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5. Anatomy IV p94-111


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Functions of Golgi/RER/SER
pg. 94
What is I-Cell Disease
Failure of golgi to add mannose-6-phos to lysosome proteins, causing their secretion outside the cell (defect of golgi)
name organelle of protein synthesis
Rough ER
name organelle of protein transport
name organelle of N-oligodsaccharide addition
Rough ER
name organelle of N-oligodsaccharide modification
name organelle of proteoglycan assembly
name organelle of steroid synthesis and detoxification of drugs and poisons
Smooth ER
Mucus-secreting goblet cells of small intestine and antibody secreting plasma cells are rich in ______ (organelle)
Rough ER
Liver hepatocytes and steroid producing cells of the adrenal cortex are rich in ______ (organelle)
Smooth ER (look at function two questions above)
pg. 94-95
T or F: Liver sinusoids have basement membranes?
T or F: Spleen sinusoids have basement membranes?
True -- "barrel hoop" basement membranes line sinusoids
Spleen sinusoids traverse the _______ pulp
Match: T-cells are in the red or white pulp
Match: B-cells are in the red or white pulp
White (within the follicles)
Pancreatic Cell Types
pg. 95
T or F: alpha cells make glucagon
T or F: B cells make somatostatin
False -- beta cells make insulin
T or F: delta cells make somatostatin
Islet cells arise from what primordial structure
Pancreatic Buds
Adrenal Cortex and Medulla
pg. 95
Zona Glomerulosa makes ________
What zona makes the sex hormones
Zona reticularis
What zona makes cortisol
Zona Fasciculata (remember GFR and "The Deeper you go, the sweeter it gets" -- i.e. salt, sugar, sex
What is the primary regulator of the zona fasciculata
ACTH (direct) and CRH (indirect)
What is the primary regulator of the zona glomerulosa
what is the primary regulator of the zona reticularis
ACTH (direct) and CRH (indirect)
What is the most common tumor of the adrenal medulla in adults
What is the most common tumor of the adrenal medulla in children
What is the main secretory product of the medulla
What is the main secretory product of Brunner's Glands and where do they reside
Secrete alkaline mucus and live in the submucosa of the duodenum
Lymph Nodes
pg. 96
Is a lymph node a primary or secondary lymphoid organ
What part of the lymph node is the site of B-cell localization and proliferation
What is the function of the medulla
Communicate with efferent lymphatics and contain lymphocytes, plasma cells, macs, and reticular cells
The paracortex is the home of ____ cells
What is the name of the syndrome associated with disfunctional paracortex
DiGeorge's Syndrome
What tissue is responsible for IgA secretion in the gut?
Peyer's patch (Think IgA -- Intra-Gut Antibody) -- Stimulated B-cells from Peyer's secrete IgA into the lumen
Lumbar Puncture
pg. 97
At what level should one perform a lumbar puncture?
Between L4 and L5 (to keep the cord alive, keep the needle between L3 and L5)
What structures are pierced?
Skin, Ligaments, Epidural space, Dura, Subdural Space, Arachnoid, Subarachnoid (CSF) (NOTE: pia is NOT pierced)
Nerve Injury
pg. 97
Injury to what nerve causes loss of dorsiflexion of foot
common peroneal (L4-S2) (PED = Peroneal Everts and Dorsiflexes)
Injury to what nerve causes loss of plantar flexion
tibial (L4-S3) (TIP = Tibial Inverts and Plantarflexes; if injured, can't stand on TIPtoes)
Loss of Knee Jerk?
Femoral (L2-L4)
Loss of hip adduction?
Obturator (L2-L4)
In adults, where does the spinal cord end?
Where does the subarachnoid space end?
divide the 31 spinal nerves into their divisions
8Cs, 12Ts, 5Ls, 5Ss, 1 coccygeal
CNS/PNS Supportive Cells
pg. 98
What cell is responsible for physical support and repair, as well as K+ metabolism
what are the phagocytic cells of the nervous system
what cells produce myelin in the CNS
what cells produce myelin in the PNS
Schawnn cells
Blood Brain Barrier
pg. 98
What three structures form the BBB
Choroid plexus epithelium, Intracerebral capillary endothelium, Arachnoid (remember CIA)
Do nonpolar/lipid soluble substances or polar, water-soluble substances pass through the BBB more easily?
