase CREB signaling

GnRH secreting neurons in the

arcuate and preoptic areas of the hypothalamus - GnRH secreted into blood and travels to anterior pituitary gonadotropes - Stimulating release of FSH and LH **GnRH regulation of gonadotropin (LH & FSH) synthesis & release from anterior pituitary donadotropes STEPS: Once released into the hypophyseal portal system, GnRH is transported to the gonadotroped. Here, it 1. Binds to G-protein coupled receptor (GnRHR-gonadotropic releasing hormone receptor) 2. This results in activation of PLC (phospholipase C) 3. PLC hydrolyses PIP2 to form second messengers IP3 and DAG 4. DAG stimulates PKC (protein kinase C)which phosphorylates transcription factors (stimulates gene transcription)- the net effect is an increase in synthesis of gonadotropins, LH and FSH 5. IP3 stimulates Ca2+ release from the ER, increasing the intracellular [Ca2+], which triggers exocytosis of gonadotropin (LH&FSH) containing vesicles from pituitary gonadotropes

Nuclei for CN I and II

are NOT in the brainstem

Primary Ia sensory neurons

are afferent neurons that spiral around the center of intrafusal muscle fibers - Secondary type II sensory neurons innervate adjacent refions of the intrafusal muscle fibers ** these afferent neurons constantly monitor changes in muscle stretch and length ** remember muscle spindles consist of intrafusal fibers

Evans Blue

assay for BBB leakage NOTE: that a small part of rodent brain is stained blue - Evans blue is given by IV injection - Healthy brain is impermeable to evans blue day- it does NOT cross BBB - leakage of Evans blue dye into the brain extracellular fluid after injury bc damage to the BBB (dye escaped blood vessels and went into extracellular space)

Rule #2: Branchial Moto (BE/SVE) fibers reside ONLY in nerves

associated with pharyngeal (branchial) arches - CN V3 (arch I) - CN VII (arch II) - CN IX (arch III) - CN X (arch IV & VI)

Pelvic Brim

bony edge (rim) surrounding and defining the pelvic inlet ** Pelvic brim divides pelvis into two parts: - ABOVE pelvic brim= False or Greater pelvis, which is part of the abdominal cavity - BELOW the brim= TRUE or Lesser pelvis that contains the pelvic organs ** Pelvis brim divides pelvis into two parts= Lesser (true) pelvis and Greater (false) pelvis

Inner (internal) Ear consists of a

bony labyrinth and a membranous labyrinth Bony labyrinth= vestibule, semicicular canals, cochlea (filled with PERILYMPH) Membranous labyrinth= semicircular ducts (ant., lateral, posterior), cochlear duct, utricle, saccule (filled with ENDOLYMPH)

The ear has a complex cutaneous innervation as, developmentally, it is on the

border of pharyngeal arch derivatives (anteriorly) and somite derivatives (posteriorly) 4 Cranial Nerves Contribute to the Innervation on Anterior Aspect of the ear: - Trigeminal Nerve (auriculotemporal nerve) - Facial Nerve - Glossopharyngeal Nerve - Vagus Nerve Cervical Plexus Innervates the Posterior ear: - Lesser Occipital Nerve (C2) - Great Auricular Nerve (C2, C3)

Inner Ear has mechanically gated

cation channels at tips of stereocilia that are activated by upwards displacement of basilar membrane - inner hair cells have a U-shape - outer hair cells have a W-shape ** Intensity of sound is related to displacement of hair cells (increased displacemnet--> higher sound)

Spinal Shock

characterized by loss of reflex, motor and sensory function below the level of cord uncomfortability - it is TEMPORARY in nature compared to chronic spinal cord injuries ** Autonomic dysfunction can be associated with injury to upper thoracic/ cervical regions 4 phases: Phase 1: (0-1 day)- PE shows Areflexia/Hyporeflexia- due to loss of descending facilitation Phase 2 (1-3day)- PE shows reflex return- due to denervation supersensitivity Phase 3 (1-4weeks)- PE shows hyperreflexia (initial/early)- due to result of axon-supported synaptic growth/connections Phase 4 (1-12 month)- PE shows Hyperreflexia (late)- due to result of soma-supported synaptic growth/connections

Glaucoma

clinical condition resulting from increased intraocular pressure over a sustained period of time ** Increased intraocular pressure damages blood vessels and optic nerve Causes: - excessive secretion of aqueous humor, or - impedance of drainage of aqueous humor from the anterior chamber (much more likely) Treatments: - Are directed toward lowering the intraocular pressure by decreasing the rate of production of aqueous humor (eyedrops) or eliminating the cause of the obstruction of normal drainage (surgery) *** If the condition is NOT treated, the optic nerve and/or retina will be permanently damged, and blindness will occur

Rinne Test

compares air conduction (AC) vs bone conduction (BC) - Normal hearing: AC>BC - Conductive hearing: BC>AC - Sensorineural hearing loss: AC>BC ** (But these are BOTH less than in the normal condition)

Ankyloglossia (AKA tongue-tie)

condition where the tongue is not separated, or freed, from the floor of the mouth - the frenulum is thicker and there is decreased mobility of the tongue

Pts with hypercholesterolemia exhibit an increased incidence of

congestive heart failure, coronary artery blockage and erectile dysfunction ** Several societies are now recommending that all men with ED be screened for underlying cardiovascular disorders, especially those men with ED between ages 30-60

Conjugate gaze

connections mediating vestibulo-ocular reflex (VOR) *** turn head to left, eye moves to right (keeps eye focused) REMEMBER: this is NOT an isolated system--> other higher cortical inputs (ex. from frontal eye fields, FEF) are relavant to these pathways Horizontal saccades (from contralateral cortex, via ipsilateral PPRF) Horizontal smooth pursuit (from ipsilateral cortex)

Ovarian Follicle

consists of an oocyte surrounded by one or more layers of epithelial cells within a basal lamina Types of follicles: - Primordial follicle - Primary follicle (unilaminar, multilaminar) - Antral follicle (AKA vesicular follicle) - Graafian follicle (AKA mature or preovulatory follicle) ** DONT confuse primary follicle with primary oocyte ** Some sources add Secondary Follicle: the characteristic feature that distinguishes secondary from primary follicles is the appearance of a follicular antrum within the granulosa layer NOTE: In folliculogenesis the follicle remanant continues to change after its egg is released at ovulation - One ovary will NOT have all the follicular stages at the same time

After ovulation, the remnants of the ruptured follicle develop into the

corpus luteum in a process termed luteinization- this process involved: Alteration in gene expression: - GC proliferation genes decreased - Genes for LH receptor & progesterone synthesis increased Follicle cell differentiation: TCs become Theca-Lutein cells: - have LH receptors - produce androgen (mostly) GCs become Granulosa-Lutein Cells: - have LH & FSH receptors - produce progesterone (mainly), some estrogen & inhibin A

The inferior parathyoid gland is found more ___ at the start of development

cranially! - BUT migrates more caudally during development and therefore is called inferior parathyroid gland

Neural Crest cells contribute to the skeletal elements of the

craniofacial region - Disruption of neural crest cells in development results in severe craniofacial malformations - Since crest cells also contribute to septation of the outflow tract of the heart into pulmonary and aortic channels--> many infants with craniofacial defects also suffer cardiac abnormalities, including persistent truncus arteriosus and transposition of the great vessels (*review this from cardio)

Vasectomy

cuts, seals DUCTUS DEFERENS - thick wall, "seen" through scrotal skin makes it easy to access and identify - testes continue to produce sperm - sperm die and are resorbed - bc sperm production continues, vasectomies can be REVERSED many years later by re-ligating the vas deferens

Sclera (white of the eye) is composed of

dense, irregular CT that provides attachment for the extrinsic muscles of the eye - Collagen bundles (type I) with interspersed fibroblasts - Covered by conjunctiva (a mucosa) - Sclera contains SOME capillaries, but there are A LOT more capillaries in overlying conjunctiva ** MOST capillaries are in conjunctive rather than sclera

Intelligence testing- Educational context

determines cognitive potential for learning - used to develop educational plans to improve academic performance and overall functioning - informs in-school treatment plans: additional therapies or vocational plans Psycho/Educational testing - intelligence and academic functioning - idenity and monitor individuals with neurodevelopmental disorders (i.e. learning disability, intellecutal disability, ADHD, ASD etc ) and emotional disorders - can be completed in the school or clinical setting - for purposes of developing school plans

During embryonic development, the testes develop in the

dorsal wall of the peritoneum - when they descend into the scrotum, they carry with them a serous sac--> the tunica vaginalis (derived from the peritoneum) ** Tunica vaginalis has a visceral and parietal layer ** Interior of the tunica vaginalis, each testis is surrounded by a thick CT capsule- the tunica albuginea

Lymphatic Drainage of the Tongue

drains into the submental, submandibular and deep cervical lymph nodes *** ALL of the lymph will ultimately drain into the jugualr lymphatic trunks and finally to the thoracic duct on the left or the lymphatic duct on the right

Erectile tissue of the penis contains numerous variably shaped,

endothelially-lined spaces that are separated from one another by trabeculae of CT and smooth muscle cells - the erectile tissue of the corpora cavernosa receive blood from branches of the deep and dorsal arteries of the penis - Deep arteries branch from nutritive and helicene arteries Nutritive: supply oxygen and nutrients to the trabeculae Helicine Arteries: empty directly into the cavernous spaces (erectile tissue) *** There are arteriovenous shunts between the helicene arteries and the deep dorsal vein

The male erection response is due to

engorgement of blood vessels in the corpus cavernosa - these vascular changes req. the interplay of the vascular endothelial cells, sympathetic and parasympathetic nervous systems (disorder in any of these can result in erectile dysfunction- "inability to achieve and maintain an erection sufficient for satisfactory sexual performance" - ALL men without physiological erectile dysfunction experience nocturnal penile tumescence, usually 3-5 times during the night, typically during REM sleep - The presence of nocturnal erections imples a normal erectile vascular response is possible

During the luteal phase of the menstrual cycle, gonadotropins stimulate the corpus luteum to secrete

estrogen, inhibin A, and large amounts of progesterone ** Corpus luteum hormones exert Negative Feedback on H-P axis, decreasing LH & FSH levels - After ~14 days, the Corpus luteum regresses & ovarian hormone secretion declines abruptly Rememebr: Inhibin A ONLY negatively feedbacks at the level of the pituitary to inhibit FSH secretion ** Progesterone and estrogen levels begin to decline in the mid-luteal phase owing to declining CL function NOTE: progesterone secretion after ovulation is associated with a rapid rise in basal body temperature of ~0.5 degrees celsius which is sustained throughout the luteal phase

If you look at the lateral wall of the middle meatus, just below the cut middle concha, there is an elevation called the

ethmoidal bulla- this bump is formed by the underlying middle ethmoidal cells and ethmoidal labyrinth - inferior to the ethmoidal bulla is a curved space, which is the semilunar hiatus, which is formed by the mucosa covering the lateral wall - the anterior end of the semilunar hiatus forms the ethmoidal infundibulum, a channel which curves upward and continues as the frontonasal duct through the ethmoidal labyrinth to reach the frontal sinus - the nasolacrimal duct and most of the paranasal sinuses open onto the lateral wall of the nasal cavity - the sphenoethmoidal recess is the conduit between the sphenoid sinus and the nasal cavity

Two different observations

ex. lab data and offspring - use two lines for observation and multiply both with the prior Ex: Two ppl are affected with DMD- II-2 has normal CK (70% of DMD carriers have elevated CK). What is her risk of being a carrier? 3/43

The rete testis (joined to the testis cords) enter

excretory mesonephric tubules (efferent ductules) - Excretory mesonepheric tubules are aka efferent ductules (ductuli efferentes)- ** think E for exit and E for efferent - The excretory mesonephric tubules link rete testis with the mesonephric ducts (Wolffian duct) - The mesonephric ducts are destined to become the ductus deferens

Reelin is an

extracellular matrix protein important for cell-cell interactions and termination of migrating neurons * Early-born neurons in first layer, called Cajal-Retzius cells, secrete Reelin, which accumulates just below the pial surface *Mutation of the reelin gene on chromosome 7- considered a LIS2 type of LISSENCEPHALY ** Without Reelin, earlier-born neurons stay attached to the radial glia fiber and block th emigration of later-born neurons ** Mutation os fhte reelin gene produce NORMAN-ROBERTS SYNDROME (rare- dont worry about this much)- characterized by an inverted cortical lamination (younger neurons deeper to older neurons) and underdevelopment of the cerebellum and cranio-facial abnormalities

From the primary visual cortex (area 17), axons project to

extrastriate regions that include BA 18 (visual association cortex), 19, temporal, and parietal regions ** In area 18, information from each channel will project to specific areas (thick, pale, or thin stripes) From area 18, there are two main streams: 1. Dorsal pathway: - projects to the parieto-occipital association cortex - this pathway is known as the "where" pathway for it analyzes spatial and motion relationships 2- Ventral pathway: - projects to the occipito-temporal association cortex - this pathway is known as the "what" pathway for it analyzes form such as letters, faces, colors

Dysconjugate gaze

eyes do NOT move together - Strabismus: congenital weakness of eye muscles that can result in decreased vision in one eye (amblyopia) - Esotropia: abnormal medial deviation of the eye - Exotropia: abnormal lateral deviation of the eye - Hypertropia: abnormal elevation of the eye - Diplopia: double vision - Anisocoria: pupil asymmetry - Nystagmus: reflex eye movement in one direction interrupted by fast, saccade-like movement in the opposite direction

Pelvic Diaphragm forms the

floor of the pelvis - Pelvic diaphragm= levator ani and coccygeus muscles (innervated by S3, S4 nerves and pudendal nerve) Functions of the pelvic diaphragm: - supports pelvic viscera (organs) - resists increases in intra-abdominal pressure - controls the openings of the rectum, urethra, and vagina - on contraction, raises the entire pelvic floor Openings of the Pelvic diaphragm for passage of urethra, vagina, rectum: - Anal canal/rectum pierces the center of the pelvic diaphragm at the ANAL HIATUS - Urethra (in males and females) and vagina (in females) and the urethra pierce the pelvic diaphragm anteriorly at the UROGENITAL HIATUS ** REMEMBER: muscles that form the pelvic diaphragm are levator ani muscle and coccygeus muscle ** Levator ani is made up of 3 separate muscles called: - puborectalis - pubococcygeus - iliococcygeus (*know is general where the muscles are located in relation to each other- will NOT be tested on specific origins and insertion points for these muscles)

What hormone "rescues the corpus luteum"?

hCG

To what receptor does hCG bind to in the corpus luteum? What does binding of hCG to this receptor stimulate?

hCG binds to LH receptors on the CL and sitmulates steroid hormone production--> this process is termed "hCG rescue of the corpus luteum" stimules: - Theca luteal cells: maintain androgen production - Granulosa-luteal cells: maintains progesterone and estrogen production - Fetal leydig cells (testes): testosterone production

If fertilization occurred about 5 weeks ago

hCG would be increasing steading and stimulating estradiol and progesterone secretion from the corpus luteum - Prolacitng (from maternal pituitary) and human placental lactogen (from the syncytiotrophoblast cells) are secreted at steadily increasing levels during pregnancy, becoming detectable at ~week 4-5 of pregnancy

What is the primary function of hPL during pregnancy?

hPL, progesterone, cortisol, estrogen and prolactin coordinate to ensure a continuous supply of glucose to the fetus by: - enhancing maternal insulin secretion by direct tropic effect on the pancreatic beta cells - promote a hyper-insulin respons to glucose - cause decreased insulin sensitivity in the peripheral tissues (adipocytes, skeletal muscle) by interfering with insulin receptor signaling - stimulating lipolysis and mobilization of FFAs ** Increased insulin resistance --> compensatory increase in insulin secretion --> normal pregnancy ** Increased insulin resistance--> insufficient pancreatic insulin secretion --> maternal hyperglycemia --> gestational diabetes

The CNS is essentially a

hollow tube The outside of the tube contains the cerebral hemispheres, brain stem and spinal cord and their contents The hollow inside of the tube in the brain consists of four filled ventricles: - 2 lateral ventricles - 1 third ventricle - 1 fourth ventricle *** The hollow tube in the spinal cord is called the central canal

Epiblast cells move through the primitive streak and node and move inward, displacing the

hypoblast to create the endoderm - after the endoderm is established--> epiblast cells form from the intraembryonic mesoderm ** remember we have 3 germ layers: endoderm, mesoderm, ectoderm

Dysmetria

improper measuring of distance in muscular acts

Physiological changes that may influence the availability of antibiotics during pregnancy

increased plasma volume - lowes amt of antibiotic that is available and as such, it may be necessary to increase the does of antibiotics given during pregnancy NOTE: - plasma binding proteins increase during pregnancy - hematocrit decreases during pregnancy - GFR increases during pregnancy - uterine blood flow increases during pregnancy

Prostaglandin analogs are used in the

induction of labor because they stimulate both uterine contractions and cervical dilation - PG analogues can be inserted vaginally to allow for cervical ripening, which alone can induce labor - If it does NOT induce labor, other medications such as oxytocin can be used *** Dinoprostone is an example of a prostaglandin agonist used for labor induction

Nasal Polyps can exist becuase of

infection, allergies etc. - Can produce "stuffiness", post-nasal drip, etc

27 y/o individual with NR5A1/SF-1 gene leading to impaired sertoli function comes in with a complaint of

infertility

Congenital Inguinal Hernia

involves the descent of intestines into the scrotum - this occurs when the connection between processus vaginalis and the peritoneal cavity is NOT obliterated and there is a large opening into which intestines can descend

Parapharyngeal Space

is a POTENTIAL SPACE in the neck (AKA lateral pharyngeal space) - located lateral to the superior pharyngeal constrictor and medial to the masseter muscle The space contains: - internal carotid artery - internal jugular vein - glossopharyngeal nerve (CNIX) - vagus nerve (CNX) - spinal accessory nerve (CNXI) - hypoglossal nerve (CNXII) - sympathetic trunk - superior cervical ganglion - deep cervical lymph nodes ** Infections in the parapharyngeal space usually originate in the tonsils or pharynx, although local infections may spread from odotogenic sources and lymph nodes

Cerebral Cortex

is a sheet of neurons, about 2.5 square feet in area, that creates the surface of the cerebral hemispheres It contains: neurons (80-100billion!) interconnecting axons (~100,000km), synapses (100 trillion) ** Highest evolutionary development of cortex is found in humans ** Implicated in higher mental processes like language, abstraction, perception, motivation, reasoning

Filamin

is an actin-binding protein important for signaling scaffols and initiation of migration of neurons ** Mutations result in PERIVENTRICULAR HETEROTOPIA, which usually occur in the FLNA gene that codes for filamen- the muation is X-linked, dominant- males usually die in utero - in females, with periventricular heterotopia, neurons that should have migrated to the cortex remain collected near the walls of the ventricles * Although the cerebral cortex is evidently missing many neurons, the intelligence of affected individuals is often normal or only mildly compromised ** the major clinical syndrome of periventricular heterotopid is late-onste epilepsy that often starts in the second decade of life

Ischemic Cascade

lack of oxygen supply to neurons --> ATP depletion; suppression of Na+/K+ ATPase (>/= ATP used to power this ATPae) --> Membrane depolarization (Ca2+ influs, glutamate release; glutamate receptor activation) --> Excitotoxicity neuron death --> Activatin of astrocytes, microglia --> loss of blood-brain barrier ingtegrity; infiltration of immune cells--> further neuronal death ** disregulation of glutamate leads to wide spread damage of neurons

Lateral plate mesoderm gives rise to what structures in the skull

larygneal cartilages

What cartilage/skeletal structures arise from the VI pharyngeal arch?

laryngeal cartilages (thyroid, cricoid, arytenoid, corniculate, cuneiform) ** these were also formed by IV pharyngeal arch Artery: roots of definitive pulmonary arteries & ductus arteriosus CN X (recurrent laryngeal branch of vagus nerve)

Positive feedback effect of estrogen occurs ONLY in the

late follicular phase just prior to ovulation

Axons in the optic nerve will ultimately project to the

lateral geniculate nucleus of the thalamus (the majority of axons do this, the "other" axons will follow one of the other 3 pathways **** NOTE: A COMPLETE lesion or disruption of the optic nerve will result in complete monocular vision loss--> blind

What is found in the lateral area of the hypothalamus?

lateral nuclei: - feeding center regulates food intake (stimulation induces eating.. destruction results in starvation) - regulates drive states for pleasure and reward - collections of neurons here may also produce orexin/hypocretin

Maxillary artery runs between the heads of the

lateral pterygoid muscle ** this muscle divides the maxillary artery into 3 parts based on its relationship with this muscle Part1 (Mandibular Part): between the neck of the mandible and the sphenomandibular ligament Part2 (Muscular or Pterygoid Part): part related to the lateral pterygoid muscle Part 3 (Pterygomaxillary Part): branches in the pterygopalatine fossa

The medial and lateral pterygoid muscles on the LEFT will move the jaw

laterally to the right

Damage to the posterior spinal artery can lead to

loss of dorsal column information (discriminative touch, pressure, vibration & proprioception sense)

The placental membrane (Barrier) separates

maternal and fetal blood and until the 20th week, it consists of 4 layers 1. The syncytiotrophoblast 2. The cytotrophoblast 3. CT in villous core 4. Endothelium of fetal capillaries After 20th week, cells from the cytotrophoblast decrease in number and disappear over large areas of the villi The placental membrane reduces to 2 layers: - syncytiotrophoblast and - endothelium of fetal capillaries

Superior and middle conchae are

medial processes of the ethmoid bone - the inferior conchae is an independent bone

The central processes (axons) of the more caudal DRG cells shift

medially as the central processes (axons) of rostral DRG cells are added to the dorsal column

Specialized ganglion cells in the retina that contain

melanopsin and are depolarized by light... their axons run in the reinohypothalamic tract.. and their function is to encode environmental illumination and thus to set the biological clock

Doublecortin (DCX) is a

micotubule-associated protein important in proper migration LISX1 occurs from doublecortin (DCX) gene mutation **Males with the doublecortin mutation exhibit X-linke LISSENCEPHALY ("smooth brain" with NO gyri) or PACHYGYRIA (fewer than normal gyri) and severe retardation ** In heterozygote females, this mutation causes double cortex (SUBCORTICAL LAMINAR BAND HETEROTOPIA, SBH) in which a band of grey matter, made up of neurons which terminated their migration prematurely, is found underneath the cortex within the white matter

Primary Ia sensory neurons wrap around the

middle of the intrafusal muscle fibers within the muscle spindle - discharge of Ia sensory neurons is related to the length of the spindle; as the muscle is stretched, the dischard rate of the neuron increases ** the Ia sensory neuron has an excitatory synapse in the spinal cord with the alpha motor neurons ** Therefore, the stretching of the muscle spindle causes Ia sensory neurons to fire causing the excitation of alpha motor neurons, which innervate extrafusal muscle fibers

At sexual maturity, spermatogonia start dividing by

mitosis 1) they can either keep dividing --> more Type A or, 2) become type B--> differentiate into sperm * type B divides until sperm "incomplete cytokinesis" - every daughter cell connected by cytoplasm ** All progeny of a type B spermatogonia remain connected by cytoplasmic bridges until the last stages of spermatid maturation, and this is essential for the synchronous development of each clone

Auricular muscles

muscles around the ear, can be either: - elevating (superior auricular) - drawing the ear upward and forward (anterior auricular) - upward and backwards (posterior auricular)

Pineal gland develops from

neuroectoderm and lies caudally in the diencephalon. Attached to the roof of the 3rd ventricle by the pineal stalk - clearly discernible on CT or MRI- accumulation of "brain sand" accounts for the opaqueness of the structure - the LACK of blood brain barrier allows the CNS to interact with the peripheral blood flow for neuroendocrine functions *** the pineal gland is a circumventricular organ in that it lacks a blood brain barrier and has a rich vasculature ** review the histology of the pineal gland!

ALL cells within the brain and spinal cord (sensory, motor, interneurons, supporting cells) EXCEPT microglia are derived from

neuroepithelial cells (from neuroectoderm) that line the closed neural tube - Neuroepithelial cells are the stem cells of the central nervous system - the cells occupy the thickness of the tube, spanning from the pial surface to the ventricular/luminal surface - they will generate radial glial cells and those radial glial cells will produce neurons and other glia/supporting cells

Pre-eclampsia

new onset of hypertension and proteinuria after 20 weeks gestation in a previously normotensive woman. Diagnosis requires two serial blood pressure readings > 140/90mmHg over 6 hours or more. Gestational hypertension (C) is high blood pressure that occurs during pregnancy without associated proteinuria. Eclampsia (A) is characterized by onset of seizures in patients with pre-eclampsia. Gestational diabetes mellitus is associated with maternal hyperglycemia, glucosuria and insulin resistance, not proteinuria or hypertension (B). Normal pregnancy is not associated with increased blood pressure, and while edema in the extremities is a common complaint for women, this combined with headache, blurry vision or dizziness are suggestive of pre-eclampsia and warrant further investigation.

Types of Sleep

non-REM (N1, N2, N3 (Sometimes we see N4) and REM sleep non-REM - "an idling brain in a moveable body" - slower EEG rhythms - higher muscle tone - absence of eye movements - absence of "thought-like" mental activity REM sleep - "an awake brain in a paralysed body" - aroused EEG pattern - sexual arousal - saccadic eye movments - elaborate visual imagery (associ. with acitivty of paramedic pontine reticular formation, PPRF which is in the PONS-visual system)

Adult Neurogenesis

only occurs primarily in 2 areas: Hippocampus and Olfactory Bulb Adult Neurogenesis differes from embryonic neurogenesis in severeal ways: 1. Is very limited in proliferation, were talking a few thousand cells a day, not millions or billions 2. New neurons in neocortical regions are not derived from a stem cell population, but from glia, which the enviornment influences to become glia or new neurons- in the hippocampus (allocortex) and in the olfatory system new neurons are generated from stem cells 3. Neurons migrate not on radial glia, BUT through the existing white matter to speficic areas in existing cortical layers

Neural projections from higher centers of the brain to the hypothalamus can elicit the secretion of

oxytocin into the blood from the posterior pituitary gland. Upon reaching the breast, oxytocin stimulates contraction of myoepithelial cells, forcing milk from the alveoli and ducts to the nipple

Tetraplegia (quadriplegia)

paralysis of upper and lower extremities as well as torso- usually due to a cervical SCI *** Incomplete tetraplegia is most common in spinal cord injury - Tetraparesis (quadriparesis): weakness affecting all four limbs may be flaccid or spastic

Coronal suture connects the

parietal and frontal bones

Lamboid suture connects the

parietal and occipital bones

Arbor Vitae

pattern of white matter in the cerebellum

Once the Ferguson Reflex (controlling oxytocin relase) is fully activated, this

positive feedback system will stimulate ocntractions until the baby is delivered NOTE: In some women, the ferguson reflex shuts OFF quickly after birth of the baby; after delivery, the uterus is NO longer being stretched, and therefore the positive feedback loop is shut off - This endogenous fall in oxytocin is the primary reason that some women require exogenous oxytocin to further stimulate the uterus and deliver the placenta In summary: physiologically it is well documented that oxytocin (acting through the oxytocin receptor) and PGF2alpha (acting via the FP receptor) induce uterine contractions. It is also well documented that PGE2 (acting through the EP2/4 receptor pathways) causes cervical ripening which will induce labor

The thalamus is most frequently damage by vascular accidents of branches of the

posterior cerbeal artery and posterior choroidal branches from the posterior cerebral artery

The Middle Cerebral Artery supplies most of the

precentral (motor) and postcentral (somatosensory) gyri *** Occlusion of a middle cerebral artery causes restricted (restricted to upper limb and face, lower limb sparred according to somatotopy) contralateral motor AND somatosensory deficits ** If the left hemisphere is involved, language deficits may be apparent

Heavy pigmentation (melanocytes) on the inner lining of the eye

prevent the inappropriate scattering of light rays

The prevertebral region consists of muscls that are locted between the

prevetebral fascia and the vertebral column Prevertebral and Lateral Vertebral muscles: 4 Deep ones: - Longus Capitis - Longus colli - Rectus Capitis anterior - Rectus capitis lateralis and then a few more - Splenius capitis - Levator scapulae - Anterior Scalene - Middle Scalene - Posterior Scalene

Rostral part of the spinal cord develops from

primary neurulation and the neural tube - The caudal most aspect (sacral and coccygeal) form during secondary neurulation and fuse with the primary tube * Spinal Cord Spinal Ganglia Central Canal

Granulosa-luteal cells (GLC) secrete

progesterone and estrogen, whereas the theca-luteal cells (TLC) secrete androgen (testosterone and androstenedione)- these cell types can also be distinguished histologically, since the TLC express high levels of 17-alpha hydroxylase and 17-20-lyase (required to convert progesterone to androgen), whereas the GLC express aromatase (required to convert androgen into estrogen)

Nucleus Solitarius is a seires of sensory nuclei located in the brainstem responsible for

receiving GVA signals (caudal part) and SVA taste signals (rostral part) from CN VII, CN IX, CN X

Optic disc is formed by

retinal ganglion cell axons leaving the retina to form the optic nerve - central artery and vein are found here ** the blind spots for the two eyes are not positioned the same and therefore there is no deficit in vision --> even with one eye closed, the visual pathways compensat or "fill in" for the blind spot

Tremor

rhythmic involuntary movement

Extravasation of Urine

rupture of the urethra (at bulbar or spongy urethra) due to crush injury or tear causing urine to pass into other areas i.e. the superficial perineal space, spread inferiorly into the scrotum, anteriorly around the penis, and superiorly into the anterior abdominal wall - if the membranous part of the urethra is ruptured, urine escapes upward around the prostate and bladder "Escape of urine into other areas"

Salivary Glands

secrete saliva into the oral cavity either directly or via small ducts - the saliva aids in lubrication, swallowing and helps start the digestive process - there can be up to 1000 minor salivary glands in the mouth- however, thre are 3 pairs of major salivary glands Major Salivary Glands (All are paired) 1. Parotid gland 2. Submandibular Gland 3. Sublingual Gland

Inflammatory Soup

series of activated factors released following tissue injury- sensitizes nociceptors in an injured area

Fluoxetine

serotonin in presynaptic vesicles released and binds to post- reuptake by SERT ** with fluoxetine it blocks SERT- so less serotonin will be removed from synaptic cleft into pre-synaptic- increases serotonin in synaptic cleft- increase binding to post-synaptic increasing signaling in post-synaptic neuron

Amniotic fluid

serves as protective cushion Primarily derived from maternal blood - 10 weeks: 30mL - 20 weeks: 450mL - 37 weeks: 1000mL From 5th month, the fetus swallows its own amniotic fluid (it drinks about 400 mL per day)- this was important for lung development, and fetal urine is added daily to the amniotic fluid Polyhydramnios: - an EXCESS of amniotic fluid (1500 to 2000 mL) - idopathic causes; or due to gastrointestinal atresia Oligohydraminos: - DECREASED amniotic fluid (<400mL) - nonfunctional kidneys, or bilateral renal agenesis, urinary tract blockages

Name 3 risks factors that contribute to erectile dysfunction

shares common modifiable and unmodifiable risk factors with cardiovascular diseases (CVD) (ex. obesity, diabetes mellitus, dyslipidemia, physical inactivity, smoking) - Cardiovascular health, diabets, and spinal cord injury are associated with erectile dysfunction

The epithelium of the prostate gland is

simple and pseudostratified columnar and lines the individual glands that constitute the prostate - Composed of cells that have abundant rER, well-developed golgi, numerous lysosomes, and many secretory granules (this is a secreting gland!!) - Smooth muscle helps to "squeeze" secretions into semen

What is preterm labor?

spontaneous onset of uterine contractions and cervical dilation < 37 weeks gestation - Has been linked to maternal stress (increased maternal CRH--> on fetal pituitary --> increases ACTH --> DHEAS--> increases estrogen --> labor)

Station

stance, i.e. manny of standing

Chronic drug treatment allows for

steady state drug concentration in blood and brain - ex. oral treatment Onset of action: slow (days) as drug accumulates to theapeutic levels Duration of action: may persist even after drug taking stops (if you keep taking drug duration will be as long as your taking it- when you stop taking it you will start to lose affect of drug once conc. drops below whats needed for therapeutic affect

LH increases

steroidogenic enzyme expression & activity--> increasing testosterone production from Leydig cells ** LH is the principal regulator of testosterone production in Leydig cells

At the apex of each testicular lobule, convoluted seminiferous tubules are replaced by short,

straight seminiferous tubulles (Straight tubules aka Tubuli recti) - ONLY sertoli cells are present in the tubule epithelium, which is now simple columnar ** The straight tubules are very short ** Straight tubules --> Rete testis

Tissue injury rapidly releases

substance which excite nociceptors - this activates the process of neurogenic inflammation and the release of Substance P and CGRP from nerve endings that results in vasodilation and mast cell activation - Mast cells release histamine which excite nociceptors - Vasodilation and edema causes additional release of bradykinin- *this long list of activated factors is known as the "inflammatory soup"- this acidic "soup" (which is represented by a H+ ion) sensitizes the nociceptos terminals --> Recall from your own experience that an injured area has heightened sensitivity

During pregnancy, the maternal hypothalamic-pituitary axis is

suppressed due to high circulating levels of steroid hormones (estrogen and progesterone)--> this leads to reduced gonadotropin levels, and thus ovulation does NOT occur - Increased alveolar ventilation in pregnancy leads to decreased arterial carbon dioxide levels (hypocapnia) - Increased plasma volume without a concomitant rise in RBC volume leads to decreased hemtocrit - Cardiac output rises by 30-50% during pregancy - Plasma cortisol levels increase steadily during pregnancy

Pupillary dilation is under

sympathetic control * Axons of pre-ganglionic sympathetic neurons (intermediolateral cell column) synapse on cell bodies in the superior cervical ganglia - the post-ganglionic axons innervate the dilator smooth muscle fibers of the iris Horners Syndrome: Disruption of sympathetic fibers to the eyes and face Consists of: 1. Ptosis= upper eyelid drooping- loss of innervation to smooth muscle in the upper eyeling 2. Miosis= decreased pupillary size 3. Anhydrosis= decreased sweating on the ipsilateral face and neck

Emission phase of ejaculation is a

sympathetic response stimulated by binding of norepinephrine to alpha-1 adrenorecptors stimulating rhythmic contractions of smooth muscle of the distal epididymis, vas deferens, seminal veiscles and prostate ** Thus, a drug which inhibits adrenoreceptors (i.e. inhibitor of alpha-1 adrenoreceptor) could inhibit the emission phase of ejaculation

Human chorionic gonadotropin is secreted from the

syncytiotrophoblast cells once the blastocyst has undergone implantation and is detectable in maternal serum ~8days post fetilization/1 day after implantation - Levels of hCG rise exponentially, doubling every 48 hrs - hCG levels reach a peak around the end of the first trimester (week 10-12 gestation) after which levels begin to decline and remain low for the duration of pregnancy. hCG is a dimer consisting of a 145 AA beta-subunit which is unique to hCG, and a 92 AA alpha-subunit, which is identical to that for LH, FSH & TSH - LH and hCG are similar in structure and function, and in early pregnancy, hCG binds to LH receptors** on the granulosa and theca luteal cells and stimulates steroid hormone production --> this process is termed "hCG rescure of the corpus luteum"

Dopaminergic Neurotransmission

synthesized from Tyrosine and can be syn from DOPA which can be given to pt by drug--> synaptic vesicles released and difusses across synaptic cleft--> postsynaptic dopamine receptors--> recycled

Corticobulbar pathways

target cranial nerve motor nuclei in the brainstem for control of voluntary musculature in the "head" *** completely different than targeting the spinal cord, hence the word "bulbar", which means brainstem

Squamous suture connects the

temporal and parietal bones

Spermatozoa passes from

testes through epididymis --> ductus deferens --> ejaculatory duct --> and urethra before leaving the body

The penis has dual function:

the delivery of urine to the outside and the conveyance of semen into the female reproductive tract Penis is composed of 3 masses of erectile tissue: 1-2) two dorsally displaced corproa cavernosa 3) Single, ventrally positioned corpus spongiosum, whose distal terminus is the head of the penis, known as the glans penis, which displays a vertical slit, the external opening of the urethra NOTE: each corpus cavernosum is covered by a resistant layer of dense CT- the Tunica Albuginea NOTE: the penis is covered loosely by skin, which distally forms the large foreskin fold and becomes thin over the glans

Conjunctiva

thin "skin" on the front of the eyeball, so-named because it conjoins the eyeball with the eyelid A clear mucous membrane consisting of cells and underlying basemement membrane (plus thin lamina propria) that 1) Covers the visible part of the sclera 2) Lines the inside of the eyelids NOTE: The Conjunctive is a mucous membrane or mucosa - consists of an epithelium (rare) stratified columnar (can vary depending on region) - sitting on a basal lamina - plus a thin lamina propria NOTE: - Sebum (holocrine) from tarsal glands is added to the tear film and helps lubricate the ocular surface - CT can be found in the tarsus

Following ejaculation

tonic sympathetic stimulation of the penile arteries returns to normal levels, thereby increasing arteriolar resistance in the vasculature supply the corpora cavernosa--> resulting in the flaccid (non-erect) state due to decreased blood flow

True Vocal Cords are defined as the

true vocal folds and the vocalis muscle - Vocal ligament (just inferior to the true vocal cords): can vibrate at very high speeds (130-180 times per second in men and women, respectively) - Vocalis muscle: originates from the lateral surface of the arytenoid cartilage and inserts into the ipsilateral vocal ligament ** True vocal fold is - open during normal respiration - closed during phonation **there are false vocal cords, above the true vocal cords- they refer to the vestibular ligament/fold and are false as they do NOT produce sound

After a sexual partner is disclosed you next want to know

type of sexual practices they engaged in so you coult better understand health concerns - also ask " do you use proection" instead of " what kind of protection do you use" - also do not assume the gender of the person they are sexually active with- always ask

Erectile dysfunction has been recognized as a clinical marker/ predictor of what?

underlying CVD, with onset typically 2-5 years before a cardiovascular event

The lateral and medial vestibulospinal tracts are modulated by the activity of the

vestibular apparatus and cerebellum

Cervical effacement occurs during Phase 1 of partuition. True or False?

FALSE - Cervical softening occurs in Phase 1 - Phase 3 has effacement, dilation Cervical effacement- gradual thinning, shortening and drawing up of the cervix into LUS - Causes expulsion of the mucus plug- "bloody show" - PGE2 acts on EP2 and EP4 receptors in the LUS and cervix causing relaxation - Uterine contractions and pressure from the descending fetus further facilitate dilation of the relaxed cervix

The umbilical artery has a higher oxygen saturation (SO2) than the umbilical vein. T or F?

FALSE - SO2 for umbilical artery= 45% - SO2 for umbilical vein= 85% (bc fetal Hb)

Physiological Changes in Circadian Rhythms

Fluctuations over 2 consecutive days - alertness and core body temperature vary similarly - growth hormone and melatonin in the blood are highest during sleep (although at different times) - cortisol peaks at waking - alertness decreases when sleeping - temperature decreases at night NOTE: when left in an "isolated situation": living in absence of exxternal time idnicators - we see a slight shift in sleep/wake cycle - intrinsic cycle= 24-25 hours

Basal Tears

Fluid that is always present in our eyes, which hydrates the eye - We produce 5-10 ounces each day and it drains through the nasolacrimal duct ** this is why you get a runny nose when you cry

Membrane covered areas ("soft spots") in immature skulls between 2 bones, where as a suture will form later

Fontanelles (4) - Sphenoid Fontanelle - Mastoid Fontanelle - Anterior Fontanelle - Posterior Fontanelle

GFR increases during pregnancy. True or False?

GFR begins to increase in early pregnancy, peaks at ~40-50% above baseline levels by the beginning of the second trimester, and then declines slightly * Increased GFR results in increased filtration and excretion of water and solutes (glucose, protein) increased urine flow and volume, decreased serum blood levels of nitrogen, creatinine and uric acid

Glymphatic System

Drainage formed by astrocytes that form a perivascular space around arteries and veins within the brain - this drainage system is most active during sleep! ** Removes debris (proteins) discarded by cells through metabolism ** Proteins, like amyloid plaques, can disrupt normal brain function (can lead to Alzhiemers)

Sleep can be measured using an

EEG (electroencephalogram) or MEG (magnetoencephalogram) EEG - measures generalized neural activity - non-invasive, painless - diagnostic uses: epilepsy, sleep disorders, brain disorders MEG - records miniscule magnetic signals generated by neural activity - better localization of neural activity than EEG - Non-invasive, painless - Diagnostic uses

PGE2 acts on the

EP2 and EP4 receptors to induce cerivcal ripening during parturition PGE2 analogs (ex. Dinoprostone) are first and foremost classified as "cervical ripening agents" (cervical ripening= relaxation= dilation)

Corticobulbar Tract Pattern of Innervation

III, IV, V, VI, VII (to upper face), IX, X are all BILATERAL ** All CN motor nuclei are bilaterally located with contralateral dominence EXCEPT for: 7,11,12 are exceptions: - VII (Facial- ventral component) to lower face: contralateral ONLY - XI (Accessory): ipsilateral ONLY - XII (hypoglossal): contralateral ONLY General Rule: Bilateral innervation with contralateral dominence (with stronger signal/innervation on opposite side) ** Unilateral UMN lesion: NO deficit- due to bilateral innervation ** Unilateral LMN lesion: IPSILATERAL loss of motor control (also: hyporeflexia, atrophy, fasciculations)

Pulsatile activity is currently hypothesized to be an

INTRINSIC property of GnRH neurons with hormonal & neural inputs providing modulatory effects - Estrogen usually has inhibtory effect on GnRH, BUT estrogen at very HIGH levels increase GnRH (pre-ovulatory gonadotropin surge) - Progesterone: ALWAYS suppresses GnRH pulsatility Things that supress GnRH pulsatility: - CRH - Endorphins - Prolactin (PRL) - & other opiods Things that increase GnRH pulsatility: - Kisspeptin - Leptin (leptin regualtes Kisspeptin expression- decreased expression of kisspeptin mRNA is evident in cases of hypoleptinemia) --> this provides evidence of a link between metabolic status and reproduction, which may have a role to play in age of onset of pubtery and help explain disturbance of menstrual cyclicity in females as a consequence of change in weight

Psycho/Educational Testing- Achievement

Important in testing for learning disability - Examines proficiency in particular subject areas (i.e. reading, writing, mathematics, etc) K-12: evaluate performance in instructional areas - compare individual performance to expacted grade level skills College and beyond: entrance exam (i.e. SAT, MCAT, USMLE)

External Genitalia at the Indifferent Stage

In 3rd week, cloacl folds form around the cloaccal membrane - Cranially, the cloacal folds join to form the genital tubercle - Caudally, the folds form the urethal folds anteriorly and the anal folds posteriorly - Genital swelling appear lateral to the urethral folds- genital swellings wil become scrotal swelling in the male and labia majora in the female

Ideational/Conceptual Apraxia

Inability to conceptualize and complete a multi-step task, or voluntarily perform a learned task with an object or tool Ex: Attempts to put shoes on before socks- unable to get dresses, and button shirt - attempts to comb hair with toothbrush

Examination of the Larynx may be done with an

Indirect Layrngoscopy with a mirror or Direct laryngoscopy with tubular endoscopic instrument

Interpersonal and relationship problems after SCI

Individuals with physical disabilities are subject to stereotypes, discrimination and devaluation - viewed as fundamentally different than "normal", "percieved as dependent or helpless" - able-bodied people tend to focus on the disabling characteristics rather than other qualities - training and support of support providers can help prepare them for their unanticipated role - community-based resources (ex. personal attendant) can help promote autonomy) - peer networks and social support groups can help for sharing struggles and strategies ** Implicit biases: suttle form of discrimination- internal beliefs that are unconscious- important to understand what implicit attitudes you might have that may affect the way you treat someone with a disability

Combined Hormonal Contraceptives (Estrogen (ethinyl estradiol) + Progestin

MOA: - inhibit ovulation by suppression of the hypothalamic gonadotropin-releasing hormone- this suppresses LH and FSH release from the anterior pituiatry - estrogen suppress FSH release and stabilizes the endometrium, this prevents intermentstrual bleeding referred to as breakthrough bleeding - Progestin suppress LH and creates thick, viscous cervical mucus which restricts passage of sperm- progestin also makes the endometrium unfavorable for implantation Adverse effects: - increased risk for venous thromboembolism, especially in women over 35 yrs old who smoke (likely related to estrogen, risk may be reduced by lowering the estrogen dose) - nausea - edema - more severe migraine headaches - acne and hirsutism: caused by progestin and androgen agonist activity - decrease lactation: caused by the estrogen component; not good for breastfeeding pts - increased risk of hormone dependent cancers: the ecidence is unlcear and there is no consensus

Letrozole in the induction of ovulation

MOA: - inhibition of aromatase- inhibit the conversion of androgens to estrogens. the reduction in estrogen decrease the negative feedback on the hypothalamus and pituitary- this increases LH and FSH levels which increases follicle development and ovulation Clinical Uses: - infertility in anovulatory females with polycystic ovary syndrome - breast cancer in postmenopausal women (the primary use of aromatase inhibitor is breast cancer)

General Structure of the Eye

Measures ~25mm in diameter - is suspended in the bony orbital sockets by 6 muscles that control its movement - a thick layer of adipose tissue partially surrounds and cushions the eye ** the optic nerve connects the eyes to the brain

Facial Nerve Injury (Bells Palsy)

Paralysis to facial muscles on AFFECTED SIDE (entire one half of the face) - Due to lower motor neuron/peripheral nerve damage

A pt comes to you with rigidity, bradykinesia, stooped posture, and tremor- what might they have?

Parkinsons - Affects substantia nigra pars compacta; dopamineric pathway (nicrostriatal pathwat) - Cause: "idiopathic", some genetic links ** affects BOTH sides of body bc loss of Dopamine occuring all throughout body

Path of parotid duct

Parotid duct runs from the anterior surface of the gland, passes over the masseter muscle, pierces the buccinator muscle and enters the mouth, lateral to the 2nd maxillary molar

From the inferior aspect (base) of the skull, the following major bones are visible (AKA basicranial features):

Parts of Viscerocranium: - 2 Maxilla - 2 Palatine - 2 Zygomatic - Vomer Parts of Neurocranium: - Sphenoid - 2 Temporal - Occipital bone

Drugs for Erectile Dysfunction

Phosphodiesterase-5 Inhibitors: - Sildenafil - Tadalafil Prostaglandin E1 Analog - Alprostadil ** these target cardiovascular system (blood flow)

Cranial Nerves in the Neck (9,10,11,12)

Glossopharyngeal nerve (CNIX): - exits the skull through the jugular foramen - in the neck it gives rise to the carotid nerve which provides visceral sensory information (GVA axons) from the carotid sinus and body- innervates stylopharyngeus muscle (BE axons) Vagus Nerve (CNX): - exits skull through jugular foramen - in the neck it branches into laryngeal and pharyngeal nerves to provide innervation to larynx and pharyngeal muscles (BE axons)- will also continue into the thorax and abdomen to provide parasympathetic innervation (GVE axons) Spinal Accessory Nerve (CNXI): - exits the skull through the jugular foramen - in the neck it innervates the sternocleidomastoid and trapexius (GSE axons) Hypoglossal nerve (CNXII) - exits the skull through the hypoglossal canal** - in the neck crosses the internal and external carotid arteries anteriorly to reach and innervate the all of the intrinsic and extrinsic muscles of the tongue (GSE axons) except palatoglossus (what nerve innervates palatoglossus!?)

Neocortex can be

Granular or Agranular - Granular= well developed layer 4 - Agranular= smllaer less developed layer 4 ** Primary sensory regions are granular *** Primary motor (area 4) and premotor (area 6) cartex are agranular

Antral (Vesicular) Follicle

Granulosa cells secrete follicular fluid (aka liquor folliculi) and create spaces between cells - Follicular fluid contains factors such as growth factors and hormones (progesterone, androstenedione, and estrogens) - Follicular fluid accumulates and enlarges the spaces to forma a cavity called the antrum ** Follicles are now called antral, tertiary, or vesicular follicles ** Located in the deep cortex Granulosa cells around the oocyte form a small hillock, the cumulus oophorus (CO) which protrudes into the antrum Granulosa cells around the zona pellucida make up the corona radiata (CR) and accompanies the oocyte when it leaves the ovary at ovulation ** Granulosa cells produce estrogen (from precursor androstenedione produced in theca interna cells) In the Wall of the Antral Follicle: - Theca interna (TI) cells appear vacuolated and lightly stained bc of their cytoplasmic lipid droplets, a characteristic of steroid-producing cells (like Leydig cells in male) *** Theca interna cells secrete androstenedione that is transported to the granulosa cells where it is transformed into estradiol by the enzyme aromatase, this estrogen then goes everywhere in the body

How does the internal carotid artery reach the cranial vault?

Internal carotid artery enters the cranium via the carotid canal and courses superior to the foramen lacerum as it exits the carotid canal and twists into the cavernous sinus ** Foramen lacerum is fibrocartilage in life- but dried out on cadavers

Major Diseases of the Basal Ganglia includes

Hypokinetic Disorders: - Parkinsons Disease (PD)- affects substantia nigra Hyperkinetic Disorders: - Huntingtons Disease or Athetosis- affect the Caudate - Hemiballismus- affects the Subthalamic Nucleus

Muscles of facial expression are associated with pharyngeal arch

II and therefore are innervated by the facial nerve, as this is the nerve within that arch - Muscles of facial expression, having developed from phayngeal arch, are innervated by branchial efferent (BE or SVE) axons of the facial nerve Facial nerve exits the stylomastoid foramen and dives into the parotid gland There are 5 terminal branches of the facial nerve (BE axons) that emerge from the parotid gland: 1- Temporal branches 2- Zygomatic branches 3- Buccal branches 4- Marginal Mandibular branches 5- Cervical branches " To Zanzibar By Motor Car" ** The intimate relationships between the facial nerve and parotid gland mean that surgical removal of the parotid gland is difficult dissection if all branches of the facial nerve are to be spared

Einsteins cerebral hemispheres

Since the death of Einstein in 1955, only 6 peer-reviewed articles had been published about his brain - Einsteins brain was average in size, BUT had a greater density of neurons in some parts of the brain and a higher than usual ratio of glia to neurons *** It would also seem that einsteins parietal lobes -- which might be linked to his remarable ability to conceptualize physics problems- had a very unusual pattern of grooves and ridges *** Somatosensory and motor cortices related to the face and tongue are much larger than normal - Prefrontal cortex: linked to planning, focused attention and perserverance- is also greatly expanded ** Whether einstein started off with a special brain that predisposed him to be a great physicist, or whether doing great physics caused certain parts if his brain to expand

Fluoxetine

Site of action: Seotonin transporter Action: - inhibition

Tetrabenazine

Site of action: Vesicular monoamine transporter 2 Action: - Inhibition

Ventral Horn Enlargements

The basic pattern of the spinal cord white and grey matter is altered according to the relative amount and density of body innervaated... more neurons are located where extremities are located The following are alpha motor neuorns packed into ventral horns: *** - Cervical enlargement (C5-T1) for the upper limb (C5-T1= brachial plexus) - brachial plexus - upper limbs ***- Lumbar enlargement (L1-S3) - lumbosacral plexus - lower limbs

Myometrium

Thickest layer of uterus Composed of 3 layers of smooth muscle: - inner longitudinal - middle circular (stratum vasculature) - outer longitudinal ** The size & number of muscle cells are related to estrogen levels During pregnancy: 1. Myometrium increses greatly both due to hyperplasia (increase in number of smooth muscle cells) and hypertrophy (increase in cell size) 2. Smooth muscle cells synthesize and secrete collagen leading to significant increase in collagen content of the uterus - contract during childbirth and to expel placenta 3. After pregnancy some smooth muscle cells will be destroyed and others will decrease in size with enzymatic degradation of collagen, and so the uterus will return to its pre-pregnancy size

What does the cranium contain?

The brain! As well as the cerebllum, brainstem, cranial nerves, vasculature and other associated structures

The Gag Reflex (Pharyngeal Reflex/Laryngeal Spasm)

The gag reflex helps to prevent choking - A reflex contraction of the pharynx that is initiated by touching the pharyngeal aspect of the tongue, uvula, roof of mouth, or the area of the palatine tonsils *** Gag Reflex is composed of an: - Sensory loop (Afferent) limb (CNIX) and an - Voluntary Motor loop (Efferent) limb (CNX) ** If the glossopharyngeal nerve (CNIX) is damaged during a tonsillectomy, then the sensory limb of this reflex is lost

Upper motor neuron lesions vs. Lower motor neuron lesions

Upper motor neuron lesion: - everything goes up - produces spastic paralysis - weakness of muscles (paresis) - hypereflexia - hypertonia with spasticity - babinski sign present - increased muscle tone - weak muscle power - disue atropjy - decreased speed of movement - large area of coverage Lower motor neuron lesion: - everything is lowered - produces flaccid paralysis - hypotonicity of muscle (paralysis) - absent or hypotonic reflexes (areflexia/hyporeflexia) - reduced muscle tone with fasciculations (twitching of muscle fibers) - muscle atrophy pronounced - very weak muscle power - lost speed of movement - area of coverage is loacalized - babinski reflex is ABSENT

MRI of the female pelvis

Why is it used? - provides superb depiction of female pelvic anatomy - useful when ultrasound is inconclusive or suboptimal - for preoperative evaluation and staging of endometrial or cervical cancer - no ionizing radiation so useful for gynecologic conditions that occur during pregnancy

_____ Is the primary uterorelaxant hormone responsible for maintenance of pregnancy by stimulating myometrial quiescence during phase 1 of parturition

Progesterone

Adie's Pupil

"Tonic Pupil"/ "Holmes-Adie Pupil" - Pupil with a poor pupillary light reflex - Pupil response is "sluggish" and slow to constrict to light - Dilation of the pupil after constriction is slow and delated- therefore they call it a "tonic" constriction or "tonic pupil" - Accomodation is slow, sluggish and prolonged ** Associated with damage to postganglionic parasympathetic innervation to the pupil/pathology to the ciliary ganglion Ex: Left eye does NOT constrict despite light, left eye is "slow" to accomodate--> Damage to left ciliary/post-ganglionic fibers

Retinal ganglion cells can be further classifed as

"parasol" or "midget" cells and these terminate in the lateral geniculate nucleus ** The nucleus is organized into 6 different layers, each layer receiving information from only one eye, and retinal ganglion cell axons will terminate in retinotopic patters Layers 1 and 2 are MAGNOCELLULAR Layers: receive inputs from parasol ganglion cells that are senstitive to movement and contrast - Layer 1 receives input from the CONTRALATERAL eye - Layer 2 receives input from the IPSILATERAL eye Layers 3-6 are PARVOCELLULAR layers: receive inputs from midget ganglion cells that are sensitive to COLOR and FORM - input to these layers alternate ipsilateral/contralateral eye

Progesterone Receptor Anatagonists

Mifepristone Ulipristal

Basal Ganglia Diseases include

- Parkinsons - Huntingtons - Athetosis - Hemiballismus

Mesonephric (Wollfian) Ducts develop into the

- epididymis - vas deferens - seminal vesicles in the male

Ester vs. Amide

Esters- ester bond O=C-O ex. Cocaine Amides: NH-C=o-CH2 ** amides have an extra "i in their name "lidocaine"

Define sexual dysfunction

Heterogenous group of disorders charactereized by a clinically significant disturbance in a persons ability to respond sexually or to experience sexual pleasure

Ataxia

Lack of finely tuned muscular movements involved in postural control..inability to coordinate voluntary movements

Nuclei for CN III & IV are in the

Midbrain

Leydig cells secrete

Testosterone Sertoli cells - secrete Androgen Binding Hormone (keeps adrogens high for the development of sperm)

In the basilar membrane of the ear, higher frequencies are heard

closer to the base - lower frequencies are heard closer to the apex

Human placental lactogen (hPL) is a hormne produced by the

placenta that promotes the development of insulin resistance during pregnancy

Primary Cortex directly receives

sensory information or directly instructs lower motor neurons

Acetylcholine transmission

synthezised presynaptic--> vesciles--> ca2+ release (botox and inhibit this)--> post synaptic or metbaolized the acteylcholinesterase

Fibrous septa radiating from the tunica albuginea penetrate the testis, dividing it into ~250 pyramidal compartments known as the

testicular lobules - Each lobule is occupied by 1-4 seminiferous tubules enmeshed in a loose web of CT that is rich in blood and lymphatic vessels, nerves, and interstitial cells (Leydig Cells) - Seminiferous tubules produce sperm (~200,000,000 per day in adulte male) - Leydig cells (interstitial cells) secrete testicular androgens (primarily testosterone)

Gonadotropin: LH and FSH in the induction of ovulation

these are indicated for ovulation induction in anovulatory women with hypogonadotropic hypogonadism secondary to hypothalamic or pituitary dysfunction- Gonadotropins are also used to induce ovulation in women with PCOS who do not repsond to clomiphene - hCG; from pregnant woemn (LH-like) - hMG; purified from urine of post-menopausal women (contains LH and FSH) - recombinant (synthesized in a laboratory) LH and FSH are now available- they are quite expensive ** hCG: human chorionic gonadotropin ** hMG: human menopausal gonadotropins

Amino Acid Transmitters

these are the Majority of excitatory and inhibitory transmission in the nervous system - Glutamate (from excitatory pyramidal cells) - Aspartate - GABA - Glycine - Taurine

Disomy

very rare, so definitely not familial occurence - Prader- Willi occurs with an incidence of 1/10000, and only a few percent of these are caused by disomy ** reference to familial occurrence is more relevant for other disease, not so much for Prader-Willi and Angelman Uniparental Disomy - BOTH copies of one chromosome came from the SAME parent - Other chromosomes normal

Injury to the posterior spinal artery will lead to

loss of dorsal column information (discriminative touch, pressure, vibration, and proprioception sense)

Both alpha and gamma motor neurons are

lower motor neurons, originating in the ventral horn, signaling out the ventral root- it is the muscle fiber target of innervation that is different

A female with presence of severe vaginal atrophy and low estrogen may experience

pain related to dyspareunia (painful sex) ** Pt with history of breast cancer should be encoraged to use dome form of a water-based lubricant to diminish the effects of vaginal dryness since estrogen is likely contraindicated

A prostaglandin synthesis inhibitor would act to

reduce prostaglandin synthesis - Since PGE2 acting on EP2 and EP4 receptors in the cervix is necessary for cervical dilaiton, and PGF2-alpha acting via FP receptors in the myometrium is a stimulus for contracting, blocking prostaglandin synthesis would inhibit these processes Also a oxytocin receptor blocker would inhibit oxytocin binding to its receptor and inhibit uterine contractions

6th step of neurotransmission= Uptake- what drugs work here?

Neurotransmitter transporters are common drug targets ** taken back up from where it was released - SERT: serotonin transporter, site of action of selective serotonin reuptake inhibitors (SSRIs), Ex: fluoxetine*** (inhibits serotonin transporter- leads to enhanced synaptic levels of serotonin- can interact with post-synaptic and can increase singaling - DAT: dopamine transporter, site of action of cocaine - NET- norepinephrine transporter serotonin norepinephrine reuptake inhibitors (SNRIs) target both SERT and NET, Ex. duloxetine - Glutamate reuptake is primarily into astrocytes

Eyelid

A pliable tissue with skin covering its external surface and smooth conjunctiva lining its inner surface - at the outer rim of the eyelid are a series of large hair follicles for the eyelashes - internally eyelids contain fascicles of skeletal muscle comprising the orbicularis oculi muscle and closer to the conjunctiva a thick plate of fibroelastic tissue called the tarsus ** The Meibomian Glands (aka tarsal glands) are a special kind of sebaceous gland--> produce an oily substance that prevents evaporation of the eyes tear film Key function of the eyelid: - to regularly spread the tears and other secretions on the cornea, since it must be kept continuously moist *** The blink reflex protects the eye from foreign bodies

Argyll Robertson Pupil

A pupil that does NOT react to light, but DOES constrict during accomodation - this is called a "Light-Near Dissocation" - Pupils can be small and irregular ** Complication in pts with Syphilis (neurosyphilis, tabes dorsalis)- deficit starts unilateraly and becomes bilateral ** Precised lesion location is unknown, but is belived to be in the pretectal area (midbrain), or region near the cerebral aqueduct, where it affects fibers dorsal to the Edinger-Westphal nucleus that are responsible for pupillary constriction, but spares ventral fibers that subserve the accomodation response Ex: Right eye does not react to light but does to accomodation

Muscles of Facial Expression Found in the Oral Region

ALL innervated by CNVII- BE axons (remember ALL muscles of facial expression are innervated in same way) Buccinator Fx: presses cheek against the teeth Depressor Anguli Oris Fx: draws corner of mouth downward and laterally Depressor Labii inferioris Fx: draws lower lip downwards and laterally Levator Labii superioris Fx: raises upper lip Levator Labii superioris alaeque nasi Fx: raises upper lip and opens nostril Levator anguli oris Fx: raises corner of mouth Mentalis Fx: raises and protrudes lower lip and wrinkles skin on chin Orbicularis oris Fx: Closes lips, protrudes lipds Risorius Fx: Retracts corner of mouth Zygomaticus major Fx: Draws corner of mouth upward and laterally Zygomaticus minor Fx: Draws upper lip upward

Assessing severity of spinal cord injury

ASIA impairment Scale (AIS) - this would be done after resolution of spinal shock (TEMPORARY paralysis/weakness/ flaccid/ spasticity) during actue injury - we know spinal shock is resolved once you see the return of reflexes (it can last a few days or weeks after acute injury From acute care to rehabilitation this AIS is used to see what sensory motor function is impaired, intact, weak etc- this is down on both left and right for motor and sensory function - individuals graded on scale (A-E) A: complete loss of mottor and sensory functioning below the lvel of injury B: incomplete- some sensory but NO motor function is preserve below th elevel of injruy C- incomplete: some motor function is preserved below the level of injury but more than half of key muscles below the neurological level cannot move against gravity D- incomplete: most (more than 50%) of motor function is preserved below the neurological level, and are strong enough to move against gravity E- normal: all sensory and motor function is normal

What are the 4 basic shape types of the Pelvis?

Gynecoid - Greek; gyne= woman - * Normal female type of pelvis; optimal shape for childbirth Android - Aner/Andro= man - * Typical shape for male Anthropoid - Anthropos= human Platypelloid - Platys= broad & pella= bowl

Polycystic Ovary Syndrome (PCOS)

Involves growing primary follicles PCOS is characterized by: - enlarged ovaries with numerous cysts and - an anovulatory state (no follicles completing maturation successfully) ** Clinical presentation is variable BUT PCOS is a common cause of infertility in women - etiology is unclear, although increased androgen production by the ovaries or adrenals is likely involved

What hormone stimulates milk ejection?

During suckling (or a though, sight or sound of infant) OXYTOCIN sitmulates contraction of myoepithelial cells lining the alvoeli and ducts - Forces milk down the ampulla of the lactiferous ducts --> Milk-Ejection Reflex

Placental Septation

During the 4th & 5th months, the decidua basalis undergoes rearrangement to form several wedge shape areas of the decidua, placenta septa, that project to the chorionic plate - the septa divide the placenta into a number of incomplete compartments or cotyledons ** Remember these cotyledons can lead to hemorrhage if left behind- they MUST be expelled at the birth of the baby

During what phase of the human sexual response cycle do emission and ejaculation occur?

During the orgasm phase - Contraction of vas deferens, seminal vesicle & prostate leads to emission - Presence of seminal fluid in the urethra stimulates ejaculation

Dermatomes

An area or region of skin innervated by a singl spinal nerve- Axons from a dermatomal area all have cell bodies in the same dorsal root ganglion ** Shingles virus may break out of the nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve - The virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponging dermatome

Syringomyelia

An enlargement of the central canal develops resulting in a "cavity" and destruction of neural tissue ** Usually occurs cervical levels - resulting in "cape" loss of pain and temperature sensation-- follows C5 dermatome/but can extend to the medulla or to lumbar levels ** Usually spares touch/vibratory perception Clinical Features: (BILATERAL LOSS) 1- Loss of pain and temperature sensation over the neck, shoulders and arms (bc of spinothalamic crossing axons at the anterior white commissure) 2- POSSIBLE weakness & atrophy of hands/arms (if damage extends to anterior horns)

Syringomyelia

An enlargment of central canal develops resulting in a "Cavity" and destruction of neural tissue - Usually occurs cervical levels results in a "cape" loss of pain and temp sensation- follows C5 dermatome/but can extend to the medulla or to lumbar level s ** usually spares touch/vibratory perception Clinical features: - loss of pain and temp sensation over neck, shoulder and arms (bc of spinothalamic crossing axons at anterior white commissure) - POSSIBLE weakness and atrophy of hands & arms (if damage extends to anterior horns)

Nervous System Components include

Central Nervous System (CNS) - brain, cerbellum, brainstem, spinal cord - cranial nerves I-II Peripheral Nervous System (PNS) - spinal nerves - cranial nerves III- XII - ganglia ** Functionally, the peripheral nervous system links the peripheral structures of the body, such as muscles and glands, with the central nervous system

Cervical glands and Cervical mucus

Cervical mucosa undergoes little change in thickness during the menstrual cycle - is NOT sloughed during the period of menstruation - Cervical mucus lubricates the vagina during sexual intercourse (there are NO glands in the vagina) Durign each menstrual cycle, the cervical glands undergo importnat functional changes that are related to the transport of spermatozoa within the cervical canal Ovulation phase: increases in amt 10 fold & watery so that sperm can pass through it Luteal phase: more viscous-restricts the passage of sperm into the uterus Pregnancy: fomrs the cervical plug

Insomnia

Chronic inability to fall asleep - Primary: abnormality in sleep- no mental/ physiological - Secondary: pain, discomfort, alcohol/drug use - of shorter duration Treatment: - Behavioraly theraly (1st line of therapy) - PHARM Ramelteon (melatonin receptor agonist)

Innervation of the Intrinsic Muscles of the Eye (Autonomic)- CILIARY MUSCLE

Ciliary Muscle Parasympathetic innervation (activates): Oculomotor Nerve (CNIII)- recieves parasympathetic fibres from the short ciliary nerves that arise from the ciliary ganglion Sympathetic Innervation (inhibitory, based on parasympathetic activity) Superior Cervical ganglion --> Internal Carotid Plexus --> Ophthalmic artery Plexus --> Nasociliary nerve (V1) --> long ciliary nerves ** changes the shape of the lens within the eye but does NOT affect the pupil or the iris

Disordered Thought Processes:

Circumstantial - drifts, but comes back (get to their point eventually) Tangential: - wanders off without direction and NOT coming back Flight of ideas: - rapid shifts with only superficial connections Word salad: - Random Neologisms: - made-up words Clang Associations: - linking words by sound (ex. rhyming) rather than meaning Thought blocking - just stop Echololy - repating what somone says

Cleft Lip and Cleft Palate

Common defects of facial development Defects ANTERIOR to the incisive foramen include: 1. lateral cleft lip 2. cleft upper jaw 3. clefts between the primary and secondary palates ** these all result from partial or complete lack of fusion of the maxillary prominence with the medial nasal prominences on one or both sides Defects POSTERIOR to the incisive foramen include: - Celft (secondary) palate - Cleft uvula ** Cleft palate results from a lack of fusion of the palatine shelves ** All defects can vary in severity

Wernicke-Korsakoff Syndrome (wet brain)

Common in alcoholics- the digestive system of an alcoholic is unable to absorb vitamin B-1 (thiamine)- this thiamine deficiency affects the mammillary bodies, cerebellum, CN III, IV, VI - Pts have a severe anterograde and retrograde amnesia, disorientation and confabulation= distorted, fabricated, incorrect "storis" or memories usually bc of dementia or brain damage-- confabulators are not liars in that they have no intent to deceive- it is simply part of the pathology *** Wernicke-Korsakoff Psychosis (( COAT RACK )) C- Confusion O- Ophthalmoplegia A- Ataxia T- Thiamine deficiency R-Retrograde amnesia A- Anterograde amnesia C- Confabulation K- Korsakoff's psychosis

What can be done for Hydrocephalus?

