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Anatomic Sciences Legend

Major Topic Arteries Blood Bone Cell Embryology Endocrine system Foramens Gastrointestinal system Abbreviation Art Bid Bn Cell Emb Endr S For GIS Hrt Jots LymS \ t is c. Major Topic ;\l uscles }\erves Nervous system Periodontal ligament/Gingiva Reproductive system Respiratory system Tissue Tooth Tooth histology Urinary system Veins Abbreviation Msl

NrvS PdVG Rpr S RspS Tis T Tlh Hist UrnS Vns

Joints Lymphatic system 1\Jiscellaoeous



Which of the following structures leave each Individual lymph node at the hilus?

Afferent vessels Efferent vessels Tonsillar tissue Lymphatic ducts




All of the following statements concerning the lymphatic system arc true EXCEPT one. Which one Is the EXCEPTION?

The main function is to collect and transport tissue fluids from the intercellular spaces in all the tissues of the body back to the veins in the blood system Lymph is a transparent, usually slightly yellow, often opalescent liqwd found in the lymphatic vessels
It consists of the bone marrow, spleen, thymus gland, lymph nodes, tonsils. appendix,

!'eyer's patches, lymph, and lymphatic vessels Just like the circulatory system, the lymphatic system has a central 'heart-like' organ to pump lymph throughout the lymph vessels The chief characteristic common to all lymphatic organs is the presence of lymphocytes


Ccpynfbt 0 1009-2010 f"H11tal ~b


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Lymph nodes are small oval bodies enclosed in librou.< capsules. Lymph nodes contain phagocytic cortical tissue (reticular lis.nte) ad.1pled to filter lymph. Specialized billlds of connective tissue, called trabeculae. divide tho lymph node. Afferent lymph~tic vessels c.arry lymph into the node, where the lymph as circulated through the cortical sinuses. It is here in the sinuses that the lymph is cleansed by mncrophages. lymphocytes. and plasma cells. The filtered lymph leaves the node through the efferent lymphatic vessels, which melle through the roncave hUum and transpon the lymph into drerent collecting ves~els, which converge fnto larger vcs.els called lymph trunks (there 11re five "Uljor lymph tnmks m tire OOdy). These lympb tnutks. in turn, empty into either the thoracic duct or the r ight l)mphati< duct. Important: The thoracic duct drains most of the body and transports lymph to the Jell subclavian vein. The nght lymphatic duct drdms the right upper portion of the body und transports lymph to the right subclavian vein.

I Not..

I. The afferent lymphatic vessels enter on the convu surface of the node. 2. There are rcwer effcnont vessels than afferent vessels associated willt a node. 3. The spleen, thymus, palatine. aod pharyngeal tonsils do not have numerous aJTercnt vessel< entering them as d o lymph nodes.

.IU"iiiHHIht dllul.llllr) "~"'IIC'rn , llw l~mtJh.tlh: '~'lllll ha .. a nntral ur!!an lu pump h mph throu~huut Uu I~ 111Jlh "'''~.h

'ht.. arl - lil~t.. "

This is raise; unlike the circularory system. tbelymphatlc system dot's not have a pump (heort) to propel lymph throughout the lymph 'cssels. Instead. the lymphatic system

depends on the ronll'ac!lons of sktletal musclu, the presence or 'ah cs fn lymphatic vessels (similar 10 t/rose in veins), breathing, nncl simple gravity to move fluid throughout the body. Functiuus of the lympltntic system: Returns tb.sue fluid to the bloodstream ; when this fluid enters lymph cupillaries, it is called lymph Lymph is returned to the venous system via two large lymph duets - the tboradc duct and the rigbt lymphatic duct 1hrn.sports 1bsorbed fsts; within the vilb tn the small intesuoe, lymph copillanes. called lacteals, tr:snspon tbe products of fat absorption away from the Gl tract and eventually into the circulatory system - Provides Immunological derenses ugulnst disease-c:ausing "gents; lymph fillers through ly111ph node. which filter out 111icroorgunisms (such a,< hatter/a) and foreign

I. Lymph contains a liquid portion that resembles blood plasma, us well 1lS No rea white blood cells (mostly lymphocytes) JDd a few n:d blood cells. 2. Lymph is absorbed from the tissue space,; by the lymphatic capillaries (which IS a I)'Sietrr of clostd tubes) and eventU3IIy returned to the venous cuculauon by the lymphatic' esscls, after lymph Oo~>s throUilb the filtering system (/ymplr IJ()(f~s). 3. In the up~r limb, a hallmark of lymphatic ,essels is that tbey follow the veins.




Which of the following develops immature T cells into immunocompetent T cells?


Bone marrow
Thymus Lymph nodes

Cop)TiJbt 0 20092010 Dentli);l;s



Which of the foiJowing lymph node ~:roups extend from the base of the skull to the root of the neck?


Facial nodes Occipital nodes Deep cervical nodes

Jugulodigastric nodes

Coprnjbl 0 2009-lOIO lkma1 Decls

'"rhe thy mus is a bilobed lymphoid orgun poSHioncd in the SU()(!rior rot'diastiown that has no l)'mpJunlcs. The m(lin function uJ'- the thymus l10 to dclfelop immature T cells into ir.nmun~ompclent T cells. The thyrnu.s ts- n.:hnivcly lingt iu newboml', corttimtes to grow until pubeny, and Uen rc~;rcsses in aduhs. Note: ln U1e adult !hymus. the hlou~ supply is lsolat~d from the pnrem:hyma (which Is the .frmatiauiug JNU'iion of the glnnd t~-5 di~tifiJ:tTffislwd from the cOft'1ecti\e ti.vsuu. or ,l(ffomu). This is so1.nelill1es rcfcmd to as, the bluucl thymus barrler. In lh.; child thymu;, the bloO<l upply 15 out as bolul<d from the l>arenQhyma, The spleen is formed by reticular and lymphlio tissue and I< tho lurgcst lymph orgn. Tile spleen lit$ in llu: l~ft bypocbondrlat! regiOil of the-abdominal c-avily between the fundUS-of'the.51.0!1'UIC'h $nd lhe diaphragm. The spleen ig purpJish io color and 'Vt.uie~ in site in difi<'rcm mdividualit. The !ipleen is 6ligbtly ovaJ in shape: W ith the. hilum on the lower mcdilll border. The amerior surH~ce is covered with peritoneum. U is enclosed in -a fibroe-lastic capsule. that dit)S inln the orgl\n. formlng trnboculne. Tho cellular material. con~i;tlntt or lymphot'}'tl:S ond moorQphagl\>, i> called >pleoic pulp, and il lies between the t.r;lbt.'Cl.ll<le, The >1>locn is the l"''l:""trngle moss oflymphpid Iissue in the body. The spl!l<'n c be oonsid~ liS two organs \o Olle: it filterS the blood and retuov~ oibnonnsl cells (sitcll a.\ n/J an. d defecrin 1't!Ji biiJotl cells), and it make~ dl~a~e-fighling components- or the. immune sy~lettl (/twlmJing muibodies arul lytllfllr"CJ''~J. T11 c body ur tho spleen ~PP"""' red a11d pulpy, >urroundcd by 11 tough cap~ule. 'fhe red pulp conSists of blood vessels- (.vphmk .vittu.wit\') inlcrwoveu with conneclivclis>-uc (splenic cor,/$). Tbe red pulp filtcl" ~1e blood'"'~ rtmoV<~ old and defective blood cells. It is the he of erythropoiesis (11/rmdjnrmrrlinn) 11111 fetus andi!ll Jnfanl The white pulp is insido the red pult>, and consists of lillie lump< of lymphoid tissue. Antibodies are nmdc inside the while pulp. Bone marrow cnntnins stem cells\ which may develop lnto any Clr SCN~rtl) di frt:I'Cfll ~ell typ~.;.S (r:nlled plur-lpOl(!l'lt} Some .sttm cells destined '() produce lnllllllllf: syslem cella serve us. sol~.rt:es for lympbucytes, whereas others develop into phugQcytes. Those tluu bocom~ lymphocytes arc ditr~,.~n:ntiatc-d to bccon1c either B ce-lls (K'Ilicll nwhu-e In 1/te bmw mm't'OW) or'f cells (''1/u'clltraveJ to tire Jhymv.t a11d mtUil'~ !here).

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The deep C~:rvical lyo1ph nod<>""' lo<:med nlqng ~1e length of ~1e internal jugular vein on each side of the neck.. deep to the stemotletdnmnslmd nmsde.1l1e deep cervical nudes extend rr um 1hc bMe of1he skull to he root oft he n"ck. ~djP~ntlolho phar)'TL<, esophagus. and trachea. The deep cervicnl nodes arc f\uthcr cluli.~moo as to fuetr relationship 10 lhe sremocleidomastoid omsele -a~ being superior or inferior. The deep oervical lymph nodes are responslble f011he drainage of mos1 of he circular chail1 of nodes, and receive ciircot oft-.renL !Tum lhe salivary and thyroid glat\<1$, lh~ lOngue, he tousil, lhu nose, lhe pharynx. and lhe larynx. All !hose v~..,l~ join 1ogether t~ fo1111 the jugular lymph trunk. This v""sel tlruins [mo ejthe.r the thoracic duct onlh left the right lymphutk duct on <11e rigb,~ "' independently (!rain. into ~ither toe ihtem~l jugtil~r. subclavian. or brachtocephalic veios. Some regional groups of lymph nodes: Po rood lymph nod., - receive lymJih frum a strip of S<:!llp abo..: lhe parotid saJivlllY gllUld. fr<lln the nnledor wnll of the extemal otditory meatus. and from the latcml pJIJ'Is uf lite eyelids and middle car. Tho ciTcrcnL lymph \'OsS<:ls drain into the deep cerviool nod"' Submandibttlar lymph nodes - located between !he sub111andibular gl11ucl and lbc IUIIUdible;
receive lymph fnnn Ihe fronl of the -se:aJp, the no:..e, ond udjn... "Vnl cheek~ the upper lip and lower

lip (I!Xcepllltd c<'l!/4'1' fXIrl); the par.masal sinuses; the 111:1xillary and mondlbulor lo<tb lt<'Opt rile IIJQJU/ibttlar im.'iWJrs); the antt"rinr two.-thlr(ls or ch~ tongue (ttfCf!fJ( lite tip); Hie floor of the ll1uuth "'nd vestibule; ~1nd t11e-gingiva. 11 hc et'fhent lymph vessel~ {ltain inlo the de~p ccrvlcul

Subne.ntal ly"'ph nodes ~ loca,ed behind lbe thin ru-1d on the mylohyoid muscle' receive lymph from the Up or the longue, the Ooor of the 11\0IItb b<'Jlcath ~e lip uf the tongue. lhc modibulsr incisor teeth and nssoclutt gioglvn. the ccmer Jl&lt uf tho lowe lip. ~nd lhc s.IJn over the chin. The effeJ'I'nl lymph vessels ~'"io into llw t ubmnndlbular ;mcl deep ccrvica.l node-!



When antigen recognition occurs by a lymphocyte, B cells are activated and""D II" \.. migrate to which area of the lymph node?

Inner medullary region Medullary cords Medullary sinuses Germinal centers

Cop)rigbl 0 2009-2010 lknlal Oeekl



The thoracic duct usually drains into the:

Left internal jugular vein Left subclavian vein Junction of the left internal jugular and subclavian veins

Superior vena cava

Junction of the right internal jugular aud subclavian veins

Lymph nodes art small, round specialized dilations of lymphatic tissue that are permeated by lymphatic channels. Their function Is primarily to act as filters. They help rtmove aud destroy antigens that circulate in the blood and lymph. for this purpose. lymph nodes con min a lot of macrophugcs. Lymphoid tissue in the nodes also produces antibodies and stores lymphocytes. Note: The nodes generally occur in clusters along the connecting lymphatic vessels particularly in the armpits, the groin, the lower abdomen, and the sides of the oeck. Each lymph node is enclosed in a flbrous capsule with internal trabeculae (connective twue) supponing lymphoid tissue and lymph sinuses. The node ~ns15ts of: Outer cortical region - comains separate masses of lymphoid tissue called ger minal centers (nodules) , which are a .source of lymphocytes. Also contains subscapular and cortical sinuses lnner medullary region - lymphoid ttssue here is arranged in medullary cords, which are a source of plasma ccUs (they secrete ani/bodies). Also conlllins medullary sinuses Lymph nodes can be classified as primary or secondary. Lymph from a particular region drains tnto a primary node or regional node. Primary nodes. m turn, drain into a secondary node or centrnl node.

Juncliun ulllnll'l.t inll'rnal


ami \uhd.l\1:111 \dm.

The thoracic duct is the main duct of the lymphatic system and is located in tbe posterior mediastinum. It begins below in the abdomen as a dilated sac, the cisterna cbyli (at the level o/ the Tl 2 vertebra) and ascends through the thoracic cavity on front of the spinal colwnn. It is the common trunk of all the lymphatic vessels of the body. and drains the lymph froon the majority of the body (legs. abdomen. 1~(1 side of loead, left arm. and leji rhoriiX). Note: The right lymphatic duct drains much less of the bt>dy lymph (only the ly mph [1-om the right arm, rig/of tloora.<. and right side of the head). Important: The thorncic duct empties into the junction of the len internal jUJtttlar and left subda ian tins (which is acwal~ tloe lx.ogimung ofthe left brachiocephtollc vein}.
~ I. Tho thoracic duct ascends throut~h the aortic opening in the diaphragm, on !'lotos the right side of the descending aorta. 2. The thorncic duct contains valves and ascends between the aortn and the azygos vein in the thorax.

The right lymphatlr duct is the right-sided cquivnlent of the thoracic duct and drains the right side of the head and neck, the right upper limb, and the right s ide ofthe thorax. The right lymphatic duct empties into the junction of the right internal jugular and right subdavlan veins (which is actually the beginning of the nght brachiocephalic 'ein).



A 25-year-old car accident victim is bought into the emergency room complaining of severe abdominal pnin radiating into the left scapula. Low hematocrit, marked hypotension, and a grossly bloody peritoneal tap all Indicate a ruptured spleen. A splenectomy will be performed, and the surgeon must remove the spleen from:

The right inguinal region of the abdominal cavity The right hypochondrium of the abdominal cavity between the stomach and the diaphragm The left hypochondrium of the abdominal cavity between the stomach and the diaphragm The hypogastrium of the abdominal cavity just below the liver

Cc.lp)-riih1 0 20092010 Den1al Ottli



An 11-yca,...old girl presents to the pedlatrl<lan with high fever, sore throat, earache, and greenish sputum. Enlarged tonsils, areas of pus, and the inflammation Indicate tonsillitis. The girl also is breathing through ber mouth; the swelling of which tonsils (also known as adenoids when enlarged) caused 'the obstruction of the nasopharyngeal isthmus? ..J

Lingual tonsils Palatine tonsils Pharyngeal tonsils

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di;~ phra~m

The spleen os an 11\ood organ roug,llly til<> so.te of fill. The spleen contains white and red pulp. The white pulp contains compact onoes oflyn1phocyt.,; swroundiog bmnches of the splenic at1cry. The red pulp consi$t< of a network of blood-fil.Jd sinusoods, nlong with lymphocytes, macrophuges, pla.-ma cells. and monocytes (plwgoqtic w/oile bluod cc/Lv). There are tbree mujor flutotions o( the spleen, 111od these ure bandied by three different tissues wltbln lht spk"ln: Retlculotndotheli~llissuc: concerned with pluogocytosos of erythroc}'les Wtd cell dcbns tium the bloocbtR>Un This same tis:ruc muy produce foci of hemopoiesis when RBCs lll'c oo<ded Venous slnuroids: afons wilh the poW<...- of the $pleen to contrnct. provides a methQd for expeUlllg the conuun<d blood to ~ increned "'"'"latory ckm:onds W!oitt pulp: J'I'O'ides lymphocytes ll1ld a wurce of pi !ISm cells 8!ld hence atltibodio~ for rbe cellular ond humornl specific immune dcfenseq Blood enters tbe S)Jietn at the hilum through the splenic rtuy and L< drnlnd by the splenic vdu, wbich joio~~ the superior mescntoric vein to fonn the hepatic puo1al vein In the liver. ibe nerves to the spleen accompany the >picnic ~rtcry and are derived from tho cellae plos.us. Note: Like the thymus. the spleen pusocs::s only efferent lymphatic vessels. Rfmember: flle srleen does not develop from th< primitive gJll, . . rio the lung. liver, panclt!S, g:illblad~r. stomach, esophagus. ..nd inttincs. The spleen ck' elop.< from ooesentbymaJ cells uf the mesem<f) anacbed 10 the pnmirive >1oll1aCh.

The tonsils at tymphotic o~gans dn lie under the <urtloco lining of the mouth and throat They an: con;idcrro ptlt1 of the secondor) lmntune <)<If on. They sit in the Te>pir:nory and alimentary Inlets on po,.inon to he ~posed to wpm or ongesoed antigens from air or food. When sufficient antigen is preset~~, tbos ,\lmultes !he B cell< in the germinal wne of tile lymphood follicle to differentiate Jold product Dllhbodies. The too.<ils are mvolved In the production of mostly secretory lgA, which tmuponed to tho $urface, pt<wtdins local immune prutcclion. There nre three sets o( toullR, 11mcd accor\ling to their postlion. The phQ. ryngeaf ton! liS uro located crn the IIOStoriur waU of tho oasopharyru;. They 1\l't at their peak or Jcvelopment dllring childhood, oud wloeo elllargtd. lhey arc referred to as adenoids. fltey arc surrounded partly by ooul-"'ctl\c tissut und partly b) clllqted pseudo31Tatllled rolumnor epithelium (,...spfru/01,' pirhelium). They contwo no <.rypts. The palatine tontll! arc located on the posu:rolateral "'"lls oflhe tllroilt. one on tach side. They te~~ch thar maximom sae dunng e:orly childhood, but atler pub<t1y dammish considerably uo i7e. 11~ are lhe tonsils that arc: notocnbly erdaq;ed when person uffm from a "sore throt." They contain muoy crypts, lymphoid follicl.,., but nu slnusC!I. The palatine tonsils are surrounded pat1ly by coooec\tve hs.sue and partly by non-keratholtcd stratllll>d squamous eplthellum. l mportunt JIOint: The be~o wny 10 di$\lngui>h the palatuoe tonsil from the pharyngenl tonsil on the histologoc love! ~the type of epithelium aswclnted With it, The tinguul tonsils nrc smaller and mora tlltlltorQus. They arc: a colle~.'ticm of lymphoid follicle,; on the posteriur portion oftbt don>um ol'thc tongue. Each has song)e crypt. They surrounded by nonkerttinized oiTatifid squamous epithelium. Remember: Peyer's patches are similar in structure and t'unctioo to the toMtl< (Pt')tr'> patche form ~lntostinal tonsils"). ~t<d w \be 'mall intestine (.tp<'<'lfiCJJII}\ tbe Uoum/, th.ey serve to deJ.1ruy the abundiUit bacteria, whoeh \\Ollld olhorwiso tbnvc on the moi>1 environment of the ml<...,une. Note: Peyer's tontcbc~ anJ tonsils arc cons.dcred sulx'J'Ih<liol and non-encapulultd lymphoid tissues.



In which oftbe foUowlng locations would one most likely lind ycUow bone marrow?

Head of long bones Center of long bones Ribs Cranial bones Venebrae

Copyrisbt 0 20092010 Oen,al Dftb



Which leukocyte is the predominant cell type In pus, and is kno .. n as the hallmark of ac.u te inOammalion bocause of its fast immune response? ~


Basophil Eosinophil

Monocyte Lymphocyte Neutrophil

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*** YeUow bone ma rrow functions primarily as a site for fat storage and is found in the eenter of long bones.
The bones are not solid structures. Cavities in the cranial bones, venebrae, ribs, sternum, and the ends of long bones contain red bone marrow. This blood-Conning tissue pro duces erythrocytes. leukocytes. and thrombocytes within bones by a proceM called hemopoiesis.
I. Before birth, the formed elements are also produced in a number of other locations, including the liver, spleen, and lymph nodes. 2. Erythropoiesis refets specifically to the production of erythrocytes.

, Not

The red bone marrow contains precursor cells culled hemocytoblasts (pluripotem stem cells) that give rise to all of the formed elemems of ~1e blood. The bemocytoblnslS give rise to various committed progenitor cells, which give rise to the different types of formed elements. For example, the erythrocytes develop from procrythroblnsts; the platelets develop from large cells called megakaryocytes. When a child is 7 years or age, yellow marrow begins to appear in the disiJll bones of the limbs. This replacement of marrow gradually moves proximally, so that by the time the person becomes an adult, the red marrow is restricted to the bones of the skull, the vertebral column, the thoracic cage, the girdle bones, and the head of the humerus and femur.


Formed Element El)'lbrocytes


Avg. NoJmm' Otscrlption

S million

Transport oxyg<n

Biconca\'e, enucleated cell

I S0.000-400.000 Small ocllulor frogm<:nos 10,000 S,400


Cranuloc:ytes: .


Lobed hUCICU"', nne granules

lobed mlti<\IS, r<d or ~cllow gnonulcs

Part of the immune

system (phaxocyto.tls) May pllagoc:ytoze Af>.Ag


Ob!CuJ< nucleus. logl11 purple


Release hi.sunune, heparin. and serooorun


Monoc}'1c5 Lymphocyte


Kidncy-&hapcd nucleus
Round nucleus. lntlc cytoplasm

Phagocytosis Produce Ab, de.< troy specific target cells


Under the microscope, erythrocytes (red blood cells) appear as:

Oval discs with multi-lobed nuclei Circular discs with centrally located nuclei Biconcave discs without nuclei Circular discs with several nuclei

11 Qlprri&bl 0 20092010 Dtntt.l Dttks


Which leukocytes (white blood cells) are the least abundant?

Neutrophils Monocytes Eosinophils Basophils Lymphocytes

~0 10 Octll.aiOecb

IJiconl'a\'(' discs \\ithout nucl ei~- the~ alsn htck mitorhondria

Tbe process of erythrocyte production is called erythropoiesis. The hormone that stimulates erythropoiesis is called erythropoietin and is produced in the lddney. The average life span of a red blood cell is 120 days. Erythrocytes, or red blood cells, make up the largest population of blood cells, numbering from 4.5 million to 6 miJiion per cubic millimeter of blood. Their principal function is to transport oxygen and carbon dioxide. The hemoglobin molecules in erythrocytes combine with oxygen in the lungs to fOJm oxyhemoglobin. The oxygen is transponed in this state to the tissues of rhe body. lo the tissues, the oxygen is released to diffuse into the interstitial fluid. Within the tisues, carbon dioxide is combined with the hemoglobin molecules to form carbaminohcmoglobin, which is transponed to the lungs. Note: About 70% of carbon dioxide, however, is transported by the blood plasma as bicarbonate ions (HCOj ). Remember: (I) The proportion of erythrocyres in a sample of blood is called rhe hematocrit- usually around 46% for male.s and 40% for females. (2) The precursor cell found in the red bone marrow tltat gives rise to all of the formed elements of ibe blood is the bematocytoblast (these are pluripotenr stem cells). which gives rise to various committed progcoitor cells, which then give rise to the. different types of formed element$. Note: Granulocyte Colony-stimularing factor (G-CSF) is the hormone that stimulates precursor cells in the boue manow to differentiate into white blood cells (leukocytes).


body weighL 4 to 61iters


Temp= 38"C pli of 7.35 To 7.45

Plasma 55% Formed

FORMED ELEMENTS (mtmber per cubic mm)



Platelets 250.000-400.000 Erythrocytes 4.3-5.8 million

NeutrophUs 60-70% Lymphocytes 20-30% Mono<)'t<s 2-6% EosinophUs 1-4% Basophil 0-1%

Important: The mnemonic "Never Let Monkeys Eat Bananas'' identifies the order of abundance of the leukocytes.

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I' GuillalnBnrre syndrome, myasthenia gravis, Wegener's granulomatosis, ""'I

and Goodpasture syndrome all have one treatment option in common. This involves taking whole blond and separating out the liquid portion and then returning this liquid portion back into blood circulation. The liquid portion \.. of the blood is called: ~

Formed elements Cerebrospinal nuid Plasma Lymph

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Platelets are best described as:

Giant, multinucleated cells Cytoplasmic fragments of cells Immature leukocytes Lymphoid cells

Cop)'n&ln C> ~010 o...., Do<b


Plasm~ is approximately 9 I% water; the other ponion is made up of various materials (see char/ below). The portion of the blood that is not plasma consists of formed clements, which includes erythrocytes (red blood cells),lcukocytes (white blood cells), and cell fragmentS called platelets. Note: Senun =blood plasma without fibrinogen (after coagulation)

Bl..OOD PLASMA 8%of body weight 4 to 61iters Temp= 38'C pH of7.35 To 7.45





{ {

AJbumins SS%

7% Water

GlobuUns 38% Fibrinogen 7%

Formed Elements

Metabolic end produces Food materials


Other Solutes 2.0%

Respiratory gases tlormones. etc:. Ions

Note: The treatment described on tlte front of the card is called plasmapheresis.




of cells

Although platelets are often classified as blood cells, platelets are actually fragments oflarge bone marrow cells called mcgakaryocytes. Platelets are minute, irregularly shaped, disc-like cytoplasmic bodies found in blood plasma that promote blood clotting and have no definite nucleus. no DNA. and no hemoglobin. Normal blood contains 250,000 to 400,000 platelets per cubic mm. Their life span is 7-10 days; they are removed in the spleen and the liver. Note: Thrombopoictin (a glycoprotein hormone) is synthesized and secreted by the liver. Thrombopoietin stimulates precursor cells in the bone marrow to differentiate into megakaryocytes. Megak.aryocytcs give rise to platelets. Remember: Platelets stop blood loss by forming a platelet plug. They contain many secretory vcskles (granules), which contain chemicals that promote clotting. When platelets adhere to collagen, they release ADP and other chemicals from their secretory vesicles. Many of these chemicals, including ADP, induce changes in the platelet surface that cause the surface to become 'sticky.' As a result, additional platelets adhere to the original platelets and form a 'plug.' Important: Thromboxane A2 (TXA 2), produced by activated platelets, has prothrombotic propenies, stimulating activation of new platelets as well as increasing platelet aggregation.



'A 61-year-old mole comes to the family physician complaining of sharp and a burning sensation in his hips and knees. The pain gradually gets worse threugbout the day, and although the knees seem enlarged, there is minimal inflammation. The physician notes slight grating and crackling sounds (crepitus) and diagnoses osteoarthritis. Tbe cause or tbe signs and symptoms or osteoarthritis Is the degradation or wb icb or the following structures io loadbearing joints:


Synovial membrane

Anicular canilage

15 CoJ!>-riih1 0 20092010 Denta.l l~'kJ


A synarthrosis Is a (an):

Joint permitting slight mobility Immovable joint Freely movable joint

S)110'ial JOints are frly movable (diardrrodial/. wllh onov<mcnt limited only by jomt ~urfa=. ligament;. muoclc:o. or tendons. They are chai"ICttrlzed by four features: 1. Articular <art:lla;e- a thin layer of hyaline can>logothot covOI'> tbe smooth onitulnr bone surfaces. lltis layer contain~ no blood vessels ur nerves. Note: The tcmporomandib\11Br jomt conlains fibrocantiA{Ic. nut hyaline cMilnl.(c. 2. J oint cavlry - m11ll Ouidfilled space >cparutllll! the ends of adjoining bones. 3. Artkulnr Qulnl) capsule - double-layered: outer loycr of fibrot"' connccuve tissue that enclose> the jo10t. 4, Synovial mcmbnoe produces synoYlal nutU. Found on both bursa and ruticulor QIMtlagc. ~ote: MOSI)OtniS ofth< body are syooial joint!. They nre clossifted funcuonally as dlarthroJes (metmsfru/y mO>'<Iblt). lu addition to lht feataun above. some synovial joinuo bave artl<ular discs (T/IU and <ltrn<>ela>mrlarjoinr/. The$e '"""" con<ist offibroeanilgc. They dJ\'ide the cavity into two separate cavities. Synovial Ould IS o clear. thick Ouid secreled by thoynovial mernbr.mc, whtch fills thcjoml capsule and lutmcatcs the articular cartilage at the end~ of the articulating bones. Supporting llgu"'cnts (cap..,u/UJ; e.timCttp.'illlm; tnld flllm,apm(ar ligaments) mnmtmn the nor mal positioo of tho bones. Ten percent of synovial JOtnls have a washer-like str\leture betwec:n bone ends called 1he meniscus. Its purpose is to absorb shock. to stabilize !he Joint, and to spread synovial Ouid. !'he menc< cus is made out of Jibi(ICanilage. but the m<'ntS<:US also has no blood supply. no nerves. and no lymphanc channel>. Diolog~eally. the mcnil.c:us ton'! heal itsdf. fhe knee metnSCU> b the n>O>t famous and mO>J. InJured meniscus in tbe body. Note: A bursa lS 1 fluidUC \hal is lined with a s)'novial membrane. The funcnon of a bursa a s 10 reduce fnction. for uample, a bursa may be locat<-d bc"\'ttfl a tendon and a bono to reduce the fric1ion of the tendon passing over lh.: bone when the tendon's muscle contracts. lnflamn\t'ltion of the lining of a bun1a t$ rcferr~d to a.s bursitis.

h nmm ahll juint

Articulations (jOltiiS) are the strucrures wb~re bones connecL There are three rn3tn class es of aruculations based on the amount or motion they allow: I. Syoarth rosh immovable joint (fibrous joint). Surures found bct\\e~n the Oat

bones of the skull are of this typt. Note: Gom11hosis is an example of a S)lllanhrosis. It is the joiot that bmds the teeth to the bony sockets (dental alveoli) in the mandible and maxilla. 2. Amp)llorthros\s - slightly movable joint (c'DI'Iilaglnnu.vjnint). One example is the symphysis pubis, where the two os coltu bones join anteriorly. 3. Diarthrosis freely movable join! (synovial joint).
Joints can also be classified based oo the type of associated conne<tivt tissue: Fibrous (joined byfibrous ~onnec:ti'f'tissue) two types: sutures (ofskull) and S)'D dumose (OOK f!f!lf rod/us and ulna) Cartilaginous (joined by jibrocurtrlage ur hyaline carrilage) - two types: S)lllchondroses, whtch are joined by hyaline cartil~ge (epiphyseal plates wirlt/n long lxmes), and symphyses, which are joined by a plote of fibrocartllage (pubic .tt'lltpity. vis) Synovilll (jolm capstile containing o synovial membrane 1/rat setrotw 11 srnoial j/uid) most joint~. ~uch as Ibe lemporomaudibulur join Is, are synovial


An 18-mont h-old boy diagnosed with Crouzon's syndrome needs to have surgery to treat the prematurely fused cranial bones. The joints In the Oat bones of the fused cranium are classified as which of the following?

Symphyses Synchondroses Syndesmoses

17 Copyripte 2009.:zoto Oentall)e(:b


The paramedics arrive at the scene of a minor motor vehicle collision. One ~ driver dalms to ha,e experienced whiplash and is ha,1ng trouble shaking her head in a "NO~ motion. Sbc is line with nodding her head in a "YES" manner. Which of the following joints allows maximum rotational movement of tbe \, head about its vertical axis (say/11g "NO")? ~

Intervertebral joint Atlantoaxial joint Atlanto-occipital joint Costovertebral joint

JointS are places or union bcrween two or more bones. Joints are dass.ified on 1he bass of their slrUCrural feanues mto fibrous. canilaginous. and synovial types. Fibrous joints {.f)'nDnhroses): are barely mo,ablc or non-movable and are found in these fonns: Sutures arc connected by fibrous connecrive tissue and are found betWec11 the nat bones or the skull Syndcsn1ose.s ore eonnec1 ed by fibrou..~ connective tissue and occur as the inferior tibiofibular a.nd tympanostapedial syndesmoses Cartilaginous joints (amphiarthroses): Synchondroses (primary cartilaginous joi11U) are united by hyaline cartilage and pcnnit no movement but growth in the length of the bone. These include cpiphy=l canilage plates and the firSt rib and sternum Symph)ses (sw:mdary carti/agittOus joints) ore JOined by a plate of fibrocanilage and ore stighlly movable JOints. These ioclude the pubtc symphysis and the intervertebral dises Syno,ial joints (dlarthrodial joinrs): Permit a great degree of free movement. They are chametcrizcd by four feature>: joint (.<ynovia/) cavit-y, rtlcular cartllag~ synovial mtrnbrane. and articular capsule. Tlu;sc joints are classified according co axes of movement in1o: Gliding (platte): include those joints found in the cArpal bones of the wrist and the tarsal bones of the nnklc Hinge: the elbow and knee joints arc examples Phot: jomt such as is found between allo. (CI) and a.'is (C2) of the vertebral colwnn Elhpsotdal (condyloitf): found bet"ccn the diSUI surfaces of the forearm bones (rodi11s ond ulna) and the adjoccnt c:aipOI bone> Saddle: found where the melllcarpa.l of the thumb meetS lbe ttap<:ztum of the carpu.

Balland-Jocket: examples include the shoulder joint and the hip joint

.\ thln1n: n ial jnint

This joint is the synovial aniculation between the inferior aniculating facets of the atlas (first cervical errebra) and the superior articulating facets of the uls (second cervical vertebra).

*** Remember the movements of the head as in saying "NO."

Note: The lltlanto-occipital joint permits rocking or nodding movements of the head as in saying "YES." This joint is the synovial articulation between the superior articulating facets of the atlas (first cervical vertebra) and the occipilal condyles of the slruU.



A 51-year-old male telemarketer has had a history of nephrolithiasis (kidney stones). A calcium oxalate buildup in the renal papilla would directly block filtrate now into the:

Major calyx Renal colwnns Minor calyx Ureter Renal pyramid

CopyriJ}It 0 2009-2010 Dnltal Dtcts




Name the following structures of the nephron in the order they are encountered from blood to urine:

Distal convoluted tubule Bowrnans capsule Collecting duct Glomerulus

Loop of Henle
Proximal convoluted tubule


\1innr cah' The kidn-ys an: lcxued at !he back of the abdomen. one 001 each side of !he spme, at !he level of !he lo"er ri~. They are a pair of reddi<h, bean-shaped organ> that are highly vasculariud and perfonn two essential functions of the urinary system: (I} fom1ing unnc

and (l) matnrnining homeostasis. Jhe lcJclney5 are located on eitber side of the lumbar spine, They lie rerroperltooenlly (exlema/ 111 tire peritonea/lining a} the a/xiomlnal C11Vity) in front of the muscle$ 111tached to the vencbral column. Internal features of kidney: Cortex - outer ltght-brown layer (glomentli and pro~imal and df<tal crJJtW>IIII<d ltthllles ar<! located h~re). Site of blood liltration Medulla - 1nner dark-brown layer. con tams cone-like structures called renal pyr:imids that arc 5cparntcd by renal columns Renal rulunu11 - cxren.~ions of renal CO!'I<!x Reool pelvis a hollow inner structure that join.< with the ureters (lhr tuber tltat conduct ur/ue ro the blaldder). Receive.< unne through Ute calyces Renal pnpiiiQ apex of pyramids, her< the collecting ducts pour into minor calyces Renal calyx extension of the renal pclv1~. Minor cnlyces unite to fomt mujor calyres. which urine is emptied into

t. The right kidney lies slightly IOt>er than the left kidney due to the large Nota tze of the right lobe of the hver. 2. Each k1dncy is surrounded by a Ohrous renal capsule and IS &upron<d by rbe adipose capsule. 3. tach k1dncy bas an indentauon, rht hilum, on the medial border, through whicl1 1he ureters. renal \'C:-!'~cls, and nerves enter or leave. 4. Each ktdncy rcceivos its blooo >upply from a rena l ortcry. a branch of the abdominnl aona.

<;tonu.:rulu' Um\nt:ln , ('tipml1. > Pru,inull . nn\ulutld tuhull" Oi,tal ('nH\ nlutt.d 1uhul1. -, Colll'CiinJ,! t..luct


l .un1 nf lh. nh.

Tbe Sllbunit of a k1dncy rruu punfics blood and ma1nta111! a qfe bslancc of .otu1es ml wa1cr" the! otphron: ttl& the fullcti011l untt of the bUmlln cM:rclory $Yslem. About one m111ion ntph!Oil$ are 1n t11e concx of c:J~Ch ltidney. and w:b one os 3 tong tubule with a dosed nd. cslled ~te Bo"man's capsule, Comp.u1~1t~ or the: ncrhron include:: Rcnl cnrpusele: which consists of ~lnmcrutus (11<11\'Qrk ofpllr<tltel cllpi/torlc..) and a double-wallud Clip. thu Bowman's capsule whtch surrounds the glomerulus tWd collects tilIrate. The nmul cotpuscl~ is the slte of tiltl't\tl\ln; tlus oom>ally produces protein-free nnd cellfree filtnu" th~t p~sses into the proximal eoovolured tUbltles. Tiae tubular portion: hns tour main reg1ons. Hhrtc from the Bowl'flo\n's <Up5Uic fil'11 passes into tht prol1nua1 tonvoluted tubule tn the (.'Ortex. Herr, glucose, am111o at1ds. m-ettlbo-lires. nJ electrolyts reabsoli>ed from fillnlte and re1Uf1led to ciroulatioo. ext, the filtrate Cllte15 the loop or l:lenlt, fu:<t 11\n,uatr it> dc><:aldong hmb aod thf<l throustt liS &>ndmg limb. Here. tho filtrate i$ COIIC<narated through eler~rolyte exchang_e and reabsOtJ>IIon ro produce a hwerosmolar fluid. This loop exltntls dec:p uuo the medulla. from there. Ou1d en1er, the distal cn..olutcd tubule, alw in 1he cortex. Hue, sodium is reabsorbe-d under the inftu enec of aldO>I<ruM. From lloe distal eonvohned tubule. tilrrate enters the oollectln~ duct, which is the dlst61 end of the nephron. l h1 s a tht ~lie of flno.l concenrmtou of flltn1fe, whtt:>h tlle11 empties into pupil lui)' ducts deep Within tho lltloollu. Aller filtration. Ouid in the noboolos of the nephrons undergoes two more proce,.es. both onvohing the peritubular e.~pillaties: tubular rrobsorptlon and tubulr srrretlou. Sotn< bloo<l 1S not liltered and p.....s Into the efferent "<=Is and pmtubular capillaries. Mru~y ubs1aoces that are filtered~ returned to 1h~ perirubular capo liMes from the tubules by r<al~on. often at hogh r.ues (eJ; nv:rttr. gluro$e, <oditun). Waste productl ftre aod etnj>!ied tnto a collecting tubule, whoch 1R discharged to the ~ttle111.




Name the foUowlng structure.~ or the urinary system in the order they are -.,. tneountered from systemic circulation to excretion from the body:

""' a

Urinary bladder Ureter Urethra Kidney

21 Cop)Tigh10 20092010 Dtnul Ott\.:



Which statement concerning urine is false? Adults pass about a quan and a half of urine each day, depending on the fluids and foods consumed The volume of urine formed at night is about half that formed in the daytime Norrnal urine is sterile. It contains fluids, salts, and waste products, but is free of bacteria, viruses, and fungi The tissues of the bladder are isolated from urine and toxic substances by a coating that discourages bacteria from attaching and growing on the bladder wall Urine forrnation is the result of three processes: glomerular filtration, tubular reabsorption, and tubular secretion The ureters regulate reabsorption and secretion, thus determining the composition of excreted urine

h.idlll' \ ~

h ' h.t ,

I nnn hi:Jdd<.' r

> t


The urinary S)stern consists of the kidneys, the ureters, the urinary bladder, and the urethra. 1l1is system filters the blood and rruuntains tbe volume rutd chemical composition of the blood .

The kidneys are paired organs, which conmin extensive vascularity uod millions of nephron. within ll1e runul cortex and rtnal medulla. The kidneys filter blood und regulnte the volume and com posh ion of body 1lwd.s during the formation of unne.
The ureters are long, slender.libromusculutu~ that t.r.lJlspon urine from lhe pelvis of the kidney to !he bas.:. of the urinary bladder ~nuse the left kidney is htghcr than 1he right, the let\ ureter IS 11!\WJIIy sligbll} longer 1hru1 lho ngh~ The uretets are narrowest wbere lboy originate, at the renal pelvi~ (urererope/vl~ junction). Note: Filling of tbe bladder conslricts lhe ureter& 111 the ureteroYestcnl JUnction, where they enter tbe bladder. Peristaltic waves, oce11rring about one to five time ech minute, move urine through Ihe

The urctbr11 is a fibromuscular tube that cun-ies urine liom the urinary blnddcr to tbe outside of the body. In males,lbeurelbrn carries semen as well as urine. Note: The portion of lhe motle urctb 1"3 lhat passes through the urogcnual diaphm~m is called lbe membranous uretbn. The urinary bladdu i~ a distensible sac that i~ suuoted in the pelvic eavity postenor tQ the symphyss puh.s. The unnary bladder .s sli{!htly tower in lbe female than tn the male. It conceotralcs und serves as a reservoir for urine, which the bladder recetves from the kidney lhrougb the ureters and discharges through lho urethra.

I hl' url'lt' n





thu' dLh.nmnint.: thl'


ur l'\(rlllrlurilll.'

ThiS 15 faiJt; the kidneys r<gUiate reab.orpt1on and secretion. thw; det<rm'"'"ll the compositton of excre1ed unne. Urine Is conlinually produced by the kidneys and .tored m the bladd<:L When full, the blatl der sends a messegc to lhc reflex center'" the eMil pnn of the >pinal cord, where tl U'II!S""' 8 reflex contractiOn Of the muscle Of\be bladder OliO C(lllse8 the Ue<:k o( the bluddor 10 <elltll. This reflex ls surpressed untillhere is an opponunity to relieve the bladder. !'he u~inory system excretes the waste products of metabolism and mullllalus I he buluncc of water and electrolytes in the blood. The ~ystcm removes nitrogenous waste as urea from the blood. Urea Is produced when foods contniniu~; protem, such as meat. are broken down iuthe

The kidne~s remove ur<a from the blood tluwJ!h tiny tilteriug uni;s called nephrOn>. U"' tOgether with water and other Waste <UbstatleeS. fonns the unnt BS it p:IS.~C$ through \he nephrous and down the renal tubul"" of the ktdncy. Remember : Pressure fTQrn the blood in tbe glomerulus cause.' fluid to tiller 11110 the Bowman's capsule. From there, tluid flows to the pro~lmal convoluted tubule, the loop or Henle, Jtllben to the distal convoluted tubule. Wlthin this system, wt~r. t;lttcosc, and sodium are renbsorbed Into the blood. Wn5tc produc1s are retained ~ntl emptied iuto a coUeding tubule, which Is discharged to the ureters. I. The urinary syatom is lined with lransltlonol epithelium. Nor.. 2. Th~ ~cnital nnd urinary system; 11n: supplied with parosympatbetk tibers from the pehlc splanebolt nrvos. 3. The ktdney<;, ureters, and urin.uy bladder are aU located rtlroperltonoally. nu, means !hey are located bfllind tbe ptritoneum, which tS the serous membr.me lining the: walls of the abdominal tnd pelvic cav1tics and enclosin1:1 the viscera.



r A 26-year~ld female has been previously diagnosed with McCune-Albright ""''

syndrome. There Is bony fibrous dysplasia of the anterior cranial base leading to the encasement and narrowing or the optic canal. Although her vision Is nor mal, there Is concern that there will be compression or the op!lc nene \.. and which of the following other stTucture(s)? ~

Ophthalmic nerve (CN V-1) CraniaI nerves Ill, IV, and VI Ophthalmic anery Ophthalmic veins

Cop)nt;bl 0 2009-2010 t)(m.aJ DL.


rA62-year~ld female visits the family physician with complain ts of right-sided

bearing loss, ringing in the right car (titrnitus), numbness over the right half of her face, and dizziness. The physician diagnoses her with an acoustic schwannoma that is occluding her right internal acoustic meatus. The Internal acoustic meatus pierces the posterior surface or the petrous part of the temporal bone. The internal acoustic meatus transmits which two structures?

Trigeminal nerve (CN V) Facial nerve (CN VII) Vestibulocochlear nerve (CN VIII) Vagus nerve (CN X)

The optic canal is located posteriorly in the lesser wing ofthesphenoid. ll communicates with the middle cranial fossa. It transmits the optic nerve and the ophthalmic artery. Bony Optnlng
Cnbrifonn plato wot~ foramina
fl)'JlOglossal caru.l

Location (Bone)

OtfoctO<y ""rvcs



Carotid co.naJ
Lacrimal canol

\tUJIIa and t><rimaJ Sph<no.t and maxilla Sphenoid

lnttmal c3rotid artery

N:u<>l><nmal (troT) duol
Jn(t'IOCbual and eygomaric nef\t:s from V2,

Inferior Olbttal G<<UTC

Smrior orbital fis:.urc


artery~ and

ophthalmtc. vein

Oculomotor. ttoehlcar, Bod obducent

ncr,. e,: lacrimal. frontal and niSO('ili31)' b11ncllos of 01>hlh>lm~< no."rVe (VI);

"!'htholmoe V<in; sympalheue fib= from


Optic canal and foratn<D

Slylomastoid roramen

Spbonotd bone

Ophc ner\'e Md ophtl\almtc ancry

Faclnl nerve


I acial nl'n t' (( \ 1//J -- mntnr and \ t,tihulm,:m:hh-.r ntn l' I( \ J 1//J



The vestlbulocochlear nerve enters the intemal acoustic meatus and remains within the temporal bone, to the cochlear duct (hearing). semicircular ducts, and maculae (balance). The facial nerve enters the internal acoustic meatus, the facial canal in the temporal bone, and emerges from the stylomastoid foramen. The stylomastoid foramen ties between tbe styloid and mastoid processes of the temporal bone. After the malo trunk of the facta! nerve exits from the stylomastoid foramen. it enters into the subsraoce of the parotid gland. It is here that it gtves off five main braocbes that will supply motor innervation to the muscles of facial expression.

,,...__, I. If you inadvenently deposit anesthetic solution in the parotid gland j Notf when giving a mandibular block, the patient will develop paralysis of the muscles of facial expression. 2. An acoustic neuroma is a tumor involving the ve.,tibulocochlear nerve as it exits the cnnial cavity. Because this tumor compresses surrounding structures or invades nearby tissues, in addition to hearing loss and equilibrium problems. a patient would most likely also demonstrate ipsilateral (same-sided) facial paralysis.


A fourth-year dental student is getting to perform operative work on a ~ mandibular molar. He is ready to provide an inferior alveolar nerve block. Thinking of his old anatomy exam!, be remind! hlnuelf that this nerve enters the mandibular foramen. In relationship to the occlusal plane oftbe mandibular molars, the mandibular foramen is located:

At or slightly above the occlusal plane and anterior to the molars At or slightly below the occlusal plane and anterior to the molars At or slightly below the occlusal plane and posterior to the molars At or slightly above the occlusal plane and posterior to the molars

Copynaht C 20092010 Dcntai DKkJ



Which of the following allows for the exit of the spinal accessory nerve from the cranial cavity?

Foramen magnum
Jugular foramen Foramen rotundum

Foramen ovate


The mandibular foramen is located on the medial surface of the ramus of the mandible just below the llnguln, midway between the anterior and posterior borders of the ramus. The foramen lead into the mandibular canal, which opens on the lateral surface of the body of the mandible at the mental foramen. Note: The lingula is a tongue-shaped projection of bone that senes as the attachment for the sphenomandibular ligamenL hmnediately behind the incisor teeth is the incisive foramen. In this foramen are two lateral apertures, the openings of the incisive csmnls (foramina of Stenson). which transmit branches of the sphenopalatine artery, and the nasopalatine nerves. Occasionally, two additional canals are present in she incisive foramen; they are termed the fo ramina of Scarpa and are situated in the middle line; when presenL they transmit the nasopalatine nerves. Remember: The inferior alvrolar nerve (brnncll Q[ V-3), artery, and vein travel through the mandibular foramen. At the mental foramen, the inferior nlvcolar nerve ends by dividing into ( I) the mental nerve, which supplies the skin of the mental region and mucous membrane and (2) the incisove branch that supplies the pulp chambers of the anterior teeth and adjacent mucous membrane.

.lm.:ui,Jr turamtn

The jugular foramen lies between the lower border of the petrous part of the temporal bone and the condylar pan of the occipotal bone. The jugualr foramen transmits the following structures: the internal jugular vein. and the glossopharyngeal, vagus and spinal accessory nerves Bony Opening Location (Bm") Contents Maxillary ne-rve (V-2) Mandibular nerve (V-3) Spinal cord, vertebral arteries. nod spinal accessory nerve Middle meningeal nrtery MenUll nerve, anery, and vein Grunter palatine nerve, artery, and vesn Lesser pnlatine nerve, artery, and vein Nasopalatine nerve and brand1es of the sphenopalatine artery Internal jugular vein and glossopharynge31, vagus, W'ld spmal accessory nerves

Foramen rotundum Sphenoid

Foramen o\-.le
Foramen magnum

Sphenoid Occipital

Foromen spinosum Sphenoid

Mental foramen Greotcr patatioe Mandible Palatsne Pnlatlne Maxilla Occipital and temporal

Le>ser palatine foramen lncssive foramen Jugular



Tbe cranial nerves that supply motor innervation to tbe muscles tbat move the eyeball all enter the orbit througb tbc:

Supraorbital foramen Superior orbital fissure Infraorbital foramen Petrotympanic fissure

Copyt~aht c

20092010 DemaJ D'LI



r During a baubaU game, a collision between the catcber and tbe runner into"""'
home plate resulted in fractures of the catcher's ribs, leading to a pneumothorax of tbe ldtlung. A pneumothorax is the presence of air into which space?

Cardiac notch

Pleural cavity Lingula


The superior O<bual R<SUte IS located pO!>ICTior!y bclwe<n the !:Jellet and lc:s<cr wmgs or lhc sphenoid bont:. The )Upcrior orbital fissUI"e corrunurueateS \\ith lhe middle cranial fossa. It transmlls the: SUP"rior and inf.nor divisions of1he oculomolor nerve (CN 1111

crochlear nerve {CN IV) lacrimal, frontal. and nasociliory br11nches of lhe ophthalmic nerve (CN VI) abducent nene {CN VI) superior and inferior divisums of the oplnhalmic vein :,ynlpathctic fibers from the ttwemnu~ plexus

Bony Opening

Location (8o11e)
Temporal Sphenoid, oeeipilal. and 1empornl

lnfenor alveolar nerve, 1111ery. tllld vtln C'hortla tymp.;;Jnerve Nerve of plel)'goid caoal (grdltr and deep Jlflmso/ nerl'.<). and artery ofplerygotd eunal

Mandibular foramen Mandible

foramen taccnam
Supraott>hl f~ramcn and canal

Suproo,bitaJ necve. artery, and vein

lnfraorbill!l toromcn Sphenoid and maxilla Jnftaarbital nme. artery. and V'tin aodcanal Pterygoid cnnal Internal ecoostic mcoiUS Sphenotd Temporal Temporal
Am~ nen es 3lld 'csscls

Foaal o.nd vestibulococblear ner\'OS

E>rtemJ acousuc

Opcntngco lympanic cavity

Pleuralt.':t\ 11\

A P"'cttation wO\IIld of lhe chest wall can I<Jid 10 o pncomolhonx (air in rht p/..,ro/ cavtryl or a hemothonut (blood In tht pl..,( crnil)1. In both of the>< siruations, dw: surfac:c <cnsloo dut binds the llmgs 10 the ches1 wall is eliminated, sod lht: lung W111 mscandy sbrinl< 10 lht: site ofa tcnnts ball. The lungs fillllle pleural divisioM of lhc thora<ic cavity: they """"'d from lhe root of <he neck to the diaphragm. 1be lungs are the main compOnent of lhe respintory sy~ they dasuibu1c atr and exchange gase~. Tbc: right and left lungs are sepora1cd by the mediastinum, which contams the

bean. blood vessels. and othermidline struc1urcs; nssurcs di\'ide each lung into lobt"S. Each primary
bronchus enters llS re~pecl"ive lung. at the hilus, an indentatiOr\ on lh mcdia:,tinal surf8cc. The bronchi and pulmonary blood vessels are bolll'l\ltogcther by connective tissue:- to fom1 the roo1 or

Ihe lung. The bJJt, the inferior surface of the lung. rest.~ on the diaphragm. The apex, lhc most superior portion of the lung. project~ above-the cla\tCie. Ri_gbt lung: Has lhrte lobH (.mperior, middle. and lnfrntJr) one! lhrte secondary (labor) bronrbl Cootains n bronchtal ses<n<niS (cort'OJIOfldmt to the rmiary bronchi) UsuaUy rteti\'CS onr bronchial arttry Has a $1lghlly 111'\lH eapacity !han lhe left lung Leftluo.g: Has rwn ICJbt!-J (S!Iperlor and in/f!rior) and IWO setQndary (lobar) bronthi Contains claM bronchial segments (con't?.'t:fX',diiiR to tl1e tertiary brr>11chJ) Contains a .:ardlac notch (on itS superior loht!), which is a.n indentation pruvid1na room rOr lbc bean Usually rece1ves t~o brontbial arteries Contains a Ungula, which is a tongue-shaped ponion of iiS superior lobe liult corresponds to lhe middle lobe of the right long
Each long is endostd in a double-layered plural tar. O..elaya is called lht: ,moral pleura; lhr olht:r iHalled llle parlelal pleura. Be<"=lht: two Iayen is lhe pleuralca>ity, which ts filled \\oilh strous Ouid.


R sps)

The trachea bifurcates into right and left primary bronchi at the level of the:

First rib Seventl1 cervical venebra Xiphoid process Plane of the sternal angle Suprasternal (or jugular) notch

Copyttaht e 20092010 Dental Dc<b



R sps)

~mphysema is a pulmonary disuse of the lung characterized by destruction o~

the s upporting structu res of the alveoli. This leads to increased elasticity of lung tissue and a pathologic Increase in the size of the air spaces. What final division or the bronchioles within the respiratory tree contains alveoli and first permits \. gaseous exchange with the blood? _J

Teniary bronchioles

Primary bronchioles
Respiratory bronchioles Terminal bronchioles


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The trachea is a metnbranous tube that begins below the cricoid canilage (otthe le1't!l of rhe 6th cuwcalertebro) of the larynx ami ends at the level of llle sternal ongle (the Jth thoracic ertebra). A series of C-sbapcd nngs of hyaline tartlla~e strengthen the lrnchea and pr~vcnt it from collapsing durmg Inspiration. The uachea is lined wath ciliated pscudostratlned columna r epithelium und murous-secrcting goblet cells, which trap inhaled debris. Ciliary action moves debris toward the pharynx for r~movul by coughing. The c~change of oxygen and carbon diol<ide between the air and the blood .x:curs in the lung.~. Air enters the moutb or nose and pas.'ICS inco the pharynx and the larynx, ~nd then illlo the traehca. A< th< trachea passes behind the arch of tbe uorta, the trachea bifurc.11"s or diVIdes into a ngbtaud left prilllary or maitt bronchus, which leads to the lung.~. Aller emering eoch lung. the trachea bifurcate 1010 right and left primary bronehi at the level of the two main hron~bl, which branch into the five lobar bronthl (se.:nnd(lry hmnr!ri). Not~: 11te rlg,ht main bronchus divides 11110 three lobar bronchi, ttnd the left main bronchus divides into two lobar bronchi. Eoch secondary or lobar lli'Onchus serves one of the five lobes of the two hiiii!S. Eacb lobar bronchus enters a lobe in each lullg (lwn lobe. Olltlte left, tltrcc lob<:s c111 the right). Withiu its lobe, each of the '"condllf)' bronchi (lobar bronchi) branch ioto tertiary bronchi (<egmenwl btvllchi). These tertiary bronchi continue to divid~ deeper in the IUUJ!b wto tiny bronchioles, which Mabdivide llllliiY times. fonn1ng ttnninal broocblolos. Each of these terminal bronehtoles gives rise to seveml respir~tory

Each resprrotory bronchiole subdivides into sever~! alveolar ducts, which end 10 clusters of small, thinwalled air 11aces called alve,lli. These clusters of alveoli are called ah<'()lor sacs und fonn the functional unit oftbe lung.

Condueting bronchioles are smaller extenston> of bronchi (little bronchi) ThQ.~ devoid of alveoli in their walls are nearer tbc lulwn of the lung. The.>e condueung passageways deliver atr to passageways that have alveoli. The hbt gcncrnltons of conducting bronchioles arc called terminal bronchinlr.s. Respiratory bronchioles, continuing fmm terminal bronchioles, branch nearer to the alveolar duct. nnd sncs nnd have occasional alvcolt in their walls. These bronchiole> capnble of respiring ure the flnt generation of possneeways of the rospirntury port iou oftbe bronchial tree. Broncltlolos arc churacteril"d by: A diameter of one millimeter or less An epithelium that progresses from cili~ted pseudosuatifil!d columnar tO simple cuboidal (rt!'lplrotory bronchioles) SnuU bronchioles have non-ciliated bronchiolar epithelial cells (Clara ulls) tbat secrete a surface-active lipoprotein Walls devoid of glands In the underlywg comtective tlssuc Woven bundles of smooth muscle to regulate th<> bronchiolar diametel Walls devoid of cnrtllt~ge (small cliClmcterttrovem.< them jitJm cflllatJSIIIJ: 111 ellfl o,(

Note: Type 11 pncumoeytes are specialized cells within the alveoli of tile lunj;S that arc adapu.'d to produce ~urfactam. 'JYpe I pneun1ocytes are CJ<trt!Tllely thin epithelial cells lining the alveoli of the respirntory tree 1111d permit gaseou. diffusion with the capiUaries.



A clumsy dentist, while placing a crown, accidentally drops it into the patient's mouth. The patient aspirates the crown. A chest x-ray "111 most likely reveal the crown lodged in the:


Right primary bronchus

Left primary bronchus
Pulmonary artery Pulmonary vein

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Which statement concerning the respiratory system is false?

The lungs lie in the mediastinum Canilaginous rings are found in the main bronchi The left lung has u smaller capacity than the right lung Clusters of alveoli called alveolar saes form the functional unit of the lung
It has two major pans the conducting pan (a branching, tree-like set ofhollow tubes) and a respiratory pan (smallest tubes and thin-walled pouches in which

gas exchange takes place)

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lmporuol: When foN'ign objects are asporaoed 1010 the trnchea, they usually pass into the right primary bronchus because it os larger. straighter, and shoncr than the len. 11 is al~o in a more direct line with the tmchea (imponanl in a dental chair lwcausc if a parient swallow. an ol:>}ect it tends to lmlgc in tlo e right bronclotts), Each lung is shaped like~ cone. h hns a blunt apex, a conca\e base (tloc/1 sit.~ lin tire diaphragm), n convex costal surface, aod a concave mcdiasllnal surface. At the middle of the mediastinal surface, the hilum is lo;:atcd. which is a depr(ssioo on whoch the bronchi, Ve$Sels, and nerves that form the root enter and leave the lung The root or the lung contains the following strUctures: Primary bronchus: the right and len bronelu n~e from the trachea and carry nir to the hilum of the lung during inspiration and carry air ftom the Inns dunng exptrauon A pulmonary artery: enters lbe hllum <)f cnch lung carrying oxygen-poor blood Pulmonary vcln(s): a superior and inferior ptoir for each lung leave th~ hilum carrying oxygcnrlch blood
-. I. The <mall bronchial arteries (wloiclo nre hrnnciles of tloe desce11ding liOrln) "Not.. also enter the hilum of each lung nnd deUvcr oxygen-ncb blood to the tissues. The bronchial aneties tend to follow the bronchial troe to the resporatory bron chioles where the bronchial anetie. annstomose \\ith the pulmonary vessels. 2. Branch<:S of the vagus nerve also pa.s the hilum of each lung.

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... This is false; the thorncic cavuy is unuunckd by the ribs and c;best muscle$. It's subdivided mto the pleural cavities, each of whtcb contain a lung, and the medl asllnum. The mediastinum 1S further dovtded anto four Br<!S- Tho middle medtnsunum contains the bean ond pericardiol sac; the anterior, pusterior, and superior areas ~rc named accordJn,g to lheir positions relative to the m1ddle mediastinum. Tho respirutory S)'Steon con.<ists of the uppeo and lower ""'piratory uacts, tbc lungs. tmd the thoracic cu~e. The respiratory system i< des[gned to e~change the carbon dioxide occumulat cd in the blood for oxygen in the airways, whlcb entel'li the lungs as air from the surrounding atmosphere. Blood trnvel~ contonuously through two doncrent circulanons: the pulmonary and the sys temic circulotrotU. 'The hean pumps deoxygenated blood from the '"'ins of the $ystemie circulation into the arteries of the pulmonary circul:!tiOII. This blood is oxygenated by the lung$. and then 11ows back to the bean to be pumped 1nto the anerics of the systemic circulation. The strucnores or the upper respiratory trnct include the nose, mou01, nasopharynx. oropharynx, luryngopharynx, and larynx. Beside" warming and hooooidifymg Inhaled air, these structures provide for tnste. smell. and the chewing and swallowing of tood The low~r r~plratory trort struttures are the trnchca. bronchi, and lungs. Bmncho b1'111lCh into bronchioles. which in 1\lm branch into lobules. The lobule includes the termonnl bronchioles and alveoli. A muc<>us membrane contaonin& baor-like cilia lines the lower trnc1, functionally, the lower tract is subdovidcd into conducting ail'\\ a~ (lire lr<teht!# ami rlre primary. lobar. and "'8"'ental bronchi) and aheoll, the site< of !!'IS exchange.



Which type of epithelium provides sensory innervation that tr avels on nerve bundles through the cribriform plate?

Olfactory epithelium Squamous ciliated epithelium without goblet cells Transitional epithelium with goblet cells

S3 Copynabl 0 2(1(19..2010 ()cnt;al Dh



While ascending to 30,000 feet, the passengers on a commercial night experience the sensation of their ea rs "popping." The swallowing or yawning that triggers this equalizes the pressure of the middle ear with the surrounding atmosphere vla the eustachian (auditory) tube. The pharyngeal opening for this tube, along with the salpingopharyngeal fold, pharyngeal recess, and pharyngeal tonsils (adenoids) are all located in the:

Laryngopharynx Oropharynx Nasopharynx None of the above


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Air enters through tb~ nQStrils (extemulllares) !bat lend to the vestibules of tlte nose. The bony roof of lhe nosal cavi1y is funned by the cribnfonn plme of the ethmoid bone. The lattral walls bae bony projections calltd conchue (SUpt!rim; middle. and lnjtrior), whlch are also referred to as the nasal turbinates. These conchae lonn shelves !bat have spaces (or grrx!l'es) benllllth lbem called meatuses (.Wfk.'l'tor, middle. 011d inferior). The paired puranusal sinuses (ma.~tl/ary.frotual, ethmtJitilll, arrd sphetwttlal) drain into Ute nasal cavity by way of tbese mt:lltu>eS. The n""olacrlmal duct, wbieb drains tears from lhe surfact of the eyes. nlao empue.< mto the na>al cavity by way of lite inferior meatus. The floor is fonnl'<l by the bard palate. The nasal cavity opens po>teriorly mto the nasopharynx vie funnel-like openings enlled the c.hoanoc (posteriOI'/IQI't!S). 1I. The vestibule> arc lined with nnnl\eratlnlz~d stratifi~d !qunmous epitheli l"ot .. um. 2. Tb<: conchJe of lite na.al fossae are hntd with psrudo;tntlfied cillatl.'d colu mnar epithelium. ). Tite olfuctory epithelium is very prominent in the upp;:r medial portion of the ossa! cavity. 4. The oa.al cavity receives sensory innctvMion from the olfuctory nerve lor smdl and from lhe trigeminal nerve for other ;;ensations. The na.o;al cavity' blood ~"\Jpply is from branches oflhe ophthalmic and masJIIary arteries. S. The tickling sensation felt in the. nasal cavity just prior to a ~neeze is carried m the madllory division or the trigeutlnal nerve. 6. During a sinus auack, painful sensation from the ethmoid ceUs is carried in tbe naodlia.ry nerve. 7. All of the parana.o;al sinll6rs dnun into tbe middle me~tu~. except lhe sphenoid sinus, which drains almost directly down the lhroaL

The pharynx (rhe t/IITX/t) is a tube that serves a. a passageway for the re.piratory .md dig~tlve trncts. lt e~ tcnds from the mouth and nasal cavities 10 tbe lurynx and cost>phn gus. The pharyn.' is dividctl into three regions: . 1 Nasopharynt - 15 the most suptrior diYislon of the pharynx. h " lllfeno o lhe sphenotd booe and lies at the level of the sol\ palate. The plu!Jyn>. " lintd Will\ cihaled p.'>Cudostratified epitbehwn (respwotnry epit/Jflrillll). 111e nasophllrytLt ha.- four opettings: two audito1 y (ettSIIIt'itiall) tubes. euch opening 0111of n lnternl wnil and connecting W11h the middle car (tynrp(lnic c11vity) two orening:; of the posterior oms (<hoonae) The son rulate end uvula fonn the antenor waU of the nasopb~rynx. Note: The t~nsor veli palntini and the levator veli palothtl muscles pr~vcot food from entering the nasophnl')'IIX. 2. Oropharynx - the middle divis1!>n of the pharyu.t: is continuous with the posterior 01'111 cavity llltd i& lined wrth sltlltified !II}UIIInOW< epithelium. The ompltnrynx extend> inferiorly from the sol\ palate to the hyo[d bCJne. The opening 11110 1he oropharynx from lhe mouth is called the fouces. 11\c lingual tonsils protrude into 1he oroph~rynx from lh~ oral cavity 111 the base nl' Ihe tongue, The arucroiateral walls of the o1 '0phur ynx $1tppon the palatine Ions [b. It is a rood nud oir passage" ay. 3. Laryngophuryns is the mos1 infcnor diviSIOI\ of tile pharynx: the l3l)'tlgopMrynx extends from lho hyoid bone to the opening of the esophagus. lbe laryngopbliT ynx is lined" fth stnrufied squnmous epilhelium. extends from lhe nropharynx abo~e to the larynx aod e,<oph~gus. The laryngopharynx a lso serves as a tMssagcway li>r food nnd air. Alr entering the laryngophuryn.x goe. to the larynx while food goes to the esophagus. ote: Food entering the lal'}nx would be expelled by Vlolem cougbtng.


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rA newborn In Ethiopia, whose mother has a human papillomavirus infection-:'

starts to grow warts on her larynx and respiratory tract. A tracheotomy Is performed in order to allow her to breathe. Which of the following structures is not at risk during the procedure?

Recurrent laryngeal branch of the vagus nerve Carotid artery Internal jugular vein
Vocal cords

Thyroid gland

Cop)Tight 0 20092010 Dtmal Dks


Tbe external carotid artery terminates within the parotid gland, just behind the neck of the mandible, where the external carotid artery gives off and t h e - - -- - two linal branches, the

Superficial temporal artery Superior thyroid artery

Posterior auricular artery

Occipital artery

Mnillnl)' anel)'
Facial artery

CopynptC 2009-2010 l)contal Dk.s


** The weal cords are above the incision area for tracheotomies and cricotbyrotomies.
Important: A cricothyrotomy is preferable to traclteostomy for non-surgeons in emergency respiratory obstntclions. In this procedure, an incision is made through the skin and cricothyroid membrane for the relief of acute respiratory obstmction. An emergency tracheotomy (tracheostomy) is most easily made by an incision through the median cricothyroid ligament. Titis ligament runs from the cricoid cartilage to the thyroid cani lage and is inferior tO the space between the vocal cords (rima gfollidis) where aspirated objects usually get lodged. The tracheotomy allows for air to pass between the lungs and the ourside air. Important: The space entered is called the cricothyroid space. Note: A tracheOtomy (tracheostomy) is rarely performed and is limited to patients with extensive laryngeal damage and infants with severe airway obstruction. Because of the presence of major vascular structures (carotid arteries and internal jugular ve.in), the thyroid gland, nerves (recurremlaryngeal branch of the vagus nen> e), the pleural cavities. and the esophagus, meticulous attention to anatomical detail bas to be obserVed.

Suprrtidal temporal
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The external carotid artery supplies structures within the neck, face, and scalp, and also supplies the maxilla and rooguc. As with the internal carotid anery, the external carotid artery begins at the upper border of the thyroid cartilage (i.e.. at the tenninatirm of the common caroTid artery and the carotid sheath). The external carotid anery tenninates within U1e parotid gland, just behind the neck of the mandible, where the artery give;; off two final branches. the superficial temporal and the maxillary arteries. ~ote: At tts origin. where pulsations can be felt. the external carotid artery U cs within the carotid triangle. Branches of the external carotid: Superior thyroid artory - supplies thyroid gland, giws off a branch to the sternocleidomastoid muscle and superior laryngeal art~ry Lingual artery - supplies d1e tongue facial trtery - supplies the face, including lips aod tbe submandibular gland Ascending pharyngeal artery- supplic.' the pharyngeal wall Occipital art.c ry- supplies the pharynx and suboccipital triangle Posterior auricular artery - supplies bnckofthescalp Maxillary artery - tenninal branch of external carotid, it gives uil' branches to the mandJ"ble, and the middle meningeal artery before passing through tb<" pterygomaxiUary fissure to enter the pterygopalatine lbssa to supply the maxilla Superficial temporal artery - tenninal branch of external carotid, supplies skin over fronM and temporal regions of scalp Important: The external carotid artery and its branches supply the muscles of the neck and face, thyroid gland, salivary glands, sc-.Jlp, tongue, jaws, and teeth.


A chiropractor performing a spinal adjustment quickly moved his patient's head from rest to tbe left. She immediately reported hemiplegia -- paralysis of half her body-and slurred speech. At the hospital, it was discovered that therapy caused an embolus to develop into a stroke. The clot arose from an atherosclerotic plaque located at the bifurcation of the common carotid artery. At what level does the common carotid artery bifurcate?

Cricoid cartilage Angle of the mandible Jugular notch Superior border of the thyroid canilagc

Co"p)rri.Jh1 0 2009-2010 Dctual Df.tks



ln carotid sinus syncope, the cardiac sinus is overly sensitive to manual stimulation and can lead to loss of consciousness. Given this, whic.h of the following statements is true?

It is stimulated by changes in blood pressure

1t functions as a chemoreceptor

It is innervated by the facial nerve

It is located at the tenninal end of the external carotid artery

It communicates freely with the cavernous sinus

Cop)Tigb1 0 20092010 Dcoral Dtet:s

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Blood is SUPJ>hed tO rl'te brain. face. and scalp viu two major seiS of vessels: lbc rl~:h and left common carotid arreries and lhe right and lrfl l'crtebrsl arteries. The nght tommon carotid arises from rhe bra.chiocephalic trunk, whrle rhe let\ common carotid anscs from lhe aortic arch directly. The common carotid lies wirhin rhe carorid shearh and runs upwards in lhe neck to the superior border ofrhe thyroid cartilage. liere it divides inro rwo puirs of blood vessels, U 1e exrcrnol ond inrernal carolid orreries. The external caroutl ar teries supply the face and scalp with blood, The Internal carotid orreries divide funber in lhe rniddle crnmal fossa inro the anterior and middle cerebral rtcries. which supply blood to the nntcrior three-fifths of cerebrum, except for pans of the temporal and occipital lubes. The vertebrobasUar anenes supply the posterror tw<>-fif\bs of the cerebrum, pan of tbc cerebellum. and the brain Slem. Remember: Four major anenes. lhe l\\O >'trlebnl and rhe mu carotid, supply the brain ,.;th oxygenated blood The two vertebral ancrie (which 11re branches of rJ~e subclminn.s) converge 10 become rhc basilar artery, which supplies the posterior brain. The circle of Willis (n/.w called the cerebmlartct1al circle) is formed by rho posterior cerebral (bnmclr of ha.vilar ortery), JIOStcrlor communicating (brOIIch q( intenwl carotid). Internal carotid, anterior cerebral, and 11nterior communicallJII\ (branch OJ Internal carotid) aneries. This circle of Willi~ forms an importanl me of collateral circulation rn rhe event of obstruction. The internal taJotid artery has no branches ou~ide the slcuU and enterS lbe skull through the carotid canal. Inside the skull. lhe internal carotid anery ghes off the ophlhalmic artery, which supplies the optic oerve, eye. orbit. and scalp. Tbe artery tcnumat<'S by pasing through rhe cavernous sinu to join the cirdc of Willis and supply the brain.

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The carotid sinos is a dilated poruon of the proximal pan of the internal caroud anery. near the btfun:arion of the common .:nrotid anery. This is usually at the le\cl of the superior border of the thyroid canilage. Cltang<-s 10 blood pressure stimulate vagal ner.e endings ill the wall oftbe carolid sinus 10 send signals along lhe vagus nen e to slow the heart rare; rhls response is referred to as the CJtrothl si nus reOex.
Important: The carolid sinus is itmervnrcd by rhe carorid sinus brnnch of the glossopharyngeal nerve and by a hl'anch of tl1c vagus nerve. Remember: The carotid body lies posterior lo the point ofbifurcntion of the common carotid artery. The carorid body is innervared by !he glossopharyngeal and \agus nerves and IS a chemoreceptor, being sensirive to CACe.5 carbon dioxide nnd reduced oxygen teoSJoo in the blood (this 'llaufd produu a rise 111 blood pre.<Srtn! 011d ht!an ratt!/. Carotid sinus syndrome is a temporary loss <)f consciousness that sometimes accompanies convulsive seizures because of d1e utlensity of the carotid sinus reflex when pressure builds in one or both carolid sinuses.


Which of the following branches of the internal carotid artery Is most frequently lmpllcutcd in a stroke?

Ophthalmic ancry Anterior choroidal Middle cerebral Anterior cho,oidal

31 Cop)TigbtO 2009-2010 Dtntal Decb



All of the following statements arc true regarding hepatic sinusolds In ""'J comparison to capillaries EXCEPT one. Which one Is the EXCEPTION? ~

Sinusoids are smaller than capillaries Sinusoids have walls that consist mainly of phagocytic cells Sinusoids are n pan of the reticuloendothelial system Both s inusoids and capillaries are composed of endothelium

44 Copyrip. 0 2009-1010 ~~~ Derls

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The middle cerebral artery is the largest branch of the internal carotid. The artery supplies a portion of the frontal lobe and the lateral surf.1ce of the temporal and parietal lobes, including the primary motor and sensory areas of the face, throat, hand, and arm and in the dominant hemisphere, the areas for speech. The middle cerebral artery is the artery most often occluded in stroke. Small, deep penetrating arteries known as the lenticuJostriate arteries branch from the middle cerebral artery. These arteries are often called the "arteries of stroke" because they are often involved in a Stroke (also called a cerebrovascular accident).

Stroke warning signs:

Sudden weakness, paralysis. or numbness of the face, arm, and leg on one or both sides of the body Loss of speech or difficulty speaking or understanding speech Dimness or loss of vision, particularly in only one eye Unexplained di7.ziness (especially wlten associated with other neurologic symptoms). unsteadiness, and sudden falls Sudden severe headache and loss of consciousness

Sinusoid\ an smalh.r than


A sinusoid is a small blood vessel similar to a capillary but with a discontinuous endothelium. Sinusoids are found in the liver, lymphoid tissue. endocrine organs, and hematopoietic organs such as tbe bone marrow and the spleen. Sinusoids are bigWy permeable, having larger inter-cellular clefts, fewer tight junctions, and discontinuous endothelial cells (meani11g that the individual endothelial cells do not overlap as in capillaries and are spread out). The level of permeability is such as to allow small- and medium-sized proteins such as albumin to enter and leave the bloodstream. Some spaces are large enough for blood cells to pass. Oxygen, carbon dioxide, nutrients, proteins, and wastes are exchanged througb the thin walls of the sinusoids. Sinusoids: Are 30 to 40 microns in diameter Are wlder and more irregular than capillaries Have walls that consist largely of phagocytic cells Form a pan of the reticuloeodothetial system, which is concerned chiefly with phagocytosis and antibody formation

The most prominent fu nctional component in the tunica media of large arteries is the:

Skeletal muscle cells Elastic fibers Smooth muscle cells Collagen fibers

CopyrigtllC 20092010 Onltal ~ks



No tunica media or adventitia is present In which type of blood vessel that exchanges subslanccs via diffusion?

Arterioles Capillaries Venules


Copynpt 0 20091010 Omtall>e<'b

Key: If the question referred to small arteries, the answer would have been smooth muscle cells. Tbe walls of blood vessels are composed of the following tunics (layers): I. Tunica intima - iru~cnnost layer, consists of a layer of simple squamous epithelium (called endotheli11m) and a thin connective-tissue basement membrane. TI1e endothelium ofthis layer is the only layer present in vessels of all sizes. Note: Atherosclerosis is tbe emergence of plaque between the basement membmne and the endothelial ceUs of the tunica intima. 2. Tunica media - middle layer, is usually very thick in arteries, and consists of smooth muscle fibers mixed with elastic fibers. Increases or decreases lumen diameter; afl'ects blood pres.wre. 3. Thnica adventitia -an outer layer of connective tissue, containing elastic and collagenous tibers. The tunica adventitia of the larger vessels is iofiltmted with a system of tiny blood vessels called vasa vasorum ("vessels of the vessels 'J that nourish the more external tissues of the blood vessel wall. Blood is carried away from the heart in large vessels called arteries. These d[vide into smaller arteries, and the smaller arteries divide into arterioles. Arterioles divide into microscopic capillaries (the exchange area of the 'J''tem). The capillaries converge to form vessels called venulcs, which join to form stiU larger vessels called veins. Veins return the blood to the bean.


Blood is carried away f'l'Om the heart io large vessels called arteries. These divide imo smaller arteries, aod the smaller arteries divide into arterioles. Arterioles divide into microscopic capillaries (the exchange area of the system). The capillaries converge to form vessels called vcnnlcs, which join to form still larger vessels called veins. Veins return the blood to the heart. Through capillary walls, which consist of a single layer of endothelial cells, blood and tissue cells eJchange gases and metabolites. Capillaries are tiny blood ' 'essels wid1 extremely thin walls that consist of endothelium only; oo tunica media or adventitia is present. They join arterioles and veoules. These blood ves.~cls aocommodate erythrocytes one at a time. In certain structures (liver. spleen, bo11e man-ow. and certain glands). tbe arterioles. rather than connecting with capillaries, empty into blood vessels called sinusoids. They have very, very thin walls that conform to the space in which they are located (form imzgular tortuous tubes).

~Notes 2. A decrease in vessel diameter causes an increase in resistance to blood flow.

- - I. The velocity or blood flow is slowest in capillaries.


Which artery supplies the liver with o:o:ygenated blood?

Common carotid artery Portal artery Hepatic artery Splanchnic artery

CopyrigbtiO 2009-2010 Dent~! Deck$


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The greatest drop in blood pressure is seen at the transition from:

Arterioles to capillaries Arteries to arterioles Capillaries to venules Venules to veins

Copyrijbt 0 2009-2010 Dental Qe.cks

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The hepatic artery brings oxygenated blood to the liver, wbile the hepatic portal vein brings food-laden blood from the abdominal viscera. Note: The hepatic porinl vein is formed by the union of the s uperior mesenteric vein and the splenic vein. Remember: All the blood supplied to the liver from the hepatic arteries and the portal vein eventually drains via the hepatic veins to the Inferior vena cava. Important: The most unusual aspect or hepatic circulation is that all the blood supplied to the liver from the hepatic anerics and the portal vein empties into the same siousoids (minute endotlrelial-lined passage...-ays In the liver lobules). wbicb therefore eonLain a mixture of arterial and venous blood. The sinusoids of each lobule empty into a common central win. The common central vein of each lobule then empties into one oftbrce hepatic veins. These veins all empty into the Inferior \'ena cava, which transportS the blood to the heart.

Important: The highest pressure of circulating blood is found in arteries. and gradually drops as the blood flows through the arterioles, capillaries, veoules, and veons (wh""' it is the lowest). The greatest drop in blood pressure occurs at the traositton from aneries to arterioles. Arterioles are one of the blood vessels of the smallest branch of the arterial circulation. Blood flowing from the heart is pumped by the lei\ ventricle to the aot1a (hugest nrte1y), which in tum branches into smaller arteries and (in ally into arterioles. The blood continues to flow through these arterioles into capillaries, venules, and fmally veins, which return the blood to the heart. Arterioles have a ery small diameter (<0.5 mm). a small lumen, and a relatively thick tunica medla that is composed almost entirely of s mooth muscle, with linle clastic tissue. Jhls smooth muscle constricts and dilates in response to neurochemical stimuli, wbicb in tum changes the diameter of the arterioles. This causes profound and rapid changes in peripheral r esistance. Tbis change in diumetcr of the arterioles regulates the flow or blood into the capillaries. Note: By affecting peripheral resistance, arterioles directly uffcct arterial blood pressure.


Which of the following salivary glands does the facial artery supply?

Sublingual Submandibular Von Ebner's


Copyrighl e 20092010 Dental Db




Which arter y does not accompany tbc corresponding nerve throughout its course?

Inferior al veolar anery Posterior superior alveolar artery Lingual anery Infraorbital anery

Copyrijh! 0 20092010 Dental Oks

'\uhm anll i hu l.t r

The facial artery supplies blood to the face, tonsils. palate, labial glands, and muscles of the lips. The facial artery also supplies the s ubmandibular gland, the ala and dorsum of the nose, and the musdes or facial expression. The facial anery originates in the uternal rarotid anery and gives off branches that supply the neck and face. Branches of the facial artery (cenical and facial porrlofl) include: Cervical ponion: TonsiUar- to the tonsils Ascending pharyngeal - 1 0 tbe pharyngeal wall Glandular- to the submandibular gland Submental - to the area below the chin Facial portion: Inferior labial- to the lower lip Superior labial - to the upper hp and vestibule of nose Lateral nasal - to the lateral wall of the nose (outer side) Angular- to the medial stde of the eye. It is the tenminal branch of the facoal anery and can anastomose with the dorsal nasal branch of the ophthalmic anery. Remember: The two terminal branches of the external carotid artery are the ;uperficialtemporal anery and the maxillary artery.

I tn:.:ual artl'n

The lingual artery arises from the anterior surface of the external carotid artery, oppo site the rip of the greater cornu of the byotd bone. The lingual anery loops upward and then passes deep to the posterior border of the hyoglossus muscle 10 enter the submandibular region. The loop is crossed superficially by the hypoglossal nerve. The loop supplies blood to the tongue. suprahyood region. sublingual gland. palaune tonsils, and tloor of the mouth. Important: In the oral region, the lingual onery usually is found between tbe hyoglossus and genioglossus muscles.
Jtd Branches of the lingual artery include the suprahyoid, dorsal Iingual, sublingual, B deep lingual bmncbes.

Note: The Inferior alveolar vein, artery, nnd nerve along with the Ungual nerve are fom1d in the space between the medial pterygoid muscle and the ramus of the mandible (preT}gomUfldibular space). Important: The injection site for the Inferior alveolar oene block is probed with a cotton tip applicator at the depth of the pterygomandibular space on the medial surface of the ramus. The needle is inserted into the tissues of the pterygomandibular space until the mandible is contacted. The needle is withdrawn 1 mm from the tissues 10 protect the periosteum, and then the injection is administered.


ln the KR, a car-accident victim who hit his face on the steering wheel arrives bleeding profusely from the mouth and nose. Upon examination, the physician discovers that along with avulsed teeth, his bard palate is fractured and the Incisive foramen is obliterated. Which artery emerges from the lncbive foramen?

Greater palatine nnery Descending palatine anery Nasopalatine anery Lesser palatine ancry

Copyrigllt C 20092010 Dental l)tot:b


Examination of a patient with an ulcerative carcinoma of the posterior third of the tongue revealed bleeding from the lesion and difficulty swallowing (dysphagia). The bleeding was seen to be arterial; which of the following arteries was involved?

Deep lingual artery Dorsal lingual anery Tonsillar anery Sublingual llncry

Copynpt Cl 2009-2010 Otftt.al Dks





ln the pterygopalatine fossa, the maxillary artery gives rise to the descenrung palatine artery, which travels to the palate through the pterygopalatine canal, which then terminates in both the greater palatlne artery and lesser palatine artery by way of the greater and lesser palatine forrnamina to supply the bard and soft palates, respectively. The maxillary artery ends by becoming the sphenopalatine artery, which supplies the nasal cavity. The sphenopalatine artery gives rise to the posterior lateral nasal branches and septal branches, including a nasopalatine branch that accompanies the nasopala\ine nerve through the incisive foramen on lhe maxilla.
---. I . The greater palatine artery supplies the mucosa of lhe hard palate posteri1 Nut..

or to the maxillary canine. 2. Mucosa of the hard palate anterior to the maxillary canine is supplied by the nasopalatine artery. 3. The soft palate and tonsils are supplied by the lesser palatine artery.

***The dorsal Ungual artery runs on the superficial surface of the tongue it is a branch of the lingual artery that delivers blood to the posterior superficial tongue. So, this anery must be the source of the hemorrhage.

The tongue is supplied by the lingual anery, the tonsillar branch of the facial artery, and the ascending pharyngeal artery. The veins drain into the internal jugular vein. The lingual artery arises from the external carotid artery at the level of the tip of the greater hom of the hyoid bone in the carotid triangle. Branches include: dorsal lingual: supplies the base and body of the tongue (posterior superficial tongue) suprahyoid: supplies the suprahyoid mt1sdes sublingual: supplies d1e Jllylohyoid muscle, sublingual salivary gland, and mucous membrnnes of !he floor of the mouth deep Ungual (renninal branch): supplies the apex oftbe tongue Remember (infonnaJion about the rongue): I. Motor innervation is from the hypoglossal nerve (CN Xll). 2. Sensory innervation - lingual (branch of trigeminal CN V-3) supplies the anterior twolbitds, glossopharyngeal (CN JX) supplies the posterior one-third (including vallate papillae), vagus (CN X) tluoogh the Jnternal laryngeal nerve supplies the area near the c'Piglottis. 3. Taste- racial (CN VII) via chorda tympani supplies the anterior two-thirds: glos-<opharyngeal (CN IX) supplies the posterior one-third. I. The tonsiUar artery is a brnneh of the fucial anery that also supplies blond to the INot.. palatine tonsil. 2. The ascending pharyngeal artery is the smallest brnncb of the external carotid anel)'. Branches include the pharyngeal and meningeal arteries. 3. ne lingual anery and fucial artery often arise from a cotnmon trunk of!he external carotid artery.




Which branch of the maxillary artery runs through the foramen splnosum ) lo. and is implicated in epidu ral hematomas? ~

Inferior alveolar artery

Middle meningeal artery

lnfraorbilal artery

Deep temporal artery

Copyrigbl C 201-1010 Dttnal r:>rctkt


After a large Thanksgiving dinner, the traditional American family notices that they all arc drowsy. The "food coma" Is a res ult of oxygenated blood being restricted from tbe brain and being shunted to the stomach in order for digestion. All of the arteries that s upply arc derived directly or 1o. indirectly from the:

Splenic artery

Hepatic artery
Gastroduodenal artery

Celiac trunk (artery)

Cop). c 2-2010 Dcmol "'"'"'

\liddll' 111l'llllll!l al :.trhn

The maxillary artery 1s the larger tennm.al branch of the eAtemal carotid artery h begins at the neck of the mandibular condyle within the parotid gland. The m::llulhuy artery runs betwoen the m;mdible and the sphenomandibular ligament anteriorly and superiorly through the infratemporal fossa. After traversing the infratemporal fossa, the ma>tillary artery enters the pterygopalatine fossa. Within the iufnuem poral and pterygopalatine fossae, the miL"IIury nrtcry gives off many branches. Branches in the blfratcmporul fos'"': Inferior ahl'Oinr artery: follows lhc inferior nlveolar nerve into tb mandibular canal and supplies tissues uf the chin and lower teeth Middle ownlngul art<l"): an importlllltanery that passes upwanl behind the mandibular ner\"e. The: ~ the sk\111 1hro11gh the foram:n spinosum. This artery supplits the meningl:$ within the skull. Note: Damage =Uts in an epidural bema.IOIJla. Small branches ~lllt supply the lining of the O.'le1nal auditory meatuS and the tympanic membrane Numerous small mu.<eular branches that supply the muscles of mastication Bnmcbcs in lhe ptcrygopalntlnc fossa: Posterior superior ah eolar artery: supplic.' th~ maxillary sinus aud the molar unll pre molar teeth Infraorbital ortcry: c'!lk'I"S the mbitnl cavity through the mfcrior otbitnl tissurc Grtattr p:tlatlne ortery: supplies the mucosa of the hard palate posterior to the ma.~tll

ary canine Pharyngeal broncb: supplies the mucou.~ mcmbr.u~e of the tool of the nawph:lrynx Sphenopalatine artery: supplies the mucous membrane of the nasal caVIty, It IS the tenrunal branch of the m8ltillary artery. Note: Damage results in cpist8ltis (noubletd) Note: The taterol pterygoid muscle dtvidetl tl!C maxillary artery into three sections: the mandibuiQr, pterygoid, and pterygopalatine.

All of the arteries that supply the stomacb are denved directly or indi~ctly from the celiac trunk (cellae artery~. The celiac artery takes its ongin from the abdominal aorta jtL<t below the diaphragm at about the le>el of the twelfth thorcic venebr:L It is the artt't)' that supplies the foreguL Tbe celiac artery is surrounded by the cellae plexus and lies behind the lc:.<~er sac ()(peritoneum. Tbe celiac llrtery has three terminul branches: the splenic, lef\ gust ric, and hepatic ancrics, Splenic artery -to the spleeu I. t..:ft gustrocplplolc: arises from ~-plemc nrtery at the hilum of the spleen to supply ihe greater curvuwre of stomacb. 2. Sbort gtlStr!cs: arise from we splenic artery at the hilwll of the. spleen lO supply the fundus of stomach. Lei! g11>'tric: artery -un~ from the celiac artery to supply the les,serL-urvature of stomach and the lower tlurd of the esopb<lgus. Hepatic artery - 10 the liver 1. Right hepatic artery - to right lobe of Uver. cystic urtery url_<es from right hepatic nnery to supply the gn11bl~ddcr.
2. l..en hepatic artery -- to left. lobe of liver. rtgbt gastric artery - arises from the hepatic artery a! the tipper borde-r or the pyloniS to supply the lesser curvature of stomach. gostroduodeuol artery - large brunch of hepatic artery that lillpplie> the p.1DCre:!S

and duodenum
rlgbt gostrocpiplnic artery: supplies gte.1ter curvature of the stomacb. sup<rlor pa.uc,..,.tiroduodcnal artery: supplies tbe upper half of the duodenum



The internal thoracic artery ends in the sixth intercostal space by dividing Into the:

Anterior and posterior intercostal aneries Subclavian and inferior epigastric aneries Superior epigastric and musculophrenic arteries

Copyright 0 20092010 Dtntal Decks


( Tbe abdominal aorta terminates by dividing into the common iliac arteries"") \.. and the middle sacral artery at what vertebral level? ~



The internal thoracic artery supplies the anterior "aU of the body from the clavicle to the umbilicus. his branch of the first part of the subclavtan anel)' io the neck. This artery descends venically oo the pleura behind ~lt costal cartilages, just lateral to the sternum, and ends in tho sixth intercostal space by dividing into !he sup~rlor eplgnstrlc and mnsculophrenlc artHies. Branche. of the internal thoracic artery tnclude: Two a.n terlor lntercu~tul arteries for the upper six intercostal spaces Perrorallng arteriH. whi~h accompany the tcrmianl branches of lbc corre,pondmg intercostal nerves The perlcardlaeophrenic artery. which accompanies the phrenic nerve and sup plies the ptrlcardtum Mediast;nal arteries to the contents of the anterior medlastinum, for example, the thymus gland Th~ superior CtlljlslStric artery, which eutcrs t.he rectus shealb and supplies the rectus muscle as f11r a~ the umbilicus 11 musculophrenic artery, which runs around tbe costal ruargiu oflhe diaphragm end supplic.~ 1he lower intercostal spaces and the diaphragm Note: The inferior epigastric artery, a branch oft.he eternal ilia~ artery, anastomoses with lhe supmor epigastric artery in the rectus sheath m lhe area of the umbilicus.

aorta a series of ves.el< th:lt convey the 10 li$sues or lbe body for th<ir nutrition. The :wna commences at the upper p.on of the !eli ventricle, aDd after a.c<nding for a shon cbSIBDCC. ar~hes bru:ltward and to the left s1de. O>tr the root of lbe left lung; the aona chen de;cend; wuhm the thorax on the left side of the ven.ebral column. passes into the abdominal Cllvlly through the aonic openns o{' the diaphragm in front of the twelfth thoracic venebm. The aorta descends behtnd lhe periconeum on the ancerior surface of the bodic.< nf the lumbnr vertebrae. Attbe level ~f che fourlb lwnbar vertebrn, the aona divides into the two eomnwu U1:1e arteries. Note: The ebaractcrlsllc future of the aorta is that it contn1ns a lot or elastic lib~rs In Its tunic media (middle Ioyer ofhloC<I esse/ wall). Anatomically, tbc aonu is craditionally dividtd into the ~~.<tending aonn, the aonie arch. and the descending aorta The descending aona is. m tum. Jubdivid<d into the thoracic OOrtll (rhut descends wirhm tl1e chesr) and the abdommal aono (rhar de.rcends within rht abdOIIItn/. Ascending aorta: a >bon 'esscllhat starts at the aortic opening of the left ventricle. Tbe ascending aorta's only bnmcbes are tbe right and leO coronary arteries. which supply the lleart mu.,.le. Aortit arch: g1ves rise to three arterial brunches: cbe bruchioccphallc, the lcfl common taroUd, and the left subclavian. TI1ese arteries fumish all of the bl~od to the hcntl, oi!Ck, and upper limb~. Descending norta: l'horclc portion: extends from T4 to Tl2 (lies in rhe posterior mNiia$1/num). All of the arterial branches (posterior mten:ostal. subco.ua/ arteries) from thiS 11art are small. They supply lbe lhora. and the cbaphrasm. Abdominal portion: extends from Tl2to L4. where the descending aON ttm>lnates by dl>idinc mto the two common tuac arteries and a small middle sacralnery. Arteries from thiS area supply tbe abdomen and pel vi~ N:gion as well as the lo-.er limbs.


As a result of curiosity, a 2-year-old boy decides to stick a sharp object up his nose and causes a nosebleed (epi.vraxls) of the anteroinferior portion of the nasal septum. This bleeding in volves the septal branches of the:


Ophthalmic and occipital aneries Sphenopalatine and facial aneries Frontal and parietal arteries Pharyngeal and meningeal arteries

53 CopyrigbtC 2009-2010 Drntal Del:b


Tbe upper half of the duodenum Is supplied by the , a bra nch of the gastroduodenal artery. The lower half of the duodenum is s upplied by the _ _ __ _, a branch of the superior mesenteric artery.

Superior pancreaticoduodenal anery; inferior pancreaticoduodenal ancry Inferior pancreaticoduodenal anery; superior pancrealicoduodenal anery Superior renal artery; inferior renal artery Inferior renal artery; superior renal artery


Cop)'n.&bt C :oo9.20 I0 Dm1.al Db

The anerial blood supply to lito nasal cavity is derived mainly from br.mches of the mulllry o.rtery. The most unponant btanch is the spbcnoralallnc artery, which enters tlte nasal cavity through the sphenop!tlati.ttc fommeu. The sphenopnlutlnc artery anastomoses with the septol brunch urlhe superior labial branch of the fnclul artery in the rcgioo of tbe vestibule, which i> a very common site of bkeding from the nose. Rrmtmber: The sphenop:tlntine an<ry IS the terminal braocb or the maxillary ortery. Other small 1111eries that upply blood to the nasal caVIty mel ode: The descenruog palollne bmnch of the maxillary artery The sup~rior labial brnnch oflhc facial anery The posterior ethrnnldal bmuch sud auterlor ethmoidal branch of the ophthnlmic uncry
Remember: I. The opbtbalmk art~ry is a branch of the internal carotid artery. 2 The nuuillary arter) is On< of the temunal an~nes of the external carotid. The other termina11111cry of the external Clln)tid as tbe s uperftciJI11mponl artery. 3. The prer)gopalaline fossa is o cone-shaped pnired d<pr.,;.<lon deep 10 tlte infra. temporal fossa. 11te ptcrygopalatioe fossa located between lite pterygoid process and the m~~>tiUary tuberosity, close to the apex of the orbit. This fossa coma ius Lbe moxillary arrery ~nd nerve and their branches ariSing ~ere. including the lnhorbitnl and sphenopolotme orteries, the mrutiUary division of the trigeminal nerve nud bl'llrlch.,., and the pterygopalaune ganglion The pterygopalatine fossa rollllllunlcte\ la1e111lly wtth the lnfratmtporal fc,.satluougb tbe pter) gumuillar~ lissu.re. medially with the MS.l cavity thcongb lh >llhruoplllaline foramen, superiorly with the ~kull tltrough the forooneu rotundunt, and anteriorly with tbe orbit through tbe lnl'erlor orblrnl

Sulh.'l iur p:lncr~JihoclniHh.nu l arfcr); inlt.'IIUI panln."Hiicuduu<hm:II:Jrh.r)

The ortenal supply of the jejunum ;md ileum 15 from branches of the uprrior mesrnlerlt artery. The intesunal branches anse from the len side oftlt~ anery ond runm tbe mesentery to rench tbe gut They !lllastomose 1Vt1lt one another to limn series of orcndcs. The lowc~t purl of the ileum is alsu suppUed by the ileocolic IIJ'tery. Tite htrgc Intestine extcutls from the ileum to the UJiliS. The large um.'!lttne is divided into tbe cec11m. the appendix. the uscendiog colon. the tratJ.Werse colon. the dt'Seending colo~ nnd tbe stgmoid colon The blood su(tftly 10 wcse areas is "l> folloWl': Cecum: the arterial blood supply is from tltc arttenor and poterior cecal anerie.. wluch are bronches of the tleocolic artery, a branch of the supenor mesenteric artery Ap)lt!ndlt: tbe ancml supply is by means of the appendicular anery, a branch of the poMerior coC1lllll'1cry A~ccoding colon: the nrterial blood sap1ly is front the ileocolic mtd right colic bmuches of the "''Jlcrior mesenteric artery Transverse colon: the tlrterial blood supply of the proximal two-third~ is from llte middle colic artery. a br.tnch of the superior mesenteric artery. The dtstnllhiro is sllpplted by th~ left cuhc artery. 3 bmncn of the mfenor mesmteric anery Orscending colon: the ancri11l blood supply i' fmm the left cohc ami <i!mlOid bmncbc., of the inferior me.~enk'ric artery Sigmoid colon: llle anerin1 blood supply is from the sigmoid brunches of the infonor mesenteric artery Note: Tbe rtetial blood supply to the rectum is from the superior. middle, Ulld inferior recwl arteries. Tbe superior rectal artery is a dln.-ct continuation of the inferior mesenteric artery. rbe middle rectal artety is a &mall branch of the mtemal tlioc anery. The infenor rectal onery !< 3 branch oftbe internal pudendal artery in the perineum. Theartcnal blood sopplyto the ~nus (anal canalj is from the superior Md infenor rectal aneries.



The left subcla\'ian, left carotid, and brchiocepbalk artery arc branches of the:

External carotid artery Celiac artery Aortic arch Common iliac artery

55 Cop)Tif,ht 0 2009-2010 ~nul Otcb

(Anof the following statements concerning the common carotid arteries are tr.;:J
\_ EXCEPT one. Wbitb one is the EXCEPTION?

The common carotid arteries are the same in length The common carotid arteries differ in their mode of origin The right common carotid artery begins at the bifurcation of the innominate artery (brachiocepha/lc artery) behind the sternoclavicular joint and is confined tO the neck The left common carotid artery originates from the highest part of the arch of the aorta in the superior mediastinum and consists of a thoracic and a cervical portion

~. . 0

58 201-2010 ,_..


