Test 2 Week 1 Flashcards Preview

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Flashcards in Test 2 Week 1 Deck (122):
1

The ___ is a protective case for the brain and has two components to it... The ___ neurocranium cradles the base of the skull (like sphenoid, temporal, and base of occipital) and the ___ neurocranium is where the flat bones of the cranial vault start to form (like parietal, occipital, and frontal)

The ___ is the skeleton of the face and has the membranous and cartilaginous components as well

The cartilaginous component has the first branchial arch cartilage called ____ cartilage and the second branchial arch cartilage is called ___ cartilage

The membranous component has the ___ and ___ prominence of the 1st branchial arch

Neurocranium, cartilaginous, membranous

Viscerocranium

Meckels, Reicherts

Maxillary and Mandibular

2

The plates of the membranous bones making up the calvarium of the skull are derived from the primary ossification center, but individual plates do not fuse and this leads to sutures and fontanelles in a new born baby

Therefore, there is a direct relationship between the development and growth of the brain with the expansion of the sutures

Apert syndrome is premature fusion of the ____ sutures and leads the child with a "tower skull" appearance

Cranioschisis is the failure of the ___ and ___ bones to form or close and can lead to a rudimentary forebrain called anacephaly

Coronal (separates frontal and parietal bone)

Occipital and parietal

3

For development you have fertilization, which leads to a zygote -> morula -> blastocyst -> implantation

Cells in the blastocyst stage become the inner cell mass and trophoblast -> inner cell mass divides into epiblast and hypoblast (along with the amniotic sac from the epiblast and the yolk sac from the hypoblast)

Next, gastrulation occurs and the bilarminar to trilaminar disc occurs via the primitive streak formed on the dorsal surface of the ____, and then invaginations of the epiblast cells cause ____ cells to replace the hypoblast, ____ cells remain on the surface, and ___ cells are formed in between the two layers

^** Endoderm and ectoderm are epithelial tissue and mesoderm is mesenchyme

The ___ is also formed, which is one of the most important structures of the embryo and formed from mesenchymal cells

^The mesoderm eventually begins to differentiate into somites, intermediate mesoderm, and a lateral plate (which consists of somatic and splanchnic mesoderm and in between the two is the coelom)

Epiblast, endoderm, ectoderm, mesoderm

Notochord

4

Pharyngeal arches appear around week ___ and the primitive ___ induces the ectodermal depression that is the precursor of the mouth, called the ___ and is separated from the endodermal foregut by the old prochordal plate (now called the oropharyngeal membrane)

The stomodeum is surrounded by 5 facial swellings of the __ branchial arch including the ___ prominence (unpaired), the ___ prominences of Arch 1 and the ___ prominences of Arch 1

^** So realize that frontonasal, maxillary, and mandibular prominences all are derived from the 1st branchial arch
*******
The membrane located in the stomodeum is the ___ membrane and eventually it dies off

4, pharynx, stomodeum

1st, Frontonasal, Maxillary, Mandibular

Buccopharyngeal

5

When the lateral nasal prominences and the maxillary prominences fail to fuse, you get an ___

Fusion failure of the mandibular swellings and the intermaxillary process (the medial nasal processes fused) and maxillary swellings leads to ____ and ___

^** The cleft chin forms due to the failure of the mandibular prominences to fuse

Dysgenesis of the mandibular swellings (first branchial cleft and position of the auricle) is called ___

Oblique facial cleft

Oblique facial cleft and median cleft chin

Agathnia

6

****************The epithelium on the anterior 2/3 of the tongue is innervated by the ___ nerve and has ___ fibers for pain, temperature, and touch from that nerve, along with the ___ nerve that has ___ taste fibers

The epithelium on the posterior 1/3 of the tongue is innervated by the __ nerve, with both ___ and ___ fibers

The intrinsic muscles of the tongue are derived from head myotomes and innervated by the ___ nerve with ___ fibers ***************** Except the palatoglossus muscle

Trigeminal nerve (specifically, the lingual nerve), GSA, Facial, SVA

Glossopharyngeal, GVA and SVA

Hypoglossal nerve, GSE

7

The ectoderm of the facial swellings are innervated by the ___ nerve

The ___ nerve supplies GSAs to the skin of the frontonasal prominence

The ___ nerve supplies GSAs to the skin of the maxillary prominence

The ___ nerve supplies GSAs to the skin of the mandibular prominence

Trigeminal

Opthalamic

Maxillary

Mandibular

8

The intermaxillary process forms the ___ and the ___

The secondary palate is derived from ____

The ___ marks the boundary between the junction of primary and secondary palates and also distinguishes anterior from posterior cleft deformities

Nasal septum and primary palate

Palatine shelves (aka lateral palatine processes)

Incisive foramen

9

Dyfusion of the medial nasal prominences leads to a ___ and a ___

If the mandibular swellings don't fuse with the maxillary swellings you get a ___

When the maxillary swellings don't fuse with the intermaxillary prominences bilaterally, you can get a ___

When the medial nasal processes fail to fuse with the maxillary swellings you get a ___

Bifid cleft nose, and median cleft lip

Macrostomia (wide mouth)

Bilateral cleft lip

Bilateral cleft lip

10

An ___ cleft deformity results from a failure of the medial nasal and maxillary swellings to fuse

A ___ cleft deformity results from when the palatine shelves do not fuse during development

Anterior

Posterior

11

The development of the branchial arches is induced by neural crest cells and the cells will form skeletal muscles of branchiomeric origin and therefore they are innervated by ___ fibers

^ Aka the muscles come from mesoderm

___ fibers are sensory fibers to ectodermal structures such as skin

___ fibers are sensory to visceral endodermal structures such as the pharyngeal mucosa

SVE

GSA

GVA

12

Name the nerve and artery that innervates each branchial arch

I
II
III
IV

5,7,9,10

I - Trigemenial (V) (mainly mandibular portion) and artery degenerates

II - Facial (VII) and artery degenerates

III - Glossopharyngeal (IX) N. and stem of internal carotid arteries

IV - Vagus (X) N. and aortic arch (left) and subclavian (right)

13

Realize there is a difference between brachial grooves (on the outside) and pouches (line the inside) **********

1) The first brachial groove is the only groove to persist, it (also called first pharyngeal cleft) becomes the ___ (2 of them)

2) The first brachial pouch becomes the ____ (3 of them)

