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SENSE ORGANS: General Chemoreceptor: chemicals, odors, tastes, composition of body fluids Descending analgesic fibers: ret.

formation to dorsal horn; secrete enkephalins and dynorphins, inhibiting 1 st order neurons from being active Encapsulated: dendrites wrapped in glial cells/con. tissue, Tactile/Meissner corpuscles: dermal papillae of fingertips, palms, eyelids, lip, tongue, nipples, genitals, light
touch/texture, 2-3 nerve fibers + mass of flattened Schwann cells; Krause end bulbs: mucous membranes, similar to tactile corpuscles; Ruffini corpuscles: dermis, subcutaneous tissue, joint capsules. heavy continuous touch/pressure, joint movements, flattened elongated capsules w/ few nerve fibers; Lamellated/Pacinian corpuscles: dermis, joint capsuels, periosteum, breasts, genitals, viscera, deep
pressure/stretch/tickle/vibration, 1-2mm long, single sensory dendrite, innermost Schwann, outermost concentric fibroblasts w/ fluid; Muscle spindles: skeletal muscles near tendon, muscle stretch/proprioception, 4-10 mm fibrous capsule, fusiform, 3-12 intrafusal fibers (lack striations/contr. except at ends), sens. fibers twine around middle or contact end; Golgi tendon organs: tendons, tension on tendons
(proprioception), reflex to inhibit muscle contr., 1mm long, nerve endings in spaces between collagen fibers Exteroceptor: external stimuli; vision, hearing, taste, smell, cutaneous First order: touch/pressure/proprioception = large, myelinated, fast; heat/cold = small, unmyelinated, lightly myelinated, slower General/Somesthetic: widely distributed in skin, muscles, tendons, joint capules, viscera; touch, pressure,
stretch, heat, cold, pain, blood pressure/chemistry Interoceptor: stimuli in internal organs, visceral pain, nausea, stretch, pressure Lingual papillae: Filliform: tiny spikes, no buds, most abundant, texture (lingual nerve); Foliate: weakly developed, parallel ridges on sides 2/3 from tip, adj. to molar/premolars, most flavor chem released, taste buds degenerate by 2-3y; Fungiform: mushrooms, texture (lingual nerve) 3
taste buds on apex, tip/sides of tongue, widely dist; Vallate/Circumvallate: large, arranged in a V at rear, deep circ. trench, 7-12 total, half of our taste buds (250 each), located on wall of papilla facing trench Mechanoreceptor: physical forces due to touch, pressure, stretch, tension, vibration; hearing, balance, skin/viscera/joints Nocireceptor: pain receptors, trauma, ischemia, excessive stim. by heat/chemicals,
absent in brain but present in meninges; Head: travel by V (mostly), VII, IX, X; V enters pons and descends to medulla, 2nd-order then to thalamus, Neck down: spinothalamic (most of somatic signals), spinoreticular (ultimately to hypothalamus/limbic system; visceral, emotional, behavioral), gracile fasciculus (thalamus for visceral pain) Primary taste sensations: sweet (tip), salty (lateral), sour (lateral), bitter
(rear/vallate), umami (meaty; glutamate & aspartate) Proprioceptor: position/movement; muscles, tendons, joint capsules Receptive field: area supplied by single sensory neuron Receptor: structure specialized to detect stimulus Referred pain: convergence of neural pathways in CNS Sense organ: nerve ending w/ connective, epi, musc. tissues to enhance/moderate stimulus Special: complex sense organs
innervated by CN, vision, hearing, equilibrium, taste, smell Spinal gating: Pain signals from peripheral nerves blocked in spinal cord, never reach brain Taste buds: groups of 40-60 cells; taste cells (epithelial cells, lives 7-10 days, apical microvilli called taste hairs project to taste pore), supporting cells (between taste cells, no hairs), basal cells; ant. 2/3 = VII, post. 1/3 = IX, palate/pharynx/epiglottis = X, all project
to solitary nucleus of medulla -> (1) hypothalamus/amygdala nuclei to activate autonomic salivation, gagging, vomiting, (2) thalamus -> insula, postcentral gyrus, roof of lateral sulcus -> orbitofrontal cortex Thermoreceptor: heat, cold Unencapsulated: sensory dendrites, lack connective tissue wrapping; Free nerve endings: widespread, esp. epithelia/connective tissue; Tactile/Merkel disc: stratum basale, light
touch/pressure, two point discrimination; Hair receptors/peritrichial endings: around hair follicle, light touch/movement of hairs Ear Auditory canal: supported by fibrocartilage; guard hairs protect outer end Auditory ossicles: 2-3 mm distance from tymp. mem to inner ear; malleus/hammer (handle attached to tymp. membrane; head suspended by ligament in cavity; short process connects to incus); incus/anvil
(triangular body to meet malleus; short limb suspended by ligament from wall of cavity; long limb to art. w/ stapes); stapes/stirrup: (arch, footplate held by ligament in oval window) Auditory pathway: CN VIII exits internal acoustic meatus of temp, ends at medulla. Project to cochlear nucleus on each side of medulla, then to superior olivary nucleus of pons (sends back to OHCs, V3 to tensor tympani, VII to stapedius,
binaural hearing; goes to inf. colliculi of midbrain). Inf. colliculi to thalamus to primary auditory cortex in sup. temp. lobe. Both cortices receive L and R signals. Bony labyrinth: contains complex of fluid-filled chambers/tubes called membranous labyrinth; vestibule containing utricle/saccule, three bony semicircular canals containing semicircular ducts (detect roation); bony spiral cochlea contains cochlear duct
Cerumen: product of ceruminous and sebaceous glands, mixed w/ dead skin cells; coats guard cells, deterrent to insects/ticks (sticky), lysozyme, low pH, waterproofs canal, protects skin/tympanic mem from water accumulation Chromatophores: forms ant. border layer of iris; high melanin = black, brown, hazel; low melanin = blue, green, gray Cochlea: 9mm wide, 5mm high; winds 2.5 coils around modiolus
(spongy) Cochlear duct/scala media: triangular space; bounded by thick basilar membrane below (which thrusts up and down, allowing K+ into hair cells, releasing glutamate), thin vestibular membrane (Reissner’s) above; scala vestibule above vestibular, scala tympani below basilar, both filled with perilymph, communicated thru helicotrema, scala tympani spirals down to round window Cochlear nerve: 9095%
from IHCs; sensory neurons are bipolar, from spiral ganglion around modiolus, axons go to core of cochlea to form VIII Endolymph: fluid in membranous labyrinth; like intracellular fluid Eustachian tube: passage to nasopharynx; normall flattened/closed, opened by swallowing/yawning, equalizing pressure on both sides of tymp. mem; allows throat infect to mid. ear Fundus: inside rear, ophthalmoscope Inner/internal
ear: in bony/osseous labyrinth in petrous temp. bone Inner hair cells: 3500, 1 row on medial side of basilar membrane; 50-60 sterocilia arranged from short to tall; actually functions in hearing; synapse w/ dendrites of sensory neruons; pyriform, globular base cont. nucleus Middle ear: bones/muscles in tympanic cavity of temp; stars w/ tympanic membrane, 1 cm diam, concave, innervated by sensory X and V,
highly sens. to pain; mastoidal air cells in mastoid process filled w/ air from auditory/eustachain tube Muscles of middle ear: Stapedius arises from post. wall, insers on stapes; tensor tympani arises from wall of auditory tube, inserts on malleus. Both muscles contract/dampen vibration of ossicles, protecting sensory cells of inner ear (tympanic reflex). Perilmyph: fluid between membranous labyrinth and bone;