-\urtic an:-h

The arclJ or the aorta is a continuation or the a.<~eending aun.a. The aorttc arch lies behind the mrutubrium Slemi and an:bcs upward, backward. and to the leO on front of the trachea (its mam tlil'f!ction is bacAwarrl). lt then passes downward to the leO of t.he tra chea, and at tbe level of the sternal angle become continuous with tbe dese~:oding nona. Branches include: The brachloccphalic artery is an extremely shon nncry and is the first bronch from lbe aortic arch . Thts artery passes upward and to the rigbluf tho trachea and divides into the right common carotid and right !ubclavian arterie! behind the right sternoclavicular joinl Remember: There are two (right ami l~fi) bmcluocephalic vein$ but only one bmchiocephalic anery. The left com mon ca rotid artery arise! from the convex surface of the aonc arch on the left side of the brachiocephalic anery. The left common carotid artery runs upward and to the leO of the trachea und enters the neck behind the lei\ stcnllx:lavicular joint. The left subclavia n orlery arises from lhu aortic arch behind the ld\ common carotid artery. The left subclavian artery runs upward along dte left side of the trachea and the esophagus to enter the root of the neck. Titis artery lll'chcs over the upex of the left lung. lmporlant: I. The upper limbs on: supplied by tb~ subdavlao ar1eries (both right and left). 2. The head a nd neck nre supplied by lhe right nod lefl common carotid a rteries.

llh ~numuu


are lhl ,uun 111 hu1,!1h

The major :utene> that supply the head and ne.:k are the common urotid and <uhctin arttriH. The on&in> from the bean of the rommU1'1 caroud and subclavtan anem-. thot i uppl} the beod and noc:k arc dtiTm:nt for the right and leO 01de! of the body For the right <ldt uf th< t..xly. the COilUl\on <arolid and sobclavtan ancnes are both branches from the bnachloc<phatk artrry. The brachioe<:phohc ane.y i< a direct brnnch ofthc Horta.
The common carocid arttry is branchless and trav..:l!t up Ihe neck. lalerolto the trachea ond lar)'1\>(, to the upper ltrdcr of the thyroid cartilage. The common carotid artory tra,el in o sheath deep lo the stemocleidomnstoid muscle. This shcnlh nl).o contains the intero:ll jugulor v~lll and the vagu51 11l'rve 1l1e common carotid arte1y cntl!' by dividing into the internal und external carotld art<rlts at about the level of the larynx. The lntornat torortd has no branches m the neck T~e internal carotid'sbronchc supply the structu~.s ln~ldt th~ cranial cavity. The intcmal carotid gaves rise to the ophthalmic artfl')~ the nta)or blood >upply of the orbit and c}c. that cnters the urbil fhmllgh the Opllt foramen (can.>/) "'tth abe op<ie nenc. The inl<'mal comlld ends by dividing onto the onrer1or and middle <erebral art<rie that eontrib<nc to the gno~~t ccrc:bntt circle (of lf!i/l~r). The <~ttmol carotid has eight branches thOI mainlY >UJ'PIY he;ut >tructures outside the c"'nial cavity. 'llte brunch<! arc as follow>: Anterior branehu: Posterior branches: I. Suporior thyroid llr1CI)' I. Ailcending pharyngcal urtcty 2. Lingual arkry 2. Occipital artery ) , Facial artery 1, Posterior auricular ancry 4. Maxillary artery 4. Superficial temporal artery

l'he subclavian oner) mcs latemlto the common caro1id anery. The subcla>tiJ\ 11'1<1') am:$ ofT branches 10 wpply both mu11creoiot al1<l exlr.lcruniJ >tructllr'eS, but its majot dcsuoauon is th<
uppef extm~~ny (~rm)


Remtmbr: On d.. lft Ide of the body, the len cummon carotid and lefi suhclovaan artcnes from the erc:h of thf aorta m the supa{or n1cdhblinlll11.



Which artery suppUes the muscles of mastication, the maxillary and mandibular teeth, the palate, and almost all of the nasal cavity?

Mandibular artery
Subclavian artery

Venebral anery Maxillary ancry

CopyriJVrl 0 2~2010 l)cnlal Ord:t


a n)


collision during a basketball game left the point guard seeing double. The"' on-cou rt physician determined that the paper-thin wall that holds up the eye had collapsed and the right eye now sat lower than it should hove, thus \..causing the diplopia. Name the proj ection of the ethmoid bone that collapsed:_,

Cribriform plate

Crista galli
Ethmoid sinus
Lamina papymcen



\ r hn.rl'nJ~ h

_ -

uftl11 \ 1,.\lll:.tr \ and

\bnd th ~r l:. r

l t-.:lh


..., .... . .


On nwtol bnoclld 6e1 bm pk.uft. to~ k fii.Ll.JI.

Alllmlr~ tlft!Oiat Mlllk!lc ~ 'collr Patitctlllt io~ipeotlra1,N!. Or'C1 nsc .. l brafteb that f~JW~ 01 mtad:ibwlar lf'th

I~trmor al\ eolu-


A..-mor supcrlor ab'COiar

l~tr.I1KWbi~.al a11~

1\ rl~''' 11ftcr the mftaortll1;(1anny passes lhrou.gb the. rnftnl'f

octll lalli~~"' and

(orlh'- maxillary anery)

ill!O th< inhodliull canal S.MI!Iatld the n:enor l'ft'l.h

OtttfiHh v1111he' ah'eOillrcmul$ ;o surply pen orthc mull-

lney anlh
Svp(~ lH thCI max:illa1Y

M.lddlt SUptti'l'!r .ai\'CC)III:

[nt'Jaofbttal al1f1Y

~h)' er

ml.) nl)l be prelo('RI

--Wcnnr -sl\el\ar

tr prf<4tec. antes t'r!!m tllc- iriiRorbiul arwry o( rbc nw:tllll')' cnay 11't<1 it pustSihNIIgh the mfcrinr orbital fiSJW.re U.S 111W

1'lwld ,.n or lk
.a.r.llllry .SCI)


lhc: CUll .,..,...... ..,. tht Ill\'COW caoals co supply llw "~ tltlw. aQd cbc: p~ ac die c:aaa:
"~lie~ ''he N&U"by antty ttllm lbr pttr)~


_.,.._,_ ....

[ au.n ~ ialil~ $11dxe orb rAWIIII1JIIIIIIf k

Dlfd r-n ofik:

mu_iJ'-ty artcT}

~ mfencwl) till.b.l.-.q. tb!: iDiirior

Cflle' . . mDIIIibul ionmdl o(*'tto~.:on.1 ~ar


ot.ro'lr flO

T.-nn.llft tmQ the mmta.1 *1MS ioctSi>.'e llOitllb a~ !lit !"t$1CJII s._pplloh &II or>bt maodibula: l<h

l11ffri(or al~lar ~'~'>'

lnfcrior aJV(OIIIf ll'l.r)'

Suprlld tbe lat'tlaf llQJI~ or the an.ltrlor k'tt.h

s"PIIl ~n


ma 4ntmot lb:tt.

I .uuin:1

ll.lp~ ral'l'a

Fitting together lO form a prote<:tive shell.lhe sk\tllos composed of paired bone> on each so de. ond unpaired bones running through it. modline. The seven unpaired bones are the front!. 1hmood. occipital, sphenoid, mandible, vomer. and hyoid bones. The 10 paired bones are the temporal bones, oncluding the tiny moddlc ..r bones (oulcl.s) of the malleus. incus- and suopes (hommPr on.-il. and stirrup). parietal, lacnmal. na$al. eygomatic, palatine, aud maxill:uy bones. The ttbmoid bone is exceedingly hgbt and sponl!). and cubical in shape: this bone ;, ituatcd at the anlaior pan of the base of the cranoum. betwc:en the two orbits. at the roof of tbe nose. and contributes to each of these ca'"ties. Tbe cthmood bone consists of four parts: a borlwntol or erlbriform plate, forming part of the base of the cronium; a perl"'ndicular plate, conslltutong part of the nasal ~tum; and two lateral msses or labyrinths. Cribriform plat@': C<mtaios many olroetory rommina. The otraolory ocrves pass lhrou"-h thc!le forumina. Note: Damage Co !Ius nrca typically rosulcs in cbe loss of sense ol' smell. icrpendicular p_ l att>: The trl.stu goUI is u nudllnc: projec1ion from the pcrpendiculnr l>ll'IIC that serves as an auachmcnt for chc falx cerebrl. Lateral masses (right and 1/1) prOJOCI downward from the cribrifom1 plate. They contnin the ctbmoid sinuses and the orbital plate Of the C lhmold bone (lamina pap)~D<'ea), The lamina popyracea form:. the paper-dun medial wall or the orboi. The 5Uperior and middle naul conchae are scroll-like projections that extend medially from the lacernl mass<: ioto ttl< o3>0I cavity.
I Each etbmoodal inus IS dtvoded onto anteriO<. middle, and posterior cthmotdal aor NorH cdls. 2 The superior wall or roof or the orbll is formed almost completely by the ort>otal plate or the frontal bone. POSienorly. the supenor wallos fanned by the lesM:r wing of the sphenoid bone.



All siJitements concerning the sphenoid bo ne are true EXCEPT one. Which one is the EXCEPTION?

The greater wing of the sphenoid bone fonns the lateral wall of the orbit and the roof of the infratemporal fossa The lesser wing of the sphenoid bone contains the optic canal (optic foramen) and helps form the superior orbital fissure and roof of the orbit
The medial pterygoid plates of the sphenoid bone provide attachment sites for two

muscles of mastication Foramina within the greater wing of the sphenoid bone provide access to both the pterygopalatine and infratemporal fossa The body of the sphenoid bone contains the sella turcica and the sphenoidal sinuses
59 CopyriJllt o 2009-2010 Dtntl Db




Bone in the mandible develops by:

Endochondral ossification Subchondral ossification Intramembranous ossification Primary ossification

Thl' nu-<ti1 1l plln :,:nicJ piaU\ of lhl' 'Jlllt'ttnicl hnlll' pnt\ idl' allarhmlnt 'ih' fur t\\U mu'dl'' nf ma.. ri..'alinn

***This is falst. Rem ember: Tbe lateral pterygoid plate provides the origin for both lbe lutensl and the medial pterygoid muscles. The sphenoid bon e is situated at the base of the skull ht front of the tempornl nnd bosilor p~rt of the occlpirol bone. It somewhat resembles a bot wit.b its wings extended, ond is divided ioto n median portion or body, two great and two small win&> cxt.:nding outward ffom the sides of the body. and rwo pterygoid processes tbat project from the bone below. Hollow body: Conr.nns the sella turdc , which houses the pitui~ary gland and the sphenoidal sinus ... Greater " lngs: llelp tD fonn the lateral wall of the orbit aod the roof of the infratemporal fossa. Contain fo ra men rotundum : transmits maxillary nerve (V-1), fora men uvaJc: transmits mandibular nerve (V-J), and foram en spinosum: transmits the mlodlc meningeal vessels and nerves to Lhe tissues covering the brain. Lesser (.w~a/1) vings: Help to fot-m Ue roof of \he orbit and the superior Drbital fissure; cou\~iu the oplie canal {optic jilramen) that transmits the optic nerve (CN U) and ophthalmic artery. Pterygoid processts: One on either side. descend perpendicularly from the regions where tbe body and great wings unite. Each process con:<ists of a medial nnd o lateral plate, the upper parts of which are fused anteriorly; a enical sulcus. tile pterygopalatine !,'<OOve, descends on the front of the line of fusion.

l nlroJIII\' IIIhr.IIHHh


The first evidence of bone ossification (hone formation) occurs :uouod the e1ghth week of preoatal development. Bones de\'elop e1tht't' through endochondral osslnea!lon (going through 11 cartilat.>inous stage) or through intramembranous ossiOeatlon (foml ing difl!ct/y a.t botle). The distinction between endochondral and inlt3lllembranous formation rests on whether a C<Jrrilage model serns as the precursor of the bone (endoc/J0/1 dral oss!/lCalinJJ) or whet.ber the bone is formed by n simpler method, without the intervention of a cartllagc precursor (intramembra/lotL< wsificatlon).
Most boots are endoehondral, meaning that Jbey began as a hyaline carUJage model
before they ossify. This takes place within hyaline canilage. This type of ossification is

priocipslly responsible for tbe (ormatton of short und long bones. Bone replaces cartilage (ostcocy tes replace chondrocytes). 1hc bones of the extremities and those p:ms of the axial ~keleron that bear weight (e.g., ertcbroe) de>tlop by eodochondt31 ossification. The Oat bones of \he skull and face, tbe mandible, and the clnviclc develop by intTatnembrhnous ossiticnl"iou. It is so called becnu.' it takes place within membr-Jnes of connective tissue. Tho mandible and mxJJI" urc formed this way.Tltis process contributes to tbe growth of short bones and the thickening of long bones. Tbb process involves tbe tnlnsfomunion of osteoblasts tO ostcocytes. Remewb.r: Once bone is formed, 11 gro\\ S by appositional growtb (gro,..rh by aclclition ofnew layers 1>11 those previau.tly formed).


B n)

'During dlstalization of molars in bodily orthodontic movement, the alveolar"" bone distal to the tooth must resorb, and the alveolar bone mesial to the tooth must apposltlonally grow. In orthodontic movement, the alveolar bone Is being remodeled. This remodeling is a function of:

OsteoclasiS and osteoblasts Chondroblasts and osteoblasts Osteoblasts and osteocytes Choodrocytcs and osteocytes

81 CopynjbtO 2()(19.1010 Dmt.al Deck$


B n)


All are functions of the skeletal system EXCEPT one. Which one is the EXCEPTION?

Lymph filtration Mineral storage Suppon


Body movcmcm

Copynsf!tCI2009ZOIO Dmtel Db

OsteoclasiS are cells lhat brenk down and remove exhausted bone ussue. Osteoblasts bui ld new bone tissue tO replace this loss.
Osleobla~u are the princtpal bone-building cells; they synthesize coUagenous fibers and bone matrix. and promote mineralization during ossification. Once this has been accomplished. the osteoblasts. wbich are trapped in their own maui'l, develop mto ostrocytes that mainlllin lhe bone tissue.

I. Ostwblasts are derived from mesenchyme (fibroh/asts) and have a high

Nott RNA content nnd stoin intensely.

2. Osteoclasis (whlrh me derl\ed from srem ~ells in tile bone mam>w- the .rome ones that pl't)llllcc monocytes and macrophages) are large multinucleated cdls that contain lysosomcs and phagocytic vacuoles. Note: A llo,. sblp's lacuna is a small hoiiO\\ created on the bone surface by osteoclastic activity. 3. Osteoid is newly fonned organic bone matnx tbnt has not undergone calci fication. Important: Osteoid difTcrs from bone in that osteoid does not huvc a mineralized

Remember: Bone is hard and resists compre;,sion because of !he mincrali7.ation of its extracellular mauix. When bone rnauix mineralizes, morganlc hydroxyapatite crystals (pr/manly calcium pho,tphare) an: deposited around the ~isting collagen fibrils. and the wa1er canteD! of the ntlltnX decreases. Bono deri'es its Oc>ttbility and tensile strength from its abundant collageu flbct1i.

I\ m11h t111r3liun

Functions of tbe skeleW system: Suppon: skeleton fonns a rigid framework to which are anacbed the soner tissue$ and organs or the body. rrotecllon: the skull :md vertebral column encloso the CNS; the rib cage protectS lito hean ,lungs, great vessel<, liver, and spleen; and the pelvic cavity supporrs the pelvlc

Body movement: boo~ serve as anchoring att!Chment.s for most skeletal muscles. Ju Ibis capacity, the bones act as levers wilh the jomts functioning as pivots "hen muscles contract to cause body movement. Hemopoiesis: the 1\.-d bone tllJIITOW of an adult produces red blood cells, white blood cells, and platelets. Mineral storage: the inorgamc mauix of bone is composed primarily of the minerals calcoum and phosphorus. rhe-~c minerals giv~ bone its It!lidity and account for approximately two-thirds of the weight of bone. About 95% of the calcium and 900!. of th~ phosphorus within the body are deposited in the bcmes and teeth. Bone uists In two forms: Comraci(OI'JP"'II'>'tUasolld ma>s) and spongy ou::ont'<:llous bone. which consists of a brnnchong network of trnbeculac. lmponant: The initiation of bone monernlization involves the foUowing (I) I Joles or pores in collagen fibers. (2) Titc release of matrix vesicles by osteobla~ts. (3) Alkaline phosphatase activity in ostcoblosts and matrix vesicles. {4) The dcgrodGtion of matrix pyrophosphate to release an inorganic phosphate group. Fracture repair mvolves the following events: (1) Blood clot formation, (l) Bridging caUus formation, (3) Periosteal callus formation. and (4) New endocbondral bone fonnauon.



At the temporomandibular joint (TMJ), hinge movements occur between the: Condyle and anicular eminence Anicular disc and anicular eminence Condyle and articular disc Articular disc and articular cavity Condyle and aniculur cavity

&3 (op)'riibl 0 2009101 0 Denl&l Ocd:$


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A patient comes into tbe orthodontist's office as referred to by his general "' dentist. T he orthodontist notes tbe patient 's tongue thrusts and notes that early treatment could 11rcvent skeletal problems. Soft tissue development Is thought to encourage mandibular growth:

Upward and forward Upward and backward

Downward and forwa rd Downward and backward

( uiHh 1~: .md articular dJ"iC

The TMJ is a synovial joint with two nnicular ca' iti~-s. Each cavity is responsible for a dif ferent movement at the joinL An anicular dtsc sits between the condylar process of the mandible oo its inferior side and the mandibular fossa and anicular eminence oftbe temporal bone on the superior Side. ThiS disc dt' ides the joint into the two anicular caviues. Wlth one cavity acting as a hinge component and the other cavity senoing as a glidio~ component. The lo.-e.r pan of !he joint, between the condyle and the anicular disc. is the hinge component ofthe joint. Wben tbc joint moves, this hinge component of the joint mo'es tir5t, to initiate mandibular opening. The upper port of the joint, between the anicular disc and the mandibular fossa and anicular eminence of the temporal bone, creates the gliding com ponent. Owing joint movement, this gliding cavity moves after the binge component to tcr minate mandibular opening.
- I. The condyle of the mandible rests in the mandibular fossa (also calleclgleuoi<l Nott< fossa) of the temporal bone. The fossa articulates with the condyle of the mandible to fonn the TMJ. 2. The articular eminence fonns the antt rior boundary of the fossa and helps maintain th~ mandible in position. This area is the functional and anicular ponton oflheTh1J 3. Separaung the mandibular fO>Sa from the t)mpanic plate postcnorly t$ the squamotympanic !inure, tbrough the medial end of which (perrorympanlc fu Sllre) the chorda tympani cx.its from the tympanic cavity. 4. The concave area between the mandibular condyle and coronoid process IS the mandibular notch (nL<o known a.v rite coronoid norch). The mandibular notch
transmits arteries and nerves 10 the masseLer muscle.

5. .... lmport'nt: The posterior slope of this eminence is tined by fibrous con nctti\'e tissue.

The space between the jaws into which the teeth erupt is generally considered to be pro vided by g.rowth at the mandibulor cond) les (~-'peciolly rhe molars). The condyle ts a major site of growth. Many arguments have been made about condyle function m mandibular growth. Most authoritic:. agree tbnt soft-tissue denlopment cames the mandible fonvard and downward, wbile condylar growth fills in the resultant space to maintain contact with the base of the skull. The bone of the alveolar process u ists only to suppon the teeth.lfa tooth fails to erupt, alveolar bone never forms in that area; and if a tooth is extracted, the alveolus resorbs after the extraction until finally the alveolar ridge completely atrophies. Tbe position of the tooth, not the functional load placed on it, determines the shape of the alveolar ridge.

Note: The long axes of the mandibular condyles intersect at lite foramen uutgnum, which indicates that these 3XC!S are directed postcromcdially.



All of the following statements concerning the nasal cavity arc true EXCEPT one. Which one is the EXCEPTION?

T he latera l walls are formed primarily by the maxi lla, palatine (perpendicular plate), ethmoid, and nasal conchae (superior. middle. and inferior) The medial wall or nasal septum is formed entirely by the vomer bone The bridge of the nose is formed by the two nasal bones The roof is formed by the nasal, frontal, sphenoid (body), and ethmoid (cribriform plat~) bones The floor is formed by the palatine process of the maxilla and the horizontal plate of the palatine bone

40 41


(;Qp)Tifht 0 20092010 Denial l)edt

A small, rounded process A prominent elevated ridge or border of a bone A large, rounded, roughened process A sharp, slender, projecting process A tuberde is:


I lu. llh:tlktl n4::1ll ur na,ul



fnrm~d 4.ntirt'l~ h~

th4. \OOh' r hunt

*** This

is false; the medial wall or nasal septum is formed by tbe perpendicular plate of the ethmoid bone, the vomer bone, and the septal cartilage. fhe rest of the framework of the nose consist' of sever.U plates of cartilage, specificnlly, dte lateral nasal caniloge and lbe greater and lesser alar cartilage. The cartilage is held together by fibrous coMective tissue.

The nasal cavity open~ on the face through the nostrils or nares and communicates with the nasopharynx through two posterior openiogs called the choanae. The area below each concha (.ruperior, middle. and inferior) is referred to as a meatus. 11tc nnsal cavity receives Innervation from the olfactory nerve (CN I) und branches of the trl&eminal nerve (CN Y). The nasal cavity's blood supply is mainly from tbe sphenopalatine branch of the muillary artery. The nasal cavity also receives blood from the anterior ethmoidal branch of the ophthalmic anery and the septal branch of the superior labial branch of the facial anery. Nole: 111e nasopalatine nerve is a para.<ympathetic and sensory nerve dmt 11rises in the pterygopalatine ganglion, passes through tht sphenopalatine foramen, across the roor of the nasal cavity to the nasal seprum. and obliquely downward to and through the lncbive canal, and itmervates the glands and mucosa of the nasal septum and the anterior pan of the baed palate. Important: The communocation bel\\l:t'n the pterygopalatine fossa and the nasal cavIty i~ the sphenopalatine foramen. The sphenopalatine anery and the nasopalatine nerve extend througb the sphenopalatine foramen.

Surfate Feato ret or Bone (et~large~~tenrs and processi!Jl): Prot~: the most gc:nenc term for bone projection that serves as a point for attach mcnt of mher structures. Erampte: Acromion process of Inc scapula, transverse proce.\s of venebrae. Epicondyle: a projection or swelling on a condyle (or above, in some cose1) Enmple: Medial and lateral epicoudylcs of femur. Spine: a sharp, slend<:r projecting process. t.xample: Spinous process of vcnebroe. spine of the scapula. Thberde: a small, rounded process. Example: Gn:ater and le..er tubet1:les of humerus. Tuberosity: a largo, rounded, roughened process. Example: Ischial tuberosity of the ischium. 'ltothanter: a large blunt proJection tor muscle attachments on OIC fcmW' Example: Greater and lesser trochanter.. of the femur. Crest: a prominenl ek'llted ridge or border of n bone. Example: Uiac cre9 of the ibum. Linea (line): a small usually somewhal1traighter than a cresl Example: linea aspera of femur. fhmUSl a major b11111ch or division or tbe miUn body Of a bone. Titi.' may have its own articulations or processes. Example: The coronoid and coudylar processes of the mandible are subdivisions of the ramus. Neck: a slight narrowing of the body of the bone that suppons the hesd Example: Necks of the humerus and femw. Lmioa: ~ ery thin byerofbooe. Example: The laminae of the venebrac.



The shaft of a long bone is capped on the end by spongy bone that Is surrounded by compact bone. This is called the:


Diaphysis Endosteum Epiphysis

Copyrijhl 0 2@..201 0 Onl1al ()(o(ks



Which cranial fossa houses the cerebellum, medulla, and pons? Anterior cranial fossa Middle cranial fossa Posterior cranial fossa

I ptph~'l"
Long bone& hove a tubular stmft. the dlaphyst.s, and w.ual1y an epiphysis at e:1ch end. During the arowing phase. the dillphysis is separated frOil\ the cpiphy~is. by an cplphyJeal eurUin~e. The- part of the diaphysis thttt he.s ad;accnr to lhe epiphyseal cartdagc ts called the metaphysis. The shaft heb u

c(ntral marrow cavhy cont3.ining bot'lc marrow. The outer pan o( tht: sba.ft h bone that is CO'\'Crtd b)'* coooo;th-.: IJJ:S:ue sheath. the: JWrfosttum.
A typir;allong boat includes the folio" lot "trucluru:

comro~ed o( c:ompa(;t



Loc:ation and FuuC'tlon

Bone sh11 ft. cooai.Mi 11 f 11 ~~ indntal tub' 11( ~untbl~ oomp3Ct bot~.


Caps d111pl~: cc.nsl!t1 o! 'POI'IIY boM urroul'\&d by wmp11c1 botiCI Wlins red bone~ fur the ptlllualan nf rnl blood eelll. \lo'luct blood: ;;c.Us. ... pl&l.ck~ Bdwca tk

""""""" ....- - o(bofto. \led~tllary t"aYii)' (\ontnU)' Jl'l.llltiOCird Jpaot V11lllln d~ipll)'lllf! oon.ta.i.ns fAtty )eiiOIN boflt



~ .-,~ qaee oi l'!tUOCK ~"I)'

N~o~ltltn& f\nmcn

Opc.nlnauuC) diophysU; pro\l~lts t1l<: illf numcol vessel,~ to t:ri'CJ llf!d exit t~ malutlaty ~-... ily.

Artla1lor.r cwtlt.tt: Ceps ncb r:p1ph~,,. COlT!~ of~'lllnearnh~ iiciliwcJ '""'"



l.ma; ~~'II),~ ofSIIJ"'*1t\~ ck1tsc: ctplar co.edlH' rissu<.

sile far Uaa.mml ~I lendltn-tnU5Cic atJD.;:ht11CN md n:spo~ub'e. (a,

Covcr.tlbt Nri'Ke- f'(bonc; CO'llSI:flt.of d~'flie "gular oorueaJvo lUIIIIC!

dlamtnlc bone~ 1tl kan1. ould I")'Cf of bcJm; DSStte: w-.m:d by per~ $CnQ (flf to taod!mcw oraM<to.. P'O'idcl PNtec'l.ol. aJ ~,.Q. .~unt~k *CWC"- tc
~ la)'C'f vfttc.t ~ mUcs U. booe liifl1t'1 n pM\'1 lks ~ fOt ~ Pw'lc l1'lltf'OW ~bc:rt- bloo4 otllt I'C'



"fa:t ,. ..,...,,llmC'f

The mtemalurfau oflhe base oflbt kull const<tS Mthrce cntnial fOSSite.lbt anterior, muldlt, and posterior. They increase in sl~e and depth from ant<nor tn posterior. The anterior and mi~dle foo:sae an: 5Cpomted by the lesser wing of the >ph,-nod bone. and the tniddle and posterior ro,.,ae are seprotcd by the petrous part of the lelllpornl bone, The anterior cranial fossa is adapted for reception of the (ronlnl lobcs of the br111 D, and is tomted by portiom ofthc trootal, ethmoid. and sphenoKI bones. The <rl'llll galli, a midline process of the clhmoid bone, gtv<S anachment 10 the ntmor elld of th< fal ~bn- On each $Ide of the crista galli ore tbo grooved cribriform pLitts of the ethmod bone. providing numenlll'i orifices for lbt delicate olfactOry nerves from the """"' mucosa to >)'ltapse tn the olfactory bulb>. 111e ntidcllo Cnltual fossa is comJx"cd nf the body lind groat wings of the $1)h<noid bone, the <qUnDtou.~ and petrott< ports ofdte temporal bon"" and the frontal angles of the pnrtotal bones. ThiY fossa is tho "busiest" Oft he cranial fos ..e. 1 his fO$Sa tOJlt8tnJ laterally the tntporatlobcs oflhc brniD. This fc>s>a tiHl!Bins the optic chiasma, optic canal, sellatiiJcic:a. and tbe hypoph~i (a.sa that hoost$1he pllUJIAr)l glaud. Wtthm thts fossa, the supc:oor orbital fi;sun,. f0<11men rotundum. fonnnm 0"1lle, fommen b cerum, and foramen spinosum arc found. In tbe temporal bone, the hiatus for both tlle le>scr and gr"'1tcr petrosal nt'fVcs w-e found. On the anlcnur surface of the petfQUS portion or l.ht lempOr'dl bone IS the lrigemltlal tnlpteSSiOn1 which llclgt..'S the trigenunnl ganglion (~emlhmar ,,. gasserian) the. fifth ne-rve.


'11\e J)<)Sterlor crontal fossa, the dccpeM of lhe fossae. ho_,. the cereb<llum. medull, and pons. Antenorly, the posterior cnll\lal fossa e.,ll:ncls to lbt ape.< of lhc pctroos ttmpontl Posreriorly. 11 IS enclosed by the oc<tpual bone. Lat<n~lly. ponmns of Lbe .<qunmoU> temporal and maS1oid pan Of the temporal bone fomt its walls. It contains fO\If impol1nnt roramina, the intcmHI acoustic meatus (fn lhct petrou.t ptlrl of tlit> temporal lxJm!) 1 ihe jllgular rommen (betweetJ rf,t:t sphenoid and occipila/ bone.<), the hypoglt>Ssal cannl (/11 1/Je occipilal bone), and the fornntcn magnum (a largt median opening ill tile floor o( tile fi> w!tfl" th mw/111/.z oblooguta b colllin11ous "'ith. tltt rpfttol cord).



Treachcr Collins syndrome is a rare genetic disorder that presents with many craniofacial deformities. One of the characteristic traits is downward slanting eyes, which is caused by underdevelopment of the bone that forms the substance or the cheek. Which bone is this that anchors the muscles of mastication and facial expression? \.

Ethmoid bone Zygomatic bone Occipital bone Sphenoid bone

6i CopyriabtO 20092010 {)(ntal Dks



Whith can be defined as a tube-like passage running through a bone?

Meatus Fossa


Copyngtlt c IOOJ.2010 Dental ~b

The zygomatic bone is siruated at the upper and Lteral pan of the face: this bone fonns the prominence of !he cheek. pan of !he lateral wall and floor of the orbit. and pans of the temporal and inrratemporal fossae. The 2ygomatic bone presents 3 ma13r and a temporal surface; four processes. the fromosphenoidal, orbital, maxillary, and temporal; and four borders. The zygomatic bone nrtlculates with four bones: the rrontnl, spbeuoidul. t~mporal (to fomt the :ygomlltlc orc/1), and maxilla. Above the zygomatic arch is the temporal fossa, which is filled with tbe temporalis musole. At13ched to the lower mw-gin of the zygomatic arch is the masseter muscle. 'lote: The tempora!is muscle p3SSes medial to the zygomatic a rch before the muscle insertS into the coronoid process of !he mllndible. The temporal rossa is a shallow depression on the side of !he Cl3niurn bounded by the temporal line~ and tcnrunating below !he level of the zygomatic arch The infratemporal crest of the greater wing of the sphenoid bone separates the temporal fossa !Tom the Infratemporal fossa below it. Important: I. The temporal imd infratcmporul fossae communicate with each other deep to the zygomatic arcil. 2. The pterygopalatine fossa communicates laterally wl!h the infratemporal foss3 through the pterygomulUary Hssu..., medtally with the nasal 1:avity through the sphenopalatine foramen, superiorly with the skull through the foramen rotuodum, and anteriorly with the orbit through the lofulor orbital fissure.

Sudace Fgah1Cf" o[ Bong

Depressions: Fissure (a sharp, dtep grO<we): a sharp, narrow, cleft-like opewng bel\\een the partS of a bone that allows for the passage of blood vessels and nerves Example: superior orbital fissure of the sphenoid. Sulcus (o grwve. but shallower and a less abr11pt cleft than 11 fissure): a shallow, wide groove on the surface of a bone that allows for the passage of blood vessels, nerves. nod tendons Example: Intertubercular sulcus of the humems, :tlternately known os the bicipital groove. Incisure (notch): a deep indentation on the border of a bone Example: greater sciatic incisure or notch of the os coxa Fovea: a small, very shallow depres:.ion Example: fovea capttis on the head of llte femur accepts a ligamenl from the bip socket or acetabulum. Fossa: a shallow depression. This rnoy or mny not be an articulattng surf.1ce Example (ofarticulating surface): Glenoid fossa of the scapula or nJttndibular fossa oflhe tcmpornl bone. Example (non-clrliculating Sll({ace): subscapular fossa. Openings: Foramen: an opening through which blood vessels, nerves. or ligaments pas. Example: Foramen magnum of the occtpttal bone, mental foramen of tbe mandible. Meatus (c.wwl): a lube-like passage runnmg through a bone Example: the acoustic meatus of the tempoml bone.

Which fossa has no bony inferior or posterior boundary'/


Pterygopalatine fossa Infratemporal fossa Temporal fossa

Cop)Tighe 0 2009-2010 Dtn11l Decb



All of the following are openings from the pterygopalatine fossa EXCEPT one. \.. Which one is the EXCEPTION? Sphenopalatine foramen Foramen rotuodum Foramen lacerum Pterygomaxillary fissure Inferior orbital fissure

Cop,ris;ht 0 :1009-2010 O...al Dttb


nf I m .. a~ of lhl 't..ull Ptt'T)"&npattd:ntTos,..




lnfntt.mportl Fossa

rnt~al' wmpontl

Circ::uc-r wtnw or JpMnoid bone Inferior surf~c of tpbcrund bon~ body

~brlluylllb<loocy Mudbty~~



Stirf"aoc C'l(lempc:nl bono

Latttal p1eryaold pll\lt

Mandibular MUTIIIJ lltJd
t)'SOmlrtic: arcll


l'lcryg"""'iiLlly r........
~~aline' canal


lnllll""'""''""' of
>Pb""'odbl(trfor IC'PlpomllliiCI

No bony botdtt

Jltcry'gou) pmt'C""-' ur Sphenoid bMC

Hluml \

:..ul 't'nt...., uf I n .....u.. uftlll 't..ull

Tt'mpora1 f'f)SSI
Mu.Jel ~

Infratemporal Fossa
l)cerygoid IU\ISC:Ies

Pter)goptlatine rosu

TemPUralis muscle AM blood vc:sach:

Blood vtSstb

plc.'us and tna.'(illary M"'ilb:) art)' (liWd ponlo.J and bnoncbos mc:h.dmg ioJr...IJ;ul told ""'Y (S<NN """""''""" braocbes mduchng middle -splroopabu!'lc *'1tnet> meningeala.rtery, mfcrior alvL-otaT art~ry. and t)OS-1eri()r
supe:rio\' al~yeollallt1~ry
Mmcbbuw ome lnocludiog tnferior ah eoollf and bnpal




Pl>rys<>PO]otr..... glioft and l11.ilWy- <

J. ut amtn l.u. trum

The pterygopalatine fossa is a small Iriangular space behind and below the orbital cnvil)l. It communicates laterally with the infratemporal fossa through lhe pterygomaxillary fissure. medially wilh lhc nasal cavity through the sphenopalatine foramen, superiorly wilh the skull through tbe foramen rorundum, and an1triorly " i th the orbit through tb< Inferior orbital fissure. The plerygopalatine ganglion lies in the pterygopalatine fossa just below 1he maxillary nerve (V-2). The pterygopalatine ganglion receives preganglionic parasympathetic fibers from rbe facial nerve by way of 1be greater peuosal nerve. The pterygopalatine ganglion .ends post.gaoglionlc parasymparbetlc fibers to lhe lacrimal g!Jmd and glands in the pala1e and the nose. Note: 111e maxillary nerve (V-2) and the prerygopalaline portion of the ma~Uin11 itrtery pass 1luough the pterygopalatine fossa.
Bouy Open Inc
Sphenopalatine lof1\mcn

Locsdoo (Bon)
Sphenoid and palatine

artery 11nd vein. n8$0p:t.llllinC: nmc

P1<1)'oid canal

Spbmood and owulla

Deep and &n:'ft.tU petto!!al net\'ei that ronn nCT"Ve o!

ptftygoid c:attal, llQ ~l.s


Posterior 'uperior al\Jcolar \'tan, artery .and nene,. lflaxill:uy 11ncry

Ma.HIIlt)' nerve (V2)

f'onunen mtundum
lnftrior orbnal

Spllcr10id Spllenood and nwulla

Max1lla and palatine


lafroorbolal and zygomaltc a<"<'. mliao<IMtal

arteJy. an4 orhthalmic \Cln

Pl<rygopllalmc conal
Pharyngeal canol

Greater and h:..ser palatine vcm,., anene~ e.nd nervesl'hw)n~l

i;pllcnoiAI and pal11irlc




Which of the following receives the 011enlng of the nasolacrimal duct?

Superior meatus Middle meatus Inferior meatus

Cop)'rigbl 0 201-2010 DeniIDcl;t




A prosthodontist designs his maxillary removable complete and partial ...,. dentures to engage the hamular notch behind the maxillary tuberosities. The hamulus Is a small slender hook, which extends from the medial pterygoid plate. The medial pterygoid plate is a component of the pterygoid process, which Is a \.. component of which bone? .tJ

Sphenoid bone Occipital bone Palatine bone Temporal bone

74 Copyn.S:.tCI10092010 Dmtl Dttks



The nasal conchae are three pairs of scroll-like, delicute shelves or projections. which bang into the nasal cavity from the lateral "ails. Tbest projecrioos assist in increasing the surface area \\~thin the nasal cavity for filtering, heating, and moistening the air. The superior und middle conchae are pan of the ethmoid bone; t11e Inferior conchae arc separate bone~ (also ,ailed the biferior rurblnares). The space below each concha is referred to as a meatus. Superior meatus: lies below and latcrnlto the superior concha. The superior measus =et,es the openings of the posterior ethmoidal sinuses. Middle meatus: lies l>t:low and lateral to the middle concha. Tlte middle meatus receives the openings of the frontal. maxmary. anterior, nod middle ethmoidal sinu.:.es. The middle elbmoidal smuscs drain omo the ethmoidal bulla (rounded prominence on the lateral wall of the middle meatu.<). The anterior ethmoidal siuuses drain into the infundibulum (/imnel-like srroctlll'e that empties info a gn>Q\'e called the hiatus semllrmaris on /he lateral wall of the middle meatus). The frontal siuuses drain into ~te inflllldibulum or directly into the middle meatus. The maxillary sinus drains directly into the hiatus scmilWlJI11S; its opening (ostium) is located near the top of the sinus. Inferior meatus: lies below and lateral to the inferior conchae. It receives the opening of the uasolttcrimal d uct. The nasolacritnul duct drains lacrimal Ouid ftom the surfnce of the eye into the meatus for evaporation during re;pirntion.

The l~n and right pterygoid processts proJC:C:I downward frt'tn near the junction of t3eh of the grc~urr Wings Within the body of the sphenoid bone. These proCCSM:S Nl\ along the poMtriOI' portion of lhC Msal passage tOward the palate. Each process consists oro nu!dhtl und a laterAl pterygoid plate. The lotrrol pterygoid plate provides the ori11111 for both lateral and medial ptctyl)oid mllllclc. The plate ai!IO fonns tile mecltal wall of the infrat<mporal fos.<a. The medial pttrygoid plate forms the pos.tcnor bnm oflbc: tatml wall of the nasal c;a\ity The mechal pla(e ends mfcnorl,) as a bamutus. a small. slender hook th&' acts b a pu11cy for lhc tensor \eli pala11n1 tendon 10 c:bangc its direction of pull from vcnic"l to horizomol, thereby tcosin& the soft palale
l~rot6Ses of Skull


,\h'COiu pnx:a'


Skull Booes
~t...llt.o c~

Auodci:d Sll"l.I(Cura

.. ,~ar......t.~W't'tb



"""''oe of t'lllfmf
t umb rnffilal1nii-norbi'IOI rlm
Fom1' oni.CUOJ lll~tr.~l ~'lrl.'lk~l ...an

I''"""'' """"'' rrooes.s.


a...... .....




........ """""' .. ~d -bo;ly

--.~ ......... ~box,._..,. (vf'Yif'llb~ or~ lbte.ctls



Fomn UllfiiOrbiU&I h ill "' J'llfUl'llt ur 111lti!nC!f latml <ftil:.l -.liTI

fll)m1) III IICniK lwrd P')Uc

''la!lllinc: proctu
~l&knold pt'OI."r'SSI

,..,....,...,... ,.,..._




Sen""" b Utlld.;neni for ~b .. -..~ ll,gUDCCIL:

T"""""" """""

,,,,1.,,of X)'gofll.4t.c: rd
t.&1tml1o ocb{J

l~JO*Ilt P'OOC'.W. 't#)m.IJC.~




FO'fltt k~n~l portit! Olan.!I'IOd!'tU tm.




B n)

A young patient arrives In the physician's office with unexplained symptoms"' for a long time. The patient has had bloody nasal discharge and painful oral lesions. A chest x-ray reveals "coin lesions", and labs reveal kidney failure. Ultimately, the isolatlon or the ANCAs JgG antibodies yield a diagnosis of ~egener's granulomatosis. Tbe dentist "bo referred Ibis patient to the ph)siciar made a note or the necrotizing oral lesion that had perforated the hard palate 'into tbe nasal cavity. Tbe roof or the oral cavity is formed by the: ~

Ethmoid and palatine bones Maxilla and nasal bones

Maxilla and palatine bones Nasal and vomer bones

Copyright 0 20091010 Dtn111 Dtcb


B n)

Most precisely, osteocytes are located In these spaces:


Lamellae Trabeculae

Copyn~t C)

76 2(109.2010 Dtntal l>t<'lu

Spectflcally, the poiAiine process of !he maxUia und the borltontal plates of the palatine bones.

The structure fonned by this union is D1e hard palute. The anterior m o-thlrds of the hard pnlme is formed by the p~latine processes of the maxilla, and the posterior unetbird is Conned by the horizontal plates of the pslatin~ bone~. The hard palate form~ not only !he roof of the oral cavity proper but also the Ooor of the nasl cavity. IJ IS covered with a mucotL~ mtmbrane and beuc:lth the muco..a ore pala1al !i:iliv>ry gland.<. The gre:uer (nmerior) palatine vein, artery, and nerve lrJvel uloJigtbe maxillary alveolar processes anteriorly where they join tlte nasopalatine ncrws and sphenopalatine artery and vein, exiting tbe nasal cavity from the Incisive foramen. The soft palate is con110uous with the hard palate pootenorly and IS "soli" becall5<' 11 does not huve ~ bony substrate bllt cootnin tough fibrous oonnective tissue shee~ the plllutaJ oponeurosis, and is covered wtth a mnoo>a. Salivary gi11J1d~ are found in the underlying connective tissue. f'osteriorly, the sofl palate suspended in the oropharyr~' ends tn the midliue uvula.
Remember : Most of lite palatal muscles receive motor innervation from the pharynanches l'rom geal plexuHof nerves. The tensor muscles uf the pnlnte receive motor b the mndlbular division ufthe trigeminal nerve (CN V-3). Sensory Innervation is provided by the maxillary dirulon of the tngeminal nerve (CN 1'-l). Anerial supply is from pan-3 (pterygopalatine portioll) of the ntA\illary rtery.

I anunu

There are two types of bone tissue: compact and SJIOn~y. The names imply tbat tile twu types of bone tissue differ in density. or how tightly the tissue is packed together. There are three types of cells that contribute to bone homeostasis. Osteoblasts are bone-forming cells. osteoclluts resort> or break down bone, and osteoc} lM are mnture bone cells. An cqwlibrium between osteoblasts and osteoclasts maintains bone tis5ue. Compact bone consists of closely packed osleons or lu.versiao systems. The haversian system consists of a central canlil C3lled the hnrshm canal, which is surround<:d by concentric rings (lamellae} of matrix. Between the nng,s of matrix. the bnne cells (O>Ieo cyres) are located in spaces called lacunne. Sm~ll channels (caua/icu/1) radiate from the lacunne tO the haversian canal to provtde passageways (hrough the hard marrix. In co n pact bone, the haversian systems are packed tightly togethet to form what appears to be a solid ma.o;s. Tbe haversian canals contain blood vessels that are parallel to the long axis of the bone. These blood vessels intm:onnecr. by way of perforating canals, with vessel$ on the surface of the bone. Spongy (cancel/ott.) boue is lighter and le~ dense than compact bone. Spongy bone conststS of plates (trtthecui<Je) and ban of bon<' adjacent to small. trregular cavities that contain ~d bone marrow. The canali~'Uii connect to the adjacent cavities, instead of a ceutral haversian canal, tu receive their blood supply. It rnay appear that the trabeculae are arranged in a haphazard maoucr, btll they arc O t"Sttnl7,od to provide maximum streugU1 similar to braces tbat are used 10 support a building. The trabeculae uf ~pongy bone follow the lines of stress and can realign if the dtrtttion of stress ch:mges.


o n)

A 62-year-old female patient with osteoarthritis Is having bcr right hip ""' replaced. A titanium-ceramic prosthesis "ill act as the bead of her femur and a poly-ethylene cup will act as tbe socket in tbe blp bone. In a normal bip, tbis cup..haped cavity that receives the head of the femur is l'alled the:

Pubic tubercle
Obturator foramen

Acetabulum Pelvic girdle

Copynatnc 1009-loto Dcnw o..u


A young couple looking to have a baby goes to a fertility clinic. The reason they are having trouble conceiving is because tbe man's sperm is incompetent and are relatively non-motile. In vitro fertilization l.s indicated and will most likely be successful. What is the long, whip-like organelle that \.. sperm use to move about? ..J

Centriole Aagellum Vacuole



Tbe os cox or hipbone is formed by the fusion of the ilium, ischium, and pubis on each side of the pelvis. The os coxa articulates \\ith the sacrum at the sacroiliac joint to form the pelvic gjrdle. The two hip bones articulate with one another anteriorly at the symphysis pubis. Tbe Ilium is the u;>pcr flattened part of the hip bone; the ilium possesses the lilac crest, which ends in front at the anterior superior iliac spine and behind at the post erior superior iliac spine. The ilium possesses a large notch called the greater sclotlc notc,h . The Ischium is Lshaped with an upper thicker part (body) and n lower thinner pun (ram11s). This part bears the weight of the body when a person is in an upright. seated poSition. Features include ischial spine and ischial tuberoshy. The obturator foramen is formed by the nmus of the ischium together witb the llUbis. The pubis is divided into a body, a superior ramus, nnd an Inferior ramus. Tite bodies of the two pubic bones articulate with each other in the midline anterior!) at the symphysis pubis. Medial to the symphysis is the pubie tubcrele. The inguinal ligament connects the pubic tubercle to the anterior superior iliac spine. Note: The acetabulum is a cup-shaped cavity on the lateral side of the hip bone lhut reeeives the bead of the femur. It is formed superiorly by the ilium, posteroinfcriorly by the ischium, and antcromedially by the pubis.

~ lagdlum

Flagella an: present in the human body o nly in the spermatozoa. Flasella are similar in structure to cilia but arc much longer. The action of the flagellum produces movement. The dUum is a short, hair-like projection from the cell membrane. The coordinated beat ing of many cilia produce orsanized movement. The baSIC struciure of nasclla and cilia is the same. They resemble centrioles in having n.ine sets of microtubules arranged in a cylinder. But unlike centriole,, each sei is a dou blet rather than a triplet or microtubulcs. and two singlets are present in the center of the cylinder. At the base of the cylinders of cilia and flagella. within the main portion of the cell, is a basal body. The basal body is es.~ential to the functioning of the cilia and nagella. From the basal body, fibers proJect into the eytoplnsm, possibly to anchor the busul body to the ceU.
Both cilia and flageUa u.~ually function either by moving tbe ceU or by moving hqu1ds or small particles across the surface of the cell . FlageUa move with an undulating snake-like motion. Cilia beat in coordinated waves. Both move by the contractiou of the tubular proteins contained within them.



The inactive X chromosome in a female cell is called the:

Pineal body
Lateral body Golgi body

Barr body

10 CopynalJtO 20092010 Oaltal DkJ


In which cellular component are glycoproteins assembled for extracellular use?

The Golgi apparatus The endoplasmic reticulum The nucleus The nucleolus

Uarr hu(h -- alm ),ncm n :" fh<


thrnmatin luuh

In the rem ale, the genetic activity of both X chromooomcs is essential only during the first

few weeks after concepcion. Later developmenr requires jusr one functional X chromosome. The other X chromosome is tmctivated and appears as a dense chromatin mass called the Barr body. Tilis Barr body is an.ached to the nuclear membmne in the cells of a normal female. In the cells of a normal male, who has only one functionral X chromosome, tbe Barr body Is absent. Important: The Barr body's preseoce is the basis of sex detenninari.on rests (for example. amniocentesis).
I. The sex of an embryo can be determined ar abour the eighrh week. :-ootH 2. Females have 4S active chromosomes and one inactive Barr body.

The funcrion of!he Golgi appararus i~ two-fold: First.rhe modification of lipids and pro Ieins; Second, the storuge and packaging of materials that wiU be exported from the cell. The Golgi apparatus is ofien called the 's hipping departme.n t" ofrhe cell. The vesicles that pinch off from the Golgi appar.llus move 10 the cell membrane, 3Jld the material in the vesicle is released 10 the outside of the cell. Some of these pincbedo()ffvesicles also become lysosomes. l mportant: The Golgi apparatus is where glycoprorelns are assem bled for extracellular use. The Golgi appararus (sometimes called the Golgi body) is similar 10 endoplasmic reric ulum (ER). h is composed of tlar. membranous sacs, or tistemae, arranged in Slllcks hke pancakes. These sracks have two poles- the cis face, which receives materials for pro cessing, and the Iran., face, through which substances are released for transport to orhcr partS of the cell . ....._ I. These cisremae are locared bcrween the nucleus and the secrerory surface of Notes a cell. 2. They package, store, and modify products that are secreted from the cell. 3. ProcoUagcn r.laments are fonncd here from amino cells. Lysosomts are cyroplasmic membrane-bound vesicles rhar cootain a wide variety of gly coprotein hydrolytic en~) mes thar st.'t'Ve to digest and destroy exogenous material, such as bacteria.


' Which of the following is the distinctive array of mlcrotubules In the core o;' cilia and nagella composed of a central pair surrounded by a sheath of nine doublet mlcrotubules (cloaracteristic "9 + 2" patttrn)?


Tubulin Malleolus

81 CopyrightC 2009-2010 Onu .al OU


Which organelle is known as the cell's ~power plant" and is maternally transmitted?


Ribosomes Centrosomes Mitochondria

\ \lllll'llll,_'

An uoneme is the core S<:alfold the eukaryotic cilia and nagella. whtch are projccuon> from the cell made up of mkrvtubul ... Thus. the axoneme scr-es as the "Sktletoo" of these orpneJies, both giving suppon to the strucrure and1 in most cases, causing 11 to bend. lbough dis-


tinctions of fw1ction and/or length may be mode between cilia and flagella. the mtemal :,tn1cturo
of the axoneme IS common to both.

The characteristje rcature of the axoneme is itS .. 9 + 2" a.rrangement of nut.Totubules and woeiat\:Cipnnelns.. as shotn in the 1magc below. Ntne pairs oP'doublet" mkrotubules. a component of the cellular cytoskeleton. fonn a ring around a oentral pair" or single mtcrotubul<" Ciliary dyueln arms, the mcuor comp1exe:. that allow the axoneme to bend, are anchored 10 these micro tubules.. The interaction~ between the ciliary dynt.ln proteins and outer doublet microtubulcs a:en .. erat< fO<Cc by stidmg the doublclS pamllelto each other, which bends the chum and enables it to

The ndial spokt, a protein complex important in regu1ahng Ihe motion of Ihe axoneme. IS also housed in the axoneme; it projeCts from each set of outer doublets townrd the central microtubules. The M:ldiol spoke is a multiunit protein Structure found in the MOnemes ()( eukaryot.ic tiha and nagella. The doublets and central sbcath> liie linked by prOtein> kno~<n as ot.rins.

= ~~~~"'
the mitotic spindle,


~ -~


Cross secrion of an uononoe

U111t" mt

4). .

Note: Centrioles arc cell orga.nc:llcs that con.stnute the ccntro~me and tbu.~, a.1d ia fonna1ion of

\1 ilut. hond ri.1 Mitochondria ore lhreadlikc structures within the cytoplasm that provide most of ~tc body's ATP, which fue ls many cellular activities.
( .fl 'lnldUH
1-u n\11~111"

PIMnas ~t::IU~111r!C'
Serv~5 113 a bound.lty oflhCI cell. tn11Jn1tinina liS inlcgrity. pr<'IIC!n moleculn. embedded in plasma rncrnbrune pcrtOnu Y.~rious runcdCMIS~ for c-xamplr, IJlCIY S<f\'e as mnrkns tbat idcncif'Ytelts or each lndividual..... liXCJ'40f molccuJ~ ror c:tnam bonnonu o~nd 04bn moluln.. and as tran$pOn s:ocdw\i.im)

f.-plosmic mlculum Rl'bosomu attached 10 roup fiR S)"l~ pmcins lhlll~:~~'"c cells ~i.a.lbc Go1Ji oompl~:x: $.1'rl00th ER syndtei;17o- lipids. incorporated in ccll membnines.stcoroid honnor;e11. and ocnain curbobydta.tcs \l$ed to IOnn &ly(;opl"tHcins

Golgi appen&hl$

Synthesi1 orbobydrate. c-ombines il WLth proceio, aod p;x:~ ahe pOO\tll:t u sJ""""'ora~ A cell' ..d1~sti"-c sysltm


ConlauJ cn;cym<es (hili dtlOXIr)' harmful sub)tAnc:c!l

C.ataboli.tm: ATP $)'1llhesiJ; a cell's 11po\l.tr plmnf'
~the amrtk.rodc, ._ tuch ia tum cbc:iMc:l: ~ Syadlc"lt.S, hrcby pll)l"IIA ascnaial rok: ta other 11 acttvmcs., rwntty. ce-ll tnn$p0rt.. maaboti:sm. and pG'Mh




Site of protein syntbl.'$ls: 1 cell'~ "'protem f~tttOfi.. ~"

ActJ-. a tlamewod: klM~ppon !be cdl and 1ts ~tic$.; f~lOQ$ \n cdl ~ fonn:s WI tJ;tenSic:KI (~illi, cilia. flactll)


Play& an tssent1al role in lhc (ormation or nbofiomes


KupfTer cells in tbe liver are a speelaliud type of:


Plasma cell Mast cell Macrophage


Cofl>'lill't C 20092010 Demll D\1


( Wbicb cell, known as tbe "mother cell," Is a part of the seminiferous tubule""' \.. and secretes hormones and proteins tbat facilitate spermatogenesis? ~

Interstitial cells Endothelial cells Senoli cells Clara cells

A macrophage u an} phagocytic cell den~ from a monoe~ te (a type ofblood .:.11). meludmg macrophagcs of lbe liver (Kupf!u ffi/j. spleen, and loose connective tissue (histiocwc).

nf llifferenl Ctlls and llwir l'rima~ Funct ion l'rlmary Function Antibody synthesis

Plllsma Mast Schwann Senoli Leydig

Mediator ofinna.mmation on contact with antigen

Fonns myelin sheath around a..ons of the PNS Produces w.;ucular fluid Produces testosterone Produces collagen and reticular fibers

Osteoblust Odontoblast Ameloblast

Forms bone mulrix, gives rise to osteocyaes

forms dentin

Forms enamel

T (l..ympltocyte<}
B (Lymplrocytts)

CeU-mediated immunity Differentiate into plasma cells Produces glucagon Produces insulin

Alpha (Pancreatic)
Beta (Pancrcoric}

Scrtoli nll\

uf Uifftnnl ( t. ll..-.. and I hl'ir


l nratiun'

Pyr.~mldn l Endoth el i ~ l

Prima ry Location Internal car (organ of Corti), taste buds, olfacoory epithelium
Cerebral conex (Ci!rebnuu) Lining blood nnd lymph ves.sels. endocardium (;nuer luycr)
Lining the brain tJCntricles nnd spinal cord

Sertoli Grulglionic

Seminiferous tubules or the testis In a ganglion pcripheraloo lhe CNS Transitional eplllelium fkdn~y.
Stra:rum spioosum of ep1dennis

w"'"' bladder)


Most common c:cll of connective tissue

Clvomnffin Pud<injc Goblet lnt""t1tial Islet \1esencb)'mal

Adrenal medulla and paraganglia ofSNS Cerebellar corte (cercb<!llum)

Mucous membranes of respiratory and intestinal tr:Jcts Connective tissue of ova-')' and ccstis

Juxtag)omcrular Renal corpuscle of kidney Found between cc~cnn and endoderm or embtyos


{iver spots are seen as a sign of aging and are actually lipofuscin granules pre~ en lin dermal cells. Lipofuscin is a yeUow-brown pigment that is produced as a result or lysosomal digestion. What is the coUecthe name given to lifeless substances, including lipofuscin granules, yolk, fat, and starch, \.. that may be stored in various parts of the cytoplasm? ~

Protoplasm Nucleoplasm Ectoplasm Metaplasm

Cop)'liJbl 0 2009-2010 DmtaJ DKU



In which phase of the interphase docs the DNA replicate in

preparation for mitosis?

S phase

M phase

Exam,J>Ies: Glycogen: carbohydrate storage gr.tnules in liver and muscle cells. Fat deposits Pigment granules: deposits of colored substances. I. Lipofuscin: yellowish-brown substance that increases in quantity as cells age. 2. Melanin: abundant in epidermis of the skin and retina. Protoplasm is a viseous, translucent, watery material that is the primary component of animal cells. It contains a large percentage of water, inorganic ions (porassirmz, calcium. magnesium, tmd sodium). and naturally occurring organic compowtds (.ruclz as proreins, lipids, and carbolzydrares). Nucleoplasm, the protoplasm of tbe cell nucleus, plays a part in reproduction. Cytoplasm, the protoplasm of the cell body that surrounds the nucleus. converts raw materials into energy. The cytoplasm is the site of most synthesizing activities ttnd contains cytosol (a viscot<v, semirransparenr fluid rlzar i.r 7()0,1, ta 90% warcr), organelles, and inclusions (meraplasm). A clear, thin lilm of protoplasm called the cell membrane always surrounds the cytoplasm. The outer pan of the cytoplasm is called the ectoplasm.


The odl cycle consists of Interphase (includmg grr:m1h and symhesis) and mitosis. CrO\o\'th is the increase in cellular mass as the resuh ofmeutbolism. Synthels is the replication of DNA in preparation for mitosis. Mltols is the splitting of the nucleus and cytOplasm that resultS in two diploid cells being formed. Tbe cell t)'cle ca.n be further dhided into: Interphase: the inu.-rval beiwcen successive cell divisions during which the cell is mecabol izing ond Ihe chromosome~ arc directing RNA syntltesis. It Includes: I. G 1 phase-- the finn growth phase 2. S phase - DNA synthesis 3. G, ph a..-- the second growth phase M phase: mito<tS (also co/It'd mryolriesls) is the diVISion or the nuclear pans or a cell 10 fonn 1wo diploid dnughtcr cells. Cy1oklnesis is the division of the cytoplasm, which accompnnies mitosis. r-------~~~-------,



OJIA ~lttUon

Dft4 reoheett.oo en4 Cl'nfNUd OUOh to:U;n



Tbe plasma membrane (cell m~mbrane):

Surrounds the cell wall and serves to protect the cell from changes in osmotic pressure Is a polysaccbaride..:omaining structure that functions in anachmem to solid surfaces, preventing desiccation, and protection Is a non-permeable membr.me enclosing lhe cell wall Is a dynamic, selectively permeable membrane enclosing the cytoplasm

CopynJhl C 2~20 1 0 Denial Dlr.t


What type of cell in the dental papilla adjacent to the inner enamel epithelium differentiates into odontoblasts?

Myoepithelial cell Mesenchymal cell Macroglia cell Mast cell

The pJasmn membn~oe (cell memb.rtme) s a thtn clastic stroewre 7.) to 10 nanometers th1tk. It is located between the cell wall and the cytoplasm. Nonnal cell membrane function is essential (or passive nuuiall diffusion a.n and Out or the cell as well IS for a<:tivc ( i t . wquiring ~nerg)') transport acn>ss the membrane. The plasma membrane conSists ofa pbospboloptd btlayer contatn ing integral and peripherel proteins. This type of membrane is called a nuid ntoslc ;utd is found in both prokryotic and cukaryotic cells. The ull wall surround~ the plasma membrane and serves 10 protett the cc:ll from changes 1n osmotic pressure, anchor 11agella. maintain cell shape. and con1rol the lranSport of molecules into and O<tt of the cell. StructureS onterior to the cell wall tnclu.lo: the plasma membrane, the C)1oplasm, and cytoplasmic constituents such as DNA, n'bosomes, and inciU5tOOS. Remember: The mitochondrion is an uraancllc of the cell cytoplasm that cons1SIS of an Inner membrane nnd no outer mernbrane (as doe.:r rhe nudeus). Mitochondria c are the principal ener gy SOW'CC of the cell (major site ofATP production) and are involved in all oxidative process.:s.

They contoin cyclic OrN-' ' A...:;....- -- - - - --

- - - -- --,

These cells have the potential to proliferate and differentiate into diverse types of cells (fibroblasts, chondroblasts, odontoblas ts. and osteoblasts). )Aesenchymal cells form a loosely woven tissue called mesenchyme or embryonic connective tissue. Important: The mestncbymal cells tn the dental papilla adjacent to the inner enamel epithelium differentiate into odontoblasts, which produce predentin that calcifies tC> be<:<>mc dentin. Mesectoderm (also called ecsomese11chyme) is that pan of the mesenchyme derived from cctodenn, especially from tbe neural crest in the very young embryo. Neural crest tells give rise to spinal ganglia (dorsal root ganglia) and the ganglia of the autonomic nervous system. These cells also give rise to neurolemma cells (Scllw(lltn cells). cells of the meninges that cover the bmin and spinal cord, pigment cells {melanocytes), chromalfrn cells of the adrenal medulla, and several skele13i and muscular components of the bead.


Cell )

rOn the playground at rettss, a young girl is stung by a bee and immediately"
breaks out In hives and starts gasping for air. The teacher grabs an epinephrine autoinjector from the first aid kit and is able to save the girl. What cells, when bound by lgE, are responsible for this anaphylactic reaction?

Mast cells Macropbages Platelets Kupffer cells

('.op)TIJIM C 2009-2010 Dcmll Ob




A ch romosome is maximally condensed chromatin wrapped around a protein base of primarily:

Hydroxyapatite Hyalurooan



Qp)npt 0 2009-2010 Dmcal Dcd.~;

Mast cells are large cells with coarse metachromatic grunules containing heparin (anticoogulant), histamine (vasodilator), and other substances (I.e., chemotactic factors, such as eosinophil chemotacric factor of annphy/axi,f and neutrophil chemotactic factor). They occur in most loose connective tissue, especially along the

path of blood vessels. These cells act as mediators of inflammation on contact with

Note: Normally, mast cells are not found in circulation. Both mast cells and basophils liberate heparin into the blood. lleparin can prevent blood coagulmion as well as speed the removal of fat panicles from ~tc blood after u fatly meal. They both also release histamine as well as smaller quantities of bradykinin Md serotonin, Note: It is mainly !he mast cells in inflamed tissues that release these substal)ces during inflammation. The ntust cells and bnsophUs play an exceedingly imponant role in some types of allergic reactions because the type of aotihody that causes allergic reactions (the lg type) has a special propensity to become attached to mast cells and basopbils. The reaction between antigen and antibody causes the nust cell or basophil to rupture and release exceedingly large quantities of histamine, bradykinin, serotonin, heparin, SRS-A (.<IOI\ reacting substance ofanaphylaxis). and a number of lysosomal cn:t)'IIICS. This, in mm, causes local vascular and tissue reactions tbal cause many, if not most, of !he allergtc manifestations.

Chromosomes arc maximally condensed forms of chromatin. Chromatin consists of strands of DNA wound around a protein base of primarily histoncs and looks like a beaded string under an eleetton microscope. Chromatin occurs in two forms: euchromatin (e:xtended) and heterochromatin (condtrL<ed). Wben a cell prepares to divide, the chromatin coils ullo compact chromosomes. Except in the gametes (germ cells), chromosomes appear in pairs. One chromosome from Mch pair comes from th<! male germ cell (sperm). the other from the female germ cell (ovu'"). NormJll human cells contain 23 pairs of chromosomes. which makes the diploid number 46. Tbe diploid number is tbe number of chromosomes of a normal cell, The huplold number is the number of chromosomes in a gamete. Usually, the diploid number is twice the haploid number. In these. cells. 22 pairs are called homologous chromosomes or autosomes. These setS con18Jn genetic information that controls the same cbaractensucs or functions. The 23rd pair are sex (X and Y) chromosomes. The composition of these chromosomes determines gender: XX produces a genetic fenude; XY, n genetic mule.


A plasma cell:

Is a formative cell present in red bone marrow that gives rise to a specific specialized cell Is a mature B lymphocyte that is specialized for antibody production

Is a mature T lymphocyte that is specialized for cell-mediated immunity

Is any phagocytic cell of the reticuloendothelial system

Copyrigbt C 2009-201 0 lkntal l)c'(kJ



A chronic alcoholic is starling to show signs of cirrhosis and liver failure. Which of the following cell types will start to become ineffective In manufacturing albumin, Obrinogen, and the prothrombin group of clotting factors?

Fibroblasts Hepatocyte Kupffer cell Erythrocyte

CopynJM 0 2()09.2010 DcstQI Dedi.

Is a lll:llurc U I~ mphm~ tl' that i\ "i)H'daliJ(d fHr

anlihud~ llfUtlm:Cinll

Plasma cells are further differentiated 8 cells tbature very impoctnnt in the production of a ntibody. They arc rarely found in the peripheral blood. They comprise from 0.2% to 2.8" of the bone marrow white cell count. Mature plosma cells arc onen o,,l or ran sb~ped, measuring 8 to 15 11m. Their npperul!DOC (mz liglzr microscopy) is quite chorac teri~tic: they bnve basophil cytoplasm nnd on ecx;entric nucleus, in addition to a pale zone in the cytoplasm that (on eleclmn mitmrcopy) contains un el\tensive Golgi apparatus. They are tound mainly in bone marrow und connective tissue. They have a short lifetime of 5 to 10 days B cell (0 l)mphtx:yres. complele matz.rarion in lhe bone marrow): produce antibody mediated zmmunity. They account for 20% to 30% of circulating lymphocytes and like T lymphooytes become ussoci~ted wi~l lymphoid organs (lymph nodes. sple~11, elc.). As B lymphO<:ytes become sensitized to nn antigen, mature B cells develop into plaJma cells or become memory B ulls. Memory B cells are formed spitic to the antl~n(s) encountered dunng the primary immune response; able to live fot a long rime, these cells can respond quickly upon secnnd exposure to tbe anugen for which they are specific. T cells (T lymphocytes or thymusdrived lymphoc:yiM): produce cell-mediated immuni ty. They account for 700.4 to RO% of circulating lymph()(.'}'les and become associated wuh the lymph nodes. spleen, and other lymphoid tissues. Upon interacting with a specific antigen, T lymphocytes become sonsitized and differentiate into sevcz11ltypes of daugh ter cells. These includu memory T cells, which r~mam inactive unti I funzre exposure to the same antigen; killer T cells, which combine with antigen on the >urface of the for eign cells. causing lysis of the fon!ign cells and the release of cytoklne,; and different subsets of helpe.r T cells, which help ctivate otber T lymphocyte.,,

The liver's functional unit, the lobule, consists of plates of hepatic cells. or hepalocytcs, that eucircle a central vcm and radiate outward. Sepuntting the hepatocyte plates from each other are sinusoid.~, the liver's capllary system. lle-patoc:ytes make up ()()"It to 80% of the cytop\asmtc moss of the liver. These cells are involved in protein synthesis, protein storage and transformation of carbohydrates, syuthusts of cholesterol, bile salts and phospholipids. nn<l ~etoxinoatlon, modification, and excretion ofexogenous and cndollenous substances. rhc hepatO<:ytc elso initiates tbc fonnation and secretion or hile. HepatO<:ytes have abundant organelles tbnt perfonn their m1merous fuoctions. Smooth endoplusmlc reticulum produces bile snits and detoxifies poisons. l'eroxisomes also detoxify poisons. Rough endopln1mlc reticulum produces blood proteius. The Golgl apparatus packages btle and nthcr sccn:tory products of the cell. G\ycosom ~tore sugar. Finally, numerous mltoebondrla fuel cdl activtty. Kuprrer cells are reticuloendotbelinl mocropbage~, which line the sinu.<oitls. They function to remove oocteri~ and to:<ins that have entered the blood through the inteStin~l capillaries. These cells have definite cytologic chamctenstics such a:. clear vacuole.<, lysosomes, and granular endoplasmic reticulum.


Tbe following Is the s ite of synthesis of rRNA:

Endoplasmic reticulum Ribosomes

Golgi apparatus Nucleolus

Plasma membrane


Cop)'figb'l C loot.lOIODtmal 0\t


( In which phase of mitosis does the chromatin condense into chromosomes """) \... and the nuclear envelope break down? ~

Interphase Prophase


TI1c nucleolus is an oval body found inside the nucleus. The nucleolus consists uf RNA and protein and is not bounded by a limiting membrane. The nucleolus is the site of rR)ofA ynlhesis. Ribosomes are small 11articles consiSting of rRNA and protem. They are commonly called the " protein f3tlorics" of tbc cell. They arc responsible for the process of translation, or taking the information from ~1e DNA, encoding on RNA, and using it to crcoate the proteins needed by the ceU . The eudoplasmk reticulum IS 3 membmnous network through the cytoplasm. The endoplasmic reticulum is continuous with the cell and nuclear membmnes. TI1ere are two types of endoplasmic reticulum: I. Smooth (rlbqsomes nre absent) .. steroid syDlhesis; intercellt1lar tnmspo11; detoxification. 2. Rough (ribosomes are attached) - synthesis of proteins for use outside a cell (extruulllllar use).
I. The nucleus of n cell is S\lrTOtmded by two membranes nod tontains DNA. Notu 2. Active cells (fibroblasts, osleoblasts. etc.) are charncterize<i by an abundance of rough endoplasmic reticulum. 3. RNA and DNA can be distinguished from one another by the Feulgtn reaction.


Mitosis IS the process of nonnal cell dtvision. Mitosis occurs whenever body cells need to produce more cells for growth or for replacement and repair. The result of mitosis ,. two identical dughter ceUs wi1h the same chromosoml content as the parent cdl. MitoSIS is pan of the entire life span of the cell. al>O called !he cell cycle. This entire cycle consists of the following stages: Interphase: the interval between succesme cell dtvtslOns dunng which the cell tS metabolizing and the chromosomes are dire<:ting RNA sylllhesis. It includes: 1. G1 phase: the firstgrov.1h phase 2. S phose: DNA synthesis 3. G1 phase: the second groWlh phase Mitosis ean be divided mto ro11r principal stages: Prophase: The chromatin, diffuse in interphase. condenses into chromosomes. Each chromosome has duplicmed and now consist< of two sister chromatid<. At the end of propha.<e, the nuclear envelope breaks down into ve~icle Metaphase: The chromosomes align at tbe equatorial plate and are beid in pla<:e by microrubules attached to the mitotic spindle and to pan of the centron>c:re Anaphase: The centromeres divide. Sister chromatids separate and move toward the corresponding polos Telophase: Daughter chromosomes arrive at tho pole<, and the microtubules rusappear. The condensed chroiTilltin expands. and the nuclear cn'-elope reappears. The C)1oplasm divlCks (C}tokinesis), and tbe cell membrane pinches inward. ultimately producing two daugbter cells The turnover rate of the cell varies greatly from one ttssue to aoolbcr. For example, there is mpid turnover in the ephhelium of the alimentary canal and epidcnrus and slow turnover in the pancreas and thyroid.


A specialized type of cell division that occurs In the formation of gametes such as egg and sperm is called:

Binary fusion Conjugation



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95 20()9..2010 iknl&l Db


Gi s)

The preferred site for vitamin B12 absorption is the:

Duodenum Jejunum Ileum


"' 52,53

Ahh ..IUh mciosts appears much murc eomphcuted than tnlt(')$h, ~iosis is rcaJiy just ""'O dhIIiOnl in ~equtnce, eacl\ on~ of whith hA!. ~rong, !1m1lanh~ to mitOS~ Mt.lorls 1, 1he lint of1hc two di'*tnn..c;, i~ oO.un callcod reduc.llon dh'i.sioo, 1t1nce II s here thKilhc chromosome comJ >Icmcnt is rc"<iuccd fm111 2N (dlplnid) 10 IN !ltaploid). lnterphll5c in meiosis is tdontkal to imcrplmso in mitosi Md there is no way, by simply ob..erving lhe ceiL to detemune wbat type or dtvl>ton the cell w1ll undergo whe~ il ~oes diVIde. M<icllic diYlSton "ill ouur only in coil lbes<>eisled "hh mole l)t f<Jnalc ,;ex organ. Prop bast I 1> virtuallt Idem teal to prophas..: in mHCISiS.. in,o1lfina the apl_')e""JI"'Jnce of the chromosomo. the develorment of the lipmdle appanttu~ . t~nd the hreakdO\\'Jl Of lill' nuch:!tr tn1..>tnbra.ne (e,wttlope). f<lcrc IS where the orllical diOercnct tXcurs between num\phase 1 il" rneiosis and mthtphase in mit~i> In the latter, al1lhc chmmo.<otncs lin4 up un \be metph!IS<' plate ut 110 p;IIIICUiat ur<lcr In mrtopltase I, the cllramosome pan ore li!!IJ<'(I on e1tlk1' >ide of lite ntc..,pltase plate. It is dunng tlnsolignmem thai chrmnarid arms 1nay overlap and h.!Jnpomrily f\bC (c/tia.rmatn}, resulting in crossovers. Ourina annpbnyo I the spindlu fiber.~ comruc~ pulling the homologous poir<llw:~y from each Qlh~r and h>wllfd each pol< uf the cell 1\ cleov~ fuiTOw lypn:ally forniS ot tlm point. folluvcd by ~ h..itJnt-dJ", btrt 1bc oucleu- mc."fl\bnmc UJ.ually 1~ not l"t':~romu:d .-nd lhe chtor\l()$()mn do nO\ dtsoppcar, At the end of teloph.,o I, ea<:h dauglttcr cell ho> "ngle set ui chrommoomc.,., half the tvtttlnumber in the origlta.l cell where tho chromosomes were present in p111r~. While, the on~inal cell wos diploid, the daughtor cell< ore now ho1>loid. Thl, " why mciol I is often ~ailed reduttlon division.

\ldosls II is qune '""pie m that 11 i imply 1tnlot1c dh'l>ton of C"'h of 1he haplotd O<!IL< produced in m~los-lt I. There is no lnlerphalt' between nrtCJ):I$ I and mclota~~: II. When me1o5is Ills complett. there will be a 1otul ur four dauJ.!hler Cl'llli, t."itu:h wttJ1 hnlr the tulal nmnber of ehromQSOmes ns the ortglnal oell In lhe c.ne of rDale <11\ICil!r<X. all four II$ will ev<ntually de\ tlop 1n10 typic\\1 Sp<rm cell. In the ca<t or f<male sti'UI.,.IrCS. throe of the cells will typt<ally boft. lcavmg a slogl< cell to ~lop 1n1o 3D ogg II thol '" uully mueb larger than a typical ,perm tell.

ll~ um

The fmU fnfe&tl.r1rr II the nu1111 Mt.! n( att)orpnon of digc:aiOO (ood. 11te .!iln.!tll inle!llrlC it sp~Xtalw:d for tht' W!npte:lion or the d!&CIIiOn proCC'SAC'\ 1'11111 tlw S\lb~ucnt att:.orpli_oo of the divested pi'O(h.ICbo. Th~ unaJI!llC'"; tme cotai_t;ts of tllr\.'C main scgmcntc; d.: Joodcf!IID,, J~junurn. and dcum_
ChncctriJrlc fdhi~ or dte. sm1U lntHtint. lndUdt; lntnUn1 \'Uil. Tbae -are fin,Cf-"ltkc f!tOJ~o'CltOib 1mo tbe 1WDL'TI (t'Off~hflny. ()j mrlc.r~ f1"'tlrri1Mtt Jrul mtiL'rl)i"S klmfna propria} .... 'rhc eplthf.ll\l m ltnlng the lumc-11 con~in~ (I( 1\ .:;imp!~: c~~fummr cp1tllclium With ~ubld cclb. ll1c 'olpi\Sll rurf"'-'C or the lbliOrpCiYC tphhc"a~ ~lb iW a '"IJriUb bardtr" b'eTit/li"Jl/IMI Q1, mr/et/J1.1'M1'1):C!'I'ftt"lf 1'} d6:Jel,. pVJ "fitrovfllt wltltlt mfol) numbt>r ~fwrul hudnd p. r absorp<i~ Ill 'Tbc awn t\mctiO'Jt of 1he m.kro''ill1 1a 10 inaeasc ~he NfactiJ\!:1 a\..&Jblc (Of ~10n The f2m,n propria of the 41lt11t1mesllnc 11 fom'led from IOQW' cunncctn'C 11\)Ut.:. 'nus wntams blood v~sM:1i1 Herv~. Olftd l(U}to lymphlltlc v~:-eb ('"~vi nfJ.mrpr/()u OJ llrdf). luh.'fUnlll gtAnds. These 8N Simple lUbUIAr &l~ndt 1hm Opi.l:ll 10 the: iUt..:StuwlluJl)C:1' bclWC...'n lh~ hll~ O( ~ll Vllh. Tilt mh.'1hMI gblncb arc 'iO.ne\imcr! caiiJ me. Cryptl tr Ut~bf.rkuhh. St...:Tetdry edJJ (Pofttfll cdlll w111! ~"' ~~todophili< .....,..1 .. .,. r.....t 1111t b>sc of 1ho ,.,...,.,.lgl<dld> r~~c filn<b<WI or 111< !ictretorY c:tll.11 ''sun not futl)' und.. ~ h4u" ... k~n Chat Chcy ~c lySt.V')~. wbk1t has anu..tw.c-lcnul proP'"7\ttJ.

Vlves or K('rckrluc. The lintn.g oftbc ~rrutll mtt~lmc h~s rt:I'IHI\neni lOlds knml/n It\ \ltl.l~o~c!. orKcrcloin.Y or pUt::.t d~u l 11n."f. These ~.ro !lWI\ 11romiuent en lhc. jrj~num. The:st folds, seen m~ros..:opcally .n rran .... vers.e sc~o."ttons, toMI$l of mucosa al1d subnl~

1. T11C main di.!itif\J(IH!ihi"& r~;JlW'e or 'he dUOdt'IUJn'l ;, lhc fllC.!~Ct... "C or gland::. In lh). 'Uh!UUCO.Sij 1 h~ dUo-dcnnl 01 OrlJtiiU'-rstthiUlb rl'fldllt.!C 1\lkaline-~~tiun~ It) COliOI\.'tbO.:t illr.: ellbcllr or gil~\no;lt~.-"tdto tbat reach lhc d\M.ldl"flutn, 'These alandsl!iiSO prov1dC the net\.~saty allo,_.aJinc cn\ll.nn,r\enl for 1hc func:tiOUin.@. ord\t L'\t1Cn(IC
~ne sec~.ons.

2. The: mal"! dtstll'lf\U\hinr Cc:\1~ <'( ~ jej.aum 11 1ht pn. ....... ""nCC vf prvmincn1 \'ahu nr Ktt'C'krinc lp/iMt

l . 11\C Ileum il almMI de.vold or v&lves of Ktrda1ns, however llirge numu.ln.JIOIIY or lymphRIIC til_I,Ut'r bntil nodular and tlcntc. arc fOund in the lamina propn111. 111\.1.,: .:an Qf,cn be !!CCI' n,a~,.roooc'('lpreally as t1.1.rvc Vthite: pcatdloCS and -.re- (;"XnnlOIII;t knOWTI as Ptyt.r'$ p.atcht<J. r~ ilitu.m IS rite prdtmd &Jtt rDr- \ibt"'ln Btl bs.arptlon. Nolt"! Tlk ilo.un acphes a\\o 1be cecum 3\ 1he iltoe"tdt jua.. tion.



r A patient comes to the emergency room presenting with jaundice and intens;'l
pain in the upper abdominal and between the shoulder blades. The physician suspects choledocholithiasis that is caused by cholesterol stones formed in "bleb organ that stores and concentrates the bile.

Appendix Gallbladder


t7 CopynahJ 0 2(109..2010 Dental Dk



Whleb comparison between the large intestine and small intestine is false?

The lumen of the large intestine is of a greater diameter than that of the small intestine The smooth muscle coat of the large intestine consists of three bands called taeniae coli that cause the colon to fonn pouches (called haustra). The smnll intestille lacks this characteristic The walls of tbe large intestine have more villi than the small intestine The cxtemal surface of the large intestine has small areas of fatlilled peritoneum called epiploic appendages. The small intestine lacks this characteristic The large intestine is about one-fourth the size of the small intestine


11te gallblnctder i~ a sac-shaped orgnn I'Oughly 3 to 4 inches long. It is li1mly attached 10 tbe lower surface of the liver and lirll on 1he righl side Oflhe abdomcnjusl below tbe ribs ar We frool The gallbladder is joined by lht Cy>1ic duel tO tho! biliary duel$ O(the ll\tr. The comnton bile duel passes down through the hed oflhe pancreas 10 drain in1n !he duodenum m 1he duodcu:~l au111UIIa. Just before !he duel cnlcr.; Ibe duodeuwn. !he common bi lo duct is joined by lhe main duel of tbe paucrca~. Note: The gallbladd<r's lining is folded mlo rugae (similar to tlr<Me on tire YIOIIItJ<'hi. The middle layer consistS of ""'Otlth muscle fibers that con1rnc1 to ejtct bile Bile is conlmuously produced by the liver and dr:uns through the hepatic ducts and bile duct t~ Ihe duodenum. When rbe small intestine is empty of food. the sphincter (Otfdls sphincter) of the b~patopnntreatic om pull (ampulla of Vme11 conMrict~. and blle i6 forced up the cystic duct to the gallbladder for srorat;e. Importan t: Sccrerioo of the hormone choltcystokimo ufter a fauy meal stimulates gallbladder contr.Jcuon lllld rclaxatiorl uf Oddi's spbincter. and the bole mixes with the llhyme. I. 11te ~hincter (Oddi ~ spltl!t(l<!l) of the bepntOIIancreatic nmpullaris is a cir Nntl'O cult1t m113Gie llw~surround~ the bepalopall~reatio ampulla (ampulla ofVater). 2 The gli!Jbladdcr does ool c.on!ain a ubmucosa ns do 1he "Olnach and mte,. rines (both lar!ll! 1111d small). 3. Bile emu lsi ties neutral fats and absorbs !lmy acids. chole~lere>l, and cenuin vitwnins. 4. Tit~ gallbladder receives blood fi'om 1he ey~tlc ane11. n brn11ch of the nght hepatic ancry. The gallbladder is innervated by vagal fiber< from the cellae pleJus. n.e lymph ctraim imo a cyshc lympb node. then inlo 1hc hepatic nodes. und eventually lilt() the celiac nudes .

.. .._ Tb1s IK faiR; the ""all; of the larg~ mteiunc lack \i.lli.

'fhc large hncninc- coMisLS or lh\' C'oton and rmm Tbe ooll)u

iM eurnpc!led ar vari,\U\ J)ltU: tht ~um. asccudiuy colon, tr:wsvet $e ~J i an, dcs"-'<'Odinlt! t."'lon, 1md sigmoid t"(lll)tt, The IJ)jX'tldix ill nu~h<to the (~IQ. n,e r~tli.ITI ts the: ttt:eond 10 last pan. (I( thl: dlgeidve uactlnd leads. iuto the IIUt rxtrt. the atl.U" The lqe inwsnne la:ks fohb Of~tlli It is chlif'ICc.enKd b) marty hbltlu lnte-tdnal glands -.ith ~e n~ ben o(p>b'et ctlls. 'llui s: tOG\tl~ dcr.cnbed b J.:,t:and~o~lilr c.phtk:UtJm Tbt tv.,>e m~e is ilK 1rte ofWllet aMOrpb~ (~ofiJ rolumnor a,.<corpli\t t"'fillJ and ''also lbc ille. uf for mation O( Chi: ftceft, The.liCCfCtiOill oflhe gabl(l:l ttl~ provide lubnCaUiOn for lhe lumlolilllJfi'u~ AbtmdiUU lymphatic 1i.ll5Ut ~s eommon in lhe la:mina llroptiu (nwmg f(l tltL/urys INU'"II!rlil populotitJIIIfl tire:

h1me11 of tit(! full:~ inte.tthl6j

Wbertat the ~imrlar smooth musc-Le- layer 1~ wnwtuom. the-IOOJitudlnal.m\\.lOCb musde or tbt muscuiMt~ it in lhc ronn of tbra! tbac.k bMds. knc:K\'n as ue.olae t(Jf{ l'he anti ~.... Uit&ih the I"C'Sl or the II'Ji! m'tShM, ba-r a "l"fl~ oflon~inal foldJ. and the q')tthdnun
becomes 1 J\rl1if1ed squsnlOUII tptltchurn Tbr LII"Jttllniettlnt _b C~Hllt)oed or 'fhrrt Pllrtll:

I . Cct~uu: the ~ginnil'\i or lh~: large intc.mnc, bllg~like Mruc:tu~ tl'!il.t reCClvt:S lhU Ucuut of Lhc ~mi'U toteidnc I ~c ~erruUorm apptndlx i~ a ntrow. bHnd tube tl'lac ntt:nd-; downward- from t~ a~nL. It c:onlalll> I"'!" amount oflympOO!d Ul.>uc 2 Co1on: pam. of thr cotuit include lhc ts~niliog t'OfO.ft -the -shof'lest 'PAR or ttte lllf!C lntc:snuc: that Wen~ upward from lh<: t'\lffi o:t the ngbt pos.1erior ~ommal wall n.c, l rtnner,e tvlon CJttt:nd, lC:fOiiS the upper -abdou\cn whtn' thl.' co1on bends down.""an.! "long the letl P')'tartol' ~tbdomirllll Wfl.ll M the dt~nd ifl,g tolon.l..ow in Ibe: ibdmncn, Ihe COlon O:UrYC.t IUIO the. pelvis towunl the-midline 1\:J the
Sma~ Jdtmoltl s:oiQJJ, l. R~tum: extends: ft<Hn lhe '"!JmOid color! to the an\Js. h ~ 11tat~t and does no1 pou~ tbc tJetuat (011 IMI ~ J!fttc't\t in tbe l"t1JI of lh.l:' t.a~ .OlC)1ane. The rec:tum .:nd$ as dk aut anal f1 . 4 clff), ._.tucb opert.) lO thl;. t."{tenor throug,h the anus. The ltl\'1 cattal is surrouoded by the 1mernaland t"Xt~l .sphl.n..:k:f muiGleli lhat cQntrot he c:c.pulsion of coruuutt tl't()twtl mowtnrt'tll.~) Important: UnJik~ tloc: of che t"C$t nr chc OJ tral:!t., tong.nudinul muscles l.lo nt'' finm a cuntinuo\l~ lt'ycr uruund the larvt lntt<~unc. InStead thr babeb of lofl.Sinldl~l 111U!i:clc. ~lied t'.tCnlu ~:ull. ru:;1 lht ltr~cth of (b( (okJn. Codlnu:ti.aru P'htr ~ -;oton 16W ~ OidWtrfl) 1""'8 the: tub m: '"'pucltertd"' appeafl'11C(



j Name tbe glands found in the submucosa of the duodenum that secrete an alka-


line mucus to protect tbe walls of the mucosa.

Peyer's patches Glands of Kerckring Henwig's glands Brunner's glands Crypts of Lieberkuhn


Coslrrltb( C 20092010 Ormal DKl.




Heartburn or GERD Is a renux disease associated \\itb s ubsternal burning pain and e'en metaplasia where the acidic jukes of the stomach enter the muscular tube that connects tbe pharynx to the stomach. This tube is called the:

Ascending colon Duodenum Esophagus



c.,yn... 0

2009-2010 Drrnal Oetlt

Urunne,.s giJiods (aLto cn/11'<1 duode11al glands or <ubm~rosol glaflds) arc small. bmnebtd. coiled tubular glands sotuatcd deeply on the submucosa t>fthc duod<'llum. These glands secrete an alkaline o uucus In protect tho wnlls of the mucosa fl'Oo n enzymes in the intestinal juice. :-lote: HostologicuUy, it is possible to distinguish lhc duodenum !Tom the Slom:u:b by the presence of these submucosal ~lands. Remember: I. The duodnum tS the lin;tpart of the smnll intestine ttnd mcn~urcs around 12 inches in length. The duodenum has a "C" shape, whb the curvnnore of the ''C" endrcllng the nead of tho pancreas. his the &honest but wodcst pan oftbe small intestine. 2. The ontcnor of the duodenum h;os fuldcd surface, which lncron>es the ovailablc surfncc UI'CII for ab~urption of sugars, fats, nnd aminu :ooids. 3. It is rerroperltoneat (lie behind rile perlm11com1). -4. It n:ceoves the common bile dutt and pancr~tk dut t at the duodt o l papilla (which i~ Q .mall, roomtled el~>ariQII ill the 1\'a/1 ofthe tlrmd1111111) 5. The .Juodcnum receives bloo<l from the superior llnercatlcodnodennl nrtory, a branch or the gastroduodenal artery, !111d the inferior poncreaticodnodeo l artery, a branch of the supcnor mesenteric artery. Importa nt : The sympt.othcli~ and parasympathetic divtsions of tbe autonomic nervou systctn control comruction of smourh muse Ius in the intc.,tinnl wall. (I) Sympatlletlc: The splancbnJc nerve p~es through the line plexu.. Postganglionic 6b<.'f!< innervate the snuU intt.<linc. Sytnpatheric stunulatioo slo" morlllty of tbe small intestine. t2) Pansyntpathetlc: Tbc vagu' ncne >llppltes a va.<l distribution of pli111Sympathl'IJO fibc.-s. Postganglionic libor~ from the celioc plexus ussociated with Ute vaguJ nen innervate the small mtestine. Parn. <oyrnpstbcuc <limulallon of lhc >mall intestonc causes oncreased motility. Note: The prcgangliomc paraympath<'tit neurons to the duodenum are located in the. dorsal motor ouclcus of the ''ogus uerve.

Tite e.~npbagus is a 10-lnch collopsiblo muscular tube 1.butlies dorsdlto the trlll:hea and ventral to the '1/Crtebru\ column. Th~ sopbogus is located behind the l!Uchcn in the lhOra.'<. Tioe esophagus extends fnun the oropharynx anoerior to ohe vertebral colllllUI. enters the mediastooum, leave.~ tbe tbon.x via the esoph~geal hlutns, and Jllln5 the stomach. The poilll whe.re the ~sophagu~ en(ls nnd the sto11mch begins is the esophugogutric j unction. The opening throu~h which the abdominal part of the o.wpbagus enters the cardiac portton of the stomatb is calltd the tsrdi c orifice. lmportan1: There is an abrupt chang<' in lbc type of surface epitbcloum ~~ the junction of the esophagus and StOtlllo ch- from 'lrntiiicd squamous to simple cnlurruwr. The esophu~:ea) wa ll comaios four layers. a> follows from the lumen omward: muCO!>n epitbc:hum, lamina propria. :md gland> .rubmucosa - connecuve tissue, blood vessels, and glands musculuris (11mldle layer) upper third, striated muscle; middle lbird. strintetlllnd smooth: loiVI!r third, smooth muscle adventitia conn~ctive llssuc that m~rges With connective tos~ue of suJTOunding structures The esophagus receive~ blood frotn the In ferior thyroid orter)', from branches of the d~scndlng thoracic aorta. and from brwoche" <lfthe left ~:asll'ic artery. ~cERO~ stands for gnstr()c!sophageal reflux disease, ond "Ball'ett'~ esopbogus'' is the metaplusia, or abnormnl change, in tho epilheliwn of the lower end of the esophagus thought to be caused hy Qhronic ~cid damage Remember: The esophagus T<'lves plll'Uyro pathetlc fiben. liom Ill~ e>ophgul branches of the vugus nerve. noe csopbagu~ receives motor Ober~ lrom the recurrent laryngeal branche. of the vugus nerve ;ond synJpothetic innervation from the esophageal plexus of nerves.



A newborn boy or J ewish ancestry has been vomiting frequently. Kis parents bring bim to the physician, who notes a narrowing (stenosis) or the opening from the stomach to the duodenum due to functional hypertrophy orthe s urrounding muscle. What is the name or the opening rron1 the stomach into the small intestines'/

Cardiac orifice Pyloric sphincter

Lesser omentum
Greater omentum

101 Copyn;ht 0 20092010 Dental Db




All or the following statements concerning the liver are true EXCEPT one. """'

Wbicb one Is the EXCEPTION?

It receives blood from the hepatic anery and ponal vein It receives autonomic nerve fibers from the celiac plexus

Its function is to store and concentrate bile

It is the body's heaviest and most active internal organ

The caudate lobe of the liver is separated from the right lobe by the inferior vena cava and from the len lobe by the fissure for the ligamentum venosum The quadrate lobe of the liver is separated from the right lobe by the gal lbladder and from the len lobe by the fissure for the ligamentum teres
102 Copynlbl 0 l!DQ9.2010 0au1 Dfctt



Th~ stomaeh i a cullapsiblc. pOllt~hke srructurc ubout 10 tnth~s Jon~ and CUJKJblc ufholdmg 2

10 4 quans. Attact>ed 10 lbc lo"~ end of the e.<11>hagus, the stomch li<o unmedtatcly inferior to the doaphntgm and extend> 10 the duodenal p<>nton or the 5111111 mt.. tine Thc <lomach toes in the len upper quadrlll11 oftho,.Momonul cavil)'. Tho lmeral surface of doe swo nach i t-ailed the \II1:Atcr curvature: Ihe ou:dinllurtnce, tho lt.,er curvuture. The lt'fer om~otuRI llly<r uf the pcritoneu;n e'\h:nd.s around lllc .:~.lomath. and lht: Rrtaltromentum tt fOund along tbegn:at<r tuMtureoftbo llomoch. The tntcnorofUte \lomach 11 hned with rows of fold> oc wrinkltll. callod rug The stom;u:b has rour malo rt-ghma: t. Cardla: mmcdiutely ditlllto the ga<tt<>o,ophageal junction of the stomch and e.-<lpbOJl"' 2. fuodu.: C!!olory.-d portion distal to the cnrdia. tying ubove and to U.e ltll of the gasw~~1 <lpt11111!.

3. llod)': lbe middle or mam ponoon of the omch. distaltuthe fundus und tapennsm Bile,

4. l'ylorus: the lower p<>nion, betwL -cn the body and tho gn~trodundennl Jllllction. The liltnnach hilS 1hrct1aycrs ul Nmoolh mll'ioel .... L he ome.r lougitudh.al. thi.: middle dreulnr. and t.be: .nner oblique nu.tsefcs~ I. Th< llllXJmum capqclt) of tho stomach is 1\bout 3 to 4 Iuers. i\lit~ 2. The stomach re<>efv~ blood from all three br~nchcs of the eeli~c iir1cty. The lcrt gastric onery suppli~ the le:>ser cuovuture of Ihe fundus nnclthe body of the stoonoch. The right gutri< anery IS a loop llutt supplies the lesser curvature and then fomlS an onastomosi' with the let\ gamic antty. The ldt ond rlgbt gOJtro-omenllll anenes supply the greater c~~n<ature. Tbe rn~cosa 6 tho stomach contains many t:strk gland~ in the l;ommn proprio: Porietal /uxym'-'1 cells: located in fundu~ and body; ><'<rete HCI, Zymogtalc (o:lu~O cells: located in fundt"' und body; '"'"'' pepslno~en En~roendocrine cells: pn:.<enl duoughout tbe stomach: produce gutrin

lh luu ctwn h


''"n 'o uul


hil t:

This is false; the gallbladder ~iva bil<, Limctntrales it by absomin11 water aod snlls. and stores it until delivered to the dtoodt:num.
BUe IS produced Wid <ltereted by htpllllC)1es (/ll'f'ralfs), whlllh are !be most \m;atile ~lis in the bcldy. Bile is """'ed by the l"er into the roonmoo hep:liJc duct. A sh<>n <")">'lie duct lrom the gullb!llddcr joins the common hepotfc duct to fium h common bile duct, which llam;pons the blle lnlenorly to the duodcmno to help etn<~sily fin for digt!.1inn. Not~: Kutoffor tells IJne U~e sinusoid of the liver and function to filter bl!cl-ri and mm1l foreign l'llbciCll OUl of the bk>od. The liver is the hceviest and most active uuemal OIJl m the body. Many of the liver' fintetiuns are vital for life. NotTMlly n:ddish brown m color. the liv<-r ti .. under \he tover and pnote<:tion of the lower ribs on the rlghl side oft he ubdomcn. 'fhe liVer huN1 11111pp<.-r (dlaploragmatic) !Ro rfnce ond a lower (vircertJ/) surface; th<two surfuces III'C I!CJI'lfaled at UK: front by allhrup inft'rior borde~: The li,er isaJillcileclto the cliaphn8flt by the t'alci!onn, tmnf!lllar. and coroMt) llgomtnts. Tho li\-.:r 15 abo joined to the Aomachtnd duod<:num by the gastrohrpft!ic and bcpotoduodenalllgmtnts rt:$Joeotively. The vlscoral surfore of the liver 1s w t;onl~tl wnh the gallbluddc'<. ~Je right kidney, J)4llt l)f the duocknum. the esophllgu..... the stomach, nnd the hepotic flexure of the colon. '1M porta bepotb -the point where ,_., and ducts cuter Wid exit the li>-er- bcs on the venlnll <urface. fhe liver is divickd it)IO r\gl1l. kfl. raudalc, and quadrate lobes The quadrate and <::ltldate lube< are fUUC11(Hllllly pan oftheletllobe, nlthough they are separated li'om it by a f~ur on the Yi>cel'l11 side und by fue fq)cl fonn ligament on the disphmsmmic side. The liver ....:elves blood from two SO\oree>: the hepllti< urtory, which Stoppli,. the hver with OJ<Yb...,.ted blooJ from lbc aona, and the hepatic portal ,.cln. wlueh carries the products of d!p1011 to the for proot!o.<ing. This blood C\'mtUll\ly drain. via the hepatic veins into the interiQr vem cuvn, wbich ~<pMs thr blood uo the beart. ~emomber: The liver has di&cstive, metabolic, and re~ulatory fllDCIIOI1S. Its chief di~e<tive /Un(ltion is producing bile, which acts as fat emulsifier 1n the small mtestine.



Gi s )

All of the following comparisons between the Ileum and jeju num are correct EXCEPT one. Which one is the EXCEPTION?

The mesentery of the ileum contains more fat The ileum has more plicae circulares (valves of Kerckring) and more villi They are both suspended by mesentery Less digestion and absorption of nutrients occur in the ileum


Copyn,ebl 0 2009-201 0 Dmtal Dll


Gi s)

Peristalsl! for what organ is controlled by taeniae coli?

Esophagus Stomach Large intestine Small intestine

~-- 0 201)0.2010"""" O.Cb



1 IH ih.um h:.1' mun plir:ll' circui;Ut.'' (Will''' of had.,m::J anti uwn '1llt

nu< is false; tile jejunum has more plicae circulares (al-cs ofKerckrirrg) and mcm' vim. Note: Tho lower pan of the ileum has no plicae circularcs (WIIve. ofKercb1ng), Comparbon of the jejunum ond ileum: JejunllDI (mrddleponion ofsma/lmtestine): extends from duodenwn 10 \be ileum I. Thicker n1u<eutar wall for more active periStalsis. 2. Has a mucosal inner lining of greater diameter for absorption. 3 t las more (UIId larg0') plkae drculllre5 (vah'eS ofKRrc*ring) 3l1d more Yilli foc greater absorption. Ueum (distal portion of rile .<mall inresrine): extends fioot~ !he jejunum 10 the cecum L More mcscnlerle fa~ 2. \lor e lymphoid tissue (Peyer $parches). 3. Blood supply is morc complex. 4. More goblet eeUs. which secrete mucus.