3) The second branchial pouch becomes the ___ (2 of them)

4) The third branchial pouch becomes the ___ (3 of them, include dorsal and ventral)

5) The fourth branchial pouch becomes the ___ (2 of them, include dorsal and ventral)

The ___, branchial ___ is where cysts or fistulas can occur

1) External auditory meatus, tympanic membrane

2) Tubotympanic recess, Eustachian tube, and tympanic cavity

3) Palatine tonsil and Root of tongue

4) Tongue, along with the Dorsal - Inferior parathyroid gland and Ventral - Thymus

5) Dorsal - Superior parathyroid gland and Ventral - Ultimobranchial body



II, groove

14

***********************Name the branchial arch that the muscle is part of

1) Muscles of mastication
2) Stylopharyngeus
3)Laryngeal muscles
4) Stapedius
5) Anterior digastric
6) Posterior digastric
7) Pharyngeal muscles
8) Tensor muscles and Tensor palati
9) Mimetic muscles (facial muscles)
10) Stylohyoid
11) Tympani

Arch 1 = MATTT
Arch 3 = Only one muscle (Stylopharyngeus)
Arch 4 = Pharyngeal and laryngeal
Arch 2 = everything else (Think, PSS, not including mimetic muscles)

1) 1
2) 3
3) 4
4) 2
5) 1
6) 2
7) 4
8) 1
9) 2
10) 2
11) 1

15

Name what branchial arch the skeletal structure belongs to

1) Incus***
2) Hyoid body ****
3) Stylohyoid and styloid
4) Hyoid greater cornu ****
5) Hyoid lesser cornu ***
6) Malleus ****
7) Stapes ****
8) Laryngeal cartilages ****
9) Maxilla and mandible
10) Reicherts cartilage
11) Meckel's cartilage
12) Sphenomandibular ligament and anterior mallear ligament

1) 1
2) 3
3) 2
4) 3
5) 2
6) 1
7) 2
8) 4
9) 1
10) 2
11) 1
12) 1

16

Impaired growth of the midface and sometimes called first arch syndrome is called ____ syndrome

Treacher Collins syndrome

17

The brachial clefts (grooves) are all closed over, except for the first one, and if they aren't closed properly then you get brachial cysts

^** Abnormal cysts produced by the lateral cervical sinus or first pharyngeal cleft can occur and lead to cysts or fistulas and these are located anterior to the ___ (so these are called lateral cervical cysts)

___ cysts are located anterior to the ear and are abnormal derivatives of the first pharyngeal cleft

SCM

Anural

18

When the thyroglossal duct connects the migrating thyroid to the tongue at the foramen cecum, it is called ___


^** In other words, the thyroid diverticulum is simply the puch from which thyroid follicular cells derive and it evaginates and descends in the neck To form the thyroid

Thyroid diverticulum

19

**************When the second brachial cleft fails to obliterate, ____s can occur along the length of the ___ muscle*********************



Brachial Fistulas, SCM

20

Sometimes a ___ lobe may extend upwards from the isthmus along the midline

************************Sometimes accessory thyroid tissue, which is an embryological remnant of the ___ duct, can continue superiorly through the hyoid bone towards the foramen caecum of the tongue and can have ___ form along the course of this tissue (aka thyroglossal cysts)*************************

^*** So in other words, thyroglossal ducts cysts and sinuses may develop from remnants of the early migration of the thyroglossal duct and remnants may also include ___ thyroid tissue

^** Dont confuse thyroglossal cysts (occur along the length of the isthmus of the thyroid to the hyoid) and branchial cysts (occur along the length of the SCM)

Pyramidal

Thyroglossal, cysts

Ectopic

21

The anterior 2/3rds of the tongue is formed via the ____ swellings (part of arch 1) overgrowing the median ___ and fusing at midline (also part of arch 1)

The posteiror 1/3rd of the tongue is formed via the ____ of the third arch overgrowing the median mass of arch II called the ____

*************The ____ demarcates the anterior 2/3rds (oral portion) from posterior 1/3rd (pharyngeal portion) of the tongue ******************

Lateral lingual swellings, tuberculum impar

^** So it forms via 3 buds total

Hypobranchial (Also called hypopharyngeal) eminence, copula

Sulcus teminalis

22

The buccal fat pad is compartmentalized and encapsulated and immediately deep to it is the buccinator muscle, which is innervated by the ___ nerve

The __ duct pierces the buccinator muscle and the orifice of the parotid duct drains into the mouth, opposite the crown of the 2nd upper molar

The skin and mucosa of the cheek is innervated by the __ nerve

Facial nerve

Parotid duct

Long buccal nerve (V3)

23

**************The ___ nerve spirals around the submandibular duct (Wharton's duct) from superior-lateral to inferior-medial
****************

Therefore in the dissection of the floor of the mouth, the duct will be ___ the nerve, and the sublingual gland will be ___

Lingual

Above, lateral

24

The floor of the oral cavity is supported by the ___ muscle so if you have a problem with the Mylohyoid nerve coming off the mandibular branch of the Trigeminal nerve, then you can get food stuck on one side

Mylohyoid

25

**********Know the innervation both parasympathetic and sympathetic for the sublingual gland and submandibular gland***********

Parasympathetics is easy... Superior salivatory nucleus -> Facial nerve -> Chorda tympani -> Meets up with lingual -> Submandibular ganglion -> Sublingual gland

For sympathetics, the postganglionic fibers come from the superior cervical ganglion, and reach the gland by coursing in the ___ or ___ plexuses in the adventitia of their respective arteries, OR it can course through the ___ plexus in the adventitia of the ___ branch of the ___ artery

KNOW IT

External carotid or facial plexuses, sublingual plexus, sublingual, lingual

26

The anterior 2/3rds of the tongue is derived from skin ____ and is considered the ___ portion of the tongue

The posterior 1/3rd of the tongue is derived from ____ and is considered the ___ portion of the tongue

The lingual tonsil is located on the dorsum of the ____ portion of the tongue

Ectoderm, oral

Endoderm, pharyngeal

Posterior 1/3rd

27

For intubation, where do you want to place your device to open up the airways?