similar to CSF Pitch: high-pitch = tip of cochlea; low-pitch = base of cochlea Outer (external): conducts vibrations to tympanic mem (eardrum); auricle/pinna to auditory canal (passage thru temp. bone; external acoustic meatus for 3cm to tympanic mem) Outer hair cells: 3 rows, 100 stereocilia in a V, tips in tectorial membrane; adjust response of cochlea to different frequencies/increase precision of IHCs; synapse
w/ sensory dendrites and axons; cylindrical w/ central nucleus Oval window: ext. ear begins, connected to stirrup/stapes Round window: covered by secondary tympanic membrane Saccule/Utricle: 2x3mm patch of hair cells, supporting macula; macula saccula lies vertically on wall of saccule (sensitive to up/down); macula utriculi (sensitive to tilt or vertical acc.) lies horizontally on floor of utricle; hair cell of macula
= 40-70 stereocilia, 1 kinocilium, embedded in otolithic membrane weighted with otoliths (CaCO3, protein) for gravity/motion. Semicircular Ducts: ang. acc, housed in osseus semicircular canal of temp. bone; ant./post. are vertically at right angles; filled w/ endolymph; each duct opens to utricle via ampulla; crista ampullaris is hair/sup. cells in ampulla; hair cells have stereocilia + kinocilium in cupula extending from
crista to cupula; endolymph lags and pushes cupula over; insensitive after 25-30 s. Spiral/Acoustic Organ, Organ of Corti: supported on basilar membrane; thick epithelium; generates nerve signals; hair cells (stereocilla microvilli on apical surface), supporting cells Tectorial membrane: rests on sterocilia, eperates endolymph from perilymph, stays calm Vestibular apparatus: 3 semicircular canals (angular acc),
ant. saccule, post. utricle (static equilibrium, linear acc) Vestibular pathway: Hair cells of maculas and semi. ducts synapse to sens. fibers of vestibular n; go to 4 vestibular nuclei in pons/medulla; each side receives both input; relays to cerebellum, nuclei of III, IV, VI (vestibule-ocular reflex), ret. formation to adjust breathing/blood circulation, spinal cord via vestibulospinal tracts to innervate extensor/antigravity
muscles, thalamus to relay to inf. end of postcentral gyrus/inf. end of central sulcus in transition zone to motor cortex. Eye Amacrine: short neuritic processes, inhibitory, project to inner plexiform layer to ganglion/bipolar cells, GABA or glycine, contrast, lateral inhibition Aqueous Humor: serous fluid by ciliary processes into posterior chamber (between iris/lens), flows thru pupil into ant. chamber (between cornea/iris),
reabsorbed by scleral venous sinus (canal of Schlemm) Bipolar cells: First-order neurons, feed to ganglion cells; rod bipolar only synapse to amacrine cells Cone: 6.5 mil, outer segment tapers, discs are parallel infolding of plasma membrane, functional in daylight intensities (phototopic vision), color; photopsin; 420 nm/deep blue, 531 nm/green, 558 nm/orange-yellow Conjunctiva: transparent mucous membrane,
inner eyelid (palpebral), ant. surface of eyeball (bulbar) except cornea, conjunctival sac between; function: secrete thin mucous film to prevent drying, richly innervated/pain, vascular. Extrinsic mus: 6, attached to orbit walls + ext. eyeball surface, 4 rectus (originate on post. wall of orbit/annulus of Zinn/annular tendon/common tendinous ring, insert to ant. region of eyeball), 2 oblique, sup. oblique travels along
medial wall of orbit, tendon passes thru trochlea, inserts on superolateral aspect; inf. oblique extends from medial wall to inferolateral aspect. Innervation: IV = sup. oblique, VI = lat. rectus, III = rest. Func: l. rectus = moves eye lat, m. rectus = moves eye med, s. rectus = elevates eye + turns medially, inf. rectus = depresses eye + turns medially, inf. obl. = elevates eye + turns lat, sup. obl = depresses eye + turns
lat. Eyebrow: enhance facial exp, nonverbal comm, glare prot, keep perspiration from eye. Eyelids/palpebrae: moisten eye w/ tears, sweep debris, block foreign obj, prevent visual stimuli, both eyelids sep. by palpebral fissure, meet at medial/lateral commissures/canthi. Orbicularis oculi, tarsal plate has 20-25 tarsal glands secreting oil that coats eye/reduces tear evap. Eyelashes are guard hairs to prevent debris,
blink reflex. Ganglion cells: largerst neurons of retina, single layer close to vitreous, 2nd-order, input from multiple bipolar, optic nerve, contribute to light intensity, melanopsin Horizontal cells: cell bodies in inner nuclear layer, input from photoreceptors, adjust for bright and dim light, inhibitory feedback, hyperpolarizes photoreceptors upon glutamate reception Intrinsic eye muscles: ciliary muscle, pupillary constrictor
(iris; via parasympa fibers from III), pupillary dilator (iris; via sympa fibers from superior cervical ganglion), innervated via (para)sympa, parasympa also thickens lens for near vision Iris: pupillary constrictor has concentric circles of smooth muscle around pupil; pupillary dilator has spokelike arr. of contractile processes, extends from post. pig. epith, myoepithelial; mediate photopupillary reflex Lacrimal apparatus:
lacrimal (tear) gland + ducts; Lacrimal gland: shallow fossa of frontal bone in superolateral corner of orbit; 12 ducts lead to conjunctiva, tears cleanse/lubricate, oxygen/nutrients, lysozyme; go to lacrimal caruncle to tiny pore/lacrimal punctum to go to lacrimal canal to lacrimal sac to nasolacrimal duct to inf. meatus of nasal cavity Lens: thick lens (4.5 mm) = near vision. thin lens (3.6mm) = far-vision. Flattened,
transparent lens fibers. Suspended via suspensory ligament to ciliary body. Tension flattens lens (9.00 mm diam, 3.6 mm thick). Macula lutea: post. to lens, 3mm diameter, fovea centralis, optic disk is 3mm medial; fovea has 4000 cones 0 rods Opic disk: blood vessels enter/leave eye here from optic nerve; exam for hypertension, mellitus, athrerosclerosis, etc Optic nerve: 1.2 mil nerve fibers; 114 receptors:1
optic nerve fiber Orbital fat: cushions eye, freedom of motion, protects blood vessels/nerves Photoreceptors: rods, cones, some ganglion. Rod/cones have outer segment (highly modified cilium to absorb light), inner segment (mitochondria, etc). Segments separated by 9 pairs of microtubules. Tunics: fibrous (tunica fibrosa) = sclera (dense collagenous con, blood vessels, nerves) + cornea (ant. transparent, admits
light to eye); vascular (tunica vasculosa/uvea) = choroid (highly vasc, deeply pig, behind retina, like chorion of fetus), ciliary body (supports lens via musc. ring, smooth muscle/ciliary muscle controls lens tension, secretes aqueous humor), iris (diaphragm, controls pupil diam, post. pigment epithelium blocking stray light to retina, anterior border layer cmtaoms chromatophores containing melanin); inner layer
(tunica interna) = retina, post. 2/3 Vitreous humor; transparent jelly filling vitreous chamber behind lens, hyaloid canal remnant of hyaloid artery in fetus; maintain sphere, retina smoothly against inner surface of chamber, focusing images Visual projection: optic nerve exits thru optic foramen, converge to optic chiasm (hemidecussation) inf. to hypotha, ant. to pit, continue as pair of optic tracts. L visual field = right