I. Valves or K.trckTinjt. The lining of !he sntoll intestine has penn:ment folds known as valves ofKerckring or plicae circulures. These arc most prominent in the jejunum. These folds, seen macroscopicully in tr.liiSversc S<!<:ltons, consiSt of muCOSll and submucosa. 2. Intestinal villi. These are fmger-like proJCCIIons into the lumen (ronsisrfng ofswface epithelium and under/yiuglamlno pmpria). The epithelium linlnt: the lumeo consist> of a simple columnar epithelium ";"'goblet coils. The apical surface oftbe absorptive epnhelial cells has a "bru~h border" (resulringfrom an orderly arro11gemem ofclo.u(\'-JXIC kcd mkrov/1/i, whidt may 1wmber several hum/red per ab.Jorpri>'f! cell). The rrotn functton of the microvilli i.s to increase the ~-urface area available for absorption.

Unlike those of the rest of Ote Gl trnct. longitudinal muscles do not form a continuous layer around the Jatt!e intestine. Instead, l.bree bands oflongirudinal muscle. called Utcolae coli, run the length of the colon. Contractions gather !he colon into bands (lwusrrn), giving the colon iL' "puckered'' appemancc.
The major funcuon of the Jatt!e lntesune (also called the colon) is !be removal of water from the material (chyme) entering it. Water is removed by absorption. Unlike !be small mteSune, !he large intestine does not secrete enzymes into its lunx:n. Histologic cbaractcristles: Epithelium: simple colu= with micro,;uns border to incrcllse surface area for absoqnion ofwater from the lwnen. Mucusseueted by goblet cells lubricates dehydrating fecal mass. Intestinal glands (CI)pt.' of Lieberltulm) invade lamina propria. 1l1c epilbeliwn lntks \1111. ~lusadaris externa: inner circle consisting of a smooth muscle layer. Contains the three bands oflongitudinal muscle, called taeniae col~ for pcri~1nlsis. Important; The vagus nerve supplies pat!ISyntpathetic fibers to the ascending and transerse colons, wh~e ~te descending and sigmoid colon along with the n.>Cntm and anus are supplied by the peMe splanchnic nerves.



( \.

Which cells, located In the crypts of Lieberkuhn, secrete an antibacterial ""' enzyme that maiotalns the gastrointestinal barrier?

Panelh cells Enteroendocrine cells

Sertoli cells

Absorptive cells

105 CopynJbl 0 2(1(19.2010


Which of the following Is not produced by tbe pancreas?


Lipase Trypsinogen Insulin

Cbolec:ystoltinio Glucagon



106 1009-2010 lkAtll Drtb

ChracteriJtic (Hht~ of the mll inrestlnt hu~lud~ ; lniHtioal ~nu. Tbt-sc. are fil1cr-Hkc. proJUunJ imo the lumen (coosuung vf n~r/r.C'C epulrtJiu, mm tmdtli)l,g lomr,a pmpritt).

The tpJOit-llum lining the lntnt::n ccU1SISt& ofn simph:~ t.'01Umnar t:p11hollum with goblet c~.:lhL 11\e p~<~l>11rface of rhe Absorpdve t'Pilhcllal cells ~.. "brush l><>rdtr" /t't'.wltfll!;[roiH un orderly ~~~g<'lrltnl qf closely-pack4!d Mlav'\illi 't'tltlch mo'' uwtbr Jt!''C'I'OI h~Jmi"'IQ ~r obsorpm~ ccfl) tbemam1Unc1ion oflbo nl<rv>tlli "10 lllCf<.,.lhc """""' areaa,.,lablc fonbsotpuon Tile lamia propria oftbt small int~tmc tS funned ftom 1(1(1~ oonnccmc: 11Ji:q,JC:. Thu. comalns blol)d ''"'"cis, nerves, and I4QIC lympharic v.,.Kcls (~fte u(<~b.wJI'PIIOn of/~111ft). " 1ntunnal g land~:. These. an:- shltple t'uhultar glands that open to the intestmnl lumen bt!!Wttfl the buc of lh< viUi. The inleslmal glands ""' somtrim<s c~llcd me crypl5 of LlcMrkdhn. Sc<n:<Ot)l cell> (Pdlld~ cells/ wi1h IIIIJ!< ac:l<lopbilie jp1tnu1<:s ""' tound th< blbt of lllc mlcstmal @lands Th<Jr runcnon 11 >1111 1101 fUlly Ul\d<1'5100d. bur II iJ; known !hal !hey <;ccr<lc ly$01.)'1nc, Wluch h3S anu..bacterial propcnies and helps mamtain che ~u.strointestiuul h~rrier. " Valves of K<'r('kring. The lining of the & mall hue~tln~e hiL!! pcnn11ncnl fbldK known :ti valvt::, Of
Kerckrittg or-plica' c1rcutaru. Th~ are mo~l pmminent 10 tht jejun11m. T11c:;~ folds. seen

IICO!lt<ally u> trOIII\<1'5<' section>. consi" orm... ._ ill1d subnlllcos8

Tbr IYP<> of l'jllthrllal tells line t~< micro' illl of lhc "brdsb budr": I. Cobld cellJ: SC\.Tt1t mucu..~, abundA nt ln lleun~. l Absorptlve tclb: pan-lei pate: 1n absocplion, simple cohunnur celts_ J. Entrr-oe.odoulne teJI.s: am.: entuo,gilitrOncs '"'rrtiJH 1/J~td rlwlet.)Jtc*l_,ild intO the
S:\(t":ml. Abundant In tbe dt.todtnum.


lte.mem\u:n 1 Rrunner'l ghu1d! (also collt.rl dkocleual sltmds or subnmoosal g/Mu/.ld urc small, brtlnChcd.

coiled, rubular aJonds sillmleJ di:cply '"~.. aubmucosa or tht duodenum. 11\es<: glands >CCNIC an

eiJah,.. mll<ll> 10 proreot U.: wills oflhc Jnlt$1Uial ]wee. l. The Utum to11tams aggrepl<s ofme.mrenc lymph nod<:Ji callod l'e)tf"> pllcbcs, "hl<h imcrOtpl and d.,.,y bcei btfor< hey ~,. lolbed by O.e diao:srive l/'llci.

( hnlt>n \tn~ in in

The pancreas is an elonga1ed gland lying behind the s1omach and in fronl of th~ aorta and inferior veuu cuva. The 1t1rge bead ufthc pancreas is framed by the C-shapcd loop oflhe d~odenum. Ex1endio,~; to lhe left from 1he bead regon are the n<:dr, body, und tail or lbe pancrea$, respe<.'lively. The tail mee1~ lhe spleen on the left of abdonlcn. Pancreatic secretions are collected by lhe main pancreatic duel (and occe.ssol}' pnurre"''" tiltcl), which, logelhel' with the bile duel, en1ers lhC duodenum at 1he duodenal ampulla (ampulln of Var..r). Most of the digcs1ivc process takes place in lhc duodenum, due lo !be acuon or paucreauc enzymes. The e1ocrioc portion is fonned by sccre1ory cell' anangcd in small sacs cnUed (inl, which secNie digestive tnzymCj; callud pnncreaUc juice.t inlo rhe inlestinc, The endocrine portion consisiS of clusten. of cells called pancreulic Islets (islars of LangerlruiiS), wbich an: scanered am()n~ the acim. The:.e cells pr\lduce insulin 11nd ~lucagon, bortnones lhat promote the cellular uplake of glucose and Ill< btcakdown of glycogen. re,,pocrively. I. Endocrine portion (.rerreles lnw t.locdsrrwtm) tiJC following enzymes: paucrcatic Upa., amylase, e<~rboxypcptidase, ela.~a<c, and dt}'!OOirypsmogen. I< lets of Langerban (cell Qjpanctro:J): Alpha cell.: =rete glucagon. Which counters Ihe RL1ion or insulin Bela cell~ secrete insulin, which promoles uplakc and swruge of gluc<)Se 2. El<ocrine portion (.recn:re.v lhmugll tlucr inlo lltwdenum): ><:cretes lhe following enzymes: pancrea1ic lip~. amylase, carboxyp<!ptidase, ela<tose, ami cbymOil')'p;inogeo. Acinar cells produee en~ymes th111 digest proteJIIS, carbobydrotes, and faiS. Trypsinogen i8U1en converted to trypsin iJ11he small imestine Note: Cbolccystoklolo is produced by the duodenum and regulates pancreatic juice





Which muscle separates the anter ior cervical triangle from the posterior cervical triangle?


Omohyoid Mylohyoid


O:lp)'li.@bl 0 201-2010 Dttalal llr'b


All of the longiludinal muscles of the pharyn are innervated by tbe vagus nene via the pha ryngeal plexus EXCEPT one. Which one is the EXCEPTION?




The neck can be further divided into triangles, the two most import:lDt being the anterior and posterior cervical triangles. The anatomic borders of the antenor cervical triangle are the medial portion of the sternocleidomastoid muscle, lbe lower border of the mandible, and the midline of the neck. Imporwnt stJ11cttarcs within this triangle arc the carotid arteries and jugular veins, thyroid gland. esophagus, trachea. lai')'OX. and vagus nerve. The posterior cervical triangle's borders are the lateral edge of the sternocleidomastoid muscle, trapezius, and clavicle. Important structures within this region are the subclavian artery and vein, suprascapular artery, and brachial plexus. The posterior triangle of the neck can further be subdivided into: I. Occipital triangle lying above the inferior belly of the omohyoid muscle. Contents includes the spinal accessory nerve (CN XI) and the superficial cervical cutaneous brnnches of the cervical plexus. Part of the occipital and parts of the transverse cervical and suprascapular arteries are also found in tbe occipital triangle.

2. Subclavian triangle lying inferior 10 this muscle.

Contents includes the superior, middle, and Inferior trunks of the brachial pinus, suprascapular nerve, and artery, the subclavian artery and vein as well a.s the external jugular vein. Important: Muscles that usually appear in the floor of the posterior triangle include the medius scalene, splenius capitis, levator scapulae, nnd the anterior belly of the omohyoid.

The stylopharyngeus is innervated by the glossopharyngeal nerve.

I 1111\,!tludm31 \ln ..dt.-.. of lh' l'h.tf\11\





Styloid PfCHX:6JI of tcrupOnil La!tral and posterior boa< rtwyngeal "-.lis

Posoerio< border or Ill< bani ~ond palole ond from lhe pohtin< 1h)'f0td cartilage:

Elevates the larynx and ~4/YOA durina swallowing


Pulls Ill< wall of !he rharyn< upward Actin& tO&ecbet.lhey pull lbe palatorharyngeal arcbc~ 1<>ward lhc midline

$31 pingopl\:ar)'ncut Lower pan of the eartil:age

or.... aoci<IO<Y '""'

hben. pus downw1rd Assists in cleonting the pbl.tyM. and bttod "lib tt.c pat...
IO(>horyugou> , _..


The functional unit of a skeletal muscle is a :

Fiber Sarcolemma Myofibril


109 CopynatJtO 2:0092010 Ottlu.l DkJ


~ nervous dental student is performing local anesthesia for the first lime on oJ
of his peers. He has read his notes meticulously but is still very shaky. After the inferior alveolar nerve Injection, he gains confidence and performs the rest of the injections without a hitch. The nut day, the classmate whom he performed injections on is complaining of jaw pain and the Inability to open his mouth. Which muscle did the nervous student penetrate during the IAN injection, which, along with the masseter for ms a sling around the mandible?

Temporalis Medial pterygoid Lateral pterygoid

Posterior belly of the digastric

63 64


Each skeletal muscle fiber is SUJTounded by a membrane, the sorcolemma. In the muscle fiber's cytopi3Sm (sarcoplasm) are tiny myofibrils, arranged lengthwise. Each myofibril consists of two types of fi~r fibers called filoments (thick myosin filaments and thin actin filaments) . The filaments are stacked in compartments called sa.rcomeres, the functional units of skeletal muscle. During muscle contraction, the sarcomere shortens when tlllck and thin filaments slide over each other. The striated partem that is so cbaractcnstic of skeletal muscle directly results from tile strucwre of the contractile units of tile muscle. Each fiber of the muscle 15 striated and made up of many myofibrils, which are also striated in the same pattern of alternating dark and light bands called the A bands and I bands, respectively. In the center of each A band is a lighter zone called the H zone; in the center of each I band is a dark, tllin line called the Z line. The portion of a myofibril between two Z lines C{)nstitutes a single contmclile unit termed a sarcomere. Each sarcomere is composed of two sets of protein fLlaments. n1e thick myosin filaments are located in tile A band. n1e thin ucll n filaments nrc located primarily in the 1 bonds but extend Into the A bands. The overlap of the actin and myosin lilnments causes the dark coloration of the A bands.: actin's absence from the center of the A bands results in tbe lighter H zone of eacb A band.


phJ \


The angle of tbe mandible rests in this shng. The medial pterygo1d muscle arises from the medial surface oftlte lateral pterygoid plate and inserts on the me-dial surface of the angle and ramus of the mandible. Important: The medial pterygoid. ma..seter, and tempomlis (main/)' anterior portion) elevate the mandible during jaw closmg (brring and chl'wing).

r I. The superior origin of the Intern! pterygoid muscle is fiom the infratemporal /Notes crest of the greater \\1ng of the sphenoid bone, and the inferior origin is from the lateral sur face of the lateral pterygoid plate of sphenoid bone. Both bca~ insert at the articular disc of TMJ and neck of mandibular condyle. Remember : The mandible IS protruded by both the action of both lateral pterygoid mu.~cles One muscle causes lateral deviation of ~tc mandible (shifts mamlible to opposite side) 2. The masnter muscle originates from the lower border and medial surface of the zygomatic arch. The muscles fibers run downward and backward to be nnacbed to the lateral aspect of the ramus of the mandible. 3. All of tlte muscles of msticatlon are innervated by the mandibular division oflbe trigeminal nerve.


The most minor manifestation of a cleft palate " ould result in a bifid:

Soft palate
Hard palate Uvula Glossopalatinc arch Pharyngopalatine arch

111 CopynjJtltC> 2009-2010 Dmtal ()(<lJ:



Which of the following musdes pulls the shoulder downward and forward?

Pectoralis major

Pectoralis minor Teres major

Teres minor

latissimus dorsi

eo,.,... 0
112 ,..,.2010-.. O..b


l 'ula

The palate is the roof of the oral cavity, oonsisting >tuenorly of the bony hard palate and posteriorly of ~ :.on palate. Transvene ridges, called palatal rugae, are located along ~ mucOU$ mcmbl'lllC$ of the hard palate, where they S<'rve as fricuon bonds agoinsl "hich the tongue ,. placed during swallowing. The uvuJa is suspended from the son palate. During swallowing. the soft pahuo and uvula arc drown upward~ closing the nasopharynx and prevcnling food and fluid from entering the nasal cavity. The neurovascular bundle or tJtc soft palate i:t the lesser palatine vein, artery, ond nerve. The pharyngeal plexus of 11<1'\es supplies the uwlar area. I. The apenure by which ~mouth communocates with the pharynx is called the b th Noteo' mus f~ucium. It is bouuded, atxwe. by the soO palate; below, by the dorsum of the tongue; and on ctthcr side, by the glossopalatinc il'()b, 2. The glossopalallne (palatoglossus) art.h (antfJio pi/laroffauces or anteriorfaucial plllar) on eilhcr side runs downward. laceralward, and forwaxd to the >ide of~ bose of the tongue, and IS formed by~ pr<>jection of the palatoglossus muscle with its eo><r &n_g m\JICOUS membrane. 3. The ph.aryngopalnrine (palatO[Jiwryngeal) arch (pa.sterior pilim<>,{ fa uces or paM< lor f aucial pillar) is larger and projects farther towurd the middle line than the aJJicri or; the pharyngopalatine arch runs downward, lateral, and backward to the side of the pbarytllL and is formed by the projccrion of ~ pal>tOplwyngeus muscle, covered by mucous membrenc. On eith.er sode, the two an:h.es are separnted below by a tnanaulor mterval. in wbieh 1he palatine tonsil is lodged. 3. The palatal sllvary glands aro fou nd beneoth the mucous mcmbrnncofllle hard and son palaCe. They arc mostly of the mucous type and contribute lo the ornl fl uid. 4. Bifid uvuJa results from lailurc of complete fusion of the palatine shelves. A unilllt <rally damaged pharyngeal plexus of nerves caU>e> th.e uvula to deviate to the oppo>tte S1dt. This is because the uwlar mu).tlc shonens the uvula when Jt contracts and the mus..cle on tbe intact side pulls the uvul~ toward that side.

Muse It

Ner\e supply

Addu cit the ann and 1 '\Hate:'l it medially

Pectomi1S major \.fcdiaJ Md lateral pectoral

nerves (rom medial and latcral cords of

bnt<hial piCJ<IlS
Pectot1 h ~



pecoral ner"\ e from media)


the s-houlder downward and forward

cord o(bmchial pleXU.'i Latissimus dorsi Thoracodorsal ller\IC rroru poo~teri Qr

Extnd~ ad ducts, and mcdtalty
rula t~ lhe arm

cord ofbr.chil plexus


Axillary nerve (C5 and C6)

Wuh tit< belp oftbo S\JJ)R>puuiUS mu~k. t abduru the upper limb tU the shoulder joint Mtdtlly rotates and Mdduc:t5 the -arm
LattraUy rota.l8 tht' t rm and stabi1 ~ lht-

Terei mjor
TettS minor

Lo\\'er subscapul ar nerve from po$tcnQt cord of brachial plcxu$

Bmocb of uillary nerve

houl<l<f joont



All muscles of mastication are innervated by the:

Ophthalmic division (V-1) of trigeminal nerve Maxillary division (V-2) of trigeminal nerve Mandibular division (V-3) of trigeminal nerve Facial nerve {Vll)

l1l CW>'nCIJI 0 1009-2010 Dttatal Ded.t


A 5-year~ld boy presents to the physician with tonsillitis. As part of her exam, the physician asks the patient to stick out his tongue and say "AAAH," in order to visualize the tonsils. Which muscle is responsible for the protraction of tongue?

Hyoglossus Styloglossus Palatoglossus Genioglossus

\ l:tndihular eli\ i'iun


nf lri~cmin:tl twn t.

Mastication is defined as the phystcal process of chewing food in preparation for swallowing and ultimately digestion. Four pairs of muscles in tl>e mandible make chewing possible. These muscles can be grouped imo two different functions. The first group includes three pairs of muscles that elevate the mandible to close the mouth. The second group includes one pair of muscles that works to depress the mandible (drop the jaw), translate the jaw from side to side, and protntde the mandible forward.

All are innervated by the mandibular division of the lrigeminal nerve ( V-3) - S~t! note below. They receive blood from the pterygoid portion of the maxillary artery.
Remember: I. The masseter, temporalis, and medial pterygoid - close the mouth (elemte the mandible) and hence account for the strength of the bite.

2. The lateral pterygoid -- opens, shifts (from side to side), and protrudes the mouth
(or mandible).

Note: There is one motor nucleus, a special visceral efferent (SVE) nucleus, associated with the lrigeminal nerve. It innervates the muscles of the first branchial arch, which consists mostly of the musdes or mutkation. They also include the ttnSOr tympani and several other small muscles. The nucleus is located in the mid pons nt the level of attachment of the trigeminal nerve to tbe brainstcm. fibers of the trigeminal motor nucleus emerge as a separate motor root.

Paired extrinsic muscles originate on structures away from the tongue and insert onto it, causing tongue movements dunng speaking, manipulating food, cleansing teeth, and swallowing.
\lu,.:lt, nf lht I nn:,:m

MuSt It

spine of mandible




Genioalosa:us Supt-rior genial

Slyloglo-"'i Sl)llood!lfO$SOf 1emporal bone

01.)Bum of tol\aue Protrmlc,s apex of tons:ue lhrolljb mouth

IAI<t1ll.;de and

Draws W>c1gu< upwotd and

Oeprc:ms tooguc


dorsum oftcmguc backward


Body and greater Side of tonuc cornu of hyoid bone


Palatogl.-..u. Pallone aponc:uro11is

Side of tongue

Pulls root of tongue upward Ph&l)'llj;cal and b11ckward, narrows plc-~tu5 orophal')'l\geal isthmU5


Most of the muscles tbat act on the shoulder girdle and upper limb joints arc supplied by branches of the brachial plexus. Which of the foUowing is not?

Levator scapulae Rhomboid major Rhomboid minor


Serratus anterior
Pectoralis minor

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A !~year-old girl who is just about to have her junior prom comes crying Into the physician' s office, but is lacrimating onJy from her right eye. The left half of her face Is also par alyzed, and the physician diagnoses her with BeU's palsy. An oral exam reveals trauma to her buccal mucosa where her teeth have bitten her cheek. Which muscle, paralyzed in BeU's palsy, is responsible for keeping mucous membranes out of the plane of occlusion and food out of the \.. buccal ' 'estibule? ~

Medial pterygoid Lateral pterygoid

Masseter Temporalis


\lmdh nf fht t\clunl <.irdlt

Scrrotullo anterior

Pulls scaruiB. forward and downward

luntn arlon

Lwtg thomcie nerve, which 3rise' from roob CS, fi, o.nd 7 of the bn<hill pt.,...
Mooial poc:oonl_,. from

POCUMah$ mmor

Pulls the $boulder dov.-nwMd and forv.1U'd Depresses the chtvic:lc and steadies this bone

medial tordorbrachi.aJ r1cxus Subclavius during movements oftbe shoulder gird1e


Nerve to 1hc :ittbclaviu.s from che UPf'<' INn~ of<he bnchaal piau>

Susptnds the h011lder ginllc from tbe skull and th Motor tibctl from the ).pn1at ve11ebml column. The upper fibers tlevatc the part of1he o~cessory ntf'\le and <en<Clt)l tlb<cs fmm lho dtinl scapula. The middle fibers pull the scapula medially. The lower fibers pull the medial bordtr ar.d fourth ~ervieat nnvts of tbc scapula downwanlso tbat !he glcoood oavtty factS upwmJ and forward

Lcv1th1r scapulile

Raises the medisl border of the 5Cilputa

Third n.nd founh ten'icul

oerv~s and from the tlor!ml
sa~pubr ncr>c



Wttb !he rhomboid minor and l...tor 5cap111,... it Donal s.;apulu """" cC5) elevates the mllal border of the scapula and pulls it medially

Rhomboid mlnur

With the rbombo1d major Md levalor sc-..a.pulae.. h Dorsal ;copulllr ncne (CS) elevates Ill< mc:dl border o f llt< =PU~ and pulls



The buccinator is one of the muscles of the cheeks and lips. On each side, the bucctnator has

a complex origin from:

Tbe maxllla along the alveolar process superior to alveolar mrugin horizontally ~ween the anterior border of the first and lhird molors The mandible along the oblique line of tht mandtble be1ween the first and third molars The pterygomandlbulor ligament The pterygomandlbulllr raphe: a thin, tlbrous band running from the hamulus of the medial pterygoid plate down to the mandible ltlnsens at OJbtcularis oris and skin a1 the angle of the mouth. It is trtlverscd by the parotid duct.

It is not a primury muscle of mastication - it docs not move the jaw - and this is reflect ed ln the buccinator's motor innervation from tbe facial nerve. However, proprioc<ptive fibers are den' cd from the buccal branch of the mandibular branch of the trigeminal nmc. The actions or the buccinator are tO: I. Move boluses of food out of the veslibule of the mouth and back towards 1he molar teelh. 2. Tense lhe checks during blowing and whistling. 3. Assist wilh closure of the mouth. --. I. The facial and maxillary arteries supply blood to buccinator mloS<:Ic. Not.. 2. Food accumulating in the vestibule might suggest tbat the buccinator is uot workil\8 properly. 3.1fthe point of a needle enters the parotid gland during an mferioralvcolar mJec lion and solution ts deposited ln the gland, the most likely result is pQni.lysls of Ihe butclnacor muscle. 4. Damage to tho facial nerve or its branches may cause weakness or paralysis of facial muscles called Bell's pals)'.



AU of the following statements concerning tile tcmporalis muscle are true ""' EXCEPT one. Which one is the EXCEPTION?

It is fan-shaped and originates from the bony floor of the temporal fossa and from the deep surface of the temporal fascia

The anterior and superior fibers elevate the mandible; the posterior fibers retract the mandible It inserts on the coronoid process of the mandible and the anterior border of the ramus of the mandible

It is innervated by the maxillary division of the trigeminal nerve (V-2)

It is considered to be one of the muscles of mastication

63 64
111 Copyngtu 0 2009-2010 Oo.al DcckJ



( All of the muscles of the soft palate participate in closing the nasopbaryru ""') \. du ring swallowing EXCEPT one. Which one is the EXCEPTION? ~

Uvular muscle Palatopharyngeus muscle Tensor veli palati muscle Palatoglossus muscle Levator veli palati muscle


:101)9.2010"""" DKb

I t b~ illtll'natld In th~ ma\ill.ln di\ isiun uf thl' tri1!l'ntinal ll\'l"\\' ( I -!)

This is false; the ttmporatis muscle is innervated by the deep temporal nerves, which are bnmches of the mandibular division of the trigeminal nerve (V-3). The tempo ralls muscle is a broad. fan-shaped muscle of mastication on each side of the head that fills the temporal fossa. superior to the zygomatic arch. This muscle originates rrom the entire temporal fossa. The temporalis then passes medially (downward and deep) to the zygomatic arch as a tltick tendon before inse11ing on the coronoid process ---. 1. The primary function of the anterior portion (fibers) of the temporalis Not.. muscle is to elevate the mandible. 2. The posterior fibers retract tbc jaw and maintain the restiog position of closure of the mouth.

Five paired skeletal muscles of the soft palate: l. P alatoglossus muscle: puUs the root of the tongue up'vard and backward. Both muscles conttachng together eause the palatoglossal arches to approach the midline. and thus the opening (oropharyngeal isthmus) between the ornl pharynx and the mouth is narrowed. 2. Palatopharyngeus muscle: pulls the walls of the pharynx upward. Acting together, the muscles pull the palatopharyngeal arches toward the midline. 3. Uvator veli palali muscle: raises the soft palate. 4. Tensor veli palatl muscle: the two muscles tighten the soft palate so that it may be moved upward or downward as a tense sheet. This muscle curves around the pterygoid hamulus. Therefore, if lhe hamulus were fractured, the actions of this muscle would be affected. 5. 1Jvular muscle: raises (and shorte11s) the uvula to help seal oral from nasal pharynx.

Important: All the paired skeletal muscles of the soft palate are innervated by the pharyngeal plexus except the tensor veil palatl, which is innervated by a branch of the nerve to tbe medial pterygoid, which is a branch of the mandibular division of the trigeminal nerve (V-3) .__ I. The anterior zone of the pulatal submucosa contains fat, while the Notes posterior zone contains mucous glands. 2. The sahvary glands of the bard palate are located in the posterolateral zone. They arise from ectoderm and are separated by connective tissue septa.



Which of tbe following travels with the esophagus through the esophageal opening in tbe diaphragm?


Thoracic duct
Azygos vein Vagus nerve

Right phrenic nerve

73 74
111 Cop)Tichl 0 20091010 Deo.tal lkds


Which of the following two sets of muscles raise the ribs during Inspiration?

External intercostal muscles

Internal intercostal muscles Innermost intercostals

Subcostal muscles

Transverse thoracic muscles

*** You can rememher this because the vAGUS travels with the esophA GUS.
The diaphragm is a flat muscle in a dome-like shape that separates the chest cavity from the abdominal cavity. 11te diapltragrn ~ pierced by several stnlerures lh." pass between the rwo cavities. The three largest of these Stmctures are the esophagus, the aorta, and the inferior vena cavn. 1'he central p11rt of the diaphragm is the centrnl tendon, whtch is fibrous rather than muscular. Tho undersurface of the diapl\ragm fonns the roof of the abdominal cavity, and Ucs over lhe stomach on th4e lefl ond the on the right. When the diaphragm contracts, it puUs down imo the abdomen, lhus creating a vacuum in lhe chest cavity that draws 3ir into the tun~. Exhaling is done by contracting the mus cles of the abdomen to force he diaphragm upward when it fs relaxed. Duri ug iusplrntion the dinphmgm move.~ dowo, increasing the volume in tbe dlmuctc cavity. During expi rA tion !he diaphragm moves up. decreasing the volume in the thmacic cavity. The upper surface is in contact with the hean and lungS: the lower ~urface cont!!CIS the liver. smmacb. and spleen. lmportsn t: The esophagus passes tb rnugh the diaphragm, while the OQI'\0, azygos vcm, and thorucic duct pal> posterior to it, The diaph ragm has th ree openings: I. Aortic opet~ing: transmits the aona, \he thorncic due~ and \he 8)gos vein. 2.. Esoph~gcal opening: transmits the esophagus and right and left 'agu.< nerves. 3. Cava l opening: transmits the inferior vena cava and the rlgbl phrenic nerve. Other rcs(llratory muscle> iucltod~ tlte external, intemaland innermost intercostals, sub costal, and 111lllsversus thoracis. These muscles an: all iunerva!ed by the iotrrcostal nerve while lhe diaplt ragm ;, Uln~ated by the phrenlr nerve. Not<: Tlle phrenic nerve travels ilirou~b the lhorax between the pericardium and the pleura.


l \hrn.ll lllll'fl'tt'lohtllnu\c..'lt>S

Suhcn,l.-tl mu' cll''

m~or touscle.s

Tbe thorax comains vital stmc!Urcs thnt enable such functions as brenching to occur. Its are the thoracic waU ancJ upper limb muscles as "ell 115 the diaphragm. Anterior thoracic waU nm!de$ Include: External inten:ostalmuscle.o;: eleven nn each side between the ribs. ~from rib to nb and run at righc angles to lite fibers of the internal and cnnrnnost muscle6. Continue toward sttmum us the internal intercustal membrane. They raise dJe ribs during insplraUoot. In ternal intercostal muscles: eleven on oach side between the ribs. 1 hey cooUDUA! toward the vertebrnl column as !he postenor intercostal membmue They d epress the ribs d uring espiration. In nermost intercostals: nm in !be !lame direction as internal httcrcostals but ure scpurnted from them by nerves and ves.els. Action unknown but probably thd srune us interuut inte~~;ostals. Subwstal muscles: originate on the inner surface of each rib ncar 1be cosllll!lllgle and insert on the inner surfuce of the first, second, or third rib below. They raise the rib~ du ring Inspiration. 'T'runsverse thoro1clc muscle.s: uttuch the pOsterior surface of tile lower sternum to the internal surface of coslal cartilages 2 lhrough 6. These mU>cles pull the ribs d o"n"nrd during explrution. lmportnnt: The.e muscles ~re all innervuted by !IJe corre;;ponding Intercostal nerves. Remember: The diaphragm is the lliJiin muscle n:pon,ible for quiet b realhlnll. The diaphnlg:m is innervated by the phrenic ncn-e.



Name the molecule that lies along tbe surfare of F-actln and physically co\ers aetln binding sites during the resting state.

G-actin Tropomyosin Troponin Light meromyosin Heavy meromyosin

121 Cop)Tiihl 0 2009-1010 Drmal DL1


j All of tbe muscles of the quadnceps group serve to extend or straighten the \ \... knee. Which one also Oexes the thigh on tbe pelvis?

Rectus femoris Vastus lateralis Vastus intermedius Vastus medius

CopynF< 0 l009-:!010 Ocoul Docb

I ropnm~u, in

Tbe main contractile system of all muscular ttssue ts based on the uller<tcttoos of two proteins. actin and myosin . The system of these proteins is sometimes called the aclinmyosiD <Ontractilc system.
Actin filaments (tlrin mrofilaments, $-8 nm in diametet) ure composed of: Actin: globular aciin (0 -acrin) molecuks are tUTangcd into double helical chains called fibrous actin (F'-ac1ilr) Thopomyosin: long, thread-like molecules. lie alon11the surface off-actin strands and physically cover actin bindin& sites during lhe resting state Troponln: a small. oval-shaped molecule attached to each tropomyosin

Myosiu ntaments (Ihick myofilmueuls, I 2-I 8 11111 iJotliameler) are composed of: '1yosln, which has two componentS: I. Light meronl) O Sin (LMM) makes up the rod like bckbooe of myosin fila

2. Heavy meromyosin (ffMJ.t) fonns the shorter globular lateral cross-bridges. which link to the binding sites on the nctin molecules during cootruction. Skeletal muscle cootrcts when a stimulus from the nervous system exettcs the individual muscle fibers. This stans a series of events that lead to interactions between the myosin {tilickfi/amants) and nctin (1/rin.fi/aments) of the sarcomercs of the fibers

The tb1g.h ha~ htO djstiocl muscle comparln1tnts (unterior u"d fKJXterio') that nre ~eparettcd by connective t1s..~ue (deep /usda). Arisu~g from the upper two~thirdo~~ of 1he femur. the quadriceps ftmorl5 muscle fonns the major muselc mass of the (rom and outer s1de or the thigh (mrreriur compmtmcntl c:overin" most of the front and sides of the: ft.-mu.r. Tlw: qu.dnc<p$ femoris bas four parts - (ul/inMnored byf~... ,..I ,.<TW) Re<:tu femoris: extends Of strughtens the knee ond alS<> Ocx the thigh on th< pelvis Vastus lotcratis l Vastus intennedius ~ All exrcnd or stmlghtt n the knee Va"tu.s medialis t The: I~ is dtvided into thrte companmeuts, W1ih the a.attrlor oompar1ment conrnlning lhe mUS(les tba11110\C the fOOl upw>nl (!l<mfj/<xlhoolll<). The blenlconprlment oootlll\> ot,c fibWans lonp" and libulari brevi> muscles. which are respoohtbl< for tumong the sole of the fOOl outward (e\'tr$ltm) The pmftrlor romp3rtmenl or the leg conusins lht plar nor tlexors. 'rhe bamstring muscles. lie tn the posli.!rlur eompartment of the thigh,. The hutwnnng muscle _group consi.s~ oi three n\Usclc:$: Boceps f<mOris l Tlw: tumstring muscles 1\mcnon to utcnd the h1p JOint aQd 0 the: Ia>.., Semotcndinosu, IJoliU. All are 1Rn<l'V3tcd ~ the ttbial """"' exc:<pl die Shott bead or the .. Semin\tmbranosus l bi~ femoris. which s inocrvacod by the conuncm fibular nenr:. The pusterlor compltrtmcnt or the calf region contains numt."f'ous muscles. (lividcd into two groups: superfidai Bnd deep. The supcrOctaJ gnwp contlins the powerful g.astrocnc:mlu:s and soleus mU$CIC$. as well as th< plantaris m"""le, wbich ore eritteal to pushing off from he ground (p/IIJ1rorflalun ofth Qll/dJOII) during \\'3ll<Jns. running, ond jum)llng, and wben Slllnding 011 IO<S. The deep c,n>up contams. the popliteus, flexor dignorum Jon~. flexor hallucls longu.\, and the t.1b1alis poster1 or muscles. n1~ llu'8CSt of these, llcxor llallucis longus, i11 critical for pu~hmg olf f1'0m the big toe aurinx walking .Nott: All of the mu.~ les of the- posterior .:omprlment (JI4f'trficlal u11d tfn:p) of the calf n:glon m imlervatcd by the tibial o t i'>O.



,.Which of the follo,.ing muscles of the anterior abdominal "all, when present," I I\.. is innervated by the twelfth thoracic nerve? .J
External oblique Internal oblique Transversus Rectus abdominis Pyramidalis

123 CopyrigblCI2.0(19.201 0 'l>ent.al Dks


The middle pharyngeal constrictor muscle attaches anteriorly to the hyoid ""' bone and the stylohyoid ligament. Like the other pharyngeal constrictor muscles, this muscle inserts posteriorly into the:

Fibers of the buccinator muscle Posterior border of the thyroid cartilage Median pharyngeal raphe Palatopharyngeus muscle


I'~ ramicl:lli'

\Ju,dl' ullhl \niL"riut \hdonun.tl \\ olll

Extem.a1 obhquc



SUpporu: abdom1n&l c:ooseob. co~ abdomi- lower ,.,-A thorK1C nm-es naJ contents; usisu in flexing and rotation of trunk. and oliohypopslric and
Ass1s1s in forced expiration, micturition, dt!fccarion, iliotnguinal nervc:~~o (L I) panurition, and vomiting

lrurrool obloque


S.m. .sabo~
IJ lb01't



Comprc:s::sc:s abdominal contentS


Rectus abdominis P)tamidolis


Compresses abdominal content$ and flexes venebral Lowt1 six thoracic nerves mU$Cle o(upinttion
Ttl!,.. obc linculba
1\\clfth thoracic tltnt'

--,. I. As the spermatic cord (or round ligament of the uterus) passes under the
Not.. lower border oflhe internal oblique, the spcnnatic cord carries with it some

of the muscle fibers that ore c~llcd the cremaster muscle. 2. The posterior abdominal muscles include psoas major and minor (innervated by the lumbar plexus). quadratus lumborum (innervated by the lumbar plexus). and the iliacus (innerl'ated by the femoral nerve).

The constrictor muscles of the pharynx are involved in the digestive process. being responsible for moving food down to lhe esophagus~ The stylopharyngeus. along with the deeper muscles of the palatopharyngeus and the salpingopbaryngeus, are mvolved in elevating the larynx.
( 11 ~ ular

\lu,ch"' uf I he

J>h,tn 11\

")1uscle Superior constrictor


Origin Pterygoid plaoe of ilic splte..,id bone


Action uppcrplwynx

Median pharyng.eaJ naphe Constricts

Inferior constrictor

<fteattr and lesser boms ofhyoid: stylobyoid ligaroen1

An:b of cricoid and obliquo line of lhyroid

MO<b>n phuyngeat ,.phe Com1ncu lowtr pharynx

Medi3n pbatyngc:al raphe Cons1ric:ts lo~cr pharynx

1-. 1. AU of the circular muscles are innervated by the vagus nerve via tbe pharyn ' Not.. t:l plexus. 2. The stylopharyngeus. palatopharyngeus. and salpingopharyngeus are aU longitudinal muscles of the pharynx.




The connective tissue layer surrounding each indh,ldual muscle fiber is called the:

Perimysium Epimysium

125 CopyriJbl C> 20092010 rkn!#l. t>ecb


r At a picnic, the klds aU decide to bang upside down on the monkey bars. One" daring kid decides that be will try to eat a grape "hlle hanging upside do" n and finds that he has no trouble doing this. Involuntary movements of internal organs such as peristalsis are produced by which type of muscle tissue?
~ ~

Voluntary muscle tissue Smooth muscle tissue Striated muscle tissue Skeletal muscle tissue Cardiac muscle tissue


an organ, sl<olctol muscle consosiS of ~vera! nssue typeS. Skoletal muscle fibers :>re long, thread-hkc cells thnl compose skeletal (.<rrlllled) tis.ue. These cells have the ability to shonen their

length ur contract.
[)._--nse fibrous coMcctove tisruo (fascta) w03ves lhrou&h a skeletal muscle at S<Vetlll dorr<-n:ntlcvtls. The epimysium is the connective tis~ue layer that envelopes the entire skeletal muscle The per-imysium is: a con1inuation of this outer fascia, dividing the interior of lhe muscle into bwuiles of muscle cells. The bundle of cells sunounded by coch pcrimysoum is <&lied a fasclrulus The endomysium is a connective tissue layer surrounding cueh muscle tiber

Each of lh< thn..'t lc' els of fascia is interconnected. allowing vessels and ncn es 10 reach individ.W fibm. and cell.

(surrounds fasciculi)


(surrounds tr.tlre mu.sdt)

Cross section of skeletal muscle

~ote: The axon of a motor nnrron is hahty bta.lk:ht..'\1. I.I..Dd ont moror neuron Innervates num f'roLU musclt fiber1. When 3 motor oc.uron rr..nsmn.~ an implll~. all of the Obfrs it lnnenatf)

<ODITOCI Simulllln<OU$)y.

Snw ulh mu ..lll lls,tu.

Smooth muscle tissue is located throughout the body. panicularly "ithin the tunica (walls) of hollow internal O<glUlS. The smooth muscle firers are elongated and splodiNbaped with a single nucleus. The myofibrils lack transverse strlatlon.s. Titcy are responsible for involuntary movements of internal organs (,,g., peristalsis). Types or smooth muscle: >junctions (electrical synapsl's) between adjacent Slngl~>ounl1: have numerous gn1 fibers. These fibers contract spontaneously without nerve signal> Esamples Include: the muscular runica of the Gl tract. uterus. ureters, and unerioles. Mulri-unlt: lacks gap junction. and the individual fibers are nutonomicnlly inner vated. Examples include the ciliary muscle tu1d the smooth muscle of the iris, ductus dcfeten.S. and oneries Skeletal muscle tissue ullaches to the skeleton and is responsible for voluntary body mo,ement. It consistS of many longated, cylindrical ceiJJ, which are multinucleated and have distinC1 1Tansvtrse striations consisting primanly of actin and myosin l>rotelns. Remember: Each skeletul muscle fiber is innervated by an axon of o motor neuronal a motor end plate (w!Jich is a large and complex terminalfomlatioll by which u11 axon ofa motor neuron establishes synaptic contact nth a skeletal mllscle).


A surgeon performing a thyroidectomy accidentally transects a nerve. The patient then presents with hoarseness and difficulty breathing. There Is a loss or sensation below the vocal folds and loss of motor Innervation to all of the Intrinsic muscles of the larynx EXCEPT the:

Thyroarytenoid Posterior cricoarytenoid Transverse cricoarytenoid Cricothyroid Lateral cricoarytenoid


<Alp)'"ibl 0

2009-2010 Dema1 Dtd.J


The axilla, or armJiil, is a localized region of the body between the upper humerus and thorax. It provides a passageway for the large, important arteries, nerves, veins, and lymph atics that ensure that the upper limb functions properly. Th e mustle that forms the bulk of the anterior axillary fold is the:

Latissimus dorsi
Pectoralis major Subscapularis

Teres minor
Teres major

ricuth~ rnill

The nerve that was transc:cted was the recurrent laryngeal nerve. ' ote: Damage to this nerve (as a res11lt ofs11rgery or disease) can result in hoarseness and difficulty breathing. I ntrinsic muscles of the larynx: Cricothyroid: stretches the vocal chords Posterior cricoarytenoid: maintains wide airways (for breothi11g} Thyroarytenoid: closes the vestibule Aryepiglottic: closes the vestibule Transvers cricoarytenoid: contracts to close the airway posteriorly for speech Lateral criroarytenoid: adducrs the vocal cords Thyroepiglotticus: helps close vestibule Vocal.is: shoncns vocal cords, is the antagonist of the cricothyrotd muscle The vagus nerve provides sensory and motor innervation to the larynx: I. The recurrent laryngeal nerve supplies all the intrinsic muscles except the cricothyroid. 2. The cricothyroid muscle is supplied by the external branch of the superior laryngeal nerve. 3. Sensation above the vocal folds is supplied by the Internal branch of the superior laryngeal nerve. 4. Sensation below the vocal folds is supplied by tho recurrent laryngeal nerve.

TI1e axilla can be visualized as having a noor, an apex, and four walls (medial. lateral. tmlerlor, and posterior). The apex is pointing toward the root of the neck. It is formed by the convergence of the clavicle (anterior). the scapula (posterior). and the first rib (medially). All the nerves and vessels of the upper limb pnss through this area. The anterior axillary fold is made up of the pectoralis major and minor muscles. The posterior axillary fold is made up of the latissimus dorsi and teru; major muscles. The base faces inferiorly and is formed by the skin and fascia of the concave ax11la (armpit). The m~dlal wall is formed by the upper four or five ribs and their intercostal muscles and the senatus unterior muscle. The lateral wall is formed by the humerus (specifically. the rora~obraclrialis and biceps miiScles In the bicipital groove of tire humerus). The posterior wall is formed by the sub~capularis, teres major, and latissimus dorsi muscles. The anterior wall is formed by the pectoralis major, minor. and subclavius muscles. Contents of the axilla: The axillary vessels Branches of the brachial plexus Both beads of the biceps brachii Coracobrachialis



Which muscle functions to turn the head side to side?

Digastric Mylohyoid Sternocleidomastoid Omohyoid

129 Copynabt 0 20092010 [)rental Dc..:kJ



The anterior and posterior pillars of the fauces enclose which area oflymphoid tissue?

Lingual tonsils Pharyngeal tonsils Palatine tonsils

6 ~
~"" 0 _,.,.""""' Do<b

~lt' riiHl'ltidum a\Cnid



Two 11'11.J~Iao actin SW:mockldomuaoid MU!IIhrilllfl s~Ctni 1DCI M.Jstoid ptOst.: o( 1nediJ.Ithin,l o( ciUVIdO tmp~ml bone 111.! oretpit:al IUJC'Ihct~ltll'fld hend lllld r~cct; cmc-

- _ ..... .. _
\lu'>h" nf ltH




Sp.nal (WI

nw.tek ft'IQtQ; bead 10


C2 ond 3

or CICCCiOt)'



pcoctSs or

ttMipOilll bone

l~lllt' !(116M u bcld 1.0 hyoid b)ll~ by tillielal


tbc m11!ldl

ra.c.sl rtmc
NC1VC 10 rey\OhylliJ

b~ Of dC\atc" t.l1t


"" , ..4


111)' or maodiblc
\1)1oh,.o.l Gocoll>ody


b)'(Md bone


~ ofhygtd Nrc ed

s- __ -- --0..~


S'> lalld J)fOOe5$ or temporal boac:

Body of hyoid ~re

lllfttlor ft'lttltll spltle of OOI!y of h.y.,.d bort:

-bl< \1-..bm:un .s1crW ...


..,.,..... ........... ..,.,....._

I:.ICVI.Itl h)-oid bunt

~ Tn~tV)IGC'ft ~ ..tlilyoi6 bC* f~elal tlts'\'t"

........ -ot

Eknta hyoid bone-

f 111! ""'.olll)l;n'(

- . .r... ,...Sboo<
Obliq~ Hnc tm

l)qlnooa .... ..,... booo


gtfd3J An\11. tcrvicllhs tCJ, } -.IJ)

F1t11 mvic:IIII:I\'C"


Manubrium s!Cm.i

Obl.qt~C lit!c oa a...


lan,itl3 of lh)'tlliiS0111.LaJc

IXpR:.s&ts tbe larynJt



Omo!l)oid ln(enorbdl}'

Uppn margin or !'Clip-

lllllctmedl<IU: ttlldoclts bc:ld to clavic.lc ucl 1\nl n"b by


[)qmt.StS tbt h)'O\If booo

Amac:crvcahs tCl, 1
(Iff(} J)

l,.o\l.er bor<.eT o( bod)" o(h,.o.l boa


The fauces is a narrow passage from the mouth to the pharynx. situated between the soft pointe and the base of the tongue; this is also called the Isthmus of the fauces. On either Stde of the passage. two membranous folds. called the pillars oftbe fauces, enclose the palatine tonsils (consist ofprt!dominantly ~tmphoid tissue). The two arches fonned by the anterior nod posterior folds of mucous membrane nrc: I. The glossopalatine (palatoglossus) arch (anterior pillar offallt:eS or anterior faucial pillar) on either side runs downward. Iaten! ward, and forward to the side of the base of the tongue, and is fonned by the projection of the palatoglossus muscle with llS covering mucous membrane. 2. The pharyngopalatine (palatopharyngeal) arch (posterior pillar offauces or pas terior faucial pillar) is larger and proje<:ts fanber toward the middle line than the ante rior; it runs downward. lateral, and backward to the side of the phttrynx, and is formed by the projection of the palatopharyngeus muscle, covered by mucous membrane.



r All of the following statements concerning eardlac muscle Obers are true"J
\.. EXCEPT one. Which one Is the EXCEPTION?

Their characteristic feature is the presence of intercalated discs Cardiac muscle fibers have less mitochondria between myofibrils and are poorer in myoglobin than most skeletal muscle fibers Make up the thick, middle layer of the bean known as the myocardium Have larger T tubules and less developed sarcoplasmic reticula compared to skeletal muscle fibers In contrast to skeletal muscle fibers, cardiac muscle fibers are sbon, branched, and single or binucleated

Cop)TIPt 0 2(109.2010 Oen:l DetU



Which of the following statements concerning the tongue Is correct?

Protrusion of the tongue requires contraction of the genioglossus muscle The tongue receives its major blood supply from the internal carotid anery

AU extrinsic muscles are inuervatcd by cranial nerve XII (hypoglo.<sal)

General sensory innervation to the anterior two-thirds is provided by the glossopharyngeal nerve

1)2 Coclrn&htO l009-l010 DmtM Ocd.

C';~nlbu; nHI,t:ll- fihL'I, ha' l' ll''' mHorhundrh hLI\H'L'n 111~ nrihril\ :nul an putJnr m nn O!,!luhin lhan 111u-.t 'kl'll'l:tl mu'cll Ohlro;;

... This is false; actually, cardiac muscle fibe rs have more muochondria betwee n myofibrils and arc richer in myoglobin tbnu most s keletal muscles. Ltke skeletal muscle fibers, cardiac muscle fibers tontaln m yolilaments (contractile units) and nrc striated with actin and myosin. Cardiac muscle fibers contain large, oval centrally placed nuclei as well as strong. but thin. unions between fibers called intercalated discs. These intercalated discs provide low resistance for cuncnt flow, Important: Within tbe mtcrcalated discs, dcsmosomes anacb one cell to anolber v.;bile gop junction' allow electrical impulses to spread from cell to cell. Cardiac muscle fibe rs contract spontaneously without ony nerve stimulus. They respond to increased demand by increasing lbe si2e of the fiber; Ibis Is known as compensatol} hypertrophy. Note: Skeletal and cardiac muscle fibers couJoot mltotically divide, but certain s mooth muscle fibers can under bonnonal influences (e.g., dun'ng pregnancy, the smooth muscle fibers of the myometrium of rhe uterus i11cret<e in length, and IICII' cells are formed).

The extrinsic muscles (ge11ioglossus. hyoglossus, styloglossus, and pa/(lloglossus) anchor lbe tongue to !be skeleton (mandible. hyoid. and temparol bones). These muscles control lbe prouusioo (genioglosnts), relnlciiOn (styloglossus). depression (hyoglossus and genioglossus), and lateral movement (palaroglossu) of the tongue. Remember: All extrinsic muscles end in- glossus (to11gue) and bogln with their site of origin. Tbe intrinsic rouscJulie entirely wilbin the tongue itself. The fibers oflbcse muscles are named according to the three spatial planes in which they run: longitudinal, transverse, wtd vertical. When these fibers or muscles contract, they squeeze, fold. and curl the tongue. All of the muscles of the tongue, both intrinsic and extrinsic, except !be palatoglossus muscle, are innervated by tl1e hypoglossolnenc. Tile pnlatoglossus muscle is innervated by !be phnryngeul plexus. Note: The palatoglossus is a small extrinsic muscle nf dte tongue that ariseb from the soft palate and instJ1S in !be tongue. The palatoglossus acts to elevate the tongue. The tongue receives its major blood supply fmm the Ungual artery (which is a branch of the &rernol cororid arrery). ote: The tenninal pan of the lingual artery, the deep lingual artery, supplies !be tip of !be tongue. The veins drain into the internal jugular vein. Remember: The trigeminal nerve provides the sensory input to the anterior twothirds of the tongue: the glossophar yngenl, the posterior ponion.



All of the following statements are true concerning the triangle of auscultation EXCEPT one. Which one Is the EXCEPTION?

"' J

It is situated behind the scapula

It is bounded above by the trapezius muscle, below by the latissimus dorsi muscle. and laterally by the medial margin of the scapula The floor of the triangle is partly fonned by the s ternocleidomastoid muscle
It is a space on the back where the relatively thin musculature allows for respiratory sounds to he beard more clearly with a stethoscope




nenous dental student is performing the inferior al\'eolllr nerve block for""'it the first time. His Injection passes the ramus, but he thinks depo~ition of the anesthetic will work. His patient complains that he can't "move his face" \. on the side of the Injection. Which gland did the dental student penetrate? ~

Sublingual gland Submandibular gland Parotid gland Von Ebner's glands

1 ht lluur uf tht trianclt h, parll~ lurnwd h~ tht \ltrnot:leiduma,lnid mthdt

This is false; the lloor is partly formed by tl1e rhomboideus majo r muscle. For purposes of description, the neck is divided into anterior and posterior triangles by the stemocleidomastotd muscle; the anterior triangle lies in front of the muscle and the posterior triangle lies behind it The antrrlor triangle is subdivided into smaller triangles by the anterior and posterior bellies of the digastric muscle and the superior belly of the omohyoid muscle. These smaller triangles include: Submental tr iangle: Boundaries: Anterior bellies of digastric and hyoid bone Floor: Mylohyoid Contents (main) : Submental lymph nodes, floor of mouth Digastric (or submandib11/ar) triangle: Boundaries: Anterior and posterior bellies of digastric and the latent! margin of the mandtble Floor: Mylohyoid and hyoglossus Contents (main) : Submandibular gland Carotid trlanglo: Boundaries: Sternocleidomastoid: posterior digastric and superior omohyoid Floor: Thyrohyoid. byoglosws, and pharyngeal constrictors Contents (main) : bifurcation of common carotid Muscular triangle: Boundaries: Superior omohyoid; >t<rnocleidomastoid and anterior margin of neck Floor: Sternohyoid and sternothyroid Contents (mairr): lnfrahyoid muscles. thyroid and parathyroid glands

If the needle misl>k<nly passes posr.riorly at th< IC\cl of the mandibular foramen,

me netdlc Wlll penetnuc the parotid ~land~ and the pauent may de\'t-lop paralysis of the musc::lc~ of facia1 expression. tfthc tip of the needle is resting well below the mandibular foramen, you will be penetrating the mtdlnl pterygoid musde.


Correct needle penetration into the pte.rygomandibular space durinv M

inferior alveolar block. lflhe needle is insenc:d too far ~tcriorly, it

nuy crttcr the p:uorid sali\"fY gland com,un.na me facial D<f'<. ing a c:omphation such b t:nrns1ent facial pa:rai)'St$.




In an automobile acddent, an anatomy professor fracturu his humerus. "' He notices that he is unable to extend his forearm, but still is able to Oex the forearm. Which muscle oftbe upper arm primarily extends the forearm?

Biceps brachii Coracobrachialis Bracbialis Triceps brachii

135 Copynp"O 2()()9.2010 """'' De<O..


Which muscles elevate the mandible and hence account for the strength of the bite?

Medial pterygoid, digastric both anterior and posterior belly, and lateral pterygoid Digastric both anterior and posterior belly, and lateral pterygoid Medial pterygoid, temporalis, and masseter Digastric both anterior and posterior belly, temporalis, and masseter

I rit:~ll' hralhti AI the shoulder. important muscles 1nvolved m th<: movement 1nclude lhc dcllol<l, wh1ch makes the rounded contour o' cr the upper surface of the ann and shoulder. At the elbow joint, importan1 muscles for flex1on mclude b1ceps brachii and brachialis. "bile the

mam extensor muscle is the lrccps.


Sltnn h<'Od

Booy no...,,.......,-


'lc:xct 11\e ann

o(elbo~ }Oint

Note: The radial nern~- is most c-ommonly inJwed in a mid ...humeral shin fracture. because

tbos nerve runs on the radoal (spiral) grooe of the humerus. The biceps braehii panocopates in Oexion at both the glenohumeral and bumcroulnar jomiS.

\lu'dl'' 111 \1:1\lll.".llmn



~ landlbular l\1o.. tmtnts



Dt -~ .00 svpmor (,ben ~k~ale 11'1c n.ndible The l)\)i1efior fibers tt"lfiiC1 the ITI.'U'I(hble


l.owu border arM& medial surr.:.ce

L.tlt'tll ~of lite DmUJof Radel (t~ltn) the llllftrJ.bk"' ... _Ole occ-t.ac tt.c ~ted~. iD muoc._

Tht supaikill bt~ anscs fiom \tedalSIIIface of !'he! ongk of As$~ 1n nisit~a (clnvm,ZJ tht the C1.1bcrosity of Ute maxilla. 1bcmll(ldible 1 tmnd1ble rtw: d t(')) bud ar\Jc~ from tbc n~ial surface of die literal piC<)..,;d pe...

~""" fi'WO~}

nc PP"' bftd . . - , ticn the Ollftt..._,.c-.,,.

li'C111ef v.ing o! lbc ~d

dibl d me artJ('\1181' dt.e of thf.T\U

F,_ til \be lied or~ .......

rhc lower bud llflcs (Mm the

'"'"" - ..,... lorcnol


l...-f1" ttrMis:: tJ,p. ~orchc f'l)lodible (durmgfi'l'l OJW!li"IJ

I""YJYod "'""

.,.,,,twit) IJ.cn . .~db;~ ofdw' ....,.,,Me

One II'IIU('It: IIUal de\'~lion of ~~~~ """-'NI1blc: fshifj llfdlldlb/' to

Important: The muscles of mastication are innervated by the trigeminal nerve (specif icolly. lhe mandibular division- V3).


A patient comes to the emergency room after boxing practice. He was hit "ith an uppercut sod heard a cnck in his jaw jolnL A cr scan shows a condylar fracture with damage to the articular disc. When the patient attempts protrusion, the mandible markedly deviates to the left. Which muscle is unable to contract?

Lei\ lateral pterygoid

Right lateral pterygoid Temporalis muscle



c..rnJI>I C> 2()()';.2010 D<mal O..b



46-year-old woman comes into the dentist's orncc for a cleaning. He notice~ that her tongue is slightly swollen, nery red, and smooth. lier diet history indicates that she bas had a loss ofappetile for quite some time and that she ha1 been feeling fatigued. A call to her physician indicates a history of iron deOeiency anemia and associated glossitis. In glossitis, the smooth nature Is caused by a lack of which papiUac that arc the most numerous and cover the \... anterior tv;o-thirds of the tongue? ~

Foliate Circumvallate Fungiform Filiform

Copyripi.O 1009~010 Ott.& Otoeb

The right and ldt pterygolds acting together are the pnme protractors of the mandtble. Wllen one muscle is oot funcuoning properly, the conlnllatcral muscle's action is uuop posed. nte lack of !he left lateral pterygoid trying to push the mandible to the right allows the right muscle to move the mandible to the leO. With this inJury, the mandible deviates toward the aiiected side. Similarly, because the muscle's insenion is disrupted (disconnected from the body of the mondlbl~) in the ease of a con d) lar fracturt, the mandible wiU also deviate toward the affected side. nte muscle Is tntact and can move the condyle when it contracts but not the body of the mandible because of the fracture. The unopposed right lateral pterygoid t:ben remains capable of displacing the mandible to the lei\. ltnportant: Jn addition to opening and promtding. the lateral pterygoid:; move the mandible from side to side. l'or right l leral excursive movmenls, the left lateral pterygoid mUJcle Is the prime mover ond vice versa Note: With a condylar neck fracture, muscle contractions might result in displnccmeut oflhe uyured condyle iolo the infratemporal fossa.


The dorsum of lite tongue is studded wilit pnpillae, of which ther;: are fottr types: Filiform - most numerous. sman cones arranged in "V"shaped rows paralleling the sui cus terminalis on the anter.or two-thirds of the tongue. They re characterized by the absence of tute buds and inc.relUed kerotlnizstion. Tbey serve to gnp food Fungiform- knob-like or mushroom-shaped projecllOJL<, they lire found on the tit> and sides ofU1e tongue. ntese t11sto buds are mncrvated by the facial norve (VII) Circumvnllate (vallate) lnrgest but fti\CSI in number, they are arranged in an invert ed "V..shaped row on the bock of the tongue. Associoted with tbe duel! of Von Ebner's glands. 11lese taSte buds rue innervMed by the glossopharyngeal net'\ (IX) FoUate - found on lateml margin.' as 3 to 4 vertical folds. These taste buds are tnnervat ud by both the facial nerve (VJJ a/liar/or papii/Cie) nntllhe glossopharyngeal nerve (IX - posterior papillae) The recept<K'$ for the sen.<e of taste (gustatiiJII) ""'located tn tlUte buds on the surface oftbe tongue. The tute buds are associated with peg-like proJe<:Uons on the ton~"'c mucosa called lingual papillae. A taste bud contains a cluster of 40 to 60 gustatory cells, as well a< many more supporting cells. Each gustatory cell is iMervated by n sensory neuron. The tongue and the roof of the mouth con tam mOS1 of the receptors for the taste nerve fibers in bnmches of the facial. glossopharynge-al, and vagus oenres. Located on taste cells in the taste buds, thest reuptors t\te stimulated by chemicals. T hey rt>5pond to four taste sensa
tions perceived by specinc nreas on the longue: sweet: on the tip bitter: ou the buck soOT: along the sides salt)~ on the up and sides

The underside of the tongue IS son and kept very moist by salivary gland .,ocretions. Beneath the tongue lie the openings of the ducts from the subUngual and submundibular gltiO<b. The l'i'enulum fonns the midline rldge on lite lower surface ul' thc tongue. The paired deep ancr ics and veins of the tongue he on each sid< of this ridge.


Which type of muscle cell uniquely contains Intercalated discs?

Skeletal muscle cell Cardiac muscle cell Smooth muscle cell

CopynafltCI 20092010 Oerul Deck-~



Wbieb or the following r efers to the sarcoplasmic reticulum present In skeletal muscle?

Releases and stores phosphate ions during muscle contraction and relaxation Releases and stores glucose during muscle comraction and relaxation Releases and Stores calcium ions during muscle contraction and relaxation

""""'"" 0 2000-2010 Oaoul Docb

( ardiar nw,cle rl'll

Smooth nwscle fibers ore composed of unlnucl~ate, >piodle-sbaped cdls (filsiform oel/s). They are mucb smaller than skeletal muscle fibers. The nuclei are situated in the widest part of each liber. Tbey do not po~ess T tubules. and their sarcoplasmic reticulum is poorly developed. These muscle fibers do om possess regularly ordered myofibrils and are therefore not striated. Their cont111Ction process is slow ond not subject to voluntary control. Skeletal mu~le fibers are composed ofbuodl~ of very long. cylindric, o!Uitinucleattd cells that possess regularly ordered myufibrils that are responsible for the striated appearauce of the cell. The nuclei nre either slender ovoid or elongated and are situated peripherally. They do contain transverse tubules (7' tlllmles). and the sarcoplnsmic reticulum is very well-de\ eloped. Their contrnction is quick, forceful, and usually under voluntary control. Tbe myofibrils (actin am/ myo.<ill} ur~ the cootrncb1e element Remember: Cardioc muscle fibers contain centrally placed nuclei as well as int~rcalated discs (contain desmo.<ome.. a11d gttp jmiCtions), wlu.ch represent junctions between cardiac muscle cells.
I. rhe satellite cell is responsible fo1 slleletal muscle regeneration. Notto 2. 1'wo T tubules lie within a single skeletal muscle sarcomere. 3. In skeletal muscle, a triad refer< to aT tubule sandwiched between two dilated cisternae of the surcoplasmic reticulum. 4. Motor units consist of a motor neuron and all the muscle fibers It supplies. 5. The major regulatol') prottins in muscle tissue ore uoponin and tropomyosm.

Kcll'll""l'' :md 'tun, calcium ion~ durin).! musclt tuntracliuu .md rl'l."ation

It is a network of tubules a.ntl sacs In skeletal muscles. This network. is analogous. but not identicnl, to !.be srnootb endoplasmic rttlculum of other cells
Remember: The enttoplasmic reticulum is an extensive network of membraneenclosed 01bules in lhe cytoplasm of cells. This organelle is classified ns granular ur rough surfaced wben ribosomes :u-e attached to the surface of the membrane and a:. granulor or smooth surfaced when nbosomes are absent. The strUcture functions in tbe syntbesb of proteins and lipids and in the tmnsport of these metabolites witltiu Lit~> cell. The cytoplasm of muscle celb is called sarcoplasm. The sarcoplasm of each skeletal muscle fiber contams many parnll.,l, thread-like strUctures caUcd myofibrils. Each myofibril is composed of ~111ltller strands called rnyofilaments that contain the contmcliiC proteins, uclln and myosin. The rcgulars!l"tial org~ation oft.he commctile proteins within the myofibnls fonn.' the cross banding. A network of membranous channels. called the snrcoplasmie reticulum. extends throughout the sarcoplasm. Note: It is mainly a great increase in l.be numbers of additional myofibrils (which is caused by progresslw!(Y greater numbers of both acmn and myosin filamclll.r in tltc myofibnl.t) that causes muscle fibers to hypcnropby. Important: The number of muscle fibers does not increases.

the size of each fiber


~ During the fourth week of prenatal development, within the embryonic period, )
'tongue development begins as a triangular median swelling, called the:

Foramen cecum

Sulcus termioalis Tuberculum impar Epiglottic swell ing

Copyngllt 01009-2010 Dmtal [)r(-'b



Tbe cartilage in lbe s~ond branchial arch is called:

Meckel's cartilage Reichert's cartilage Thyroid cartilage Cricoid cartilage


tuh~ n: ulum imvotr -- ur mLdian lunJ.!IH' hurl

Ttlc tubt'rt"ulum lmpar h: a ffia ngulilr mcdluo .swelling lht.n ill luc:utt:d in the midline. o.n the floor \'f the pnmihvc pharynx. in the embcyo"s coruotned ndS31 and oral c:t.Yifies.. Thh $.lructure g1vcs tftc firs1
indicauon nftongue ~dopmmt araboutllx fourth \\cclc oftmbt)onic lofc.Sooa. '"0 di.,.ltnn& u bulb (1atcralltngo.al :Nellmgs/ de.elop un each side of the mtdlon toogue bud. All of these antnior swcUin_gs Itt from he growth of mesenchyme oflhe fi~ bruntlual2uthes (or mnmflln, /ar tlldtes) and fuse to fom1 the anterior two-thirds or bot!)' of !he tOOb'UC. The: 1osterior onto-third Q f base Of the longue ls fom1ed by a pair of 'wellin~, the ropula ({fflm tlrr 111/rd M1d ports ()/ tltt' .fourih bnmchlol

E'en fanbcr J>O>I<rior 10 the copula i$ the pi'OJ<Cil<>n of a third m<dlan s"'cllmJ!,tbe tplglotti< '"tiling. winch deelops from the .,...,.byrne ofthe po>to:noc pans of the fnurth branch~al """"' Thisswclllli
maik$ the dcvel()pmml of Ihe most postenor t'e810D of th.:--ton~uc flnd of dle fu ture epiglottis.

Remtntber: The. hr:.tntlti_.l

(plwryng~ol) arches are

stacked biiAterlll $\'il'IHn~,ts ofci.ssue that :~ppt11r

jnfrr ior to Ihe $l.omodcum durin& lhc founh week of embryonic development The~ bnmcbia1 arche\ are sb: pa_lrs of V-sbaped ban wnh a oore rntsencbymt.. r,,m~-d by nrunl rttst cells that mlgnte ro tile neck rCJion, Th< branch11l ""'""' are covered e<l<mally b)' :lodtml and toned tntanally b)' eododtrm. These ar~hcs )l.lppon the hu~l wa1l' of the pnnuthc pharynx.

1. Rlfld tOngue ~~ che ~sult ofhu:k of rusivn of the diliUtllonguc buJs (Or lmo:ral .r~'f!lli,J/.S). Note; Thl') $terns to be common in South American iltfiuu~. 2. The Cifth br.nchill archs a~ so rudimc:ntary thai they arc -ub~m in buman~ or- a.rc

intlu<led wirb lh< fourth bnincb>allllthcs Be<\\..., the 1lxth and <ighlh ,..eeks of pm~atal <kvclopmcn~ the rhtcc maJor ..II VIII)' gl:ulds bt~m a
q-titheUt~l prohfen~tions, or bud,, from the lodctmallioing uf the pnmith e rn"uth (Mmnmltmffl) The rol,llldcd tcnnm~tl t.-nd.<t or the~ tpithcliat buds JVOW into tJ1u underlyiug mesenchyme, pro,hu;in_ the secretory ccll5, or gJaodular fti!Jnl. and the duc:ulJ ;;ystQll. The:. pawuthJ g,lanru apJ)....-.tr early Ul the: snth week and Art the firS( to form. lllc submandibular glands appear late in the sixth w-tt\.. aad the Jubllngul ~lnlb appear on the eighth wttl

Each f13tred branchial arch bas its own developing cartilage, nerve, vascular, uod muscular components within each mesodennnl core. TI1ese elements 11re of neural crest origin.
Derivothes of the branchial arch cartilages: First arch canUage (Meckel 's cartilage) - is closely related 10 the developtng middlo ear; becomes ossified to fonn the mullens and incus of ohe middle enr, sphenomandibular Ugament. and po>rtions of the sphenoid bone.
Note: \1ost of this cartilage disappe3rs as lhe bony mandible fonns by intramembran-

ous ossification IIS1cral to and in close association with 11, yet only some of~eckel's cartilage makes a contribution to it. Its fate is said 10 be dissolnlion with minor
contributions to ossiOcntioo. Second arcb cartilage (Ref~hert s ~artiiQge) - ts also tloscly ~lated to the developing middle car; become; ossified to fonn the stapes of the middle ear, !he styloid pmce-ss of the temporal bone, the stylohyoid ligament. the lesser comu of the hyoid bone, and the upper ponion of the body of hyoid bone. Third arch cartilage (llllllamcd cartilage) - ossifies to fonn p3rt of tbc byold bont. Fourth through s inh arch curtllttges (wmamurl cmri/age) -- ruse io form the

laryog.,..il cartilages.


During the fourth week of prenatal development, the upper lip Is formed when eaoh ruses with eaeh as a result of the underlying growth of the mesenchyme.

Frontooasal process; lateral nasal process Maxillary process; medial nasal process Lateral nasal process; medial nasal process Maxillary process; lateral nasal process

89,90 91,92
~~ C ~2010DmWDeda


During the fourth week of embryonic development, the first branchial arch divides to form:

The two medial nasal processes The mandibular and maxillary process The rwo lateral nasal processes The lateral and medial nasal process


Thm. the"'' '(IIJry proc.Hus oomnlMJte: to the stdc( of lhe urrcr hp. and lhe tf\o mcd11l na.sa.l Jlr'f<<>e. conmbuu: ro the middle ofrll< upper lip. ~osron ofrhc:J<C proec:.sc ro form rhe upper hp 1~ \,':Offiplncd t1uring tbc S~th week orrrenatal tie\'elopmcn~ When tht g:roo'VCS bctWe-t:n the ptiK:C..IiSf;i; ~"' oblircrnred. The ~t~lllury procosm on tach sl~c nrrhc developing fntc paniotly fUM: 1\irh rhc mndlbular iircb to fonn the labi-a! con\rni15u~. orcorDl'!fl. or the tnoulh. .\ fler fonnoll011 Oftht ltOmod<um (tht primitii'P /hDIIIh} buunll \\ilhin rJic founl> bulges oru~ue aprenr H\fctior to 1he primuivc mouth. the t"o la r-~:.e mnndibulor proccner tll the fU'SI hnmt.hial MOh, n1~ mondlhll" fOrnlS o..o~~ o result of the fi1sioo of the riMiu and lei~ mnndibuJnr prtwcsscs. ne mrmdible i rhe f11St pMion of rht ll<>t ro fonn nfl<r the cr.uuon oftl>C wmodcwn. ' Ole: Th~ mndlbl< (r.'l!pl]nr the CVIII~~es) ond rh~ mO>ill are mo..ty ll>mcd by branoo.s o,slfication. l11c mad II 1s fturoe:d primttrily by mcrgin,g or the 1wo smnller lllR.~IIIRry processell or the first brancbial n,:h. These mxillary ptwe>S<:$ also turm rhe upptr check rcgioo> and most or the upper lir Ounn& thelounh \\'ed<. ~ r.,otonanl proust {fHwtn.,te</lso fonm.ll bulge oftt<$UC in th< upper mclnl ata, at the "'"" <ephallc <nd uf rho cmbi)'O, nnd is the emmaI boundury )f the ttomodewn In Ihe future, the froniOnf\Snl proce!l~ ~.t&vc~ r(:-c h> the Up(14!r face:. whit;h lncludcs the forehead. btidg< of ll05<, ptirrutry palate. MS3l:1Cptllm. and all tmcrures tdotcd ro the nc<lial na,-.t




Tlle 11A.ul placodn fonn In Lhe antcnor portion of1ht fronwnual prQC4.)..JUlll supenur to 'be sto-

modeum, durrns 1he founh Wt"ck. l'lu:sc two button like lllruC{UJ'('$ fom1 a.ll" bilutcml ccrodennnl duckeoing,< thnl lartr develop into olfoctory cells fur the ~en>arion ol' smell. I he middle p<mron of rlle rit<Ut !!JfiWIOB IIIOOJ\<Jihc nasal placocfn aprdn I' twO Crt>CCOI<haped SW<Ihnt:S ill1d art .:Oiled the mrdjaJ na,.a1 pf"'fti.'<tl. which fu.(Oe tU form d1e mtddle portion o(liu~ 0C'$e from 1he fOOl to the ape-M tll'ld ~he cemer ponion of 1 he t.ippcr lip nml atso the philtrum rcg1 un On the uutcrponiun nrthc nasal placodcs, there are also two ulhercrc~e:llt-~hi1pcd <;:welllngs, the t:ucrttl oaJMIJirocesses. which will

fonn rhc oloe. or sidClS of tM no<e. fu>1on of!he lat<r>l """'!. moxllry, and medial nasal processes fomiS ~ nJtes, or nv>tril<. :-.ote: Loteral rlrf\in~ or th lip "'wit from rhc f>ilorc of dte maxillary and mediol na;;al processes to f\110.

f h1. m111111ihuhtr ;.tnd mo.t\ilh1n pro""''' - otb:o "allttl prmu iutn Ct''


and rnaudihular

The bronchi~! (plrm)'llgea/) urches arc smc~erl hilaierul sweUings of tissU< thor appear nferior to the sromodeum dunng t:h<: rounh wctk of ~mb.ryomc ~c.... clopment . The;e branchial arches are sl~ pain of U-ihlll~d bars with 11 core m eonchym e ll>trMrl by neural crest tell that mi!!r31 e to lhe neck region. The bt'lluchi.al urchl'& arc C<lVere<.l cxrernally by ectoderm and lined rntemnlly by endoderm. The ectodcm1 between the areb"' fom1 clefts (grooves) called bnmchial (pfwryitgealj dens (l:roo'oes). Ute arches lll'l! bordered medially by the pharynx, which IS lined by endodenu. Medially each uflh~ branchial nrcl1~s is separated by a pharyn~el pouch, The~" pouches approach the corresponding brancbinl cleil The uppruximationofthe cctodenu of the pharyngeal cleft ""th rbe endodenn of the ph8l)'llgeal PllUCh forms the pburyngcal membrnne. The groove and pouches arc named (llfl/llbCfl<il) the sanrt as 1he preceding arch After formAtion oflhe stomodeum (ihr pruuilt<e mnmlll but still wi!h10 Ute tourth wee!.. rwo bulges of tissue 3rJle<lr infen()f" to Urc pnmitive moutb, the tWO large mandibular processes of !he tlrsr branchial ureh. Important: The mandible fonns osa result uf rhe fusion of rbe Utesc two largomnudibu-

lnr processes.
Note: The mandibular sympbysi is a lil1n1 ndgc in the midline on !he surf~ce of rhe bony mandible whore the rnlll1d1ble is fom1ed by the fu>ion of tl10 mandibular p1'0cesscs. The two smaUcr mu lllal")' processes of 1bo first l>rurrchtal ar~h torm the mnx.illa. th lrppet check region.. aud mo~l of 1he upper lip.



Which pharyngeal pouch gives rise to the inferior parathyroid and the thymus gland?


Second Third Fourth


Cl 2(109..2010 DmlaJ t>U




The primitive mouth, or stomodeum , initially appears a s a shallow depression in the embryonic surface at the cephalic end before the fourth week of prenatal development.

Ectoderm Endoderm Mesoderm



Four well-defined pairs of pharyngeal pouches develop as endodermal e,aginations from lhe lateral walls lining lhe pharynx. The pouches develop as balloon-like structures in a craniocaudal sequence between the branchial arches. Note: The fifth pharyngeal pouches are absent or rudimentary.
Pharyngeal Pouch
~irst gro<J1;~).

Structures Derived From

Contributes to the fonnation or the tympanic membrane (wilhfirst brtmchiaf auditory tube. tympanic cavity. mastoid antrum
Palatine tonsils


Third and founb

Pnmthyroid and thymus gland<

l.ctu(kf 111

The oral cavity (primirive mowlt or stomodeum) appears as a shallow depression in the embryonic surface ectoderm. At this time (befort' rhe fourth wee/c). Ibis stomodeum is limited in depth by the oropharyngeal membrane ((buccopharyugeal membrtme). This temporary membrane, consisting of external ectoderm overlying endodcnn. was fonned during the third week of prenatal developmenl The membrane also separates the stomodeum from the primitive pharynx. The primitive pharynx is the cranial portion of the foregut, the beginning of the future digestive tract. The first event in the development of the face, during the fourth week of prenatal development. is disintegration of the oropharyngeal membrane. With this disintegration of the membrane, the stomodeum is increased in depth, enlarging it. In the future. the stomodeum will give rise to the oral caviry, which is lined by oral epithcllum, derived from ectoderm as a result of embryonic folding. The oral epithelium and underlying tissues will give rise 10 the teeth and associated structures. Note: A plane passing th.rough the right and left anterior pillars marks the separation between the oral cavity and oropharynx in the adult.


T he palate, both hard and sort, begins fo rmation in the:

Third week of prenatal development, within the embryonic period Founb week of prenatal development, within the embryonic period Fifth week of prenatal development, within the embryonic period Sixth week of prenatal development, within the embryonic period

93 94
107 Cclp)1'iiln 0 '2009-1010 ~rual ~lr.t


Which cranial nerve supplies the muscles derived from the first pair of branchial arches?


Trigeminal Glossopharyngeal

Hl'lh \H'l'k ul pnrwt;tl tiL\elnpmeut. \\ilhin fh(' cmhQnnic pt'riml

The palate is Conned from two separate embryomc srructures: the pnmary palate and the secondary palate. The palate is then completed during tl1e 12th week of prenatal development. The palate is developed m three consecutive stages: The fonnation of the primary p3late The fonnation of the secondary palate The completion of the palate Primary palate formation: During the fit\h week. the intermaxillary segment arises as a result of fusion of the two medial nasal processes within the embryo. The intermaxillary segment gives rise to the primary palate. The primary palate will form the premaxillary portion of the moxilla (the anterioronctilird ofthejinal palate). This small portion is anterior to the incisive foramen and will contain the maxillary incisors. Secondary palate formation: During the sixth week. the bilateral maillary processes give rise to two palatal shelves, Or lateral pnlatine processes. n 1ese tWO palatal shelves elongate and move medially toward eacb other. fusing to form the secondary palate. The secondary palate will give rise to the posterior two-thirds of the hard palate. \\hich will contain the maxillary canines and posterior teeth, posterior to the inctsive foramen. The secondary palate also gives rise to the son palate and its uvula. Completion ofthe palate: To complete the palate. the secondary palate meets the posterior port1on of the primary palate. and fuses together. These three processes are completely fused, forming the final palate, botl1 hard and sot\ portions. during the 12th week of pre natal development.

I ri:::t.lnin:tl
B1 amhi.tl \n:tu. ' ' .uullkri\ ,tti\l' 'lru"rnn\

Fust arc:hewo (ffwmdibtllur)

Future Ntrns and Musdes

Trigarunal nO"\re-, mUK1 of
tmsot \-th palatine ~td

Future Sktlttal Struttort's and Ugamtnts

'1aUtut~ nd tnctt" of mlddJc- e&(.

mctudmg. a.ntC':nCM' ha:o.meat masticatiOI'I, mylbbyod and a.n\erior of the ma11Cu5..apl!cnoJt3Udbu1ar Uanmtm, ld poo.l~n of belly of dip~uic:, enwr tymJ'IMi. 'he~oid b(ll'leFao.al IICI'-t~ $CalpCdNs mo:k-, muscles or r.e;al P'f"C$\Oft. pooeriol' belly of the dJ~Irie musclt.llt)'lohyoid ml.b4:1e
G~gal ""'..

Seoaad .......


Stapes IDd portJO..- ofmalkus and '~ ofm:s4<tlt car. ~~Cylohyoid lig.ameflt. StYloid PfOC$ afll'l~ tempunr.l bone. tcs;.cr eomu of hyoid hooe, upptt poninn of bOO)' or b~'Oid


"""' Gra.n-comliloflr)'O'd bone.lawu port100: ufbod)


h) Old bone ~am-tc Fourth lh<oo' Superior lal')1lg~1 brnn(h tnd l..larynl:i~al CAfli1oaet tixlb urdlat ~nt ltryn.&ea.l branch orva@US rteNe, kwtOt pal#ti.nc ~lr$.
pfw)Qie.l ~ Ultnnsit

nqcles or diC: taryax


The nasal cavllles are formed from which embryonic structure?

Stomodeum Frontonasal process lntennaxillary segment Nasal pits

{;op)-n&h1 20092010 Ot:ntall:)r.('ks



Tbe ooronary sinus receives most of the \'Cnous blood from the heart and empties into the:

Right ventricle
Left ventricle

Right atrium
Left atrium

C~ e1G09-ZOIO o-.1 Dccb


I min' !!Ill\ llt' 1 lufiiiU 111 ul llu I .n'

E1nbryonk StruttUre

INM lhh

Ma.nc!OOim ttl\ (Jim hr'ottriJJ~I u~~~

~Wii!Uy """"'( ..)


Onlc:t\ic) ~

fiurure 'rh~u L-,

1!:(14dcrr.ulilqwN101t C1tlar!ed by

fu!oOd tr\IID6ib..Uv ~~ 111:16 neur:'ll crest tell

L.uwer I!Jf, l(t'ftf f'att, mand.iblr wr~b i610Cf.llo.l fltfr'IICI

Miclfi. t ppcr 1 .. tidcs.. dsU. ~ paiiM.:. p.lllenut
~ ofuw.l.tl.a I!Jl CU"Iilled fblkS..~IC ~

S\JI)Criot uc& ~ swtt1i:ftc (s)


"-!pits McclitllM&I pro..::nt{_tsl
h1ICII'I'IUiJIIII')' 11(~111

""'""" I!C"'OOamal

purnoe of~l bcJots;

.~1~aJ and '-'m1 ri&AI pnn~ro~MU~

t~UUC lnd Clt:lm!l Cft~l

.. .., pi""""


f~ ~IIX'dsal


N.toidk oC-- f'H11Nm n':JI"'\ II"'CtiiP.i'Jb? llpiCilll

r~tCed mcdW nutltlfOI.'Csses F~~ lrllml.o,GIJI&i

~.asolc;rttuiiJ OOfd


ft,l'lli..-.r p011ki11ul mn.xilll "'lUI .;~\.Oitl(!i ~od tmUII!t. J'fitl'W'}' poil.ol>



i.N:nmatl sat, IIQIII~al dllct

ltichl alnum

When viewed from lhe back (posterior view), Ihe most obvious struciUI'C lying in I he coronary sulcus is the coronary sinus. This sinus receiv~s most of 1be venous blood from the heart lllld empties inlo lh" righ1atrium. Its tributaries are the small cardiac ,eln, n1lddle cardia< vein. and the grealer <ardlac \tin. Thete is a <mall \tin that arises along I he tel\ side of lhc left atrium just beneath the tower Jell pulmonary artery (called tllu ohliquc elu). This ve1111S a n.m nant of the embryonic left superior vena cava. The great cardlac vtin: opens into lhe left ew~mity ofthe coronary sinus. Thi~ '1!in receives tributaries from 1be lei\ atrium and bolh ventricle<: one. lhc left marginal \'ein. IS of considerable site. nnd asecnds along the let\ margin of the heart. The small cardiac vein: opens into the right extretnily of the coronary sinus. This vein re<:cives blood frocn 1he back of the right atrium and ventricle; the right marginal 'ein ascends along lhe right margin of the hean and joins the >mall car<hac in the coronary sinus. or opens directly into the nghl atrium. The mtddle cardiac vein: encb in the coronary sinus near its rigJll extremity. Tbe obUque nin: ends in lhc coronary sinus"""' ilslef\ extremity; this 1S continuous above wilh !he ligament of the left -ena cava. The following cardiac veins do no I cod in lhe coronary sinus: The anterior cardiac veins: comprising three or four small vess<ls which collect blood from the front oflhe right ventricle and open inlo the ngbt atrium: the right marl(inal vein frcqucnlly opens 1010 the right atrium, and is 1berefore sometimes regarded as belonging to this group. The ~moUcst cardiac veins: consisting of n number of minute veins which nrise in lhe muscular wall oflhe bean,; lhe majority open inlo the atria. but a few end in lhe \entricles. Note: n., anterior Interventricular artery (left amerior descendmg arr~ry1. a bronch ofthc left coronury anery. accompanies Ihe great cardiac ' 'cin. The posltlrlor (or descending) inlerventrlcular artery, a branch of the right ~'Oronary urtery. accotnp:mies the middle cardia( vein.





All of the following s tatements concerning curdiac muscle arc true EXCEPT one. Which one is the EXCEPTION!

It makes up the muscular component of the heart known as the myocardium Cardiae muscle cells are faintly striated, branching cells, which connect by means of intercalated discs to form a functional network It contracts voluntari ly Its fibers are separate cellular units, wbicb (unlike other striated muscle fibers) don't contain many nuclei It responds to increased demands by increasing the size of its fiber; this is known as compensatory hypertrophy

9 J

C 20()9.2010 OC'n1aJ t>cd,_f


I' When the SA node fails, or the SA node impulse is blocked, "bleb structure""'iII
\.. must take over as the pacemaker for the heart?

Sinoatnal node Atriovent:ricular bundle Purkinje fibers Atrioventricular node

Cop)'nllll 1'009-2010 Drr1CU ()c(b

It t.'ontr:u:h \nlunt~1dl~

.,. ThLS IS (liS(_: it C(NilmClS in\ oluntarily. The !'ltrtngth and freqUt.-ncy or tbr h.ear1 beal arc eomrollcd by 1hc ouaonomie nCI'ous I)Sictn. Dmh porS.<)'mpaahetic and >ympslhtdc pons of th' autoncunic- nervous ~ylttem are nwolved in thu control or the hcun. The h<mrt 1$ al,o hll.S an internal n~.,-vo"' syslem mode up of Ihe SA (s/ooMrial llt!de) nnd lh" AV (alriO\~IIlrinlior) node fhc AV bundk (Hu) leav<:lhe AV node near Ihe lll"er f""' uflhe mll'Tl\lnal J'IUm and sploiS O\'er the upptrl""" of lhe onlctVCDlnCUitr ,<plum mlo a lefi bundle branch 1ond a ril!)u bundle b~<tnch. The cardouc muscle i; Ihen supploed by branche> uf the 1wo hundll-s. Speciulh:cd cardiac.: muscle C:l!IIS in the woll oflbe: heArt rup1dly imtit1h: or conduct an cleclm:nl fm.. pullie lbroughoullhc myU<ordium. fhc lil!lllll ;, inolmtcd b)' lhe>lnoatrlal (SA) node (f'<JC<'Iflaicer) ond $p<1:0dJ 10 \he n:st of tile rigbtalr'lal lll)ocardoum dir<clly. to Ihe let\ atnol myocatd1um by -.ay of bundle of mtcralrial conduetins fibers. ~nd lo Ihe atriovemncular (A ~J node by woy of three
lntl.-modttl bundles. 'rlle AV node theumiuntes a $ignnl that IS conducted thruugh the \1C I1irtcu1nr tl'IYtx:ardiwn hy wuy oflho alriovenui<uiJir bundl~ (bu11JI uflhl and Purltinjc flb<n, lmponant: The 'louatrlol nod, located at JllOCtoon of the >Up<nor nnu th< righl eurlcle, lillie mns1 rapdly ~c-polanttn cardiac muscle hssue of lhe h""n Tbis os 11hy the .SA 11ode IJ\ refe~d 11.1 as the .. ,.ac~: ma k er"' of the hum't


J lememl}er: lhe conducting $y:,tcm

und not rttf'\ICS.




b all mtxlifled


muscle fibern

1'1lc 'l mpolhttic fib<.-. ~""" from J!Incnts T2-T4 of the oponol cord ond 41\! Ji~lnbuacd ~H>>ugh Hoc middl< cervical ~nd ccrvico-ahomcc (or rellu~e) gan~lin and 1hc fi~l r,,.., Q;lngli;o uf Ihe lho r.-cic syrupnl.hctic ch"in. The l'yntiWlhc1iG libcrs puss luto the cardiac p1cxug :md frottlthcre to th ~ SA notle 1nd the ciiTdiut: rnll>CI< The dfL'<I of lhc ~ympalhellenm es at thu SA node inn 'ncrea"' an heart rote The efrect on llle mllSCie ~ an mcreuc in rise of pn:>~ure "nhon the 1~'llln<le. Ulll>
lnl'l'Ca.li:ln stroke voiUint.:.

The vagu; nerve provides pQrosyrnpatbotie control to ahe heurt. Th~ effect oflhc VUGUS nerve at the SA node is lh~ opposite of abe symP"theti< n<rves; it dcc=seslhc hun rate. TI1e vagw nerve abo decreases the excitah1li1y of lhc juncuonal ttsloUC around the /IV node, and this resuiiS in slow..- transmi&SIOn. Note: Slr<lng va,;nl snmulaaiun here may pmduce 1111 /IV block.

\trio' \'lit riruhJ r nucll

Tbe bean contains musses of uodul tis><~<. cxcilable tl&~ue that c<mduc\5 unpulses aud stimulates the hc'llrtbellt intrinsocolly Tlu conduction YMem signals !he heart ttl beat independently. II does not requtrc any e~temaltnfluencc.<. The impulse to stimul31c the he~nbeal passes through the ~onduction system stmcturcs in thos order; SA node - AV nodc- AV hundle- l'urkinje Obers. rhe S.\ node" in the wall oftbe rigbt trlunt. ncar the entrance of the ~upcraor vena cava. The SA nooc 1ypic!llly tlcpol;1rizes ~ron1nneously utlhe tJte 60 10 100 tnlles per minute, cuusiug the utr1a lo contrncl. Impulses from the SA node pa. 10 the alraovcntric ular oooc (A V node/. otriovemriculnr bundk (A V hundle, nr ht)nc/le o{His). ;;md finally 10 the condUcttOn myofibets (P11rk111je fihen) within the vemriculor walls. Sumuhtlion of tlto conduction myofobers C3ot,es Ihe veouicles 10 conuucl simull~ncnusly.



1. Tite r.ue ofthe discharge of the SA nod sets the rhythm of the enure heart. 2. The rllythm originates from the SA node because the SA node derolariz"" more frcqueo uly (60-trl(l bear. pt!r mfnule) thnn the AV 1 10de (~0-6() he11ts per min me) and ventricular conducting systeln (30-40 heaL< per mimi/e) ~o the AV node and ventricular conducting sy,tem are "capwred" by the ~onu' IJl)puJ~ and dnvco 01 60-100 beats per minme. 3. In sinus rhylhm, every P-wavc 15 followed by a QRS complex. the RR in terval is reguL1r, and the P-R interval ts les;, than 0.2 SCC<>nds. A r..t $Inns rhythm, r,~<ter tbao 100 beats a minute, is IJtown as sinu t<hycurdla whil" a slnw rhythm, slower than 60 ben~~ min11t<, is known a.> sln u! brnll,yrardlu.


The apex of the heart is located at the level of the:

Third left intercostal space

Fourth left intercostal space Fifth left intercostal space Sixth left intercostal space

153 Copyfl&bt 0 201-2010 Dm11l D:l.


In the fetal hea rt, the permits blood flow from tbe right atrium to the left atrium.

Fossa ovalis

Fommen ovale
Foramen roiUildum

Ductus aneriosus Ductus venosus

J be apex of the hean is fonncd by lhe tip of the left vemricle and is located at the level
or the firtb len Intercostal space. The ventricles are larger and thicker walled than the atria. The right ventricle pumps blood to and from the lungs. Tho l~tl ventricle, larg~r und thinker walled than tltc ,; ght. pumps blood through all other vessels of tha body. Note: The ventricles receive blood frorn the atria. Important: The left ventricle enlarges brieOy in respon.~e to coarctation (coustrlctum) of tbe aorlll.
Remember: The hean functions as a double pwnp. The right side (right atrium) receives deoxygenated blood from the systemic circuit via the superior aud wfc:rior venae cavae as wellllS the coronary sinus. The blood then goes from the right atnum to the right ventricle via the rigbt AV valve. The right ventricle then pumps blood into tbe pulmonary circuit (\~a the p ulmonary semilunar tofv~. which allows blood lo flow Into
the ptllmMary arteries).

Note: Resistance to pulmollliry blood now iu the lungs cnusts o strain on tl1e tight vemride nod result in ventricular hypertrophy.

The le1 side (lejl arrium) receics o~genated blood from the lungs by way of 1he pulmonary veins. This blood then Oows through the left AV valve mto the lefl ventncle" f rom the left ventricle, blood passes through the aortic valve and cmcrs the arch of the aonn. which will deliver the blood to the body's systemic circuiu..

Fur:.tntl'n H\ alt

Remember: In the fetal bcart, tbe foramen ovate permits blood to Oow from the right a trhtm to the left atrium. The blood will tl>en pass to the left ventricle and the aorta, thereby bypasstng the noofuncuonal fetal pulmonary circuiL Eventual!), the foramen ovale becom~ pennanently closM with fibrous connective tissue and becomes tbe fossa ovalis in the adulL The fossa ova lis is situated at the tower pan of the aerial septum, above and to the ten of the orifice ofthe inferior vena cava. The annulis ovIIJ fonns the upper marg>n ofthe fossa. The atrial portion of the heart bll$ relat ively thin IVttiiS and is divided by tbe atrial septum into the right and ten ~tria. 'f hc vemricular portion of the heart bas thick walls and divided by tlte ventricular septum tntO right and left "eutriclcs. Note: The liga mentum arWriosum is a rc1 nnant !If the ductu~ arteriosus in tbe fetus. The ductus artenosus is a nonnal fetal structure. a llowing blood tO bypass circulation to tbe lungs (blood is shunted from the p11/monory artery to the uortic arm). Since the fetus does not use hts or her lungs (oxyge~ (\ pmt'ided thvugil rill! motlter splacenta), Oow from the right ventricle needs nn outlet. The ductus provides this, sht1ming now from the left pulmonary artery to lite aorta just beyond tho origin of the anery to the left subclavian artery. The high levels of oxygen that the ducms is exposed 10 aner binb causes the ductus to clo>c 10 most cases within 24 hours. When it doesn't clo!>e, 11 is tenned a patent ducrus ortcriosus. After binh, lbe ductus aneri<>sus become.' the ligamentum artcriosum, which conuecL~ the arch of the norta to the toO pulrnonnry artery.


A worker in the meat-processing Industr y comes down with an illness, presenting with symptoms offever, headache, and sore throat. A few days later, he feels chest pain and has pink, frothy sputum. His physician states that the worker bas a viral infection caused by coxsackie B. This patient has Inflammation or which layer or the heart {the thickest and tire workhors<!)?

Epicardium Myocardium


1SS Capyngbt 0 2009-2010 Dttll.liDtd;i


The left atrium and left ventricle are supplied by the:

Anterior interventricular branch of the left coronary ancry Circumflex brnnch of the left coronary artery
Marginal branch of the right coronary artery

Posterior interventricular brnnch of the right coronary artery

\1~ o~~Jnlium

Lavers or Lbe heart: i. lntcrnnl or endocardium - Homologous with the tunica intima of blood vessels. Lones the surface of lhe he:ut chambers with a simple squamous endOihelium and underlying loose connective u.~sue containing smnU blood vesseb.

2. Myocardium .. Homologous wilh lhe tunu:a media of blood ves~ls. Fonns the bulk oflhe heart mass and eonsosts predominantly of cardiac muscle cells arran~;ed in a !;pi ral configuration. This spiral arrangement allow~ the heart to "wring the blood from !he ventricles toward !he aortic and pulmonruy semilunar valves.
J. Pericnrdlum - is the set of membrnnes around the bean (ills act11ally compo.<ed of three loyen ofmembra11e.<). The innermost is the 'isceral pericardium. the middle os !he parietal pericardium. and the outer ooe tS the extra one. called the fibrous pencardium. The inner two (vi.vceml mul parietal) arc rather thin tmd ddicutc. The uuter one, the librous JX'ricardium. os tough. Important: The major sen.-.ory nef\1~ to the p:sn etal pericardium i~ from branches oftlo phrenic ntr\'e (C3-1;5).
l utp()rlant: The bean and its pericardium make up the contents of the middle medl a~tinum. TI1o left and right phrenic nef\~s and tl1eir adjacent artcnes lie to lhc left nod nght oftbe pericardium and anterior to 1he r()(IIS of t11~ lun[!.S.

ircumn~ ' hr:.~.ud1

ut thl' 1 \'ft cornnan


The anerial biQQd supply of1hc hcan IS prov1d,'tl b~ ~ right and Jell coronaryarten~s. which nn>< from the aorut iUIIDCdiately aOO\c the JNII< ""he Th..") and thctr maJOr branch<> ore dl5tributcd
m ~the sur race of lhe 1\ea.n l}lni wnh1n &,UbtTicardlnl connecci' c tissue. Tile rlgbr coronary ur1\ry arises from the ~lntt"nor'30rtic s1nus oftl1e ~ending uortn and rUn) fOr ward betwc'Cn the pulmonar) trunl. and the right euncle. Th1> anery I!JV<S ri"" to an tm[IOIUnt brunch immtdtately aner leavtna the 8.)tlding aut1a This as the anterior righ suriaJ bntnch. whit.:h gwcs nl)e lo t.hc 1 mpor1nm uodalartN)'. 1111:,. nnery ftupphes the SA node ur pucernl\kcr of lho heart. Ole right comoary llltcry conunues in t(le coronary sulcus, givina oil' noorgtoal bronch. u. htch supplies the ri!lht ventricle Finlly.the ngbt cM>oary anery gl\ me to th< t>Ostuior In tenen1rltular branch (posll!rfor fles~ttlldln.g at"-''''), whic;h ~upphe" buth vcmrlclt!s. aml lhtn
a.no..,tomoscs wilh lhe l.'lrtwuOcx

from t11e let\ coronary 1 1 rtery.

The left coronary artory, wbich os usually larger than the ri&Jit comrntry llt!Cf)'. ons~ fn>m the lcR pcKterior 30<11< slnU.> or the ascending aorta rorwaod bel ween the pulmonary 11'111\k and the left aur1 cle. This arte-ry dh11dcs into un anterior fotcrventrlcuJar brnuch (lt!fl anlerlur ,/e~ uc"ding urlery), which rupplics the right and tel\ vcnh'icla and the intCNI!ntricular \(;ptum, onO a cln:wnftt\ bnonch, whicll.upphes the left auiunt and the left '""tnclo. Important: nu: ruuerlot interv<:ntriculor artery ts 1 he one 1 nost u!'tl.'tl lnvo h~~ 1R coronary ocC'ha&auns :ind IS often the une that is bypassed in hypnss cardiac surgery. "'"' OM four Rts or '"'''es that keq> the biQQd OOWtng in the proper dnrtuon lhmul!h thee hom-


"""of lho h<-ar1:

Rigbl nnd lfl trloventrlculor valv<s (AI' V<l/1~~)- ore located bctw<en the atria and the 'entnclc. TI1c valve on the n&h is callc'Cithe tricuspid ' olvt; on the !eli h is called the bicuspid {ttfhra/1 \ah These ,.l,es preC1'1t baciJlow ofbiQQd onto the atna during ventriCillar con lr:sctum. Sentllunar vslves -the pulnoonary semilunar valveilo.:nted on the pro.,unll c'Od of the pulmC>Mry trunk. The aortic umllunar 'ahe is located in the pmximol end of 1he orta. lllce vatvcs prevent return ofbtuud 10 tl1e ''-'n1ricles lfnm the ~!Jr1n ancJ pUI InOo(~ry (runk ~tfkrcon


Which group of structures empties directly into the right atrium?