Valleculae Epiglottica

28

****************************Unilateral ____ palsy results in paralysis, atrophy, and fasciculations of intrinsic muscles of the tongue

When protruded, the normal ___ muscle deviates the tongue ____ the affected side
*********************
^ This is because the genioglossus muscle protrudes the tongue

Bilateral paralysis may cause awairway obstriction (dyspnea), dysarthria (unclear speech) and dysphagia

Remember all extrinsic and intrinsic tongue muscles are innervated via the Hypoglossal nerve, except the ___ muscle (which elevates the tongue and closes the faucial isthmus during deglutition) and is innervated by the ___ nerve via the ___ plexus

Hypoglossal

Genioglossus, towards

Palatoglossus, vagus, pharyngeal

29

Lymphatics of the tongue drain into the ___, specifically the jugulodigastric or jugloomohyoid nodes

In a radical neck dissection they will take out the deep cervical lymph nodes

Lymphatics from the palatine tonsil drain first into the ___ lymp nodes

Deep cervical lymph nodes

Jugulodigastric (tonsillar)

30

****************************The Tensor Veli Palatini is innervated by the ___ nerve and ___ the ___ palate along with opening the ___

The Levator Veli Palatini is innervated by the ___ nerve and ___ the ___ palate

**********Paralysis of either of these muscles allows the non paralyzed side of muscles to pull or deviate the ____, ___ the normal side *************

The palatoglossus muscle, which is not innervated by the Hypoglossal nerve (the only tongue muscle that isn't) is instead innervated by the ___ nerve and arises from the posterolateral hard palate
************************

It is important to realize that if you have a deviation of the uvula, you wont be able to distinguish which nerve is damaged unless you know other things like if there is dysphonia (Difficulty speaking) = vagus nerve, if there is loss of sensation to the forehead = trigeminal

Mandibular nerve (V), tenses, soft, auditory tube

Vagus (via the pharyngeal plexus), elevates, soft

Uvula, Towards

Vagus

31

The anterior 2/3rds of the palate is the ___ palate and innervated via the ____ nerve and artery

However the very anterior portion of the hard palate is not supplied by the palatine nerves and arteries, instead it is supplied by the ___ nerve and vessels

The posterior 1/3rd of the palate is the ___ palate and innervated via the ___ nerve and artery

Hard, greater palatine

Nasopalatine

Soft, lesser palatine

32

The ___ nerve is closely related to the floor of the tonsillar fossa and therefore palatine tonsil

Glossopharyngeal

33

Fractures of the nose occur at the junction between the ___ cartilage and the ___ and ___ bones

^** aka an impact on the external nose often fractures the nasal ____ at the junction between the septal cartilage and bone

___ is commonly used to view and surgically approach structures in the nasal cavity

Septal cartilage, ethmoid and vomer

Septum

Anterior rhinoscopy

34

The ___ and __ conchae are part of the ethmoid bone and the ___ conchae is a seperate bone

^** The conchae increase surface area of the nasal cavity and humidify and warm inspired air

Superior and middle, inferior

35

The ____ is located posterior and superior to the superior concha and the ___ drains into it

The ___ concha and meatus contains the ehtmoidal bulla, hiatus semilunairs, and openings for the maxillary, ethmoidal, and frontal sinuses

The ___ forms a bony eminence overlying the middle ethmoidal air cells and the ___ is a trough located anterior and inferior to it

The openings for the __ sinus is located in the posterior 1/3 of the hiatus semilunaris and the ____ is located in the anterior-superior portion of the hiatus semilunaris is is the opening for the __ sinus

Finally, the ___ is located in the inferior meatus, 1cm posterior to the anterior edge of the concha

Sphenoethmoidal recess, sphenoidal sinus

Middle

Ethmoidal bulla, Hiatus semilunaris

Maxillary, ethmoidal infundibulum, frontal (and anterior)

Nasolacrimal duct

36

The posterior 2/3rds of the nasal cavity is derived from ___ and innervated by the __ artery and the ___ nerve via ___ fibers

The anterior 1/3rd of the nasal cavity is derived from ___ and supplied by the ____ artery and the ___ nerve via __ fibers

___ nerves also are located in the nasal cavity in the olfactory epithelium and supply ___ fibers

The ___ nerve is a branch of the sphenopalatine ganglion and innervates the mucosa of the gingiva and hard palate in the area of the upper incisors

Endoderm, sphenopalatine artery (the terminal branch of the maxillary artery), branches of the sphenopalatine ganglion, GVA

Ectoderm, anterior ethmoidal artery (branches off the ophthalamic artery), anterior ethmoidal nerve, GSA

Olfactory nerve, SVA

Nasopalatine nerve

37

****************The roof of the ___ sinus is the floor of the ___********************

^ This is important because a blowout fracture to the orbit can cause herniations into the maxillary sinus And then the infection can spread into the brain

The posterior wall forms the anterior wall of the ____ fossa and ____ fossa
*********************

^*You can sometimes reach the sphenopaltine ganglion through the maxillary sinus

Maxillary sinus, orbit

Sphenopalatine and infratemporal

38

A toothache of the first or second molars can be indicative of ____ sinusitis

Maxillary

39

**************************Name the Sphenoidal sinus relationships

1) Posterior
2) Superior
3) Anterior
4) Inferior
5) **** Lateral *****

Transsphenoidal surgery is one way to access the ____ *****************

1) Pons, basilar artery
2) Pituitary
3) Nasal cavity
4) Nasopharynx
5) Internal carotid, V1, and ******Cavernous sinus******

Pituitary

40

The frontal sinus has a relationship with the ___ sinus and the frontonasal duct drains into either the ethmoidal ____ or the ___ recess of the ___ meatus

Ethmoid, infundibulum, frontal, middle

41

The vidian nerve is formed by the ___ and ___ nerves and conveys Postganglionic sympathetics, ____ parasympathetic, and ____ fibers to the sphenopalatine ganglion

The ___ and ____ nerves also come off the sphenopalatine ganglion and convey GSA (V2), GVA (VII), GVE parasympathetic, and postganglionic sympathetic fibers to the mucosa of the inferior surface of the soft and hard palate

The ___ nerve also comes off the sphenopalatine ganglion and sends the same components as the nerves above ^ and innervates the mucosa of the posterior nasal septum and lateral nasal cavity

Greater pretosal and deep petrosal, GVE, GVA

Lesser and greater palatine nerves

Nasopalatine nerve

42

Name if the structure is found in the external, middle, or inner ear

1) Ossicles
2) Osseous Labyrinth
3) Pinna
4) External Auditory Meatus
5) Membraneous Labyrinth

