Exam 1 Lecture Objectives

Know all cranial nerves (CN), their location, function, and if they are categorized as being motor, sensory, or both regarding function

(S) CN.I - Olfactory Nerve (Smell) (S) CN.II - Optic Nerve (Sight) (M) CN.III - Oculomotor Nerve (Eye movement; pupil constriction) (M) CN.IV - Trochlear Nerve (Eye movement) (B) CN.V - Trigeminal Nerve (Touch & pain/chewing; Opthalamic, Branch, Maxillary Branch, Mandibular Branch) (M) CN.VI - Abducens Nerve (Eye movement) (B) CN.VII - Facial Nerve (Facial Expressions) (S) CN.VIII - Vestibulocochlear Nerve (Hearing & Balance/Understanding space) (B) CN.IX - Glossopharyngeal Nerve (Tongue & Pharynx) (B) CN.X - Vagus Nerve (Digestive System) (M) CN.XI - Accessory Nerve (Head movement) (M) CN.XII - Hypoglossal Nerve (Tongue)

Know the Clinical significance of atherosclerosis. How is this formed?

*Atherosclerosis:* Narrowing of the arterial wall due to lipid deposition, formed by fat/lipid entering in arterial wall

Know the clinical significance of the following: Cleft palate and Cleft lip.

*Cleft Palate* - Fusion failure of the palatine process, nasal bone, and/or median palatine process (requires surgery; could be caused from increased steroid exposure or other factors unknown) (most common kind of posterior cleft palate) *Cleft Lip* - Fusion failure of the maxillary/medial nasal processes causing uni/bilateral labial groove (requires surgery)

Know the difference compact and spongy bone, including location of each. Where would you expect to find red bone marrow?

*Compact Bone:* Dense outer layer, the middle long shaft of bone *Spongy Bone:* Internal network on the ends of bone that house trabeculae, in which red bone marrow production occurs

Know the paired and unpaired bones of the skull

*Cranial:* PB: Temporal & Parietal UPB: Occipital, Frontal, Sphenoid, Ethmoid *Facial:* UPB: Mandible & Vomer PB: Maxillae, Nasal, Lacrimal, Inferior Nasal Conchae, Palatine, Zygomatic

Know all the structures of the eye: external, and within the anterior and posterior chambers

*External Eye Structure* 1. Cornea (anterior & transparent) 2. Lens (posterior to iris, pupil) 3. Optic Nerve (posterior; medial to optic axis) Anterior Chamber - Bordered by cornea, iris, & lens (contains aqueous humor; clear fluid) Posterior Chamber - Behind lens (vitreous body; jelly substance w/ H2O and holds eye open)

Know the Clinical significance of the following: Horner's Syndrome, Direct and Consensual Light Reflex, Glaucoma, and Cataracts

*Horner's Syndrome:* Classic triad (miosis/constricted pupil, partial ptosis, hemifacial sweat loss/anhidrosis) *typically see one normal eye, while the other eye has miosis, weaknesses of eyelid, sagginess in eye* *Direct & Consensual Light Reflex:* Shows ability of CN.III, where light in shone in 1 eye, and the other eye covered still constricts (ipsa/contralateral constriction) is NORMAL and is lost if head trauma occurs *Glaucoma:* Increase of intraocular pressure and retinal flow, causes blindness and retinal ganglion cell loss (impaired drainage of aqueous humor) *Cataracts:* Progressive generation and opacity of lens due to deposited aggregated proteins, leads to blindness or vision impairment

Know the Clinical significance of hydrocephalus and meningitis. What causes these conditions? How are they diagnosed? How are they treated?

*Hydrocephalus:* Excess buildup of CSF in the ventricle system (due to overproduction or decreased reabsorption of CSF) - Diagnosed w/ notable swelling is seen in children (mainly) and adults - Treated by installing a shunt and valve that connects the abdominal cavity and swelled location to drain CSF *Meningitis:* Inflammation of the meninges -Diagnosed w/ CSF -Treated by having patient curl in fetal position, locate the L4 and L5 vertebrae in which a catheter is placed to reach the subarachnoid space, and proper medication is given whether it be due to viral or bacterial infection

Know the two types of bone ossification, and when each occurs during growth and development; which bones are developed through each physiological method

*Intramembrane Ossification (Membrane Bones):* Happens during fetal development, flat bone is developed (skull, clavicle, etc), derives from mesenchyme *Endochondral Ossification (Other Bones):* Happens in all stages of life, helps with bone repair, derives from hyaline cartilage

