NEET MDS Lessons
Anatomy
The Paranasal Sinuses
- These sinuses are air-filled extensions of the respiratory part of the nasal cavity.
- They are in the following bones, frontal, ethmoid, sphenoid and the maxilla.
The Frontal Sinuses
- These are located between the outer and inner tables of the frontal bone, posterior to the superciliary arches.
The Ethmoidal Sinuses
- These comprise of several small cavities, called ethmoidal air cells, within the ethmoidal labyrinth (G. labyrinthos, a maze) of the lateral mass of the ethmoid bone.
The Sphenoidal Sinuses
- These occupy a variable amount in the body of the sphenoid bone and may extend into the wings.
The Maxillary Sinuses
- These are the largest pair of paranasal sinuses.
- They are pyramidal-shaped cavities that may occupy the entire bodies of the maxillae.
The Salivary Glands
- There are three large, paired salivary glands: the parotid, submandibular, and sublingual glands.
- In addition to the main salivary glands, there are numerous small accessory salivary glands scattered over the palate, lips, cheeks, tonsils, and tongue.
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Cartilage model is covered with perichondrium that is converted to periosteum
- Diaphysis-central shaft
- Epiphysis-located at either end of the diaphysis
- Growth in length of the bone is provided by the emetaphyseal plate located between the epiphyseal cartilage and the diaphysis
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Blood capillaries and the mesenchymal cells infiltrate the spaces left by the destroyed chondrocytes
- Osteoblasts are derived from the undifferentiated cells; form an osseous matrix in the cartilage
- Bone appears at the site where there was cartilage
Microscopic structure
- Compact bone is found on the exterior of all bones; canceIlous bone is found in the interior
- Surface of compact bone is covered by periosteum that is attached by Sharpey's fibers
- Blood vessels enter the periosteum via Volkmann's canals and then enter the haversian canals that are formed by the canaliculi and lacunae
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- Marrow
- FiIls spaces of spongy bone
- Contains blood vessels and blood ceIls in various stages of development
- Types
- Red bone marrow
- Formation of red blood ceIls (RBCs) and some white blood cells (WBCs) in this location
- Predominate type of marrow in newborn
- Found in spongy bone of adults (sternum, ribs, vertebrae, and proximal epiphyses of long bones)
- Yellow bone marrow
- Fatty marrow
- Generally replaces red bone marrow in the adult, except in areas mentioned above
- Ossification is completed as the proximal epiphysis joins with the diaphysis between the twentieth and twenty-fifth year
Ligaments of the Joint
- The fibrous capsule is thickened laterally to form the lateral (temporomandibular) ligament. It reinforces the lateral part of this capsule.
- The base of this triangular ligament is attached to the zygomatic process of the temporal bone and the articular tubercle.
- Its apex is fixed to the lateral side of the neck of the mandible.
- Two other ligaments connect the mandible to the cranium but neither provides much strength.
- The stylomandibular ligament is a thickened band of deep cervical fascia.
- It runs from the styloid process of the temporal bone to the angle of the mandible and separates the parotid and submandibular salivary glands.
- The sphenomandibular ligament is a long membranous band that lies medial to the joint.
- This ligament runs from the spine of the sphenoid bone to the lingula on the medial aspect of the mandible.
NEUROHISTOLOGY
The nervous system develops embryologically from ectoderm, which forms the neural plate
Successive growth and folding of the plate results in the formation of the primitive neural tube.
The neuroblasts in the wall of the tube differentiates into 3 cell types:
Neurons: conduction of impulses
Neuroglial cells: connective tissue and support of CNS
Ependymal cells: Lines the lumen of the tube.
- Specialized neuro-ectodermal cells which lines the ventricles of the adult brain
- Essentially also a neuroglial cell
Basic Unit = neuron
Exhibits irritability (excitability) and conductivity
A typical neurons consists of:
Cell body : Has nucleus (karyon) and surrounding cytoplasm (perikaryon) which contains organelles cell's vitality
Dendrites: Several short processes
Axon:One large process
Terminates in twig like branches (telodendrons)
May also have collateral branches projecting along its course. These exit at nodes of Ranvier
Axon enveloped in a sheath, and together forms the nerve fiber
Classification:
May be done in different ways, i.e.
Functional = afferent, efferent, preganglionic, postganglionic, etc.
Morphological = shape, processes, etc
A typical morphological classification is as follows
a. Unipolar: Has one process only Not found in man
b. Bipolar (so-called ganglion cell):Has two processes Found in sensory systems, e.g. retina olfactory system
c. Multipolar: Has several process Most common in CNS
Cell bodies vary in shape, e.g. stellate (star) , pyramidal
d. Pseudo-unipolar: Essentially bipolar neurons, but processes have swung around cb and fused with each other. They therefore enter and leave at one pole of the cell.