Endoscopic third ventriculostomy (ETV): - usually used for obstructive hydrocephalus where a fiberoptic endoscope is maneuvered into the lateral ventricle, interventricular foramen and the 3rd ventricle - there, the floor of the 3rd ventricle can be "broken" to allow CSF release and absorption Shunt: Thin, long tubing, is situated in a ventricle and then threaded under the skin - excess CSF is carried away from the brain to be absorbed elsewhere, many times in the abdominal region - a valve is able to control the flow of CSF

Anal Triangle

Fat-filled area surrounding the anal canal Contents: - Anal aperture: the opening of the anus - External anal sphincter muscle: voluntary muscle responsible for opening and closing the anus - Ischioanal fossa: wedge-shaped spaces willed with fat** and CT, each fossa (right and left) is located laterally on either side of the anua Ischioanal Fossa (Ischiorectal Fossa) - fat-filled fossa that allows for expansion of the rectum/anus with passage of fecal material Contents: - dense fat - pudendal nerve & internal pudenal vessels within the pudendal canal - inferior rectal nerve & vessels crossing the fossa to reach anal canal *** Pudendal Canal (Alcock's Canal) - canal that transmits pudendal nerve and internal pudendal artery & vein

Activation of which fetal endocrine axis appears to be key factor in initiating phase 2 of paturition?

Fetal Hypothalamic-Pituitary Adrenal Axis - Increased placental CRH--> increased fetal ACTH --> increased cortisol and increased DHEAS --> increased estrogen Increased estrogen then leads to: - increased cervical EP2, EP4, and PGE2--> Cervical Ripening - increased myometrial CAPs--> Braxton Hicks Contractions

Lateral Corticospinal/Pyramidal System

Fibers cross at: - Pyramidal Decussation (there is NO synapse before the corss- the axons simply cross here to reach their side of action) Deficits: - Lesion rostral to the decussation results in CONTRALATERAL hemiplegia - Lesion caudal to the decussation results in IPSILATERAL hemiplegia - Lesions to the pyramidal decussation will produce BILATERAL deficits in either upper or lower limb depending upon location Hemiplegia= total or partial paralysis on one side of the body NOTE: Corticospinal (pyramidal tract: -Origin: Cortex (primary motor cortex, premotore, somatosensory, etc)- UMN -Target: Spinal cord ventral horn- LMN (alpha motor neurons) -Decussation: pyramidal decussation (medulla)

What cells of the endometrium are involved with decidualiztion?

Fibroblast-like stromal cells differntiate into round cells with glycogen and lipid droplets: "predicidualization" - provides nourishment and structural support to the invading blastocytes (if present) - Once decidualization has been initiated, no further implanation events can occur *** Decidualization process continues in pregnancy until the majority of stromal cells in the functionalis zone are differntiated- i.e. the endometrium is transformed into the decidua of pregnancy --- once it has been initiated NO additional implantation can occur

Area of highest visual acuity

Fovea - it is the central fixation point for each eye - light reachs rods and cones without having to pass through the other layers - Infromation from the fovea is carried in about half of the axons in the optic nerve and half of the cells in the primary visual cortex Macula= the region surrounding the fovea, which also has a high visual acuity

Psychological Assessment

From APA - clinically- focused assessment of personality, psychopathological symptoms, cognitive and neuropsychological processes, and interpersonal behavior - psychologists use tests and other assessment toold to measure and observe a clients behavior to arrive at a diagnosis and guide treatment - gathering data for purposes of description, classification, prediction, intervention planning, and monitoring- "snapshot" vs continuous monitoring

Mullerian fusion defects with obstruction

HURT! - Ex: Noncummicating Horn, Unicornuate Uterus In Mullerian Fusion Defects - If obstruction to menstrual flow.. Frequently cyclic pelvic and menstrual pain - Can have retrograde menstrual flow through the fallopian tube... with associated endometriosis - NO cervical or vaginal obstruction + irregular uterine contour + cyclic pain: Non-communicating uterine hron - Commonly associated with ipsilateral renal abnormalities: order an intravenous pyelogram

External Carotid Artery

Has 8 branches 1. Superior Thyroid Artery 2. Ascending Pharyngeal Artery 3. Lingual Artery 4. *Facial Artery 5. Occipital Artery 6. *Posterior Auricular Artery 7. *Maxillary Artery 8. *Superficial Temporal Artery " Some Anatomists Like Freaking Out Poor Medical Students" **** Facial, posterior auricular, mental branch of the maxillary and branches of the superficial temporal artery will supply the face/scalp

The fetus produces Hb (HbF) that is distinct from adult Hb (HbA) ---

HbA is composed of 2 alpha and 2 beta chains HbF is composed of 2 alpha and 2 gamma chains - Fetal Hb affinity for oxygen is greater than that of HbA - Notably, the P50 (partial pressure of oxygen at which Hb is 50% saturated) of fetal Hb is lower (~18mmHg) that that of HbA (~26mmHg) - As such, the oxyhemoglobin saturation cure is left-shifted for HbF compared to HbA - the greater affinity of HbF for oxygen is explained by lack of interaction of HbF with 2-3BPG - In adult RBCs, 2-3,BPG binds to beta chains of HbA - HbF lacks beta-chains and has gamma-chains which interact less efficiently with 2-3,BPG

A pt comes to you with wild flailing movements of one arm and leg?

Hemiballismus - Affects subthalamic nucleus (if both damaged can have bilateral symptoms, but usually only ONE side is affected i.e. STROKE would only affect one side) - Cause: Older people, stroke; small ganglionic branch of the posterior cerebral artery

Goldenhar Syndrome (AKA Oculo-Auriculo-Vertebral (OAV) Syndrome):

Hemifacial Microsomia: abnormal development of the lower half of the face on one side - congenital malformation of the first pharyngeal arch & second pharyngeal arch (cause is unknown) --> leads to abnormal development of nose, ear, mandible, lip, soft palate, facial muscles and muscles of mastication on ONE SIDE resulting in facial asymmetry (65% of cases) with patients having a "crooked" smile (** remember muscles of mastication where from Arch1) - pts often have tumors and dermoids (saclike growth) of the eyeball and vertebral defects (spina bifida, fused and hemivertebrae) ** Fairly common congenital anomaly, occurring in 1/5600 births and is the second most common defect after cleft palate and lip

Lymphatic drainage of the Pharynx and Larynx

Pharynx: Nasopharynx --> retropharyngeal lymph nodes Oropharynx --> Jugulodigastric lymph nodes Larynx: - Lymphatic vessels SUPERIOR to the vocal folds drain into the superior deep cervical lymph nodes - Lymphatic vessels INFERIOR to the vocal folds drain into pretracheal/paratracheal nodes THEN into inferior deep cervical lymph nodes ** Rememeber- all of th elymph will ultimately drain into the deep cervical nodes, then the jugular lymphatic trunks, and finally to the thoraic duct on the left orrr the lymphatic duct on the right NOTE: the palatine tonsil drains through the pharyngeal wall into jugulodigastric nodes in the region where the facial vein drains into internal jugular vein

In addition to the Desire phase, what are the other 4 phases of the human sexual response cycle?

Phase 0 (Desire): urge to seek sexual stimulation Phase 1 (Excitement): first noticebale physical changes; increase in blood pressure, respiration rate, heart rate and skeletal muscle tone; pelvic congestion begins Phase 2 (Plateau): increase in blood pressure, respiration rate, heart rate; myotonia pronounced; erection prominent; labial and vaginal swelling, vaginal lubrication increases Phase 3 (Orgasm): heart rate, blood pressure, depth and rate of breathing at maximal levels; intense muscle spasms throughout body; emision and ejaculation; intense vaginal contractions Phase 4 (Resolution): blood pressure, heart rate and respiratory rate return to baseline; skeletal muscle tone normalizes; erection subsides; labial and vaginal swelling subsides

Describe the cascade of events which occur in the final 6-8 weeks of gestation that lead to the onset of labor?

Phase 2: Activation phase= preparation for labor - Final 6-8 weeks of gestation (until cervical dilation begins*) - Change in estrogen and progesterone ratio (increased estrogen) - increased uterine expression of CAPs, cervical ripening Transition from Phase 1 (Quiescence) to Phase 2 (Activation) * Activation of fetal hypothalamic-pituitary adrenal axis: increased placental CRH--> increased fetal ACTH --> increased cortisol and increased DHEAS--> increased estrogen ** Increased estrogen leads to: - increased cervical EP2, EP4 and PGE2--> cervical rippening - increased myometrial CAPs--> Braxton Hicks contractions

Progestins Drugs

Progesterone Medroxyprogesterone acetate Norethindrone Levonorgesterel Norgestimate Drospirenone

What are the primary functions of progesterone and estrogen during pregnancy?

Progesterone and estrogen are required for pregancy maintanence - removal of CL (removal of ovaries/oophorectomy) before 6 weeks of gestation, inadequate placentation or placental abnormaliits, result in inadequat steroidogenesis and loss of pregnancy Progesterone roles: - transforms the endometriuma into a receptive tissue capable of supporting an invading blastocyst - stimulates stromal secertions- nutrition for the early embryo - suppresses myometrial contractility - inhibit ovulation- negative feedback to hypothalamus and pituitary - stimulates breast alveoli and lobule development, inhibits lactation Estrogen roles in: - Uterus: stimulates VEGF expression and angiogenesis; stimulates eNOS, increasing NO, inducing vasodilation. Combined effect of enhancing uteroplacental blood flow - Myometrium: increase gap junction formaiton, increase progesterone receptor expression- preparation for labor - Brain: stimualates prolactin production directly and indirectly (via inhibition of dopamine)- mammogenesis and negative feedback to anterior pituitary inhibiting LH and FSH secretion- inhibits ovulation - Growth: Growth and development of the breast, growth of the pituitary, myometrial proliferation

Sense of position and movement of ones own limbs and body without using vision

Proprioception 1- stationary-position of limbs (limb-position sense) 2- sense of limb movement (kinesthesia) 3 Types of Proprioceptive Mechanoreceptors: 1- Muscle Spindle Receptors (stretch receptors- have intrafusal muscle fibers) 2- Golgi Tendon Organs (sense contractile force or effort exerted- have extrafusal muscle fibers) 3- Joint receptors (sense flexion or extension of the joint)

Blood-testis Barrier

Protects maturing sperm from immune system - Adjacent sertoli cells are bound together by TIGHT JUNCTIONS at basolateral parts of the cells, forming the blood testis barrier - The spermatogonia lie in a basal compartment that is situated below the barrier - During spermatogenesis, cells after division "squeeze through" and traverse junctions to lie in adluminal compartment situiated above the barrier (thus, spermatocytes and spermatids are in adluminal compartment) - Differentiation of spermatogonia leads to the expression of sperm-specific proteins *** Bc spermatogenesis does NOT begin until puberty, these sperm-specific proteins will be recognized as "foreign" by the immune system and provoke an immune response that would destroy the germ cells - The blood-testis barrier prevents the passage of immunoglobulins into the seminiferous tubules, prevents auto-immune rection **NOTE: OJ= occluding juntion/zonula occludens/tight junction NOTE important ID tip: - sertoli nuclei are OVAL - spermatocyte and spermatogonia nuclei are ROUND

Movements of the Temporomandibular Joint (TMJ)

Protrusion: lateral pterygoid assisted by medial pterygoid Retraction: posterior fibers of temporalis, deep part of masseter, and geniohyoid and digastric Elevation: temporalis, masseter, medial pterygoid Depression: gravity and digastric, geniohyoid and mylohyoid muscles

Which muscle helps to prevent defecation?

Puborectalis muscle - it contracts and relaxes to control the defecation process- it is a skeletal muscle (under voluntary control) - forms sling around anorectal junction of rectum and anus to create angle *** Puborectalis contraction helps maintain fecal continence (prevent defecation) - puborectalis muscle relaxation reduces the angle at the anorectal junction to allow defacation in conjunction with relaxation of the internal and external anal sphincters REMEMBER that the puborectalis muscle is one of the 3 muscles that make up the Levator ani muscles (the other two are iliococcygeus and pubococcygeus)

Progesterone ("Pro-gestation")

Source: Ovary (placenta) Biosynthesis: from pregenolone by 3beta-HSD Control of synthesis: LH & hCG upregulate expression & activity of desmolase & 3beta-HSD Effects: Brain: - Negative feedback on hypothalamus & pituitary - increased body temperature (~0.5 degrees celsius) Myometrium: - decreased contractility- quiescenece (prevents early expuslion of a newly implanted fetus) Cervix: - thick, non-elastic, viscous cervical mucus- forms mucus plug hindering sperm transport Breast: - growth & proliferation of lobules and alveoli Endometrium (during the secretory phase): - increased vascularization, extension of spiral arteries - increased size and coiling of glands (cork-screw shape) - increased glandular secretions - stromal edema and differentiation

Rima vestibuli

Space between vestibular folds ** the tirangular opening beween the 2 vestibular folds (fals vocal cords) at the entrance to the middle chamber of the laryngeal cavity

Rima glottidis

Space between vocal folds ** the triangular opening between the vocal folds (true vocal cords) and mucosa-covered parts of the arytenoid cartilages- this is narrower than and inferior to the Rima Vestibuli- this opening separates the middle chamber above from the infraglottic cavity below - both the Rima Glottidis and the Rima Vestibuli can be opened and closed by movement of the arytenoid cartilages and associated fibro-elastic membranes

Specific vs Non-Specific Nuclei

Specific: receive input from a single sensory or motor system- output is usually to a singl area of the cerebral cortex Non-specific nuclei: receive inputs from multiple regions and output is usually to multiple areas of association cortex

Pharynx and Larynx Arterial supply

Terminal branches arise from either the inferior and superior thyroid arteries, which arise from the external carotid or thyrocervical trunk Pharynx: 1. Ascending pharyngeal artery (from external carotid artery) 2. Ascending palatine and tonsillar branches (supplies palatine tonsil) of the facial artery 3. Pharyngeal branch of inferior thyroid artery (from thyrocervical trunk) supplies lower pharynx 4. Numerous branches from the maxillary and lingual arteries Larynx: 1. Superior Laryngeal artery (from superior thyroid artery (from external carotid artery) 2. Inferior laryngeal artery (from inferior thyroid artery (from thyrocervical trunk)

Detached Retina

The neural retina separates from the retinal pigmented epithelial cells - an injury to the eye or face can cause a detached retina (plus other causes) As a result of retinal detachment, the photoreceptor cells are no longer supplied by nutrients from the underlying vessels in the choriocapillary plexus of the choroid ** Rods and cones in detached retina will die unless retina is reattached (to RPE) within a day or two

Somatotopy

The orderly representation of "body parts" in cortex - More neurons are provided in cortex for those regions that we use more frequently in our environment! Hands/face have more neurons designated for them in both motor and somatosensrory primary cortices than other regions ** Homunuclus: bulit based on density of neurons (little guy with big hands and lips)

What are the branches of the 2nd Part (Muscular/Pterygoid) of the Maxillary Artery?

This is the origin of 4 Branches 1. Deep temporal arteries (Anterior and Posterior Branches) 2. Masseteric artery 3. Buccal artery 4. Pterygoid branches ** these four branches course with the nerve branches of CNV3 and can course either superficial or deep to the lateral pterygoid muscle

Rubrospinal, Reticulospinal (medial), and Vestibulospinal- clinical siginificance to rigidities

Supratentorial Lesion: Lesions located ABOVE tentorial notch - All brainstem nuclei (including red nucleus) are intact - DECORTICATE RIGIDITY Infratentorial Lesion: Lesion extends BELOW tenrotial notch - Red nucleus influence is removed - Extensor rigidity predominates - DECEREBRATE RIGIDITY

A pt presents to you with 46XY karyotype, femal genitalia and internal female organs (uterus, fallopian tubes, cervix, vagina), low levels of estrogen complaining of the inability to get pregnant- what can she have

Swyer's Syndrome: 46XY Female - Mutations of SRY gene - Defective testes determining factor protein: indifferent gonads do NOT differentiate into testes - No leydig or sertoli cells: no testosterone or antimullerian hormone (AMH) - No testosterone: wolffian ducts degenerate- no internal male organs - No testosterone= No dihydrotestosterone (DHT): external genitalia fail to virilize--> female genitalia - No AMH: Mullerian ducts--> internal female organs (uterus, fallopian tubes, cervix, vagina) Treatment: - Gonads: undeveloped clumps of tissue: "streak gonads" - High predisposition for gonadoblastoma or dysgerminoma: surgical excision early in life - Estrogen Deficient: begin hormone replacement therapy during adolescence to induce menstruation and development of femal seconday sex characteristics - Hormone replacement therapy also reduces risk of osteopenia and osteoperosis - DO Not produce ova: may be able to become pregnantthrough egg or embryo donation

Innervation of the Dilator Pupillae (Intrinsic Muscle of the Eye)

Sympathetic Innervation: Superior Cervical Ganglion (T1) --> internal carotid plexus --> ophthalmic artery plexus --> nasociliary nerve (V1) --> long ciliary nerves *** Dilates pupil

Innervation of the thyroid and parathyroid glands

Sympathetic: Remember, 2-neuron chain originating from spinal cord (T1). Post-ganglionic axons originate in the cervical ganglion (superior) to target glands Parasympethic: CNX (nerve fibers arising from superior laryngeal nerve and recurrent layrngeal nerve) *** Nerves are vasomotor, NOT secretomotor- endocrine secretion is controlled hormonally, pituitary input

Prepubertal Hypogonadism

Symptoms: delayed puberty, small penis & testes, decreased muscle mass, lack of facial hair, high-pitched voice Biochemical Findings: - decreased serum testosteron - increased LH/FSH (primary- in testes) OR - decreased LH/FSH (secondary/tertiary in hypothalmus or pituitary) Treatment: Androgen Replacement Therapy

T or F: There are lots of smooth ER and Lipid droplets in Leydig cells and other steroid-secreting cells

TRUE! All steroid hromones are made from cholesterol which is made in the sER REMEMBER: - Leydig cells are the testosterone producing cell of the testis - Tends to have conspicuous lipid droplets associated with smoothER - Leydig cells are making A LOT of cholesterol (precursor for the steroid hormone testosterone), which collects in lipid droplets

Tactile Sensations (Superficial Receptors)

Tactile sensitivity is GREATES on hairless (glabrous) skin on fingers, lips, palms & sole of foot - Fingerprints contain a dense matrix of mechanoreceptors - Mechanoreceptors sense changes in skin contour when an object is pressed against it Meissners Corpuscles (Abeta) - located beneath the epidermis within the dermal papillae at the edge of the papillary ridge - sensitive to LIGHT touch - concentrated in areas sensitive to light touch, such as fingers and lips - Encapsulated unmyelinated nerve endings - Rapidly adapting Merkels Receptors (Abeta) - transmits pressure, position, and texture sense- ALSO, 2 pt discrimination - small epithelial cell that surrounds the nerve terminal - located at the center of the papillary ridge - slowly adapting

Lateral Motor Systems

Target the spinal cord and control appendicular musculature (limbs) 1- Lateral Corticospinal 2- Rubrospinal

The Lacrimal Appartus

Tears are produced by the lacrimal glands (tubuloacinar serous glands) located beneath the conjunctiva on the upper lateral side of the orbit - Myoepithelial cells below the epithelial cells of the glands aid in the release of tears - Tears drain out of the eye through lacrimal punctum, eventually coming to the nasal cavity (why your nose gets stopped up when you cry) - Lacrimal fluid (tears) contain mucus, antibodies (IgA), lactoferrin and lysozyme

Head and Neck- Pulse Points

Temporal pulse: The superficial temporal artery or the anterior branch of the artery can be palpated- in some inidivdual pulsations of the superficial temporal artery can be seen through the skin Carotid pulse: The common carotid artery or the external carotid artery can be palpated in the anterior triangle of the neck Facial pulse: The facial artery can be palpated as it crosses the inferior border of the mandible immediately adjacent to the anterior margin of the masseter muscle

What components of the eye alter the light path to focus it on the retina?

The refractile components of the eye ** When light passes through the eye, it spasses through 4 transparent, refractile media: 1. Cornea: ** the chief refractive element of the eye 2. Aqueous humor: of the anterior and posterior chambers (minor role in diffraction) 3. Lens: **2nd in importance to the cornea in diffraction 4. Vitreous body: (minor role in diffraction)

Hypogonadism (decreased androgen production)

Types: 1. Primary: testicular dysfunction (increased LH/FSH) 2. Secondary: pituitary dysfunction (decreased LH/FSH) 3. Tertiary: hypothalamic dysfunction (decreased LH/FSH) Causes: Testes (primary): Gonadal dysgenesis (ex. Klinefelter syndrome), testicular damage, LH receptor defects, enzyme defects in testosterone biosynthesis Hypothalamus (tertiary) & Pituitary (secondary) : GnRH deficiency (ex. Kallmann Syndrome), mutated GnRH receptor, pituitary tumor, trauma, hyperprolactinemia (inhibit GnRH release) Effects: - Fetus: ambiguity of genitalia - Puberty: poor secondary sexual development - Adulthood: reduced libido, muscle atrophy, erectile dysfunction, infertility

Ductuli Efferentes

Their epithelium is composed of (mixed cuboidal & columnar epithelium) 1. Nonciliated cuboidal cells, and 2. Ciliated cells that beat in the direction of the epididymis (sperm are sitll IMMOBILE here) * The non-ciliated cells absorb musch of the fluid secreted by the seminiferous tubules * The ductuli efferentes gradually fuse to form epididymis NOTE: The non-ciliated cells reabsorb testicular fluid, while the ciliated cells propel the immobile sperm to the epididymis--> where they gain the ability to swim ** Straight tubules --> Rete testis --> Ductuli Efferentes --> Ductus Epididymis

There are 5 pharyngeal arches (** 1st pair appear by end of 4th week)- describe these arches

There are 5 pharyngeal arches: 1st, 2nd, 3rd, 4th, 6th ** the 5th arch exists only temporarily during embryogenesis *** Also, the 4th and 6th arches are "lumped" together for they both contribute to some of the same structures and are both associated with Vagus (CNX) nerve

Formation of the Amniochorionic Membrane

There is "movement" of the fetal membrane due to the increased production of the amniotic fluid (10 weeks: 30 mL, 37 weeks: 1000mL) At the end of month 3, the amnion has expanded so that it comes in contact with the chorion - There is then fusion of the amnion and chorion to form the amniochorionic membrane obliterating the chorionic cavity - this membrane ruptures during labor (breaking of the water) - the yolk sac then usually shrinks and is gradually obliterated

Reticulospinal tracts

There is a feedback loop between the reticular formation nuclei and the cerebellum *** Input from the premotor and motor cortices are integrated in that loop ** Primary targets of these projections include the nucleus reticularis pontis oralis of the PONS and nucleus reticularis gigantocellularis of the MEDULLA ** projects to the spinal cord= reticulospinal fibers Medial Reticulospinal Tract: "GO" - Excitation of anti-gravity, extensor musculature/activation of the pontine (medial) reticulospinal tract facilitates (+) spinal reflexes Lateral Reticulospinal Tract: "STOP" - Inhibition of axial extensor musculature and MRT/Activation of the medullary (lateral) reticulospinal tract inhibits (-) spinal reflexes Combined together these lead to: - modulation of muscle tone - regulation of posture

What if there is an issue in the internal carotid artery and it affects the lateral aspect containing the uncrossed axons?

This can occur if there is bilateral calcification of the internal carotid arteries ** this scenario affects the UNCROSSED axons of the temporal retina carrying nasal visual filed information --> There can be unilateral nasal hemianopia or a bilateral nasal hemianopia

In each orbit, there is a 23 degree angle between the

Visual and Orbital axes * Due to the difference between visual and orbital axes, individual eye muscle movements are not always pure, but usually the result of a combination of muscle movements

Vulva (aka Pudendum or Female External Genitalia)

Vulva is the female external genitalia or also known as the pudendum - vulva means "covering" in latin - it protects the opening of the urethra and vaginal canal - highly sensitive area in relation to sexual arousal Parts of Vulva: - Mons pubis --> rounded, fatty area located anterior to pubic symphysis - Labia Majora--> thick skin flaps - Labia Minora--> thin skin flaps - Clitoris --> erectile tissue - Vestibule --> contains openings of the urethra and vagina - Bulb of the vestibule - Bartholin's glands

Wechsler Scales

WPPSI-IV - Wechsler Preschool and primary scale of intelligence (Age 2 yrs, 6 months- 7yrs, 7 months) WISC-V - Wechsler Intelligence Scale for children (age 6-16 years, 11 months) WAIS-IV - Wechsler Adult intelligence scale (16-89 yrs)

Reciprocal Innervation (inhibition) in the Myotatic Reflex

When a stretch reflex is activated, the opposing muscle group must be inhibited, preventing the muscle groups from working simultaneously against each other ** the inhibition is accomplished by an inhibitory interneuron in the spinal cord The Ia afferent neuron bifurcates in the spinal cord: - one branch innervates the alpha motor neuron that causes the homonymous muscle to contract, producing a movement - the other branch innerves the Ia INHIBITING interneuron, which in turn innervates the alpha motor neuron that synapses on the opposing muscle *** the inhibitory neuron prevents the alpha motor neuron from firing, thereby reducing the contraction of the opposing muscle

Two principals of cortical dimensions/orientations

When we move along the radial dimension, orthogonal (at a right angle) to the pial surface, we traverse cortical layers When we move along the tangential dimension (parallel to the piral surface we traverse cortical areas ** this is well demonstrated in sensory cortical areas ** Cortex is organized into functional units called cortical columns - vertical array of 300-600 neurons including cells from layers I- VI - all neurons in the column respond to the same stimulus from one location - adjacent columns may respond to a different stimulus from the same location - each column functions as a processing unit and is interconnected with adjacent columns Another ex: Cortical Columns in the Visual System - Orientration Columns: a column in primary visual cortex may respond specifically to a bar of light in a particular orientation

Movements of the Temporomandibular Joint

Gliding Movements: protrusion and retrusion (translation) occur between the temporal bone and articular disc- SUPERIOR joint cavity Hinge Movements: depression and elevation and rotational/pivoting movements occur in the INFERIOR joint cavity NOTE: during the initial 15 degress of depression, the condyle remains in the mandibular fossa- BEYOND 15 degrees, the mandibular condyle glides forwards onto the articular tubercle of the temporal bone ** Somatosensory innervation (GSA): Auriculotemporal and Masseteric Branches of the mandibular enrve (CNV3)

What happens if there is a blockage of CSF flow or absorption?

Hydrocephalus! 1- Communicating OR Non-obstructive Hydrocephalus: - CSF ABSORPTION is impaired - usually bc of functional problems of the arachnoid granulations (villi) or blockage distal to the Foramen of Magendie 2- Noncommunicating OR Obstructive Hydrocephalus - CSF FLOW is impaired within the ventricular system proximal to Foramen of Megendie 3- Normal Pressure Hydrocephalus: - A type of communicating hyrocephalus, that is characterized by enlarged ventricles in OLDER persons- characteristic triad of symptoms are dementia, gait problems and urinary incontinence *** NOTE: most common cause of hydrocephalus is cerebral aqueduct stenosis- if these is a blockage of CSF, pressure increases--> enlarged ventricles and cranium expansion can occur

Voluntary Motor Innervation (GSE) to the Tongue

Hypoglossal Nerve (CNXII) innervates ALL volunatry muscles of the tongue... EXCEPT Palatoglossus *** the one with "palate" in its name is innervated by the Vagus nerve (CNX- Pharyngeal Branch)

What are the 12 cranial nerves?

I- Olfactory II- Optic III- Oculomotor IV- Tochlear V- Trigeminal VI- Abducens VII- Facial VIII- Vestibulocochlear IX- Glossopharyngeal X- Vagus XI- Accessory XII- Hypoglossal "On Occasion Our Trusty Truck Acts Funny, Very Good Vehicle Any How"

Inhibition of the thalamus, NO EXCITATION to the cortex occurs in the

INDIRECT pathway of the Basal Ganglia

Limbic system & Normal Memory

Identiifes certain events accoring to their biological significae to the organism (hypothalamus/amygdala) OR According to their "learned" significane (hippocampus, thalamus, cingulate cortex) ** Without appropriate identification of events as "significant" by the limbic system the cortex is unable to permanently store these events for later recall *** The Limbic System mediates between the needs of the hypothalamus and the plans of the Neocortex to deal with the realities of the environment and the needs of the moment

Types of Apraxia

Ideomotor Ideational/Conceptual Constructional

Cerebrospinal fluid (CSF) Rhinorrhea

If a nasal fracture is severe, it may cause fracture of the cribriform plate of the ethmoid bone - this results in a breach in the meninges and can provide a pathway for CSF to drain from the subarachnoid space into the nose ** may lead to meningitis due to the open communication of the nasal cavity and cranial vault structures ** Rhinorrhea= runny nose

Long Term Depression (LTD)?

If synapses simply continued to increase in strength as a result of LTP, eventually they would reach some level of maximum efficacy, making it difficult to encode new information. Thus, to make synaptic strengthening useful, other processes must selectively weaken specific sets of synapses - long-term depression (LTD) is such a process LTP and LTD both require the activation of NMDA glutamate receptors and entry of Ca++ into the post-synaptic cell - The major determinant of whether LTP or LTD occurs appears to be the amount of Ca2+ in the postsynaptic cell: small rises in Ca2+ lead to depression, whereas large increases trigger potentiation - As LTP will phosphorylate proteins, LTD will de-phosphorylate proteins- proteins that may control the efficacy of transmission ** Both LTP and LTD allow for synaptic plasticity and changes in activity, connections & patterns

Vaginismus

Involuntary contraction of the muscles of the pelvic floor

"Bedside" mental status testing

Involves more neurological approach Assesses following: - altered mental status (coma, delirium, inattention) - dementia (presence and severity) - psychiatric symptoms (ex. psychosis, depression, mania) - identifying focal abnormality of cortical and subcortical system (ex. cranial nerve and sensorimotor exam)

Glutamate receptos as drug targets

Ionotropic (NMDA) Ketamine - Non-competitive (use-dependent) NMDA receptor antagonist) Therapeurtic usese: Anesthesia, pain, depression - Drug of abuse (ketamine is a drug of abuse Metabotropic mGluRs - Allosteric modulators in clinical trials for depression and schizophrenia

Astigmatism

a condition of unequal curvatures along the different meridians in one or more of the refractive surfaces (cornea, anterior or posterior surface of the lens) of the eye, in consequence of which the rays from a luminous point are NOT focused at a single point on the retina

Hemispheric Specialization

Left (Dominant- usually) Hemisphere - speech center - writing - general interpretive center (language, mathematical calculation) Right (NON-Dominant) Hemisphere - music - analysis by touch - spatial perception analysis, drawing

Menstrual Cycle

Menarche is the 1st menses (age 9-14) - occurs from pubert- menopause (age 45-50) - During this time, pituitary gonadotopins produce cyclic changed in ovarian hormone level - Cyclic changes in hormones produce cyclic changes in the endometirum- the menstrual cycle Menstrual cycle phases: - Menstrual phase - Proliferative phase - Secretory phase Menstrual cycle: 28 dyas - Day 1: menses: the beginning of the menstrual period (consists of degenerating endometirum mixed with blood from its ruptured microvasculature) Proliferative Phase (AKA follicular/estrogenic phase): "Early Proliferative (follicular) phase" - Follows the menstrual phase, runs from day 6-14 - Concurrent with folliculogenesis and ovarian estrogen secretion - At the beginning, endometirum is thin (5-6mm) - Then, estrogens induce cell proliferation and regeneration of the functional layer of the endometirum - Epithelial cells in the basal ends of uterine glands proliferate and form a new endometrial lining ** Glands become striaght tubes with narrow, nearly empty lumens - endothelial cells of the spiral arteries proliferate: lengthening of arteries- microvasculature is established - stromal cells proliferate: collagena nd ground substance - at the end, endometrium is 3mm thick Secretory Phase (AKA luteal phase) - Follows ovulation (runs from day 15-28) - Corpus luteum secretes progesterone - Progesterone stimulates epithelial cells of the uterine glands to secrete, and accumulate glycogen ** Glands dilate and coil- corkscrew shape - the spiral arteries lengthen and spiral and superficial microvasculature now includes thin-walled, blood filled lacunae - The endometrium reaches its maximum thickness (16mm) ** The endometrium is prime for implantation ** Secretions form bubbles at luminal margins and are discharged into the glandular lumen ** The tissure clearly shows the increased stromal edema and gland cell hypertrophy - NOTE the irregular shape of the once striaght tubular glands Menstrual Phase: If fertilization does NOT occur - regression of corpus luteum (apoptosis) - dramatic decrease in progesterone - arterial cells synthesize prostaglandin- vasoconstriction and local hypoxia - hypoxic cells release cytokines - cytokines increase vascular permeability - migration of leukocytes - leukocytes, epithalil cells, endothelial cells and stromal cell produce enzymes including matrix metalooproteinases (MMPs) ** Break down of the functional layer including epithelium, glands, stroma and vasculature - sloughing away of tissues as menses ** Blood loss is limited by vasoconstriction - menses lasts 3-4 days on avg - thin basla layer is left unaffected

Decerebrate Rigidity

* 4 "e's"= 4 limbs extended - extensor posturing (all limbs extended) - jaw clenched - neck extended ** Due to damage to brain INCLUDING the midbrain - Medial Reticulospinal and Lateral Vestibulospinal (MR and LR) are intact-- Damage to Rubrospinal and descending axons providing cortical inhibitory control of MR and LV

What are the 6 Branches of the basilar artery?

*1- Anterior inferior cerebellar artery (AICA) *2- Superior cerebellar artery *3- Posterior cerebral arteries 4- Paramedian pontine arteries 5- Long circumferential branches 6- Short circumferential branches

Suicide risk factors

- history of prior suicide attemptos or self-injurious behavior - Age- increased risk in older adults - Gender- women try more often, men try more lethal means - Mood disorders, substance abuse/intoxication, psychotic disorders, PTSD, cluster B personality disorders (ex. Borderline), conduct disorders (rage, violence, impulsivity) - percipitating events associated with humiliation, shame, or despair (ex. loss of a relationship or job, financial problems, or medical illness) - history of abuse, social isolation, veteran status, native american, caucasian ethnicity

Adult Male Hypogonadism

- increased moodiness, faitgue, depression, inability to concentraate, failing memory - balding - loss of male body hair (axillary, pubic, & facial) - breast discomfort, gynecomastia - reduce strength & stamina - abdominal obesity - reduced sexual interest & function, low sperm count - increased risk of osteoperosis Treatment: - androgen replacement therapy - LH/FSH for restoration of fertility - inhibition of PRL in case of hyper-prolactinemia

Postcoital/ Emergency Contraception

- indicated for use in cases of mechanical failure of barrier method or in circumstances of unprotected intercourse - Plan B: the progestin levonorgesterel is marketed without a prescription for women 18 yrs of age or older - The selective progesterone modulator ulipristal is also used for emergency contraception- Ulipristal prevents progestins from binding to the progesterone receptor- it may inhibit or delay ovulation and alter the endometrium preventing implantation - Mifepristone, may also prevent pregnancy by antagonising the progesterone receptor- it is NOT approved by the FDA for postcoital contraception- MIfepristone combined with misoprostol is used for early pregnancy termination (this is the one that CAN terminate a pregnancy- others listed above CAN NOT)

Neurogenic vs. Spinal Shock

Neurogenic Shock: - Damage to the sympathetic pathways in cervical/upper thoracic spinal cord - loss of sympathetic innerveation of the heart ** key feature is a LOW heart rate (HR) despite low blood pressure (BP) - loss of vasomotor tone and decreased BP and low hear rate (or at least the HR does NOT respond) ** Loss of sympathetic tone Spinal Shock: Flaccidity and loss of reflexes - the injured cord may appear clinically completely non-functioning - However, function may return with time

Endometrial Cycle follows a characteristic

series of events under the control of cyclically released ovarian estrogen & progesterone Menses (progesterone withdrawal): Day1-5: characterized by spiral artery constriction, endometrial degradation, uterine cntraction & expulsion of functional layer ** by convention the first day of vaginal bleeding (menses/the period) is considered day 1 of the menstrual cycle Proliferative phase (estrogen dominated): Days 6-14: regeneration of functional layer- proliferation of glandular epithelial , stromal & artery endothelial cells, lengthening of glands and arteries- endometrial thickening Secretory phase (progesterone dominated) Early Days 15-23: glandular synthesis and secretion of glycogen, glandular dilation and coiling- corkscrew shapw- stromal edema, spiral artery elongation Late Days 24-28: differentiation of stomal cells into rounded cells containing glycogen & lipid droplets- predeidualisation- glands and stroma begin to regress

Microglia DO NOT

come from neuroepithelial cells, but originate from embryonic mesoderm (similar to immune and blood cells) and reside in mesenchyme

Just before ovulation the oocyte

completes the first meiotic division (now a secondary oocyte) ** Immediately after expulsion of the first polar body.. but arrests at metaphase and never completes meiosis unless fertilization occurs ** If fertilization does NOT occur within about 24hrs, the oocyte begins to degenerate NOTE: - The first meiotic division is completed in a single mature follicle just before ovulation during each menstrual cycle- A secondary oocyte and the first polar body result from the unequal division of the cytoplasm - The secondary oocyte begins the second meiotic division but stops at metaphase II - 2nd meiotic division is completed after ovulation and after a sperm cell unites with the secondary oocyte- A secondary oocyte and a second polar body are formed Ovulation: - In the hrs b4 ovulation, the dominant follicle bulges against the tunic albuginea, develops a translucent ischemic area, the STIGMA, in which tissue compaction has blocked blood flow - Granulosa cells produce prostaglandins and extracellular hyaluronic acid- loosens cells and increases the volume, pressure, and viscosity of the follicular fluid - Degradation of collagen in the tunica albuginea and surface epithelium- weakening of ovarian wall (stigma) - Prostaglandins diffuse from follicular fluid-- trigger smooth muscle contractions in the theca externa If pregnancy does NOT occur--> corpus luteum becomes corpus albicans in a couple of weeks If pregnancy DOES occur, corpus luteum grows very large and is maintained ~4-5 months, and then forms corpus albicans To Help remember: ** red--> yellow--> white forming Corpus Hemorrhagicum (ruputured follicle fills with blood; clot forms right after ovulation- this is from blood vessels of the theca interna proliferating- angiogenesis) --> Corpus luteum (clot dissipates, walls collapse; highly cellular) --> Corpus albicans (cells degenerate, replaced by collagen-rich scar)

The special senses begin to develop as

ectodermal thickenings called placodes * The placodes then form pits, which will then further develop to form adult structures: - Otic Placode --> Otic Pit --> Otic Vesicle= vestibular & auditory components of the inner ear - Lens/Optic Placode --> Lens pit --> lens vesicle --> lens, corneal epithelium, eyelid skin - Nasal/Olfactory Placode --> nasal pit --> primitive nostrol = olfactory system

All of the structures in the head and neck- be it skin, skeletal muscles, glands, special senses (taste, vision, hearing, smell), reflexes, autonomic functions- are innervated by

either cranial nerves or the cervical plexus

Endoderm gives rise to

epithelial lining and glands of digestive and respiratory tracts

Onset of therapeutic action in brain may require

gene synthesis and neuroplasticity (ex. antidepressants) - A prolonged increase in stress hormones (glucocorticoids) can lead to a decrease in synapse numbers - Antidepressants can increase the levels of key neurotransmitters (ex. serotonin), which leads to increased expression of brain derived growth factor (BDNF), a neurotrophic factor that is involved in: - synatogenesis, neuronal plasticity, potentially neurogenesis - neuotrophic= "growth" of neurons ** some drugs have delayed effect bc need to change gene synthesis and neuroplasticity

Neurogenesis

generation of new neurons (production of new neurons)- very few divide in adult brain only some areas - Neurodegeneration: loss of neurons- death/decrease in complexity (from 100,000 to 80,000- lost 20000 due to injury- i.e. ischemic injury or maybe atrophy of neurons) - Neuronal plasticity: neurons becoming more complex- more synapses & dendrites- in response to learning and experience- synapses being used alot become stronger- synapses less used become smaller - Disinhibition: if you inhibit and inhibitory neuron will lead to excitation of another neuron - if A and B are inhibitory the effect on C is excitatory (i.e. GABA--< GABA which are inhibiting ---< Glu (excitatory) - Neurotrophic factors: signaling molecules that increase growth and plasticity of neurons (infant neuron --> mature neurons via neurotrophic factors)

Paraplegia

impairment in motor or sensory function in lower extremities ** Incomplete and complete paraplegia are the second and third most commonly seen in spinal cord injuries Hemiplegia: paralysis of one half of the body; typically in focal brain injuries (stroke) --> NOT often seen with SCI- its usually due more to focal injuries- left MCA stroke--> R sided weaknes/paralysis

In relation to the human sexual response cycle, what is the refractory period?

inability to repeat orgasm for a period of time in men - following the refractory period, additional orgasm is possible - the resolution state, involves return to pre-arousal state (to physiological baseline)

Puberty is the physiological transition between childhood & adulthood characterized by

secondary sexual development - Avg age of onset is 9-14 yrs, marked by testes enlargement (gonadarche) ** Percocious puberty (early puberty) is defined as puberty beginning before age 9 in boys - Takes ~4yrs to complete Preceded by Adrenarche (pubertal transition of the adrenal gland): - Rise in adrenal DHEA, DHEAS, & Androstenedione at ~age 7-8 yrs - Normal puberty in those with Addisions disese & premature adrenarche Characterized by: - increased linear growth velocity- pubertal growth spurt avgs 28 cm - changes in body composition- increase lean body, skeletal and muscle mass - increased sebaceous gland sebum secretions- acne - testes enlargment, pubic hair growth (pubarche), penis enlargement, prostate, seminal vesicle & epididymis growth, initiation of spermatogenesis (spermarche), facial & body hair, larynx enlargement & voice deepening, increased libido & sexual potency

Autonomic innervation (GVE-Axons- sympathetic and parasympathetic) from Pterygopalatine Ganglion provides

secretomotor to glands of palate, pharynx, nasal cavity, sinuses and lacrimal gland *** The pterygopalatine ganglion contains parasympathetic cell bodies- sympathetic axons simply pass through

CNV Trigeminal is the major

sensory nerve of the face 3 Divisions: 1. Ophthalmic Division - Resident= GSA 2. Maxillary Division - Resident= GSA 3. Mandibular Division - Resident= GSA, BE * BE= muscles of mastication

Muscle spindles are

sensory receptors within the body of the muscle that primarily detect changes in muscle length Consist of specialized muscle fibers (INTRAFUSAL) encoled within a connective tissue capsule *** intrafusal fibers are within the capsule embedded between extrafusal fibers 3 types of intrafusal muscle fibers: dynamic nuclear bag, static number bag and nuclear chain fibers *** the muscle spindle has BOTH sensory and motor components

REMEMBER... anterior spinal artery occlusion at the level of the

spinal cord is DIFFERENT than the medulla

Norepinephrine neurotransmission

synthesized in presynaptic neuron packed in vesicles--> released via calcium dependent mech--> binds to post synatpic receptors--> salvaged by NE transported into pre-synatpic transporters

Remember out principles of the CNS- we see that one side of the visual field (NOT left or right eye, but the visual field) will be processed by the

opposite brian ** This is reason for the optic chiasm- everything in the left visual field needs to be on the right and vice versa and this is why the temporal retinas stay on the same side and the nasal cross so that we get the right and left visual field representations going to the correct occipital lobe Ex: - Right visual hemifield is seen by the temporal left retina and the nasal right retina - Left visual hemifield is seen by the nasal left retina and the temporal right retina ** Retinotopy: the whole pathway is retinotopically organized, but NOT proportionally: fovea is "magnified", so there is a distored retinotopy NOTE: Note only is the visual field separated into "hemifields", but it is also divided into quadrants ** the center "circle represents the fovea

Choanae

posterior openings between the nasal cavity and the pharynx - they are rigid, as the boundaries are all bones

Most common cause of secondary ammenorrhea is

pregnancy Ex: - High prolactin, estradiol, estriol, and progesterone - Low LH and FSH - Amenorrhea ** these are all consistent with pregnancy Increased estriol levels indicate placental production and is a useful indicator of pregnancy. Aromatase inhibitor treatment can lead to menopausal symptoms (including amenorrhea) due to low (not high) estrogen levels. Hypothalamic amenorrhea (e.g. caused by stress, weight loss, excessive exercise) and an adenoma producing prolactin both inhibit the pulsatile GnRH release and hence can lead to low FSH and LH, but also to low (not elevated) ovarian hormone production. Women with polycystic ovary syndrome typically present with signs and symptoms of hyperandrogenemia, amenorrhea, elevated estrogen levels, but typically also with an elevated (not suppressed) LH/FSH ratio

Blood-CSF barrier

separated the arterial blood from the cerebrospinal fluid 3 structural parts: 1- Choroidal epithelial cells interconnected by tight junction - the side facing the CSF has an increased surface area due to microvilli 2- Basement membrane 3- Endothelium: created by pia mater capillaries that contain fenestrations ** tight junctions between choroid epithelial cels prevent substances escaping from blood into CSF= blood CSF barrier ** Choroid epithelium is almost completely surrounded by choroidal capillaries

Thoracic Outlet Syndrome

refers to a compression of the neurovasculature as the structures exit through the thoracic outlet Thoracic outlet includes 3 confined spaces: 1. Interscalene triangle: between anterior scalene muscle anteriorly, middle scalene muscle posteriorly, and the first rib inferiorly- impingement of subclavian artery and trunks of brachial plexus 2. Costoclavicular space: located in the anterior portion of the superior thoracic aperture between the clavicle and the first rib 3. Subcoracoid space: between the coracoid process superiorly, the pectoralis minor muscle anteriolr, and ribs 2-4 posteriorly ***Neurogenic Thoracic Outlet Syndrome (NTOS): Compression of the nerves, and the resulting symptoms, is most common. Results in: - Numbness/tingling in the arm/fingers - Weakness in the hands - Pain in the upper back - Pain above clavicle

Vertebral Artery

arises from the 1st part of the subclavian artery- 1st part is medial to the anterior scalene It is the 1st branch from the first part of the subclavian artery Vertebral artery has 4 parts: 1. Cervical: arise from subclavina artery and pass superiorly to reach the transverse foramina of the C6 vertebra (pre-foraminal) 2. Vertebral: pass through the transverse foramina of the upper six cervical vertebrae (foraminal) 3. Suboccipital: after passing through the transverse foramina of C2, these arteries travel across the posterior arch of C1 and through the suboccipital traingle before entering foramen magnum 4. Cranial: inside the skull the two arteries join to form the basilar artery (intradural or intracranial)

Corpus Luteum

(yellowish body) After ovulation, the ruptured follicle is transformed into the corpus luteum (the process is known as luteinization) - release of follicular fluid results in collapse of the follicle wall so that it becomes folded - some blood flows into the follicular cavity and forms in it a coagulum Two layers of mature follicle are involved in the development of the corpus luteum: 1. Cells of the membrane granulosa - called now granulosa lutein cells - produce progesterone and some estrogen 2. Cells of the theca interna: - called now theca lutein cells - produce progesterone and androstenedione

Decorticate Rigidity

** 2 "e's"= 2 limbs extended - flexor posturing (arms flexed and adducted) ** Due to damage to the brain ABOVE midbrain - Rubrospinal tract and Middle Reticulospinal and Lateral Vestibulospinal intact so BOTH can function! Damage to descending axons providing inhibitory cortical control--> Spastic bc doesnt know what to doe (MR and LV tracts are overreacting)

Functions of the Intrinsic Muscles of the Larynx

- Adjust tension in vocal folds - Open and close the rima glottidis - Controls inner dimensions of the vestibule - Facilitates closure of the laryngeal inlet Intinsic Muscles of Larynx: ** Pat the cat very lightly: PATTh(e)CATVL - Posterior cricoarytenoid - Arytenoid oblique - Transverse arytenoids - Thyroarytenoid - Cricothyroid - Aryepiglottic (extension of arytenoid oblique) - Thyroepiglottic (extension of thyroarytenoid) - Vocalis - Lateral Cricoarytenoid

Pontocerebellar System

- Afferent sensory information from the cortex (Occipital, Frontal, Parietal & temporal lobes) enters the lateral zone or pontocerebellar region - Corollary motor fibers also enter the lateral zone from the corticospinal tract- these efferents cross the midline and enter the cerebellum through the middle cerebellar peduncle - Cerebellum analyzes the sensory info and what effect that may have on any voluntary movement along with the intended Corticospinal output - Lateral zone projects to the dentate nucleus, which then projects through the superior cerebellar peduncle, crosses the midline, synapses on the VL nucleus of the thalamus- VL nucleus of the thalamus then projects to motor & premotor cortices for modulation of the Corticospinal Tract

Parkinson's Disease

- Hypokinetic disorder (less movement- exciting indirect pathway--> less exciatation to cortex bc less inhibition of thalamus) - Degenerative disorder of CNS - Degeneration of dopaminergic neurons in substantia nigra (specifically SNc) - Degeneration of nigrostriatal pathway (i.e. connection from SNc to striatum) ** NOTE: we can compensate till down to 10-20% of Neurons --> this will be the critical point when symptoms are obvious and it is beyond the point where we can effectively restore ** Leads to Bias for indirect pathway --> decreased excitation to cortex--> slowness of movement Clinical Features: - Tremor, rigidity, bradykinesia, anteroflexed posture, postural instability, freezing/festinating gait, poor balance, falls etc. Treatments: - Loss of dopaminergic neurons in PD is major target for symptomatic therapy: Levodopa (l-dopa), Carbidopa, Levodopa+ Carbidopa (Sinemet), Dopamine (D2) agonist, Selective MOA-B Inhibitory (Selegiline= Eldepryl)

Extrinsic Muscles of the Eye are innervated by 3 Cranial Nerves which are:

- Oculomotor Nerve (CNIII)- innervates superior rectus, medial rectus, inferior rectus, inferior oblique, levator palpebrae superioris muscles - Tochlear nerve (CNIV)- superior oblique muscle only - Abducens nerve (CNVI)- lateral rectus muscle only ** SO4LR6AO3 - Superior Oblique= CNIV - Lateral Rectus= CNVI - ALL others= CNIII *** All of these nerves pass into the orbit through the superior orbital fissure

Which two pharyngeal arches come from CNX?

- Pharyngeal arch IV: superior laryngeal branch of vagus nerve - Pharyngeal arch VI: recurrent laryngeal branch of vagus nerve *** Note they are from different branches of the same nerve

Rostral Rhombencephalon --> Metencephalon. What develops from the Metencephalon?

- Pons - Cerebellum - 4th Ventricle

Clinical correlations related to ARAS (Ascending Reticular Activating System)?

- Pons/midbrain lesions may produce long lasting coma (centers in medullar are intact) - Hyperactivity Attention Deficit Disorder: abnormal neuronal circuits is one of the possible reasons

Boundaries of the Nasopharynx

- Posterior to the choanae (paired openings of the nasal cavity) - Superior to the soft palate - Roof is the body of the sphenoid and part of the occipital bone - Continuous inferiorly with the oropharynx at the pharyngeal isthmus Features of the Nasopharynx: - Torus tubarius & Torus levatorius (the levator veli palatini muscle creates torus levatorius fold) - Pharyngotympanic tube opening - Pharyngeal & tubal tonsils - Pharyngeal recess - Salpingopharyngeal fold

Boundaries of the Oropharynx

- Posterior to the oral cavity and inferior to level of soft palate - Superior to the upper margin of the epiglottis - Palatoglossal folds on each side mark the boundary between the oral cavity and oropharynx (oropharyngeal isthmus) Features of the Oropharynx: - Platoglossal arch/fold (palatoglossus muscle) - Palatopharyngeal arch/fold (palatopharyngeus muscle) - Lingual tonsil - Palatine tonsil - Uvula - Vallecula

SRY gene encodes for the SRY protein (previously known as testis-determining factor- TDF)- If the protein and gene are functional then:

- Primitive sex cords proliferate and penetrate deep into the medulla of the indifferent gonad forming testis cords (medullary cords) - Testis cords is separated from surface epithelium by a layer of fibrous connective tissue called the tunica albuginea

Motion Sickness (Kinetosis)

- Vestibular system afferents activate projections to the reticular formation of pons and medulla - Subsequent activation of autonomic centers results in motion sickness ** Motion sickness can lead to vomiting - Receptors on the floor of the 4th ventricle of the brain represent a chemoreceptor trigger zone (CTZ), known as the area postrema, stimulation of which can lead to vomiting NOTE: CTZ is OUTSIDE the BBB-- this is relevant for drug action

Functions of the intrinsic muscle of the layrnx

- adjust tension in vocal folds - open and close rima glottidis - controls inner dimension of the vestibule - facilitates closure of the laryngeal inlet ** Larynx is highly mobile and can be moved up and down and forward and backward by the action of several EXTRINSIC muscles that attach either to the larynx itself or to the hyoid bone

Primary hormones produced by the ovary in response to LH/FSH stimulation include

- androstenedione - testosterone - estrogen - progesterone - inhibin

MSE (mental status examination) screeners (pen and pencil) useful for

- dementia - altered mental status - delirium - stroke - traumatic brain injury - brain tumor - depression - schizophrenia - multiple sclerosis - substance abuse - heart failure - HIV - parkinsons disease - Hungtintons disease - sleep disorder *** useful for tracking over time

Wormian (intrasutural bones)

- extra bone pieces that can form at the suture of the skull - may be mis-idenitified as fractures on radiographs (so dont think its a fracture!)

Types of Spinal COrd injury depends on

- level of spinal cord injury- determines what parts of the body might be affeced by paralysis or loss of function (higher injury = more extensive effect on motor and sensory) - complete: severe damage to spinal cord and no motor or sensory function below the level of the injury - incomplete or partial= some evidence of motor and sensory function (ex. feeling but little or no movement) - primary damage: iniuries from the initial trauma (Ex. vertebral fracture or displacement, compression) - secondary damage: indirect result of an insult (edema, inflammation)

Beckwish-Wiedeman Syndrome

- macroglossia - anterior ear lobe crease and posterior helical ear pits This is a syndrome of overgrowth (height >97th percentile): - Neonate: omphalocele, macroglossia, visceromegaly, ear pits, adrenocortical cytomegaly, and renal abnormalities - Hypoglycemia - Embryonic tumors in childhood (Wilms tumor, hepatoblastoma, neuroblastoma, rhabdomyosarcoma) - Growth may be asymmetrical (Ex. L leg and arm longer than the right) - Sometimes normalization of phenotype with age

Grey Matter in the spinal cord has a

typical H- or butterfly appearance Is organized into divisions referred to as horns (the embryonic plates) - Dorsal horn (derived from Alar plate): Sensory ** BMP important for development of sensory - Ventral horn (derived from Basal plate): Motor ** Sonic Hedgehog importnat for motor development - Intermediate (lateral) horn- in thoracic and upper lumbar segments only

Latent phase of stage 1 of labor

typically lasts up to 8 hrs and encompasses cervical effacement and dilation to 3 cm THEREFORE, if a pt is in Phase 3 of partiution and stage 1 of labor for 24 hrs and her cervix is 2cm dilated- her pregnancy is progressing much slower than usual

Jugular venous pulse (pressure)

visualization of the IJV used to assess the venous pressure and waveform- is a reflection of the functioning of the right side of the heart (right atrium)

The vocal ligament is found under the

vocal fold (true vocal cord) and the vestibular ligament is under the vestibular fold (false vocal cord) *** NOTE: the vestibular ligament is separated from the vocal ligament by a gap- both are attached to the arytenoid cartilage, BUT because of positioning the vestibular ligament is lateral to the vocal ligament when viewd from above

Reticular formation is localized into 3 longitudinal zones- what are they?

1. Midline - Raphe Nuclei (Serotonin) 2. Medial - Ascending & descending projections - Motor functions - Magnocellular nuclei 3. Lateral - Cranial nerve reflexes & visceral functions - Sensory functions - Parvocellular nuclei There is also a rostral-caudal organization: - Midbrain RF: related to brain/cortical functions - Pontine & medullary RF: related to spinal cord functions

Pterygopalatine Ganglion Branches

1. Nasopalatine Nerve 2. Greater Palatine Neerve 3. Nasal Branches 4. Lesser Palatine Nerve 5. Pharyngeal Nerve 6. Orbital branches ** All of these branches supply the palate, nasal cavity and sinuses- there are a lot of mucus membranes in these regions, so there is a secretomotor function (GVE) (GLANDS!) as well as somatosensory (GSA) function (pain, pressure, etc.)

Able- bodies privilege

- you can go about your day without planning every task, like getting dressed or going to the bathroom - you can play sports easily - public transportation is easy for you - others dont get frustrated with you in public for needing special accomodations or holding up lines - you dont have to worry about others reactions or able-ness - leisure activities like gardening, knitting or woodworking are easy for you - you can expect to be included in-grup activities - well-represented in movies, books, and TV shows - others dont assume you need to rely on them to accomplish tasks - dont have to think about your daily pain level when planning events and acitvity - housing that accomdates your physical needs - ppl dont make fun of you bc of your ability - public access to buldings, parks, restaurants etc- is easy for you - you get hired pppl dont assume its based on your ability - dont face job discrimination based on your ability - your ability isnt butt of jokes in TV shoes and movies

Neurotransmitter cell groups in the diffuse modulatory system

1- Cholinergic - ACh 2- Monoamines - Dopamine - Noradrenaline/Norepinephrine - Serotonin - Histamina - Adrenaline/epinephrine - (adrenaline/epinephrine- these are mainly produced by the adrenal medulla, but are produced in some neurons of the CNS) 3- Neuropeptides ** Each system has a small core of neurons (only a few thousand) - Each neuron from the core can influence more than 100,000 postsynaptic neurons spread throughout the brain - The synapses are NOT terminal but rather run along axons (called "boutons en passant") ** Each system only MODULATES the actions of other neurons and does NOT turn them ON or OFF (like adjusting the volume on a radio instead of the power) ** Differs from direct synaptic transmission: - NT is NOT quickly reabsorbed by the neuron - NT are released in the space between neurons and not necessarily at the synaptic terminal

What are the 4 main pathways related to the Visual System?

1- The primary visual pathway (how occipital lobe receives info- so we see) 2- Pupillary light reflex (eyes dilate or constrict in bright light or dark)- pretectum: reflex control of pupil and lens 3- Tectospinal pathway (superior colliculus- orienting the movements of head and eyes) 4- Retinohypothalamic pathway (hypothalamus- regulation of circadian rhythms)

Neural tube (spinal cord) has 3 layers:

1- Ventricular layer (proliferative and first to form) 2- Marginal layer (second to form) 3- Mantle layer (last to form)- becomes the inner grey matter of the spinal cord

What are the 3 primary binding proteins that regulate the transport and storage of testosterone?

1. Androgen Binding Protein- ABP 2. Sex Hormone Binding Globulin- SHBG 3. Albumin - ABP is manufactures in Sertoli Cells and Localized to the seminiferous tubules - ABP is NOT secreted into the circulation - SHBG is synthezied and secreted primarily by the liver - SHBG IS secreted into the circulation - Albumin & SHBG are circulating plasma proteins that bind testosterone ** SHBG binds T with HIGH affinity- 44% of circulating T ** Albumin binds T with LOW affinity- 54% of circulating T NOTE: - ABP & SHBG are transcribed from the same gene and have the AA sequence- ABP is synthesized in the testes (by the Sertoli Cells in response to FSH stimulation) and IS NOT secreted into the systemic circulation, whereas SHBG is synthesized predominantly in the liver and IS secreted into the systemic circulation - Albumin has a 1000-fold lower afinity for testosterone than SHBG, but the concentration of albumin is so much higher that the binding capacities are similar

5 other cells types in the retina (4 are neurons)

1. Bipolar Neurons - synapse with photoreceptor cell with their ONE dendrite, and ganglion cells with their ONE axon 2. Ganglion cells (Neurons): - large, multipolar neurons - the axons of these neurons form the optic nerve and pass to the brain 3. Horizontal cells (Neurons): - synapse with the synaptic junctions between the photoreceptor cells and the bipolar cells and modulate the synaptic activity 4. Amacrine cells (neurons) - synapse with the synaptic junctions between the bipolar cells and the ganglion cells and modulate the synaptic activity 5. Muller Cells NOT NEURONS *** - support cells for the nueral retina, neuroglial cells - appear to be structurally and functionally equivalent to the astrocytes of the central nervous system in that they envelop and support the neurons and nerve processes of the retina

CSF circulation

1. CSF is secreted by choroid plexus in each lateral ventricle 2. CSF flowd through interventricular foramina into 3rd ventricle 3. Choroid plexus in 3rd ventricle adds more CSF 4. CSF flows down cerebral aqueduct to fourth ventricle 5. Choroid plexus in 4th ventricle adds more CSF 6. CSF flows out two lateral apertures and one median aperture 7. CSF fills subarachnoid space and bathes external surfaces of brain and spinal cord 8. At arachnoid villi, CSF is reabsorbed into venous blood of dural venous sinuses Basis: Choroid plexus--> ventricles --> subarachnoid space --> arachnoid villi --> sinuses --> internal jugular vein

Kubler- ross Model: 5 stages of grief

1. Denial: hard to face reality, may develop a false, preferable reality 2. Anger: recognition that denial cannot continue- "why me? its not fair who is to blame" 3. Bargaining: hope to undo or avoid further grief 4. Depression: things begin to lose meaning to griever- "im so sad, why bother with anything- Whats the point" 5. Acceptance: comes to terms with inevitable future, calm/stable minset- " its going to be okay- i cant fight it may as well deal with it" *** KNOW THIS - ppl dont have to go in order, may start at diff steps or may not go through certain steps at all

3 layers of the cranial meninges

1. Dura Mater - dura mater (periosteal/endosteal layer) - dural sinus - dura mater (meningeal layer) 2. Arachnoid Mater - arachnoid membrane - subarachnoid space - arachnoid trabeculae 3. Pia mater - is bound to the surface of the brain by astrocytes ** PAD from deep to superficial

In the 4th week: the tongue will form from

2 lateral lingual swellings and one median swelling all from the 1st pharyngeal arch --> this will form the anterior 2/3s of the tongue - A second median swelling, the copula (2nd pharyngeal arch) is overgrown by the hypobranchial eminence (3rd and part of the 4th arch)--> will form the post. 1/3rd of the tongue - 4th arch contributes to the epiglottis and the laryngeal orifice is just posterior ** Muscles of the tongue are derived from occipital myotomes and travel along the hypoglossal nerve (CN XII- CN12) [ EXCEPT palatoglossus muscle (CNX))]

One-and-a-half Syndrome

2 or 3 structures can be damaged- ALL on the IPSILATERAL SIDE 1- MLF and Abducens (CN VI) Nucleus of 1- MLF, Abducens, and PPRF Ex: * There is NO abduction to the left bc the LEFT aducens is affected * There is NO conjugate gaze to either the left or right bc the abducens and PPRF are affected on the left (no communication to the MLF on the right for adduction of the right eye!) and the MLF on the left is affected, so there is no adduction of the left eye on conjugate gaze ** Therefore, the left eye CANNOT move horizontally at all and the right eye loses half of its movement, with ONLY the ability to abduct being intact.. so, 1 and a half ** ALSO, convergence still is intact for both eyes because of the pathway for convergence does not travel through these structures

The Palate "Rood of your mouth" is divided into

2 parts: 1. Hard Palate - Concave, "fits" the tongue, palatine process of the maxillae and horizontal palatine plates of palatine bone 2. Soft Palate - Movable, "soft", posterior 1/3rd of the palate which is suspended from the posterior border of the hard palate - Has NO BONE, but a dense palatine aponeurosis which blends posteriorly with the muscles of the soft palate

Why do some drugs have effects in brain and others do not?

2 reasons: 1. target must be present in brain for it to have an effect (i.e. drug working on beta 2 are in bronchioles- it would not have affect on brain) 2. Some drugs can cross blood-brain barrier and some cannot- if cant cross it will NOT have an effect

One hypothesis for imprinting

A fast growing fetus will come out big and "ready" - fetus with better survival/mothers resources taxed more - parternal genes leading to increased growth is selected for Less strong growth of fetus will tax the mother less - mother can live to try another time - maternal genes limiting fetal growth are selected for Conflict of interest maternal vs. paternal genome - this conflict probably stronger in species with higher number of offspring per pregnancy ** increased paternal, decreased maternal --------- Expression pattern: Maternal chromosome: No methylation --> CTCF binds to insulator (remember, this protein is blocking long distance interaction) Enhancer: - no interaction with IGF2 promoter--> no product - interactions with H19 promoter --> H19 transcript is produced Paternal chromosome: Methylation + associated proteins (Me) covers the IC/I ---> CTCF protein CANNOT bind Enhancer: - No interactions with H19 promotter (not accessible) --> No product - Interactions with IGF2 promoter --> IGF2 transcript is produced

Lasik Surgery

A procedure that permanently changes the shapw of the cornea - A microkeratome is used to cut a flap in the cornea - Cut is made just under ** Bowmans membrane, this holds the flap together and a hinge is left at one end of this flap - The flap is folded back revealing the corneal stroma * Pulses from a computer-controlled laser vaporize a portion of the stroma - the cornea is shaped to correct nearsightedness and farsightedness or to correct astigmatism errors - The flap is then replaced

External jugular venous distention

A sign of increased central venous pressure - Normally, the external jugular vein is just visible above the clavicle for a short distance - Abnormally, the external jugular vein is prominent throughout its course along the side of the neck May be indicative of: - Heart failure - Superior Vena Cava Obstruction - Enlarged supraclavicular lymph nodes - Increased Intrathoracic pressure

Types of Psychological Assessment

- Neuropsychological testing (done by neuropsychologicts) - intelligence testing - psycho/educational testing - objective personality/mood assessment (ex. MMPI, PAI) - projective personality testing

How do you know a section is the Caudal Medulla?

- Nicely defined Nucleus Cuneatus & Nucleus Gracilis - Pyramidal Decussation (at the most caudal level near the junction of the medulla and spinal cord)

Periorbita

The periosteum lining the bones that form the orbit - it is continuous at the margins of the orbit with the periosteum on the outer surface of the skull and sends extensions into the upper and lower eyelids (oribtal septum) ** In posterior part of the orbit, the periorbita thickens around the optic canal and the central part of the superior orbital fissure- this is the point of origin of the 4 rectus muscles and is the common tendinous ring ** COMMON TENDINOUS RING: is where the 4 recti muscles attach

Release of the oocyte during Ovulation

The secondary oocyte and coronar radiata, along with follicular fluid, are expelled by the local smooth muscle contractions and drawn into the infundibulum of the uterine tube with the help of fimbriae where fertilization may occur ** Cells of the ovulated follicle that remain in the ovary re-differentiate under the influence of LH and give rise to the corpus luteum

Development of Female external Genitalia

Think opposite of male! - The genital tubercle elongates slightly to form the clitoris - Urethral folds do NOT fuse and form the labia MINORA - Urogenital groove is open and forms the vestibule

Testing CN X

Uvula ** Phsyician asks the patient to "open up and say ahh" - physician will observe the uvula, many times with a tongue depressor - if there is an obvious deviation to one side, this indicates weakness of the muscles on the opposite side - intact muscles on the side to which the uvula deviates elevate and "pull" the uvula towards that side UVULA DEVIATES TO OPPOSITE SIDE

Innervation of the Inner (internal) ear

Vestibulocochlear Nerve (CNVIII) - Divides into Vestibular (balance) and cochlear (hearing) after entering the petrous portion of the temporal bone through the internal acoustic meatus

The Ear is aka

Vestibulocochlear/ Vestibuloauditory System - Auditory system: hearing - Vestibular system: balance Outer (external) Ear: - for air conduction Middle Ear: - bone conduction (sound waves) Inner Ear: - neural conduction to brain

The neck is a tunnel/cylinder that provides continuity and passage between the head and thorax- there are 4 compartments that provide a longitudinal organization- what are they?