1) Middle ear
2) Internal ear
3) External ear
4) External ear
5) Internal ear

43

The hearing receptors in the inner ear are protected by 3 mechanisms

1) Sudden, loud sounds cause the footplate of the ___ to rock side-to-side rather than depress directly into the fenstra vestibuli

2) Continuous loud sound causes the contraction of the ___ and ____ muscles and attenuation of vibrations

3) The ___ pathway in the CNS is capable of filtering, focusing, and attenuating sound

1) stapes
2) Stapedius and tensor tympani
3) Cochlear

44

___ transmission is done via the external auditory meatus, ___ conduction via the ossicles of the middle ear, and ___ conduction via the inner ear

Air, Bone, Fluid

45

Blood supply to the pinna (aka auricle) is via the ____ and ____ arteries and trauma to the pinna can cause an ____ (can lead to cauliflower ear)

Superficial temporal and posterior auricular

Auricular hematoma

46

During an ostoscopic examination of the external auditory meatus, one must put the auricle ___, ____, and ____ in order to visualize the tympanic membrane

Upward, outward, and backward

47

The tympanic membrane (which divides the external from the middle ear) has three layers, the outer epidermis layer (aka the skin layer) is innervated by the ___ and ___ nerve and has ___ fibers

The middle fibrous layer forms the pars tensa and pars flaccida (anterior-superior quadrant)

********And the inner layer (inner mucous membrane) is innervated by the ____ nerve with ___ fibers ***********

The ___ nerve courses through the anterior and posterior mallear folds

V and X, GSA

IX (Glossopharyngeal), GVA

Chorda tympani nerve

48

*************************Name the structure that has a relationship with the tympanic membrane to structures of the middle ear cavity

1) Superior-posterior (3 structures)
2) Superior-Anterior
3) Inferior-Anterior
4) Inferior-Posterior
***********************

1) Long process of incus, Stapes, Fenstra vestibuli
2) Auditory tube
3) Carotid canal
4) Fenestra cochleae

49

*****************************The ___ nerve has a close relationship with the middle ear cavity, but it is NOT IN THE MIDDLE EAR CAVITY... It bulges in its bony canal into the cavity, but it is not in the cavity ******************************

^Makes a bend at the geniculate ganglion

The cochlea is ____ and the semicircular canal is ___*************

Facial (and the semicircularcanal for the facial nerve)

Anterior, posterior

50

Inflammation of the middle ear cavity is relatively common in infants and children and is called ____

Otitis media

51

____ is the ossification of scarring of the small ossicular joints (malleus, incus, and stapes) that prevents the transmission of sound from the TM to the fenestra vestibuli

Tests for ____ conduction is normal, but ___ conduction is reduced

Otosclerosis

Bone, nerve

52

The tensor tympani muscle is innervated by the ___ nerve and tightens the tympanic membrane and attenuates its vibrations

The stapedius muscle is innervated by the ___ nerve and pulls the stapes out of the fenestra vestibuli to act as a protective mechanism to prevent excessive movement of the stapes due to loud sound

Mandibular nerve of V

Facial

53

The epithelial lining of the middle ear is innervated by the ___ nerve via ___ fibers (think about the fact that the inner part of the TM is the same) and the middle ear arteries are the ____ branch of the ___ artery and the ___ artery

Glossopharyngeal nerve, GVA, stylomastoid, posterior auricular, anterior tympanic

54

The inner ear is comprised of a complex series of endolymph filled ducts, tubes, and sacs called the ___ labyrinth, which is suspended within perilymph by the ____ labyrinth...The ___ nerve innervates receptors in the membranous labyrinth

************The inner ear is innervated by two distinct divisions of the ___ nerve called the ___ division which innervates the organ of Corti and conveys auditory info, and the ___ division which innervates the maculae utricle and saccule, along with the cristae ampullaris of the semicircular ducts and conveys static and dynamic position-sense info for equilibrium

**** SO THESE THREE NERVES PASS THROUGH THE EXTERNAL AUDITORY MEATUS**********

Membranous, Osseous, Vestibulocochlear

VIII (vestibulocochlear), Cochlear (VIIIc), Vestibular (VIIIv)

55

The inner ear is supplied by the ___ artery, a branch of the ___ artery

^ Arteriosclerosis of this artery can result in vertigo, nausea, and other inner ear abnormalities

Labyrinthine, anterior inferior cerebellar artery (AICA)

56

*************Name if the structure is located in the osseous (bony) labyrinth or membranous labyrinth

1) Vestibule (houses the utricle and saccule)
2) Cochlear duct
3) Cochlea
4) Endolymphatic duct
5) Semicircular ducts
6) Semicircular canal
7) Utricle and saccules
^ Detects linear acceleration and low frequency vibrations (respectively)
8) Aqueduct of the vestibule
9) Scala vestibuli and Scala tympani
10) Perilymphatic duct

***************

**************The receptors are inside of the ____ area **************, specifically, the ___ duct which contains the ____ organ which contains the receptors for hearing

1) Bony
2) Membranous
3) Bony
4) Membranous
5) Membranous
6) Bony
7) Membranous
8) Bony
9) Membranous
10) Bony

Endolymph, cochlear, spiral organ (aka the organ of corti)

57

So one more time, the ___ labyrinth encloses the perilymphatic space that is filled with perilymph

The ___ labyrinth has ducts, tubes, and sacs, filled with endolymph and suspended within the osseous labyrinth

Osseous

Membranous

58

***********The bony core of the cochlea is referred to as the ____ and the ___ nerve passes through here **************

The spiral lamina projects from the modiolus like threads of a screw

Modiolus, Cochlear (VIIIc)

59

The anterior two thirds of the tongue consists of a core mass of ___ (including longitudinal, transverse, and oblique muscle)

The posterior 1/3 is mainly aggregations of ____ tissue (includes the tonsils)

Skeletal muscle

Lymphatic

60

*****************************The development of the tongue comes mainly from 4 of the pharyngeal arches

The anterior 2/3rds comes from the first ___ arches and consists of the ____, which comes from arch 1 (innervated by Trigeminal nerve) and a little bit from arch 2 (innervated by the facial)

^**That means it gets its sensory fibers (GSA) from the ___ nerve and the SVA taste fibers from the ___ nerve