half of retina = medial left, lateral right. Optic tracts to lateral geniculate nucleus of thalamus to form optic radiation to primary visual cortex. Ass. area ant. to prim. Photosensitive ganglion cells to midbrain to superior colliculi (visual reflexes of extrinsic mucles), pretectal nuclei (photopupillary, accommodation reflexes of intrinsic). Retina: attached to ora serrata and optic disk. Post layer = pigment epi, absorbs light
not yet absorbed and reflects the light to eye. Next to photoreceptors (rods/cones), bipolar cells, ganglion cells. Rods: 130 mil, outer segment is cylindrical, 1000 membranous discs studded with rhodopsin, responsible for night/scotopic vision, saturated/nonfunctional in lighting Olfaction Granule cells: send fibers back to olfactory bulbs, inhibit mitral/tufted cells Olfactory axon: leaves thru olfactory foramina in
cribriform plate of ethmoid; CN I Olfactory bulbs: where fibers enter, beneath frontal lobes; fibers synapse w/ dendrites of mitral cells (farther from glom) and tufted cells (closer to glom); synapse in glomeruli; each glomerulus is 1 odor Olfactory cilia: 10-20 immobile cilia on olf. neuron; embedded in mucus on epithelial surface Olfactory mucosa: path of epithelium for olfaction; roof of nasal cavity; 5cm^2 of superior
concha and nasal septum; rest of nasal cavit = respiratory mucosa; women more sens. esp. during ovulation. 10-20 mil. olf. neurons (lifespan 60 days), epithelial supporting cells (lipfuscin), basal cells (diff. to olf. cells) Olfactory tract: axons of tufted/mitral cells; course posteriorly along underside of frontal lobes; end in inferior surface of temp. lobe (primary olf. cortex) w/o passing thru thalamus, travel to insula,
orbitofrontal cortex, hippocampus, amygdala, hypothalamus Diseases Amblyopia/lazy eye: decreased vision in an eye; use eye patch, atropine in stronger eye; 1-5% of adults; onset age 5 Astigmatism: Inability to simultaneously focus light rays that enter eye on different planes; eye does not focus light evenly on retina; due to deviation in shape of cornea or abnormalities in lens, corrected with cylindrical
lenses/glasses/surgery Cataract “Waterfal” clouding of lens, distorted vision, some congenital, age-related hardening and thickening of lens, diabetes mellitus, smoking, sunlight, oxidative stress, metabolic changes in deeper lens fibers promote clumping of crystallins. Vacuoles/clefts between lens fibers. Vit. C increases cataracts. Surgically remove lens, implant art. lens. Chalazia: infected tarsal gland
Conjunctivitis/pinkeye: inflammation of c.; reddened, irritated eyes; allergies, bacteria (children, pyogenic like Staph, Strep, Haemophilus influenzae, Chlamydia. Hyperacute = Neisseria gonorrhoeae/meningitidis), virus (adults, adenovirus, herpesvirus treated w/ acyclovir, upper resp. tract infections); pollen/animal hair contagious Color blindness: color vision deficiency; cannot see color/differences in color; cannot
develop 1+ / 3 sets of cones; males more often (X chrom); physical/chem damage to eye, optic nerve, brain; Ishihara color test plate; red-green (8% M, 0.5% F Northern European descent), blue-yellow, total Diplopia/double vision: simultaneous perception of two images of single object that may be displaced horizontally, vertically, diagonally, rotationally; impaired function of extraocular muscles; mechanical
problems, NMJ, disorders of cranial nerves, supranuclear oculomotor pathways, toxins (alcohol) Glaucoma Drainage of aq. humor blocked, intraoc. pressure builds up, compresses retina and optic nerve, even. causes blinding. Halos, blurry vision. Puff of air directed at cornea, measure deformation. Eye drops. Tonometer measures intraocular press. Hyperopia: farsightedness, abnormally short eyeball, light rays
not in focus yet, convex lens force early convergence Leprosy/Hansen disease: infection of nerves by leprosy bacteria abolishes sense of pain Myopia: nearsightedness, abnormally elongated eyeball, light rays focus early and then divege, corrected with concave to force premature divergence Nyctalopia: night-blindness, inability to see in low light; due to birth disorders, injury, lack of vitamin A, most common
cause: retinitis pigmentosa (deg. of rods) or def. of retinol; opp = hemeralopia/inability to see in bright light Otisis media: middle ear; upper resp. infections spread to tympanic cavity/mastoidal air cells; acute otitis media (AOM, ear pain/crying/less sleep/young children) and otitis media with effusion (OME, fluid for >3 months), Native American/down syndrome, fluid accum. causes pressure, pain, impaired hearing;
may cause meningitis; can cause fusion of ossicles thus hearing loss; drain fluid from tymp. cavity via drainage tube (myringotomy); tube relieves pressure, heals infec. Pneumococcal/influenza vaccine, breastfeeding first 6 mo, avoiding tobacco smoke; paracetamol, ibuprofen, benzocaine, opioids, amoxicillin (antibiotic) Presbyopia: declining ability to focus on nearby objects, aging, due to declining elasticity of
lens, age 40-45, reading glasses/bifocal lenses Retinal detachment Pigmented/neural layers detach, vitreous humor seeps between. Can cause perm. blindness (photorec. no nutrients). Retina torn in traumatic blow, head jerks opposite direction. “curtain drawn across eye, sootlike spots, light flashes” Reattach with laser early on. Strabismus/cross eyed/heterotropia/squint: eyes do not align, interferes with
binocular vision and depth perception; lack of coordination of EOMs; 4% of children; convergent/esotropia; divergent/exotropia; upwards/hypertropia; downwards/hypotropia; eyes may alternate in focusing, disregard inputs from deviant eye, exercises, patch Sty: inflammation of smaller eye glands NERVOUS: Stats Spinal motor neuron: 8000 synapses on dendrites, 2000 on soma Cerebellum: 100,000
synapses/neuron. Cerebral cortex: total 1014 synapses, 2-3mm, 14-16B neurons, 6-layered neocortex, IV thickest in sens, V in motor, axons entering white mat. from III, V, VI, 75% ass. cortex General Nerve: bundle of nerve fibers/axons wrapped in fibrous connective tissue. Enteric: smooth muscle/glands, dig. tract, 100 million neurons, esophagus motility, stomach, intestines, enzymes, acid. Ganglion: knotlike
swelling in a nerve, cell bodies concentrated there, somas outside CNS, enveloped in epineurium cont. with nerve. Somatic sensory: skin, muscles, bones, joints Visceral sensory: viscera of thoracic/abdominal: heart, lung, stomach, urinary bladder. Properties of Neuron: excitability/irritability, conductivity, secretion. Sensory neuron: light, heat, pressure, chemicals Interneuron: 90% Motor neuron: muscles/gland
cells Soma/cell body: 5 to 135 um in diameter, nucleus, large nucleolus, mitochondria, lysosomes, Golgi, inclusions (glycogen granules, lipid droplets, melanin; lipofuscin produced when lysosomes digest, pushes nucleus “wear and tear”), rough ER, cytoskeleton (microtubules and neurofibrils/actin filaments) creating staining Nissl bodies, LACK CENTRIOLES. Trigger zone: axon hillock + initial segment, first
generates Aps Axon: 1 to 20 um in diameter, can branch to axon collaterals, cytoplasm = axoplasm, membrane = axolemma, neuron has at most 1 axon, terminal arborization: extensive complex of fine branches, ends in synaptic knob/terminal button. Multipolar: 1 axon, 2+ dendrites, most common. Bipolar: 1 axon, 1 dendrite, olfactory cells, retina, inner ear. Unipolar: single process, carry sensory to spinal cord,