Visceral compartment: - trachea, larynx, pharynx, thyroid, parathyroid glands Vertebral compartment: - cervical vertebrae, spinal cord, muscles associated with the vertebral column 2 Vascular compartments: - two carotid sheaths that contain the common carotid artery, internal jugular vein, vagus nerve *** superficial musculature and fascia enclose these compartments

3 Paired Constrictor Muscles of the pharynx

** ALL Innervated by CNX and function in the Constriction of the pharynx - Superior Constrictor - Middle Constrictor - Inferior Constrictor ** Developed from pharyngeal arch IV The constrictors attach anteriorly and laterally to ligaments and bone - Posteriorly, all the constrictors meet in the midline pharyngeal raphe that extends downwards from the pharyngeal tubercle - The superior constrictor is continuous anteriolry with buccinator at the pterygomandibular raphe ** Gaps between these constrictor muscles allow structures to pass through the pharyngeal wall

What is the relevance of polyspermy block? what is the relevance of sperm hyperactivation?

** Gradual release of sperm from the isthmus helps to reduce the number of sperm available at the point of fertilization and helps to prevent polyspermy (fertilzation of an oocyte by more than one sperm), which is fatal for embryonic development *** After ovulation, sperm become HYPERACTIVATED- increased intracellular Ca2+ and whip-like thrashing of the tail. Generates the propulsive force necessary to escape the tubal epithelium and penetrate the COC and dense ZP

Innervation of the Cornea

** NO blood vessels (for transparency), BUT cornea is highly innervated *** The cornea is the MOST densely innervated tissue of the body (for comparison, the corena has 300-600 times the sensory innervation density of the skin) ---> this is to PROTECT THE EYES! The cornea has unmyelinated nerve endings sensitive to: - touch (eyes are very sensitive to small particles that land on cornea) - temperature - chemicals *** ALL trigger blink reflex and tear production - Cornea is densely innervated with sensory nerve fibers via the ophthalmic division of the trigeminal nerve - the ciliary nerves run under the endothelium and exit the eye through holes in the sclera apart from the optic nerve (which transmits only optic signals)

Major landmarks in the Cervical Spinal Cord include

- Dorsal Columns: Fasciculus Gracilis & Fasciciulus Cuneatus - Posterior Median Sulcus - Posterior Intermediate Sulcus - Posterior Lateral Sulcus - Lateral Funiculus (lateral column) - Grey matter - White matter - Central canal - Anterior White commissure - Anterior Median fissure - Anterior Funiculus (anterior column)

Caudal Rhombencephalon --> Myelencephalon. What develops from the Myelencephalon?

- Medulla - 4th ventricle

Nasal passages into which sinusese empty

- Sphenoid Sinus has direct opening through the sphenoethmoidal recess - Ethmoid sinus has posterior cells and anterior & middle cells- the posterior cells pass through the superior meatus directly and the anterior & middle cells pass the the middle meatus via the ethmoid bulla - Frontal sinus passes through the middle meatus via the frontonasal duct into hiatus semilunaris - Maxillary sinus pass into the middle meatus via the hiatus semilunaris - Nasolacrimal duct passes into the inferior meatus directly NOTE: anterior & middle cells of ethmoid sinus, frontal sinus, and maxillary sinus all pass through the middle meatus

Effort closure of the larynx (i.e. coughing, childbirth, defecation, high pressure)

- Vocal folds and vestibular folds adducted - Rima glottidis and vestibule closed

Common grief reactions

- disbelief - sadness/sorrow - fear - vulnerability - anger/rage - guilt - impaired concentration - search for meaning - social withdrawal - sleep or appetite disturbance - decreased motivation - spiritual confusion ** If grief becomes intense and interferes with funcitoning, depression, and anxiety may be present- if untreated, can lead to more severe presentations, such as thoughts of suicide

What muscles arise from the IV pharyngeal arch?

- pharyngeal constrictors - cricothyroid - levator veli palatini - palatoglossus - palatopharyngeus - salpingopharyngeus ** Proximal part of the R subclavian artery & a portion of the arch of the aorta ** CN X (superior laryngeal branch of vagus nerve)

Lateral Medullary Syndrome vs. Lateral Pontine Syndrome

1- Disruption of nucleus ambiguus and nucleus solitarius is seen ONLY in Lateral Medullary Syndrome (issues with gag reflex, taste, dysphagia, etc) 2- Motor nucleus of V and Principal sensory nucleus of V may be affected in a Lateral Pontine Syndrome (especially if it is rostral lesion) with ipsilateral loss of touch sensation from the face and disruptionn of muscles of mastication on ipsilateral side 3- Facial nucleus is sometimes disrupted in Lateral Pontine Syndrome but NOT in Lateral Medullary Syndrome- This would result in a loss of facial expression and other problems if the nerve fibers were disrupted

Reliability

Accracy and consistency; prescision A reliable test is: - relatively free from error - provides repeatbale, consistent results *** will we get same values if test is repeated? ** Consistency in results

Which branch of the internal carotid artery course along the longitudinal fissure to supply the medial aspect of the frontal & parietal lobes?

Anterior Cerebral Artery

Association cortex loop of Basal ganglia

Association cortex--> caudate--> globus pallidus--> dorsomedial nucleus of thalamus--> association cortex ** for thinking/reasoning

Sleep Architecture

Awake: alpha and beta rhythms REM: beta rhythms (increases at the end of the night) Non-REM: N1: theta rhythms N2: spindle and K complex N3: delta rhythms (first third of night-parasomnias)

CN V

CN V- Trigeminal ** Major somatosensory nerve of the face 3 Divisions: V1 (Ophthalmic)- Resident= GSA V2 (Maxillary)- Resident= GSA V3 (Mandibular)- Resident= GSA, BE, BE= muscles of mastication

Administration of NSAIDs to a woman in labor inhibits contractions. How?

COX inhibitors inhibit myometrial contractions by decreasing prostaglandin synthesis and thus prolonging pregnancy in preterm labors

Vascular Tunic (middle layer of the eye)

Choroid - Areolar CT; highly vascularized - Supplies nourishment to retina - pigment absorbs extraneous light Ciliary body - Ciliary smooth muscle and ciliary process, covered with a secretory epithelium - Holds suspensory ligaments that attach to the lens and change lens shape for far and near vision - epithelium secretes aqueous humor Iris - 2 layers of SM (sphincter pupillae and dilator pupillar) and CT, with a central pupil - Controls pupil diameter and thus the amount of light entering the eye

ADHD

Common referral questions for psychoeducational testing - Why is neuropsychological testing useful? bc if concerned about bias or if it may be something else. - Who has problems with attention and behavior? Commonly used rating scales (in two settings- at home and school usually) - connors rating scales - achenbach child behavior checklist - ADHD symptoms rating scale - NICHQ vanderbilt assessment scales NOTE: - bias and other ppl could also have problems concentrating- so not always certain that diagnosis is actually ADHD

Pharyngotympanic/Auditory/Eustachian Tube

Connects the nasopharynx and middle ear - this connection is important because it allows for pressure equalization of the middle ear with the nasopharynx (salpingopharyngeus and tensor veli palatini) *** Infections in the oropharynx/ nasopharynx can travel to the middle ear

Maxillary Sinus

Drains into the middle meatus via the semilunar hiatus - Innervated by the anterior, middle and posterior alveolar nerves from CNV2

Deja Vu

Feeling that one has experienced a situation or event before.. an overwhelming sense of familiarity - most likley is an anomaly of memory - Network overlap between short and long term memory.. the unconscious ming (long term) perceives current situation before conscious mind (short term) does ** It is associated most commonly with temporal lobe epileptics or seizures-- the synaptic firing is all off and there is an incorrect perception of a memory *** Many times associated with religious or paranormal phenomenon

Lesions to Medial Temporal Lobe

Fornix lesions--> Minor Disruption of Memory Functions Bilateral Hippocampal Lesions--> Major Disruption of Memory Functions Unilateral Hippocampal Lesions--> produce little to no impairment

2nd order Synaptic Relay from Spinothalamic System:

From DRG (1st order cell body)--> 2nd Order cell bodies in Dorsal horn of spianl cord can go to Lamina I (marginal layer)--> Lamina II (substantia gelatinosa)--> Lamina V (nucleus proprius)---> fibers cross midline in Anterior White Commissure --> Ascends via the spinothalamic tract to 3rd order cell body at VPL --> Somatosensory cortex (S1)

Inner Ear

Functions: transform mechanical vibrations into neural signals NOTE: inner ear contains distinct, specialized receptors for hearing and balance *** Bony labyrinth is filled with perilymph *** Membranous labyrinth is filled with endolymph

Somatosensory Innervation (GSA) to the Pharynx

General Sensory innervation (GSA) is different for the three subdivisions of the pharynx: - Nasopharynx: CNV2 (pharyngeal branch) - Oropharynx: CNIX (via the pharyngeal plexus) - Laryngopharynx: CNX (superior laryngeal nerve and pharyngeal branch)

Indifferent Structures that give rise to the Internal Genitalia

Genital ridge - Males--> Testes - F--> Ovary Primordial germ cells - Males --> spermatozoa - F--> Oocytes Sex cords (testis and corticol) - M--> Seminiferous tubules - F--> Follicular cells (form ovarian follicles) Mesonephric (Wolffian) ducts - M--> Appendix of the epididymis, Ductus deferens, Ejaculatory duct - F--> Epophoron, Gartners duct (cyst), Paroophoron Paramesonephric (Mullarian) ducts - M--> Appendix of testis, prostatic utricle - F--> Uterine tubes, uterus, upper vagina Urogenital sinus (lower) - M--> bulbourethral glands, prostate gland - F--> Lower vagina; vaginal vestibule, greater vestibular glands, urethral and paraurethral glands

Hematoma vs Hemorrhage

Hematoma: collection of blood in tissue- occurring outside of large vessels- they are clotted are more "static" Hemorrhage: is blood that accumulates from a ruptured blood vessel and there is on-going bleeding- if symptoms are sudden, extreme headache or other, it is most likely a subarachnoid hemorrhage due to a vascular acident like an aneurysm

Nuclei for IX, X and XII are in the

Medulla

Benign prostatic hyperplasia (BPH)

Non-malignant growth of the prostate stimulated by DHT - common age-related disorder - 50% of men will have BPH by age 60; 90% by age 85 - attributed to the local effects of DHT ** Obstruction to urinary outflow & bladder dysfunction causes symptoms & signs - urinary retention, painful dilation of the bladder, inability to void, urinary frequency, nocturia, urgency ** Finasteride (a 5alpha-reductase inhibitor) is used clinically to treat BPH

Nuclei and Modality of CN III- Oculomotor

Oculomotor Nusleus --> (GSE- voluntary motor) Edinger- Westphal Nucleus --> (GVE- Visceral motor)

Pathway Representation for Ascending/Afferent/ Sensory Tracts

Pathways= chain of synaptically-related neurons Cell body is labeled 1st, 2nd, and 3rd order 1st Order Cell body: located in somatosensory ganglion (ex. DRG or somatosensory ganglion related to cranial nerves) 2nd Order Cell Body: in the Spinal Cord or Brainstem 3rd Order Cell body: in the Thalamus

The cerebral cortex can be classified into

Primary cortex and Associative Cortex 1- Primary Cortical Regions consist of: - primary sensory regions which DIRECTLY receive sensory input - primary motor regions with DIRECTLY instruct/control lower motor neurons 2- Associative cortical regions process and integrate information from one or more primary cortical regions- Can be divided into 2 types - Unimodal: receives input from a single primary cortex - Heteromodal: functions require integration of abstract sensory and motor information together with motivational and emotional influences

What causes basal body temperature to increase during the luteal phase of the menstrual cycle?

Progesterone secretion after ovulation is associated with a rapid rise in basal body temperature of ~0.5 degrees celsisus which is sustained throughout the luteal phase

Watershed Zones

Regions of brain that receive dual blood supply branches of two major arteries One vessel occlusion: - ischemia occurs in the region supplied by that vessel and there is usually sparing of regions near adjacent vessels Two adjacent vessels occluded: - regions between the 2 vessels are most likely to exhibit ischemia and infarction ACA-MCA: proximal arm & leg weakness (regions of homunuclus often include the trunk & proximal limbs) MCA-PCA: probelms with visual processing

Foramina Associated with the Common Tendinous Ring and their Contents

Superior Orbital Fissure contains: - Oculomotor Nerve (CNIII) - Trochlear Nerve (CNIV) - Ophthalmic Division of Trigeminal (CNV1) - Abducens Nerve (CNVI) - Ophthalmic Vein Inferior Orbital Fissure contains: - Inferior Ophthalmic Vein Optic Canal: - Optic Nerve (CNII) - Ophthalmic Artery

Validity

Test is accurately measuring what it is supposed to 3 categoris: 1. Content: content of the measure matches the objectives (what you want to measure) 2. Construct: the measure you use is consistent with other measures of the same construct 3. Criterion: how much your measure can predict expected external constructs

Neuroplasticity

The brain has the ability to change depending on the envrionment of the subject over time ** As marian Diamond has published: The brain can change in newness, challenge, exercise, diet and love Ex: blindfold someone for 2 days, visual cortex will re-organize to process sound and touch

Spermiogenesis

The final stage of production of spermatozoa ** NO cell division in this stage The spermatids are transformed into spermatozoa, cells that are highly specialized to deliver male DNA to the ovum (become lean, mean, swimming machines) *** STILL immotile at this stage after release into lumen Principal changes during spermiogenesis: 1. Formation of flagellum (makes it motile) 2. Condensation of chromatin (protects chromatin during "bumper car" swimming) 3. Loss of excess cytoplasm as residual body (makes it more aerodynamic) 4. Formation of acrosome (allows it to gain entry into egg) ** Mitochondria align along flagella--> provide ATP for dynein in flagella

White Matter

areas whenre there is a preponderance of myelinated axons; many axons of a myelin sheath that is mostly lipid and therefore has a fatty, white appearance

Assessments are ____ of a persons functioning on that specific day/time

"snapshots" - may look different in other contexts - presentation may change over time - children: skills and needs may change over time, depending on increasing demands - treatments may impact functioning: baseline vs. post-treatment evaluations (i.e. medication or surgery for epilepsy treatment- evaluate before and after treatment)

Arterial Supply of the Pharynx and Larynx

** Terminal Branched arise from either the inferior or superior thyroid arteries, which arise from the external carotid or thyrocervical trunk Pharynx: 1- Ascending pharyngeal artery (from external carotid artery) 2- Ascending palatine and tonsillar branches (supplies palatine tonsil) of facial artery 3- Pharyngeal branch of inferior thyroid artery (from thyrocervical trunk) supplies lower pharynx 4- Numerous branhces from the maxillary and lingual arteries Larynx: 1- Superior laryngeal artery (from superior thyroid artery (from external carotid artery) 2- Inferior laryngeal artery (from inferior thyroid artery (from thyrocervical trunk)

What makes up the spinal cord?

- 31 pairs of spinal nerves - 31 spinal cord segments (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 cocygeal) - 33 vertebral bodies The spinal cord occupies the entire length of the vertebral canal until the 3rd month of fetal life! - then it grows at a slower rate than the vertebral column Therefore, in the adult, the spinal cord ONLY occupies the upper 2/3rds of the vertebral column... the lumbar and sacral nerve roots must descend quite a ways to exit through their respective intervertebral foramina *** Conus medullaris in newborns ends at ~L3 and in adults it is at L1/L2 ** The spinal root fibers (lumbar and sacral fibers) that exit the transverse foramina caudal to L1 form the cauda equina * These fibers still exit the vertebral canal at their appropriate intervertebral foramina ** Lumbar puncture is safe in adults CAUDAL to L3

Commonly Clinically Tested Reflexes & Grading

- Biceps Reflex: involves Biceps Brachii, C5, Musculotaneous nerve - Brachioradialis Reflex: involved Brachioradialis, C6, radial nerve - Triceps Reflex: involves Triceps brachii, C7, radial nerve - Myotatic Reflex: involves Quadriceps femoris, L3/L4, femoral nerve - Achilles Reclex: involes gastrocnemis, soleus, S1, tibial nerve Grade 0= Absent 1+ or += Hypoactive 2+ or ++= Normal 3+ or +++= Hyperactive WITHOUT clonus 4+ or ++++= Hyperactive WITH clonus ** Clonus= series of involuntary muscular contractions due to sudden stretching of the muscle - particularly associated with upper motor neuron lesions

Major subdivisions of the CNS

- Cerebral hemispheres & Diencephalon - Brainstem & cerebellum - Spinal Cord

Treacher Collins Syndrome (AKA Mandibulofacial dystosis)

- Due to mutation on Chromosome 5 which is inherited in an autosomal dominant pattern - Mutation results in failed migration of neural crest cells in the first pharyngeal arch (makes maxilla/mandible) --> leads to abnormalities in ears (incus, malleus), palate, maxilla and mandible ** Children with Treacher Collins Syndrome often have sunken appearing cheeks, as well as small lower jaw and chin (micrognathia), absent (anotia), or unusually formed ears, and downward slanting eyes. A cleft palate may also be present - RARE: occurs in 1/50,000 births

Physiology of Erection and Treatment strategy for Erectile Dysfunction

- Erections are the result of neural activation, cavernosal smooth muscle relaxation, increased penile bloodflow, and venous occlusion - Nitric oxide (NO) activates guanylate cyclase to generate cyclic guanosine monophosphate (cGMP)--> leading to sequestration of calcium and smooth muscle realaxation - Phosphodiesterase type 5 (PDE5) inhibitors act by inhibiting PDE5 and increasing cGMP concentrations

What Symptoms would be present in a Lower Motor Neuron (LMN) lesion?

- Everything is "lowered" - Produces flaccid paralysis - Hypotonicity of muscle (paralysis) - Absent or hypotonic reflexes - Fasciculations (twitching of muscle fibers) - Muscle atrophy Ex: LMNL to the corticospinal tract would mean there is NO one to provide action on reflex or any signal out to the peripheral nerve for voluntary motor --> flaccid paralysis --> no movement

Activation of semicircular canals

- Head rotation--> excitation of hair cells in one horizontal semicircular canal and inhibition of hair cells in the other - Long-lasting head rotation--> adaptation of firing in vestibular axons - When rotation is stopped--> vestibular axons from each side begin firing again, BUT with opposite patterns of exciation and inhibition

Foramina Associated with CNVII (CN7)

- Hiatus for greater petrosal - Pterygoid canal (contains GVE, GVA and SVA axons) - Pterygopalatine fossa (pterygopalatine ganglion would "live" here)

Drug therapy targets androgens/endocrine system

- Hypogonadism- decreased androgen secretion - Benign prostatic hyperplasia (BPH)- inappropriate growth of hormone dependent tissue - Prostate Cancer- inappropriate growth of hormone dependent tissue - Hypergonadism- excess androgen activity in childhood (precocious puberty) - Anabolic steroid abuse- excess androgen; not recommended clinical use

3 Receptors Types

- Mechanoreceptors (Deep) - Mechanoreceptors (Superficial) - Nociceptors (pain) - Thermoreceptors (temp) Types of Sensation: - Discriminative Touch - Proprioception - Nociception - Temperature Sense For each sensation there are different dimensions to that stimulus: - Modality= class/type of stimulus (i.e. mechanoreceptor, thermo etc.) - Location= what receptors within the sensory system are active - Intensity= total amount of stimulus energy delivered to the receptor - Timing= when the stimulus/energy is received or lost by the receptor

Hematoma Locations

- Meningeal artery --> Epidural hematoma - Dural venous sinus --> Subdural or epidural hematoma - Vein at attachment to sinus --> Subdural hematoma - Cerebral artery or vein --> Subarachnoid hemorrhage, intraparenchymal hemorrhage, intraventricular hemorrhage

Somatotopic Organization of the Spinothalamic System in Spinal Cord

- Most rostral regions are located more medially *** Lateral spinothalamic from Medial to lateral: CTLS (Cervical, Thoracic, Lumbar, Sacral) for temp and pain *** Anterior Spinothalamic for Crude touch: more medial you have pressure, laterally you have touch

Internal Jugular venous (IJV) puncture and central venous catheter

- Needle and catheter can be inserted into the IJV, or subclvain vein, for diagnostic or therapeutic purposes - Right side IJV is usually perferred as it is usually larger and striaghter - Palpate the common carotid artery and insert the needle to the adjacent IJV

Major Connections of the Globus Pallidus Interna (GPi) and the Substantia Nigra Pars Reticulata (SNr)

- Receives inhibitory information from striatum, globus pallidus externa - Receives excitatory information from subthalamic nuclei - Sends inhibitory information to the thalamus

Testocular Steroid Hormone Biosyntheiss involves

- desmolase - 17 alpha-OH - 17,20-lyase - 3beta-HSD And testosterone can be converted to dihydrotestosterone by 5alpha-reductase (found in urogenital tract, skin, hair follicles) or to Estradiol by Aromatase (found in adipose tissue, liver, skin, brain) ** The primary testicular steroid hormones are - testosterone - DHT - estradiol ** testosterone is quantitatively the most important testicular steroid hormone, and 95% of ciculating testosterone is produced by the Leydig cells under LH stimulation - Testosterone conversion to estrogens is controlled by aromatase, expressed in the testes and in extragonadal tissues, particularily adipose tissue, liver, skin & brain - the contribution of testicular estrogen to the total circulating estrogen in males is apprx. 20% - Testosterone conversion to DHT is catalyzed by 5alpha-reductase expressed primarily in testes, in the urogenital tract, skin & hair follicles- the contribution of testicular DHT to the total circulating DHT in males is apprx 20%

Right hemisphere

- left neglect (left hemineglect- inferior pairetal lobe): disorder of ATTENTION - problems with visuospatial/constructional abilities - cortical sensory problems (ex. double simultaneous stimulation, two point discrimination) - Anosognosia: lack of awareness of the persons difficulty

What cartilage/skeletal structures arise from the II (hyoid) pharyngeal/branchial arch?

- stapes - lesser horn & upper body of hyoid bone - styloid process - stylohyoid ligament ** Corticotympanic and stapedial arteries ** CNVII (CN7- facial nerve)

What enzymes is primarily responsible for sperm penetration and of the expanded cumulus cell matrix surrounding the oocyte (i.e. the COC)? Where is this enzyme located?

--- Hyperactivated sperm espace the isthmus epithelium and reach the COC------ Hyaluronidase in the sperm head*** degrades hyaluronan in the expanded cumulus matrix - sperm then penetrates the cumulus mass - then on reaching the ZP, sperm bind to ZP3 - this then initiates the acrosome reaction, with acrosin release - acrosome-reacted sperm penetrates the acrosin-degraded ZP, enters the perivitelline space and fuses with oolemma

General Plan of Cerebellar Pathways

1- Corollary Motor Discharge - Cerebellum receives input from motor structures - Motor inputs convey the "intended" results or goals of the descending motor outputs 2- Sensory Feedback - Cerebellum receives input that conveys exteroceptive & proprioceptive info about the "results"- actual effect of the motor output on both muscles & the relationship to the external world 3- Modulatory Output to Motor centers - Cerebellum COMPARES the "intended" movement and "actual" motor response that results from motor pathways - Cerebellum then computes adjustments needed to the motor systems to produce smooth synergy of motor output we label as COORDINATION!

What structures are found in the tuberal area of the hypothalamus?

1- Dorsomedial nucleus - stimulation results in hyperphagia (obestiy) and rage - some neurons produce hypocretin/orexin which may modulate wakefulness - orexin neuron loss leads to narcolepsy 2- Ventromedial nucleus Anterior part: sexually dimorphic (larger in females- femal-typical sexual behavior) Superior part: satiety center..tells your body that youre "full" lesion causes hyperphagia (overeating) ** Leptin can bind to the ventromedial nucleus to signal to the brain that you are full and reduce food intake (leptin also binds to the arcuate nucleus to act upon NPY as well as the dorsomedial nucleus) 3- Arcuate nucleus - some neurons release dopamina to inhibit the release of prolactin by the pituitary gland - other neurons contain neuropeptide Y (NPY) and influence hunger - Grehlin, produced by the fundus of the stomach and the arcuate nucleus (stimulates growth hormone from the anterior pituitary) increases food intake and fat mass

Nuclei of CN IX: Glossopharyngeal

1- Nucleus Ambiguus (BE) 2- Inferior Salivatory Nucleus (GVE) 3- Nucleus Solitarius Caudal (GVA) 4- Nucleus Solitarius- Rostral (SVA) 5- Main sensory & spinal nucleus of V (GSA) Axon Modlaities: BE, GVE, GVA, SVA, GSA

What are the 5 branches of the Internal Carotid System?

1- Ophthalmic artery 2- Anterior choroidal artery 3- Posterior Communicating artery 4- Middle cerebral artery 5- Anterior cerebral artery

Regions of the Hypothalamus (Cadual to rostral)

1- Posterior area - posterior nucleus - mammillary body 2- Tuberal area - arcuate nucleus - ventromedial nucleus (UMN) - dorsomedial nucleus (DMN) 3- Anterior area - supraoptic nucleus - paraventricular nucleus - anterior nucleus - suprachiasmatic nucleus 4- Preoptic area - medial preoptic nucleus - lateral preoptic nucleus - median preoptic nucleus - preoptic periventricular nucleus 5- Lateral area

Secondary Neurulation occurs in Weeks

5 & 6 The caudal most part of the spinal cord (sacral and coccygeal regions) froms by secondary neurulation where mesenchymal cells condense, form a cavity and this second tube connects with the tube from primary neurulation

A pt presents to you with a normal epididymis, vas deferens, seminal vesicle, and ejaculatory ducts all emptying into a bling ending vagina and a high testosterone to DHT ratio- what can they have

5 alpha reducts deficiency (5-ARD) - Predominantly female at birth (except for clitoromegaly in some) - Virilization at puberty: increased testosterone production by testes "drive" testosterone --> DHT conversion - Concentration of testosterone and estrogens are normal male ** MIF works so there is normal epididymis, vas deferens, seminal vesicles, ejaculatory ducts.. all emptying into a blind ending vagina ** Due to the 5-alpha-reductase 2 defect, testosterone to DHT ratio is high - FSH levels are usually elevated (testicular defect?) ---- Summary of 5 alpha reductase deficiency 46, XY - autosomal recessive; mutations SRD5A2 gene - genitalia usually ambiguous with small hypospadic phallus, blind vaginal pouch Wolffian duct: normal derivative Mullerian duct: absent - Normal testes - Decreased facial and body hair; no temporal recession, prostate not palpable - Increased T/DHT ratio secondary to decreased T--> DHT conversion - increased incidence in DR, turkey, highlands of new guinea - Gender role behavior: can change from femal sex (or rearing) to male at puberty! Treatment: - If male reassignment chosen: high dose testosterone/surgical repair hypospadius ** Fertility is possible- BUT IVF/ICSI is often required

Hormonal Secretions of male embryonic gonads are essential for normal sexual differentiation

6 weeks of Gestational age - Male (XY) with SRY region --> develop Testis 8 weeks - Testis give rise to sertoli cells and leydig cells 8-10 week going into 10-12 weeks - Sertoli cells make MIS --> mullerian ducts regress (aka paramesonephric ducts) --.> NO fallopian tubes, uterus, cervix, upper vagina - Leydig cells make testosterone and DHT - the testosterone--> Wolffian Ducts (aka mesonephric duct)--> Seminal vesicles, epididymis, ejaculatory ducts, vas deferens 12-14 weeks ** the DHT which had been converted from testosterone from 5alpha reductase leads to: - genital tubercle--> penis (no clitoris) - urogenital folds--> penile urethra (no labia minora) - labioscrotal swellings--> scrotum (no labia majora NOTE: In the absence of these secretions, female internal and external genitalia will develop NOTE: testicular descent into the scrotum occurs shortly before (and in some instances shortly after) birth and appears to require both testosterone & DHT

Cranial Nerve Nuclei in the Midbrain

CNIII- Oculomotor has 2 axon modalities: 1- Oculomotor Nucleus: (GSE) 2- Edinger- Westphal Nucleus: (GVE) CNIV- Trochlear has 1 axon modality: 1- General Somatic Efferent (GSE)- voluntary motor to superior oblique

Aorta branches at ___ level to distribute blood to pelvis and lower limbs

L4 - Abd aorta bifurcates at L4 vertebral level into right and left common iliac arteries - Each common iliac artery branches into external iliac aerty and internal iliac artery

Role of Substantia Nigra Pars Compacta (SNc)

Modulatory (Dopamine) function via actions on direct and indirect pathway - SNc INHIBITS the Indirect pathway - SNc EXCITES the Direct pathway ** Gives an overall NET RESULT of movement (will increase movement !) *** SNc degenerates in Parkinsons Disease (will lead to slowness in movement if removed)

3 parts of the pharynx include

Nasopharynx Oropharynx Laryngopharynx

Imprinting

is normal, present in many chromosomal regions in humans (~25) >100 genes listes as imprinted - Imprinting is a modification to DNA/chromosomal proteins that is erasable = parent-of-origin-specific silending of a gene Imprinted= INACTIVE ** Imprinting is NOT inherited in the normal sense of the word During gametogenesis: - imprinting is erased - new imprinting is added according to sex of parent Mechanism: Step 1 - Methylation of CG base-pairs - Reversible - Does NOT interfere with base pairing - Symmetrical - During replication, one strand is template for methylation of other strand Methyl group added to location 5 in Cytosine- as can be seen, this is not interfering with binding to guanine so base pairing is nromal - the location of the methyl group is accessible to proteins binding to the DNA double helix Beyond methylation: - modified histones specific for silenced genes localize - at least two non-histone proteins help maintian status ** Essentially similar to the changes that happen after methylation in areas silenced by X-chromosome inactivation, even though the initiating factors (leading to methylation) are different Methylation/Imprint changes during Gametogenesis - During gametogenesis the imprinted areas are cleared of all signs of imprinting including the methylation - Shortly thereafter, brand new imprints are added to all chromosomes in the gamete precursors - Errors in the processes described here can sometimes lead to disease state in the child ** One way that this process can go wrong is if an imprint is not removed in the early stage Methylation changes during Embryonic development - Imprinted areas are protected - there is a second wave of demethylation after zygote formatiion, but this demethylation does NOT affect thsoe areas that are imprinted - later in embryonic development, new methylation again does NOT change the imprinting patters of the chromosomes **Errors in this process described can sometimes lead to disease state in the child (** here mainly if protection of the imprint fails)

Control of the reproductive axis in females orginates in the hypothalamus with the

periodic pulsatile release of gonadotropin-releasing hormone (GnRH) - GnRH pulse ~ every 90-120 minutes - Intermittenet stimulation of the gonadotropes - Pulses in LH & FSH secretion - Pulsatile release of GnRH is CRITICAL for gonadotropin (FSH, LH) secretion ** Continuous (non-pulsatile) GnRH down-regulates GnRH receptors & suppresses gonadotropin release--> this is therapeutically useful if suppression of ovarian hormone production is desired SO - pulsatile administration of GnRH maintains serum FSH and LH concentrations, while continuous infusion leads to rapid & reversible suppression of both LH & FSH release

The nasal mucosa lines the nasal cavity and consists of

respiratory epithelium and olfactory epithelium - The function of the nasal mucosa is to humidify and warm the inspired air- surface area is increased by the shape of the conchae and mucosa *** Mucosa is adhered to the conchae of the nasal cavity and is continuous with the mucous membranes of the sinuses, conjunctiva, and pharynx *** Thick mucosa, rich with goblet cells, lines the nasal septum and produces mucous *** We know that the nasal mucosa and mucous membranes of the sinuses can be commonly infected and inflamed resulting in a stufyy, runny nose and discomfort ** When infected/irritated the mucosa may swell, blocking the nasal passage **Remember conchae AKA turbinate bones

During preganncy- all 3 estrogens (estrone, estradiol, estriol) are

secreted in large amounts and act as vasodilators to increase blood flow to the uterus and growing placenta - Estriol is synthesized by the fully functional placenta after the luteal-placental steriodogenic shift, and is considered the estrogen of pregnancy

Pia Mater

thin, delicate and richly vascularized! - closely adheres to all external surfaces of the CNS - projections of pia mater into the brain ventricles are called choroid plexus

Pudendal Nerve

Main Motor & Sensory Innervation to the Perineum - Pudenda= "To be ashamed".. Why? Due to 3 functions and their organs occurring in the perineum.. micturition, defecation & copulation or Pee-Poo-Pleasure/Procreation ("3 P's") ** Pudendal Nerve originates from S2,S3,S4 nerve roots: - exits our greater sciatic foramen - crosses the ischial spine, and enters through the lesser sciatic foramen to get to the perineum - travels along pudendal canal in the ischioanal fossa and gives rise to 3 branches 3 Branches of the Pudendal Nerve: - Inferior rectal nerve - Perineal nerve - Dorsal nerve of clitoris (female); or Dorsal nerve of penis (male) ** remember the foramina and ligaments that create the passageways for some neurovasculature - Greater sciatic foramen - Sacrospinous ligament - Lesser sciatic foramen - Sacrotuberous ligament

Where do the GSA axons from CN IX (GlossopharyngeaL) terminate depending on if the information is touch or pain?

Main Sensory Nucleus of V and Spinal Nucleus of V ** CN IX carries GSA from skin posterior to ear, posterior 1/3 of tongue, soft palate, oropharynx, palatine tonsils, mucosa of the middle ear, auditory tube & mastoid air cells

Where will GSA axons from CN X terminate depending on if the information is touch or pain?

Main sensory nucleus of V and Spinal Nucleus of V ** CN X carries GSA from skin posterior to the ear, dura in posterior cranial fossa, posterior and inferior aspect of the external auditory meatus, mucous membranes of pharynx and larynx

For how long after the birth of an infant can women continue to lactate?

Maintenance of milk production depends on: 1. Prolactin surge on suckling 2. Removal of milk on a regular basis ** Milk production can continue for YEARS if sucking continues, rate however declines

Primary physiological changes during orgasm in males and females

Male orgasm: - Rigid erection: further compression of the veins results in further increase in intravacernous pressure & maximum (rigid) erection. Contraction of vas deferens, seminal vesicle & prostate leads to emission. Presence of seminal fluid in the urethra stimulates ejaculaition- immediately post ejaculation, males enter refractory period Female orgasm: - Strong muscular contractions of the outer one-third of the vaginal wall and the rectal sphincter. Rhythmic contractions of the uterus. Feeling of intense sensual awareness oriented at the clitoris & radiating upwards into the pelvis

Two physiological changes that occur during the resolution phase in men and women

Males during resolution phase: - Contraction of smooth muscle and arterioles of corpora cavernosa reduces blood entry and increases venous drainage. Arterial venous blood flow return to minimum. Loss of erection and return to flaccid state (detumescence). Testes descend; scrotum thins Females during resolution phase: - Vaginal contraction and vasocongestion ceases. Clitoris leaves its retracted position, uterus returns to normal position. Labial swelling subsides. Heart rate, blood pressure, and respiratory rate return to normal

Tongue

Mass of striated, volunatery muscles covvered with mucous membrane Dorsum of the Tongue: Divided into R and L halves by a median septum or furrow 3 Parts: - Oral (anterior 2/3rds) - Pharyngeal (posterior 1/3rd) - Root (base) ** Anterior 2/3rd and posterior 1/3rd are separated by a V-shaped sulcus terminalis - the apex of the terminal sulcus points posteriorly and is marked by a pit called the foramen cecum ** Foramen cenum is an embyrological remnant that markes the site of the upper end of the thyroglossal duct (thyroid gland) - The mucosa of the anteiror 2/3rds has papillae (fungiform, foliate, circumvallate and filiform) - the first 3 containtast buds and the filiform are just there to provide abrasion (SO filiform has NO TASTE BUDS!) - The posterior 1/3rd has NO papillae but does have a nodular surface due to underlying lymphatic lingual tonsils Ventral Aspect of the tongue: - Smooth, NO papillae - Deep lingual artery and vein - Lingual nerve - Submandibular duct and sublingual gland

CT of the lower pelvis (Male)

Structures from anterior to posterior - urinary bladder - prostate - rectum Other imaging modalities for visualizing the prostate include: MRI of the prostate used to: - evaluate extent of prostate cancer and spread - plan radiotherapy treatment **can also visualize prostatic hypertrophy Ultrasound of the Prostate used to: - check size, location and shape of the prostate gland - during a prostatic biopsy - to look for signs of prostate cancer

Secondary Amenorrhea

Pregnancy - most common cause of seconadary amenorrhea - FIRST investigation to be carried out on a sexually active female presenting with amenorrhea should ALWAYS be a pregnancy test Hypothalamic causes: - 30% of non-pregnant amenorrhea - Disruption of GnRH secretion= decreased FSH & LH secretion - Excessive exercise, stress, anorexia, decreased body fat Pituitary causes: - Hyperprolactinemia: 30% of cases *** Dopamine agonists (ex. bromcriptine are used to treat hyperprolactinemia) - PRL inhibits pulsatile secretion of GnRH, decrased FSH & LH - dopamine inhibibts PRL, TRH stimualtes PRL - May be associated with galactorrhea - Lactating women are typically amenorrheic Ovarian causes: - depletion of follicles (estrogen deficient, increased FSH and LH) - PCOS: 20% of cases (increased androgen) Typical work-up: hCG, FSH & LH, estrogen, PRL, TSH, androgen, SHBG, BMI

L-DOPA

Site of action: - Amino acid decarboxylase Action: - Substrate

Why sleep?

Sleep removes metabolites from the brain REM sleep - increases after learning (especially learning complex material) - is when conceptual, long term memories are consolidated by the hippocampus - "clears out the brain", providing uncluttered mental space - organizes/files information for later use

Nystagmus

Slow phase of movement followed by fast phase in opposite direction (NOTE: direction of fast phase is used to name the nystagmus) Physiological: - optokinetic - vestibulo-ocular reflex Pathological: - congenital - vestibular: asymmetric stimulation of semicircular canals - neurological disease (of the vestibular system) NOTE: Nystagmus & Caloric Testing (Checking ocular reflexes) ** Caloric testing can be used to check the integrity of brainstem (VOR) in a comatose patient) ** Dolls eye test can also be used - Dolls eye sign= good! (brainstem is intact) - Dolls eye absent= BAD! (brainstem damaged, VOR damaged "COWS" - Cold--> opposite - Warm--> same ** this mnemonic is NOT helpful in comatose patients Ex: Healthy subject - Cold water in Right Ear --> Left beating nystagmus - Cold water in Left Ear --> Right beating nystagmus - Warm water in Right Ear --> Right beating nystagmus - Warm water in Left Ear--> Left beating nystagmus Ex: Unconscious Pts (COWS does NOT apply) - there is NO fast component when the patient is in a coma - If brain stem in tact and cold water placed in R ear--> both eyes only have slow component (slow component to right only) - same if cold water in Left ear (same for warm) ** check that you are right here Ex: Comatose pt with MLF lesion (bilateral) - cold water in right: abduction in R, NO adduction in left ** Check this also Ex: Low brainstem lesion - NO slow OR fast component

Causes of Spinal Cord Injury

Traumatic: - damage to the vertebrae, ligaments, disks of the spinal column, or spinal cord itself - may stem from sudden, trauamtic blow to spine that fractures, disloacts, crushes, or compresses one or more vertebrae - can also result from penetrating object (ex. gunshot or knife wound) Non-traumatic: - multiple sclerosis, tumor, degeneratic diseases, osteoporosis, arthritis, hemorrhage, infections (ex. syphilis), and inflammatory pathologis (ex. meningitis)- these have diff presentation than traumatic and have more brain involved in effects - MVC make up 46% of injuries - Falls - Viloence - then sports Also age: - MVC major cause across life span - falls across life span increases with increasing age - causing by violence or sports goes down with age ** older individuals vulnerable to falls resulting in spinal cord injury

Why take drugs that act in the brain? (What do you want the drug to do?)

Treat pain: - morphine - acetaminophen - duloxetine Treat psychiatric disorder - haloperidol (antipsychotic) - fluoxetine (antidepressant) Treat neurological disorder - carbamazepine (antiepileptic) - L-DOPA (drugs for parkinsons disease) Decrease arousal: - diazepam (sedative) Increase alertness: - caffeine - nicotine Feed a substance use disorder: - alcohol - heroin - nicotine Just for fun/curisoty: - marijuana - alcohol

With decreased estrogen production after menopause,

the vaginal mucosa and other estrogen-dependent tissues (including the vulva) can become atrophic ** Characterized by dryness, inflammation, and thinning of the epithelial lining of the vagina - Topical estrogen therapy can restory the integrity of the vaginal epithelium, as well as the support tissues around the vagina - Long-term use may require the addition of a progestin due to potential systemic absorpiton and effect on the endometirum ** Dypareunia can often be improved with the use of estrogen cream used vaginally - Water-based lubricants may also be helpful, but petroleum jelly or other oil-based lubricatns are contraindicated bc they can cause irritation of the vaginal mucosa and can weaken latex condms NOTE: oral progesterone can be given to decrease hot flashs but it would NOT alleviate vaginal atrophy

A delta has

thin myelin C fibers have NO myelin ** local anesthetics target these bc they are related to signaling pain and temperature ** wanting to prevent sensations of pain ** these fibers transmit pain- higher does of local anesthetics will affect other fibers related to touch, pressure and motor So with increasing local anesthetic concentration: pain--> temperature--> touch --> pressure--> motor

Question about sexual partners

" Do you have sex with men, women or both men and women" Practices: types of sexual contact the pt has had with these partners Pervention of STIs: what methods of protectiont he pt uses such as condome, limiting physical contact, etc Past STIs: any history of STIs and any treatment they may have had Prevention of pregnancy: questions on the pts reproductive history or intentions

What is the Reticular Formation?

"Archaic"/ primitive brain structure - present in ALL vertebrates - conveniently located in the brainstem at the interface between the spinal cord and higher brain structures - loose network of nuclei throughout the brainstem - active in BOTH directions: ascending and descending pathways ** What are the behaviors and body functions that human beings have in common with all other vertebrates? - cardiovascular - respiratory - reflexes - wakefulness/consciousness

non-REM: Stage N3

"Deep or Slow-wave sleep" Characterized by: - Delta waves Subjects experience: Parasomnias - Night terrors (during 1st third of the night) - Bed wetting (Nocturnal enuresis) - Sleep walking (somnambulism) - Sleep talking (somniloquy)- not to be confused with harmless dream speech

non-REM: Stage N1

"Drowsiness" Characterized by: - transition from alpha brain waves (awake, eyes closed) to theta waves (somnolence/drowsy sleep) Subjects experience: - Sudden hypnic jerks (positive myoclonus) - Hypnagogic hallucinations - Loss of some muscle tone - Loss of most conscious awareness of external

Long-term: Non-Declarative (AKA Procedural Memory)

"How-to" knowledge.. skills and procedures - thought to involve simpler processes- acquistion requires significant repetition - driving a car, playing an instrument, learning to swim ** Structures involved include: basal ganglia, premotor cortex, cerebellum NOTE: Basal Ganglia is most often affected with damage to subcortical structures (basal ganglia) -> Problems are seen with Huntingtons Chorea or Parkinsons Disease

Nervous system control of erection, emission and ejaculation

"Point, Shoot, Score" - Point (erection)--> parasympathetic NS - Shoot (emission)--> sympathetic NS - Score (ejaculation)--> somatic NS

Deep Cerebellar Nuclei (DCN) and their excitatory afferents constitute a

"deep excitatory loop" whose output is shaped by a "cortical inhibitory loop" that inverts the sign of the input signals - The purkinje neuron output to the DCN cell therefore generates an error correction signal that can modify movements - The climbing fibers modify the efficacy of the parallel fiber-Prukinje cell connection, producing long-term changes in cerebellar output ** Output of the Deep Cerebellar Nuclei is the result of the balance of excitation from mossy & climbing fibers and inhibition by the purkinje cells

Radial Glia work as the

"railway" for migrating neurons - Excitatory cortical neurons are generated during embryological development by asymetric division of progenitor cells which line the ventricular wall - Newly-born neurons migrate out of the matrix of the ventricular zone and into the intermediate zone (future white matter), through the subplate, and into the cortical plate, and stopping in the marginal zone at the pial border ** The neurons do this by literally climbin on strands of radial glia cells which span the distance from the ependymal to the pial surfaces, like the spokes of a wheel ** It has been discovered that radial flia are actually neuronal progenitors-- the radial glia cell divides and gives rise to faughter cells, which then use the mother cell as their scaffold for migration- whether all progenitor cells are born of radial glia cells is unknown

Haloperidol

"typical" antipsychotic - Older names: "neuroleptics" and "major tranquillizers" - used to treat psychosis (particularly in schizophrenia) Haloperidol is a "typical" (first generation) antipsychotic - high potency: leads to extrapyramidal effects, parkinsonism Pharmacology: - Competitive anatagonist at D2 receptors - Blocks the effect of DA at this receptor ** decreases psychotic symptoms

Spina Bifida: Rachischisis & Craniorachischisis

* A Neural Tube Defect - Caudal Neuropore fails to close - Vertebrae still fail to fuse, are open, and leave the spinal cord exposed - Pts with rachischisis have motor and sensory deficits, chronic infections, and disturbances in bladder function * this defect often occurs with an anencephaly - seen as craniorachischisis Craniorachischisis is a variant of rachischisis that occurs when the entire spinal cord and brain are exposed- rachischisis with anencephaly - it is incompatible with life and pregnancies often end in miscarriage or stillbirth- infants born alive with cranorachischisis die soon after birth

Spina Bifida Occulta

* A Neural Tube Defect - Caudal neuropore fails to close - one or more vertebrae fail to fuse on the bony arch dorsal to the spinal cord - this is mesodermal in origin ** Remember: mesoderm --> somites --> sclerotome= vertebrae and ribs NO involvement of the meninges or spinal cord and skin is CLOSED ** Hydrocephaly may develop in spina bifida if the spinal cord is tethered to the sacrum- As the vertebral column lengthens, tethering pulls the cerebellum into the foramen magnum, cutting off CSF flow *** Not certain why hair tufts are seen, but an abnormal invagination of ectoderm into the posterior closure site of the neural tube may cause the issue

Basal Forebrain Nuclei

* A Subcortical region of the Limbic system *** Cholinergic (ACh) neurons= main function in the CNS is attention, learning & memory The Limbic system performs an analysis of events that determines the value or significance of that event - that "value" may be conveyed to the entire telencephalon by the basal forebrain - whether the basal forebrain helps decide the "value" or simply "supports" the formation of memories is unclear ** One may think that without activation of the basal forebrain, events are NOT properly coded for long-term storage, which may explain why individuals who take certain tri-cyclic anti depressants may have memory problems ** tri-cyclics can block cholinergic receptors

What does the retina and brain "see"?

* Eye has a lens, just like a camera, and the image on the retina is "up-side-down" and backwards - so the superior retina will process the inferior part of the image Ex. when viewing a tree--> the eye percieves it upside down- so the inferior retina will process the "top" of the tree --> the brain, or more specifically, the visual cortex in the occipital lobe, will adjust the image to its correct orientation

Somatotopy of the Spinothalamic System in Spinal Cord

* More rostral regions are located more medially ** This is why the system is also called the "anterolateral system" as the axons are located in the "anterior"/ "lateral" aspect of the spinal cord most medial: cervical, thoracic, lumbar, sacral (most lateral) most ventral: pressure, touch, pain, temp (most lateral)

Cholinergic: ACh Systems of the CNS

* Pontomesencephalic region: laterodorsal tegmental nucleus & pedunculopontine nucleus * Basal Forebrain: medial septal nucleus, nucleus of diagonal band, nucleus basalis - Basal forebrain cholinergic systems are damaged in Alzheimers Disease - Effects of ACh are generally excitatory and are thought to function in attention, memory, and learning - Central block of ACh causes delirium and memory deficit

Descent of the Testes

* Reaches inguinal region by 12 weeks * Migrates through inguinal canal by 28 weeks * Reaches scrotum by 33 weeks Testes need to descend during development from the posterior abd wall to the scrotum via the inguinal canal - initially attached to posterior abd wall by urogenital mesentery (CT) - mesentery at the caudal pole of testis forms the caudal genital ligament and the intra-abdominal gubernaculum - intra-abdominal gubernaculum--> terminates in the inguinal region - extra-abdominal gubernaculum--> takes over and extends to the scrotal floor Factors controlling the Descent of the Testes: - Intra-abdominal gubernaculum guides intra-abdominal migration - Intra-abdominal pressure, due to organ growth facilitates passage of testes trhough the inguinal canal - Regression of extra-abdominal gubernaculum completes movement of testes into the scrotum

Development of the Vagina

* Remember the vagina has an upper and lower portion from 2 different origins - The caudal tip of the fused paramesonephric ducts contact the tip of the urogenital sinus and the sinus tubercle forms (cranial portion of ug sinus) - The sinus tubercle gives rise to the two swellings called sinovaginal bulbs - Sinovaginal bulbs proliferate to form the vaginal plate - By the 5th month, the vaginal plate has elongated and a canal forms within the plate ** Wing like expansions form around the caudal end of the uterus froming the fornix: anterior, posterior and lateral fornices - The lumen of the vagina is separated from the urogenital sinus by a thin tissue plate called the hymen The hymen consists of: - thin layer of vaginal cells - epithelial lining of the urogenital sinus NOTE: The vagina has DUAL ORIGIN - the upper part is derived from the paramesonephric ducts and the lower part is derived from the urogenital sinus

What are the branches of the 3rd Part (Pterygomaxillary) of the Maxillary Artery?

* This is the origin of 6 branches 1. Sphengopalatine artery (nasopalatine artery) 2. Descending palatine artery (terminates as greater and lesser palatine arteries) 3. Infraorbital artery (terminates as middle superior alveolar and anterior superior alveolar arteries) 4. Posterior Superior Alveolar Artery 5. Artery of Pterygoid Canal 6. Pharyngeal Branch

Changes in uterine tube histology during menstrual cycle

* Triggered primarily by estrogens - Cilia elongate * BOTH cells types - undergo hypertrophy during the follicular growth phase of the ovarian cycle and - undergo atrophy with loss of cilia during the late luteal phase

Hypothalamus

* a Diencephalic component of the limbic system - controls BP and electrolyte composition - regulates body temp by controlling metabolism and behavioral responses - controls energy metabolism by regulating feeding, digestion, and metabolic rate - regulates reproduction via hormonal control of mating, pregnancy, and lactation - controls physical and immunological responses to stress HEAL! - Homeostasis - Endocrine - ANS - Limbic

Genital Ducts

* think opposites for male and female! 1. Mesonephric (Wolffian) duct: destined to be the MALE genital duct 2. Paramesonephric (Mullerian) duct: destined to be the FEMALE genital duct ------ Undifferentiated gonad--> either becomes XX or XY - If XX (absence of SRY gene, SRY protein)--> Ovary --> Persistence of Paramesonephric (Mullerian) Ducts - If XY (presence of SRY gene and protein)--> Testis--> Persistence/differentiation of Mesonephric (Wolffian) ducts

There are 2 muscles associated with the ossicles (malleus, incus, stapes) of the middle ear

** BOTH help to dampen/mediate the response to loud noises Muscles: Tensor Tympani: I- Tensor tympani nerve (branch of medial pterygoid nerve (V3) Fx: Contraction pulls handle of malleus medially, tensing tympanic membrane, reducing the force of vibrations from loud noises Stapedius: I: CN VII (nerve to stapedius) Fx: Contraction pulls stapes posteriorly, preventing excessive oscillation in response to loud noises NOTE: Contents of the Middle Ear include - Ossicles - Stapedius - Tensor Tympani - Chorda Tympani Nerve - Tympanic Plexus of Nerves (CN IX)

What are clinical features that may occur if there is a Unilateral lesion to the corticobulbar tract to the Internal Capsule (Genu)

** Contralateral deficits, predominantly Corticobulbar inputs disrupted to the trigeminal motor nucleus: - no effects on muscles of mastication as there is BILATERAL innervation by corticobulbar axons (so no jaw deviation!) Corticobulbar inputs disrupted to the dorsal facial nucleus: - upper quadrant of facial muscles NORMAL as there is BILATERAL innervation by corticobulbar axons Corticobulbar inputs disrupted to the ventral facial nucleus: - contralateral paralysis of lower quadrant facial muscles (supranuclear palsy) Corticobulbar inputs disrupted to nucleus ambiguus: - uvula deviates TOWARDS lesion on phonation, dysphagia (difficulty swallowing), dysarthria (difficulty articulating speech), hoarseness of voice Corticobulbar inputs disrupted to the hypoglossal nucleus: - tongue deviates AWAY from lesion upon protrusion Corticobulbar inputs disrupted to the accessory nucleus: - unable to rotate head AWAY from lesion with resistance and unable to raise shoulder on ipsilateral side against resistance

Deep Cerebellar Nuclei

** Each group of nuclei is associated with a lobe or zone! Lateral to Medial: "Dont Eat Greasy Foods" Dentate Nucleus "D": - works with the pontocerebellar system (most lateral) Emboliform Nucleus & Globose Nucleus (Together they are called Interposed Nuclei) "E" & "G": - work with spinocerebellar system Fastigial Nucleus "F": - works with the vestibulocerebellar system

Withdrawal Reflex

** Polysynaptic AKA a nociceptive or flexor withdrawal reflex A spinal reflex intended to protect the body from damaging stimuli (ex. heat or pain) ** It is polysnaptic causing stimulation of sensory and motor neurons through an interneuron: 1. Heat stimulates receptors in the skin, triggering a sense impulse that travels in the afferent neuron to the spinal cord 2. The afferent neuron synapses with interneurons that synapse with efferent neurons - Efferent neurons send impulses to flexors to stimulate limb withdrawal - Efferent neurons send inhibitory impulses to extensors so flexion is NOT inhibited (reciprocal innervation) ** when a person touches a hot object and withdraws his hand from it without thinking about it ** an unconscious (or drunk/drugged) individual does NOT exhibit the reflex- this person is at greater risk of damage as they CANNOT respond to the stimuli

What happens after we leave the cranium via the jugular foramen?

** Remember that veins are carrying de-oxygenated blood back to the heart, so flow is moving in the opposite direction to that of arteries Internal Jugular Veins: - Drain blood from the brain and cranial vault - Retromandibular and facial veins are contributors * Drain to the brachiocephalic veins External Jugular Veins (has Anastomsis with Retromandibular) - Drain blood from occipital, cervical, scapular and anterior jugular veins into the subclavian veins ** remember that the subclavian and brachiocephalic veins (2 of these!) ultimately drain into the superior vena cava

Memory and Sleep

** role of sleep and memory formation/consildation is an area of very active research * Procedural memory: - improved/enhanced with sleep, but the window is small - you must get sleep that night - research shows that sleep apparently rearranges memory within the brain and may organize data/memories into a more efficient storage location ** Declarative/Episodic memory: - sleep will NOT improve your mmemory, but will help you retain and consolidate facts ** Emotional episodic memories may depend on dreaiming sleep for consolidation- cureent research is looking at modifying sleep neurochemically to prevent consolidation of negative, emotional episodes

Anterior Corticospinal Pathway

** Remember this is a descending tract - Axons terminated mainly in cervical and upper thoracic cord for BILATERAL control of axial & girdle muscles... Axons DO NOT cross at the decussation of the pyramids - Pathway ends in the mid thoracic region - Most of the axons cross the the level of the spinal cord that they will innervate, but some project ipsilaterally- the contralateral projection is more dense Upper Motor Neuron: 1st order cell body is located in the primary motor cortex - signals travel on axons (tract) via the internal capsule through the cerebral peduncle & pons to cervical spinal cord levels Lower Motor Neuron: 2nd order cell body is located in the ventral horn of the spinal cord grey mater - bilateral output to axial & girdle voluntary musculature ** BILATERAL INNERVATION!!- So a lesion to the anterior corticospinal tract axons on one side would produce possible paresis (weakness) and NOT paralysis- this is because there is a bilateral innervation of the lower motor neuron cell bodies so the both sides are receiving a signal (innervation)

Dorsal Column/ Medial Lemniscus System

** Remember this is an Ascending Tract Level of DRGs: - T7 and below= signal/information will be carried in Fasciculus Gracilis - T6 and above= signal/information will be carried in Fasciculus Cuneatus Where do fibers cross the neuroaxis? - Caudal Medulla as Internal Arcuate Fibers Deficits? - Lesion in the Fasciculus Gracilis, Fasciculus Cuneatus, Nucleus Gracilis or Nucleus Cuneatus result in IPSILATERL deficits in touch, pressure, vibration, 2pt discrimination - Lesion in the Medial Lemniscus results in a CONTRALATERAL deficit

Objective Assessments- Mini-Mental Examination (MMSE) and Montreal Cognitive Assessment (MOCA)

** Screeners*** fairly reliable estimates of gross cognitive functioning - low scores indicate greater deficit - developed to discriminate normal cognition from mild cognitive impairment - some evidence to suggest that the MOCA is more sensitive - Social background, education, verebal abilities, etc. can influence results and need to be considered with any interpretation ** imporatnt to build rapport and facilitate cooperaton and best effort- better to give at the end of the visit rather than at beginning NOT and intellegence test NOT a precise or comprhensive measure of cognition, affect or behavior -------- these tests assess - orientation - language - attention - following commands * MOCA similar diff format MSSA- cutt off 23 (23 or less= impairment) MOCA (25 or less= impairment, some reserach says 23 may be better)

Vasculature of Thyroid and Parathyroid Glands

** Similar to pharynx and larynx There are 2 sources of arterial supply to the thyroid gland that provide an anstomotic relationship around the gland: 1. External carotid artery --> superior thyroid artery (1st branch) --> supplies antero-superior aspect of thyroid gland 2. Subclavian artery --> thyrocervical trunk --> inferior thyroid artery --> supplies postero-inferior aspect Venous drainage can be separated into the superior poles, middle, and inferior poles of the glands: 1. Superior poles of the gland --> superior thyroid veins (accompany superior thyroid artery) --> internal jugular vein 2. Middle of the lobes of the gland --> middle thyroid vein (run with inferior thyroid artery) --> internal jugular vein 3. Inferior poles of the gland --> inferior thyroid veins --> brachiocephalic veins

Amygdala

** Subcortical region of the Limbic system - Emotion and Drive - Important in connecting emotional signifcance to perceived stimuli - It interprets or defines the emotional significance of sensory events and controls appropriate behavior and learing - Activity in the amygdala has been found in states of fear, aggression, anxiety The amygdala receives inputs from: - visual association cortex - audiotry association cortex - somatosensory association cortex - visceral cortex - hypothalamus Amygdala elicits autonomic responses by connections with the hypothalamus: - tachycardia, increased respirations, release of stress hormones Animal studies: - stimulation= aggression - ablation= tame (Kluver-Bucy syndrome) Human imaging studies: - hyperactivity when shown threatening faces or situations - depressed patients exhibit exaggereated activity when interpreting facial emotion ** 2011- Dr. Adrian Raine (University of Pennsylvania) noted that adult psycopathes appear to have an 18% reduction of the volume of the amygdala compared with non-psychopaths- this difference might explain why psychopathes lack remorse, fear and guilt

What is the importance of ganglia in the head? (i.e Pterygopalatine Ganglion)

** The ANS innervates targets via a 2-neuron chain from either the brainstem (para) or spinal cord (symp) - when we see ganglia in the "head", they HAVE to be PARASYMPATHETIC (the rule! III, VII, IX, X) - the ganglia hous the cell bodies of the 2nd neuron, where the synapse occurs, and then the post-ganglionic axons carry the signal to the target *** GLANDS are what need to be automatically innervated in the head (there a mucous membranes and numerous glands in the head) ** We will see postganglionic parasympathetic fibers from the ganglion and sympathetic fibers from the carotid plexus traveling on these branches and on branches of the maxillary nerve

3 Paired muscles of Female External Genitalia

** These are the SAME in males Ischiocavernosus Muscle - covers the crus of the clitoris - contracts to force blood from the crus of the clitoris into the distal part of the clitoris for its erection Bulbospongiosus Muscle - covers and compresses the vestibular bulbs and constricts the vaginal orifice to aid with sexual arousal Superficial transverse perineal muscle

Lateral Corticospinal/Pyramidal System

** remember, this is a descending tract Where do the fibers/axons/tract cross the neuroaxis? - pyramidal decussation (there is NO synapse before the cross!- the axons, and signal simply cross here to reach their side of innervation Deficits? - lesion rostral to the decussation results in CONTRALATERAL hemiplegia - lesion caudal to decussation results in IPSILATERAL hemiplegia ** hemiplegia= total or partial paralysis on one side of the body

Spinothalamic System (aka Lateral Spinothalamic tract)

** remember, this is an ascending tract Level of DRGS - all spinal cord levels (pain & temp come in at all levels throughout the spinal cord Where do fibers cross the neuroaxis? - directly upon entering the spinal cord and cross in the anterior white commissure Deficits? - A lesion to the spinothalamic tract results in loss of pain and temperature from the CONTRALATERAL side of the body - A lesion to the 2nd order relay of synapses or Lissauers tract will result in an IPSILATERAL deficit

Patient H.M.

** this is how we know that memories are stored in cortex Anterograde/Retrograde Amnesia in H.M. Patient H.M.: - had no change in intellect or preceptual abilities - could acquire new motor skills - had mild retention of visual and tactual mazes ** Period of anterograde amnesia (hippocampus gone- proved memories are stored in cortex, NOT hippocampus)

Vestibulocerebellar System

- Afferent sensory input from the vestibular apparatus enters the cerebellum through the inferior cerebellar peduncle (ICP) and projects to the medial zone of vestibulocerebellar region - Corollary motor fibers also enter the vestibulocerebellar region from the vestibulospinal tract - The cerebellum then compares the vestibular input with the "intended" output of the vestibulospinal tract and "computes" the required corrections - Vestibulocerebellar region projects to the Fastigial Nucleus and the Fastigial Nucleus axons reach the vestibular nuclei to regulate the output of the vestibulospinal tract (equilibrium/balance) or other medial motor system pathways

Paleocerebellar System (AKA Spinocerebellum)

- Afferents from muscle spindles/joint receptors ascend on the spinocerebellar tracts and travel trhough the inferior cerebellar peduncel (ICP- Dorsal Spinocerebellar or Cuneocerebellar) or Superior Cerebellar Peduncle (SCP- Anterior Spinocerebellar) to reach the intermediate zone or paleocerebellar region - Corollary motor fibers also enter the intermediate zone from the Rubrospinal tract - The cerebellum then compares the "intended" output of the Red Nucleus with the state of the muscles and "computes" the necessary corrections between the "intended" Rubrospinal output and the state of the muscle, tendons & joints - The intermediate zone projects to the Globose & Emboliform nuclei and they send efferents out the Superior Cerebellar Peduncle (SCP) and across the midline to the opposite Red Nucleus to modulate the ouput of the rubrospinal tract or other lateral motor system pathways

Physiological effects of Testosterone in males

- Embryonic differentiaton of Wolffian duct-derived structures - Pubertal growth of penis, seminal vesicles & larynx - Spermatogenesis - Anabolic effects on skeletal muscle & erythropoises - Libido, erectile function - Inhibition of breast development - Aggressive behavior

Anatomical position in female pelvis of the 2 Uterine Tube (Fallopian Tube)

- Attached to superolateral aspect of uterus on BOTH sides Uterine tubes are.. - paired structures that extends from the uterus to the ovaries - has 4 parts: uterine part, isthmus, ampulla (the LONGEST AND WIDEST part), and infundibulum (the funnel-shaped termination formed of fimbriae) - conveys the oocyte to the uterus and transport of spermatozoa toward the egg - fertilization usually takes place within the AMPULLA of the uterine tube

Anatomical position of the Ovaries in the Female pelvis

- Attached to superolateral aspect of uterus on BOTH sides- located close to uterine tubes Ovaries are.. - two almond-shaped structures that lie on the lateral walls of the pelvic cavity - suspended to lateral pelvic wall by suspensory ligament of the ovary - attached to uterus by ovarian ligament (or ligament of ovary) - suspended by mesentery called mesovarium Function: - produce oocytes and steroid hormones

Mechanism of Action of Local Anesthetics: Use-Dependent Blockade of Voltage-Gated Sodium Channel

- Bind to OPEN and INACTIVATED channel conformations - They prevent channel reactivation and Na+ permeation - They bind an intracellular site - Nonionized LA crosses the membrane, LA+ (ionized form) binds channel (intracellular site) Effect: Before LA, many channels can be recruited--> large current - after applying LA, individual channels become blockes, so the sodium current is REDUCED - with smaller sodium current, neuronal depolarization is suppressed--> DECREASED PAIN

Affect- "weather" (ex. snow- what you are seeing)

- Broad/Normal: normal variability in facial expression, vocal pitch, use of gestures - Restricted: decreased display of emotional responses - Blunted: strongly decreased display of emotional responses - Flat: Complete lack of emotional responses (can indicate psychotic symptoms) - Labile: sudden alterations in emotional responses not due to environmental events

Core Language Circuitry

- Brocas Area (BA44,45) - Wernicke's Area (BA 22,39,40) - Arcuate Fasciculus (connects these two above) Additional areas involved in language: - Anterior association cortex - Posterior association cortex - Subcortical structures - Connections to the contralateral hemisphere via corpus callosum

Neural Crest Cell Derivatives

- CT and bones of face and skull - Cranial nerve ganglia - C Cells of the thyroid gland - Conotruncal septum in the heart - Odontoblasts - Dermis in face and neck - Spinal (dorsal root) ganglia - Sympathetic chain and preaortic ganglia (review previous Dr. Welke lecture) - Parasympathetic ganglia of GI - Adrenal medulla - Schwann cells - Glial cells - Meninges (forebrain) - Melanocytes - SMCs to blood vessels of face and forebrain

Ventral horn somatotopy

- Cells supplying proximal musculature are medial to those supplying distal limbs - Cells supplying flexor muscles are dorsal to those supplying extensor muscles Ex: - Medial Motor Cell Column (all levels) - Lateral Motor Cell Column (C5-T1 and L1-S3)

How do you know a section is the Caudal Midbrain?

- Cerebral peduncles - Superior Colliculi

At what gestattional stage is hCG detectatble in maternal serum. When does the conc. of maternal hCG peak? What is the rate of increase in hCG levels during preg? What cells secrete hCG? what conditions could be implicated by the detection of abnormally low/high hCG levels?

- Detectable in maternal serum 8-10 days post fertilization - Levels peak in 9th-10th week and decline steadily acter - Levels rise in exponential manner during early pregnancy, doubling every 48-72 hrs - hCG is secreted by the syncytiotrophoblast cells Low hCG indicative of: - inadequate implantation/placentation - non-viable intrauterine or ectopic pregnancy High hCG indicative of: - multiple pregnancy - gestational trophoblastic disease (GTD)- tumor porducing high hCG

Angelman Syndrome

- Developmental delay noticeable from 1/2 year of age - Progressive, several years to full syndrome - Gait ataxia, tremoulous hands, intellectual disability, speech impairment, inappropriate laughing/smiling/excitability --> Microcephaly, seizures frequently seen - Incidence 1/20,000 ** Loss of expression of UBE3A in 15q11.2 UBE3A= Ubiquitin-protein ligase E3A

Pupillary Light Reflex in the case of damage to ONE optic nerve?

