Anatomic sciences (nerves misc reproductive s. perio lig).txt

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Anatomic sciences (nerves misc reproductive s. perio lig).txt
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  1. A gag reflex overcomes your patient as you lightly swab an area of the oropharynx. What nerve carries the sensory fibers of this reflex?

    - Trigeminal (CN V)
    - Facial nerve (CN VII)
    - Glossopharyngeal (CN IX)
    - Vagus nerve (CN X)
    • Glossopharyngeal (CN IX), carries primary afferent neruons to the gag reflex (innervated the mucous membranes of the fauces)
    • This is a mixed nerve (motor and sensory), that originates from the anterior surface of the medulla oblongata. along with the vagus (CN X) and spinal accessory (CN XI). It passes laterally in the posterior cranial fossa and leaves the skull through the jugular foramen, to supply sensation to the pharynx and the posterior 3rd of the tongue. It descends through the upper part of the neck along with the internal jugular vein and internal carotid artery, to reach the posterior border of the stylopharyngeus muscle (to which it supplies motor somatic fibers to).
    • The otic ganglion is a small parasympathetic ganglion that is functionally associated with the glossopharyngeal nerve, it is located immediately below the foramen ovale in the infratemporal fossa. The otic ganglion is one of FOUR parasympathetic ganglia of the head and neck (submandibular ganglion, pterygopalatine ganglion, and ciliary ganglion).
    • The following nerves also recieve preganglionic fibers from the parasympathetic division oculomotor (ciliary ganglion), facial (pterygopalatine and submandibular ganglia) and vagus (small terminal ganglia)
  2. Your recent patient presents to your office complaining of severe pain in his jaws around the temporomandibular (TMJ) joint. He chews three packs of gum a day, and his wife tells him he grinds his teeth at night. What nerve provides major sensory innervation to the TMJ?

    - Masseteric nerve
    - Auriculotemporal nerve
    - Facial nerve (CN VII)
    - Trochlear nerve (CN IV)
    • Auriculotemporal nerve arises from the posterior division of the mandibular nerve (V-3). It supplies posterior portion of the TMJ.
    • Nerve to the masseter (masseteric nerve) also a branch of V-3 carries a few sensory fibers to the anterior portion of the TMJ. Deep temporal nerves (anterior, middle and posterior) innervate the temporalis and carry a few fibers to the anterior portion of the TMJ.
    • Pain in fractured condylar neck, capsule and disc and even secretory fibers from the otic ganglion that go to the parotid all come from the auriculotemporal nerve.
  3. When walking to his car late night, a professor hears footsteps behind him. His sympathetic response results in dilated pupils, a dry mouth and constriction of blood vessels in his face resulting in an ashen look. The sympathetic response for the head and neck is mediated by cell bodies located in the (IMG 150):

    - Superior cervical ganglion
    - Middle cervical ganglion
    - Inferior cervical ganglion
    - Ganglion impar
    • Superior cervical ganglion
    • Paravertebral ganglia lie on each side of the vertebrae and are connected to form the sympathetic chain or trunk. There are usually 21 or 23 pairs of these ganglia (3 cervical, 12 thoracic, 4 lumbar, 4 sacral and a single unpaired ganglion lying in front of the coccyx called the ganglion impar.
    • Three cervical ganglia:
    • Superior cervical ganglion: uppermost and largest. stretching from C1 to C2 or C3. Lies between the internal carotid artery and the internal jugular vein. Innervates the viscera of the head.
    • Middle cervical ganglion: small, located at the level of the cricoid cartilage, it innervates the viscera of the neck, thorax (heart and brinchi) and upper limb.
    • Inferior cervical ganglion: occurs at the C7 vertebral level, commonly fused to the first thoracic sympathetic ganglion to form stellate ganglion. Innervates viscera of the neck, thorax (heart and bronchi) and upper limb.
    • * Gray rami connect the sympathetic trunk to every spinal nerve. White rami are limited to the spinal cord segments between T1 and L2
  4. A 62yo woman complains of excruciating stabbing pain on the right side of her face on her cheek, 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. The working diagnosis is a neuralgia of what cranial nerve?

    - Facial
    - Abducens
    - Glossopharyngeal
    - Trigeminal
    • Trigeminal nerve exits the infratemporal pons as a sensory and motor root. The larger sensory root enters the trigeminal ganglion (gasserian) in the middle cranial fossa, the smaller motor root passes under the ganglion and joins the mandibular division exiting the foramen ovale.
    • Somatic sensory cell bodies of the ganglion's sensory fibers enter the:
    • ophthalmic division V1: to supply sensation to orbit and skin of face above the eyes
    • Maxillary division V2: supply general sensation to the nasal cavity, maxillary teeth and palate
    • Mandibular division V3: general sensation to the mandible. TMJ, mandibular teeth, floor of mouth, tongue and skin of mandible.
    • Axons of the neurons enter the pons through the sensory root and terminate in one of three nuclei of trigeminal sensory nuclear complex: Mesencephalic nucleus (muscle spindle, proprioception), chief or pontine nucleus (light touch) and spinal nucleus (pain and temperature, head and neck)
  5. A patient with incontrolled diabetes comes into the clinic for some periodontal work. You notice that her right eyelid is now dropping, which it was not doing a year ago at her last appointment. From class, you recognize that nerve damage can be the result of chronic high blood sugar. An upper eyelid that droops (ptosis) may be caused by damage to the:

    - Trochlear nerve (CN IV)
    - Abducens nerve (CN VI)
    - Oculomotor nerve (CN III)
    - Optic nerve (CN II)
    • Oculomotor nerve (CN III), supplies the following extraocular muscles; medial, superior, and inferior recti; inferior oblique and levator palpebrae superioris. The oculomotor nerve sends preganglionic parasympathetic fibers to the ciliary ganglion. 
    • In most cases ptosis is caused by either a weakness of the levator muscle (muscle that raises the eyelid) or a problem with the oculomotor nerve.
    • LR6, SO4, AO3 all exit the cranium through the superior orbital fissure and innervate the extrinsic ocular muscles resulting in movements of the eyeball.
    • Trochlear nerve (CN IV) is the smallest nerve that only innervates one muscle (motor superior oblique), and the only to emerge from the dorsal aspect of the brainstem.
  6. The splanchnic nerves (greater, lesser and least) arise from the:

    - Cervical sympathetic ganglion (chain)
    - Thoracic sympathetic ganglion (chain)
    - Lumbar sympathetic ganglion (chain)
    - Sacral sympathetic ganglion (chain)
    • Thoracic sympathetic ganglion (chain)
    • Paravertebral sympathetic ganglia lie on each side of the vertebrae and are connected to form the sympathetic chain or trunk. These nerves arise from thoracic ganglia (T5-T12) ...they all pass through the diaphragm.
    • Thoracic splanchic nerves (specifically the greater splanchic nerve) to the celiac plexus consist primarily of preganglionic visceral efferent fibers.
  7. A 34yo female complains to her physician of hoarseness. The physician notes drastically enlarged lymph nodes in the aorticopulmonary window and suspects involvement of a branch of the vagus nerve. Which branch loops posteriorly around the aortic arch and ascends to enter the larynx?

    - Right recurrent laryngeal nerve
    - Left recurrent laryngeal nerve
    - Right superior laryngeal nerve
    - Left internal laryngeal nerve
    - Right cardiac branch
    • Left recurrent laryngeal nerve
    • The left vagus gives rise to the left recurrent laryngeal nerve
    • The right recurrent laryngeal nerve splits from the right vagus before entering the superior mediastinum at the level of the right subclavian artery. The nerve hooks posteriorly around the subclavian artery.
    • Both recurrent nerves pass deep to the lower margin of the inferior constrictor muscle to innervate the intrinsic muscles of the larynx responsible for controlling the movements of the vocal folds.
    • Both recurrent laryngeal nerves (right and left) innervate: all the muscles of the larynx except the cricothyroid which is supplied by the external laryngeal branch., mucous membrane of the larynx below the vocal folds, mucous membrane of the upper part of the trachea.
  8. Which of the following muscles is not innervated by the hypoglossal nerve?

    - Palatoglossus
    - Styloglossus
    - Genioglossus
    - Hyoglossus
    • Palatoglossus (is supplied by the vagus nerve)
    • Hypoglossal nerve leaves the skull through the hypoglossal canal medial to the carotid canal and the jugular foramen (which allows exit of the spinal accessory). After it leaves the skull it is joined by C1 and C2 fibers from the cerval plexus. This nerve is a MOTOR nerve that supplies all of the intrinsic and extrinsic muscles of the tongue EXCEPT THE PALATOGLOSSUS.
    • Lesions of the hypoglossal nerve: Unilateral deviation of the protruded tongue toward the affected side (lack of genioglossus function). Injury of the hypoglossal nerve produces paralysis and atrophy of the tongue on the affected side with deviation towards the affected side.
    • Dysarthria: inability to articulate can be found.
    • If the genioglossus is paralyzed, the tongue has a tendency to fall back and obstruct the oropharyngeal airway with risk of suffocation.
  9. After depositing enough lidocaine 2% to anesthetize the nerve entering the mandibular foramen, a dental student removes the needle to approximately half the depth of the initial target, whereupon another bolus of anesthetic is deposited. What nerve is most likely anesthetizes by the second bolus?

    - Hypoglossal nerve
    - Long buccal nerve
    - Inferior alveolar nerve
    - Lingual nerve
    - Glossopharyngeal nerve
    • Lingual nerve, is a branch of the mandibular division (V-3) of the trigeminal nerve. Supplies sensation to the anterior 2/3rd of the tongue, floor of the mouth and mandibular lingual gingiva. Mandibular duct has an intimate relation with the lingual nerve , which it crosses twice.
    • The lingual nerve descends deep into the medial pterygoid, where the nerve is joined by the chorda tympani (branch of the facial nerve) which conveys the preganglionic parasympathetic fibers to the submandibular ganglion and taste fibers from the anterior 2/3rd of the tongue.
    • * cutting the lingual nerve after its junction with the chorda tympani will result in a loss of taste and tactile sense to the anterior 2/3rds.
    • The chorda tympani conveys general visceral efferent fibers (motor fibers, like all parasympathetic nerve fibers) of the parasympathetic division of the autonomic nervous system. It carries special visceral afferent fibers for taste.
  10. The glossopharyngeal nerve (CN IX) innervates all of the following EXCEPT one. Which is the exception?