Superior \ena cava. coron81)' sinus, and hemiazygos \tin Coronary sinus and pulmonary vein Pulmonary and bronchial veins Superior and inferior venae cavae and coronary sinus Coronary sinus and azygos vein

Cop)rigln C 20092010 Drntal Dkl


A patient "ilh a " heart-\atve problem" comes into the dental clinic for periodontal therapy. Sbe sa)'S that her old I>Crlodontist always gave her antlbiotlcs before trcntmcnt, and Insisting that the dentist bear the problem, she places the stethoscope in the left fifth intercostal space n1cdialto the \.. nipple line. Which heart valve Is best beard over the apex oft he heart? ~

Tricuspid valve Mitral valve Pulmonary valve

Aortic valve


Sulllrinr ancl inftrior H'ltlH' l':t\ ar ami rurnnar~ \inu'

The coronary sin us lies in the posterior part of the coronary sulcus (atrioventricular grooe) and opc11S in the right atrium between the operung of the inferior ''e03 cava nnd tl1e roglll atrioventricular orifice, ils opening being guarded by a semiluntlr valve (T/rcbesitm valve). The superior vena cava opens into the upper pan of the right atrium. The superior vena cava returns the blood from the upper half of lhe body. The Inferior vena cava (larg~r than the .<rt(Jerior mna C'Qva) opens into the lower part of the rigbl atrium, The inlcrior vena cava returns the blood from the lower half of the body. flow or the blood through the heart: I. Entering the right atrlum are the coronary sinus and the superior and inferior venae cavae canying rlco:<ygenated blood from the systemic circuli. 2. Upon contraction oftl1c rlgbtatriutn, blood passes through the rightAV valve to the right ventricle. 3. Upon contraction of the right ventricle, blood leaves to pass to the right and left lungs via the pulmonary arteries. 4. Blood gases are exchanged in the lung. and oxygenated blood rotums 11a pulmonary veins to the left atrium. 5. Upon contraction orthe len atrium, blood passes through the len /\V val'e to lhe left l'entricle. 6. Upon contracUon or the left ventricle, olygenoted blood pnsses through lite aortic valve to the systemic circuit via the aona and its branches.

\t11r.tl 'ah l' (/11, "'piJ 'alt't'l

The four vahes of the hean ure designed 10 allow one-way now only or blood. Their function is to J>rcvent backllow into tl1e releasing chamber. The four ltean valves work in pairs in tandem: During entrlcular s~stole, the cmricles of the bean contract. and the pulmona11 a nd a ortic vahes open lo allow blood to be pumped into the pulmonary 811d general cii'Clllatory systems, respectively, whi le the mitral nnd tricuspid valves remnitt closed. Dunng ventricular diastole, the aon1c and pulmonary valves close, while the atri oventricular valves (th~ mitral and trirrupid a lves) open to allow blood to pass from Lhe atria to tle ventricles. 1. The. atrioventricular valves- the mitral und 1ricuspid vnlvcs- separtne the Notes atrium and ventricle on the lefltmd right sides oftbe heart respectively. 2. The aortic and pulmonary vah e.< are said to be semilunar valves. be.:ause each consists of three half-moon-shaped valve cusps Lhat are nuachcd to the in side wall of the aonic and pulmonary anerie.~. 3. The apex of the heart lies in tlte left fifth intercostal space medial to the nipple line. about9 em from tbc midline. Tlus location is useful for detcnnining the left border of the bean and for auscultation of the mitral (bicuspid/ valve. 4. The tricuspid vah'e is best heard over the right half of the lower end of the body or the sternum. S. The. pulmonary ' 'alve is best heard over the second left intercostal space. 6. The aortic vahe is best beard over the second right intercostal space.


A 10-year-old eirl comes into the physician with complications from Group A streptotocc:al infection, namely rheumatic fever. She Is presenting with aortic valve stenosis, which Is causing her di:a.iness and syncopal episodes. In the healthy heart, during diastole, the aortic valve:

Prevents reflux of blood into the right ventricle Prevents reflux of blood into the right atrium Prevents reflux of blood into the left atrium Prevents reflux of blood into the lefl ventricle

159 Cop)TiC}n 0 20092010 Onltall>tc:k


The pectinate muscles are prominent ridges of the atrial myocardium located on the inner surfaces of much of the: Right atrium Right ventricle Left atrium Lefl ventricle

lrr\rnh rl'llu\ tf hloud intu llu left Hnlridl There are four vahes that keep blood flowing in one dirc!Ction through !he heart: The right and left atrio,cntrlrular ' '"lvcs -- separate the atrium and ventricle on the leO and right sides of the heart, respectively. - Trlcu<pid valve or right AV valve - guards !he right atrioventricular orifice; consists of three cusps. Thi!. valve controls lhe flow of blood through !he right AV opening. Nott: TI1in but str ong fibrous cords of the chorda~ tcndlneac nnach the cusps of this valve to lhe papillary ntuRies oflhe right ventricle. Tbe mitral vahe or left AV valve - guards the lei\ atrioventricular orifice; conststs of two cusps. Chordae te ndineac anach these cusps 10 papillary muscles of lhe left ventricle. Important: Overdistension of the valves of the atrioveutricular orifices of lhe heart is prevented by tbe ppillary muscles and the trabeculae carncae (nucle ridges and bulges lining lire righl\'enlric/e Q(llre lreart). The semilunar valves: - Pulmona.r y nlve- guards the pulmonary orifice (berween tire nghr erflricle and rhe pulmonary llrii'IJ'): consislll of three semilunar cusps. -Aortic vtlve - guards the aortic orifice; consists of three semilunar cusps. Not~: When these valves are closed it prevents backflow of blood into the left ventricle. ... Important: There are no chordae tendlncue or papillary muscles associated wirb these valve cusps. Papillary muscles are found only in the ventricles of the henn.

Ril,!hl al rium

The pectinate muscles are promincut ridges of attial myocardJum located on the inner surfaces of much of the right atrium and of both auricles (whrdr are small eanical

pouches projecting/ram the upper anterior portion of~ach atrium).

The crista terminnlis is a vertical mtr:s<:u\ar ridge that runs alons the right atrial wall from the opening of the superior vena cava ro lhe rnferior vena cava. The crista tenninahs provides the origin for the pectionte muscles. Note: The crista terminalis represents the junction between the sinus veno>'US and the
heart in the developing embryo. h "represented on lhe extemal5urface of the heart by

a vertical groove called the sulcus terrninalis. lmportant: The SA node is located in the crista ternrioalis near the opening of the superior vena cava. Remember: PapiUury muscles arc cone-shaped mu:s<:les that rcnninnte in the tendinous cords (choroae tendin~ae) that attach 10 the cusps of the atrioventricular \'ah-es (rricrupitl and nurra/'(JIoe). P&pillary mu.~cles are round only in the \'entritles of the heart. nte papillary muscles do not help the valves to close. Instead, these muscles prevenllhe cusps from being everted (or being blown out) back into the atrium during ventricular conuaction.


In a cardiac tamponade caused by trauma, tbe pericardia] sac nus up with nuid. The Increased pressure on the heart prevents the pumping chambers from nmng up properly and in turn causes inadcq uate pumping of blood. The pumping chambers of the heart are anatomically known as:

Vena cavae


161 Cop)naJ!1 0 20092010 OcDoal Dtd.


r Which gland Is sometimes called the " master" gland of the endocrine system, ~
\.. because this gland controls the functions of the other endocrine glands? ...iJ


Thymus gland
Parathyroid glands
Pituitary gland

\ l'tllril'lt>\

The aduh heat~ ;_.. n hollow. four-chambered muscular U'I!Jin that is about the St7e of a dosed flsLAbout two-thuds oflhe hcan'smass is to the left orthc body midlit>e. 1'11e heart and tt> peri cardium make up the contentS ofthe middle media.s11num.11 prricardlunt IS a tough doublrvnllcd fibrous membranous sac Otat surrounds the heart. 11to outer wall of the sac is culled the parietal pcricurdium: Ute inner wall of the ""cis csUcd the visceral pericardium (etli cardium). T11e ponetal and ''isceral p<:ricardia are continuou. T11ts coOiinuhy take> place at the pOints where the maJor blood vessels ente< and lone the hcllrt. In betweettthe"' walls IS tbe perlcardial cavity, whtch con~11ns serous Ould that minimize. friction 01; the heart bents. The anterior surraoe of the hean 1s ttlw known ns 'he sternocu~-ral surf1tce. The anterior sur~ fnce shows p:lrtS or each of the four cltambers of the heart. Right atrium (RJ\) } are sman and located toward the superior regton ortbe heart and Left atrium (LA) are sepnralod by the thin. muscular interatrial S<ptum. Right vemrtclc (RV)} arc lnrger and are located at the apex of tlle heart and arc sepa l.eti entriclc (LVI rated by 1be thick. muscular intervenu'iculat sepmm.
l 'hrte borden or the heart: Risbt border: mude up of the roght ~tnuon Inferior border: made up of right au'iurn. right ventricle. nod left entricle Lcfl border: made up of the ldl entricle The left and n~:ht 'en Irides make up the dlaphragmatlc surface of the bean. This part rcsu on tl\C tlbrous pllrt ufthe ilinphrogon. Thc lrt atrium mnkcs up the ~o-cnlted l.>asc of the heart. When the body ts in the supine tM>sition (lying 011 It !tack). the hcrt ~Is on ItS base, and the I""' of the heart (th up of the left l'f'ntride) piOJe<:IS up and to tbc ldi and lib into a depression on the diaphragm.

Th~> pimitary

ghmd 1s no larger than a pea (weighs onll' 0.5 gnu11). and rests ln the sella turcica. a depression io tl1c .1phenoldal heme at Lbe buse of the hratn. The pituitary connects witil th hypothalomu.~ via the infundibulum. through which this gland recehes che.-nicaland neural sumuh. The pituitary gland is often referred tO ns the "master rndocrinc gland" bccau~e it conli'C))S SO many oliler glands. It dOt:S thl~ through the action of tropic bormoncs -hormones that affect the aollvity of tiDOther endocrine gland. For this reason. the piluitary gland b 'I tal to life.

The pituitary develops from two different sources: an upgrowth from the ectoderm of
tbc stomodeum and a dowu~;rowth from the neurocctodcnu or tbe dicncepbnlon, in other words, an upgrowth from the roof of the mouth and a down growth from the Door of the brain. This double nl'igln explains wlty the pituitary gland IS composed or two cOil'tllletcly different types or tissue. The adenohypophysis (glmrdulnr pllrtiOII) arlsC:i from the oral ectodenn, and the neurohypophysis (lltr>'Ous JH)rtion) urijpnates from the neuroectoderm. During the developmental stage (about rllree weeks), a dierticulum coiled Rathke's poueb arhc. from the roof of the stomodeum (primitil't! momll) and grows toward the bmin As this flO\tCh approaches the developing neurobypophysi~ {po.<l<rior lobe}, its attachment with the mouth is lost. The pouch then goc~ on to form the port ion of tho nin1itary glund known a, the adenohypophysis (anterior lobe).


E ndr s)

Diabetes insipidus Is characterized by the secretion of large amounts of dilute urine because of a deficiency in antidiuretic hormone. Antidiuretic hormone is secreted from the: Anterior piruitary Posterior pituitary Adrenal medulla Adrenal conex Thyroid

Ccp)'n&bl c 2009-2010 DmlaJ Db

( A1"1ATOM1C



A SO-year-()ld female was diagnosed with anaplastic thyroid cancer and underwent aggressive surgery to remove most of the thyroid. Unfortunately, """' the surgeon also excised tbe parathyroid glands. Which of the following could result from !be excision ofthe parathyroid gland!? Strengthening of muscles Weakening of bones Muscle convulsions Decalcification of bones

Tbt puuitary hns IWO mrun regions. The l~rger region. the anterior potuitary (odenohypophJ'Sls), produces at least six hormones: Mnentonlc - CPA B-FLAT GH, ,Croluctin rrom Alpha cel.ls. Retn cells: fSII, Ul, ACTH,ISH. I. Growth hormone (GH)- promotes growth in general, panicularly the skeletal sy~

2. Corticotropin (ACTII)-- controls the secretion of adrenoconical hormones, wboch in tum affect Uoe membollsm of glucose. proteins, and fat. 3. T hyroid-stimulating hormone (T.S'H) -controls secretion of thyroxine by the thyrood. 4. Prolactin - promotes mammary gland development and milk production. S. FoiHde-sllmulating hormones (FSH)- stimulates growth ofGraniian follicle.< in the ovary and promotes spermatogenesis in the mate. 6. Luteinizing hormone (L/1) - stimulates secretion of sex hormones by the ovary and .,-tis.
The posterior pituitary, whtch makes up ubou\25% of the gland, serves as a sto..age area for: I AOB (onrufluretoc hon11one or n.~opres>ill) - conrrols the rate of water cxcreuon onto the urine. 2. Oxytocin -- helps to deliver milk froiJitJte glands of the breast to the nipples during nursing. Note: ADH anti oxytocin are produced in the hypothalamus and tntnsponed on axons to the posterior lube of !he hypophysis ior storage and secretion.

A deficiency of I'TII """lead to tetany. muscle weakncs$ due to a lack of available cal cium in the blond. The body'ssmallest l:nown endocrioegland>. the parathyroid glands an: small. pea-like organs embedded beneath the postcnor surface of tht th)TOid gland. Most peOple ha~e four of thom. Working 10gether as t1 single gland, the porathyroid glands produce parathyroid honnone. l'ar:rthyroid bonnone is the most important regulator of calcium and phOSilhorus cone<:ntration in extracellular fluod It finds tts major target cells in bone and kidney. r~~esc glands are esRntlal forlifc. Each parathyrotd gland has u fibrous tissue caJ)l'Ule and t"o types of cell~: Chief cells- produce parnthyroid honnone, whoch acts to raise the concentration of calchnn in the blood and reduce tbc concentration of pbosphate ions Oxyphil tell< - function is undeu:muned fhey receive onner\'ation from the postganglio"ic sympatbcuc fibers of the superior conic! ganglion. The superior palr receives its blood supply frum 1he superior thyroid artery (from cxremal carotid) and the inferior pair froon the infcri6r tltyrold llrtcry (from thymcr~vlcal

ott: Tbe lh) roctrvltallrunk is shon and duck and arise. from tbe fU"St ponion of the sul>clavian anery close to tbe medial horderofthe scalenus anterior. Thostnmk dovides almost ommediately into the followmg thoee branches: inferior thyroid. supra~<Cnpulnr, nnd 1ranswrsc cervical (or srlfoerjicial cervical) lll'lerles. I. These glands develop from w third and fourth pharyng<:al pouches. 'lot.,. 2. The tlny pineal ~tlnd lies at the back of the third \ entricle of the brain. This gland produces the hormone n1clntonin. This hormone is thouhtlo play a ntlmbcr of roles in humans, uocluding the regulation of the sleep-wake cycl.,, body temperatUre regulation. and appetite.


E ndr s)

Which hormone is the most plentiful a nterior pituitary hormone and is also ) \. controvers ial for use in athletic sports and body building? ~

Foll icle stimulating honnonc (FSH) Luteinizing hormone (l..H) Prolactin Growth hormone (GH) Thyroid-stimulating honnone (TSH) Adrenocorticotropic hom>one (ACTH)

165 Copyn&t!t . 2009-2010 Dental Dl.~


E ndr s)

When trying to locate the parotid d uct, a freshmen dental student in anatomy """' class would consider each of the following relationships EXCEPT one. Which one Is the EXCEPTION? Its opening can be seen in the vestibule of the mouth opposite the maxillary second molar tooth It extends from the anterior border of the parotid gland
It can be palpated as it crosses the faoe, superficial to the masseter muscle

It is superior to the zygomatic arch

104 :>

Remember: The anterior pituitary gland mak~s four tropic bormon~s FSH. LH, ACTH, and TSH . This gland also makes two regular hormones - GH and prolactin. G rowtb hormone (also called somatotropin) targets most body cells, especially those in the bones and muscles. It accelerateS body growth, stimulates cellular uptake of amino acids and protein synthesis, and stimulate.< carbohydrate and fa t breakdown. Prolactin promotes breast development and stimulates milk development. Prolactin release is triggered by rising levels of estrogen.



'upuiur ro


nrch- if i~ ;~cfuall~ inft:.rior In



The parotid gland is the largest of the .alivary glands and is a purely serous glond. It is situated below the external auditory meatus and lies in a deep hollow behind the ramus of the mandible and in front of the sternocleidomastoid. This gland is divided into deep and superficial lobes (which enclose tire facial nen't!). Therefore, a ponion of the parotid lies superficial to the mandibular ramus, and another portion lies deep. The parotid gland is drnined by Stensen's duct, which crosses the masseter muscle and pierces the buccinator muscle to open into the vestibule or the mouth opposite the maxillary secon d molar. Parasympathetic secretomotor fibers from the inferior salivary nucleus of the glossopharyngtal nerve supply the parotid gland. The nerve fibers pass to the otic ganglion via the tympanic branch of the glossopharyngeal nerve and the lesser t'Ctrosal nerve. Postganglionic parasympathetic fibers reach the parotid gland via the auriculotemporal nerve (bra11ch of V-J), which lies in contact with the deep surface of the gland. The u temal carotid artery and its terminal branches v.'itbin the gland, namely the superficial temporal and the ma.xiUary arteries, supply the parotid gland. The lymphatic vessels drain into the parotid lymph nodes and the dtt>p cervical lymph nodes.


Endr s)

T he part of a developing salivary gland destined to become responsible for its functioning Is called the: Nephron Follicle


{:orl)ns!ll 0 20092010 Den!1l D~


E ndr s)

A death-row inmate who was notorious for aggressive and hyperactive

behavior is complaining of abdominall>aln. Hospital tests reveal bilateral tumors that are secreting excessive catecbolamines. The pheochromocytomas are located on which endocrine gland?

Anterior pituitary Pancreatic islets (l.Angerhans)

Adrenal medulla

Adrenal conex

,\th.nollll'l"i' it i' IIH' hmctii)ll~tl unil in 'alhar~ :,!l:uul\ Exocrine glands...., stnK:turaUy and functionally subdhidtd by sepia. platelike mvagmauoos oftheir connecme tis;uc capsules 1111> ammgement app!Jes mninly 10 the pancreas ond sali vary glands. I. Lobu nee the largcSI oft be subunits and ore separutcd by connCCii>< ris:me sept. 2. Lobules ate subunits oflhe lobes aod an: ~par.ued by thin extens1on' of tbe !iCJl'3. Adenomeres are secretory subunits oflobules. Adcnomeres con:;'" of all !he ~retory cells lhat release their products into o single imralobular duct. 4. Ado! (m(J/Ieoli) ore smaller secretory subunits. Each acinus is a ;phcric colle<:tion of secretory etlls sw-rounding tbe bhnd-eoded tenninatiun ol a ~wglc JOtCfcaLttd duct.

An adenomen is COn1p6Sed or:

lntertalnted ducts transpnn saliva to lnrgcr ducts S triated ducts contain a lot or ntitochondrin respo~!!iible for elcctmlylo and "ater transpon during Sretion. Simple.low colutnnarepitbehum lh~<: tho.: duelS Clandulor ull$ - synthesize &lycoprotein> Types of sull''"l')' glands: Major I. Paro1id gland- pwcly StrOllS gland 2. Subm3ndibular (11rbmaxlllao1 gland - mhed serous and mucou~ gland 3. Sublingual glnno - purely mucous ~:land Minor are located on the; I. Lip> 2. Cheolc. 3. Tongue von l::bntr's j:lllnds are n>S~ciuted wi01 cfrcumollnte papill" 4. Hord palate

\dn:n:1l nll-rlulla

Stinutlatiun of the adrenal medullA cuu.o;es th~ 1\'lca.<e of large quantitic> ofcpl nepbrlne and norepinephrine. The same effects are also cau.ed by din:ct sympathetic stimulation, ~ C<!ptlhe errcc~ last longer when llle medulla src:tes tlle honnones. Wuh (If withOut one or the other (medulla or .vympatlretlc 11enes), the oljlans would still be stimulat<d. In other words.lhc medulla functions in a manner shnilr to postgunglionic sympathetic cells. The two adrenal gtonds (ulso C(JI/ed suprarennl glands) arc nauened. >Umcwhal trinngularh:lped endocrine glands resting upon the supCf10r poles of each loom:y at the baclc of llle abdomen. Each gland h3S an outer pnn. the cortex, and a core, the medulla. The adrenal cortex produces three main t>'JlC" of hormones: Glucocorticuids: which arc produced and released under Ute control of adrcnoconlcotrophic hOflllUIIC (ACTH) from tbe pituitary. influeuccs the metabolism offal, protein. and carbohydrate>, promotmg the breakdown of protem and the release of fat and sugars into the bloodstream Minerolocorticolds : stimulate tho relea.-.e of sodiWll in the kidneys

Sex ~t<rolds
The adrrnal mtdulla contains many modified nerve cells, which produce the homtoncs ep lnephrinc and norepinephrine ((1{/rena/ine nnd noi'Oifrenal/ne). 11te~c bormoncs ~re re leased in bursts during emergency situations or accompanying intelt'IC emotion. They act to mcreasc llle strength and rate of hear1 contractions, r.usc the blood sugor le,cl, elc,ate the blood pressure, and mcreasc breathing. Important: The adrenal medulla develops F rom ucuroeetodcrm, while the adrenal cortex ucvclops from mesoderm. 'iote: Nturotoderm is a special~ group of tell; lhat di ffcrcnuate from the ectoderm. lloeurul crest cells arc a specialized group of cells developed front neuroectoderm that migrate from the crests of the neural folds and disperse to sp~ifio sites wilhln the mes nc h)m c. They also inOuencc a speeJali)1Je ofmcenchyme, the Cclo mescncbyme.to fom1 dental tbi.ues.



Par.; nervosa Infundibulum

The portion of the pituitary gland that arises from an outgr owth or the hypothalamus is the:

Adenohypophysis Neurohypophysis

Cop)'Tiaht 01009-2010 DentaiDcd.s




Exocr ine glands indude all or the rono.,ing EXCEPT one. Whjch one is the EXCEPTION?

Sweat glands
The prostate gland Bile-producing glands of the liver The pituitary gland Lacrimal glands

Gastric glands



Remember: The posterior lobe fonns from on outgrowlh of !he hypolhalrunus and conUiins axons from the neurosecretory ceUs of the hypothalamus, along with neuroglialike cells (piwlcytes). n>e anterior lobe (aduuohypophysi<) is fonncd from an invagination of the pharyngeal epilhelium (Rathke's pouch)- thus, the epithelial nature of its cells Important: I. The anterior pilultary or ndenohypophysis is a classical glaud composed pedominantly of' cells that secrete protein hormones. 2. The posterior pituitary or neurohypophysiS is not really an organ bU1 an extension of!he bypolhalamus. It is composed largely of the axons ofbypotl>alamic neurons that extend downward as a large bundle behind the ante ior pituitary. It also forms the socalled pituitary st~lk, which appears to suspend the anterior gland from the hypothalamus. The tropic hormones (F'Slf, LH. ACTH. and TSIT) arc hormones that affect the uctility nr another endocrine gland. Releasing or inhibiting hormones produced by the hypothalamus control these hormones of lbe anterior pituitary. Prolaelin and growth hormont (GH) also made ie the anterior pituitary are not cons1dered 10 be tropic

Secretory cells of the anterior pituitury are categorized anto two g -oups. according to their staintog properties. Addophils (acrdil' <lai11): secrete Gil, and prolactin Bsso11hils (basic stain): secrete TSH. FSll. LH. and ACTH

I h('

pitUif.lr~ ~l.uul

F.xncrine glands are glands whose secretions pa~s into a system of ducts that lead ultimate!) tn the exterinr of the body. So the inner surface of the glands ond the ducts that drain them ore topologically cnnllnuous with the ex>erior of the bod) ( the din/. Endocrine Rltnds. in contmst. place their seen:tions into the imemal en\ irnomcnt - the blood. Classification of exocrine gland>: Type M secretion l.M ocous (secnuc mums= mter~ mucin)- buccal glands, glond.< of the o;ophagw.. cardiac aod p) loric glands of the stnmach 2.Ser<>Ui (en;yme.t)- parotid gland, pancreas and uterine glands 3. Mued (nmCOIIN tmd somtiS) -- submnndibular nnd sublingual sallvory glands. glands of the nasal ca,ity, paranasal sinuses, nosopbarynx,laryn.\,trachea. and bronclu ~lode ofse<:rttlon J. Merocrine -- only cell secretory product rcle.1Sed from membrnne bOlmd secretory granules - pancreatic acinar celb 2.Apocrine - secretion of product plus small ponion of cytoplasm - fat droplet secretion by ruiiJ1lmary glands 3. Uolocrine -- entire cell with secretory product - sebaceous ~;lands of skin and

Structu re or dU<I !)'Stem I. Unbnanebed - ''simple~ glands- sweat glands 2. Dranched - ~compound" glonds - pancreas ShnJIC or secretory unit I . Tubular - cylindrical lumen surrounded by secretory cells -- sweat glo.nds 2. Ad nar (al-.:olar) - dilated sac-like secretory unit - sebaceous and mammary glands 3. Tubulnochta r (tubu/ooilrolar) -- intermediate in shape or having both tubular and alveolar secretory units - n1ajor saUvar') ~:lands




A young girl Jlrcscnts to the physician with a large, round face, a "buffalo hump," and central obesity. She also bas a history of hypertension and insulin resistance as a result of increased cortisol from Cushing's syndrome. Which anterior pituitary hormone controls the production and secretion of glucorticoids such as cortJsol?

Follicle-stimulating bonnone (FSH) Luteinizing hom>one (J.JI) Adrenocorticotropic hortnone (ACTH) Thyroid-stimulating hortnone (TSH)

171 Cop)'n,ah1 C 2009-2010 l'kntal DU



A pancreatic CJtncer patient bas a tumor that presses on the ampulla ofVater.

This has been causing him GIJ>roblcms because the tumor obstructs the \.. common bile duct and the main excretory duel of the pancreas known as:

V.'hanon 's duct The duct of Wirsung Bartholin's duct Woltlinn duct

172 ~ ,.. l(JC)9.l010 Ortol De<:b

Adrenocorticotropic hormone. as ils name omphes, sumulates the adrenal conex. Moce ~pocifically. this hormone stimulates secreuon of glucoconicoids such as corfuol, and has litlle comrol over sccreriou ofuldosterone, the other major steroid hormone from the adrenal conex. ACTH is secreted from the anterior pituuary 1n response to corticotTOpln-reiU$Ing hormone from the hypothulnrnus. Conocotropinreleasing hormone is secreted in response to many types of stress. which makes sense in view of the ''stress ouuongement'' 1\onctions of glucocorticoid.~. Conicotropinrcleasing hormone itself is inhibited by glucoconicoids. Folticle-slhnulating hormone (FSH): ln females, FSlt initiates ovanRn follicle development and secoetion of estrogcas in the ovaries In moles, FSH stimulates sperm production in the t<Stes (spcrn1<1toge11esrs) l .uteiniLiog hormone (LH): In femAles, LH stimulates secretion of estrogen by ovarian cells 10 rcsul1 111 ovt1la lion and stimnlalcs fonnatiou of the corpus luteum and secretion of progesterone In males, LH S1imulates the onterstitial cells of the testes to sccrtle testrn.tcrooe Thyroidstlmulatinl: homtone (fSif) !gul3tes thyrood gland nctivities, uptake of iodine, and synthesis and release of thyroid honnones.

I hlthu:luf \\ ir,un)!

The pancreas is a retroperitoneal organ located posterior to the stomach on the posterior nbdominal wall. The poncreas's large head 1s frumed by the Cshapetlloop of the duooenum. while the tail touches the spleen. The patl<'re-.os riY> >1 role in both the d1gtsll\ e and endocrine sy:>~ems. The panereas l> co\ ered '" a tissue capsule tha panotions the gland into lobule.. The erodocrine function of the pancreas is concemed with both foodslloll'release dunng fa>t ong and foodstuff storage after meals. fhc h\O parocreallc hormonu responSible for~ functions are glucagon and Insulin, respectively. These two hormones nre produced in spc cial cell types willtfn many tiny spherical clumps of pancreatic tissue. which are known as the pancreatic islets or the Islets of Langerhans. Withm the i~lets of L.111j1<rhsos, the alpha cells secrete glucagon, "boch elevate. blood sugar; beta ctUs secrete insulin, \\bich affects the melabolisrn of fats. proteins, and carbohydrates: and della cells S<:<:rcte somatost:ltln, '"bich can inhibit I he release of both glucugon and Insulin. Two ducts that may be associated with the pancreas: I. The main pancreatic duct (duct of ff!inrmg) - begins a< the tail and joms ohe common bile duct 10 fonn the hepaloJiancreatic ampulla (umpulla of J111er) before opening lnto ~1c duodeount. This ampulla discharges bile and puncreatic enzymes into ohe descending ponion (second port) of the duodenum. 1. 1 he accessor) panerutie duct {Sontorln/S duel} - when P'"'cnt opens >eparatel} into 1he duodenwu . .., I. Bartholin's duct is tile major sublingual duct (ll'hen presem) that drains the Nolet' sublingual salivary gland and opens on the sublingual papilla in doe floor of the

2. Wotman duct (ol<u mlled til~ mesonephlc clucr) l an embryonic duel that develops w d1e male into the deferent duct in the female, II ~ obliter:oted.


Endr s)

On a patient's panoramic radiograph, the dentist notices a small, well-defined radiolucency that sits Inferior to the mandibular canal. 1 he dentist performs a sialogram that rules out a true cyst and makes the "orking diagnosis a static bone cavity (Stafne bone cyst). Which of the following salivary glands creates the de11ression in bone that radiographically gives the above ftllpearance'!

Sublingual gland Von Ebner's glands Submandibular gland Parotid gland

CopynaJ'It 0 2Q09..20 I0 l>eolal Dt..




Tht major gland(s) ofthe immune system is:

The thyroid gland

The adrenal glands

The pineal gland

The thymus gland

"""'"P ., 100'>-lOIO De-' Ocds

Snhm.Jmlihul.lr cl:1nd The ubmandibular slnd We!Jibs balfllle \\eithl oflh< Jl'lfOIOd. Tht<glond "often rcf<rred to as 1he >Ubmoxillal)' glnnl. This glnnd lies m !he sutnnndlbulor triIP formed by the unltrior !IIId

posu:riC\r J-.cllics of the dil;aslnt' muscle t'l"d lhc inrt:fiOf llUir~m or the IMOndibh:. The gland 18 poSliiOii<d med1al nd tnfenOr 10 lbe mandibUlar IUJ!IU.< f'31'll) ~'nor an.t panly inf<'110f IO I~ bast oflhe poolenor half oflhe mandible. The glond forms 'C" oround !he unlcrior mOl'!\In oflhe m~luhyold muscle. which d1vide.< the submond1 bular ~lond inlo 11 supc:rtimnl and deep lobe. The deep lobe compdliCH the majurlly pf the ~land. Tho ~landulru clements rue n miAIUrC of <trollS 1mostlrt and mucou> acini ~>llh wcne S<:rou< demilune< 11.< "1he case w1th lbc paroud 5land.lbe JO.u.-nn~ndlbultu gland i; investcJ in 1lS own capsule, "'htch to; a1w conhnumn with the ~uperficia1 lnyer of deep C'C"'Ic:nl fa.."icia. lmport:unt: The mnq.;lnlll 1113Udlbular l)rllnch of the rnciut nerve <~ur><> superliclllco the >uhmandibular 81and nd deep to Ibe placysm The submandibular duct (11"/~nrton. duct/ ari>C> JTom he deep portion or 1M gland and crosse the hn~ual M"C In the reg10n of chc sublinJ!Ual gl11nd to ICTiliiiiDie. on I he ubliugunl CMimtlc (f'Uf'lll<i! ndjacent1o tl1e h11>o uf the sublingual f enulum. When Ihe subhn&ual due< (811rlhuli11 ~
Juc/1 LS rr~l!flt. 1l Ul!.uQIJy tcnnln:lto. On Or ncar lhC li!Ubmaf\dibulnr canu14.JC also. lrnpor1anr. The lingual nent "'1111 MkJ:nd \Vhwton's duct. 1an1ng lih.1'1ll.md t.-nd1ng meditJl co the due~. while CN XII (lilt il,l-p<gluS<il ,.,w) l~""llel s clw >ubmandbulor duQl nmningJul

mfcmor 10 it
Blood ppl~: The blood supply is ftum the sublln~ual btoncb of th<! lln~ual all<"')' ami from d~r >ubmtnlal hnnth oflhc fotlal rtcry. The fllt1alaney tonn.< ~ groo>C m ched<:Cp pan uflhc gland, ~nd lhcn curve up :u-ound llw inferinr mill'gn M1hc mandible to ourply the lilcc. vcu1> drum mtu lhc lbclol ond lilll!unl veins. rh< Lvmph "'''-'ICls drain mlo the uhmandit.llur and deep cenl, ..llymph mldcs l nnen'atlun: Pansyrnpllt.htllt' )C'(.'TCtomotor- fibe.,.... lnrm the ~u~nor .s.ah~Qry nucleus nr the rulal nerve. The nt."rvc Obcr11 p21ss l() 1hc -.ubnnandlhuhu nnnglion vln the ehurda 1yrnpnni ur und lhc liqgual nervt. Pa>lgon:Piulll< por.u~ mpatbrllc fobeM> IJ'l.S ID the @lond ia the lingual nrrw. PO>tganglionc )mpllhrric r~~><t, rt"a.:h Ill< 1ill>d as a plc.us of"''""' arou..t the J~cal ond lingual ar1c110>.



th~ nHI'


Tlte thymus gluud is a duetle~s gland II>Cnted clecp 10 the Sl~ruum a1 1d is sitUnlcd in the superior m cd hutinum. At birth. the cb~miiS ~cigb~ about a half of no ow>ee. ancl funber CJ1Iatge5tO oboul ,cn IIUDCI.' b)' rubcrt). l'ollo11i11g puherl)' lh~ lhytnU> >brink> 10 a fully fibrou rcmuanl, weighing nbout a ltnlf of an mmco. While 1he thymus is pl111 of Jhe endCicrine system. the 1hyruus'< prunary funcuon i that <lf a l!ffllpb organ. Th~ thymus IS the eentnll corurol nrgan for the unmune S)'>trm. l~mphocyll."$ onglnn~r from uemocytOblusls (slcm cell>) in red bonu mnrrow. Those ilitn enter tbe tb.ymus mature und develop into acuvn1cu T lympbooytel> (I.e.. able 111 respoml to <lniiR<"IIS en("OUIIIetl!<l elsewltere In the body) They then diide imo two groups: "Thos~ lhn1 r<-t"lller 1he blood: lhese urt' transponed 10 dc,elopm); second:uy lymphoid tt..<ues, such as lymph tlodcs :Jnd Hplccn. Tbuse that remain in the thymus gland aod are the wuree ul'ftuure gcn<t:~tions ufT lymphocyte<. Muny n111ricn1s function us imp(lrtonr cofactors in the manufncllJre, .<ooretion, and function of 1hymlc honnones. Zinc. vitamin Bt., and VItamin C ore ~rhJp~ tbe mu~l en heal. Zinc is perhaps the mo>1 cnucal mcnel':ll involv.:d m thymus gland fun~ion ancl thyJnus hotmune oction. Zinc is uwulved in vutually ever y apcct or immunity. 1. The lhymu; hns no afferent lymphmics or lytnpiU1hc nodules. "'"'"' 2. Olh~r lymphoid O'l!ans ongioatc ~oxclusidy from mesenchyme, wh<N.ons the 1hymus has n double embryolo~lc origin. Th~ lymphocyt~~ are denvcd from hematopoietic stem cells (me.-e~uJhym~!. while Hussall"s corpllscles fepitirelium) arc derived from endoderm of th third phaJYugcal pouch. 3. The at1eries >Upplyiog lbe 1hymwc nre tlt-n\'ed from the inter nal mammary, upertor lhyrold, ;md Inferior thy roid rtcries. h is innurvatcJ by 1he va ~ u~ nerve.



An aggressive duodenal ulcer has the potential to perforate the small intestine and Involve other organs. A posteriorly penetrating ulcer has the potential to adhere to this organ, which is both an exocrine and endocrine organ.

Thymus gland

Thyroid gland Parathyroid glands


Co!>Y"'!!> C> 2oe-201o """" Du



A patient with DiGeorge syndrome can present with cleR palate,

autism, heart defects, and a hypoplastic:

Thyroid gland Thymus gland Pituitary gland



The pancreas is a retroperitoneal organ located po~terior to ~ stomach on the posterior abdominal woiL The pancreas's large head is framed by the C-shaped loop of the duodenum, whi le the tail totches the ~plccn. The pancreas plnys a role in holh the digestive and endocrine system.,. The pancreas is covered in a tissue capsule that partitions the gland into lobules Endocrine ponion (I.<let of/..ongcrlwns endocrine cell.<ofpaiii:NJfl,f): Alpha cells- secr~te glucagon, wluch counters ~le action of insulin. Beta cells - secre1e insulin, which helps carbohydralc metaboliSm. Oelta cells - secrete somatosutin, whtcb ac1S locally within the tslciS of Lange mans themselves to depress the secretion of both insulin and glucagon. Important: The degeneration of the islets ofl..1111gcrhans leads to diabetes mellitns. Exocrine portion: Acinar cells (poncreatlc e-wcnne cells)- these cell~ are filled with secretory granules coutainiog the digestive enzymes (mainly tryp.in, chymotrypsin, 1Hmcrealic lipase. and amylase) that an: secreted into the lumen of the acinus. Remember: Pancrenuc secretions contain bicarbonate tons and are alkaline in order to neutralize dte acidic chyme that the stomach chums out.

I h\1111h t:land

Defects in cbrotnosome 22 (rrmso nfmost case" oj'DIOeorge syndmme) muy cause a baby's thymus gland tn be smaller than normnl (hypoplastic). tn some cases. children wilh DiGeorge 5YIIdronte don't ba' e a thymus gland a1 alL Remembrr: The primary fwtcnon of the thymus is the processiug aud maturation of special lymphocytes (willie blood cells) eaUcd T lymphocytes or T cells. which are as,,ociated with antibody production. T lymphocytes migrate from the bone mnrrow to the thymns. where they marure and differentiate until activated. Wh1le in the lhymtts. the lyntpboc)'!es do not re.pond to pathogens and foreign agents. After the lymphocytes have matured, they enter the blood and go to other lymphatic organs. where the lymphocytes help provide defense against disease. The lhymus also produces a honnonc, thymosln, which Slimulates !he matunnion of lymphocytes in other lymphatic organs. Note: The thymus glnnd also produces thymic lymphopoietic fnctor (TI.F/, which confers immunological compc1cnce on thymus-dependent cells and induces lymphopoiesis. The lhymus gland is u primary lymphoid organ (alollg wlt/t the spleen, toosils, lymph nodes, alld Peycr's patches) that consists of 1wo )(l bcs surrounded by a thin layer of coonecuve !issue. The thymus &lund is located deep 10 1he sternum in the superior ntediastinum. This glond consists of an outer cortex tbnt is primarily lymphocytes. The Inner medulla also comains lymphocytes and Bassall's corpuscles. These corpuscles are tbougbt to be vestiges of epithelium; their function is unknown Important: Tlus organ appt:ars to be the ntlUier organ in immunngenesis in the young and is beheved by some (bur llOt all) 10 monitor tlte total lymphod system throughout life.



All of the following contain mucus-secreting cells EXCEPT one. Which one is the EXCEPTION'r

Submandibular glands Sublingual glands Parotid glands Glands of the esophagus Mucosa of the trachea

Copyns:llt 0 2009-2010 Omtal Ocd;j


E ndr s)

The thyroid gland can be examined In which of the following triangles of the neck?

Submental Glandular Carotid Submandibular (or digastric) Muscular (or visceral)



l'he.~ glands are ct~mp ltl ~l}


Both ol>e major and mmor ~lionry aiiJlds an: c:ornpo<c:d of boch tpUbeUuno and conoecU.c oinue. lprtlldl3l celt; bvlh hn< obe duco <y>l<1n and produce o~e.ah_.. Con=me oi.,uc surrounch !he "J)H~tlium. prou~cnns

uncl suppOrtlni the gland, 1lte connective us~tu: of the glond

i~ divided

mm the

C8J)~U1L 1

which &urr('IUndS the outer p011lon of the entire olnnd. and 5t.ptu. Each !lt:ptum hdpo divide the iMer ponion of the gland into larger lob..-. and smaller lobule>. ~rndr<lial <>ell> ohal produre s:dtva ""' calltcJ so<:"IOr) ccltl. !'be IWO IJip<' uf t:creoory c<ll< are
as ettbcr otU<!Ott> or serous cells. Sc~tttory cel1~ ltn: (ound in 11 gJlJUp, or ado u.s fJtfl,rol.


udni). whtch rescnlhlcs a clusoer of srnres. 11<11 ocinu.< COII~il or. single IY'f ,,f cuboidlll cells,

ephlu:lhtl cells SOJTOtlndi"S a luru<'n a cemrol O J )tning where tJle $tlltva is dcpusl11:d aller hcir1g produced by'"" ,..,.,<tory cells n.~ lh~ ionm ofacini arc classofic:d ,. orh oype or cpnhelial <:ell rn:.ettland lhe produ<~ heing produced.





or ~..cou.s cells producint: 0 !OCM~t."t secretory JJI'Oduct: BN ~'tncro.lly~'phcriclll with

a t~arrow lu.mcu
Serow cell coooain W!; amouoos orrlR, IT ribo>omc$. prommcn1 Gol&i eomple~. and ODfnl:rolll J"'l<tA-cith. mtmbnme-botmd VCSi<IOS called ..ccrc1~ry !lf'lll\lfts. In ctlf<ohal f>I'O duce dig~:-t.tivt enZ)'llltSJ the..1le vesicJcs are called Z)'llh'&cn gmnules .Mucous Adni: Con>po>od of onu<oos eclls producn111 moco\IS >relory product. arc U>llltlly mO<c rubular wilh a ..-ider hllll<.:n Most rnUC'OUS cells cone am latge n\lmbcrs f'f mucanogctuc grnnul~ an their ap1cal ~.-ytopla5m ~ lle<l Acini: tlave both mUC:(l\,1!; cell$ surrounding. the lumen and 11 'i4'I'OIJII d~ilun t or cap of .!U!rotJII ttll"> '1uperiic:ial w the group of mucons 5ecrecory fls These caps. or serou, dtmUunt>. "'-'a1:1< mlv Ill<: h1~.hly c:onohuod moerccllular .-pace, between the mucous cells. Th~y .arc- UJ\'Ic-Jat.ed wuh the mi~cd ac~n1 of the suhlinaua' and sttbnumdibulnr glond; well as the ~Iandi oo f tfu, tsophnsu ~nd oroch11


tor ,.,,nru/)

Remember: 11tc neck is arbitrarily subdivided inrotwo oriongiL-s by thu sternocleldl)mustoid mu~cJc: the aniHior nod posterior triW1glos. l11e ""terior lrinngle is then sub divoded into the s ubmental, s ubmandibular, musculur (oJr voul!rol), and tbe urolld triangles. The po.oetior triangle is then subdl\ ide4 min the ocdpiLal ~nd supradaicu lar (umod011culorl lriangles. 11tc largest ot'lhc endocrin~ glands. the thyroid gllliitl conslsls of1wo lobes, U te right nnd left. whicb are jo'"cd across by a thiu balld t111led tb< i<lhntu s. T~e lhyroid glnnd is on " H"sbaped struclU"' localed anterior to the upper pan ot Ute 1rochet1 near its JUIICIIOn wnh the larynx . Thyroid epithelial cells-- Ill< cells respon~ible for synthesis or'thyroid Mnnonc .. are tli'I'Dnged in spherts c<~llcd tuyrold follideJ~, These follicles are filled with colloid. Colloid is composed oflbyroglobulm nnd 1odinc nnd is the "'Ofllge form of the thyroid bormon"" T3 o.od T4. Note: Thyroid hormone IS cQ<npO>ed of 1wo diff~rcn1 subsonnces: thyroxine (also called T4, ot rerraiodotltymnine) and trilodolh)'ron lnu (TJ). Thyroid homoooe has severnl funclinns, the main one being In rletennine the metabolic rot< ofb<ldy hs~ues. Important: The production or thyroid hormone is under th" t()Q!rol of th~roid~llmu latlng hormone (1'SH), which is released from rbe piluioary gland. In ltddltlon '" lhyroid epithelial cells. the o hyroid glnn<l houses ouo no her ionporlunt eo d~rine cell. Nt."'lled in spaces betweon tbyroid foll icles arc para follicular or C rolls, which 5rete the hormone calcitonin. Calcilooin acts to reduce blood calcium. OJlP').,ing the effects of pan~thyroid bl)rmone (PT/1), Note: Tbe thyroglossal duel is n narrow canal thol coouecL< the thyroid glnud U> t~ tongue d~rins dcvcloprneut. This duct diStipJI'-ars soon uftcr develop men I of the sluttd. Jn the adull lhe proximal end oflbe duct Jl"rsists as Ihe ror11men ctcu nt of the longue.



~ Hospital tests on a patient identify a tumor In the hypophysis that Is excessively secreting growth hormone. Given that the patient Is a 4-year-<lld male, what is the expected outcome if no trcatntcnt is performed ?

Pituitary giantism


Pituitary dwarfism


CopyriaJu 0 ZOOSIlOIO Ote rtl Oh



In which .wnc of the adrenal gland a rc mlneralocorticoids secreted from?

Medulla Zona glomerulosn Zona fasciculata Zona reticularis


The amount or growth hormone secreted by the anterior pituillll)' gland cau have a dramatic effect on bone development: Pituita ry gint- twnor prior to adolescence, excessive GH delays ossftcation of ep1physeal camlage (nun-fiion of epiphyses) . Acromegaly -rumor after adolescence, excess GH secreted after ep1physeal cart; Iages have been replac-ed by bone (fitsion ofepiphyses), , Pituitary dwarf -- GH deficiency =uhing in early replaccmem of ep1physcal can.lages by bone. Tmport1 tnt point : TI1e deciding factor in whether giga.ulism or acromegaly wi ll occur wbeo there is oversecrction of growth hormone by the pituuruy gland is whether the cplp b )$CS or the long bones ha,e fused with the shaft or not, 1\vo lobes of the pituitary J!land (hypophys/,r cercbrl): 1. Posterior lobe- Wlmyelinatcd nerve fibers, secretes AOH and oxytocin, 2. Anterior lobe Alpha cells (acidophl/,r: stain strrmgly with acid dyes) 1. Somnlotropes - secrete GH 2 Lactotropes- secrete proloctin Pa rs d lstalis Beta cells (basupllil, v; .<lain .rtrongly with basic dvc,r) I, Corticotropes -- secrere ACTH 2. Gooudotropes - secrete FSII and LH 3, Tbyrottopcs - ,o:crcte TSH *** The pars in termedla and tuberalis have no proven function in mammals.

.lun.t t.:lomuulo\a

The two adrcnol glands (11/so called sr<prcmmal glands) are flattened. somewhat triangular-<haped endocrine glands restmg upon the superior poles of eaeh kidney ur the back of the abdomen. Each glond has an outer pan, the corte~, and a core, the medulla, The adrenal cortex is composed of three layers, or zones (endocrine tells 111'1! organized into these tlrree ar~as), 1. Zona glomrrulosa - thin layer composed of clusters ofcell< beneath 1he conneelive tissue capsule. Cells secrete tltc mineralocorticoid,, primarily aldosterone, which :rn: involved witlt the maintenance of electrolyte and wnter balance. 2. Zona rasclcula.ta -a thick middle layer, the cells are arranged in parallel columns that run at right angles to ~te surface of the glnd. Cells secrete tlte glurocorllcolds, primarily cortisol, Small nmounts of estrogenic- and androgenic- like substances are also produced, 3, Zona reti<ularis- mner layer of cortex, cells arc arranged in a network of interconnecting cords, Secretes small amounts of cortisol and dchydroepiandrosterooc

Remember: The meduU of the adrenal gl3nd really is modi tied nervous tissue and functions in :t manner similar to po~tgllnAiionlc sympathetic ceUs --stimulation of the adrenal mcdulln causes the release of large quantities ofe11inepbrine nnd norepinpb rine, The same eO'eelS arc also caused by direct sympathetic stimulation, ucept the effects III.St longer when the medulla secretes the honnones, With or without one or the other (medulla ur sympatltetic nerves), the organs would still be stimulated.



Meibomian glands (or tarsal gla11ds) are sebaceous glands located nt the rim of the eyelid that function to protect the eyes (rom drying out. Meibomian glands, which release the entire secretory cell witb the sebum secretion, are thls type of gland.

Apocrine Holocrine

Copyrisbt 0 20091010 Dm~l Oecli



Which salivary gland can have either numerous small ducts that open onto the noor of the mouth or a single main excretory duct (Bartlwli11 s d11ct) that empties at the sublingual caruncle?

Submandibular gland Parotid gland Sublingual gland

CqJ)-nJh1 0 20092010 rknll Db


Exocrioo gl1nd have a Ju..1 chrou11 wluch lhm produce (sweat. ..a/h.,, dige.r/1\'e PIIJYI!Itl, etc.) IS rei~ F..xc>enno glands wichio lhc incc:gumcnlllt)l sy<l<m incJu~e sebaccouo vl<lnch I> h/ch "" uss~dated n rlh Jrarr fo//ic/1 and Ol'l! donc't!d .from eclnd.rm), s\\ eal glands. and mnntmary
glands. Wi1h111 lhe di.:cst.ivc sys1em. exocrine glands mcludt 'hu salivary glands.. g:lstrte glands

Mthin the stomnch, and ~he exocrine por1ion orlht JXIn'-TCas.


Ch,siticatinn ul' 1'\m'rim. (;lands

Example> SaliviU)' ...d rrun;rube slond. .:crmin S'\\eat g:l.a..n&b
MlltUDe!l' glaocb., ,"efta,iq w.tol &ll!llds


1be lland ceJI'{ produce their STdiOCU ud rtlense !hem enco lhc clucc, cau:siug no cboma,ce lo lhc cell


The ICCr'C'UOM a('(:Wtlulate in one pan of1he ecU, collod doc ap!Cil regJOII Thcs part b<caks ofl fmm che rut or lh~ ceU ~long "''ith soote oytopJasm. rcleastng ltJ. pmduct inlo lhe <!ucc
and n::htMt the. "+bc.1t: ceU h'll(l Ote du~t. 'This Jestroys the c.cll, which ih rq>laced by a oew growth <:ell.

H(IWc:r111e Ac:cumul:nc lheJr secretions-ir1 each ceii'K t.')'tuphmn

S~h:tceo"-~ gJt mds nft:ktn

Endo( riot glands ;CCII.'IC !heir products (lwn11oner) 11110 lhc cnlermotoul flue~ sum>undong lhe SIXTetory cells front w~coh !hey diffuse 1n10 c~pillanc>IO be carried away by tho blood l:nrlotrine glands constilule the <nducnn~ system and inc:luJ<: lbc puuuary, lhyrocd, JIMIIh)nliJ. odrel\lll, ai\J pineal glands as "ell 11> che gonad> and lhc i>lc11 of Ungcrhans fexucrilc~ <Y:II.< (!( lh< pGnrrr<U/. The major ullt ry gl1nd tpumlld. "'INnanJi/Julur. und scrM/ngua/) are cbsolficd compound cubwoaheolor ~;lands. lhcy delier chetr iall\ncy secretion> into lhc moulh by "oy of l:orge ~--:<.:reory ducts (Srenft11 :r, Whor't(m \, amltlr~ numtrotts small Rh;,u.-. S Jurl.f) rcspecthcl)'. 1'\ote: TI>e pornlld gland and von Ebner's gla nd nr tho only adull salivary slunds chat arc purely serous.


Suhlin::.:,m1l t,:l:lml

The sublcngunl gland cs the smallest oftb~ thrtc main salivary gland>. It cootnm.< hotn serou~ and murous (witlt .<em11s demilunr.J acme, the lat1er predommatcng. II b locmed beneath the oral mucosa in the floor of the lll()Uih bcc\\ccn rbe rnillldible on one srde rued the gcnmglo..sus and hyoglossus muscles on tlce ocbor side. The sublingual gland sils on lbe mylohyoid muscle. UnUk~ the submnndcbulur gland. which drsirus via 011e lnrgc duco, the sublingual glnnc.l dmins via approxim~c~ly 1220 small duets (RM11u.: ducts) al11ng the sublinb'tl~l fold along the floor of the mouth. Tbe subhngunl glfinrl is iunervated by pnrnsymJlathetlc secrctoml)tor tlbers from superior sulivnoy nucleus of cbe facial nerve. Tbe nerve fibers p3ss co the submandlbular gtlnglinn via lhe chorda 1)111Jranl nerve and lhc Ungual nerve. Postganglionic parasympathetic fibers pass 10 the gland \'ia the lln(tual nerve. Postgangliomc symr;~chetic liben; "'ach the gland as a plexus of nel'\<es around lhe facial and lin(!Wll anenes, fhe blood supply ~ from the sublingual branch of che lingual anery and from the submental branch ufche fadal artery. lmporla nt: T11e veins clrain inco U te facial and liogunl ''~Ins. The lymph ve$Sds tlncin in111the subcnnndibulnr and deep cervical lymph node. Sometimes che numerous su~bllngual ducts (12 IIJ 2/J ;, numbel) JOin 1 11 form u single main excretory duel {Banltoli11 i; duel} chat usual I~ em plies on co the submandibular duct Note: Yon Ebner's el:~nds are located around the drcumvallau: papclla uf the IUilf,'Ue. Their main funcuon ts co rinse lhe food a"ay from the papilla aJlo:r lbe foocl has~ IBSted by the ta.<tc buds. Those gland are purely serous.


E ndr s)

The portal venous system occurs when one capillary bed drains into another capillary bed through veins. There are three portal systems In the human body: the hepatic portal system, the renal portal system, and a portal system involving which endocrine gland?


Thyroid gland Pituitary gland

Adrenal gland

183 Copyright C 20092010 Dc11tal Otds




A pathologist receives a salivary tissue biopsy of what the dentist believes is pleomorphic adenoma. Howe,er, the dentis t f~rgot to mention the site or the biopsy. The pnthologlst identifies certain histological structures that would indicate that this sample is not from the parotid gland. What structures can be seen in histologic examination of the submandibular and sublingual glands but not In the adult parotid gland?

Myoepitbelial cells Serous cells Intercalated ducts Serous demilunes Striated ducts

PituitaQ J.!l:md

A ponal venous system occ~ when a capillary bed dratDS into another captllary bed thtough vcms. Both captllnry beds aod the blood vessels that connect lite beds arc con sidered pan of the portnl venous system. They ar~ relatively uncommon as the maJOrity of capillary beds drain mto the hean, not imo nnother capillary bed Portal veoous systems arc considered venous because t.ltc blood vessels thnt join the two capillary hcds nrc either veins or venule;. Examples of such ~ystcms include the hepatic portal system. the hypophyseal portal system, and d:te. renal portuJ system Blood supply to lh~ pituitary gland is from the right and lett superior hypophyseal arteries and fmm the right aud lelllnftrlor b) pophyseal aneries. which are branches of the internal carottd anery. These fonn the nch va.,cular hypophyseal por121 system. Thts system of blood vessels links the hypothalamus and the anterior pituitary. This system allows eudocnne communte:ttion between the t\\10 structures. The veins dmin into the in tercavemous $i11uses. lmt>ortant: The neurohypophysis contains abuudnnt axons whose cell bodi~s (trc lo cated mainly in the suprnoptic and paraventricular nuclei of the hypothalamus.

or Ori;:in and Trrminulu~:~ ul Pituilar~ Gland

AdenobypophJ sil (gltmlur poriiOil/

Oral ectodtnn (from roofo(ttolll<Hieum)


Pars disralis Pmmberalis Pan tnt<mnedta

Pao;nerv\l58 lnfimdtblllum

} Antcnor lobe } Posterior lobe

lftum}loor uftltenuplulltml

(nerve portion)

Important: Se<retory cells are found in a group. or acinus (plurol. ocim). which resem-

bles a cluster of grapes. There are three forms of acmi. serous, mucous. :tnd mtxed.
Mixed arinl: these glands bave both serow and mucous cells. The mucous <ells form tubules. butthetr end arc capped by serous cells that secrete berween the tnncou. celt~ intercellular >pace. These serous caps on mucous cells are called scrou demilunes. Appl'Oximmely I0% of submandibuJur glands contaiu serous demilun~s. hut these glands are predominantly serous acini, which constitute 90% of the gland. The sublingual gland contains !Serous demilunes amid iL~ predominant mucous cell population. Serous cells are present cxclusivdy un demilun<! or mucc)US tubules. Note: Tbe key potnt is that the paroud gland and the vou Ebner's glands are pun!ly serous and do not contam any mucous or mi1ed acuu. These demilune cells secrete mucus that contains the enzyme lysozyme th>t degrades !l!c cell walls of bacterin. Jn this way, lysozyme confers antimicrol>ial acuvity to mucus.
Rcmemb~r: All of the major salivary gland~ (parotfd, .w bmandlhtllflr. allfl subllllgual} are classified as compou nd tubulo:Uwolar gluds. This m~ans that their ducts branch repeatedly (comtXJtmd) and their secretory ponions arc tubular and compose.! of small sacs called ulveoll or acini.


Endr s)

Follicular "colloid" is a protein substance that stores:

Thyroglobulin Triiodothyronine Thyrotropin


CopynJ}It 01009-2010 DenQI Ol.t




1 The small, pea-shaped pituitary gland (h)popllysis) is J""ated on the inferior"""~

"surface of the brain. This gland is positioned In the:

Infratemporal fossa of the sphenoid bone Sella turcica of the sphenoid bone Crista galli of the ethmoid bone Cribriform plate of the ethmoid bone

rh, roclnhulm
Thyroid epilhehal cells (folficulor cells) -- the cells responsible for synthesiS of thyroid hormone-- are am~ng<d in spheres called thyroid follitle5. Th~sc follicles nre filled wi1h colloid. Collotd I> composed of thyroglobulin nnd iodine illld is the storage fonn of the thyroid honnones T3 (iod01hyronine) and T4 (tltymxinc ar rctraiodotll.wrminc). When the pltulluty j\l~nd secretes thyrotropin, the colloi.d becOme$ uctlvc, ond thyroglobulin molecules arc released nnd token bock into the folliculnr cells by endocytosis. where the tnoleculcs ate broken down into thyroid bormoucs, tbyroxmc (T4) and triiodothyronine (TJ). :-lote: The T3 Blld T4 .1re collecti~ely referred to 11.\ the thyroid hormones. This hormone then passes out of lhe follicular cell< snd enter.; the blood5trc~m. Wnhin the bloodstrerun, almost all of the thyroid bonnones ate bound to pla.<ma proteins such llS thyroid-binding globulin (TBO). The thyroid normally produces aboutlO% T3 and 90% T4. In tht! tissu<"s, howeveo, much of the T4 1~ converted to T3, which is the major active form of tbe tbyroid hormones I the cellular level. Follicular cells remain inactive at timus ol' low thyroid hormon~ need and can he activated when it is necessary for tlle mubdi7JUion of colloid found wilhtn t11e thyroid follicle. :Sole: MetabnUcally inactive follicular colloid will stain ~cidopbtlic (stu/Its Jtrongly ...lth oc1d stains) wbile metabolically acthe folli~ular collmd Will stain bas1c stams). basophilic (stairu strong/!'




ur lhl 'JIIU.'OUid buill..'

The sdl turcica (literal/; ThrkisJ sttddle) ~a suddlesbaped depte;;sion tn the sphenoid bone at lhc base of the skull. The seat of the saddle is known ns the bypo(>hyseal fossa, wlticb holds the pituitary gland (hypophysis t~rrbri). l.oeated anterior!) to the hypophyseal fossa is tile tuberculum sellae. Complettng the fonnation of the saddle WJtc>norly is the domom sellae. The dorsum sellae ts terminated laterally by Ute pu.ottrlor clinoid processes. 1 1. n1c crista gn lli is a sharp upw!U'd proJection of the ethmoid bone in Lhc midNot., line, for the nttachnent of the fillx ccocbri. 2. The cribriform plate consists of perfurotcd areas on either ide of the crista galll. h trunsmits olfactory nerve bundles. 3. The infratemporal fossa ties inferior to the temporol fossa ond the onfrutem por.al crest on 1he greater wing of the sphenoid bone. 4. The noor of the sella run:ica L< also the roor of the spbenuod smus. Important points to remember concerning the pituitary gland : I. Blood supply 1s from tbe right :t11d left superior hypophyseal al'1cnc; .ond from tlo e right and lei\ Inferior hypophyseal aneries, whttll are branches oftbc ontcm;tl carotid artery. These fl)rt\1 the rich vascular hypophyscai i>Ortol system_ 2. Tho nlltetloo 11llultnry or adenohypophysis is a classical gland composed prcd(lminantly of cells that sectl!te protein honnone;. 3. The posterior pituitary or neurobyJ!OPhysos is not reaUy an organ butttn e~tension of the hypothalamus. The posterior pituitary IS composed largely or the axon~ of hypothalamic neurons that extend downward a.~ a large bundle b.:hind the antenor pituitary. The posterior pilllltaty also forms the \0-(:0IIed pituitary stalk- whtch nppc:ars to suspend tloe :>oocrior gland from lh" hypothalamus.



Oxytocin and vasopressin arc synthesized in the hypoyhalamus and are transported to the pituilary gland for storage by ""Yof:

Myeli nated nerve fibers Both myelinated and unmyelinated neNe fibers Unmyelinated neNe fibers

CopyTia}lt 0 20092010 Dm~l Ob


Conicospinal tract Rubrospinal tract Vestibulospinal tract Reticulospinal tract

A fighter pilot in W\VJJ gets shot down during a mission. Miraculously, he survives but arrives at the hospital unable to perform fine motor movements such as writing his name or buttoning his shirt. Which descending tract of the spinal cord would be damaged In this case?



l 'tun~ l'linah:cl m:n l' tilwr'

As oppos~d to the anterior lobe (odenohypophysis) , \Vhich prc.entS epithelial characteristics, th~ posterior lobe (neuroll,pophysls) comists of about I00.000 unmyelinated nxons of secretory nerve cells, the cell bndics of which are housed in lhe supraoptic and paravcntriculur nuclei of the hypo~talumus. The secretory products (oxytocin ond vosopressfn IADHll are transponed down the axons and stored in the axon terminals of these neurons in the neurohYJlOphysis. ~se products are released into t~ bloodstream when needed. Thus, oxytocin and vasopcessin are syn thesized In the hY ilothulamus tlnd stored In and released by the neurohypophysis (specifically, rlre
pars JJen.'Osa).

Important: The hypotbalamo-bypopbyseal portal tnct refers to the way in which secreuons by the anterior pituitary are controllc.d by honnones called bypotbalamie releasing and Inhibiting factors. These fnctors are secreted within the hypollmlnnms itself nnd then conducted to the anterior pituirory through the rich vnscular hypophyseal portal system. rhis system of blood vessels links the hypotbalamU> :md the :mterior pituitary. This system allows endocrine commuoicauon between !he two structures. Remember: The pituitary glund is an endocrine gland located in the sella t\lfcica of the sphenoid bone, attached to the hypothalamus by a stalk (infundibulum). Through the infundibulum pass impona11t ncrw tracts and substances that act upon the pituitary.

( ntlu.o\,pin.lllr.H."I
l'rucl~ d.~t~ndmJ: IOthe spmal cord :~re con~ml!d Wllh volonlory motor fum.:uon, mu:;clc tone.. rc:ilexes

and equ1hbnum1 vrsccrnl innervation, and moduhatlon or asccndmg s~nsory signab. UnivtrsaUy rt!;u.n.led \1)' lhc single most i .mponant li1Cll'Onccmed "ith ltd volUDtiU')' acthiry.lhc:: cortlcospinallract origUlOin rrom pyramicloshap<d Its tn d)., pn:mOCOC', pnmOI)' moiQC', and primal)' seno,QC')' oomx


\131' lh"<tndln:.,: I r.Hh orlht '111n.ll urd


Funetl01 1




Ll'etal oonaoospin.al

Voluntary mo"cmcot. eontract.on or individual Of .....0-ofmusoleo, panlr:v.latly those movinJ hands. finsm. fert, and toes ofopposilo.side
$3me. U II I.C'taJ coctiClX(Mfttll

lAtetill whtlC Motor attu or


wtbral ronc' oppos:ite ~ from Uilet Jocallon 1 o cord


......... ,.,

AnttriiK corticoo;:p!nsl
t-/irct:l11}~1 14/J
L~tl~oo"'"f l ret~eulo&rhnl*l


""'""' .....t y - of
""""std< M3inly (acalhotory influcnc:c on molOr neurons to skdct~l



Motor C()C\(_'( but on lar..-nJ Of -~ nk .. toe&I ton in cord column,.


LtuemJ y, hjte Retlculw fonnntla11, L.ucrol '"' eolwrub midbrain, ponll. !lnd untc:rlot 8nt)



MWy anbobitooy ..n._ on motor nturoas tO ske.lctal muscles

""'""'" ... bite


Rrocular fonnalion. J.ooml or medulla m"udy anlcru'lf" j:fl)'



Coonlmotlon of body D0\1Cmtllt and poslm=

l..au:rnl wbltf Red nucleus cot1111111:1 (oj midbraml

~teriJ \\-hilt

IDtcriUf ~(mY

V anhlolospnlll

Medi.tlcs tile ooOu..- or the

..cstibtdar end organ and lhc t<:tcbcllum upon exti!OSor muscle tone


L:stmJ \c:Wibultr nudeus. (4th vtnfric/tJ

"' """""or Latc:ool

!lmenor Kfi!IY column\


A 56-year-old male Jlatlent with type JJ diubcte comes into the emergency room with a painful blistering skin rash localized over the left side of his forehead. The unilateral nature Indicates a herpes zoster (sllingles) infection. A localiLCd a rea of skin tbat has its sensation via a single nerve from a single nerve root of the spinal cord, and which is isolated In s hingles, is <ailed a:

Fasciculus Dermatome Spindle


Copyrigbt 0 2009-1010 Dmtal ()h


Which cerebral lobe is the visual processing center of the human brain?

Parietal lobe Occipital lobe

Temporal lobe

Frontal lobe

110, Ill , 112


C.O.'riabl c 20092010 ""'"' O.Cb

Oerma1omts ~ 1be aru-. of <kin $l1Jlplicd by a smalc spmal nct.,.e, bowc>tt. lhcre 1> 11>-..ally <om< ""erlap ~- odj~~CC~~I dnmatomcs. Eaob of lhe 31 sc~'m<nts uf 1hc <pinal cord giVe< n: 10 opour
flf spinal nt:I'C$. whtC'h cany messages into and ou1 of the CKS. These spinal ncl"\'t.S bnnch huo snd

service particular areas of the body. Ultimately, c1'!eh nt-rvc ends up innervating a differen1 rrt~ion of the ~kin, called n c1c:rmtomt'.. with the exception of ~pinnl ne:rve Cl, which d('CS 1 \0l ploy a role in

Pt'!riphetal n ~r"vt inncrvl,lion of the skin (t'Uimtvml:~ lnnenYJtitm' n.sually forms ;1 ditfcl'<!nt pBttem lro111 spinal nerve ~"'in mnc.'f\'IUion (dermrttome) because the ventral primary divh;ion.; ur ,pir,~l nerves form pluuse.s. Thb allows multiple spinal nM~.) lo cons.titute 3 penphernl nerve. For example-.. the museui(J<;llbni:OO$ nerve" oompaoed of,..,.tral pnmory dt,.Stons of <pinal n<r>cs CS. C'6.111d C7. \Vhcn 1he <Ul.UI<OU> poruon of lh< ncne r<acho:$ 1llc ...,,n of 1hc l&lttal foranl<tl, lilt bnmcht> from eac!> of1he S{Nnl """'"' su1111lY 1hrir rapccthe<ltnn>141'ne$ Kt) J>')in11o ro~mb<rr: Thep3nomor dislribwon of 1hc: pcnpherolnm c ('IISCOIOC'IllanNIUJ) 1$ dtffOftiU from 1ht dtn113Hl1n< pollem Important: Crani~l nCI'\'( dt.:rmaLOmcs do ru;t hi''"C 1ny o\eri3Jl (aiY not tnnl!'t,o:ucd by molY! than one nt::n!e) whcrca; "f"nal nerve <k-muuomes onrl.ap c:.1c.h other by SO"rGas instmJncc aga.tN.1 aoe-:tht-eiia or a dermatome. The lO~!i uf the ovcrh1p reqUires lht: lus:s of i nnervation 10 tbree adjacent

in !he middle dermatome. For e:rampl e~ aJI thr~e of 1he dursal TS, and 'l'6 W()Uid ha\le 10 l:'le sew:ccd or durnu~-:d to creme anesthesia in dcnntuome 'I'S. Severing a. pet;ph!!ml n~rve produces a different l'attcm of anesthe!iia Of! the $kio. 'iOii: This i"' di~gnosed by the ncurolugJS1 to detenninc if the' le. .o1ion ls '" Mt.pm~tl ncn1t' or pc:dphtral m:rvt. R emt.f"'tMr: Rrferml p:un is c~uscd when the knsory fi~ frOD\ an internal otpn rotc:r the <pirPJ cord in the same rooc a, m)trs froo1 a de:rmal.OI'I1t. The br1tn ~ poor at inlcTJirrll"-i vur.~t pam JfKi imlead 1Ditt'fl'<l$ 11 '"' pain from 1he somobc ore& of tb< dnmatom<. So pam m 1hc: IIQtl IS often inltrpl'tiM .,. J'&ln in 1ht left orm or shoulder. pam tn the dtophmgm i ini<I'J>f'ltd 1011!1 the lfi da,~c1e md neck. and the 'ssilch in your "Side you sc.nnc-umts feel when runnmM: is p:uo 10 1hc liver as ns vessels vasocon ~t ri ct.

de.rmatome~ m produce ;mctilhi!Sia ruol't ur in1erco~t.11l nerves T4,


Ocdpilal JuiH.'

The cerebrum or contx (rhe extensn.vtomer I.Ji tr of gray matrer ofllll! urebral hcmuphereJ)

is the hugest pan of the human brain, associDted \\1th higher brain function >u<:h a;; thougbl and act1on. The ccn:bralconcx is divided 1010 four <eenons. called "lobes": tb< frontal lobe. parietal lobe, uccptallobe, and temporal lobe Note: (I) 11le limbic sys1em, ofieu n:ferred to as the "emotional brnln," is found buried wuhin lhe em:brum. (2) Basal nuclei are I!I"Y mal ter structures deep wnbin each cerebral hcm15pl1ero th.11 help 10 control skeletal muscle activity.
;\rca nf Ctrebrnl Cortex

lsasSO'ilited wnh n:asonmg. mo1or sk:ilb, lu~bcrl...-~~:1 cuv.nitiun., and a.~tV< lanpge


rrcrronlalat'ta or frl'lflgl

Coocemcd Wllh lhc t:ontrol or social bebavtar, mohvatMMt. and

pbnntlll! Primary moltr trn
~of ianp1lOJ;<"

<ffn>n1al lob<


Is assoc;iau)IJ w.lh proct"Ssing UCiilt s.eru;ory mrl'lmall~>n RKh 1ti

presSUI"\'., \OUCh., lnd f)JI Ul

. . .

l'mrce:nlrtliO"'' Mp!tnetaJ lobe Primary ur\fory .Ntor bQUl}nt or IJU!iletnlral ~, Pr1mary IJI!ItCl area So uw.tolltll.~OI')' ~(')rh.~ Is esscntioiiOIJ1e:. procestiQ! of the body'! .st'~



Prtm11ry wl~u~t l arn

Primary auditory torttx. ~hldl is importa.nl tOr iDICJJ'TWn.g !10tlnd11Dd the tangu~~ ~C' heat. Primary olfactO') ana

Ttmptnu lot~



Msoc:iatcd lh lbt (ormanon of memories


Which structural component of a neuron sends Impulses away from the cell body?

Neuroglial cell Perikaryon Dendrite Axon

Copyrigln C 2009-2010 l)mlal Db



A 14-year-old female patient presents to the physician with hypeq1igmented lesions (cafc-au-lait spots), hamartomas of the iris (Lisch IIOdllles), and auxiliary freckling (Crowe's sig11). The patient had previously been diagnosed with neurofibromatosis, but is now complaining of generalized pain and tingling. The physician discovers mulliple neurolemmomas, classifying the dbcase as a form of neurofibromatosis. Neurolemmomas are a sarcoma of which cells that are responsible for myelin formalion In the peripheral nervous S)Stem?

Astrocyte Oligodendrocyte

Scbwann cell
Microglial cell Satellite cell
Copyritbl 0 1()09. 20 I0 Dm!al Ded.$-



Nervous tissue is composed of two types of cells: I. ~eurons -ttallSmit nerve impulses. 2. :oleuroglial cdls (glial cells) are non-ducung suwon cells"' of nervous tissue. ElUII11ples include astrocytes, anacbed to the outside of a capillary blood vc>sel in the brain, phagocytic microglial cells, and ciliated ependymal cells that form sheath that usunUy lines Ouid cavities in the brain. SITuctore of a neuron: Cell body (perikaryon) .. contain~ the nucleus and most of the cytoplasm Locmed mostly in the central nervous system as clusters called nuclei, some found in U1e peripbcral nervous system as groups called ganglia. Dendrites - neuronal procc.~scs thm send the impulse toward the ceU body. There may be one or many dendrites per cell. Some neurons lack dendrites. Axon (nerve fiber) .. neuronal process that sends the impulse a\Vay from the cell body. If lhe axon is covered \Vith a fatty substance called myelin. the axon is refem:d tons o myelinated fiber. lflhere is no myelinated cover, then the axon is referred to us an unmyellnated fiber. Neurons are classified according to structure (based on the nwnber afproresse.f that extend from tM cell body): bipolar, unipolar, or mulnpolar (most common). They are also classified according to function: motor (~ffel'l!nl), <Cn$ory (afferent), or interneuron
(which lie between sensol) and moturnermm.v in the CNS). Note: Whether or not someone feels different <rimuli (pain. temperature. pN.>SIIrc. vt<.)

is detennined by the specific nerve fiber stimulated.

SdnH1nn cd l - also calll'd

n curnll'nlmoc~ tc

nr neurolem ma cell

Sch\Vann cells in the peripheral nervnll' syMem serve as supponive. nutrithe, and service facilities for neurons. The gaps m the m:elin sheath lhat occur between adpccnt Schwann cells are called nodes of Ran,1er, and serve as points along tbe newon for generating a signal. Signals jumpmg from node to node travel hundreds of time> foster than sig11als traeling along the surface of 1he a.on (lrnoH'n as StdlotOI)' cmrdll(:tion). This aUows your brain to communicate Mth your toes in a few thousandths of a second. 'iote: There are no Scb\1 ann cells m the CNS (central nen-ous .fptem); ll1c myelin sheath (In the CNS) is fonned by the processes of tle oligodendrocytes. Remember: The neural cest is a buncl or neuroectodermal cells that lie dorsolateral to tl developing spinal cord, wher-e they separate into clusters of cells (neural crest f)el/s) tho develop into dorsal root gnnglfon cells, autonomic ganglion cells, chromornn cells of the adrenal medulla, neurolemma cells (Schwmur cell.<), int~~tumentary pigment cells (me/anocytes), and U1c meningeal covering of the brain and spinal cord. Importan t: Microglial ceUs lire the resident immune ceUs of the cent!"'.al nervous ~ystem. Their function resembles thnt of tissue macrophages.



Which of the following a scending tracts of the spinal cord function to carr y pain and temperature sensory information to the thalamus?


Lateral spinothalamic uact Anterior spinothalamic uact Fasciculi gracilis Cuneatus

Spinocerebellar tract


Copyright () 2()09.2010 0tn1al Otd:s



N rvs)

Which of the following spinal nerve structures is exclusively composed of sensory fibers?

Ventral root

Dorsal root
Ventral rami

Dorsal rami


I :Jltral \(linnth:tlamil- tr.Jct

The white mancr of Lhe spinal ron! oonwns tracts that ~r.~vel up and down the cord. Mlllly of these ~roe~s tra\elto and from the brain 10 provide sensory input 10 the brain. or bring motor sllmuli from the brain to oomrol effectors. Aft"Jldlng tracts, those !hal troveltoward tbc hrnin are sensory, desrendln~ tructs are motor.
\1!1j tlr

II :wh ul I h1 'tiiiHII ( u rd



Loau.llln a>l&ltnM






OMIO"ht sa-

Pa1n. tc:mpcrlllun:.l\l!\i tnldc touc.b Li!tral W~ti.C

l'nod<-~ad ........

Pe-ttenot _gray (Olumu

oppositr side:
~rcnor pay roWmo opposile'$4c




~~""""-~md~J'~ itCf~ aJ'Id tWOpoin\


r~-- \j,bue. Sp;ool _ , . ""'" ....

- ..


d.ic:nminaciUfl, also COCUCJ(I;Is


Anln'lor ;tt111 ptxltri Unc:unsl'ious kineslhc:si.a qm!Oftbcllc

bi.OIOI whu,e

Anterior or posccrlcn
gray ool\unn


Note: For mosttructs. tbe nnme will indicate If it is n motor or sensory tmct. Must sen sory tracts names ~gin with spino, indicating urigiu in the spinal cord, and their names

end witl1tbe part ofthe brain where the ll:lct leads. For example, the <~ino~halamlc ll'ICI travels lfomthe spinal cord to the lhalamus. Tracts whose names ~&lD wuh 3 pan ofthe

brain art motor. for example, the comcospiiWitroct begms with fibers leavmg the c:=bral conex and tnwels down toward IJ'Oior neurons in the cord.

Uon.tl rnut

Tbt sprnal c:ord


(motor) palh11o"l)'> forrno5t oftheOOdybdo" lh<h<>d andn...:k. The spinal cd bcglmatlh< bram<~em lnd ends at bou.t the a.ccond IU11100r~cncbra.. T'hc \tlbt"f)', motor, Bltd inlcmeutoll) ~found m11ific patb of the tptn&f cord3nd nt-01rby SU'OC'UltCS Stn~~l') ne-uron~ hl\'e lheir ce.U bodies tn Ihe. ~pma1 (r/Qr $ul mm) ganghon. TheJrtxQI'lS tr'8\'GI through the dorsal root in1o the gray maner nf1he cord \Vithm the gray mauer a~ 1l'lteme\il'(1ns wnh which tbe ~en"'JY ncun,ns may co'tlncct Also Joe; led ~o the w:ray lrtJ1rt;;.r Jre the motor n~uror~s whose s.xons Ui\'tl out the cord lllnn.~gb the nontrl'l root. The whue nuu

the. connuon c:c-nttc for lht ~oc::'(~ as well as the afferent (stnJui'Y) ond effert"nt


1er 'S\Irroundll the gray nliHtC'r, It contains tJie splnoltr.'IC'L\ rhru ascend ;uul descend Ihe. :splnul curd. At J I placc~~o t~IOD,Q the .spmnl curd, Ihe dorsal and vcn1t:~l Mlll$ come 1ngc~her to fonn lifhntl ner"t$. Spinal nl.'fVC.~ coob'lin both Rcnsory -and moto1 fibers, .:~ ''~'most nerves. SpinnJ ncnclf nrc uiven 1\Uil'~.. rhattnJicotc the: portion or the vct~cbral coluo111 m whrch the ncnt$ arise. 1llere nr< ~ ctn lUI (CI llllloro<ic (T/112), s lumblr (llI.J). 5 ....., (St.S5), ill1d 1 COC<)g. .J ...... t'ocrvc C"l !.ttlsts bt.C~ttn dtt Cnlniun\ an.,l 3t1i1J (/~t &tt'\iical 'ff~bnzl. ilnd Ci ames bet\WCil the 7d ettY1"11nd a '>I fhorac1c wnc:btl A111hc other.; arise: below rhc re"-pcctn-e \t:ffcbra or fomJtr vct1cf'q 10 lltc n.sc of


ranu. ptbltnotly.

thtsacrum. Srrnal n<rv<'l di\ld< mto b<an<h<s <aile.! .-.mi. Vr:rrlr.l pnmary ramr exit interiorly. an~ dorsal prtmary

A nerve plr-t.UJi IS a 1'\t'lworl:- or adjac.ent Spinal nerves dut JUfn togelht..T. Tbe name of t~ch plcX.lh de ~bcs. the urea its ncncs supply. 'fbe major nerve pfexu..,cs ttnd areas r.bcy supply :u~: ctrvicat: htlld, ,eck, shoulders, dinphr.agm brachial: upper limbJ and some neck -and should~r musck"S lumbar: p8.11 O( lht abdominal wall, luwet limbs:, und cXIt."rtllt1 maJe gt."flhah;~ satrtll: penncum. buttocks, and most uflhc lo~Ac:r hmbs pudendal: cJtle:mal female gtnitalta Sensory impub.:$ rn"laloog the5CUS"'Y (oj]cnnL w sudillgJ ncur;l parbWllys to the l<ll>Ory <or tu in the pon.,.llobo of the brarn wbeft they m rnl"'l'fctcd. Moror uopolses ,,.,..1r,.., the b<aon to toe 11111SCICS aloo& the moe (tfJ'"tn~ or d<$C'<ndlllt;) pothWll)> Thcsc impuls<s on~,na~ rn the motor conex ofthe front~ I lobo ancltra\'d along ppr:r rnoror ncuton' to the peripheral nOf'ous >)'litem t;pl"" motor nn:roM una10acc '" lht bram and front MO major 'Y5"1.;m.s. thr pyramJd.Jll ""d rxtrapyran1idal syn ems.


A student dozing orr in class is unexpectedly called on by the professor to a nswer a question. Not knowing the answer, the hair on the back of the student's neck stands up, his pupils dilate, and his heart starts to race. This ligbt-orOigbt response is controlled by tbe:

Somatic nervous system

Autonomic nervous system

Skeletal division Sensory nervous system

1 5
Cql)Tiihl 0 20091010 ~tl Dks



Which meningeal layer Is fibrous and forms the falx cerebri and falx ccrcbelli?

Dwamater Arachnoid mater (membrane)

Pia mater

Copynabl c 200..2010 DtmaJ Decb


The cenrnl n<nous S)'lit<m includes the bnun and spmal cord. The peripheral off" ous S) tm consiSL< of all body""""" Motor neuron pathways are of two typ<">" >Otni lit l.<kel~tol) and utonomic (>mnotll mr<,cle. cardiac mu.<tle. and glmuls). '111< autonomo~ ~ystem i~ subdivided into \he wympathetlc and parasympnlhctic systems. Tho I'NS coot, ists of all nervous St!\ >C(UJ"eS located outside the CNS. The PNS includes the cronial nurvet).lln~tng J1'(1ollthe infbrior<tspoct oft he bmin. nod the s~inal nerves, nrisiug li-om tbe spinal cord. '11tc ~NS ls divided fitncti<>nally into ercnt (.ven.,ory) and ~ffcnut (molr~r) di visions. The offert no dlvl<lon of the PNS includes sornRiic sensory neurons which curry ompulses 10 the CNS ti-om the skin, t'>scia. and JOool"- alon~: with 'isce1111l ><n> ol')- neurons. which carry ompul~ from obe vi_, of the body (lmngn- pangs. blood Jll"i!...Wf"t) to th CNS l'be cfTC r<nt dl>ilioo ufthe PXS is divided mto the sumo lie (\'olomtnry~ lind auronumi< (m-olulltary) ocrvuu~ system
( umpuri,un nt lhl Sumalir :nul \ulnnumk
:\enuu~ S~\h.'lll"i

r. ff <Cto~

Sltete~al noUS<le

Glands. t~moo th musc::le. cardJ .c- rruL&CIC


csuany volunlllr)'

Uwally nwolonwy

O..e nerve fiber rrom CNS Two""""' m.... from O.S 10 effecror,

to efTector. no l!J.Dl!lia


Acrl)'k:bolm< (Ach)

~- ... S3'1gl""' Ach and nxqllnc:pilnne INE/

E.<C1t110 ooy or inlubooocy

E!fcooon t8f8tL cdl!; Always excttablc

Effector ~ <11m Arion Flaccid pa;alys~>

Dcn.:rvation hyper!;ensltlv,ty

Uur:1 rnahr

The mcrunges m three concentric protect!\~ membranes surrounding the brain and spmal cord (rhe CNS). 1. Dora mater -the outennost tough fibrous layerthot lines \he skull and fonns folds. or rct]ecuons. that ~csccnd into the brnoo's fissures and provide staboluy. T he dural folds nrc the following: Falx ccn:brl He< in the longitudinal fissure nud separates the cerebral hemispheres Tentorium ccrcbelll- separates do c ccrebnun and the cerebelhom F11lx ccrchclll separates the two lobes of the ccrebeUom 2. Arachnoid noembrane -- is a fragile network of collagen and elastin fibers with a cobweb-like appearnnce. The arachnoid r.nembrdne has moderate vusculuri ty and ltes between the dura mater and the pin mater. 3. l'ia mater -- iruoermQSt membrane. it is ao et.remely thin membrnne made up ofcollagen and clasue fibers containing many blo<ld vessels. The pia mater adh~ closely to the braon and spinal cord. These arc the structures invohed in mcrungous, an inflammation of the meninges, Which, if severe, may become encephal o tis. an Inflammation of the bra on. 11te ~ubaraehnold space, filled With cercbroSllinal Ould, separates the aruchnoid membran" and the piu ntntcr. 1n addition, the meningenl area has two potemial spnccs: pldural5J>ucc- over the dura mater; becomes a real space in the prcscnc0 of pathology. s~ch o~ accumulation of blood from n tom meningeal artery (ul! epidur11/

Subdural spat e- a clus<dspace with no egn:ss between the dura mater and the arochnoid membrane; often the >itc ofbemormage after head trauma ;.lote: In the ventricles of \he brain. the pta mater and ependymal cells contribute to the formation of rhe chcoroill ple.{US~s. It is these plexuses that regulate the tntrnvemricular pressure by seere11on and absorption of cerebrospinal ftuod.

A patient in the dental clinic hates getting alginate impressions taken on him because he is a "gagger." Which or the following is the most inferior portion of the brainstcm and controls renex activities such as coughing, gagging, and vomiting?

Midbrain Pons Cerebrum Medulla

Ccp)rigln 0 20092010 Otn,al Oks


N rvs)

( \..

Which of the following meningeal structures Is a ring-shaped fold that allo"'s the passage of the infundibulum of the pituitary gland?

Tentorium cerebclli Falx cerebri

Falx cerebclli
Diaphragma sellae

\I Nlulln The broln ~lcm, which is continuous whh 1he spinal cord below. consists of the mid broin, pons, ~tud medulla. P:l!l!ting through the brain stem are ascending pathways cnrrying smsory information from the spmnl cord to the brnio. and descending palhW'a)'S. carrying motor command down to the spinal cord. Centers in tile bnun stem regulate many vital functions. including beartbeut, respirdtion.and blood pressure. The mldbraln connects dor.;ally wi1h the cercl>ellum. The midbrain relays motor sig uals from the cerebral eor1ex to ll1e pons. and sensory 1r:1nsmission in the opposite direction, from the spinal cord co the thalamus. Tbe oculomotor (CN 1/1) and II'OCWear (CN IV) nerves arise in the midbmin. The s ubstantia nigr~ in the m1dbrain helps 10 conltol movement. lesonns of the aubsll1nti3 oau>c Porkin.sun 's diseuse. Tbe pons Ues below 1he midhmin uud connects the cerebellum wolltthc cerebmm. The pons also links the midbrain 10 1he medulla oblonpUI. It is involved with motor activity of the body and o~1ns. In addition 10 hou.<ing one of1he brain's respomtory centers, 1bc pons acts as pathway for conduction tmct~ between bnun centcrs and the spinal cord, and serves as the oKit point for cranial nerves V, VI, VU, and VII I. The me!! nil oblongBia is the most inferior portion the brain stem and is a small, coneshnpcd structure thai joins the spinal rurd al the levd of the foramen mag)lum. The medulla oblongata functions primarily os a rday s1a1ion for the cro.S111g ofmotor tram between the spinal cord and the brain. The medulla oblongata also contains mcchanisms for controlling rcfleK activitie> such as coughing. gagging, swollowing, and vomiting. It's the site oforigin for cranial ocrvt'1> IX, X, Xl. and Xll. The mcdullaoblonaa1n also cooHains a central core ofgry maner called the rctlco~ar formaUon. This area 1~ in~olved in regulaung lccp and arou><\1, and io pain pcm!J>Iioo, and tncludes Vllal centers that regulate breathing and he;on acu,;ry,


The dura mater is the omerumst toush l1brous layer thai lines lbe skull ~nd fonns fold., or reflections, that descend into tbe bnun, tls,ures und provtdesH1b1l ity. Tbe dw'a nl~ier is composed of two lnycr~. The endoteullo~er dheros tightly to the inner swfb llftlte cranium, and the meolngeollayer fonn.' pnrmion~ (folcls or rrjlectimu) cbatdesc<'tld into the bram's fissures and provtde stability. The duro I folds are the following: Two vertical folds: Falx cerebri -- lies in the IQngitudinal lissure and sepnrnres the cerebral hemispheres. Contam< Inferior t1nd superior uglttlll sinus.,. FIr tere~rlli - separates the two lobes of the cerebellum Conmi"" occipital sinus. A horlzoutlll fold: Tentorium cercbelll separa1~s the cerebnun and me cerebellum. Concnins 1he straight, transvene. aud suptrlor petrosal sinuSC'!.
The dural veoou~ sioust>S are spaces between tbe endosteal and meningea11aycl'li of ~1e dm o. TI1c sinuse~ ~'Onlaiu venous blood Ihat onginu!es for the ntost pan from the bmi1 or cranial cavity. The sinuses contain an cndoohcli~llining t11 u1 IS contillUOtls 1111 0 t11e ve1ns Ihot arc connected to the aiuu<cs. There are no valves in the simo.es or in tl1c veins that are connectcd In the sinll'>tS. The \'ll'it majoril) of tbe 'emlll'> blood tu the sinus drains froon the cranlwn via 1be intemal JUgular vein.

Note: The diapbragma sellae. is a ring~~uped folu of dum m. nu..,. covering the sella n1r cica, ~nd containing an U!lerture lor passage of 1be iufuucJibt~um ol'the ricuitary gland.



Basal nuclei

The hypothalamus Is part of the:


Cqt)right C 2(1()C).l(IJ0 DtMall>tch


Which type of neuroglial cells form myelin in the CNS?

Astnx:ytcs Oligodendrocytes Microglia Ependymal cells

COfl>-naM 0
200 4:0092010 Ocmal DJr.s


The brain lies within tbe cranial cavity of the skull and is mnde up of billions of nerve cells (neurons) and supporting cells (glia). Neuronal cell bodies group together"-' gray matter, 31\d their processes group together a. wbire matter. The brain can be divided mto four main pans: the cerebrum, diencephalon. bmin stem. and cerebellum, The cerebrum is the largest part of the brain ami consbiS of the five paired lobes with the two cerebral hemispheres, connected by a mass of white matter called the corpus callosum. The cerebrum accounts for about 80% of the bruin's mas> and,. concerned with higher functions. including perception of sensory rmpulses. instigation of voluntary movement, memory, thought, and rea;oning. There arc two layers of the

- The cerebral corte< is the thin, wrinkled gray mauer covering each hemisphere -The cerebral medulla is a thicker ~ore of white maner The diencephalon hes beneath the cerebral hemispheres and bas two main structures -the thalamus ami the hypothalamus. Tbe walnut-sized thalamus is a large mas~ of gray matter that lies on either sidt: of the third venmclc. The thalamus is a great relny station on the aiTerenl sensory pathway 10 the cerebral cortex. The uny hypothalamus fonns the lower part of the lateral wall and floor of the third ventricle. The bypothala mus exerts an inDuencc oo a wide range ofb.>dy functions. Remember - Each portion of the braJJI cow;isL<; bastcally of three areas: I. C ray matter -- composed primorily of unrnyellouted nerve cell bodies 2. While matter- tom posed basic.ally of myellnoted nerve fiber.. 3. Ventricles-- spaces filled with cerebrospinal nuid The cerebellu m is auacbed to tltc bratn and feantres a higllly fold'd ~urfuce. It is 1111 porumt in the control of movement and balance.



;o.;euroglial cells. tho; uther major cell type in neural tissue. provide structural integrity 10 the nervollS system and ftLnctional support that enables neurons to perfonn. Neurogliu dt> not typically have synapS<:.\ nttheir surface. Classically neuroglial cells arc described as existing only in the central nervous system (bral11 md ~pined cord). Cells in the PNS that suppon neurons include Schwann cells and satcllitt cells. !\'ott: With the uceptlon or llli<fOllli. which denvc from mesod~rm , all neuro~lla derive from l'<'toderm

M1ny ~ aawbed 1o th<:ir

f'nnn m.yeUn .!halhr ruvund axon& 111



11 bod)'
~mi\Ocr edl bodies than Mrrot:ytcs and relntlve1y fewer processes teav;nt; ll\e cc11 txxty

1 1>c CNS
~loin phagoc)tlc c<IIAnd :uuig<n p.....,ring <tlb 10 lilt CNS


Smallest cell bodic 1mong. tM ncurosJia

C'<>lllllUUt cells "''~' Cllintod f=

Ependymal <ttb
Ch~r~idal tolls

Line m ostoft.h~ "cntrieulM<S)'Sicmof

Form the inner 1 -aytr of lJ1L' choro1d

Modified cpcndymlll cc:lls

plexus. Stcrete tfN.'br~ pin lll fluid anto lbe wntriclo.

S.iellue celli Schwrum lis


Small, flanened cells

Flattcntd celts am1na:;cd in seri6

Sut11mrt ct"-U bodi~s In yanglia Wllhtn the rNS

Form Jn)'tlin With en the P~S


As a general rule, parasympathetic preganglionic neurons synapse with postganglionic axons in ganglia:

Near the thoracolumbar region

At the cranial nerves

gans Near or within 1nrgel or Of the paravenebrni chain

201 Copyrlgllt 0 liJ09.2010 Dental Dtt\s


The tbird ventricle of the brain communicates with the fourth ventricle by the:

The two foramina of Luschka The intervenlrieular foramen The cerebral aqueduct The foramen of Magendie

Cop)Tigllt 0 20091010 OC'ftQI Dttb:

111e aulonumit ntr,ous system nut.S bodl1y functiont~ Withoul our awareness or rontrol. 111!:1 the. mo1 or ~ySicm to visceral orgnnll. It rs divided iniO IWu systt:ms; Sympathetic (lhdruco-Jumbar) di\lMon:
"Fighl frigb~ or Oig~r Deri\c~ from lhool<rcand lumbar '1'111&1n~(TI-L2) Preganglionic nturons (mrduwltd); rclw-cty sbon Cell bodoos an: located anllle ontcm><daobter.tl gray column oflll(Jfaeic and lumbar ,cncl>rn< - Prcgan(lhonic ucuums c1ut ""n~ra.l root .... into while l"l'nn.u commumCAIIUllS - ,.ynL'Ipse w11h

postgang1iomc axon in periphcm.l p.o.ngliqnat the .snmc l"wcl or another level - Ncurolransrnincr is acttyl~hl)linc Postganglionic uoos {Wtml-tllnat~dj rdarivcly lortll . Cell bodoc>"' jl<riph<nl Jloi!ISI"' cxu:nd ro visceral Ol'gilll>

Omnbuuon as wadc>p<d
Neuro1r2nsmmer is nort'pinephnnc Parasympalhttlc (rraniai&OC'I'OI) diVIMOn' -"(ood or StX" . Dcrivod lrt>m <r3nlnl and $Ueml ncrw - Dl Ill. Vll. IX, >n<l X; Sl-S4 PregangUunlc neurons (mytllllillti.l) . relali\e-ly lon& .. Synapse with P\l'Slgan.,ghomc axonoc m pnglia close 10 organs ~auorransmittcr is aeetyk:hohnc r ..~gngllonlc nons (umwrdmaltdl: !1:1amdy shon .. .NeurotmnQniUc:r is accrylcholinc: - 01stnbuuon i~ more spec:cfic nnd lc~s d(ffuse lh::tn Jtymrathcric Sympathetic ''S. Pnnasympafllelk Most organ..; bnvt < hlHil11nc:rva6on In generaJ, the actions of one system oppoo;c ahosc of the ot~r Bolh dav1sion:t r\! toopersth m sall\vy @larKb Predomtnant&one ts parasymp:~tbttlt tn most <Kgan) Symporhcuc tone exists solei.\ an ~nal medulla. swear glonds. pilo<:r<eror mu~cle< ofskill. and

many blood \'C~<11

Sympathetic J1.,1 nbU110n \ends tube 1111m! difruse whereas parn..;ympathetic i' mvrt spedtic

There ZIJ'e four \tnlf'ides an <he bram. They connect wath tl!Cit other.lhc cmral canal oflbe spinal cord, and the lnlbarathnoid sp3ce >Um>unding the brntu and spinaloord. The entrklos contain ccrcbro~pinol nuid, which act> ns a shock absorber. cu$hioning 11te bmin from mechanical tbrces. I he right and lei\ lalfral nntrlcles are in the ri&ht and lcll e<:rebral henusphcres. respec tavely. The \eotricles communacure "ith tbe nmow third ventricle an lh< dicncepholon through a small opening, the intenentricutar foramen (/(>ramen ofMmtl"()). l'bc third ''en tricle is continuous with the fourth ventricle \ia the cerebral aqueduct (ul>o called tlw aqueduct ofSylvius) that rraverses tbc midbrain. The l'ounh ventricle is located dor.;alto tlw pons und medulla. and ventrnl tu Ute cerebellum. A single median a pertu rl! (foramen ofMa gemlie) lltld n pair ortolcral apertures (foramen oj'Luschka) provide communication betw.:cu the founb vcntncle and the subarachnoid sp:u:e.

Cerebrospinal fluid is produced tnainly by a Slnlcture called the choroid pie> us in the lar cral, thir<l and founh ventncle.. CSF flows from lho lnlernl ventricle to tho third venrrtclc through rhe Interventricular forame n (aL'o called thefarnmen ofMomV). The rhird ventra cle and the fourih vent riel~ arc connected <o each other by rhe cerebral aqueduct (also culled t/oe aqueduc1 ofSyMru). CSF then Oows into the subarachnoid space ihrouglt the foramina or Luschka (Ihere ore two ofthe.<el and the foramen of Mogeodie (only one ofthese). Nolo: Absorption oftbe CSF into the bloodmeam takes place in the superior sagittal sinu; through SU'Uclures called arachnoid 'lUi. When the CSF pressure is grearer than the venous pressure, CSF will now into the bloodstream. Bowcver, the arachnoid villi acl as one way valves"- if the CSF pressure is less than the venous pressure. the arJchtHtitl vlli will NOT let blood pass into the ventricular system.



A 23-yearold male medical student is experiencing diplopia and goes to get ""' an MRI done. The scan shows non-descript pcrivcntricular lesions, and so a spinal tap Is done to determine wbetber the patient has multiple sclerosis. Which space is entered when a spinal tap is performed?