The posterior 1/3 is from mainly the ___ arch, innervated by the ___ nerve and a little from arch 4 (the vagus nerve)

^** That means it gets its sensory fibers from the ___ nerve and SVA taste fibers from the ___ nerve and the ___ nerve

Also remember the motor innervation to the tongue muscles is the ___ nerve

*******************

2, lateral lingual swellings

Lingual nerve (branch of the trigeminal), facial nerve

3rd, glossopharyngeal

Glossopharyngeal, Glossopharyngeal and vagus nerve (at base of tongue)

Hypoglosal nerve

61

The dorsal surface of the tongue (aka the top of it) is covered by ____ epithelium, supported under by a lamina propria and then a muscular core

NKSS (Non-keratinized stratified squamous)

62

The dorsal surface has 4 different mucosal projections called ____

The ___ are the most abundant, spiky shaped, and ___ (do or don't) have taste buds

The ___ are mushroom shaped papilla and ___ have taste buds

The ____ are very limited in number (only 9-10) and ___ have taste buds

The ___ are leaf shaped and rudimentary in humans, these ___ have taste buds

^** So only filiform don't have taste buds

Lingual papillae

Filiform, don't

Fungiform, do

Circumvallate, do (lots of them)

Foliate, do

63

The circumvallate papillae are located near the ___

The ____ papillae help grab a hold of food

Sulcus terminalis (the line that demarcates the anterior vs posterior tongue)

Filiform

64

A manifestation of psoriasis, which affects the dorsal surface of the tongue is called ___ and leads to atrophy of the ___

Geographic tongue, filiform

65

For all the papilla on the tongue that have taste buds associated with them, they also have ___ glands and secrete a ___ that helps break down food and ____ that binds to things you are eating and help take the taste particles into a taste bud via the taste pore

Serous (aka Ebner's glands)

Lingual lipase, VEGP (Von Ebner's gland protein)

66

So Filiform papillae have NO taste buds, Fungiform papillae have taste buds across the ___ surface and Foliate papillae have taste buds across the ___ wall and the Circumvallete papillae have hundreds of taste buds in their ___ wall and located near the posterior part of the tongue

Apical (top), lateral, lateral

67

A taste bud (and the same concept for smell) has three cell components including a taste ___ cell, a ___ cell (aka immature taste cell) and a ___ cell (or basal cell)

^** Taste basal cells sit towards the bottom and olfactory basal cells sit towards the top of the epithelium

receptor, supporting, stem (aka precursor)

68

Along with taste buds on the tongue, they are also found on the __ palate, posterior ___, and ___ in order to register if a taste is bad rather than swallowing it

Soft, pharynx, epiglottis

69

The basal portion of taste receptor cells make contact with ___ nerve terminals derived from neurons in the ___ ganglia of the ___, ____, and ____ nerves

^* So The three nerve fibers innervate the three different cell types

Afferent, sensory, facial, Glossopharyngeal, and vagus

70

Taste starts when soluble chemicals called ___ diffuse through the taste pore and interact with G proteins called ___

These G proteins are linked to the ___ (which are present in the apical microvilli of the taste receptor cells) and cause GTP to bind to the alpha subunit and activate target molecules which are ion channels in the taste receptor cells

Increase in intracellular ___ triggers the release of NTs at the synapse with the afferent nerve terminals

Tastants, gustducins

Taste receptors (TR1 and TR2)

Ca2+

71

The 5 taste sensations are ___, ___, ___, ___, and ___

___ stimuli are on the tip of the tongue, ___ stimuli are slightly posterior and lateral to the tip of the tongue, ___ stimuli are on the anterior 2/3rds of the tongue along the lateral margin, and ___is at the back of the anterior 2/3rds of the tongue

^** Umami is a receptor for ___ and the distribution is unknown (it is found in most proteins and added to foods as MSG - Monosodium glutamate)

Sweet, sour, bitter, salty, and umami

Sweet, Salty, Sour, Bitter

Glutamate

72

Taste buds on the palate (and likely the posterior pharynx and epiglottis) register primarily ___ and ___ tastes

Bitter and sour

73

The CD36 receptor responds to ___

Fat

74

The anterior 2/3rds of the tongue has its origin from the first 2 arches, which contain the ___ tongue bud and the ___ swellings

The posterior 1/3rd of the tongue has its origin from the ____

Median tongue bud and lateral lingual swelling

Hypopharyngeal eminence

75

The nasal cavity consists of olfactory epithelium (pseudo-stratified columnar), mostly pseudo-stratified columnar epithelium with goblet cells called the ___ epithelium, a lamina propria with serous and mucous glands, mast and plasma cells, and an extensive vascular plexus (cavernous bodies)

The functions include:

1) ____ the surface of the nasal cavity via secretions from serous and mucous exocrine glands, along with goblet cells

2) ___ the air via the conchae.

3) ___ regulation via swell bodies

Respiratory

1) Moistening
2) Filtering
3) Temperature

76

The olfactory epithelium is located in the roof of the nasal cavity on the upper surface of the superior conchae and like taste, also contains 3 cell types including the ___, ____ and ___ cells

The receptor olfactory cells are ___ sensory neurons

Olfactory cells, supporting (sustentacular) cells, and basal cells (stem cells)

Bipolar

77

When you breathe in an oder, the ___ glands secrete a serous fluid in which the odoriferous substance is dissolved via binding to an ____

The OBP and odorant complex now gets carried to the odorant receptor (OR) which is located on the olfactory ___ (which are projections from the olfactory receptor cell's dendrites above the epithelial surface)

Next, olfactory receptor cells are activated and send electric signals to the brain... This occurs via axons from olfactory cell receptors with the same ORs, terminating in one to three ___ located in the ___ (which penetrates the cribriform plate of the ethmoid bone to get to the olfactory bulb), exciting ___ cells that forward the signal via the olfactory nerve tract to higher regions of the brain with maintained specificity (aka to the corticomedial amygdala portion of the brain)

Olfactory serous glands (also called the Glands of Bowman), OBP (Odorant-binding protein)

Cilia

Glomeruli, Olfactory bulb, mitral

78

A loss of smell is called ____ and is due to a loss of neurons in the brain called ___ cells, that receive input from the olfactory neurons

^** This is due to the olfactory bulb not developing properly

Anosmia, mitral

79

In ___ syndrome, a patient will have anosmia (loss of smell) and small genitalia/sterility