    - Stylopharyngeus muscle
    - Palatopharyngeus muscle
    - Parotid gland
    - Carotid sinus
    - Posterior tongue
    • Palatopharyngeus muscle (is innervated by the vagus)
    • The Stylopharyngeus muscle is the only muscle supplied by the glossopharyngeal nerve, it also supplies preganglionic parasympathetic motor fibers to the otic ganglion,, these fibers synapse with postganglionic fibers in the ganglion to supply the parotid gland.
    • Visceral sensory branches of the Glossopharyngeal nerve:
    • Lingual branches: are 2 in number, supply the vallate papillae and mucous membrane covering the base of the tongue and mucous membrane and follicular glands of the posterior one third of the tongue, communicates with lingual nerve
    • Pharyngeal: distributed to the mucous membrane of the pharynx and is the sensory limb of the gag reflex.
    • Carotid sinus nerve: to carotid sinus (baroreceptor) and carotid body (chemoreceptor)
  11. The cervical plexus consists of anterior rami from C1-C4; some of these fibers reach the hyoid muscles by running concurrently with which cranial nerve?

    - Phrenic nerve
    - Vagus nerve
    - Glossopharyngeal nerve
    - Spinal accessory nerve
    - Hypoglossal nerve
    • Hypoglossal nerve
    • There are four main pairs of nerve plexuses that are formed by the mixing and branching of the ventral rami of the spinal nerves:
    • Cervial plexus (C1-C4)- cutanous innervation of skin of the neck, shoulder and upper anterior chest wall, phrenic nerve is the motor nerve of the diaphragm
    • Brachial plexus (C5-C8 and T1)- posterior triangle of the neck, supplies nerves to upper limb. 3 chords posterior, lateral and medial
    • Lumbar plexus: L1-L4, main branches are femoral and obturator, lower abdomen and limbs
    • Sacral plexus (L4-L5 and S1-S4): main branch is the sciatic nerve largest nerve in the body.
  12. The branch of the trigeminal nerve that innervates the midface, palate and paranasal sinus exits the cranial cavity through which structure?

    - Superior orbital fissure
    - Optic canal
    - Foramen rotundum
    - Pterygomaxillary fissure
    - Foramen ovale
    • Foramen rotundum
    • The ophthalmic division (v-1) enters through the superior orbital fissure and provides sensory innervation to the eyeball, tip of the nose, skin over the upper eyelid, and skin of the face above the eye. Branches include 
    • lacrimal, frontal, nasociliary, supraorbital, supratrochlear and external nasal nerves.
    • * NOTE: during a sinus attack, painful sensation from the ethmoid cells is carried in the nasociliary nerve.
    • Maxillary division (v-2): passes through the foramen rotundum and provides sensory innervation to the midface, palate, paranasal sinuses and maxillary teeth, branches include infraorbital, zygomaticofacial and zygomaticotemporal nerves.
    • * NOTE: the tickling sensation felt in the nasal cavity prior to a sneeze is carried by V2
    • Mandibular division (V3): skin of the cheek, skin of the mandible, lower lip and side of the head, also TMJ, mandibular teeth and mucous membranes of the cheek, floor of the mouth and anterior part of the tongue. Branches include mental, buccal and auriculotemporal nerve.
  13. The 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 supply the mylohyoid and what other muscle?

    - Anterior digastric
    - Geniohyoid
    - Stylohyoid
    - Genioglossus
    • Anterior digastric
    • Digastric muscles: Anterior belly (innervated by the nerve to the mylohyoid, branch of the V3 division of the trigeminal) Posterior belly (innervated by the facial nerve)
    • Mylohyoid muscle: innervated by the nerve to the mylohyoid V3 division of trigeminal 
    • Geniohyoid muscle: innervated by the first cervical nerve through the hypoglossal nerve
    • Stylohyoid: innervated by the facial nerve
    • Infrahyoid muscles: all innervated by the ansa cervicalis
  14. Which of the following nerves carries parasympathetic fibers in addition to motor innervation?

    - Optic
    - Olphactory
    - Oculomotor
    - Trochlear
    • Oculomotor, exits the superior orbital fissure
    • Parasympathetic visceral motor efferent innervation: of the contrictor pupillae and ciliary muscles
    • Somatic motor efferent: superior, medial and inferior rectus, and inferior oblique along with levator palpabrae of the eyelid
  15. The entended course of the abducens nerve from the brainstem to the eye makes it vulnerable to injury. In blunt force trauma to the head, 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?