- Direct and consensual reflexes are LOST if light is shone in the "damaged" eye: there are NO signals reaching the brainsetm via that optic nerve so neither response will occur - Direct and consensual reflexes are intract is light is shone in the NORMAL EYE: the optic nerve is normal so signals will reach the brainstem causing constriction of both pupils via the synaptic pathway and output on the oculomotor nerves CN II Lesion--> Loss of direct pupillary light reflex

Considerations of DSM-5

- Disorders are categorically organized (however, disorders often have overlappy symptoms- i.e. anxiety and depression); be aware of differentials and comorbid disorders - Patients may or may not meet criteria for a disorder at different times in their lives (can recover from depression (: ) - Cultural, social, and familial norms should be considered (normality vs. pathology) (ex. in some cultures grief is a very long process and its normalized) - gender differences (ex. schizophrenia more common in men) - prevalence and base rates (i.e., psychosis in an 8-year-old? it is very unlikely)

Pierre Robin Syndrome

- Due to abnromal development of first pharyngeal arch, specifically of the lower jaw - Micrognathia (undersized mandible) causes the tongue to be displaced superiorly and fall back in the throat- for this reason, the palate does not close * Breathing problems may also result, requiring devices which maintain an open airway - Occurs apprx. 1/8500 births

Mood "season" (ex. Winter)

- Euthymic: normal mood, no significant depression or elevation - Euphoric: strong feelings of elation - Dysphoric: subjectively unpleasant feeling - Labile: alternated betweene uphoric and dysphoric moods - Anhedonic: inability to feel pleasure from acitivities usually found enjoyable (used in diagnosing if ppl used to have pleasure and no longer do- but ppl can just have this modd chronically) - Irritable: easily annoyed and quick to anger - Expansive: feelings of self-importantce and grandiosity (can indicate manid state or narcissm)

What are the branches of the Ophthalmic Division of the Trigeminal nerve?

- Frontal Nerve - Lacrimal Nerve - Nasociliary Nerve ** these all carry out somatosensory signals (GSA axons) to the brainstem ** remember somatosensory is "touch"/"pain" *** The lacrimal nerve will also provide innervation to the lacrimal gland (secretomotor/GVE axons)

Structures Contributing to Formation of the Face

- Frontonasal prominence--> forehead, bridge of nose, and medial and lateral nasal prominences - Maxillary prominence --> cheeks, lateral portion of upper lip - Medial nasal prominence --> philthrum of upper lip, crest, and tip of nose ** When the medial nasal prominences and maxillary prominences merge, there is a deeper structure formed, which is the intermaxillary segment (this segment is continuous with the rostal portion of the nasal septum- formed from the frontal prominence) Intermaxillary Segment has 3 components: 1. Labial: forms philtrum of the upper lip 2. Upper jaw: four incisor teeth 3. Palatal: forms the primary palate - Lateral nasal prominence --> Alaw of nose - Madibular prominence --> lower lip

7 Nerve Fiber Modalities/ Types

- GSE (General Somatic Efferent): motor fibers to skeletal, voluntary musculature - GSA (General Somatic Afferent): fibers that carry GENERAL sensation (touch, pressure, pain & temp) - GVE (General Visceral Efferent): motor fibers to smooth muscle, glands, viscera - GVA (General Visceral Afferent): fibers that carry VISCERAL sensation - BE/ SVE (Branchial Efferent/ Special Visceral Efferent): motor fibers to skeletal, voluntary muscles that developed from branchial (pharyngeal) arches - SVA (Special Visceral Afferent): taste & smell - SSA (Special Somatic Afferent): vision & hearing

Key neurotransmitters in CNS

- Glutamate - Gamma aminobutyric acid (GABA) - Dopamine - Serotonin - Norepinephrine - Acetylcholine - Neuropeptides Focus on their receptors and signal transduction pathways and the drugs that target these systems

Age-related changes in gonadotropin secretion

- GnRH is present in the hypothalamus by 4 weeks gestation and FSH & LH are present in the pituitary by 10-12 weeks gestation- Gonadotropin concentrations peak at mid-gestation, fall to low levels before birth and again increase at 2 months of age - During childhood, gonadotropins are secreted at very low, but detectable levels - At puberty, owing to increased release of pulsatile GnRH, FSH and LH secretion begins to rise, eventually culminating in sufficient LH to induce ovulation- this initial ovulation is followed by the first occurrence of menstruation or menarche - the gonadotropin surge does NOT occur with regularity early in pubescence and most cycles in early pubert are thus, anovulatory - During the reproductive years, maturation of the HPO axis is accompanied by secretion of larger levels of gonadotropins, and the occurrence of regular, ovulatory menstrual cycles - At menopause, owing to lack of negative feedback from the ovaries, LH and FSH levels rise

Huntington's Disease

- Hyperkinetic Disorder (increased movement) - Degenerative disorder of CNS - Repeat disorder on chromosome 4 - Onset between 20-50 yrs of age - Region: striatum- specifically the medium spiny neurons of the caudate ** Severe atrophy of the striatum (putamen and caudate nucleus) Clinical Features: - Chorea, Athetosis, Aggression, Depression, Dementia (sometimes initially mistaken for substance abuse bc it affects mood) **Just like in Athetosis: Degeneration of indirect pathway --> increased excitation to the cortex--> slow writhing movements (chorea)

Pharyngeal arches are associated with which CNs?

- I (mandibular): CN V3 - II (hyoid): CN VII - III: CN IX - IV: CN X - VI: CN X (* CN 3,7,9,10)

Subarachnoid Cisterns

- Interpeduncular Cistern (cisterna interpeduncularis or chiasmatic cistern) - Pontine cistern (prepontine cistern or cisterna pontis) - Quadrigeminal cistern (superior cistern or cistern of the great cerebral vein) - Cerebellomedullary cistern (cisterna magna)

Name the site of action of the following drugs - Ketamine - Morphine - Capsaicin - Acetaminophen - Gabapentin - Duloxetine - Carbamazepine

- Ketamine: NMDA receptor - Morphine: mu opiod receptor - Capsaicin: TRPV1 channel - Acetaminophen: COX-1 variant - Gabapentin: Pre-synaptic VGCa2+C - Duloxetine: NET and SERT - Carbamazepine: VGNa+C

External Genitalia (Vulva) of female are:

- Labia majora (skin) - Labia minora (folds of mucosa) - Clitoris (erectile tissue; contains many sensory nerve endings) - Vestibule (urethra and vagina open into this space) - Vaginal orifice (in vestibule) - Vestibular (Bartholin) glands: secrete mucus; open on inner surface of labia minora

Grey Mater structures in the Lateral Horn (aka INTERMEDIATE ZONE) of the thoracic cord?

- Lamina VII: intermediate grey and lateral horn only from T1-L2 - Pregnaglionic sympathetic neuronal cell bodies are in the intermediolateral cell column of the lateral horn - S2-S4 levels are autonomic nuclei for the PARAsympathetic system - Clarkes Column (nucleus dorsalis & Clarkes nucleus)= send unconscious proprioception to the cerebellum

How do you know a section is the Pons?

- Large Middle Cerebellar Peduncles - Pontine Nuclei (white) and decussating pontocerebellar axons (dark)

Larger -sized vs Smaller-sized dots in the Reticular Formation in the brainstem

- Larger-sized dots represent magnocellular (large-celled regions)- efferent connections - Smaller-sized dots represent parvocellular (small-celled regions)- afferent connection NOTE: - Long processes reach many areas of the CNS (hypothalamus, cortex, spinal cord, cerebellum) and synapse with almost all tracts going through the brainstem - Short processes: local connections *** Very complex connections with convergence, divergence and overlap

Cervical Plexus- Cutaneous Branches (GSA axons)

- Lesser occipital nerve (C2): skin of the neck and posterosuperior to the ear - Greater auricular nerve (C2, C3): Ascends over sternocleidomastoid muscle towards inferior aspect of parotid gland- innervates skin over parotid gland, mastoid process, inferior ear, and angle of mandible to mastoid process - Transverse cervical nerve (C2, C3): passes over sternocleidomastoid muscle anteriorly, supplies skin of anterior cervical region - Supraclavicular nerves (C3,C4): passes over sternocleidomastoid muscle inferiorly and laterally- supplies skin over lateral neck and shoulder- includes medial, intermediate, and lateral branches ** Erbs point= site located at the posterior border of the sternocleidomastoid muscle where the four cutenous nerves from the cervical plexus emerge

How do you know a section is the Rostral Midbrain?

- Mamillary Bodies (MB) - Red Nucleus (RN) - Thalamic Nuclei: Medial Geniculate Nucleus (MGN) and Lateral Geniculate Nucleus (LGN)

What artery and nerve supply structures that arise from the I (mandibular) pharyngeal/branchial arch

- Maxillary Artery - CN V3

Disorders of the menstrual cycle

- Menorrhagia: excessive or prolonged uterine bleeding at menstruation (>80ml of blood loss, or lasting >7 days in duration) - Amenorrhea: absence of menstruation (primary: no manarche by age 16) (secondary: failure of 3 or menstrual periods in succession in a female who previously had established a cycle- common in athletes, anorexics, bulimics, stress - Polymenorrhea: uterine bleeding that occurs at interval <21 days - Oligomenorrhea: uterine bleeding that occurs at intervals >35 days (commonly due to anovulation- menstrual cycle with no oculaiton= no CL= no progesterone, prolonged unopposed estrogen= endometrial build-up), manifestes as irregular, often excessive bleeding - common in adolescents, peri-menopause, PCOS ** Abnormal uterine bleeding (AUB) is a very common complaint, accounting for one-third of outpatient visits to gynecologists

Short vs. Long term Responses in Neuron

- Output of a neurons depends on sum of inpute - Neurotransmission is fast (milliseconds) Neurotransmitters act on: 1. Ligand-gated ion channels (LGICs) (AKA ionotropic receptors) - Na+, Ca2+, K+, Cl- channels - increase or decrease membrane potential --> increase of decrease activity of voltage gated ion channels (VGICs) --> increase of derease likelihood of action potential --> affect gene expression 2. GPCRs (AKA metabotropic receptors) - slower acting bc changing metabolic concentration of cAMP, IP3, kinases, Ca2+ --> increase or decrease activity of voltage-gated ion channels (VGICs) --> increase or decrease likelihood of action potential --> affect gene expression ** gene expression will strengthen or weaken the synapses

Contents of the Parotid region (Fossa)

- Parotid gland and parotid duct - Parotid plexus of the facial nerve (CN VII)- "To Zanzibar By Motor Car" - Retromandibular vein - External Carotid Artery - Masseter Muscle

What are the 8 branches of the external carotid artery?

- Superior thyroid artery - Ascending pharyngeal artery - Lingual artery - Facial artery - Occipital artery - Posterior auricular artery - Maxillary artery - Superficial temporal artery ** Some Anatomists Like Freaking Out Poor Medical Students

Anatomical position of Vagina in the Female Pelvis

- Posterior to bladder and urethra - Inferior to cervix and uterus - Anterior to rectum and anal canal

Estrogen Contraindications

- Pts at high risk for estrogen dependent neoplasms (endometrial and breast cancer) should no receive estrogen - Pts with a history of thromboembolic disorders - Heavy smokers (especially those over 35 yrs old)

Branches of Sacral Plexus (L4-S4)

- Pudendal nerve (S2,S3,S4): innervates skin and muscles of perineum - Pelvic splanchnic nerves (S2,S3,S4): provide parasympathetic innervation to pelvic organs and Nerves that go to the lower limb: - Superior gluteal nerve (L4-S1) - Inferior gluteal nerve (L5-S2) - Sciatic nerve (L4-S3) - Posterior femoral cutaneous nerve (or posterior cutaneous nerve of the thigh) - Nerve to piriformis, nerve to quadratus femoris, nerve to obturator internus

Left Hemisphere

- Quality of speech production: dysarthria, dysphonia - Aphasia: verbal expression and language comprehension, repetition **Brocas aphasia: expressive aphasia, difficuly producing lang, comprhension conserved ** wernickes aphasia is opp. of brocas *** Gerstmann Syndrome: - Inferior parietal and temporal lobe lesion (dominant side) - L/R disorientation - Finger agnosia - Acalculia (difficulty calculations) - Agaraphia (difficult writing)

Major Connections of the Globus Pallidus Externa (GPe)

- Receives inhibitory information from striatum (Caudate+Putamen+Nucleus Accumbens) - Sends inhibitory information to striatum, GPi, subthalamic nucleus, and substantia nigra pars reticulata (SNr) - Receives excitatory information from subthalamic nuclei ** NOTE: subthalamic nucleus is the ONLY excitatory nucleus in the basal ganglia

Types of Ocular movements

- Saccades (scanning): rapid horizontal and vertical eye movements- used to redirect gaze so a different image falls on the fovea--> saccades are what is used all the time in everyday life--> scanning the environment, reading, watching a movie or lecture - Smooth-pursuit movements (tracking): eye folow a moving object to keep the image stationary on the fovea without moving the head - Vergence: the axes of fixation converge when an object moves toward the eye, or diverge when it moves away - Convergence- accomodation, pupillary constriction Reflex eye movements: 1. Optokinetic response (combination of saccades and smooth-pursuit-- folowing a moving object and whne it moves out of the visual field, the eye will "saccade" back to the original position 2. Vestibulo-ocular reflex: slow eye movement in the opposite direction of head rotation, followed by a rapid (saccadic) movement of the eyes in the direction that the head is turning

Prostatic Secretions

- Slightly alkaine serous fluid - Milky or white in appearance - Usually constitutes roughly 30% of the volume of the semen along with spermatozoa and seminal vesicle fluid - Prostate gland also secretes several enzymes, including prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) ** fyi PSA helps to liquefy coagulated semen for the slow release of sperm after ejaculation - the formation, synthesis, and release of the prostatic secretions are regulated by dihydrotestosterone pH of semen: Semen is amde alkaline overall with the secretions from the other contributing glands- the alkalinity of semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm

Interaural Time Delay (ITD)

- Sound from Right-> reaches right ear first (there will be an interaural delay before the sound propagates to the left ear) - Sound from Straight ahead--> has NO interaural delay (sound reaches both ears at the same time) - Sound from Oblique angle on right--> will be partially delayed to LEFT ear **** Interaural time delay (ITC) occurs in the MEDIAL SUPERIOR OLIVE (MSO) Ex: 1. Sound reaches left ear first 2. Action Potential begins traveling toward MSO 3. Sound reaches right ear a little later 4. Action potential from right ear begins traveling toward MSO 5. Action potentials converge on an MSO neuron which responds most strongly if their arrival is coincident ** Time Delay is better for lower frequency

Physical Consequences onf SCI

- Spinal Shock: immediately after injury, lasting several hours to several weeks with subsequent recovery- flaccid paralysis, anesthesia, loss of bowel/bladder control, loss of reflex activity- brady cardia and hypotension, gradual recovery of reflexes - Loss of motor/sensory funciton - lung and breathing problems: pulmonery, edema, pneumonia, pulmonary embolism- weakness of diaphragm and chest wall muslces- impaired clearance of secretions, ineffective cough, hypoventialtion, etc - deep vein thrombosis: highest incidence between 72hrs and 14days- very common: all pts should receive prophylactic treatment - pain - bowel and bladder managment - GI and stress ulceration - temp control: may lack vasmototr control and cannot seat below the lesion - Pressure sores: can develop quickly- most ocmmon in buttacks and heels- freq. truning is important - nutrition and weight control issues - increased risk for stroke or siezure - sexual dysfunction SCI chronic complications - 55% of patients are re-hospitalized with first year of SCl- due to genitourinary and respiratory complications, pressrure ulcers most common reasons - increased age and SCi severity impacted complications risk

7 muscles are associated with the posterior triangle of the neck in addition to the inferior belly of the omohyoid (an infrahyoid muscle)- what are the 7 muscles?

- Sternocleidomastoid - Anterior Scalene - Middle Scalene - Posterior Scalene - Splenius Capitis - Levator Scapulae - Trapezius

Veins of the Root of the Neck

- Subclavian cein is a continuation of the axillary vein and lies anterior to the anterior scalene muscle - At the 1st rib, the subclavian vein joins the internal jugular vein to form the brachiocephalic vein (both brachiocephalic veins form the superior vena cava) - Main tributaries to the subclavian vein are the external jugular vein, anterior jugular vein and dorsal scapular veins - The retromandibular vein drains into both th einternal and external jugular veins - The internal jugular vein starts at the jugular foramen, draining the brain, internal skull and deep neck structures - The vertebral vein drains into the brachiocephalic vein

Boundaries of the Laryngopharynx

- Superiorly: the upper margin of the epiglottis - Inferiorly: to the level of C6 vertebrae - Anteriorly: the wall consists of the laryngeal inlet superiorly and the posterior wall of the larynx - Posteriorly: the inferior pharyngeal constrictor Features of the laryngopharynx: - Piriform Fossae - Epiglottis - Laryngeal inlet *** Piriform Recesses (sinuses): Between central part of larynx and lateral lamina of thyroid cartilage - Act as channels that direct solids and liquids from oral cavity around the laryngeal inlet into the esophagus ** Certain objects (ex. fish bones) can become lodged in this recess- if the object is sharp, it may pierce the mucosal membrane and damage the recurrent laryngeal nerve

Harmful substances that can cross the Placenta

- Synthetic estrogen diethylstilbestrol (DES): crosses placenta easily, can cause carcinoma of the vagina and abnormalities of the cervix and uterus in the female, and in the testes of males who were exposed to DES during their intrauterine life - Many virues (rubella, cytomegaloovirus, coxsackie, varicella, poliomyelitis viruses): cross the placenta without difficulty- some can cause infections, which may result in cell death and birth defects ** Congenital Cytomegalovirus infection: causes hearing, eye, brain, liver, spleen defects - Most drugs: cross without difficutly resulting in serious damage to embryo/fetus. Heroin and cocaine can cause fetal habituation - Most bacteria are TOO large so they DO NOT cross the placental barrier - In some cases, this transplacental transfer may be beneficial and drugs may be deliberatly administered to the mother in order to treat specific fetal conditions. For ex., steroids may be given to the mother to promote fetal lung maturation and cardiac drugs may be given to control fetal arrhythmias

Superficial Muscles of Mastication

- Temporalis (located in the temporal fossa) - Masseter (located in the face) Temporalis Origin: temporal lines of parietal and sphenoid bones Insertion: coronoid process of mandible Innervation: Deep temporal nerves (CNV3) Function: Elevation and Retraction of mandible Masseter: Origin: zygomatic arch and zygomatic process of maxilla Insertion: angle and lateral surface of ramus of mandible Innervation: Masseteric branches (CNV3) Function: Elevation and protrusion of mandible

Androgens given for Male Reproductive System

- Testerone - Testosterone esters (Testosterone enanthate) - 17a-alkylated androgens (methyltestosterone)

Events occuring during testicular descent

- Testicular arteries descend with the testes - Processus vaginalis (an evagination of abdominal periotneum) follows the gubernaculum into the scrotal swellings - The processus vaginalis, accompanied by muscular and fascial layers of the body wall, form the inguinal canal - In the scrotum, the processus vaginalis covers the testis forms tunica vaginalis which is compose of an inner visceral layer and outer parietal layer - The connection between processus vaginalis and the peritoneal cavity is obliterated at birth ** In addition to being covered by peritoneal layers derived from the processus vaginalis, the testis become ensheathed in layers derived from the anterior abdominal wall through which it passes. Consequences: - thus, the transversalis fascia forms the internal spermatic fascia - The internal abdominal oblique muscle gives rise to the cremasteric fascia and msucle - The external abdominal oblique muscle forms the external spermatic fascia - The transversus abdominis muscle does NOT contribute a layer bc it arches over this region and does NOT cover the path of migration

GABAa is an important target for drugs- what drugs can act there?

- The ligand itself- GABA - Benzodiazepines, ex; DIAZEPAM - Barbiturates - General anesthetics - Alcohol (ethanol) ** all bind to diff. locations Receptor structure: - 5 subunits, many variations (diff genes- so some drugs can be useful for sleep disorders while not useful for epilepsy so there is variation in GABAa receptors

Oral region includes

- The lips, oral fissure, oral vestibule, gingivae, oral cavity, teeth, tongus, hard and soft palate, palatine tonsils and salivary glands ** it is the area where food is initially processed for digestion ** It manipulates sounds produced by the larynx for speech, singing, etc

Bioavailable testosterone consists of

- Unbounded testosterone "Free", ~1-2% - Testosterone loosely bound to albumin ~54% Unavailable Testosterone is that which is bound to SHBG ~44% Key pts: - SHBG binds DHT, Estrogen and Testosterone - Binding affinity: DHT > Testosterone > Estrogen - SHBG-DHT binding affinity is VERY HIGH - Circulating DHT bound to SHBG is UNAVAILABLE for peripheral tissues - DHT must be produced within the target tissue to exert its effects NOTE: Levels of Albumin-bound T & Free T remain relatively the same--> Increases in SHBG reduce the amount of bioavailable testosterone --- The 1-2% of testosterone that is freely available is the most biologically active, and it is this freely available (i.e. unbound) T in the circulation that crosses the cell membrane and exerts androgenic effects - T binds so loosely with albumin that it dissociates freely, and therefore albumin is considered the transport protein delivering testosterone to where it needs to go throughout the body Collectivly, free T and albumin-bound T are considered "Bioavailable" and are utilized by the body - the vast majority (95% or more) of T bound to SHBG is removed from the systemic circulation after the first-pass through the liver, and therefore, T bound to SHBG is largely considered "Unavailable"

Sensory organs in our head can signal through the brainstem via

- Vestibular nuclei - (vestibulospinal tract (med & lat))--> medial white matter in spinal cord--> axial and proximal musculature in periphery - Superior Colliculus--(tectospinal tract)--> medial white matter in spinal cord --> axial and proximal musculature in periphery

Each pharyngeal arch (1st, 2nd, 3rd, 4th, 6th) has an associated:

- artery - nerve - skeletal component (cartilage) - mesenchymal core (loose CT) ** Wherever the muscle cells migrate, they carry their nerve component with them! ** Arches, clefts, and pouches develop in the lateral wall of the pharynx NOTE: - internal endoderm contains the pharyngeal pouch "internal pouch" between pharyngeal arches - external ectoderm with external cleft between the pharyngeal pouches * remember within each arch is cartilage, musculature, arterial supply and a nerve

The spaces between the seminiferous tubules in testes are filled with

- connective tissue - nerves - fenestrated capillaries - lymphatic vessels ** At puberty, another cell type becomes highly visible: LEYDIG CELLS--> secrete testosteron Testosterone is important for: - spermatogenesis - sexual differentiation during embryonic and fetal development - - control of gonadotrophin secretion NOTE: Dihydrotestosterone is metabolite of testosterone secreted in testes--> acts on many organs and tissues of the body during puberty and adulthood (ex. muscle, hair pattern, and hair growth) NOTE: - Leydig cells often display cytoplasmic crystal of Reinke, the function of these crystals is unknown

Lobes and zones of the prostate

- consists of a base, apex, anterior, posterior and two lateral surfaces - the prostate is divided into lobes: anterior lobe, median lobe, lateral lobes (left and right lobes), and posterior lobe ** The prostate is also divided into different ZONES according to their function: - Central zone (CZ) - Peripheral zone (PZ)- *** peripheral zone is the MOST common site for prostate cancer - Transitional zone (TZ)

Neurovasculature of the penis

- deep artery of the penis supplies the corpus cavernosum to fill it with blood for an erection - spongy urethra or penile urethra travels through the corpus spongiosum

Self-concept after SCI

- depression, anxiety, PTSD and feelings of helplessnes are higher than in the general population - even healthcare professionals may be quick to assume that behaviors are related to psychological reactions to overwhelming loss - adopting an overly catastrophic perspective may convey a defeatist or pitying attitude - most ppl adapt well following SCI and (after a period of adjustment) have a positive self-concept and report being satisfied with life - healthcare professionals should NOT assume they know what the pt is experiencing- instead they should ask questions and provide opportunities for engaging in a discussion

Ex of things that could cause erectile dysfunction

- enlarged prostate gland compressing the pudendal nerve - hyperglycemia --> insulin resistance, and men with type II diabetes have a higher incidnece of erectile dysfunction **NOTE: cardiovascular disease issues are always leading cause and take precedent

Paramesonephric (Mullerian) ducts develop into the

- fallopian tubes - uterus - upper third of the vagina in the female For lower 3rd of the Vagina: - Caudal tip of fused paramesonephric duct contacts tip of the urogenital sinus: sinus tubercle - Sinus tubercle gives rise to the two swellings: sinovaginal bulbs - Sinovaginal bulbs proliferate to form the vaginal plate - Vaginal plate elongates and a canal forms within the plate

Dominant (usually LEFT) Hemisphere

- language - skilled motor formulation (praxis) - arithmetic: sequential and analytical calculating skills - musical ability: sequential and analytical skills in trained musicians - sense of direction: following a set of writen directions in a sequence

What cartilage/ skeletal structures arise from the IV pharyngeal arch?

- laryngeal cartilages (thyroid, cricoid, arytenoid, corniculate, cuneiform) ** proximal part of the R subclavian artery and a portion of the arch of the aorta * CN X (superior laryngeal branch of the vagus nerve)

What are the first bones in the body to be ossified?

- malleus - incus (from 1st arch) - stapes (from 2nd arch)

Basal ganglia are

- masses of grey matter in cerebral hemispheres - inferior to floor of lateral ventricle - embedded within central white matter, radiating projection and commissural fibers Also called: - cerebral nuclei - basal nuclei

Non-dominant (usually RIGHT) Hemisphere

- parasody (emotion conveyed by tone of voice) - visual-spatial analysis and spatial attention - arithemetic: ability to estimate quantity and to correctly lone up columns of numbers on the page - musical ability: in untrained musicians, and for complex musical pieces in trained musicians - sense of direction: finding ones way by overall sense of spatial orientation

Anatomical position of the Rectum in the Female Pelvis

- posterior to vagina and uterus - anterior to sacrum Anal canal (terminal part of the digestive tract) ** remember External anal sphincter is voluntary, internal anal sphincter is INVOLUNTARY Pectinate line= an irregular line formed by the inferior limit of the anal valves Superior to pectinate Line: - anal canal superior to pectinate line is derived from the embryonic hindgut - it drains lymph to internal iliac lymph nodes - receives visceral motor innervation (mixed sympathetic and parasympathetic) and sensory innervation - arterial supply from inferior mesenteric artery - venous supply to portal venous system (hepatic portal vein) Inferior to pectinate line: - anal canal inferior to pectinate line is derived from embryonic proctodeum - it drains lymph to the superficial inguinal lymph nodes - receives somatic motor and sensory innervation - arterial supply from internal iliac artery - venous supply to caval venous system (IVC) ** NOTE: separation of "visceral" and "parietal" at the pectinate line ** Due to different embryological origins of the superior and infeior parts of the anal canal, there is a difference in nerves, blood supply and lymphatic ABOVE and BELOW the pectinate line

Androgens as Drugs

- readily absorbed across all epithelial surfaces (very lipophilic) - oral testosterone is ineffective bc of its high first pass metabolism (will metabolize too quickley) - compounds developed to be efficiently orally bioavaialable (17alpha-alkylated androgens) are hepatotoxic (ex. methyltestosterone)- 17alpha-alkylated androgens are less androgenic than testosterone - Fatty acid esterification of the 17 alpha group increases the lipid solubility of testosterone (ex. testosterone enanthate*)

Drug distribution through tissue- from site of injection of local anesthetics

- reduced by adding a vasocontrictor, ex. epinephrine (reduce rate of which local anesthetic concentration drops) ** epinephrine in brachial plexus- but SOME sites DONT adminster with local anesthetics and those are targets fed by end arteries- bc vasoconstriction there will have problem if blood flow can get to that area- ex. penis, ear lobe, fingers- can cause gangrene if adding vasoconstrictor with local anesthetic- so use of this depends on location!) - vasocontrictor prolongs duration of action by 25-50% - local inflammation acidifies the environament and REDUCES membrane permeation of local anesthetic (LA--> LA+) - HCO3- can be added to increase local pH and increase membrane permeation (pushs more drug to unionized to cross cell membrane and more in the intracellualr environment and available to interact with binding site on voltage gated sodium channel) Metabolism: - Amides: metabolized in LIVER; CYP mediated - Esters: metabolized in PLASMA (ex. butyrylcholinesterase/pseudocholinesterase) -- **CSF lacks esterases so longer duration of action of spinal analgesia (so ester longer duration given spinally than by given to another site bc protected by esterases in spinal environement) Excretion- renal

Pelvis is made up of:

- sacrum - 3 paired bones of the hip: iliac, ischial, pubic * Before puberty the bones of the hip are "unfused" - they are connected to each other by the triradiate cartilage (a y-shaped epiphyseal plate occuring at the junction at junction of the ischium, ilum and pubis in the immature skeleton) In the adult pelvis: - 3 hip bones are fused Joints of the pelvis include: - sacroiliac joint - pubic symphysis Important landmarks of the pelvic structure: - iliac crest - anterior superior iliac spine - anterior inferior iliac spine - posterior inferior iliac spine - ischial tuberosity - greater sciatic notch - obturator foramen Acetabulum - concave surface of the hip bone - formed where the 3 bones of the hip meet - articulates with the head of the femur

FSH leads to

- sertoli cell proliferation & seminiferous tubule growth - spermatogenesis - androgen binding protein (ABP) - inhibin B *** FSH plays an important role in the development of the immature testes, by controlling Sertoli Cell proliferation & seminiferous tubule growth - Bc the tubules account for approximately 80% of the volume of the testes--> FSH is of MAJOR importance in determining testicular size in the adult male

All corticobulbar fibers have BILATERAL innervation EXCEPT for

- ventral nucleus of CN7 (contralateral) - Accessory (ipsilateral) - hypoglossal (contralateral)

2 Components of the Epithalamus

1- Pineal Gland - a midline, UNPAIRED structure - attached to the roof of the 3rd ventricle by the pineal stalk - overlies the tectal (roof) area of the midbrian 2- Habenular nuclei (part of limbic system) - afferent input from stria medullaris thalami - efferent to interpeduncular nuclei

There are three major channels that undergo processing in the visual cortex

1) motion 2) form and 3) color ** The three characteristics are separated at the level of the lateral geniculate nucleus and then terminate in different layers of the primary visual cortex (brodmanns area 17) *** layer 4 is recieving things from the thalamus NOTE: Layer 4 of the primary visual cortex is functionally important bc of the projections terminating there from the lateral geniculate nucleus - Layer 4Beta contains many myelinated axons resulting in a pale appearance- this area is called the "stria of Gennari" ** Because of this stria, the primary visual cortex (BA 17), along the banks of the calcarine sulcus, ir referred to as striate cortex

What are the 3 lobes of the hemisphere

1- Anterior Lobe 2- Flocculonodular Lobe 3- Posterior Lobe ** 2 Hemispheres (right and left) separated by the vermis - Primary fissure, separates Anterior and Posterior lobes, which make up the body of the cerebellum - Posterolateral (dorsolateral) fissure separates body from flocculonodular lobe

Nuclei for CNVII: Facial

1- Facial Nucleus (BE) 2- Superior Salivatory Nucleus (GVE) 3- Nucleus Solitarius Rostal (SVA) 4- Main Sensory & Spinal Nucleus of V (GSA) Axon Modalities: BE, GVE, SVA, GSA

Classifications of Pain

1- Fast/Stinging "intital Ow" 2- Slow/Buring 3- Epicritic: easily discriminable and WELL-localized 4- Protopathic: NOT definitely localized & can only be described in a general way 5- Nociceptive: awareness of pain by nociceptor stimulation by a noxious stimulus 6- Neuropathic: lesion to the PNS or CNS pain pathways Nociceptive Receptors 1- Mechanical: respond to crushing pressure and have large receptive fields 2- Thermal: respond to temperatures about 45 degrees celsius or below 15 degrees celsius 3- Polymodal: respond to both high threshold mechanical, chemical and thermal stimulation Types of Nociceptive Fibers: 1- A-delta fiber: fast, thick, myelinated fiber that carries AFFERENT info about intense/acute pain 2- C-fiber: small, UN-myelinated fiber that carries AFFERENT info about slow, throbbing, chronic pain

CSF system has 2 parts

1- Internal: includes the lateral ventricles, interventricular foramina, 3rd ventricle, cerebral aqueduct, 4th ventricle (20% total volume) 2- External: includes the subarachnoid spaces and cisterns (80% total volume) *** these two parts communicate via aperturs of the 4th ventricle

What are the 2 ways which motor tracts can be classified?

1- Location in spinal cord (either lateral or ventromedial) Lateral Pathways: - Lateral Corticospinal Tract - Rubrospinal Tract ** these tracts provide voluntary motor innervation to appendicular musculature (limbs!) Ventromedial Pathways: - Lateral vestibulospinal tract - Medial vestibulospinal tract - Lateral reticulospinal tract - Medial reticulospinal tract - Tectospinal - Anterior Corticospinal tract **** These pathways provide voluntary motor innervation to axial and girdle musculature involved in postural tone, balance, orientation 2- By origin of the tract (either from brain or brainstem) Brain= Corticospinal (pyramidal) and corticobulbar Brainstem= Vestibulospinal, tectospinal, reticulospinal, rubrospinal (all these are extrapyramidal systems)

Organizations of Spinal Cord White Matter include (5 Categories of fibers)

1- Long ascending tracts: medial lemniscus, spinothalamic, fasciculus fracilis, fasciculus cuneatus 2- Long descending tracts: corticospinal tract 3- Propriospinal fibers (propriospinal fibers= intersegmental or intrasegmental connections- occur primarily in three regions: fasciculus proprius, lissauers tract and the anterior white commissure) 4- Motor neuron fibers that exit via the ventral spinal roots 5- Dorsal root ganglion afferent fibers which enter the spinal cord

What are the 3 layers of the Cerebellar Cortex?

1- Molecular layer (outermost layer): consists of stellate & basket cells (both cell types are inhibitory interneurons) 2- Purkinje Cell layer: consists of purkinje cells 3- Granule Cell layer (innermost layer): consists of Granule and golgi cells With 5 different neuronal types in the local circuitry: 1- Stellate cells 2- Basket cells 3- Purkinje Cells (ouput neuron) 4- Golgi cells 5- Granule Cells NOTE: - Climbing fibers wrap around Purkinje Cells - Purkinge Cell axons- are the major outputs of neurons in the cerebellar cortex

What structures are found in the anterior area of the hypothalamus?

1- Paraventricular nucleus and supraoptic nucleus: collection of neurons which regulate water balance - secrte oxytocin (released during labor) OR vasopression (ADH) promots reabsorption of H2O - destructon of 90% of ADH neurons produces diabetes insipidus (chronic excretion of very large amounts of urine (polyuria), causing dehydration and thirst - paraventricular can regulate autonomic functions in spinal cord 2- Anterior nucleus - thermoregulator area - stimulation causes heat dissipation (vasodilation, sweating, and drinking (polydipsia) - destruction results in anhydrosis, hyperthermia 3- Suprachiasmatic nucleus - - controls circadian rhythms- endocrine cycles and sleep/wake cycles

Lateral Pontine Syndrome (Occlusion of AICA- Anterior Inferior Cerebellar Artery)

1- Spinal V nucleus & tract --> loss of pain and temp sensation from the ipsilateral face 2- Spinothalamic tract --> contralateral pain/temp sensation loss from "body" 3- Descending sympathetic fibers --> ipsilateral Horners syndrome 4- Cerebellar peduncle, vestibular nuclei --> ataxia, vertigo, nausea 5- Cochlear nuclei --> ipsilateral hearing loss 6- Facial nucleus, main sensory nucleus of V and motor nucleus of V can sometimes be affected

Disturbances in Vasuclar Supply

1- Stroke - abrupt vascular insufficiency or bleeding into or adjacent to the brain - ischemic (loss of O2) or hemorrhagic - usually caused by a thrombus (clot formed within a vessel) or embolism (clot or plaque carried in the bloodstream) 2- Transient Ischemic Attack - TEMPORARY.. caused by minute particles that occlude arteries and then are degraded 3- Aneurysms - swellings of arterial walls.. usually at bifurcation - can compress brain structures as it swells or it can rupture and can cause severe problems

What structures are found in the posterior area of the hypothalamus

1- mamillary body - involed in learning and memory - destruction produces disorders of memory, emotion, drive 2- posterior nucleus - thermoregulatory area - stimulation causes heat conservation, vasoconstriction - destruction results in inability to thermoregulate - produces poikilothermia (cold blooded organisms) and body tempereature that varies directly with environmental temperature 3- tuberomammilary nucleus - histaminergic cell group that is important in regulating wakefulness and arousal

Main sensory inputs to maintain an upright balance

1- proprioception carried in dorsal columns and spinocerebellar tracts 2- visual system 3- vestibular system ** If all three are intact, the brain is able to maintain balance - the sensorimotor integration is through the dorsal columns and cerebellum ** the visual system can be removed by closing the eyes - if the proprioceptive and vestibular pathways are intact, balance will be maintained ** If the dorsal columns (proprioception) are damaged, then two of the sensory inputs (visual and poprioception) ar absent and the pt will sway and then fall Romberg Test: - Pt stands feet together, eyes open and then closes both eyes for 20-30 sec without support; positive test with eyes open suggestive of cerebellar ataxia; with eyes closed suggestive of impaired proprioception (ex. from pathology of dorsal columns) **** A positive Rombergs sign (pt falls while eyes are closed) points to a loss of unconcious proprioception - Damage to the dorsal columns - It is not a test of cerebellar fx as a pt with cerebellar damage would sway NO MATTER WHAT! and therefore you would not even need to do this test.. they will probably sway or deviate upon entering your office

Steps in Neurotransmission

1. Action potential propagation 2. Neurotransmitter synthesis 3. Vesicular storage 4. Metabolism 5. Release of NT 6. Uptake (clear synaptic cleft of NT) 7. Degradation of NT (decreasing its conc. in synaptic cleft) 8. Receptor activation 9. Post-synaptic effects (continuation of signal to post-synaptic neuron) 10. Retrograde signaling *NOTE: in brain astrocytes maintain extracellular environment in brain- they are enriched in transport proteins to restore synaptic cleft (Tripartate synapse: pre-synaptic,post-synaptic, and astrocytes)

3 chambers of the eye include

1. Anterior chamber - space between the cornea and the iris 2. Posterior chamber - space between the posterior surface of the iris and the anterior surface of the lens *** Anterior and Posterior chambers contain a watery fluid called Aqueous Humor 3. Vitreous Body or Chamber - space between the posterior surface of the lens and of the neural retina - contains a transparent gel substance (hyaluronic acid and widely dispersed collagen fibers) called VITREOUS HUMOR (*** can contain "floaters") ** Like air inside an inflated soccer ball, the vitreous humor gives the eye its shape

Contents of the Posterior Triangle of the Neck

1. Arterial: occipital artery, 3rd part of subclavian artery, transverse cervical artery 2. Venous: external jugular vein 3. Nervous: CNXI, cervical plexus, supraclavicular part of the brachial plexus 4. Muscles: Scalenes, inferior belly of omohyoid muscle, levator scapulae, splenius capitus 5. lymph nodes: various ** Posterior triangle can be further divided into occipital and subclavian triangles

The fibro-elastic intrinsic membrane of the larynx links together the laryngeal cartilages and completes the architectural framework of the laryngeal cavity- The intrinsic membrane consists of two parts which are-

1. Conus elasticus (cricovocal membrane)- thickens to form the vocal ligament superiorly and the median cricothyroid ligament anteriorly 2. Quadrangular membrane: lower margin thickens into the vestibular ligament

Functions of the Placenta

1. Exchange of gases, nutrition, and electrolytes - O2, CO2, by simple diffusion. Even short-term interupption of the oxygen supply is fatal to the fetus 2. Transmission of maternal antibodies - Maternal IgG begins to be transported from the mother to the fetus at about 14 weeks- In this matter, the fetus gains passive immunity 3. Hormone production - progesterone - estrogen - human chorionic gonadotropin/hCG - somatomammotropin/placental lactogen Mother to fetus: - oxygen, water and electrolytes, nutrients (carbs, AAs, lipids), hormones, antibodies, vitamins, iron, and trace elements, drugs, toxins, alcohol and some viruses Fetus to mother: - CO2, water and electrolytes, urea and uric acid, creatinine, bilirubin, hormones, RBC antigens

Major Arteries of the Neck

1. External Carotid Artery Has 8 branches, but the first two branches contribute to structures in the neck these are - Superior Thyroid Artery - Ascending Pharyngeal Artery 2. Subclavian artery Thyrocervical trunk: - Transverse Cervical artery - Suprascapular artery - Inferior thyroid artery

Hormonal changes associated with Menopause

1. Follicle depletion= decreased estradiol and decreased inhibin B..leads to.. 2. Increased GnRH 3. FSH and LH secretion 4. Stromal cells secrete T and A4 5. Adrenal continues to secrete androgens 6. Aromatization of androgens in adipocytes= primary source of menopausal estrogens NOTE: Production reate of ALL steroid hromones is decreased following menopause - Progesterone levels decline owing to anovulation - Adrenal secretion of androstenedione & DHEA continues and becomes the primary source of estrogen precursors - Continues androgen production from the ovarian stroma (androstenedione and testosterone) - Estrone becomes the dominant estrogen - Estradiol becomes negligible **Predominant estrogen in post menopausal woman is estrone (with biological potency of 1/10th that of estradiol) NOTE: total estrone production rate does NOT increase in menopausal women compared to premenopausal women

Primary Functions of the male reproductive system

1. Germ cell (sperm) production & maturation 2. Endocrine function - embryonic sexual differentiation - development of male internal & external genitalia - male secondary sex characteristics - spermatogenesis - control of the male reproductive neuroendocrine axis - sexual function, libido

Vascular Contents of the Infratemporal Fossa

1. Maxillary Artery (has 3 parts and 17 branches)- it is a branch of the external carotid artery 2. Pterygoid plexus of veins - Remember that the cavernous sinus has connection the pterygoid plexus of veins *** Infection can spread (mainly through facial/ophthalmic veins) and a cavernous sinus thrombosis can occur if a clot travels from the facial vein to the cavernous sinus

Muscular Contents of the Infratemporal Fossa

1. Medial Pterygoid Muscle (Superficial and Deep Head) 2. Lateral Pterygoid Muscle (Upper head and Lower Head) 3. Inferior Part of temporalis Muscle 4. Sphenomandibular Ligament

Suicide Inquiry- (Columbia-Suicide Severity Rating Scale (C-SSRS))

1. Have you wished you were dead or wished you could go to sleep and not wake up? 2. Have you actually had any thoughts about killing yourself? *** if yes to 2, answer 3,4,5,6 *** if no to 2, do to question 6 3. Have you though about how you might do this? 4. Have you had any intention of acting on these thoughts about killing yourself as opposed to you have the thoughts bbut you definitely would not act on them (high risk) 5. Have you started to work out or worked out the details of how to kill yourself? do you intend to carry out this plan? (high risk) ALWAYS ASK question 6*** 6. Have you done anything, started to do anything or prepared to do anythin to end your life? (i.e. collected pills, obtained a gun, gave away valuables, wrote a will or suicide note, held a gun but changed your mind, cut yourself, tried to hang yourself) **ANY yes indicated need for further care ** 4,5,6 Yes escort immediately to emergency personnel for care ** do not leave person alone stay with them until they are in the care of professional help Columbia Scales Detected - 29.7% of pts with suicidal ideation and 18.7% of pts w/ history of suicide attempt that were undetected by clinical interview - 59% of suicide attempts via telephone assessment--> 18% detected by chart reviews

Regulation of the hypothalamic-pituitary- testicular axis

1. Hypothalamic GnRH pulse generator modulated by neural & hormonal factors - Testosterone, Estrogen, DHT & PRL --> DECREASE GnRH - Leptin and Kisspeptin--> INCREASE GnRH 2. Anterior pituitary gonadotropes modulated by ciculating hormones & metabolites - Testosterone, DHT & estrogen --> DECREASE LH - Inhibin B--> DECREASES FSH NOTE: - Testosterone, DHT & estrogen feedback negatively at the level of the hypothalamus to inhibit GnRH release. GnRH pulsatility is also affected by other factors, including prolactin (PRL), leptin & kisspeptin --Decreased GnRH, results in decreased LH and FSH - Testosterone, DHT & estrogen feedback negatively at the level of the pituitary to inhibit LH- LH inhibition is mediated at the pituitary via decreased gonadotropin-specific Beta-subunit synthesis - Inhibin B feeds back negatively to the pituitary to inhibit FSH release by reducing synthesis of FSH-specific Beta-subunit Clinical Correlation: Male pts with Kallmann Syndrome are hypogonadal due to deficiency in LH & FSH bc of a failure of GnRH neurons to migrate from the olfactory bulbs, their embryological site or origin- these pts do NOT have sufficient hypothalamic GnRH to maintain LH & FSH recretion and the testes fail to undergo significant development

SAFE-T suicide assessment- 5 step evaluation and Triage

1. Identify risk factors: note those that can be modified to reduce risk 2. Identify protective factors: note those that can be enhanced 3. Conduct suicide inquiry: suicidal thoughts, plans, behaviors, and intent 4. Determine risk level/intervention: evaluate risk and chose appropriate action to reduce risk 5. Document: assessment of risk, rationale, intervention, and follow-up

3 Branches of Pudendal Nerve

1. Inferior rectal nerve (or inferior anal n.) - motor innervation to lower 1/3 of anal canal - motor to external anal sphincter muscle (voluntary) - sensory to skin of anal triangle 2. Perineal nerve - motor innervation to the contents of the deep and superficial perineal pouches - provides sensation to labia in females and scrotum in males (innervates irrectile tissues) 3. Dorsal nerve of clitoris or Dorsal nerve of penis - sensory innervation to clitoris in females or penis in males (SENSORY ONLY!) ***Pudendal Nerve Block - an injection of local anesthetic near the pudendal nerve - used to alleviate pain from minor surgery to perineum, events related to vaginal childbirth, or general perineal pain Procedure: - a finger is placed on the ISCHIAL SPINE and the needle is inserted in the direction of the tip of the finger on the spine to deposit the anesthetic near the pudendal nerve - pudendal nerve block can also be done subcutaneously through the buttock by inserting the needle on the medial side of the ischial tuberosity ** transvaginal approach in female ** male with access through anus NOTE: the ISCHIAL SPINE is the bony structure a physician will use as a landmark for this injection

4 layers of the Deep Cervical Fascia

1. Investing Fascia: envelops sternocleidomastoid, trapezius and muscles of facial expression 2. Pretracheal Fascia - Muscular layer: envelops infrahyoid muscles - Visceral layer: envelops pharynx, larynx, trachea, esophagus, thyroid gland, parathyroid glands, buccinator and pharyngeal constrictor muscles 3. Carotid Sheath: common carotid artery & internal carotid artery, internal jugular vein, vagus nerve, deep cervical lymph nodes 4. Prevertebral fascia: Envelops musculature around the vertebral column and phrenic nerve - Anterior extension is called alar fascia, between the buccopharyngeal fascia and the prevertebral fascia proper

Ovulation, under control of FSH & LH, involves structural & functional remodeling of all compartments of the dominant follicle & surrounding area .. such as

1. Meiosis resumption: primary oocyte arrested in prophase I under LH stimulation matures to secondary oocyte with emission of first polar body- devleopment arrests at metaphase II 2. Cumulus expansion: FSH & LH stimulate cumulus cell secretion of large amounts of an ECM glycosaminoglycan, Hyaluronan, into the intercellular space, expanding the COC volume **Ovarian & follicular walls present a multi-lamina barrier that must be breached for COC release 3. Follicle wall breakdown: FSH & LH stimulate production of proteolytic enzymes & prostaglandins which facilitate disintegration of a precise area (stigma) of the ovarian surface adjacent to the apical region of the ovulatory follicle, permitting oocyte release into the peritoneal cavity

Dopamin pathways in the brain

1. Mesolimbic- ventral tegmental area to the nucleus accumbens or other structures of the limbic system - increased activity linked to increased DA; psychotic behavior; drug-induce psychosis (ex. cocaine) - "reward" pathway* 2. Nigrostriatal pathway: from substantiat nigra to striatum - degeneration in Parkinsons disease*

Each nasal cavity has 3 general regions

1. Nasal vestibule 2. Respiratory regions 3. Olfactory regions NOTE: The lateral wall of the nasal cavity has 3 curved shelves of bone, conchae (superior, middle, and inferior concha), which project medially and inferiorly across the nasal cavity ** The medial, anterior, and posterior margins of the concahe are open, creating three (3) meatuses (superior, middle, inferior meatus) and 4 passageways for air to flow ** Conchae can also be called turbinate bones

Cerebral Cortex is NOT statis in its arcitecture across regions - decribe is architecture

1. Neocortex - 6 layered cortex* - 95% of cerebral cortex in humans 2. Allocortex - 3 layered cortex - Archicortex (hippocampus) - Paleocortex (olfactory) 3. Juxtallocortex or Periallocortex (4-5 Layers) - entorhinal cortex - parahippocampal gyrus - cingulate cortex - orbitofrontal cortex 4. Subcortical - amygdala - basal forebrain

What are the branches of the Internal Iliac Artery (the main blood supply to the Pelvic Organs and structures of the Perineum)?

1. Obturator artery - travels trhoguh the obturator canal with the obturator nerve and vein - supplies blood to muscles of medial thigh 2. Umbilical artery - in utero, it transports deoxygenated blood from fetus to the placenta- becomes obliterated after birth - gives branches called superior vesical arteries to supply superior part of bladder - common variation in 20% of population where "aberrant obturator artery" branches from the external iliac artery 3. Superior vesical artery - supplies blood to superior aspect of urinry bladder and only in males gives blood supply to vas (ductus) deferens 4. Inferior Vesical artery (MALES only) - supplies blood to inferior aspect of the bladder, prostate gland, and seminal vesicles 5. Uterine artery (FEMALES only) - supplies blood to uterus, uterine tubes, part of ovaries, and vagina - forms an anastomosis with the ovarian artery which also supplies blood to ovary - ** important to note that the ureter travels inferior to uterine artery within the pelvic cavity 6. Vaginal artery (FEMALE only, usually branches from the uterine artery) - supplies blood to vagina and inferior part of bladder in females 7. Internal Pudendal artery - MAIN artery supplyng blood to perineum (muscles of perineum, external genitalia, and erectile tissues of the penis and clitoris) - exits pelvis via the greater sciatic foramen and follows same course as the pudendal nerve to enter the perineum via the lesser sciatic foramen 8. Inferior gluteal artery - exits pelvis through greater sciatic foramen to emerge inferior to piriformis muscle in the gluteal region - supplies blood to gluteal region 9. Middle rectal artery - supplies blood to the MIDDLE part of the rectum - forms anastomoses with superior and inferior rectal arteries 10. Iliolumbar artery 11. Lateral sacral artery 12. Superior Gluteal artery - exits pelvis through greater sciatic foramn to emerge superior to piriformis muscle in the gluteal region - supplies blood to gluteal region

5 Tanner Stages in Females

1. Preadolescent. No palpable breast tissue. No pubic hair 2. Breast bud stage- Development of a breast bud, with elevation of the nipple (papilla) and enlargement of the areolar diameter- sparse, straight hair on the labia majora 3. Further enlargement of breast & areola; no separation of their contour. Increase in amount & pigmentation of now curly pubic hair 4. Areola & nipple project above the breast, forming a secondary moung- pubic hair is adult in type, but not spread to medial thighs 5. Recession of the areola to match the contour of the breast; the nipple projects beyond the contour of the areola and breast- pubic hair is adult in quantity, type and distribution ** the is a sexual maturity rating (SMR) system which is useful in cases where delayed of precocious puberty is suspected or folloed- it provides a means of documentation and standardization- precocious puberty is usually defined as the onset of secondary sexual development before age 7 in girls

Fascial Spaces in the neck

1. Pretracheal space - between the investing layer covering the posterior surface of the infrahyoid muscles and the pretracheal fascia (covering the anterior surface of the trachea and the thyroid gland), which passes between the neck and the anterior part of the superior mediastinum 2. Retropharyngeal space - between the buccopharyngeal fascia (on the posterior surface of the pharynx and esophagus) and the alar fascia (part of prevertebral) 3. Prevertebral space (** DANGER SPACE!) - between two layers of the prevertebral fascia: the alar fascia and prevertebral fascia of the vertebral column- creates a fascial space that begins at the base of the skull and extends through the posterior mediastinum to the diaphragm *** Danger space bc infection can spread DIRECTLY to the thorax, and to either side as the space is continuous NOTE: Fascial planes and spaces determine the direction in which an infection of the neck may spread

Descending/ Efferent Pathways

1. Pyramidal/ Corticospinal Pathway - anterior corticospinal pathway - lateral corticospinal pathway 2. Trigeminal Pathway - Motor nucleus of V 3. Subcortical/Extrapyramidal pathways Lateral group - rubrospinal tract - raphespinal tract Medial group - tectospinal tract - vestibulospinal, lateral and medial tract - reticulospinal tract

What are the 10 layers of the Retina?

1. Retinal Pigment epithelium 2. Rods and Cones 3. Outer limiting membrane 4. Outer nuclear membrane - has mainly nuclei of rods and cones 5. Outer plexiform layer 6. Inner nuclear layer - inner nuclear layer has many nuclei of amacrine, bipolar, horizontal and mullers cells 7. Inner plexiform layer 8. Ganglion cell layer 9. Layer of optic nerve fibers 10. Inner limiting membrane ** NOTE: Plexiform- having the form of a network or plexus; intricate or complex

Two cell types in epithelium of epididymis

1. Rounded basal cells (stem cells/precursors to principal cells) 2. Columnar/principal cells (have long microvilli (stereocilia)- function in the uptake of excess fluid)

Functional Centers of the Reticular Formation

1. Sensory/Afferent - affective/emotional qualities of pain - pain modulation - cortical activation/ascending reticular activating system (ARAS) - wakefulness 2. Motor/Efferent 3. Autonomic: Cardiovascular & Respiratory 4. Reflexes: vomiting, swallowing, coughing, chewing, suckling, sneezing, micturition etc. 5. Eye movements

3 states of Consciousness

1. Sleeping - sensations are dull/absent- thoughts are logical and repetitive - movements are occasional and involuntary 2. Waking - rapid eye movements (REM) occur often- sensations are vivid & externally generated - thoughts are logical & progressive - Movements are voluntary 3. Dreaming - rapid eye movements occur often- Sensation are vivide and internally generated - thoughts are illogical and bizarre - movements are absent

Control of pupil size

1. Sphincter Pupillae muscle - a CIRCULAR band of smooth muscle cells, innervated by PARASYMPATHETIC nerves carried in the oculomotor nerve (CN III) (IFs vimentin, desmin) - * is responsible for REDUCING pupillary size in response to bright light 2. Dilator pupillae muscle - A thin sheet of RADIALLY oriented contractile processes of pigmented MYOEPITHELIAL (IF is keratin) cells constituting the anterior pigment epithelium of the iris (like spokes on a wheel) - This muscle is innervated by SYMPATHETIC nerves from the SUPERIOR CERVICAL GANGLION and is responsible for increasing pupillary size in response to dim light NOTE: ** Failure of the pupil to respond when light is shined into the eye- "Pupil Fixed and Dilated"- is an important clinical sign showing lack of nerve or brain function

Cells of the Testes

1. Sustentacular cells of Sertoli (aka sertoli cells) - found in the seminiferous tubules - derived from surface epithelium of the genital ridges - produces Mullerian inhibiting substance (MIS) - AKA anti-mullerian hormone (AMH) 2. Interstitial cells of Leydig: - found between the testis cords (future seminiferous tubules) - derived from intermediate mesoderm of the genital ridges - by the 8th week, Leydig cells produce testosterone - the testes are now able to influence sexual differentiation of genital ducts and external genitalia

Stimulation--> Erection

1. The shift in blood flow leading to erection is controlled by PARASYMPATHETIC NS following sexual stimulation (ex. pleasurabl tactile, olfactory, visual, auditory, and psychological stimuli) 2. The parasympathetic impulses trigger local release of nitric oxide, which has two effects - causes relaxation of smooth muscles of the branches of the deep and dorsal arteries of the penis, increasing the blood flow into the organ - simultaneously, the arteriovenous anastomoses undergo constriction, diverting the flow of blood into the helical arteries if the erectile tissue of the penis * As these spaces become engorged with blood, the penis enlarged and becomes turgid and erection ensues * The veins of the penis become compressed, and the blood is trapped in the vascular spaces of the erectile tissue (maintains erection)

Following differentiation of the cloaca, three portions of the urogenital sinus can be seen- which are:

1. Urinary Bladder (majority) which is connected to the allantois 2. Pelvic part of the urogenital sinus - membranous and prostatic part of the urethra in males - membranous urethra in females 3. Phallic part of the urogenital sinus - contributes to the penile urehtra in males - contributes to the vestibule of the vagina in females ** Review from Renal Embryology

The interior aspect of the larynx is lined by mucosa and consists of 3 regions which are

1. Vestibule: superior part of the laryngeal cavity between the laryngeal inlet and the vestibular folds (folds that enclose the vestibular ligaments) 2. Middle part: between the vestibular folds and vocal folds- a very small and thin area 3. Infraglottic space: Inferior part between the vocal folds (folds that enclose the vocal ligaments) and the inferior opening of the larynx ** NOTE: laryngeal saccules= extensions of the laryngeal ventricles which contain numerous mucous glands that provide lubrication to the vocal folds

When do you use Bayesian Calculation- Application to Medical Genetics

1. When DOUBT about risk exists, and 2. When there is ADDITIONAL information * Most often additional information is: - phenotype of the person itself - phenotype of offspring - test results (uncertain) - penetrance different from 100% ** In other words: if a person has a 0% or a 100% risk for something (certainty) then Bayesian analysis is NOT relevant - Bayesian analysis is ONLY relevant for in between values Simple examples: 1. Sisiter of a hemophilia pt has a risk of 1/2 for being a carrier; what happens if she has an affected boy? - her risk changes to 1 (she is for sure a carrier) 2. In a family with an albino, an unborn sibling has a risk of 1/4 for becoming an albino, and of 1/2 for being a heterozygote; what happens after birth of a baby with normal phenotype? - the babys risks become 0 for being an albino and 2/3 for being a heterozygot ** Relevance: that you have a step wise progression: you have one risk, then an additional observation occurs leading to a recalculation of the risk - there is however, no reason to use a formal framework for these two cases- they are easy enough that you can do them without - Bayesian calculations are using a framework to handle slightly more complex cases

Levels of spinal cord injury

1. cervical SCI (C1-C8) - causes quadriplegia/tetraplegia- paralysis or weakness in both arms and legs - all regions of body located below the neck affected - may result in loss of physical sensation, respiratory problems, bowel, bladder, and sexual dysfunction 2. thoracic SCI (T1-T12) * not as common bc rib cage - paraplegia: paralysis or weakness of legs - occurs less often due to protection from rib cage - may result in loss of physical sensation, bowel, bladder, and sexual dysfunciton - may have weakness in torso but generally good control of hands 3. lumbar SCI (L1-L5) - causes paraplegia: paralysis or weakness of legs - may result in loss of physical sensation, bowel, bladder, and sexual dysfunction - upper body, shoulder, arms and hands are usually unaffected 4. Sacral (S1-S4) - rare: weakness or paralysis of hips, legs, feet, and genital organs - loss of bowel and bladder funciton as well as sexual dysfunction

Grey Matter in the spinal cord is separated into

10 Lamina NOTE: we have Nuclear Groups: named by location and cell body morphology- but this leaves much of the grey matter unaccounted for and Rexeds Laminae (10 cytoarchitectonic layers or region) - I-VI are in dorsal horn - VII and X are in the intermediate zone - IX motor cell columns are in the ventral horn (accounts for all of greymater) Lamina I (marginal layer-posteromarginal nucleus)= mostly "nociceptive-specific" neurons Lamina II (substantia gelatinosa)= almost exclusively interneurons Lamina III, IV, V (all three= nucleus proprius)= mostly nonoxious stimuli, however Lamina V is wide dynamic range and the spinothalamic system may use these lamina Lamina VI= Lateral neurons receive corticospinal and rubrospinal fibers and medial neurons receive afferents from muscle spindles and joints Lamina VII= (nucleus dorsalis & Clarkes nucleus)= neurons that respond to non-noxious joint receptors for manipulation of joints Lamina VII (intermediolateral nuclei)= neurons that respond to noxious & more complex properties (sympathetic neurons! T1-L2) Lamina VIII (interneurons)= neurons that respond to noxious & more complex properties Lamina IX= alpha motor neurons (ventral horn) Lamina X= neurons around the central canal *** 1-6= sensory 1,2,5= pain 3,4,6= proprioceptive and nonnoxious 7= proprioception and symp. 9= ventral horn motor neurons

Lateral Spinothalamic Tract

1st Order Cell Body= DRG at all spinal cord levels (via Lissauers tract) 2nd Order Cell Body= Dorsal horn of the spinal cord - fibers cross the midline in the Anterior White Commissure in the spinal cord then ascend via the spinothalamic tract to.. 3rd Order Cell Body= VPL of the thalamus - VPL sends the signal to primary somatosensory cortex (S1) DRG--> (lissauers tract)--> cell bodies in various lamina in dorsal horn --> (spinothalamic tract) --> VPL --> Somatosensory Cortex S1 *** If you blow out the spinothalamic tract- it is carrying info from the other side - so you would affect the contralateral side - Pt with loss of pain/temp from right means the have a lesion on the left side of this tract - this is becuase probability of blowng out the spinothalamic tract is of the greatest possibility in this Spinothalamic/Anterolateral (lateral spinothalamic tract)

Gustatory Central Pathway

1st order neuron: Cell body is in specific ganglia, either geniculate (VII), petrosal (IX) or nodose (X) - signal travels in solitary tract to enter the medulla and synapse in the solitary nucelus (nucleus of solitary tract 2nd order neuron: cell bodies in solitary nucleus (rostral) - axons ascend in solitariothalamic tract to synapse in the ventroposteromedial nucleus (VPM) of the thalamus 3rd order neuron: cell bodies in ventroposteromedial nucleus (VPM) of the thalamus - axons project to the primary gustatory cortex (ipsilateral) in the insule - projections and connections also include the hypohtalamus and amygdala

Ventricular System

2 Lateral Ventricles: - Left and Right - C-Shaped structure in each cerebral hemisphere 5 parts: - anterior horn - body - posterior horn - inferior horn - atrium Third Ventricle: - Midline space in the diencephalon - "Doughnut" Shape when viewing from the lateral aspect with a "doughnut hole" that represents the interthalamic adhesion Fourth Ventricle: - Shaped like a tent with a double peaked roof - the most caudal of the four ventricles with the cerebellum located more dorsally and the pons and medulla more ventrally

External Iliac Artery and its branches

2 branches of External Iliac Artery - inferior epigastric artery - deep circumflex iliac artery ** External iliac is branch from the common iliac artery - it exits the pelvis by traveling inferior to the inguinal ligament - it enters the femoral region where it then changes name to femoral artery

The cerebrum (cortex) is the largest and most complex part of the brain and consists of ___ hemispheres

2 hemispheres: the cerebral hemispheres ** The hemispheres contain many folds which function to increase the surface area of the cortex - the bulges/ridges are called gyri - the valleys/grooves are called sulcli

On the posterior aspect of the spinal cord

2 posterior spinal arteries can be found On anterior aspect there is - 1 Anterior Spinal Artery ** Spinal cord is long so it also receives help from - intercostal arteries - lumbar arteries - sacral arteries

What does the term "functional progesterone withdrawal" mean?

3 major factors induce the forceful and rhythmic contractions that, in association with effacement and dilation of the cervix, constitute the obstetrical definition of labor 1. Increased levels of PGs (especially PGF2alpha) produced by the myometrium and fetal membranes 2. Increased Myometrial cell interconnectivity 3. Increased Myometrial responsiveness to OT and PGs These changes are mediated by a coordinated desensitization of uterine cells to the progestational effects of progesterone (functional progesterone withdrawal) and increased sensitivity to estrogen (due to increased ER expression). Estrogen stimulates induction of genes encoding CAPs, transforming the myometrium from a quiescent to laboring structure

Physical changes associated with puberty are clinically classifed by the

5 Tanner Stages of Development 1. "PRE-PUBERTY" Preadolescent. Testes, scrotum & penis are of childhood proportion & size- NO pubic hair 2. Testes enlarge (GONADARCHE), some reddening of scortal skin- NO enlargement of the penis- Sparse growth of long, striaght, slightly pigmented pubic hair, appearing chiefly at the base of the penis 3. Penis grows in length, further growth of testes & scrotum- hair is considerably darker, coarser & curlier 4. Penis increases in length & girth with development of glands- testes & scrotum further enlarge - Scrotal skin further darkens- hair is NOW adult type, with no spread to the medial surface of the thighs 5. "ADULT" Genitalia are adult in size & shape- No further enlargement takes place after stage 5 is reached- Hair is adult in quantity and type, distributed as an inverse triangle and spread to the medial surface of the thighs

Soft Palate is formed and moved by

5 muscles and is covered by mucosa that is continuous with the mucosa lining the pharynx and oral and nasal cavities - the small muscular projection that hangs from the posterior free margin of the soft palate is the uvula Muscles of the Soft Palate are all Innervated by Paryngeal branch/plexus of CNX **EXCEPT for Tensor Veli Palatini which is innervated by Medial pterygoid branch of CNV3 5 Muscles and their Functions: - Tensor Veli Palatini: tenses the soft palate; opens the pharyngotympanic tube - Levator veli Palatini: only muscle to elevate the soft palate above the neutral position - Musculus Uvulae: elevates and retracts the uvula; thickens central region of soft palate - Palatopharyngeus: Depresses soft palate; moves palatopharyngeal arch toward midline; elevates pharynx - Palatoglossus: Depressure palate; moves palatoglossal arch toward midline also; elevates back of tongue *** these muscles developed from pharyngeal arch IV- EXCEPT for tensor veli palatini that developed from arch I NOTE: the Palatine Aponeurosis= A fibrous sheath attached to the posterior border of hard palate, which provides and attachment site for palate muscles

Cryptorchidism

97% of testes descend to the scrotum before birth- IF NOT, descent will be most likely completed furin the first 3 months postnatally Cryptorchidism= Failed descent of testes - It is one of the most common congenital anomalies, occuring in 1-9% of boys worldwide- More than 200,000 cases per yr in US ** It is important to NOT conduse undescended testicles with "retractile" testicles- After 6 months of age, a male child has a reflex (cremasteric reflex) that temporarily pulls the testicles up to protect them when hes cold or frightened - Usually just one testicle is affected, BUT about 10% of the time both testicles are undescended - Can result in failure to produce sperm - Linked to higher rate of Testicular cancer in adulthood (though the risk is still less than 1 in 100)

Leuprolide in the induction of Ovulation

A GnRH agonist (exact same mechanism of action in males) - Pulsatile administration via a pump mimics normal effects to stimulate hypothalamic- pituitary axis - conitnuous administration via a depot injection will downregulate anterior pituitary GnRH receptors to suppress the axis, resulting in "chemical castration" ** Continuous stimulation has a good chance of being replaced in future by GnRH antagonist as discusedd for degarelix in male repro NOTE: there will be an initial stimulation of the axis before the inhibition occurs, and this can have clinical ramifications * will induce menopaudal symptoms in adults (Including males, to some extent)

Cryptorchidism

A condition in which one or both of the testes failed to descend from the abdomen into the scrotum - occurs in about 4% of male neonates, but in most of these individuals the testes move to the scrotum during the first yr - bilateral cryptorchidism causes infertility if not surgically corrected by 2 to 3 yrs of age

Sialolithiasis or "Salivary Stones"

A conditon where a calcified mass, or sialolith, forms within a salivary gland **most commonly in the duct of the submandibular gland - inflammation or infection of the gland may occur as a result ** Sialolithiasis may also occur because of existing chronic infection of the gland, dehydration, or increased local levels of calcium ** In most cases, the cause is idiopathic (unknown) Symptoms: - pain and swelling of the affected gland that gets worse when salivary production is stimulates Ex: when chewing/smelling food

The lens

A crystal-clear, oval, flexible body that is biconvex (curving outward on both surfaces) - sits behind the iris and focuses light on the retina - is suspended from the inner surface of the ciliary body by a ring of radially oriented fibers - is made up of apprx 35% protein and 65% water it does NOT contain: - blood vessels - nerves - lymphatics Parts of the Lens Lens capsule: - thick basement membrane (primarily type IV collagen) surrounding lens (backwards basal lamina) - attachment site for the zonules Lens fibers: - extremely long cells that have lost their nuclei and organelles, arranged in a regular lattice - cytoplasm filled with CRYSTALLINs *** Crystallins make the lens transparent--> when they become opaque this causes CATARACTS

Hysterosalpingography

A hysterosalpingogram is a radiographic evaluation of the uterus and fallopian tubes and is used primarily to assess fallopian tube patency Indications: - infertility - recurrent pregnancy loss - suspected anomalies How is it done? A cannula is placed in the cervical os and a water-based contrast material is injected slowly under fluroscopy into the endometrial canal Normal Hysterosalpingogram: - after the uterus is filled with contrast, it drains into the fallopian tubes and SPILLS into the peritoneal cavity Abnormal: * If there is blockage of a fallopian tube, the contrast proceeds to the point of obstruction - Fallopian tube obstruction is confirmed by the absence or partial filling of the fallopian tube with contrast - There is NO spilling of contrast into the peritoneal cavity ** the liquid will NOT leak Conditions causing fallopian tube obstruction: - salpingectomy and tubal ligation - prior pelvic inflammatory diseases - prior ectopic pregnancy - endometriosis * Hydrosalpinx - fluid filled dilation of the fallopian tube - NO spilling of contrast into the peritoneal cavity - If the fluis is infected (i.e. pus) it is a pyosalpinx - if the fluid is blood it is a hematosalpinx Causes of hydrosalpinx: - peritubal adhesions secondary to pelvic inflammatory disease - endometriosis - ovulation induction - post-hysterectomy (without salpingoophorectomy) - tubal ligation - tubal malignancy * Uterine anomalies - hysterosalpingogram can be useful in identifying an abnormal uterine cavity (ex. bicornuate uterus) Remember: - this occurs during embryology when the proximal portion of the paramesonephric ducts does not fuse but the distal portion that develops into the uterine segment, cervix and upper vagina fuse normally Some other uterine abnormalities visible on hysterosalpingogram: - leiomyomas - endometrial polyps - unicornuate uterus - didelphys uterus

Long-Term Potentiation (LTP)

A long lasting enhancement of synaptic transmission resulting from high frequency stimulation of the presynatpic cell paired with the depolarization of the postsynaptic cell ** thought to be one of the physiological underpinnings of learning and memory- occurs at glutamatergix synapses in the hippocampus ** does strength of experience= synaptic strength?? At rest, both receptors will bind glutamate, but the NMDA receptor will be blocked by Mg++ and no current will flow - The EPSP is then mediated by the AMPA channel - High frequency stimulaitn will cause summation of EPSP's (Excitatory Post-Synaptic Potential) , leading to a prolonged depolarization that expels Mg++ from the NMDA channel - Mg++ removal allows Ca++ to enter the postsynaptic neuron and this increase in Ca++ within the dendritic spines is the 2nd messenger trigger for LTP - Ca++ entering the cell will also activate postsynaptic protein kinases- these trigger a series of reactions that leads to the insertion of new AMPA receptors into the postsynaptic spine - This, then, increases the neurons sensitivity to gutamate - LTP can also cause an increase in the ability of the presynpatic neuron to release glutamate - This requires a retrograde signal, in the form of NO, to travel from the postsynaptic to presynaptic neuron Long-term changes: - protein kinases also activate transcriptional regulator CREB, which causes expression in genes that produce long lasting changes in synaptic structure Second to minutes= ongoing electrical activity, changes in different ions & 2nd messenger systems Minutes to hours= protein phosphorylation & covalent modifactions Hours to years= changes in gene transcription & translation resulting in structural changes of proteins & neurons

Nuclei and modality of CN VI- Abducens

Abducens Nucleus -> (GSE- Voluntary motor)

Neuropathic Chronic Pain

Aberrant activation of pain neurons - Neuropathic low back pain - peripheral neuropathies - Poste herpetic neuralgia - Trigeminal Neuralgia - Central post-stroke pain - Spinal cord injury

Judgment and Insight in Mental Assessment

Ability to anticipate consequence of bahvaior & make good decisions Test: "what would you do if you found a stamped, addressed letter on the side walk? Awareness of ones own ilness and/or situation May also need to not: - reliability/accuracy of patients report - impulse control

Epispadias

Abnormal opening or openings in the DORSAL aspect of the penis - Associated abnormal closure of the anterior abdominal wall and with exstropy of the bladder - RARE: 1/30,000 *** Epi- up high- PEE IN YOUR EYE

Injection of what directly into the corpora cavernosa of the penis can aid in stimulating erection?