Nonpolar/lipid soluble
Why is L-dopa, not dopamine, the treatment of choice in Parkinson's Disease
L-dopa crosses the BBB
pg. 98
What are the functions of the hypothalamus (7)
Thirst, Adenohypophysis control, Neurohypophysis hormone synthesis, Hunger, Autonomic regulation (including circadian rhythms), Temperature regulation, Sexual urges (TAN HATS)
Does the anterior hyporthalamus control cooling when hot?
Yes, think Anterior Cooling = A/C
Does the posterior hypothalamus control heat conservation?
Yes, think no Posterior hypothalamus = poikilotherm (cold blooded snake)
Which nucleus is responsible for hunger?
Lateral nucleus
Which nucleus is responsible for satiety?
ventromedial nucleus (without which you grow ventrally and medially
Posterior Pituitary
pg. 99
Which nuclei of the hypothalamus project axons into the posterior pituitary?
supraoptic nuclei (ADH) and paraventricular nuclei (oxytocin)
Functions of Thalamic Nuclei
pg. 99
What is the function of the lateral geniculate nucleus?
Visual pathway (remember Lateral is needed to Look)
What is the function of the medial geniculate nucleus?
Auditory pathway (remember Medial is to hear Music)
Function of the ventral posterior nucleus, lateral part (VPL)?
receives body senses (proprioception, pressure, pain, touch, vibration)
Function of the ventral posterior nucleus, medial part (VPM)?
receives facial sensations, including pain
Ventral Nuclei (VA/VL) functions?
Limbic System
pg. 99
What are the functions of the limbic system?
Feeding, Fighting, Feeling, Flight, and Sex (the five Fs)
What two areas does the hippocampus project to?
the subiculum (mammillary nuclei) and the septal area
Trace the pathway from Mammillary body to hippocampus.
Mammillary body, anterior nucleus of thalamus, cyngulate gyrus, entorhinal cortex, hippocampus
Basal ganglia
p. 100
Describe the primary function fo the basal ganglia.
The basal ganglia mediates voluntary movements and postural adjustments
What are the roles of the direct and indirect pathways?
Indirect pathway inhibits movement; Direct pathway facilitates movement.
Delineate the flow of processing in the direct pathway.
Putamen (inhibitory) => Gpi (inhibitory) => Thalamus: inhibition of Gpi => activation of thalamus
Delineate the flow of processing in the indirect pathway.
Putamen (inhibitory) => GPe (inhibitory) => GPi (inhibitory) => Thalamus; induces loss of inhibitory influence on Gpi => inhibition of thalamus
What is the anatomical defect in Parkinson's Dz?
Loss of substantia nigra pars compacta (SNc) dopamine output to putamen => activation of indirect pathway and inhibition of direct pathway
Name three other movement disorders associated with basal ganglia processing.
Chorea, athetosis, hemiballismus
What is the clinical presentation of chorea?
sudden, jerky, purposeful movements; Chorea= dancing, think choreography
What is the clinical presentation of athetosis?
slow, writhing movements, especially of fingers;
What is the clinical presentation of hemiballismus?
sudden, wild flailing of 1 arm; half ballistic= as in throwing a baseball
What is the anatomical defect in hemiballismus?
contralateral subthalamic nucleus lesion
Cerebral cortex functions
p. 101
Where is the primary sensory cortex (S1) located?
anterior aspect of parietal lobe
Where is the primary motor cortex (M1) located?
posterior aspect of frontal lobe
Where is the primary visual cortex (V1) located?
most posterior aspect of occipital lobe
What are the Brodman's Area designations for S1, M1, V1?
S1: 3, 1, 2; M1: 4; V1: 17
What is the role of Broca's area? where is it located?
inferior aspect of frontal lobe; mediates motor speech (production)
What is the role of Wernicke's area? Where is it located?
superior temporal gyrus; mediates speech comprehension
Brain lesions
p. 101
What is a consequence of a lesion in:
Broca's area?
motor (expressive, nonfluent) aphasia; BROca's BROken speech
Wernicke's area?
sensory (fluent, receptive) aphasia; Wernicke is Wordy but makes no sense
Arcuate fasciculus?
conduction aphasia: poor repetition w/ good comprehension and fluent speech
Kluver-Bucy syndrome: hyperorality, hypersexuality
Right parietal lobe?
spatial neglect syndrome (contralateral)
Mammillary bodies?