    - Right ptosis
    - Loss of light reflexes on the right side
    - Inability to adduct the right eye
    - Medial deviation of the right eye
    - Loss of corneal reflex on the right side
    • Medial deviation of the right eye
    • The abducens nerve innervates the lateral rectus muscle responsible for lateral gaze (its contraction causes the eye to be abducted). Lesion of this nerve results in strabismus (cross-eyed) and diplopia (double vision)
    • Besides the muscles of mastication the trigeminal v3 motor also innervates: mylohyoid, anterior digastric, tensor tympani and tensor veli palatine.
  16. 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
    • Sympathetic and afferent fibers
    • Sensory fibers in the dental pulp originate in the trigeminal ganglion and are categorized from smallest to largest in diameter, into C-fibers, A-delta and some A-beta fibers.
    • A-delta fibers are myelinated low threshold mechano-receptiors and are responsible for the first pain signal. C-fibers are unmyelinated, high threshold fibers poly-nodal and respond to several types of stimuli, these most likely cause the sensation of second pain
    • Pulp contains both myelinated and unmyelinated fibers.
    • Pain originates in the pulp due to free nerve endings (afferent fibers) which are the only type of nerve ending found in the pulp and are specific receptors for pain (regardless of the stimulation)
  17. Which cranial nerve has visceral innervation?

    - Trigeminal nerve
    - Facial nerve
    - Vagus nerve
    - Hypoglossal nerve
    • Vagus nerve, is a mixed nerve that leaves the brain from the medulla and passes out of the cranial cavity through the jugular foramen. It consists of the following components
    • Somatic (branchial motor): soft palate, pharynx, intrinsic laryngeal muscles, palatoglossus (actually a palatine muscle based on its derivation and innervation)
    • Propioceptive: To the muscles listed above
    • Visceral (parasympathetic) motor: To thoracic and abdominal viscera
    • Somatic (general) sensory: from inferior pharynx and larynx
    • Visceral sensory: from thoracic and abdominal organs
    • Taste and somatic (general) sensation: root of the tongue and taste buds on the epiglottis
    • Pharyngeal plexus contains both motor and sensory components. The motor nerves are believed to come from the vagus nerve.
  18. Which of the following is a component of the optic disc or papilla?

    - Central artery
    - Cones
    - Sensory efferent fibers
    - Myelinated nerve fibers
    - Oculomotor nerve
    • Central artery
    • The optic disc also called the optic papilla" is the small blind spot on the surface of the retina. The optic disc is the only part of the retina that contains no photoreceptors (rods or cones). The disc consists of unmyelinated axons of ganglion cells exiting the retina to form the optic nerve.
    • The optic nerve has only a special sensory component. Special sensory conveys visual information from the retina (special afferent)
    • After exiting the eye at the optic disc, the two optics nerves meet at the optic chiasma
    • The central artery of the retina, a branch of the ophthalmic artery pierces the optic nerve and gains access to the retina by emerging from the center of the optic disc
  19. Which of the following receives fibers from the motor, sensory and parasympathetic components of the facial nerve and sends fibers that will innervate the lacrimal, submandibular and sublingual glands?

    - The semilunar ganglion
    - The geniculate ganglion
    - the otic ganglion
    - The ciliary ganglion
    • The geniculate ganglion, is an L-shaped collection of fibers and sensory neruons of the facial nerve located in the facial canal of the head. It receives fibers from the motor, sensory and parasympathetic components of the facial nerve and sends the fibers that will innervate the lacrimal glands, submandibular glands, tongue (anterior 2/3rds), palate pharynx, external auditory meatus, posterior digastric and facial expression muscles.
    • Important branches of the intrapetrous part of the facial nerve: Greater petrosal nerve, Nerve to the stapedius and the chorda tympani.
  20. A patient with bilateral vision problems receives a diagnosis of a pituitary adenoma. The neurologist tells the patient that his optic nerve is affected. More specifically, which portion of the optic nerve is most likely affected?

    - Optic tract
    - Lateral geniculate body
    - Optic chiasma
    - Medial geniculate body
    • Optic chiasma
    • The optic nerve CN II, arises from the axons of the ganglion cells of the retina, which converge at the optic disc. The optic nerve leaves the orbital cavity by passing through the optic foramen (also called the optic canal) of the sphenoid bone with the ophthalmic artery and enters the cranial cavity., nerves from both sides join to form the optic chiasma
    • The optic tract emerges from the posterolateral angle of the optic chiasma and passes backward around the lateral side of the midbrain to reach the lateral geniculate body.
  21. Which statement concerning the left vagus nerve is false?

    - It can be cut on the lower part of the esophagus to reduce gastric secretion (termed a vagotomy)
    - It forms 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.
    • It contains parasympathetic postganglionic fibers, this is FALSE
    • The vagus nerve contains parasympathetic preganglionic fibers to the thoracic and abdominal viscera.
    • Vagus nerve, general functions:
    • Motor and sensory from the larynx
    • Motor to all of the muscles of the pharynx except the stylopharyngeus (CN IX) and all muscles of the soft palate except for tensor veli palatini (V3)
    • Communicates taste from the epiglottis
    • Sensory from external auditory meatus
    • Afferent from viscera above left (splenic) flexure
    • Parasympathetic to the lungs, heart, stomach and myenteric plexus
  22. All of the laryngeal muscles are innervated by the recurrent laryngeal nerve EXCEPT one:

    - Posterior cricoarytenoid
    - Thyroarytenoid
    - Cricothyroid
    - Transverse arytenoid
    - Lateral cricoarytenoid
    • Cricothyroid
    • The vagus nerve possesses two sensory ganglia: Superior (within the jugular foramen) and Inferior (just below the jugular foramen) ganglias.
    • Superior ganglion: has meningeal (supplies dura matter) and auricular (supplies auricle, external auditory meatus
    • Inferior ganglion: has pharyngeal (pharyngeal plexus) and superior laryngeal.
  23. The semilunar ganglion is a large, flattened, sensory ganglion of the _______, lying close to the cavernous sinus in the middle cranial fossa.