This is due to the fact that they have a defective gene called ___, which codes for ____ (a cell adhesion protein expressed in the olfactory system and medial walls of the primitive cerebral hemispheres)

Since this gene is defective, ____ secreting neurons can't migrate properly from the olfactory epithelium to the brain... This causes no GnRH to be secreted, and therefore no ___ to be secreted, which is needed for gonadal development and genital maturation (hence the small genetalia and sterility)... On top of that, the olfactory neurons also do not grow properly allowing the cones to migrate into the brain, which is why anosmia occurs

Kallman syndrome

KAL-1, Anosmin 1

GnRH, LH

80

Name the five layers and three cell types of the retina

Outer nuclear, Outer Plexiform, Inner nuclear, Inner Plexiform, and ganglion cell layer

Photoreceptors (rods and cones), Internerous (bipolar cells, horizontal cells, and amacrine cells), and ganglion cells (output cells of the retina that project to brain)

81

___ cells have high sensitivity and low spatial resolution and are good for ___ vision (since so many rods can send signals to a single ganglion) and contains the pigment ___

____ cells have low sensitivity and high spatial resolution and are good for ___ detection and contains the pigments ___

Rod, night, Rhodopsin

Cones, color, Opsins (red, green, blue)

82

In the dark, the rod cells have ___ channels that are tonically ____ (opened or closed?) and therefore the cell is depolarized, which means it releases ____ that acts on the bipolar cells to create an IPSP and therefore NO signal is sent through the optic nerve fibers

However in the light, the channels become closed and the cell then becomes hyperpolarized, causing NO release of glutamate and this takes away the inhibitory effect on the bipolar cell, allowing the bipolar cell to release it's NTs and cause and EPSP on the optic nerve fibers to send the signal

^** Also note this signal transduction occurs in the outer segment

Na+, Open, glutamate

83

The photoreceptor molecule in rods is rhodopsin, and contains the protein opsin linked to _____, which changes to ___ when light photons bind

^** Note that retinal is a from of Vitamin A

The rhodopsin molecule has a ___TM domain and is linked to ___ in opsin by a ___-base linkage and when protonated the maximum absorption is achieved at 500-nm

11-cis-retinal, 11-trans-retinal

7, lysine (296), Schiff

84

Name if the proteins of the outer segment are found in the disc membrane or surface membrane or ancillary proteins

1) GPCR
2) Guanylate cyclase
3) Rhodopsin
4) Transducin
5) Na/Ca exchanger
6) Rhodopsin Kinase
7) Phosphodiesterase
8) cGMP-gated Na channel
9) b-Arrestin

^** The levels of ____ controls pretty much everything (so light decrease cGMP and the dark produces it)

1) Disc
2) Surface membrane
3) Disc
4) Disc
5) Surface membrane
6) Ancillary
7) Disc
8) Surface membrane
9) Ancillary

cGMP

85

The photoreceptor outer segments undergo ____ via the ___ epithelium in order to renew the cells

Disc shedding, Pigment epithelium

86

The red and green opsin genes are on the ___ chromosome (compared to blue on Ch7 and Rod on Ch3)

Homologous recombination can lead to the loss of genes for specific pigments

X

87

***********Name the three elements that lead to Macular degeneration

And the macular carotenoids (aka the xanthophylls) include ___ and ___**************

UV rays (high concentration of photons), High lipid content, and high respiratory quotient (high O2 flux)

Lutein and zeaxanthin

88

**************Deficiency in Vitamin A (part of the photoreceptor as retinal) causes night blindness, keratinization of the GI epithelium, skin dryness, and lack of tear production called ___***********

____ from the gut can be converted to retinol (vitamin A) and retinol is transported in the blood via the RBP (retinol blood plasma)

Xerophthalmia

Beta-Carotene

89

So the pathway for light is it comes into the rod cell and hits rhodopsin, (which is comprised of opsin and 11-cis retinal linked via a schiff base) and this causes the retinal (remember this is a form of Vitamin A so they can be used interchangeably) to be converted into an all-trans configuration

This causes retinal to no longer fit into the opsin binding site, and therefore opsin now undergoes a conformation change to metarhodopsin II which is so unstable the it splits into opsin and all-trans retinal

Now the opsin activates the the G-protein called ___, causing GDP to be converted to GTP, which binds and activates the ___ to cause hydrolysis of cGMP to 5'-GMP and this decrease in cGMP causes cGMP-gated channels on the plasma membrane to close and therefore no influx of current and reduction of circulating dark current

Transducin, PDE (Phosphodiesterase)

90

For recovery, three things happen

1) The all-trans retinal ____ from the protein (the rhodopsin 7TM receptor)
2) ___ phosphorylates the C-terminus
3) ____ binds to the phosphorylated part

1) Dissociates
2) Rhodopsin Kinase
3) B-arrestin

91

When light is hitting the rods, it causes a ___ in cGMP, which causes the ion channels to ____, and therefore no Na+ OR Ca2+ can enter the cell

Both ions decrease (more importantly, Ca2+) and when Ca2+ is low, it causes the activation of ___ and this ends up ___ the cGMP levels to reopen the channels for recovery

So in other words, light-induced lowering of ___ levels coordinates the recovery

Decrease, close

Guanylate cyclase, increasing

Ca2+

92

For the retinoid cycle, once the all-trans-retinAl gets displaced from the rhodopsin molecule for recovery to take place, it gets converted to all-trans-retinOl and then brought into the ___ where it gets esterfied to all-trans retinyl ester via the enzyme ___ and then isomerize to 11-cis-retinOl via the enzyme ___ and then converted back to 11-cis-retinAl and then brought back into the rod cell and reattached to the rhodopsin from where it came

Pigment epithelium, LRAT, RPE65

93

*******Retinitis pigmentosa is genetic defects, predominantly from a defect in ___ from a miss-folding and can also come from the enzymes ___ and ___ in the retinoid cycle

Rhodopsin, LRAT and RPE65

94

********Tears are produced in the ___ gland, and roll over the surface of the eye and enter the lacrimal ___, which are then carried into the superior-lateral asepct of the lacrimal sac and through the ___ duct to enter the nasal cavity (which is why we get a runny nose when we cry) at the ___ nasal ____******