pseudounipolar: start off as bipolar in embryo, processes fuse, peripheral fiber carries to soma, central fiber carries to spinal cord. Fiber bypasses soma. Anaxonic: multiple dendrites, 0 axon, no APs, brain, retina (help in contrast), adrenal medulla Myelin: 20% protein, 80% lipid (phospholipids, glycolipids, cholesterol). Speed of myelination: 0.5 – 2.0 m/s in small unmyelinated (2-4 um diam), 3-15 m/s in small
myelinated, 120 m/s in large myelinated (20 um diam) Unmyelinated: In PNS, one Schwann cell harbors 1-12 nerves in grooves, overlap at neurilemma, one entire basal lamina Node of Ranvier: 1 – 2 um long Internode: 0.2 – 1.5 mm long Neurilemma: secrete nerve growth factors, stimulating regrowth of axon Endoneurium: forms regeneration tube guiding axon to destination Perineurium: wraps around fascicles,
20 layers of squamous epithelium-like cells Epineurium: several fascicles, dense irregular fibrous connective tissue, blood vessels penetrate Synapse: axodendritic vs. axosomatic vs. axoaxonic synapse Diverging Circuit: nerve fiber to several postsynaptic cells Converging circuit: many sources funneled to one neuron Reverberating: a – b – c – d, c restimulates a with collateral; diaphragm/intercostal muscles
(inhale) Parallel after-discharge: synpases reconverge, delayed for 0.5 ms, continued firing after stimulus, reflex arcs Mixed nerve: sensory and motor fibers, most nerves = mixed Somatic fiber: skin, skeletal muscle, bone, joint Visceral fiber: blood vessel, gland, viscera General fiber: muscle, skin, glands, viscera, blood vessels Special fiber: eyes, ears, olfactory/taste receptors, chewing, swallowing, facial
expression Neuroglia CNS Oligodendrocytes: bulbous body, 15 armlike processes each myelinating axon, myelination spirals inward, no neurilemmal/endoneurium Ependymal: resemble cuboidal epithelium, no basement membrane, rootlike processes in underlying nervous tissue, produce CSF, cilia on apical surface. Microglia: yolk sac, 10-15% of all brain cells, small macrophages, develop from monocyte stem
cells, phagocytize foreign matter Astrocytes: most abundant, 90% of tissue, nonsynaptic regions of gray matter, support, perivascular feet, form BBB, convert glucose to lactate, secrete nerve growth factors, influence signaling, regulate chemical comp, form scar tissue (astrocytosis/sclerosis). PNS: Schwann cells/neurilemmocytes: Theodor Schwann, form neurilemma (sleeve) around PNS axons, 100 compact
layers, myelin sheath between neurilemma (outermost layer, has nucleus/cytoplasm) and axon; also regeneration of damaged fibers (CNS can’t, but enclosed in bone = less trauma). External to neurilemma: basal lamina -> fibrous endoneurium Satellite cells: surround somas in ganglia of PNS Membrane Potential Donnan Effect: large impermeable negatively charged intracellular molecules attracting positively
charged ions (Na+ and K+) and repelling negative ones (Cl−) Resting: -70 mV neurons, -95 mV skeletal, -50 mV smooth, -80/-90 mV astrocytes, -12 mV erythrocytes. Depol: at -55 mV Peak: 30-40 mV AP: lasts 1 ms Neurotransmitters Acetylcholine: NMJ, preganglionic, postganglionic of para and some sympa (sweat glands/vessels) Norepinephrine: postganglionic neurons of sympa. Glutamate: excitatory of
brain. Weak stimulation activates AMPA (slight dep). Mg2+ blocking NMDA. Sufficient stimulus expels Mg2+ admitting Na+, Ca2+. CAM kinase phosphorylates AMPA, increasing conductance, upregulates AMPA. Ca2+ sends retrograde NO. Aspartate: excitatory of spinal cord GABA: inhibitory of brain Glycine: inhibitory of spinal cord Dopamine: inhibitory, prevents excessive basal nuclei Serotonin: monoamine,
tryptophan, GI tract (90% enterochromaffin cells for intestinal movements), blood platelets (vasoconstrictor, hemostasis, clotting), CNS (mood, apetite, sleep), well-being/happiness; metabolism: MAO > 5-hydroxyindole acetyldehyde > aldehyde dehydrogenase (ADH) to 5-hydroxyindole acetic acid OR aldehyde reductase (AR) to 5-hydroxytryptophol > HIMOT > 5-methoxyindole acetic acid OR 5-methoxytrptophol
Histamine, beta-endorphin Autonomic Adrenergic: a excitatory B inhibitory Autonomic Tone: background rate of activity of (para)sympa Baroreflex: High BP stim baroreceptors in carotid artery/aorta, CN IX to medulla, CN X from medulla slow heart, reducing BP. Cholinergic: Muscarinic muscarine (mushroom toxin), cardiac/smooth, gland, excites/inhibits Nicotinic nicotine, pre/post ganglionic synapse, adrenal
medulla, NMJ, always excites Collateral/prevertebral ganglia: Thoracic ganglia 5 to 9/10 > celiac ganglion > stomach, spleen, liver, s. intestine, kidneys; thoracic ganglia 9 and 10 > celiac + s. mesenteric ganglia > s. intestine, colon; lumbar ganglia > inf. mesenteric ganglion > rectum, urinary bladder, reproductive organs Craniosacral: parasympathetic, somas in pons, medulla, S2-S4, long preganglionic end in
terminal/intramural ganglia; Fibers: III lens/pupil, ciliary ganglion, ciliary muscle/pupillary constrictor; VII tear/salivary/nasal glands, pterygopalatine ganglion at maxilla/palatine bones, chorda tympani ends at submandibular ganglion; IX , preganglionic form tympanic nerve, ends in otic ganglion, parotid salivary gland; X, cardiac plexus, pulmonary plexus, esophageal plexus, vagal trunks form abdominal aortic
plexus for abdominal organs. S2-S4: ventral rami, form pelvic splanchnic nerves lead to inf. hypogastric plexus, travel via pelvic nerves to distal half of colon, rectum, bladder, repro. organs Effectors: glands, smooth/cardiac muscle, excitatory/inhibitory effect, denervation hypersensitivity Paravertebral ganglia: connected to s. nerve by communicating rami, adj. to vert., interconnected by long. nerve cords, 3 cervical
(sup, mid, inf), 11 thoracic, 4 lumbar, 4 sacral, 1 co. Head=T1, neck=T2, thorax/upper limb=T3-T6, abdomen=T7-T11, lower limb=T12-L2, spinal nerve route (sweat gland, piloerector muscle, blood vessels of skin/skeletal muscle), sympathetic nerve route (iris, salivary glands, lungs, heart, thoracic blood vessels, esophagus, form carotid plexus, sup./mid. cervical ganglia form cardiac nerves), splanchnic nerve
route (T5-T12 pass w/o synapsing, lead to collateral/prevertebral ganglia, contribute to abdominal aortic plexus – celiac, sup. mesenteric, inf. mesenteric ganglion, liver, spleen, adrenal glands, stomach, intestines, kidneys, urinary bladder, reproductive organs) Postganglionic neuron: Axon extends to target, either ACh or NE, unmyelinated, gray communicating ramus Preganglionic neuron: Soma in brainstem/spinal
cord, axon terminates in ganglion, uses only ACh, small myelinated, white communicating ramus Solar plexus: celiac/superior mesenteric ganglia Sympathetic/thoracolumbar: short preganglionic (lateral horn, exit from T1 to L2 -> sympathetic chain of ganglia/paravertebral ganglia), long postganglionic Sympathetic vs. Parasympathetic: dilation v. constriction (pupil), relaxation for far vision v. contr. for near vision
(lens), none v. secretion (lacrimal glands), secretion v. palmar swearing (sweat), hair erection v. none (piloerector muscles), inc. vs. dec. (heart rate), vasoc v. dilates GI blood vessels (viscera blood vessels), dilation vs. none (skeletal muscle blood vessels), const. vs. dilates facial (blood vessels of skin), bronchodilation v. bronchoconstriction (bronchioles), reduced urine output v. none (kidneys), none v.