    - Hypoglossal nerve (CN XII)
    - Facial nerve (CN VII)
    - Oculomotor nerve (CN III)
    - Trigeminal nerve (CN V)
    • Trigeminal nerve (CN V), is the most voluminous of all the cranial nerves, it is sensory for the facial regions and motor for the mastication muscles.
    • Trigeminal exits the inferolateral pons as a sensory and motor root. The larger sensory root enters the trigeminal (semilunar or Gasser) ganglion in the middle cranial fossa. The smaller motor root passes under the ganglion and joins the mandible division as it exits through the foramen ovale.
    • The geniculate ganglion: L-shaped collection of fibers and sensory neurons of the facial nerve located in the facial canal of the head. Receives fibers from the motor, sensory and parasympathetic components of the facial nerve and sends fibers that will innervate the lacrimal glands, submandibular glands, sublingual glands, tongue, palate, pharynx etc...
    • Taste fibers from the posterior 1/3rd of tongue are from glossopharyngeal nerve
    • Loss of lacrimation can be due to an injury to the greater petrosal nerve.
  24. Which cranial nerve supplies the derivatives of the second brachial arch?

    - Glossopharyngeal
    - Trigeminal
    - Vagus
    - Facial
    • Facial
    • First arch (mandibular): trigeminal, muscles of masication, mylohyoid, anterior digastric, tensor veli palatine muscles
    • Second arch: facial nerve, facial expression, posterior digastric, stylohyoid muscle, stapedius.
    • Third arch: glossopharyngeal nerve, stylopharyngeal nerve
    • 4th through 6th arches: Laryngeal branches of vagus, levator palatine muscles, muscles of larynx
    • *Ophthalmic nerve CN V-1, is NOT considered branchiomeric. It does not innervate branchial arch derivatives. It instead innervates structures derived from the paraxial mesoderm found in the frontonasal process of the developing embryo.
    • Facial, trigeminal (except for its V-1), glossopharyngeal and vagus are considered to be branchiomeric in origin because they originate from branchial arches.
  25. A lesion of the facial nerve just after it exits from the stylomastoid foramen would result in:

    - An ipsilateral loss of taste to the anterior tongue
    - A decrease in saliva production in the floor of the mouth
    - A sensory loss to the tongue
    - An ipsilateral paralysis of facial muscles
    - A contralateral paralysis of facial muscles
    • An ipsilateral paralysis of facial muscles
    • Facial nerve emerges from the brainstem between the pons and the medulla, it controls muscles of facial expression (and inner ear) and taste to the anterior 2/3rds of the tongue, but also supplies parasympathetic fibers to the submandibular gland and sublingual glands via the chorda tympani.
  26. The trapezius and sternocleidomastoid muscles receive motor innervation from the :

    - Glossopharyngeal nerve
    - Vagus nerve
    - Accessory nerve
    - Hypoglossal nerve
    • Accessory nerve (exits the jugular foramen)
    • Glossopharyngeal (exits the jugular foramen)
    • Hypoglossal (exits the hypoglossal canal)
    • Vestibulocochlear (exits the internal acoustic meatus)
  27. Which of the following organs is retroperitoneal?

    - Stomach
    - Kidneys
    - Liver
    - Gallbladder
    - Spleen
    • Kidneys
    • Abdominal cavity: includes the Peritoneal cavity (abdomen surrounded by peritoneum, potential space between parietal and visceral layers) and the Retroperitoneal space (area behind the peritoneum, where retroperitoneal organs are)
    • Retroperitoneal organs: aorta, inferior vena cava, kidneys, adrenal glands, pancreas, uterers, most of duodenum and ascending and descending parts of colon.
    • Abdominal contents: Peritoneum (a thin membrane that lines the walls of the abdomen and pelvic viscera, it is considered "the ballon" in which the organs are pressed into from the outside) It is divided into 2 parts.
    • Parietal peritoneum: lines the walls of the abdominal and pelvis cavities
    • Visceral peritoneum: covers the organs. 
    • *Peritoneal cavity can be divided into 2 parts greater sac and lesser sac.
  28. A 47yo patient with pancreatic cancer is put on multiple chemo-therapeutic drugs. Unfortunately, as 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 fluid
    - Contains less glucose than intracellular fluid
    • Has a higher sodium/potassium ratio than intracellular fluid
    • Intracellular fluid: 2/3rd of the bodys water, not homogenous in the body, conglomeration of fluids from all over the body, primary solution for potassium and organic ions. is 2/3rd your bodies water weight.
    • Extracellular fluid: 1/3rd of the bodys water, about 20% of body weight, is primarilty NaCl and NaHCO3 solution. Can be divided into
    • Insterstitial fluid
    • Plasma
    • Transcellular fluid
    • Tissue fluids bathe the cells
  29. A 15yo patient comes into the emergency room with diffuse abdominal pain, loss of appetite, and a fever. On palpation of the lower right abdomen he feels pain, and even a greater rebound pain when pressure is released. The diagnosis is appendicitis. The appendix is located in which abdominal region?