Conus medullaris
Subarachnoid space Arachnoid space Central canal

Copyrigbt 0 2009-2010 Dmtal Db


:'lleuron ceU bodies are located in:

White matter of the spinal cord

Gray matter of the spinal cord

Copyriglat 0 201'J9..2010 Oen~&ll)ec;b

Th< 1pioal cord ends 10 the adult around L1 (l.i lo L2). The dura aod amchnoid, bowe\er. conhnue down to levd S2, where the arachnoid fuses wnb the filum terminale. Tims, a needle inserted between the spines at L2 and L3 will enter the subarchnold lllQce, which is filled with cerebrospin~J nuid, without injunng the spinal cord. Cerebruspinl nuid (CSF) is a colorless, thin nuid found in the veuuicles <>C the bruin, the subaraenootd space, and the centml canal of the spinal cord. CSF is produced I!Ulinly by a structure called the choroid pleJus in lhe lateral, third and fourth ventricles. CS~ escapes the veutncular system of the bram through the tbrre forrumna of the fourth ventricle and so enters tlle s ubarachnoid space. CSF now circulates both upward over the surfaces of lhe cerebral bcmi"f'heres and downward around the spinal cord. The subaraGbnotd space extends down a; far as the second sacral \ertcbra. Evenmally, tlle nuid enters the bloodstream by passiug toto the arachnoid villi and difTusins through their walls. I.Tlte choroid 1 lexuses regulate the intruvcntricular pressure by secretion und Not<s absorption of cerebrospinal fluid. 2. The cerebrospinal fluld, along with the bony and ligamentou; walls of the vcrtebml canal, protects the spinal cord from injury. 3. Ependymal <ells are cells that ll\llke up the lining membrnnc of tbe ventricles of the brain and of the central canal oftlte spinal cord. The)' are also present to the choroid plcu of tbe centrnl non ous system and partiC1pate in the production of cerebrospmal flutd.

V.'ithin lhe pinal rd. the H-~ ma:s.s of PI> maucr "' dhlded inao ~ "l:uth c-on:s.1'R I'Mtft)y vf DhU"''t1al ec:U bocha and u in1mnediacc tone Pot-lt-rlor (IIM'IOI) horns: Are .spt"Cia.hztd tu ptl"C\"\) ~'OJ)' inronnaliOO M~ch as IO\II:h. f'IJM, and joint kJ15-Illinn. and to relay this iofonnalltm 'o HI( br.1m Antcrlur ('>-"1Ural) horns: comaiu .mutor ncun.Wi. wluch uausmil messages out 10 lh rnlt'ie1~ vla spmal nnvc11 An inrerm(':dllllt 10ttt: COIII<tln$11Ul11Y intemcurons that UN in \Jolvc~t in linkin iucomtnM ~t:nwry ncuroM wilh outgoing mutOt ncuruus to brint; about 111110nm1N (r~fltxJ rtsponk51hal do not l1 wulvt: d1( bnun. \Vbit:t matter SUI'f\)IJUdlll~ the: OUICf J'l3Il u( tho.c hom-e COI\fiS') Of myelin~ ltd 11CJ\C Jibrh gt'UoUp~tl functi'lloaJiy m vcnical c:olunuu., Of tracts. lmportani: 1be cd1 bodi~ ('flOe sontari..: motor ~)ISttm lte ""ithin lhc aottrior or \tntr.J hom. 1 he cell bodies of the 50f"ft3lx: st:n'Df') ~tern lie wuhan the P'G"trlor or t.kmal hom 'The nct'\es that Uc "11hln tbr sptnaJ cord a.re u.p~r mo1or ntui"'Dt (UA.fNtJ, 100 \heir rurkuon 11 so rany 1.be mcsS&~"C:S bxlt and (onh from tlk bm.in tot~ spu\11 ncn~ 1lang lhc Sf!'lnil tract. The Ipfnal ntn H lbat brMch out ho1u 'he o;pinsl rord to lbc: blhcf parts of the body art calk"d lo~rr oJolor nt'urons (l.AINr). lh.ese spmal nC'J"oc:s exttn:nd enkr a1 e.ach 'mcbrat lc\ d and CO'Inmunkutc lf>ith spcciric ll'tt!S of the body. J'he sensory porU,,ns or01e LMN cany m~~gcs about SC1,~tlon l:t.Jm the skm aud Olh~r body p3m and

'"""'111! throu!lh lite ..,eb<ot <3mlt

The spinal cord cxt.cnck rmm chc: ba.w ortht ~l;ulllfl J

PQtrtl ~bo-te

two-thirds oftht o;,ay dov., '~ Mck.,

organ!' 10 tlte brain The motor portions orlht LMN send 11\CM'It!(t.S rrom tl~e Imtin \0 lll" vtmou.s body rarL't \o 1nitintc action..~ Mith 11.!1 niUSCit! movement. Important: S)'mJUithl'Ht prtJtllngllonlc: ntlJrfin ntuh.'S Preganglionic oturonr may du un~ or three Lhlng'i: L Enter lhe paru\'c:nebml gat~.g.lioo at the. srunc: 1U\tcl \ril the \rohi-tl.! ramtt:s c:otnmllnt~~ns ~a.n..J syn:~pse
tbtt-e. 2. Entcr lbe prllrl\enct>ntl g>DSE.., artd cillteJ .....00 ot ckfcen<lto aoomcr levcll<l '>"'I" a1 that

!e-el J. Pass Lhroufb the p1ra~mebntl gal'l@hon via the \\<hue nmus. commuru~ and cyrnq~ m ' melml i111&lion.


In the peripheral nervous system, which fibers carry impulses to skeletal muscle?

Somatic sensory (afferent) fibers Visceral sensory (afferent) fibers Somatic motor (efferent) fibers Visceral motor (efferent) fibers

20$ Copyright Cl 2009-2010 Dent1 Dtcb


The ciliary, pterygopalatine, submandibular, and otic ganglia arc all:

Sympathetic ganglia Parasympalhetic ganglia Bolh sympathetic and parasympathetic ganglia Neither sympathetic nor parasympathetic ganglia

2M Cop)tn&bt c 2()09.2010 Dental Dceb

Soma tk mulnr (,.jj ntntJ fihrf' Functionally. the fibi.'f't of pt"ripberaJ net'\e~ may Cllhtr be somafit or ' lsttr111 and abo e1thc:r 't:nsor) (ojftTI'JU) or molor lcfforrnl). Tbt.re are rour lypts of fibers: I. Somatic stosory (n(for-ent) liben carry impulses from tutaneaus t nd propriocq>ll\e rectptor:.. 2. Vis('eral senttory (qfft!"nt) fibers can)' irnpu111!e$ from the viscera. 3. Soma lie motor (effernu) fibers carry impulse~ tn $\t:Cietal musde. 4. Vlseeral ruotor (ejfC!rem) fibers carry impulse~ to smooth Rnd cardiac muscle und to ghmds. Somatic motor"' vl,c.eral mol or-: Somatic: mol or nt.:urons arc din.-ctcd from con"ollevelA tu skelc:tl!l muscles and m volunu1ry. Visceral motor nruronJ are din:cted (rom tht hypodualamus and midbrain and 11ft \ olunto.ry. hut ha\'C input from the cone:..'\ .and thalamus. Somatic lo"tr mocor neurons at"C" in cbc ventral hom or pay mattcr and the ncurotl'lnsmltl at skd<Utl muscle IS trctytcboline. VtsraJ moror nt urons cumc: from f:f'IDla) ntf\"t"S ot tbe mtennediolau:rn1 gr2y hom, mvol\c rwo neurons, and the neurotransmitter is. either acetylcholmc: or norepinephrine al ctther tardioc muscle. imootb muscle. or ilands.
C'umpun,un nl fhL' S~mp.ltiH.'hl' :tnd Pttt.t\\lllfl:IChelic Uhhiun'

t)n&ln In t;NS
\..aaut~n ul


C.:rnntc_,-1 (Cl' lli.VII. IX.
nd X: S2-S4)

Thorncolwnbar (T ILl)
Plmt\crtclJral p.nJbS ldjxtni CO


Tcnnical ganglia r.earor w.thln

Jpioal column and I'"" cncb<al pn_Jlia ammor to 1 t

f lbcr I=Jih

Sbon pr<ganglloru.: l.ong poogaogllonc


Sbori post&anJiionc
Minim:~ I (tbout1 .2)

Lo"' -gl;ooM:

.Ntturonlll dl\trgcnoc Extenswe (abolu l

F.tfcct5 on J)IStcnt


Otlen \\idespttad and t:nrr.ll

MQre local ami o;;pccific

Parasympacheuc pnghJ are the !lltonomsc f:lliJ.h3 ot lhe J'MU}'mparhctic ncnous ))SU."'JJ Most are small lenniMl poaJII 0< mlrJmaral g2:1gliL > IWIItd !hey be ncar or wilhm the c>tpns they
inner\ ate. Parasympalhttl< gonglla: C~ lll Cilia.-,. Rnxlioo- eye CN VII Pttr')~upalatine and submaodlbulafw_"ngllun- eye and nasaJ DlUC~a CN LX Olic ~:ngllotl -parotid .salivary glam1


CN X To ~:mgl1a on em:h organ S2-s4 To lafC intestine, rectum, gt:nitalia, urttun. lmd urinary bladder Neurotran~mltter 1.~ acttyleholine al pre-- and po~tg.QngJionlc synapse!! S)mp11lhetic. SCAngli: organized lnto two c:bain.s that run JXtmllclto and oo either side oftl\c spimal cord. Para"t rttbral J.tn,aha; lie: un each .side oft be- ve-rtebrae and areeonntcted lo fonn the symp:alhc.."tie<ham or uunk. Th<'f1: .., ll<ually21 or 2) P'IJl'S ofll1<"' pn&Jia: ) in thetnVtcal n:giOO. t 2 1 n !he d~ racu: rcsi""- J Ill 111<: tumbot region, 4 ., the soct'll ~:ion. and a stngte. uupw-ed pn~hon tymg m fron o f the -.:yx ealkd the g2:1glion impar. Ct"ftll g.&ll&lia- superior; middle Of ioftr1or ct.n Jtal ganglioa Tboradc. lumbar and scrat ganglia Prt\'t th:bral (or pYr!oortlc) ganglia: pmvide uons tht!.l are dis:tribuled with 1hc three mUJOr gas~ rroinLt::,tlnal art~ncs arising from the.aona "CeUac g11nKiiun Supetior ltnd Inferior mesenteric gangliofl tnftrior bypoga~tric ganglion ** Neurotnmnlllftrl' norepinephrine (NE), ~:tttqt on adtenal mtdufla wbert il i1 actl)'lcholint.
Whitt ramus and J,trA) r:~muJ tommuo.Juos: ~\bile nmuJ comm~nictn.s; All sympalbttic. prqan~llonk neurons eolcr che parncnc:bfll pnghon cbatn v, the "'hue ramus communicaas. They art white btc:aus the nnv~ are m)t:liMttd. Gray nmus cotnmuniC'aa.s carry llDI:n)'thnatcd poslganst)Jonjc sympatbeti(" ocn ei tn peripheral organs.. They aregroy bcn.Uk they are onm)tlinaltd.

Endoderm Mesoderm Ectoderm

Which of the foUowiog embryonic tissue types gives rise to the central nervous system?


Copyright 0 20092010 lkntzl Deck$


An endodontist is performing root canal therapy on his anxious dental patient. His anesthesia has been successful throughout the access preparation, cleaning, and shaping. Just before he starts to obdurate, he sticks a paper point in the first canal to dry it out. The patient jumps up in pain from the stimulus. Which type of primary afferent fiber carries information related to sharp pain and temperature?

A-alpha fibers
A-beta fibers

A-delta fibers

C-nervc fibers

208 Copyrisht 0 ~20 1 0 Den!l.ll Ottb


During the laner part of the third wtck ofprenatal development. the ceniilll nervous system begin~ to develop in the embryo. Many steps oecur during this wt\Ok to fonn the heginning of the ; pinul cord and brain. First. a speciaUzed group of cells differentautes from the ectoderm. These cells nre the neuroectoderm, nnd they ore localized to the neural plnte of U te embryo. The neUI-al plate is a band of cells that extends the length ofthe embryo, from the cephalic end to a he caudal end. This plate undergoes further growth and thickening, wb.icb cause tbe plate to deepen and htvuginate centrally. fomtiog the neural groove. Near the end of the third week. the neural groove deepens further and is surrounded by the neural folds. As nan her growth oftbe oeuroectodenn occurs. the neural folds nteef superior to Ute neural groo' e, and a neural tube i~ fonned during the fourth "eek. Theneurnlrube undergoes fusion at its most supenor ponion and forms the future spinal cord as well as other oeurnl ussues. Important: Dunng l11e third week. 3lJOUJer specialized group of cells, ahe neurxl crest e.ells, develop from the ncuroc.-toderm. These cells magraa e from the crests of tlte neural folds and disperse within the mesenchyme. These mib >rated cells nrc involved iu the development of uuny face ~nd neck stncnares. such as the branchinl arches. Note: These ncuraal cre5t cells are essential in the development or the face. neck. and oral tissues. Remember: The growth of neural fusue during the fourth week of prenatal dc~elop meru causes folding of the embryonic disc into an embryo. establishing for abe tim time the human axis and placing tissues in their p10per poSiuoos for further tmbyonic de>elopmenl.

PriuaMy arre...,ot a~ons ore the nerve fibers connected 10 the different types of receptors in the slM, muscle. and internal OI'Jl1IOS. These primary afferent nxons come Ul different diameters and can be davided into different groups based on tbetr size. Here, an order of decreasing size, arc the different nene fiber groups: A-alpba, A-beta, A-delta, and Cnerve fibers. Aalpb. A-bell!, nod A-della nerve Ober.; are insulated watb myelin, Cnerve fibers are unmyelinated. The thickness of lite nerve fiber is correlated hl the speed with which informntion travels in ia -- the thicker the nerve fiber, the faster inftrrmol!ull travels in it. lmpurtunt: A-alpha nerve fibers curry information rclnted to proprioception (muscle .tenre) Abcta nef\t fibers carry information rcluted to touch A-delta ~r\e fibers curry informntion ~lnaed to pain and temperature C-ner,c (jbers eM!')' mfonnation relatetlto pain, tempel"!ltu...,. and itch Autonomic neurotransmitters: All autonomic preganglionic synapse> bnve Ach ns the neurotransmitter (nlcnrinll

All (tostgun~llonlc parasympathetic synapse~ have Ach as the neurotrtmsmuter (mrLtcorinhJ'CCOf i/Or s) ' Most poslf(augllonic sympathetic synapses have NE as the neurotransmiuer (adrenergic rt!L'e{Jtor.<J

Sympathetic preganglionic neurotrnnmallcr at adrenal medulla as Aeh (nkorimr fl!ceptor) --release of epinephrine and nortpnlephrine (80/]0) Sympathetic poslgllllglionic neurotmn,nutter at S"'eal glands is Arh (maucnrintc rercpton)


~ ~


A gag rencx overcomes your patient as you lightly swab an area of the oropharynx. What nerve carries the sensory fibers of this rcnex?

Trigeminal nerve (CN V) Facial nerve (CN VII) Glossopharyngeal nerve (CN lX)
Vagus nerve (CN X)

209 Copyn.a,ht c 2(109..2010 Denial Dts


Masseteric nerve
Auriculotempornl nerve Facial nerve (CN VII)

Trochlear nerve (CN IV)

The glossopharyngeal nerve is a mixed nen e {mowr and sensary), whicb origmates from the anterior ~urfucc of the medulla oblongata nlong with the 'agu.~ nerve (CN X) and spinal acccs.~ry nerve (CN XI). The gh>ssophtryngeal nerve passes laterally in the posterior cra nial fossa and leaves tlte sk'\tll through the jugular foramen to supply sensation to the pharynx and posterior third or tho tongue. The ~ell bodies of these sensory neurons are located iu the superior und Inferior ganglia of this n~rvc. The glossopharyngeal nerve then descends through the upper part of the neck along with the internal jugular vein and internal carotid artery tQ reach the posterior border or the stylopharyngeus muscle of the pharynx to which the nerve supplies somatic mo10r fibers. :"'ote: Th< glossopharyngeal nerve carries prim3ry afferent neurons to the gag re0es (the g/at.<aphtlf)'ngea/ nene innt!I"'YJtt.r the IPII/l'OII$ lllt!mbrane;; ofthe fauces}. The otic ganglion i~ a small parasyutpathetlc ganglion that is funcuonally a>soeiated uith the glossopharyngeal nerve. The ouc gani:lion >S located immediately below the foram~n ovalc in the iniTatemporal fossa. The otic ganglion is one or fottr parasymputhclic ganglia of the bead and Mtk, (lite orJrers are rlw .mbmlllldilwlar ganglion, ptl!l)'gOpolatine ganglion. <Inti cili111'' ganglion). The tympanic and lesser petrosal branches or the glossophuryngcnl nerve supply preganglionic parasympathetic secretomotor fibers to the otic ganglion. Here the fibers synnpse, and the postganglionic fibers leave the ga nglion nnd join lbe auriculotemporal nme. As the auriculotcmpornl nerve passes the p:uoud gland, postganglionies leave the ner\c to enter the sub>tance of the gland. Important: Terminal ganglia recetvc prcgangh~>nic fibers liom the para>ymJlllthctic division. The followmg cranial nerves also contnm preganglionic lr>ympathctlr fibers: oculomotor (ciliary ganglion/, radlll (ploygopalatille and sllbmandlb11/ar gnnglin), and vngus (small terminal gang/it//.



The auriculotemporal nene aris.:s frt>rn the postcnor division of the mandibular nme (V-3}. The aunculou:mpornl nerve suppli~' the poscerlor portion of the TMJ. The nerve to the masseter (masseteric lletW). obo o branch ofV-3, carries a fc\\ sensory libers to the :out~rlor portion of the TMJ. The deep temporal nerves (anter/(lr, mtddle, and pwueriur /)tatcllcs) Innervate the tempomlis muscle and carry a few fibers to the anterior ponion of the TMJ as well. I. P3iu ill\pulses from a patient's rructured condylar neck arc tamed by the au nculotcmporol nerve. 2. Pam (TMJ patient) is transmtUed in the capsule and periphery of the disc by the auriculotemporal n<'TVe. 3. The auriculocempotal nerve carrtCS oome secretory fibers from the otir ganglion to the parotid salivary gland. 4. The TMJ, as is the case with all joints, receives uo motor innorvnuon. The muscles tbnt move the joint receive L he motor innervation. 5. Its urterinl blood supply is provided l>y the superficial tmporul und maxillary br-Jnches of the external caruHd artery.


N rv)


When walking to his car late at night, a poofessor hears footsteps behind him. His sympathet.ic response (fright-or-flight) results In dilated pupils, a dry mouth, and constriction of blood vessel$ in his face that makes him look ashen. Which ganglia, located at the level or the Ct.C2 vertebrae, house the cell bodies that cause the sympathetic response in the bead?

Superior cervical ganglion Middle cervical ganglion Inferior cervical ganglion

Ganglion impar

Copyng;:n 0
~2010 ~nlal lkd:s



A 62-ycar-old woman complains of an "excruciating, stabbing pain" on the "'

right side of her face on her check, lip, and nose. She complains that this is the worst pain she has felt in her life. The pain is triggered by light contact, chewing, or even drafts of cold air. T he working diagnosis is a neuralgia of 'what cranial nerve (the principal se11sory nerve to the head and face)? ~

Facial nerve (CN Vl/) Abducens nerve (CN VI) Glossopharyngeal nerve (CN IX) Trigeminal nerve (CN V)


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Suprrim Ct.' I"\ ical J!aiiJ,!Iiun

Paravertebral sympathetic ganglia lie on each side of the venebrac and are connected to fonn the sympalbclk chain or trunk. There are usually 21 or 23 pairs of these gan glia: 3 in lbe cervical r<g.on, 12 in the thoracic reg.on, 4 in the lumbar region. 4 in the sacral rtgton, and a single, unpaired ganglion lying in front of the cO<:Gyx called the gan glion irnpnr. Three cervical ganglia: 1. Suprlor cervical ganglion: the uppennost aod lorgest, St:tching from the level ofCito the level ofC2 or CJ. This ganglion lies between the internal carotid artery and tbe lntHnul j ugular vcin. The supcri(lr cervical ganglion innervates viscera of the bcud. 2. Middle cervical ganglion: small, located at tl1e level of the cricolcl cartilage. 11lrs ganglion is rdated 10 the loop of the inferior thyroid ancry. lnnervates \iscero of the neck. thora.' (i.e.. the bro11chi ond het~rt). and upper limb 3. IJtfcrior cenical ganglion: occurs at the C7 ertebrallcel Mo~t commonly i> fused 10 the lirst thorncrc sympathetic ganglion to fonn u stellate ganglion. Innervates viscera of the neck. thorax (i.e., the lm mt:"hi and heart). oml upp~r limb. lmpnrtant: The I:""Y r.unl connect the symp.,thetic trUnk to every spinal nen c. The " bit rami are limited to the spinal cord SC!,'ITl<Pts bet"ecn n and U The cell boclies of the v!scer111 efferent t1hcn in visceral nrnnches or rhc sympatltetio trunk arc located in the inlcrrnediol:tiHnl cell column (or lateral hol'll) of the spinal cord; the cell bodies of ' lscenl afferent flbers are located in the dorsal root ganglia

Th.: trigtmlnal nen r eMislhe infeml~:m:mlllO'b a,. a scowl')' ;md motor l'('l()t, The t.ng~r lt'tt trtory

roat cnlcrs cbe trigeminal (:;tmilrmnr. guxxrrlcmt ganglion in \he middle c1nmul fu),sa. l11 c: llil'ce sensory ()ivisions or tile nerve arise front 1hc ganglion 11nd le-ave 1 he cnuuol cavily 1 hrouHh [\lramiTUl rrtlhc spbenoi~ bone. The smaller motor ruot pos""s under the Qlln21ion Md JOitb the lnaJxbbular division as 11 cxu~ through the fonmeu fnaJt. Tile mand1bular diuSJon lnnC-f\:ttc~

eighl 01u:lt:. Somatic sensory cell bodlcs of the ~olliiOn 's sensory nbcrs enter tbc: Ophthalmic division (fl-1) to S\tJlJ>Iy general SCll>alion lo the orbit and skin of fnce above

Maxillary division (Vl) to supply go:ner.>.l scn.salton to the no.>;&l cavity, ona..ill3l)' teeth. palate. and skin "'.,. n10xilta ~londlhular division (V-3) to supply g<:noral sensuon ro tho mandrblc. TMJ. 0\ilnJibular
teeth. floor of mouth, tongue, lind skin ofm:mdihle n u: UXOIL,. of the neuron,; cnh:r the pon!i thrOuMh tile sensory rout and lcmlinuu; in onC' ofdh! lhrec llUcle( o( tlu: tngcminal ;c~nsory nuclear t01t1pleX:. ~lutncrpbalit nuclt us m<ditcs proprioccpuon (ex mt.-<;kspinJ/e) C.hld or pontin~ nutltut mrdiau. "S d1scrimmativc ~cn~11un (a (tght tou,h) SpinA l nuclcu, (med/ut<S pout onJ tcmpcrutllre.{IYJm the lt<ad mtd IlCeA) eun be dtvided mlo llueu rewons along. us lcmath : lhe r~giOil o los~~t to thu mnuOl Is culled Mahruu:ltus ora II~. 1 hc mteldlo region i!t culled subnurh1oll) inlrrpnlaris. auJ the rcgitm c.:.lO!te~t to the: tail iM cnllcd subnuclt u.s uudoli~. The p::ain fibcrllii oecualty syn~tpe an \ubnucleu.~ cnud3lb.. Noto: PR>pnocCp<ie libcr> from muse~ and the T\IJ an: found only tn the mandibular dilimn The cell bodit>S or J)I'Uflrioceph'-e G .rst urdcr neurons arc found tn the 11lCJencrl> lntlk nucleu...., not

the tngenunsl ganglion. Br2nchlomerlc (lhf!armrR deri1~djfom em(>tycmic hranchlr1/ nrdte.~J motor Obcr.!l innervate 1he tcmporoli>. mos.<etcr. mc:d:ll and latcrl pterygoid. ru11crior belly uf the dtj;>Stnc. mylohyoul.
tensor tympani, and t~I\.\Or wli
p:~l~ttoi (p.llari)



Tbc pterygopalatine ganglion contains l>reganglionic parasympathetic axons from which cranial nerve?

Oculomotor (CN Ill) Facial (CN VII) Trigeminal (CN V) Glossopharyngeal (CN IX) Vagus (CN X)

Copyrlaflt 0 2()09.2010 Dcntallkd:s



~ A patient wlfh uncontrolled diabetes comes into the clinic for some periodontal work. You notice that her right eyelid Is now drooping, which II was not doing a year ago at her last appointment. From class, you recognize that nerve damage can be the result of chronle high blood sugar. Au upper eyelid that droops (ptosis) may be caused by damage to the:

Trochlear nerve (CN IV) Abducens nerve (CN VI) Oculomotor nerve (CN Ill) Optic nerve (CN II)

Copyright Cll009-2010 Dental Dttb

Fada I / ( \ I //I
These lburf'1'red PJ11ha "'''M' all prasympadl<uo ~otK"' "> lh< h<ad aod n<d<. Tb<y IRlh< <oh>ty puglion, poetyi<>!'Oiaronc: pujlhO"- submandibular pnghon, and rhe ouc ganglion. Each bas lhree roou rnlenna lhe ganglion and 1. ,'Jriablo num~ of e..'iting brn:ochcs. The motor root Clt'l'l'tS prH) naplic para.sympalh~th: n.;r.e fibers that tennina:t rn thc ganglion b)W'fiiPS

ing; the poslsynapne fibers travel to wge1 organs The sympathetic: ruot c~mitt p~stsyoaptic sympat11etlc fibers thot tmvcrse the ganalion whhl)ut synapsing The senwry ruoc cames general stnsory li~ that nlso do not synttpse in the ganglion

- Some ganglia also eflny speeial sensory fibers lbr t:.:ne

P.1n1"' 111fMihc1u ( lnt!ll.



~pal\ o('k oftM Gil lklakral die C!f*CIICI'C


, . , . . _ . . .,.nu.-.padtfdc: ftk:n &or,) dw t'C~ hCtW' h$cp1tJ...k ,.,.af)....,.,_lrlt:dc: IJbes: b\~ ~. th= lbor'l cil..ry l)tn t4 S)'tllp~~t.htek nbr:n from tbc: 1t1W"r'MJ Cll\>lid rAh
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plct)'I.OPIJJihlle f"M6a

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Po:.canall4*1c panilympatbetk !'ibers reach the muMIIIII) nerve b)

one ror '" P"'lk-nlc branei1Cl1 - lhCiile f'Cilcb 1.1te lncrinul jll llod; othcfl. Nil u11hc; p;,IAiitlC nnd nn.-111 nts'IIC I<' lbe pa~linc lnd nllt.allli..!Mlt SywnptJ1t!ffe nt~otN ~eb the png!um viJ.I.h,e humwl t:orocl'd ~\l e!CUS
l'rt~nJlklnlt p;~nt:ymplh~!t-



1bt latml wrf'll(c oflhe hyo&lcmt$

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I "1\MI Mrwt

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sopm.r ~ll.h\atJ ruxkus of thr &.:tal nc'f\'C viii &be choNI t)tf'C)Anl eN
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Sy~dtdk Obnt m VUOIDCIIOt kl rht ~ 1ct.'C1t efdw cl.-4t

rrttOat:f9ttk prat)"lllpatlllftk fiben Qn_f."tmle ID 1bt

1r'lrmur uln.ry r1uelru' oftfle glo$iopl'wyn_ia) fK"1"1't
.aurwulotnnr.onl l\ef'\~ fi~

mcd~al ~ ll~e m~~ndiboln


l"MtV'l.i:lkttl1c parafyl'npttbt'tic tibers Jeavc: 1M ilniJitoR lltldJOin lhl" m ~omotor to 1M pUO(hl j!,IAnd

Oculomnlu r nl'fh' I( \ 11/J

The oculomotor nerve supplies the followmg extraocular muscles: medial. superror, and inferior rccli; inferior oblique; and levalor palpebru su ptrlori s. The oculomotor nerve sends preganglionic parasympathetic (ibers to lhe ciliary ganglion, The postganglionic fibers lea\e the ganglion in lhe short dliry nerves to supply the sphincter pupillae and the crliary muscle. Note: In most ca>es, pto~is is caused by either a weakness of the levator muscle (muscle that rai.ves tire lid). or a problem wilb 1hc oculomotor nerve. Remember: The trochlear nerve (CN IV) supplies lhe superior oblltJUe muscle (the ml4scfe that wrn$ the eyeball illferlarly and laterally), and lhe abducens nerve (CN VI) supplies the lateral rectus or I he e) e. The oculomotor nerve (CN Ill), !Tocblear nerve (CN IV), and abducens nc.- e (CN VI) all exit tbe cranium through the superior orbital fissure, They iDllervale the extrln.sic ocular muscles, resull ing in movements of the eyeball. Note: The trochl ear nerve is the smallesl ernnlal nerve and the only cranial nerve that emerges from the dorsal (back) a s jJCCI of I be bralnsteru.



The splanchnic nerves (greater, lesser, tmd least) arise from the:

Cervical sympathetic ganglion (chain) Thoracic sympathetic ganglion (chain)

Lumbar sympathetic ganglion (chain)

Sacral sympathetic ganglion {chain)

COfl)'tght C 20092010 Dental Dtotkt



A 34-year-old female patient complains to her physician of hoarseness. The physician notes drastically enlarged lymph nodes in the aorticopulmonary window and suspects involvement of the recurrent laryngeal nerve. The path of the recurrent laryngeal differs on the Left and right sides of the body. Which one (right or left) loops posteriorly around the aortic arch and ascends through the superior mediastinum to enter the groove between the esophagus and trachea?

Right recurrent laryngeal nerve Left recurrent laryngeal nerve

211 Copyngbl c 200t-2010 Otmal ~b

llwraru: '~ mp:tlhLIic J.!OIIIJ.:Iiun tdwin}

Remember: Para,ertebral S)mpathetic gangli11 lie on each side of the vertebrae and are connected to fonn the sympathetic chain or tru nk. These nerves arise from tbornclc ~nnglia (TS - T/2). Note: They all pass through the diaphragm. The 1>rcganglionic sympathetic fiber.; may pass through the ganglia on lbe tbomcic part of the sympatbetic trunk wnbout syru~psing. These myelinated fibers form the splanchnic nerves. of which tbcre are three: 1. Greater- formed from sympathetic fibers from TS- T9. The nerve passes through tll< crum of the diaphragm to end in the celiac gmJglion, 2. L~sscr- formed from sympathetic fibers from T 10 T11. The nerve pass through the diaphragm with the ireatcr to end in the aorticorenal ganglion. 3. Least- arises from the last thoracic ganglion. and. piercing the dwphmgm, ends in lbe renal plexus. l mponant: Thoracic splanchnic nerves (specifically the greater splanchnic nen e) to the celiac plexus consist primarily of preganglionic visceral efferent fibers. The postganglionic ftbers arise !rom the excitor cells in the celiac plexus nod are distributed to Ute smooth muscle and glands of the viscera.

f \'If

H'\.'UITl.'OI hu-~

n!.!l'.IIIH.'n l'

The let't \'&.g us gives nse to tbe Jet't ~urnnt laryngeal nene. The right ~current laryngeal nene spins from the right vagus befo re entering the superior mediastinum at the level of the right subclavian artery. The nerve books pOSteriorly around the subclavian m1ery and also ascends in ~tc groove between tbe esophagus and trachea.
Bo~> re<:urrenr laryngeal nerves pass deep to the lower margin of the inferior con.~trictor muscle to innervate the Intrinsic muscles or the larynx respOnsible for controlling the movements of the vocal folds.

The right recurrent laryngeal nerve innervates: All of the muscles of the larynx. except the cricothyroid, which is supplied by the external laryngeal branch olthe superior laryngeal nerve The mucous membrane of the larynx below the vocal fold-' The mucous membraue of the upper part of the truchca Note: Thi< nerve comes in contact with lbc thyroid gland and come5 into close relationship with the inlerior thyroid artery The Jert recurrent lazyngeal nerve innervates: The same muscles and mucous membranes as the right recurrent laryngeal, except on the left side Remember: A few cardiac brunches arise from ~1e vngu$ and enter the cardiac plexus. TI1C$t are preganglionic parasympathetic nerves that synapse with pOStganglionic parasympathetic nerves in the hean. They innervate the hean muscle and conducting system (SA node. etc.).



All or the following statements concerning the hypoglossal nerve (CN XJI) are true EXCEPT one. Which one Is the EXCEPTION?

It is a motor nerve supplying all of the intrinsic and extrinsic muscles of the tongue.

except the palatoglossus. which is supplied by the vagus nerve

It leaves the skull through the jugular foramen medial to the carotid cnnal

It passes above the hyoid bone on the lateral surface of the hyoglossus muscle deep to the mylohyoid muscle
It loops around the occipital ancry and passes between the external carotid artery and internal jugular vein

Soon after it leaves the skull through the hypoglossal cana~ it is joined by C I fibers from the cervical plexus
217 <Alp) n$111 C 2009-20)() Dc1l~l Dt<U



One method or the inferior alveolar nerve block, where tbe target is tbe mandibular foramen, encourages remo,al or the needle about halfway and deposition of approximately one-third or a carpule of anesthetic. This method is meant to anesthetize the nerve, which carries general sensation from the anterior two-thirds of the tongue. T his ner ve is the:

Hypoglossal nerve (CN Xll) Chorda tympani Recurrent laryngeal nerve Lingual nerve Glossopharyngeal nerve (CN IX)

.,.,..... "' ,.,.._lOIO Dftoooll)cda


lhl 'kUII thrnUJ.!h lht. ju~ul;.tr [nr: H11l'll nlldialto lh(' C':lrlltid


***This is false; it leaves the skull through the hypoglossal canal medial to the carotid canal and jugular foramen. Note: The jugular foramen allows for the exit or the spinal accessory nerve from tbe crnninl cavity. Important: The hypoglossal nerve travels from the carotid triangle into the submandibular triangle of the neck. LesionJ or the bypoglosul nerve: Unilateral lesions of the hypoglossal nerYe result m the deviation of the protruded tongue toward the affected side. This is due to the lack of function of the genioglossus muscle on the diseased side Injury of the hypoglossal nerve eventually produces paralysis and atlophy of the tongue on the affected side with tbe tongue deviated to the affected side. Dysarthria (inability to articulate) may also be found Important: lftbe genioglossus muscle is paral)"Led, the tongue has a tendency to fitll back and obstruct the oropharyngeal airway with risk of suffocation.



The lingual nerve is a branch of the mandibular dh is ion (V-3) of the trigeminal nerve. It supplies general sensauon for the anterior rno-thirds of the tongue, the floor of the mouth. nnd mandibular lingual gingiva. "!ole: The submandibular duel has an intimate relation with the lingual nerve, which crosses it twice. The lingual nerve descends deep tO the lateral pterygoid muscle, when: the nerve is JOined by the chorda tympani {branch of the facial 11ene), which conveys the preganglloni< parasympath etic fibers to the submandibular ganglion and taste fibers from the anterior ho-thirds of the tongue. Important: If you cut the lingual nerve after itS junction with the chord tympani, the tougue would have a loss or taste and tactile sense to the anterior two-third~.


I. The chorda tympani emerges from a small canal in the posterior wall of the tympanic cavity (petrotympanic fiSSure) after crossing the medial surface of the tympanic membrane. h joins the lingual ne~e in the infratemporal fossa. 2. The chorda tympani nerve conveys general visceral efferent fibers (motor jiber.r) of the parasympathetic division of the autonomic nervous system. lt carries special visceral atTerent fibers for taste. 3. Parasympathetic n~n~es are general visceral efferent fibers.



T he glossopharyngeal nerve (CN IX) Innervates all of the followlnj: EXCEPT one. Wbicb one is the EXCEPTION?

Stylopharyngeus muscle

Parotid gland Taste to the anterior two-thirds of tlte tongue Taste to the posterior one-third of the tongue Carotid ~inus

218 CopynJhl Cl 20092010 Del\1 11 f)e(b




All of the following statements concerning the cervical plexus and its branches are true EXCEPT one. Which one is tbe EXCEPTION?

The motor nerves for most of the infrahyoid muscles are bran<:hes of the ansa cervicalis (/()()p formed by C 1. C1, and C3) Cervical nerves CS-C8 contnl>ute 11>01or fibers to the cervical plexus
It is positioned deep on the side of tbe neck, lateral to the first four cervical venebme An important brtlnch of each cervical plexus is the phrenic nerve that supplies the

diaphragm The supraclavicular nerves innervate the skin over the shoulder The transverse cervical nerve provides sensory innervation to the anterior and lateral pans of the neck

129, (30,13 1

Ta\h' lo lh~ .ulhriur hu,..thirdo;; nf tht: IOJ11!Ut'

The glossopb3r)'ngeal ntf\'e innervates the st~ lop baryngeus muscle Ma the Hlll<ettfar brandt). h Is lbe only mu.ele lbat is supplied by this nef\e. This muscle is 3 l3ndmark fQr locating the glossopharyngeal ncf'le because llS the nme ent<TS lbt pharynscal wall, it CUf'les postcnorly nround tbe lateral margin of this muscle. lt1 addition to the somn1lc motor inncrvnlion nf the stylopharyngeus, the glossopb-

aryngcal nerve supplies preganglionic parasyrnJtnlhctlc mutur fibers to the otic gnn~llon. n.ese fibers synar<e with lhe postgan~:~lionic fiber~ in the g:mglioo to supply the parotid gland. The pregAnglionic ncnes leave the glossopharyngeal nerve a~ the tympanic nene. which enters lbe middle ..,. caity and panicipatos 111 lht formation uf the tympanic pie~us. The tympanic nerYe reform> u the les""r petros.! nerv<. lc:avc. the Cfllllia.l cavily through the foramen ovale. and tnters the otic ganglinn Post,ganglionic;.r; are tanied by lhe aurietdotcmpa!lll nene fVJ) to the p..-otid VIsceral seru~ory hr nches of the glossopha ryn ~eal ntnc: Lingual branches- nre two in number; one supplies the va.llrue papillae and the mucous membr' Jn~ cover111g the bose of the tongue; the other supplies the mucous membrnne an~ folliculur glands of the posurior onc-thirrluf the longtte, and commU tliClltes wlth the
lingual uerv~ Also COI'rles .fome ucretomowr jilwr.v l<ltlw l(lumlv Pharyngeal distributed to the mucous mc10brune of the pharynx. Is the sensory limb
of the gag n:.Oex Carolid lou< ner. to c;ttotid >illll:l (l>ororw:qlwr) and carotid body (<hmo-

receptor) Remember: The lingual nene (hranoh of VJ) descends deep to the lateral plerygoid mu.<cle. where the liogul ntf'le is joined by lhc <bordu tympani (branch o/tlie/aclulllt!M'<'), whtch

conveys the (tregnn~llonlc pamsympathelic Obers to the sobmaodibuln rgAngllon nnd taste fibers frmn the anterior h\'tHhlrds of the tongnc.

( tn ical llt'l " ' ' ( ~-C H l'Hnlrihufl' mulor lilnr'

In lht Cl'n kal


*** This is false; C I - C4 contribute motor fibers to th~ cervical plexus.

Tite fo ur m ain pairs of nerve plexu.<cs tbal are formed by the mixing :utd bnmching oftht ventral rarul the spinal nerves: I. Cervic.al (llexu~ (C l-C4)-- provide> culaneous innervation to the ~km of1he nt'Ck, shoulder. and upper :utterior chest wall tts well a< motor innervation to the mfmhyod (strap) muscles and geuiohyold muscle. n1c phrenic nerve (C3-C5) is the motor


nerve to Ihe skeletal muscle of the diaplmtgm. 2. Brachial plexus (CS.C8 and Tl)- fomocd in the posterior lriaoglc of the neck, the brachial plexu.< ex lends into the axilla. supplying nerves to the uppcr limb. It has lhr cords: posterlo~ axillary and radial ore main branches lateral - musculocutaneou.~ nene is mam brnnch mcdilll - ulnar nen e is main branch ~ole: ll1e median ner.-e fonns its two head.' (me<flal and lnreral) fnom the medinl nnd lateral cords.


3. Lumbor pies us (LI IA) - formed in tbe llSOas muscle, th<! lumbar plexus suppUc,< the lower abdomen 1111d parts or lb~ lower limb. Maiu branches ate the femorul nnd

obturator nerves. 4. Sacral plclU S (l-1-LS and Sl -s4) - It~ in the posterior J>l'lvic wall in front of lhe ptrifonns muscle. The sacr:l) plelllJS ~uppltes the low~ oock, pelviS, and part> of the thigh, leg, and foot. 111e main branch t< the sdatlc (largest IJI?T\'C m rM body).



Wblcb divblon of the trigeminal nerve exits the cranial ca,;l) through the ation to the midfaee foramen rotundum and provides sensory innen (lower I!Jelid to tire upper clreek), palate, and paranasal sinuses?

Ophthalmic division (V-1) Maxillary division (V-2) Mandibular division (V-3)

Copyn.&ht C1 2~2010 DmtaJ I>~

126,127,132 J33


T he mylohyoid nerve is derived from the Inferior alveolar nerve just before it enters the mandibular foramen. The mylohyoid nerve descends In a groove on the deep surface of the ramus of the mandible, to the supply tbe: Anterior and posterior belly of the digastric muscle Mylohyoid and anterior belly of the digastric muscles Stylohyoid and posterior belly of the digastric muscles Geniohyoid and stylohyoid muscles

The ophthalmic division {V-1) enters the orbll through the superior orbital nssure and provides s~osory lnnervalion to the eyeball. up of lhe nose, .~kin over lhe upper and Lower eyelid, and sktn of the face above lhe eye. Branches include the lacrimal. fromal, nasociliary, supraorbital, supratrocblem, iJJfmtrochlear, and e)(temal nasal nerves. Nole: During u sinus attack, painfi.1 l sensation from t.he ethmoid cells is curiccl in !he nasociliary nerve. The maxillary dh'l.slon (V-1) passes lhn)ugh lhe foramen rotundum and provides sensory innen allon to lhe midface (IH!Iow the eye and above the upper lip), p:tl:tle, parana.al sinuses. and the maxillary teelh. 'lotc: The tickling sensation felt in the nasal cavity JUSI pnor to a sneeze is canied by the maxillary divis1on of trigeminal. Branches include lhe Infraorbital, zygomaticofacial, 3lld 1.ygomaticotemporal nervto. Sensory innervntlon of mandibular dlvhinn (V-3) c~ to lhe sk.in of the cheek. the skin of the mandible, and the lnwer Up and Side of the head. Sensory innervation ulso includes the TMJ, mandibular teeth, the mucous mcmbrnncs of the cheek, the fioor oflhe mouth. and the anterior part of the tongue. Branches include the mcneal. buccal, and auriculotempo1'111 nerves. Important: 111e trigeminal nerve contams no parllJympathelic component at it> origin. The ner"cs hranches are used by rhe oculomotor. faciaL and giO>;.opharyngcal nerves to distribute their preganglionic para') mpathelics to the parasympstltctic head ganglia.

.,,. The mylohyoid nerve arises from the mferior aleolar nerve. a l>mncb of the mandibular division ( Y-J) of the rrigemmal nerve {VJ Function of mylohyoid: eJe,ates hyord bone. base of tongue. and Ooor of n~oulh. The mylohyoid Une, which gives origin to the m)lobyoid, is found on lhc body of tne mandible. The sublmgual gland is located 'upcrior to tlte mylohyoid muscle. When nln1 is placed for u periapical \-lew of the mantlrbulnr molar.s, it is the mylohyoid muscle that gets in the wny if it is nor relaxed. Important: Swelling atlhe angle of t.hc rn~ndiblc and the lateral neck is nften the result of detlection of cxudnres by the mylohyoid muscle. Suprab)'Oid muscles: -Digastric musdcs -Anterior belly: innervated by nerve 10 the mylobyoul. which tS a br4nch of the mandtbular dh "ion of the trigeminal nerve - Posterior hclly: tnner.'&ted by the factal nerve - ;\1ylohyold muscle: innervated by nerve to lhc mylohyoid, which is a branch oflhe mandibular division of the trigeminal nerve - Geniohyoid muscle: lnncrva!ed by the first ccrvlc.11 nerve through the hypoglossal nerve - Stylohyuld: innervated by the facial nerve Tnfnthyold mu~clcs: - Omollyoid muscle: innervated by llllSll cervicalis - C 1, 2, and J -Sternohyoid nru<cle: innervated by unsa ce" icalis- C 1. 1, nod 3 - Ste.rnolb) rold muscle: inne"ated by ansa cervical is - Cl. 2. and 3 - Tb~toh) oid muscle: inne"-ated by the fir.st cervical nene. "hich accompanre& the hypoglossal nerve to the suprahyood regton, 411d then bmnches from 11 to reach lhe thyrohyoid OlU>Cie



Whi<h of the following nerves carries parasympathetic Obers in addition to motor innervation? Optic (CN 11) Olfactory (CN I) Oculomotor (CN Ill) Trochlear (CN IV)

136,137.,138 139
223 Copyn,ahl C 2(1()1)..2010 Den111 Dt<U



The extended eour>" of the abducens nene from the bralnstem to the eye makes it \'Ulnerable to injury. In blunt force trauma to the htad, an individual's petrous temporal bone is fractured, leading to the injury of the right abducens nerve. Which of the following would be a sign of that injury?

IUght ptosis Loss of light reflexes on the right side Inability to adduct the right eye Medial deviauon of the right eye Loss of corneal reflex on the right side

Oculnmulur (( \ 11/J

SHe or E11t from Skull Cribriform plate of ethmoid hoM Optic for1rnen

Spetbl &f:n..or)' (GpitJI4f/]#r'tlltJ
Spcdal 3tnsor)'

Sense of smell


(CN //)


Conveys \'isu:.l i.nronrulli<m from the re~jna

OculomotOr Superior orbiLal ti~.;ure ICN J/1)

Som1lle notor Supplies four of the six cx1rooeul11r (g~1eral Jomurlc ejfrrettt) muscle$ of the: eye arw.t I he IC'\o'l'llor palpeb~ $Uf)tfioris mu!!Cie o( tht upper eyelid

(~~ ~ fi"(J/ t'/JnwttJ


Supmor orb1111 fiuurc

Somatic motor
(g01UOI1/(),.lDiit: t>ff~ll)

Paras)'n:lpa!Jitelie IMtf\'" l bOn ofthe pupdlat ond nbaoy -Ia tnnm~es tbt 5Upmor oblique



The four extraocular muscles that the oculomotor nerve innervates arc the: Superior rectus muscle Middle rectus muscle Inferior rectus muscle Inferior oblique muscle



ialinn uf the ri::!ht

t~ l'

Remember: The abducens (CN VJ) oen c inncf\ ates the lateral rectus muscle of the eye. The lateral rectus muscle is responsible for lateral gaze (ilS contrac/1011 causes rhe eye robe abductt-d). A lesion of this nerve results'" mt>dial strabismus (~ross-eyed) and diplopia (double 1isio11).
Nerve Sire of Exit rrom Skull Component Trigeminal: (CN I') Bnnthll l motor
V-1 Ophl.babnlc
Y2 M<lllillty


Superior orbital fissure

Fonuntn rotundum
Foramen ova!e

V-3 Ma.xlibu.l.v

(special ''(SCf'rol dferenr) mastication: Masseter Temporali.s

. . . . . . .

lnne:rvotcs the mu!leles of

Me<bat t*'Ya<>1CI Lacmt pl<t)JOlCI

Ankrio<dtTcmor tympan Tensor veli palatine

Also illncfvalcs: Mylobyoid

Ccnrrl ttn~ry

General scnsndon to the

(gMttral .)'Qmatic affire.m) major part of the he'd

Abduocns (CN VII

Superior orbital fissun:

Somatic motor lrmervatcs the lalel'll rCUS (gtntro.l somatic t./ftnitl) RIU!C!C




The principal types of nerves found In the dental pulp are:

Parasympathetic and efferent fibers Sympathetic and afferent fibers Sympathetic and efferent fibers Parasympathetic and afferent fibers

Copyngl\1 C 2000-2010 l)('ntlll Drclc.s



Which cranial nerve (which technically does not arise from tire brain) Is the only nerve to start in the cranium and extend below to tbc head, and innervates the viscera?

Trigeminal (CN I?
Facial (CN VII)

Vagus (CN X)
Hypoglossal (CN Xll)

Copyngbt Cl 2(1()9.2010 ~~~ Dttb

s~ llljlilllnlh,: :tlltl :tiTl'rt.'lll fihl11'"i

The sensory nerve fibers in the dentnl pulp originate in the trigeminal ganglion and are

categorized. from smaUcst 1o largest dirunetcr, into C-fibers. A-della. and some A-beta
fibers. On the other hand, postgnngllonic sympathetic nerve fibers onginale in lhe superior cervical ganglion. A-della fibers are myelinated low-threshold mechano-rcc~ntors and nre responsible for the so-called "first pain signal~. C-fibers ane unmyelinated. highthn:<hold fibers They are termed poly-ncxllll because they respond to several types of stimuli such as mechanical, chemical or thermal stimulation of the pulp. C-fibers most likely mediate Ute senS<ltiot of "second pain". Note: The pulp contains both myelinAted and unmyelinated nerve libel's. Tooth rmlp consi.s~< of a loose type of conn~'Ciive tis~11e. '"main components are thin col13gen fibers 8l111nged asymmerncally plus a ground subMan~e comaiUlUI! glycosaminoglycons. Tooth pulpts" highly innervated and vosctdarizcd ss~e. Numerous fibroblsts arc present. Surounding the pulp and ~cparuti11g it fro.n the denrin arc the odontoblasts. lmportsnt: l'ruo originates In the pulp due to fre~ nerve endings fuf}c~mfibers). which arc the only type of nerve ending found in the pulp and ate specific receptors for p~in. Regardless of the source of stimulation (heal. tl1id, Jlres81tl'('), the only response '~ill be nain. Note: Vasomotor sympathetic Obers are thc)ught to end on blood vessels. Functions of tile pulp: l . ~utritive- \Cty rich blood supply that surrouuds the odont<>blas~~2. Formative -- periphel'ullayer of pulp cells gives rise 10 tl1e odontoblasts thnt form dentin. 3. Sensory - free nerve endings that make conmct with the odontoblasts.

The vagus ncr. ~~a mi~e~ nerve thai lc:o\'0\ dte brnin from the 1m:dullo 3nd ptlSS<s out of the cranial cavity lhmugh the jugu1l1r foramen. rhr '"gus nerve descen~> In the neck In the cnrmld sbcolh behmd the Hllcmal and con1100n ...r~td anerics and Ihe internal jugut.u- vein Both right nd left vgat 1runl.< ~""" lhrough the posltrtor mediastinum on lhc <><'!'hagus and enter the ahdorrunol caVIty wth the <>Opha&1JS- The 'apus nerves suppl) '""' vi>ccro or the nc'<k.. thor:u., 11n~ abdomen to 1he lefi colic (.\pleukJ fle:wre of Ute large inu:sune. l11e vngus llervc consH!IS nf

\ <J~U\ - - (

fO.IIUa l

'\ , n,~

Unll\thlal t'llOCor

SUJ)plies lhe ~ohmtury musde~<'rthc pharynx aud moKI of&hc huynlC, nli
Pa~Uy11lpllh<CIC \llll<f'~hOO

;,~'-''"' vsscernl t'lfcn:lll) \Wills lhc: palatoglc!.Su:i muscle o(thc tongue

\'bunl moior

tgmwo.l 'istTIYll t ffenru) ('b1U)'11x.

or chc: -Ch muscle and glands or \he l1!ynx. and\,...,.. oflhethoru and bdomtet

PnwiJcs viseerut scnSttty infonmuiun from 1he IMynJt



(S:tntnil vi.~reml a{Tf!l'i,'M) lind ubdommat artd lhun~etc visccru. 15 welt u.s the ttNtGh n:ccptors uftht: aoruc 1rth iDd. cbcmor~cepton or tht aortic bodlcs
(~'f:rrrrct romazr. ~p~tll


Prvvldtii gc:mnl 5tniCM')' fnfonnalioo lfvm \be skin of the bxk 01 rhe ear and fJtkrnal audiiOI')' meatUS. ~ru. of 1he e.\.tanal .surface ur the 1)'mpanic mcmbrnnc. and lhc J lhnrynx



A "crt minor COHtp\'lnetu of eN X. ProvldCila5.1tscn~tion from tht: tp&toctk ret;ton


I. The abdominal vtsccra below the left colic nexure am.l the ('K'Ivlc andgemtu.lia arc with 1)1.\l'lh)'nlpalhetic prcyungllonics from tht flCIVic SphU\Chnio ncrY(.11, 2~ M10: phqryngt~lll,l~xus of nerves <:Otllttins both n1010rand sen'iC:lry componenb. The

motor nerves~ behC\.ctl tocon:t~ from the "111US n<r\'c


N rv)

The only part of the retina that does not contain photoreceptors, and lro.contains tbe axons of ganglion cells that form the optic nene, is known as the~ Photo spot Optic chiasm

Oculomotor nerve (CN Ill) Optic disc

Cop)'rljjhl 0 20092010 ~~~~I Dh


Which of lhe following receives fibers from the motor, sensory, and parasympathetic components of the facial nerve and sends fibers that will innervate tbe lacrimal, submandibular, and sublingual glands?

Semilunar ganglion Geniculate ganglion

The otic ganglion The ciliary ganglion


e 2009-2010 DtmaJ Dtds

The Optic dbc (ttlsu clllled the optic p<1plll11!is tile small hlind spot on the surface of the retina, locatedaboul 3 mm to the n3sal side ofbe ma~ula. The oplit disc is the only pan of the I'Citna that contains no phOIOn:<:<"J'IOTS (rods m <orrcs). The disc consist5 of a.xons of ganglion cell~ exning the retina to fonn the optic nerve. The;e a>~ons are accompamed by the cemrnl artery and vein of tho t'Ctinu. The optic nene luis only a special sensory compon<nt Spcctal sen<Ory oooveys vhual ioformRtlon from the rellna (special ttf!erelll). Viual mfonna1i0n ent<'T!> the eye mthe fonn of photons of light thut are convened to electric~! signnls w !he retina, These signals nre cUJTied vin the optic nerves, chiasma, and trnct to the lateral gc.nicuiMe nucleus or cn~h tbalumus ami then 10 the visual centers of the brain ll>r interpretntior\. Remember: After e>.iltnl! the eye at the opuc di,;c, the mn Optic nerves (une fmm each ntect ut the optic chlosma. IL lS here Ihat the axnns from the m<<hal (nas<tl) half of each retina cross to the opposite s id,, while those from the late111l half of \lach reti1111 r.:maiu on the 5ame side. From the opttc cbia.<roa. a~ons that perceive ~~~ l~n v~~ual {icld form the right optic tract. These opti<: tract tibers ynnp<e in lh~ lat"TOI geniculate nuclct "'1th gerucnlocalcarine fib(rs (optic rtu//(1/loraJ !hot tenninatc on tbe banks of the calcanne sulcus in the primnry visual con~x (BIYidnrann ,; 01-ea 17) of Ihe ocdpital lobc. n ms, lhc right visual field is interpreted m the leO beuliophere of tl>e braln ond vice
ey e)

.'\ole: The centnll artery nr the retina, br.lllch of the opbtbalnuc ancry, pirc:es the opnc nerve ond gaiM access co the renna b) emergwg from tbe center of the opnc dtsc

I Ill' l!l' UH: nl:~h: g.m 1:lmu

The- a;e:ntt'Uiatc ganglion 1 .s an [...shaped t<'ll(.'('tton. t. tihm und se.ntOJ1' nf.."Umns nfdll! faeiel ntr,c localcd iu lhe I Bcial catla1 C\f lhChe-ad. The ~t."IU C\tlu1c. gi1tl,.U.hon receive), llbL'rt. fr..,m lhe moloa, Jil~u .sQty. uml I)OI".tsympa1 hcuc cumpon1tnt.\ or th~: r~cud nerve n11d Mend\ fibers that \VillttU '\cJ'\181 c lhc

lacnmnl glunlli. submandibulAr g lands ubhnj,'\JUI gtaud,, IOnJ1U< ramtrwr nolhil'l/$), J'.llit< phai)'DJ<, t\l<ml a1Jd1IO<)' rnerus.. Sla!"'dus I'O'Ienor ~~~~or lhe di~';l$lll' musclo, "Yidb)ord nlllsclc, and ntuscle; of fGA:tolexp,.,.>IOO\.

Sensory t nd v~rasympalhetk lnpu t~ ii~ ~:'imt"d tn(n the gcnlcttlu'e .,;aJl.HhUn Vln lhc ~f"\1. In

tennedms. Motor fiber:; ()J'C c.amcd vm lhc f~tctnJ n~l"'\ e pruJ )Cr. The grentt1r petrC)o;QI nrrve, winch
c:trries St1\)tJry O ber$ n~ well a" prcg!il1t_(llonle pnn)yntiH\thetl..: fibers, emerges f[t)m lhe tUUe:-

rior llSp<'Ct or the gangliuu.

Important bnncbe;, of the fntrapetrou' pa rt of tfrr tad I nrn i.': f'he grtattr petrosal nene ati~ (TUnt lhe facial ncn.e tl 1ht gemculatc: Ja.ng.lion. Til.: nt"f'\C' rontam" prcgangti.,mc p.:tl'\'liYmpathchc liben; Ihat puss tu tho pterygnp.thUt"e pnglitln t1nd ore thcol'C n:luyed dunugb the zygomatic and tucrim~tl n~rv~ tOIhe la.crimr1l ~lnnd~ ot11er polotgan~
glionic flbcr!W l'ilS.!i lhrough the na.snl nntl]\llh1\ine nerves (U lhc glands onh~.. fU\.tC0\1$ mernbrune

of the nose: and ~ltttc: the nenc also aJntums many 1 u.,1u fibers from the mucow m..:mbrane. of the Pillu:. 'l'be Dl'TV\: enteq,ocs on sutfac<: or the I"""""' part or !he temp<lrat bone 1111d "'"' furwl!l'd ro enrer lh< fonmen locenmJ. It is here JOined by lh< ~eep prtro'"l nen e from 0 >ympatheuc plcxtL<on the 1 ntcml earolid artety and ti>rms th< urve to the ptrl ~oid camtl. ThiHpus. ~~ rorwttrd and eutcrs tJle pterygopolnum: f()ss:L Wht,:lt! I( ends in the pttrr)' gO(!ahlllne ~angUon. The ntrve to Ibe stap<llh" ari,.., frvm the facial ner.c 10 <oppl~ thc >tlpedu.,. muscle Tb< t honl I) mpanl """" from the facial " c JUst above tbe sl) lollliSiotd fornn"-"' The nCr>e lca\ts the tympnn1 c cavrty lhroo~h the J"'II'OtympodiC ftsSore ami cntoi'OI the rnfrarempoml rossn, where the nerve joins the Hngunl oenc. l11 c chorda tympn.n1contofns many tasfc Oben from the mucous mc&nbrnnc covering the :anterior tw(Hhil\ls of d1L' wngoe, nnd t.he tloor t>r1hc: mouth Tl\c ncrveai!ID contains preganglionic parasymputhetic ~e<'ntunwtor tibc111hill rc:tch the wbmandibulor gllll@lioo and are then: n:la~cd to 1~c ;ubmandtbulu JnJ sublin!;U!Il >alivruy




\.. Expansion of the 11ituitary gland by a tumor can put pressure on the crossing-over fibers at this X-shaped structure formed by the meeting of the two optic nerves. The name or tbls structure is:

Optic tract Lateral geniculate body Optic chinsma Medial geniculate body


e 20092010 ~ma1 Decks



Which statement concerning the left ' 'agus nene is false?

It can be cut on the lower part of the esophagus to reduce gastric secretion (termed a

It fonns the anterior vagal trunk at the lower part of the esophagus

It passes in front of the left subclavian artery as it enters the thorax

It contains parasympathetic postganglionic fibers It contributes to the anterior esophageal plexus

The optic oerc (CN II) arises from a.<ODS of gangllo? cell~ _of the ~~ina. which converge at lhe optic disc. The optic nerve leaves Ihe orbnal cavny by Jll'SSII'Ig lhrough the optic foramen (also called optic canal) of lhe sphent>id bone with the ophthalmic artcrv and then cmers 1he cranial cavity. 1l1e nerves on t>olh si<lcs join nne un01her to fonn ;be optic chiasma. Here, lhe nerve fil>ers 1hnt arise from tl1e mcdiul (lltl$111} balr of eacb retina cross llac midline and enter U 1c optic n-oel ofthe opposi1e side; Ihe fil>ers from the lalel"dl (remporal) half of each re1ina pa.,s (lOSieriorly in lbe optic l!acl of the sarne side. The optic tract emerges from the posterolalcral angle of the optic chiasma and passes backward around the lateral side of the midbr:1io to reach the lateral geniculate body. Remember: The optic nerves cany impulses associa1cd .-ilh vision. Like the olfactory nerves. the optic nerves are entirely sensory. The optic nerves are aciUally br:1an tr3cts rather than true nerves, since the optic nerves nre formed from oulgmMhs of the embryonic diencephalon.



p :ll',t"'\mp:Jihl'fic po\l!,!OIHCiionk


- This IS fa be; the vagus Dtn e cam~ parasympathtiiC preganglionic nbcn; 10 the tbo<acic and abdommal viscera. The Jell agu5 ntnt enters lhe tbOI'al< m front ofthe ltfl subcla\iaa artery aod behand the left brarhioccphall< eln. The nerve then cros;cs ahelef\ sade oflhe aortic arch und i< its<lf crossed by the kfl phrenic nerve. The loft vagus nerve pns.<cs behind the root of the left lung. forms the pulmonary plexus. and cominucs to form the esophageal plexus. Tl1o left vagus nerve enters lhe abdomen in front of the esophagus ahrough the esophageal lalla Ius of the diaphragm as the anterior vagal trunk (I"COc/h.'.S the mtte.rior surfut:e oftlte stomnchj, .'Vole: The vagus nerves lose their identity in the esophageal plexus. At the lower end of the esophagtL<. brunches of the plexus reunue to form an anterior vagal trunk (allleri<>r gasrric nene), which can be CUI (\agotomy) to reduce i!lbtric secretion. The right vagus ntn t crosses the anterior surface of1he ril(btsubcla ian artery and enters lht thonu posterior lo the right brachiocepholle ein, laternl to the tnch<a, and Just posterior 10 tbc arch of the azygos vein. The nerve passes posterior to the root of ahe right lung. conlributmg to the pulmonary plexus. The nerve also contributes to the esophageal plexus. The Dl:l'\t en1ers the abdomen behind the esophagus through the esophageal hiatus of the diaphrogn1 ns the posterior vagol ll'lank (rellches the posterior sw:fnce <Jj tile stomach). The agus nerve (CN <XJ: General t'unclions Molor to and scn.~ory from tbe l;uynx Motor to all of the muscles of the pharyn.. eccpt the stylopharyngeus Q"mm CN XI) and all muscles <>fthc soft palate exeept the lens<>r >eli palatini (from maJidibularcl~>lrioJr ojC.V


Communacates lllSie from area around epiglotll> Sensory from e"emal auditory meatus 1\fferen1 from vi.<c:era above lei\ (splenic) colic flexure Parasympa1he11c to the lungs. heart, stomal!h. and myenaerlc plexus

EXCEPT one. Which one is the EXCEPTIOIV'?


r All or the J~ryngeal muscles are innervated by the recurrent laryngeal nerve~

Posterior cricoarytenoid Thyroarytenoid Cricothyroid Transverse arytenoid Lateral cricoarytenoid


Copyrigbt ~ 2009-2010 l>mtf.l ~l;J


The semilunar ganglion is a large, Oattened, sensory ganglion ol' the , lying close to the cavernous sinus in the middle cranial fossa.

Hypoglossal nerve (CN Xll) Facial nerve (CN VII) Oculomotor nerve (CN Ill) Trigeminal nerve (CN V)

Copyripa 0 2()09..2010 ~~~ [)cocb:




The \lgu.s nerve posses;es '"" sonsury ganJ!Iia: i. Superior ganglion - lies on nerve within the ju~:war foramen 2. Inferior ganglion - lk> on ncrvcjusl belnw the Jtlllular foramen Bnmchcs that ttrise from the superior ganglion: Meningeal- supplies dura mater Aurfcoin- supphes auricle, oxternal audiiOI') meatus Branches that arise from the lnrerlor ganglion: Pharyngeal fonn pharynReal plexus, suppliel' oil of the mu>cl<.' ut the pharyn. e1eep1 th~ stylopharyngeus muscle (innenntNI ~~ glo<S"f>h<>ry.'<~ge<l n<W) ond all of the muscles of tile soft palntc, csetpt rlte tensor vcU pulultni rilltreure.l b)' nuurrliiJ11111r nmw:. V-J). It joins branches from the glossopharyngeul nerve nnd thesyo npathctk tmnk, to fbrm the pharyngeal pie~ us.
Superior laryngeal - d1\ides: imo;

Interns! 11') ngtal trnvels with superior lor) ngeaJ artrl') and pierces the thyrohyoid ncembrane. SuppJicj mucous membrane> ofthlarynx abo' e tht ,out folds. - Ellernal !at) ngeal - travels with sup<rlor thyroid arkry and upplics the cricothyroid nousde. The right recurrent laryngeal nerve aris.:s front tho vug11s, as the nerve cnls;es the first pan of the subclavian artery. The nerve supplies sll oftbc muscles oftht larynx etce(lt the cricoi.hyroul, whieh Is supplied by the cxccmallaryngeHJ brunch of the superior larynllenl nerve. The nerve nisoupplies th~ mucou:1 membr.uce of the laryn hetow the 'ocl folds. ond the mu' cotos mcmbmne of the upper part of the trachea. The len roc:urrent lryngeal none anses from the \1lgusas the nene cro~ aile an:b of the uona in the th<>rax. The nene supplies abe same mu.cles and mucous onemhnmes B.< abe right rccurrcnt lnryngeol nerve. except on tbe lefl ;ide.

llte tngeminal n~rw. or CN v, IS the m~t HtiUtnlllOUS of an ofthe cr;uual nerves. ran of the first branchial ~rch '"mandibular arch, tbe tngeminal nerve is scnsonal for tho fadol regions and mo101 for tho masticatory mu:.cle>. The trigeminal nerve exit~ tbe infcrol~teral pon; ns u sensory and motot roo1. The laeger sensory rootontcr~ tbe ttlgeminal r~emilumw w Oa.<<erj gungllon in the middle cr-n ial fossu. The three sensory divisions of the nerve arise !rom the ~unglion '"'cl leave the cramnl cavity through foramina in tile spllenoill bone. Tbe $tnaller motor root passes u.~~der the ganglion and jon~ the mandibular division 11.' it exits UtMugh the foramen oale. Tbe llllUidibular division mnervates eaghl muscle>. Remember: The genirulntc ganglion is an Lshapo.'d eollecuou of tillers and senSllry neurons of the facial nerv located on the facial canol of the he.ad. The ganalion rcecives tibcrs fMm ~tc motor, set\Slii'Y und parasynt(lntlaetlc cornpoMnts or the rudal nenc nlld sends fibers lbul will innervate the lacriannl glands, subonnndlhulnr glands, sublingual gland<, tongue (antel'im two-tl tln'/.,), palate, plt~ryu.~. external auditory meatus, stapedius. postenor belly of the dig11.<lnc muscle. stylohyoad muscle. and muscle~ of facial expresston. TI1c greater petrosal nerve (brtmth of th~ jacllll nen"e) ans<s from the gentculal< ganglton. This nerve as the paras) mpathctlr root of the pttrygopalatine ;:augUon. fl nms through tltc fact~! C&lllll and groove on the petrous portion of the tcmpornl bone be<ide the fornmen lncentm through the pterygoid canal to reuch the plorygopalathtc ganglion. lmportunt: This nerve o.~rrics preganglionic t (j'or the /aalm~/ gltlnd> as well plltuympathetic fibers to tbc pterygopalatine googlioa cU glands of the p<rlare utttlllaralrovily). I. Taste fibers to the posttrior ooe-tblrd or the tongue are from the glosso'lot.. pharyngeal nerve. 2. Loss of lacnmation (dry e.~e) ean be dur 10 an injury tu the III'C.1h!r petrosal nerve.




Which cranial nerve supplies the derivatives of the second branchial arch?

Glossopharyngeal (CN IX) Trigeminal (CN Jl)

Vagus (CN X)
Facial (CN VJI)

2U Copynabt 0 2009-2010 Dtn1 11.1OK-l:s





A lesion of the facial nerve just after II exitS from stylomastoid foramen would result in:

An ipsilateml (same .ride) loss of taSte to lhe anterior tongue A decrease in saliva production in tbe floor of the mouth A sensory loss to the tongue
An ipsilateral (same side) paralysis of facial muscles

A contralateral (opposile side) paralysis of facial muscles

CownJtn 0 2009-2010 IXrl~l Decl:J



Furia! (C


th :llh:IH.II \rdtl'' .uul lkrn ;~tiu 'tnu.:tun...-.



Future Nrnf':l and Muscles

future Skc&etal Strutturrs and ligaments


ltota11ew;anJ ~o(tmddk ar. in.:ludO:J ~I.C'rioc bgamen-t Tripn!Aal tWf\ r. mu.scles o( nas:tica:uon. rnytobyoid ud an.tcriOf af me maneu~. spbcthlmsru:fibubr hltOment, tiod pan ions of lhC' srhenofd flol)t bdly ofd1Slll1ric:, u:n:sor lympam. lt"nSOr vtli pai.Aiu~ mu!Kie$
Faci~ ft<T'r~. JQPtdlus rnusck. nmsdts or rxYJ c.~FftSS!OO. """"""lodly o(lbc: dip-

l1ut\l MC:hCIIi
FOUrth d.ltOU$:h

">"*>""' ' - JlyloOd- ollbc: ....,...J bono. tt'$$CI' C'Cic'U ofhyt'ld bofte, ~ J)C'Wtl\ln ofbodyofb:rotd

Sf.Jpg. llilld portJOn' ornulfeu.:. and toto. or mlddlr- ear,

musck. ~y~d mo.~lt

Gk>~$0rharyntnl nt1'e. C~ylopfw)1Jgt:tl mus.:lt

of hyoid bqc~ loWtl' portiou ofbady Mthe



m:urmn ~~ bracb of VIJU IIO'Yt. lC\"UUf palame musc:k:s. phar'yilinl ~ors, intnmte

~... ~-and


musclC!i or lhe lirynx

Note: The lrigemiual, facial, glossopharyngeal, and vagus ncrv<!s are said tu be branchiomeric (nmrsomltic) in origin because tbey originate from the brunchial arch<>.

The facial nerve is the nerve of facial expr~slon. The facial nerve is a mixed nerve

containing both sensory and motor comj)QnentS. h emerges fiom tbe brain>tem between the pons nod the medulla. and controls the muscles of facial expression, nnd taste to 1he anterior two-thirds or the tongue. The facial nerve's main function is motor control of mOSl of the f>Kral muscles and muscles of the inner car. This nerve also supplies parasympathetic fibers to dte submandibular gland and sublingual glands via the chorda cympunl nerve and the
ln addition, the nerve receives taste sensations
I ada I

submandibular ganglion. and to the lacrimal gland via 1he pterygopuhlline ganglion. from 1he anterior two-thirds of the tongue. The facial nerve has four components with distinct functions:
( uuual

,.,.rH \ 11

CnmJonent Brand,llal mocor

~a/ \-&c.-..rtJ/ ~m:.nl)

Supplies the muscles cf facial expresstOn: posterior hell) of di&BStrit mwcle: saylob)-Otd. and aped~"'


\'bcual moiGr

Puasympalbet1t lnnet'\'11ion of the lacnmal, subm:md1buiM, and. su.bhngual

(g""'"'''"cfm/ effr:mrl) a lands:, as ~ell u mucous membmnt1 of 1he nasoph~nx and che hard and ~ft palate



{grlu:hll -tUI'nan~c ajftr-n~t)

<kncral sensation from the skin or1bc concha of the auricle and from a small area b<hlnd !he ear
PnMdes taslc $<115aliOn fiom lbc &Dierior awo-lhirds or lbc IOilgUe; lwd and sofl pala1t'S

Sptdat StDWr)~
(Sf"'rlal a{f.,..nl)

Key point: Branehaal molar fibers conSlllule the largest poruon of Ibe fac1ul nerve. The remaining tluee comj)QnenJS are bound in a distiocl fascial shc:alh lrom the bmnchinl motor fibers. Colle<:t,.ely, these lbree componenls are referred to as the nervus intcrmedjus.



The trapezius and sternocleidomastoid muscles receive motor innervation from the:

Glossopbaryngeal nerve (CN IX)

Vagus nerve (CN X)

Accessory nerve (CN XI)

Hypoglossal nerve (CN Xll)

Cop)Tight 40 20092010 Dtn~l Oc<:h



~ All or the following organs are intraperitoneal (peritonealiud organs having a 'meselllery) EXCEPT one. Which one is the EXCEPTION/ ~


Transverse colon Kidneys



Ncn 't
O"""plwyog<ol /CV/Xi

Sltt or E1:i1 from Skull

JllJt.~lu foramen

Rr..ttdal m<ltDr
r~ tlcrrT.II/ (/fUPitll

S~ii~Ph the li)>l""'l"r)'ltJIC\11 lfllllfdt'


\lKtnl_,fiCCnl dk.nul.t

,....,... . llllllm---o(I

DKkD!Jtnk of-.c~llr'Yf!1'.. aid -~oftM Chen ... aflrlbncl


V\M'tral M"n$01')'
fitfll~m( vlscrful 11ff~rlll

Carn.u ,;~1

Sle'll.o.'Y lnfam\adon rom

d~ csrod>l S.n.d 11rt.l Mll1

CttlfNII ttMI')'
(~lfC"''dl $()111NllJ~-olflfr*"ll

"""".....,. ..........

Pnw~~t ~iol' llnfomwloa trufttktkirto(lhfc-.awnRIOI!r.ler.lal .r.ccormt"'-..-..:~

__ ...~-


Sprtbl ttftSOI)