Wernicke-Korsakoff's encephalopathy: anterograde amnesia (think alcoholism)
Cerebellar vermis?
Truncal ataxia and dysarthria
Cerebellar hemisphere?
Limb ataxia and intention tremor
Reticular activating system?
Cavernous sinus
p. 102
Name five nerves and one vessel that pass through the cavernous sinus.
CN III, IV, V1, V2, VI; internal carotid artery
Foramina: middle cranial fossa (CN II-VI)
p. 102
Name three structures passing through optic canal (one nerve, two vessels).
CN II, ophthalmic artery, central retinal vein
Name five structures passing through superior orbital fissure (four nerves, one vessel).
CN III, IV, V1, VI; ophthalmic vein
Name the foramina of exit for each division of the trigeminal nerve (CN V).
Standing Room Only: V1 = Superior orbital fissure; V2 = foramen Rotundum; V3 = foramen Ovale
Foramina: posterior cranial fossa (CN VII-XII)
p. 102
Name four structures passing through the jugular foramen (three nerves, one vessel).
CN IX, X, XI; jugular vein
Name structures passing through foramen magnum.
brain stem, vertebral arteries, spinal roots of CN XI
Name two nerves passing through internal auditory meatus.
Extraocular muscles and nerves
p. 102
Describe the innervation of the extraocular muscles.
LR6SO4R3 : Lateral Rectus = CN VI, Superior Oblique = CN IV, and the Rest are CN III
Pupillary light reflex
p. 103
List in sequence the nerves, brain structures, and muscles involved in the pupillary light reflex from illumination of one eye to bilateral pupillary constriction.
Light => retina => optic nerve => optic chiasm => optic tract => prectectal nuclei (synapse) => Edinger-Westphal nuclei (synapse) => oculomotor nerve => ciliary ganglion (synapse) => pupillary constrictor muscles
Internuclear ophthalmoplegia
p. 103
What is the characteristic lesion in internuclear ophthalmoplegia?
destruction of the medial longitudinal fasciculus (MLF) => medial rectus palsy on attempted lateral gaze
Name three characteristic clinical features of internuclear ophthalmoplegia.
1. On attempted lateral gaze, contralateral eye fails to abduct past midline; 2. Contralateral nystagmus on attempted lateral gaze; 3. Normal convergence
What neurologic disease is commonly associated with internuclear ophthalmoplegia (aka MLF syndrome)?
multiple sclerosis; think MLF = MS
Visual field deficits
p. 104
Name the visual field defect associated with a lesion of each of the following structures:
Right optic nerve
Right anopsia
Optic chiasm
Bitemporal hemianopsia
Rigth optic tract
Left homonymous hemianopsia
Right Meyer's loop (temporal lesion)
Left upper quadrantic anopsia
Right Meyer's loop (parietal lesion)
Left lower quadrantic anopsia
Dorsal optic radiation
Left hemianopsia with macular sparing
Cranial nerves
p. 104
Classify each cranial nerve (1-12) according to its function as a sensory nerve, a motor nerve, or both.
Mnemonic: Some Say Marry Money But My Brother Says Big Brains Matter Most
Name the cranial nerves that innervate the eye muscles.
Oculomotor (III), Trochlear (IV), and Abducens (VI)
Name the cranial nerves that innervate the facial muscles (extraocular muscles excluded).
Trigeminal (V): mastication; Facial (VII): facial movement
Name the cranial nerves associated with sight, smell, hearing, and taste.
sight: optic (II); smell: olfactory (I); hearing: vestibulocochlear (VIII); taste: facial (VII) for ant. 2/3 of tongue and glossopharyngeal (IX) for post 1/3
Cranial nerves and passageways
p. 104
Which cranial nerves pass through the superior orbital fissure?
Which cranial nerves pass through the internal auditory meatus?
Which cranial nerves pass through the jugular foramen?
Brain stem anatomy
p. 105
Which cranial nerves exit the brainstem caudal to the pons?
Cranial nerves VI through XII
Which cranial nerves exit the brainstem rostral to the pons?