    - Umbilical
    - Epigastric
    - Hypogastric
    - Lumbar
    - Hypochondriax
    - Iliac
    • Iliac
    • The abdomen is divided into 9 regions (like a tic-tac-toe board)
    • Umbilical: around the umbilicus, portions of small and large intestine, inferior vena cava, abdominal aorta
    • Right and left lumbar: lateral to the umbilical region, portions of the small and large intestines and right and left kidneys
    • Epigastric: immediately below the diaphragm and superior to the umbilical region, pancreas, most of the stomach and liver, inferior vena cava, abdominal aorta and duodenum
    • Right and left hypochondriac: lateral to the epigastric region, contains diaphragm, kidneys, stomach , spleen and pancreas
    • Hypogastric (pubic): inferior to the umbilical region, bladder, urters, sigmoid colon and small intestine
    • Right and left iliac (inguinal): lateral to the hypogastric region, portions of small and large intestines
  30. In an elderly adult, the thymus is mostly atrophied, and the remains lie in the superior mediastinum. In a pubescent boy, the thymus is at its largest, with an average mass of 35 grams. When it is this size, the thymus will be present in which other division of the mediastinum?

    - Anterior mediastinum
    - Middle mediastinum
    - Posterior mediastinum
    • Anterior mediastinum
    • Mediastinum is divided into 4 parts
    • Superior mediastinum: Arch of the aorta, right and left common carotid, jugular veins, brachiocephalic veins. vena cava, thymus, esophagus, trachea, vagus, cardiac plexus
    • Inferior mediastinum: directly below the superior and is divided into 3. ANTERIOR (lymph nodes, thymus in children), MIDDLE (pericardium, heart, phrenic nerves, main bronchi) and POSTERIOR ( esophagus, trachea, arch of aorta, lymph nodes, azygous and hemiazygous vein) mediastinum.
  31. A 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 in his left ear, and his hearing is slightly muffled. The infection most likely spread to the middle ear via which structure?

    - Vestibular apparatus
    - Auditory tube
    - External acoustic (auditory) meatus
    - Acoustic apparatus
    • Auditory tube - also called the pharyngotympanic tube, eustachian tube
    • The auditory tube equalizes air pressure on either side of the tympanic membrane, the middle ear communicates posteriorly with the mastoid air cells and the mastoid antrum through the aditud ad antrum.
    • Ear consists of: External ear (consists of auricle, receives sound waves, external auditory canal) Middle ear (malleus, stapes and incus, stapedius muscle and tensor tympani muscle) Inner ear (vestibule, semicircular canals. cochlea)
    • * Middle ear infections are prevalent due to connections between tympanic cavity with mastoid air cells and nasopharynx.
  32. Which of the following does not completely pass through the structure that divides the ventral body cavity into an upper thoracic cavity and a lower abdominal cavity?

    - Aorta
    - Azygous vein
    - Phrenic nerve
    - Pericardial sac
    - Esophagus
    • Pericardial sac
    • Bodies caivites are divided into dorsal and ventral.
    • Dorsal cavity: Cranial (encloses the brain) Verebral (spinal cord and vertebrae)
    • Ventral cavity: Thoracic cavity - Pleural cavities (right and left), each containing a lung and the mediastinum, heart, esophagus, thymus. Pericardial cavity (thin film of fluid between visceral and parietal layers. Abdominopelvic cavity- stomach, bladder, reproductive structures, spleen , liver
  33. A young woman with no secondary sexual characteristics, short stature, and webbed neck walks into the physicians office. Her medical history indicates a karyotype labeled 45,X. This woman, diagnosed with Turner's syndrome, is unable to conceive children, one reason potentially being that the site of oogenesis is non-functional. What is the site of oogenesis in a healthy female?

    - Ovary
    - Ovum
    - Oocyte
    - Oviduct
    - Ovarian lucanae
    • Ovary, main function is to produce mature ova.
    • Oogonia: are stem cells that give rise to the lifetime supply of oocytes that are present in the females ovaries by the time she is born (they degenerate throughout life).
    • Primordial follicles: containing primary oocytes in the sexually mature ovary are stimulated to develop by secretion of FSH from the anterior lobe of the pituitary.
    • During the maturation of the egg, four daughter cells are produced, one of which is the large fertilizable ovum, while the others are small rudimentary cells called polar bodies or polocytes.
  34. Consider the following structures:
    1. spongy urethra 2. ductus deferens 3. prostatic urethra 4. epididymis. Name the path that sperm travels upon ejaculation.

    - 1,3,4,2
    - 1,2,3,4
    - 2,4,1,3
    - 4,2,1,3
    - 4,2,3,1
    • 4,2,3,1
    • Epididymis, then through the ductus deferens (which joins the duct of the small vesicle for from the ejaculatory duct), Then to the prostatic urethra where it mixes with seminal vesicles to form seminal fluid. Then passes through the spongy urethra where it enters the penis.
  35. Cooper's ligaments are fibrous bands attached to the musculature and function to support:

    - Each testis
    - Each ovary
    - Each body of the epididymis
    - Each breast
    • Each breast
    • Cooper's ligaments are strong, fibrous processes that run from the dermis of the skin to the deep layer of superficial fascia through the breast.
    • Breast cancer causes dimpling of the overlying skin and nipple retraction
  36. The inguinal canal is an oblique passage through the lower part of the anterior abdominal wall and is present in both males and females. In females its primary content is the round ligament of the uterus. In males, which of the following structures does not pass through the inguinal canal?