Lacrimal, Canaliculi, nasolacrimal, inferior nasal meatus

95

Oculomotor nerve palsy results in ___ (droopy eyelid), ____ (pupil dilation), and eyes turned ___ and ___

Ptosis, mydriasis, and down and out

96

The ocular muscles of the eye all attach to a tendinous ring called the annulus tendinius , except for the ___ muscle

Also, the ___ muscle is the only one that inserts into the muscular layer of the upper eyelid

**************What are the innervations for all these muscles? ****************

^******* So if you have a lesion to cranial nerve 3, the superior oblique and lateral recuts muscles will still work

Inferior oblique

Levator palpebrae superioris (LPS)

SO4 LR6 and all the rest 3
^* SO = Superior Oblique via trochlear nerve, LR = Lateral rectus via abducens

97

The Levator palpebrae superioris (LPS) is part of the ___ division of the Occulomotor nerve, so if this is affected then ___ will occur (since it attaches to the upper eyelid)

The __ muscle is also part of the superior division

And the ___, ___, and ___ muscles are part of the inferior division

Superior, Complete Ptosis

Superior rectus (SR)

Medial rectus (MR), Inferior rectus (IR), and Inferior Oblique (IO)

98

The ___ test looks at extraocular muscle function

Cardinal signs of gaze

99

If the Abducens nerve is lesioned, then the lateral rectus muscle is defective and the patient loses the ability to ___duct the affected eye (so the eye deviates medially and loss of lateral gaze)

^** If there is increased intracranial pressure, it can compress the ___ nerve and result in paralysis of the LR muscle

If the trochlear nerve is lesioned, the patient loses the superior oblique muscle and therefore can not ___duct and ___ the affected eye (aka they can't look down when the eye is adducted)

Abduct

Abducens

Adduct, depress

100

Pupil dilation will occur via an ___ in sympthetics or a ___ in parasympathetics

** So if you have a lesion of the occulomotor nerve, and mydriasis (pupil dilation), it must be due to decreased parasympathetics since the nerve is lesioned...

In other words, mydriasis is seen in oculomotor nerve palsy when the parasympathetic pathway to the sphincter pupillae muscle is disrupted

Increase, decrease

101

The preganglionic parasympathetics for the eye run with the ___ nerve from the ___ nucleus and synapse in the ___ ganglion, where postganglionic parasympathetic fibers are conveyed to the eye to innervate the ____ and ___ muscles as ___ fibers

^** So pupillary constriction and thickening of the lens (near vision) are parasympathetic responses and are components of accommodation (a cortically mediated response)

The Postganglionic sympathetics come from the superior cervical ganglion -> Internal carotid nerve -> Internal carotid plexus -> Ciliary ganglion (don't synapse) ->Dilator pupillae and tarsal muscles

Oculomotor nerve, Edinger-Westphal Nucleus, Ciliary, ciliary muscles of the lens and sphincter pupillae muscle of the iris, GVEp

102

A consensual light reflex response is when you shine the light in one eye (the eye being stimulated) and the other eye is observed

When a light is shined into someones eye, the afferent component is mediated by the ___ nerve, and the efferent component is mediated by the ___ nerve (the parasympathetic component)

The ___ light reflex is when a light is shined in an eye, and the ipsilateral pupil constricts and a ___ light reflex is when a light is shined in an eye and the contralateral pupil constricts

Optic, Occulomotor

Direct, Consensual

103

*************The consensual light reflex has the same components as the direct light reflex, except with the addition of the _____**********************

KNOW THE PATHWAY BECAUSE THEY WILL GIVE US A LESION AND ASK WHAT THE PRESENTATION WILL BE

So for example, lets say we shined a light in someones right retina and the right pupil constricted, but the left did not. And when we shined the light in their left retina, the left pupil constricted and the right did not... What structure is lesioned?

Now lets say we had a lesion of the right optic nerve, what would happen if we shined a light in someones right retina, and what about in their left retina


^** You get the point, just know this stuff

Posterior commissure

Posterior commissure

Right retina, nothing would happen (no constriction bilaterally).... Left retina we would get a direct and consensual light reflex

104

A decrease in the amount of light to the retina causes a sympathetic response mediated through the brainstem and upper spinal cord to cause the pupil to ___

___ syndrome results from the interruption of this pathway and is characterized by a traid of ___, ____, ____ symptoms

^**It can be caused by a tumor on the lungs, aortic or carotid artery aneurysm (bother lungs and arteries press against the cervical sympathetic trunk to decrease sympathetics) or idiopathic problems

The pathway for this consists of a stimulus of decreased light -> Retina -> Optic nerve -> Superior Colliculus -> Pretectum -> Reticular Formation -> Lateral Reticulospinal Tract -> Preganglionic sympathetic neurons -> Superior Cervical Ganglion -> Pupillary dilator muscles -> Pupil dilation

Dilate

Horners, Slight Ptosis, Miosis (pupillary constriction), and Anhydrosis (lack of sweating)/flushing of red

^PAM

105

***************************Remember, complete ptosis is due to the ___ nerve lesioned and therefore loss of innervation to the __ muscle

This is different however from slight Ptosis which is due to loss of innervation to the ___ muscle, which is only attached TO the LPS to help elevate the eyelid and therefore only helps elevate (not as strong)

*******************

Occulomotor, LPS

Tarsal muscle of Muller

106

Accommodation is when the eye changes optical power to maintain a clear image or focus on an object as the distance varies (and with this the pupil constricts or dilates)

When viewing objects in a near field of vision, three things occur (called the traid of accommodation) including

1) ____ due to the ___ muscles aka cross eyed

2) Pupillary ____ due to contraction of the sphincter pupillae muscles mediated by the parasympathetic component of the occulomotor nerve

3) ____ of the lens due to relaxation of the ciliary muscles and is also mediated by the parasympathetic component of the occulomotor nerve

1) Convergence of gaze, Medial recti (MR) muscles

2) Constriction

3) Thickening

107

*************** Accommodation is a ____ mediated response, which originates in the ___ field of the ___ lobe and projects to the midbrain

*******************
Accommodating gaze and vision to view objects in the near field is mediated by the ___ nerve from either the Edinger-Wesphal nucleus for pupillary constriction and thickening of the lens, or the Oculomotor nucleus for Convergence of Gaze