contraction/emptying bladder (muscle of bladder wall), thick mucous sec v. thin serous sec (salivary glands), dec. v. inc. (GI motility and secretion), glyc. breakdown v. synthesis (liver), dec. vs inc (pancreas enzyme sec), loss of erection v. erection (penis/clitoris), stimulation vs none (ejaculation) Sympathoadrenal system: Adrenal medulla secretes 85% epi, 15% nor, trace of dopamine Neurulation 19 days
Neuroectoderm is dorsal streak that forms neural plate: most neurons/glia except microglia (from mesoderm). Flanked by neural crest (autonomic ganglia/postganglionic) 20 days Neural groove forms w/ raised neural folds 22 days Somites sclerotomes, myotomes and dermatomes; vertebrae, rib cage, occipital bone, muscle, cartilage, tendons, skin of back Neural tube formed by 4 wks, rostral opening closes 25
days, caudal opening closes 27 days to amniotic fluid, preganglionic neurons. 26 days Neural crest PNS, sensory/autonomic nerves and ganglia, Schwann, ad. medulla, two inner meninges, melanocytes, dermis, bones of head/neck Week 4 Forebrain/prosencephalon, midbran/mesencephalon, hindbrain/rhombencephalon. Neural tube forms: Cervical flexure formed between s. cord and hindbrain. Cephalic flexure
formed in midbrain. Week 5 Forebrain: telencephalon and diencephalon (optic vesicles become retina), midbrain stays mesencephalon, hindbrain: metencephalon (pons + cerebellum) & myelencephalon (medulla). Week 14 Schwann/oligo lay down myelin, little distinction between white/gray matter, most postnatal brain growth, dietary fat needed Brain Anatomy Affective lang. area: opp. Broca, producing tone,
R Amygdala: frontal portion of temp. lobe Angular gyrus: Read/write, sup. to Wernicke, parietal Arbor vitae: Branching white matter in cerebellum Association: same hemisphere, long = diff. lobes, short = different gyri in lobe Basal nuclei: caudate nucleus, putamen, globus pallidus (putamen + g. pall. = lentiform nucleus, putamen + caud. = corpus striatum) BBB: Astrocytes use perivascular feet, form tight junctions
between endothelial cell, permeable to water, glucose, lipid-soluble substances like O2, CO2, alcohol, caffeine, nicotine, anesthetics, absent in circumventricular organs (CVOs) in 3rd/4th ventricles, allows HIV to invade. Blood-CSF barrier: composed of ependymal cells joined by tight junctions Brainstem: (diencephalon), midbrain, pons, medulla, ends at foramen magnum Broca: inf. prefrontal cortex, Brodmann
area 44 (pars opercularis), 45 (pars triangularis), expressive/nonfluent aphasia Cerebellum: 10% volume, over 50% neurons, 2 nd largest, 60% surface area of cerebral cortex, posterior cranial fossa, all input goes to cortex, output comes from deep nuclei, muscle coordination, fine motor control, muscle tone, posture, passage of time, eval. of sens. input. Inf. peduncle = medulla, Mid. peduncle (rest of brain input)
= pons, sup. peduncle (output) = midbrain. Spinal input = spinocerebellar, inf. peduncle. Cerebral aqueduct: Passes down core of midbrain, leads to fourth ventricle Cerebrum: 83% volume CSF: buoycancy, protection, chemical stability. 500 mL produced/day, only 100-160 mL present at once, 40% subarachnoid space ext. to brain, 30% general ependymal lining, 30% choroid plexus. Filtration of plasma through
blood capillaries, modified. Driven by pressure/heartbeat.k Choroid plexus: spongy mass of blood capillaries on ventricle, produce CSF Corpus callosum: Thick bundle of nerves, connects L/R hemisphere Commissural: cross between hemispheres, ant./pos. commissures, corpus callosum Deep nuclei: 4 masses of gray matter embedded in white matter, cerebellum Diencephalon: epithalamus, hypothalamus,
thalamus Dura mater: outer periosteal layer, separated by dural sinus, inner meningeal layer (continues into vertebral canal, forms dural sac around spinal cord), no epidural space, attached to cranium in foramen magnum, sella turcica, crista galli, suture Epithalamus: pineal, habenula (limbic to midbrain), roof over 3 rd ven. Equilibrium: cerebellum, brainstem, lat. sulcus, central sulcus Falx cerebelli: separates L/R
of cerebellum on inferior side Falx cerebri: extends into long. fissure between L/R hemi. Folia: folds in the cerebellum, like gyri Fourth ventricle: Between pons and cerebellum, forms central canal extending into medulla Frontal: goes to central sulcus, cognition, speech, motor Granule cells: tiny, densely spaced, most abundant neurons, cerebellum Gyri: Thick folds Hearing: primary aud. cortex in sup. temp/insula,
aud. association area inf. in temp, deep in lat. sulcus Hemisphere: left=categorical (lang/analysis), right=representational (insight/art/spatial/sightsoundsmelltaste) Hippocampus: long-term dec. memory, medial temp. lobe Hypothalamus: walls/floor of 3 rd ventricle, extends ant. to optic chiasm, post. to mammillary bodies, hormone sec., autonomic eff, thermoreg, food/water, sleep/circad., emotion, mem. Insula:
deep to lat. sulcus, taste, hearing, visceral sens. Interventricular foramen: Lateral ventricles connected to third ventricle Limbic system: emotion, learning, cingulate g, hippocampus, amygdala, mammillary b, hypo/tha. nuclei, basal nuclei, frontal cortex; nucleus accumbens = happy, amygdala = fear Longitudinal fissure: Separates L/R hemisphere Mamillary bodies: each have 3-4 nuclei, relay from limbic to thalamus
Median/Lateral Aperture: 1 median, 2 lateral, lead to subarachnoid space on brain/spinal cord, absorbed by arachnoid villi. Medulla Oblongata: foramen magnum, extends 3cm, end at groove between medulla and pons. Last 4 CN begin/end in medulla nuclei. Cardiac center: rate/force of heartbeat. Vasomotor center: Regulates BP/flow by dilating/constricting vessels. 2 respiratory centers: Inspiratory (tractus
solitaries, dorsal RG), expiratory (ambiguus, ventral RG). Speech, coughing, sneezing, salivation, swallowing, gagging, vomiting, sweating, gastrointestinal secretion, movements of tongue/head. 2 pyramids, separated by ant. median fissure. Olive lateral to pyramids. Has gracile/cuneate fasciculi. Corticospinal tract: 90% decussate at pyramidal decussation. Inferior olivary nucleus: Gray matter post. to corticospinal
tract. Relays signals to cerebellum. Ret. formation: post. to inf. oliv. nuc. CN V emerges from pons, nucleus extends to medulla. Midbrain: Continuation of ret. formation, medial lemniscus. Cerebral aqueduct passes. Central (periaqueductal) gray matter: Awareness of pain. Tectum: 4 corpora quadrigemina, superior colliculi: visual attention, inferior colliculi: auditory input, relay to thalamus. Tegmentum: ventral to