Know the contents of the middle and inner ear

*Middle Ear:* 1. Malleus 2. Incus 3. Stapes ***Auditory Ossicles - transmit sound from middle --> internal 4. Tensor Tympani Muscle 5. Stapedius Muscle *Inner Ear:* 1. Labyrinth (Outer boney labyrinth, perilymph, and filled w/ endolymph) ***located by petrous portion 2. Oval Vestibular Window (middle of boney labyrinth) 3. Vestibule (membranous saccule and utricle that carry sensory epithelium and help with balance/movement) 4. Cochlea (containing Organ of Corti; helping w/ sound production)

Know the different type of neurons and glial (aka neuroglia) cells in the PNS and CNS, as well as their function

*Neurons/Neuroglia In PNS:* - Satellite Cells: Form the myelin sheath around soma in the ganglia - Schwann Cells: Form myelin sheath around axons - Sensory (Unipolar & Bipolar Cells) *Neurons/Neuroglia in CNS:* - Astrocytes: abundant, extract blood sugar, control neuron environment, synapse formation, propagate Ca2+ signals (memory), sense glutamate release, aid neuronal growth - Microglia: small/less abundant, phagocytes (aka the macrophages of CNS), engulf invaders and dead neurons, derived from monocytes (BC's), go to CNS during fetal periods - Ependymal: line center cavity of brain/spinal cord to help circulate cerebrospinal fluid - Oligodendrocytes: Wrap processes around axons to form myelin sheath - Interneurons & Motor (Multipolar Cells)

Know the Clinical significance of the following: osteoporosis, osteomalacia, osteosarcoma, and arthritis

*Osteoporosis*: Decline in bone mass in which bone reabsorption outpaces bone deposit (will typical occur to women after menopause due to estrogen that helps maintain bone density) *Osteomalacia*: Bone inadequately mineralized (doesn't harden completely) *Osteosarcoma*: Type of bone cancer *Arthritis*: Numerous joint-damaging diseases

What is the Clinical significance of Otis externa and Chronic Otitis media? How is a myringotomy used to treat the later of the two conditions?

*Otitis Externa:* swimmers ear; may cause bone hyperplasia (degeneration of bone) & narrowing of meatus *Otitis Media:* infection of the middle ear *Myringotomy:* Incision is made in tympanic membrane to insert drainage tube for pus/secretions; will come out on its own

What are the names, functions, and locations of the paravertebral muscles?

*Rectus capitis* - flexes head *Longus capitis* - bends head forward and sideways *Longus coli* - brings spinal area forwards and sideways

Know the locations and innervations of the following muscles: sternocleidomastoid, infrahyoid muscles, suprahyoid muscles, genioglossus, styloglossus, and hyoglossus

*Sternocleidomastoid* - Long muscle connecting sternum to styloid/mastoid processes (Innervation: CN.XI - Accessory Nerve) *Infrahyoid Muscles* - Sternohyoid, Sternothyroid, Thyrohyoid, Omohyoid (Innervation: Cervical Ansa C1-C3) *Suprahyoid Muscles* - Mylohyoid, Stylohyoid, Geniohyoid, Digastric Muscles (Innervation: CN.V & CN.VII - Trigeminal & Facial Nerve) **ANTERIOR DIGASTRIC IS ONLY CN.V)** *Genioglossus/Styloglossus/Hyoglossus* - Areas of the tongue (Innervation: CN.IX - Glossopharyngeal Nerve)

What is the location, innervation and function of the tensor tympani and stapedius muscles? Which is important in the development of hypercusis?

*Tensor Tympani* - Helps keeps the tympanic membrane tense so that sound can reverberate (Innervation: CN.V) *Stapedius Muscles* - Help regulate sound transmission (Innervation: CN.VII) *Hyperacusis* - Increased sensitivity to sound due to loss of stapedius muscle function (helps to dampen sound stimuli)

Within the meninges, where would you find cerebral spinal fluid (CSF)? How is CSF "produced?" How is CSF recycled back into the blood? What is the importance of the choroid plexus? Where is it located?

-CSF is located within the subarachnoid space in the brain and spinal cord -CSF is produced by the Choroid Plexus -The Choroid Plexus is located in the 3rd and 4th ventricle that allows CSF to be filtered from the blood by having modified ependymal cells work with the capillary endothelium for the CSF to enter through the sagittal sinuses, get filtered from blood and metabolic wastes and enter bloodstream through dural sinuses

Know the organizational structure of skeletal muscles

1. Epimysium 2. Perimysium 3. Fascicles 4. Endomysium 5. Muscle Fibers/Cells 6. Myofibrils

What are the names, locations, and innervations for the extraocular muscles?

1. superior rectus (CN.III) 2. inferior rectus (CN.III) 3. medial rectus (CN.III) 4. lateral rectus (CN.VI) 5. inferior oblique (CN.III) 6. superior oblique (CN.IV)

Know the location and function of the paranasal sinuses

Air filled sinuses surrounding nasal cavity (frontal, ethmoid, sphenoid, maxillary bones) that warm and moisten inhaled air, help w/ sound resonance & making head lighter

Know the following direction-related terms: anterior/posterior; superior/inferior; proximal/distal; rostral/caudal

Anterior/Poster - Front/Back Superior/Inferior - Above/Below Proximal/Distal - Towards trunk/attachment/Away from trunk/attachment Rostral/Caudal - Towards head/Towards tail

How could the facial artery and cavernous sinus be involved in the development of encephalitis or meningitis?