Cortically, frontal eye (8), frontal

Occulomotor

108

Due to ___, this can lead to the disease called ____ pupil and the pupils are unreactive to ___, but constrict during ___ and this can be due to destruction of the ____ (which is important in the light reflex, but not in accommodation)

DO NOT CONFUSE THIS WITH a similar condition called ____ pupil... Here, the pupil is once again unreactive to ___, however for accommodation, the pupil will at first appear to be non-reactive to convergence, however if it is held for a few seconds, then the pupil will slowly constrict
^Due to _______

Syphilis infection, Argyll-Robertson, light, accommodation, Pretectum

Holmes-Adie (also called tonic pupil), light, lesion of ciliary ganglion

109

************************Hymphema is the presence of blood in the ____ chamber of the eyeball due to trauma to the ____

Subjconjunctival hemorrhage is due to the rupture of the ____ and restricted to the subconjunctival tissue or bulbar fascia

Conjunctivitis is due to the inflammation of the ____

****************

Anterior, great arterial circle of the iris

Deep pericorneal plexus

Superficial periconreal plexus

110

There are three types of ___ fractures, which are referred to as Le Forte type 1-3

1) Le Forte Type 1 is a ___ maxillary fracture, separating the teeth from the upper face and occurs just above the alveolar processes and passes through the alveolar ridge, lateral nose, and inferior wall of the maxillary sinus

2) Le Forte Type 2 is a ___ shaped fracture with the teeth at the pyramid's base and the nasofrontal suture at its apex. This fracture passes through the alveolar ridge, lateral walls of the maxillary sinus, inferior orbital rim, and nasal bones
^** It usually involves part of the ___ margin of one of the orbits

3) Le Forte Type 3, also called a ___ dysjunction, is a ___ shaped fracture and the face has basically been separated from the base of the skull. The line passes through the nasofrontal sutures, maxillofrontal suture, orbital wall, and zygomatic arch
^**Both eyes are affected

Results in a Panda bear like appearance

Maxillary

1) Horizontal (aka transverse)

2) Pyramid, medial

3) Craniofacial, Extensive trasnverse

111

The orbits lateral wall is made up of the frontal, maxilla, zygomatic, sphenoid, ehtmoid, lacrimal, and palatine bones

There are many different nerves that course into the orbit (including ciliary ganglion, nasociliary, occulomotor, trochlear, and Trigeminal V1), the Ophthalmic artery and all its branches (comes off the ICA), and the superior and inferior Ophthalmic veins (which drain into cavernous sinus)

The optic canal conveys the ___ nerve and ___ artery

The superior orbital fissure conveys the ___ nerves (list all of them) and the ___ vein

The inferior orbital fissure conveys the ___ artery and nerve, and the ___ nerve

The infraorbital sulcus conveys the ___ vessels and nerve

Optic nerve and ophthalmic artery

3, 4, 5, and 6 nerves, ophthalmic vein

Infraorbital artery and nerve, zygomatic nerve

Infraorbital

112

Blow-out fractures usually occur to the orbital ___ and include the ___ bone and part of the ___ bone and can cause herniation of certain orbital structures into the ___ sinus

Clinical presentation includes enophthalmos, diplopia, orbital emphysema, and malar region numbness

Floor, zygomatic, maxilla, maxillary

113

Face trauma can be transmitted to the optic canal, which can cause bony deformations and therefore contribute to ___

It is the ___ portion of the optic nerve that is the most frequent site of injury and can be vulnerable to iscemia, secondary to orbital fracture due to compression of the ___ artery

TON (traumatic optic Neuropathy)

Intracanalicular, ophthalmic artery

114

The ___ artery is the chief artery to the orbit and usually the first branch off the ICA

It gives rise to the ___ and ___ arteries which supply the optic nerve

***********The ___ artery is also the main supply to the retina and supplies the retinas four quadrants through an upper and lower ___ branches and an upper and lower ____ branch*******************

^** So if a question stem tells us the patient has had an atherosclerotic disease (think occlusion to some sort of artery) and NO trauma then think of an occlusion to the central retinal artery, versus if there is trauma to the face think TON (which is compression of the central retinal artery)

Ophthalmic

Posterior ciliary and central retinal (supplies the anterior optic nerve)

Central retinal, temporal, nasal

115

The ___ artery supplies the upper eyelid and scalp and the ___ artery supplies the medial portion of the upper eyelid and scalp

Supraorbital

Supratrochlear

116

Off of the Ophthalmic division of the Trigeminal nerve (V1) there is the mneumonic ___ to remember the main branches off V1... This includes the lacrimal nerve, which terminates at the lacrimal gland (GSA fibers), the frontal nerve (travels above the LPS and has GSA fibers), the ___ nerve which is the main sensory (GSA) nerve to the eyeball

^** The nasociliary nerve has 5 branches


NFL N= Nasociliary, F = Frontal L = Lacrimal


Nasociliary

117

Tic Douloureux is also called ____ and this is characterized by shock, lightning like plains to the face that is quick and goes away fast

Trigeminal Neuralgia

118

V1 (all sensory) exists through the ___

V2 (all sensory) exists through the ___

V3 (sensory and motor) exists through the ___

Superior Orbital Fissure

Foramen Rotundum

Foramen Ovale

119

***************************For the corneal reflex, remember the innervation from in by ___, out by ___

This means the afferent nerves are via the ___ nerve off the Trigeminal nerve, and more specifically it is the ___ nerves

The efferents are via the ___ and ___ branch of the ___ nerve
^For the motor innervation, remember it is the branches *********************

5, 7

Nasociliary (V1), long ciliary nerves

Temporal and Zygomatic branches of the facial (VII) nerve

120

For the complete corneal reflex pathway, a stimulus is initiated by lightly touching the eye -> Receptors: Naked nerve endings in the cornea -> Afferent fibers: ____ nerve -> Sensory nucleus called the ___ nucleus of ___ -> Motor Nucleus: Facial Nucleus -> Efferent fiebrs: ___ nerve -> Effector: Orbicularis oculi muscle -> Response: Blinking (both direct and consensual)

Nasociliary (long ciliary nerves more specific), Descending Nucleus of V, facial

121

KNOW WHAT IS LOCATED IN THE CAVERNOUS SINUS************

KNOW IT

Nerves 3, 4, 5, and 6, and the ICA

122

The superior ophthalmic vein and central vein of the retina drain into the ___

Cavernou sinus