aqueduct, contains red nucleus, cerebellum connects, most mammals: rubrospinal tract. Substantia nigra: dark gray-black, melanin, relays inhibitory signals to thalamus/basal nuclei. Removes unwanted muscle contr. Parkinson disease, tremors. Cerebral crura: anchor cerebrum to brainstem. Crura+tegmentum+s. nigra = cerebral penduncle. CN III-IV originate in midbrain. Superior cerebellar peduncles. Memory:
declarative (event/fact), procedural (retention of motor skills, motor ass, basal n, cerebellum), faces/voices/familiarity = sup. temp, social role/goals = prefrontal Motor homunculus: toes most medial, tongue most lateral Occipital: Visual Orbitofrontal cortex: gust, olf, visual; flavor/desirability of food; lies on floor of frontal lobe above eyes Pons: 2.5 cm long. 2 pairs of peduncles attach to cerebellum (middle/inf.).
Sleep, respiration (pneumotaxic = rate/pattern, limit inspiration, parabrachialis; apneustic: stimulate inspire, inhibit expire), bladder control. Anterolateral system contains spinothalamic tract. Ventral spinocerebellar tract. CN V-VIII begin/end here. Postcentral g: somesthetic signals, primary somesthetic cortex Parietal: to parieto-occipital sulcus, general senses, taste, somesthetic ass. area Projection: extend
vertically, internal capsule between thalamus, b. nuclei; corona radiata Purkinje cells: large globose, distinctive, cerebellum, huge amount of dendrites comp. into a plane, axons travel to deep nuclei Pyramidal cell: tall, conical, thick dendrite, knobby dendritic spines, output neurons, fibers leave cortex Reticular formation: somatic motor control, gaze centers, central pattern generators (breathing, swallowing),
cardiovasc. control, pain modulation (descending analgesic fibers), sleep/consciousness, habituation (reticulate activating system/extrathalamic cortical modulatory system) Sens. homunculus: lower limb=sup/med; face=inf/lat; genitalia = most medial, abd. viscera = most inferolat Smell: primary olfactory cortex in med. temp., inf. fron. Stellate cells: spheroidal soma, short dendrites, receive sensory input, local
processing Sulci: Shallow grooves Superior saggital sinus: just under cranium along midsaggital line Taste: primary gust. cortex in inf. postcentral gyrus of parietal lobe, ant. insula Temporal: lateral sulcus to parietal, hearing, smell, learning, mem, vision, emotion Tentorium cerebelli: horizontally over post. cranial fossa, separates cerebrum/cerebellum Thalamus: superior end of brainstem under cerebral hemisphere,
4/5 of diencephalon, intermediate mass joins 2 thalami, 23 nuclei, sensory input, motor control, limbic system. Nuclei: Anterior group: limbic system, memory/emotion. Medial group: emotional output to prefrontal cortex, awareness of emotion. Ventral group: somesthetic output to postcentral gyrus, cerebellum/basal nuclei to motor cortex. Lateral group: somesthetic output to association cortex, emotional limbic
system. Posterior group: Visual signals to occipital lobe (lat. geniculate nucleus), auditory signals to temporal lobe (med. geniculate nucleus) Transverse sinus: runs horizontally from rear of head to ear, empty to internal jugular veins of neck UMN: pyramidal cells of precentral gyrus Vermis: Connects cerebellar hemispheres Vision: primary visual cortex, bordered ant. by visual association area (remainder of occ,
inf. temp.) Wernicke: recog, post. to lat. sulcus, L, Brodmann area 22, receptive/fluent/sensory aphasia, lang. memory Cranial Nerves Sensory: I, II, VIII Motor: III, IV, VI, XI, XII Mixed: V, VII, IX, X func., origin, termin., cranial passage, effect of damage, test Olfactory (I): smell; olfactory mucosa in nasal cavity; olfactory bulbs; cribriform foramina of ethmoid to bulb; impared smell; smell test (coffee, vanilla, clove
oil, soap) Optic (II): vision; retina, thalamus/midbrain; optic foramen; blindness; inspect retina with opthalmoscope, test visual acuity and peripheral vision Oculomotor (III): eye movements, open eyelid, pupillary constriction, focusing; midbrain; somatic fibers to levator palpebrae superioris, sup, med, inf. rectus, autonomic fibers enter eyeball & lead to iris constrictor, ciliary muscle; superior orbital fissure; drooping
eyelid, dilated pupil, inability to move eye, rotate laterally at rest, double vision; diff. in size/shape of pupils, pupillary response to light, track moving objects. Trochlear (IV): eye movements; midbrain; superior oblique; superior orbital fissure; double vision, inability to rotate inferolaterally, eye points superolaterally, head tilt to affected side; ability of eye to rotate inferolaterally. Trigeminal (V): Largest CN, major facial
sens. Opthalmic (V1): sensory; touch, temp, pain from upper face; sup. region of face, eyeball surface, lacrimal gland, superior nasal mucosa, frontal/ethmoid sinuses; pons; superior orbital fissure, no upper face sensation; corneal reflex (blinking in response to eyeball touch). Maxillary (V2): sensory, same as V1, lower on face; middle region of face, nasal mucosa, maxillary sinus, palate, upper teeth, gums; pons;
foramen rotundum, infraorbital foramen; no middle face sensation; touch, pain, temp w/ pinpricks. Mandibular (V3): Mixed, sensory is same but lower on face, mastication; sens: inf. region of fance, ant. 2/3 of tongue (not buds), lower teeth/gums, floor of mouth, dura mater. motor: pons; sens: pons, motor: ant. belly of digastric, masseter, temporalis, mylohyoid, pterygoid, tensor tympani of mid. ear; foramen ovale;
loss of sensation, impaired chewing; palpate masseter/temporalis while clenching teeth, move mandible side to side, open mouth w/ resistance. Abducens (VI): lateral eye movement, inf. pons, lateral recuts, superior orbital fissure; inability to move eye lat, eye turns medially at rest, test lateral eye movement Facial (VII): Temporal, zygomatic, buccal, mandibular, cervical branches; sens: taste, motor: facial
expression, secretion of tears, saliva, nasal/oral mucus; sens: taste buds of ant 2/3, motor: somatic fibers to digastric muscle, stapedius of mid. ear, stylohyoid, facial expression, autonomic to submandibular/sublingual salivary glands, tear glands, nasal/palatine glands; internal acoustic meatus, stylomastoid foramen; inability to control facial muscles, sagging, can’t taste sweets; ant. 2/3 tongue w/ sugar, salt,