ll"<ib' <!tli',..,ri
A~auJar r~tn

Provides w:c 5ro54bOfl fWinl JStt'rior \li!O--th!RI oflhc tOng~~r

lnner.-alC$ mute:kl of1bo llll')'tiX at~d


81'111dtbll nt61 _.f'-4':,1LIIhll ...,,

~~~"" H~eroi ~f,


fi.YJHlt~l WJal

lnct.bl .,.,. t91DM

...... wck-"

l!IICt't ..ccs tbt lni'U* -


lf't'l"f.J. dc.VJWl ,ff~

(~t'fll-"m1 jl).ll!t.!tJC' ~jll'f'ti!IJ

S.cuGtk motur


lnncr.--.tes .t.ll oru.e llll!ln.u: and tnOSl or the t:\ttilbit mu.'<l< c.r the \Ofllj;\l< ~t11tO,'om.t. 11J'II1g/~ 'S, Qttt/ >\J~t.a.m.u"""~t'/nl


1111~ kOWIICi tnQSid


fiJ"' -4/ ,zfftrnUJ

Tolhrll!"pD l1fCoru l.w ketlroa To die scmirirt'Ular c:uult f\>f blanoe

Abdominal ca"il): the major part of the abdom:r.opeh1< <anry. bounded by the lllonococ doaphragm and the pelvic: l:nJi:,_ The abdominal cavity meludes both tht> pcritont:~l t':&\11y and the rtrropcritoneal space. Peritonul cnlty: that part ofllu; ;t\xtomen :;urroundcd by peritoneum. nus IS 11 potential space be

lwccn the paricml and viscc:raJ layers of peritoneum

Rciruperhonul space: the area bchmd (f>b$Jbfot roJ the peritoneum. Rctro~ruoocal organs AI'\! located in this ~pace
Abdominal coottiUJ:

Peritoneum: a chin. serous membrane hning &he wall\ ~r the abdominal and pel\ic cavities and tlothing the abdommal and pelvic v1sccra. The peritoneum can be regarded a.~o 11"'balloon.. inro which o.rgans are pressed into from the outl!ldc. The peritoneum has ''isceral and p,.rletal layers,just like
the pleurul c;~vity P:nielal ptrhontun}: Jines the walls of the abdommJ.Iand pel\ic e3vides Visceral ptrltoneum: CO\'ers the orpns .--H Tbc potentiAl space between lhe rwo layers.. which is m cfTect the- mside space of the balloon. b called the prrJtonut ta\il).

The perhone.l ca\hy can be divided into l\\O pans: Greater nc: is llle main component of che peritoneal cavity and eXtl-ndS from the diaphr-.tgm down to the pelvi, Lesser sac: I.S smaller and lies bch1nd the sromath The lVo'O $1CS 11rc in free communkation ~ith one ftnocber through :m oval "tndow c-.allcd tht' optnin.g of lht 16str .sac, or the tpiplok for3mtn The lertns intraptrhonHI and rtlroperhoneal are U$Cd to dtscnbe the relatlOm.hlp o(\"llliOU$ organs to tbe ptritonea.l ccwenng. An ocpn is saJd to be lntrap-er-itontal when it is abn<htiOially covered w1th \'1$CCra) petltOncum, The rollowing Of'8:i.ll1.; O.re Considered to be lntraperitontal: the SI011'U1Ch, jejunum. tlcum. !ipJocn. tmnwerse colon. liver. 1tnd gnllbladder. ltetroptrlfcmel\1organs arc chose 1 hatlie behind the peritoncurn ond are only partially covc:red witb visceral periloneutn. The followmg organs or :;true~ rurcs are consideced to be rttroperhont t1; the aorta, inferior vena c-ava. kidneys, adrenal ghmds. pan~ CTeas. urcten., and the 154:ending and desccnchng pans of lhc. colon.. 'lott: \ftst-nttr1u are two-layered fold\ or puitoncum conneenng pans of the anh:~uncs 10 the posterior Abdominal wall These folds pcnnt blood.l)mpb. \esscb. lnd nerves to reach !.he viscera.



A 47-ycar-old patient with pancreatic cancer Is put on multiple chemotherapeutic drugs. Unfortunately, us a side effect of the drugs, his kidneys start shutting down, and this leads to hypervolemia, or excess extracellular fluid. Extracellular fluid:

Is composed mainly of transcellular fluids Makes up the major proportion of total body water Has a higher sodium/potassium ratio than intracellular Ouid Contains less glucose than intracellular Ouid

237 Copyn!Vtt Cl 2(1(2010 Dtntllkd:s



A 15-yeal'-old patient comes into the emergency room with diffuse

abdominal pain, loss of appetite, and a fever. On palpation of the lower right nbdomen he feels pain, and even greater rebound pain when the pressure is released. The diagnosis is appendicitis. Which of the nine regions of the abdomen contains tbe appendix?

Umbilical Epigastric HypOgastric Lumbar Hypochondriac



11~1"1 :t

hi!!hlr ~odium 1pnt:l"'\iUIII ratio than inlr:trdlular fluid

/42. K' 4) ,.,, lntrocellular fluid (Na' 10. K 140) The body's water is effectively compa1tmentalized into several major divisions.

*** ExtraceUular fluid (Na'.

Intracellular fluid (/CF) comprises two-tblrdsofthe body's water - If your body has 60% water, lCF is about 40% of your weight. The ICF is primarily a solution of potaSsium and organic anions. proteins, etc.
(Cellular Soup!)

The cell membranes and cellular metabolism control the constituents of this ICF. . TCF is not homogeneous in the body. ICF represent.~ a conglomeration of fluids from ulllhc differeot cells. Extracellular nuid (ECF) is the remaining on(\..thlrd of the body's water ECF is about 20% of your weight. The ECF is primarily a NaCI and NaHCOJ solution. -The ECF is further 'ubdivided into three s ubcomparmtents: Interstitial Fluid (ISF) surrounds lhe cells. but does not ctreulatc It comprises about lhree-quaners of the ECF Plasma circulates as the extracellular component of blood. It makes up about one-quaner of the ECF 'l'ronscellular nuld is a set of fluids tbat are ouiside of the nonnnl companmcntS. These l-2 liters of fluid make up the CSF, digestive juices. mucus, etc. Note: Theepidemlis of the skin obtains nourishment by diffusion ofti:.suc Ouid from capillary beds located in the dermts. This tissue Oujd (a/so called inrerstitiofj/utd) contains a small percentage of plasma proteins of low molecular weight thai pass through the cap illnry walls as a consequence of the bydrostauc pressure of the blood. This fluid bathes tbc cells.


The abdomen

IS dt\1ded Into nine regtons b) four Imaginary plancs " like a tl<-tactoe bnard". I. Umbilical .. around the umbilicus: mcludes ponions of the smnll and large intestines, inferior vena cava. and abdominal aona.

2. Rlght and left lumbar -- lateml to umbilical region; contains portions of the small and large intestines nod ponions of the right and left kidneys. 3. Eplgam1c - immediately below the diaphragm and supenor to lhe wnbilicnl region; contains ponions of the pancreas aud most of the stomach and the liver ' inferior ''ena cava. abdominal aona, and duodenum. 4. Right and left hypoehondl'iac -- lateral to Ihe epigastric region. Contains ponions of the diaphragm, kidneys, and stomach, the spleen. and pan of the pancreas.
5. B) pogastric (puboc} - mfenor to the umbilical region; contaans the bladder, ureteJS, and portions of the stgmoid colon and small intestine.

6 Rl~hl and leO lilac (ingllinol) .. lateral to the hypogastric region; contains ponions of the small and large o nlestincs.



r In an elderly tulult, the thymus is mostly atro1>hied, and the remains lie In the~
superior mediastinum. In a pubescent boy, the thymus is at its largest, with an average mass of3S grams. When it is Ibis size, the thymus will be present in whitb other division or the mediastinum?

Anterior mediastinum Middle mediastinum

Posterior mediastinum

('q!)'n&ln 0 20091010 Dtn,al Oteks



rA college professor has taken a week off with a bad upper respiratory Infection ~
that will not resolve. At the end of the week, he has an earache iu his left ear, and his bearin~: Is slightly muffied. How would an infection spread from the nasopharynx to the middle ear?

Vestibular apparatus Auditory tube Extcmal acoustic (auditory) meatus Acoustic apparatus


\nft'f iur IUl'clia,tlnnm

The thoracic cavity is surrounded by the ribs aod cbe't muscles. lt"s subdiided into the plewul cavities. ench of whieb contain.' a lung, and the mediasrinum. whteb oonwins the hc.-ut, large vessels oflhe heart. trachea, esophagus, thymus. lymph nodes. and other blood vessels and nerves. fhe medlosrinnm is further divided mto four areas. Lfted below are some oflhe major struclures contmncd within the differeot regions. ({/ n nnruith111tlre ,\tOpe nfthe!!e car-ds Ia li<l o/1 o[tlil'l<Jnlorls of the nr<'drortirra). 'lote: Some stnrctltres overlaJ!rnto differ<'llt areas. Superior medlaslinum -arch or the ortn, left sud nght subcl~vian artcrle> snd veins, rigb! nnd left common carotid arterie.<. right and Iell internal jugular vein, l'igbt and left brachiocephalic veins, bmthioocphalic artery. upper hal{ of the superior vena ca'a. right and left pnmory bronchu.~. trachea, esopbagu.<, thoracic duet. thymu&, the phremc nerves. vagus nerves, cardiac plcxu$ of nerves. and left recurreut laryngeal nerve Inferior mediastinum - reg ron directly below the superior oncdiostinum This is 'ubdtvrded into three regions: anterior, truddle. and posterior 1. Anterior mediastinum - lymph undes, br:mth~s of intemal tbomcic artery; in cbildren, coot~itts the inferior part of the thymus gland. 1. Middle mediastinum pericimliwn, heart and atljacent great w:;sel5. the phrenic nchcs, and the main bronchi. 3. Posterior mediastinum -thoracic n(lfUI. thoracic duct. esopha~o'IJS. rracbca, right and left main hroncbus, bracbioccphalic an~ry. left common carotid Hrtery, left ~lib clavian artery, arch of aor1n, esophageal rlexus (bmrrcltes oj vagts und sp/am-lmfc 11erve.t), sympQihetic chatn ganglia. azygo and bemrrv.ygos ~cins. and many lymph


The auditor)' tube cquulizcs arr wcssurc un either side ot the tympanic membrane. The middle enr commumcutcs rostel'lurly with the mastoid "ir cell; und the nmstold nnuum thr~ugl the adhus ad antrum.
Tbe en con>bts of: El.lernal ear - consistS
~r th~ auricle (I'"'"") and the external uditory Thrs pan l'~"Cc..iVcs sound waves. The ltU ricJe e:onsbts C.flrlllft~lt10Uc; tl:ntihcllx. C I'UX of the hell>,., lobule.,. tro~u.s. and condua.. The exttrii:AI ltUdUory unal i~ a narrow chamber n,eu..,unng_



about I inch long Thi> c~~nol connectlo the uricle with the 1ymponrc ntembnonc m the middle eru-.
Middle cor <atiry)- an o&rlillcd cavity withm the pctrous nrt of the temporal bone. Tho middle ear '"'ontains lhrec small hones or us:slcles, the mallus (hammer)~ ).tlap(ls ('rimrp), and lr1tu (om//) that transmit sound. Lined with mucosa, the muldle ear i> bound ed latcrnll) by the tymponte membr.\11<: and mediolly by the &)val and round windo"; Also contains rn o IDU<<Ies -the supcdiuJ must! e. which rs the <mallest of the sktletnl muscles n U1e body, und the ten.<or t) rnpnni muscle. T11e tyrnpnlc membrane, con;ishnlJ of lnycrs nf skrn. fibrous tissue, aud OlUCO\IS mcmbusnc, tran~nuts 'lound vibnal1011~ to !he (JHcmal c:nr. Inner ear - .:onsistll urctoscd. tluid-fillcd Sp;IQeil within the tcrnponrl booc. The Inner car i> a bony lib) rlnth, wb1ch mcluclcs lhnlc connected ruct~ - the >tilibul, the ~emi c:lrc.ular canals, and the cochlea. These .structures t\re lin(d witlt a ~rous mcmhrnnc that fl>rm.< tl1e m~rnbranou tubynnth. A fluid en lied perilymph fills ihc ~p11c< between tho bony labyrmth and the membranous lubyrlnth. Note: Within the cochlc lies the co<: blear duo~ a triangular, mernbronollS ~\rUctll!C howuog the organ of Carli. The receptor organ lor hCl!P injl. the organ of Coni tr~lbmrt$ sound 10 the cochlear brunch of the OCOilstic (CV 1'1/J) nerve.


Cli niul con1lderotiooo: Middle car

nd the !Uiiopharyru<.

infection~ (olills m~dlql ~....,quite

prevalent 3Jid may

become cxtcnstvc due to t.:~o.mncctions between I he tympanic ClWity and bvth the ma.'ttokllur cell"




Which structure divides the anterior (vemral) body cavity into an up11cr thoracic ca\1ty and a lower abdominopelvic cavity?

Diaphragm Stomnch Lungs


c 20091010 lkntal Db



A young woman with no secondary sexual cha racteristics, short stature, and webbed neck walks into the physician's office. Her medical history indicates a karyotype labeled 4S,X. This woman, diagnosed with Turner's syndrome, is unable to conceive children, one reason potentially being that the sire of oogenesis is non-functional. What is tbe site of oogenesis in a healthy female?

Ovary Ovum Oocyte Oviduct


:U2 CoyricJu 0 20091010 Dmul D<d.J


Hiaplu :tl!lll

Body cavitie< are spacc8 within the body thot contaiu the hllcmnl organs. The dorsal (pf>.~fe rior) 1111d ventul (anJerior) caviuos are the two major closed cavities. Donal ra,ity is subdl\ided into t>u '--aviti~ I. Cranial cil)' (skull} - et1<<1SeS the bram 2. Verlebrol covity (also ~oiled rhcl !>mal or \'Crlehro/ <aua/) --is formed by portions of tho bon<-. (lerrei>n,,J that form the spine. It encle>scs the >1Jinal co1-d. These cwu c:willt$ commurucare 1hrough the foramen magnum. These c:a~ides nre lined by meni11gcs. The fluid in tllese C1>1lits is called cerebroplnal nuid. Ventral~' it)1: is !liUbdivided imo two cavities l. The thoTatlc cavity. is surrounded by the ribs and cheS1 muscles. The thoracic cnvtl)' i~ subdiv1ded into: Pleural uvlt.les (light and ltj/) -each of which contain.~ a lunl! and tbe m~dlast lnum, \lohich conwins the hean. large,.._...,,, of the heat'l. trachea. csophagUil. thymus, lymph nodes. &nd other blood vessel> and nerve<. Remember: The mediastinum ,. funbc-r divUied mto four areas: the tn>ddle, tbllllnt erior, posterior. and M.lpl"rior arens . Pericardia! CliVI!)' - between the VISCtrnlund parietal layer!< or the srou rerlcnrdium. contain< u thin film of fluid 2. Abdominopelvk nlty, wtuch ll3s tWQ regions Abdominal rail)' -- contatn< the stomach. inteS1mes, spl<etl. ltv<..: Wid olbcr tnt emal organs Pelvic ta,iry .... inferior to the-abdominal cavi1y. contains bladdt:r. )Qme reproduct ive structures (see he/ow), and the rectum. In the male - the paired dt~<:tus deferens and semU131 vesicle ami the unl'alt<d prostate. In lbe reml - tlle pmred ovaries and the unp:nn:d utents. ***The two cavities (rhoruclc aod ol><lul/ll/lopeM~) corrununtcate lhtou~h an operung in the diapbragm called the ltluhJS.

fh a n

Jk fjurt...,.. eniptital O<gllns, snuatcd LillSC to the sid< wlls of tho: pelVIS, and an- supponed by the brua.d llg11ment of thr ull!r'Us:. All the- OVJI)I\ hii,'Od llllll lymph:uic ves~ct~. ont.l ner\'elO enter lit 1he hilum. Oe11c11th its surface ef')llhclium 1 s -u. ti)I''U.~ that encloses the m~dulla 111 lUI em. The bulk or tht ov:try I!J the supponin :nrucmre called the nTonu.. Nutt: The m01ln fuucuon of lht O\li.\n(.'' u 10 prodUtt mtturr o<va. The corto tOII.tains O't a Jl \hrfcmn stage"> of ck"Vc1c>pmenL The ova b<gin as prtmordW (I'K',1n, f\U"-

rounded by a layer offlatccU' called grauuiMa reU~ At puberty. the gr11nulo.. C<il> begm to muluply
and fom11hc multilayered the['a inrern th111 ~ecn:~c.s ~strogen~: chc 1\Urfl\tindln Slf'Otnal edt~ nmn the

thec:-a exttrnM. A spJit appcan: in the 1h~'C.'t ioltttKt ttnd expands: ID form a nuid-fillc.-d l'ilvity th:u plhhts the. oocyte ro OIIC' side. the rolhclc i5 now. c.-..fian roiUde. 0\ lllation takc:'ll place Jb the m""dte ofn.tb cncnsm.J:ll t )'clt'- a Or.wfia.n rollicJe Ol('fllr(S to ~lease h.s U\!Utn, which cmcrs the urtrlnt lube. ne empty fllllicle lillt wtlh hliKKI and f\'8,rcs.~~'S an10 a cnrpus lut'eum. If the ovum i!) frrttll:zt~tJ, the corpu!) IUtt'll.lm wlll pt.-rsl~t 11nd co1uinue st.'trcllng ,,rogt!~tertwe tO maiultlln f'reguancy. Jf not. th.: corpilS lutcum <lhnnkll intO 1.1 mAll ma.t;.... of coll01~t:nous tissue - tbt cor
pus 11hlcan~:.

s .. ,. Lhat

I 0411:ottia (&'"R'Jt~r oogoniuntl an: " a n celb that g,,.t n~c to th~ lil'etime ~upply ofuocyce1 lltt: present lrt th~ remale's UVIU'ie!i b)' the rime !t-he I~ bom. Notr~ The UN:)'ICS ~in to d.:gcncnue. and tht proec:ss conhnue' throvghout aduh life. 1'be~c. an: calh:d "tn:tic folll('le~. 2. rrlmfJtdillotlleleJ cumain ill,& primary oocyl~ 111 1he ~e1(ually mature. uv11ry11rc stimul11tcd 10 devetor by s~c:rct1on of FSH fmrn the antmor lube or the pttuitary. Pnmary roll ide" (1ft fh~

)11,, ~Miotic 4/J~Jsum' ~come "-tcondary follic:t.:) with the (otnL:Ji10t'l or 1he antrum lcovw' Fully n~arure Graafian folhcles tonQinlng >ond..r) OOC)'1<S (1)1 '~' sYind 11trioll< ih11>i1>11l rtlea~ the egg nno 1he abdoounal ca\ II)' un4.trthc mOoc:ncc ofW to~ sv.qn inlu the ns1ium of the falloptM 1'\abll (t4fC.I'ine ruhc, r)l.'idurl) to be ttn1 li?cd and ~ubscqucntly in1planted in tht morus ordi,.,anlcd 1rnoC ICrtiUzO<I.
3. Dllnng m.liturah''" of the ega. fQur duus,tner <ltll!. Grt produced. unc of' \\hich Is the 1af};c. r~rciliublt uvu m. \\htle ~ otbns life ~It rudimentary cells nlleJ pot:~r bodlts Pr



Consider the following three tubes [1. epit/11/ymis 1. oviduct 3. ejaculatory ductj.
When a man and a woman are participating in sexuaJ intercourse,

name the path the sperm travels upon ejaculation .



2,3, I

152 153
C'op)TislJt C> 20092010 Dcontal Dkll


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Cooper 's ligaments - fibrous bands attached to the musculature- support:

Each testis Each ovary Each body of the epididymis Each breast

CopynJbl Cll<M-2010 OtoW ()e.cb


Spum i> formed in lhe l fi!OS and !hen p.ICS along 1he ductus d~ferus, which JUIDS chc d ur l oft be seminal ' eslcleto form the ejacula wry dueL During ej~<tulahou, the S])l'l11\ rom bines with sern:oons from ll1il prostate gland and stmlnol \'esicles ro fonn I he seminal Ould. The testes are IWO oval organs conl~ined in <he scrolum; <he rigb1 one is u.uully h<gher !han the left by oeurly" half inch. The lcsris is oap1><d by 1 he epididymis. Thtt el)ldldymls ls n tortuoll.5, C.shnJX:d, cord-like lull<! aboul 20 feel long localcd in tho !iCI'O IUJll. Tbe tubo emerges from lhe IRiltls lht ductus (vas) defer ens. The ductus defcreos and ils surroundina vessels and nerves form !he spermatic curd, which ruus upward tn the levl of ll1e pubic tubercle of the pUbtc bone. JX,;scs through lhe in~tulnol canal, nnd tb<:n turns sruarply ro en<er

the pelvic C8VIIy. The dUCTliS deftn:ns then heado IO,.ard !he back of the pi'OSI81C ,land. where the ducrus deferens e'pands into llllampulla ond joins the ducr oftbe scn11nal 'e<icle to form chc ejatularory durt. The ejarulatory ducr pcne1rates lhe prosllltc gland 10 upcn inro the prostatic urrrhra. Afier leaving !he prostaTe ~tlnnd, 1he urethra runs lhroul:}llhe muscles of the urogcnnal diaphragm, and en1ers the pcnio. I. fhc ejaculatory duct is one of the 1wo pasSllgeways tllat carry semen from the Nn<;o proslutc gland 1 0 the nre<hrn. The uvlducl ((flllopicm mbe) is one of n pair of ducts opcnin nl one end into the menlb und 111 Ihe other end into the perironenl cavity. over ll1c ovary. Each rube serves us n pt,.suge throug~ which an ovum i> carried w tht Ultrus and through which spermatozoa move out toward the ovary. 2. Stcre~llia are long~ nonmoule nlttO\'tlli that cover the rree surfaces of some of lht p:.l'Udcb'II'Dhficd rolumnsr epithchurn !hal lmes lhc in.<ide of lhc epidJdymis. Ste!'e()l.~li ''''"'" to fac:ililate lhe I>:ISUIIt uf nutnents from che cp11hclium 10 The sperm b) ln..Teasing the epithelium'~ ' '"f""e are..'1/ote: Srcr~'<JC1ha iltC aL.o present In the durms (v</ deferens. wh1th ~~ ~l>o lined wilh pscudostrduficd columnar ephhellutn.

The mammor)' glands (brensls) an: lncated on ei~1er side of the :HItenor chesl wall over tbe greater pecrorul and the wrlcnor srnrus muscJeq. Th!Se glands are specialized acces.<ory glands 1!1&1 >ecrele miU.. They are formed frQm many smsU tubule' grouped uno lobule. Severnllobul~~ coi\St\ttne a lobe. each of which bas liD lnlrrlobuler duct. Many ofrltesc duel< c:cmbfue tO fann a lctlferous duct, which lennfnat"'l atlhe mpple. The nipple IS prescn1 Qll euch brast and J'rescms as a centraUy located pltnemcd area of erectile tissue ringed hy au aruolu thnt 's darker 1hnn lbe adjiltelllli;,~uc. The arterial supply of the breast~~ fr01 11 perromllng branches of the lnternul thoracic artery and the lntorcostnl arteries. The nxillary artery nlso suppli"'l the gland vtn tiS lat cr~l thvrucic oud thorMcoacromial br~nchcs. Several c~Ail\5 of lymph uodt>s drnio ditTcrem area.' of the b~st aod 3Jttlla. n1e nodo chains and I he areas they drain are as foUows: pe.::toral mo,t of the bren.t and nntcrior cbe.r brachutl- mos1 of the ann subscaput r- poslcrior 'hest wall and pan of lho ann minaxiUary- pecton~l, brachial and subscopulnr nodes iuteynalmnmmnry node'< m:unmary lnbes I. Breast <~lnccr ca<Les dimpling of the ove!lying skin and uippl~ reunctlon. Not.. 2. fhe suspensory lfgamenls (Coopers 1/f!,umenl.t) are strung. librous processes that run from lhc dennis of Lbe sk<n to the d<ep l~yer of superficial faociu thru11gh the breas1. 3. Important: Mammary. sweat,laTimnl. and salivary glands ron~,in a specal type of smoo1h muscle ccll called myorpltheliaJ cells (star-shaped). Tbese cells hove processes thar >piral urowtd ~e of the secretol) cells of theie glnnds. llle conlra<'lion of the!.c flX~!t:S force& the <eerelion of lhc glands toward !he duel~.




The Inguinal canal is an oblique passage through tbe lower part or the anterior abdominal wall and Is present in:

Males only

Females only

Both sexes

Copyright 0 2()09.2010 Dmtti !Xc\:f



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The most common type of urinary tract infection (UTI) Is an infection of the urinary bladder called cystitis. Women more commonly get UTls because what passageway between the urinary bladder a nd outside of the body is shorter in females than In males?



Ductus deferens Theca internn

154J 55

c 1()09.2010 Oml&llkd:i

llulh "il'\C\

Tbc Inguinal ~on1l allows stnJcturesofthe spermatic cord 10 P"""' to tutti from tbe letis to tltc abdomell in tbe male. In the female, the sm:tlltr canal penni IS Ihe passage of the round ligament of the uterus from the uterus 10 lhc lab1um maj us. ;-lote: In bout S~"l<<S, the canal also tran$mits the Ilioinguinal nerve. The pcrmulic cord L~ a collection of stnJciUrC.< that 1mverse tl1c ingu1nal canal and Jl'lSS to and from tltl.' testis The spcnnaric cord is covored Wllb three cunccnlric layen. of fasCia derived ftom the layers of the antenor nbdominal wall, and begi~ at the de~p In guinal ring latcrnllo the mferior cpigas1ric anery <tutl end~ nt the testis. Struclun:s oftbe spermat)c cord: Ductus (WJS) d~fcren> .. 11 is a cordlik~ 5\r\lctUTC. II conve) S sperm lrom the epididymis 10 the ejaculatory duct, whocb is a pasl;ageway fanned by the union of lite defereut duct (ms d~{i!rf!ll>') amlthc e>crelor)' duct of the seminal \'csiclc. Tbc eJacu latory duct opens into 1he prosiJitlc urethra. Tes tlculor ortfry' brJJJch of !he abdominal aona: supplies mamly the tes1is and lbe epididymos Tesliculur veins an xlensive venous plexus. the pampinlform plexus, leaws the postcl'ior border of 1be 1es1i~. As the plexus nscends. it becomes reduced in size into n single testiculnr vein. This runs up on1l1e JXI'Itdrior abdominal wall und drains mlo the lei\ renal wm on the lei\ sodc. and inlo 1he inferior vena cava on the right stde. Testicular lt mph vessels - ascend lhrougb the onguinal cMnal and pass up over the posterior abdominal wall 10 reach the lumbnr lymph nodes on lht fdc of lhc aona at the level ur tlle firstlumbnr venebr!L Autonomic nerves ~ympa1hetic fibers run with the 1esticular artery &om the renal or aortic sympalhetic ple.,u>es. Afferent o;ensory nerves accompany 1he effen:nl sympalhetic fibers.

l nthra
TI1< 11re1bra is olio be that convey~ urine from lhe unnary hh\Utlcr 10 the oul<idt Oflhe body.lho wall

oJ' th.; u.rcthm 1:!. It ned wilh mlleous mcmbraue~ 1 "'d ~ontain ;~ 1' rei:Ui\lely dm:llaycr uf amnmh m1,1..r clc liss:ue. It 6150 CQntain!; numcrou' mucous plitnds, called .. urtthnal gltruh.- that .:-tttt'tc mo~u.~
ioiO the \lrtlhnl c:anal

subjects the ft:male to more ftequtf\1bladder mr~ctioos. 13ecuuse 1he male mcl.hm l m .. ~;ls 10 the penis, tbe rn;itc llrethm 15 loup,er tbun the tcmulo urt:(hru. This r..:qutn:K an Jl\\latlini orguni:un to tr.tvel u ~l'l:3ter di!rlance to g;aifl ilCCCS$ 1 0 the urio::uy hhtd<kr t:lim1n.al~Jli urine: by the rnalc tt:ncb 10 n\~h the umhra before n uwadill!! O<g.1DI51ll ~ rco<h lhc urinary hi odder I. The ftmale u~hra open inlo the "''''bule between the clil<lns and the vagi011. WMtt" 2. lo l1\c male, th~: melltra B (SI.) convey~ M:mctn fi'om the rt'pfrn.luch\'e orgun.s during c:Jn~ula tioo. 111c male utt!.thnt i:~ dlvid<:d iuto tJl 'tt parts: - pronatlc: il is-lhc widt):t ~md m~t ,l!l:atable pnnion or~ urtthru . mtrobraoo-us: "I he. ibo{k'SI, and lea.,u diltuabk:: fi0'\100 oru~ uretht-.t P<nllt: il i> the lon!l<$1 and 1\Atmwtl!l pmtion; bulboumhrnl glolil> open omo 11 3, The un.-1cr i!'l a pcured l'll'\St\ge'f\oy lhat t.r:~n.:~p<trts the urine fuun the 1\1 dney to the unnary

The urc1hra beong shorter i11tht rrmale (pbout f

em fo11g}

ll1011 it is in dt< tns1e (obuut :n '"' /0/Jg)

bladder forconcentration und storsge until the Ul'int! is vnided.

lmportanr: The IICc:.eS.~)ry gland-4. which produce most Of the scmc:n, include th-e: Th.: tmtoal >tsi<les an: pr.tt't"d""" a1 <be: base of the bladd<r. Til< bulb<>ufflbNI1 glands (C"ot'P"' :r glori!IJ/. al<o p3orcd. ate located tnfcrior to tlte prot41e Kland. The prosh.Cc gland 1s l'hllfled like iln invened pyrunud and Ues undt.:r the hludder, with the poin11ng downword llmcrgtnE lhlm the neck of the bladder. the urdh!U """' <noc.Uy thro<.8)t lbe prosllt<: glal14. and <xtb just on !font of the aP< 11>< pro>lltc gl;nd


I>RS lowO major groups of gltn<ls:

periur~tflrttl gJands: t~rc in the ccmrol 1ont sutrOund i n~ the urethra
rnaf11 ghwdJ: -ate In the peripheral ~oo~

All th~ alnods Optl\ into lht p~ll!lhC urelhra -and se<:n:te lbc-entymc: atld phospht l. alie._ fib-nooly,ln, lnd .orne proteins. PI"'SQilC ...~on makes u.. 3botJ,t 15~"- ur ~C'D.



( '


is the permanent sterilization of women in which this structure, where fertilization occurs, is severed and scaled.

Uterine tubes Uterus

Labia majorn

247 Copynjbt Cl 2012010 Dental Db



A 17-year-old male patient who has no history of vaccinations comes into the physician's office with bilateral swelling of the parotid glands, fever, headache, and orchitis. Orchitis is the ;1alnful swelling of what organ, which produces male gametes? Prostate gland Ductus deferens




( Jrc ~ n' uf lht 1-tnJ:Jk Uqu udut "' t'

""'',It_ m

Organ (s)
P'f'odu~ o"a

{ft:nulle gum cells) and female JCJC h()t'n\()1\es (c:Jtrogt'IIS (md progc:Jtft'Otle)
Rcteivc the ovum from the <WMY Md provide silt wheft fertil~ion of the O\'U.IU t:an take p~cc. The tubes sme as a conduit alona whieh the lpCTlll8toz:oo travel co reach the O\-,nl

Uterine tubes {follopitm tJtlw-~)

labia majora


a.s a site for lhe rcccption. retention, tnd nutrhion of the fertilized o...-um

NOt Oftl)' is tbc- female~ canal buc allo tcn"tS as the or:ererory dues rot the mcftSil'\Jal now and forms pll1 of the birth c::anal form tnU'IJftS ofpudcod:aJ dcfl cnclote lnCI pcokd ocbu cxtemalocpodw:b"c orpns


form mare,inJ ohescJ'buk: pro4et1 opcnaap of , ..,Jil'll .S Ul'dtn

Provit: feding of pleas\.lrt: cfuriQa JtunuJadcn Secrete lubricacing fluid into the vesubulc and VlgJnaJ opening during coirus Product flnd secrete milk for nourlllhmC'I\1 of an infMI

Vt$1jbu)ar vt.and&
MammaT)' glM<b


(Jr :,.:.n' ofl hl' \bit' l.f:qnutltufl\ t


Orgn (f)
T es1<0(1)

f uactioa

Procktce Spc:ml and 1$0Sltrone (malr .fe:t h<>rm0111:)

l!nc loses and protU testes

Epididymis (})
~atc &l.and

J)ortion of the seminal duet in whieh sperm maturt aod are stored

Ouetu.\ (wzs) dcrmn, (1) Transport sperm d~ng ~IL(ulation upwn.rd inside the spcmuuic cord to the urethfll

Produces semen, the fluid that ciLI"fics spcnn; Lhis fluid helps protccc spcnn rrom the vagiMs acidity during cjac:ulatKln

Serrunal "es5cln

n pGir)

Stcrtte me majority o(lhc flwd (alkaUn~ Gild ncA lnfiwtos~J ID sc:mrn


Scemt Ouid thai lubricates ld'Cetn and md or pct~i$

Recei\.-e spenn and addlb\U to poduce sc-miNI Ovid: run tbn;K1,gb !he proscc and open 11'110 tbt umbra
Mtle saua.l organ that pbSCI bolh urine and &penn

I Ejacnbmry docu {1J




( \.

A new alien species is discovered that reproduces in a unique manner without gonads. This would mean that the species did not have:

The uterus in females and the epididymis in males The vagina in females and the ductus deferens in males The ovaries in females and the testes in males The uterine tubes in females and the ejaculatory duelS in males


Copyngtll ~ 10092010 1Xn1 allkcts


Pdi / G)

Surrounding the root of each tooth is a specialized epithelium known as:

Connective tissue attachment

Periodontal ligament auachment Junctional epithelium Nasmyth"s membrane


CopyrialJ c 20(19..2010 Om..l ()c(!b

The 1l\ nies arc elhptlcal Qrgons. silllllted clo~- to the side walls of lhe pelvis, and arc supponed by the hroad lig~ment or the <II eros. All ofth~ ovary's blood and lymphatic vessels. and nerves ontcr ut the hilnm. Beneath its surface epithelium is a cortex thnt enclose. the medulhtat its cotc. Tite bulk of the ovary is the supponmg Sll\ICI\Ire called the strotn3. Not~: The main fimction of th~ ovaries tS to produce mature ova. The ovatiC$ also prcxltJce steroid honnones estrogen ami progesterone. Estrogen -promote the development ond maimeotu1ce of female o:.xual chamcrer istics and the l>ropcr sequence of evenll! 111 the femole rcproducrive cycle (me11strua/

; l'rogesterone - mamtains (alo11g wllil <Utrogett) the linmg of the uterus ncccs<asy for <uccessful pn:gnancy. R~member: Ovulation takes place in the middle of ench menstnllll cycle a Gmnuan follicle rupllll'/:.1 to release its C > vwn, whicb enters thr uterine tube. l1c emptY follicle till~ with blOod ond reg= mto a tO'llUS luceum. lfth~ o\'\lm is fcrtlll~ed. the corpu< lotoltlm wtll pcr.;t and conuuue secreting progesterone to main rom pre!lJ1ancy. If not the corpus luteum shrinks into a small mas< 11fcoUagenuus tissue the corpus olblcns.
'C pnired SlrtiChores that are suspended wiU 1in the scorw11 fhc testes (Jingu/a": testis) a1 m the rn.Ue. They produce spenoatozoa and sex hormones (andmge,>). Sperm ore produt<d in the 5emlniferous tubules and stoted outsule the resu~ m the epididymis until ejaculated. Attdrogcns. the ruosl impartllnt one l>eiog testosterone, nr~ synthe~i>.ed ami secreted mto the bloodstream by interstitial cellc (of L...tlg) found 111 the intorstitium of the t"''tis between the seminithous tubules. Testosterone is re,;pl>nsible for gro" th and tn31ntenance of mal~ st'f.unl ch11ntctensucs 1111d for sperm produ~tion



l1lr dentojunclional cpilbclluon is th~ juncriou between the h]nlh surfac~ and the gingival tissues. Togother, the sulculr epithelium and junctional "llllhclium form the dcntnglugival junctional ti\Snc. ntey art composed Qf nonkcroliniud stratilielf squamous epithelium. Sultular cpltltellurn (a/su m/led t:t"f!tlcular epitltclium) .. wu1ds wy Jiom the looth. creating tt ginglvul sulcus, or $pace that is filled with gingival Ouid or crevicular Ouill. Junct.ional epithelium -a deeper extension of the !mlcular epithelium. the JIIOCt tonal epithelium l>cgins at1lte base of the sulcus. This epithelium ts a collru ltke band of stratified ~quamous ep>thelium that is flnnly ~twched to the toodt sutfuce by way of an epithelial uttachmcnt. At the epithelium's be1,<inniug, iL ts approximately 15 to 30 ccU layers thick. and at ito apical end, the epitbcliwn os only a tcw ceU lllyc:n~thi<:k. The junctional epithelium consists ur two layers: a basal layer oud suprabasalla) er. Important: Tho superficial, C>r stlprab:ssul, epithelial cells of the junctional epithelium provide tbe hernldesmosomcs a11d an Internal basal lamina ~>at create l>lthellal attachment. The epithelial nuuchmem is '"'Y strong m a beai~Y ~tate. acung ._, o type of -.:al bet\\e.:tl the SOfi gtngovol US!<UCS and th< bard lt~'U< surface. u In ideal gingival hellh, the jwltttottal epithelium i locnced entirely on cnumel ubove the cemcnlocnnmel Jtmction. Note: Hlstologlcally, the be" way to diStinguish thu free ging1vn (row the epttheli!ll attachment is the fact that the epithelium uftlte epithcloal a!lachmcnt does not contain rete pegs or conne.:live lis~ue popllltoe and the free gingiva docs. Rete pr~:s are epithelial proJccrious that extend into the gingival connective tissue. CnMctlvc tissue P"llllle are connective tissue projections th~t extend inm th<t overlying epithelium.



Which fiber subgroup of the glnghal fiber group (gingiva/ligament) inserts in tbc cementum on the root, apical to the epithelial attachment, and extends into the lamina propria of the marginal gingiva?

Circular ligament Dentogiogival ligament Alveologiogival ligament Deotoperiosteal ligament

251 Q)pynalll 0 20092010 Oen;1l Db


All of the following are lined by keratinized mucosa EXCEPT one. Which one is the EXCPTI0IV!

Dorsum of the tongue

Soft palate

Hard palate Gingival tissues

lh.nln'2inch allil;!~fnrnt

Gongival fibers are collagen libers that support only the margin:ol gingival tissue.' to mainoain their rclation<hip to the tooth. Tbe gingivnl Obcr group (also mlled tire gmgi,.,/ /igam~m) is the name gh en to separate but adjacent fiber groups that are found wilhm the lamina propria of the marginal gingiva. Norc: Some hisrologists consider the gingival ligament to be part oflhe principal fiber> (n/so called tire alnwlogingioulligllnr~nt) of the POL. Gingi,al Ugament (ur gingival fiber gmup): Circular ligament . this fiber subgroup of the gtngival fiber group is located in the lamina propria of the matg~nal gingiva. The circular ligament encircles the tooth and helps mrunwin gingival inrcgriry. Ocntoglngivallignment -this fiber subgroup of the gingival fiber group on~rts in tbe cementum on the rooL aptcal to rhe epithelial attachment, and ~tends into the lamina propria of the margutal gingova. Thus, this ligament has only one mineralized uuacbment to the comentum. The dcntogingival ligruncnt works wirh the circular ligament to maintain gingival integrity. Ahealoglngivalllgamt nl -this tiber subgroup of the gingival fiber group extends from the alveolar crest of the alveolar bone proper and rodiatcs corona tty into tloc overlying lamina propria of the marginal gingiva. These tibers may possibly help to anach tbc gingiva to lhe alveolar bone because of lheir one mineraliled anachmentto boue. Dcntopcriosteal llgament --th:is fiber subgroup of the gingh-al fiber group course; from lhe cem.,tum. near tiJe cementoenamel junction. across the alveolar crcsL Titese fibers possibly anchor the rootb to the bone and protect the deeper periodontal ligament

~of1 p:tluh: The oraJ mucosa Is a mucou.'i m(lmbnme t~ t ~O"'-~ JJI -.~am uude tbe ural eavity ('<cert tbe tth.. Til< 0011 mii<Oft V>ria 10 color rram pin).'" lorom;to 1""1'1= drrcohll cmanwln-.do.tt'lkin colO< The rlf\.lCU.tre oflhc' oral mu~l va.Mefl dcpettdin' (If\ It! k1<11ton tn the OQI U\tlty tnd the function orlhlll trt'3.

I\ 1... uf (lr:t.l 'luC0\9

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........ a.....


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-- """"-_..._
lm c"ffva. ,..IIC!kiJ gm@lvn,


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trrid' . .ec ......

. . . . . ana.w,


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~"'*~ OlicJ ...... I'"r'"'l

pcp.lbk' ........,....,.
!nUl)' !tiC

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RIIN!c:ry 11ollt~ !CI'll\liCI 1m.\ ""'''ICIIC)', wrntlo ..


Kf'nt.llni:rtll epilhlt!lun.

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\I""'J~ 'J't~t.l fk filil'CIIltlCif\II!IMildr 1!"1'"1~

~l'lfx>cl bill*

p!IIJl- .... aotl.a~~>t~~

J T'bt-l.irno& ora bt a h> ~ 11 canlposcd or a oqk<nUniad epchehat ~ Y.itb lht rttt ptr;t. The pre.\m of rtte pegs, is lndle:arin of th~ prcsmcc of inJ1amma1ion. 3. The junction qftke lining. m1com wilh the nmsliculOry mucus:a tllthe mueQ l:lnglvat jtmctloo. ' l' h t Orl.) Jt'I UCUS1i iJ COIPpMtd oft"' U l.a)rn: I Str clntd squ m&us rpitbttium, 'hic.h may be non\;.era.t.mlcd. par.akeratiradcd. or onhokmUnized dq?Cnd.ng UfiOU tts locatton. 2. L1nllo11 propria ( COrfntt:tl\t> U;uutt), whi.ch tUJ)pl)rts the tpilhclhun Suhdivided into two l1yers (papt/lo" anJ ,,..~). h may be aua.:hed 10 the palOSt<wn or '"" olYCOtu bone or Ul~ 0\<f the Jubmuto1a (liw Jt1bmW:Wt1 COftflliM {{laNds. blood 1'(Ssds. onJI flrnT.J) Nott: A bt t.ment nlt hlbtam It tocalcd belWn""r! lhc ural cpilhelium and the eonnooU\'C ussuc rhe ~emcnl membrane i.11 compostd O l two l a)tr~ balaJ UDd rctiC:I.II3t lanuna.
e ...

Rt mc.mbu. I. The t rcvlcutar (SI,Jt:t,/ol') epithelium ;md a:mgival t:ol ore "!Joktractub.t!d &:h'lglvalll'!'tei


Pdl /G )

Scaling and root planning are periodontal treatments that can remove calculus and also stimulate the gingiva. Usually, a periodontist waits rour to six weeks after a scaling and root planning procedure ror re-evaluation or therapy. "!"his allows healing or the connective tissue by what main cellular component ohbe gingival connective tissue?

Osteoblast Odontoblast Fibroblast Ameloblast

Copyn&hl C1200SI2010 Delllll DtcU


Pdl / G)

Similar to the alveolar bone, the POL Is derived rrom the:

Dental papilla Dental sac Stratum reticulum Stellate reticulum

15' Copyripl 01009-2010 Dmtal Dreck

Fihrnhl:prd All forms of epithelium. whether associutcd with linwg. masticatory. or specialized mu cosa. have a lamina propria deep to the basement membrane. The lamina propria. hkc all forms of connective tissue proper. has 1\\.o layers: p:l!lillacy and dense. The lamina propria is densely collagenom. with a system of oollagen fiber bundles called the ginglvnl fibers (gingivalligamanl). These fibers brace the marginal gingiva against the toolb. provide the rigidicy necessary to withstund the mechanical insults of mastication, and unite the free marginal gingiva wuh the cementum of the root nnd adjacent attached gingiva. These fibers are continuou~ With the periodontal ligament. The PDL is also considered to be connective tissue. It surrounds the root and connects it with the alveolar bone by its principnlfibers (alveolodemal/igamem). which are ulso collagenous fibers. The mo~t common cell an the lamina propria, like all types of connective tissue proper, ;., the fibroblast. The fibroblast is responsible for lbc synthesis and secretion of collagen as well OS other proteins. Therefore. fibrobla<ts are rest>Onsible for healing of the gingtva lvllowins surgecy or disease processes. Other ctll$ present in the lamina propria in smaller nutnbers are the white blood cells sucb as PM Ns. mast cells, macrophagcs. nod lymphocytes. Remember: The collagen fibers of the gingiva are c3lled the gingi>'al fiber group or gingival llgament, which consists or five ligaments or groups: the ~ircular ligament, deotogingival ligrunent. dentoperiosteulligament. and nlvcologingivul ligamenL Note: The gingival apparatus is u term used to d=ribe the glngh'al ligament (or group.t) and the epithelial attachment.

The periodontal ligameotts that pan of the periodontiUm that provides for the attachment of the teeth tOthe surmunding alveolar bone hy way of the cementum. The l'DL app(ars as the pcrlodoutal s pace of0.4to I.S mm on radiogmphs, u radiolucent area between the radiopaque lamina duro or the alveolar bone proper nod the radiopaque cementum. The POL IS an organ1led fibl'()us conne<:rhe tissue th~t also maintains the gingJva n proper relationship to the teeth. In addttiou, lbe POL transmits occluS<tl forces from the reetb to the bone. allowing for a small umount of m<rvement and acting as a shock ab sorber for the soft tissue structures around the teeth, such as the nerves and blood vessels.
1. The POL becomes very thin and IQSeS the r~Jsr arrangement of its liber when a tooth loses its function (lr)pafunctwn). This also occurs in aTeas of tension as opposed to areas of compression. Teeth io bypcl'funclion ha>'e lUI Increased PDI. widUt. 2. Unlike other connective tissue> of the periodo~tiWll.the POL does not show the chang., related to aging, although the POL can undtrgo drostic changes as a result of periodontal disease. 3. Reutnnnts of Henwig's epithelial root shenth found in the POL of fu~ctio_nal tooth are called epithelial rests or Malasse.. These groups of epttbehal cells lti3Y become located m the mature periodontal ligament (called



Which of the following fiber groups of the alveolodental ligament is the most '\. numerous of the fiber groups and covers the a pical two-thirds or the root? .tJ

Alveolar crest gJOup Horizontal SJOUP Apical group Jnterradiculnr group Oblique group

Copynghl 0 2009-201 0 OC'ml Dtcks


, I "

The periodontal ligament space Is vital to the functional life of the tooth because this space:

Contains nervous and vascular elements Allows for physiologic movement of the tOOih Provides a cellular soun:e for new cementum and bone All of the above

Obh ~fU l' !,!nJU{I

The ponc:opol fibcn of th< POL ""' pr;...rily >mpc<d of bundles oi IJ p< I rollogtn fibtllt These fibers con.necl 1he: ccn1cntum to the ;dvtolar bone. The main rnnci)la.l fiber group 11 the ahtolodtntal Ug~mt.at, WhiCh COfiSIStl orn,e fiber ,b'l'OUps; Alnolodentalllgamtnt: The h"eolar crnt grou1, of the alvt..-olodental ligllnH:nt.; ongimnes an the alvco1nr c:n:~~ot of the

ufvco1t1r bone proper Bnd f&.ns ou11o inl-trt Into lht: r.f.'rvitall'emcnnun at nriuus angles. 111c funcllon of thi~ group is 10 ~t-it 1illing, Jnlru...qvc, e:ttrulilvc. ond rouuionl forces. l,e aplc:n.l croup Q( Ihe ;JIYC\Jlodcm~l li~~ment: radittr~s from Lho! upit-.1.! n:ion of 1hc cc:rucnrum 10 insertlntu the: surround1ng alvwlur bone propct lhe fun-cliQn of thl$ group I! to R:l!ISI C'"n&sfvc foo:es. wluch try lo pull the tooth outward. and rot.ni~nal for\."<:< Tht obliqu groop ofoh< alveoloderualligilrtl<onL the most nutmfous ofthe fibto (!lOOp< anu com th< apiCal twotblld> of Ill< root. n,;, tuoup orieonau:s In th< alvcolu bon< p<op<r ond nrcnds aptcally to 111.~ mono apieally into th< C<!JK'Iltwn on an Pbli~~VC tmi1Uief. The funct.,o ofth l;JI>Ilp

Tht borlzootal e.up nr the alvcolo<lcnlol IJgamn Otigti\Oie< m \he alveolar bon< proper apiCal
10 irs 111\'~l "r crc-;t and inserts into lhe c.emeJ\ltinl h.Jruuntally. (he: function of 1h111 croup 111 lu rcsisi

1.i to ~1St

inlnuwe forces. whicb try to ptah the IOOih lftWilrd. as \\'~U b Mlttu.mttl r\)tl:a

tiltmg forces. wbtch work to fQree th:.: tip dth4.:r m~:.sially, dtsudly, lingually, or f<\Cil\11)'. lind 10 rc-slsl romtlon::tl r..,rce,s, 1'be ltuerrudlcuiGr ~:roup of 1 hc d\'eolodeulu1 hpnmcnt: found ooly m 1nullirOUI~ H!~lh. Ttns !;tour J!t in.;~'ffcd on Ihe e-cmcnrum or\'"~ ru4.1t to 1M cecnennun ofd\e othcr r(l(l' tm rouiJ) ~upcrfi('13.l to lhc mt.crrlldtculnr $tpt\lm ud thus h:IS no bony ltll\chmern.. The function or 1h1s {!.NU(11J hJ work logdhcr w1th the alvrohn -=rest and apical JP'O"P" 1 0 NS1SI ;nmmve, ~tr\1$1\-C-. ulling. and roftUjonal

'>ott: Another pr~n<:~J'<Il foba 01hcr man lh< alvcoi.U<noal hc>mall is the irlltrdeotollfganlrnl. or lr&niStptal ti.gmul. n.., fiba" puur (txJ/lt .l tl\l'l.uqtc~l flhrr$} insa1S mcs:Wiy ot mladcm.~Jiy tnlo tl>c <<nil:al oemcnl\Un ofn<1gl\boring teeth over the ol\ .olor crest of the alveobir bone proper Thus..lh<
fibers travel from 01.-mentum to ccme:ntwn wnh'-"'' ~my bony :machment. The funcuon ofth1-t group is lO rcs1st rouuionu.t rorccs and thw bold the: te.elh m mt~roxnmtl con! act. Important; Th ~ t.nd.i the pnncipat ~. \\'hltb dl'e emhc:dded into tht ccmL"QUIID BJ1d ftlventar


bone, are callt.'<l Shupey's flben.,

\II ulllll' :1huH

Flrnclions of the POL;

Support: ptQ\ ides auacbment of the tNth tQ th~ alvoolar bone Formative: con111ins cells re<;ponibl for formation of the periodonhum ~utrilive: contains a vHScular net\\Orlc pro' i<hng nutri~nts co its cc:lb Sensory: conusins afferent nerve fiber. ~sponsibl< for paiu, prw;ure, ood propm>ceptlon llemodcllttll: comains cells responsible for remudel1ng of the pedo<lonlltttn Import aut: Orlhodontic treatment is possible because U1c PDL conlinuously rcspunds and Cl\a!lges liS the II:SU\1 Of \be 1\lnctional M:\l\lttomcn\s \mpo>od upon tho rOL by externally applied forces. Contents of the POL: Fibroblasts: like all conn~tive tissues, they are the moSt conunon cell Cementoblasts and .ementotlasts
OsteoblastJ and osteorlasts l\1acropbages, masl cells, and eosinophlls Uodiffercntluted mesenchymal cells Ground substance: proteog\ycaus. glycosnminoglyctins, glycoprotein~, and water The PDL bas a va~culor s upply (arises from tile max/110/y urle1y). lymphatics ( drafn ''' the submandibulurlyntpll nodes), and a nerve supply. which enter che apical furumen of the tooth to supply 1he pulp. Two types of nerves are found within the PDL: I. One type is arrercnl, or sensory, w~ch is myelinated and ttan-'>mits sensacion. 2. The other rypc is autooomit sympathetic, which regulates the blood vessels. Two 1ypes of nene endings are found in the POL: I. Frtt nerve ending$: roovey pain. 1. EncapsuiRted oerve endings; convey pre-sure.



Which type of epithelium, characterized by multiple layers that can contract und expand, would be found lining the urinary bladder?

Simple squamous epithelium Stratified columnar epithelium Stratified cuboidal Transitional epithelium

1 8

Copyri,gbt Cl 20092010 Dcr.Utl Decks



Upon returning from a two-week trip tO Mayan ruins in Mexico, a Harvard archeologist keeps getting compliments on his tan. Melanin is produced by melanocytes, which are located In which layer of the epidermis~

Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum of stratum genninativum Stratwn basale of stratum germinativum

Cop)ri&:hll C 20092010 Dtnul DoeU



Simple squamout rphbtllum .. single laytt of tlun. Ott celb.; fitncrions in g.u rxchan~ hna: blood ,cssrls and variou1 me1nbra1ter.; Endulhtlrum linmsthc t-~~rdiov.ascular system Epithelium limna the ~he.oU In luo.gs Mesothelium Uning body cavities and c-oat~ organl'- ('I( theM! cavnies Slmplt cuboidal ...pHhcllum .... :,ingle ID,ycr of cubc~!h npcd t'ells; canies on se-l:reuuu aml1sbsorpuon: Es>ithdhuu linin c:tll1'-'i!ling: ducts. prodmnl, and disml rubules of tlle kidney Epi1hcliu111 lining thyroid follicles Simple column11r tpllhtllum- dong;ucd cells; functlOI\.'i in pro1ecuon. secretion and ab:torptlon: Lining of \he rnoll and l.rge intestine, the jSallbi.Jdcf. and the Slorn>oh

Utennc qntbclium Salivary &land """'"" ducts lclcmallimna of the 1113Jorit:y of the mholat ga<lnlimestimolUOCI Stratified squomous rplthrllum - eo.nposed of nwty la)m of t:<lls: protooiS und<:rl)'\1\i c:clls from
enW'Urunental nuctulltons: Epidennts nflhc .ktn (kem,;~,t;ed}

Lining. of the esophagus (usually ,rot ktratlnl:cd) Stratified cuboidAl epit h~lium composed of mauy layers of tube.-i;harOO tt! ll~: Ducts or the sweu1 gland~ Stralificd colurun~r tpllhelhun -l'Ofllposed of numy laytni uftlongmcd cell$:
large due~ o( ~ll hVIIf)' glands

Male urcduu Speciallztd epithelium:

. Pstudostrlintd cotuouatr tpllhdlutn. tkK\ltatcd cclll lop one :~.nothtr \\'ilh n\ldCt toca\Cd ;u Jno(li ~Wlltun "lb; may IDH:! c1h1 dul Nnct1nn ta move fluids~ tbe cctls Luling of the urper respiratory """ Un:~ . Trtnslllonal r:1,lthtliurn - ~peciaH1.cd 10 undefll!n di~1cnsion; hdps prcw;ul urlruuy nuids from
two or more

diffusing outwards ~


Lining or Jmri-" uf the mule reproductwe fiYslc:m

Slr;tlum ha\.lh. ul \lr.llum



The epidermis is the outer, thinner ponton of the: 'kin. The epiclennis ts av~cular. h develops from embryonic ectoderm. The epidemn.> <onst,L of four layers. From Innermost to ourtrmosl they are: I. Stratum germlnath um - conmons the: only cells of the epidemus that rct\C nutrition, cells m constantly Wldergoing division 11nd betng pushed up to the body surface. Two subdivisions Lnclude:

Stratmn basnle deepest layer; cuboidal to colmuuar cells; site of continuous cellu lor reproduction. \1elanocytes, wbich produce melfouiu, are located here Strorum spino5um- oext deepest layer; contains cells called Langcrhaus cells; con tain.s nerve cells The twu subdivisions together are somcllmes called the malpigltian layer. 2. Stratum g.ronulosum - three to five rows of flat cells; site of leratin prodUC1tl)n 3 Stratum luddum -only in the thick sktn uf the palms and soles: const$15 of clear, flat, dead cells 4. Stratum corneum outennost layer of cpodemus; 2S to 30 rows oflla~ dead cells rtUed with kerurin: conhnuously shed and replaced Note: Tho bottom l~ycr of the stratum genn inativum, the strut'um bnsnle, has cells tlout are shaped like columns. In this layer, the cells divide and push already fonned cells imo his hcr layer.;, As the cells move into the rugbcr layers. tho cells Ou~en and eventually die. The top layer ofthe epidermts, the stratum curneum, is madt of dead, flat skin cells that shed abom every two week>, Important: There are three rypes of spcciahzed cells in the cpidenms. The melon~) tt produces pigment (mela11in), the Langorhans ctll ts the front tine defense of the tmmune system in the slun. end the l<orlinoq 1< produces kcraun (a protecme protem), They are the most common cell type on the epidt:mlis of the ski~ No1e: Tonofibrils (fihrill11r srmcfllral proteins) and desmosomes are espectally well developed jn kernrinocytes.


The oral epithelium Is covered by a layer or:

Stratified cuboidal epithelium Stratified squamous epithelium Stratified columnar epithelium Pseudostratified columnar epithelium


Copyri,gb1 C 2009-2010 Dcn1aJ Dtd:s



Which type of collagen is unique to basement membranes?

Type I Type n Type Ill Type IV


Cop]."rip. 0 20092010 Omtal Oceb

Slnllifh:d "luamnlh t.pithdium This strnt"iOcd squamou' epithelium ucts os a mechanJcnl bnrricr and protects the uoderlyms tissues There arc three IYI>O< foulld within the oral c:lvoty: I. Nookt>ratiniztd (nun1 common)- sclecu-..t barrier. atrs as s cushton. Cells do not conll1n keraun l'i as.~iated ~ uh hmng muco"a (/.~.. buQI 011J lohia/ muroso. mr~eosa lining llrt floor of tltt mouth, erolrtrl .rurfac-e oftlte torogr,., cmd the .IU/1 pa/me) 2. Orthokerfttini:z.ed (leu.Sf commUJI) - nssociated with masticatory mucosn {I.e hnrd palate a1uJ the u/lached gl.,g!lw, also the. lirl}lual papillae"" lito dorsa/ surfor. of the to11gue) 3. Parnkeratinized - a..societed with mas11catory mu<Osa (I.e auach~d glgit'IJ, ;,, higher lewis than ortllo/watml!ottoo. and the tmtgue~ dorsal tifa~J Note: The main diffen:ncc between paraktrallnit..td cpithchwn and orthoker:ulnized epnhehun1

is in tho cells of the k""'"" layer. In parakerotinizod epithelium, the superficial layer is slill being
shed or lost. but these. ce-lls olthe keralinluycrcontain not on I) keratin but also nuclei, unlike those of orthokerntinizod <:pithcl[unt. Other ctlltyp<s (other than keratinOC}'t<S) found in the oral epithelium: l:plthtllal <11$- form a cohesh< sbCCI that restS'$ phystcd forces and serv., as a batric1 to tnfcetion
1\telunocytes - synthesize melanin

Langcrhans cells - antigcrt pl'l!S<)nling cells. pari or immune system

Gran~rtln l!tUs -antigen ('lr f!Senting cells., port of immune system ~lrrkel coli$ -II.>SOCIMod with scru;ory nc:nc eodin!!'> Wblte blood cells- PMNs are the mo>t commonly occurring All fonns or epithelium(\, lletht!r associarad ~ uh lmhrg, mastit'fii(W)1, or ~pecla/f:etf mrtNJ.WJI h:ave a lamina proprio (''Oiilll!CIIIIt' tissue pruper) dct."P to the l)asemcm mernhrtmc. It suppons the cpuhehtun 11nd is subdivided into two layers !papillary 11ml tlcnse). It ntay be anathod to the p<;."riosttum of the alvt.-olar bone or interposed ova the submucosa (the subHtutMa con1a1tu glands, blood teJjels, and roenu).

l'iote: A basement m~bune is locattd between the ontl 'Pulleltum ana the oonnecnve nssue.
Till! ba)entt..m' membrane IS composed or 1"n l11~ers -- OOsal ttnd reticular lami11a.

hI"' I\

... 90"!. of the collagen ln the body is in types I. II. Ill, and IV. Typ~ I is associated wilh (bONE). Type II is associated with cunilage (carTII'OI/age). Type Ill is associated with reticular fibers (reTifREEiculm:J. T}'f>e IV is associated with the noor (FOUR) or the basement membrane. The basemtnl membrane is a thin. actllular slnlcture I ways located between any fonn of epithelium and its underlying connective tissue. The basement membrane consists of two layers: The basal lam inn (pmduced by the epithelial cell.): superficial ponion of the b;)semenl membrane. Consists of two layers microscopically: The lamina Iucida: clear layer, closer to the: epithelium The lamina deosa: dense layer, closer to the connective tissue The reticular lamina: this layerts a thin layer composed of type IV collagen (which is unlqrte 1(1 ba.semerttmembraftes) lihcrs as well as reticular fibers produced and secreted by the underlying connective tissue. Altachmut mechanisms are also pan of the basement membrane. TbeSt: imol\e hemldesmosomcs wilh their auachment plaque, tonofilnmenis from the epithelium, and the anchoring collagen fibers rrom 1he connective tissue.


T is)


The human body contains four basic types of tissue. Which type is classiOed according to the number of cell layers and the shape or the cells on Its surface?

Nervous tissue

Muscle tissue Connective tissue

Epithelial tissue

Copyright Cl 201-201 0 Dem11 Dec:b




Which or the following epithelium functions in the secretion and propulsion of mucous by cilia?

Simple epithelium Stratified epithelium Pseudostratified epithelium


tpilheliallh'Ul' Simple: single layer of cells Squamous e pithelium is a single layer of Oat eells; lines an:as in whtch substances such as gases need to cross readily Cuboidal epithelium is a single layer of cells of equal height and width; lines areas involved with secretion and absorption Colunuuor <llllh<lium is a single layer of cells ta ller than wide; I inc' areas of absorp-

tion Stratified: multiple layers of cells

SquamouJ epithelium lines areas necdin11 protection C uboidal eplthtlium lines areas ofmd-siLed dun Columnar epithelium lines large ducts Specialized tpithelium: specialized to undergo diSTension PseudostratiOed eolumna.r epithelium is specialized for S<:<:rction and mo\ement along luminal surfaces (multiple la)'ers oft'ells) Transitional epithelium lines areas that accommodate increase in luminal a rea by changes in cell shape (also has low permeability) -- is a stratified cpithcl ium Conn ective tissue -- tYJles: Solid soft: connective tissue proper, specialized (adipose, fibrous, e/a,uic, reticular) Solid lirm: cnni1age SoUd rigid: bone Fluid: blood.lympb t\1uscle - types: l nvoluntry: smooth and cardiac Yoluntuy: skeletal

Ntne -- typeS:
Afferent: sensory Efferent: ll'IOtor

Slratilil'<l t:pifhdium

Simple epithelium has only a single layer of cells, all contacting the basal lamina.

Stratified epithelium has two or more layers, with only the dccpct layer contacting the basal lamina, PseudostntiOed epllhelium appears multilayered, but is actually only a single layer with aU of lhe cells touching the basal lamina. The positioning of the nuclei witbin tbe individual columnar cells causes this illusion.

uf Uilhnnt I ~Pl'' ut l.pilhelium



Function (s)

DiffUsion and filtralloo Secretion or ib<o<pt1oo

Ab<oq>tioo and secretiOCI
Prolccuon. pre'e:nl.) "''Iter kKs


Squamous Cuboidal Columnar

Varie.~ between cuboid~ I and ~~quamous Columnar cells atop one another with nuclei located at two or mo~ level~

Procection and secretion



Transitional Pscudostra,ilitd

Specialized to undergo di,tcn~ion

May bave cili~ tlmt function to move

within ce Its

fluids past the cells




T~ndons ,

ligaments, cartilage, and bone are considered which type or human body ti~sue, which supports and binds other tissues?

Epithelium Muscle tissue

Nerve tjssue
Conneccive tissue

Coprri&ht 0 20092010 Dc11tal Dt<ls



Simple squamous epithelium Is most likely round lining the:

Upper respiratory tract

Urinary bladder


Princip:1l l,iuch uf l tlri'IH'' TypH

Ep,.hohl tissues Ot:sc.riplion nd Funcdon


May be .,..(.,"'!~t)or ,....,., (sffYfrif/td) loym thl<k, Two types. lower .surfac.-c bound La 3: $U[tp0nl\ e basemen! Covtring nd Urttng c:phhc:bun1 membntnc; mllfii~CA~ Ily t'ICliv.: tibuc: awscular; eover d1e ('()vm d.c out11ide of the body turl3(:e ofltw body nd lffic !he viUiou.'l body c:avitie:s. aud line~ tnu:n1~tl organs d~.s.. and vcsscl1 Gl:andubr quthdNm


OMiidtrabJe Ul.lette:JI~;tlar mamx: mn.oucaUy 9Cii' t

liS.Suc: used rur JUM)Ort (bonu tmd e<u'f'lla.~J. for
aUachmcnt or Other U!iSUCS (umd01U, IJgmmmis, OJifi fascia~). or for ocJtct specialktd runoetions ($uch us b/Q6</)

lh&bly - (urqxjw CDTtJ/,.); .......

Teudoos ud b~-"' eoni1ogc od booc. :adipore ltsiUC. bklod

Typ~ ol'e<mncttiH~

. .

!Issue propel ~

. . .'-4ipo.c

Molar 0en,'4C ("'*ular) Elastic Rru<ulu



Limited mitollc: Mtivny; composed ofj!pC'Cializ:ed ccU! 'Thfrelypc:o thai Art Cllp;;~bh~ of oomraeti.nM lind thrreby dtt.TCll'i.n'li In Smoolh length; these 11'-SUt'B mO'I'' t the skeleton. propcllhc: blood Coroioc thn>o;!Jout Ill< body. al1d ai4 ill dill"'""' b)' moin~ rood Slcd""l d'li'OUgb the dlpti\ t Ind.



Umik:d llllaobC .atvily; uanmut mesuges: throughout 1be body

Fam1 brant. spm1 con!. .and ntn (~, consm lar~cl ) hf' reUs (IWIroJf J
wicb lmig pl"(uoplsgn'tc c.v;tensions.

\ .1 .. \ulaiiH t'

Epithelial tissue! can be clo~sified into rno m:lin calegQne~ on lht' basis of lhc1r arrangement mto layers or cells: I. Slm11lo: cons isis of a single layer of cpilhelial e<lls. The further classtficaliun u( tissue In volv<5 di1Ten:n1 types of epithelial cells accordtng 10 >h:lpc: they can be: Slmpl squamout epithelium : con.<i<l$ or Oattcn<.-d. platelike eptlh<lial cells.. lines blood and lymph:ltic ve:.scl'- beon, and s.-rou< CO\itics and hoes the air 5<1CJ (al-eoli) oflhc lunJIS Simple cuboidal epithelium: consests of cubc~shapcd cells thallene the ducts ofvanous glands, such as certain portions of Ihe salivill)' gland ducts. Simple columnar epithelium : consisiS ofrectan&ltlor or tall cells, such as in the hnin of olhersalivary ducts, as well as the 10ncrenamel cpitheliun. whose cells become am<lobls<~s 2. Strotifted: CODSL<I$ of lwo or"""" la~c:rs of eel!;, wtth only lbe loWI'r level conlliCttng lbe basement membnsne. Only the Shope ofll~e surl'ace Ioyer 1S used to dctcmunc lbe classification ofsiJ"tifled epithelium. Slratlfied squomo1u epithelium: most ofd>e opithclinl tissues irt the body are of this type, which include the superficial portion of the skin and oral mucosa. Can be kertiru<cd oc nonkeratinized Stratifted epithelium can also be: cuboidal or columnar or a eombmntion oft~.
Eipithellaltissue can nlso bo cla.<Sified ns ps<udostratified pllbeliutn. Tit is epilhclium faLM:Iy appears US 11\Uiti(')Je layers IJt."C3USe the Cells' nuclei appear at dlffcrent(Cycls. 1'his type Of ~.:pithtlium lines tJH! upper respirator) rract, includin,a the nasal uvhy and paranaulslnuses. This type or opithelialltssue may be dilated or noucUiated 31 tbe tissue surf~. i\'ote l'>c:udosuatific-d cthaled columnar epnh<lial cells belp trap and transpon particles brought in throuah 1be nasal pa>;a&cs and lungs. Remember: Transit-icuml epithelium, which lines the urinAry bladder, ureters, and pt'tr1 o(thc urethra. makes up specinlizcd tissue that allows for the eAp~msion of -an organ with only minlnMl resistance from the tissue.


Tis )

A Obrous connective tissue sheath containing blood vessels that surrounds most cartilage is called the:

Pericardium Perichondrium Periostewn


265 Copynabt Cl 201-2010 Dcntallkcks


T is )

Tbe formation or osseous tissue, which Is responsible for tbe increase in the length or long bones a nd the healing of bone fractures, occurs due to:

Endochondral ossification

Heterotopic ossification
Intramembranous ossification



c 20092010 Oenul Dt<:ks


Cartilage is type of dense, fibrous connect{\ e us;uc, which supports and shape< vanous t>tru<:tuteS- It also cu>hon1 ond absorbs shock. Caniblge i comrose<f of cells called ehondro<)'1e~ lhat arc dispersed In 0 fll1ll, SCI-like ground subslllnce, <Oiled the matrix. nteso cell> re>idc in dcpn.."Ssions in the mnlnx, ca11cd h\ruoaP. CartHage contains no blood n~ssel5~ and nuuic::~u~ nrc diffused through the mntri~. Canllage is found in tlc joints. the rib cage, the car, the no>c, nd the throat and between ntcrvonchMtl discs. Note: Tbc only blood supply to cortllac is pmvukd by blood vessels tltat enter the conilagc through the pcnchcmtlrium. Important: n,e cxc1'1ion to the rule tltat cun.lla~c is always covered by a pcrlchondrltllll i< the artitlllir earlllo~c at syno.-lol]oint. There arc: three oubtyprs b"'d on thccompu<noon Clfthe matrix: I. R;taline canola~e- bas a high proponwn uf malriA and lin< collgc:notos lib<rs Tbro<tghuut chddhoocl ond odolesccnc:e, h) aline <3nllagc plays an tmponam emn n the wowth io LtnJ:Ilt of1011~ bonc.s (t'fiiPh.ll<t!lll p/nii!JI are rompn<tJl ofhy,lm<' cortilagc). Covers the arucular urfilwof nearly ~II $)'00\ ial joints. h is mtapable of repair when fl'ltctul"\:d Note: Type II collngcn noukcs up40% ~fthis cartilage's dry weight . 2. FI1Jrocartlh1ge - hHs a large nwllbcr of collaJ;Cn fol)Crs embedded 111 a small amoum of nnlnx. Filli'OCIIrtilugc Ls found In the discs withm joint<(U.JI., 1/1e 1MJ. stem udmmllarjolnl, tmd lrJwe;omt) nnd on th< anicular surfacC> ofth< clnvclc and nUUidible. 3. Elo5tit curtiln~c - similar to hyaline cartilage. CJ(<'<pt tlasric c;tt1ilage pos~csses lorae numbers ofciii.Stoc libc~ embcdd;.'d in the matrix. Elasr.ic canilage is ""'Y Oe.lble anti Is found on the auncle oflh< car. the cxt<mill auditory mcattl.'l, the auditory tube. and the cptalotu.s I. Cl\lltlot;c is a proewsor to endochondml boot:. '~t.. 2. The mnlriA is mainly composed of protrog!)cans, a special type or glyc:osammoglycans. The moSt conunon tyres ""' cltondroltlu utfate and keratan >ulfte.
3. TI1c

is \'ery 1mponant 1n 1 he gro'Wlh of cani1agc~

4. No cnldum salu ttre pre~t and, 1ht!rcrore, canilage dOC .out appem em x-mys.

Endochondral ossification begins Wllh J")tnts tn the cartilage calk-d " primal) onlfiu.Uon center.." They mostly app<ardunnJ! fetal development. thou~>b a few shon bones begin thetr primary ossificariou after btnb They at"< responsible for the formation of the diapb) ses of long bones, sbon bones, and cenain pans of uregulnr bones. ~~ccondary ossJncation" QOOUTS after bin h. anti fomts the epiphyses oflong bones and tho ox~milic.' of irregular aod flat bones. The doaphyses and the epiphy>~s M long bones remain separated by a growing zone of osrlllage (the metupbysls) until the child reaches aduiUtood (18 rQ 2j y ('!Jrs oft~ge), whereupon the cartilage ossifies. fitsing the two together. Note: Heterotopic ossllicauon is the formation of booe outs1de the skekiOn and is seen in diseasecS such os myositis ossificans. Long bones tncr<n>e in length during srowtb and development. The tpipb)SUI plat~ (drsc) is n " 'edge of hyaline canlfage account in& forth" increase. Thts plate is fowtd between the "l'pby>is (bu/{>O"r end) and diuphy<tS (wbular shajl) at <ach end of tht bone. The cartilage cells of the epiphyseal plate form layers of compact bone ti~sue, adding to the lcng1h of the bone (irrtemitial grr;wtlt). Tlus di:.c becomes inactive w mo~t indtvidu als by the late teen~ nr early twenties. Remember: Bone formalion or developtncnt occurs hy two method$: I. lntrumetubranous os.,ificatiou mainly occurs during fonnation of the ORI bones of the skull: t~c bone is formed from mesenchyme tissue. 2. Endocltortdflll ossification occurs in lon11 bones. ~uch as limbs; tbe bone is formed from cortilge.



A patient in tbc dental clinic states in his medical history thnt he has heart disease and occasionally takes nitroglycerin for his pain. During treatment, the patient clutches biJ chest and frantically points to his jacket pocket. The dentist obtains the nitroglycerin bottle from his jacket, remoYes one tablet, and places it:

On tbe soft palate On the gingiva Sublingually

On the buccal tissue


Cor>-nJhl 0 20092010 Dcnlll ~kJ



What structures act as "molecular sponges" and hold water in the extracellular matrix of cartilage?




Suhliugualh In general, the permeabilities of the oral mucQ5a decrease in the order of sublingual greater than buccnl and buccal greater thou palautl. Tins rank order is based on the relative thickness and degree of kcratinizarlon of those tissues, with the sublmgual mucosa being relntivdy thin aJtd nonkeratinizcd. the buccal ~1icker and nonkeratinl:red, and the palatal intennediate in thickness but keratinized. Important point: The oral cavity is higbl)' acceptable for systemic drug deltvcry. The mucosa is relatively penneable with a rich blood supply. and the virtual lack of Langerbans cells makes tbe mucosa tolernnt of potential allergens . This route nlso bypasses the First pass et'fect and avoids presystemlc elimination in the G l tract. Example: Nitroglycerin tablets are given subtingually for rapid absorption. Rem ember: The oral mucosa is composed of an outermost layer of stratified squamous epithelium. Below ~lis lies a basement membr.me, a la111ina propria (connective tissue JliTJf>Cr} foUowed in most cases by tbe ubmucosa as the innermost layer. The composition of the epithelium varies depending on the site tn tbe oral cavity. The mucQ5a of aJUS subject to mecbartical stress (the girrgia ami hard palate) is keratini:r.ed (specifically. orthokeratinized). The mucosa of tbe soft palate. the sublingual, and the buccal regions, bowcve1. Is not keratinized. Note: Alveolar mucosa is very simi tar to sublingual mucosa in thst tt. roo. appears red due to the numerous blood vessels and the thin epithelial covenng.

Cartilage matrix is a homogeneous material principally composed of protcoglycans, macromolecule.~ with a proteinaceous backbonr, to which is nuached complex carbohydrates (the.<e carb<Jirydrates art! "glycosaminoglycans. IISI/ally abbreimcd GAGs). The GAGs radiale from the protein core like the bri>"'les of bcute brush. The principal GAGs of caailagc are chondroitin sulfate and keratun sulfate. Another mutrix component is llyalurontr acid, a gelatinous mucopolysaccharide. The hyaluronic acid aciS as a sort of cement to bind the proteoglycans together into large aggNgates. l mportllnt: Because of the chemicalnarure and orgauilation of the glycosammogly cans. the ground substance can readily hmd aud hold water, which allows the ussue to assume a gelntinous nan1re that crut resist compression and penni! some degree of diffusion through the matrix Note: Chondroc)1es produce all the componentS of canilage: the matrut material nnd the fibers as well. Hyaline cartilage fonns nearly all of the fell!I skeleton. ln the adult, the remuanls ure: Articular ear!Uage- smooth and shpp..-ry, it lines movable joints Costlll cartilages- al the sternal ends of the ribs Respiratory cartilages - movable external nose nnd septum. larynx, trachea. and bronchial wolls Audltory cartilages -external auditory meatus and pharyngotympanic tube



At the gymnastics center, a 22-year-old male doing nips on the trampoline lands incorrectly on his ankle and dislocates lt. In the emergency room, the physician must provide traction to replace the ankle, and the procedure is without Incident. The patient is told that although there are no fractures the bands or fibrous connective tissue that connect bone to bone are almost definitely tom. T hese bands are called:




Copynaln o 2009-2010 tXo~al ~>~




~~Which type or connective tissue, seen in ligaments and tendons, is composed""''l

\.. of closely packed collagenous fibers arranged in a consistent patlern?

Loose connective tissue Deose irregular connective tissue

Dense regular connective tissue Elastic connective tissue

i~HIII l' UI\

ligaments are dense. strong. flexible bands offibrou.' connecuve tis.ue that he bones to other bones. Ltgaments that connect thejoint ends ofboncs either limn or facilitate movement Ligaments also provide stability. l 'endons are strong, nexible bands of fibrous connective tissue that ntlllch muscle~ t9 the fibrous membrane that covers bones (perio;tcum). Tendons move bones when kcletal muscles contratt. Important: When a tendon or ligament is auached to the bone, the atwching fibers are called Sharpey's nber5. They are periosteal collagen fibers that penetrat~ the bone matrix, binding the periosteum to the bone. R cmemher: The periodontal ligament contains collagen fibers that are insencd on one side in the cementum and on the other side in alveolar bone. The ends of these collagen fibers are Sharpey'~ nbers. BursA e nre smnll. synovial, fluid-filled S<ICS located around joints at friction pomts between tendous.lignments. and hon~s. Bursae aetas cushions. t. A fasciculus is a botmd group of individual muscle fibers. The fas<:lcull are Not..- the bundles of 11llll>cle fibers composing a muscle. In tum, each muscle ts surrounded by a connective tissue culled fascia. 2. The fascia secures tl1e muscle to a tendon. 3. An :1poneurosis is a sheetlike tendon. 4. M"niscl are CRSCcnt-sbaped interradicular fibrocartilagcs m ccnam jornts. including the knee.

Connective tissue derives from mcs<nchyme (meso.lem). Compared with epithcli\1111, conne<:tive tissue is usuaUy composed of fewer cells spaced funher upan and contntning larK amounts of matrix between the cells lettepr ill aJ1pose conntcti>'" tissue). The mosr common cell LS the fibrobi~JL Other cells found in connecti>e nssuc include migrated whne blood cells such as macrophages. basophtls (mast cells). lyn1phocytcs (including 111amut teJI.,), and neutrophils (PMNs). Connective tissue includes bone, canilage, mtd odipose t.fatty) tissue. Connecuve tis<uc serves "connerong" funcnon. It &upports and binds other tissues. ~nlike cpuhelial tissue, connecrive tissue typically has cells ,;cauered throughout an extmcellular matrix. One method of classofying conneclive tissue is :tccordin~ to tc.cme, which I> either: Soft: include~ those tissues found in the deeper luycrs of tile skin nnd oral mucosa Fim.: conststs of different types of conilage Rigid: COO>UIS of bone Fluid: consisL< ofblood wtth all its components and lymph Soft connective tissue can be classified as: Loose (llrt!Oiatj: consislll predominantly of cells or matri~ in an ttn:gular or loose: nrrn 0ge.. ment. ServtsM paddin~; for the deeper pon1ons oflhe bod) Dtnse: whtch provides >true rural :rupp<>n. has greater fiber (protem) conccolnltion. and os tightly packed. Dense is further subdavided into: Pense regular connective lissue: has n regular arrangemt:Dt of tightly packed, strong, parallel collasen libers with few fibrobllll-1 cells. This tissue includes tendons. ligaments. and aponeuroses. ~e i r~ular connective tissue: has rightly packed. strong. parallel C(ollagcn fibers arranged in an lncouslstcnr or irregutnr pattcm. This tissue b found in o be tlennis. Sllbmucosa of the GltraCt. Organ cup~lll,.., and deep (._,cia.



A 71-year-old woman presents to the dentist wilh multiple blisters on the oral mucosa. She states that the physician has diagnosed bcr with bullous pemphigoid (BP), an autoimmune disease in which the body targets certain intercellular junctions. In BP, the junctions Ihal are targeted are those tbat anchor the basal cells of the epithelia to the underlying basal lamina, causing the epidermis to dNach. Which junctions are affected In BP?

Desmosomes Hemidesmosomes Adhereos junctions


Copyript 0 20(19.2.010 Dtnl.ll DU



Proteinaceous lubes that connect adjacent cells are called:

Tight junctions

Gap junctions Adherens junctions

l-1 t mifll""IIIO,IIIO(' Bricks in 11 building must he stuck together and ~l'lc1 tied sornehow to the fi'undruion~ Similarly, cc:lls within tiMUe< and organs mu).l be anchored to one aoother and att;~.chtd to compof1C111S: ufibe extnacc:l lular molnl<. Cdl h;m: deeloped liC\'naJI}"Jl<' oflnttrullular )unctioas to sem: 01<'<C fnct;om. and in each case,an.oonn~ protcnlllext<nd througb IM pti<m m<rnbrano mlink <Y'"'kdml proltins

cell to C)'tOJikelrtal prote&ns in ncigbbonng cdl5 a~ well a5 tn proreuu., il'\ lht e"tracc:Uular mam:t.



Cytoskeletal Anchor 'l'ransrucmbnUtl\ Linker Ties Cell To:

lntcnneduue filamentS


lntermedlale !iltmml$


EC matrix

Adht:rcns JUnDiiO!\> Act1n filmcnts

EC matrix

An intercdlu1arjuncrioo bct\\oceo cens i:S. de..~mosome. The desmosome ~r.J co ht disc-sbapcd IDd can be hkCIIcd loa "spol "ckl." Another type of intercellular Juncnon is a hen1idesmosomt. whittt mvotvcs an altachmenr of1 celltn an acljilCtn1 noncellu1dr ,urfacc. hupodanj! J11is type tlf uttac:hmcnt is JlN!Cnt w1tJ1 t.he iMV1Hll epirhcllum lh!tl allaches 10 lhe tooth surftLCC (ca lled lf;t jumHnnnl "'plrJJt!lltuu of tire upilht.litll mtiJCiutttrtO M well as In Ihue which occllr5 hc:twecn rualls and Nil I beds. Nott : The: chnteal condu$on known a.s bullou1 pt1nphl,::old lnvolns l~ disrupu.on of htmdamoloOmd and c:omequen sepan1oon oflbe cpi1helli1Jll fl\lm the ba"llamma Ano1ho- type of fr\l~rccllulou junction ts ''hat is ca.llrd 811 adhtrem; juuclion (aliHJ t'UIIed ~mwlu tul Jtt-,+elu). n,es.; juncrioa; thflrc the characteristic of anclmring ccllr. 1 hcuugh their ~:ytoplnsmic :t.Ctln tjl .. amcuts, Tbc:re IS cons1tlerub1e morphologic divcrsiry among t~dh~rcns JUOCUUIIIf. 01ose that tic cells 10 ~ne a.nolber are seen as isolat4.-d strtotks or spuiJ.. ura\ bands th:al compltteiy c:ncm:le the cell The: band rype o( adhcmJs j1111<1ion> IS &.'"'"""ted ,.,111 bu!l<ll<S Of .<lin fila111""1s lflal alsO CIICfrclc lht cell JUSI below the plasma nu:mbroiiC. Spot-Ilk< dht~n< juncnons help cells adheretu tile crncellular ""''"' Adhen:ns junctions art lhoughl tu pan"k1pate 10 foldmg and hendlng nf ~:pilhcllal cell )hccts.

Gap junrtlons are pro1eiuaceous rubes some 1.5 10 2 run in diameter. l11ese tubes allow material to pass from one cell to the next without having to pa.'s 1hrough the plasma membranes of the cells. Dissolved substances sucb. tiS ions or glucose can pass through the gap JUnctions. They are fonned by transmembrane prole ins called connexlru. Gap junctions are scpanote from the componeniS of the junctional complexes. gap junctions facilitate cclllo-cell communication. :-lotc: Because Ions can Oow through gap junctions, they pernUt changes in the membrane potentiallo pass (rom cell to cell.
Funrllonally, there an: three groups of cell jwtcoons: J OcdudingjunrtioM - whiehjoln the plasma membr:mes of adjacem cells tightly

together. 2. Anchoring junctions which physically connect adjacnt cells and !heir cylu sk.elcton.s, but leaven spHcc scpamtingthe plasma membranes. 3. Communicting junctions- which pem1it lbc p;>ssag~ of chemical and electrical signals betwen the JOined cells. Gap JIIPCtioos belong lo this group. Such spcc:alized celt junctions are fow\11 in many tissues throughout the hody, but arc especially abundant in epithelial tissuu, where some cell junctions nrc organized into groups called juoctlonnl complexc~. Three disriuct components of a jnnctionnl complex: A tight junction An Intermediate junction A desmosome A 11 of whfch ar~ A$SOcialed with the plasma membranes of adjncem cells



What type of cartilage is found in the auricle of the ear, the enemal auditory meatus, the auditory tube, and the epiglotris?

Hyaline cartilage Fibrocartilage

Elastic cartilage

Copynabt Cl 201-2010 Dttl~aiDtd,,



Which layer of skin is mainly composed of areolar connective tissue and adipose tissue?

Epidermis Hypodermis



1 9

ElasliL ' l">t r liht~l'

Remember: Elastic cartilage is similar tO hyaline cartilage, except elastic cartilage pos" sesses large numbers of elastic fibers embedded in matrix. Elastic cartilag~ is very ncxible and is found in !he auricle oftbe ear. the external auditory meatus, the auditory tube, and the epiglottis. Ca rtilage can develop or grow rn size in two different ways: 1. I nterstitial growth is growth from deep within the tissue by the mitosis of each chondrocyte, producing a large number of daughter cells within a single lacuna, each of which secretes more matrix. thus expanding !he ussue. 2. Appositional growth- is layered growth on the ou1side oftbe u.~suc from an outer layer ofchondroblasts within perichondrium. Growth of bone: Apposlriool growth or layered formation of bone along its periphery, is accomplished by the osteobJasts, which later become entruppcd as osteocytes. Because of its rigid structure, interstitial growth is not possible. ** po not confuse bone growth \vitl1 bone formation or development. Bone fotms by either endochondnl ossiOcaUon or intramembranous ossifkatlon.

The integumentary S)Sttm consists of the skm and its many derivatives (hafr. glmrds. rrarl.< , tmd sensory r-eceplors), 11te skin is composed of many tissues stmcrurally joined tor specific ftancrions. Strucrure of skin: The outer epidtnnls: which cons1Sls of stratified 5qu:unous epithelium. h de\ el"!l' !Tom embryonic ectoderm. l11e outer dennis t> avascular. The principal cell of the epidrnm IS called n keratlnocyrc. The outer dermis consists of f<>ur layers. From Innermost to outermost. they are: the strnnun germi.ontivum (wlriclr lws t\''0 .'wbdfviJ10II.t~ tire sl,.tuum basale and stratum spillo~,m), stratum grunulosum, stratum lucidum, and s1ratum corneum The inner dermis: thicl:er portion of rhe skin: composed of COMecnve t1ssue wtth col-

lagenous and elasllc fiber< for lOUgbness. The inner denn" develops !Tom embryonic m~ dcrm and contains blood ''essels, nerves. &lands, and hair follicles. It IS a strong, strt:tchable layer that essentially holds the body together. The inner dermis has tWo main regions: pplllary layer: upper dennal region reticular layer: dccpest skin layer The subdermis (lrypodtnnis) is the la}er of tissue du..aly underneath the dennis. l'lle ;;ubdennos is mainly composed of arwlar (loos~) connective ri~suc and adipose tissue. Tite >ubdemtis's physiological function> include insulation, the storage of energy. and aid in the anchoring of the skin. The subdermis also cushions the underlying body for extra protection against trauma_ The skoo also contams several other relevant struc.twt!>. 111Cluding tho following: Basement membra ne: collagenous membrane between the epidemn> and dermi that holds them mgethcr Meissner's corpuscle: oval body in thu J ermis. thought to participate in tactilesenstion Ruffini's corpuscle: oval capsule containing the ends of !ltnsory fibers in the dermal papillae



Which layer of the dermis contains blood vessels, nerves, and other cells?

Papillary layer Reticular layer

275 Cop)'li&h1 0 2009-2010 Dt:ntal Otc.kl


Cementum is the closest in composition to which ofthe following?



Dental pulp

276 Cooynpl lOI-2010"""" Do<b


Ia~ l' l

The dermis is the thicker pOrtion of the skin. The derm1s is compo5ed of connecuve tiSsue with collagenous aod elastic fib<:rs for toughness. The dermis develops from embryonic mesoderm and contains blood vessels, nerves. glands. and hair follicles. The dermi.~ is a strong, strctchnble layer that essentially holds the body together. The dermis bus cwo

main regions:
1 Pa pillary Ioyer - thin and less fi brous; has projections (papillae) that extend up toward the epidermal layer. This tayer contains the blood vessels thai supply the overlying epide1mis. The layer contains fibroblasts. mu.>r cells. and mncrophagcs. 2. R eticular layer -- 1hick and fibrous. and is continuous with the hypodecmis. Blood vessels from the hYJ'Odermis pass through this layer. lt conlllin.< more reticular fibers and fewer cells than the papillary layer.
Cburacteristics of the subdermls (hypodm11is) that connects the denn 1 s with we underlying fascia of muscles: CompOSed primarily of loose (areolar) connective ussue !\laj or site or fa t depo>itlon (500A> of body far} l ias good blood supply


Cementum is the bone-like mineralized ti~sue covenng the anatomical roots of teeth. The primary function of cementum is to nllnch Sharpey's fibers. It has tbe l'ollowing


Slightly soner and lighter in color (r~llowJ than dentin Fonnod by oementoblasts from the POL. as opp<>sed to denim, whicb I fonnod from odootoblasrs of the pulp. It develop; from the dental sac Most closely resembles bone (more so than dentin). e<cept there aro no haversian system.< or blood vessels it is avll5cular Mature cementum is b) ,.eight 65% mineralized or morganie matenal (mom/) , a /cium hydroX)'DfJOtite), 23% organic material, and 12% water The orgonlc ponion is primarily compOsed of collngen and protcrn

llns no nerve innervation.

Thickest at the tootll"s apex and tbinnes1 at the CEJ at the c.orviJc of the lOOib Important in onhodomics. Cemen1Um is more rtshtlan to resorption than alveolar bone, pem111ting orthodontic movemeu1 of teeth withnut root resorption Two types of cementum (fmrctlotrully t!rcre Is no difference): I Acellular (sometimes called primury cenrenrum) - consists of the first layers of cementum dt'l'OSited at the DCJ: aecllulnr cementum IS fanned at 3 ~low rtc and coottuns no embedded cementoeyt es, usually predominate on lhe coronal two-th1rds nf the root Thhmcst at the CEJ. 2. CeUular (sometime.< called secorrdary cememum) - consists uf the last layers of cementum deposited over the acellular cementum: cellular cementum is fonned at a faster rate tllan acellular cementum and contains embedded cemtnloblast>. Cdlalar cementwn occurs more frequently on the aplclll tblrd of the root . Cellular cementum is usuaU y the thickest to cmnpensatc for ocdusaJ/Iudsal . , ,1ear und passive eruption of the toolh. Note: The com position or bo ne is roughl) )0% inorganic, 25~. collagen. and 2s water.


When using a high-speed handpiece to remove caries from o tooth, the dentist must drill past the enamel into dentin. The first layer of dentin (atth~ DEJ) is called:

Imratubuiar dentin Intertubular dentin

MantJe dentin
Circumpulpal dentin Interglobular dentin

Cop)'n&lll 0 20092010 Dmtal Okt

The ner.e plexus of Raschkow is located in .-bich zone or the dental pulp?

Cell-rich zone Cell-free zone (zone of Wei/) Odontoblastic layer

\l:111tlr lhntin

Montie dt rHfn l:i the firsl predeuhn thnt forms and matures Within the tooth. Man1 le dent'".
shows a difren:nce in 1he direction of the mineralized collngcn fibers compared with the rc-sl ol dcntiD.t wlth the libcrs pcrpcndiculur to the: DEJ. MantJc dentin also has more pcntubular dentin lhnnlbc inner porllOII> oflhc dcn1on and lh"" has higher lt,ols of mineraluolion The layer of denlln around lbe OUiu polpal wall is called <lraunpulpal dondo. All circum~pal

dOJiun ;, form.:d sod ma1ure. Rcr ol81llle den lin. Tl~ collag<n fibers of tlrc,unr>ulpal denun are nJDo nly parallcl10 1he DEJ compared w1th 1hooe of ID!lollt dcolin. Circumpulpnl demin mukc-. up I he bulk Of tho dc111in Ill a IOOih.

,.,_""'... ........

~tt~~lbe: tlolblllcs

I \IW"Ilf lhuhn



lll$'-b c:&)gfied
f lrt"l denllft f,:,mJtld
l>c1 1!.in tbrmed 11~n- w.hllk 1 lcnlln
~Lied lt.u kUDII.v) ~~~~aa



Clf\.'\IIIJJ~ dOnun l.a.)lcr DI'O\IDIS OUICf' pulpul wnTI

Prtnwy Jtnt..n

FcxmaJ bdfoo!'CI ~nioft of apl..::~t ~muncm Fbtme'd "'art ta{'ldl)'; "mort




Fnn:nred J">Wcc....d tflcM


rct1wy cJrnu11 hwJ\IJIIOP'IIlcm l a.~~~1n fl'lf1nC!d u. ~ "' lljttl)' .. (Tomes ' fiber) of OJ\ Re member: Etleh dcnhual tubule coru.un.s lhc cytop11sstmc cell process

hiiJJOrtant: Odonloblasts secrcu: the organic compuucn1s of the denhn malrlx The fibro~ n\atrix is mostly t)'pt: I collagtu. Noe: Dead lrl<ls <onsisl or group~ of empty lubules due: IO the dealh of the od<>nJoblast:. whose proccs><:S fonner1y filled Ill< luhulr< These traCt. na.e been annbuled 10 the asi1111 ~rocess of lhe denlinal lis.<ue. They may -lsu be oaused by caries, L'nmon, ca. ily preparation. ot odontobl:J.stic crowding,

( l'llfnt'

IUOl' (:. onc


The pulp IS the ID.llc:nnosltssue of the tooth The pulp IS formed from the central cells ofthe dental papilla. Anatomy of the 1 1ulp: Coronal pulp- located in the pulp chamber und form.~ pulp homs Radicular pulp -- located in the pulp canals (root portion oftvoth) Apical foramen - oommunic~les With the POL *" A~cessory canals may also be associau:d with the jlUip. Remember: These form when ll~nwig's epilbeliBI roo1 sheail encoumers a blood ve<scl duriug root fonnation, Root structure 1hen fonns around 1he vessel, fonnintt lhe accessory canaL The central 1.one or pulp proper contains large nerves and blood vcscls. This area IS lined peripherally by a specialized odontogenic area thai has the following zones
(from the outenno<t zone closest to tlrf' detrtin to tire lnncmwst zone oftM pulp); Odontobla!llc layer: lines tl1c outer pulpal wall and consists of' the cell bodies of

odonloblasts. Cell bodies oflhc afl"creUl axons from 1he dentinal 1uuules are located between cell bodies of the odontoblliStS. Cell-free zone or zone of Well: contains fewer cells !han the odomoblastic layer. The capillnry and nerve plexus (plexus of Rcuchkow) are located here Ce!l-rlcb Ulne: con1ains an iocrea.<ed density of cells compared with tbe cellfree zone aod also bas a more extensive vascular system. Co01a10s fibroblasts and odomoblast progenitor cells. Pulpal core: located in the center of the pulp chamber; consist~ of rnany cells and an extensive vascular supply. Excep1 for the loca1ion. the pulpal core is very similar to the cell-rich lone.


Amelogenesis (the f ormation of enamel) begins at the :

Cementoenamel junction (CEJ) Dentinoenamel junction (DEJ) Cementodentinal junction (CDJ) Mucogingival junction (MGJ)

Cf)fl)'l'iJhl 0 2009-2010 lktual OeekJ


Pulpal involvement of a carious lesion in a young child much more likely because:


Caries progress faster in primary teeth Caries can enter primary teeth from the enlarged apical foramen The pulp chamber is larger in primary teeth compared to permanent teeth Reparative dentin is not as functional in primary teeth as it is in permanent teeth

Ot:nlin u ~o. n.uud

junc tinn ff>l-.))

Amtlogenesl> is the proeess of enamel mauix formation tbot oecun during the >ppositional ~tage or 1001h development. Enamel matrix is produced by omeloblast cells. These cells are columnllf cells that wlferontiatc dunng the apposition stage 111 the crown area. The enamel matrix L< secreted from each ameloblast from its Tomes' process. Tomes' process is the secretory surface of tlJe ameloblast that faces tbe dentlnoen:unel j unction (De}) . Enamel matnx is first formed in the incisal/occlusal portion of tbe fUture crown neAr the forming OEJ. Important: The OEJ is tbe iuterfaco between the dentin and enamel. The D6J IS the remnant of the onset of enamel fonnauon Dur1nJl amelogenesis, a melohlnts enter their first formative state fler the first layer of dentin is rormed. They secrete enmnel matrix as they retre'.lt away from the DEI. Ibis matri>. then minerallus. Remember: enamel ts produced in a rhythmte fa~hion. Important: The odnnloblasts begin dentin fomtation (deminoge11esi.) lmmNJiqt~ly before enamel formntion by the ameloblasts. Dentinogenesis begins with the odontoblaSts laying down a dcnlfn lltO trix or predentin. moving from !he DEJ inward toward the pulp. 'fhe mOM! rccemly fon11ed layer of dellt ln is nlw~ys adjacent to the pulpal surlacc. Note: Predentin or dcnri n matrix is a mesenohynml llfOducr consisting of 11onmlncrnlized collagen fiber;. These odootoblasts are induced by the newly formed ameloblasts to produce predentin tn layers. moving away from the DEJ.
I. The DI:J i$ also the area at which rAit lnration of tooth beguu !'lot.. 2. The morphology of the DEJ is determined at the bell stage. 3. The olde5t enoDI~I in a fully erupted molar is located at the L>EJ underlying
a tu!op.

4. Research has shown 1hnt in order for amcloblasts 1he M ru.tum inl ermedium must be presem.


fonu enumcl, tolls from

I hf. pull' t.: humlu.r h l:tq.~tT in pl'inwn h.tlh l'CJ111pan.tllo pcrmancnl llclh

The dental pulp tS a connecuve tissue. and thw. ha. all of the components of such a riJ!S\Ie: interceUular S\tb>tnn~c. ussue fluid, cells. lymphatic<. \'ll$CUiar s~.,em. nerves. and fillets (lfloillly C()l/ogcn und some retiCillarfibers). Cells found in the pulp: Fibroblasts: mo>t numerous Odontoblats: only cell bodies are loentetl in the pulp UntlJITorentlnted m""enchymal ceU s
WBCs nnd RDCs

'IWo ryves of uer ve< are ~ssociated with the pulp: Myelinated nerve.: re llte <lXotts of senwry or nlferent neurons O tatan: located in lhe dentinal tubuJ.:s in detllm The usocioteJ n<rw cell bodies a"' located bet" eel\ the odon tobla.<IS' cell bodies in the odontoblastic layer of the pulp UomyeUnatNI ntrvh: are assoc:iated wnh the blood vessels In addition tO being the fonnative organ of the dcntm, the pulp also hOI$ the folio" tog functions; Nut rlthe - tho pulp keeps the orgalllt cornpontn\$ or rhe surroundmg rnnlcr:llizcd tissue supphed With moisture and nutnents Sensory ... extre!llc-S in temperature. pressure. or trauma to the- U enun or l'ulp arc
l'rOl<tlivc tbc formation or reparative or secondary dentin (/Jy rite odomnhlot.<t>) linpor tunt cli nical Information : l'ulp C'.lpping is more succes.sful in young teet.h because: The apical fommen of a young pulp is large The youn~ pulp contains more cells (odonrobltJJt/cJ The young pulp tS very vaseular The youn~ pulp ba.< f<wer fibrous elemcnl~ The youns pulp bas more tissue Ouid ** Tho young pulp Jacks collat~rl cireulntion
p~rccivcd us p:11n


The main function of eementum is to provide rough surface anchorage for attachment of:

Transseptal fibers Sharpey's fibers Oblique fibers Alveolar crest fibers


COJJ)'n$b1 C 2009-2010 Dtnlal t>b


Tootb sensitivity to cold, bot, or p~.ssure stimuli is usually caused by exposure of wbicb oral tissues?




Sh:upL ~

\, lilll'n:

Cemenmm is composed of u mineralized fibrous matrix and cells (cementocytts). The fibrous matrix consists of both Sborpey's fibers and intrinsic oonpenosteal fibers. Sharpey's fibers are the tenninal portions of the principal fibers of the POL (alveolodentallfgllment) tlwt are each partially inserted into the outel' part of the cementum at 90 degrees. or a right angle, to the cementa! surface, as well as the alveolar bone on their other end. Remember: Cementum is the bone-like mmeralized tissue covering the anatomical roots of teeth. The two basic types are acellular and cellular. Other functions of cementum include the following: Compensates for the loss of tooth surface due to occlusal wear by apical deposit ooo of cementum throughout life l'rotects the root surface from resorption dunng vertical eruption and tooth movement I. Histologically, cementum differs from enamel in the following ways: Not.. Cementum has collagen fibers Cementum bas cellular components in the mature tissue 2. Cementoid is the peripheral layer of developing cementum that is laid down by cemenloblasts undergoing c~mentogenesis. Cementoid is uncalcified or Immature. 3. When the cementoid reaches the full thickness needed. the cementood surrounding the ccmentocytes becomes calcified or matured and is then considered cementum. 4. Ccntentocytes are ccmentoblasts entrapped by the cementum they produce.

Cnmpari~rr;un nf

Clu. l>entalllnnl I ilrri"i.\lf'




Alveolsr Bone
\1 """'"""


Erusmel orpn Epithelial


Denuol papttlo
Conn .ecuvc tisli-Ut:

D<:ntol papma

'fnoe of tissue
lnoopnic '""<Ls lncremcnuol hn<l

Conne<.:tivt tissue Connective tiuue


65'CcmmlObla~ts. ~m<ntodasu

Arte~ t aod rc"c11a I
hne11 Osteocyto

Lines of Retzius Amoloblasts

Imbrication h.nts of A.rrnt and re' cr~ von Ebllcr sa' lines

Form.-.ti,,-e cells




25% organic ~nd 15%

Organic and wnICr levels

Tt.~~ formation oncr eruption

1%organic ond ZO% o1ganic and lO'A, watrr 3%water Nooe

POS:Sible None:

23% organic and








Generally, as the dental pulp ages, the number or cells _ _ __, and the number or collagen fibers

Decreases; decreases
Decreases; increases Increases; decreases
Increases; increases


c 20092010 rkml DeckJ


Topical application of nuoridc and more recently amorphous calcium phosphate (ACP) are both treatments to remincralize the hydroxyapatite in which tissue- the hardest calcified tiss ue In the human body?




l )rcnot\l'\ : incrca\l''

Important: As the dental pulp ages, lhe following chattges take place: Decreased: - intercellular suhstance. water, 1111d cells *** Mnjor decrease in lhe number ofundiflerentiated mesenchymal cell< - size of the pulp cavity due to the adduion of secondary or teniary dentin

Increased: - number of collngcn fibers -calcifications withio lhe pulp (called dcntides or pulp stone.<) Important point: As the pulp ages. 11 becomes more fibrotic. leading to a reduction in the regenerative capacity of the pulp.
Remembtr: I. The only ty pe of nerve endmg found tn the polp tS the fret orne ending, which is a specific receptor for pain. These prun receptotS are located 10 the plexus of Rascbkow. Regardless of tbe source of stimulation (heal, cold, pressure). the only rcspoo sc will be pain. 2. The pulp conlatns both m~elinated (mostly) and unmyelinated nerve fiber>. They are afferent and sympatbeuc. 3. The myelinated fibers are the a.xons of sensory or afferent neurons that are located in the dentinal tubules in dentin. 4. The unmyelinoted 11hers are sympathCtlC and associated "llh the blood vessels. Note: Proprioceptors (which respond tn .wmuli regarding movement) arc nut found In the pu lp.

t n:tmd

Enamel is the hardest calciOcd tlssnc .n the human body and tho richest in c"tciwn. Enamel is highly mineruliJ!ed and is totally acellular. h consists of approximately 96% tnorganic material (primari(l' calciw" and plwsphon~t o.v hydro:ry11putite), 1% organic material, and 3% water. Enamel is of ectodermal origin. The o rgnnic matrix consists mainly of protein. wldch is rich In proline. The fundamenllll morphologic unit of enamel is the enamel rod or prism - bound together by an mterprismatic substance (interrod substance). Each IS fonned in mcrerucnts by a single cnamelfonniog cell. the ameloblast. Most enamel rods extend the width of the enamel from the DEJ to tbe outer enamel surface. Consequently. each enamel rod is oriented somewhat perpendicular to the OEJ aod the outer eoamel surface. The specific shape of tbe enamel rod is dictated by the Tomes' process of the nmeloblust. In most cases, each enamel rod is <:ylilldrical in the longitudinal ~ectioo. In most urens ofcname~ the enamel rod is about 4 micrometers in diameter. Note: The o!dest enamel in a fully erupted tooth is located at the OEJ underlying a cusp or cmgulum. Other important facts about enamel: It bas no powtr of regeneration - the nmeloblasts lose the~r functional ability "ben the crown of the tooth has been completed It has no power of metaboltsm lt has no means of combating bacterial mvasioo - the susceptibility o f the mineral component to dissolution [nan acid environment is the basis for dental decay h has no nene supply It is a good U1ennal insulator The ucld solubility of the surface enamel is reduced by nuondc {this is the basis for /he topical application offluorides In dental caries prewmtlon)


What percent of mature enamel is not inorganic hydroxyapatite?

10% 16%


Cop)'n,ab1 C 2009-2010 DtmaJ Dk:t


Which of the following is the line found in all deciduous teeth and in the larger cusps of the permanent first molars that marks the division between enamel formed before birth and enamel formed after birth?

Hunter-Schreger bands Lines of Retzius


Neonatal line

Enamel is a highly mineralized sttucture containing approximately 96% ino rganic material. This inorganic component consists of mainly (909S%) calcium hydroxyapatite with the chemical fommla ofCato(P0,)6(0H)2 Other minerals. such as carl>onate,tnagnesium, potassium, !iOdium, and nuoride. arc also present in smaller amounts. Note: Due to the high inorganic content, enamel appears opticaUy clear on a histologic section of the human tooth. Enamel also consists of nn organic matrix (/%)and ~>ater (3%). Tbas organic matriK and water content decreases as enamel marures. At the same time, the inorganic content mcreases. Enamel is semitranslucent and rums various shades of yellow-wbite because of the underlying dentin. The enamel on primary teeth has li more opaquu crystalline form and thus appears whiter than on permanent teeth. Note: Enamel is a selectively permeable membrane, allowing water and certain ions to pass via osmosis.

Enamel fonnation begins at the future cusp and spreads down the cusp slope. As the ameloblasts retreat in incremental steps. the ameloblasts create an ani fact ln the enamel called the lines of Rcltiu~. Where these lines terminate at th~ tooth surface they create tiny valley> on the tooth surface that travel circumfcrentially around the crown known ns perikymata or imbtitatlon tines of Pickerill. One of the lines of RelllUS is accentuated and is more obvious than the others. It,. the noonatalline that marks the division bet\Vten enamel formed before binh and that which is produced after birth this neonatal liue is found ilt ull deciduous teeth and in the larger cusps of the permanent lim molars. Enamel lufts ate fan-shaped, hypocalciftcd suuctur"" or enamel roo thai Notu project from the dentinocnamcl junction into the enamel proper. They uc found an the inner one..,h{rd of enamel and represent areas of less mtnerali-union. Emnncl tufts are an anontaly of cryslllllizatioo and seem iO have no dinical importance. Enamel 5phtdlcs represent short dentinal tubules near tlie OEJ. They result nom odontoblasts that crossed the basement membrane befor~ it mtnernlized inao the OEJ. These dentinal tubules become trapped during the apposition of enamel morrix. and enamel becomes mineralized around them. They may serve as pain

Enamel lamellae are partially calcilied vertical defects in the enamel resembling cracks or lracrures that traverse the entire length nfthc crown frum the surface to the DEJ. They are narrower and longer than enamel tufts. Enamel lamellae are an anomaly of crystallization and seem to have no clinical importance. The tenn Hunter-Schrc~er bands tofers to the altcntnung light aud dark lines seen in dental enamel that be11in at the DEJ and end before they reach the enamel surface. They represent areas of enamel rods cut in cross~section dispersed bet\\ecn areas of rods cut looguudanally.


Where would you expect to see the incremental lines of von Ebner?

Alveolar bone Eoamcl


Copyn,aht 0 2(11.2010 Dcnta.IDb


The organic component of dentin primarily consists of:

Collagen fibers Elastic fibers Odontoblasts Amcloblas!S

l>c. nlin

The Incremental (or imbrication) lines of von Ebner in dentin can be likened to the growth rin~ or incremental lines of Retzius in en3Jt1el. The incremental lines of von Ebner show the incremental na!Ure of dentin appositton and run at right angle to the dentinal tubules. The contour lines of Owen are a number of adjoining purallel imbricmion lines tha( are present in stained dentin . These comour lines demonstrate a disturbance in body metabolism that aftects the odontoblasts by altering their fonnntion efforts. These contour lines appear together as a senes of dark bands. The mo!.l pronounced comour line is the neonatal line that occurs during the t:rauma of birth. Otlter contour lines occur with tetracycline staining of the teeth. in which the nn tibiotic becomes pcnnaoently and chemically bound to the dentin. Tomes' granular layer is most often found in the peripheral portion of the dentin beneath tbe root's cementum adjacent to the DCJ (dentinocememaljuroctiofl). This area only looks granular because of its spotty microscopic appearance. The cause of the change in this region of dentin is tmkoown.

( oll.tcc.n filwr-..

Dentin is the specialized connective tissue that makes up the bulk of the tooth, extending for almost its entire length. Dentin is hard. elastic, 70% inorganic, 20% organic, and I0% water. The Inorganic component consists of mainly calcium hydroxyapatite with the chemical fonnula of Catr,(P04 MOH)z. This calcium hydroxyapatite b similar to that found in higher percentages in enamel and in lower percentages in bone and cementum. Smaller amounts of other minerals. such as carbonate and Ouoride. are also present. rl. Unllke cnmtl, which is acellular, dentin has a cellular compQneot that N otu is retained allcr it~ fonnation by odontoblasts. 2. Dentin and pulp tissue arc both formed by the dtntal papilla. Pulp tissue is a loose, very vascular, and non-calcified connective tissue while dentin is ava scular and a calcified tissue. 3. The main cell type in dentin is the odontoblast, which is derived from cctomcscnchymt. 4. Dentin is much softer than enamel but harder than bone. Dentin is more nexiblc (lower modulus of elasticity) tltan enamel. Dentin's compressi\e strength is much higher than its tensile strength. 5. Dentin is more ruioerulizcd than cementum or bone but less mioerall~ed than enamel. Morphologically and chemically, dentin bas many characteristics in common with bone. 6. The major organic component of dentin is type I collagen fibers (91% to


In orthodontic tooth movement, bone remodeling Is forced. Tbe bands, wires, or appUanccs 11ut pressure on one side of the tooth and adjacent alveolar bone, creating a zone of In the PDL. This leads to bone . On the opposite side of the tooth and bone, a zone develops In the PDL and causes the or bone.

Tension; deposition; compression; resorption Compression: resorption; tension: deposition Compression; deposition; tension; resorption

Tension; resorption~ compression; deposition

2a9 Copyn,aht Cl 2009-2010 Dtn~al l)e(ks



Apical absNsses of which teeth bave a marked tendency to produce cervical spread of infection most rapidly?

Mandibular ccntml and lateral incisors Mandibular canine and first premolar Maxillary first and second molars Mandibular second and third molars

OnbOOontic movement of teeth always causes remodeling oftbe alveolar bone proper to accommodnce movement of the teeth. Important: The new alveolar bone deposited during orthodontic trencment is best described as lntrn111 cmbranous.

Ostcoblasts (dem-edfrom mesMchyme. f.e.jibrob/tlSIS) are bone-fom1ing cells that secrete tbe collagen nnd minerals needed to lay down new booe in c.heir vicinity. OsteoblaslS that have been trapped in the osteoid produced by otbcr S\UTOunding osteoblasts are called oste<Kyle5. Osteocytes maintain bones. play a role in controlling the extracellular concentration of calciwn and phosphate, and arc dtrectly ~lHoulatcd by calchonio and inhibited by PTH (poratltymid ltonllone). OstcOciMts (wlliclr are tlerll'ed ji'Om stem cells /11 rite bone marrow -- tile same o11es that produce monOC) res and macrophages) are bone-resorbmg cells. They are essential panners for bone modeling and remodeling. Their res<>l'fltive activity allows the pcnnnnenl renewing of bone and regulates calcium homeostasis. l. A similar situation is the alleroate loosen1ng and tightening of a deciduous !'.o1..- tooth before 11 is lost. This 15 caused by the alternate resorption (umcmoclasiS. osteoclasiS) and apposition (cememoblasts. ostcoblasts) of cementum and bone. 2. During active tooth eruption, there ts apposition of bone on aU surfaces of the alveolar crest and on all walls of the bony socket. Remember: Pennanem teeth move occlusally and buccally when erupting.