Acetylcholine - ACh binding to M3 receptors on endothelial cells stimulating production of NO--> NO diffuses to smooth muscle cells and stimulates penile artery smooth muscle relaxation, vasodilation and erection Things that would lead to vasoconstriction and inhibit erection: - Angiotensin II - ADH - A substance which inhibits formation of NO - A substance which stimulates calcium entry into vascular smooth muscle cells

Adie's Pupil vs. Argyll Robertson Pupil

Adie's Tonic Pupil - Response to light is poor or absent - Affected pupil is initially larger than its normal fellow pupil, but becomes smaller over time and remains tonically constricted - Accomodation is slow and prolonged Argyll Robertson Pupil - Accomodation is quick - Bilateral small pupils that do not react to light - Associated with Neurosyphilis "ARP" - Accomodation Reflex Present - Pupillary Reflex Absent

Ultrasound of the Appendiz

Advantages of ultrasound - lack of ionizing radition (preferred imaging modality in children and pregnant women**) - can be performed at the bedside Disadvantages: - lower diagnostic accuracy - highly variable test performance - appendix less frequently visualized Normal Appendix on US: - blind ended tubular structure extending from the cecum - maximal outer diameter less than 6mm - completely compressible by the transducer Acute Appendicitis on Ultrasound: - NONcompressible appendix - double wall thickness diameter more than 6mm - focal pain over appendix with compression - appendicolith - increased echogenicity of inflamed periappendiceal fat - fluid in the right lower quadrant

What are the 2 inputs into the cerebellum?

Afferents to the cerebellum arise from numerous sources, however they enter the cerebellum and terminate in 2 ways: 1- Mossy Fibers - terminate as excitatory synapses with dendrites of the granule cells - provide info about movements (muscles involved, direction, speed & force of movements) 2- Climbing Fibers - axons from inferior olivary nucleus "climb" the dendrites of purkinje cells & teminate as excitatory synapses - provides info about errors in the execution of movement- provides an error signal when a movement does NOT correspond to what was intended ** BOTH climbing and mossy fibers also teminate on the DCN (Deep Cerebellar Nuclei)

Rehabilitation

After acute phace, treatment is focused on returning as musch functioning as is possible * all individuals and spinal cord injuries are different- goal is to develop a unique plan to help the person funciton in their own environment by: - understanding his/her injry - becoming as independent as possible with activities of daily living (bathing, dressing, grooming, etc) - improving physical mobility and using adaptive equipment - bowel and bladder training - skin care - medicaiton regimen - sexual education Factors associated with motor return - initial grade of impairment at the time of admission - pin prick sensation at the time of initial examination - presence or absence of early motor return - motor funciton at 1 month after injury Rehabilitation team: physician/nurses, physical therapist, occupation therapist, psychologist, social worker, etc

Descent of the Ovaries

Again think opposites between males and females! - Testis migrate significantly, ovaries minimally in comparison - The ovaries descend to a location inferior to the pelvic brim - The cranial genital ligament forms the suspensory ligament of the ovary - The caudal genital ligament forms the ligament of the ovary and the round ligament of the uterus ** The round ligament of the uterus extends into the labia MAJORA

Muscles of the Larynx (9)- Innervated by CNX

All innervated by the Recurrent laryngeal nerve from CNX EXCEPT cricothyroid which is innervated by External branch Superior Laryngeal nerve of CNX "Pat the cat very lightly" P- posterior cricoarytenoid: abduction and external rotation of the arytenoid cartilage- primary abductors of the vocal folds and openers of the rima glottidis A- Arytenoid oblique: sphincter of the laryngeal inlet T- Transverse arytenoids: adduction of arytenoid cartilages T(he)- Thyroartytenoid: sphincter of vestibule and of laryngeal inlet C- Cricothyroid: forward and downward rotation of the thyroid cartilage at the cricothyroid joint A- Aryepiglottic (extension of arytenoid oblique): adducts arytenoid cartilages and acts as a sphincter on the laryngeal inlet T- Thyroepiglottic (extension of thyroarytenoid): depresses the epiglottis V(Very)- Vocalis: Adjusts tension in vocal folds L (lightly)- Lateral cricoarytenoid: internal rotation of the arytenoid cartilage and adduction of vocal folds

Vestibular Pathways

Ampullae of the semicircular canals project to --> Superior Vestibular nucleus (SVN) and rostral portion of the medial vestibular nucleus (MVN) Maculae of the utricle and saccule terminate in the lateral vestibular nucleus (LVN) Macula of the saccule also projects to the inferior vestibular nucleus (IVN)

Tracheostomy

An operative procedure to surgically create an airway in patients with PROLONGED respiratory failure or upper airway obstructions An incision is made through the 3rd-4th tracheal rings Important anatomical relationships: - Isthmus of the thyroid gland (level of 2nd tracheal ring) - Thyroid artery - Infeiror thyroid veins - Left brachiocephalic vein Indicators to perform a tracheostomy: - Extensive maxillofacial trauma - Anatomical structures blocking the airway ex. laryngeal cancer - Long-term need of ventilation

Superficial Musculoaponeurotic System (SMAS)

An organized fibrous network composed of the - platysma muscle - parotid fascia - fibromuscular layer covering the cheek ** It divides the deep and superficial adipose tissue of the face and has region specific morphology ** SMAS lies inferior to the zygomatic arch and superior to the muscular belly of the platysma The fibromuscular layer of the SMAS integrated the superficial temporal fascia and frontalis muscle superiorly, and with the playsma muscle inferiorly * It plays an important role in facial expression bc many muscles of the face have attachments with the SMAS- It is an important layer in "FACE LIFTS" (Rhytidectomy) as the SMAS layer is drawn up and fixed to lift more superficial muscular and dermal structures Layers: 1. Skin 2. Subcutanous 3. Musculo-aponeurotic **** (what were talking about above) 4. Retaining ligaments and space 5. Periosteum and Deep Fascia

Cervix

Anatomical Postion in Female Pelvis: - Posterior to bladder - Superior to vagina - Inferior to the rest of the uterus - Anterior to rectum Cervix is the - Neck of the uterus - Protrudes into the vaginal canal - Has internal opening into the uterus called internal os - Has external opening leading to vagina called external os

Seminal Vesicles (Seminal Glands)

Anatomical position in Male pelvis: - posterior to bladder - superior to prostate - anterior to rectum Seminal vesicle - merges with a ductus deferens to form an ejaculatory duct - secretes an alkaline, nutrient-rich component to the seminal fluid to help neutralize acid in female reproductive tract

Urinary Bladder

Anatomical position in female pelvis: - posterior to pubic symphysis - anterior (as well as inferior at times) to uterus - anterior to vagina - superior to urethra Urinary bladder is a reservoir that stores urine until its time to release urine from the body - Considered a vesicle= "fluid filled sac"- this is why its blood supply is called superior vesicle artery ** Bladder is separated from pubic bone by a POTENTIAL SPACE, called the Retropubic space or prevesical space

Uterus

Anatomical position in female pevlis: - Posterior (and superior) to bladder - Superior to vagina - Medial to ovaries - Anterior to rectum Uterus is - Pear-shaped - Site of implantation for fertilized egg to grow and develop Composed of: - Fundus - Body - Isthmus - Cervix (neck) NOTE: Uterus is normally positioned in Anteversion & Anteflexion So.. there are variable positions of the uterus: NORMAL= Anteverted and Anteflexed Abnormal= - Anteverted - Retroverted - Retroverted and Retroflexed

Ejaculatory Duct

Anatomical position in male pelvis: - located INSIDE the prostate gland tissue in the posterior aspect There are 2 ejaculatory ducts - formed by the merging of ducts from the seminal vesicle and ductus deferens - delivers glandular secretions and sperm to the prostatic urethra

Ductus Deferens (Vas Deferens)

Anatomical postion in male pelvis: - terminal portion of vas deferens is posterior to bladder - superior to prostate - anterior to rectum Ductus Deferens.. - conducts sperms from the epididymis to the ejaculatory duct - the terminal portion of the ductus deferens in the pelvis is enalarged forming the ampulla of the ductus deferens

Androgenetic Alopecia

Androgen-dependent male pattern baldness - most common form of alopecia - requires genetic pre-disposition DHT causes follicular miniaturization: - shortened growth phase of hair follicles - progressive hair thinning & loss - characteristic pattern Treatment: inhibitors of 5alpha-reductase (ex. Finasteride) (may have side effects such as decreased libido and erectile dysfunction)

Olfactory Nerve (CN I): SVA- Smell- What are some terms about smell?

Anosmia: loss of sense of smell Hyposmia: decreased ability to smell Hyperosmia: increased ability to smell Dysosmia: distorted perception of odor Phantosmia: perception of odor where there is none Agnosmia: loss of verbal ability to classify, contrast or identify odor sensation, even though ability to detect and distinguish between odorants is present

Somatosensations (GSA) and Taste (SVA) to th Tongue

Anterior 2/3rds - Derived from 1st pharyngeal arch so associated with trigeminal (CNV) - Somatosensation (GSA axons) is carried on the lingual nerve (mandibular division of the trigeminal (V3)) - Taste (SVA axons) is carried on CNV3 to the chorda tympani nerve of CNVII Posterior 1/3rd: - Derived from the 3rd arch so is associated with the Glossopharyngeal (IX) nerve - Somatosensation (GSA) axons and taste (SVA axons) are carried on lingual branch of IX Epiglottic (root/base) region: - Derived from the 4th arch so associated with that nerve, which is the superior laryngeal nerve of the vagus (CNX) - Somatosensation (GSA axons) and taste (SVA axons) are carried on that nerve

Root of the Neck- Subclavian Artery is divided into 3 parts by the

Anterior Scalene muscle 1st part (medial to anterior scalene muscle): 1. Vertebral artery 2. Internal throcic artery 3. Thyrocervical trunk - Inferior thyroid artery - Ascending cervical artery - Suprascapular artery - Transverse cervical artery 2nd part (posteior to anterior scalene muscle): 1. Costocervical trunk: - Superior (supreme) intercostal artery - Deep Cervical artery 3rd part (lateral to anterior scalene muscle); 1. Dorsal scapular artery

Estrogens/Drugs

Are lipophilic compounds and are readily absorbed through the GI, skin, and mucus membranes - oral estradiol is rapidly metabolized by liver enzymes- First-pass metabolism reduces the effectiveness when estradiol is administered orally - Modified estrogen compounds that have lower first-pass metabolism are used as orally bioavailable drugs- Commonly used synthetic estrogens include: ethiny estradiol (used in most oral contraceptive preparations) - Conjugates equine estrogens are derived from pregnant mare's urine- they are comprised of mostly estrone sulfate- used for oral estrogen supplementation in menopausal women - Synthetic plant derived estrogens are also available and frequently used for oral supplementation in menopausal women

Thyrocervical Turnk

Arises from the 1st part of the subclavian artery - it is the 3rd branch from the 1st part of the subclavian artery The Thyrocervical trunk has 4 branches: 1. Inferior thyroid artery 2. Ascending cervical artery 3. Transverse cervical artery (superficial branch travels along the trapezius muscle and the deep branch follows the rhomboid muscles) 4. Suprascapular artery ** this trunk supplies blood to the thyroid and parathyroid glands, larynx, pharynx, brachial plexus, cervical and shoulder muscles and skin in the region

Internal thoracic artery

Arises from the 1st part of the subclavian artery - it is the second branch from the 1st part of the subclavian artery - travels inferiorly, deep to the anterior aspect of the throacic wall to supply the anterior thoracic wall The internal thoracic artery bifurcates into tits terminal branches at the level of the 6th intercostal space into: - musculophrenic artery - superior epigastric artery *** The internal thoracic artery branches into the anterior intercostal arteries that supply the upper six intercostal spaces- the remainder of the intercostal arteries arise from the musculophrenic artery

Costocervical Trunk & Dorsal Scapular Artery

Arises from the 2nd part of the subclavian artery, posterior to the anterior scalene muscle - it is the 4th major branch from the subclavian artery The costocervical trunk usually has 2 branches: 1. Superior/Supreme intercostal artery: supplies the upper two intercostal spaces 2. Deep cervical artery: supplies deep cervical muscles ** The dorsal scapular artery may also arise from the costocervical trunk 3rd part of the subclavian artery: the Dorsal Scapular Artery - is HIGHLY VARIABLE: when it arises from the thyrocervical trunk, it is called the deep transverse cervical artery - if it arises from the costocervical trunk or the 3rd part of the subclavian artery, it is called the dorsal scapular artery

Amide local anesthetics

Articaine: - used extensively in dentistry Prilocaine: used in dentistry, a metabolite is o-toluidine can cause methemoglobinemia** - individuals deficient in glucoe-6-phosphate dehydrogenase have increased risk Lidocaine: wide range of uses - topical, eye drops, intravenous, infiltration, epidural, epinal EMLA: * local anesthetic cream Lidocaine+ prilocaine - used topically Bupivacaine - Injected - infiltration, peripheral nerve block, epidural, psinal anesthesia - long duration of action so not used in day surgery - **higher risk of cardiac toxicity (Except spinal)- this is why ropivacaine was made Ropivacaine - injected - infiltration, peripheral nerve block, epidural, spinal anesthesia - long duration of action so not used in day surgery

How to address sex practices with adolescent patients

Ask if it would be ok to discuss some health concerns privately with the patient - Physicians should discuss sexuality with their adolescent patients to address their overall health - Ideally, the physiican would begin speaking to the pt regularly wihtout the parent present at each visit, so that this becomes normale - This may vary based on a number of circumstances indlucing culture and patient preferences

Aponeurotic Layer of the SCALP

Attached to the skin by the dense CT of the second layer, this layer consists of the occipitofrontalis muscle, which has - a frontal belly anteriorly - an Occipital belly posteriorly - an aponeurotic tendon, called the epicranial aponeurosis (galea aponeurotics) that connects the two bellies

Autonomic Vs. Somatic Reflexes

Autonomic Reflexes: GVA axons (CN9&10) conveying information from receptors (interreceptors: ex- chemoreceptors or mechanoreceptors) in organs which cause visceral motor efferent neurons to regulate activity on organ tissue (cardiac, smooth muscle, glands, etc) Somatic Reflexes: Afferent axons conveying information from exteroreceptors: touch, pain, smell, taste, vision, sound) to an efferent axon that transmits a signal from the CNS to an effector (skeletal) muscle at the neuromuscular junction

Friedreichs Ataxia

Autosomal recessive disorder on chromosome 9 in which there is an expansion of GAA trinucleotide repeat within a gene that codes from protein FRATAXIN --> mutation causes reduction in frataxin (which is though to be a mitochondrial matrix protein that may be involved with iron storage and preventing iron overloading) **** Accounts for hald of all cases of hereditary ataxia Sxs and symptoms occur bc of the degeneration of NS: - Spinocerebellar tracts, dorsal colums, corticospinal tracts, DRG and peripheral nerves are specific targets - Dentate Nuclei, clarkes column, and the cerebellar peduncles may also be affected - "sensory ataxia" from dorsal colum degeneration and "motor ataxia" from cerebellar structures implicated Sxs: muscle weakness & uncoordination ** Diabetes and Heart Disease may be present in some pts

Friedreichs Ataxia

Autosomal recessive disorder on chromosome 9 in which there is an expansion of a GAA trinucleotide repeat within a gene that codes fro the protein frataxin --> mutation causes a reduction in frataxin - Frataxin fx is unclear although one hypothesis is that is a mitochondrial matrix protein that may be involved with iron storage and preventing iron overloading - Friederichs ataxia accounts for half of all the cases of hereditary ataxias Many signs and sxs occur bc of the degeneration of NS: - Spinocerebellar tracts, dorsl columns, corticospinal tracts, dorsal root ganglion and peripheral nerves are specific targets. Dentate nuclei, clarkes column and the cerebellar peduncles may also be affected. "Sensory ataxia" from dorsal column degeneration and "motor ataxia" from cerebellar strucures implicated *** Sxs include: - muscle weakness and uncoordination - Diabetes and heart disease may also be present in some patients

Lateral Corticospinal/ Pyramidal System

Axons terminate along all levels of the spinal cord to provide somatic (voluntary) movement to contralateral limb musculature Upper Motor Neuron: 1st order cell body is located in the Primary Motor Cortex - signals travel on axons (tract) via the internal capsule through the cerebral peduncle (Crus cerebri), pons, and pyramis as the pyramidal tract or corticospinal tract ~85% of axons cross in the decussation of the pyramids Lower Motor Neuron: 2nd order cell body is located in the ventral horn of the spinal cord grey matter - peripheral nerves of the lower motor neurons in this system target voluntary skeletal muscles (radial nerve, median nerve, femoral nerves) ** NOTE there is NO synapse in the caudal medulla it can cross automatically ---- An accident in the midbrain and blow out the corticopinal tract --> pt loses voluntary motor function to the left side - bc R brain trying to control L side Blowing out the tract in the caudal medulla will lead to loss of function bilaterally If you blow out the coritcospinal tract in the spinal cord- will have hemiparalysis the will affect same side ** SOO lesion in pons or midbrain- opposite side affected ** Lesion in spinal cord- same side affected

Ovaries

Basic functions: - Oogenesis: productiong of oocytes - Production of hormones: androstenedione (estrogen precursor), estrogens, progesterone Gross structure: - almond shaped structure - 3cm long, 1.5cm wide, 1cm thick - consists of a outer cortex and inner medulla * Covered by simple cuboidal epithelium (AKA the surface germinal epithelium); previously believed to be the origin of female gamete cells) - An underlying dense CT layer called the tunica albuginea gives ovary white appearance - Outer cortex consists of a stroma of cellular CT and ovarian follicles - Inner medulla consists of loose CT, lymphatics and blood vessels

Paramedian Branches, Long Circumferential Branches, and Short Circumferential Branches are all Branches off the

Basilar Artery Paramedian Branches: - supply the medial portion of lower and upper pons Occlusion affects: - corticospinal tract, facial nucleus, abducens nucleus and pontine gaze center ---> MILLARD-GUBLER SYNDROME Long Circumferential Branches: - supply most of the tegmentum of the rostral and caudal pons Occlusion affects: - gaze centers, spinothalamic tract Short Circumferential Branches: - supply an area in ventrolateral pons Occlusion affect: - descending sympathetic fibers, pontocerebellar fibers, spinothalamic tract

Why is it possible to transplant corneas w/o putting recipient on immunosuppressive drugs?

Because of the "immune privileged" status of the cornea, caused by: 1. Absence of vascularity that hinders delivery of immune elements (antibodies, antigen-presenting cells etc.) 2. Absence of corneal lymphatics that prevents delivery of antigens to T cells in lymph nodes

Chromosome 11p15.5 Locus

Beckwith-Weidemann/Silver-Russell Syndromes CDKN1C= inhibitor of cell division IGF2= growth factor ** Extra IGF2 expression or lack of CDKN1C expression --> overgrowth (BWS) ** Lack of IGF2 expression or EXTRA CDKN1C expression --> Undergrowth (SRS) ------ - CDKN1C produces the protein p57kip which inhibits cyclin-CDK complexes - IGF2 produces the insulin-like growth factor 2 protein which acts similarly to IGF1 but is more important early in life ** there is some difference in tumor profile depending on which of the two genes are dysregulated - IC1 and IC2 are two different imprinting centers NOTE: Causes of BWS - 50% due to IC2- loss of methylation - 5% due to IC1- gain of methylation - 20% due to uniparental disomy - <1% due to CDKN1C mutation which can be familial

Oogenesis (the development of oocytes- equivalent of spermatogenesis)

Before birth: - Primordial germ cells from the yolk sac migrate to the primordial gonads where they differentiate to form oogonia - There are about 600,00 oogonia in the 2nd month, 7 million in the 5th month - Loss of oogonia due to a degeneration process called ATRESIA resulting in about 400,000 at birth and 300,000 by puberty - During fetal development, mitotic division of oogonia produce primary oocytes which are found in primordial follicles ** Primary oocytes start the process of meiosis but arrest in 1st meiotic prophase During childhood: - the ovary is inactive and the primary oocytes with primodial follicles remain arrested in meiosis I NOTE: Primordial follicles- contain primary oocytes (DONT confuse stage of follicle with stage of oocyte) From puberty: - Ovary is active, folliculogenesis occurs ** Before ovulation, the primary oocyte completes meiosis I, enters meiosis II and arrests here From 1st meiosis, 2 daughter cells are formed: - 1st polar body (which degenerates) - a secondary oocyte which is found in a vesicular or antral follicle Ovulation involves the release of (usually) 1 oocyte from the ovary around day 14 of a typical 28 day cycle - Up to 450 oocytes are released over a reproductive life (30-40 yrs) *** 2dry oocyte begins meiosis II and arrests until fertilization takes place If fertilization takes place: the secondary oocyte completes meiosis II producing a 2nd polar body and ovum If fertilization does NOT take place the secondary oocyte degenerates

What are the primary effects of estrogen on the breast during gestation?

Before pregnancy the breast is predominantly adipose tissue without extensive glandular or ductal development Under the influence of rising concentrations of estrogen, progesterone and prolactin (PRL) during pregnancy, the ductal, alveolar and myoepithelial elements undergo marked hyperplasia and hypertrophy in preparation for lactation - Ductal proliferation and branching is predominantly controlled by estrogen - Estrogen also stimulates synthesis and release of PRL - PRL appears to be necessary for estrogen to exert its effects ont he breast - Progesterone is involved with development of alveoli and lobules, and estrogen priming is necessary for progesterone effects ** High plasma progesterone and estrogen during gestation inhibit the active secretory effects of PRL on mammary alveolar epitehlium (by interfering with PRL binding to PRL receptor) and in this way inhibit lactation during gestation

Preantral follicle growth

Begins with initial recruitment of a group/cohort of primordial follicles from the "resting pool" into the "growing pool" - this is a continuous process (groups of primordial follicles are recruited to grow daily in premenopausal women) - transition of a primordial to a primary follicle takes more than 150 days - primary to secondary follicle transition can take 120 days - thus, it takes >300 days for recruited primordial follicles to grow & develop through the preantral stages Antral follicle growth: - Growth and maturation from early to late antral stage takes ~60 days - at the late antral stage, ~15 follicles are selected from the group to continues developing (cyclic recruitment)- it is from this group that one large antral follicle is selected early in a menstrual cycle to undergo continued growth and development for ~10days- this Graafian or Dominant Follicle is the follicle that goes on to ovulate Atresia (follicle degeneration via apoptosis) can occur at any developmental stage

Treatment of Pain

Best way to alleviate pain is to treat the underlying disease - If not treatable--> chronic pain NSAIDS (non-steroidal anti-inflammatory drugs) - reduce inflammatory pain - ibuprofen, aspirin, acetaminophen Opiods: - mimic the action of endogenous opiods - Morphine, codeine, methadone Nerve Blocks: - interruption of nerve impulses by local anesthetics - Lidocaing: blocks the fast sodium (Na+) channels in the cell membrane- the membrane will NO depolarize, will NOT transmit an action potential, which leads to its anesthetic effects Neural Stimulation: - Transcutaneous, spinal or deep brain stimulation Ablative Neurosurgery Anterolateral (spinothalamic) cordotomy: - spinothalamic tract sectioned after the fibers have crossed Cingulotomy: - lesions to cingulate gyrus or frontal lobe - DO NOT produce pain cessation but block the emotional aspects to intense pain.. pain is still felt but it is no longer profoundly unpleasant

Lesion or disruption of the optic chiasm can lead to

Bilateral loss of the temporal field--> one half of the field and therefore a "bitemporal hemianiopia" aka "anopsia" Commonly caused by: - pituitary adenomas - meningiomas - carnipharyngiomas *** Glioma or Demyelination can affect the optic chiasm NOTE: the structures near the optic chiasm: - internal carotid artery (i.e. aneurysm, ectasia, anomalies) - cavernous sinus (i.e. Schwannoma, inflammaiton, Car-cav fistula) - infundibulum and pituitary gland (i.e. Rathke cleft cyst, cranipharyngioma, germinoma, eosinophila gran., metastistis, adenoma) - hypothalamus (i.e. glioma, hamartoma, germinoma, eosoniophic gran) - meninges (i.e. meningioma, inflammation) - sphenoidal sinus (i.e. squam cell carcinoma, chordoma, sarcoma, matastisis, inflammation) ** All these can cause issues to the optic chiasm and create chiasmatic visual disturbances --> leading to Bitemporal Hemianopia

Nerves of the Pelvis

Both somatic (voluntary) and autonomic (involuntary) nerves contribute to innervation of pelvis Pelvic girdle is innervated by nerves from the following: - Sacral plexus (L4-S4)--> innervation to perineum and lower limb - Coccygeal plexus (S4, S5, & coccygeal nerves)--> for cutaneous sensation of anal region - Pelvic autonomic nerves --> innervation for pelvic cavity and pelvic organs

Papez Circuit

Brain circuit identified by James Papez in 1937 and originally was thought to control emotions ** We now know that this circuit is important for the formation & storage of new memories Hippocampus --> Fornix --> Mammillary bodies --> Mammilothalamic tract --> Anterior nucleus of the thalamus --> Internal capsule --> Cingulate gyrus --> certain areas of the cortex to be stored (CA1, CA2, CA3, CA4--- DG (Dentate gyrus)

Effects of Estrogen

Brain: - positive and negative feedback on hypothalamus and pituitary- menstrual cyclicity Cardiovascular sytem: - vasodilatory, anti-vasoconstrictive, anti-artherosclerotic effects (decreased CVD risk) Skeleton: - increased osteoblast activity, decreased activity- maintenance of bone density Breast: - proliferation of mammary ducts Progesterone receptor: - increased expression Liver: - increased SHBG, HDL, decreased LDL, clotting factors Secondary sex characteristic: - pubertal enlargment of breast,s uterus, vagina, broadening of hips, distribution of fat in breasts and buttocks Endometrium: - proliferation, thickening, lengthening of uterine glands- proliferative phase of menstrual cycle Cervix: - thin, non-viscous, elastic, alkaline carvical mucus- facilitates sperm entry Vagina: - maintains vaginal wall thickness & lubrication - epithelial glycogen accumulation, increased lactic acid, decreased vaginal pH Fallopian tube: - increased activity of ciliated & non-ciliated (secreteory) cells- facilitates oocyte transport & nutrition Uterus: - increased uterine blood flow - increased myometrial contractility

Supporting Ligaments/ Fascia in Female Pelvis

Broad Ligament: double fold of peritoneum (mesentery) that helps to transmit blood vessels to female reproductive organs, stabilize and support these organs - it extends from the lateral side of the uterus to the lateral pelvic wall to help hold the uterus in place in addition to other structures Has 3 parts - Mesosalpinx (Gr. Salpinx, tube): supports the uterine tube - Mesovarium: attaches to and supports the ovary - Mesometrium: attaches to and supports the uterus Round ligament of the Uterus: holds the fundus of the uterus forward, keeping the uterus anteverted and anteflexed Endopelvic fascia to support and anchor the uterus: - Uterosacral (sacrogenital) ligament: extends from the cervis of uterus to the sacrum - Cardinal ligament (transverse cervical ligament): extends from the cervix to the lateral wall of the pelvis *** The cardinal ligament provides the MAJOR support for the uterus - Pubocervical Ligament: extends from the pubic bone to the cervix Ovarian ligament: - connects ovary to the uterus Suspensory Ligament of the Ovary: - extends upward from the ovary to the lateral pelvic walls and transmits the ovarian vessels, nerves and lymphatics

CN IV

CN IV- Trochlear Nerve has only 1 axon modality: 1- General Somatic Efferent (GSE) - Voluntary motor to superior oblique * SO4LR6AO3 *NOTE: if you can move its either GSE or BE- and if structure is NOT coming from a pharyngeal arch then it is GSE - remember branchial archeas are only associated with V3, 7, 9, 10

Lesion to Cortcospinal (pyramidal) tract Rostral to the pyramidal decussation

Can be due to Vascular lesions: - midbrain: Webers - pons: Millard-Gubler - medulla: Medial Medullary Sxs: - CONTRALATERAL hemiplegia/hemiparesis - Coupled with oculomotor nerve palst (midbrain), ipsilateral Bells Palsy and esotropia (abducens dysfunction) (pons), ipsilateral tongue paralysis (medulla)

CN IX

CN IX- Glossopharyngeal Has 5 modalities: BE/ SVE, SVA, GVE, GVA, GSA 1. BE/SVE axons to one muscle- innervate stylopharyngeus 2. SVA axons carry taste perception from the posterior 1/3 of the tonuge 3. GVE axons innervate the parotid gland - Parasympathetic (GVE) axons emerge as the lesser petrosal nerve from the tympanic plexus through the lesser petrosal hiatus - Lesser petrosal nerve then leaves the cranium through the foramen ovale - Pre-ganglionic parasympathetic axons synapse in the otic ganglion, and go to the parotid gland via the auriculotemporal verve (V3) 4. GVA axons from the carotid body (chemoreceptors) and carotid sinus (baroreceptors) 5. GSA axons from sensory from skin posterior to the ear, posterior 1/3 of tongue, soft palate, oropharynx, palatine tonsils, mucosa of the middle ear/tymphanic cavity, auditory tube & mastoid air cells - soft palate & oropharynx for the afferent part of the gagreflex NOTE: Glossopharyngeal emerges from the brainstem in the lateral medulla and exits the posterior cranial fossa through the jugular foramen - Tympanic nerve branches from CNIX and enters the middle ear and sensory (GVA & GSA) axons form the tympanic plexus within the middle ear

Cranial Nerve Nuclei in the Pons

CN V- Trigeminal 1- Motor Nucleus of V (BE axons originate here) 2- Principal (Main, Chief) Sensory nucleus of V (GSA axons (touch) terminate here from branches of V1, V2, and V3 3- Mesencephalic nucleus (** can actually span into the midbrain) - GSA axons (proprioception) terminate in the Mesencephalic nucleus and then the nucleus communicates with the motor nucleus of V to monitor force of bite, adjustment of musculature for appropriate chewing CNVI- Abducens Nuclei - GSE axons originate here to innervate the lateral rectus CNVII: Facial Nuclei 1- Facial Nucleus (BE axons originate here to innervate muscles of facial expression and stapediua) 2- Superior Salivatory Nucleus (GVE axons originate here to innervate the lacrimal, submandibular, sublingual glands & glands innervated by branches of the PPG- pterygopalatine ganglion 3- Nucleus Solitarius- can be shown in the medulla but the nucleus is actually a column that expands into the pons- SVA (taste from anterior 2/3 of the tonuge) axons terminate in the rostral collection of neurons

CN V2

CN V2 (Maxillary) Pathway ** Maxillary nerve travels under the dura to the foramen rotundum which it passes through - A major branch, the infraorbital nerve continues through the inferior orbital fissure, gives off the alveolar nerves and then leaves via the infraorbital foramen where it ends as the superior labial nerve, palpebral nerve and nasal nerve - Zygomatic nerve ( a second branch of the maxillary nerve): psses through the inferior orbital fissure and carries GSA axons of CN V and GVE axons (parasympathetic and sympathetic) from CNVII - the zygomatic nerve branches into the zygomaticotemporal nerve and zygomaticofacial nerve --- It also connects with the lacrimal nerve of CNV1 to reach the lacrimal gland

CN VII

CN VII- Facial Nerve Has 4 Modalities (BE/SVE, SVA, GVE, GSA) 1. BE/SVE axons to muscles of facial expression - Facial nerve axons travel through the internal acoustic (auditory) meatus and through the petrous portion of the temporal bone - BE/SVE axons exit the cranial base via the stylomastoid foramen - Muscles of facial expression are innervated by BE/SVE axons of CNVII that course through the stylomastoid foramen and branch across the facial musculature 2. SVA axons (taste) from the anterior 2/3rds of the tongue and some taste from the palate - travel towards the brainstem on the lingual nerve of CNV3 and then transfer the signal to the chorda tympani nerve of CN VII 3. GVE axons to the submandibular, sublingual and lacrimal glands - travel in the chorda tympani nerve arising just superior to the stylomastoid foramen - chroda tympani nerve runs trhough the tympanic cavity and passes through the temporal bone to join the lingual nerve of CNV3 in the infratemporal fossa - from the lingual nerve, preganglionic axons synapse in the submandibular ganglion than travel to the submandibular and sublingual glands via arteries - Greater petrosal nerve exits the petrous portion of the temporal bone through the hiatus for the greater petrosal - it joins the deep petrosal nerve (sympathetic GVE axons) to form the nerve to the pterygoid canal - Nerve of pterygoid canal passes through pterygoid canal and enters the pterygopalatine fossa - In pterygopalatine fossa, preganglionic parasympathetic axons synapse in the pterygopalatine ganglion - Postganglionic fibers travel via the zygomatic branch of CNV2, and then travel to the lacrimal nerve (branch of CNV1) to reach the lacrimal gland 4. GSA axons from "patch" behind the ear

CN X

CN X- Vagus Nerve * Exits the cranial cavity through the jugular foramen Has 5 Modalites: 1. BE/SVE axons: innervate the majority of the muscles of the pharynx, larynx, and soft palate 2. GSA axons from skin posterior to ear, dura in posterior cranial fossa, external auditory meatus, muscous membranes of pharynx & larynx 3. GVA axons from thoracic & abdominal viscera & aortic body (chemo & baroreceptors) 4. SVA axons (taste) from the root of the tongue and epiglottic region 5. GVE axons (parasympathetic) to thoracic and abdominal viscera to left colic flexure- secretomotor to glands of the pharynx/larynx, thyroid & parathyroid glands and innervation of thoracic & abdominal viscera ** Synapse is in or around target organ ** Damage can lead to difficulty swallowing, hoarse speech, difficulty breathing

What CN play a role in the orbit?

CNIII, IV, VI innervate the voluntary musculature Branches of the Ophthalmic Division of Trigeminal contribute to somatosensory and sympathetic (dilator pupillae) signals and CNIII contributes the Parasympathetic innervation (sphincter pupillae)

CN III

CNIII- Oculomotor Nerve has 2 axon modalities (means 2 functions) 1- General Somatic Efferent (GSE): voluntary motor to palpebrae superioris, superior rectus, medial rectus, inferior rectus, inferior oblique muscle 2- General Visceral Efferent (GVE): Visceral motor to sphincter pupillar for pupil constriction *** Rule #1: parasympathetic fibers reside in CN 3,7,9,10- so CN III will have GVE

Muscles of Mastication

CNV3 (Mandibular division) - Masseter - Temporalis - Medial pterygoid - Lateral pterygoid

Cranial Nerve Nuclei in the Medulla

CNVIII: SSA - Cochlear Nuclei (dorsal and ventral) - Vestibular Nuclei (4) CN IX: Glossopharyngeal Nuclei 1- Inferior Salivatory Nucleus (GVE axons originate here to innervate the parotid gland) 2- Nucleus Ambiguus (BE axons originate here to innervate the stylopharyngeus muscles) 3- Solitary Nucleus: GVA axons from CN IX (perception from carotid body and sinus) terminate in the caudal collection of neurons and SVA (taste from the posterior 1/3rd of the tongue) axons terminate in the rostral collection of neurons CN X: Vagal Nuclei 1- Dorsal Motor Nucleus of X (GVE axons originate here to innervate mainly the thoracic and abdominal viscera) 2- Nucleus Ambiguus (BE axons originate here to innervate the muscles of the larynx, pharynx, and palate) *** remember from cardio module- that a collection of nuclei within nucleus ambiguus is also cardio-inhibitory in nature (GVE) via the vagus nerve- that collection will innervate the heart in addition to the dorsal motor nucleus of X 2- Solitary Nucleus: GVA axons from CN X (aortic chemo, and baroreceptors, thoracic and abdominal viscera) terminate in the caudal collection of neurons and SVA (taste from epiglottic regions) axons terminate in the rostral collection of neurons CN XII: Hypoglossal Nuclei - GSE: voluntary motor to muscles of the tongue- genioglossus, hyoglossus, styloglossus ** REMEMBER: a lesion to the hypoglossal nerve will cause the tongue to deviate towards the side of the lesion

Occlusion of the Anterior Cerebral Artery leads to

CONTRALATERAL motor and somatosensory deficits restricted to the lower limb (ex. if R compromised --> L side shows symptoms- this area supplies the medial anteiror and posterior paracentral lobule which innervated the lower limb) Sxs: decreases touch, pain and maybe spastic paralysis ** remember the anterior cerebral artery supplies some of the precentral (motor ) and postcentral (somatosensory) gyri **** anterior cerebral artery only affects lower limb- remember your somatotopy!

What fills the ventricles and space?

CSF! - Cerebrospinal fluid (CSF) is produced in the ventricles, primarily by the choroid plexus, circulates through the ventricles and around the brain ** CSF protects and cushions the brain

Septal Deviation

Can be congenital or due to trauma - extreme lateral deviation of the septum may result in obstruction of the nasal passages and reduced airflow, causing difficulty breathing, nosebleeds and sleep apnea with a possible mild to severe loss of smell * may be corrected surgically by septoplasty

Lesion of Corticospinal (pyramidal) tract in the internal capsule (posterior limb)

Can be due to Lacunar strokes Sxs: - CONTRALATERAL hemiplegia/hemiparesis - may be coupled with cranial nerve signs due to corticobulbar involvement

Primary Amenorrhea

Can be due to congenital & developmental anomalies: - Outflow obstruction: ex. imperforate hymen - Absent Uterus: ex. Mullerian agenesis (46XX), Complete Androgen Insensitivity syndrome (46XY) - Hypogonadotropic Hypogonadism: Kallmann Syndrome- dysfunctional development of GnRH neurons, associated with anosmia (decreased FSH,LH & estrogen) - Hypergonadotropic Hypogonadism: Gonadal dysgenesis (ex. Turner syndrome, 46 XO) (increased FSH & LH, decreased estrogen)

Female erectile tissure

Clitoris and Bulb of Vestibule Clitoris: - erectile tissue of the female that contributes to sexual sensation during intercourse - located inferior to the pubic symphysis and is attached to the ischiopubic rami by its crura (legs) Bulb of the Vestibule: - elongated body of erectile tissue Bartholins Gland (greater vestibular gland): - is near the bulb of the vestibule and is located on each side of vestibule of the vagina and secretes mucus that acts as a lubricant during intercourse

Opiods

Codeine, Morphine MOA: - opiod, receptor agonists (at the mu-receptor subtype) - mimic the effect of endogenours opiods (endorphin, enkephalin) ** Opiod analgesics have pre- and post- synaptic actions that reduce NT and reduce pain transmisstion Presynaptic: decreased Ca2+ influx, decreased NT release (increased cAMP from GiGo) Postsynatpic: increased K+ efflux (bc increased GRK from GiGo) Metabolism: *** codeine is metabolized to morphine Pharmacological effects: - analgesia - Adverse effects: constipation, euphoria, miosis Therapeutic uses: - Codeine: mild to moderate nociceptive pain - Moriphine: moderate to severe nociceptive pain **NOCICEPTIVE PAIN ** opiods are not best for severe pain if it is neuropathic pain- opiods NOT go to for neuropathic but yes nociceptive

Why is the cornea transparent?

Collagen type I fibril arrangement in corneal stroma allows light passage ** each bundle at right angles to next one NOTE: after damage to corneal stroma, formation of non-aligned scar tissue BLOCKS light and this can require Keratoplasty to fix Corneal Transplant (Keratoplasty): - MOST widely practiced form of transplantation in humans; ~40,000/yr in US - Needed when a cornea no longer lets light enter the eye properly bc of scarring (trauma) or disease - The graft is taken from a recently deceased individual with no knwon diseases or other factors that may affect the viability of the donated tissue or the health of the recipient - Since the cornea has NO blood vessels (it takes its nutrients from the aqueous humor) it heals much more SLOWLY than a cut on the skin

Transformation zone of the cervix

Columnar cells are constantly changing into squamous cells in an area of the cervix called the transformation (transitional) zone bc the location of the transformation zone varies with age among women: - in teenage girls, the transformation zone is on the immature cervixs outer surca and is more susceptible to infection than in adult women - in older women, the transformation zone may be higher in the cervical canal ** Neoplasmic changes leading to development of cervical cancer most frequently begin in the TRANSFORMATION ZONE NOTE the abrupt cahnges from non-keratinized stratified squamous epithelium (vagina) to simple columnar epithelium (uterus) **junction of endo- and exo-cervical mucuous epithelium

Hormonal Contraceptives

Combined hormonal contraceptives (estrogen + progestin): - combination oral contraceptives - transdermal patch - intravaginal contraceptive right Progestin-only contraceptives: - progestin-only pills ("mini-pill") - injection/IM/SubQ (medroxyprogesterone acetate) - intrauterine device (IUD) - Subdermal implant Administartion: - Oral: usually provided in 28-day packs- the first 21 pills are active (contain hormone)- pills for the last 7 days contain inert ingredients- during the last 7 days; menstrual/withdrawal bleeding usually occurs- it is possible to skip the inert pills and continue a new pack with active pills to avoia bleeding - Transdermal patch: is applied for 21 days- usually there is an interval of 7 days before a new patch is applied; withdrawal bleeding usually occurs - Vaginal ring: inserted for 21 days- usually there is an interval of 7 days before a new ring is inserted; withdrawal bleeding usually occurs - Progestin injections: administered every 3 months - Intrauterine devices: usually implanted for up to 6 yrs - Subdermal implants: inserted over the triceps and last up to 3 yrs

A young girl present to you with breast, amenorrhea, no vagina, and only 1 kindey what could she have

Complete Mullerian Agenesis (Mayer-Rokitansky-Kuster-Hauser Syndrome) Presentation: Primary amenorrhea, Absent (or hypoplastic) vagina Complete form: NO mullerian system development! (Rudimentary cords may exist) - Ovarian function is normal - Physical growth and development are normal 33% of these patients have urinary tract abnormalities (ectopic kidney, renal agenesis, horeshoe kidney, abnormal collecting system) 12% have skeletal anomalies (usually of the spine) Treatment: - usually no indication for removal of mullerian tissue, unless there is active endometrial activity without egress - patients wishing to be sexually active usually require surgery to create a neovagina - procedures in the past have been less than satisfying and were very complex - The laproscopic Vecchietti Procedure, and its variants have been very successful in the minimally invasive creation of a neovagina

Hypospadias

Complete or partial lack of fusion of the urethral folds - Results in abnormal opening or openings along the VENTRAL surface of the penis - Occurs in 3-5/1000 (relatively common) ** Hypo- Below- PEE ON YOUR TOE

Molar Pregnancies (Hydatidiform Moles)

Complete vs. Partial Hydatidiform Moles Complete - 46,XX or 46XY- parternal origin - Fetal/embryonic tissues ABSENT - Hydratidiform swelling of chorion villi is diffuse - Trophoblastic hyperplasia is diffuse - Scalloping of chorion villi is ABSENT - Trophoblastic stromal inclusions are ABSENT - 15-20% risk of neoplasia - NO expression of p57 NOTE: - complete mole is uniparental, so like a disomy taken to the extereme Partial - 69, XXY or 69, XYY- 2 sets of paternal chromosomes - Fetal/embryonic tissues present - Focal hydratidiform swelling of chorion villi - Focal trophoblastic hyperplasia - Scalloping of chorion villi present - Trophoblastic stromal inclusions present - 1-5% risk of neoplasia - p57 is expressed NOTE: p57 is imprinted and only expressed from the maternal chromosome- it is likely not the only imprinted gene involved but it is the one that is tested clinically: if the product is absent then the mole is complete

Brown-Sequard Syndrome

Compression or lesion of ONE-HALF* of the spinal cord Clinical Features: 1- Ipsilateral voluntary motor loss below the level of the lesion (spastic paralysis) and affected lower motor neurons on the ipsilateral aspect would cause a flaccid paralysis at that level 2- Ispilateral loss of discriminative touch, vibration and position sense 3- CONTRALATERAL loss of pain and temperature sense below the level of the lesion- also loss of pain and temperature ipsilateral to the damage at the level i.e. In cervical level: - Damage to the ENTIRE dorsal column on the RIGHT: loss of touch/discrimination from RIGHT below the level bc blowing out of fasciculus cuneatus & gracilis (these DO NOT cross until the Caudal Medulla) - Damage to the right Corticospianl tract--> loss of voluntary motor and hemiplegia or spastic paralysis on the RIGHT - bc the corticospinal tracts also crosses in the caudal medulla and we are below the cross at this point - Damage to the spinothalamic tract "anterolateral" on the right would lead to loss of pain and temp on the LEFT - ** anytime you see spinothalamic it is carrying pain/temperature from the OPPOSITE SIDE!

Complete Cord Transection

Compression or transverse lesion of the ENTIRE spinal cord ** you will lose EVERYTHING below the injury Clinical Features: 1- loss of discriminative touch, vibration & position sense 2- loss of pain & temp sensation 3- loss of voluntary motor loss from below the lesion

Common Imagine Modalities

Computes tomography (CT scna) - basically constructs a 3- dimensional image from a series of 2 dimensional X rays - cheaper to perform than MRI - high contrast resolution - downside: moderate to high radiation exposure Magnetic resonance imaging (MRI): - very high contrast resolution, especially between soft tissues of brain - magnetic nuclei (hydrogen atoms/protons) of a patient are aligned in a stong, uniform magnetic field, absorb energy from tuned radiofrequency pulses, and emit rediofrequency signals as their excitation decays - T1 weighted (D): grey matter looks gery and white matter looks white, CSF looks black - T2 weighted (C): grey matter looks lighter than on a T1 and white matter looks dark - CSF looks white

Dandy-Walker Syndrome

Congenital absence of the lateral (Luschka) and median (Magendie) apertured which can cause hydrocephalus - partial or complete agenesis of the cerebellar vermis - dilation of the posterior fodds - possible absence of the corpus callosum DWS: Dilated 4th ventricle, "Water on the Brain", Small Vermis

Direct Pathway of the Basal Ganglia

Cortex--> Striatum--> GPi --> Thalamus --> Cortex - Cortex excites striatum, striatum can do what it wants to do, which is INHIBIT GPi - GPI then no longer inhibits the thalamus, so the thalamus is "dis-inhibited" and more excitation can go to the cortex ** In direct pathway-> thalamus is DISinhibited and there is MORE EXCITATION to the cortex ** remember Glutamate is activating GABAergic is inhibitory Dopaminergic is modulatory

Anterior Cord Syndrome would affect the

Corticospinal and Spinothalamic tract leading to loss of - pain and temperature sense - motor loss

Central Control of Eye Movements

Conjugate Movements serve two main purposes: 1- To move an image onto the fovea (saccades)... or 2- To keep the image on the fovea (smooth pursuit) ** A network of neural structures throughout the brainstem, cerebellum and cerebrum are involved in the initiation and coordination of conjugate eye movements! The brainstem centers differ for the type of movement, but connections with the cerebellum and cerebrum overlap Saccades: In order to generate rapid HORIZONTAL (L to R) saccadic movements, the Paramedian Pontine Reticular Formation (PPRF) is required--> PPRF projects to the abducens nucleus, with each PPRF projecting to the ipsilateral side In order to generate rapid VERTICAL (up & down) saacadic movements, the Rostral Interstitial Nucleus of the Medial Longitudinal Fasciculus (riMLF) is required (located in the reticular formation of the rostral midbrain) --> riMLF projects bilaterally to the motor neurons for all the elevator muscles of both eyes and to the motor neurons for the ipsilateral inferior rectus and the contralateral superior oblique **NOTE: you have saccadic eye movements when studying a face

Projection Fibers

Connect the cortex to subcortical, brainstem and spinal cord targets ** Form the internal capsule: 1- Anterior Limb - contains thalamocortical fibers, cortico-striatal fibers, fibers connecting the putamen/globus pallidus with the caudate and fibers from cortex and thalamus to the pone 2- Genu - contains mostly corticobulbar fibers, some thalamocortical fibers 3- Posterior Limb - contains mainly corticospinal fibers (anterior 2/3rds, some medial lemniscus and spinothalamic fibers, optic and acoustic radiations and few corticobulbar fibers (corticofugal))

Puberty is the period during which secondary sexual characteristics develop under the influence of ovarian steroid hormones

Consists of a series of predictable events that usually proceed in a predictable pattern, with some variation in timing of onset, sequence & temp - progression through all stages takes ~2-4yrs Means age of onset in girls is 10.5 yrs, marked by breast bud development (Thelarche) followed soon after pubic hair development (Pubarche). A growth spurt usually occurs at ~11.5yrs followed by the first menstrual period (menarche) at ~13 yrs - 2 yrs pre-puberty, DHEA & DHEAS from zona reticularis of adrenal levels rise- Adrenarche ** The tanner system/scale consists of description of secondary sexual characteristics relating to breast and pubic hair changes- there are 5 Tanner Stages *** About two yrs b4 puberty the zona reticularis of the adrenal glands under influence of ACTH begins to secrete precursor androgens, and serum DHEA and DHEAs levels rise - this is known as adrenarche ** These androgens have no known role in puberty, but adrenache and pubarche are coordinated

Broadmanns Areas- Cerebral Hemispheres

Cortical layers were examined and divided into histologically distinc regions- each with characteristic cell types - Broadman (1909) numbered the studed regions consecutively from 1 to 52- however, areas 12-16 and 48-51 were defined in lower mammals and NON-human primartes, but are NOT found in humans - This results in 43 areas in human cortex (even though we see 44-47 in the above picture) ** Over the years, 40 more areas were identified to total 83 ** In 2016, through MRI and neuroanatomical approaches, a total of 180 brain regions have been identified- they found that the map was accurate, but that the size of the areas in it varied from person to person - these differences may reveal new insights into individual variability in cognitive ability and disease risk

Female Androgens

Control of sceretion: - Adrenal androgen secretion is stimulated by ACTH - Ovarian androgen secretion is stimulated by LH - Androgens DO NOT feedback to pituitary in females Metabolism: - Metabolized in the liver, conjugated with glucuronic acid or sulfate & excreted in urine or bile Bound: - Testosterone: SHBG (80%), Albumin (19%), Free (1%) - DHEAS, DHEA, Androstenedione: Albumin Physiological Effects of androgens: - Adrenarche (pubertal transition of the adrenal gland) - Pubarche (development of pubic hair, axillary hair & adult sweat gland (apocrine) odor- pubic hair developemnt is stimulated by adrenal and ovarian androgens - Libido & female sexual function - Substrate for estrogen synthesis in utero, during reproductive life, menopause Androgen Deficiency (syndrome?) - female sexual dysfunction, low libido, blunted motivation, lack of well being Effects of Excess androgen: - prenatal masculinization/virilization - premature adrenarche, pucharche - hirsutism, acne, oligomenorrhea, amenorrhea, femal pattern baldness, clitoromegaly, deepening of the voice, male body habitus (physique, body build)

After ovulation, the granulosa and theca cells of the Graafian follcile reorganize to form a large temporary endocrine gland called the

Corpus Luteum - has a prominent rich vascular network * the hemorrhage into the ovulatory cavity associated with follicular rupture is accompanied by proliferation & penetration of capillaries and fibroblasts from the surrounding strome - the resulting neovascularization of the developing corpus luteum makes it possible for gonadotropins and other hormones (ex. hCG) to be delivered to the corpus luteum and for secretory products to be efficienyly transported into the circulation The fx life span of the corpus luteum in a non-fertile cycle is normally 14 +/-2 days - unless preg occurs, it is transformed into an avascular scar referred to as the corpus albican after this time **Regression of the corpus luteum (known as luteolysis), encompasses functional changes (decreased endocrine function), as well as structural changes (apoptosis and tissue involution)

Indirect Pathway of the Basal Ganglia

Cortex--> Striatum--> GPe--> STN--> GPi--> Thalamus--> Cortex - Cortex excites the striatum, striatum can do what it wants to do, which is inhibit GPe - GPe can now no longer inhibit STN, so STN is "disinhibited", and free to do what it wants --> which is excite the GPi and SNr - Both GPi and SNr are excited to do their job, which is to INHIBIT the thalamus, so the thalamus sends LESS excitation (little to none) to the cortex - In the indirect pathway the thalamus is INHIBITED --> little/NO excitation to the cortex **REMEMBER that - Glutamate is excitatory - GABAergic is inhibitory - Dopaminergic is modulatory

Epidural Hematomas

Covex/lens shape - expansion stops at skull sutures (where the dura mater is tightly attached to the skull) - expansion inward toward the brain rather than along the inside of the skull - if there is on-going bleeding (hemorrhage) from injury, there can be loss of consciousness, followed by lucidity and then deterioration and death *** Source of blood can be Meningeal artery or Dural Venous Sinus

Cranial Activation and the Reticular Formation

Cranial nerve nuclei and collateral sensory fibers form an outer shell surrounding the reticular formation- this allow for the reticular formation to be in a position to receive a variety of sensory inputs - Trigeminal (somatosensory info), solitary (taste info), olfactory, visual (superior colliculus), auditory and vestibular all contribute fibers that synapse on reticular formation nuclei - The reticular formation does NOT maintain the specificity of the information it receives from these systems- Therefore, it sends non-specific ascending fibers to the thalamus (centromedian/ventral anterior) thus altering the excitability levels of neurons in the thalamus and ultimately the cortex *** Non-specific thalamic nuclei can also influence specific thalamic nuclei at the level of the thalamus before signals reach cortex! (review specific/non-specific nuclei of the thalamus in Diencephalon lecture!)

Restless Leg Syndrome

Creeping/crawling feeling in lefs - 3 or more times in 3 months - occurs at rest - temporarly relieved by movement - may delay onset of sleep - worsened by fatigue - cause unknown (thought to be a dopamine/Fe deficiency)--> increased in women and pregnancy Treatment: - exercise and increased sleep time - PHARM Ropinirole (stimulates dopamine release)

Subdural Hematoma

Crescent-shapes with a concave surface away from the skull - expansion along the inside of the skull creates the concave shape that follows the curve of the brain - expansion stops only at dural reflections (ex. tentorium cerebelli and falx cerebri) - may see midline shifts of brain structures ** Source of blood can be Dural Venous Sinus or Vein at attachment to sinus

What androgen is the precursor for placental estradiol synthesis? where does this androgen come from?

DHEA is produced in the fetal adrenals and supplied to the placenta where it is converted to estrone and estradiol

Major Androgens in Female Serum

DHEAS> DHEA > Androstenedione (A4) > Testosterone > DHT - DHEAS, DHEA, A4: require conversion to T or DHT to exert androgenic effect - DHEAS--> DHEA by sulfatase in the adrenals, liver, small intestine - A4--> T by 17beta-HSD in the ovary, skin & adipose tissue - A4--> E1 and T--> E2 by aromtase in ovary, adipose tissue, skin, bone, brain - T--> DHT by 5-alpha reductase primarily in the skin, liver and urogenital tissues In terms of potency: DHT> T> A4> DHEA> DHEAS - Only T & DHT bind to androgen receptor (AR) - therefore, andostenedione, DHEA & DHEAS are not "true androgens"- However, the weak androgens can be converted to T & DHT and overproduction of any of these hormones can lead to androgen excess - DHT acts within target cells & little enters the circulation- conversion of testosterone to DHT in peripheral tissues is limited in females because of high levels of SHBG and also by peripheral conversion of testosterone to estrogen by aromatase

Healthy sons for X-linked recessive trait

DMD sons--> what is the risk that the daughter is a carrier? 1/2

CN V does NOT innervate taste receptors, but

DOES play a part in mouth "feel" ** it carries general somatosensation from the anterior 2/3rds of the tongue- so it helps use respond to pain and temperature - Capsaicin: directly activates pain & temp receptors of the oral cavity - Whisky (neat) produces a bruning sensation - Air pollutants, ammonia, ethanol, vinegar, CO2 (soft drinks) Activation of oral trigeminal afferents may induce reflex actions desigened to prevent inhalation or further ingestion of food - increased salivation - vasodilation - tearing - nasal secretions - sweating

Marcus Gubb Pupil (or Relative Afferent Pupillary Deffect- RAPD)

Decet in the direct response subserved by the OPTIC NERVE - Optic Neuritis or Retinal Disease is a common cause ** Remember that if there is a complete CN II lesion, there would be NO constriction whatsoever - In Marcus Gunn, we have an afferent defect, or a defect to some of the fibers within the optic nerve or extension from the retina, such as in multiple sclerosis ** This is an afferent pupillary defect meaning that some of the afferent fibers are compromised- either from the retina or along the optic nerve ** Dilation occurs in the eye with the afferent defect bc the pupils respond as if the light shone in the eye was dimmer-> this produces less bilateral constriction, so the eyes are more dilated compared to when light is shone in the normal eye - If you continue to swing the light, the pupils will both constrict when the light is shone in the normal and dilate when the light is shone in the abnormal eye Ex: When the torch is swung into the affected eye, there is temporary paradoxical dilation of the pupils; this indicated a defect in the afferent limb of the affected eyes pupillary reflex- the torch may have to be swung back and forth several times

Internal surface of the Bladder and Urethra

Detrusor muscle: wrinkled, smooth muscle fibers of the bladder - ureters open into the posterior bladder wall at the ureteric orifices - urethra: conducts flow of urine out of the body and is shorter in length in females than in males - external urethral sphincter muscles contracts to compress the urethra and stop the flow of urine (innervated by pudendal nerve)

Sexual Differences in Pelvis Shape

Differences in pelvis shape are related to heavier build and larger muscles of most men and adaptation of pelvis in women for parturition (childbearing) ** Female pelvis is rounder and larger for child birth Pubic arch is wider in Female Pelvis - Pubic arch is a surface feature of the bony pelvic girdle - Can also be called the subpubic arch ** Narrow pubic arch in male *** Wider pubic arch in female pelvis Main differences between female & male pelvis are the 1. Inlet 2. Outlet 3. Cavity 4. Pubic arch

Pelvic Measurements in Obstetrics

Dimensions of female pelvic inlet and pelvic outlet are of obstetrical significance: - bony canal through which the fetus passes during normal child birth - pelvic deformities and variations may cause difficult labor (dystocia) Conjugate= a measured diameter of the lesser pelvis *** Conjugates must be measured to determine the capacity of the female pelvis for childbearing and vaginal delivary Types: (True) Obstetric Conjugate: - anteroposterior diameter measured from sacral promontory to (midway) posterior margin of pubic symphysis- CANNOT be manually measured properly due to the bladder in the way **** Obstetric conjugate should be 11.0cm or more for "safe" vaginal delivary of baby - is the SHORTEST pelvic diameter through which the fetal head must pass during birth Diagonal Conjugate: (easier to measure) - diameter measured from sacral promontory to bottom of pubic symphysis - used to estimated obstetric (true) conjugate by measuring then subtracting 1.5cm to 2cm ** Physicians can measure any number of pelvic diameters/conjugates (ex. transverse, anatomic, interspinous, obstetric, oblique, diagonal) manually but mainly using ultrasonography when examining female pelvis during ob/gyn examination ** Measurement of pelvic diameters= Pelvimetry

Dorsal Column/Medial Lemniscus System

Discriminative Touch! Also pressure, vibration, proprioception, 2 pt discriminiation (non-noxious stimuli) - highly developed in humans ** Gracilis= T7 and below ("lower limb") ** Cuneatus= T6 and above ("upper limb") 1st Order Cell Body= DRG - Fibers travel via Fasciculus Gracilis or Cuneatus 2nd Order Cell Body= Nucleus Gracilis and Nucleus Cuneatus in the caudal medulla - Fibers cross midline as Internal Arcuate fibers and travel via the Medial Lemniscus to... 3rd Order Cell Body= VPL of the thalamus - signal ascends on fibers to Somatosensory cortex (S1) DRG -> (fasciculus gracilis or cuneatus)-> Nucleus gracilis or Cuneatus-> (medial lemniscus) -> VPL --> Primary Somatosensory Cortex

Canal of Schlemm and Trabecular Meshwork

Drains 2-3 UL of fluid/minute ~20 UL= 1 drop from an eyedropper (i.e 10 min--> 1 drop, 1 hr--> 6 drops, 10 hrs--> 60 drops) Flow of Aqueous humor: Aqueous humor is produced by the ciliary processes in posterior chamber--> flows through pupil into anterior chamber --> drains out through Trabecular Meshwork --> Canal of Schlemm --> rejoins venous system

2 Types of Ataxia

Disordered contractions of agonist & antagonist muscles & lack of coordination between movements at different joints 2 Types: 1- Truncal Ataxia: - lesions to vermis/flocculonodular lobe - loss of equilibrium, wide stance, problems balancing, veering to one side - pts have an unsteady "drunklike" gait ** Tandem Gait Test= "walk the line".. pts fall or deviate toward the side of the lesion during walking 2- Appendicular Ataxia: - lesions to cerebellar hemispheres/lateral zones - affects lateral motor systems- movement of extremities, skilled/fine voluntary and planned movements - errors in force, direction, amplitude and speed - patients have an unsteady "drunklink" gait Pts can exhibit: - Dysdiadochokinesia: pts with cerebellar dysfunction are unable to pronate and supinate - Hypotonia: loss of muscle tone - Dysmetria: improper measurement of distance or range for a movment

Speech Association areas

Dominant (LEFT) Hemisphere - Brocas Area (BA 44,45) - Wernicke's Area (BA 22,39,40) Spoken Language (Hearing & Speaking): Primary Auditory Cortex (BA41,42)--> Wernickes Area (BA 22,39,40) --> Brocas Area (BA44,45) --> Primary motor Cortex (BA4) Written Language (reading our loud) Primary Visual Cortex (BA17) --> Visual association cortex (BA18,19) --> Wernickes Area (BA22,39,40)--> Brocas Area (BA44,45)--> Primary Motor Cortex (BA4)

Drugs targeting dopaminergic neurotransmission

Dopamine transport inhibitors: Cocaine, a drug of abuse - blocks the dopamine transporter (DAT) and norepinephrin transporter (NET) - blockes voltage gated sodium channels Releasers of dopamine: Amphetamine, a drug of abuse or a therapeutic for attention deficit hyperactivity disorder - stimulates dopamine and norepinephrine release from presynaptic vesicles Increase dopamine levels **** Selegiiline is a monoamine oxidase type B inhibitory - reduces dopamine catabolism

Diplopia

Double vision - Examination of eye movements is very imporatnt - Lesions to peripheral nerves on one side can cause impairment of extraocular eye muscles, therefore disrupting voluntary movement of the eyes and binocular vision resulting in diplopia ** Diplopia can be vertical or horizontal in nature ** Can be very disruptic to everyday life

Ethanol (alcohol)

Drug class: a sedative- hypnotic MOA: Positive allosteris modulator at GABAa receptors - potentiates the actions of GABA (like diazepam- dont want to take both together bc would get exaggerated effect) - also potentiates the actions of other GABAa allosteric modulators - Effects at other sites as well Pharmacological effects: CNS depressant - low doses are anxiolytic and produce behavioral disinhibition - high doses can cause loss of motor control (i.e why we dont drive on alcohol), ataxia, sedation, anterograde amnesia, coma Periphery: - vasodilation, hypothermia, diuresis (reduced vasopression release) Psychological dependence: drug craving Physical dependence: Tolerance: pharmacodynamic: - adaptive responses that counteract the effects of ethanol - cross tolerance with other GABAs receptor modulators Withdrawal (abstinence) syndrome: - insomnia, shakiness, anxiety, palpitations - seizures, hallucinations ** Can be life-threatening so must be taken seriously Drug interactions: - additive with other CNS depressants (sedatives, antihistamines, opiods, etc)

Cocaine

Drug class: a stimulant, a drug of abuse MOA: - inhibits dopamine and norepinephrine transporters (DAT, NET) - also inhibits voltage-gated sodium channels (local anethetic-like effect) Pharmacological effects: - Psycho-motor stimulation (hyperactivity (manic behavior), anorexia, insomnia) - cardiovascular sitmulation bc elevation of norepinephrine (HR, BP, arrhythmias), stroke, MI - can cause profound depletion of dopamine (crash after binging on cocaine) Psychological dependence: - strongly rewarding - drug craving Phsycial dependence: - not as strong as ethanol or opiods

Nociceptive Chronic Pain

Due to tissue injury and release of inflammatory activators - Mecanical low back pain - Rheumatoid arthritis - Osteoarthritis - Chronic inflamamtory conditions - Post-operative pain - Spors/exercise pain

Sertoli Cells functions differ in Development vs Puberty

During Development: 1. Synthesize and release antimullerian hormone, which determines maleness After Puberty: 1. Support, protect and nourish the spermatogenic cells- they stretch from the basal lamina to the lumen 2. Phagocytose excess cytoplasm discarded by maturing spermatids (residual bodies) 3. Secrete a fructose-rich fluid into the lumen that nourishes and facilitates the transport of spermatozoa through the seminiferous tubules to the genital ducts 4. Synthesize androgen-binding protein (ABP) under the influence of FSH ** ABP assits in maintaining the necessary concentration of testosterone in the seminiferous tubule so that spermatogenesis can progress 5. Secrete inhibin, a hormone that inhibits the synthesis and release of FSH by the anterior pituitary 6. Establish a blood-testis barrier NOTE: - Sertoli cells secrete componens of the basal lamina

Graafian Follicle

During each menstrual cycle, usually one follicle grows much more than the others and becomes the dominant follicle, rest enter atresia * Dominant follicle is the ONE follicle that reaches the most developed stage of follicular growth (Graafian/mature/preovulatory follicle) and undergoes ovulation - The single large antrum of the mature or preovulatory or graafian follicle accumulates follicular fluid rapidly and expands to a diameter of 2cm or more - the granulosa layer becomes thinner - the thecal layer is thick NOW: Secondary oocyte is in Graafian Follicle- finished 1st meiotic division and entered second meiotic division ** when released from the Graafian follicle and into the oviduct, the ovum will contain 3 layers: oocyte, zona pellucida and corona radiata

Corticobulbar fibers of the Hypoglossal Nerve

EXCEPTION: CONTRALATERAL corticobulbar innervation ONLY Unilateral UMN Lesion= tongue will deviate AWAY from the lesion upon protrusion - tongue muscles on the contralateral side no longer receive innervation so tongue "pushes" to contralateral side Unilateral LMN Lesion= tongue will deviates TOWARDS the lesion upon protrusion- tongue muscles on ipsilateral side no longer receive innervation so tongue "pushes" to the same side

Otitis Media

Earache and bulging red tympanic membrane may indicate pus or fluid in the middle ear, a sign of Otitis Media - Middle ear infections are often secondary to upper respiratory infections *** More common in children due to the angle of the pharyngotympanic tube (less steep, so bacteria/infection can enter middle ear more easily!) - Inflammation and swelling of the mucous membrane of the tympanic cavity may cause partial or complete blockage of the pharyngotympanic tube - Ear popping is common ** If untreated, it may cause impaired hearing as a result of the scarring of the auditory ossicles ** An otitis externa infection may be associated with otitis media if the eardrum ruptures

All sperm and eggs are identical (world wide) BUT

Egg vs. sperm are different from each other - Therefore, it is clear that imprinting is removed during gametogenesis before being applied again to all chromosomes - Normal development only happens if the zygot contains one chromosomes imprinted on way and the other chromosome imprinted with the other pattern NOTE: during spermatogenesis and oogenesis 1. erase old imprint 2. estabilish new sex-specific imprint

Extraocular Movements of the Eye

Elevation: upward movement of the pupil, facilitated by superior rectus and inferior oblique muscles Depression: downward movement of the pupil, facilitated by the inferior rectus and SUPERIOR oblique muscles **Elevation and Depression of eyeball occurs along the Transverese Axis Abduction: movement of pupil to the lateral side, facilitated by the lateral rectus muscle Adduction: movement of the pupil towards the medial aspect of the face, facilitated by the medial rectus muscle *** Abduction and Adduction of the eyeball occurs along the vertical axis Extorsion: movement of the top of the eye AWAY from the nose, facilitated by inferior rectus and inferior oblique muscles Intorsion: movement of the top of the eye TOWARD the nose, facilitated by superior rectus and superior oblique muscles *** Extorsion and Intorsion of the eyeball occur along the antero-posterior axis

Cricothyrotomy

Emergency procedure used to obtain an airway when other more routine methods (ex. laryngeal mask airway) are ineffective or are contraindicated An incision is made through the median cricothyroid membrane Indicators to perform cricothyrotomy: - trauma causing oral, pharyngeal, or nasal hemorrhage - clenching teeth - maxillofacial trauma or foreign body obstruction *** Cricothyroid artery may be compromised and pushed into the trachea during this procedure- if the clinician does NOT identify that this has happened, the pt may aspirate the blood and this could be fatal

What is the difference between emission and ejaculation?