Cranial nerves I through V
Which cranial nerves are associated with the cerebellopontine angle?
Dural venous sinuses
p. 105
What is the main location of CSF return via the arachnoid granulations?
superior sagittal sinus
Describe the route of CSF from the superior sagittal sinus to the internal jugular vein.
superior sagittal sinus => confluence of sinuses => transverse sinus => sigmoid sinus => internal jugular vein (via jugular foramen)
Which three sinuses combine to form the confluence of sinuses?
superior sagittal sinus, straight sinus, occipital sinus
(p 106)
Homunculus is the topographical representation of the body that exists in what 2 areas of the cerebral cortex?
Sensory and Motor areas
Sensation for ____(What part of the body) is generally located superior medially on the primary sensory cortex while ____ is located more laterally
Lower limbs, Head and neck
Lesion at the anterior cerebral artery will canse deficit in sensation or movement in which part of the body?
Lower limbs
Circle of Willis
(p 106)
Which artery supplies the medial surface of the brain, leg-foot area of motor and sensory cortices?
Anterior cerebral artery
If you suspect a lesion in both Broca's and Wernecke's areas, a lesion in which artery could be the cause?
Middle cerebral artery
At which artery in the circle of willis is the most common place of aneurysm? You often see visual symptoms
Anterior communicating artery
This is also another common area of aneurysm. aneurysm causes CN III palsy
Posterior communicating artery
This artery comes off of middle cerebral artery and supply internal capsule, caudate, putamen, globus pallidus
Lateral Striate
In general, in stroke of anterior circle you would see what kind of deficits?
Sensory and motor dysfunction, aphasias
how will a stroke of posterior circle will manifest?
(p 106)
You would ask the patient to say this to test CN X (vagus)
"La la la" tests which CN?
XII - Hypoglossal (innervation of the tongue)
"Mi mi mi" tests which CN?
VII - Facial (innervation of lips)
Vagal nuclei
(p 107)
This nuclei confers visceral Sensory information (eg: taste, gut distension)
Nucleus Solitarius (VII, IX, X)
Nucleus aMbiguus confers Motor innervation of what part of the body?
pharynx, larynx, and upper esophagus (IX, X, XI)
This nucleus sends parasympathetic fibers to the heart, lungs, and upper GI
Dorsal motor nucleus
Play this game: Where is the Lesion??
(p 107)
patient's tongue deviates to the left
left CN XII
Patient's jaw deviates toward the left
left CN V
patient tends to fall toward the left side
left lesion of the cerebellum
Patient's uvula deviate to the left
right CN X lesion
Patient's shoulder droop on the left
left CN XI lesion
Patient has weakness turning head to the left
right CN XI lesion
Herniation syndromes
Which of the following herniations can cause compression on the brain stem that can result in coma and death? 1. Cingulate herniation 2. Transtentorial herniation 3. Uncal herniation 4. Cerebellar tonsillar herniation
1 herniates under the falx cerebri and does not cause coma and death. 2. Transtectoral, 3. Uncal, and 4. tonsillar herniations can
Uncal herniation can cause the following clinical signs, name their causes
(p 107)
1. Ipsilateral dilated pupil, ptosis
Stretching of CN III
2. Contralateral homonymous hemianopsia
Compression of ipsilateral posterior cerebral artery
3. Ipsilateral paresis
Compression of contralateral crus cerebri (Kernohan's notch)
4. Duret hemorrhage
Caudal displacement of brain stem
Spinal Cord
(p 108)
The dorsal columns have 2 tracts. The Fasciculus ____ carries nerve fibers for _____(part of the body). The fasciculus ____ carries tract from ____ (part of the body)
Cuneatus, upper body and extremities. Gracilis, lower body and extremities
The lateral cortical spinal tract carries what type of fibers, and how are they arranged in the spinal cord?
motor fibers, arms medially, legs laterally
What tract carries pain and temperature sensation? Where is it located on the spinal cord?