\lantlihul.1r rwcuntl aud lhh-d runb,...,

Cenain anatomic features determine 10 a lar~e extent the acnml direction thai infection may take. The atlacltmcul of muscles may decmnine the roule that :Ill infection will take. channehng the infec11on into cenam tissue SJ!'Ice<.
~I lid


or \h\lt'""\'\ and .... lul.ll'

Cllnlc"l Prtsenttllm of l.tt:~n

Ma:Q.UII)' 'oi:SIIbWe

rcttb MMt Conunonlylnvoh(d

Muilt..y ~and IA....C mcisoc Ma.ullary ur~ine. (ifroN IJ 1Jwrt and in/MCH' ltllf'WJMr -m&JIIi oris) Maxillary pn:anolm Max.illat)' molars (IJ'INul roo!) art ~~~on .md Jlf{trl()r to /N;.criftalu~")


MatU.,y central t.nttw

Maxi liar)' canine (ifroot u ltmg flnd .wtpuftutv ln-a/01' tiiiJ.:.rlfi oris) MaxiJJuy l~rerul in<:i~
Mofj]J.uy pmnolm (linpDI ,_)

Nasolabial ddn n.'gK)o


MwU"Y .,.,..,. (pdlo141 roJ

Perforatl(ln 10to aw:Uiitf)'

Maxilll'tly molart (Jfbt~Cet~l rf>Ols ar~ lmtll)



Bu<W !lido wrf~~:

Man~ .. 'ICSI.Ibu.le

molln (i/buca.l roou au ~tprrW {() bw<aOD'->1}

Mmd.ibu.Lir ittcisors (if1'0011 M~t.dwn atJ snptrinr., W~t:r~laltsJ Mandibul eanines and pre:molaC'i I ifroou ar-t sMn ur~J ('U{'<'rior ro dlprtruors) Mandibul~~r rtrs1 and te<:Ond molar$ (ifroots ore slon umltUJit'rior '" I'HtccmatorJ
Mand ibu1u i.Deison (ifrotJI.f o" ltmg unJ ucforior to Mftflalb)
Mmdh:d fi~ molar (if flft!IIO/ f'l)fJJf b mort tmd nqNrlt;r IQ m.rloiryo1dl Mandlbul.lr ~nd molar tifm~gW~IIllf)llt shorl and .ruptrior ra 'fJ).foll>'f!ld)

Subrrv:nt:al lun ~&ior'

Sablmpal teJioo
Sbbnmn(liblll~r'Skin (c~on

Mandibulur scoond 010l:u (if lt~'1l(.J[ rot>~ Is lung and /Jifrr!Qr 10 m)luhhmiJ MandibuLar dl:ird molln (I/nJ()IS art m/D~ toiW)'Io-'11 t,tkl}

The lamina dura is the hard layer of bone surrounding tbe periodontal ligament along the roots of teeth. T he lamina dura is a component of wbicb of the following?

Alveolar bone proper Supporting alveolar bone

Alveolar crest

Cortical plate

Cop)Tight 0 20092010 Dental Oceks


A delicate membrane covering the crown of a newly erupted tooth Is called:

The primary enamel cuticle

Henwig 's root sheath Plasmalemma


Copyri&ht 0 ZQ.lOIO Dmtt.llkd:s

\h rnl3 r hmh.' p rttpl'r

111e alveolar process is thai pan of 1he maxilla and mundil)le that forms und suppom !he socke1s of the teeth. Like all bone, ma1urc nlveolar bone IS by weight60'Yo minernlizcd, or in organic- rruuerial. 2S% orgolnic material. and lS% water. The inorganic compcment consist'\ of mainly caldum hydroxyapatht with 1he chemical formula of CBtofPOtl.\(OH)2. This ealcium hydro\yopallle is similar to thai found in higher percentages in enamel ;md dtnbn and is most similar 10 1bat of cementum. The aheolar pmcess consists OfhO main pans: l. Alvtolr bone proper .. is u Oun layer of compact bone that is a SJXI\:Iolizcd continua cion of the cnrticul 1>lnte wtd fmms the tooth socket ur alveolus. Note: The lnminu duralo 11 horseshoe-shaped whnc line oo a dent;!] radiogroph !hat ruughlycorrespands 10 the alveolar bone proper. The lamma dum ""-' minute openinl!S thai provide paSsnges for vascular and nerve: componems. ltts compo>e<l of compact bonr, but is sometimes called bundle boot due to 1he presence of bundles of perfQf'3tinl! Sharpe~s fibers. 2. SupporlinA 1\'toiRr bone --tho! buoe that surrounds lh< alveolar bone proper and gives suppon lo the ~ocker. h consists of: CortJcal plnte - Structurally. 1he cunicl plalc " compu._d ol' lingual and facial plates of compact bone, The eortical plate is dense in nature and proides streng1h and protection nnd IICIS as theaiUlchm<nt for skclcml nul<4'1es. The mandibular cortical plate is more d,-nse !han the maxilbcry cortical plate aod bu fewer perf0r.1uons for the paSSlll,!e of nerve. and blood vessels. Note: The ulvcolnr crest is the highest point of 1he alveolar ridge nnd ,joins the fucial and Jingunl conical plales. Spongy bone (mucel/ou.r bon)- tills in the nrcd hctweon conical pltc>llnd alveolar bone proper. This typ< of bone 1< not presetll in !he anrcnor r<gion of !he m"uth: here the cortical plate is fitsed 10 the alveolar bone proper. Th1~ is also~ o er the radicu!M buc cal booc of the mnllillary ~tenOI$ Note: The alvolar bono proper tS tbe only essential 11ort of the bone sock~!. The su1> poniug alveolnr ~one is not alwnys ]>rosen~

I h\' prima r~

\'llUIU\'1 t:ulidc

Also called Nasmylh's m~mbrane. It is produced by the ameloblast cellallerit produces the enamel rods. 11te primary <numtl cuticle consists of two extremely thin layers (tire Inner ana clear /Jnd .vlriiCIIIreles.<. tile ower one cellulat1. coverin~: the entire crown of newly eruptM teeth and ~ubsequcntly abraded by mastication; the culicle is evident mi croscopicaUy as an amorphous material between the nuachment epitbeli~m and the tooth. This cuticle IS wom away by masttcation 8rtd cleaning. Nasmyth 's membrane is replaced by an organic dtpostt called the pellicle, wbicb is fonned by salivary proteins. It is this pellicle that is invaded by bacteria 10 form bacterial plaque lha~ if not remo\ed, will cause

den\a\ caries And peri()dontal disease.

Remember: Enamel is incapable of repairing lbclr once it is destroyed (wrlike tlenti11), After the ameloblnsts are finished with bolh enamel apposition and maturation. they be come part of the rtduced enamel epllbellum, atoog with the other portions of the com pressed enamel organ. The reduced enamel epithelium fuses \vith tho t>ml mucos:t, creating n c:tnalto allow the enamel cusp tip lo erupt through the oral muc'<ISa into tho Qrn[ cuvity. 'Unrortunatcly, llo ameloblasts are lost fore,er as the 1\sed tiosutiS disintegrate during tOOth eruptiou, preventing aoy further enamQI apposition.


A physician determines that a patlcnt with acromegaly will develop a skeletal class Ill occlusion due to excessive growth of the mandible. What causes the formation of resting lines as seen in the cortical bone of the mandible?

Growth of the mandible by appositional growth Grov.'lh of the mandible by interstitial gro~~o'lh Growth of the mandible by both interstitial and appositional growth

Copyrigllt 0 2009-2010 Dml;all)t();s


Triacctate fiber Tomes' fiber Tag fiber Korff's fiber

Dentin is considered a living tissue because of odontoblastic cell processes known as:

Remember: 1. Bone apposition is the deposition of suocessive layers of bone on those already pres
ent. 2. Due to its rigid structure, bone can grow only by appositional growth. However.

cartilage can grow by both appositionnl and interstitial growth. Remember also that both the maxilla and mandible develop from tissues of the first branchial arch, or mandibular arch. The maxilla forms within the ma.,illary process, and the mandible forms within the fused mandibular processes of the mandibular arch. Both bones start a.~ small centers of intramembranous ossifiCAtion.

lunu,. tihtr

These odontoblastic processes (Tomes 'fibers) occupy the dentinal tubules. The~ is one per odontoblast. It jq because of these odontoblastic cell processes \bat dentin Is
roosidered a living tissue, with the capability to ~act to different stimuli and produce secondary, sclerotic. and!or reparative dentin. Dentin sensitivity is not \\ell understood. One theory is that Tomes' fibers are receptors and transmit an impulse to pulpal nerves. The preferred theory is thatlluid movemeot within tltc !lobules, in response to a stimulus. triggers the pulpal nerves. Remember: The odontoblasts begin dentin formation (dentinogenesis) immedhotely before enamel formation by the nrneloblasts. Dentinogenesis begins with the odontoblasts laying down a dentin matrix or predentin, moving from the DEJ inward toward the pulp. The most rccen!ly formed layer of dentin is always adjacent to the pulpal surface. Note: Predentin or dentin matrix is a mesenchymal product consisting of nonmineralized collagen fibers. Remember: Amcloguesis is the proces of enamel matrix formation that occurs during the appositional stage of tooth development. Enamel matrix is produced by ameloblast cells. These cells are columnar cells that differentiate during the apposition ~lllge in the crown area. The enamel matrix is secreted from each ameloblast from its Tomes' process. The Tomes' process is the secretory surface of the ameloblast that faces the deotlnoenamel junction (DE.!).

I. The cell body of the odontoblast lies in tbe pulp cavity.

2. The dentinal tubules are S.Shaped (curmturF) in the ero" n due to overcrowding of odontoblasts. This curvature of the tubules decreases In root


( \..

Which of the following is p roduced In reaction to various stimuli such as attr ition, caries, or a restorative dental procedure?

Primary dentin Secondary dentin Reparative dent in

Mantle dentin

Cop)ri&ht e 20092010 De-nu l Decks



H is 0

( \..

All of the following arise from the dental sac EXCEPT one. Which one is the EXCEPTION?

Alveolar bone proper

Periodontal ligament Dental pulp


Rrparolll\l' <hnlin

Reparative dentin or tertiary dentin is dentin formed 'ery rapidly in locali7ed regions in response to a localized injury to exposed dentin. The mjury could be caries. ca'iry preparation, attrition, or recession. Odontoblasts 111 the area of the affected tubules might die because of the mjury, but neighboring undifl'etentinted mesenchymal cells of the pulp move and become odontoblasiS. Tertiary dentin tries to seal off the injured arcu. thus tbe tenn reparatjve dcn1in. Primary dentin is the dentin formed in a tooth before the completion of the apical foramen of the root. Primary dentin is characterized by a regular panem of tubules. Secondary dentin is the dentin that is formed after completion of the apical foramen. Secondary dentin is formed at a slower rate than primary dentin and is less mmerahzed. Secondary dennn IS a regular and somewhat uniform layer of dentin around the pulp eavity. Secondary dentin is made by the odontoblastic layer that lines the demin-pulp interface. ~ote: Tbc junction berween primary and secondary dentin is c.hamcterized by a sharp change in the direction of dentinal tubules. When dentin Is dumagcd, usnally by the chronic injury of caries, odontoblastic processes die or retmct, leaving empty dentinal tubules. Areas witb empty dentinal tubules are called dead tracts and appear as dark areas in gound sections ofto01h With time, these dead tracts can become completely filled with mineral. This region is called blind tracts and appears white in sections of @tound tooth. A certain type of tcniary dentin eaUed sclerotic dentin fills the blind tracts. The adaptive advantage ofbhnd traCts i.~ the sealing off of the dentinal tubules to prevent bacteria from entering the pulp cavity. Clinically, this sclerotic dentin appears dark. smooth. and shiny.

Dental pulp

Perip.heral cells of the dental papilla dtft'erentiate into odomoblasts that produce predentin tlut Clllcifies and becomes dentm. The center of the dental papilla will become the d ental pulp. Cementoblasts differentiate from the inner layer nf mesenchyme of the dental sac. adjacent to tlte tooth t'OOI. Cemcntoblasts are cells that form cementum. Tbe dental sac will also form the per iodontal Ugament and the a lveolar bone proper. Cells from the Inner enamel epitbelium of the enamel organ differentiate into ameloblas ts thnt produce enamel. The inner a nd outer enamel epithelia of the enamel organ come together in the neck region and form ller twig's epithelial root sheath.




The dental lamina, a thickening of the oral epithelium that produces the swellings of the enamel organs, Is nrst seen histologically:

Second week in utero Sixth week in utero Tenth week in utero Fourth month in utero

Copynght C 2009-201 0 Dcn~tl ll"l.t

Tb~ reduced


His 0

enAmel epithelium forms a s the collapse of what structure?

Cervical loop Hertwig's epithelial sheath Enamel organ

Dental lamina

163 164

By the third week al\cr conception, the primitive mouth (11omodettm) has formed. Over the next few weeks. the tongue, jaws. and palate develop. During the sixth week, formation of the teeth commences. and by eight weeks, all of the pnmary (decrduou) incisors, canines, and molars are discemable. Tooth development appears to be initiated by the mesenchyme's induct1v~ influence on the overlying ectodenn. Early in the sixth week, there appears to be a thickening of the oral ep1thelium (which is o deriva1i1e ofrhe surface <>ctodenn). These thickenings or Usbaped l:>ands are called the dentallomlna and follow the curve of the primitivejaws. At certain points on the dental lamina, the ectodermal cells proliferate and produce swellings that become the enamel organ. Inside the depression of the enamel organ, an area of condensed mesenchyme becomes the dental papilla. Surrounding both the enamel organ and dental papilla is a capsule-like structure of mesenchyme called the dental sac. Note: The enamel organ separates from the dental lamina after the first layer of dentin is deposited. Remember: Each tooth is the product of two tis.~ues that intemct during tooth development, the oral epithelium and the w1derlying ectomesenchyme. The omt epithelium grows down into the underlying ectomesenchyme and fom1s small areas of condensed mesenchyme. which become tooth germs.

I namd nrc,an

Following the formation of tbe crown. the enamel organ (the inner and outer erwmel epithelium. sltatum inlcrmedium. and srcllare reticulum) collapses to form the reduced enamel cpilheUum that covers the tooth through emption. The reduced cnamfl epithelium coosiSis of the maturelprotecu e ameloblasts and remnants of the outer la~ers of the enamel organ. Numerous capillaries, which had formed to supply oxygen and nutrients to the ameloblasts following dentin fonnation, surround the reduced enamel epithelium. The reduced enamel epithelium IS 1mponant in the fonnation of the dentogingh al junctlon, whieb is an area where the enamel and oral epithelium come together as the tooth erupts into the mouth. This forms the initial junctional cp1Lhelium (or epithelial ollachmenl), which later migrates down the tooth to assume its normal position. Remember: The junctional epithelium (or epithelial a/lochmem) altacbes the gingival tissues to the tooth usmg bemldesmosomes. The apical extent of the junctional epithelium is usually the cementoenamel junction.



His 0


Which structure functions to shape the root (or root.!) and induce dentin formation In the root area so that It Is continuous with coronal dentin'!

Dental papilla Dental lamina Dental sac Hertwig's sheath Enamel

2111 CoPYTiabt 0 2()09.2010 Dtn~allkcl:s



His 0

Listed below are the usual events In the histogenesis of a tooth. Place them in their correct sequence (from what happe11s first to what happens lllst).

Deposition of the first layer of dentin Differentiation of odootoblasts Deposition of the first layer of enamel Elongation of inner enamel epithelial cells

The structure responsible for root development is Ute cervical loop. The cervical loop is the me5t cervical portion of the enamel organ. a bilayer rim that consists of only inner a nd outer enamel epithelium of the eoamel organ. The cervical loop be&Jns to grow deeper into the surrounding mesenchyme of the dental sac, elongating and moving away from the newly completed crown area to enclose more of the dental papilla tissue and fonn Hertwig's C J>lthelial root sheath (HERS). H.trtwlg's sheath is an epithelial diaphragm tbat is derived from the Inner and outer enamel epithelium of the enamel organ. After cro" n formation. the root sheath gro"s down and shapes the root of the tooth and induces fommtion of root dentin. Uniform gro\VIb of this sheath will result in the formation of a single-rooted tooth, while medial outgrowths or evaginatlons of this sheath will produce multi-rooted teeth. After the first root dentin is deposited, the cervical ponion ofHenwig's epithelial root sheath breaks down, and this new dentin comes in contact with the dental sac. Thts communication stinaulates cells to differentiate into cemcntobl~sts that produce cementum. This process is called cementogcnesis. Note: Accessory root canals arc fonned by a break or perforation in the root ~heath before the root dentin is deposited.

I. Flun~~tion of lh\' inner rnaml'l l'pilhelial n.'lh of thl l'tnlml'l or:.:,an: thi

inllmnt.'\'' nlt.'\l'IICh~ mal .:l'll\ on lhl' att intu mlontohhl\h (#] bdoll') 2. J)itftn.ntiatiun nf juluntnhla'h


uf lhl dlOta11H11Jilla IO difflnnfi-

.l. lltJ)tl,ilinn of fhl' n.-.... la~t.'r nr tllntin .... llqm ... itiun of tlu. lir<rol la~lr nr l'n:und

Tooth development is dependent on a series of sequential cellular interactions between epithelial and mesenchymal components of the tooth germ. Once the ectomesenchyme influences the oral epithelium to grow down into the ectomcsenchyme and become a tooth genn. tbe above eventS occur. I. Some texts include lbe deposition of root dentin and cementum as #5 in Notts the histogeuesis of a tooth. 2. Korff's tlbcrs is a name given to tbe rope-like grouping of fibers ill the periphery of the pulp that seem to have something to do with the formation of dentin matrix. Remember: Histogenesis means the formation and development of the tissues of the body, in this case the tooth.





Identify the following areas of a developing tooth bud on tbe schematic drawing below.

Oral epithelium Dental lamina Enamel organ Dental sac Dental papilla

('op)'l'lfht 0 2009-2010 !Xntal [)r(:b


The four distinct layers of tbe enamel organ include all of the folio,. log EXCEPT one. Wbitb one is the EXCEPTION?

Outer enamel epithelium Inner enamel epithelium Stratum granulosum Stratum iotermedium Stellate reticulum

Oral tpilbelium

Dental lamina----,

Dental papilla Dental

Four layers of the enumel organ: l. Outer enamel epithelium (OEE) . lhe outer cellular layer of lhe enamel organ (very thin). This layer outlines the shape of the fulure developing enamel organ. 2. Inner enamel epithelium (fEE) . 1he innermost cellular la~er oflhe enamel organ (very thin). The cells in this layer will become ameloblasts and produce enamel. This layer Is essential for lite initiation of dentin formation once enamel is formed. 3. Stratum lntermcdlum - this area lies immediately lateral to the inner enamel epithelium {thidcer than both the OEE and lEE). This layer of cells seems to be essential to enamel formation (prepares mthiems for the ameloblasts of the lEE). 4. Stellate reticulum this area is the central core and fills the bulk of the enamel organ. This layer conlains a lot of Intercellular Ould (mucust)pefluid rich in albumin) that is loSt jusl before enamel deposition. Remember: After enamel formation is completed. all of the above struclurcs of the enamel organ become one and form the reduced enamel epithelium. This is imponant in the formation of the dentogingiv;ol junctlon, which is an area where the enamel and epithelium eome together as the tooth erupts into the mouth. This forms the initial junctional epithelium (or epithelial al/achmenl), which later migrates down the tooth to assume its normal posilion.




A young girl presents to the dentist with yellow, thin, chalky enamel, but sound dentin. The diagnosis Is amelogenesis lmllCrfecta and is a genetic disorder with malformed enamel. In amelogenesis imperfccta, there Is an error in what stage in the nrc cycle or a tooth?

Bud stage
Cap stage

Bell stage
Apposition Calcification

Cop)'l'igl11 0 l0092010 Oc-nt11l Decks





A cementicle Is a spherical, calcified body that lies in the periodontal ligamen t or fused to the cementum of a tooth. The remnants or the epithelial \.. root sheath that then become calcltled to form a cementicle are called: ~ Accessory root canals The epithelial rests of Malassez The dentinoenamel junction (DEJ) The ccmcntoenamcl j unction (CEJ)


I. Initiation (sixth tose>'t'tlllrweeks)- Ectoderm lining stomodeum gives rise to oral cpithehwn and then tO dental lamina. adjacent tO deeper I.'Ctomesenchyme, which is influenced by the newal crest cells. lnduollon os the maon process involved. Congenitalab sence of teeth (anodontia) and supernumerary teem result from an interruphon m thts phase. 2. Bud stage (eighth wk) Growth of dental lamina into bud that penetrates growing ectomesenchyme. ProlifHation is tbe mam process invohed. 3. Cap stage (nimh In tell/It weeks) Enamel organ fonns into a cap. surrounding the mn.~s of the de mal papilla from the e<:tomesenchyme and surrounded by the mass of the dental sac also from the ectomesencbyme, thus forming the tooth germ. ProUfcrotlon, differentiation, and morphogenesis ore the mnin processes involved. Dens in demc. geminauou, fusion, and tubercle fon11ation occur during this phase. 4. Dell stage (eleventh to rweljlh week.1) final shaping of[l)()th. cells differentiate into specific tissue fonning cells (omeloblasu. odonlt!blasrs. cememoblusrs. und fibruh/asu) in the enamel organ. Histodifferentla tlon and morphodifferentiation are the main processes invol~ed. Macrodontialmicrodontin occur during this stage. 5. Appo.drion (varies per tooth) ceU that were differentiated into specific ussue-fonn ing cells begin to deposit the specific dcntaltL'>S\Its (enamel, dentin, cememum, tmd pulp). Enamel dysplasia, concrescence. and the fonnJJUOn of enamel pearls occur during thts Stage. 6. Calcilkation (varies JNr rooth) minerali1.ation 7. Eruption (aries per tooth) 8. Attrition (varies per tooth) Note: Dentinogenesis irupcrfecta :md nmeloglncsis impcrfeda occur during hostO differentiation (Bell stage).

The epithelial rests ofMalass<:L are remua.ms of Henwig's epithelial root s heath ,.,I() e01
be found as groups uf epithelial cells 10 the periodontal ligament Some rests dcgenernte: others become calcified (fonn cemcnticlc.t). Rt.member: Th purpose or Henwig's epnhehal root sheath os to shape of the root (or roots) and indu~e Mntin formation (b)' stimulating the diffrrentiallon ofodolllobla.tL<) in the root area so that it is continuous woth coronal denrin. After tllis root dentin ~~ deposited, the cervical portion of the root sheath breaks down, and thi~ new dentin comes in contact with the dental sac. This contoct stimulates cells From we dental sn~ tO differentiate into cells that will produce cementum, the PDL, and tlte alveolar bone proper. Important: The continuity of Hcrtwig's epithelial root sheath must be broken ill order for cementum to be deposited during tOOth development (cememogen~sir). llertwig's epithelial root sbearb is characreri2ed by: The formation of ceU rests (resiJ ofMalosse:) uo the PDL when the sheaths timet rons have been aceomplished The bsence of a stellate reticulum and a stnuwn intennedium Remember: The structure responsible for root develOpment is the cervical loop, wbicb ts the most cervical pomon of the enamel organ.




Histologically, the dentin or the root is distinguished from the dentin of tbe crown by the presence of:

Incremental lines of Rctzius Rete pegs Tomes granular layer Sharpcy's fi bers

S05 Cop)-nJh1 0 20092010 DcnuiOh



His 0

The tooth germ is composed of all oftbc follo"ing EXCEPT one. Which one is the EXCEPTIOJV!

Enamel organ Dental sue Dental pulp Dental papilla

Tomr\ cnmul.tr I<J~ l'r luf,a 'allcd rh, ~rmmlar lara oj Tium"'J Important: Histologically, the dentin of the root is distinguished readily from the dentin of the crown by lhe presence of Tomes' granular layer. Tomes' granular layer is most ofien found in the peripheral ponion of the dentin beneath the root's cementum, adjacent to the dcntinocementaljunction (0CJ).11lis area only looks grnnu lar because of its spotty microscopic appearance. Tbe cause of lhe change in this region of dentin is unknown. It muy be due to less calcified areas of dentin similar to interglobular dentin or loops of the terminal portions of braocbing dentinal tubules found near the DCJ similar to lhat of the DEJ. lnterglobul:tr dentin diffcn from Tomes' grnnul3f layer in that interglobular dentin usually occurs a sbon distance inside the DEl. Remember: Enamel formation begins at the future cusp and spreads do"o the cusp slope. As the amdoblasts retreat in incremental steps, lhe ameloblasts create an anifact in the enamel called the llncs of Retzius. Whtre these lines terminate at the tOOth surface, they create tiny valleys on the tooth surface that travel circumfcrcntially around the Ct'Own known us perikymata or im brication lines of Pickco lll. O ne of the lines of Retzius is accenmmed and i~ more obvious than the others. It is the neonata l line that marks the division between enamel formed before birth and that which is produced aner btrth - this neonatal line is found in all deciduous teeth und in the larger cusps of the permanent first molars. I. Globular dentin: refers to areas of both primary and secondary moneraliza-

1\ota rion 1n dentin.

2. loterglol>ular dentin: refers to areas in dentin where only primary mineralization has occurred 'vithin the predentin. Interglobular dentin is slightly less minernlized than globular dentin. Interglobular dentin is especially evident in coronul dentin and near the DEJ.

Ul'ntal pulp

Componenu of the tooth germ: l. Enamel organ, whicb is formed from orol epitheliu~ wbicb is denved from ectoderm. The cn:trnel organ bas four di<llntt cell layers: I. Outer enamel epitheliwn 2. loner enBmel epitheliwn 3. Strntwn intermedium 4. Stellate reticulum The enamel organ will give rise 10 enamel and will eventuully form Hertwig's epithelial root sheath (HERS).
2. Dental sac. which is formed from mesenchyme (eetomesenchym~). which is denved from neural crest cells. The dental sac surrounds the de\'cloping tooth germ and will give rise to the cementum, tbe POL, and the al\eolar bone IJrOper.

3. Dental papilla, whlc.il is also fonned from mesenchyme (ectomesendoymc), which is derived tlom neural crest cells. The dcntol papilla will give rise to the tlcntln and dental pulp. Note: The outer layers of cells difTerentiate into th.e odontoblasts (defltin-fnrming cells).



The portal vein is about 2 inches long and is formed behind the neck of the pancreas by the union of the:

Left gastric and the left colic veins Appendicular and the inferior mesenteric veins Superior mesenteric and the splenic veins Right gastric and the right colic veins


Copyti&hl 0 20092010 l)con~;al Ottb



Mos t posterior in tercostal veins empty Into the which In turn empties Into the at the fourth thoracic vertebra.

Femoral vein; inferior vena cava

Subclavian vein; brachiocephalic vein Azygos venous system; superior vena cava Splenic vein; hepatic ponal system

308 Copyricht 0 1CJ09.2010 Oct:lt&l Offi.s

The porto I vdn (mwt commo11/y rejim'l!tllo us tire hep!lllc portal H'in) l~ n major vein that drains blOC<! from the obdominal pan oflhe gaStrouttcsiiMI tract from the tower third ufthe e'ophag~ 10 h~lflllay down the anal canal. the ponal vem also drain< blood from the spl<et\, panea., and gallbladder. The portal vein enters the hv.,. and break up mto >inu.<oids, from which blood piiSses into the h~patic veins thKijoitlthc mfenor vena cnva. ll1e portal vein is form<d beltind the nc~k of the panoreus by ihe union of the uperlor nttscntcric and the splenk veins. The portl vein o;;ccnd to the righ~ bchi11d 01c tlrst part of the duodenum. and enters tbe l.,..,r omcnt11m The pon:ll vein then runs upward m fron1 of the opening imo the le;ser &ac to the porta hepolh, where u dtvides intO nghr ond lei\ brancho, before enrenng
the liver.

Almost all of the blood coming from tho digestive Sysrcm drains into u spocoal vcnou dt<:ulnrion called rhe portal tlrculutlon. Th{s b becou>< it contams ull ~ nutrients and roxins that ha>e been absorbc<l along rhe digestive ltllct frnm mgested food. llefore these tbsorl>ed ublitances can It" m10 lhe r>emie clrculutrOI~ rhe portal con.,dariou musr be filr...ed lirM to remove or "dermMy" !hom. This tilteting lind dcto"fi""'""' nre funchtt< or tllo liver. The tribuumes of the ponal vein are I he: Splonlr vein: joiJl.'l the 'uperior ~1\<nt vein to form the ponl \'etn Inferior moteric -rln: is joined by the splenic \eon. whoch dnun$1he accesS(\<) dr gesuve OlltiUJS or tile pancreas aod spJ.~n. liS well ns pan Of the stom"ch Suplrlor n1eseuterh: vein: joins tho spll."nic vein to fonn1he ponu1 vein Cusrrlc vein, wboch drains the urper pan M the stomach. aud l.bc cytlc veins. which drnio the gollblndder, ulso dTBin iniO the ponal eio Not.: Onee bi<JOd cklivcred by the hcp.,uc porull sys1em Ius filtertd through lbe liver. rhe blood Is terumed to the hean "in rb< Inferior ' 'ena ca,a. lnopor1nnl: The pol'l~l vein tarries h\itt as much blood ns tlo~ hepatic nr~ery.

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The lrtttrnftljugular and ubcla\1ian ><Ins of eacb >ode join at the firsr intcrc01aol cnrtllo&o to fom1 the superior v0no cnvft. Anmtercnsml vuin runs ulo>lgside each i111crcosral urtcry. Each side has clewu posteriorimercost"l veins and uno suhcoslal vein. Mosr potennr intercostal veins '-"mP'Y intn the ft:t.)'gOs vcnOU5 sy~tem, wbich in tUrn em11ties mto the $Up~rtor ,eoa cava at rbe four01 thomcic venct>... The til:) CO> veins COtiM>ts ur!he main 8l)IIOS vem, 1hc Inferior bentiALy~os vein, and the superior hemiaeygos v.:m. They dram blqod from the po.'\terlor pans of lhe mten:osUll spnceo, tlo posterior obdonnnol wall. the ptricardium1 Uoc diophragm. the bronchi. and the csopbugus, The unaon of rbe aty~;o< 'eln is 'anahle h b otltn fonnod by the umon of tbc rlgbl asCt'ndin{llumbar vem IIllO the rlgbtsubeostal ein. n1c ~Lygos vdn osnds thmugh the .our ric opening in 1be dwpbrogm on !he ci!lht si~e of the ui'IK to the level nf 1hc fifth rhomcic vertcbl'ft. 1-lcre the vein urches forwurd above d1e roor oflhe righ11Ung to er\lpty in10 the pos terior 1urface of'rhe superior nna cav. "'ute: n,e 117YI!O> v<in leave5 ou impression on the nghr hma us the "''" arche;, ow the root Tbe li7Y!l< vein has numeroU> tributnries 11\al inolllde the d~tht lower lntei"(OJIIal vem.<, rh.: rigbtsoptrior lnoen:ol~l ve111.1he superior ond inferior hemiaeygos veon. and num<wu orediastinol vems. The supCI'IOr vena cnv11 i.!t one of the tWo mAin vein~ (rite mlrcr hein,g the fu/&tio,~ "enu c :uwr) bringing dooxygennrcd blood from the body to lho belli~ Vcms fiom the head and upp.:r bady feed onto the supenor vcnu cava, which empties intu the nght atrium or the hc:!tl. '\olf: The infenor veno uava carnes blood bac~ to lhe right atrilUll from the lower pan or rhe body. Remember: At the 1'0()1 of the neck, rbolntornal ju.gulr veiu joiM rho sulk:lovian ' 'cin to fonn the large brachiocepltalic "cin. This O<!ctii'S un bnth Rid"" of the Muk, and rhc twn brachlocCJihUc veins tillite in lhe suporior medhtstinum to font) the 1uperior en11 cava (tht <IZII80S vein uiJO /olru tltcpostermr aspect ofthe rx:rior vena CD\'0 Justlwfo,Y! 11 pw~tes
the pertcanfium).


Each subclavian vein Is a continuation of the-:-:-----.,. and runs from the outer border of the nrst rib to the medial border of the scalenus anterior muscle.

Brachial vein Brachiocepbalic vein Internal jugular vein

Axilla.ry vein


c:opyn,bl c 2009-2010 Dmtal Dtcb

Oxygenated blood leaves the placenta and enters the fetus through the:

Foramen ovale
Ductus venosus
Umbilical aneries
Ductus arteriosum

Umbilical vein

The subclavian veins are two large veins. one on either side of the body. Each subclavian vein begins at the Oilier border of the l11'$t rib as a eonnnuation or the axillary vein. At the medial border of the scalenus anterior, the vein joins !he Internal jugular vein to ronn the brnchlocephalic vein. lmporhmt: Tbe subclavian vein crosses the first rib anterior to the scalenus anterior muscle. The uternal jugular nin lies in the superficial fascia deep to the platysma. The vein passes downward from the region or the angle of the mandible to the middle of the clavicle. This vein perforntus the deep fascia just above the clavicle and drains onto the subclavian vein. ~ 1. The subclavian vein follows the s ubclavian nrtery and tS separnted posterNoc.S iorly by the insettion of scalenus anterior muscle. 2 . The thoraric duct usually dmins into !he junction of the left internal jugular and subclavian veins. 3. BradtloJ vtin - drains venous blood !Tom deep antebrachial regions and brachial regions into the axillary vein. 4. Cephalic vein - drains venous blood from the radial side to tl1e autebrachtum and brJchiwn into the axillary vein. 5. Brothlocepbalie vein - eitber of two vecns (right ami left) formed by tbe union of the internal jugular and subclavian veins. 6. Suptrior vena CA\'a - a large vecn formed by the union of che l"o hrachlocephalic veins; this vein bas no valves. It receives blood from the head. neck, upper limbs, and chest and empties into the right atrium of U1c heart. 7. The Inferior ' 'en a cava (larger tl111n the superior wma cam) opens into the lower pa" of !he right atrium: !he cnferior vena ca,.., is guarded by a rudimentary, non-functioning valve. The cnferior veon cava rerums blood 10 the heart from lbc lower half of the body.

Blood leaves the placenta and enters the fcn1 s chrough che ucnbilical vein. It is the only fetal vessel to carry blood lhal is rich In oxygen and outrio11ts. All of the other vessels carry a mixture of anerinl and enous blood. Aiter circulaun; in the fetus. the blood returns tu the placenta through the uonbltleal art<r1H.
UrtlbilfcaJ vein



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CaMects lht pl11ecnis tOthe 'rr~n.'tJ)QCU flut.ntnHich f0m1:t. the. rouru.l Ug~nt ful:so ltVCTj f(lrms I rNjor portion a( 0\)gl:'QI.ted blood (rom ~~~ u th~ ligtu~te~Hmrt h.'7'U)

Ill< ....bill<al """'


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blood directly lncoche

mltrior veoo Cl\\1'11

f(l(ntj t.ht lqcamttuum vmu!'um, n fibrous COrti in the lhcr

Ct.>oc> 11 bonb and bcccmes lh<
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Opcruns 'bel"- lh< riil> a.<~ A 1hun1 to ~ tllt left al'lia p.il~ bKu.try
Between lht pulmonary trunk aud the aonic nrch


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llgamcnt'-lm tutcnosum

Untnhc:al arlcoo Arise from ll'&cma1 iltK: mcnes; ASIQC\!Ucd wnh tM: umbilicat <:ord

T-bl<>o.!f""" Atrophy co '->me lhc tcml \be f~ h.ti.M piiC"tutl wnblhtllllitamerus



Exchange of gases in the tissue occurs in:



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All of the following nenes are embedded in the lateral wall of the cavernous sinuses EXCEPT one. Which one is the EXCEPT/ON?

Trocblear nerve (CN I V)

Ophthalmic nerve ( CN V-1) Oculomotor nerve (CN Ill) Maxillary nerve (CN V-2) Mandibular nerve (CN V-3)

312 Ccp)-nJbl 0 201)9.2010 Dmal DKU

Unlike the ancne:. ond ew.. capillaries arc: very thin and fngile. Tbe aplllanes an: actually only one epithelial celt thick. They are so thin that blood cells can only pass tbrough !hem in single lite. The exchange of o~ygen and carl>on d10Kide ~akes place through thctllin capillary wall. Arteries nnd veiM run parallel throughout d1e body with a 11 eb-likc networi< ofcopillnrics, embedded 111 tissue, connecting them. The ortcrlcs pass their oxygcnrich blc>od I<> lhe capillaries, which nllow the exchange of gu.<os whhin the th-, -ue. The capillaries then pass their ~e-rich blood to the veins for lml1SJXlrt back to the heart.
( 'wn1101ri,nn of\ cin,, \rtlril'' ~uul

< apillaril'"'

J\zfb arrent:~ to ...c:ans

lllood du'CCii<111


To bean
Tnm eLasnc

Mu1c.le la)'t'f

lbick elastJc None

Nune Nune

Semilunar valve$

lligh ";th pul"" Less., no J'llllc'ic

Vory low with pulse

O,.)gt..on concemnnion Oxygrnd Mixture 0co'<)'~enatcd Differences io blood pressure are reOected 111 vcssel Structure: Arteries -thick. muscular walls to accommodate the flow of blood at ht~h speech and
pressures Anerioles - tlunnrr walls WI coru.'1rict or dilate as~ to control blood flow to the capillaries Capillar ies - .-ails composed of only smgl< Ioyer of entlothellal cells Venules - rece1ve blood from capnlaries; 11UIIs thmner than those of arterioles

Veins - thiuuer walls but larger diametm than aneries: maintain low blood l)re:ssure re quired for rchu11 lu hean
\1andihuhu mnl'

f( \

I -3)

The two cavernous sinuses are large ~em> lying within the skull ca"ity. immcd1ately behind eaeh eye ~Cicet ~nd ou either >1de (If the pituitary gland. They connect with the veins of the face and those of the brain. Thes< sinuses empty by way of the superior petros al sinuses into the transverse siouses that continue as the sigmoid sinuses. The sigmoid sinuses end at the jugulor forum en by becoming tbe ioterual)ugular veins. These sinuses are nlso emptied by the Inferior pctl"osal sinuses that dmin into !he internal Jugular veins. Because the veins of the hC<ld do not have valves, blood from the cavernous siou.es eon t1lso drain anteriorly into the ophrhlrulc ''eh1s. The cavernous sinus is an important structure been us~ ofits location 011d its contents. This sinus carries in its lateral w91l the third crantal (oculommor) nerve, the fourtb cronial (trodtlelJr) nerve, and pano I (the ophthtJ/mic 11cn-e) and 2 (the maxillary flene) of the fifth cmnial (trigeminal) tlerw. Remember: The Internal earotid artery and the abdu~cn' nene (CN VI) pass through tbe sinus.
l. A en vernon$ sinus thrombosis is a blood ciOl within the cuvemous sinus. ole.< This clot causes the cavernouN s inus syndrome. 2. The covemous sinus syndrome is chnrsc1 c1 i zed by edema of the eyelids nnd the conjuncuvao of the eyes and puralysls of the crnnial ntl'ves tim course through the cavernous sinus. 3. The ortlltal cavity is drained by the sul'er lor and inferior opblbalntle veios. The uperior ophtbahni< vein communicates m front with the racial vein. Tbe inferior ophthalmic vein communicates through the inferior orbital ti<Sure with the pterygoid venous plexU> B01h veins pass backward through the superior orbital fissure and drain into the cavl'rllous sinus.


The veins of the brain are direct tributaries of the:

Internal jugular vein Dural sinuses Diploic veins

Emissary veins Pterygoid venous plexus


CO())'n.hc C 20092010 Dot1al Dtct.s


The pterygoid venous plexus Is a venous nehork associated with the pterygoid muscles. It reeelves Yeins tbat correspond to branches of the maxillary artery, a nd the network's posterior end is drained by the:

Facial vein
Maxillary vein

Brachiocephalic vein
Retromandibular vein


llur .11


faJ,o t ul/,tl' t'lt'hral \lllll"f'' or.,;,""'-" of tlura mntcr)

The dum! sinuses are large. endolhelium-lined venous channels siiUated between !he two l~yers of dura mater. the endoslcal and the rneningCJtllayers. Tite dural sinuses are devoid of valves and are part of 1be vonOIL' system of llte dura mater. Major cranial sin use-' include a postero-superior group, at the upper and back part of the skull (sue II as superior sagl11al. inferior sagittal, straight, transerse. and occipital) and an nntero-inferior group, at the bas!: of!he skull (s11ch as cavernott. petrosal and basilar plexus). Important: The cins of the brain are direcl.lribuu~ncs of the dural venou.. sinuses. I. The emissary tins, which are valveless. connect the dural venous sinuses Not with the veins of ll1e scalp. 2. An emissary vein. found in the foramen ovnlc, is a means of communication between the pterygoid plexus and lhe cavernous sinus. 3. The iliploic veins lie in channels in the dtploe of the skull and communicate with tbe dural sinuses. the veiru of tbe scalp, and Ute menlng~~l veins. 4. The intfrual jugular I'Cin begins in the jugular fora.men liS a continuation of the sigmoid sinus. Tbts vein descends m the carotid sbeath and ends io the braebiocephallc vein. II receives blood from the brain. face. and the neck. 5. Generally. th~ vems of the head and neck do not have valves.

\l.1\ll1.1n \dn

Veins conesponding to all branches of the muillary artery drain into the pterygoid pitXUS O( \'tinS. This pleltUS occupies the mfratemporal fossa and is ituoto:<l ""'w=n tbo tcmporolis and lateral pterygoid muscles. It is a venous network associated with the pterygoid muscles. Its posterior end is druined by the maxillary vein. The network communicates with the racial vein tllrougllthe deep facial vein. Importan t: The following venous channels have direct connections with the pterygoid venous plexus - the ma.~illary. deep fucial, infraorbital, and posterior superior alveolar veins. The maxillary win is a shon vessel that drains the posterior end of !he plerygod venous plexus. This vein runs backward with the maxillary anery on the medial slde of the neck of the mandible and joins the supcrfklal temporal ' 'ein within the purorld gland, 10 fonn the retromandibular vein. Tite fa<lal vein is foaned 111 the medial llllgle of tJoc eye by union of the ~upraorbital and supratrochlear veins. This vein auastomoscs with the retromondlbolar vei n (anterior brandt) below the border of the mandible. The facial vein ends by draining into the main venous SIJ\lcture in the neck, the Internal jugula r ein. Remember: The internal jugular vein descends througll the neck within the carotid ~heath and unites behind tbe sternoclavicular joint with lhe subclavian vein to form the bracblocepbalic vein. The braeblocepbalic ehts (right and left) unite 111 the superior mediastimtrn to fonn the superior vena cava, which returns blood to the right atrium of tb.e beart.


Which of the following are considered to be primary resistance vessels?

Large arteries
Arterioles Capillaries

Large veins

Copynabt Cl 2009-2010 Den1ILI Dccb


The great veins of the neck are all derivatives from the:

External jugular vein Internal jugular vein Retromandibular vein Superior vena cava

311 Copynsbt 0 20091010 Dmtal D:L$

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d~ribul:ion o ( Q:nJI.c \,KIIpul

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Re'-ivcl)' ..... Po.ihk - ~

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Pti.tntuy IUI.$-IIm UloJOd aad tissue hsllllttwa)' 1 0 l~~:~n from ussucs; \CSSd$: dclemnnt oc:n ~ ~xd1:lngt: biQOd tkt\'thr
fi"IM arrmoi~~:C to

I. Veins have tbinnu walls than arteries but ha>e larger diamettrs because of the Notfl low blood p.-.ssurcs requored for vc:uou., return to the bean. 2. Valves in the '"tons of the neek, anns, and leg.' prevent venous back now. 3. Important: With the exception of ~ t>ulmonary vessels and certain fetal vessels, arteries tnmsport oygenated blood, und veins uanspolt deoxygenated blood. 4. Venules continue from capillaries nnd merge to form veins.

The two hugest'"""" in the body arc the superior and Inferior,.,.,. cavae. wboch clnlio mto the hCM fioom above and belo.,... rcspccu\ely. The gre11 of the neck arc all dawativel. from the superior ,en a ca,a. The superior vena cava i~ a laJiC:. yet $hon vein that carTit.."S deoxygenated blood from the upper half of tho body to the hean's right atrium. The superior vcM cnvo is formed by the left and right brachlocephalic veins, There are three main veins in tlw m'tk. .. the e~ternal.
autcrlor, and Internal jugular veins.

fhe txt<roaljugular vctn originat<"S from just behond the mandible"s angle. and is fonned b) the unification of the posterior auric-ular 'ltCtn and lhe posterior di\lsion or chc retromandfbular vein. Note: The rttromandibular <in ttself i Conned wnhtn the paroud gland. This vein's fonnation ~from the unifocatioo of the suprfitialtemponl and the ma.d lfa ry Hins.

The Internal jugular vein, which drains the head and brnin,joins the subchH IAn vc1 n to form the bracblocepbalic vein. The hrrt and rlgM brathloccphalic veins join to form the superior vcnn cnva, which drains into the hcn.n. The anterior jugular vein arises below lht chin from th..: vein.c;; droining. U 1c chin and lower lip, plUSeS dOwn the front Of the neck SUpcrficially, and tcnninaU.S in the C.'temal JUguJor Vein at the lateral bo~r or the 40ttnor srnlene muscle. I. The bnchla~ baslli<. and rep hall< vcms clnlin the uppec hmbs: lbcsc eon> drain into Not the nltJary vein. "'htch becomes the subclavian vem. 2. The IZ)'gos vein. which drainS! Lhe lhomdc cl\vity,joins the superior \'tna c.ava1just before il enters the heart. 3. The femorul vein droins the lower 1imb, becoming the external ill or vein as il ente~ the lnmk, where the vein is joined by the intc.rnnllllat vein from the pelvis to become the common iliac vein. 4. The two c:ommoo mac veins join to form tbt inferior vena"' a, whic:h passes up ilic posterior abclominol wall. whet< the inferior vena cava is joined by >-cins from the kidnoys. pads, Ji,-u. nnd baek region. The iof<nor 'ena cava passes through the doaphragm and .... """ th< bean.



Which venous sinus of the cra nial cavity turns forward and then downward through the posterior part or the jugular foramen, to become continuous with the superior bulb of the internal j ugular vein?

Sigmoid sinus

Superior sagittal sinus

Transverse sinus
Straight sinus


318 C 2009-2010 De:lltal Oetl s



Wbi<h vein communicates "ith tbe superior ophthalmic vein and thus "ith the cavernous sinus, allo\\ing a route of infection from the face to the cranial dural sinus?

Occipital vein Facial vein Lingual vein

Posterior auricular vein


1009-2010 [bql [)c(b

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The du~l H no11ulnu..,. ""'spaces betw<en the ~~~hnd mcntngc:tllaym ofIll< dura. The>< <inusc:s c::omain vc:oout b1oocllhl.t Ofiginates for the most p.tt fnm, tht' bntin or cnunal avny. 'The: 1iinuses contain an mdolhc1iaJ 1inin,g that is continuous mto the ''cuu that :.rc connected to the smusc:s. 'lbt'ff are no \'ah es in the :.inu.scs or tn the veins that are connecled tu 1 ht: sinuses. fhc vast majority 'rthe venQu~ blood in the smuse~ drams fmm the c:ranium via the: fnltrnlll j ugular v~in , The .superior sa gittal ~in us is found in the upper bord<.-r ufth.: falx Ct:rtbri Bnd begins Itt the: cnMD galli. The J-1tpi'nur ~ashtul sums i.s fed by blood frorn the !Hipenur ccrdnnt veins and cnd.'i 81 thu COt\Hucn<:e:

of sinuse.'i near the lntc.:nml occipital protubc-r.t.ncc. The Tnre.rlor <~agithll sinus is IOC3ted in the lower free bnf..ter t,r th(: fat~ ccrcbn bl:twccn the two cerebnd hemi.;;phe.~. This s1.nus beg-..ns anteriorly and end~ w1th its JUnction wnh the 5tral!!,ht s1n\t.:'l The srni$thl sinu' orlcJn,a:rts with the uni"'n ofd'lc peat ('t'rcbnl \"Ctn and infenor t.agntalltinu~. 'The &trlligbt sinus lUllS f'l'<l<rlorly in ohe)\RlC1ion between !he flx ..,.belli and 1ct\Ulrium emb<:lh 10 hecolne
<Qntinll<>U> wtlll one ll'1liSVme Sinuses (trtml N>tnlfU>ftl)' thtl~ji) The ronrnou lnu!ts ""'found oo eith<r side ofd>< body oflht rh-id !>one on 1l!1ddlc mn,.l fossae:. TheK ~IUUI!r<.t.. ~c1\'e blood from tbe sphenopant1a1 \muse:, tha1 are located Wldmtt'lllh the fn:"c edges uf tht Jem.r wmgs of the ~phenoid bnne. B1~ also dm1ns mto the eavemou~ sinuses v1111he 5\1~ perior and inferiOr ilphtbAlmk Vtill~. The ct\\'('fll UUS SIOUSC$ dram pos!t"riorly tbrt,Ugh the SUpCl inr Hnrl inferior pe1rosnl sinu.st:s Md infenorly through the pterygoid f)k~u~ uf veins. The ~uptrlor IJetrosal sinuses life located In the t:dltC or Ihe tentorium certbeJit on th ~ rid"!.! uf lht pctrons part of the tempumllxu.e. Thi$C' sinust!i dr:.in mto lhe tra.uven:esifl~c:s The Inferior pttro,.l slnuns arlO fo\Uld aI!lie bMt O(\he ptltQUS part of the lttuporol bone m the nostcriorcranial f0553C when: these sinUses empty lnto the mu:maiJugular \Ctn. The baJUt.r iJtiU} inCA:ttonnects ...,ith infmor pt"trOS&I sinu$cs and thr inu::m.d vencbr.l pius. Tbc lnf\f\trM sinuKS ~'\mod latt:caUy from the connuen..:c or)imJSC5 in the! lenronum c:cTCbclli The U'UIS\'ttSC: SlnUK! tnnel \'t'n&ral()' \0 btaxM tM SlltnC)ld SIRU~ o( C3Cb Side.


n.t: sigmoid .-ln uit'!i bend mlo an S-sha.ped cune &nd tononue mto the truemaJ j~ulcr \Cm lhtough
the jugulAr tOrarncn rbc occipital s1nu~ is toea led ln the pOslerlf.'r tt.Adted border of the falx ccrebelll. Thut !IIIIU~ t'Uitununie:ateS sup~.:ric..tly with the connucnce ofsumsc.:1 ..:~nd lnfenorly witb the lmr:mul vc:n~hf'nl plexus.

hu:i:.~l H ' ln

The fad l vemts fonned at the medial angle oflhe eye by the union of the supraorbital and upral rocblea r vein.<. The facial \ein is connec1<d to Ihe superior opbtbalmit 1em directly 1hrough the supraorbita l 1 ein. By me..ns of the superior oph1halm1C, lhe facial vein is connecled IO the ca~ernons sious. TI1e facial vein descends behmd the facial artery to the lower margin of lhe body of lhe mandible. The fooial vcm crosses superficial to the oubmandibular gland and is joined by 01e anterior division of the retromandlbular vein. The facial vein ends by drnlning into the internal jugulnr vein. l mportnn h Oanl!t r tria ngle of the face- o lrianglo exists O un approximulely covers the nose nod maxilla ond goes up to the region bc1wcen ih< eyes_ This is an area in which superficial veins communicate with tbe dural sinuse~ The facial vein has no valves, and a backOo11 can cause an infection to getln1 o Ibe dural sin usu. lhrough the deep f.aclal eln (vin pi<'IJ'f:Od p/e.~u} and superior ophthalmic ein (via cavernous sinus). Anastomoses 10 remember: I. Deep facial vein is a communication between 1he facial vein and the plerygoid plexus. 2. Superior ophlhuhnic vein is a conun unlcution b~lween Lite facial vein :md 1he cavernous sh1tn .


...J I


I" All of the following characterislics are true concerning veins EXCEPT one. ' ' \
Wbicb one is the EXCEPTIO!V!

Thick tunica media with a lot of muscle fibers Thick tunica adventitia with little elastic tissue Larger lumen and thinner walls than the aneries they accompany Some contain valves and vasa vasorum

31t Cop)'liatn 0 2009-2010 Dtn111Dttts

*** Veins have a thin tunica media with few muscle fibers.


Large (t'I<Utic arteries) Very thkk tunica media that oontains a lot of t.la~tlc fibt.rs and some smooth mtl9Ck
Small (mU$~flfar urteril!s) Tunica media consiSt$ oral~ entirely smooth mustlt. eelb with few clastic fibers Small ves.sels (diamett'T < .5 Min), small lumen, thicker tunkll me<Ha with a lot of smooth musde fibers

Arteriolt.s CapiDarles Venulq

.()I diqmet{'r), walls hne endothdlal layer only Small ve$$C:I$ (Q

Small vessels; walls have e:ndochelium and ~-ery thin tunica adventitia; larger vcnuks ba~c thick" tunica advmtitia Thin hllllea media with few smooth muscle fibers: thick tunka advudtla with liule elastic tissue; largn lumen and thinner walls than tbc arteries the)' aeoompan)'; some contain valve$ and vasa vasorum (mdrlenr bkxxl \'(eSS('l$ lfral supply 11/e walls of
/Qtgt: wins)


Biochemistry/Physiology Legend
Major Topic Blood Carbohydrates Central nervous system Circulatory system Disorders/Diseases ON A/RNA Enzymes Gastrointestinal system Heart Hormones Kidneys Lipids Liver Abbreviation Bid Carb CNS Clrc S Disord/Dis DNA/RNA Enz GIS Hrt Hrm Kid Lipids Liv Major Topic Membranes Metabolism Minerals/Vitamins Miscellaneous Muscles Nerves pH Proteins/Amino acids Reproductive system Respiratory system Special sense organs Substances Tooth/Mouth Abbreviation Mbr Metab Min/Vit Misc. Msl

pH Pro/AA RprS Rsp s

Sub Tth/Mth


Sugars that contJI.in aldehyde groups that a r e - - - -- - to carboxylic acids are classified as sugars:

Oxidized, non-reducing Oxidized, reducing Reduced, non-reducing Reducing, oxidizing



Which of the folio" lng glycosaminoglycans can be found functioning in syno'ial fluid?

Heparin sulfate Keratan sulfate Hyaluronic acid Dermatan sulfate Chondroitin sulfate

2 Copyn,p'll 0 20092010 Otmal DttU

(hiditt'll. reducing

*"*Examples In clude: !acrose, maltose, glucose, galactose, and fructose. Reducing sugars contain a free anomeric carbon (oxygen 011 C/ mom is ttVailablefor redox reacllou) that can be o:<idized. lf the oxygen on the anomeric carbon (the carbonyl group) of a sugar is not attached to any other structure, thnr sugar is a reducing sugar. A reducing sugar can react with chemical reagents (see note # I belmv) and reduce the reactive component. Note: The anomcric carbon itself becomes oxidized. Important point: This reaction is the basis of a reduciog-sugnr test. whicll was classically used by clinical laboratories to screen for d iabetes (presence of excess free glucose In the blood) and other inbom errors involving the inability to metabolize other reducing suga~. Important: Most current clinical tests for blood g lucose utilize glucose o.<idase linked reactions. Because the reducing groups of both glucose and fructose are involved io the glycosidic bond, sucrose is not a reducing sugar. lo otlter words, sucrose contains no

free anomcric carbon.

I. Common test reJigents are Benedict's reagent (CuS01 lcilrllle) and 'Notes FeWiog's reagent (CuS0 /tartrate). They are classified as reducing sugars 4 since they reduce the Cu' to c u , which forms as a red precipttate, copper (I) ox ide. 2. Glucosuria, the presence of glucose in the urine, can be caused by low insulin levels, high blood sugar levels, impaired tubular reabsorption, or a high glomorular fil tration rate.

tl ~

uluronic 3cid

The must abundant bctcropulysaccharides in the body are tbe glycosuminogly<-ans (GAGs). These molecules are long w1brancbed polysaccharides containing a repeating disaccharide unit. The disaccharide units contain either of two modified sugars N.. acE"tyJ ..ga.lattosamine (GaiNAc) or N-acet)'t-glucosaminc (GicNAc) and a uronic acid such 1lS glucuronate or iduronate. GAGs are bighly negatively charged molecules, with extended conformation thai imparts bigb viscosity to the solution. GAGs are located primarily on the surlace of cells or in the extracellular mairix (ECM). Along with the high viscosity of GAGs comes low compressibility. which makes these molecules ideal for a lobricatiog Ouid in the joims. At the same rime, their rigidity provides stntcmral integrity w cells and provides passageways between cells, allowing for cell migrntion. The sped fie GAGs of physiological significance

are hyaluronic acid, demunan sulfate, chondroi"tin sulfate, heparin. hepariu sulfate, and
k.ertatt sulfate.
( h.truchn<;llcs ul (, \{ .,


l .ocallr.~llnn


S_ynot.'iat fluid. vitreoU$ humor, ecM nf loose C'OI IJle(tiv~ 1jssue

C-anita_ge, bone, heJSn vah~
Basemen! membranes, oompnncrus of

Lf)tge potyn1cn. ~ Qbsorbjug

M(l.)'l Ab,lrtil;lnl

Chondmirin lilllfate


H~nn sulfo.Jc:

Ct:mtain$ hi,sbet 3Cdylnted ah.eu.<~:~~mine


cell sutfacc.-s

Componc:nt ufimracellulu.r granules or Serves 11$ nn t:nticotlgulbnt. nlOre" 11ulfntrd mest .:ell$lininl? the IUlcne:s-of the than hepilrin sulfutt: lungs, livc:r.ltnd skin Slon. blood \'essds, hean valves
t'oml-a. bone. c.aniWgc 11ggre-g-n1ed Wltb

Dcmatao sulmtc Kemlin $lllrMe

Mosr hel01'1et10\L\ GAG

ctlondroilin !Sull'lnes-


Which intestinal enzyme breaks down the 0-glycosidic bond between glucose and fructose?

Maltase Lactase

Copynght 0 20092010 ()ental Dk..s

Glucose, fructose, and galactose are classified as:


Monosaccharides Disaccbarides Oligosaccharides Polysaccharides

Cop)rigbt 0 2009201 0 Dt11tal l.)t(;ks


A ilisaccbnride is a carbohydrate whose molecules contain two s11gar units . .Examples include: Maltose ("beer .wgor '') - consists of two glucose molecules joined together by a reaction (condensation reaction) in which a molecule of water is removed. This reaction produces a bond between the two glucose molecules called a glycosidic bond. The intestinal enzyme maltase promotes the conversion of maltose into glucose. Lactose ("milk sugar'') - consists of glucose and galactose. The intestinal enzyme lacrase promotes the conversion of lactose into glucose and galactose. Sucrose ("table sugar)- consists of glucose and fructose. The intestinal enzyme sucrase (invertase) promotes the conversion of sucrose into gl ucos~ sod fructose. R~member: The final digestion of these substances (disaccharide.<) to absorbable monosaccharides is completed by enzymes of' the small intestine (mallase, sucrase, cmd lactase). These monosaccharides can then be absorbed by enterocytes. Monosaccharides can be linked by glycosidic bonds to create larger structures (disaccharides. oligosac<'harides. and polysaccharides). These bonds form when the hydroxyl group on the aoomeric carbon of a monosaccharide reacts with an - OJ-! or - NH group of another compound (ryptcal(v an a/cohn/, purine, pyrimidine, or in this case another sugm~. Maltose, lactose, and sucrose cousisr of monosaccharides joined by au 0-glycosldic bond.
,___ I. If o;otygen is involved, rltis bond is classified as 0-glycosidic; if nitrogen


is Involved. this bond is classified as N-glycosidic. 2. D-glucose is a monosaccbsride, the most important of the aldohexoses.

\ l onos:H."l"h aridl's

The simplest of the carbohydrates are tlte monosaccharides, which can be classified ac.cording to tbe n\Jmbcr of carbon atoms they contaiu. Those with three carbons are called trioses (for example, glyceraldehyde and dih,vdro:<y ocetalle); four. tetroses (for ex!lmple. erythrose): five, pentoses (far ~xanlple, ribose); aud six, hcxoses (fur example, glucose). Monosaccharides with. an aldehyde as their most oxidized ftauc1ional group nre called aldoses (for example. glyceraldehyde); those with a keto group as their most oxidized functional group are called ketoses (for example. dihydroxyaceto11e). Remember: The naming of con.figurations of simple sugars (mo/losacclrarides) and amino acids is based on the absolute configuration of glyceraldehyde. Tbe symbols Land D refer to the absolute con figuration of tbe four constituents around a specific chiral carbon (asynunetric carbon) in monosaccharides and amino acids. In a Fisher projection. the 'D form has the hydroxyl group on the right; tl1e L form bas the hydroxyl group on the left. Sngars of the D form, which are related to 0glyceraldebyde, nre the most common in nantre. Other monosaccharides include: mannose, ribose, and l(ylose.


Which of the following polysaccharides requires the glucan transferase to breakdown?


Starch Glycogen Cellulose Glycosaminoglycans

Cop)'tiJh'O 2009-2010 Dcn~~ol Dtt-ks

Which of tbe following statements concerning glycosaminoglyeans Is true?

They contain branches of N-acetylneuraminic acid They seldom contain sulfate groups They are most ofien positively charged They contain repeating disaccharides They contain short oligosaccharide chains

I Cop)'lilhtC 2009-2010 Denulll)cd:J

Polysaccharides are carbohydra1es that are po1ymers of monosae-charides. Polysaccharides are made up of many sugar units joined by COJldensation re.actions (wMdr rt<Srtlts 111 g(cosldic bonds). Sinco polysaccharides have large molecules. rhey are insoluble. Their main functions in living organisms are to act as storage molecules (.rrarclr unci glyoogen) or as struc\ural materials (cellulose). Homopolysnccharidcs (starc/r, gl)'cogen. dextrans. and glucans) contain only a single monosnc.charide species. lleteropolysacch~rides (glyc<mllnhrog(vcans) contain a number of differem monosacch aride species. The two most important sto,..~e polysaccharides arc starch and j\l)'cogen. Starch is a large. insoluble carbohydrate that forms an lmponam energy store in plants. Starch is a polymer and consists 0( a large number of a-glucose molecules j~incd tu!:clhcr by conden~lion reactions. It consists of two main components thnt may be present in different proportions. Amylose (whidr is rmbrmrclred) forms long Straight chain while amylopectin has highly branched chains with alpha-1 ,4 linkages. Note: Both amylose and amylopectin arc rapidly hydrolyzed by the enzyme olpho amyl11se, which is secreted by the par~tid glnnds and the pnncrcns. Gtycog.u, like umylopccun, is u branched polyrnor of glucose, However. glycoj!.cn is more highly branched (witlr 11-/,1$ /fnkuge,,) 011d v<ry comp:rct. 11 is especially ahundnnt in tho liver. Nute: The glucose units of glycogen can enter tho glycoly~ic pathway afier removal by the :ction ofglycogen phosphorylase, Note: rhe cleavage of glycogen b<:yon<l a brsnching point rcqlflrcs the activity of glucantnlllsfcrun nnd amylo-&IJ>ha-1,6 glucosidase.
Cellulose is the most common organic compound on earth. Cellulose L< not digestible by 1m m.ans1tnd fs often rofern.>d tollS "dietary fib~r~ or "roughago," acting as a hydrophilic bulk ing agent for feces. The term glycan r..-fers to a polysaccharide or on oligosaccharide.

l he~ cmtl~dn rcpcalin~ diliiHCrh~uidcs

The most abundtLnt hetcropolysaccburiMs. in the body are the glycMaminoglycan~ (GAGs). GAGs are long, linear carbohydra te chains that contaiu repeating disaccharide units, which usuHily contain~ hexos;tmine~ and a uronic acid. GAGs often contain sulfate groups. The uronio acid and sui tate residues cause GAGs to be negatively chaflled. They are nnbr11ncbed and do not contaln N-acerylueuraminfc

Held. GAOs arc highly negatively charged molecules. with extended conlonnution that imparts high vlscoslly tO the solution. GAGs are located primari ly tlf! the surface or cells or in t~e extr acellular rnatriJ< (ECM), Along wilh the bigh viscosity of GAGs comes low tomprcssibillfy, which makes these molecules ideal f<>r a lnbr.icntiog fluid ln the joints. At the same time, GAGs rigidity provide$ structural in tegrity to cells <UJd provides passageways betwee!l cells, alhnving for cell migration.

L G lycosaminoglycans function as important structural components of connective tissu (wlri~;/1 includes adipose tis.~ue. < artilage, and' hone as well as cnllagenmrs, ela.<tic, and relicular fib~rN) . lotportaul: GAGs net as "molecular sponges" and hold water in the extracellular tnatriX. Z. ltyuluroni c l!cid i; unique among the GAGs iu tbar i1 does not contain any sulr.-.te and is oor found covalently attached to proteins ~s nre prmeuglycans. 3. Tite nlJiiority of GAGs in the body arc linked to core proteins, fonniug prolcoglycans (also t:ltlled nwcopo~y.<occhmi<Jes). 4, The bucterial tell wall contains a h~teropolysaccharide made up of ahemating N-acctylglucosaminc aud N.acel}'lmtn:1l1Tlic licid un!t:;.


The ground substance of the extracellular matrix is made Ull of:

Type 11 collagen Type Ill collagen Proteoglycan molecules Fibrillin

7 CoP)'ri&bl 0 20092010 Otntal Oks


The most abundant glycosaminoglycan in the body is:

Keratan sulfate Dennatan sulfate Chondroitin sulfate Heparin sulfate

CopynaJ>t" 20091010 _ , , .,....

PnHLogl~r:tn mulccuiLs- which ure uhmtt 95~~~ po(l','illlTiwritle autl5~o protein

Proteoglycans consist of a core protein witb glycosaminoglycans (GAG.<) attached in a brush-like fashion. The linkage of GAGs to the core protein involves a specific trisaccharide composed of two galactose residues and one xylose residue. The protein cores arc rich in serine and threonine residues, which allow mulriple GAG attachments. Major functions include: lubricants. extracellular matrix. and being a molecular "sieve.'' Glycoprote!ns are prOteins that have a carbohydrate covalently attached to them. The carbohydrate portion of most glycoproteins differs from that of proteoglycans in that it is shorter and branched. They serve as enzymes, honnones, antibodies, and structural proteins. Glycoprotetns are often components of cell membranes and are involved in cell-to-cell interactions. Glycolipids (or sphingolipids) are found in the cell membrane with the carbohydrate portion extending into tbe extracellular space. They are derived from the liptd cerantlde, and tb.is class of compounds includes cerebrosides, globosides, and ganglioside&.

Chondroitin o.,:u lfure

Chondroitin sulfate is a major constituent in various connective tissues. especially in the ground substance of blood vessels, bone. and cartilage.. In cat1ilage chondroitin sulfate, provides structure by holding water and nutrients. and allowing other molecules to move through cartilage - an important property, as there is no blood supply to cartilage. Chondrollin may work by acting as a building block for proteoglycan molecules, and may also have anti-inflammatory properties. Importa nt : In our joints, chondroitin sulfate contributes to strength. nexibi lity, lllld shock absorption. Remember: The extr acellular space in animal tissues is tilled with a gel-like material, tlte extracell ular matrix, also called grou nd s ubstance, which holds the cells of a tissue together and provides a porous pathway for the diffusion of 011trients and oxygen to individual cells. The gruund substance is composed of an interlocking meshwork of beteropolysaccharides (glycosaminog/ycans), most covalently linked to protein fonning proteoglycans, and fibrous proteins. Important: Hyaluronidase will promote depolymer izatioo of the extracellular matrix (ground substance). Hyaluronidase is an enzyme that splits hyaluronic acid (glycosaminoglycan) and so lowers its viscosity and increases the permeability of connective tissue and the absorption of nuids.
---... I. Heparin coma ins the largest proportion of sulfate (ve>'. even mnre thnn heNotes parin sulfate).

2. Hyaluronic acid conlllins the lea~ I proportion of sulfate.

For each letter, choose the most appropriate answer to fill in the blank.

Dextrans are (A)_ _ of (B)_ _ produced extracellularly by bacteria and yeast. The enzyme used to produce dextrans is (C) _ _, and the substrate is (D) _ _ . A side product of dextran production is (E) _ _, which is formed into (F) _ _ and stored intracellularly as reserve nutr ients.

(A) Monosaccharides f polysaccharides f oligosaccbarides (B) Glucose f fruc tose f galactose (C) Dextran synthase f glucosyl transferase f fructosyl transferase (D) Maltose f sucrose f lactose (E) Glucose f fructose f galactose (F) Starch f glycogen f !evans

e 20092010 Dent:~ I Dctb



Which statement concerning rods and cones is incorrect?

Rods contain rhodopsin -a photopigrnent Cones are respOnsible for color vision Rods are used for dark adaptation Rods and cones are located in the retina Cones are more abundant than rods

Copyright C 2009-2010 Dental Ocd:s

(A) Pol~:mcdulfid('S (U) (;lucu'e (C) Ghlcos~ llnmsfcrase (tlextrau



{El Frurtuw (F) l.e\ans (jim:llms)

Dcxtrans are polysaccharides of glucose produced extracellulary by bacteria and yeast The enzyme used to produce dcxtrruts is glucosyl transferase (de.Ytran SIICrtse), and the substrate is sucrose. A side product of dextran production is fructose which is fomted into !evans (fructans) and stored inrracellularly as reserve nutrientS. A few bacteria, notably Streptococcus mutans, produce dextran from sucrose. Dextran is a "sticky" polymer of glucose molecules linked together in 11- (1,6) linkages with some a- (1-3) branches. ll is produced outside bacterial cells by tbe enzyme dextran s ucrase (glycosyl INmsforase). 'This enzyme splitS sucrose into glucose and fructose and links the glucose molecules into a dextran polymer. The dextran is deposited as a thick glycocalyx around the cell and seems to be essential for the cariogenicity of Streptococcus nwtans. Note: Levans ((ructans) also increase the adhesion of bacteria to surfaces of the teeth and promote the formation of dental plaque. It is formed from the fructnse moiety of sucrose by the enzyme levan sucrase. Levans are considered to be reserve nutrients for bacteri<L


are mon. abundant than nuts

The retina Is the innermost layer (nervous tissue) of the eye. Tbe retina receives visual stimuli and sends the infom1ation to the brain. Photoreceptor cells called rods and cones compose the visual receptors (for the optic nerve) of the retina. Rods and cones contain photoplgments. There are fou r different pbotopigments, each consisting of a protein called an opsin to which a chromophore molecule called retinal is attached. Opsins differ !Tom pigmem to pigment and confer specific lightsensitive properties on each phOtopigmenl. Note: Retinal is produced from vitamin

Rods contain a pb01opigmem called rhodopsin. Their response [ndicates dffferenr degrees of brightness, but the entire rod system is charactetized by a relative lack of color discrimination. Rods are numerous in the periphery of t~e retina. Cones are primarily responsible for color vision. There are dtree ditTerent types of cones (red, green. aud blue). Each one contains a different photopigment and is selecttvely sensitive to a particular wavelength of light. They are concentrated in the center of the retina, c.spccially in the fovea. I. During dark adaptation (night vision), rhodopsin is synthesized tn the 2. Cones arc the principal pbotoreceptors during daylig ht or in brightly lit areas. 3. Rods are more abundant, have higher sensitivity. and lower acuity compared to cones.
Nlltes rods.



Which of the following structures of the eye l!&n !Ill! change in shape?

Lens Retina

Cornea Iris

11 CopyriJ'ht 0 l.OW2010 Dcol3l DeW

A sound wave will s trike the
fir st'~


Membrane of the oval window Membrane of the round window Tectorial membrane Tympanic membrane

Copyrigh! 0 20092010 Denul OeckJ

Corm. a Basic anatomy of tbe eye: Cornea - The crystal clear dome that covers the front of the eye. The maJOnty (70%) of tbe bending (TY!froctlng) of light rays 1S accomplished by the cornea The shape of the cornea does not (honge (wull tile exception of small cltange that ouur mer a lifetime). L ens - The crystalline lens fmishes the focu~ing of ligbl. The lens helps to "fine-tune" vision, and it is able to change shape tO allow focus on near objectS. When tbe lens becomes cloudy, it ts coiled a cataract. Pupil -This is the opening m the middle of the iris. Iris- This is the part of the eye thut gives it color (I.e.. blue. green. brown). The iris functions like a shutter in the camcrn analogy. allowing more o r lcs. light.nto the eye. l~etina -This is a thin layer of nerve tissue that senses light. Spcc~alizcd cells called rods and cones convert light energy into nerve signals that travel tbrougb the optic nerve to the brain. The retina is analogous to the tilm in a carne,ra. Fovea -This is tbe center of the retma tbat receives the focus of the objrtt of regard. Nerve ceUs are more densely packed on this area, so illl3ges that are focused on the fovea can be seen in greater detatl. Optic nerve - This is the nerve that runs from the eyeball to the bram. The t>ptic nerve carries information from the retina to the brain for interpretattoo. Note: The eyeball itself is divided mto two segments, each filled with Outd. The anterior segment has two chambers (anreriur and ptmerior). which arc both tilled witb aqueous humor (watery .fluid). and the posterior segment is filled with vitreous humor (thick. gelatinous material).

I' lllfJ~tnh: mcmhnuu:

Sound waves strike the tympanic membrane ond couse it to vibrate. This eaus"" the membnane of the oat window tu vibrate. whtch causes 1he tterilyrnph to the bony labyrinth of the cochlea and rndol)mph in the membranous labynnth of the o:ochka 10 move. This moement of the endolymph caus"" the basilar mcmbra11~ to v1br-te. wh1eh, m turn. stimulates hair cells on tbe organ or Corti to uansmn nerve unpulscs along the cramal nerve. Eventually. nerve mrulscs reach the auditol)" conex and aro mterpretcd as sound. Parts of the Ear: External car - consists of the cxtemal pan (pinna) and the car canal. Au dele (pinna) - direcls ~ound wove!\, External auditory cnnal (mcnltts) .. contain~ hair aod centmen (brown carn-a.t). serves as a resonator.

ear (rympauic covlt)~- M air-tilled cavity in the temporal bouc. Auditory tube - equalizes pressure. Ossltles (malleus. 111ct<.r, Slllftu.J - link together to transmit sounds to the oval window. Inner ear- formed by a membranous labyrtnth within a bony labyrinth. Vestibule {saccule t~nclurncle) - :.ssociattd W!lh sense of balance. Semicircular canal$ concerned with equilibrium. Cochlea (contam.r rwo memhraMs. ~sttb11lar one/ INuilar) ponu>n of toner ear responsible for heanng. fhe sptral org~~n (orgn of Corti) contams the r~eprorf (called hair cef/s) for bearing. The cochlea is the baste functional UDit of beanng because tbis ponlon transforms Ouid vibratiOn from sound waves tmechanlcal elltrg)~ into a nerve impulse {ele<'lri(al ene1gy).



#'A patient comes to your office directly from an eye appointment. The ophthal=' mologist has used tropicamide to induce mydriasis of the eye. What significance does this have on his or her dental appointment?

The patient will not be able to distinguish colors when you present h im or her with the color choices for his or her dentures The pupils are dilated, so the patient will be sensitive to the dental light if you don't control it well The pupils are constricted, so the patient will have trouble seeing anything without high light The patient has tempora rily lost the ability to control his or her lenses, a nd so he or she will not be able to focus on anything
Copyngh! 0 20091010 Dc:ntal Deck$



Normal range for hemoglobin is different between the sexes and is for women. approximately for men and

5-8 grams per deciliter , 2-3 grams per deciliter

9-1I grams per deciliter, 7-9 grams per deciliter 13-I 8 grams per deciliter , 12-16 grams per deciliter 20-22 grams per deciliter, 18-21 grams per deciliter

14 Co(l)'liglll 0 2009-201 0 Oenttl Ded(*

Thl pupih. .tfl' dihlhtS. tlnn ' l \"unlrulll 'HII.

~u llu

p .lli-:nl niiiiH' " "U\IIIH" fu thE'

d~nf :ll

h:,:hl if \uu

Remember: I. Mlosi is 1he constriction of the pupil of1he eye. Mio~is can b< cnused by s nonnal response to un increase in light, certain dn1gs, nr pathological conditit\ns. 2. Mydriasis i~ 1hc prolonged abnormal dl111tlon of tbe pupil of the eye 1ndnccd by a drug or caused by a disease. In myopia (t~eorslghled,ess), tbe eye is too long for the refractive power of the lens. and far objec1s arc focused at a point in front of I he retina. The eye can focus on very ncar objects. Th1s is caused by a cornea that i~ >leeper. or an eye rha1 IS lonttr, than a normal eye. !'learsighted people 1ypically see \\ell up close but have d10iculty sc~ing far away. To treat myopia. concave ltnses are used. Farsightedness, or hyperopia. occurs when hght en1ering the eye focuses behind the retina. instead of directly on it. This is caused by a cornea mat is Oattcr, or nn eye that is shorter, thnu a nonnal eye. Fars1gbted people usually have rrouhlc seeing up close but may also have diniculry seeing far away as well . To ttem hyperopia, C(lll\' e)C lenses are used. Astigmatism occurs when 1he curvature of the lens ts not unifonn and is corrected with cylindric len ~ Presb)opla ~~ the inability of me eye lo focus sharply on nearby obJects. resulung from the loss of elast1ci1y oflhe lens with advancing age. Presbyopia is corrected with bifocal$.

Hemoglobin a quaternary pro1ein consos1ing of four 1<n1ary (fold~d) polypcp1ide chains - two alpha chams and two bet chains. Each chuin b:u l!ll 11550Ciatcd iron-C(ln10inmg heme group. Oxygen can bond to the uon of 1be heme group. or catbon dlo,jde can bond to amine groups of 1he amino acids m the polypeputk chains. HemoglObin o< essenlialto tbe ability of erythrocytes to transpnn oxygen oud carbon dioxide. and n single erythrocyte c01 11ain, up to 300 million hcmoglobm molecules. Important pOio11: Each hemoglobin molecule contains four iron 01oms. Eoch 810111 ~i01ds one diatomic oxyscn molecule for a onnx1mum capacity of eight oxygen UtOJ11$ per hemoglobin molecule. ~oTma l Olood Valuts of Hemoglobin ( tnQ 111/ I ci/J Women: 12 to 16 grams per deciliter Men: 13 10 Ill grams per ckciliter 'lewbom 14 10 20 grams per deciliter l mporhlnl: The Hgb value depends on the number of RllCr and 1he amount of 11gb In each RllC. A low Hgb value i~ found in anemia. 10 hyperthyroidism and in cirrhosis uf the liver. A high llgb vah1e is found in polycythenoin, in COI'D. and iu congestive hcun failure. l, He1 noglobin carries oxygen to tl5suc from the lungs and cu rbon dloxld~ Notes away frono tissue lo 1hc lungs. 2. Blood leaving lhc lungs is 98% saturated wi1h oxygett. However, tbc hemoglobin of normal 'eoous blood re1urning to the lnngs It only 75% saturated. J .Corbomlnobemoglobin IS hemoglobm 1hat IS carrying carbon dio.,de from the ussue.1 to rhe lungs. Whereas abou1 97"o of the oxygen ~~ tnosponed by bemoglob1n, only about 30% of rhe carbon dioxide is earTied by hetDoglobou; 1be rest IS trAJl.~ported as bicarbonate. or as carbon dioxide.

For each letter, choose the most appropriate answer to till in the blank.


(A) is a major type of protein present in human blood plasma. It represents an important (B) reserve for the body and, more Importantly, plays a crucial role in maintaining the blood's (C) _ _ __ pressure, which tends to draw water (D) the capillaries.

(A) Beta-globulin I albumin I hemoglobin I fib rinogen (B) Oxygen I iron I amino acid I carbon diox.ide (C) Hydraulic I colloid osmotic I oncotic

(D) Into I out of

15 Copyright e 20092010 tkn~al Dks

The principal hormone for calcium-level regulation is:


Calcitonin Parathyroid hormone Thyroid hormone Vasopressin/antidiuretic hormone

16 Copyngbt 0 20092010 Denal Dc<k.s

j \)


( R) \minn acid IC') ( ulluid u'rrimutit..

(UI Inth

Serurn -albumin. oOt.n referred to sim1)ly os albumin, is lhc most abund:ant pJiL.'imii: rrolcin u1 humuns and olhcr mammals. Albumin i~ ess(.'ntial far maintainius lhc u~molic pre-ssure nt:~ded for J)f()pcr distrih11ti00 Of body Otllds betWec:.n irttRVftSCUiar COmpartme.niS lllld

body tissues. Albutnio also acts as a plasma carrier by non-spe<:ifically blndiog severalltydruphobic lilter<Ud hormones itnd as -a transport J)I'O~ein for hemin -and fatty acid~. ~onnnl blood \10IUC! for ttlbumln is 3,55.0 g I H)O mi. Albumin is decreased in l'nalr'l\ttriti(tn, livor

f;ul'ure. and pregnancy. Colloid osmotic pressure in the plasma is also C'~lld onco(ic pressurl'. This- pressure. tend!f to drow WQter into the capillaries by osmosis. Note: The capillruy toomhr;ute I~ highly permeable 10 water as well a~ 10 the other subsumces dissolved 10 plasnta amJ tissue nuid.s. e:<cC'pC the plasma protems (mainly albumin). Tbis prts,sure ~~ il'l1J)OI'htl'lt because it prevents plasma loss from t11e capillal'it.S, This colloid o~moltc IJressu,e tnthe plusu1U 1s u,.po~td by the coll'oid osmouc J)ressure in the- interstitial nuid, Wh1 ch re-sult~ from the presence of nondiAu.<iible prot~i1\S in ~h~:. inl~;;rstitial fluid. Thts pl'e.'~sUHl tends tn tJrnw w~tt~r out of the capiHarie!O by osumsis. Important: If forces tendirtS to ! OOVI.! Ouid out or a capillary arc
grcalt:J than fore!,."~ ltrlding to OIOVC {luid in, nuid w111 lc;avc, t111d Vite versa. I . l'he other force~ that r'tgulatc. the movemeni of nuu1ocross capHlury membrane& Nolts are the tluid or hydraulic pressure fnsil;le the cnpilll'lry rarevu(l qfaneriul am/ vetwu~ Pf{!,\''Wi'es) and lhc nuid pressure IH interntitlul fluid. 2. The kidney is the organ tl1nt JS c hiol1y IO>l)<>nsiblo for the re~ulauon uf the oslllolic- prcssuro in the body nuids by reguluting.lh~: fi.!::lbsorption of water ill restlQnse (()

antidiuretic hormone (A DH or \~t~sopt't'.s~ln). 3. Albumin also transports thyro)(in ,'> ntl triiodothyronine as well a~ ruuy t~citls, bilirubin, bile aci&, steroid hormones, phannaceutic<!ls, und inurga.nlc ions. Wilh the eU!CIJtion of ttlbumin, -almost all pla.;ma J'lfC'IIein~ art ylycoprotcins.

rarl1th~ ruid


Tho hwnan body contains 1-1 .5 kg Ca"", most of which (about 98%) is lvcated in th<' mineral substance of the bone. The nonnal plasma conceotratiou of clcilm1 varies between 8.5 mg% sod 10.5 mg%. Calcium l~vels are regulate{! by parathyroid 1\omlOlte (PTfl), which increases bone resorption and rcahsorprion of calciurn in the kidney tubules, which in tum increases plasma calciUm levels. Vitrumn UJ rcgulutes the uptake of calciwn in the Gl tract. Low serum calcium levels will result in hyperirritability of nerves and muscles. Patients With hyperparathyroidism will have increased renal calcium c<erction and will also bu prodi~JJO..<ed hJ an increased llkcllhootl of b11ue fractur~. The bone resorption seen in elderly patient> with low dietary calcium is fntcn;;ificd by parathyroid honnone. Calcillm blood levels nrc increased in hypervitaminosis D. iu hyperparathyroidism, and In hone cancer and otbet bone diseases. Calcium blood levels are clccre~scd rn severe didrrhca, in hypoparath)'l'Oidism. and in avitruninusis D (ickets and osteomalacia).

Plasma phosphorus couceotratlon (tor111111 is qpproximatcly 4 mg%) is also regulatod by !JUra thyroid honnone. fncreased hormone causes the kidneys to increase the rate of phosphate excretion. which decreases plasma phosphate concontration.
Pla~ma glucose concemrution (normal Is approximolely 1110 mg%) is regulated by insulin (lower.t glacose levelv) and glucagon (increase.< glucose levels) . GluCQse nonually does not ppcar in the urine although glucose is freely filttr~d because it h reabsorbed in the proximal convoluted tubule of the kidney (lite rellilltresholdfor glucose has 1101 been e.rceeded). lmporta.n t: The oormnl glucose clearmtce is 0 mglruln.

Which of the following blood equations is correct?


Serum; plasma - fibrinogen Plasma = serum - fibrinogen Serum = hematocrit + plasma Hematocrit = fibrinogen - plasma


Copyright e

2009-lotoDetlut Dks

The general term for reactions that prevent or minimize loss of blood from the vessels if they are injured or ruptured is:



Homeostasis Hemostasis

18 Cop)'ligb.t C 20092010 Dctltal Oed:s



plnsma tihrinu;,!t'll

Human blood constitutes about 8% of the body's weight. BIO<>d consists of cells and cell lragments in an aqueous medium, tl>e blood plasma. The proportion of cellular elements, known us hematocrit, in t11e tOlal volume is approximately 45%. The blood is the most important transport medrum in tbe body. Blood maintains homeostasis and plays a decisive role in defending the body against pathogens. Serum is the clear, thin, and sticky fluid portion of the blood obtained after removal of the fibrin clot and blood cells. Serum differs from the plasma in Ibm serum lacks fibrin and other coagulacion products. Plasma is blood minus the formed elements. h is ihe fluid portion of the blood (plasma makes up 55% of the blood). Plasma also contains no cells. Plasma contains: Proteins (7%) -consist of albumins, globulins, and fibrinogen, Water (9 1%) Other solutes (2%) consist of metabolic end products, food materials. respiracory gases, hormones, and ions. ---,. I. Remember: The other 45% of the blood consists of formed elements Notes erythrocytes (red blood t:ells), leukocytes (White blood cells) , and thrombocytes (platelets). 2. The function of platelets in hemoswsis is that !hey agglutinate and plug small ruptured vessels.

Tbrough a three-part process. cbe circulatory system gtmrds against excessive blood loss. In this process, vascular injury activates a complex chain of events -vasoconstriction, platelet aggregation, and coagulation ~that leads to cloning. This process stops bleeding without stopping blood flow through the injured vessel. Three essential steps for blood clotting: 1. The production of tbrombin from prothrombin during the clotting process requires a prothrombin activator, whic.h is lbnned either by way of an extrinsic pathway or by way of an intrinsic pathway. A tissue faceor (tlss</e thromboplastin) not normally presem in the blood participates in the extrinsic pathway, buc only factors present in the blood panicipare in the intrinsic pathway. 2. Prothrombin activator acts enzymatic.11ly to catalyze the fonnation of thrombin from prothrombin, 3. Thrombin acts as an enzyme to convert fibrinogen into fibrin threads that enmesh red blood cells and platelets to form the clot itself. I. When b lood vessels are ntpcured and tissues are damaged, both tho extrin'Note sic and intrinsic pathways arc usually activated. 2 . In cirrhosis of the liver, prolhrombio and fibrinogen levels will be deficient and cause impaired clot fom1ation. 3.Homeostasis- tendency toward equilibrium between different but inter dependent elements of an organism. 4. Erythropoiesis- the production ofred blood cells. 5. Syne.resis - liquid separating from a gel doe to funher solidification or coagulacion.



r Iron, the most Important mineral In the formation of hemoglobin, Is resorbed~I

\.. mainly In the and Is only resorbed as


Large intestine, Fe> Large intestine, Fe Upper small intestine, Fe' Upper small intestine, Fe'


Copyn;}lt Cl 2009-2010 Otmal Decb

Universal donor Universal recipient Neither of the above 0 blood type is referred to as:


l !ppt-r small inh."Siiuc

(duodenum)~ 1-'c~ (ferrum~.


Iron is quantitatively the most important tmce element. The hwuan body contains 4-5 grams of iron, which is almost exclusively present in protein-bound fonn. Approximately 75% of the tot~l amount is found in heme proterns, mainly hemoglobin and myoglobin. In addition to hemoglobin aud myoglobin, 15% to 25% of iron is stored in the liver, spleen. and bone marrow, mainly in the form of intracellular iron-protein complexc~ called ferritin and hemosiderin (o comp!e-t of ferritin, denatured ferritin , and otlrer proteins). Iron is resorbed almost entirely in the upper part ott be small intestine, primarily in the duodenum. Here iron immediately combitles in the blood plasma with a beta globulin npotransfcrrln, to fonn transferrin, which is then transported in the plasma. lroo is bound loosely with tiausfcrrin and can be rolascd to MY of the tissue cells ~t any point in the body. Approximately 60% of excess iron is storeJ in the liver. The iron Stored in ferritin is call ed storage iron. Important: Iron can only he resorbed by the bowel in bivalent form (i.e. 11s Fe''), For rbis reason, reducing ageuts iu food sucb. a.~ ascorbate (viramin C) promo!~ Iron uptakt.

I. The dominant factor contTolling absorption or iron from the Gl tract is

' Note< the Sllturalion of mucosal cells with tron.

2. ffcmochromaiosis is an iron-storage disease that results in the deposition of iron-containing pigments in rhe peripheral tissues with characteristic brouzing of the skin, diabetes, and weakness. 3. Bilirubin is a product of heme degradation.

Type 0 people do not produce ABO antigens. Therefore. l)'pc 0 rcople's blood normally will not be rejected when it is given to others 1\-ith different ABO l)'pes. As a result. type 0 people are universal donors fur transfusions. AB-I)'pe people do not make any ABO antibodies. A-B type peolpe's blood does not discritlllnate agamst any other ABO l)'pe. rherefore, they re uuiversol receivers for transfusions. All humans and )nany other primates can be typed by the ABO blood group. T here arc four type.: A, B, AB, and 0 . There are two antigens and two antl~odles that are mostly responsible for the ABO types, The specifoo comb[nation of these four components determines ~n individua's type. T)le table below shows the possiblo pcntlutations of antigens und 1111tibodies with the corresponding ABO types {"ye...' 111dicates 1/re prese11ce Qj' tJ companent. and uo" indicmes ils abse,ce ;, the blood ofau imlivitlual).

A 1)0 Blood T ype


Antigen A

Antigen B

Antibody Anti-A No

Antibody Anti-B

No No









For instance. type A people have the A antigen an the surface of their red cells (us shown in tire urbleaboe) .As a result, anti-A antibodies will not be produced because they would cause the destruction of theit own blood. However, if B-type blood is injected into their systems, anti-J3 antibodies in the plasma will Tccognizc the blood us alien and burst or agglutinate the introduced red cells In order to cleans~ the blood of alien protein.

The amount of oxygen bound to hemoglobin:

Increases if DPG concentration increases Is constant between Po2s of 40 mmHg and 100 nunHg Decreases if the Pco2 increases Is directly proportional to the partial pressure of 0 2 Increases if the temperature increases

21 Cop)'ligbl 0 2009'20 I 0 lkntal Ottb



IA ' ll of the following will promote the release of oxygen from oxyhemoglobi; ---the hemoglobin dissociation curve will shift to the right-- EXCEPT one. Which one is the EXCEPTION?

Increased carbon dioxide concentration (Pcoz) Increased tissue temperature Increase in the pH Increased diphosphoglycerate (DPG)

22 Copyri.gbt e 20092010 lkn~31 Dk$

Hemoglobin is lbe oxygtn-bearing protein of red blood cells and constinues about 33~. of rhe cell weight. Oxygen is picked up in the blood (from the lung>) and forms 01ybemoglobin (HbO:): blood leaving the lungs is saturated with oxygen and carries oxygen ro rhe tissues with decreased oxygen pressure; oxygen splits away from the hemoglobin and creates reduced hemoglobin (HHb). The combination of bemoglobm (lib) with oxygen (0:) is r~venible, and wberher Hb binds wilb or releases 0: depends m large pan on !he oxygen partial pre.~sure (Po,). When lbe Po1 [s relatively high, (as in tire pulmonary capil/(lr/es), Hb bas a higher affinity for 0, and is 9R% san~rored. At a lower Po,, (as in 1/te tissue capillaries), Hb has a lower affinity for 0 2 and is only parrially saturated. The partial pressure of 0 1 (ppO~is u factor in determing the amount of 0 1 bound to Hb; however there is no diretl proponionnliry ro lbe pp0 2. The ppC0 1, pH, rem perature, and OPG levels SUilCrsede the ppO, 's influence. The following ~tualions also promore the release of oxygen from oxyhemoglobin: ( *** Oxygen diSsociation Cllr\'e shifts to the right) lncrea,s e in diphospboglycerste (DPG) lnuease in tissue lemperature - exercise. physical activity - Decreased pH - increased artenal H ion concentration

This shifts the curve to tlle len. The influences of pH. Peo2 , and temperature on the oxygen bindmg by hcmoglobrn (Hb) operates to ensure adcquare deliveries of oxygen to activ tis.ues. When a muscle is actively contractrng, the following events occur: lactic acid is produced (lowering the ptl), C02 is produced by the tissues (thereby increasing Pro:), and hear is produced (thereby increosing tissue temperature). Therefore. the by-producrs of exercise are also the exact factors I hal Mlrnulate o, release from oxyhemoglobin. Active !Issues have the following characteristics: - Lnwer pH. Nore: Aciwc co11ditious wrll decrcnse rhe alliniry of Hb for 0 2 . The ltrgher rite H" ion concentration (lower p/1), rhc less 0 1 is bound to Hb. Increased arterial Pco,. Note: The panial pressure of carbon dioxide (Pco} affects the binding of 0: to Hb because carbon dioxide molecules brnd with Hb molecules and alter lhc l ib molecule, thereby reducing their affinity for 0,. Therefore, the higher the Pco2 the less 0 2 is bound ro Hb. Increased temperature. Note: The higher the temperature. the less 0 2 is bound ro Hb ar any gi,en Po2 - Increased DPG. .Note: Ilypox1a increases the form01inn of DPU which also shifts rbe oxyhemoglobin dissociation curve lo the nghl.



Which of the following globin chains are not commonly found in humans?



COpyrigh! 0 20092010 Dcnul Decks



Which of the following is considered to be the normal hemoglobin?

Hemoglobin H Hemoglobin S Hemoglobin M Hemoglobin A Hemoglobin C

Copyri,aht 0 2009-2010 OC'n1al Dks

A Mole<ule of Hemoglobin Is Composed of the following: I. Globin (protei11) portion Consists of four polypeptide chains 1wo alpha chsins aod rwo beta chains. Tbe norm;U aduh globin portion of Hb consists of two alpha and two beta chams. and the normal fetal globin portion of Hb consists of two alpha and two gamma chains. 2. Four rlngsb:.tped berne molecules (nfJilprmein groups) Each heme is a nitrogencontaining organic pigment molecule- t.hnt has a single atom of iron in the reduced state (F(t' ~ or ferrous iron) in its ttmer, which can combine with one tnolecuJe of oxygen. These heme groups arc- auachcd to 1 hc globin polypeptide chains.
Each iron atom can bind reversibly with one molecule of oxygen; therefore, a hemoglobin molecule c~n potentially associate with four oxygen molecules. When it is combined with oxygen, tbc compound is called oxyhemoglobin. When the hemoglobin molecule is not combined with oxygen. the. c.ompound is cul led dcox.yhemoglobio (reduced

- - - I . Hemoglobin combines reversibly with carbon dlos ide at tJle prottin .Notes- portion of the he-moglobin molecule. .. 2. Carbol\ monoxide decreases the <\mount or oxygen that can ~ lnutSpOr1Cd by hemoglobin by competing with oxygen for hemoglobin binding sites. Carbon monoxide has a much hlghH afl'inity (240 x ssronger) for hemoglobin than does oxygen. 3. As pH decreases, so does the affinity of hemoglobin for oxygen. 4. l\tttbcmoglobio contains iron in the ferric state rrr:J) and cannot funclion as an oxygen carrier. 5. Hemoglobin is n major H' buffer ortbc blood. Deoxygenated hemoglobin is less acidic than oxygena< ed hemoglobin and thcrcrore ideally suited to bulf<T lbc H' ioru; (comlngfrom tiss11e COz).

lll'mngluhin .\

Hemog.l obio C is abnormal hemoglobin in wbkb lysine has replaced glutamic acid, causing reduced plasticity of the red blood cells. l:lemoglobirl H is an abnormal hemoglobin composed of four beta chains; it is usually associated with a defect in three of the four alpha chain genes resulting in alpha-thalassemia. Hemoglobin S is an abnormal hemoglobin in which valine has r eplaced glutamic acid in I be. beta chain. The presence of hemoglobin S causes the red blood cell to deform and assume a sickle shape when exposed to decreased amounts of oxygen

(suclt as might happen wlten someone exercises or in lite pcripltcral circulation). Sickled red blood cells can block small blood vessels, causing pain and impaired circulation, decr~ase the oxygen-carrying capacity of the red blood cell , and decrease the cell's life ~pan. HemoglobinS is the predominant form of hemoglobin in persons with sickle-cell anemia. Important : A major effect of sickle cell anemia is the decreased solubiUty of the deoxy form of hemoglobin.
Hemoglobin M is a group of abnonnal hemoglobins in which a single amino acid substitution favors the formation of methemoglobin and is thus associated with methemoglobinemia.

Erythropoietin is produced by _ _ _ _ _ , and bas its primary action on the


Kidney, liver Liver, kidney

Bone marrow, kidney

Kidney, bone marrow

CopyrigbtO 20092010 Den1ul Oects



There are three major cells in the stomach that help to digest the food you ingest. There are four major secretions. Match the secretion to the ceU that produces it.



Parietal Chief

Pepsinogen Gastrin

Intrinsic factor

CoP)'ri.gbt 0 2009-2010 ~ntal Deck!!

1-.:idm' hone m;Jrrm\

Erythropoietin is a glycoprotein honnone produced in tbe kidneys that stimulates the production of red blood cells by bone morrow. The production of erythropoietin. and thus erythrocytes. is regulated by a negative-feedback mechanism !bat t> sensitive to !be amount of oxygen dehvered to the tissues (panicular(v rile kidne);). Anoxia (low oxygen) leads to greater production, while an increased oxygen supply leads to decreased production. The site of action of this hormone appears to be at the hemocytoblast (a pluriporem srem cell). Inadequate erythropoiesis leads to anemia, increased cardiac output, and hypoxia. Excessive erythropoiesis can lead to polycythemia, an increase in blood viscosity, and sluggish blood fl ow. Important: Anemic individuals have no1mal oxygen tension but reduced oxygen content in their systemic arterial blood. Characteristics of erythrocytes: I. Biconcave discs, 7.5 microns in diameter, lack nuclei and mitochondria. 2. Contain hemoglobin. 3. Have a lipid membrane contaaning lipoproteins and specific blood group subst ances (A. 8, 0). 4. The principal function is to transport os)gen and carbon dio~lde. 5. The proportion of erythrocytes m a sample of blood is called the hematocrit - 46.2% for males and 40.6% for females is !be normal range. 6. The amount of bile pigments excreted by the liver is a good indicauon of the amount of erythrocyte destruction per day. 7. Life span of erythrocytes lOS to 120 days.

........................ I I< I ancl Inlrilhil" Iactor ( hll'l cl'll\ ..................... .... ... Ptp,innc.tn (. tdh .................................. ( .a,trin

laril'lllll'ell ~

Gastric pits are depressions in the epithelial lining of the stomach. At the bonom of each pit is one or more tubular gustrl< glands. Chief cells produce !be en.tymcs of gastric juice. and parietal cells produce stomach acid. These glands produce as much as 2-3 liters of secretions per day. Tbc plf of gastric secretion is 1.0-3.5. Note: The mucus produced by mucus-secreting cells is very alkaline and protects the stomach wall from being exposed to the highly acidic gastric secretion.
Ctll lype

Part of Srumac.h SterNion prOOutlt

Stimulus tor SrcrNion

Parietal cells

Body (/imd<~)


(<'"'"' ')
Chie( cells (/.)'mORenic)



Body lfimd.s)

l>epslnoaen (con-.,~rtt>d to peps;,


Gas1rin Vagal sti111ult1tt011 (ACh) Hi :~tam inc Vagal



G :Us
(meromJocnnr utlr-)


Mucuo Ptp<11101:m

Vayal !ltirmJIJuon fua GRP)




Vapl !ltinllllauon (A Chi


For each of the following, tell whether it will SLOW or SPEED up gastric emptying:

Gastric inhibitory peptide Activation of the sympathetic nervous system Activation of the parasympathetic nervous system

Activation of the enteric nervous system Cholecystokinin Ingestion of food and its presence in the stomach
~ahl 0 20092010 ""'"' Dc<ks


GI S )

Th~ following list contains: Three (3) secretions from tbe enteric tndocrlne systtm that stimulate tbe pancreas Three (3) secretions from the pancreas acinar cells O ne ( I) secretion from the pancreas duct cells Categoriu tlum as to wltich ones are which:

Cholecystokinin Amylase Chymotrypsin


Secretin Gastrin
Copyn,aht 0 2009-2010 lkn111 Detk:s

G:tc.;lric inhihitnry peptide ... Sln\\ Adi\ :1tinn uf llll' c.;yrnpathl'lic O("nuus syc.;tcm ... Slo\\ :\tti\:lliuu nfthl' IHlras~ mpathe-tic mnnu. c.; '~ liiitl'm ... SJH.+ld ti J) ~rln.:Hu ... Shm .\eli\ :Uinn nf lht. tnhrk mn uu\ s~ stem ... Slo\\ C'hult.cy,tnldniu ... Slon l u:,:t.'stiun ur ruol1 :md its l)rt.''il'n(."(" in the sromach ... !\p(('d lljl

foodstuffs entering the duodenum, CSJH:clally rut_ $ und acidic

cbymc~ stimulate lhc release of honnones. including cholecystokinin, secretin, and gtric Inhibitory peptide (GIP), l.bnl inhibit the pyloric pump. Note: Sro111ach o11ptyin~ is fnhr~ced by the presence of food in the stomach aud ga5tTin.

The small intestine sends inhibitory signals w the stomach to slow sccrt:tion aut! motilily~ Two types of signals are used: nervous and (ndoc-rint. Oisten~;on of lhc.
into gastric inhibitory

small intestine. as wel l as chemical and osmotic irritation of the m\,ICOsa, is transdu~ed impulses in the emenc nervous system. This uervuus p3thwa.y is caJicd the enterognnric reflex. Secondly, enteric l\ormooes such as dwlc.cySlokinin
and ~!Oecretin are released from cells in the srunll iot~slinc: :Jnd ountributte lo

sllppression of gnstric activity. Remember: !n general. sympathcUc stimulation causes inhlbilion of gastrointestinal secretion -and motor activity, and coouaction of gastrointestinal Sflhincters and bloo(l vessels. Conversely. parasympathetic stinurlf ond acetylcholine typically stlonulate tbe$e digestive acliVities,

They are two majQr types of contraction< 111 the ()J trac\, pcrlsrnlsb ~nd mixing (segmenJulion) eontracrlons. Peristaltic contractions generate propulsive movements. Mixing contractions strve lo spread oul the foodstUffs- and increase the surfac-e area available for dige-sliC'In and absorpLion.

Slimul:lturs urI h..: pancreas: Chole"cystnl,inin. !\('i.'l"l'tin. (;a!'lrin Pancn~h adnar ccll sccn.tions: \ m~ last:, Ch~ nu11r~ p~o;i n~ rQ (l'ltin ramnas due& l'l'll Orrit.'Crl'tiOn"i: Rkarhnn:ltt. inn

Secretion from the exocrine pQncrcQs is regulnt<d by both neural and endocrine controls. Durin& interdfgestivc periods. Ycry little secretion rakes plact. but as food enters the stomach and. a little later, chyme flows into the smaU intestine, pancreatic secretion is strongly stimulated. Like the stomach, Ihe pancreas is innervated by the

vagus nerve., which anticipation of a meal.


n low-level stimulus to soerCJtion in response to

l'ancrearle ~~crctions (daily secrelioll 0,7-2.5: with a 11H beiWeetl 7.5 a11d R.8) from pancreatic acinar cells include enzymes involved in protein breakdown (ttJ'psln. chymotrypsill, olld curhuxypu~vpeptidose), carbohydrate breakdown (amylose). and fat breakdown (lipase, cholesteml esterase, pilosplto/lpase). Pancreatic enzymes arc secreted in an inactive fonn called a zymogen, and are then activated in the small intestine. Note: Pancreatic duct cells secrete a Jluid that is high in bicarbonate ion. Tbc secretions t1f the exocrine gastric glands, com)>Oscd of the mucous, parietal, and chief cells, make up the gastric j ulce (dt~ily .vecretion 2..J liters; with tt pH betwee/1 J.Q ~ltd 3.0), Gastric see.retions includ<' HCL, mucus, pepstnogco, and inlrin~ic facto r.
lnte~tinal secretions (doily s~cretiot~ ,,~,townwillt (t pi{ bellveen 6,5 nnli 1.8}, mainly mucus, are seorcted by goblet cells and cnterncytes.

Bile (p/1 around 7.8) is produced by the liver and sto red in the gallblodder. Bile aids it1 the emulsification, digestion, and absorplion of fatS. Cholecystokinin is a horruont' produced by the wall of the UppU part or the intestine. It siirnulates t~e contraction of the gall bldder, releasing bile.

Your patient tomes in and s ays that his physician bas diagnosed him with pernicious anemia. As you know, this is caused by the malabsorption of vitamin 8 12

I. What protein is crucial in the absorption of vitamin 8 12? Gastrin Intrinsic factor Pepsin
2. What cell type is the cause of the faulty production of this glycoprotein? Chief cells Parietal cells Mucous neck cells G cells 3. What type of glands contain these cells? Pylonc glands Gastric glands Cardiac glands None of the above; they are not pan of the glands
Cop)Ti&htO 2009-2010 f)tn!al Dttb

Neural, mechanical, and hormonal factors affect the intensity of segmentation within the small Intestine. For example, djstension of the intestine by chyme and parasympathetic neural activity both the contractile force, while sympath etic neural activity it.

Decrease, increases
Increase, decreases
Have no effect on, increases

None of the above

Cost>Tishl o 2009.20 1 o Dm~al .:>11

t. lnlrinsic f:1clor 2. P:trill;tl cdls J. ~Oih.' nf tlw ahO\ l~ :