Emission: - Contractions of SM of vas deferens, seminal vesicles and prostate stimulate seminal fluid secretion and movement into the posterior urethra. This is accompanied by contraction of the internal urethral sphincter Ejaculation: - Semen in the urethra triggers spinal cord reflex - Additional prostate and seminal vesicle secretions - Contraction of bulbospongiosus and ischiocavernosus muscles, compression of the root of the penis and expulsion of the ejaculate (ejaculation)

Gynecomastia

Enlargment of the male breast - Benign proliferation of glandular tissue of male breast with presence of rubbery or firm palpable mass >05.com diameter extending concentrically from the niple Differential Diagnosis: not to be confused with breast cancers that are typically unilater, non-tender, and often fixed masses found exxentric to the nipple-areolar complex Cause: - Imbalance between estrogen action relative to androgen action: decreased androgen/ increased estrogen Physiological gynecomastia: - Newborn: transplacental transfer of estrogen - Puberty: high estrogen-to-androgen ratio in early stages of puberty - Aging: increased fat tissue= increased aromatase activity Pathological gynecomastia: - Drugs: antiandrogens (ex. flutamide for prostate cancer), estrogenic - Hypogonadism - Increased SHBG - Increased serum estrogen (ex. sertoli cell tumor) - Increased androgen-estrogen conversion-> increased aromatase activity

Epidural vs. Spinal Anesthesia

Epidural: - drug to OUTSIDE of spinal cord, on surface of dural membrane - delivered on outside of dural membrane - catheters allow infusions or repeated bolus injections - SLOWER onset of action than spinal - LARGER dose than for spinal *** TOXICITY!: if dose is inadvertently given intravascularly or intrathecally (dose must be placed exactly where it is supposed to be!) - ** Chloroprocaine (short_ - Lidocaine (medium) - Bupicavaine (long) - Ropivacaine (long) Spinal: - subdural or arachnoid and in CSF - injection into CSF - SMALL doses relative to same drug, diff injection site (in CNS drug protected from diffusion and metabolism- so other places like nerve block or epidural drug is near blood flow and enzymes in blood may metabolize drug, so conc. high when injected but will drop down bc metabolism of the drug- BUT in spinal cord we DONT have this blood flow so metabolism/diffusin of drug less so conc. of drug not dropping at same rate so smaller dose fine) - Solution density and position of pt affect diffusion of local anesthetic (ask pt to lie in specific way to stay in part of spinal cord we want it to- will reduce diffusion of drug away from where we want it to have its affect) *** Local anesthetics inhibit A delta and C fibers (sensitive to local anesthetic) - in spinal cord we have sympathetic and motor fibers near by also- so motor fibers have LOW sensitivity (need more drug to inhibit motor- same with gamma and beta) - preganglionic and postganglionic (sympathetic and sensory)- are very sensitive so do need as high dose - larger region of body affected in autonomic and sensory fx and smaller region with decreased motor fx related to conc. of drug where we have relavant fibers

Nerve control of Erection & ejaculation in Male

Erection: - Parasympathetic nerve impulses - blood accumulates in erectile tissues Orgasm: - Culmination of sexual stimulation - Accompanied by emission and ejaculaiton Emission and Ejaculation: - Emission is the movement of semen into urethra - Ejaculation is the movement of semen out of the urethra - Largely dependent on sympathetic nerve impulses "Point & Shoot"

Which branches of the NS are primarily involved with control of erection, emission & ejaculation?

Erection: parasympathetic --> Ach binds to endothelial muscarinic receptors stimulating eNOS and NO release--> NO also released from cavernous nerve it then diffuses into SMCs, binds guanyly cyclase catalyzing conversion of GTP to cGMP which activates PKG --> PKG stimulates K+ efflux and Ca2+ uptake into the ER= SM relaxation and vasodilation Emission: sympathetic innervation- movement of ejaculate into the posterior urethra- result of rhythmic contractions of smooth muscle of the distal epididymis, vas deferenes, seminal vesicles and prostate - accompanies by constriction of the internal sphincter of the bladder, thus preventing retrograde ejaculation of sperm into urinary bladder Ejaculation: somatic reflex (spinal cord reflex) triggered by the entry of semen into the urethra and results in rhythmic contractions of the ischiocavernousus and bulbospongiosus muscles - propels semen forcefully from the penis

Cortico-cortical connections

Essential for motor functioning - Posterior parietal cortex (BA 5 and BA 7) to Premotor and supplementary motor cortices (BA 6) - Supplemental and premotor cortices (BA 6) to primary motor cortex (BA 4) - Primary somatosensory cortex (BA 3,1,2) to primary motor cortex (BA4) and inverse

Estradiol, Estrone, and Estriol

Estradiol - MOST POTENT - from GCs, CL - secreted in reproductive life Estrone - Weaker (1/10th potency of estradiol) - from peripheral, GCs - secreted in menopause (& post-menopause) Estriol - least poent (1/100th of estradiol) - peripheral , placenta - secreted during pregnancy These are all - Bound: with low affinity to SHBG, loosely bound to albumin - Metabolized: in liver, conjugated with glucuronic acid or sulfate & excreted in urine or bile Control of Synthesis: In HPO Axis - FSH: increases aromatase, 17betaHSD expression & activity - LH: stimulates androgen synthesis

Estrogen Drugs

Estradiol Ethinyl Estradiol Mestranol

Role of Glycogen in the Vagina

Estrogen stimulates the epithelial cells to synthesize and accumulate glycogen * Bacteria metabolize glycogen to lactic acid- creating a relatively low pH (~3.0) within the vagina * Low vaginal pH provides protection against pathogenic microorganisms - Alkaline prostate secretions of sperm counteract this for survival of sperm ** Clear spaces in vaginal epithelial cells are occupied by glycogen

Objective Personality Assessment

Evaluate thoughts, emotions, attitudes, and behavioral traits involved in interpersonal functioning - determine personality strengths and weaknesses (i.e. carrer assessments) - identify psychopathology or personality disturbances Ex. Minnesota Multiphasic Personality Inventory(MMPI-2), and Personality Assessment Inventory (PAI)

What does the Cerebellum do?

Evaluates differences between intention and action and adjusts operations in the motor cortex and brainstem while a movement is in progress and also during repetitions of the same movement How does cerebellum do this? 1- Receives information about commands & feedback signals associated with the execution of movement 2- Output from the cerebellum is focused on centers that control motor neurons (motor cortices & brainstem) 3- Cerebellar circuits can be modified...important for adaptation and learning

Defferentiate between organic and psychogenic causes of ED

Ex: Inability to achieve erection with a partner, but persistence of morning erections may suggect psychogenis as opposed to organic causes of ED Psychogenic: - performance- related anxiety - traumatic past experiences - relationship problems - anxiety - depression - stress

Pupillary light reflex in the case of damage to ONE oculomotor nerve?

Ex: Left oculomotor nerve damaged - When light is shone in the left eye--> direct reflex is LOST, BUT there will be a consensual response in the right eye- the left optic nerve is ok and the right oculomotor nerve is ok - When light is shone in the right eye, the direct reflex is intact, but the consensual reflex is lost: the right optic nerve and right oculomotor nerve are ok - the right optic nerve can signal to the nuclei in the brainstem, but the singal is NOT carried on the damaged oculomotor nerve, consensual pupillary constriction is lost CN III lesion--> Loss of consensual pupillary light reflex

Full term placenta

Examination of the placenta should occur after birth - Maternal surface of the placenta should be dark maroon in color and should be divided into lobules or cotyledons- the structure should appear complete, with NO missing cotyledona - Fetal surface of the placenta should be shiny, gray and translucent enough that the color of the underlying maroon villous tissue may be seen - The normal cord contains two arteries and one vein

Inhibitory, Excitatory and Balanced Neurons

Excitatory input: - Excitatory post-synaptic potential (EPSP) - depolarizing - membrane potential is less negative - ex. -70mV --> -60mV - ex. AMPA receptors, Na+ influx when channel opened Inhibitory input: - Inhibitory post-synaptic potential (IPSP) - Hyperpolarizing - Membrane potential is more negative - ex. -70mV --> -80mV - ex. GABAa Receptor, Cl-influx when channel open Balance- Excitatory and inhibitory input: - additive - IPSP, EPSP, or no change ** equal and opposite

Physiological changes during the excitement phase in men and women

Excitment in men: - Penile filling: psychological or physical stimuli cause release of neurotransmitters (ACh, NO) which induces smooth muscle relaxation= increased blood flow to the penis; erection begins; partial elevation of testes; scrotal skin thickens; testes pulled closer to body Excitment in women: - Increased blood flow and vasocongestion stimulates vaginal lubrication, swelling of the clitoris, labia minor & vagina. The body of the uterus ascends (tenting effect), pulling the cervix away from the vagina, increasing vaginal length

A female triathalon runner with low BMI presents to you with no period for that past few months- what can she have

Exercise Induced Hypothalamic Amenorrhea (Hypothalamic suppression) - LOW FSH and LH Presents with: - Amenorrhea (or oligomenorrhea and hypomenorrhea) - Low gonadotropins - Normal prolactin and sella turcica - Common in competitive athletes and demanding activities Two major influences: - critical amount of body fat (about 22%) PLUS stress itself NOTE: Competitve athlete: 50% less body fat than the non-competitor- Much under critical 10th percentile (22%)... her BMI is 16 Female Athlete Triad: Menstrual Dysfunction + Low Bond Mineral Density + Eating disorders ------------ Hypothalamic Suppression: - Increased Endorphins --> Suppress GnRH secretion (arcuate nucleus of hypothalamus) - CRH --> directly inhibit GnRH release (by augmenting endogenous opiate release) - CRH--> via ACTH can increase cortisol *** Resembles Anorexia Nervosa... exercise, body control/preoccupation, strive for perfection - Markedly estrogen deficient... risk of CVD, osteoperosis/fracture, vaginal atrophy Treatment: - estrogen/progestin replacement (OCP is great choice) Pregnancy: - decrease exercise or - ovulation induction with gonadotropins

Acoustic Neuroma

Expands out of the internal auditory canal, displacing the cochlear, facial, and trigeminal nerves located in the cerebellopontine angle --> Eventually, the tumor compresses the brainstem Types: Small Acoustic Neuroma: - hearing loss or tinnitus in ipsilateral ear - impaired balance, causing vertigo (sensation of spinning) ** Also; vestibular schwannoma Large Acoustic Neuroma: - hearing loss (in ipsilateral ear) - headaches with blurred vision - numbness or pain on one side of the face - problems with limb coordination on one side of the body - less often: muscle weakness on one side of the face - in rare cases: changes to the voice or difficulty swallowing

Vagina

Extends between the vestibule and the cervix of the uterus - muscular tube lined with mucous membrane that fold into rugae - can expand to accomodate intercourse and childbirth - serves as excretory route for the menses, receives the penis and semen during intercourse, and is birth canal during childbirth NOTE: Superior part of vagina surrounds the cervis to form a vaginal fornix - Anterior vaginal fornix - Posterior vaginal fornix - 2 lateral vaginal fornices

Scalp

Extends from superior nuchal lines and external occipital protuberance posteriorly, the superciliary (above eyebrows) arches anteriorly and the zygomatic arches laterally "SCALP" Skin: - Thin, except in occipital region - Contains many sweat & sebaceous glands & hair follicles Connective tissue (dense): - Richly vascularized layer that is well-supplied with cutaneous nerves Aponeurosis: - Tendinous sheet that serves as an attachment site for muscles Loose Areolar Tissue: - Sponge-like layer that includes potential spaces that may distend with fluid as a result of injury or infection - Allows free movement (back and forth) of the scalp proper (1st three layers: S.C.A) Pericranium: - Dense layer of CT that forms the external periosteum of the neurocraniums - Firmly attached but can be stripped fairly easily, except where the pericranium is continuous with fibrous tissue in the cranial sutures (so this is hard to rip off)

Cervical Sympathetic Chain

Extends from the base of the skull to the level of T1 vertebra - located posterior to the carotid sheath and anterior to the muscles of the vertebral column in a paravertebral location - signals travel on sympathetic fibers from the level of T1 (remember! this is where the pre-ganglionic cell bodies are located) superiorly through the sympathetic chain to supply target structures in the head and neck *** 3 paravertebral ganglia are located in the cervical region: superior, middle, and inferior *** Fibers from the superior cervical ganglion (arising from T1) supply sympathetic innervation to the head and neck region

Boundaries of the face

Extends from the superciliary arches to the inferior ascept of the mandible and back to the ears on either side - Observation of the face can tell a physician a variety of things about a patients health - NOTE: in most superficial region, there are distinct compartments of the face that are separated by delicated CT septa and retaining ligaments --> years of gravity and changes in volumes of the adipose and CT= aging

Anatomical Divisions of the Ear include

External Ear Middle Ear Inner (internal) Ear - External ear and middle ear are separated by the tympanic membrane- BOTH areas are mainly involved in transference of sound waves to the inner ear - Inner ear contains the organs for balance, equilibrium (vestibular apparatus) and hearing (cochlea) ** NOTE: the pharyngotympanic (eustachian) tube connects the middle ear to the nasopharynx (ear popping!) ** External ear= auricle (pinna) and external acoustic meatus

Arterial supply to the nasal cavity is provided by branches of the

External and Internal Carotid Arteries: Internal carotid artery= Anterior and posterior ethmoidal arteries (branches of ophthalmic artery) External carotid artery= Sphenopalatine and greater palatine are branches of the maxillary artery and superior labial and lateral nasal branches from the facial artery ** REMEMBER! the ophthalmic artery originates from the internal carotid artery and the maxillary artery from the external carotid artery

Cervical ripening occurs during phase 1 of parturition. True or False?

FALSE Cervical Ripening occurs in Phase 2 - Phase 1 there is softening of the cervix

T or F: GnRH neurons secrete GnRH continuously

FALSE! GnRH neurons DO NOT secrete GnRH continuously GnRH pulses ~every 90-120 minutes --> intermittent stimulation of the gonadotropes --> Pulses in LH and FSH secretion ** Pulsatile release of GnRH is CRITICAL for gonadotropin secretion - Conitnuous GnRH down-regulates GnRH receptors on gonadotropes & suppresses gonadotropin release NOTE: - Control of the reproductive axis originates in the hypothalamus with periodic pulsatile release of GnRH - GnRH is secreted in a pulsatile manner- bc the t1/2 of GnRH in blood is only 2-4 minutes, these pulsatile burst of GnRH cause very obvious increases in GnRH levels that result in release LH & FSH Clinical Correlation: Continuous GnRH secretion (or continuous administration of an analog) does NOT permit normal pulsatile LH & FSH secretion- INSTEAD it causes down-regulation of gonadotrope GnRH receptors, and thus suppresses gonadotropic release and gonadal function - this explains the underlying mechanism for the therapeutic uses of continuous administration of GnRH analogs in conditions such as percoucious puberty and hormone-responsive cancers

Corticobulbar tract for Facial Nerve (CN VII)

Facial Motor nucleus is split into DORSAL and VENTRAL components - DORSAL part of the nucleus: innervates the upper quadrant of the face (muscles of facial expression) and follows the rule (bilateral corticobulbar innervation, contralateral dominance) -*** VENTRAL part of the nucleus: innervates the lower quadrant of the face (muscles of facial expression) and is an EXCEPTION, corticobulbar fibers innervate the CONTRALATERAL side ONLY

Nuclei and modality of CN VII- Facial

Facial Nucleus --> (BE- Voluntary Motor) Superior Salivatory Nucleus--> (GVE- Visceral Motor) Nucleus Solitarius --> (SVA- taste & GVA- visceral afferent) Main Sensory & Spinal Nucleus of V --> (GSA- Touch & pain)

Long-term: Declarative Memory

Fact- what, where, why Two types: 1- Episodic Memory= memory or life events 2- Semantic Memory= memory of meanings & understanding that do not involve memory of certain event *** Virtually unlimited storage capacity & storage duration

Name 2 factors invovled in the maintenance of oxygen delivery to the fetus?

Factors that keep the increased oxygen needs met include: - increased maternal blood supply to the placenta - PaO2 and PaCO2 of maternal and fetal blood (double bohr and double haldane effect) - presence of fetal cardiovascular shunts - higher hemoglobin concentration in the fetal blood - presence of fetal hemoglobin (HbF)

Types of Aphasia

Fluent? Yes or No No: Do they comprehend? No or Yes - No--> Global Aphasia - Yes--> Brocas Aphaia Yes fluent: Do they comprehend? No or Yes - No--> Wernicke's Aphasia - Yes --> Conduction Aphasia Vascular territories - Superior MCA artery --> Brocas Area - MCA- ACA watershed territory - Inferior MCA territory --> Wernickes Aphasia - MCA-PCA watershed territory Occlussions: - Arcuate Fibers--> Conduction Aphasia - BOTH Superior and Inferior MCA--> Global Aphasia

Ovarian Cycle

Follicular Phase: - folliculogenesis (maturation or growth of ovarian follicles)- follicles secrete estrogen Ovulation: - release of oocyte from the dominant (the most mature) ovarian follicle- occurs around day 14 of a typical 28 day cycle Luteal phase: - formation of the corpus luteum (luteinization) - remnant of the pre-ovulatory dominant follicle- the corpus luteum secretes progesterone - regression and formation of corpus albicans (scar tissue) ** The ovarian cycle coorelates with the menstrual cycle- influenced by gonadotrophins - Follicle stimulating hormone (FSH): stimulates folliculogenesis - Luteinizing hormone (LH): stimulates luteinization (transformation of the mature ovarian follicle into a corpus luteum)

Trigeminal System

For Fine touch, vibration, pressure & proprioception from the face (proprioception is also associated with the mesencephalic nucleus 1st Order Cell Body= Trigeminal Ganglion via Trigeminal Tract to... 2nd Order Cell Body= Principal (Main, Chief) sensory nucleus of V via Trigemino-Thalamic Tract (trigeminal lemniscus) to.. 3rd Order Cell Body= VPM of the thalamus Axons from VPM ascend to somatosensory cortex ---- V Ganglion --> (trigeminal tract)--> principal sensory nucleus of V --.> (trigemino-thalamic tract) --> VPM --> Primary somatosensory cortex (S1)

When we view spinal cord or brainstem sections we will view them in anatomical orientation and not the clinical, therefore:

For sections of brainstem & spinal cord; - Dorsl is at the "top" of the picture - Ventral is at the "bottom" of the picture *** Left side of the section is the right side of the patient

Posterior Cranial Fossa

Formed mainly by temporal and occipital bones - small contributions by sphenoid and parietal bones * houses the cerebellum, pons, and medulla Contains 4 Foramen with structures passing through: - Foramen Magnum: End of brainstem/ start of spinal cord; vertebral arteries; spinal roots of accessory nerve (CNXI); meninges - Internal acoustic meatus: Facial nerve (CNVII), Vestibulocochlear nerve (CNVIII), Labyrinthine artery - Jugular Foramen: Glossopharyngeal Nerve (CNIX), Vagus nerve (CNX), Accessory Nerve (CNXI), Inferior petrosal sinus; sigmoid sinus - Hypoglossal canal: Hypoglossal nerve (CNXII), meningeal branch of ascending pharyngeal artery - Condylar canal: Emissary vein (** emissary veins connect veins outside the cranium to the venous sinuses inside the cranium)

Layers of the Urogenital Triangle

From Deep to Superficial: Deep perineal pouch: - space between pelvic diaphragm and perineal membrane - contents: part of urethra, nerves/vessels**, and external urethral sphincter - in males, also contains bulbourethral glands and the deep transverse perineal muscles Perineal Membrane: - Layer of strong fascia, which is perforated by urethra and vagina - separates superficial and deep pouches - provides attachment for muscls of superficial external genitalia - help supports pelvic viscera ** Superficial Perineal Pouch: - space between perineal membrane and deep perineal fascia (colles' fascia) - contents: erectile tissues** that form the penis and clitoris, three muscles of external genitalia** (ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles), in females the greater vestibular glands (Bartholins glands) Deep Perineal Fascia= Colles Fascia - membraneous fascia covering the superficial perineal muscles Superficial Perineal Fascia: - superficial fatty layer (subcutaneous tissue) - continuos with (Camper's fascia) superficial fascia of abdominal wall Skin

Location of vestibulochochlear system in the skull

From the brainstem it travels through the internal (auditory) acoustic meatus where it enters into the petrous portion of the temporal bone to reach the membranous labyrinth *** Remember it divides into "vestibular" and "cochlear" nerves to innervate the respective structures

Outer Ear

Function: conduct sound waves to tympanic membrane Made up of: - Auricle/Pinna - External Auditory Meatus Cerumen (ear wax): - Mixture of ceruminous and sebaceous gland secretions - Thick and waxy, has hydrophobic and acidic properties Fx: lubricate skin, impede entry of foreign particles, prevents water from entering skin Clinical correlate: Otitis Externa - "swimmers ear" - inflammation of external ear - mild-severe pain - usually caused by bacteria (humidity, excessive moisture, contaminated water)

Mammary Gland

Function: to secrete milk to nourish the newborn - Each mammary gland consists of 15-25 lobes of the compound tubuloalveolar type - Each lobe, separated from the others by dense CT with much adipose tissue, is separated gland with its own lactiferous duct - Each duct emerges independently in the nipple, which has 15-25 pore-like openings **Mammary glands of both genders are identical for the first decade or so of life - when the female reaches puberty, the breasts increase in size as a result of adipocyte accumulation in the CT and increased growth and branching of ducts **After weaning, the alveoli and ducts regress with apoptotic cell death NOTE: - before pregnancy- gland is inactive, with small ducts and only a few small secretory alveoli - alveoli develop and begin to grow early in pregnancy - mid-pregnancy, alveoli have become large and have dilated lumens - at partuition and during the time of lactation, the alveoli are greatly dilated and maximaly active in production of milk components - after weaning, the alveoli and ducts regress with apoptotic cell death Stroma of non-lactating mammary gland is HIGHLY VARIABLE, depends on individual - can have dense, fibrous CT in stroma - or can have predominantly adipose tissue stroma **non-lactating have more stroma than acini and tubules Lactating mammary glands - have minimal stroma ** consists of compound tubule-alveolar glands - alveoli are lined by simple columnar or cuboidal epithelium filled with vacuolated milk secretions Milk secretion is controlled by: 1. Prolactin: stimulates alveolar cell secretion 2. Oxytocin: stimulates contraction of myoepithelial cells that squeeze alveoli and cause milk ejection ** Lactating mammary gland undergoes APOCRINE form of secretion - the apical plasma membrane surrounds fat droplets and buds off - the cell does NOT die, the plasma membrane does NOT lose its integrity

Middle Ear

Function: transform sound waves into mechanical vibrations Consists of: - Tympanic membrane - Ossicles: Malleus, Incus, Stapes - Auditory tube (eustacian tube) ** Middle ear= air filled cavity in petrous temporal bone - lined with mucous membrane - communicates with nasopharynx via Auditory (Eustachian) tube Tympanic Membrane: - semi-transparent - covered externally by thin skin - covered internally by thin mucous membrane - concave- pit (umbo) caused by tip of the malleus Ossicles: - articulate via synovial joints - covered by simple squamous epithelium - cause vibration of oval windoa, tus causing movement of fluid in cochlea Clinical Correlate: Otitis Media - inflammation of middle ear - persistent severe earache - often caused by migration of pathogens or microorganisms from the nasopharynx to middle ear via auditory (eustacian) tube - without treatment --> hearing loss may occur

Suprahyoid & Infrahyoid Muscles

G- Geniohyoid- C1 via CNXII T- Thyrohyoid- C1 O- Omohyoid- Inferior belly: C1-C3 S- Sternothyroid- C1-C3 S- Sternohyoid- C1-C3 Mylohyoid- V3 (nerve to mylohyoid) Stylohyoid- VII Anterior digsatric- V3 (nerve to mylohyoid) Posterior digastric- VII

7 Nerve Fiber Modalities/Types

GSE: (General Somatic Efferent): motor fibers to skeletal, voluntary musculature GSA: (General Somatic Afferent): fibers that carry GENERAL sensation (touch, pressure, pain & temp) GVE (General Visceral Efferent): motor fibers to smooth muscle, glands, viscera GVA (General Visceral Afferent): fibers that carry VISCERAL sensation BE/SVE (Branchial Efferent/Special Visceral Efferent): motor fibers to skeletal, voluntary muscles that developed from branchial (pharyngeal) arches SVA (Special Visceral Afferent): taste & smell SSA (Special Somatic Afferent): vision & hearing

Testing CN IX and X

Gag Reflex - tests the sensory and motor components of CN IX & X - it is a reflex in that it is INVOLUNTARY ** The physician will touch the back of the pharynx and the palate will elevate ** remember that the sensory component (GSA) is carried by CN IX and the motor component (BE) is carried by X

4 Gaps between the 3 Paired Constrictor muscles (Superior, Middle, Inferior) in the Pharynx

Gap 1 (between superior constrictor and base of the skull) contains: - phayngotympanic (eustachian) tube - tensor veli palatini muscle - levator veli palatini muscle Gap 2 (between superior constrictor and middle constrictor) contains: - tonsilar branch of facial artery - stylohyoid ligament - stylopharyngeus muscle - glossopharyngeal nerve - lingual artery Gap 3 (below middle constrictor) contains: - internal laryngeal branch of the superior laryngeal nerve - superior laryngeal artery (from superior thyroid artery) Gap 4 (below inferior constrictor muscle) contains: - recurrent laryngeal nerve (from vagus nerve) - inferior laryngeal artery (inferior thyroid artery)

Clinical imagine with gadolinium (Gd)

Gd does NOT cross the BBB in healthy tissue ** Bright signal indicates BBB permeability and leakage of Gb from blood to tissue (has left vasculature and entered extracellular compartment of the brain)

GSA

General Somatic Afferent - Fibers that carry GENERAL sensation (touch, pressure, pain & temp)

GSE

General Somatic Efferent - motor fibers to skeletal, voluntary musculature

5-alpha-reductase deficiency (5-ARD)

Genetic males (46, XY) with NO 5alpha-reductase= NO DHT - Y chromosome= functional testes= MIS and testosterone secreted --> regression of mullerian ducts & differentiation of Wolffian ducts - NO masculinization of external genitalia, underdeveloped prostate Birth: ambiguous genitalia, appear female Puberty: increased testosteron: male seconadry sex characteristics, virilization of external genitalia "Penis at 12", male pattern pubic hair, voice deepens Presentation: female, primary amenorrhea, no breast development, blind-ended vaginal pouch, normal males levels of testosterone and estradiol, elevated testosterone: DHT ratio

What are the major categories of female sexual dysfunction?

Genito-pelvic pain/penetration disorder: vulvovaginal or pelvic pain, tensing of the pelvic floor muscles or recurrent difficulties with attempted vaginal penetration Secual interest/arousal disorders: absent/reduced interest in: sexual activity, sexual thoughts, initiation of sexual activity, pleasure or arousal in response to sexual cues/during sex Orgasmic Disorders: recurrent pattern of delayes, infrequent or absent orgasm

Seminiferous tubules have complex stratified epithelium aka

Germinal Epithelium that contains two cell types: 1. Sertoli cells (several functions) 2. Spermatogenic cells, from which the germ cells eventually develop ** the stem cells (spermatogonia) are located at the basse of the epithelium - the other cells are arranged in the order of development i.e. spermatogonia, spermatocytes, spermatids, spermatozoa ** this process of differentiation of spermatogonia to spermatozoa is calle spermatogenesis--> it takes usually ~74 days

Carbohydrate intolerance that develops with the onset of pregnancy or is first recognized during pregnancy is termed what? What are the risk factors for this condition? How is this condition diagnosed?

Gestational Diabetes Mellitus (GDM) Risk factors: - History of impaired glucose tolerance - Personal or family history of diabetes or GDM - Pre-pregnancy BMI>30kg/m2 - Maternal age > 25 years - Ethnicity (higher in hispanic-american, african-american, native american etc.) Diagnosed: ** Involves drinking 150ml solution containing 50g of glucose - Blood glucose >140mg/dL (7.8mmol/L) 1 hr post GCT is indicative of GDM and follow up testing with oral glucose tolerance test of GDM diagnosis is recomended OGTT involves drinking a solution containing 100g of glucose and blood glucose levels are measured horuly for 3 hrs ** 2 abnormal values are required and sufficient for diagnosis of GDM - Abnormal blood glucose post OGTT: > 180mg/dL 1 hr post OGTT - > 155mg/dL 2 hr post OGTT - > 140mg/dL 3 hr post OGTT

The principal regulator of gonadotropin secretion is

GnRH - GnRH stimulates secretion of gonadotropins (FSH & LH), which in turn stimulates secretion of ovarian hormones (estrogen, progesterone, inhibin) * Ovarian hormones then act via classical negative (and positive) feedback loops to inhibit (or stimulate) GnRH and gonadotropin secretion - estrogen and progesterone negative feedback on anterior pituitary and hypothalamus - inhibin negative feedback on anterior pituitary Steps: 1. GnRH secreting neurons in the arcuate and preoptic areas of the hypothalamus 2. GnRH secreted into blood (primary capillary plexus of hypophyseal portal system) and travels to anterior pituitary gonadotropes 3. Stimulating release of FSH and LH from anterior pituitary it does this by.... 1. GnRH binds to G-protein coupled receptor (GnRHR) on gonadotropes) 2. Results in activation of PLC 3. PLC hydrolyses PIP2 to form second messengers IP3 and DAG 4. DAG stimulates PKC 5. PKC phosphorylates transcription factors and stimulates LH and FSH gene transcription 6. IP3 stimulates Ca2+ release from ER 7. Ca2+ triggers exocytosis of gonadotropin containing vesicles Following GnRH stimulation of gonadotropes, LH and FSH are released into the circulation & transported UNBOUND to plasma proteins to the ovary - LH and FSH receptors are transmembrane G-protein coupled receptors (Gs GPCR) - LH/FSH binding stimulates transcription of genes involved with 1. follicle growth & development 2. up-regulation in expression of enzymes involved in ovarian steroid hromone biosynthesis (steroidogenesis)- progesterone, androstenedione, testosterone, estrogen 3. synthesis of protein hormones: inhibin

Targets of Anti-Androgen Drugs

GnRH receptors - continuous agonist administration; inhibition via receptor desensitization - competitive antagonists - in pituitary 5alpha-reductase - competitive inhibition Androgen Receptors: - competitive inhibition - target tissue and on hypothalamus and pituitary

A pt with short stature, low hairline, shield sphaped thorax, widely spaced nipples, and brown spots presents to you with karyotype 45XO/46XX and streak gonads- what can they have

Gonadal Dysgenesis- Turners Syndrome - Inheritance pattern: sporadic/spontaneous - X-chromosome mosaicism (45XO/46XX) and X-Chromoome Defects - Ovary "streak gonads": accelerated oocyt loss from week 20 of gestation onwards and through first few postnatal months and years - Number of primordial follicles varies among individual patients Management: - Hormone replacement around 12 yo - Estrogen: sexual developemnt - Progestin: prevent endometrial hyperplasia - Growth hormone: short stature - Androgens: encourage muscle growth

Embryonic origin of the Gonads (testes and ovaries)

Gonads: develop from genital ridges - genital ridges are formed by the condensation of intermediate mesoderm and proliferation of coelomic epithelium ** Coelomic epithelium refers to the epithelium that lines the coelom or body cavity- it forms the outermost layer of the male and femal gonads, thus forming the germinal epithelium of the female or male gonad

As FSH continues to stimulate GCs of antral follicles, to secrete hromone, grow and diffferentiate- this culminates in development of a

Graafian (Dominant) Follicle * this is the follicle that will ovulate As the dominant follicle increases in size, it becomes progressively more differentiated, in terms of structure & function This differentiation is mediated by FSH binding to FSHR on GCs GCs differentiate into 3 distinct subgroups: 1. Outermost mural GCs 2. Cumulus oophorus, which projects from the mural granulosa and surrounds 3. Corona radiata- the cumulus cells which are in contact with the oocyte ** Mural GCs: - cease proliferating - increase FSH receptor (FSHR) - increase aromatase, 17beta-HSD - increase estradiol synthesis - express LH receptor (LHR) - progesterone synthesis ** this occurs immediately prior to ovulation

How are "brain" cells organized in neural tube differentiation?

Gradient between Bone Morphogenic Proteins (BMPS) and Sonic Hedgehog Protein (SHH) dictates the specificity of neuron formation - Bone Morphogenic Proteins (BMPs) arise from the surface ectoderm and are important for ventral/dorsal patterning of the embryo and formation of dorsal (sensory) cell types - Sonic Hedgehog Protein (SHH) is produced by the notochord and is important in induction of the neural plate and formation of ventral (motor) cell types

SHBG has

High affinity binding The binding affinity of SHBG (from highest affinity --> Weakest affinity) DHT> Testosterone > Androstenedione > Estradiol > Esterone ** Steroids bound to SHBG are transported to the liver & metabolized Metabolites are either: 1. Excreted directly in bile 2. Conjugated to glucuronic acid or sulfate, & excreted in urine NOTE: Steroid hormones bound to SHBG are metabolized in the liver to biologically inactive water-soluble derivatives Testosterone metabolites are: - excreted directly into bile for elimination, or - conjugated with glucuronic acid or sulfate and released back into the circulation- from here they are excreted in urine ** Liver is constantly degrading & producing high levels of SHBG, which maintains high serum levels of SHBG in both men and women- SHBG is also produced in much lesser amounts by several other organs, but the majority of SHBG is manufactured and released by the liver NOTE: The levels of SHBG is INCREASED by estrogend and is decreased by testosterone- the plasma level of SHBG in normal men is one third to one hald that in women, and the level is higher than normal in hypogonadal men Clinical correlation: In presence of liver damage (due, for example, to liver disease, chronic alcohol ingestion, cirrhosis), the rate of metabolism of steroids and production of SHBG is decreased

What structure is responsible for deciding what information should be stored as memories?

Hippocampus

Allocortex includes

Hippocampus & Olfactory (piriform) cortex

Most distinctive & visible feature of hyperandrogenism in females is

Hirsutism - excess terminal (thick, pigmented) body hair in a male distribution (upper lip, chin, linea alba, around nippled) - extent or amuont of hirsutism has been correlated to serum androgen concentrations Hyperandrogenemia may be due to: - excess adrenal or ovarian androgen secretion - decreased SHBG= increased bioavailable free T - ingestion or application of anabolic steroids Ex: moderately severe hirsutism in a young woman- associated with development of male body habitus, temporal balding, acne & clitoromegaly Clinical correlation: Pylcystic Ovary Syndrome (PCOS) is the most common endocrine disorder in premenopausal women, with worldwide prevalence of 6-7% - Most PCOS women exhibit biochemical (elevated serum androgen) and clinical (hirsutism, acne, male-pattern hair loss) evidence of hyperandrogenism

Micturition Reflex

How is the reticular formation involved? - Pontine micturition center (PMC), also known as Barringtons nucleus located in the pons - PMC receives input from cortical regions and spinal cord (the PAG acts as a relay between) - In healthy adults, micturition is under voluntary control - In infants, individuals with neurological injury or the elderly, urination may occur as a reflex ** Micturition reflex: internal urethral sphincter remains tense and detrusor muscle relaxed (sympathetic stimulation)- the parasympathetic stimulation causes the detrusor muscle to contract and internal urethral sphincter to relax- the external urethral sphincter is voluntarily relaxed (somatic) Cortical: switch from storage to voiding Brainstem: storage and voiding reflexes

Right-Way and Wrong-Way Eyes

If there is a lesion of the hemisphere that affects the motor cortex and the frontal eye field just rostral to it, you will see that the eyes will look AWAY from the motor deficit and towards the hemisphere lesion- this is called "right-way eyes" ** Right way eyes look TOWARDS the hemisphereic lesion (lesion is NOT in the pons!) - If there is a pontine lesion, which may affect descending voluntary motor fibers and the PPRF, then the eyes look TOWARD that motor deficit and therefore away from the side of the damaged PPRF- this is called "wrong-way" eyes *** Looking AWAY from the side of the damage REMEMBER that the frontal eye fields initiategaze to the opposite side- so if the left frontal eye field is damaged, the eyes will be "STUCK" towards the left-- unable to look to the right

Development of the Female Genital ducts

In absence of the Y chromosome, SRY gene and SRY protein female development is the default - Paramesonephric ducts (R/L) develop; mesonephric ducts regress 3 parts of the developing female genital duct: 1. Cranially it opens into the abdominal cavity 2. Caudally it crosses the mesonephric duct and grows toward the paramesonephric duct on the opposite side ** Part 1 and 2 will become the uterine tubes 3. Caudally, R and L paramesonephric ducts fuse with each other: - the tip of the fused paramesonephric ducts contacts the posterior wall of urogenital sinus and forms a swelling called the sinus tubercle ** Part 3 (R/L), fused with the paramesonephric duct from the opposite side, will become the uterus, cervix, and upper vagina ** NOTE: lower vagina is of different embryological origin *When ducts FUSE in the midline, a broad transverse peritoneal fold called the broad ligament of the uterus is formed- the broad ligament extends from the lateral aspects of the fused paramesonephric ducts to the pelvic walls * The uterus and broad ligament divide the pelvis into 2 pouches (spaces) - Rectouterine pouch of Doglas (uterorectal) between the uterus and the rectum and the - Uterovesical (veicouterine) pouch between the uterus and the bladder

Androgen excess

In children: percocious pubert (<age 9) In adults: anabolic & androgenic effects Causes: Hypothalamic tumors, androgen producing tumors, adrenal hyper-androgenism, anabolic steroids ** NOTE can lead to reduce sperm count and thus infertility Treatment: GnRH agonists, surgical removal of tumor

Testosterone levels & functions vary throughout the male life-cycle

In fetal life: -Increased testosterone for the differentiation of the fetal genitourinary tract, masculinization of the male genitalia & testicular descent Neonate: - Serum LH, FSH, & testosterone are measureable for several months after birth - followed by a reduction in gonadotropin and androgen to very low levels - Mechanism of this period of quiescence of the hypothalamic-pituitary-testicular axis is unknown, but it appears to involve a CNS restraint on the "GnRH pulse generator" At puberty: -Pulsatile secretion of gonadotropins for development of the male genitalia & initiation of spermatogenesis - Sperm starts - Decreased testosterone During adulthood: -Increase in testosterone to maintian secondary sex characteristics, spermatogenesis, muscle mass, bone density, drives male libido During Senesence: >Age 30, declining testosterone and sperm (~1% per yr) adversely affects various aspects of male health (ex. loss of libido, reduced muscle and bones mass) - and increased gonadotropins

Axon Reflex (Flare Response)

In response to injury, signals initiated in the sensory nerve travel antidromically (oppsite to normal direction) on other branches of sensory nerve fibers to reach an effector= blood vessel and mast cell ** Signaling starts in the middle of the sensory axon at the stimulation stie and transmits signals directly to the efector ** There is NO integration center or synapse involed (*NOT a true reflex)- the signal is diverted to the effector without passing back through the CNS ** This axon reflex is thought to promote the spread of vasodilation and inflammation in the region of cutaneous injury Triple Response of the Axon Reflex: 1- Red spot: at site of injury (capillary dilation) 2- Flare: redness around the site of injury 3- Wheal: exudation of fluid from capillaries NOTE: Orthodromic= normal direction

Development of the Ovary

In the ABSENCE of the SRY protein- the ovary forms Formation of the medulla: - in the medullary region, primitive sex cords dissociate into clusters of cells contianing primitive germ cells which are later ** replaced by vascular stroma (see histo of female repro lecture) Formation of the cortex: - In the 7th week, surface epithelium proliferates and gives rise to another set of cords, the cortical cords (as they are located in the cortex) - In the 4-5th month, cortical cords split into clusters of cells that surround primitive germ cells- the surrounding epithelial cells, derived from surface epithelium, develops into follicular cells - the primitive germ cells develop into oogonia- Oogonia (plural for oogonium) are primordial oocytes- Oogonia give rise to primary oocytes by mitosis

Maxillary Artery and Pterygopalatine Fossa

In this fossa, the maxillary artery give off several branches: 1. Sphenopalatine artery (nasopalatine)- to nasal cavity 2. Descending palatine artery (divides into greater and lesser palatine arteries to supply hard and soft palate, respectively) 3. Infraorbital artery (supplies inferior eye muscles, lacrimal sac) 4. Posterior, middle, and anterior superior alveolar arteries (teeth and gingiva) 5. Artery of pterygoid canal 6. Pharyngeal branch ** this is the 3rd part of the maxillary artery- located in the pterygopalatine fossa where it gives off terminal branches

Ideomotor Apraxia

Inability to carry out an imaginary action in response to a verbal command Ex: verbally asked to make an action (ex. to salute a flag, light a match, make a stop signal, blow out a candle) BUT cannot perform the action

Descending Motor Systems From the brainstem

Includes Medial motor system (extra-pyramidal) and Lateral Motor Systems Medial Motor Systems 1- Lateral Vestibulospinal Tract 2- Medial Vestibulospinal Tract 3- Lateral Reticulospinal Tract 4- Medial Reticulospinal Tract 5- Tectospinal Tract *** NOTE: Medial Motor systems control the proximal axial and girdle muscles involved in postural tone, balance, orientation of the head and neck and autonomic gait-related movements- these paths extend ipsilaterally or bilaterally *** unilateral lesions of these tracts produce NO OBVIOUS DEFICITS! ** These tracts are voluntary motor axons; they are just "outside" of the pyramidal system and are therefore a part of the extra-pyramidal ** Even though these above have "lateral" or "medial" in their name, they are ALL a part of the MEDIAL MOTOR SYSTEMS- the "lateral" or "medial" just indicates the anatomical position of the tract Lateral Motor Systems 6- Rubrospinal *** These tracts assist in controlling the extremities

Pulmonary function test that are consistent with normal physiological changes in pregnancy

Increased: - inspiratory capacity - tidal volume (thus increases the minute ventialation, which is responsible for the respiratory alkalosis in pregnancy) - minute ventilation Decreased: - functional residual capcity (reduced to 80% of the non-pregnant volume by term) - residual volume ** These combined changes lead to subjective shortness of breath during pregnancy ** Respiratory rate does NOT change during pregnancy

Sinusitis

Inflammation and swelling of paranasal sinus mucosa - remember the paranasal sinuses are continuous with the nasal cavity so sinusitis and rhinitis can occur together - infections may spread from the nasal cavity to the sinuses - if several sinuses are inflamed it is called Pansinusitis - inflammation usually blocks one or more openings of the sinuses into the meatuses

Rhinitis

Inflammation and swelling of the nasal mucosa - Usually during a severe upper respiratory infection or because of allergies Rhinitis is categorized into 3 types: - Infective rhinitis: acute or chronic bacterial infections - Non-allergic: autonomic, hormonal, drug-induced - Allergic: pollen, mold, animal dander, dust, general allergens

Optic Neuritis

Inflammation of the optic nerve usually seen in patients with multiple sclerosis (MS) - Pts have blurred vision and pain behind the eye - The optic nerve consists of about a million axons that tranmist impulses from the eye to the brain, so even if some axons are lost as a result of demyelination, the pt may not notice any permanent damage to their sight - Since only one eye is usually affected, there can be a difference between the image seen by the normal eye and the affected eye ** In MS, diplopia arises when demyelination results in weakness of the eye muscles --> when pairs of muscles fail to coordinate, the eye fails in conjugate gaze --> usually, the trochlear nerve is affected

Tonsillitis

Inflammation of the tonsils - commonly caused by viral strians that cause the common cold, but can be bacterial ("strep throat") - high fever, sore throat, ear/head aches, swollen lymph nodes Tonsillecotmy: removal of palatine tosils (MOST COMMON) - surgical removal is recommended for hypertrophic (enlarged) tonsils and for patients who have had several infections in a year or past few years *** (seven infections in one year, five in two years, 3 infections/yr within 3 years) The palatine tonsils are highly vascularized with all of the following supplying that tissue: - * Facial artery (dominant artery supply) - Ascending pharyngeal artery (from external carotid artery) - Dorsal lingual artery (from lingual artery) - Lesser palatine artery (from descending palatine from maxillary artery) AT RISK during a tonsillectomy of the palatine tonsil: - Tonsillar branch (glossopharyngeal nerve-CNIX: travels through the lateral wall of the pharynx and carries GSA signals from the palatine tonsil and oropharynx - Internal Carotid artery: courses posterolaterally to palatine tonsil

Neuronal Structure/Function relationship

Information comes into neuron from dendrites through cell body into axon hillock where it may or may not lead to propagating signal- if enough will transmit down axon to terminus and then will have Ca2+ release to dendrites of next neuron of sequence ** Post synaptic membrane is on dendrites of next neuron on the sequence *Pre synaptic neuron has ligand-gated ion channels and or/GPCRS so this is the first target of the NT and if enough signal--> open on sodium channels to cause transmission (voltage-gated Na and K channels- along axon) --> at nerve terminal we have voltage- gated Na, K and Ca Channels to postsynaptic neuron

Inhibin B vs Inhibin A

Inhibin B: - secreted by GCs of small antral follicles - stimulated by FSH acting on GCs - follicular phase of the menstrual cycle - inhibits pituitary FSH synthesis & secretion Inhibin A: - secreted by GLCs cells of the corpus luteum - stimulated by FSH acting on GLCs - luteal phase of the mentral cycle - inhibits pituitary FSH synthesis and secretion

Lesions to primary motor cortex

Initial paralysis and weakness, often due to stroke involving middle cerebral artery or anterior cerebral artery

Autonomic Nerves of the Pelvis

Innervate pelvic cavity structures to control blood flow, hormone levels and body functions NOT under conscious control (INVOLUNTARY) Consist of: 1. Sacral sympathetic trunks= sympathetic nerve fibers to pelvis - when sympathetic trunks (with ganglia) from lumbar region travel down to sacral region they can be referred to as sacral sympathetic trunks - sympathetic nerve fibers to pelvis Function: - contraction of internal genital organs during orgasm - inhibits defecation 2. Pelvic splanchnic nerves (AKA nervi Erigentes)= parasympathetic nerve fibers of pelvis - preganglionic PARASYMPATHETIC fibers from S2,S3,S4 spinal cord levels (**the ONLY splanchnic nerve in body to carry PARASYMPATHETCI fibers) - joins with R and L hypogastric nerves to form the inferior hypogastric plexus - Organs supplied: distal transverse colon, descending and sigmoid colon, rectum, all viscera of the pelvis and perineum Parasympatehtic stimulation: - increases contraction of bladder for urination - peristalsis/contraction of rectum for defecation - stimulates erectile tissue of genitalia to produce erection 3. Superior hypogastric plexus - contains SYMPATHETIC nerve fibers Comprised of: - lower lumbar splanchnic - visceral afferent nerve fibers Descends into pelvis and divides into right and left hypogastric nerves 4. Inferior hypogastric plexus - MIXED autonomic plexus (BOTH sympathetic and parasympathetic innervation *Formed by union of nerves from: - pelvic splanchnic nerves: parasympathetic - hypogastric nerves: sympathetic - sacral splanchnic nerves: sympathetic * Gives rise to many other smaller plexuses to innervate organs involved with urination, defecation, erection, ejaculation, and orgasm

Innervation and function of the Muscles found in the Posterior Triangle of the Neck

Innervated by Accessory Nerve (CNXI): - Sternocleidomastoid: individually, will tilt head toward shoulder on SAME SIDE rotating head to turn face to OPPOSITE SIDE; acting together, draw head forward - Trapezius: assists in rotating the scapular during abduction of humerus above horzontal; upper fibers- elevate, middle fibers- adduct, lower fibers - depress scapula Innervated by Cervical Plexus Dorsal Rami of C3/C4 cervical nerves: - Splenius capitis: together draw head backward; individually draw and rotate head to one side (turn face to same side) C3,C4; and dorsal scapular nerve (C4,C5): - Levator scapulae: elevates the scapula Anterior Rami of C4 to C7: - Anterior Scalene: elevation of rib 1 Anterior Rami of C3 to C7: - Middle Scalene: elevation of rib 1 Anterior Rami of C5 to C7: - Posterior Scalene: elevation of rib 2 ****

Pharynx Muscles (6)

Innervated by CN X (pharyngeal Nerve): - Palatopharyngeus - Middle constrictor - Salpingopharyngeus - Superior constrictor - Stylopharyngeus- IX (Muscular Branch) - Inferior Constrictor- X (Superior Laryngeal Nerve)

Suprahyoid and Infrahyoid Musculature are innervated by

Innervated by Facial Nerve (CN VII): - Stylohyoid: pulls hyoid bone upward and in a posterosuperior direction - Digastric, posterior belly: pulls hyoid upward and back Innervated by Mylohyoid nerve (from inferior alveolar branch of CNV3): - Digastric, anterior belly: opens mouth by lowering mandible; raises hyoid bone - Mylohyoid: support and elevation of flood of mouth; elevation of hyoid Innervated by Fibers from anterior ramus of C1 carried along the hypoglossal nerve- CNXII - Geniohyoid: fixed mandible elevates and pulls hyoid bone forward; fixed hyoid bone pulls mandible downward and inward - Thyrohyoid: depresses hyoid bone, but when hyoid bone is fixed raises larynx Innervated by Anterior rami of C1-C3 through the ansa cervicalis: - Omohyoid: depresses and fixes hyoid bone - Sternohyoid: depresses hyoid bone after swallowing - Sternothyroid: draws larynx (thyroid cartilage) downard Suprahyoid muscles: - stylohyoid - digastric, posterior belly - digastric, anterior belly - mylohyoid - geniohyoid Infrahyoid muscles: - thyrohyoid - omohyoid - sternohyoid - sternothyroid

Extraocular Eye Muscle Movements

Innervated by Oculomotor Nerve (CN III): - Superior rectus: elevates, adducts, rotates eyeball medially (intorsion) - Inferior rectus: depresses, adducts, and rotates eyeball laterally (extorsion) - Medial rectus: adducts eyeball - Inferior oblique: ABducts, elevates and laterally rotates eyeball (extorsion) - Levator Palpebrae Superioris: Elevates superior eyelid (deep layer, the superior tarsal muscle, is innervated by sympathetic fibers) Innervated by Abducens (CNVI): - Lateral Rectus: ABducts eyeball Innervated by Trochlear (CNIV): - Superior Oblique: ABducts, depresses and medially rotates eyeball (intorsion)

Inputs and Outputs of Striatum

Input: Cerebral cortex, Substantia Nigra, Thalamus Output: Globus pallidus (GPi and GPe), Substantia Nigra (SNr and SNc) ** Output: INHIBITORY

Input and outputs of the SUbthalamic nucleus

Input: GPe (globus pallidus externa), cortex Output: GPe, GPi (Globus Pallidus interna), SNr (substantia nigra pars reticulata) ** Output: EXCITATORY**

Input and outpus of SNr (Substantia nigra pars reticulata)

Input: Striatum, subthalamic nuclei, GPe Output: Thalamus ** Output: INHIBITORY

Major inputs and outputs to the basal ganglia

Inputs to basal ganglia: cerebral cortex to Putamen and Caudate nucleus and Subthalamic nucleus Outputs from basal ganglia: Globus palidus interna and substantia nigra pars reticulata are main outputs of basal ganglia (to thalamus, which then projects back to the cortex) ** thalamus receives inhibitory inputs from basal ganglia (globus pallidus and substantia nigra pars reticulata) which would dampen the activating/excitatory response of thalamus on cerebral cortex NOTE: If there is LESS going on in the basal ganglia--> less inhibition to the thalamus--> more excitation to cortex can do more of what it wants to do

Basal Ganglia Connectivity

Inputs: - Striatum - Subthalamic Nuclei (STN) Outputs: - Substantia nigra pars reticulata (SNr) - Globus pallidus interna (GPi) 2 Maint pathways: Direct Pathway: Cortex--> Striatum--> GPi --> Thalamus --> Cortex - Cortex excites striatum, striatum can do what it wants to do, which is INHIBIT GPi - GPI then no longer inhibits the thalamus, so the thalamus is "dis-inhibited" and more excitation can go to the cortex ** In direct pathway-> thalamus is DISinhibited and there is MORE EXCITATION to the cortex Indirect Pathway: Cortex--> Striatum--> GPe--> STN--> GPi--> Thalamus--> Cortex - Cortex excites the striatum, striatum can do what it wants to do, which is inhibit GPe - GPe can now no longer inhibit STN, so STN is "disinhibited", and free to do what it wants --> which is excite the GPi and SNr - Both GPi and SNr are excited to do their job, which is to INHIBIT the thalamus, so the thalamus sends LESS excitation (little to none) to the cortex - In the indirect pathway the thalamus is INHIBITED --> little/NO excitation to the cortex

Intelligence testing (IQ)

Intelligence: novel problem-solving and reasoning abilities; a persons estimated "potential" to learn **** Wechsler Tests most widely known - Also have Stanford-Binet 5 and Nonverbal intelligence (wechsler nonverbal abilitis; TONI-3; Leiter) - assesses cognitive potential - determing cognitive and neurological functioning or changes in the context of various medical hisotry (i.e. brain injury, developmental delay etc) - brain injury: capacity, decision-making - educational and vocational decision (.i.e. ADHC, learing disability, intellectual disability)

Commissural Fibers

Interconnect homologous (same) areas of TWO hemispheres ** Axons of cells from layers I, II, III make up commissural fibers 1. Corpus Callosum (largest) 3 Parts: - genu connects anterior frontal lobes - body connects posterior frontal lobes, all of the parietal lobes and superior temporal lobes - splenium connects the occipital lobes 2. Anterior Commissure - connects the olfactory nuclei, amygdalas, and anterior temporal lobes 3. Posterior Commissure - connects pretectal nuclei important for the pupillary light reflex

It is important to note that the pelvic cavity contains the organs of reproduction, urinary bladder, part of GI tract, rectum and several muscles- What is the MAIN blood supply to pelvic organs and structures of the perineum?

Internal Iliac Artery (via its branches) NOTE: Additional arteries also enter the pelvic cavity: - superior rectal artery (branches from inferior mesenteric artery) - ovarian artery (branches directly from abdominal aorta) (** Note: testicular artery is not included bc it travels within the inguinal canal) TIP: best way to indentify internal iliac artery branches is to see where they are going, especially with branches supplying pelvic organs

All venous drainage from pelvis and perineum travels through the

Internal Iliac Vein - the veins have similar names as their artery counterparts - Internal iliac vein will merge with the external iliac vein to form the common iliac vein - R and L common iliac veins join to form the inferior vena cava (IVC)

Major Veins of the Neck

Internal jugular veins: - drain blood from the brain and cranial vault - retromandibular and facial veins are contributors - drains to the brachiocephalic veins External jugular veins: - drain blood from occipital, cervical, scapular, and anterior jugular veins into the subclavin veins Retromandibular vein: - Fromed by joining of superficial temporal and maxillary veins Divides into 2 branches: 1. Anterior branch drains into internal jugular vein 2. Posterior branch contributes to formation of the external jugular vein *** Remember that the subclavian and brachiocephalic veins ultimately drain into superior vena cava Thyroid Veins: - drain into the brachicephalic vein (inferior thyroid) and internal jugular vein (superior and middle thyroid) Anterior Jugular vein: - Begins near the hyoid bone where several superficial veins of the submental traingle join - Descends in the midline and the anterior border of the sternocleidomastoid muscle

What is pain?

Internation Assoc. For study of pain (IASP)-1994: "an unpleasant sensory and emotional experience associated with actual or potential tissue damge, or described in terms of such damge. "whatevere the experiencing person says it is, existing whenevere and wherever the person says it does"- McCaffery, RN 1- Pain is always SUBJECTIVE 2- Pain is always unpleasant and is thereofre and emotional experience 3- Pain can be reported in the absence of tissue damage or any patho-physiological caused "Phantom Limb pain--> amputees can still feel pain" ** Pain scale rated from 1-10 (10 worst pain possible)

Sleep Apnea

Interruption of breathing while sleeping - Periodic decline of oxygen content in the blood 2 types - Obstructive: something obstructing- like excess pharyngeal tissue - Central: something wrong in brainstem (this causes a pause in the diaphragm)

Muscles of the Penis

Ischiocarvernosus muscle - insert into the corpus cavernosum/the crus of the penis - innervated by pudendal nerve - maitains errection of the penis by compressing the crus and the deep dorsal vein of the penis, thereby reducing venous return Bulbospongiosus muscle - inserts into the corpus spongiosum - innervated by pudendal nerve - compress the bulb in the male, impeding venous return from the penis and thereby maintaining erection - contraction will also constrict the corpus spongiosum to help expel the last drops of urine or the semen ejaculate

Testosterone Physiological and Pharmacological efffects

Its effects are due to: - direct binding to the androgen receptor - conversion of testosterone in some tissues to dihydrotestosterone, which also binds to androgen receptor - conversion of testosterone to estradiol, which binds to the estrogen receptor Has effects on - external genitalia - hari follicles - internal genitalia - skeletal muscle - erythropoiesis -bone - libido

NMDA receptor antagonist for chronic pain

Ketamine MOA: - Non-competitive inhibitory of NMDA receptors Therapeutic use: - Neuropathic pain: used at sub-anesthetic doses - Anesthesia ** Also a known drug of abuse NOTE: use-dependent channel blocking antagonists like ketamine (also the following work on the same: PCP, methadone, memantine, dextromethorphan, amantadine)

Obturator Nerve

L2, L3, L4 - supplies motor and sensory innervation to medial thigh - travels along the LATERAL pelvic wall through the obturator canal (along with the obturator artery/vein) and exits pelvis to get to MEDIAL this region - obturator nerve travels near ovary in female pelvis Clinical Significance: - Obturator nerve is at risk of injury during an oophorectomy (surgical removal of an ovary) or by compression from ovarian cyst

Sacral Plexus

L4-S4 - formed by lumbosacral trunk (L4,L5) and ventral rami of S1-S4 nerves - travels down along posterior pelvic wall and lies anterior to piriformis muscle - its branches provide innervation to perineum and lower limbs

According to the Pederson hypothesis, what is the principal cause of LGA infants

LGA (large for gestational age) - Pederson hypothesis describes how maternal hyperglycemia causes fetal hyperglycemia and this can lead to complication of fetal growth and development - Glucose can readily cross the placenta, while maternal insulin does not cross the placenta - During pregnancy, fetal blood glucose is 80% of maternal value Maternal hyperglycemia --> fetal hyperglycemia --> hyperplasia of fetal pancreatic beta-cells--> fetal insulin hypersecretion--> fetal fat deposition --> macrosomia (LFG)

Two cell & two gonadotropins are required for luteal hormone synthesis also

LH works on both the theca-lutein cells and granulosa-lutein cells FSH also works on the granulosa-lutein cells ** The physiological mechanism by which the corpus luteum produce progesterone and estrogen requires 2 cells and 2 gonadotropins - Delivery of LH to theca-lutein cells (TLCs) timulates synthesis and secretion of androstenedione (mainly) and (some) testosterone - Androgens diffuse into granulosa-lutein cells (GLCs) where they are aromatized to estrogens (estradiol (mainly) and (some) estrone) under direction of FSH - Delivery of LH to GLCs stimulates synthesis and secretion of progesterone ** this is the steroid biosynthesis pathway of the corpus luteum in the luteal phase of the menstrual cycle and the primary source of progesterone and estrogen during this stage

Albumin binds testosterone with

LOW affinity and "delivers" testosterone to tissues throughout the body Testosterone bound to Albumin (A): - low binding affinity - dissociates readily throughout the body - testosterone is available for target tissues ** Recall that steroids pass easily through the cell membrane and therefore require a binding protein for transport - the mechanism that transports testosterone throughout the body is the Albumin-Testosterone Complex

Innervation of the Lacrimal Gland (GVE axons)

Lacrimal gland recieves both parasympathetic (production of fluid) and sympathetic (reduction in secretion) innervation Parasympathetic path: Facial nerve (CNVII) --> greater petrosal nerve (CNVII) --> nerve of pterygoid canal --> pterygopalatine ganglion (synapse) --> zygomatic branch of maxillary nerve (CNV2) --> lacrimal nerve (CNV1) to lacrimal gland Sympathetic path: Superior cervical ganglion (origin of post-ganglionic axons in spinal cord) --> axons travel on internal carotid plexus --> Deep petrosal nerve --> nerve of pterygoid canal --> fibers pass through pterygopalatine ganglion --> zygomatic nerve (CNV2) --> lacrimal nerve (CNV1) to lacrimal gland

What effect does breastfeeding have on gonadotropin release?

Lactation inhibits cyclic ovulatory function Suckling --> decreased dopamine --> Increased PRL --> decreased GnRH pulse --> decreased FSH and LH = Anovulation and lacctational amenorrhea ** Pregnancy protection (98% effective) ONLY with ALL of the following: - less than 6 months postpartum - breastfeeding exclusively (no other food or liquid being supplied to the infant - amenorrhea ** If these conditions are NOT met, the risk of unintended pregnancy while breastfeeding is high. Additional contraceptives are recommended 3 months after delivary if another pregnancy is undesired

Spinal Cord Gray Matter

Lamina I: mostly "nociceptive-specific" neurons.. some "wide-dynamic range" neurons that can respond to both noxious and non-noxious stimuli Lamina II: almost exclusively of interneurons (nociceptive & wide-dynamic range)- C-fibers synapse here *****Almost exclusively interneurons and C fibers synapse here Lamina III & IV: A-beta fibers for non-noxious stimuli Lamina V: primarily WDR neurons- A-beta, A-delta, and C-fibers ALL project to these neurons and fibers *** receives projections from A-beta, A-delta, C-fibers and fibers from visceral structures

What are some Grey mater structures/lamina found in the Dorsal Horn?

Lamina I= Nucleus Posteromarginalis (marginal nucleus)- at all levels--> mostly "nociceptive-specific" neurons Lamina II= Substantia gelatinosa (all levels) --> almost exclusively interneurons "helpers can be excitatory/inhibitory" Lamina III, IV, and V: Nucleus proprius (proper sensory nucleus)- at all levels --> mostly nonoxious stimuli, however, lamina V is wide dynamic range and the spinothalamic system may use these lamina

Right and Left Hemispheres are Specialized for Different functions

Language and mathematical ability is lateralized in (dominant) hemisphere - Left in 95% of right handed people - also Left in 70% of left handed people ** Muscical skills, facial recognition and spatial comprehension are lateralized in right hemisphere NOTE: there is a case of a girl who lived with half a cortex

Kluver-Bucy Syndrome

Large bilateral amygdaloid lesions produce the Kluver-Bucy syndrome - Wild, aggressive animal (cats/monkeys) become placid, display hyper- and inappropriate sexuality... many times attempting to mate with others of the same sex or with inanimate objects - Will also place various objects in their mouths and reject them based on taste.. unable to associate stimuli with rewards - Visual "agnosia"- inability to recognize objects- this occurs although the visual system may not be affected nor is there any significant memory loss

Total Layrngectomy

Laryngectomy: removal of the larynx - A total laryngectomy is a surgical option for patients with advanced stage laryngeal cancer - Apprx. 3,000 patients in the US have undergone this surgery - Pt ends up breathing thorugh a stoma (permanent hole) that opens directly on the anterior aspect of the neck - A total laryngectomy has dramatic consequences for the pt, mainly through loss of speech ** Total laryngectomy is defined as the removal of the larynx and complete separation of the airway from the mouth, nose and esophagus Electrolarynx= a device that creates vibration that is carried into the mouth to create speech Tracheoesophageal Voic Prosthesis (TEP) is powered by continuous airflow from the trachea to the esophagus

Prefrontal Cortex

Last brain region to develop, the "new" part of the brain, larger in humans and may relate to intelligence, self-awareness, consciousness of perception & experience Working Memory: - a type of short-term memory - limited in capacity and storage duration - items are held in a "buffer" until a goal is reached Executive functions: - operates in problem solving, planning, goal setting, weighing outcomes (positive vs. negative), making judgment , reasoning, motivation, decision-making, responsibility, social control, willpower, rule-learning - Interconnected with brain regions involved with emotion (amygdala, arousal systems, attention) - there may be reduced volume, or connectivity dysfunctions, in individuals with psychological disorders such as depression, sociopathes, schizophrenics, ADHD Case: Phineas Cage "No longer Cage" after his incident in 1848 (was profain, irresponsible, lost his job- all bc of an injury on railroad that injured his pre-frontal cortex/made him lose his excecutive function

What are the 2 Olfactor tracts?