    - Spermatic cord
    - Ductus deferens
    - Testicular veins
    - Ejaculatory duct
    - Lymph vessels
    • Ejaculatory duct
    • The inguinal canal allows structures of the spermatic cord to pass to and from the testis to the abdomen in the male. In the female, the smaller canal permits the passage of the round ligament of the uterus from the uterus to the labium majus. (in both sexes the canal also transmits the ilioinguinal nerve.
  37. Cystitis, also known as a urinary tract infection, most commonly affects the urinary bladder in females. This is mainly due to the difference in length and exterior communication of which female structure?

    - Ureter
    - Urethra
    - Ductus deferens
    - Theca interna
    • Urethra, is a tube that conveys urine from the urinary bladder to the outside of the body. It contains numerous mucous glands, called "urethral glands" that secrete mucous into the urethral canal.
    • In the female it opens into the vestibule between the clitoris and vagina
    • In the male it conveys semen and urine and is divided into 3 parts. Prostatic, membranous and penile.
  38. Tubal ligation is the permanent sterilization of women in which this structure, where fertilization occurs, is severed and sealed?

    - Ovaries
    - Uterine tubes
    - Uterus
    - Labia majora
    Uterine tubes, also called fallopian tubes
  39. A 17yo male patient who has no history of vaccinations comes into the physicians office with a bilateral swelling of the parotid glands, fever, headache, and orchitis. Orchitis is the painful swelling of what gametogenic organ?

    - Prostate gland
    - Ductus deferens
    - Testes
    - Scrotum
    - Penis
    • Testes
    • Epididymis: portion of the seminal duct where sperm is mature and stored
  40. Not having gonads would mean, not having which 2 organs?
    Ovaries in females and Testes in males
  41. Surrounding the gingival portion of the root of each tooth is a specialized epithelium known as

    - Connective tissue attachment
    - Periodontal ligament attachment
    - Junctional epithelium
    - Nasmyth's membrane
    • Junctional epithelium
    • The dentogingival epithelium is the junction between the tooth surface and the gingival tissues. Together, the sulcular epithelium and junctional epithelium form the dentogingival junctional tissues. They are composed of nonkeratinized stratified squamous epithelium.
    • Sulcular epithelium (crevicular epithelium): strands away from the tooth, creating a gingival sulcus, or space that is filled with gingival fluid or crevicular fluid
    • Junctional epithelium: deeper extension of the sulcular epithelium, begins at the base of the sulcus, has a collar-like band of stratified epithelium that is firmly attached to the tooth surface by way of an epithelial attachment.
    • * In ideal gingival health, the junction epithelium is located entirely on enamel above the cementoenamel junction.
    • Can be distinguished from free gingiva by the fact that epithelial attachment tissue does not contain Rete pegs (epithelial projections extending into gingival connective tissue).
  42. The connective tissue of the marginal gingiva is densely collagenous, containing a prominent system of collagen fiber bundles called the gingival fibers. They consist of:

    - Type I collagen
    - Type II collagen
    - Type III collagen
    - Type IV collagen
    • Type I collagen
    • Gingival ligament (not part of the PDL) is associated with fibers that maintain the functional integrity of the periodontium. It is composed of:
    • Circular group: Encircles the tooth and maintains the gingival integrity, located in the lamina propia of the marginal gingiva.
    • Dentogingival group: inserts in the cementum on the root, apical to the epithelial attachment, and extends into the lamina propia of the marginal gingiva. Has only one mineralized attachment to the cementum, works with the circular ligament to maintain gingival integrity.
    • Alveologingival group: fiber subgroup extends from the alveolar crest of the alveolar bone proper and radiates coronally into the overlying lamina propia of the marginal gingiva. Help attach gingival to bone because of their one mineralized attachment to bone.
    • Dentoperiosteal group: courses from the cementum, near the cementoenamel junction, across the alveolar crest. These fibers anchor the tooth to the bone and protect the deeper periodontal ligament.
    • Transseptal group: located interproximally and form horizontal bundles that extend between the cementum of approximating teeth into which they are embedded. Lie in the area between the epithelium at the base of the gingival sulcus and the crest of the interdental bone and are sometimes classified with the principal fibers of the PDL.
  43. All of the following are lined by keratinized mucosa EXCEPT:

    - Dorsum of the tongue
    - Soft palate
    - Hard palate
    - Gingival tissues
    • Soft palate
    • Oral mucosa is a mucous membrane that covers all the structures inside the oral cavity (except the teeth)
    • Types of oral mucosa:
    • Lining mucosa: buccal, labial and alveolar mucosa, floor of the mouth, ventral tongue and soft palate. NON KERATINIZED, FEW RETE PEGS, STRAT SQUAM EPITHELIUM
    • Masticatory mucosa: free gingiva, attached gingiva, hard palate, interdental gingiva and dorsum surface of tongue. KERATINIZED, MANY RETE PEGS, thick lamina propia.
    • Specialized mucosa: dorsal tongue surface. MOSTLY KERATINIZED (fungiform and circumvallate non-keratinized)
    • Oral mucosa is composed of 2 layersStratified squamous epithelium (can be non-keratinized, parakeratinizd orthokeratinized depending on lcoation) and Lamina propia (connective tissue that supports epithelium, may be attached to periosteum (2 sublayers papillary and dense)
    • *Basement membrane is located between the oral epithelium and connective tissue, composed of 2 layers basal and reticular lamina.
  44. Sacling and root planning are periodontal treatments that can remove calculus and also stimulate gingiva. Usually, a periodontist waits 4-6 weeks after a scaling and root planning procedure for re-evaluation therapy. This allows healing of the connective tissue by what main cellular component of the gingival connective tissue?

    - Osteoblast
    - Odontoblast
    - Fibroblast
    - Ameloblast
    • Fibroblast
    • All forms of epithelium (whether lining, masticatory or specialized mucosa) have a lamina propia deep to the basement membrane. The lamina propia, has 2 layers (papillary and dense)
    • Lamina propia is densely collagenous with a system of collagen fiber bundles called gingival fibers (gingival ligament), these are continuous with the PDL (also a connective tissue)
    • Most common cell in the lamina propia is the Fibroblast, it is responsible for the synthesis and secretion of collagen as well as other proteins. Therefore they are responsible for the healing of the gingiva following surgery or disease processes.
    • The Gingival apparatus is the term used to describe the gingival ligament and the epithelial attachment.
  45. Which of the following structures is not a derivation of the dental follicle?

    - Pulp
    - Cementum
    - Periodontal ligament
    - Alveolar bone
    • Pulp
    • The dental follicle (aka Dental sac), is responsible for the development of the supporting structures of the tooth. This includes the cementum, PDL and alveolar bone. The pulp is a derivation of the dental papilla.
    • PDL appears as the periodontal space of 0.4-1.5. in Rx, it is an organized fibrous connective tissue that also maintains the gingiva in proper relationship to the teeth.
    • PDL becomes very thin and loses the regular arangment of its fiber when a tooth loses function, teeth in hyperfunction have an increased PDL width.
    • Unlike other periodontal tissues, the PDL does not undergo drastic changes as a result of periodontal disease.
    • Remnants of Hertwig's epithelial root sheath found in the PDL of a functional tooth are called epithelial rests of Melassez. These cells may become mineralized in mature PDL forming cementicles.
  46. Which of the following fiber groups of the alveolodental ligament is the most numerous of the fiber groups and covers the apical 2/3rd of the root?

    - Alveolar crest group
    - Horizontal group
    - Apical group
    - Interradicular group
    - Oblique group
    • Oblique group
    • The main principal fiber group is the alveolodental ligament (PDL), which consists of five fiber groups:
    • Alveolo crest group: originates in the alveolar crest of the alveolar bone proper and fans out to insert into the cervical cementum at various angles. Function is to resist tilting, intrusive and rotational forces.
    • Apical group: radiates from the apical region of the cementum to insert into the surrounding alveolar bone proper. The function of this group is to resist extrusive forces, which try to pull the tooth outward and rotational forces
    • Oblique group: most numerous, covers the apical 2/3rd of the root. Originates in the alveolar bone proper and extends apically to insert more apically into the cementum in an oblique manner. Function is to resist intrusive and rotational forces.
    • Horizontal group: originates in the alveolar bone proper apical to its alveolar crest and inserts into the cementum horizontally. Function is to resist tilting and rotational forces.
    • Interradicular group: Found only between the roots of multirooted teeth, run from cementum into bone, forming the crest of the interradicular system, Function is to work with other groups to resist intrusive, extrusive, tilting and rotational forces.
    • * Another principal fiber other than alveolodental ligament is interdental ligament or transseptal ligament. This group inserts mesially or interdentally into the cervical cementum of neighboring teeth over the alveolar crest of the alveolar bone proper. Thus the fibers travel from cementum to cementum without any bony attachment. Function is to hold teeth in interproximal contact.
    • * End of principal fibers embedded into the cementum and alveolar bone are called Sharpey's fibers.
  47. 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 tooth
    - Provides a cellular source for new cementum and bone
    - All of the above
    • All of the above
    • Functions of the PDL
    • Support: attachment to alveolar bone
    • Formative: formation of periodontium cells
    • Nutritive: vascular network provides nutrients to cells
    • Sensory: nerve fiber responsible for pain, pressue and propioception
    • Remodeling: cells responsible for remodeling of periodontium
    • Contents of PDL
    • Fibroblasts: like all connective tissue, most common cell
    • Cementoblasts and cementoclasts
    • Macrophages, mast cells and eosinophils
    • Undifferentiated mesenchymal cells
    • Ground substance: proteoglycans, glycoaminoglycans, glycoproteins and water
    • PDL vascular supply arises from maxillary artery and lymphatics drain to mandibular lymphnodes except for incisors that drain to submental.
    • Nerves: Afferent, sensory, myelinated sensation Autonomic sympathetic, regulates blood vessels

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