B/c the facial artery connects with the facial vein that has an anastomoses (connection) w/ the angular vein --> this leads to a connection point @ cavernous sinuses and since the brain sits directly on top of it, infections or bacteria that enter that connection point in the facial veins can now enter the brain and cause encephalitis or meningitis

What is the sensory innervation of the face?

CN.V - Trigeminal Nerve (Ophthalmic/Maxillary/Mandibular Branches)

Know the Clinical significance of brain tumors.

Can grow in several locations and symptoms will depend on size and shape and these can damage the brain (metastasis from primary tumors can be released in the brain aka cancer cells)

What are the seven bones that form the eye orbit?

Frontal, Sphenoid, Zygomatic, Maxillary, Palatine, Lacrimal, and Ethmoid

What is the lacrimal apparatus, and where is it located?

Located in the superolateral portion of the eye, tear production occurs (lacrimal gland produces tear --> goes through puncta lacrimalia --> into lacrimal canal --> enters lacrimal sac --> nasolacrimal duct --> runs down inferior nasal meatus)

Know the names, locations, and innervation for all mimetic muscles (Spoiler alert: they are ALL innervated by CN VII- facial nerve)

Mimetic Muscle Groups (4): *Scalp -* 1. Epicranious (occipitofrontalis): wrinkles in the forehead; astonishment *Eyelids -* 1. Corrugator Supercilli: vertical folks, protects against light; thinker's brow 2. Orbicularis Oculi (orbital/palpebral/lacrimal): lateral folds; concern *Nasal -* 1. Nasalis *Mouth -* 1. Orbicularis Oris: closing mouth, sucking shape w/contraction 2. Zygomaticus Minor 3. Zygomaticus Major: lifts corners of mouth up; laughter/pleasure 4. Risorius: w/ zygomaticus major, produces nasolabial folds; laughing muscle 5. Levator Labii Superioris 6. Depressor Labii Inferioris: pulls lower lip down; perseverance 7. Levator Anguli Oris: lifts corners of mouth; self confidence 8. Depressor Anguli Oris: pulls corners of mouth down, sadness 9. Buccinator: blows air out mouth, keeps mucous membrane free from folds 10. Mentalis: chin lip furrow; doubt/indecision 11. Platysma: tenses anterior neck skin

Know the names, locations, and innervations of the muscles of mastication

Muscles of Mastication: - Temporalis (elevator of lower jaw) - Masseter (closes jaw by elevating mandible) - Lateral Pterygoid (guiding mandibular movements) - Medial Pterygoid (elevates and pushes mandible forward) Innervations of MoM: CN.V - Trigeminal (Mandibular Branch)

Understand how a neuron interacts with a skeletal muscle fiber to cause a contraction; know the importance of the neuromuscular junction

Nerve ending releases neurotransmitter (Acetylcholine) to skeletal muscle cells --> travels Synaptic Cleft and binds with receptors --> Action Potential occurs --> enacts the process of producing the release of Ca2+ --> Binds with Actin in the myofibrils and interacts with Myosin --> being muscle contraction

Within the inner ear, what structure is considered the organ of balance? Which is considered the organ of hearing?

Organ of Balance: Vestibule (Sacculi, Utriculi, & Labyrinth) Organ of Hearing: Organ of Corti (in cochlea where sound is produced)

Know the blood supply and drainage of the head and neck.

Starts from the common carotid artery and vertebral arteries (*Circle of Willis*) that bring blood up in the head and is drained out into the internal jugular (*FACIAL blood supply comes from the external/internal carotid artery where facial artery SUPPLIES and facial vein DRAINS to jugular vein*)

Know the location and innervations of the salivary glands.

Sublingual Gland Submandibular Gland Parotid Gland *All innervated with CN.IX - Glossopharyngeal Nerve and VII - Facial Nerve*

What is the Clinical significance of the TMJ?

TMJ - Temporal Mandibular Joint TMJ Syndrome - Acute/chronic pain in the TMJ or mastication join (where condylar process and temporal bone meet)

What is the location, function, and hormones produced by the thyroid and parathyroid glands?

Thyroid Gland - capsule covered in sheath consisting of the isthmus (right and left lobe) *releases Thyroxin (metabolism) and Calcitonin (Ca2+ blood metabolism)* Parathyroid Gland - release parathyroid hormone (PTH) to stimulate osteoclasts in breaking down bone matrix and releasing Ca2+ into blood (parahormone)