vinegar, quinine, response of tear glands to ammonia fumes, smile/frown/whistle/raise eyebrows/close eyes. Vestibulocochlear (VIII): hearing/equilibrium; sens: cochlea, vestibule, semicircular ducts of inner ear, motor: pons; sens: hearing at medulla, equilibrium at medulla/pons junction, motor: outer hair cells of cochlea of inner ear; internal acoustic meatus; nerve deafness, dizziness, nausea, loss of balance,
nystagmus (eyes oscillate); nystagmus, hearing, balance, walk straight Glossopharyngeal (IX): sens: taste, touch, pressure, pain, temperature from tongue/outer ear, regulate blood pressure/respiration, motor: salivation, swallowing, gagging; sens: pharynx, middle/outer ear, post. 1/3 of tongue (taste buds inc.), internal carotid artery, motor: medulla; sens: medulla, motor: parotid salivary gland, post. tongue glands,
stylopharyngeal muscle (dilates pharynx in swallowing); jugular foramen; loss of bitter/sour taste, no swallow; gag reflex, swallowing, coughing, speech, post. 1/3 tongue bitterness and sourness Vagus (X): most extensive, sens: taste, hunger, fullness, GI discomfort, motor: swallowing, speech, decelerate heart, bronchoconstriction, GI secretion and motility; sens: thoracic/abdominal viscera, root of tongue, pharynx,
laynx, epiglottis, outer ear, dura mater, motor: medulla; sens: medulla, motor: tongue, palate, pharynx, larynx, lungs, heart, liver, spleen, dig. tract, kidney, ureter; jugular foramen; hoarness/no voice, no swallow/GI motility, fatal if both CN gone; palatal movements of speech, swallow, gag reflex, weak voice, inability to force coughing Accessory (XI): partly brain, swallowing, head neck shoulder movements; medulla,
C1-C6; palate, pharynx, trapezius, sternocleido; jugular foramen; head/neck/shoulder movement impaired, can’t shrug on one side, sternocleid paralysis, head turn to injured; head rotation shoulder strug against resistance Hypoglossal (XII): tongue movements for speech, food manipulation, swallowing; medulla; in/extrinsic tongue muscles; hypoglossal canal; no speech/swallowing, no tongue protrusion if both
gone, deviation/atrophy of tongue on side; deviation of tongue w/ protrusion/retraction, protrusion against resistance Spinal Cord Defecation/micturition reflexes, Exits from foramen magnum, passes to L1. 1.8 cm thick, 45 cm long. 31 pairs: C1 (between skull/atlas)-C8, T1-T12, L1-L5, S1-S5, Co Rootlet: 6-8, enters dorsal horn from dorsal root, converge to form ventral root Root: penetrate dural sac, enter
intervertebral foramen, shortest in cervical region, longer inferiorly Ramus: divides after emerging from intervertebral foramina into rami Dorsal ramus: innervates muscles/joints in spine/back skin Ventral ramus: larger, innervates ventral/lateral skin and muscles of trunk, leads to nerves of limbs. Thoracic region: forms intercostal nerve travels along inferior margin of rib, innervates skin/intercostal muscles, int.
oblique, ext. oblique, transversus abdominis Meningeal branch (recurrent nerves of Luschka): reenters vertebral canal, innervates meninges, vertebrae, spinal ligaments Ventral median fissure, dorsal median sulcus. Cervical enlargement: inferior cervical region, nerves of upper limbs. Lumbar enlargement: lumbosacral region, pelvic/lower limb nerves Tapers to medullary cone/conus medullaris. Cauda equina
L2-S5 (root of Co) Dura mater forms dura sheath, tough collagenous membrane. Epidural space blood vessels, adipose, loose connective tissue. Epidural anesthesia. Arachnoid mater: arachnoid membrane is simple squamous. Collagenous/elastic fiber, CSF span subarachnoid space (called lumbar cistern) below medullary cone. Pia mater delicate, translucent membrane. Forms terminal filum and coccygeal
ligament anchoring cord to L2. Denticulate ligaments extend from pia to dura. Dermatome: area of skin each spinal nerve except C1 receives sens. input from, overlap by 50%, must sever 3 spinal nerves to nullify one dermatome Reflex: quick, involuntary, stereotyped reactions reactions of glands/muscles to stimulation Reflex arc: somatic receptors, afferent nerve fibers, integrating center, efferent nerve fibers,
skeletal muscles. Monosynaptic reflex arc = no interneuron. Patellar tendon: motor output to quadriceps femoris, inhibit ipsilateral hamstring. Ipsilateral reflex: CNS I/O on same side. Contralateral reflex: CNS I/O on opp. sides. Intersegmental reflex: sensory signal enters at one segment, leaves at higher/lower level Stretch reflex: inc. muscle tension in resp. to stretch. Maintains equilibrium/posture, stab. joints,
smoother joint actions. Patellar. Flexor reflex: Contr. of flexor muscles resulting in withdrawal of limb from injurious stimulus. Crossed extension reflex: contr. of extensors in one limb when flexors of opp. limb contract. Golgi tendon reflex: Inhibition of muscle contr. when tendon is stretched. Central pattern generator: groups of neurons coordinating, simple repetivie muscle contractions, sequence of ouputs to
extensors/flexors Anatomy 2 dorsal horns, two ventral horns, right/left connected by gray commissure, central canal (remnant of lumen of neural tube). Lateral horn present in thoracic/lumbar regions; sympathetic neurons, uses ventral root w/ somatic fibers. Columns/funiculi: dorsal/posterior, lateral, ventral/anterior. Tracts/fasciculi (column, decussation, functions): Ascending Cuneate fasciculus: dorsal, medulla,
sesnsations of limb/trunk position and movement, deep touch, viscera pain, vibration from T6 up Gracile fasciculus: dorsal, medulla, same as cuneate, below level T6. Medial lemniscus formed from second-order fibers of gracile/cuneate decussations Spinothalamic: lateral and ventral, spinal cord, sensations of light touch, tickle, itch, temperature, pain, pressure Spinoreticular: lateral and ventral, spinal cord (some
fibers), sensation of pain from tissue injury; end in gray matter reticular formation in medulla/pons; third order from pons to thalamus, fourth order to cerebral cortex Dorsal spinocerebellar: lateral, none, proprioception; 2 orders Ventral spinocerebellar: lateral, spinal cord, same as dorsal spinocerebellar; 2 orders; cross over once but cross back in brainstem Descending Lateral corticospinal lateral, lower medulla,