Spinal Thalamic tract, ventral part
Play this game: Where is the Lesion?? Pt II Ill name its common location on the spinal cord, you name the disease
(p 108)
in grey matter, affect lower motor neuron only, cause flaccid paralysis
Poliomyelitis / Werdnig-Hoffmann disease
Mostly white matter of Cervical region, lesion are asymmetric and random
Multiple sclerosis
grey matter, and motor tracts: upper and lower motor neuron deficits
Amyotrophic Lateral Sclerosis
everywhere, but spares the dorsal columns
Ventral artery occlusion
dorsal column, impairs propioception and causes locomotor ataxia
Tabes dorsalis (tertiary syphilis)
central white commisure and ventral horns
Brown Sequard Syndrome, UMN, LMN, Facial Lesions
Mr. Brown-Sequard was struck on the spinal cord that resulted in the hemisection of the spinal cord at T3 level. Give me 4 symptoms that you may find in him
1. Ipsilateral motor paralysis 2. Ipsilateral loss of tactile, vibration, proprioception senses 3. Contralateral pain and temperature loss 4. Ipsilateral loss of ALL sensation at the T3 level
What are the signs of Lower Motor neuron lesion?
everything lowered: « muscle mass, « muscle tone, « reflexes, downgoing toes
What are the signs of Upper Motor neuron lesion?
Upper = everything up (tone, DTRs, toes)
True or False: Upper motor neuron lesion of the face causes contralateral weakness of lower face only
True or False: Lower motor neuron lesion of the face causes contralateral weakness of lower face only
FALSE: weakness of both upper and lower face seen
A patient comes in with facial paralysis and inability to close the eye on one side of the face, suggesting Bell's Palsy. What diseases might you see in him that could have caused his condition?
ALexanger Bell with STD: AIDS, Lyme, Sarcoid, Tumors, Diabetes
Upper motor neuron lesion coming from the facial nucleus result in what?
contralateral paralysis of lower quadrant
Spinal muscle control
(p 110)
What is the difference between alpha and gamma motor neurons?
alpha fibers participates in the reflex arc and cause extrafusal contraction. Gamma neurons are stimulated by CNS to contract intrafusal fiber to increase sensitivity of reflex arc
Brachial Plexus
What are the 5 divisions/parts of the bracial plexus?
Roots Trunks Divisions Cords Branches (Randy Travis Drinks Cold Beer)
Play this game: Where is the Upper Limb nerve Lesion??
Claw hang
Trunk of C8 and T1
Wingled Scapula
Long thoracic nerve
Decreased thumb function, Pope's blessing
median nerve
Patient comes into the ER with trauma injury that broke his humerus bone. Two weeks later when you examined him, you noticed that his wrist is dropped. Neuro exam showed that the triceps and brachioradialis reflexes of the same arm are absent. What was t
radial nerve (innervates BEST!) Brachioradialis, Extensors of wrist and fingers, Supinator, and Triceps
Patient has lost power of his arm muscles. He could not longer flex his wrist or fingers, and has trouble with thumb movements. History showed that he broke his had a suprecondylar fracture (of the humerus) What was the injured nerve?
median nerve
Patient has clawed hand. Exam showed that he has imparied wrist flexion and adduction, impaired adduction of thumb and last 2 fingers. He also has lost of sensation over medial palm and pinky finger. What was the injured nerve?
ulnar nerve
Patient dislocates his shoulder and could no longer use his deltoid.
axillary nerve
Patient could no longer flex at his elbow joint and supination of his forearm is weakened. Exam shows loss of biceps reflex and variable sensory loss of his forearm
musculocutaneous nerve
Following a blow to his shoulders, the patient presents with limb hanging by side (paralysis of abductors), medially rotated (paralysis of lateral rotators), and protonated forearm (loss of biceps)
C5 and C6 roots. Known as Erb-Duchenne palsy
Thoracic Outlet Syndrome
Thoracic outlet syndrome leads to loss of the compression of ____ artery and ____ trunk of brachial plexus
Subclavian, inferior (C8. T1)
In thoracic outlet syndrome, when the patient turn his head toward the opposite side, you notice the dissapearance of _____ (what physical finding?)
radial pulse
What muscles would you expect to be atrophied as a result of thoracic outlet syndrome?
thenar and hypothenar eminences, innterosseous
What neurological symptoms would you see?
sensory deficits of medial side of forearm and hand
Clinical Reflexes
What nerve root do you test for if you illecit the following reflexes?
1. Biceps
2. Triceps
3. Patella
4. Achilles
What is the Babinski reflex a sign of? When is it normal?
UMN lesion, its normal during 1st year of life

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