thl~ :tn. not part of the ~lund~ ... ,. I hl''i{' cdh antl:Jrt ofthl' t:pilhdium .md 1Jrl' not parr of

tlu.~ ~.:land....

The secretory glands in the stomach can be deUneated into 3 regional divisions: Cardiac glands: mucous secreting found primarily in proximal stomach. Gastric or oxyntic glands: HCI, pepslnogen, and mucous. Pyloric glaods: mucous secretion into stomach and gastrin into the blood. Found in "Aotrum," region oear pyloric sphincter. Note: Enterocodocrinecells (G cellv) scrctc. gastrin. which is absorbed in the blood and carried to the gastric glands, where gastrin stimulates rbe parieta I cells to secrete HCL. Cell t)']les in gastric or oxyntic glands: Mucous neck cells: secrete mucous, and some pepsinogen, migrate to rep1ace surface epithelia. Parietal cells (oxyntic cells): secrete HCI and intrinsic factor Chief cells (peptic cells): pepsinogen Functions of secretions: Hydrochloric acid produces an acid environment that helps to kill bacteria and to activate pepsin. This solubilizes C-01\oective tissue. Secretion is increased by acetylcholine 1 gastrin, and histamine. Pepsin proteolytic enzyme secreted in an inactive form (pepsinogen) and converted by stomach acidity or by autocatalysis to pepsin. Active m pH <5.0. Mucous- -viscous and alka1ine. produce-S a barrier along the walls of the stomach to protect the stomach from the ~cid and from abrasion. lntrinsi~ fartor a glycoprotein that is essential for normal absorption of vitamin B 12 in the intestine. Without intrinsic -factor, pernicious anemia wi ll develop.

I nlrcus(.~ dccrrolst's

Coordinated contractions of smooth muscle, called segmentation, pantctpate m several ways to faci litate digestion and absorption in the small intestine: Foodstuffs are mixed with digestive enzymes from the pancreas and bile salts from the biliary system. Nutrient molecules in the lumen are constantly dispersed, allowing them to contact the epithelium, where enzymatic digestion is completed and absorption occurs. Chyme is moved down the digestive tube. making way for the next load and eliminating undigestible, perhaps toxic, substances. Following a meal, when the lumen of the small intestine contains chyme, two l)']les of motility predominate: segmentaiion contractions chop, mix. 11J1d roll the. chyme and peristalsis slowly propels the chyme toward the large intestine. - - I. Chyme is the semifluid contents of the stomach consisting of partially Not.. digested food and gastric secretions. 2. Gastric motility and emptying are influenced by distension of the stomach (via neural reflexes and gastrin) and by volume nod composition of chyme in the duodeown (via enterogaslrlc rcj7ex and intestinal hormones).



( \..

Which of the following pairings is incorrect regarding the absorption in the small intestine?

Fructose - Facilitated diffusion Free fatty acids- Simple diffusion Dipeptides - Primary active transport Glucose Secondary active transport


CopyriShtC l0W2010 Den1ol Decks

Place the following phases of gastric secretion in their proper order:

Intestinal phase Gastric phase Cephalic phase

32 O.lpyrialn O 1()09..2010 Onnal Ded:s

Oiplptid('li rrimar~ artiH tr:msporl

*** Dipeptides are absorbed by secondary active transport. The bulk of dietary lipid is neutral fat or triglyceride, composed of a glycerol backbone with each carbon linked to a fatty acid. Additionally, most foodstuffs contain phospholipids, sterols like cholesterol, and many minor lipids. including f.1tsoluble vitamins. In order for the triglyceride to be absorbed, two processes must occur: Large aggregates of dietary triglyceride, wbicb are virtually insoluble in an aqueous environment, must be broken down physically and held io suspension -a process called emulsification. Triglyceride molecules must be enzymatically digested to yield monoglycerides and free fatty acids, both of which can efficiently diffuse into the enterocyte.
The key players in these two transformations are bile salts and pancreatic lipast. both of which are mixed with chyme and act in the lumen of the small

Dipeptides and amino acids are the end products of protein digestion. The final digestive stage occurs by brush border peptidases, and absorption immediately follows. Absorption across the brush order occurs by multiple secondary act ive transporters utilizing either the sodium or hydrogen gradients. Disaccbarides and small glucose polymers are hydrolyzed at the brush border by lactase, sucrase, maltase, and alpba-dextrinase. The resultant monosaccharides, glucose and galactose, are then absorbed by secondary active transporters driven by tbe sodium gradient. Fructose absorption is mediated by facilitated diffusion.

Crphalk phasr (;as I ric phasl' lnestinal phase

Phases of Gastric Secretion: Cephalic phase ("wake up call'): sensations of thoughts about food are relayed to the brainstem, where parasympadtetic signals to the gastric mucosa are initiated. This directly stimulates gastric juice secretion and stimulates the release of gastrin, which prolongs and enhances the effect. Gastric pha,se ("full steam ahead"): the presence of food, specifically the distension food causes, triggers local and parasympathetic nervous reflexes that increase the secretion of gastric j uice and gastrin (which further amplifies gastric jtlice secrelio11). Products of protein digestion can also trigger the gastrin mechanism. Intestinal phase ("step on the brakes ') : as food moves into the duodenum, the presence of fats, carbohydrates, and acid stimulates hormonal and nervous reflexes that inhibit stomach acth<ity.

( As an action potential reaches a skeletal muscle cell, which of the following

1\.. the proper order of substances moving into and through the muscle cell?


Acetylcholine, Calcium, Troponio, Tropomyosin, Myosin heads Calcium, Acetylcholine, Troponin, Tropomyosin, Myosin heads Acetylcholine, Calcium, Tropomyosin, Troponin, Myosin heads Calcium, Acctylcholioc, Tropomyosin, Troponin, Myosin heads

33 Copyn&flt C 20092010 ()cntnl Db

' The immediate source of energy for muscle contraction is ATP binding to "' myosin. The ATP pool, however, is extremely small and has three sources of replenishment. Which of the following is not a source?

Creatine phosphate Lactic acid Glycogen Cellular respiration

Coprrigll~ . 10092010 Dentall)cd;s

\ret~ lcholirll'. Calcium~

I ro1mnin. I rnpnm~ osin.



When an action potentia l arrives at a muscle cell, the action potential causes Ca1 " to be released from the sarcoplasmic reticu lum. As intracellular Ca'' is increased, Ca'' hegins to bind 10 ITopouiu C on the thin filament.>. causing a conforma1ional change in troponin that permits the intcruction be1ween actin and myosin.
After calcium binds with troponin, tropomyosin moves from its blocking position,

penuitting actin and myosin to interact. High-energy myosin binds weal<Jy to actin subunits: however. when illorgauic phosphate is '"leased from myosin. the rnyosin bind tightly to the actin subunits. Energy stored in the high-~ncrgy myosin i> discharged, and the myosin h~ds swivel, pulling on the lhin filaments. This repeated pulling of the thin filamems past l.be tliick filam"nts toward the cenlers of the sarcomercs draws the Z lines closer togrther, a.nd the muscle fiber shortens (contracts). This proces. is culled th e Sliding Filament Theory. Note: This process is repeated as long as calcium ions are bound to rropooiu and AJP is available. Once calciUm ious are rctw-ned to the sarcoplasmic reticulum, 1ropomyosin moves back io10 its blocking position and prevent~ fttrthor interaction be.twccn higb.cncrgy myosin and actin subunits. Contraction ceases. a11d I he rnt~scle ubcrs relax. Important: In the contrartile cyele, the dissociation of the actomyosin results from AT!' replacing ADP on the myosin heads. Remember: Composition of myofilament$ T hick lilamcnt- composed mainly of be pr01eio myosin . 'l'bin ftlamonu composed mainly of the protein uct.in.

The hydrolysis of ATP (adenosine ll'iplro<phcl!e) provides the immediate source of energy fur muscle comraction. Although a musde J i oer contains only enough ATP to poWer a few twitches, ils ATP ''pool" is rcplcnishod as ncc<lod, The three sources of highenergy plt\lspbate to keep the ATP " pool" ti llrd are creatine phosphate, glycogen, and cellular rr>11irntion in the mitochondrin of rhe muscle fibers, Creatine phosphate -The phosphate group in crc~tinc tJhosphate is attached by a "high.~nergy" bond like that in ATP. Creatine phosphat dorives it.> hign.energy phosphate from ATP and can donate the phosphate back to AOP to form ATP. Creatine phosphate + ADP io+ creatine i' ATP. Tbe pool of creatine phosphate t11 the fiber is about I0 times larger than that of ATl' and rhus serves as a modest reservoir of AT!'. Glycogen -Skeletal muscle libers comain about 1% glycogen, The muscle fiber can degrade lltis g.lycogeJ by glycoggno!ysis, producing glucoselphosphatc. This enters the glycolytic pathway to yie ld IW<J molecules of ATP for each pail of lactic add molect~les produced . Not mucb, but enuugh !u keep the muscle function ing if it fails to receive sufficient oxygen to meet its ATP needs by respiration. However, this source [s limited. and evcnt\oally rhe muscle musl depend em cellular rCSt-pirntion. Ccllnlnr rcspirtion Cellular respiration not only is required to meet tho A 'rP neods of a mUAole engaged in prolonged activity (thus clwSilfg /1/0rc rupid t111tl dueper bteathing), hut is also required afterward' to enable the"body to resynthesize glycogeu from the lactic acid produced earlier (deep brmtiJing continue.< jiw a time after exerct~<e is slopped). Noto: The body must repay its oxygen Jcbl.

During exercise, which of the following is thought to be an immediate \ '\.. source for high-energy phosphate groups with which to replenish ATP ? }

Phosphoenolpyruvate Creatine phosphate

Cop)-riSht C l0092CIIO l)mt-11()red:$



' As yon complete the seating of a crown, you ask your patient to tap lightly the articulator paper. Which of the following statements is correct in describing the physiology of the patient's light tapping?

The "all or nothing'' phenomenon occurs; all fibers in the masseter and medial pterygoid are partially stimulated, causing a light contraction Fractionation occurs; each muscle fiber involved is stimulated only by a fraction of the alpha-motor neurons innervating the fiber, and so the fibers contract tightly Fractionation occurs; only a few small alpha-motor units are recruited, and the masseter and medial pterygoid muscles contract lightly The "all or nothing'" phenomenon occurs; the muscles that close the mouth are stimulated fully but are countered by stimulation oftbe muscles that open the mouth, causing as light closing of the mouth
C<lp)-rightO 200?-2010 ~utal 0-l:s



Creatine phosphate is one of the basic mus cle energy stores, particularly in fastswitch glycolytic fibers. Normal metabolism cannot supply energy as quickly as a muscle cell can use it, so an extra storage source is needed. The phosphate group can be quickly transferred to ADP to regenerate the ATP necessary for muscle contraction. Tbe phospha te compounds found in living organisms can be divided arbitrarily into two groups based on their standard ftce energies of hydrolysis.

1. Higher phosphate group-transfer potential than AT P: Pbosphoenolpymvate Carbamoyl phosphate Acetyl phosphate Creatine phosphate 1,3-diphosphoglyceric acid 2. Lower phosphate group-transfer potential than AT P: Glucose- 1-phosphate Glucose-6-phosphate F ructose-1.6-dipllosphate Creatine

fr.nlionatiun occurs: onl~


ll rl'\\ sm~tll :tlph:Hnotm unit\ are recruited and thl' nwdial pter)coid muscks contr~lct lil!h11)

The motor unit is the a lpha-n1otor neuron and all of the muscle fibers t11at lt innervates: Each muscle- is composed of several muscle fibers Each muscle [jbcr is innervated by a slngle alpha-motor neuron Each alpha~motor neuron innervates many mus<:lc fibers All of the fibers innervated by a motor neuron contract when that motor neuron fires un action potemial

Remember ; The Si:ce Principle 4 ~ motor units are recruited in order of the size of the moror unit. If only a small amount of tension is required to perform d1e move men~ then only small motor unils wfll be activared. If greater force is required, more and larger mmor units will he recr uited. Important: \Vhcn a patient bires down rapidly on an unexpected hard surface while chewing, tbe cessation of motor unit recruitment in the Jaw closing muscles is caused by p eriod ontal mechanoreceptors. fra ctionation means that it is not necessary to activate all of the moror units in a muscle. The contraction of skeletal muscle is controlled by the nervous systern. Action potentials traveling down somatic alpha motor neurons cause dcpolnrization of the skeletal muscle fibers at which they terminate. The junction between the tcnninal of a motor neuron and a muscle s at a neuromuscular fiber is called a neuromu!\cular j unction. When an action potential arrivejunction, calcium ions enter the nerve tenninal, causing the release of acetylcholine from synaptic vesicles within the motor neuron. Acetylcholine then bincl..s to the nicotiojc cholinergic receptors in the muscle fiber plasma membrane. This causes depol arization~ which triggers an action potential (rhe action potcntial travels along the membrane and the t~tubules). TI1is action potential triggers the release of calcium ions frum the sarcoplasmic reticulurn. This leads lO crossbridgc fonuation between actin and-myosin. These interactions arc responsible for the development of tension and tl1e shortc:ning of tl1e fibeo;.



AU of the following statements concerning muscle fibers arc true EXCEPT one. Which one is the EXCEPTION!

Fast-twitch fibers are about twice as large in diameter Slow-twitch fibers have a greater resistance to fatigue The enzymes of oxidative phosphorylation are considerably more active in slowtwitch fibers Fast-twitch fibers contain more mitochondria and myoglobin Fast-twitch fibers can deliver extreme amounts of power for a few seconds to a minute

37 Copyright() 200!MOIODental Ob

All of the following statements concerning muscle spindles are true EXCEPT one. Which one is the EXCEPTION?

They are found within the belly of muscles They consist of small, encapsulated intrafusal fibers and run in parallel with the main muscle fibers (exrrafusal fibers) The finer the movement required, the smaller the number of muscle spindles in a muscle They detect both static and dynamic changes in muscle length

38 C;lopynJht 0 2009-2010 Den;al De<:lts

Fasl-h\ilch lihlrs


mor{' mifochondria and


*** This is false; see chart below.

h::~racfl' ri\ lll''

of Skl'lttal \lusde l'ihtrs

Characteristic Myosin-ATPase activity Speed I Intensity of conlnlction Resistance to fatigue Oxidative capacity Enzymes for anaerobic"glyeolysis Mitochondria Sa.rcoplasmic reticulum Capillaries Myoglobin eontent Glycogen content

Slow T\vitcb (Type I)


Fast Twitch (Type ll) High Fast I High


Slow / Low

High Low Many Less extensive Many High


Hi gil Few
More extensl ve
Few Low


Hi gil

,....__ I. "Fast" muscles a.re for rapid. powerfut actions (jumping. shorl disJant:e Not~ running! while "slow" muscles arc fo r prolonged activity (body posture,

marathon). 2. Oxidative capacity is related to (I} the number of capillaries, (2) the myoglobin content, (3) the number of mitochondria.

Tht riawr tht mu\ l'III{'Ut H'C.Juired. the smaller the numbl'r of musclt spindll'S

in muscll'

This is false; the finer the movement required, the greater th~ number of muscle spindles in a muscle.


Muscle tone is "fine-tuned" by two .sensory organs:

I. Mu.sclc spi" ndle (measures muscle length) three components: I. Specialized muscle fibers: {intrafusalfibers)

2. Sensory terminals: group Ia and IJ afferents 3. Motor terminals: gamma motor (efferent) neurons ***Activates alpha motor neuron when stretched. 2. Golgi tendon organ (measures muscle tension): innervated by a s ingle-group Ib sensory (affereflt) fiber. Inhibits alpha motor neuron.

-:J !.The muscle spindle is a small, highly differentiated part of muscle Note$ tissue located within the belly of muscles and ruos parallel with the main muscle fibers. 2. The annulospiral endings (sensory terminals) are wrapped around ~pec ialized muscle fibers that belong to the muscle spindle (imrafisa/ fibers) and are quite separate from the fibers that make up the bulk of the muscle (extrafusa/ fibers). 3. Motor (efferent) neurons can be fu rther classified as alpha or gamma motor neurons. Alpha motor neurons innervate and stimulate skeletal muscle. Gamma motor neurons innervate tbe muscle spindle. 4. Activation of the gamm~ motor neuron maintains the spindle sensitivity.



When a muscle is _ _ _ __, the is considered and t he result Is

reflex reacts. This reflex

Contracted I Golgi tendon I monosynaptic I contraction Stretched I Golgi tendon I disynaptic I relaxation Stretched I stretch I monosynaptic I contraction Contracted I stretch I disynaptic I relaxation Stretched I stretch I monosynaptic I relaxation

39 Copynaht 0 2009-2010 OC'n;al De<ks


Msl )

Three basic clements Four basic elements Five basic elements Six basic elements

All reflex arcs have:

C<>pyrigh! 0 20092010 IXnul Dks

Sln:lchl't.l / sln.lch

/ nwnoo,~naplir I


The stretch reflex, also known as the myotatic reflex, responds to passive stretching of the muscle. The muscle stretch is detected by muscle spindles \VhOsc afferents (Ia fibers) synapse. with lower motor neurons (a motor neurons) and iutcrncurous (Ja inhibitory imemeurous}. The renex is important for Ute automatic mtintennnce of posture and muscle tone. When the muscle is stretched, so is the muscle spindl e. Tbe n1usclespindle depolarize.~ in response to srretclting (senses tlte change in lengrlt) and sends action potentials to the spinal cord where it synapses With a motor neuron. This triggers the stretch rcllcx, causing the muscle to c<lnrract. The basic fuuct ion of the muscle spindle is to convey infurmation to the cemral nervous systl'fn concerning muscle length aud tension. lruportant: The sensory receptors serving the stretch reflex are classified as proprioceptors.
Strercl1 reOa ,.,.,.j.,k)

Numbtr or Synap11es


Afferent Fib.,..



Mu$le ls. stretChed

Connacdon \')fthe mu~cle

Oolg; ...,don refl<ll Disywlpti< (o/!J.>pblif't:)

Atxor~wi1hdmwal rafle~ {tlj1ttr 1611ch

Muscle oonuuct!) lb

Rela1{:uiun of t.ho m~&scle




fl, II(. and Jpslbu~l fle.\iOO, COI!Irllli!et'l)


ing u lint stove)

1. The Golgi tendon refle.l is the reverse of the stretch reflex. Golgi tendon orgaus also depolarize io response to muscle stretch but inbibit tbe motor neuron, causing the muscle to relu . 2. The flexor-withdrawal reflex fs a polysynaptic reflex th&t is used when n person touches a hot object or steps ou 11 oeedk.

The reflex arc is a simple neurul pathway connecting receptors to an effector, A receptor detects a st[tnulus or environmental change. An effector is an organ of response (i.e., skeletolmusc/e). It produces a response calkd a r enex. Rotlexcs ~re quick because they involve few neurons. Reflexes are ~ither somatic (resulrmg 111 t'Ontracrion of skeletal muscle) or autonomic (nr.civr:tion of smooth uml cmdiat muscle). All reflex arcs have si~ bnslc element.~: a receptor, o<ll-'0'Y (a.fleri!llt) neuron, integration center (CNS), interneuron. motor (effereur) neuron, and effector. Spinal TeOexes are somatic reflexes mediated by !lte spmaJ c<.>rd. Two importa11l s pinal rellexe<> influence the contraction of skeletal muscles. These are: I. Slret~h re llex - it is initiated at receptors called JUuscle spindles that are sensitive to muscle length and tension. This reilex stimulates the metched muscle to contract. An example is the patellar rrnex (knee jerk r~flex). in which U1e striking of the patellar tendon at the knee causes the quadriceps muscles to contract and swiug the lower leg forward, 2. Tendon rellex - it is initiated at rc.ccptors call ed ncurotendinons organs (Onlgi tendon urgans) <hat are sensitive to tension that occurs us a result of m\lscular COJ ttraction or muscle stretch . This reflex stim~lat<:s the contracted muscle to relax. Note: When tlte stretch rellex stimulates !ltc stretched muscle to conrract, antngonistic muscles that oppose tbe c<lllrraction are iuhibtted. Tbis occurrence is called reciprocal inhibiUon, and tbe neuronal mechanism that causes this reciprocal relationship is called reciprocal innervation.


In a single muscle, there are both intrafusal and extrafusal fibers. All of the following statements are true in tbe description of intrafusallibers EXCEPT one. Which one is the EXCEPllON?

Contain nuclear bag fibers that detect fast, dynamic changes Innervated by gamma-motor neurons Contain nuclear linking fibers that transmit afferent signals Encapsulated in sheaths to form muscle spindles Contain nuclear chain fibers that detect static changes


CopyriJhtCl 20092010 Denllll Oed:s



the spinal cord, the Hsbapcd mass of gray matter is divided into""~ horns, which consist mainly of neuron cell bodies. Cell bodies in the posterior (dorsaf) horn relay:

Voluntary motor impulses Reflex motor impulses Sensory impulses A II of the above

Copyright C 20092010 [)en!al Ok11

Cont.1in nuclc.u linking fihrrs Ihat transrnil <tft"ercnt sij!nals 1\vo '!)'pes of Muscle Fibers: 1. ExtrafusaJ Fibers Fibers that make up tl1e bulk of the muscle lm1ervated by alpha-motor neuron.s (efferent ner/lons) Provide the force for muscle contraction

2. Intrafusal Fibers Are encapsulated in sheaths to form muscle spindles Innervated by gamma-motor neurons (efferent neuron.<) Two '!)'pes of Intrafusnl Fibers: I. Nuclear bag fibers Detect fast, dynamic changes in muscle length and tension . lnnervated by group I a affereuts- fastest iu the body. 2. r\uclcar chain fibers Detect s tatic changes in muscle length and tension. !noervated by the slower group IJ afferents. Remember: l. A sensory (afferent) neuron transmits afferent nerve impulses from the receptor (perip/reral ending of a sensmy neuron) to the spinal cord. 2. A motor (efferent) neuron transmits efferent nerve impulses from the integrating center (in 1l1e spinal cord) to an effector (muscle cell).

T his dorsal horn is also referred to as the dorsal root ganglia. Those cell bodies in the anterior (vemrol) born (root) transmit motor impulses.
The white matter surrounding these horns consists of myelinated nerve fibers, which
f01111 the ascending and descending tracts. A tract represents a group of axons within the central nervous system having. the same origin. termination, and function. and is often named for its origin and termination (i.e., spinothalami< ilact).

Axons of cells that run on the same side as their cell bodies of origin are referred to as ipsilateral. Axons of cells that run on the. opposite side of their cell bodies of origin are referred to as contralateral.
Note: Sensory pathways are ascending sys1ems (i.e. , spinothaltimlc and

systems); motor pathways are- descending systems (i.e .. pyramidal and extmpyramidal systems). Remember: The white matter refers to those parts of the brain and spinal cord that are responsible for communication between the various gray matter regions and between the grey matter and the rest of the body. ln essence, the gray matter is where the processing is done and the white matter is the channels of communica[ion. Hy analogy, the gray matter is like the CPU in a computer, and the- white matter is like the printed ci.rcuJt board that connects it to the other parts oft he computer. White Matter vs. Gray Malt~r -- Both the spinal cord and the brain consist of: Wltite Matter = bundles of a.'ons each coated with a sheath of myelin Gray .' \'latter = masses of the cell bodies and dendrites. each covered with synapses In the spinal cord, the white matter is at the surface, and the gray matter ioside.ln the brain of mammals, this panem is reversed.



Which structure functions to control complex patterns of voluntary motor behavior?

Hypothalamus Hippocampus

Basal ganglia

Copyriatu 0 20092010 lkn1al Dts

All of the following are main str uctures of tbe hindbrain EXCEPT one. Which one is the EXCEPTION?

Medulla oblongata

Cerebral hemispheres Cerebellum

Copynjhl 0 20092010 Dnltal Decks



Coiled ions of ntne e.ells (nuclei) lie at the base of the cerebrum (subconlcal) m structures called the: Basal ga nAii - includes the caudate nucleus, putamen. globus pallidus. suhstantia tugrn. snd the ubthalamic nucleus. The basal ganglia's lltnction is to control complex patterns of volwttury motor behavior. T halamus -

a large ovoid mass of groy mutter Uuu rolays ull sensory stimuli

(etcepl olfo,rory) ns they ascend to the cerebral cortex. Otttput from the cmte~ also
can sYOOPSC in the thalamus. Oypoth alamus- control' lllllny homeostatic proc:esses. which are ollen BN)Ctnted with the autonomic nervous system. The hypothalamus is involved tn regulating body temperatUre. water balance. appetlle. gastrointestinal activity, sexual activity, ~lcep, and even emotions such as fear and rge. The hypothalamus also regulates the release of the bornu.>llC.< of Ute pituitary glund; und thus the hypothalamus greatly a!Teets the endocrine system. Important: Stimulation of che posterior bypotltalnmus by a reduction In tore temperature will produce shivering. Hippocampus- functions in tht consolidation of memories and en teaming.

The basal ganglia are a group ofanatomically closely related subcorucal nucle1. Dncmge
to these nuclei dCX's not cause "eakness. but can cause dramatic motor abnormalities. CUnical syndrome~ associated with damage tu these nuclei include l'arktnsonism. Hemiballismus (hemichorea), and lluntington's chorea.

The human forebrain /prosencephalon) is mudc up of: A pair of eerebral hemispbert's, called the telencephalon
A group of scructures located deep within the cerebrum that make up the diencephalon Main Structures of the Hindbrain (rhambMC'-fllrulm): Cerehellum - lies beneath the cerebrum JUSt above the brd.n stem. The cerebellUln's fu nctio11< are concerned with coordinating voluntary muscular activity. maintaining equilibrium, and conrd inntiotL Pons- connects the cerebdlum with the cerebrum and links tho mnlbrnin to the medulla oblongata: serves as the exit p.>int lor cranial nerves V. VI, and VII, Medulla oblongata -the medulla looks like u swollen tip to the spmnl cord. Nerve tmpulses ansmg here rh) thmically <timulate the intercostal muscles and diaphragm -- making breathing possible. Al110 regulates the beanbeat and regulates the dtamcter of arterioles, thus adJUSting blood flow. Note: Tbe neurons controlling breathing have mu (iJ) receptors, the receptors to which opiat~s. like heroin. bind. This nccountb fo r tlte suppressive effect of opiates on breathing. The bralo st~m l!es immediately interior to the cerebrum. just antcrtor to the cerebellum. T he brain s tem conststs oftbc midbrain, pons, and medulla oblongutn. The midbrain (mc,,ellcepha/on) connects dorsally with the cerebellum nud contains large voluntary motor oer. e tracts. The limbic system rs a primitive bracn area deep wtthin the tempor~llobc. Bcsrdes initiating baste dnves -- hunger, aggression, a nd emotional f""Hngs and sexual arousal -- the limbic system scree~ all sen~ory messsges trut ehng to the cerebral cortex.


Patients occasionally come to your office and claim that they are having trouble maintaining their oral health. For each of the following problems, try and match the most appropriate lobe of the cerebrum that is not functioning properly.

Patients' complaints are: I. I always forget if I brushed my teeth already. I just cannot remember if I already did -- so I just assume I did. 2. I ... ummm ... just cannot make my wrist move the brush ... um ... but .. . and .. .why do l need ... to brush my teeth? 3. Every time I grasp my brUSh 1 it won ~, fit in my mouth. It also huns to have the water on my teeth. 4.1 brush every day, bull have !rouble getting IOOihpas1e on my brush. I have no trouble getting my brush to my mouth, bull just cannot manage 10 see the toothpaste and the brush. Lobes or the cerebrum arc: Temporal Frontal Parietal Occipital
45 Copyri,ght 0 2009-201 0 lknul Ottks


For the following questions, usc the same answer choices.



Capillaries Arterioles


Copyri&}ltCI 2~2010DcrunJ l)ccb

I. Tl'mpuriJIIohe - this p<Jtilnt will nl~o h:J\'1.' trouhll' hearing you rc~pond 2. Frunl:tl Lub~: - motor truuble. and truuhk ulth lanf,!ua~c expression J. l,aril.t:lllohl' - ~t. nsutions -' Ocripitallnhl - Pttknl has 'is inn truuhll'~ ~- tdl him or h~:r to put toothpu(\te dinrtly fH) his ur hl~r lrtth anduS\' Ihe hrm.h as nurmal

The cerebrum {cerebral cortex), of the brain, occ11pies the supetior po rtion of lhc cranial cavity. The cerebrum consists of right and left hemispheres. The right controls lhe !ell side of the body; the !ell hemisphere, UJe right. The corpus callosum is a maS-s of nerve fibe.rs connecting tbe hemispheres.. Each cerebral hemisphere is divided into four lobes, based on anatomical landm11rks and functional differences. The lobM arc named for the cranial bones that overlie thorn. Note: In addition to the !unctions of the primary areas in each lobe, the vast r oajority of the cerebral cortex is in\olved in assocHLtivt and higher order functioning such as ideation, language, and thought. Luhcs of the Cerebrum Frontal

Contains the pnmary motor (mo,emem) area and influences personality, judgment. abstmct tc3Soning. social behavior. and language expression.
Controls heanng, language comprehension, storage and n..'Call
of memories.

Temporal Parietal

lntcrprcts and integrates $ensation, including pain. tempe-rolure. and touch: interprca size, shape. distance, and tc.xmre; imponan1 for >waroncss of body shape.
Fuuctions m~inly lo interpret visuaJstimuli.


I. . \rll.'ril~ 2. ,\rtHiolls J. \ ' tins 4. S)sh.rnic n ins - E.YCEPT/0.\' -- (JUihnun:~ry vd11s c:1rry O\)':!rnafld blond. and pulmnnar~ artc1ies cnrr~ dt.>o\~'l!<'l1:1h'd hlom.l) 5. \ ' l'ins have higher cmnpliance. and urterit~ han. a lnw ... r compliance

Systemic arteries - 1ransport pre-ss1tre nw\Y the hear1 to tissues of the body. Tese arrerios have strong muscular walls to withstand the high pressure aod low compliance. Note: The pulmonary and umbilical arteries are the only urtenes thut contaiu unoxygenatcd blood.
Systemic -veins- function as conduit~ for 1he lrausport of unoxygenutt'd blood from thf

tissues back to the heart. These veins have larger lumens and thinner walb; than dte arteries the veins accompany but a higher CQmpliance, and act as volume reservoirs. Some conta[n valves (i!specially the vei11s oj' tire limh<) that allow blood to flow tOWiir<l the bean but not away from it. Note: The pulmonary vein~ arc the only veins that contain oxygenated blood. Capillaries - this is where the exchange or fluid. nutrients, and metalxllic waste products occurs. between the blood and the interstitial spaces. The capillary walls are very lhin. They consist of a single )ayer of endothelial cells surrounded by a thin basal lamjna of the tunica tntimu. Note: The amount of blood 01at tlows through the caplllaries per minute is equal to the amount of blood that flows through the aorta per minute. Arterioles - regulate the flow o f blood into capillaries. Blood flO\V is regulated to meet tissut! metabolic: oeeds. Vcnules - are very small veins that collect blood from the capillaries; venules gntrluntly coalesce into progressively larger veins.


C irc0

Veins Venules

Which structures are the site of highest resistance in the cardiovascular system?
Arteries Arterioles

When these structures ore acted on by nitric oxide or adenosine, they will: Constrict Dilate Stay the same This will affect total peripheral resistance in what way?
Increase Decrease Stay the same

Copyrigbl 0 20092010 IXntaJDccki

For the following questions, usc the same answer choice.~.


l. Which 2. Which 3. \Vhich 4. Which 5. Wbicb

circuit supplies the aheoli of the lungs? circuit supplies the connective tissue of the lungs? has a lower blood pressure? bas a greater volume of blood flow per minute? circuit involves the thick-walled left ventricle?

Pulmonary circuit

Systemic circuit
Both Neither

Copyng.htC 20092010 Denml Deets

I. \rteriole"

2. llilafl'
.1. th."i: n;t\e

Arteriolts are lhe las1 small branches oflhe artenal sySlem and ael as control Vllvts lhrougb "'hch blood IS released imo 1he capillanes. Ar1eriolos vary in dJBmeler rang1ng from 30 11m 10 400 fADl. Any aneT) smaller ehan 0.5 mm in diame1er is considcrN to be an an<riol<. They have a small Jwnen and a rclauvely thick tunica modia thai is compo;ed lmost entirely of smooth muscle. with ,er y Ill tie elastic tissue. The inlima of an nncriole 1$ composed of endolhelial cells lying Oil a basement membrane with an underlying line internal clastic lami na in the larger tll'le rioles~ Arterioles play a major role m regulating 1he now of blood inlo the capillories. 131ood flow to tissue is mainly regulated by arteriolar diameter. Constriction of the nnedoles restricts the now of blood into the capillaries. while dilauou allows the blood to enter lhe cupillaris more freely. lmportonl: Arterioles are rhe primary resi;toncc vessels and dc1onnin< rbe distribution of" cardluc ourpu1. Arteriolar resrstance is regulated by the autonomic nervous system. Remember: Alpha 1-adrenerg1c roceptOrs arc round on the arterioles of the skin and splanchnic crrculahuns. Beta zadrenergic receptor> are found on artenoles of skele-tal muscle. Local blood llow is regula red b) trssut mC111bolr<m. Various humoral factors can alliO aff<et arteriolar diame1er, includ~ng eodothelins (asnconsrricror). nitric o"dc. and adenosine (va.vodilarnr.<). Sympathetic o<llvallon resuiiS in an O'erall vasoconstnchun or arterioles and an increase in IOIDlJ>Criphcral rcsrslancc (TPR). Key Polo I: An increase in nncrlolor re'i~Hlnc:~ w11l wcr~ast TPR_




! . s~,ll' RJic circuit


.a . 't.ithl'r (they hu(' th, \fmu. ulm ut 5 I./min)

5. ~~'lc-mk circuit
')'~em can be d1v.ded uno No s eparstt cirtultJ~ c-..ch leaves and mums 10 the bean. The purnp for rbe pulmonary circuit, "hich <ir.:ulatc> blood 1hmugb lhe lungs, Is Lhe rigbt \folrlrle. The left nntrlcl< tS the pump for lhe ~)>lemlr circuit, wbicb provides rhe blood >Upply for the tiS$\lc cells of the body. I. Pulmonary circuit - Pulmonary crrculalion tr:msporiS oxygen-pour blood from the righr venlticle 10 the lungs where blood picks up a new blood supply. Then the rulmonRry circulation rclunrs tbc: oxygcn-ricb blood t<l the l ~ll atrium Note: The vessels oflhllt t1rcuil <upply only th ~ alveoli. 2. Syst.(!mlc circuit - The systcn11C clrculuuon provides the funcuunal blood supJlly to a,lll)ody tissue.. The: systemic c:irculotum corrlc!l mcygen and nutrients ~o lbe cell~ nud rucks up carbon dioxide -and W3.!1te products. Sy.t~tCin!C circulalion carries O);ygeuutc:d hloud flom lh~ len ventricle. 1 hrough the srtcncl', to the capillaries in the tissue~ of the body, Frum the li>su capillaries. the dcoll)'gcnatrd blood return.< 1hrough a 'Y>lcm of veins ro the ng)lt rium or lht heart l"olt: The vessels ofth1scin:urttranspoo blood lo all1i"'ucs of1hc body ucept the ahe<~ll Nott: The: votume- or blood n o~ Jk:r mmme (S UmiHJ h the: $0\JtlC in both ~n.::u1b.

The \'~is

R.tntembtr: I Mean arterial blood pressure carchac oulpul .- 10<al periphmll rcsisrancc 2. \ 'ascular complinre =- ralt of change C\flhe "aseuld.r "Volume I change 111 ~.uur~ l . Blood pressure in lhc pulmomuy circuit IS mucb lo~er than that or tht '))Mcmtc

circulation, bec-ause pulmonary artcrto1e:. ttrc usually dilated and have litllt rcslstanre 10 blood flow. The pulmonary vencl~ arc hlathly tompllant, aJiowing the pulmun.uy tu'tuit tn ~turc bluod volume \\.1lthoul chongu'l~ blood pressure,



s )

If' Your patient tells you that he just had a heart bypass operation. He says that"" they used a vein from his leg and re-routed blood that previously flowed through his left anterior descending coronary artery (often referretl to as tile widow maker). Which of the following explanations is correct in answering II.. how a vein can adequately replace an artery? _.J
Although veins have higher compliance nonnally, when under high pressure, compliance decreases, and so the vein acts very similar to an artery when put in these conditions.

Although veins have lower compliance nonnally, when under the high pressure, compJi .. ance increases, and so the vein acts ver)' similar wan artery when put in these conditions.
Although veins have higher resistance nonna lly, when under the high pressure, resistance decreases, and so the vein acts very similar to an artery when put in these conditions. Although veins have lower resistance nonnally, when under high

pressure, resistance increases. and so the vein acts very similar to an

artery when put in these conditions.
Coopynght ~ 2009-20 I0 Denioll)ed:,.


( '


Yottr patient presents with stage 1 hypertension. Ris blood pressure is 1 SO mmHg I 99 ounRg, confirming his diagnosis.


I . Is his pulse pressure nonnal, high, or low? 2. To bring his blood pressure down to normal, he could attempt to do what to the total peripheral rcsistanc.e?

Increase it DccreMe it
3. Normally, the mean prc>sure in the aorta is about 100 mmHg. Eventually, the blood will return via the vena cava at a pressure o f 4 mmHg. Where did the blood pressure decrease the most as blood traveled through the body?

Large veios Large arteries Arterioles VcnuJcs Capillaries

50 Cupyngb! 4) 2'0092010 Dental Decks

\lthuu:!h \ ein'\ haH' hiciH.' r " mnpll.uu. norm all~." lun under hi).!h pn.-.,un. c.:nm""' :1nd '\O lh(' H'in a~o:h \l'f~ 'imilar tu an al"l('r~ nlu.n put Itt lhl'\~' pll:mn. dt(rea"

Total peripheral rtsistan<e (TPR) regulates the flow of blood from the systemic ar1enal circulation into the eoous Ctrculauoo. Cardiae output regulates the now of blood from the veins back into the arterial side. The amount of blood located in the systemac veins 11 regulaced by their coruplia11ee. Sympathelic activation decreases vcnou compliance and returns more blood back to the heart, increasing cardiac output and blood prcsurc, thus causing more biOO<lto be pushed through the anerial circulation. The ability of a blood vessel wall to cxpnnd and contract passively with changes in pressure constitutes un uuportnnt function of large aneries and \eins. This ability of a vessel to dlsientl with increasing trnMil'lurul pressure (/11slde minus outside pn.~o,mre) is quantified ns vessel compllo~nce (C). wh1ch is the change in volume (DV) divided by the change in pressure (DPJ. Important points about compllan<e: {I ) Compliance decreases at Ingber pres>tlteS nnd volumes (i.e.. \'e.fsels become ..SIJfftr at higher pressures and WJlumes). (2) At lower pr<ssures, the compliance of a vein tS about 10 10 20 rim'" greater than that of an anery. Therefore, veins can accommodate lar&e changes in blood volume w1th onl) a small

cbangt in pressure. Howe,er. at higher prt':>!tures and \olumes. \lenous compliance

becomes similar to arterial compliance. This makes veins suitable for use as arteril

by-pass grafts. Relative volumes or blood at rest in dlff<renr parts or the adult cardioascular system : 66~. -in the syslcmic vems, venule~ 6% - in the hean 11% in the systemic anerte~. arterioles 5% in the capillaries ll% - in the pulmonary loop

I. ll 1:,:h Z. UtHl':hl' il
.1. \rll'rmlh- lhl' \ill of bi~tu.,f n'i'I:U1H

Although capillaries bave a smaller diameter than anerioles. there are vastly more capillaries arranged in parallel than there are artertol~. Thus, most of the pressure drop in the systemic circulauon occurs 1n the arterioles. Pressure decreases as blood mows through the systemic circulauon. This prc,sure gradient is required for blood Oow. Remember: blood Oow = pre~sure gradient I resistance The reslstanre to the now of blood ofrered by the entire system1c ctrculot ion is co iled the totoI peripheru l rcslstuncc (Tf'R). The target systolic blood pressure is 120 mmllg, and the recommended diastohc blood pressure is 80 mmHg. However, as blood enters arterioles. the pressure can drop to as low as 30 mmHg. The pulse pressure equals the systolic pressUie 1mnus the diastolic pressure (Pulse p uttSure SBP-DBP). The most 1mponant determinant of pulse pressure as stroke \'Oiume. The pressure is highest tn the aona and lowest in the venae cavae. ll'otes 2. Mean pres~ure is as follows: in the aorta - 100 mmllg: at the end uf the arterioles - 30 mmHg; and 111 the ' 'en a cava -- 4 mmHg ,



s )

Whith two of the following will increase tissue edema?

Increased colloid osmotic pressure of the plasma Increased colloid osmotic pressure of the interstitial fluid Increased capillary fluid pressure Increased interstitial fluid pressure

51 CoP)'naht 0 20092010 [Nntal ()e(k.s


Circ s)

~our patient has just finished her 2-hour appointment and is eager to get out;)
the office. She stands up from the chair ,ery fast, and quickly becomes dlay and nearly faints. This Is termed orthostatic hypotension.
I. Which of the following receptors are most imponant in the shon-temt regulation of her

blood pressure and returning it to nonnal? Stretch receptors in the caro1id si nus Chemoreceptors in the aortic bodies
Chemoreceptors in the carotid bodies Stretch rece ptors in the pulmonary circulation

2. This drop in blood pressure will cause what to happen? Sympathetic impulses to increase Parasympathetic impulse> to increase Both to increase Neither to increase 3. The effect OD the heart wHI he: Increased bean rate. decreased stroke \Oiume Increased bean rate. increased stroke \'Oiume Decreased bean rate, decreased stroke volume Decreased bean rate, increased stroke volume
Copyri1ht _, 20()9..20 I 0 IXDIIJ Docks

I m:n.asl'd ca,)ill:u, nuid JlrCS\11fl' l ncreawd colloicJ osmotic pressure hf thl.' intl'rslilial lluid

Capillary pressure is the pressure of the blood within the capillaries. Capillary pressure tends to fo rce fluid out of the capillaries and into the tissue spaces by liltration through rhe capillary walls. Capillary pressure ls determined by venous pressure and arterial pressure. The colloid osmotic pressure. of the interstitial fluid tends to uraw water out of the capillarie.~ by osmosis. The interstitial fluid pressure is the pressure of lhe interstitial fluid, and it opposes the capillary pressure. This pressure tends to move fluid out of the tissue spaces sud into the capillaries. The colloid osmotic pressure of lbe plasma (also called the onco/ic pressure) opposes the colloid osmotic pressure of the interstitial tluid. This oncotic pressure tends to draw water ioto the capillaries by o;;mosis.
All ancre~se in capiUary permeability (e.g., due tn iufecliou) can also result in u~sue

edema. Edema formation is reduced by lympbatic drainage oftl1c interstitial space. I mportant: When the right ventricle weakens, fluid builds up in the. peri]lhcral tissues, leading to edema and liver engorgement.

I. Sfrt'tch receptor' in llu. co1rotid -;in us 2. S) mpathctic impul~r~t'~ to incrr~se ' lncrl'ast.d ltt~art r!ll(, incrcas('d >slrokl' \olume
baror<~eptor regulatory system is compo>cd of two groups of stretch rec~pmrs: ( I) un< group 1n the c::Hotitl sinuS:t!S near the bifurcations of the common carotid anerit:S i" lll~: nee~ and (2) a sccon/J group i n the arch of the aorta. These receptors dclc~::t clmn~cs in b1mul pre.o;sure and feed lhc information back to the cardiac control ce-nter ~d the. vasomo~or c..:-mc:r i11 the medulla. In response~ these control centers a lter the rauo between sympathetic: 11nd


parasympathetic output. If the pressure fs roo hlgb, a dominance of parasympathetic impulse>

will reduce the pressure by slowing the hearl rate. reducing slrokc vo)ume, and dilating blood "reservoir.. vessels. If the pressure is roo low. a dominance of sympathetic impulses will
increase the pressure by increasing 1J1c- bean rate and stroke volun1c Q.nd cnnstricting "*reservoir" vessels. Stretch receptors in the elirOiiiJ sinus arc stimulated by elevated blood pressure. resuhing in the acthatlon of the pamsympat.hetlc nervous system and fnhlbirion of the sympathetic nervous system to reduce blood pressure back toward its set poinL
Chtmor~ceptors i-n the carotid and aortic bodies~ as well us chemoreceptive neurons in the vasomotor center of tJ1e medulla itself, d..:tect lnercascs in carbon dioxide. decreases 10 blood oxygen, and decreases in t, li (which i.'i re(l//y an increase bt lly1irogen i'on concentration). This infonnation feed.~ back to tJ1e cardiac control ccnlcr and vasomotor control center fhe ffil.{dUlla, which, in lutn, alter the ratio JHUasympatbctic and sympathetic ()l.ltpUt. Whrn ox.ygen drops. carbon dioxide increases. and/or pH drops, a dominance of sympa(bctic impulses increases heart rate and stroke volume and constricts "rcs.:rvoir'" vessels. in response.



Stretch receptors in the- a1ria a nd pulm('lnary circulations arc stim ulated by an expansion of blood ' 'olumc. They DO NOT dirccily respond to changes in sy~temfc arterial blood pressure~



It's 4 o' clock on a Friday afternoon, and you are about to do a quick preparation and restoration. When you give the injection, the patient complains of severe discomfort. You realize you forgot to aspirate the needle flrst, and you have just Injected into an artery......


I. Your needle passed lhrough the anery layers in which order? Tunica adventitia, tunica media, tunica intima Tunica media, tunica intima. runica adventitia Tunica intima, tunica media. tunica adve.ntitia
Thnica adventitia, tunica intima, tunica media

2. Judging by their relative thicknesses, which is the toughest vessel to puncture?


Vein Capillary
3. Which layer is thicker; tunica me<lia or tunica adventitia?

4. Which layer is innervated by the autonomic nervous system? Tunica intima Tunica media Tunica adventitia 5. By puncturing this artery, you have hit lhe vessel wilh lhe grealcSl: Resistance

Pressure Cross-sectional arc-a

Blood volume
53 CopyrlgbtC '2009-2010 Dent:t1 Db


Disord I Dis)

I - -- - - - - - '

somctlmes called vasogenic shock, results from the disruption of autonomic nervous system control over vasoconstriction. ~

Anaphylactic shock

Cardiogenic shock

Hypovolemic shock


e 2009-2010 Dn!ta1 Oreckll


or Venel

'l'un1ca intima

Tunle Mtdl~~;

(Smooth MuseJe; Elastic Connective Tissue-) Allows consaiction and dil-ation of \lt:Sstl~ thicker than m ..-cins; mus etc iMervatcd by au1onomic fibm:

Tunic Adventitia (fibrous C't.m,u!ctit'e Ti.'>.Wte)


SmO<>th lin ins

ITovWes flexjble support tbal resistS collapse or injury; thicker Ulan in Ycins; thinner 1han tumca media


Smooth hning wlth se- AIJows cons~ri~ion and dilation of milunnr valves to ensure vessels; thinner t_ han in ::uterit:~.;
OntWa)' Oow

muscle inncrva1cd by autonomic


Pro\'ides nexiblc support thai resisucollapsc or injury: thinnt'f than tunica media


M3k.es up w lir<: wall of

capillary; thinness per

mitS ease ofD"ans.J>OI"'

across vessel wall

Properties of Vessels
Arteries Arterioles Largest pre.ssure Largest resistance

Capillaries Veins

Largest cross-secliooal area Largest blood volume

.'\eurn!!,l'llir shock

Shock is the collapse of the cardiovascular system, characterized by circulatory deficiency and the depression of vital functions. There aro several types of shock: Hypovolemic shock - caused by the loss of blood and other body Auids. Neurogenic sboc.k - caused by the failure of the nervous system to control the diameter of blood vessels. Cardiogcnlc shock- caused by the heart failing to pump blood adequately tO all vital parts of the body. Septic shock - caused by the presence of severe infection. Anaphylactic shock - caused by a life-threatening reaction of the body to a substance to which a patient is extremely allergic. Shock is the inadequate perfusion of tissue. The symptoms of s hock include tiredness, sleepiness, and confusion. The skin becomes cold and sweaty and often bluish and pale. Other symptoms inc I ude tachypnea (rapid respiratory rate), hypotension (low blood pressure). and tachycardia (high pulse rate). The stages ofshock: I. Compensated: compensatory mechanisms (activation ofthe sympathetic nervous system, increased cardiac ouiput, oml increased total peripheral res;sumce) maintain perfusion to vital organs. 2. Progl'essive: decreased perfusion of the heari leads to cardiac depression and deereased cardiac output. 3.Irreve rsible: depletion of high-energy phosphate reserves. Death occurs even if treatment can restore blood flow.


Disord I Dis)

' Jay Sack is a pediatric patient of yours. AI a young age, be was diagnosed "it;;" [ray-Sachs disease. Be bas severe mental and motor deterioration, and your treat men! is minimal as be is expected to die by age 5. His neurologic symptoms are due to the accumulation of the CM2 ganglioside. This is caused by:

A deficiency of a lysosomal enzyme that degrades gangiiosides Increased synthesis of the ganglioside precursor, ceramide A genetic deficiency of phospholipase A2
An increased concentrat10n of the UDP-sugars required for ganglioside synthesis

Copyn&bl 0 2009201() DrntaiiHch


Disord I Dis)

A patient walks into your office "itb yellow discoloration oftbe skin, sclera, and ti.ssues. You Immediately can infer that:

TI1e patient has jaundice caused by hyperbilirubinemia TI1e patient has jaundice caused by hypobi Iirubinemia The patient has diabetes insipidus caused by high levels of ADH The patient has diabetes insipidus caused by low levels of ADH

Cop)'~l C

2009-2010 Deml Deets


d-.,l>f the lipldos... m: I group ur tollemed m<taboli< di.onlcr> In winch hmnful

emouniS u(fauy INII<rial> ..ucd hpuls accumulate'" some: oflhe body's oells and tiSSU<i P<ople with
the$e disorders C'Uht'f do not produce- eoough nf o~ llf'1ht enzymes needed LO met.abo1lzc: hpH.l" or rhc

i-ndhidua.ls produce eneyme$ that do not work properly 0\ er time, lhi_o; ext'..:ssh C' il<rragc of lltts can cause pcnnancnt ccllulnr 11nd tissue damage. J :Nl.rticularly tn the brain. peripheral nervous S)~em. ltver,

and bone marrnw,

Cauclltr dlsran 111 the n1os1 common of tbe lipid sl<irugc disc.scs, It 1s caused by u ddic11.111C:)' of lhc: enzyme ~lll coctrebl'osido!ie. Fatty motcrii\1 t.:nn collect m the splt"en. Hvet, kfdncyr,. lung'\. hrnint -and bone marrow. SyrnJltom~ may inc tude: enlarged spleen and liver. liver malf\tn<.:uoo, skclclal dts-. orders. nd bone I~:Sions that m.ay caus-e ~'" K\cre nc:umlogic oompJica:lions .swellins of Jyrnph nodes. and (ocauloaliy) adjattn< joint>. di,.ended nbdomen, brownish tint to !he tk1n . .,.,.,1.., '-"<
~ftnltnn.. Pltk dllea.se IS JctuaUy 8 group Of tUI\QOmal f'('(lC::SSI\C- dJsordcB c:IU'-C.'<d by n :tunlU latlon of faa and tholesttmlu\ ce1h. of the lhc:r. ~plcc:n. bone martow. lun1t1. nd. an 1t0rne p:lttcntJ,

blood pl.llclctt. 1111<1 yellow'"""' in the C)'t>. nu, d.-<< p;ontrobrly lt-eq\J<nttn Bnuhcs orAsbke> nan (rontrof.._.,.,.,. E~l JeWish an<eW')

bl'3in. ~eurological c-ompltt'Srions mJt)' inch1 de 1U\JOC!a. eye par3lysi~t, brllm deg(11tt:mon, learning pn1\llcms. SpiiJoticit)'. fc:tdin!,! and swa11owing 1.hnicu lt 1~. li:tum.'d spcech 1 losr. of muscle tone, hyperstnslhYitY to touch. aod some cun1eal cloudma. 1l1e diseiJ!Ilt: rc.sulrs frotn tbt- deficiency \lrt h~ cnz:yrnc sphlngomyellruai\lt, which re.<iulls in the autlumularion nr spb l n go01 yeJJn ~ The ch4JtI1Sc iS mor~,: com1m>n in 1h(,sc of Ashkenazi Jewish anccstty TayS~hs dlsu~e ~~ &t nm: inherited dJSOI'dcr th~t causes progressive destructi!Jrl "'r nc~e ~dl5 in the bnin and ;p1nal cord (the ce,II,,JJ ntMo~, ~.ct.-m) The d!SC3St: is uu:;.cd by a dclit1erscy
of cbc enzyme ber . bhou.mlnidrue J\ ~hich rewhS' u1 th~ ucumulatlon or C:tfl gangUo!ldts. e~pt.:~11lly in ne-urons. The dl~i"t tXturs pnmarily in familu~ .. orAsh1cen&71 Jt\\ i~h aottstry ll '" charwetmled by CNS dcgcnt'n111.m "'nh ~\ere menuI and motor detcrionu"n. Death usual!) uecurs by ase 5. Knbbt dls.ellt ''an autosomal reci:$Sh-c dt50f'dC'r cau~ed bydeficicnty of the t"'n:tyme galaciO'\) 1ctramldasr. t~abry dl~tast, ttiS.O known u alpha--gahtcto,ldlut~A dendenc:y, causes a buildup ol (any mutcn"l in the au101101nic nervous system, eyes, kjdne:yl!<, unJ Cl:lrdiovascular system.

Tht p:Hilnl h.1 ... j:tUudin cau"icd h' 11, P"thillruhintmi:J JIIWldiee i> a ytllllWI>~ Jtocoloomoo ofrhe skutsnd ol 1he "h11e. of the eyeo ulb<d b~ abnonnally high ltvcl or !he ppmcnl bilirubin in the bloocbtream. Jaundice JS \el')' r,:(lmm<m Al'd is lbe IQ_dang mamrc~UUCH1 ofhn-r di.SCJSe. Jaunchce C.tn OC:C\lt AI
tmY age lind In (llh" ~X. and. IS t. :0:)'1t1JXUtn Of many dltri01"\1Cti~ liver d1seibe~ p.JI~ti.Jnt~. r.anc-rt411C

and acute biliary nb~otruction The normal pta,mo t.'at'l~trahon of bilirubin




.-ng per I00 ml uf pl~sma . In jsun<hcc. the plastlll

Dyptrblllntblnttn la c:ould be cause-d b):

of b11irvbincan


co :t.i htg.h as

hKrtas~d f,lfirobJn produc-non Dtcrcasc\1 \tptnkc into the Hver cells .. lm,-,aJred cunJUJ:Pition lnterfc:rcncc wnh the ~creuoa ofOOiljll!:,-tlttJ bltrubin Example> of .w..:..., m Whith hyperbillrubineml b oll>er>rd:
fltmoi}II<Jounrll : ResultS '"ncffhed pcOOuct"'m <.'(bfhf\1.,10. Here mort b.tinlbH11$ cQ41jup1ed and c;w;cKIC'd 1h3n nunnally, but the COilJU,gauon m-twusm is Ch e:whclmcd, and Ill abnorm~lly lllll< OII"IOWII ofunconjUJlllted bilirubin i> round tO lhe hloodGilbe.rt's dlstase:

May be c:t~u l!c.d h)' ~m inability of the hepah.~YltS t(l L1k.o 1.1p bilirobm &om the h1ucxJ. As:\ teSUh1 unconju~ned bilirubin u t~:~unwhH~.
Ph)'$lol ogltt~l

jltundlce twd CrlglerNojjllt

~)1 n drn m c:

Are c:onchllon1 in whiC'h c-onjugalit.~n h lmpu1rcd. Untonjuga<ed bilirubin i> relllin<'<l by tho bvdy
Oubhwoho<on <yndromo: Is ass~>CiarcJ with ln>h1ii1y of the hepotot:yt<! to ~r<t< co1\jupted bihrubm ol\er il h>.< been

COOJIIPiod bil1rubm n:l\lm> 1o the blood BiliaT) ob>truetlon: (For v:att~piJ bthat)' clruh aUS<s backup nd rc:11fhorp1ion of<oiii\IJ!Oied holirubon. Blood I<' tis ofcoojugoted bilirub10 ,..,,..,,,..,


Disord I Dis

( Oo the medical history form, your patient answers yes to aU of the following) \.. symptoms. Your patient are most likely suffering from what condition?

Feel nervous, moody, weak, or tired

Have hand tremors, or have a fast or irregular heartbeat, or have trouble breathing even when you are resting Sweat a lot, and have warm, red skin that may be itchy Have frequent and sometimes loose bowel movements Have fine, soft hair that is falling out Lose weight even though you are eating normally or more than usual

Copyri_gbt C 20092010 ()('n.tal DtckJ


Disord I Dis

Addison's disease occurs when the adrenal glands do not produce enough or the D ~ormone and, in some cases, the hormone . A.

Glucagon, estrogen ADH, oxytocin Cortisol, aldosterone Epinephrine, norepinephrine

Cop)'rigbl 0 20092010 Delta! Dc<:k$

II~ perlh~


Excessive production of the thyroid honnone thyroxine produces the symptoms of bypcnhyroidtsm. The primary role of thyroxine is to stimulate cellular metabolism, growth, and differentiation of all tissues. lu excess, therefore, thyroxme leads to htgh basal metabolism, fatigue, weight loss. excitabflfty, elevated ICntfleramrc, and generalized osteoporosis. People wnh Gruvcs' diseQse (the most cummmrjonn of!ryperthyiYJIIIismJ oflcu hove ad ditional symptoms, including the following: Goiter, which is an enlarged, painless, soli thyrmd gland Thickened nail that lift off the nail beds Mytedema, whrch is lumpy. ttddr>h, thick >kin on !be from of the shin.' and some times on top of the feet Clubbmg (fltlgers "ith wid~ tips) Exophthalmos (bulging eyes)
I. Oral manifestations arc not too tcmnrkable, but if th~ disturbance begins Note< iu tbe eotly years of li fe, premaluru eruption or the treth and loss of the deciduous dentition are common finding,. 2. Plumm~r'> disease (also called Pcmy ~ tlr<etLVe) is tlte cau.<e of ubout 5% of cases of hyp<~nhyroidi<m. Tbts ~sulrs from the pre.~ence .,r m:my toxic thyroid nodules \>itbm the thyroid gland. Exophlhaltnos is r-..re 3. The symptoms of hypoth) roldism include weight gain, ~nld mtolerancc, decreased cardiac output, hypovenrilation. droopmg C)Ciids. lowered pitch of voice. mental and physical slowness. constip~uon. dry sk.in. coarse hair, and puffinc~, of the face, eyelids, and hand.

Addison's dbuse tolro ,;a(fed odrenul /n.<ufliden~. or ilypQt.'Orti.rolrim) is a life

threatentng conditron cuused by parttBI or "'mplctc fatlure o( adrenocortical fu nction (insuffici~nl giH<'<JCOrtiCOJc(s ond mmeralocorlll:ocdsj. More than 90". nf the cnne~ of the adrenal must be destroyed before obvioui sytnptl>m< <lur. In 70% of people wtth Addison's disease, the CIIU~e tR not prectsely known. but the ;tdrenal gland 11re 01ffected by an autoimmune rructlon in which tit< bally's tmmune system attacks aod destroys the adrenal cortex. In the other 30%. the adcenul glnnd nre destroyed by cancer. an 111feclion such as tuberculosis~ or unutb~r 1 dentifiable d)senrse. The disease ls chnractcrized by weight lOS>. musde wcakne~s. fatigue, low blood pr.,;sure. and sometimes darkening or thf skin in both c.,po,cd an.l nonexposcd pans of the body. Oral signs consiSt of dinu>e pigmentation of the gtngiva, tongue. hard palate. und buccal mucosa. Conisol is oomu.lly procluced by the adrcoal gland>, locatedjustab'"" the lodll<.")'>. It belongs to a class of bo~ called glucocortlrolds. which affect alniOst evel') organ and ll>SU< in lhe body. Conisol's most imponant joh i to help the body respond Ill stn:ss. Amon~ conts.>l's other vitultasks, conisol: Helps maintatn blood pressur<: and cardmvascular 1imction Helps slow the immune system's inllummatory rc:.<ponse Helps bolnnce the ell"ects of insulin In bn::tkmg down sugar for ener~y Helps regulate the metabolism of protein>. CQrbohydmtcs. and fats Helps maintain proper arou.al und sen.-. of well-being Aldosterone btlong> tO a classofhomtonescalk~l mlneralocorticoids. uloo ptttduced by the adrenal glancb. It helps maintain blood pres""< and water and salt balance '" the body by helping the l..ldney n:tain :.odiwn and excrete powstum. \\"h<n oltlootc:ront' proclucuon taUs too low, the ktdneys are not able to regulate salt and warer b31anee, uusing blood volume itDd blood prcs.,uro to drop.


Disord I Dis)

All of the following statements about a person with type I diabetes mellitus are true EXCEPT one. Which one is the EXCEPTION?

There is linle or no insulin secretion Dietary treatment may not suffice There is hypoglycemia Ketoacidosis and dehydration may develop

Cop)'rigbl 0 20091010 Denl.ll Oecb


Disord I Dis)

Diabetes insipidus resembles diabetes mellitus because the symptoms of both dl~eases are:


Decreased urination and hunger

Increased urination and thirst

Decreased urinary output and weight gain Increased urinary output and weight loss

.,. .,. This is. raise; there is hyperglycemia. Diabetes is a disease in which the body either fils ro produce any Insulin (type I . ol.<o ~ailed Insulin-dependent or juverrile-onset). or the insulin thnt the docs produco ;, unable to ade quately trigger the conversion of food into energy (I)'J)e 2, "lsu called llonillsulilldepe~~tle/JI or adult-onsel). Sylllptoms or diabetes: Excessive rhirst Frequent skin, bladder, or gum infections Frequent urinmioo lrrit3bility Weight loss l'iu!!ling or nwubntss in hands or feet Blurred vision Slow-to-heal wounds Increased hunger Extreme unexplained fatigue
( 1111Jlllf"~()n ul I \pt I 1111d I 'JH ! lhahcl~'' \lt'lilm
Ch.araer erl~tlt

T)pt 1 Ulahtft!

Typl' .2 Dlabt:tli$

r...:vel ofrru.1.111-n ~100

Typical ageofmto.:t-

Nooc: nr almosl nooe

M!ly be: mmnott or 01\.tCed norm11l


I D-10%

Pc:rtentayc of diabet.es

Oc$tructmo ofB otll\


R.OOuc< ~~tiVIly of Insulin '6 carget ~lls

,.,_;ftlod Wilh obesity


Speed of deve:k>pmcnt M

Cm1mun lflln~led

Oevelop.ncnt of ketoJS1S

fmsul tn injhOn~ Jietar; manal!cc1nem

mecary conrrol ~d weiglu redoolot~: ocett slomolly ani h)'ll<l!l)yccmic droll'

lm:naM:d urination and thi"t

Diabetes insipidus i. not-the same as diabetes mellitus. Diabetes io~tpt<lu roserubles diabetes mellitus because the symptoms of both dise~ses arc increased urination and thirst However. in every other respect, including the causes ~ud treauncnt of the <llsor<lers, the iliseases at completely unrelated. Sometimes cliabetes insipidus is reft"rrtd to as ""'''ate.r' diabetes to dfstin,Yllish it from the more common cliabetes mellitus or '"sugar'~ diabetes. Diabetes insipidus (D/) is a disordl;!r in whjch thcr~ ls an abnormal increase in urine nutpu1, Ouid intake, and often thirst. Dl cause:; symptoms >UCh as urinary frequency, nocturia (frcquclll awakening at night to ttrinate). or enuresis (irtVt>lunwry z'nnation dun'ug sleep or 'hedwel ling"). Urine output is increased because it is not concentrated normally. Consequently, in stead ofbeiog a yellow color, the urine is pale. colorless. or watery in appearance and the measured concentration (osmnlality or $pecljicgravfty) is low. In diabetes insipidus (Dl), thero is a failure to either produce ADH (more co/IWIOII) or for the laduey tu respond to ADH (rare). Ln Dl, there is almost pure water loss. often witl1 maintenance of norOlal sodiunl balance. ln Dl, the insufficient levels of antidiuretic hormone (ADH) cause e.cessive thirst (polydipsia) and e~cessive production of very dihue urine (polyuria). The normal net inn ofADH is to increase the reabsorption of water from the renal tubule, producing a smaller volum" of concentrated urine. AOU is produced in the hypothalamus, and then stored aud released into the bloodstream by the J lOSterior pituitary gland in response to elevated plasma osmolarity. Important: Hypoactivity ol' the posterior pituitary glaud or destruction of the supraoptic nuclei of the hypothalamus will result in diabetes insipidus. This deOciency of ADA results in failure of tubul;u- reabsorption of warer in the kidney and the consequent passage of a large amount of diluto urine ond great thirst. Note: ln diabetes insipidus. the body fluid volumes romoin pretty clos<O to normal $0 long as rhe person dtfnks enough Water to make op for the increased clearance of water in the urine.


Disord I


Have mental retardation Jlave srunted growth

Newborns wllh phenylketonuria:

Have seizures, tremors, or jerking movements in the arms and legs Don r have any symptoms


Cocl>,.iahtO 2009201 0 lkntal Oeel:s



In your practi~e, you see quite a few HIV/AIDS patients. These patients ba"e the unique ability in that they c.an:

Produce(+) ssRNA from a(- ) ssRNA molecule Produce(- ) ssRNA from a(+) ssRNA molecule Produce DNA from an mfu'IA molecule Produce dsRNA from an s;,RNA molecule

Cocl>'rialt1 o 200920 1 o J>mtal Oecl:s

u Newborns with phenylketonuria don't have any symptoms. Without treatment,

though, babies usually develop signs of PKV within a few mouths.

Enz) nu: Uclicu.nn

Cause or En1.yme T'hst I s Oenclc-nc PhcnylaJanine hydroxylase

Results or De.fidenc:y Appeamnc:e of phenylalanine and its degradalion pmd1,1Cl$ (c..g.. pkcn:ylketOMs) in lbe urloe


Maplt.syrop wine Alpha-keto acid dchydtogenast


Branched amine~ acids (wlin~, i.tolt'IIC'im:~ ami le11cine) are CXCfl!tcd ~n til<" c.srin~
Oxidized l!rodlscts ofbOftlogentisic &cjd @ivc urine \II
da:rk color

llomogentistc ucid oxidase Delieimey of he intestinal and k.idnty tr.loSpOrt protein of cystine Tyrosinase


K id.ney stcmes
Defect of melanin pro<JuctiOI Jih.al resul13 in p311ial or full nbs::.ooc or-pigm~'1ll0lrion


- - I. Phenylalanine and tyrosine are both essential amino acids. Notes 2. Tyrosine is produced by hydroxylation of the C$sential amino acid phenylalanine. 3. In phenylketonuria, tyrosine cann ot be synthesized in adequate amounts and is required in the diet.

Product ()'JA from a mR'\.\ rnnlr-cul('

*** Using lhe enzyme "reverse transcriptase"

Reverse transcriptase is a DNA polymerase rhat uses RI\'A as its template. Thus, the enzyme is able to make genetic iofonnation now in the reverse (RNA -- DNA) of its normal direction (DNA -- RNA). Certain RNA viruses contain within the viral particle a unique RNA-directed DNA polymerase that is called re\'ersc transcriptasc. On infection, the single-stranded RNA viral genome and the enzyme enter the host, and the reverse transcriptase catalyzes the synthesis of a ONA strand comp lementary to th e viral R.~A. Reverse transcriptase enzymes are foUJld naturally in certain viruses called retroviruses. These are viruses in which the genetic information is carried on an RNA molecule. When one of these viruses infects a host cell, it uses this enzyme to make a complementary DNA (eDNA) copy of its genetic infonnation, which is then incorporated into the host ON A. - - . I. The human immunodeficiency virus (H!V), the causative agent of AIDS, .Sotes' is a retrovirus. 2. The drugAZT (a thymidine analog) is a competitive inhibitor oft he H.IV reverse transcriptase. The wild-type reverse transcriptase seems to have a bigb affinity for AZT and other base analogs. 3. Reverse transcriptase is one of the enzymes used in genetic engineering, in which tbe enzyme can be 11sed to obtain a copy of a particular gene from the relevant mRNA .



Some proteins are produced by r ibosomM that are attached to the cytosolic surface of the rough endoplasmic reticulum. Whkh of the following is not a possible destiny of these proteins?

Becoming a collagenase Becoming a sodium/potassium pump Becoming a proteolytic enzyme Becoming a ribosome

63 Copyright C 2009-2010 Dc1t~al Deets



Genetic recombination experiments depend hea,ily upon the action or which two enzymes?

Restriction endonucleascs Alkal ine phosphatase DNA ligases

Creatine kinase

64 Copyri.gbt 0 20092010 Denu.J Deck$


a ribosonu

Because ribosomes are found in the cytoplasm of cells and are made of rRNA. Ribosomes are the protein-synthesizing machines of the cell. They Lnmslate the information encoded in messenger RNA (inRNA) into a polypeptide. Ribosomes are small smtctures found nouting free in the cytoplasm (polyribosomes) that contain rRNA and protein. At a ribo$ome, amjno acids are linked together in the order specified by mRNA to form a polypeptide. or protein (/his process is called prorein ,vnrlu!Sis or rranslarion). Ribosomes have enzymatic activity, T~ey catalyze the forma<iou of peptide bonds, which link amino acids to one another. Many ribosomes in different stages of~tanslution can be attached to a single mRNAstrand, thus multiplying its effect . Some are anacbed to the cytosolic surface of the endoplasmic reticulum mmbrane (wlte1t they are allac/1ed, 1/ is railed nmgh endoplasmic reticulum. RER): others remain as free ribosomes tu Oto cytop13$m. Proteins fomted by ribosomes attached to Ute RER are destined for secretion from the cell, iucurpuratJon into the plasma membraue. or !ormation of lysosomes. Since Hll protein synthesis begins on free ribosomes, atraclunent of a ribosom" It> Ute RR requires the presence of a specific sequence at the am ino end of the growing protein chain to signal Ute attachment of the ribosome to the ER. I. The 70s ribosomes are tbe sitt.S or protein synthesis (nanslaiiau) in Not.. ba"tcrial cells and chloroplasts. 2. The 80s ribosomes are the sites of protein synthesis (tr!lns/atirm) in the cytoplasm of eukaryotic cells. 3. The other answer choices are incorrect because: -A collagenase invul vt-s secretion !Tom the cell. -A pump protein involves incorpomtion into the plasma membrane. -A proteolytic enzyme involves incorporati(m i~to Jysosomes.

l~l'St rirf ion t'tHIHU lll'IL'USt'S

l>i\ .\


Tlte nuclease is used to cleave both the DNA to b~ Dloncd and o plasmid DNA. The specificity of the n11cleose is such that, when mued. the DNA to bu cloned rutd tho: plasmid DNA will anneal (base pair) and can then be joined tQgerher by a DNA ligosc. Important point: Restriction enzymes ore site-specific endonuclease~. Southern blotting is a technique that can be used to detect mutations in DNA and cau also identify DNA restricuon fTagmenb;. lt combines Ute use of restriction enzymes and DNA probes. Advances in tbis technology /ONJI cloning) are revolutionizing many aspects of medicine, agriculture. and other industric,~. Commercial products of r ecombintnt DNA tec hnology include hurnon insulin ({or diabe1es), anticoagulants (tissue plosminugenfacto~. or ythropoletin ({or 1111et/lia), and bum an growth hormone (for

l. The first organism used for DNA cloning was E. coli. and it is $ Iill the 'lot most cQmmo~ nos\ cell. Bacterial c loning vectors include plasmid s, l>acteriophg"'l. and cosmids. 2. Som~ otber enzymes that ar~. used in recombinant D NA technology (ge11e clo11ing) arc: DNA polymerase l -- tills in the gaps in duplexes by stcp-wi$c addition of nucleotides to 3' -end. Reverse transcriptase --makes a DNA copy of an RNA molccul~. E;ronucl~ases -- remove nuclcotidcs from 3'-ends of a DNA strand.



All of the following statements arc true EXCEPT one. Which one is the EXCEPTION?

The replication of DNA involves some RNA intermediates The replication of DNA involves DNA liga.s e linking DNA molecules together The replication of DNA requires unzipping of the DNA molecule The replication of DNA involves the bui lding oft he new ssDNA strand from 3' to 5'

Copynght 0 20092010 l>tMIII ~ks



Which or the following enzymes Is not involved in unwinding, unzipping, and rezlpping the DNA molecule during replication?

Topoisomernses Helicascs Gyrases Polymerases

I he. r('pliration ol 1>:":.\ itnuhes the l'rnm .r tn ~


nf' th('

IH'\\ :oo;!-iO~-\


***&'<A intermediates are involved to prime the DNA polymemse and later being rc. placed by DNA. Replication is the process of completely duplicaHng the DNA witbin a cell. The primary enzyme in this process is DNA polymerase, which reads a single strand of DNA from the 3"-end toward the 5'-end while forming the new, complementary, continuous strand from the 5'-end toward its 3'-end. As the DNA polymerase complex moves along the DNA molecule the original complementary strand (laggi11g strand) is also duplicated. The DNA polymerase that is moving along the Jagging strand from the 5' -end toward the 3' -end titus tilllnOt form a cominuous copy of the Jagging strand. Instead, the DNA polymerase forms approximately 1,000 to 5.000 base long multiple segments (Okazaki fragments), which arc joined together by DNA ligase to form a continuous stTand. DNA polymerase can only add nucleotides to a pre-existing piece of nucleic acid (primer). During replication. the primer is provided by R NA polymerase, which has no primer requirement. The short IObase segments created by RNA polymerase are removed, once the DNA has been added to it, by an exonuclease, and the gap in the sequence is filled in by a DNA polymerase. I mportan i point: RNA polymerase synthesizes polypeptide chains from oucleotidcs and does not require a primer chain. Note: Topoiso mcrascs are responsible for unwinding supercoiled DNA to allow DNA polymerase access to replicate the genetic code. The enzyme DNA gyrase reforms the supercoilcd structure once the replication fork has passed.

Pol~ me rases

*** Polymcrases are used in

replication itself.

The hydrolysis of DNA (deoxyribonltcleic acid) wi ll yield: Phosphor ic a cid Deoxyribose (sugar) Nitrogenous base (adenine, guanine, thymine, aud !J'tosine) Tite hydrolysis of RNA (ribonucleic Acid) wW yield: Phosphoric acid Ri.b ose (sugar) Nitrogenous bases (adenine. guaniue. uracil, and cy tosine)
I. Ribose and uracil arc the only differences between the products of R..'IIA 'Nores and ONA hydrolysis. 2, DNA is double-stranded ; RNA is siJ1glestranded. 3. R eplication forks are sites at which DNA synthesis (replicmion) is occur-

4. Helicascs unwind the helix. Topoisomerases arc responsible for unwinding supcrcoi led DNA to allow DNA polymerase access to replicate the genetic code. The enzyme ONA gyrase re-fonns the supercoiled structure once tbe replication fo rk has passed.



Which of the following Is contained in a nucleoside?

Nitrogen base Ribose/deoxyribose sugar Phosphate

Two of the above All of the above

&1 CopyriSbtC 2~ 2010 Dcn1ol Db



Which of the following are the same in RNA and DNA molecules?

The purines The pyrimidines Both the purines and pyrimidines Neither the purines and pyrimidines

Copyn!Pt 0 2009-2010 Dtnlal Detb

T" o of thl' abo\ r

**" Nitrogen base and sugar, A nucleotide also contains the phosphate.
A single base-sugar-phosphate unit is called a nucleotide. Without the phosphate group, tbe molecule is called a nucleosid. These individual nucleotides are linked together to form a polynucleotide chain (tire link or hond is between a plro.<plrate group of one nucleotide and tire sugar of the ne:rt). lf tbe polynucleotide chain contains the sugar ribose, the chain is called ribonucleic acid (RNA): if tl\c contains the sugar deoxyribose, the chain is called deoxyribonucleic acid (DNA). Nucleic acids store and transmit information to synthesize ilie polypept ides aud proteins present iu tlre body' s cells. Nucltic acids are complex molecules composed of stmctures known as nitrogenous bases (pru1nes and pyrimidines). five-carbon sugars (pentoses), and phosphate groups (w!ric!r contain plwsphoru.< and Q>}'gen). Important : The backbone of nuclek acids is made up of alternating, phosphate and pentose units , with a purine or pyrimidine base a"ached to each. The cat;ibolism of a nucleotide (single bose-sugar-pho. plrare writ) results in no energy produc.lion in the form of ATP (as opposed to tire cmabolism of a lipid, protein, ur carbo!rydrate, w!rlc!r does).

'I lu Jlurint.s ***The purines (A and G) are the same.

.DNA, the pyrimidine bases are thymine (T) and cytosine (C). In R;~A, the pyrimidine bases are uracil (U) and cytosine (C). *** The phrase "CUT down lhe pyramids" may help you remember that cytosine. uracil, and thymine are all pyrimidines. Remember: The backbone of the DNA molecule is constant throughout the entire molecule, and consists of the deoxyriboses linked by pbosphodicstcr bridges (I.e., !he 3'-0H group of tire sugar of one is linked to tire 5'-0H of rlre nexl sugar by a phosphate). The variable part of the DNA is the sequence oftbe bases, and tlte precise soquence of the purine and pyrimidine bases carry IJ1c genetic infonnarion to express the characteristics of the organism. The DNA chain bas polarity with one end of the chain ha,ing a 5'-0H group while the other end has a 3'-01 r group. - - 1. Purine bases that are consumed In tbe bum<Ul diet ao the form of DNA or Notes RNA are mostly excreted in the form of uric acid. Xanthine oxidase catalyzes this formation or uric acid from purine bases. 2. The use of tetrohydrofolic acid (TFA) by several of the enzymes in purine and pyrimidine synthesis has made 'J'FA metabolism a prime target for a number of anti metabolites, such as methotrexate, used rn cruwer chemotherapy. 3. Ultraviolet light produces pyrimidine dimcrs in DNA, which then interferes with replication and transcription. These lesions are removed via tbe action of rur exonuclease, an enzyme that excises it 12 bp (ba.ve pair) fragruent surrounding the dimer. Then DNA polymerase J !ills iu llr< gap, :rnd DNA ligase seals the searns.



Which of the following RNA mutations is least likely to have a significant effect on the product protein?

The elimination of the third amino acid in a codon The elimination of the first amino acid in a codon A substitution of the third amino acid in a codon A substitution of the first amino acid in a codon

69 Cop)Tight e 2009-201 0 Dcn~al Ottb



r A sequence of DNATeads "A-T-T-GC . many hydrogen bonds would ~Yl - -A." How
\.. you expect to see holding this sequence to its complementary strand?

1 4


1 8

CopyriJhl 0 2009-2010 Dc-.lltal Otcks

\ \Uh\tilulion of fhl' third aminu .1dd in a cm.J:on Due to the "'\Yobble" effect Oegeneracy or the gene lie code: There are 64 different 1riplet codons, and only 20 nOJino acids:. Unless some amioo acids are specified by more than one codon (sometimes nfrnw!d to a\ a triplet), some codons would be completely meaningless. Therefore, some redundancy is buill into the system; some nmino odds arc coded for by multiple codons. In some cases, lh~ redundant codons arc related to each other by sequence; for example. leucine as specified by the codons CUU, Ct.JA. CUC. and CUG. Note how tbe codon~ are tlw same e~ccpt for the third nucleoti de position (althe .l 'ut~d). This third posiuon is known "' tho " wobble" position of the codon. This is because in a nwnber Qfcases, rhe identity ot' the base at Ihe third position can wobble. und the same 31111110 acid will slill be specifLcd, This property allows .some prorection agaillSI mu til~ion -- if a mutation occurs at the 1hird position of a codon, the~ is Agood cb:l.uce tbat tbe. amino acid specified ln the encoded protein won '. t <-h-angc. l mpo rtnt: Only trypt<ophan, mcth1onlne, and sclrnocystcine arc coded by just one codon. Tbc other lR amino acids ~to coaed by t>vo or ruorr. Codons that srecify 1he sume an11nn acid are callc(l synonyms. Several of the codons !Serve special f\utctions: l. lnititttion codon (II UG) signals the beginning of roiYJleptide chaons and codes ror 111elhion1nu: thus illl proteins begin with methionita.'. 2. Termination coduns (UAA. UA(;, nnd UOAJ .. signal the cud of polypeptide

chain ~yn.thesis. These oodons are ttlso rofcrred to as stop coduns or nunsrnst' codons. I. An anticodon is a specific sequen.ce- of three l'\llcleolidt;S in v transfer RNA. Not~ complementary to a codon for an am iuo acid In n messenger RNA. 2. Remember; The IWO RNAs ue paired antlparll<l the first base of the c.odon (olway.r reading iu the 5 ' -- J tliremimiJ pairiog with the third base of the anlicodon. fo r example, if 1he anticodon on a 1ransfer RNA is 5' ACG 3 then its corresponding codon on the messengor RNA would be 5' CGw 3' .

14 (2 in each 1-T puiriu~ ami 3 in



The two antlparallel polynucleu tlde chains of double-helical DNA are not identical in either base sequence or composition. Instead, they are complementa ry to each other. Wherever adeniue appears in one chain, tl1ymine is found in the other: similarly, wherever guanine is found in one chain. cytosine is found in the o lher. Important point: The acluality that separated DNA strands are able to r eassociate represents the conseqt1 euce of the fact that DNA strands are cumple.mentary. Note: Watson and Crick deduced this s pecificity of base pairing because of stearic and hydrogen-bonding factors. In the Wa tson-Crick structure, the twu chnins or strands of the helix are ntipurallcl, such that one strand runs 5' to 3' ("five prime lc> three prime') whi le the other l'\lllS 3' to 5'. The DNA d o uble helix is held together by iwo sets of forces: hydrogen bonding between complementary base pairs and base-sta cking l ntQractlons. The helix structure results in a m ajor and 11 mluor groove being formed along tl1c DNA molecule. Tb~ major groove is the binding region for many p ro teins th.at control tbe transcriptional activ[ty o f the DNA molecule. l.mportant: Three h y clru~cn bonds can form between G and C, but o nly t wo can form betweeo A and 1 . The weaker bonding between A ~nd T (or U /11 RNA) is Ltsed in transcription to aid in the release of the newly formed RNA from t he DNA rcmplate.




A sequence of DNA is "T-A-G-T-A-T-CAT," What would the complementary RNA sequence be?

A-T-C-A-T-A-G-T-A A-U-C-A-U-A-G-U-A U-T-C- U-T-U-G-T-U

71 CopyriJb! 0 2009-2010 Oo:ntal Olx:kl



( All of the following statements concerning the backbone of DNA arc tru;'\
\._ EXCEPT one. Which one is the EXCEPTION? }

h is constant throughout the molecule

It consists of deoxyriboses linked by " phosphodiester bridges" or "phosphodiestcr bonds"

It is hydrophobic
It is highly polar

Cop>'liSh1 0 20092010 Oenttl Dc-ks

A-l '-C-A-l' -A-C.-l'-A

cousi~ts of two polynucleotide chains that run In opposite directions to one another. The two strands of DNA fonn a double hcUx that runs antiparallel such that one strand nms 5' to 3' t:flve pri1ae 10 three prime") while the other one runs 3' to 51 The purine and pyrimidine bases that are opposite one another (adenine with thymtne and guanine wit!t cytosine) in each polynucleotide chain are linked together by hydrogen bonds. The A-T buse pair has two hydrogen bonds while the G-C base pair bas three. This base pairing (A wilh Tand G with C) is known as complementary base pairing.

A complete DNA molecule

Remember: This complementary base pairing can also occur in RNA and between RNA and DNA; however, uradl subslllutes for thymine in RNA. Uracil base pairs with adenine. Important point: The A-T base pair promotes helix stabilization in DNA but docs not do so in RNA .

!.In all DNA, the number of tl!ymioc residues equals tlle numb~r of adenine
)iot.. residues. Also, the number of g uanine residues equals the number of

cytosine resid11es. 2. P urines are the larger of the two types of bases fount! in DNA. 3. In addition . the sum of purine residues equals the sum of pyrimidine residues (A + G ~ T C). 4. The melting temperature of tht double helix is a function of the base comrosition with a higher GC content having a higher melting temperature and an increasod stabili ty of the double helix.

It is h)drHphnhir

This is false; it is bydropbilic. The backbone ol' ON A, which is constant throughout tbe molecule, consists of deoxyrlbuscs linked by Jlllosphodlester bonds. .Note: The backbone of RNA couststs ofrlboscs linked by tbe same phosphodicster bonds.

Spe~iOcally, the 5 ' -hydroxyl gr011p of one nucleotide unit is joined to the 3' -ltydroxyl group of tbe next nucleotide by a phospbodicstcr linkage. Thus, the covalent backbones of nucleic acids consist of alternating phospbate and pentosc residues, and a purine or 11yrimidine base is attached to each pentose. The 5'-0H group and the 3'0H moiety are Hnked in <1 condensation reaction. Features of the DNA Double Helix: 1\vo DNA strands form a holical spiral, winding around a helix axis in a right-handed spiral. The two polynucleotide cbains run in opposite directions. The sugar-phosphat< backbones of the two DNA strands wind around the helix axis like the railing of a S}liral staircase. The bases of the individuul nucleotides are on the inside of the helix:, stacked on top oft'llch <>Uler like the steps of a spiral staircase.

l. The backbones of both DNA nod .RNA are hydrophilic and highly polar.
Note 2. The hydroxyl grouJlS of the <ugar residues form hydrogen bonds with

water. 3. The ribose phosphate p011iou of purine and pyrimidine nucleotides comes from 5pho<phoribosyl-lpyropbosphate (PRPP) . PRI'P is synthesized from ATI' and ribnsc 5-phosphnte, whicb is primarily formed by the pentose phosphate pathway.



Which material comprises most of the RNA in the eell?

Messenger RNA Transfer RNA Ribosomal RNA

Cop)righ1 0 2009-2010 Dnl\21Deb

The activity level of which enzyme controls the rate of glycolysis?

Aldolase Phosphoglucose isomerase Phosphofructokinase Triose phosphate isomerase

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Ribosom;ll It'\ \ Transfer RNA is next. followed by messenger RNA. Types of RNA: I. Messenger R. " 'A (m.RNA) molecules carry infonnation (genetic <:ode) !rom DNA in the nucleus to ribosomes in lhe cyloplasm, where polypeptides and proteins are synthesized (lranslatiort} -- utRNA Is the 1emplu te for protein syn thesis a nd conlalns the rodon.

1. Transfer R NA (tRNA) molecules carry the amino acids to ribosomes, where the amino acids are linked together in the order specified by mRNA to limn l)articular polypep1ldes nnd pro1eins. Nole: Amino acyl-tRNA synthetase is a group of ligases (enzymes) that ensures thllt the correct amino ac\d is attached to the tRN A with the COITect anticodon 10 be used during protein synlhcsi~. Individual enzymes arc highly specific for one amino acid. No error check i.ug occurs during the tran$1ation process on the ribosome.

3. Ribosom al RNA (rRNA) molecules ate the major componenr of ribosomes, which are the physical and chemical stntctllres on which protein molecules are actuall y assembled. Remember: Transcrip tion is the process in which DNA serves as a template for the assembly of molecules of RNA (all three types). This process involves the enzyme MA polymerase.

Phosphol ructokina"il'

Phosphofructoltinast (PFK) is a glycolytic enzyme that catalyzes the irreversible transfer of a phosphate from ATP 10 fruclose-6-phosphate. TI1is is the moSI important control point of glycolysis. lmportanl point: The phosphofructokinase reacrion is 1he rare-limiting step in glycolysis. The rct1clion, wbieb is shown below. requ.ircs an input of energy from ATP. fructose6-phosphate + ATP pllOsPho-rruitOkinas.r fructose-l.6-bisphospbntc + ADP This allosteric enzyme IS Slimulaled by ADP and AlvlP and is inhibited by ATP and citrate. In other words, the enzyme is most active when d1c energy of a cel l IS low. l'ructose-2,6bisphosphale i,s an lmportaJli allosteric acliVaiOr ol"thls enzyme and an allosteric inhibitor of fructose-1,6-bispbosphalase, which physiologically reverses thfs rcac1ion at lhe. end of glu concogenc$IS (glucose iYntlresis). Aldola~e convens frucwse-1,6-hisphosphalc (6-carbou metaboJite) into two J..c~trbo n metabolites. dihydroxyacelonc phosphate and glyccraldehyde-3-phospllate. ThiS 1~ called the aldolytic reaction of glycolysis. Aldolase is plentiful in skeletal and hear! muscle ussues. Glycolysis occurs in the cytoplasm in the absence of 0~1'geo and involves the lbllowing~ I. Two molecules of ATP are used to pho:<phorylatc glucose and start glycolysis. 2. 'nte phosphorylaled molecule is !hen broken down in a series of reactions inlo two, !bree carbon molecules (lysis). 3.Two molecules of NAD capture " and are reduced to 2 molecules ofNADH H 4. Four molecules ofAT I' are produced by substralc phosphorylarion. 5. The end product pyruvate may then either undergo aerobic respiration in the mitochondria or anaerobic respiration (/e1,;entation). Net Gain on ATP I. l'hosphoglucosc Isomerase catalyzes < ho isomerization of glucuse-6-phospha<e 111 ~Ot~ fructosc-6-phosphate. 2. Triose pho5ph16te i!iomcrase iruerconvcns dihydroxyncetonc phosphale and glyoernldehyde-3-phosphftte.

I. The flrst sign of myocardial infarction In a patient is a

high plasma level of which enzyme listed below?

li.. 2. ln liver disease, wbicb two of these enzymes will be elevated in the plasma?..J

Creatine kinase (CK) Lactate dehydrogenase (LDH) Glutamate-pyruvate transaminase (OPT) Glutamate-oxaloacetate transaminase (GOT)

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All of the following statements concerning transamination reactions arc \\.. true EXCEPT one. Which one is the EXCEPTION? .J

These reactions involve the transfer of an amino group from one amino acid to an a -keto acid The enzymes that catalyze these reactions are known as transaminascs or aminotransferases Glutamate and a -ketoglutarate arc often involved in these reactions, serving as one of the amino acid/a -keto acid pairs Pyridoxal phosphate (PLP), which is derived from vitamin B. serves as the cofactor for these reactions All am ino acids participate in these reactions at some point in their catabolism
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I. Cnatinc Kina\e (Ch) 2. (;lutamolfc-u,uluaCltah. lnn~lliiiiii:&Sl' ((,'{}TJ Lluhtm:tll.. p~ rll\ at{' tr.msmninuse (fii*T)

** The plasma levels of these ellzymes are commonly determined in the dingnosis of
myocardial iufu rction. They are panicularly useful when the ECG is dinicuh to

*** Cre-atine klnase is the nrst heart enlyme. to appear in the blood after a hean attack, GOT is the ncxlto appear, followed by GPT and LDH.
Some enzymes show relatively high activity in only one or a few tissues. The presence or increase<! levels of these enzymes in plasma thus reflectS damage to the corresponding

For example: In rhe liver: Glutamate pyruvate transaminase (GPT): also called alanine aminotransferase (ALT). This enzyme functions in the trnnsam1nation of alphakeioglularate and L alanine to glutamate and pyruvate. Glutamate-oxaloacetate tran< amlnase (GOT): also culled aspanate aminotransferase (AST). ***These two enzymes are elevated in nr:ar1y all liver diseases. ln the beart: Creatine kinase (CK): also called creatine phosphokinase (CPK/ Lactate dehydrogenase (LDH) : dffterenr isozyme characteristic of heart muscle Glutamate-oxaloacetate transaminase (G01J Glutamate-pyruvate transaminase (GP1J

.\11 nminu :tcich participate in these r('actions al some puinl in thl'ir CHI.tholism

... This is false; lysin~. serine, no threonine are not transaminated. The first step in lhe catabollsm of most amino acids involves the removal of the a amino group. Once removed, this nitrogen can be utcorporated into other compounds
or excreted.

Nitrogen is trans ferred from one amino acid to another by transamination reactions, which always involve two different pairs of amino actds and thctr correspondi ng o.-keto acids. Note: Glu tamale and a -kcloglutarate usua lly serve as one of the paors; transaminases (aminotransferases) catalyzed the oan~fcr of amino grQups; all transaruinases require the coenlyme pyridoxal phosphate. [n contrast to transamination reactions that transfer amino groups, oxidative deamination reactions result in the liberation or the amino group as free ammonia (NH.). Tbcse reactions occur primarily in the liver and kidney and provide a ketoacids (for energy) and ammonia (which Is o source of nitrogen in urea synthesis). Note: En:r.ymes involved in deamination reactions include glutamate deh ydrogenase (/'or glutamate), histidase (for histiditre), aud serine deh ydratase (for serine and threonine). All amino transferases (transominascs) share a common prosthetic group, pyridoxal phnsphate (PLP). PLP is tl1e coenzyme fonn of pyridoxine or vitamin a,. It functions as an imermediate carrier of amino groups at the active site of aminotransferases. PLP undergoes reversible transformatio11s between its aldehyde form, pyridotal phos phate (PLP). which can accept an amrno group. and its aminated form. pyridoxamin e phosphate (PMP), which cau donate its amino cid to an a -keto acid.



All of the following are true of oxidative dcamination reactions EXCEPT one. Which one is the EXCEPTION?

Provide a -ketoacids for energy Provide ammonia for urea synthesis Occur mainly in the liver and kidney
Provide a detoxification mechanism

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Carbonic anhydroses arc -containing enzymes that catalyze the reversible reaction between carbon dioxide hydration and bicarbonate dehydration.

Manganese Selenium Zinc


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Deamluatlon is also ao ox.Jduthr e reuction thal occurs under aerobic conditions in all tissues b111 especially the liv~r lllld kldney. During o~idative deamination, an amino acid i conwrted into the corresponding keto add (for "'IC'ltJ~ by the removal of tho amine functional group as nmmonin and the :otniuco functtonul !:roup is replaccod by the kelOn~ gruup. The lm monia eventually goes imo the urea cycle. O~idathe deAmination occun1 primarily on glutamic acid bcocause glutamic add was t))e end prodttct of many transamination reactions. Glutamate dehydrogenase is :m enzyme of the o~idorcducrose class that catalyzes the o:<idative deamioation of glutam<Ue, Atnmoni is released. nod r.t ketoglmarate is fhrmed. Glutaruate dehydrogenase is tmusttnl in that it can usc either NAO 01 NAOI as " coenzyme. The reversible reaction has a major function m both tl1 e synthesis and degradalion of glutamic acid and, via trnosamiuases, o1b.;r amlno acids as well. important: Both asporate aruinotrnus fcrQSO (AS'f) and alanine aminotransferase !ALT) ar~ hausiUlJinase. (ambwlralt'.[e,'ases) T~ey 1te not involved in oxidative deamiuation ret;~ctions~ In coutrast to traosaml.uariou r('attions that transfl!r amino groups, o~ldatlve deauJ!natlon results in the liberoriotJ of til~ ~mino group as free ammonia. L Glutominase deaminatcs glutamine to glutamate and anunuuium ioo~ NotCJ' aspar-agina~e dcaminatcs asparagine to aspanate aud a:Jnwonium iou. 2. Glutamate i~ unique in thar it is the only auuuo acid lhut uodcrgocs rapid oxidative deamination . .3. Hilidine is de.1miunted by histidasc to form :munonium iot1 (NH) and

4. Serine and threonine UJ'e deautinmed by serln~ dohydratase. Serine ~c; couv~rted to pyruvate, and threonine ro o.ketobutyrate: ammonium ion -is released.

Zinc Carbon dioxide (CO;) is a 1<cy metlibolite in all lfving organisms. Carbon dioxide exists in equilibrium with bicarbonrue (NCO;-). which is poorly soluble in lipid membranes compared to corbon diox[de; carbon dio~ide can freely diffuse in and out of the cell, while bicarbouote must be tronsponed. The conversion of bicarbonate to carbon dioxide f<ocilitates liS arnnsport into the cell, while the conversion of carbon dioxide to bicarbonate helps nap the carbon dioxide in dte coli. TI1e interconversion of carbon dioxide and bicarbonate proc<eds slowly at pbystologic>l pH. so organisms produce enzymes to speed up the process. Carbonic anhydroses arc zloc-conliuJng enzym.stbat catalylcl.he rcve.rsible reaction bcMecn carbon dlndde hydration a.od bicarbonate dehydration, Carbonic anhydrase eatalyzes !he follo,ving reaction: H20 1 102 <-> II' I llC03
Carbonic unhydrose is one of the fastest known l~n~es (nue molecule a/ curbouitonilydr(Ise ca11 p/'Q~ess one million molecules ofC01 eaclr .vecmrd) and is found in grout

concentration in erythrocytes. Carbonio anhydrase is an enzyme that cnnbles red blond cells to lr:msport carbon dioxide from the tissues to the lungs. I, Within the erythrocyte. uarbonic 3nhydrase facilitates the combmatiou of carbon Note df()Xide und water to form carbonic acid, 2. C!U'bQJtic ;mhydrase also functions in the kidney with the renhsurpllun of bicarbonate ion, 3. Although nol required for carbon dioxide and water to fnm1 carbonic acid~ c.arbouic -unhydrasr greatly increast.).S the reaction in hoth rt:speciS (fu,.muliun
uml disNot'iotion).

4. Mosl of the carbon dioxide (CO) is transported in the blooo as hicarhnnnlr Ion (HCO.rJ Jt is converted to crboni< acid (H1COJ) more rApidly in whole blood ~han in plasma, The reuon for t:his is thet whule blood contnm erythro cytcs with cnrbonic auhydrnso wbik p1a<ma doe$ not tonlain orythrocylcs.



Which of the following components of the electron transport chain accepts only electrons?

FMN (flavin mononucleotide)

Coenzyme Q (ubiquinone) Cytochrome b Oxygen

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Which of the following is not a classification of an enzyme?






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C~ tnchrnme

D(l'lpt h)dro~""

b --the c~totbroml:'s acnpt and ('l('ctron\,


l..'lel'trons. J h<.> other


of the energy cnnserved during cawbolism reactions occurs near the end of the metabolic series of reactions in the elevtron transport chain. The electron lran ~port, or respi ratory chain, gets Its name from the fact electrons are rransp011ed to meet up with mcygeo from respiration at the end o f the chain. This chain is present in tho inner mitochondrial membrane and is the final commiHi pathway by which electrons derived from different fuels of the body flow to oxygcu. Electron transport and ATP synthesis by oxidative phosphoryla\ion proceed continuously in all cells of the body that cotltain mitochondria. Compunetts of the electron transport cbaint FMN: receives e lectrons from NADH 1111d transfer~ them through Fc-S centers to coenzyme Q. FMtJ is derived from ribonavin. Remember : NAD is derived from

Th~ majority

Coenzym e Q: receives electrons from FMN and also through fe-S centers from FADH 2 Coeozyme Q is not derived from a vitamin (th~ body 'J'Iltile.<izes it}. Cytochrome~ (b. c, a. tz11d a:J: receive electrons from the reiluced fonn of coenzyme Q. Each cytochrome consists ofa heme group associated with a protein; cytochrome~ is also called cytochrome oxidase. llctnc is synthc.sizcd from glycine and succiuyl CoA in humans. H~me is not derived from a vitamin . On:en: ultimately receives tb.e electrons at the end of the chain .and is reduced to water. Remember: A coenzyme is a nonvrotein substance (orgalliC cofactor) that combines with an apoenzyme (the protein portion of a complex enzyme) to f01m a holoenzyme (<1 complete. cotalytieally active enzyme Jysrem).


Enzymes are catalysts. Most arc very large proteins. Enzymes bind temporarily to one or more of the r~actanL~ of the reactiop the enzymes c~talyze. In doing so. they lower the a mount of activa tion energy needed ancl thus speed up the renctioa. The funcuoning of the enzyme is determined by tho $bape of tho protcio. Enzymes are s ubs tr ate s pecific. For example, the enzyme peptidase (which break. peptide bond. in proteins) wiU not work on srareb (which is hroken down by hWIIIIIII'''Odllceti amylase in the mowh). The arrangement of molecules ott the enzyme produces an area known as the active s.i tc within which the specific substratc(sj wi ll "fit." Jl rccogtli~c~, con fines, aod orients the substrate in a particular direction. Cl.assilicotion of enzymes: Oxidoreductases: catalyze a redox reaction Tnutsfer;~Ses: transfer a functional group 1lydrolascs: cause hydrolysis reactions Lyases: break C-0. C-C. or C-N bonds Isomerases : rearranges functional groups Ligases: joins two molecules for example, DNA ligase joins pi~ces of DNA !.Substrate concentration, pH, temperature. and cn:>:yme concentration all have lllute< an etl'ect on the activity of an enzyme. 2. Tbe enzytlliltic model that "-'SUtn"'' that en7ym~s hove nexible cotlformations is called induc~d fit. 3. The inact ive precursor of au euzymc i cal led a proen:<ym~. 4. A catalytically inactive protein formed by removal of the cofactor fi'om an active enzyme is called an apoenzyme.



'vour patient has Alzheimer's disease and asks you about this new article read on blood clotting problems. Re mentions that they talked of an enzyme that has been found to be deficient in AD patients. The Jack of this enzyme would prevent him from dissolving clots at a normal rate. !Appropriately enough, he forgot the name of this enzyme. Help this patient \.. by telling him what enzyme he is thinking of. ~

Prothrombin Thrombin Fibrinogen Plasmin

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A zymogen is converted to the active enzyme form through which of the following ways:

Removal of a peptide fragment Addition of a peptide fragment Addition of an amino group Removal of an amino group

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Plasmin ~~ it is also r.tllld tihrinol~sin Plasmin is nomtally present in the blood in an inactive form called plasminogen. Substances known as plasminogen activators (for example. urokina.<e produced in the kidney) can convert plasminogen to plasmin, which will cleave the peptide bond in fibrin, leading to itS breakdown and dissolve clots.

Fibrinogen is a soluble protein normally present in the plasma that is essential to the blood clotting process. Fibrinogen is convened into an insoluble. thread-like polymer called llbrin by the enzyme thrombin. Thrombin is produced from the inactive plasma protein precursor prothrombin, which is formed i n the liver. In the presence of thromboplastin and calcium ions, prothrombin is converted to thrombin. Note: Research has sbowo that thrombin acts upon the arginyl-glycine linkages (<pecific peptide bonds) in fi brinogen to produce a fibrin monomer.

f~tmo' al

nf *' pt'llfidt lragmcnf

Zymogens are enzymatically inacthe precursors Of proteolytic enzymes. The digestive enzymes that hydrolyze proteins arc produced and secreted as zymogens in the Stomach and pancreas. They are convened to their active forms by removal of a peptide fragment in the lumen of the digestive tract. Proteolytic enzymes, are synthesized as inactive zymogen precursors to prevent unwanted destruction of cellular proteins. <1nd to regulate when and where enzyme activity occurs. Note: The release and activation of the pancreatic zymogens is mediated by the secretion of cholecystokinin and secretin. A good example of what occurs when some zymogens become active enzymes inside the cells is seen in acute pancreatitis, in which the premature activation of some of the pan creatic enzymes, such as trypsin, phospholipase A2 and elastase, produce the autodigesz~ mn~ens

Site or Synthesis Stomach

Zymogen Pepsinogen Chymotrypsinogen Trypsinogen

Active Enzyme Pepsin Chymotrypsin Trypsin

Pancreas Pancreas Pancreas

Procarboxypeptidase A Carboxypeptidase A Procarboxypeptidase B Proelastase Carboxypeptidase B EJastase


Starch molecules are broken down by enzymes known as:




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Your patient's medical history says that she has von Gierke's disease, She is \ \.. missing the eneyme which converts .



Glucose-6-phosphatase, glucose-6-phosphate to glucose Glucose-6-phosphatasc, glucose-6-pbosphate to fructose-6-phosphate Pyruvate carboxylase, pyruvate to phosphoenolpyruvate Pyruvate carboxylase, pyruvate to 2-phosphoglycerate

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Amylase ls the pame given to glycoside hydrolase enzymes that hreak down starch iuto glucose molecules, Amylase is also known as ptyalin. Although the amylases are designated by different Greek letters, they all act un a-1,4-glycosidic bonds. Classification or amyla<eo: a-amylases: By acting at random loca~ions along the starch chain. rtamylas, breaks down long-chnin carbohydrates, ultimately yielding mnltotriose and maltose rrom amylose, or mnltosc, .J!Iucusl!. a.ntJ ''limit dextrin'' fron' amylopectin. Because uamylase can at:l :111ywher~ ou the subtrate, n-amyln$e tends to be faster acthtg than ll nmylnse. In animols,n~;unylase JS n major digestive enz)'nle. Note: In human phy~iolog_v, both the snlivary snd paucreutic amylase-s nre o.-amylases. ~-amylue: working from the non-r<duciu