fine control of limbs. Ventral corticospinal ventral, none, fine control of limbs. Decussate later in spinal cord, so control contralateral muscles. Corticospinal forms pyramids on ventral medulla, so called pyramidal tracts. Tectospinal begins in midbrain region called tectum, ends at neck, ventral, midbrain, reflexive head-turning due to visual/auditory stimuli Lateral reticulospinal starts in ret. formation, lateral, none,
balance and posture, awareness of pain regulation Medial reticulospinal starts in ret. formation, ventral, none, same as lateral reticulospinal. Both contain descending analgesic pathways to reduce pain signals to brain. Lateral vestibulospinal Both begin in brainstem vestibular nuclei, ventral, none, balance and posture (extensor muscles) Medial vestibulospinal ventral, medulla (some fibers), control of head position
Rubrospinal almost null in humans, muscle coordination in mammals Plexuses Formed by ventral rami Cervical C1-C5, geniohyoid, thyrohyoid, scalene, levator scapulae, trapezius, sternocleidomastoid Lesser occipital n: somatosensory, upper third of medial surface of ext. ear, skin post. to ear, posterolateral neck Great auricular n: somatosensory, most of ext. ear, mastoid reg., parotid salivary gland to slightly
inf. to angle of mandible Transverse cervical n: somatosensory, ant. and

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analog to LH and interacts w/ LHCG receptor of ovary, promotes maintenance of c. luteum, - charge repels immune cells of mother, facilitate trophoblast invasion, produced by syncytiotrophoblast Skin: Keratinocytes of epidermis convert 7-dehydrocholesterol to cholecalciferol, hydroxylated
in liver to calcifediol (25-hydroxyvitamin D3), hydroxylated in kidney to calcitriol (1,25-dihydroxyvitamin D 3)/active vitamin D Small intestine: CCK in response to fats from enteroendocrine cells of duodenum, gallbladder releases bile, satiety Steroid hormones: aldosterone, androgens, calcitriol,
cortisol, corticosterone, estrogens, progesterone Stomach: gastrin, HCl release; ghrelin, hunger Testis: testosterone, androgens, estrogens, inhibin. Seminiferous tubules produce sperm. Wall of tubule = sustentacular/Sertoli cells = inhibin, regulate sperm. Interstitial cells/Leydig cells between
tubules make testosterone = male reprod. sys., masculine physique, sex drive, sperm produc. Thymus: bilobed, mediastinum, sup. to heart, behind sternal manubrium, involution at 14, 10g, becomes fibrous/fatty, thymopoietin, thymosin, thymulin) Thyroid: largest, 20-25g, bilobed, adj. to
trachea, below larynx, tapers sup, isthmus joins, pyramidal lobe in 50%, supplied by sup. thyroid arteries from ext. carotid arteries, inf. thyroid arteries from subclavian arteries, drained by sup/mid/inf thyroid veins, flows to internal jugular and brachiocephalic veins, follicles lined by sim. cub.
epi of follicular cells, filled with colloid of thyroglobulin, secrete mainly T4 (80 ug, 98% circulating form), 4ug of T3 (more active form), alters gene expression, more mitochondrial enzymes to make ATP, Na-K pump stimulated, higher met. rate/O2 con., calorigenic, brain dev, bone growth, GH,
quickens somatic ref, heart rate, absorb carbs, lower cholesterol; C (parafollicular cells) secrete calcitonin, inhibits osteoclasts Diseases Addison: primary adrenal insufficiency, hypocortisolism; hyposecretion of glucocorticoids/mineralcorticoids leads to hypoglycemia, hypotension, weight
loss, weakness, loss of stress resistance, darkening of skin, fatal dehydration/electrolyte imbalances; due to immune system reaction against 21-hydroxylase/TB; secondary insufficiency due to low ACTH/CRH Diabetes mellitus: 10% = Type I/IDDM, autoimmune destruction of beta cells, low
insulin; 90% = Type II/NIDDM, defective receptors, cannot absorb glucose/AAs, elevated glucose, glucose in urine (glycosuria), profuse urine output (polyuria), intense thirst/hunger, muscle atrophy, weight loss, cardiovascular (microangiopathy)/nerve damage (endothelial cells do not need
insulin to take up glucose), ketoacidosis because cells break down fatty acid not glucose, can cause nerve damage (diabetic neuropathy) and remove pain Goiter: swelling of neck/larynx due to enlargement of thyroid, 90% iodine def, hyperthyroidism: adrenergic stimulation, tachycardia,
palpitations, tremor, high BP, heat intolerance, hypermetabolism; hypothyroid: weight gain, cold intolerance, lethargy, constipation; uninodular = inactive/toxic nodule; multinodular = inactive/toxic; diffuse = whole enlarged; Class I = only by palpitation, Class II = palpable/easily seen; Class III
= very large/retrosternal, pressure causes compression marks, cause = iodine, selenium, hashimoto, cyanide-rich cassava Graves’: Basedow syndrome, high metabolism, toxic diffuse goiter, thyroid autoimmune, hyperthyroidism, irritability, muscle weakness, sleeping problems, tachycardia,
poor tolerance of heat, diarrhea, weight loss, pretibial myxedema (lymphocytes react against TSH rec, tissue/scar, deposition of glycosaminoglycans), exophthalmos, cause: antibody TSI acts like TSH, excess TH; raised T3/T4, low TSH, low TRH, TSI, inc. radioiodine uptake, Yersinia
enterocolitica mimic thyrotropin receptor, HLA DR3 gene Hashimoto’s thyroiditis: chronic lymphocytic thyroiditis, autoimmune, thyroid gland destroyed, weight gain, tired, constipation, depression, pains, treatment = levothyroxine, enlargement due to lymphocytic infiltration/fibrosis, antibodies
against thyroid peroxidase/thyroglobulin destroy follicles, invasion by T cells; diagnose = TPOAb (anti-thyroid peroxidase antibodies), high TSH, anti-Tg, anti-microsomal antibodies Hypoglycemia: low blood sugar, clumsiness, trouble talking, dilated pupils, confusion, loss of consciousness,
seizures, death, hunger, sweating, shakiness, weakness; cause: insulin, sulfonylureas, eating less, exercising more, alcohol, kidney failure, hypothyroidism/tumors; diagnose: diabetes=3.9 mmol/L (70 mg/dL), reg.=2.8 mmol/L (50 mg/dL), newborn=2.2 mmol/L (40 mg/dL), check for insulin
and C peptide level, treatment=dextrose Myxedema: severe hypothyroidism (pretibial in hyper), deposition of mucopolysaccharides in dermis = swelling, connective fibers separated by glycosaminoglycans, hyaluronic acid, chondroitin sulfate, other mucopolysaccharides, binds water =
edema; tongue thickening in laryngeal and pharnygeal mucous membranes = thick slurred speech, thin hair, dry skin, coldness

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