Lateral Olfactory Stria: to primary olfactory (piriform) cortex Medial Olfactory Stria: bilaterally to limbic/forebrain structures Basic Concept: - Some neurons are responsive to a SINGLE odorant - Some neurons are activated by MULTIPLE odorants - Perception of an odor can change with concentration - Using this combinatorial manner to detect odorants, as humans, with only ~400 genes coding for olfactory receptors, can distinguish and form memories of more than 10,000 different smells!

Development of the Cerebellum from the Metencephalon

Lateral aspects of the alar plate in the rostral metencephalon thicken to form rhomic lips During the third and fourth months these lips continue to enlarge to form the cerebellum At 5 months, deep fissures develop in the cerebellar surface, and both midline (vermis) and lateral (hemisphere) zones are apparent

What are the 3 extracapsular ligaments that stabiilized/ support the Temporomandibular Joint (TMJ)?

Lateral ligament: prevents POSTERIOR dislocation of the joint Sphenomandibular ligament: limits movement of mandible INFERIORLY - is "slack" when joint is closed Stylomandibular ligament: Limits excessive opening of the mandible

6 layers of the Neocortex of the Cerebral Cortex have different inputs and outputs

Layer I is most superficial and layer VI is deep - Layers I-III: receive inputs from cortex and outputs to other areas of the cortex (association or commissural fibers) - do NOT project outside of the cortex - Layer IV: receives inputs from the thalamus - Layer V: outputs to the striatum, brainstem and spinal cord - Layer VI: outputs to the thalamus

Linking Brain and Behavior

Left hemisphere: language Right hemisphere: visual-spatial Frontal: executive functioning, planning, problem-solving, set-shifting, judgement, abstract reasoning, expressive language, control of voluntary activity Temporal: memory, auditory processing Parietal: sensation/perception, linguistic skills (anomia, agaraphia, alexia, dyscalculia), spatial awareness Occipital: vision, awareness of movement

Damage to Medial Lemniscus on the Right will lead to loss of touch on the

Left side - So an infarct affecting midbrain/medial lamniscus--> loss of ability to discriminate touch, pressure, vibration on the left Lesion to crossing fiber in the Caudal medial would lead to loss of touch info from BOTH sides (remember that the cross in this pathway occurs after 2nd order in Nucleus gracilis or Nucleus Cuneatus and these live in the Caudal Medulla Lesion of Nucleus Gracilis on R -> loss of touch to lower limb T7 & below from the RIGHT because the axons do NOT cross till after 2nd order neuron Now if you have break in posterior spinal artery- affect the dorsal aspect that blows out the fasciculus gracilis--> loss of touch, pressure, vibration from lower limb T7 and below from left side Loss of fasciculus cuneatus- would lead to loss of touch from T7 and above

Contralateral Homonymous Hemianopia

Lesion or disrution of the: - Optic Tract - Lateral Geniculate Nucleus - One side of the primary visual cortex (lesion or tumor) ** NOTE: the same side of the visual field is LOST in each eye, CONTRALATERAL to the lesion = "Contralateral homonymous hemianopia"

Gerstmann's Syndrome

Lesion strongly localized to the dominant inferior parietal lobule, in region of angular gyrus Tetrad of Symptoms: 1. Agraphia (impaired ability to write) 2. Acalculia (impaired arithmetic calculating ability) 3. Right-left disorientation (difficulty identifying the right vs left side of the body 4. Finger agnosia (inability to name or identify individual fingers)

Internuclear Ophthalmolplegia

Lesion to the Medial Longitudinal Fasciculus (MLF) - Input to oculomotor nucleus is disrupted for conjugate gaze- eye ipsilateral to the lesion does NOT adduct on attempted conjugate horizontal gaze - NO coordination of medial and lateral recti muscles ** Convergence is intact! Inputs to the oculomotor nucleus mediating convergence DO NOT travel in the MLF

Trigeminal System Pain & temp from the face

Levels of 1st order cell body? Trigeminal ganglion in pons Where do fibers cross the neuroaxis? Caudal Medulla Deficits? - Lesion in Descending tract of V (spinal trigeminal tract) or Spinal Nucleus of V results in IPSILATERAL deficits in Pain and temp from the face, teeth, anterior 2/3 tongue and palate, etc. (ALL structures from the trigeminal peripheral nerve maps that have GSA axons from them!) - Lesion of the Trigemino-thalamic tract (trigeminal lemniscus) results in CONTRALATERAL DEFICITS

Ligaments of Pelvic Girdle

Ligaments= Bone to Bone - Iliolumbar - Sacrospinous ligament - Sacrotuberous ligament - Anterior sacroiliac ligament - Posterior sacroiliac ligament * Strong ligaments support and strengthen pelvic girdle joints - During pregnancy, hormones (progesterone, estrogen and relaxin) cause relaxation of pubic symphysis and pelvic ligaments facilitating passage of the fetus through the pelvis

How does the pupillary light reflex work?

Light activates retinal ganglion cells - Axons of those cells are within the optic nerve- the signal travels trhoguh the nerve to the optic tract, bilaterally, to synapse on nuclei of the pretectal area - The signal then travels along axons bilaterally to the Edinger-Westphal Nuclei (GVE) (pre-ganglionic parasympathetic fibers) - Signal travels along axons from the Edinger-Westphal on the oculomotor nerves to the ciliary ganglion where they synapse - Post-ganglionic fibers travel to the pupillary constrictor muscles to constrict the pupil NOTE: - Damage to Optic nerve--> NO direct or consensual response - Damage to Oculomotor Nerve--> NO direct respons in affected eye but there would be consensual response in unaffected eye - Damage to Edinger-Westphal Nucleus (GVE)--> NO reflex whatsoever

How does pupillary light reflex work?

Light activates the retinal ganglion cell s - Axons of those cells are within the optic nerve- the signal travels though the nerve to the optic tract, bilaterally, to synapse on nuclei of the pretectal area - The signal then travels along axons bilaterally to the Edinger-Westphal nuclei (pre-ganglionic parasympathetic fibers) - The signal travels along axons from the Edinger-Westphal on the oculomotor nerves to the ciliary ganglion where they synapse - Post-ganglionic fibers travel to the pupillary constrictor muscles to constrict the pupil Lesion sites: Damage to one Optic nerve: - Direct & consensual reflexes are lost if light is shone in the "damaged" eye: there are NO signals reaching the brainstem via that optic nerve so neither response will occur - Direct & consensual reflexes are intact if the light is shone in the normal eye: the optic nerve is normal so signals will reach the brainstem causing constriction of both pupils via the synaptic pathway and output on the oculomotor nerves ** CN II lesion --> loss of direct pupillary light reflex Damage to one Oculomotor nerve: Ex: Left oculomotor nerve damaged - When light is shone in the left eye, the direct reflex is lost, BUT there will be a consensual response in the right eye --> the left optic nerve is ok and the right oculomotor nerve is ok - When light is shone in the right eye, the direct reflex is intact, BUT the consensual reflex is lost: the right optic nerve and right oculomotor nerve are ok. The right optic nerve can signal to the nuclei in the brainstem, but the signal is NOT carried on the damaged oculomotr nerve, consensual papillary constriction is lost ** CN III lesion --> loss of consensual pupillary light reflex

Which position is optimal for veiwing of the Perineum?

Lithotomy Position - position of the body for medical examination, pelvic surgery, abdominal surgery, or childbirth - pt lies on the back with the hipd and knees flexed and the legs spread and raised above the hips often with the use of stirrups - allows physician to get closer accessibility to perineal region for procedures

Drugs to treat Nocioceptive and Neuropathic Pain

Local Anesthetics: - Lidocaine - Capsaicin

Lidocaine

Local anesthetic for neuropathic and nociceptive pain MOA: - blocks voltage-gated Na+ channels responsible for neuronal signal propagation Administration: - cream or injection Pharmacological effects: - local anesthetic at site of application ** unionized to cross cell membrane, ionized inside to block channel Therapeutic use: - local anesthesia, nerve block, epidural - BOTH** nociceptive and neuropathic pain - (also used to treat ventricular tachycardia)

Capsaicin

Local anesthetic for nociceptive and neuropathic pain MOA: - agonist at TRPV1 receptors (sense heat- they desensitize but have initial pain sensation) Administration: - cream or liquid (topically) Pharmacological effects: - activates sensory neurons continuously leading to a desensitization of the sensory axons and depletion of substance P Therapeutic use: - **nociceptive and neuropathic pain - muscle/joint pain - diabetic peripheral neuropathy, postherpetic neuralgia

Remember that the "big brain" provides inhibitory control on the

Lower Motor Neurons through the corticospinal tract! If those fibers are disrupted, the lower motor neurons are "hyper" - In decorticate, Rubrospinal AND "MR LV" are hyper (not being inhibited/monitored) so there is flexion AND extension - In decerebrate, damage occurs AT or BELOW the red nucleus, so rubrospinal tract IS NOT working and the "MR LV" is NOT being inhibited so there are ACTIVE, so upper limbs are extended and lower limbs are extended NOTE: if a pt first exhibits decorticate rigidity and slowly progresses to decerebrate- it is evident that the injury is progressing caudally- and this is bad news in that it is moving closer to the pons/medulla and could compromise cardiovascular and respiratory centers and be fatal! Remember: Decorticate= arms flexed, lower limbs extended Decerebrate= arms extended, lower limbs extended NOTE: all three tracts (rubrospinal, medial reticulospinal and lateral vestibulospinal are involved in BOTH posturings)

What is the typical duration between the onset of the luteal phase of the menstrual cycle and the onset of menses? What regulates this timing?

Luteal phase correlates with secretory phase of uterine cycle (days 15-28) after the ovulation of an oocyte - characterized by a structure that will support implantation of a zygote (if fertilization of the mature oocyte has taken place) - If fertilization does NOT occur, menstruation occurs 14 days after ovulation, marking beginning of the next menstrual cycle - Menstrual phase is days 1-5 - Day 1 of the menstrual cycle is marked by the day on which bleeding begins - The length of the menstrual phase varies for all women an avg 2-5 days - Proliferative phase follows menstruation (days 6-14) - this is characterized by regrowth (proliferation) of the endometrial layer which was lost during menstruation. ** Progression of these phases is controlled by hormones produced by endocrinec cells in the ovaries- which are controlled by hormones produced by the pituitary, which in turn is controlled by hypothalamic hormones Menstrual phase: estrogen high, FSH high Proliferative phase: estrogen high Secretory phase: high LH, spike in FSH, increased progesterone

Gonadotropins

Luteinizing Hormone (LH) Follicle Stimulating hormone (FSH) Human menopausal gonadotropins (hMG) Human chorionic gonadotropin (hCG)

Gonadotropins

Luteinizing Hormone and Follicle Stimulation Hormone - Until recently, only available as biological products, recovered from human urine - Human chorionic gonadotropic (hCG); from pregnant women- LH-like - Human Menopausal gonadotropins (hMG); purified from urine of post-menopausal women- contains LH and FSH - recombinant (synthesized in a laboratory) LH and FSH are now available- they are quite expensive

Thyroid and Parathyroid glands- Lymphatics

Lymph drains to - prelayngeal nodes - pretracheal nodes - paratraceal nodes THEN into - superior deep cervical nodes OR - inferior deep cervical nodes ***Remember! All of the lymph will ultimately drain into the deep cervical nodes, then the jugular lymphatic trunks, and finally to the thoracic duct on the left or the lymphatic duct on the right

Lymphatic Drainage of the Palate

Lymph from the palate drains into the deep cervical lymph nodes - ALL of the lymph will ultimately drain into the jugular lymphatic trunks, and finally to the thoracic duct on the left or the lymphatic duct on the right

Head & Neack Lymphatic Drainage

Lymph nodes of the head and neck can be divided into two groups: Superficial and Deep Superficial Lymph Nodes: - Recieve lymph from scalp, face, and neck - Arranged in a ring-shape, extending from underneath the chin to the posterior aspect of the head - Include groups such as the occipital, mastoid, pre-auricular, parotid, submental, facial, and superficial cervical groups Deep lymph Nodes: - Recieve all lymph from the head and neck - Organized in a vertical chain located within close proximity to the internal jugular vein in the carotid sheath - Can be divided into superior and inferior deep cervical lymph nodes - Include pretracheal, paratracheal, prelaryngeal, retrophrayngeal, infrahyoid, and supraclavicular groups ** Remember all of the lymph will ultimately drain into the deep cervical nodes, then the jugular lymphatic trunks, and finally to join the thoracic duct on the left at the subclavian vein or the lymphatic duct on the right

Finasteride

MOA: Competive inhibition of Type II 5alpha-reductase--> results in decreased conversion of testosterone to dihydrotestosterone (suppression of serum DHT levels- prostate volume decreases) Clinical uses: - Androgenetic alopecia (male pattern hair loss) - BENIGN prostatic hyperplasia Adverse Effects: - impotence, gynecomastia (more infrequent when compared to GnRH agonists and androgen receptor inhibitors) ** go away when stop taking the drugs

Why is psychological assessment useful?

Medical: brain injury, neurological disorders, degenerative disorders, dementia, disease and treatment effects (ex. brain tumors, leukemia, cancers), congenital disorders, chronic pain, treatment, etc Difficulting with mood, relationships, and overall functioning Determine comborditiy Children: problems with behavior, mood, development, or academics Legal: determining capacity, guardianship, power of attorney Aptitidue and placement/ career decisions

Major Landmarks on the Dorsal Aspect of the Brainstem

Midbrain - pineal gland/body - lateral geniculate body (visual) - medial geniculate body (auditory) - R/L superior colliculus (visual) - R/L inferior colliculus (auditory) Pons - Superior Cerebellar Peduncle - Middle Cerebellar Peduncle - Inferior Cerebellar Peduncle - Facial Colliculus (floor of 4th ventricle) Medulla Oblongata - Gracile Tubercle - Cuneate Tubercle

Lips

Mobile musculofibrous folds surrounding the mouth - lips are covered externally by skin and there is a transitional zone that continues into the oral cavity and is continuous with the mucous membrane - function as valves of the oral fissure and are used for grasping food, sucking liquids, keeping food out of the vestibule, and assist in forming/producing speech ** remember that there are several muscles of facial expression that can act on the oral fissure/lips

Emotional State in a mental status examination

Mood (described feeling) -ex. REPORTS feeling depressed (low, hopeless, suicidal) or manic (high, euphoric, irritable) Affect (visible feeling) - ex. SHOWS decreased (blunted, restricted, or flat) external expression of mood Congruence ex. described mood and visible affect ar dissimilar Appropriateness ex: laughing while telling a sad story

Function of Association Areas

Most developed part of the cerebral cortex - necessary for perceptual activities, like recognizing objects - integrates meaning, rather than just idenitfying simple characteristics

Occipitofrontalis Muscle

Moves the scalp, wrinkles the forehead, and raises the eyebrows ** it is attached to the aponeurotic layer of the SCALP Innervation: Front belly: temporal branches of the facial nerve (CN VII) Posterior belly: posterior auricular branch of the facial nerve (CNVII)

Amyotrophic Lateral Sclerosis- ALS (Lou Gehrig Disease)

Motor neuron disease in which BOTH upper motor neurons and lower motor neurons** degenerate in cortex, brainstem & spinal cord - occurs in both familial (10% of cases) and sporadic forms) - unsure of the cause, possible superoxide dismutase (familial) or Ubiquillin2 protein, that is related to repair or disposal of other proteins as they become damaged - In ALS patients, the protein is unable to remove or repair damaged proteins and the proteins begin to pile up in the cells, eventually blocking normal transmission of brain signals in the spinal cord and brain leading to paralysis ** Initial compliant is weakness in a limb (limb onset) ** Disease usually begins in one limb, psreads to that opposite limb and then may take over other muscle regions Clinical Features: 1- Combination of weakness & atrophy of limb muscles, cramping and fasciculations and general hyperflexia 2- Flaccid paralysis at the level of the lesion, spastic paralysis below the level of the lesion 3- Pts also have problems with swallowing (dysphagia), speaking (dysarthria) and breathing 4- "Touch", smell, taste, vision, and hearing are NOT affected in this disease ** LMN freaking out --> spastic below UMN degeneration ** Flaccid @ level of LMN degeneration --> wont work @ all ** eventually get Nucleus Ambiguss- larynx, pharynx, palate (breathing centers shut down)

Nuclei and Modality of CN V- Trigeminal

Motor nucleus of V --> (BE- voluntary motor) Main sensory nucleus of V --> (GSA- touch from face) Spinal nucleus of V--> (GSA- pain from face) Mesecephalic Nucleus --> (GSA- proprioception)

Buccinator Muscle

Muscle of the cheek that presses our cheek against our teeth - it is a muscle of facial expression

Pelvic Floor and Pelvic Wall

Muscles line the floor and walls of the pelvic cavity - Pelvic floor supports the pelvic viscera and is formed by the pelvic diaphragm Muscles of the Pelvic Wall: - Piriformis (covers posterior wall of the pelvis) - Obturator internus (covers the lateral walls) Muscles of the Pelvic Floor (Pelvic Diaphragm): - Levator ani (puborectalis+ pubococcygeus+ iliococcygeus) - Coccygeus

Pharynx

Musculofascial half-cylinder that extends from the base of the skull to ther C6 Vertebral level - Composed of 3 paired longitudinal muscles and 3 paired constrictor muscles - It is continuous inferiorly with the esophagus and anteriorly with the nasal cavity, oral cavity and larynx

Global Aphasia

Mute or NON-fluent - Comprehension: Poor to absent ** No fluency, No Comprehension ** Damage to Broca and Wernickes area --> occlusion of both superior and inferior MCA

2 Muscles that make up the FLOOR of the oral cavity and cheek

Mylohyoid I: Nerve to mylohyoid (branch of the inferior alveolar branch of CNV3) Function: supports and elevates floor of oral cavity; depresses mandible when hyoid is fixed; elevates and pulls hyoid forward when mandible is fixed Geniohyoid I: C1 Function: Elevates and pulls hyoid bone forward; depresses mandible when hyoid is fixed

Myotatic (deep tendon, stretch, knee-jerk) Reflex

Myotatic Reflex= Stretch Reflex, deep tendon reflex or knee-jerk reflex ** From the Greek "myo"= muscle and "tatic"= stretch ** It is a muscle stretch reflex in response to passive stretching due to stimulation of muscle proprioceptors ** In this reflex, contraction of a muscle occurs in response to a sudden stretch induce by a sharp tap by a rubber hammer on the tendon of insertion of the muscle Deep tendon reflex occurs in the following steps: 1. Sense organ (muscle spindle) 2. Ia sensory neuron (afferent, axon) 3. Alpha motor neuron (efferent) 4. Effector (extrafusal muscle fibers) ** Dont forget about Reciprocal Innervation (inhibition) in the Myotatic Reflex

Can Somone Swallow their Tongue?

NOPE! ** the tonuge has a muscular floor that holds it in place - when someone is unconscious or having a seizure, it is imporatnt to open the airway- the tongue may fall back or there may be another obstruction, but the tongue is NOT "swallowed"

Hypothalamic nuclei are ___ homogenous

NOT homogenous! Ex: Paraventricular Nucleus (PVN) 1- Neuroendocrine cells, from medial to lateral: a) parvicellular cells secretin SS: somatostatin TRH: thyrotropin releasing hormone CRH: corticotropin releasing hormone b) magnocellular cells producing oxytocin and vasopressin AKA ADH 2- Descending pathways: dorsal, lateral and ventral

Paleocerebellar (AKA spinocerebellum), Pontocerebellar and Vestibulocerebellar Systems are

NOT isolated from one another- there is considerable overlap, reflecting the action of the cerebellum in coordinating motor centers - there are other connections (tectospinal system & cranial nerve nuclei III & V) but the specifics are NOT well understood In any event: - ALL systems are necessary for the cerebellum to effectively and simultaneously coordinate all descending motor ouputs

Frontal lobe syndromes

NOTE there is NO single frontal lobe syndrome Apparently Contradictory Behavior Seen in Frontal Lobe Syndromes - Apathetic indifference vs. Explosive emoitonal lability - Abulia vs. Environmental dependency - Akinesia vs. Distractibility - Persevertation vs. Impersistence - Mutism vs. Confabulation - Depression vs. Mania - Hyposexuality vs. Hypersexuality

Lumbar puncture/spinal tap

Needle pierces the skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (contains the internal vertebral venous plexus) dura, arachnoid, and finally the subarachnoid space, where CSF is dran from the lumbar cistern ** Adult: L3/L4 or L4/L5 ** Child: L4/L5

Injury to nerves/Axons

Nerve degeneration: : - Anterograde degeneration (sometimes referred to as Wallerian degeneration) means that the segment of the nerve DISTAL to the injury site degenerates - Retrograde degeneration means that the nerve PROXIMAL to the injury site degenerates - Most degeneration occurs as a Wallerian degeneration, with a small amount of retrograde degeneration *** Nerve regeneration: In general, axonal tracts in the CNS do NOT regenerate well following injury - this is in part because of the inhibitory proteins expressed by oligodendrocytes In PNS, nerves CAN regenerate ** - regrowing nerve fibers appear to regrow into channels made by schwann cells which can guide these fibers to their respective targets

Neurovasculature of the Hard Palate

Nerves are branches of CNV2 - Nasopalatine nerves (emerge from the incisvie foramen) - Greater palatine nerve and artery (artery arises from descending palatine from maxillary artery- part 3, through the greater palatine foramen) - Lesser palatine nerve and artery (artery arises from descending palatine from maxillary artery-part 3, through the LESSER palatine foramen) NOTE: The ascending palatine artery (from facial artery) and palatine branch of ascending pharyngeal artery (from external carotid) will also contribute to the soft palate

The axons of neurons in the PNS form

Nerves! Many of these nerves form interconnected plexii, such as the: - cervical plexus - brachial plexus - lumbar plexus - sacral plexus

Alzheimers Disease

Neuronal degeneration in Alzheimers Disease preferentially affects the hippocampal foramtion, temporal cortex and basal forebrain - Individual typically have greater deficits in semantic aspects of declarative memory compared to episodic declarative memories *** In research: grew human brain cells in a gel, where they formed networks as in an actual brain- they gave the nuerons genes for Alzheimers disease- within weeks they saw the hard Brillo-like clumps known as plaques and then the twisted sphaghetti-liks coils known as tangles-- the defining features of Alzheimers disease

Therapeutic Use of Carbamazepine and Gapapentin

Neuropathic pain for both! Carmazepine: - Neuropathic pain: trigeminal or glossopharyngeal neuralgia - Epilepsy, bipolar disorder Gabapentin: - Neuropathic pain: postherpetic neuralgia - Epilepsy

Neuropsychological testing

Neuropsychology is a subset or specialty of psychology * Examines brain-behavior relationships: - cognitive and behavioral functioning: identifying strengths and weakness Often works with pts in medical settins - useful in diagnostic clarification (i.e. differential diagnoses, medical vs behavioraly presentations - involves knowledge of neuroanatomy, cognition, and behavior Tests: - attention - executive functioning - processing speed/visual- motor skills - visual-spatial skills - language - memory - adaptive functioning - mood/behavior Neuropsychology in Medical setting: * Pts often have co-occuring psychosocial dificulties, especially those with chronic medical conditions - impact of a known nuerological disease/injury - determine localization of impairments - track progress over time (i.e. treatment, brain injury rehabilitation) - clarify diadnoese that have been medically ruled out (i.e. neurological injury vs psychiatric diagnoses) - informs treatment planning: surgery, return to work/school - monitior drug treatment/therapy (i.e. oncology treatments, brain tumor, hydrocephalus, epilepsy, sickle cell disease, stroke) - dementias: types, medication vs progress - alcohol and drugs (i.e. Korsakoff with alcohol, THC- marijuana

Neurotransmission step 2. Neurotransmitter synthesis

Neurotransmitters can be: A. Amino Acids Glutamine --Glutaminase--> Glutamate Glutamate--GAD--> GABA* (inhibitory) B. Acetylcholine Acetyl-CoA + Choline --Choline acetyltransferase* --> ACh C. Serotonin Tryptophan** (a dietary AA**) --tryptophan hydroxylase--> 5-hydroxytryptophan --5-hydroxytryptophan decarboxylase --> 5-hydroxytryptamine (5-HT= serotonin) D. Catecholamines Tyrosine ** (dietary AA) --tyrosine hydroxylase --> Dihydroxyphanylalanine (DOPA) --AA decarboxylase--> Dopamine* --Dopamine beta-hydroxylase --> NE* --- phenylethanolamine-N-methyltransferase --> Epinephrine (hormone from adrenal glands primarily- little use as NT in brain) *** L-DOPA (aka L-dopa and levodopa) is a precursor for dopamina synthesis and is used in treatment of Parkinsons* Disease, a disease in which dopamine levels are reduced (parkinsons is due to loss of dopamine in the brain) - cant use dopamine directly bc doesnt cross blood brain barrier

What decreases the resistance in arteries leading to the sinuses of the penis?

Nitric oxide is the vasodilator that is normally released, causing vasodilation in these arteries Ex of thing that would increases resistance to blood flow in the penile arteries: - stimulation of the sympathetic nerves innervating the arteries - inhibition of activity of the parasympathetic nerves leading to the arteries

What fetal precursor is necessary for placental progesterone synthesis?

None The placenta lacks the ability to manufacture cholesterol- Cholesterol is provided from the maternal side and is converted by the placenta to pregenolone and progesterone

Mesoderm can give rise to

Notochord - nucleus pulposus of intervertebral discs * Somites (derived from paraxial mesoderm) 1. sclerotome: vertebrae and ribs 2. dermatome: dermis of dorsal body region (skin innervation) 3. myotome: trunk and limb musculature Intermediate mesoderm - kidneys - gonads * Lateral Plate Mesoderm I. Somatic Mesoderm - parietal serosa - dermis of ventral body region - CT of limbs (bones, joints, and ligaments) II. Splanchnic Mesoderm - wall of digestive respiratory tracts (except epithelial lining) - visceral serosa - heart - blood vessels

Nuclei and modality of CN IX- Glossopharyngeal

Nucleus Solitarius --> (SVA- taste & GVA- visceral afferent) Nucleus Ambiguus--> (BE- voluntary motor) Inferior Salivatory Nucleus --> (GVE- visceral motor) Main Sensory & Spinal Nucleus of V --> (GSA- Touch & pain)

There are four pharyngeal clefts associated with pharyngeal arch formation, but only ___ contributes to the adult structure

ONE! - The dorsal part of the 1st cleft will penetrate the underlying mesenchyme and give rise to the external auditory meatus - the epithelium at the bottom of the meatus assists in formation of the eardrum ** The 2nd cleft grows over the 3rd and 4th clefts and then merges with the epicardial ridge, forms the cervical sinus, but eventually disappears

Uterine oxytocin receptor (OTR) number reaches a maximum in phase 2 of parturition. True or False.

OT receptor number increases 200-to-300 fold during pregnancy, reaching a MAXIMUM during early labor - Circulating OT does NOT increase until FULL cervical dilation *** Phase 3- Stage 1 is Cervical Effacement and Dilation (from the onset of labor to full cervical dilation at 10 cm) Phase 2 is "Activation"- characterized by ripening of the cervic and increased expression of CAPs

Which conjugate is the important one to determine if the head of the fetus can pass through pelvic cavity during birth?

Obstetric Conjugate ** Obstetric conjugate= diagonal conjugate minus 1.5 to 2cm - obstetric conjugate diameters should be 11cm or greater ** remember vaginal examination is used to determine the diagonal conjugate

Corneal (blink) Reflexes

Occur whenever there is a stimulus that disrupts the cornea- usually occurs from "something in ones eye" such as dirt, particles, or another foreign substance - also occurs in the presence of bright light- think about walking out into the sunshine from a movie theater-- your eyes automatically will "squint" ** Remember that general sensory afferents from the cornea are carried on the long ciliary nerves (branches of the nasociliary nerve) of the ophthalmic division of the trigeminal nerve- the efferent action is controlled by the facial nerve, particularly orbicularis oculi, which causes contraction of the mucsle fibers around the eye ** In the case of bright light, the optic nerve (CN II) is the afferent pathway NOTE: a cotton wisp can be used to test the corneal reflex

Sleepwalking (somnambulism)

Occurs during NON-REM sleep - unusual autonomic and/or motor responses (repeated episodes of walking at night difficult to wake) - More common in children than adults Treatment: resolve waking anxiety and getting pt to sleep earlier

Forgetting is Normal

Older Memories are no longer able to be recalled from storage.. usually a gradual process Forgetting occurs bc: - the event was never consolidated in the first place - inability to retrieve memory.. the necessary cues are not there - interference from other memories.. most likely new memories - damage to the brain (i.e. Alzheimers, aging) *** you can cease forgetting by.. repetition! LTP Factors that do impact learning and memory: - nutritional states - level of stress - temperature - blood oxygenation - sufficient sleep is essential for optimal mental performance

Pelvic Fractures

Open Book Pelvic Fractures: - describes any fracture that significantly disrupts the pelvic ring - unstable fractures **will see diastasis of the pubic symphysis and widening of both sacroiliac joints (right is greater than left) Malgaigne Fractures: - 2 ipsilateral pelvic ring fractures which are vertically oriented (anterior to acetabulum or posterior to the acetabulum) - usually involves the posterior ilium - unstable fractures

Medial Vestibulospinal tract

Origin: Medial, inferior, lateral vestibular nuclei of the medulla Decussation: BILATERAL- cross in the medulla Termination: Cervical spinal cord lamina VII-IX (5-9) Function: Maintains posture of the head and neck- NOTE that it terminates in cervical spinal cord levels

Rubrospinal Tracts

Origin: Red Nucleus Decussation: Midbrain, projects contralaterally Termination: Cervical spinal cord in lamina VI-VIII Function: - Facilitates motor neurons that innervate proximal flexor musculature - Functionally parallel to the lateral corticospinal tract, assists this tract - In humans, it is small and its clinical importance is uncertain, but it may participate in taking over function after corticospinal injury

Specific Relay Nuclei

Optic tract --> Lateral geniculate nucleus (LGN) --> primary visual cortex (area 17)- for vision Brachium of inferior colliculus--> medial geniculate nucleus (MGN)--> primary auditory cortex (areas 41,42)- for hearing Medial lemniscus & spinothalamic tract --> vetral posterolateral (VPL) --> primary somatosensory cortex (3,1,2)- for pain, temperature, touch, proprioception (body) Trigeminothalamic tracts and solitary nucleus --> Ventral posteromedial (VPM)--> primary somatosensory cortex (3,1,2) --> pain tmeperature, touch, proprioception (face) and taste Dentate nucleus, substantia nigra, globus pallidus--> ventral lateral nuclei --> primary motor cortex (4) and premotor cortex (6)- for movement Globus pallidus, substantia nigra --> ventral anterior (VA) nuclei --> primary motor cortex (4) and premotor cortex (6) - for movement Mamillothalamic tract --> anterior nuclei --> cingulate gyrus- for emotiona nd memory (limbic) Subdivisions of visual cortex --> lateral dorsal (LD) acts in concert with the anterior nucleus --> parietal cortex - emotion and memory (limbic)

Estrogen Routes of Administration

Oral: ethinyl estradiol and mestranol Transdermal: patch, gel, spray and emulsion Vaginal: cream and ring ***Parenteral routes (avoids first-pass metabolism) of administration can cause 17beta-estradiol (estrogen secreted by the ovary) bc first-pass metabolism is avoided Clinical Uses: - Systemic estrogen therapy should always be combined with a progestin in women with an intact uterus, addition of a progestin reduces the risk of endometrial cancer**** - Hormone replacement therapy in menopausal women: reduces menopausal sxs such as hot flashes and vaginal atrophy, for women who have had a hysterectomy, estrogen only therapy is recommended (avoid the side effects of progestins), low dose vaginal, estrogen only therapy is recommended for woemn who only have urogenital symptoms (vaginal atrophy) - Hormone replacement in ovarian failure (premature or oophorectomy) - Horomone replacement in hypogonadism: administer estrogen and progestin combination to produce sexual maturation and optimal growth (treatment usually starts at 11-13 yrs old), monitor timing, dosage and bone maturation to prevent premature epiphyseal closure (could cause shorter stature than they normally would have) - Contraception Adverse effects: - Endometrial hyperplasia could lead to carcinoma (addition of progestin removes/reduces this risk) - Estrogen can cause proliferation of breat tissue and subsequently breast cancer- addition of a progestin does NOT convey a protective effect- the risk factor is low but may still be significant bc of the high prevalenece of breast cancer in women - postmenopausal uterine bleeding - increase in frequency of migraine headaches - cholestasis and gall bladder disease - hypertension - thromboembolism - nausea - breast tenderness - peripheral edema

Muscles of facial expression in the orbital region

Orbicularis Oculi: - I: CN VII- BE axons Fx: - Palpebral part: closes the eyelid gently - Orbital part: closes the eyelid forcefully Corrugator Supercilii - I: CN VII- BE axons Fx: Draws the eyelids medially and downwards

Cognition in Mental Assessment/ Mental Status exam

Orientation - person, place, time, situation Ex: does not know name or where home is, where they are right now, year, date time, what is going on Memory - immediate, recent, remote Ex: cannot remmber 3 words when questioned after 5 minutes, activities that occured during the last 12 hrs (rule out confabulation- filling in memory gaps with fals information), cannot reember where she was born (remote) Attention And concentration*** know difference from memory: Ex: cannot pay attention to you without being distracted by other stimuli, cannot repeat a string of 3-6 numbers forward to backward (digit span) or spell word backwards like "world" Cognition: - verbeal, spatial, abstraction ability Ex. cannot read a simply paragraph of tect, copy a simple drawing, describe how a pear and appler are aline or meaning of a proverb "people who live in glass houses should not throw stones" ** can also be affect by sensory/motor- ex hemiparesis in hand bc motor problem Speech: - volume, speed, articulation, language Ex. speeks too softly, pressured, not readily understandable, uses word poorly or has poor vocabulary

Corticobulbar Tract

Origin: - Primary motor cortex, frontal eye fiels, primary somatosensory cortex- from somatotopically organized regions for the "head" Termination: - Cranial nerve motor nuclei Location in internal capsule: - Genu Decussation: BILATERAL innervation with CONTRALATERAL DOMINANCE *** Exceptions are CN VII (upper face, CN XI and CNXII) - VII to lower face: contralateral ONLY - XI: ipsilateral - XII: contralateral ONLY

Lateral Reticulospinal tract

Origin: Reticular formation in the medulla Decussation: Bilateral, partial cross in medulla Termination: All levels of spinal cord in lamina VII-IX (5-9) Function: - INHIBITORY effect on voluntary motor and reflex responses of axial and limb muscles - DECREASE muscle tone by inhibiting muscle spindle activity

Medial Reticulospinal Tract

Origin: Reticular formation in the pons Decussation: NONE, bilateral Termination: All levels of spinal cord (predominantly cervical) in lamina VII-IX Function: - Facilitates voluntary movements - Increases muscle tone (act on gamma motor neurons)

Tectospinal tracts

Origin: Superior colliculus (visual system) Decussation: Midbrain, projects contralaterally Termination: Cervical spinal cord in lamina VI-VIII Function: - tract coordinates head, neck, and eye movements, primarily in response to visual stimuli

Monoamines- Histamine: Systems of the CNS

Origin: Tuberomammillary nucleus of the hypothalamus; projects widely Functions: sleep-wake cycle, arousal ** Antihistamine medications used to treat allergies are thought to cause drowsiness by blocking CNS histamine receptors

Lateral Vestibulospinal Tract

Origin: lateral vestibular nucleus of the medulla Decussation: NONE, ipsilateral only Termination: ALL levels of spinal cord (predominantly lumbar) in lamina VII-IX Function: May inhibit some flexor motor neurons, but mainly provides excitatory influence on spinal motor neurons innervating extensors to maintain posture (Ex. extensors in the legs) Ex. Cross-extensor reflex (other leg extends to keep you balanced)

Monoamines: Dopamine: Systems of the CNS

Originates in substantia nigra pars compacta and ventral tegmental area - Mesostriatal (nigrostriatal)-- damaged in Parkinsons Disease - Mesolimbic- involved in "positive" symptoms of Schizophrenia and Drug addiction - Mesocortical- involved in cognitive deficits and hypokinesia in Parkinsons disease and "negative" symptoms of Schizophrenia - Neuroendocrine- involved in tonic inhibitory regulatin of anterior pituitary prolactin secretion, pituitary tumors (prolactinoma)

Monoamines: Noradrenaline/Norepinephrine Systems of the CNS

Originates in the locus coeruleus and lateral tegmental area- project to entire forebrain - Functions in attention, sleep-wake cycles, mood and sympathetic activities ** Attention-deficit disorders (ADHD) are often treated with medications that enhance noradrenergic pathways - Norepinephrine and Serotonin are important in mood disorders such as depression and manic-depressive disorder, and in anxiety disorders including obsessive-compulsive disorder

Monoamines: Serotonin: Systems of the CNS

Originates in the raphe nuclei: rostral raphe nuclei project to entire forebrain; caudal raphe nuclei projects to cerebellum, medulla, and spinal cord - Disruptions in serotonin may be involved in depression, anxiety, Obsessive- compulsive disorder (OCD), aggressive behavior & some eating disorders - Cadual raphe functions in pain modulation with the periaqueductal grey (PAG)

Fetal Hb has a lower p50 than adult Hb. what is the primary consequence of this difference?

P50 of HbF is lower (18-20 mmHg) than HbA (26.6mmHg) - this means HbF has a higher oxygen-binding affinity and at any given PO2 HbF will bind to more O2 than HbA (ex. HbA is 50% saturated with oxygen at a PO2 of 26.6mmHg, while HbF is 82% saturated with oxygen at the same PO2) ** The higher P50 of HbA is due to the right shift that occurs in the presence of high levels of 2,3-BPG in red blood cells - 2,3 BPG binds to the beta-chains of HbA disrupting O2 binding - HbF does NOT have beta-chains and gamma-chains interact less efficiently with 2,3-BPG *** thus the oxygen saturation curve for HbF is left shifted in comparison to the oxygen saturation curve for HbA

Describe the mechanism of action of Viagra in the treatment of ED

PDE5 usually acts to breakdown cGMP to terminate the erection signaling mechanism ** Sildenafil (Viagra) inhibits PDE5, increasing cGMP in smooth muscle and enhancing erectile function

Which prostaglandins stimulate cervical ripening and dilation?

PGE2 stimulates ripening via EP2 and EP4

Which vertebral branch supplies much of the inferior surface of the cerebellar hemispheres?

PICA ( Posterior Inferior Cerebellar Artery) It also supplies - the lateral medulla and choroid plexus of the 4th ventricle

Which hormone is primarily responsible for galactopoeisis?

PRL is the primary hromone responsible for maintain milk production once it has started (galactopoeisis)

Referred Pain

Pain arising from deep visceral structures is felt on the surface of the body - Ex: ischemia brough on by a MI is felt as pain in the left arm, neck, shoulder, and back, rather than in the chest ** this happens bc the same dorsal horn neuron in lamina V receives afferent signals from visceral nociceptors as well as cutaneous nociceptors --> Result: higher brain centers incorrectly ascribe the pain stimuli to the skin instead of the deeper visceral structure

Dysmenorrhea

Painful menstrual periods - very common complaint of menstruating females and has a prevalence as high as 90% - it is caused by increase production of endometrial prostaglandins- resulting in increased uterine tone and strong contraction **Prostaglanding synthesis inhibitors (ex. NSAIDs) are useful for relief of symptoms of dysmenorrhea

Pap smear and cancer of the Cervix

Papanicolaou (PAP) test is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix - It is perfomed by opening the vaginal canal with a speculum, then collecting cells at the outer opening of the cervix at the TRANSFOMATION ZONE (where the outer squamous cervical cells meet their inner glandular endocervical cells) ** Test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) and cervical dysplasia) ** The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer

Oculomotor Nerve Palsy

Paralysis of Superior Rectus, Inferior Rectus, Medial Rectus, Inferior Oblique & Levator Palpebrae Superioris Common Causes: - Diabetic neuropathy, aneurysm, trauma - Increased intracranial pressure - Cavernous sinus pathologies ** Eye is in a "DOWN AND OUT" positions at rest.. why? Bc which two muscls are funcitoning? - lateral rectus: ABducts the eye - superior oblique: ABducts, depresses and medially rotates the eye --> SO eye takes on a "DOWN AND OUT" position ** Pupil is dilated and unresponsive.. Why? bc parasympathetic fibers for constriction of the pupil are traveling on the oculomotor nerve-- so, disruption of those fibers causes the pupil to slightly DILATE ** Paralysis of Levator Palpebrae superioris (innervated by CNIII) will cause the eye to be closed (complete ptosis)

Abducens Nerve Palsy

Paralysis of the Lateral Rectus muscle ** Damage produces a loss of abduction in the affected eye, or an esotropia, along with horizontal diplopia ** CN VI can be affected by issues (tumor, aneurysm, mass) in the cavernous sinus or increased intracranial pressure-- can also affect CN III and CN IV Ex: Inability to abduct when looking to the right-- right eye is affected - looking to the right is normal- right eye is able to adduct but NOT abduct

Trochlear Nerve Palsy

Paralysis of the Superior Oblique Muscle * Damage produces a vertical diplopia & hypertropia- eyes are "UP AND IN" and can have an abnormal extorsion (due to unopposed inferior oblique muscles)-- diplopia is due to this extorsion ** CN IV is the most commonly injured nerve in trauma bc it is small and thin and travels from the dorsal aspect of the brainstem-- also caused by aneurysms & lesions in the midbrain ** Hypertropia and Extorsion in the affected eye - Superior Oblique is the ONLY muscle depressing the eye when looking inward - Patients are at risk of injury when walking down stairs ** Pts will tilt their head away from the affected eye to relieve the diplopia caused by the extorsion and tuck their chin in to alleviate the hypertropia *BUT, may pts then complain of neck pain from the odd positioning SO NOTE: - Head tilt AWAY from affected eye corrects the extorsion - Looking UPWARD slightly (CHIN TUCK) corrects the hypertropia

Trochlear Nerve Palsy

Paralysis of the Superior Oblique muscle ** Damage produces a verticle diplopia & hypertropia- eyes are "up and in" and can have an abnormal extorsion (due to unopposed inferior oblique muscle)--> diplopia is due to extorsion **CN IV is the most commonly injured nerve in trauma bc it is small and thin and travels from the dorsa aspect of the brainstem-- also caused by aneurysms & lesions in the mibrain Superior obliwue is the only muscle depressing the eye when looking inward ** Pts are at risk of injury when walking down stairs ** Pts wil tilt their head away from the affected eye to relieve the diplopia caused by the extorsion and tuck their chin in to alleviate the hypertopia --> BUT may pts than complain of neck pain from the odd positioning

Abducens Nerve Palsy

Paralysis of the lateral rectus muscle - Damage produces a loss of abduction in the affected eye, or an esotropia, along with horizontal diplopia CN VI can be affected by issues (tumor, aneurysm, mass) in the cavernous sinus or increased intracranial pressure- can also affect CN III and CN IV Pts will present with - Esotropia in the affected eye Ex: If right eye affected: inability to abduct when looking to the right (right eye able to adduct, but not abduct so looking to the left would be normal) and vice versa

Facial Nerve Injury (Bells Palsy)

Paralysis to facial muscles on affected side (entire one half of the face) * lesion to a lower motor neuron would affect the R side and lead to a R side bells palsy (i.e. lower motor neuron always affect SAME side- R. facial nucleus- innervates R muscles of facial expression ** 5 branches of Facial nerve= To Zanzibar By Motor Car - temporal - zygomatic - buccal - marginal mandibular - cervical

Conjugate Horizontal Eye Movements

Paramedian Pontine Reticular Formation (PPRF) - refion of the reticular formation which is important for horizontal conjugate gaze- the left and right eyes moving in the same horizontal direction (right or left) during changes in posture or head movements *** this was covered in visual system lectures, rememeber that PPRF is part of the reticular formation

Innervation of the Submandibular and Sublingual Gland

Parasympathetic (GVE axons): Facial Nerve (CNVII) --> Chorda Tympani Nerve (CNVII) --> Lingual Nerve (CNV3) --> Submandibular ganglion (Synapse)--> Lingual nerve (CNV3) to glands Sympathetic (GVE axons): Superior Cervical Ganglion--> axons travel with the internal carotid plexus and facial artery --> glands ** NOTE: - All glands ABOVE the oral fissure are innervated with the greater petrosal nerve of VII - All glands BELOW the oral fissure are innervated by Chorda Tympani of VII

Innervation of the Sphincter Pupillae (intrinsic muscle of the eye)

Parasympathetic Innervation: Oculomotor nerve (CNIII): preganglionic axons (GVE fibers) from the brainstem travel to the ciliary ganglion (synapse) and postganglionic axons travel to the sphincter pupillae via short ciliary nerves that arise from the ciliary ganglion *** constricts pupil (reduces its size)

Hypothalamic Nuclei and function

Paraventricular and supraoptic nuclei - regulate water balance - produce ADH and oxytocin - destruction causes diabetes insipidus - paraventricular nucleus projects to autonomic nuclei or brain stem and spinal cord Anterior nucleus - thermal regulation (dissipation of heat) - stimulates parasympathetic NS - destruction results in hyperthermia Preoptic area - contains sexual dimorphic nucleus - regulates release of gonadotropic hormones Suprachiasmatic nucleus - receives input from retina - controls circadian rhythms Dorsomedial nucleus: - stimulation results in obesity and savage bahvior Posterior nucleus - thermal regulation (conservation of heat) - destruction results in inability to thermoregulate - stimulates the sympathetic NS Lateral nucleus - stimulation induces eating - destruction results in starvaton Mamillary body: - receives input from hippocampal formation via fornix - projects to anterior nulceus of thalamus - contains hemorrhagic lesions in Wernickes encephalopathy Ventromedial nucleus: - satiety center - destruction results in obesity and savage behavior Arcuate nucleus - produces hypothalamic releasing factors - contains DOPA-ergic neurons that inhibit prolactin release

Spinomesencephalic Tract

Pathway mediating pain suppression Neurons in Lamina V of spinal cord activate PAG neurons via the Spinomesencephalic Tract - PAG neurons are usually inhibitory on Nucleus Raphe Magnus (NRM neurons) - However, when PAG neurons are activated, they STOP the inhibitory input to the NRM and the NRM neurons are ACTIVATED (dis-inhibited) NRM neurons (serotonergic) project to lamina II excite enkephalinergic interneuons in the spinal cord--> these bind to receptors on C and A-delta fibers and inhibit the release of substance P and activation of the second-order neurons that projects to the VPL of the thalamus, thus reducing further activity in afferent pain fibers & other nociceptive spinal cord neurons Gate Control Theory of Pain: - Some laminae of the spinal cord NOT oly receive input from nociceptive fibers (a-delta/c-fibers) but from non-nociceptive fibers (a-beta) as well - Large diamete non-nociceptive A-beta fibers going trhough the same gate can inhibit the transmission of the smaller nerves carrying the pain signal through an inhibitory interneuron ** Gate can be shut by stimulating nerves responsicle for carrying the touch signal which enables the relief of pain through massage techniques or rubbing..whats the first thing you do when you hit your thumb with a hammer? Rub It? (this non-noceciptive from Abeta fiber helps to inhibit pain for a bit)

Uterus

Pear-shaped organ, 3 parts: - Fundus: part of the uterus above the level of the uterine tubes - Body: part of uterus from the level of the uterine tube to the level of the isthmus of the uterus - Cervix: part of the uterus below the level of the isthmus of the uterus (this part opens into the vagina) 3 layers of the uterine wall: 1. Endometrium - inner mucosa layer lined by simple columnar epithelium 2. Myometrium: - middle thick layer of highly vascularized smooth muscle 3. Perimetirum: - outer serous layer (or visceral peritoneum covering the uterus) - consists only of mesothelium and a thin layer of loose CT ** each month the uterine wall undergoes cyclic changes in preparation for embryo implantation

Contralateral Homonymous Hemianopia with Macular Sparing

Phenomenon associated with vascular disturbances to ONE occipital lobe bc of the posterior cerebral artery occlusion/accident - visual information from the fovea goes to the occipital pole of the primary visual cortex - it is thought that, due to anastomoses, the occipital pole can be supplied by the middle cerebral artery or other vessels LEADING TO: - contralateral homonymous hemianopia with macular sparing - contralateral superior/inferior quadrantopia with macular sparing **NOTE: without blood--> neurons will die bc not getting nutreient--> areas can be sparred with the help of middle cerebral artery (macular sparing)

Rods and Cones

Photoreceptors Both rods and cones are neurons whose apical portions, known as outer segments, are specialized dendrites - these outer segments are surrounded by retinal pigmented epithelium (RPE), which provides nutrients and metabolic support - the other end of the rods and cones form synapses with the underlying cells of the bipolar layer Rods: - specialized receptors for DIM light - perceive ONLY light Cones: - specialized receptors for BRIGHT light reception, they also perceive COLOR 3 Types of cones: - each cone expresses one of the 3 possible types of pigment: Red, Green, or Blue (each a different gene product) In each eye: ~100-120 million rods ~6 million cones (less cones than rods)

Vestibulocerebellum

Phylogenetic Classification: Archicerebellum Anatomical Classification: Flocculonodular Lobe Connections/Functions: - Main input is from semicircular canals, vestibular nuclei, visual system - Balance, equilibrium, eye movements- motor execution (medial motor system) Deficit Symptoms: - Truncal, stance and gait ataxia - Vertigo - Nystagmus - Vomiting

Spinocerebellum

Phylogenetic Classification: Paleocerebellum Anatomical Classification: Anterior lobe, parts of the vermis; posterior lobe, medial parts Connections/Functions: - Main input is the spinocerebellar tracts - Adjusts ongoing movements & regulates muscle tone- motor excecution (lateral motor systems) Deficit Symptoms: - Ataxia, chiefly affecting the lower limb - Oculomotor dysfunction - Speech disorder (asynergy of speech muscles)

Blood-brain barrer (BBB)

Physical and Metabolic barrier Physical barrier: - very low rate of passive diffusion - tight junctions between adjacent endothelial cells - basement membrane, pericytes, astrocyte psudopods Metabolic barrier: - BBB endothelial cells are enriched in enzymes that degrade circulating molecules (neurotransmitters, cytokines, etc.) Selective permeability: - BBB endothelial cells are enriched in transporters (influx and efflux) - Ex. multi-drug resistance proteins, p-glycoproteins, organic anion transporters (OATs), glucose transporter

Retina (internal layer of the eye)

Pigmented layer - pigmented epithelial cells - absorbs extraneous light - provides VitA for photoreceptor cells Neural layer - photoreceptors, bipolar neurons, ganglion cells and supporting Muller cells - detects incoming light rays; light rays are converted to nerve signals and transmitted to the brain

Function of the Pineal Gland

Pineal gland is an endocrine gland involved in seasonal and sleep-wake cycles in mammals - melatonin release from pinealocytes is: promoted by darkness (sleep promoting) and inhibited by light ** the variation in blood melatonin levels causes changes in the hypothalamus, pituitary gland, and other endocrine organs that influence the circadian rhythms of functions and behaviors For example, melatonin has antigonadotropic effects in many species.. more darkness= less gonadal function (seasonal cycles) ** experiments singled out one receptor, MT1, as the mechanism via which melatonin acts to inhibit the specific orexin neurons that wake you up- this discovery could help lead to medications that target only the MT1 receptor instead of multiple receptors, which could lead to fewer side effects for those who take sleep-promoting drugs

Kallmanns Syndrome

Presents with - primary amenorrhea with anosmia - hypogonadotropic hypogonadism secondary to absent GnRH --> decreased LH/FSH --> decreased estrogen - anosmia or hypsomia - gonads are completely normal - infantile sexual development - low gonadotropins - NORMAL femal karyotype - variable inheritance patterns Absence of: - olfactory bulbs - straight gyrus (gyrus rectus) - medial orbital gyrus Treatment: Estrogen/progesterone replacemnt Conception desired: ovulaiton induction

Prader-Willi Syndrome

Presents with HYPOTONIA in infancy (even prenatal) - includes difficulty feeding - developmental delay from day 1 - Intellectually: mild disability (on top of that- learning disability, poor academic performance) - HYPOGONADISM, frequent CRYPTOORCHIDISM in males, underdeveloped clitoris in females - HYPOPIGMENTATION in 30-50% of patients - growth hormone deficiency is frequent - appetitie increases in mild childhood often with inability to feel full--> results in morbid obesity and type 2 Diabeted unless parental control - Behavior: temper tantrums, stubbornness, controlling, and manipulative behavior, compulsivity, and difficulty with change - Incidence 1/10,000 *** Loss of expression of several genes in 15q11.2-13 Genes involved - SNRPN= small nuclear ribonucleoprotein polypeptide N, predominantly expressed in brain - NDN= Necdin

The ovary is a

Primary Endocrine Gland It contains multiple, distincitve steroid-producing cells: - Granulosa cells (GCs) - Theca cells (TCs) - Granulosa lutein cells (GLCs) - Theca luteins cells (TLCs) - Stromal cells (SCs) All 3 major classes of reproductive steroid hormones are produced by the ovary: - estrogens - progesterone - androgens *Hormone secretion by each cell depends on the expression of steroidogenic enzymes - GCs secrete estrogens (estradiol, estrone) & some progesterone - TCs, TLCs, & SCs secrete androgens (androstenedione, testosterone) & some 17-OH-progesterone - GLCs secrete progesterone & some estrogen Ovaries also secrete peptide hormones: - Inhibin A, Inhibin B & Anti-Mullerian Hormone (AMH) NOTE: - in the ovary, the major source of hormone production are the cells of the maturing antral follicles & the corpus luteum - the ovarian stroma is capable of producing androgens also & forms a major source of androgens (and thus, estrogens) during menopause

Why is the pterygopalatine fossa so important?

Primary function of pterygopalatine fossa is distribution of branches of the maxillary nerve (CNV2) and maxillary artery - it communicates with nasal and oral cavities, orbit, infratemporal fossa, pharynx, and middle cranial fossa 7 passages permit communication between the pterygopalatine fossa and other regions of the head including: - Two foramina: sphenopalatine, foramen rotundum - Two fissures: inferior orbital, pterygomaxillary - Three canals: pterygoid, palatovaginal, palatine Flow chart: Infratemporal fossa can go: - Through gap deep to zygomatic arch --> temporal fossa OR - Through pterygomaxillary fissure --> pterygopalatine fossa--> through sphenopalatine foramen --> nasal cavity OR - Through inferior orbital fissure --> orbit

What are the major changes to lung volumes and capacities that occur during pregnancy?

Primary respiratory changes in pregnancy: - Increased tidal volume, minute volume, alveolar ventilation - Increased alveolar and arterial oxygen (PO2 and PaO2) - Decreased arterial PCO2 - Increased pH (respiratory alkalosis)

Follicles

Primordial Follicle - Primary oocyte (25 micrometers) arrested at prophase I, single layer of squamous GCs, surrounded by a basal lamina Primary Follicle (AKA unilaminar primary follicle) - 60 micrometers - Follicle recruited to grow: oocyte growth to 30micrometers, single layer of cuboidal GCs expressing FSH receptors (FSHR), zona pellucida (ZP) begins to form Secondary Follicle (AKA multi laminar primary follicle) - 200 micrometers - Fully grown primary oocytes (100micrometers) surrounded by ZP, 2-10 layers of GCs, theca layer with associated vasculature laid down outside basal lamina, theca interna cells express LH receptors (LHR) Tertiary (Antral) Follicle: - 1mm - Multiple layers of GCs interspersed with follicular fluid (antrum), theca layer differentiates into 2 layers, the steroidogenic theca interna with LHR and the smooth muscle like- cells of the theca externa Graafian (Dominant) Follicle (AKA Mature graafian follicle) - 20mm - Largest pre-ovulatory dominant follicle, large fluid-filled antrum, GC differentiation into steroidogenic mural GCs (surround the antrum) & cumulus GCs (surround the oocyte)- All GCs express FSHR; Mural GCs express LHR immediately prior to ovulaiton

Primary follciles

Primordial follicles become lined with simple cuboidal/low-columnar epithelial cells *** Follicle is now called a unilaminar primary follicle - Cells proliferate and form a stratified follicular epithelium of granulosa cells (connected by gap junctions) called the granulosa--> the primary follicle is now multi-laminar primary follicle - Granulosa cell secrete estrogen and some progesterone - Oocytes secrete specific proteins (ZP-1, ZP-2, ZP-3, ZP-4) that form an extracellular coat of glycoproteins called zona pellucida (bind sperm and induce acrosomal activation) Stromal cells form the follicular theca (gr. outer covering) and subsequently divide into theca interna and theca externa - theca interna is a layer of cuboidal cells which are highly vascularized and secretes androstenedione (estrogen precursor) - theca externa consists of fibroblasts and smooth muscle and merges with the surrounding stroma

Pupillary Constriction and Dilation

Pupillary Dilation is under Sympathetic Control - Axons of pre-ganglionic sympathetic neruons (intermediolateral cell column) synapse on cell bodies in the superior cervical ganglia - The post-ganglionic axons innervate the dilator smooth muscle fibers of the iris Horners Syndrome: Disruption of sympathetic fibers to the eyes and face. Consists of: 1) Ptosis= upper eyelid dropping- loss of innervation to smooth muscls in the upper eyelid 2) Miosis= decreased pupillary size 3) Anhydrosis= decreased sweating on the ipsilateral face & neck Pupillary constriction is under Parasympathetic control - Pupillary Light Reflex: Shining a light into one eye causes the pupil of that eye to constrict (direct light reflex) and causes constriction of the pupil in the other eye (consensual light reflex) ** Anisocoria= pupil asymmetry

Within the 6 layers of the Neocortex, there are two cell types which are

Pyramidal neurons and Non-pyramidal (interneurons) Pyramidal neurons (primarily in layers II-III, V and VI) - pyramidal dendrites contain spines, which are preferential regions for synaptic contact - pyramidal cell shave long axons, synapse in cortical or subcortical areas - synapses are glutamatergic Non-pyramidal (interneurons) - most cortical interneurons are GABAergic

Reticular Activating System and its link to sleep

RAS was believed to be the sole mechanism responsible for sleep/wake cycles, where: deactivation= sleep and activation= wakefulness BUT this is NOT the case! - Sleep is an ACTIVE process - There are stages of sleep that result from a dynamic interaction between different transmitter systems in the reticular formation as well as other areas such as the hypothalamus

REM

Rapid Eye Movement Characterized by: - Beta waves - Rapid eye movements - Rapid low-voltage EEG Subjects experience: - muscular atonia - dreaming (elaborate imagery with the PONS) **REM accounts for 20-25% of total sleep in most adults "Awake brain- paralyzed body" NOTE: REM is associated with increases in - Hear rate - Respiration rate - Penile erection

8th step of Neurotransmission= Receptors- what drugs work here?

Receptors may be located on pre- or post-synaptic neurons or on glia * post-synaptic involved in the information pathway - Chemical synapses like pre-synaptic neurotransmitter release to post-synaptic neuron activation/inhibition *** Auto-receptors (like autostate- generally inhibitory and inhibit further NT release- if excess NT in synaptic cleft- leads to inhibit to stop further NT release): pre-synaptic receptors, agonist is released neurotransmitter GPCRS (AKA metabotropic receptors) - Coupled to second messenger systems via G-proteins (ex. muscarinic (ACh), dopamine, adrenergic receptors (activated by NE) ~30% of drugs act at GPCRS Ligand-gated ion channel receptors (LGICs) (AKA ionotropic receptors) - multi-subunit, homo- or hetero-meric complexes - Contain an integral ion pore (ions flow through pore down its concentration gradient when open) Ex. nicotinic (ACh), NMDA (activated by glutamate), GABA-A (GABA)

Prevertebral and lateral vertebral musculature

Rectus Capitis Anterior: flexes head at atlanto-occipital joint Rectus Capitis Lateralis: flexes head laterally to same side Longus Colli: flexes neck anteriorly and laterally and sligth rotation to opposite side Longus Capitis: flexes the head Innervation: - Rectus capitis anterior and Rectus capitis lateralis are innervated by: Branches from anterior rami of C1, C2 - Longus Colli: Branches from anterior rami of C2 to C6 - Longus Capitis: Branches from anterior rami of C1 to C3

Anatomy of a Reflex Arc

Reflexes can be classified by CNS involvement: - intraspinal: occur in a singl spinal cord level - intersegmental: involve 2 or more spinal cord levels- afferent signals enter the CNS and bifurcate into short ascending/descending branches that then synapse on the motor neurons at those levels - suprasegmental: neurons in the cortex or brainstem that influence the activity at the spinal cord levels Components of reflex arc: 1. Receptor (receptor end of a dendrite or a specialized receptor cell in a sensory organ): sensitive to an internal or external change (muscle spindle) 2. Sensory neuron (dendrite, cell body, and axon of a sensory (afferent) neuron): transmits nerve impulse from the receptor to the brain or spinal cord 3. Interneuron (dendrite, cell body, and axon of a neuron within the brain or spinal cord): serves as processing center; conducts nerve impulse from the sensory neuron to a motor neuron 4. Motor neuron (efferent): dendrite, cell body, and axon of a motor (efferent) neuron: transmits nerve impuls from the brain or spinal cord to an effector 5. Effector (a muscle or gland outside the nervous system): responds to stimulation by the motor neuron and produces the reflex behavioral action ** The reflex arc is the neural pathway that produces the reflex ** Because this arc involved an impuls being sent to the spinal cord and on to the effector muscles (it does NOT have to go to the brain!)- the response is RAPID (1-2 milliseconds)

Accomodation

Refraction by the lens - The muscles of the ciliary body contract and relax, causing the lens to either fatten or become thin - As the shape of the lens changes, so does its focus - Used for near vision--> Accomodation *** Needed to shift focus to near objects (ex. reading): - the reason most ppl need glasses for reading as they get older is that the lens stiffens with age and cannot focus on near objects as well (aka cant accomodate)

Danger Area of the Face

Region of the face where infection can spread from the facial or ophtalmic veins (lacerations, blemishes) to the CAVERNOUS SINUS - the danger area is where this is most susceptible to occur ** remember that the facial, angular ceins and opthalmic veins anastomose *** May cause meningitis or abscesses from the infection *** Cavernous Sinus Thrombosis can occur if a clot travels from the facial vein to cavernous sinus

5th step in neurotransmission= Release- What drugs work here?

Release is Ca2+ dependent - there are several ways that neurotransmitter release can be affected by drugs (ex. by increasing or decreasing Ca2+ influx) ** Botulinium toxin (AKA Botox) cleaves SNARE proteins and prevents vesicular release of ACh from motor neurons, leading to muscle paralysis- used to decrease wrinkles, frown lines etc. *** is is SPECIFIC for acetylcholine!

3rd layer of the eye

Retina - innermost, photosensitive layer Composed of 2 parts: 1. Neural retina - nonphotosensitive part - photosensitive part 2. Retinal Pigment Epithelium (RPE) - single layer of simple cuboidal, melanin-containing epithelial cells

List the Visual pathway starting from Retina

Retina --> Optic nerve --> Optic chiasm--> Optic tract --> Lateral geniculate nucleus (LGN)--> Optic radiations (either temporal (aka Meyers loop) or parietal loop)--> Primary Visual cortex (area 17)

Primary Visual Pathway

Retinal ganglion cells course through optic disc --> forming the optic nerve (CN II) --> L visual field processed by the right ocipital lobe crosses at the optic chiasm --> optic tract --> Lateral geniculate Nucleus (body) of thalamus --> occipital lobe via optic radiations--> to Primary Visual Cortex (Brodmanns Area 17)

Imaging of the Urethra

Retrograde Urethrogram: diagnostic radiologic procedure used to image the integrity of the urethra Indication: - pelvic trauma - urethral strictures How is it done: - position the pt obliquely at 45 degrees - retract the foreskin and clean the penis - place a small catheter into the urethral orifice and inject the radiopaque contrast solution - images are obtained under fluroscopy REMEBER: Male urethra is divided into (4 parts): Anterior urethra: - penile (spongy) urethra - bulbar (bulbous) urethra Posterior urethra: - membranous urethra - prostatic urethra Retrograde Urethrogram can be used to: Depiciting a Tear: Occurs in: Urethral Trauma: due to blunt or penetrating trauma * DO NOT insert a foley catheter Depict a Urethral Stricture (Narrowing of the distal bulbous urethra) Urethral stricture occurs after: - urethral trauma - infection - radiation therapy - latrogenic causes (i.e. doctor leaving in catheter for too long)

The response of a Rod Photoreceptor cell to light

Rhodopsin molecules in the outer-segments discs absorb photons - photon absorption leads to the closure of Na+ channels in the plasma memebrane --> this HYPERPOLARIZES the membrane and reduces the rate of neurotransmitter release from the synaptic region ** Because the neurotransmitter acts to inhibit many of the postsynaptic retinal neurons, illumination serves to free the neurons from inhibition and thus, in effect, excites them

Hemispheric specialization for Attention

Right (non-dominant) hemisphere is MORE important thatn the left (dominant) hemisphere for attention in most individuals - Normal - Severe left neglect - MInimal Right neglect - Severe Right neglect

Hemispheric specialization for Spatial Processing

Right (non-dominant) hemisphere is more important than the left (dominant) hemisphere for spatial processing in most individuals - visual cortex - dorsal "where" stream - ventral "what" stream

Alprostadil

Route of Administration: - intracavernosal injection - intraurethral suppository MOA: - prostaglandin E1 analog--> causes vasodilation of smooth muscle- when injected in the penis, this allows blood to flow to corpora cavernosa Clinical uses: - Refractory erectile dysfunction (SECOND LINE treatment when pts do NOT respond to PDE5 inhibitors) - * Maintaining patent ductus arteriosus in tetralogy of Fallot Adverse Effects: - Hypotension, flushing, tachycardia, penile discomfort, penile fibrosis

Sildenafil and Tadalafil (AKA Viagra and Cialis)

Route of administartion: oral MOA: - Increase cGMP by inhibition of phosphodiesterase type 5 (PDE5) - cGMP produces smooth muscle relaxation- PDE5 is expressed predominantly in erectile smooth muscle and pulmonary vasculature Clinical uses: - erectile dysfunction - pulmonary hypertension Adverse effects - headache, flushing and nasal congestions - Sildenafil inhibition of PDE6 in the retina can cause blue tint to vision - ** In presence of organic nitrates (ex. nitroglycerin) vasodilation is amplified can can result in significant hypotension--> PDE5 inhibitors are contraindicated in pateients taking organic nitrate vasodilators

What determines onset and duration of drug action in CNS?

