Three closing of the mouth muscles
Temporalis
Masseter
Medial pterygoid
Name the attachments of the jaw closing muscles
Temporalis- temporal fossa to the coronoid process of the mandible
Medial pterygoid- angle of mandible to the pterygoid plates on the sphenoid bone
Masseter- angle of mandible to the zygomatic arch
Jaw opening muscle and its attachment
Lateral pterygoid- condyle process of mandible to pterygoid plates on sphenoid bone.
Describe the nervous innervation of the mouth, nasal cavities, oro and laryngopharnx, glands etc.
CN V1 supplies the anterior part of the nasal cavity
CN V2 supplies the posterior part of the nasal cavity
CN V2 also supplies the superior half of the mouth
CN IX supplies the nasopharynx and oropharnx along with the parotid gland.
CN X supplies the layngopharynx and trachae
CN VII supplies both the sublingual and submandibular gland.
The tongue- anterior 2/3rds supplied by CN V3. Posterior 2/3rds supplied by CNX
Name the four external muscles of the tongue
Hyoglossus- posteriorly under the tongue
Genoglossus- big ass muscle under the tongue
Palatoglossus- attaches to the roof of the mouth then onto the tongue
Styloglossus- attaches towards the back of the roof of the mouth onto the tongue.
What are the external muscles of the tongue responsible for?
Position of the tongue
What are internal muscles of the tongue responsible for?
Shape of the tongue
Which nerves supplies the extrinsic muscles of the tongue
CN XII
Muscles of the pharynx
Internal longtidinal muscles- allow the movement of the larynx upwards closing the laryngeal inlet
External constrictor muscles- overlap each other and contract sequentially. Divided into superior, middle and inferior.
Constrictor muscles are supplied by?
Cranial nerve X
Longitudinal muscles supplied by?
Cranial nerve IX and X
Which muscle closes the lips and which nerve is it supplied by?
Orbicular oris and supplied by CN VII
Describe the process of swallowing
Lips close (orbicular oris muscle) Tongue pushes bolus of food backwards towards oropharynx Sequential contraction of the pharyngeal constrictor muscles to push food bolus inferiorly At the same time the inner longitudinal muscles shorten, closing the laryngeal inlet.
Location of upper oesophageal sphincter
c6
Called the cricopharyngeus
Roth spots
Retinal haemorrhage- due to bacterial endocarditis
Quincke’s sign
Alternate flushing and blanching of the nail bed due to pulsation of sub-pappillary arteriolar and cappilary nail beds.
Sign of aortic valve insufficiency
Oslers nodes
Painful nodules on the pulp of the terminal phalanges of the fingers and toes.
Caused by bacterial endocarditis
Kartagener syndrome
Rare genetic ciliopathy of the cilia lining the respiratory tract
Abnormal ciliary action can cause chronic sinusitis and bronchitis
Raised J waves
Hyperthermia
Aortic co-arctation
Best heard left of the scapula
Wilsons disease
Copper deposits- familial condition. May be associated with dementia
Features common in all eukaryotic cells
An outer membrane An inner cytosol A cytoskeleton Membrane bound organelles Inclusions
The plasmalemma
Seperates the cytoplasm from the outside environment. Bimolecular layer of amphipathic molecules.
Membrane proteins in the plasmalemma
Can diffuse laterally however are anchored down. Therefore protein distribution may be uneven.
Inclusions
Dispensible and may be present only transiently. Represent components that have been synthesised by the cell itself.
What makes up the cytoskeleton?
Microfilaments
Intermediate filaments
Microtubules
Microfilaments
Made of actin fibres. Can assemble and desemble quiclly. Very dynamic
Intermediate filaments
Composed of 6 main proteins. Bind intracellular elements together in the plasmalemma
Microtubules
Composed of two tubulin subunits, alpha and beta. Originate from a centrosome and grow towards the periphery. Act as the motorway network of the cell. Two proteins, dynein and kinesin associate with organelles or molecules and drag them. Kinesin moves towards the periphery whereas dynein moves towards the centre.
The nucleus
Contains chromosomes and is the location of RNA synthesis
Enclosed by two membranes with nuclear pores. Between the two membranes is a perinuclear cistern.
The outer nuclear membrane is studded with ribosomes.
Euchromarin
DNA undergoing transcription
Heterochromatin
DNA that is condensed and not undergoing transcription
Ribosomes
Formed in the nucleolus and are instrumental in protein synthesis. HAs both large and small subunits.
Endoplasmic reticulum
Associated with protein synthesis and the initiation of glycoprotein formation.
Smooth endoplasmic reticulum
Synthesis of lipids
Processes proteins
Golgi apparatus
Packaging and modification of proteins
Mitochondria
Produce ATP
Cristae are the internal folds
Endocytosis
Membrane invaginates- fuses making a vesicle.
Two types of stroke
Ischaemic or haemorrhagic
What is a stroke?
Acute onset of focal neurological symptoms and signs. Due to disruption of blood supply.
Ischaemic stroke
Thrombotic, embolism, hypoperfusion
Virchows triad
Blood stasis
Endothelial injury
Hypercoaguble state
Haemorrhagic stroke
Burst blood vessel. Could be due to weakened blood vessel walls in aneurysms or in arteriovenous malformations.
OR inflammation of the vessel wall due to vasculitis.
Risk factors for stroke (non modifiable)
Age Family history Gender Race Previous stroke
Risk factors for stroke (modifiable)
Hypertension Hyperlipidaemia Diabetes Atrial fibrillation Congestive heart failure Alcohol excess Obesity Physical inactivity Poor socioeconomic status Smoking.
Stroke mimics
Hypoglycaemia
Siezure
Migraine
Space occupying lesions such as tumours.
History and examination
Any signs of AF
Neurological examination to find out which type of stroke.
Investigations into stroke
Brain imaging- only way to tell which type of stroke
MRI with DWI
MRI with GRE
CT brain +/- angiography
In ischaemic stroke- investigations directed to find the cause of thrombosis or embolism.
Cardioembolism
Infarcts in more than one arterial territory
Atheroembolism
Infarcts in the same side as the effected carotid artery
TIA
Focal neurological lesions that resolve within 24 hours.
Management of stroke
Aspiring 75mg Dipyridamole 200mg BD Statins In AF- anticoagulation Control hypertension
Surgical management
Haematoma evacuation
Releif of raised intracranial pressurre.