Route of administration affects onset and duration of action - singl dose (ex. inhalation - i.e. nicotine) or intravenous bolus: plasma levels rise rapidly then fall as drug is distributed throughout the body Onset: as soon as drug reaches therapeutic level; highly perfuse tissues are first to "see" drug ** how long does it takes until that concentration is reached in the brain Duration of action: for as long as therapeutic levels lasts; redistribution takes drug from highly perfused to lesse perfused tissues - brain levels (of "free" drug) rise and then fall ** Implication of drug action in brain? *** depends on how long we have that conc. or higher in brain

Testosterone Pharmacokinetics

Routes of Administration - Intramuscualr (IM)- testosterone enanthate - Transdermal- patch or gel - Buccal tablet * All drug delivary methods bypass first-pass metabolism - transdermal delivery is advantageous bc plasma testosterone levels remain fairly constant - IM requires injections and can produce variability in blood levels, but relatively few other complications ** must avoid first pass metabolism with all of these Metabolism: - 5alpha-reductase catalyzed the conversion of testosterone to dihydrotestosterone which binds to the androgen receptor with higher affinity than testosterone - Aromatase (CYP19) converts testosterone to estradiol - Hepatic metabolism converts testosterone to the biologically inactive metabolites (first-pass metabolism) *** 5 alpha-reductase and aromatase are targeted by drugs that regulate androgens

Occupational problems with SCI

SCI may make it impossible or impractical to return to a previous jon - american with disabilities act 1990 (amended in 2008) prohibits discrimination based on disability- however, barriers may include: worksite accessibility, transportation issues, inflexible work schedules, and negative employer attitudes - access to and effective use of assistive technology is a major influence on employment success- support, training and VOCATIONAL (learing new ways of how to do your job- can al) rehabilititon can help overcome barriers - individuals who return to work after SCI live longer, more satisfying and healthier lives than those who do not Recreational difficulties in SCI: - leisure activities are an important source of pleasure, personal pride, relaxation, physical wellness and social support - can be important to find alternative activities

Auditory Pathway

SLIM Sound --> Cochlear Nucleus --> (S)uperior olivary nucleus--> (L)ateral lemniscus--> (I)nferior colliculus --> (M)edial geniculate nucleus (MGN) of the thalamus --> to superior temporal gyrus NOTE: Auditory nerve carries signal into the brainstem and synapses in the cochlear nucleus - Fibers may cross in the trapezoid body (ventral acoustic stria) - Fibers synapse in the ipsilateral and contralateral superior olivary nucleus - Thus, cells in the superior olive receive inputs from both ears and are the first place in the central auditory system where binaural processing (stereo hearing) is possible **** Recal that processing occurs in the medial superior olive (for timing) and lateral superior olive (for intensity) - The output of the superior olive ascends in the lateral lemniscus - some nuclei within the lateral lemnisucs further process sound - Afferents synapse in the inferior colliculus in the midbrain, then projections (brachium of the inferior colliculus) synapse in the medial geniculate nucleus (MGN) in the thalamus - Thalamic afferents reach the superior temporal gyrus through the internal capsule - From the superior olive onwards, afferents are generally distrubuted bilaterally so unilateral damage at any level does NOT usually result in deafness in either ear

Central Cord Syndrome (large lesion) caused by Syringomelia can lead to

Sacral sparing ** phenomenon in which damage to the spinothalamic tracts leave pain, temperature and simple tactile sensations intact in sacral deramatomes - In a central cord syndrome the anal region and genitalia are "spared" of any sensory or motor deficits - the sacral/coccygeal somatoropic regions of the anterolateral tract are very lateral and therefore can be spared and there may be complete loss of pain/temperature sensation EXCEPT in this region ** imagin a compression, compressing from the medial aspect "outwards", sparing just those fibers carrying sensation from sacral regions (S2-S4)*** *** Remember that the spinothalamic system carries not only pain/temperature but the anterior spinothalamic pathway (** review slide 23 from brainstem lecture) can carry crude touch, so patients could feel a pinprick or "touch" in the anal and genital region - maintaining sensation in this region is a good indicator that the spinal cord is NOT entirely compromised ** In these very low sacral levels, motor functions to the anal sphincter/urethra may also be spared

A pt presents to you with cessation of menses over a duration when 3 normal cycles would have occurred or Amenorrhea of 6 months in duration

Secondary Amenorrhea

Parotid Gland Innervation

Sensory innervation (GSA)= CN V3 (Auriculotemporal Nerve of V3) Visceral motor innervation (Secretomotor)- GVE Sympathetic (GVE) Innervation: INHIBITS saliva production - Preganglionic fibers: originate from nuclei (cell bodies) in the spinal cord (T1) - Postganglionic fibers: originate in superior cervical ganglion- signal travels on axons from this ganglion along the external carotid artery to reach the parotid gland Parasympathetic (GVE) Innervation: STIMULATE saliva production - Preganglionic Fibers: originate from nuclei (cell bodies) in brainstem (inferior salivatory nuclei) - Signal travels on the lesser petrosal nerve of the glossopharyngeal nerve (CNIX) to the otic ganglion (signal synapses in this ganglion) - Postganglionic fibers: originate in the otic ganglion and signal travels on the auriculotemporal nerve (CN V3) to reach the parotid gland

A newborn boy (46 XY) with a micropenis at birth is found to have a mutation of NR5A1/SF-1 gene leading to selective impairment of sertoli cell -- at 16 y/o what are his blood serum levels

Sertoli cells--> produce inhibin B (stimulated by FSH) - the pts Testosterone and LH will be normal - Inhibin B levels will be low - FSH will be high bc NO negative feedback

Central Control of Eye Movements: Smooth Pursuit

Smooth pursuit movements are used to keep moving imaged on the fovea or in the visual field - the cortex is responsible for the initiation of smooth pursuit - the path is similar to that of saccadic eye movements, BUT visual association cortices (motion-sensitive regions) work in tangent with the frontal eye field ** In this scenarion, we see the cortex projecting to pontine nuclei and then to the flocculus of the cerebellum and subsequently the vestibular nuclei@ - Vertical smooth pursuit movements are initiated bilaterally and horizontal smooth movements are initiated by the ipsilateral hemisphere

Pathway Representation for Descending/Somatic (Voluntary) Motor

Somatic Motor pathway have a 2-neuron chain, from the cortex, to ultimately send a signal along a peripheral nerve to innervate voluntary musculature 1st order cell body: for the UMN (upper motor neuron) is located in the primary motor cortex 2nd order cell body: from the LMN (lower motor neuron) is located in the ventral horn of the spinal cord grey matter ** REMEMBER - CNS: axons are bundled together to form tracts - PNS: axons are bundled together to form nerve ** Cell body and tract create the upper motor neuron ** Cell body and nerve create the lower motor neuron

Scalp & Face- Cutaneous Innervation

Somatosensation (GSA)... From scalp ANTERIOR to the ears and the vertex (top) of the head is carred by: branches of Trigeminal Nerve (CNV) - Supratrochlear - Supraorbital - Zygomaticotemporal - Auriculotemporal From scalp POSTERIOR to the ears and vertex is carried by: Cervical Nerves: - Great auricular (C2/C3) - Lesser occipital (C2) - Greater occipital (C2) - Third occipital nerve (C3) ** Somatosensation (GSA), cutaneous innervation of the face is carried by branches of the trigeminal nerve (CNV) to the brain to be processed - Remember this nerve was associated with the pharyngeal arch I - The trigeminal nerve is called "tri" bc it has 3 branches 1. Ophthalamic (V1) 2. Maxillary (V2) 3. Mandibular (V3)

What is the ZP protein to which sperm bind before the acrosome reaction? What is the primary enzyme released during the acrosome reaction?

Sperm bind to ZP3, stimulating release of acrosomal contents= Acrosome reaction ** Binding to ZP increases intracellular Ca2+, stimulating exocytosis of acrosomal contents. ACROSIN digests the ZP allowing aperm to reach the oolema --> inner acrosomal membrane with its oocyte binding proteins is now exposed

Sperm Path

Sperm is produced in the testis in seminiferous tubules --> epididymis --> ductus (vas) deferens --> ejaculatory duct --> prostatic urethra--> membranous urethra --> penile urethra --> exit the penis ** Along the way, secretions are added to semen from: - seminal vesicle - prostate gland - bulbourethral gland

Affective/emotional qualities of pain & pain modulation of the Reticular Formation

Spinoreticular Tract (paleospinothalamic tract) - Chronic, dull pain (C-fibers) project to cingulate, somato-sensory cortex and hypothalamus - Collaterals also go to the reticular formation for emotion, arousal, motivation Spinomesencephalic --> Raphespinal Tract - Pathway mediating pain suppression - Uses PAG and Nucleus Raphe Magnus

Standardization

Standardized psychological tests: given under standard, set conditions (i.e., questionnaires, rating scales, performanve tests) Standardize on a clearly defined "norm group" - individual is compred to the "norm"/standardization group - descriptions: superior, high average, average, low average, below average, extremely low *** THE MORE SIMILAR THE INDIVIDUAL IS TO THE STANDARDIZATION SAMPLE, THE MORE USEFUL THE TEST RESULTS

Caffeine

Stimulant (in drug class- methylxanthine- we saw this in resp.) MOA: Competitive anatgonist at adenosine A1 and A2 receptors - different MOA to other stimulants, ex. amphetamine, cocaine Pharmacolofical effects: CNS - cortical arousal with increased alertness and decreased fatigue Periphery - Vasoconstriction, increased HR, increased BP Physical dependence Tolerance- pharmacodynamics - tolerance to stimulating effects - up regulation of adenosine receptors Withdrawal - fatigue, sedation, headaches, nausea Caffeine sensitivity - some individuals are more sensitive to caffeine than others- caused by genetic variation in CYP1A2 or adenosine receptors Uses: - Apnea of prematurity - To increase alertness

Drug interactions

Stimulants: - Interactions with stimulants (additive- i.e. amphetamine + caffeine --> excessive stimulation and cardio symptoms) - Interactions with CNS depressants (counteracting- i.e. caffeine with ethanol- balance between the two) CNS depressants: - interactions with stimulants (counteracting) - interactions with CNS depressants (additive): potentially FATAL (ex. alcohol + diazepam- leads to overdose, sedating antihistamine (H1 antagonists), opioid, etc) ** alcohol + opiods --> overdose frequently

The neural axis bends/flexes at the junction of the midbrain and diencephalon- for this reason, the directional terms we use need to take into account this flexure

Structures rostral to the midbrain: - Anterior= rostral - Posterior= caudal - Superior= dorsal - Inferior= ventral Structures caudal to the diencephalon - Anterior= ventral - Posteiror= dorsal - Superior= rostral - inferior= caudal

3 Longitudinal Muscles of the Pharynx

Stylopharyngeus Salpingopharyngeus Palatopharyngeus - Stylopharyngeus & Salpingopharyngeus: elevate the pharynx - Palatopharyngeus: Elevation of pharynx; closure of the oropharyngeal isthmus when swallowing NOTE: elevation of the pharynx will shorten and widen it ** Stylopharyngeus is innervated by CNIX ** Salphingopharyngeus and Palatopharyngeus are innervated by CNX *** The muscles developed from pharyngeal arch IV- EXCEPT for stylopharyngeus that developed from arch III

Somatosensory and Voluntary Motor Innervation of the Larynx (GSA & BE)

Superior Laryngeal Nerve (CNX): Divides into internal and external laryngeal nerves at the level of the hyoid bone - External laryngeal nerve: supplied inferior constrictor and cricothyroid muscles - Internal laryngeal nerve: passes through the foramen in the thyrohyoid ligament- somatosensory (GSA axons) to the laryngeal cavity ABOVE the vocal folds Recurrent Laryngeal Nerve (CNX): Somatosensory (GSA axons) to laryngeal cavity BELOW the vocal folds (INCLUDING the vocal cords) - voluntary motor (BE axons) to ALL intrinsic muscles of larynx EXCEPT cricothyroid - both nerves generally ascend in the neck in the groove between the trachea and esophagus *** recurrent laryngeal nerve enters the larynx DEEP to margin of inferior constrictor (Gap4)- the terminal branch is known as the inferior laryngeal nerve after the nerve passes by the cricothyroid joint **** Symptoms of Reccurrent Laryngeal Nerve damage: hoarseness of voice, noisy breathing, changes to vocal pitch. DYSPHONIA!

Extraocular Eye Muscles Movements & Innervation

Superior Rectus - elevates, adducts, rotates eyeball medially (intorsion) Inferior Rectus- Depresses, adducts and rotates eyeball LATERALLY (extorsion) Medial Rectus- Adducts eyeball Inferior Oblique: ABducts, elevates and laterally rotates the eyeball (Extorsion) Levator Palpebrae Superioris: Elevates superior eyelid (deep layer, the superior tarsal muscle, is innervated by sympathetic fibers Lateral Rectus: ABducts eyeball Superior Oblique: ABducts, depresses and medially rotates eyeball (intorsion) ** ALL are innervated by the Superior Branch (superior recuts and levator palpebrae superioris) or Inferior Branch (inferior rectus, medial rectus, inferior oblique) of the Oculomotor (CNIII) EXCEPT FOR - Lateral Rectus- innervated by Abducens (CNVI) - Superior Oblique- innervated by Trochlear (CNIV)

Hoffmans reflex

Test to examine reflexes of the upper extremities - physician taps or flicks the nail of the middle or ring finger to produce flexion of the index finger to the thumb - if there is NO movement of the index finger or thumb during the test, the person has a NEGATIVE Hoffmans signs - if the index finger and thumb move, the person has a POSITIVE Hoffmans sign *** A positive Hoffmans sign may indicate a neural issue, such as hypertonia or hyper-reflexia, from an upper motor issue, but some normal, healthy individuals may exhibit if they are generally hyper-reflexic

Best studies for visualizing the Testicles

Testicular ultrasonography is the primary diagnostic modality for evaluating the testicles Indications for testicular/scrotal utrasound: - evaluation of scrotal pain - evaluation of testicular swelling or masses - testicular trauma - infertility - undesended testis in children Color Doppler Ultrasonography helps to detect blood flow within the testis Normal testicles: - normally, there is uniform, symmetric vascular perfusion of the testes * Increased blood flow is a sign of inflammation of the testicle (orchitis) - lack of blood flow means no perfusion of the testicle Testicular torsion: ** In testicular torsion, doppler ultrasonography reveals NO detectable blood flow in the testicle

Gag Reflex (AKA pharyngeal reflex/laryngeal spasm)

Testing CN IX and X ** gag reflex tests sensory and motor components of CN IX and X - it is a reflex that is involuntary ** physician will touch the back of the pharynx and the palate will elevate ** remember that the sensory component (GSA) is carried by CN IX and the motor component (BE) is carried by X ----- Helps to prevent choking - a reflex contraction of the pharynx that is initiated by touching the pharyngeal aspect of the tongue, uvula, roof of mouth, or area of the palatine tonsisl ** gag reflex is composed of the SENSORY- afferent limb (CN IX) and VOLUNTARY LOOP- efferent limb (CN X) ** If glossopharyngeal N (CN IX) if damaged during a tonsillectomy, then the sensory limb of this reflex is lost

Androgen Replacement Therapy

Testosterone clinical indications: Primary hypogonadism: - acquired or congenital failure of the testis from many possible causes including: cryptorchidism, bilateral torsion, orchitis and vanishing testis syndrome Secondary hypogonadism/hypogonadotropic hypogonadism - acquired or congenital deficiency due to the hypothalamus or pituitary, hypothalamic-pituitary injury could be the result of tumors, radiaiton or trauma

Lissencephaly- Miller- Dieker Syndrome

The LIS1 gene (on chromosome 17) codes for a microtubule-associated protein important for maintaining the proper speed of migration MDS is an autosomal dominant disorder - Mutations cause Type-1 Lissencephaly with severe mental retardation- the brain is smooth and the cortex has 4 layers instead of 6- this disorder is not usually passed on because affected individuals usually die in infacncy or childhood ** In lissencephalic brians- note the thickened cortex and paucity (scarcity) of gyri and sulci

What is the key to sexual dimorphism? (Male vs Female for different forms of a species)

The Y chromosome! At fertilization: - Male= 46, XY - Female= 46, XX The male Y chromosome contains the gene called Sex-determining region of the Y chromosome (SRY) gene- this encodes for SRY protein (previously known as testis-determining factor- TDF) *** SRY protein initiates a chain of events leading to gonad differentiation into testes and production of anti-mullerian hormone and testosterone ** Therefore in simple terms the SRY gene encodes for the SRY protein which determines whether male or development takes place

Parmokinetics of a local anesthetics

The body will - Adminster, distribute, metabolize and excrete the drug 1. Administration: topical, subcutaneous, infiltration (deeper than subcutaneous injection), nerve block, epidural, Spinal (spinal can be subarachnoid/intrathecal mean same thing) ** Topical Anesthesia (mucus membranes and skin) - Benzocaine (for mouth ulcers) - Lidocaine - Lidocaine+Prilocaine ** Also ophtalamological use with eye drops topically Infiltration: local anesthetic into mount to treat teeth- may be administered with epinephrine or HCO3- (why?) - Lidocaine - Bupivacaine - Articaine (used in dentistry) Peripheral Nerve Block: I.e. in shoulder with brachial plexus--> anesthesia of large portion of arm OR into fingers to anesthestize nerves of finger (diff sites depending on procedure) - Chloroprocaine (short) - Lidocaine (medium, 1-2hr) - Bupivacaine (long, >4hr) - Ropivacaine (long, >4hr)

Neural Pruning

The cerebral cortex overproduces neurons, about twice as many as it will eventually need ** this overproduction of neurons, forces the neurons to compete for neurotrophic factors and those that acquire sufficient quantities survive ** this allows for the selection of the "fittest" most useful synapses

The structures in the inner ear convey information to the brain about balance and hearing-

The cochlear duct is the organ of HEARING The semicircular ducts, utricle, and saccule are the organs of BALANCE

What changes occur in the endometrium in preparation for receipt of a fertilized oocyte during the luteal phase of the menstrual cycle?

The corpus luteum secretes progesterone, estrogen and inhibin A - the corput luteum regresses after ~14 days and declinings progesterone levels (progesterone withdrawal) stimulates mensturation Luteal phase corresponds to the the Secretory phase: - In the early secretory phase, progesterone stimulate endometrial gland synthesis & secretion and secretion of glycogen and glycoprotein. By mid-secretory phase, stromal edema develops, accompanied by proliferation of spiral arterioles - Uterine receptivity to an implanting embryo is limited to a discrete period of time during the mid-secretory phase of the menstrual cycle called "Window of Implantation" estimated to span from days 19-24 of the (ideal 28-day) menstrual cycle (5-10 days after ovulation) - In the late-secretory phase (after day 24), the window of receptivity closes (becomes non-receptive to implantation). During this period, progesterone stimulates fibroblast-like endometrial stromal cells to differentiate into rounded cells, containing glycogen nd lipid droplets. These differentiated stromal cells are referred to as "predecidualized" stromal cells. The glycogen and lipid droplets provide nourishment to the early invading embryo. The decidualization process continues in pregnancy until the majority of stromal cells in the functionalis zone a differentiated- i.e. the endometrium is transformed into the decidua of pregnancy. Once decidualization has been initiated, no additional implantation can occur

Trigeminal- Motor Nucleus of V- Where do fibers cross the neuroaxis?

The corticobulbar axons (bilateral) targeting the motor nucleus of V cross in the cortex and therefore the motor nucleus of V and the peripheral axons innervate the IPSILATERAL muscles of mastication Deficits? - Lesion of Motor Nucleus of V or peripheral axons result in IPSILATERAL atrophy of all muscles of mastication - Upon opening the jaw, the jaw will deviate IPSILATERALLY (toward the side of the lesion) due to weakened pterygoid muscles - muscles on opposite side will push towards the weakened side as there is NO opposition

Ejaculation

The forceful expulsion of semen from the male reproductive tract - Ejaculation, unlike erection, is regulated by the SYMPATHETIC NS "point and shoot" - p is parasympathetic, s is sympathetic These impulses trigger the following sequence of events: 1. Contraction of the smooth muscles of the genital ducts and accessory genital glands forces the semen into the urethra 2. The sphincter muscle of the urinary bladder contracts, preventing the release of urine (or the entry of semen into the bladder) 3. Bulbospongiosus muscle, which surrounds the proximal end of the corpus spongiosum undergoes powerful, rhythmic contractions, resulting in forceful expulsion of semen from the urethra ** Ejaculation is follwed by the cessation of parasympathetic impulses - arteriovenous shunt is reopened, vascular spaces slowly empty of blood --> as the blood leaves the vascular spaces, the penis undergoes detumescence and becomes flaccid

Dislocation & Fractures of the Temporomandibular Joint

The mandible may disloacte medially, laterally, anteriorly or posteriorly - may accompany fractures of the mandbile - posterior dislocations are rare as they are prevented by the lateral ligament **ANTERIOR dislocation is MOST COMMON and occurs when the mandible is shifted forwards if the mouth is excessively opened NOTE: dislocation of the temporomandibular joint may damage the facial and auriculotemporal nerves (injury of the auriculotemporal nerve will lead to instability of the joint) Other Fractures include: - Coronid process fracture- Uncommon and usually singular - Fractures of the neck of the condylar process associated with the dislocation of the temporomandibular joint - Fracture of the angle of the mandible is usually oblique and may involve the alveolus of the third molar tooth - Fracture of the body of the mandible usually passes through the socket of the canine tooth *** If you see a mandibular fracture on one side, check the other side as well! Fractures can occur in pairs, one on each side!

Voluntary Motor Innervation (BE) of the Pharynx

The pharyngeal plexus is formed by: - Vagus nerve (CNX) - Glossopharyngeal nerve (CNIX) - Sympathetic trunk (via the superior cervical ganglion) *** All the muscles of the pharynx are innervated by the vagus nerve (CNX)- mostly through axons from the pharyngeal plexus of nerves EXCEPT FOR - Tensor veli palatini (CNV3) - Stylopharyngeus (CNIX) NOTE: the pharyngeal plexus of nerves is located in the fascia that lines the outer/external aspect of the pharynx

How is the fetus protected from over-exposure to androgens and estrogens?

The placenta is a giant exchange unit that protects the fetus- it must efficiently deliver everything the baby needs and elimnate all of the wastes Primary function: 1. Transport: nutrients, gases & wastes between mother and fetus 2. Protection: maternal antibodies, barrier against some infectious agents and drugs 3. Endocrime: hormones regulate pregnancy, metabolism, fetal growth, partuiton

During what part of gestation does the fetus gain most weight?

The rate of fetal weight gain increases steadily from 10-28 weeks, after which a high rate of growth is maintained until week 36. Growth rate then falls. - The increase in fetal weight gain from week 28 onwards coincides with formation of fetal adipose tissue ** Formation of fetal adipose tissue is slow until week 28 of gestation, after which it is laid down rapidly in subcutaneous and intra-abdominal stores *** The period of rapid growth coincides with fetal formation of adipose tissue

Gingiva (Gums)

The soft, mucosal tissue that lines the base of the teeth and mouth - they provide a barrier/seal to protect deeper tissue from any items in the mouth - Attached (proper gingiva) is firmly attached to the alveolar processes of the teeth and a bit lighter in color - Alveolar gingiva and mucosa is a continuation of the mucosa of the cheeks, floor of the mouth and mucosal aspect on the interior lips

Endometrium

The surface epithelium of endometrium: - simple columnar epithelia Consists of: - ciliate cells - secretory cells which line the tubular uterine glands ** the glands secretions function to provide the initial nutritional support of the conceptus ** Endometrial/uterine glands: line the uterus body, and change in appearance and secretion during the menstrual cycle - before the mothers nutrient-rich blood supply is plumbed in, ALL the materials and energy for bulding a baby are supplied by secretions from glands in the uterus lining Layers/Zones/Strata Basal Layer: - highly cellular lamina propria and contains the deep basal ends of the uterine glands * Does NOT shed in menstruation Superficial functional (spongy) layer - spongy lamina propria, rich in ground substance- includes most of the length of the uterine glands and the surface epithelium (uterine lumen epithelium) ** Undergoes profound changes during the menstrual cycles ** Shed during menstruation ** Underlying lamina propria (stroma) - abundant fibroblasts and ground substance

Reticulospinal Tracts

There is a feedback loop between the reticular formation nuclei and the cerebellum - input from the premotor and motor cortices are integrated in that loop - primary targets of these projections include the nucleus reticularis pontis oralis of the PONS and nucleus reticularis gigantocellularis of the MEDULLA *** Projects to the spinal cord= reticulospinal fibers! Medial Reticulospinal Tract= "GO!" - Excitation of anti-gravity, extensor musculature/ Activation of the pontine (medial) reticulospinal tract facilitates (+) spinal reflexes Lateral Reticulospinal Tract= "STOP" - Inhibition of axial extensor musculature and MRT/ Activation of the medullary (lateral) reticulospinal tract inhibits (-) spinal reflexes Combined together --> Modulation of muscle tone and Regulation of Posture

Epistaxis (nosebleed)

There is an anstomoses of several arterial vessels in the anterior part of the septum and this area is called Kiesselbachs plexus or Littles area - Epistaxis is associated with injury/trauma, infection, hypetension, medication - Anterior bleeds happen 90% of the time and are mainly from dryness that results from inspired air and nose picking - Posterior bleeds can occurs and usually require medical attention as bleeding is more profuse *** Nasal packing: placement of strips of gauze into the nasal cavity to create pressure on the bleeding site. Alternately, other materials that promote clotting may be used

There are two sets of paried joints which aid the movement of the vocal cords within the larynx- what are they?

They are synovial! 1- Cricothyroid Joints: enable the thyroid cartilage to move foraward and tilt downward on the cricoid cartilage 2- Crico-arytenoid Joints: enable the arytenoid cartilages to slide away or toward each other and to rotate so that the vocal processes pivot either toward or away from the midline- these movement abduct and adduct the vocal ligaments

Which drugs work on the Action Potential Propagation in Neurotransmission?

This signal propagates through Voltage-gated Na+ chennels - Carbamazepine: drug for epilepsy* - use-dependent block (aka state-dependent block) Channel cycles from: - closed/resting (inside negative compared to outside -70mV) to - open (membrane potential changed- depolarized), to ** open state allows sodium to go through - inactivated (still depolarized but now channel blocked), to - closed/resting MOA: **Carbamazepine binds to inactivated channel and slows conversion to closed state - it PREVENTS high frequency firing- slows down action potential propagation

Thought and perception in Mental Assessment

Thought: 1. Content: - phobias - free-floating anxiety - obsessions - delusions - ideas of reference (it all refers to me) - magical thinking 2. Form or process - the way thoughts are orgnaized and expressed - normal: clear, logical, easy to follow & goal-directed vs.. Perception: Distortions - illusions (not always diagnostic- misinterpretating seeing someone at night) - hallucinations - depersonalization - derealization

Dura Mater: Dural Septa

Tough and inflexible, sensitive to pain, has its OWN blood supply * Separates compartments of the cranial vault * Restrict brain from displacement 1. Falx cerebri separates cerebral hemispheres 2. Falx cerebelli separates cerebellar hemispheres 3. Tentorium cerebelli separates cerebrum from the cerebellum Tentorial Notch: opening in the tentorium cerebelli that surrounds the midbrain

The axons of neurons in the CNS form

Tracts

Follicular Atresia

Typically around 20 follicles mature each month, but only a single follicle is ovulated - the follicle from which the oocyte was released becomes the corpus luteum - the rest undergo follicular atresia Involves: - apoptosis and detachment of the granulosa cells (regulating event) - autolysis of the oocyte (autolysis= destruction of cells or tissues by their own enzymes, especially those released by lysosomes) - collapse of the zona pellucida - macrophage invasion and phagocytosis of the debris

Motor Systems

UMN= Upper motor neuron - most cell bodies located in cortex, some in the brainstem LMN= Lower motor neuron - cells bodies located in brainstem, or spinal cord ** Association cortex, basal ganglia, and cerebellum send information to UMNs- Association cortex (ex. sensory) communicates directly with motor cortex (via cortico-cortical connections)- Basal ganglia and cerebellum send information to UMNs via thalamus

Development of Male Genital Ducts

Under influence of the Y chromosome, the Mesonephric (Wolffian) ducts (and tubules) persist and develop - as the mesonephros regresses, the excretory mesonephric tubules become epigenital and paragenital tubules --> Epigenital tubules contact rete testic and form the efferent ductules of the testis --> Paragenital tubules do NOT join and become the vestigial paradidymis The mesonephric duct becomes the MAIN genital duct in the male - from the efferent ductules, the mesonephric duct elongaates and convolutes to form the ductus epididymis - the mesonephric duct obtains a muscular coat and forms the ductus deferens - the later out-budding of the mesonephric duct is the seminal gland (vesicle) - the ejaculatory duct forms beyond the seminal gland - *** The mesonephric duct opens caudally into the urogenital sinus

Mullerian Fusion Abnormalities

Unicornuate: 1 horn of the uterus (restricted growth of the baby) Arcuate: dent at top of the uterues (little problems) Septate: septum divides the uterus (linked to recurrent miscarriages) Bicornuate: heart shaped Didelphys: RARE! 2 cervix, 2 uterus completely separate- can get pregancy like in unicornuate only in 1 horn PT will present with NO obstruction to menstrual blood flow.. so pts does not present with pain - decreased uterine musculature.. may lead to premature delivery - Septate uterus: septum is avascular and space occupying.. Implantation difficuties and recurrent miscarriage; excise **** Sepate can be distinguished on either a Hysteroscopy or 3D ultrasound - to fix this you do a hysteroscopic resection - sepatate has a unified uterine fundus *** Bicornuate uterus can be identified with an HSG, MRI of the pelvis or a laparoscopy of pelvis (bicornuate uterus has one cervix)

Superior Alternating/Webers/Medial Midbrain Syndrome

Unilateral damage to the ventral region of the midbrain caused by occlusion of the posterior cerebral/basilar arteries - results in superior alternating hemiplegia (ipsilateral oculomotor nerve palsy bc oculomotor nerve affected) & contralateral hemiplegia bc corticospinal axons affected ** can also affect corticobulbar axons and then hypoglossal functions and the lower muscles of facial expression on the contralateral side will be affected ** substantia nigra can also be compromised

Lesion to the corticospinal (pyramidal) tract at the thoracic spinal cord

Unilateral lesion - ipsilateral monoplegia Bilatearl lesion - paraplegia

Lesion to the corticospinal (pyramidal) tract at the cervical spinal cord

Unilateral lesion- Brown- Sequard Syndrome - Ipsilateral hemiplegia/hemiparesis (paired with loss of discriminative touch and pain perception) Bilateral lesion- damage to C4/C5 - Quadriplegia

Sound Intensity and Pain threshold

Unit: decibel, dB ~0 dB: softest sounds 120 dB: pain threshold >120 dB: dangerous 150 dB: tympanic membrane can rupture 160 dB: immediate physical damage (ex. jet taking off, jack hammer)

Venous drainage of the Pharynx and Larynx

Unlike the arteries, which arise frm the external carotid and thyrocervical trunk, the veins drain blood into the internal jugular vein (which drains to the brachiocephalic vein --> superior vena cava) - terminal branches match arterial names, i.e. sueprior laryngeal, superior and inferior thyroid, etc.

Venous drainage of pharynx and larynx

Unlike the arteries, which arise from the external carotid and thyrocervical trunk, the veins drain blood into the internal jugular vein (which drains to the brachicephalic vein) --> superior vena cava ** terminal branches march arterial names, i.e. superior laryngeal, supeiror and inferior thyroid, etc.

Optic Disc Abnormalities

Unmyelinated axons of the retinal ganglion cells pass through the sclera and aquire myelin sheaths to form the optic nerve ** remember the optic nerve is an extension of the CNS and therefore has meningeal coverings - the sclera creates the dural sheath and is lined by arachnoid and pia - subarachnoid space around the nerve communicates with the spaces around other parts of the brain *** Therefore, increased intracranial pressure can transmit to the nerve, compress it and cause edema=papilledema (Grade 1,2,4) ** Papilledema often occurs secondary to brain tumors or hemorrhage bc of associated increased intracranial pressure Signs of Papilledema include: - venous engorgement - blurred disc margins - elevation of the optic disc - hemorrhages of the vasculature

Brain Venous Drainage

Unpaired Venous Sinuses: - Superior Sagittal Sinus (main location of CSF return via arachnoid granulations) - Inferior Sagittal Sinus - Confluence of Sinuses (where they join together) - Straight sinus - Occipital sinus Paired Venous Sinuses: - Transverse Sinuses - Sigmoid Sinuses - Superior & Inferior Petrosal Sinuses - ** Cavernous Sinus (is located on BOTH sides of the sella turcica of the sphenoid bone) - Sphenoparietal Sinus ** these are ALL draining deoxygenated blood into the internal jugular vein

Upper Motor Neurons vs Lower Motor Neuron

Upper Motor Neuron (UMN): - Control lower motor neurons - cell bodies are located in the brain stem and cerebral cortex - axons descend to reach spinal cord and synapse on LMN or interneurons on the side opposite to their side of origin *** Most UMN fibers reach the spinal cord in the CORTICOSPINAL TRACT - other UMN arise from red nucleus, reticular formtion, and vestibular nuclei Lower Motor Neuron (LMN): - are located in ventral horn of spinal cord and cranial nerve motor nuclei of the brainstem - axons exit the spinal cord from the ventral root and join spinal nerves to synapse on skeletal muscle at neuromuscular junction

Which structure is vulnerable to injury during a hysterectomy due to its proximity to Uterine artery?

Ureter - Ureter travels INFERIOR to the uterine artery on its way to the bladder - "Water under the bridge"= ureter/urine underneath uterine artery - Ureter at risk of being clamped and ligated instead of uterine artery during hysterectomy (surgical removal of the uterus)

2 Triangles of the Perineum

Urogenital Triangle - area between ischiopubic rami and a line joining ischial tuberosities - contains urethra and external genitalia - anterior half of the perineum *contains structures of the urogenital (urinary and genital) system - roots of the external genitalia - in women, the openings of the urethra and the vagina - in men, the distal part of the urethra is enclosed by erectile tissue and opens at the end of the penis Layers of the urogenital triangle: - Deep perineal pouch - Perineal membrane - Superficial perineal pouch - Deep perineal fascia - Superficial parineal fascia Anal Triangle - area between coccyx, sacrotuberous ligaments and a line joining ischial tuberosities - contains anus (anal orifice and external anal sphincter) & ischioanal fossa

Finger-Nose-Finger (Pass-Pointing) Test

Used to help determine appendicular ataxia - pt is asked to alternately touch their nose and the examiner's finger as quickly as possible..tests for irregular wavering movements caused by limb weakness & abnormal movements caused by ataxia - Movement can be initiated, but execution is poor ***NOTE: often time both truncal and appendicular ataxia can exist in a patient

Oral Cavity Drug Administration

Used when rapid (<1min) absorption of drug is required where they are absorbed by simple diffusion - Drugs enter the sublingual vessels and or mucosa - The absorption potential of oral mucosa is influenced by the lipid solubility and therefore the permeability of the solution (osmosis) - Sublingual drug administration is applied in the field of cardiovascular drugs, steroids, some barbiturates and enzymes ** there is also Buccal Drug Administration

Uterine Blood supply

Uterine artery gives rise to the --> arcuate arteries (anastomose in the myometrium)--> radial arteries (basal layer)--> small straight arteries (supply the basal layers)--> coiled spiral arteries (functional layer)--> arterioles--> capillary bed including thin walled dilated lacunae--> drained by venules

Some clinical correlations related to the Vagina, Cervix, Uterus

Uterine prolapse - drooping/falling of uterus from its normal position due to weakness of pelvic floor muscles and the cardianl ligament (the cardinal ligament provides the MAJOR support for the uterus) Hysterectomy - surfical removal of the uterus (and sometimes with the ovaries) Culdocentesis - needle puncture of the posterior vaginal fornix to aspirate fluid from the rectouterine pouch (pouch of douglas or cul-de-sac of Douglas) Pap smear (Papanicolaou test) - screening test for cervical cancer by scraping cells from the opening of the cervix and examining them under a microscope - a speculum is inserted into the vaginal canal to gain access to the cervix

2nd layer of the eye

Uvea or Vascular coat ** This is the middle layer of the eye and consists of 3 parts: Iris, Ciliary Body, Choroid 1. Iris - Forms the colored, visible part of the eye in front of the lens - Is a contractile diaphragm that extends over the anterior surface of the lens--> regulates the amount of light that enters the eye - Light enters through a central opening called the pupil - The pupil is a hole, there is NOTHING there - It appears black becaus one looks through the lens toward the heavily pigmented back of the eye Consists of highly VASCULARIZED loose CT, contains: - scattered smooth muscle cells - melanocytes - fibroblasts ** Covered on its posterior surface by highly pigmented epithelial cells, the posterior pigment epithelium 2. Ciliary body - a ring-like thickening of the choroid - within the ciliary body is the CILIARY MUSCLE (*Contraction of the ciliary muscles changes the shape of the lens, which enables it to bring light rays from different distances to focus on the retina "accomodation") - ciliary body has ~70 ciliary processes that form the suspensory ligaments of the lens NOTE: - Zonule fibers are elastic fibers (contain FIBRILLIN) - ** Marfan's Syndrome: defect in FIBRILLIN- about 6 in 10 ppl with Marfan syndrome have dislocated lenses in one or both eyes 3. Choroid - contains mainy venous plexuses and layers of capillaries ** Highly vascularized layer that provides nutrients for underlying retina - loose CT containing fibroblasts - contains pigment, abundanct melanocytes give the choroid its characteristic black color (the melanocytes prevent the reflection of incident light) - the anterior rim of the uveal layer continues forward, where it forms the stroma of the ciliary body and iris NOTE: many of the nutrients for the retina come from choroid blood vessels

Blood Brain Barrier

Water soluble dyes that were injected into the peripheral circulation did NOT stain the brain or the CSF but collored the choroid plexus and the peripheral tissue - injected the same dye into the subarachnoid space: colored the brain and CSF but not the peripheral tissue BBB - a membrane that control the passage of substances from the blood into the CNS - it is composed of endothelial cells and tight junctions of the capillaries of the CNS - supporting cells of the brain, particularly astrocytes, are thought to be important in producing signals or biochemicals that induce tight junction formation in the endothelial cells *** important bc functions in preventing or slowing the passage of various chemical compouns, radioactive ions, and disease-causing organisms from the blood and into the CNS ** BBB is a benefit and a hindrance- keeps many compouns out, which can be good, but is a barrier when creating pharmaceuticals NOTE: a medical start-up compant CarThera in France, have opened and closed the barrier on demand with the help of an ultrasound brain implant and an injection of microbubbles- this allows chemotherapy drugs to enter and help destroy cancerous gliobastoma cells Disruptions: - failure to maintain the integrity of the BBB can lead to effects on the CNS - complete breakdonw of barrier function--> brain tumors - subtle barrier impairment without end organ damage--> disease states, MS, Alzheimers, HIV, stroke, diabetes, eating/weight disorders

Retrograde amnesia

a deficit in retrieving memories PRIOR to brain injury usually from "generalized" or broad lesions or trauma - Infantile amnesia: inability to remember episodic memories from before 3-4 yrs of age- limbic system and memory structures are not fully developed so events are not consolidated - Psychogenic amnesia: inability to recall episodes or personal information- usually of a traumatic, stressful or emotional experience- there is no apparent brain damage and is related to a psychological emotional response - Transient global amnesia: temporary, transient, loss of memory that is not related to any cause or condition like stroke, seizures or trauma

Larynx

a hollow musculo-ligamentous structure with a cartilaginous framework suspended from the hyoid bone superiorly and attached to the trache inferiorly - The larynx is both a valve that closes the lower respiratory tract and also produces sound Composition: - 3 large UNPARIED cartilages: cricoid, thyroid, and epiglottis - 3 pairs of smaller cartilages: arytenoid, corniculate, and cuneiform - A fibro-elastic membrane and many intrinsic muscles *** The angle between the two laminae is more acute in men (90 degrees) than in women (120 degrees) so the laryngeal prominence is more apparent in men than women NOTE: during swallowing, the dramatic upward and forward movements of the larynx facilitate closing the laryngeal inlet and opening the esophagus ** Cricoid= "ring-shaped"

Serotonergic Neurotransmission

a monoamine ** tryptophan used for synthesis in pre-synaptic into vesicles--> release via calcium dependent path--> post synaptic receptor changes signal transduction ** serotonin transporter reuptake into pre-synaptic (recycling)

Fovea Centralis

a shallow depression located about 2.5mm lateral to the optic disc - the visual axis of the eye passes through the fovea - *** Cones are highly cocentrated in the fovea - *** the area of greatest visual acuity Macula lutea: - a yellow-pigmented zone that encircles the fovea

Vagina

a musuclar tube lined by stratified squamous mucosa containing abundant glycogen - There is NO epithelial keratin layer (non-keratinized), BUT the mucosa is protected by an acid environment resulting from bacterial growth on a glycogen substrate supplied by the mucosa - The upper vagina merges with the uterus at the cervix NOTE: no glands in vagina- mucus in the vagina is produced by the cervical glands and greater vestibular glands (of Bartholin) 3 layers: 1. Mucosa - non-keratinized stratified squamous epithelium - lamina propria is rich in elastic fibers, commonly contains lymphocytes and neutrophil 2. Muscularis 2 indistinict layers of smooth muscle - inner circular - outer longitudinal 3. Adventitia - Dense CT rich in elastic fibers (form a strong elastic wall) and contains an extensice venous plexus, lymphatics and nerves

Menopause

a normal condition that all women experience as they age - Defined as the last menstrual period - Depletion of the follicle reserve - Preceded by ~4yrs of perimenopause, avg age of menopause is 52 yrs **Transition to menopause (perimenopause period) is associated with symptoms resulting primarily from reduced ovarian steroid synthesis. These include: - Mood swings - Headahces & migraine - Anxiety - Hot flashes, night sweat -Dyspareunia, vaginal atrophy - loss of libido - weight gain - fatigue - sleep issues - irregular bleeding - hair loss - dry skin HAVOC - Hot flashes, Anziety, Vaginal Atrophy, Osteoperosis, Coronary artery disease

Nucleus Solitarius

a series of sensory nuclei located in the brainstem and is responsible for receiving GVA signals and SVA taste signals from CN VII, CNIX, CN X Nucleus Ambiguus - is a group of large motor neurons that give rise to efferent voluntary motor fibers (BE axons) of CN X, which supply the laryngeal and pharyngeal muscles ** if supply to this region is interuppted, an individual loses the swallowing, cough & gag reflexes

Temporal Fossa

a shallow depression on the lateral aspect of the skull - it includes the scalp, tissues, muscles and neurovasculature that lie in this area superior to the zygomatic arch NOTE: the Pterion is in this region- this is the area of the skull that is thin. * the middle meningeal artery is located internally at this point and rupture can produce an epidural hematoma

Temporal Fascia

a strong fibrous layer that overlies the temporalis muscle- it originates from the superior temporal line and passes inferiorly where it fuses to the zygomatic arch

Gamma motor neurons

a type or lower motor neuron that takes part in the process of muscle contraction by innervating intrafusal muscle fibers ** Unlike alpha motor neurons, gamma motor neurons DO NOT directly adjust the lengthening or shortening of muscles Gamma motor neurons regulate SENSITIVITY of muscle spindle fibers so sensitivity of muscle fibers can be maintained during contraction - this role is important in keeping muscle spindles taut, thereby allowing the continued firing of alpha neurons, leading to muscle contraction **THEREFORE, sensory information is conveyed by primary type Ia sensory fibers and secondary type II fibers and motor innervation is conveyed by gamma motor neurons

In a non-pregnant cycle and in the

absence of hCG, luteal function declines dramatically after ~14days. The decline in progesterone production initiates menstruation If conception does occur during a cycle, the syncytiotrophblast cells of the implanting embryo secrete the hormone human chorionic gonadotroping (hCG) -hCG functions in a similar manner to LH, binding to LH receptors on the corpus luteum and stimulating progesterone and androgen production - In pregnancy, the corpus luteum does NOT undergo regression after 14 days - hCG "rescue" of the corpus luteum in early pregnancy is essential for pregnancy maintenance

Slow synaptic neurotransmitter

act primarily via GPCRS Only Some NTs have discrete pathways (NOT glutamate and GABA bc they work everywhere in the brain) - but there are pathways identified for others **** Know the locations of the following - Nuclei for cell bodies for Dopaminergic neurons: ventral tegmental area (VTA) and substantia nigra (SN) - Cell bodies for norepinephrine in Locus coeruleus - Serotonin cell bodies in Raphe nucleus - ACh cell bodies in the nucleis basalis of Maynert (cell bodies for cholinergic neurons)

Hydrocele

an accumulation of serous fluid in a body sac - A congenital hydrocele is a hydrocele that communicates with the peritoneal cavity through a narrow opening (patency of the processus vaginalis)- rarely, there may be an associated hernia - A hydrocele is formed if the patent processus is ONLY a small opening- in this case only fluid from the peritoneal cavity will pass down the processes- this causes the hydrocoele ** Transillumination allows for detemination if there is fluid in the scrotum - if fluid is present, the scrotum will allow light transmission and the scrotum will appear to light up with the light passing through - however, if scrotal swelling is due to a solid mass, then the light will NOT shine through the scrotum

Inhibin B acts directly on the

anterior pituitary to inhibit FSH secretion - Inhibin B is produced & released from Sertoli Cells in response to FSH stimulation - Heterodimer glycoproteins consisting of an alpha and beta subunit - classic negative feedback mechanism - secretion dependent on Sertoli cell proliferation, maintenance & spermatogenesis -- all these functions are regulated by FSH - Inhibin B levels correlate with total sperm count & testicular volume --> can be used as an index of spermatogenesis NOTE: - Inhibin B is produced and released from Sertolie cells in response to FSH stimulation - Inhibin B belongs to the family of glycoprotein hormones & growht factors - other members of this family include MIS and activins - there are 2 inhibins, inhibin A and inhibin B (both of which are heterodime glycoproteins consisting of an alpha- and beta- subunit - they have the same alpha subunit, but inhibin A has a Beta a subunit, while inhibin B has the beta b subunit - Inhibin B has a physiological role in males - the role of inhibin A in males is uncertain ** Primary function of inhibin B in males is to SUPPRESS the secretion of FSH from the pituitary in a classic negative feedback mechanism through binding to a membrane-spanning serine/threonine kinase receptor and reducing synthesis of the FSH-specific Beta-subunit Clinical correlation: - Serum levels of Inhibin B have been shown to correlate positively with total sperm count & Sertoli cell function- As such, assessment of serum levels of inhibin B provide a useful marker of male fertility

Cervical Plexus is formed by the

anterior rami of cervical nerves C1-C4 - Cervical plexus forms in the substance of the muscles making up the floor of the posterior triangle - it consists of muscular (deep) branches and cutaneous (superficial) branches ** The cutaneous branches are visible in the posterior triangle emerging from beneath the posterior border of the sternocleidomastoid muscle

During the early-mid follicular phase of the menstrual cycle, gonadotropins stimulate

antral follicle growth and steroidogenesis - Estradiol & Inhibin B exert negatic feedback on the H-P axis, reducing FSH & LH secretion ** Inhibin B acts at the pituitary gonadotropes to inhibit FSH secretion in a classic negative feedback mechanism - inhibins have no effect on hypothalamic GnRH NOTE: - in the early follicular phase of the menstrual cycle, antral follicle secrete estrogen which exerts negative feedback on the hypothalamic-pituitary axis, reducing GnRH, LH and FSH secretion

Mental Status Assessment

begins the moment you walk in the door It is critical the you evaluate: 1. patients appearance, behavior, mood, thought processes, speech and cognitive functions 2. whether the patient is suffering from psychosis 3. whether the patient is suicidal How do we do this? 5 pillars of mental status exam 1. general presentation 2. emotional state 3. thought and perception 4. judgment and insight 5. cognition

Ovaries are endowed with a fixed number of primordial follicles at

birth - As women age, the primordial pool depletes - Number of follicles initially & cyclically recruites decreases as ovarian reserve diminishes NOTE: During Optimal Gonadotropin Stimulation, which occurs from puberty to menopause, ~15 antral follicles are "rescued" just before the beginning of every menstrual cyclte (cyclic recruitment) to continue growing - Under continued gonadotropin sitmulation, one of these large antral follicles is selected to develop into the dominant Graadian follicle and undergoes ovulation- all other follicles (subordinate follicles) undergo atresia ** As females get older, the number of resting (non-growing) primordial follicle in the ovaries diminishes- As such, the number of follicles recruite to grow (initial recruitment) and rescued (cyclic recruitment) each month also declines as a women ages- Eventually depletion of the pool of resting follicles leads to ovarian follicle exhaustion and menopause (ovarian depletion)

Urethra conveys urine from the

bladder to the outside of the body - In males, the urethra also carries semen during ejaculation *About 20cm long; divided into - prostatic - membranous - penile ** Both the membranous and penile urethra are lined with stratified (or pseudostratifed in some parts) columnar epithelium - Prostatic urethra was lined with transitional epithelium (urothelium) - Towards end of penile urethra, transitions to non-keratinized stratified squamous epithelium

In placental development- Extraembryonic mesoderm that lines the inside of the cytotrophoblast is now known as the

chorionic plate - Connecting stalk is the only place where extraembryonic mesoderm crosses the chorionic cavity - Trophoblast layer develops primary villi which are a proliferation of the cytotrophoblast cells surrounded by the syncytium - Next, the mesodermal cells penetrate the core of the primary villi and grow towards the decidua basalis: and a secondary villus is formed ** These mesodermal cells then differentiate to form a villus capillary system: a tertiary villus is thus formed So at the beginning of week 3 (primary villus)--> secondary villus -- at end of week 3 we have a tertiary villus Capillaries in the tertiary villi now make contact with the capillaries that are developing in the mesoderm of the chorionic plate and the connecting stalk - these vessels will establish contact with the intraembryonic circulatory system that is forming Cytotrophoblastic cells reach deeper into the endometrium- they make contact with other cytotrophoblastic cells to form the outer cytotrophoblastic shell ** the shell eventually surrounds the entire trophoblast with the resutl that the fetus is firmly attached to maternal endometrial tissue

Micturition

coordination between the somatic motor system and autonomic nervous system with cortical, supraspinal and spinal inputs 1. Stretch receptors detect filling of bladder, transmite afferent signals to spinal cord 2. Signal return to bladder from spinal cord segments S2 and S3 via parasympathetic fibers in pelvic nerve 3. Efferent signals excite detrusor muscle 4. Efferent signal relax internal urethral sphincter- urine is involuntarily voided if not inhibited by brain 5. For voluntary control, micturition center in pons receives signals from stretch receptors 6. If it is timely to urinate, pons returns signals to spinal interneurons that excite detrusor and relax internal urethral sphincter- Urine is voided 7. If it is untimely to urinate, signals from pons excite spinal interneurons that keep external urethral sphincter contracted- urine is retained in bladder 8. If it is timely to urinate, signals from pons cease and external urethral sphincter relaxes- Urine is voided

Frontal lobe has to do with

decision-making, problem solving and planning - Temporal lobe: memory, emotion, hearing, and language - Parietal lobe: reception and processing of sensory information from the body - Occipital lobe: vision

Testosterone action in target cells can be

direct or indirect 1. Testosterone enters the cell & binds to the androgen receptor (AR)- direct 2. Intracellular testosterone can arise from weaker androgens (i.e. DHEA, Androstenedione) 3. Testosterone can be metabolized to estradiol by aromatase- Estradiol binds to its recepto (ER) in the same cell, in a neighboring cell, or enters the circulation exerting autocrine, paracrine or endocrine effects, respectively 4. Testosterone can be converted to DHT by 5alpha-reductase- DHT also binds AR, with a greater affinity than testosterone - DHT is the most potent activator of the androgen receptor, and the DHT-activated androgen receptor has a longer half-life, prolonging androgen action and amplifying the androgen signal - Distinct physiologic responses can, however, be atrributed to each hormone ** Testosterone, DHT and estradiol ALL bind to cytosolic steroid receptors- the cystosolic AR and ER is complexed to regulator proteins (heat-shock proteins)- Hormone binding results in the dissociation of the heat-shock protein complex, dimerization of the receptors, nuclear translocation, and DNA binding to regulatory elements - The final result is the activation of gene transcription

Triangles of the Neck are

divisions created by musculature The 2 major triangles (anterior & posterior) are further subdivided into smaller triangles Anterior Triangle: Base: inferior margin of the mandible Lateral border: sternocleidomastoid muscle Medial border: midline of the neck Subdivided into 4 smaller triangles: - Submental - Submandibular - Carotid - Muscular Posterior Triangle: Base: lateral 1/3 of clavicle Lateral border: trapezius muscle Medial border: sternocleidomastoid muscle Subdivided into 2 smaller triangles: - Occipital - Subclavian

Diplopia

double vision - Examination of eye movement is very important! - Lesions to peripheral nerves on one side can cause impairment of extraocular eye muscles, therefore disrupting voluntary movement of the eyes and binocular vision resulting in diplopia (can be vertical or horizontal in nature & very disruptive to everyday life)

Implantation of a zygote into the uterine wall involves invasion of the

endometrium by the syncytiotrophoblast around 7 days post fertilization - fertilization and early cleavage of the zygote to the morula stage occurs in the fallopian tube - after apprx 4 days, the zygote (now at the blastocyst stage) enters the uterine cavity and remains free-floating for apprx 3 days- Enzymatic digestion of the zona pellucida and infiltration of the endometrium by the syncytiotrophoblast result in implantation - trophoblast cells seek out and erode into maternal vessels, remodeling them into high capacity low resistance vessells - During these early stages of embryogenesis, endometrium is primed by progesterone secreted by the corpus luteum in the ovary in response to pitutary gonadotropin secretion. ST-derived hCG maintains the corpus luteum until placental synthesis of progesterone is established at 7-9 weeks of gestation. -Overall strategy of emergency contraception is to inhibit or delay ovulation (block the LH surfe by negatic feedback); if ovulation has already occurred, the other effects may decrease the oppotunity for fertilization and/or implantation - The zone pellucida (which surrounds the oocyte and embryo until hatching at fertilization) is formed during early folliculogenesis

Thinning and reduced viscosity of cervical mucus, coupled with increased vaginal secretions during intercourse

enhances sperm transport through the lower portion of the femal reproductive tract - ability of cervical mucus to be stretched between the fingers is indicative of a receptive, estrogen-primed cervix - slight contractility of the uterus aids in sperm transport through the endometrial lumen - cilia beat frequency becomes rhythmical and secretions increase in the fallopian tube, which enhances both sperm and oocyte transport- decreased vaginal secretions, predecidualization of the endometrial stroma and decreased uterine contractility are all effects induced by progesterone during the secretory phase of the menstrual cycle associated with preventing "late" fertilization and are not associated with enhacing ovulation

During the late follicular phase of the menstrual cycle, gonadotropins stimulate growth and maturation of a dominant graafian follicle which secretes large amounts of

estrogen * Estrogen now exerts POSITIVE FEEDBACK on the H-P axis, stimulating a surge in LH & FSH, which induces ovulation apprx 24 hrs later LH & FSH stimulation of the TCs and GCs of the dominant follicle induces changes in gene expression - this results in OVULATION with release of the oocyte & surrounding cumulus cells into the peritoneal cavity and development of Corpus luteum (CL) ** Cumulus oocyte complex (oocyte+ surrounding cumulus cells released at ovulation)

For most tissues, the blood supply IS the source for

external fluid-borne material to reach a tissue, but this is NOT the case in the hypothalamus - for the paraventricular nucleus in particular, the third ventricle is another highway into the hypothalamus, for good or ill carrying its own combination of function-modifying chemicals into the center of this entire structure

Preantral follicle growth is INDEPENDENT of

external influences, while antral follicle growth requires gonadotropins ** During the preantral developmental stage, follicles are endowed with the "potential" to respond to gonadotropins and synthesize hormones- necessary for further (antral) growth SO - Intraovarian factors are necessary and sufficient for follicle growth to the late secondary/preantral stage - Gonadotropins (LH & FSH) are necessary for follicle growth to proceed beyond the preantral stage of development

Menstruation

first phase of the menstrual cycle (days 1-5) during which the functional endometrial layer which has built up the proliferative and secretory phase of the previous cycle falls away (sloughs off) and is discharged from the body - duration of menstruation (aka the menstrual period) varies a lot between women but avg. 2-5 days

The seminal vesicles are NOT reservoirs for sperm, they are

glands - that produce a yellowish secretion that contains spermatozoa-activating substances such as carbohydates, citrate, inositol, prostaglandins, and several proteins *** Main carbo is fructose, main energy source for sperm motility ~70% of ejaculate is from seminal vesicles NOTE: Seminal vesicles appear as honeycombed saccules with thin, highly branched folds of mucosa, lined by pseudostratified columnar epithelium - the saccular dilation of the gland--> its contraction expels the accumulated secretion during ejaculation

In non-pregnant women, the secretion of prolactin is

kept tonically suppressed by secretion of dopamine frrom the hypothalamus - PRL is the main hormone fo lactation - Hormone levels increase early in pregnancy due to the influence of estrogens - HOWEVER, lactation does NOT occur early in pregnancy bc estrogens and progesteron inhibit the interaction of prolactin with receptors located on the alveolar cell membranes - At term, estrogen and progesterone levels decrease, dopamine levels decrease, PRL levels increase and milk production begins after delivery

Most, though not all, sensory (ascending) and motor (descending) tracts cross from one side of the nervous system to the other - this has the interseting functional consequence that the

left brain controls the right body and the right brain controls the left body *** For this reason, lesions/trauma on one side of the neural axis can result in symptomseither on same side (ipsilateral) or opposite side (contralateral) to the lesion *** Left and Right sides of the brain are connected by bundles of axons called commissures (crossings occur in commissures) - Decussations= crossings

Progesterone withdrawal stimulates

menstruation - decreased progesterone at the end of the luteal phase owing to corpus luteum regression is termed "progesterone withdrawal" Levels <5 ng/mL stimulate menses/menstruation Physiologically normal menstrual cycle parameters: ~80mL (3oz) of non-clotting blood & endometrial tissue expelled from the vagina over ~2-5days - menstruation typically occurs every 21-35 days (mean 28 days) Abnormal uterine bleeding (AUB)- is menstrual bleeding outside of these normal parameters **these progesterone withdrawal occurs naturally at the end of the luteal phase of the menstrual cycle due to regression of the CL (or when progesterone containing contraceptives are withdrawn) ~80mL of menstrual fluid is lost

Age-related Macular Degeneration

often called AMD or ARMD is the leading cause of vision loss and blindness among americans who are age 65 and older - Exact cause unknown, but evidence suggests both genetic and environmental (UV irragiation, drugs) components - The disease causes loss of central vision (in the macula lutea), although peripheral vision reamins unaffected Two Forms: - Dry (atrophic, nonexudative) form, most common form - Wet (exudative, neovascular) form (considered a complication of dry form) Age-related macular degneration begins with characterstive yellow deposits in the macula called drusen between the retinal pigment epithelium and the underlying choroid - causes atrophy and depigmentation of RPE, and obliteration of capillaries in the underlying choroid layer ** These changes lead to deterioration/death of cones in macular resulting in the formation of blind spots in the visual field - Wet ARMD is a complication of dry ARMD caused by neovascularization of blind spots of the retina in large drusen - these newly formed, thin, fragile vessels frequently leak and produce exudates and hemorrhages in the space just beneath the retina, resulting in fibrosis and scarring

First stage of labor corresponds to the time from

onset of labor to full cervical dilaiton - It is divided into 2 phases: the latent phase describes cervical effacement and dilation to 3cm; the active phase corresponds to the period of rapid cervical dilation from 4-10cm (fully dilated) The second stage of labor corresponds to the time form complete cervical dilation to delivery of the fetus The third stage of labor corresponds to the delivery and expulsion of the placenta (after fetal delivery)

From the lateral geniculate nucleus, axons enter the white matter forming

optic radiations and at this point the visual fields are carried as quadrants There are 2 streams of optic radiations: 1- Parietal stream terminates in the cuneus: this radiation is carrying information from the superior retinal quadrant (inferior visual field) 2- Meyers loop, or temporal stream, terminates in the lingual gyrus- this radiation is carrying information from the inferior retinal quadrant (superior visual field) *** Visual field is separated into quadrants In the RIGHT calcarine sulcus and primary visual cortex (area 17): - The cuneus is receiving the LEFT INFERIOR visual field quadrant for each eye - The lingual gyrus is receiving hte LEFT SUPERIOR visual quadrant for each eye ** NOTE: that the fovea (area of highest visual acuity) recieves more neurons in the cortex SO the LEFT Meyere Loop will have axons from the RIGHT superior visual fied from each eye ** REMEMBER: that the visual fields end up "upside down and backwards" on the retina--> so the inferior retina process the superior visual field

The ascending and descending pain pathways naturally modulate pain signaling and therefore provide targets for

pain treatment Drug targets: - Neurotransmitters and other molecules that cause pain (prostaglandins, glutamate, substance P, and other neuropeptides) - Neurotransmitter systems that suppress pain signaling (endorphins, enkephalins, and NE) ** Drugs can alter the release of these NTs or act as direct receptor agonists or antagonists ** Further, inflammatory responses at the site of tissue injury can be targeted to give pain relief ** Inflammatory mediators cause pain (increased substance released from injury to extracellular environment --> activate or sensitive pain neuron (ie substance P, histamine, bradykinin, H+, CGRP etc)

Estriol is

produced by the placenta after the luteal-placenta shift - and can be identified easily on a graph due to the rapid rise beginning at approximately 8 weeks of gestation, since estriol levels are very low (and possibly undetectable) before pregnancy. In non-pregnant women, estriol is produced as a byproduct of estradiol and excreted, and therefore most women have very low circulating levels of estriol. During pregnancy, large amounts of estriol are produced by the placenta, due to the metabolism of the large amount of DHEAS produced by the fetal adrenals. Estriol levels can increase about 1000-fold during pregnancy. Recall that estriol is recognized as the 'estrogen of pregnancy'. Chorionic gonadotropin is detectable within 1 week of pregnancy - and peaks at during the first trimester. Remember that the luteal-placental shift indicates a functional placenta and is associated with increasing levels of estriol and falling levels of hCG and 17-OH progesterone (A). The plasma concentration of Estradiol, Estrone, Progesterone and Prolactin all exhibit very similar patterns during gestation. The hormones all increase during gestation and peak just before or at parturition. Note that all of these hormones are produced in maternal tissues prior to pregnancy and therefore, these hormones never start at a concentration of 'zero' (B, D, F, G). The concentration of hPL also increases during gestation - however, hPL is produced by the growing placenta and is detectable in serum at approximately 4-5 weeks of gestation (E).

Corproa Amylacea are

prostatic concreions, composed of glycoproteins, which may become calcified - they are characteristic of the prostate gland - their numbers increase with age - they are thought to be harmless

The eyelid covers and protects the eyeball and is strengthened by the

superior and inferior tarsal plates, which are dense bands of CT with muscles above: Levator Palpebrae superioris Muscle: - Inserts into the superior tarsus and the skin of the superior eyelid and raises the eyelid - Innervated by CNIII Superior Tarsal Muscle: Consists of smooth muscle fibers, deep to the insertion of the levator palpebrae superioris - Functions to keep the upper eyelid raised after the levator palpebrae superioris has raised it ** Sympathetic Innervation: superior cervical ganglion --> axons travel on internal carotid plexus --> ophthalmic plexus --> oculomotor nerve (superior division)

The Sertoli and Leydig Cells are the two principal cell types responsible for

testicular function Sertoli cells: - support spermatogonia - form blood-testes barrier - Mullerian Inhibitng Substance (MIS) - Androgen Binding Protein (ABP) - Have FSH receptors - Secrete Inhibin B ** FSH supports spermatogenesis and stimulates Inhibin B secretion (Inhibin B, a peptide hormone, enters the circulationa nd acts on the anteiror pituitary to inhibit FSH release- classic negative feedback loop) Leydig Cells - Have LH receptors - Produce Testosterone ** Leydig Cells respond to LH stimulation by secreting Testosterone- the primary male androgen ** Testosterone enters the circulation and acts on the anterior pituitary to inhibit LH release on the hypothalamus to inhibit gonadotropin releasing hormone (GnRH) release

In males- aging is associated with a natural decline in

testosterone bioavailability - because SHBG increases Declining testosterone results in hypogonadal symptoms & declining male health: - anemia - decreased bone and muscle mass, energy, and libido & sexual function Benefits of testosterone replacement: - in older men with low serum testosteron & hypogonadal symptoms remain unclear - Potential harmful effects include exasperation of androgen-dependent diseases (ex. prostate cancer, benign prostatic hyperplasia) ** There is no shapr "andropause" in men, instead there is a gradual decrease in total and free testosterone in the circulation

Hypogonadism is the main reson for

testosterone replacement - Secondary or primary hypogonadism - Secondary issue in pituitary or hypothalamus but testis still work (low testosterone- feed back loop wont be taking place- no LH or FSH in response to low testosterone) - Primary hyogonadism: problem with testes- FSH and LH being released but damage to testes/issue with testes there is no testosterone produced in response to these high levels (low testosterone, high LH and FSH)

Posterior Cord Syndrome would affect

the Dorsal columns- leading to loss of vibration and position sense loss (loss of touch, pressure, vibration)

BBB

the brain is protected environment - blood cells, blood proteins, etc are excluded - ions, small molecules have regulated entry ** endothelial cells with tight junctions - no aqeous channels- also have pericytes and astrocytes so substance must also cross this layer to access other components of brain - Na+/K+ ATPase and glucose tranporters - and substances in blood need transporters to get through to the brain

Choroid plexus can be located in

the lateral ventricle, interventricular foramina, 3rd ventricle, 4th ventricle, so CSF can be produced there and enter the circulation *** Choroid plexus is NOT usually found in the cerebral aqueduct

Rhodopsin

the photoreceptor protein of rods, is a seven-helix, G-protein-coupled receptor with a light- absorbing chromophore, 11-cis retinal, covalently attached ** retinal goes cis --> trans; activated retinal taken up by RPE and regenerated NOTE: in dark there is HIgh cGMP levels--> cell depolarize in light there is decreased cGMP levels --> cell hyperpolarize

Posture

the position of the body

Platysma

thin, superficial muscle that drapws over the neak and mandibular region- it can extend over the clavicle to the deltoid Fx: can pull down the mandible, which opens the mouth and can pull the corners of the lips out to the side and down, which forms a frown ** it contributes to wrinkles with age as the skin sags and is less elastic ** this is a muscle of facial expression

TSH works on thyroid gland releases

thyroid hormones ACTH on adrenal cortex --> adrenocortical hromones FSH and LH on testis and ovary --> testosterone and estrogen LH on testis and ovary releases estrogen and progesterone Prolactin --> ovary and breast--> estrogen and progesteron Growth factor --> bone, muscle, organs and diabetogenic factor works on fat tissue MSH --> skin (melanocytes) **** all these first hormones are beind secreated from hypothalamus *** review this from endocrine

Throughout the reproductive lifespan of women (puberty to menopause) a single oocty is ovulated each month- all other oocytes

undergo atresia (apoptosis) - Mid-gestation there are ~7million oocytes - At birth there are 1-2million follicles - Reduced to <400,000 follicles at menarche - 400-500 dominant follicles selected for ovulation **99.9% of a woman's follicles undergo ATRESIA ****** Depletion of ovarian follicles results in the end of menstrual cyclicity & cessation of ovarian hromone production - less than 40 yrs: premature ovarian insufficiency - greater than 40 yrs: menopause NOTE: Age at the onse tof menopause has a strong genetic component, but is also influenced by environemental factors, ex. cigarette smoking significantly depletes the ovarian resereve ** An overly rapid rate of atresia or development will deplete the reserve and give rise to premature ovarian insufficiency (POI) Common misconception: missing menstrual periods or contraceptive use does NOT "save" follicle or lengthen" reproductive years- groups of primordial follicles are continuously entering the growth phase in females- If gonadotropins are insufficent when the follicles reach the late antral stage to stimulate antral development, the follicles undergo atresia

Prostate Gland surrounds the

urethra as it exits the urinary bladder - it consists of 30-50 discrete branched tubuloalveolar glands that empty their contents via excretory ducts into the prostatic urethra - the prostate is surrounded by a fibroelastic capsule rich in smooth muscle - septa from the capsule penetrate the gland and divide it into lobes - the glands produce prostatic fluid and store it for expulsion during ejaculation

In stained sections, cell bodies appear

white and axons dark ** In wet sections, cell bodies appear dark and axons white ** Remember: - Grey Matter: consists of neuronal cell bodies, dendrites and interneurons - White Matter: consists of myelinated axons *** In the Spinal Cord we will always be looking at a stained section so the Grey matter is internal and the white matter is external ** In the brain in a wet section: - Grey matter is external - White matter is internal