Typical neuron:
- Has 2 or more dendrites
Close to the cb the cytoplasm of dendrites has Nissl granules as well as mitochondria
Only one axon Arises from axon hillock, Devoid of Nissl granules, Encased in myelin sheath
No additional covering except for occasional foot processes of neuroglial cells
May branch at right angles
Branches at a node of Ranvier is known as a collateral
Ends of axons break up into tree-like branches, known as telodendria
Axons may be short (Golgi Type II) e.g. internuncial long (Golgi Type I) e.g. pyramidal neuron
Nucleus Central position Large and spherical
Chromatin is extended and thus not seen in LM. This allows the nucleolus to be prominent
Cytoplasm (perikaryon)
Surrounds nucleus May be large or small, shape may be round, oval, flattened, pyramidal, etc
Contains aggregates Nissl granules(Bodies) which is also sometimes referred to as rhomboid flakes
aggregation of membranes and cisternae of rough endoplasmic reticulum (RER)
numerous ribosomes and polyribosomes scattered between cisternae
(Polyribosome = aggregate of free ribosomes clumped together)
responsible for ongoing synthesis of new cytoplasm and cytoplasmic substances
needed for conduction of impulses
highly active in cell protein synthesis
resultant loss of power to divide which is characteristic of neurons
- Golgi network surrounding nucleus (seen in EM only)
- Fibrils made up of:
- neurofilaments
- microtubules
Tubules involved in:
1. plasmic transport
2. maintenance of cell shape
3. essential for growth and elongation of axons and dendrites
Neurofilament:
1. provide skeletal framework
2. maintenance of cell shape
3. possible role in axonal transport
(Axonal [axoplasmic; plasmic] transport may be antero- or retrograde. Anterograde transport via neurotubules is fast and moves neurotransmitters. Retrograde transport is slow and is the reason why viruses and bacteria can attack and destroy cell bodies. E.g. polio in the ventral columns and syphilis in the dorsal columns).
- Numerous mitochondria
- Neurons lack ability to store glycogen and are dependent for energy on circulating glucose
Impulses are conducted in one direction only
Dendrites conduct towards the cb
Axons conduct away from cb
Synapses:
- Neurons interconnect by way of synapses
- Normally the telodendria of an axon synapse with the dendrites of a succeeding axon
axo-dendritic synapse
This is usually excitatory
- Other types of synapses are:
axo-axonic
May be excitatory and/or inhibitory
axo-somatic
May be excitatory and/or inhibitory
dendrodendritic
Usually inhibitory
- Synapses are not tight junctions but maintain a narrow space the so-called synaptic cleft
- The end of an telodendron is usually enlarged (bouton) and contains many synaptic vesicles,
mitochondrion, etc. Its edge that takes part in the synapse is known as the postsynaptic membrane and no
vesicles are seen in this area
- Synapses may be chemical (as above) or electrical as in the ANS supplying smooth muscle cells subjacent to adjacent fibres
Gray and White Matter of Spinal Cord:
- Gray matter contains:
- cb's (somas) of neurons
- neuroglial cells
- White matter contains:
- vast number of axons
- no cb's
- colour of white matter due to myelin that ensheathes axons
Myelin:
- Non-viable fatty material contains phospholipids, cholesterol and some proteins
- Soluble and not seen in H&E-sections because it has become dissolved in the process, thus leaving empty spaces around the axons
- Osmium tetroxide (OsO4) fixes myelin and makes it visible by staining it black. Seen as concentric rings in cross section
- Myelin sheath (neurolemma) is formed by two types of cells
- Within the CNS by Oligodendrocytes
- On the peripheral neurons system by Schwann cells
- Sheath is formed by being wrapped around the axon in a circular fashion by both types of cells
Neuroglial Cells:
- Forms roughly 40% of CNS volume
- May function as: 1. support
2. nurture ("feeding")
3. maintain
Types of glial cells:
Oligodendrocytes:
- Small dark stained dense nucleus
- Analogue of Schwann cell in peripheral nervous system
- Has several processes which forms internodal segments of several fibres (one cell ensheathes more than one axon)
- Provides myelin sheaths in CNS
- Role in nurturing (feeding) of cells
Astrocytes:
Protoplasmic astrocytes:
- found in gray matter
- round cell body
- large oval nucleus with prominent nucleolus
- large thick processes
- processes are short but profusely branched
- perivascular and perineurial foot processes
- sometimes referred to as mossy fibres
Fibrous Astrocytes:
- found in white matter
- polymorphic cells body
- large oval nucleus
- long thin processes
Microglia:
- Neural macrophages
- smallest of the glial cells
- intense dark stained nucleus
- conspicuously fine processes which has numerous short branches
Cerebral Cortex:
Consists of six layers which are best observed in the cortex of the hippocampus
From superficial to deep:
- Molecular layer:
- Has few cells and many fibres of underlying cells
- Outer granular layer:
- Many small nerve cells
- Pyramidal layer:
- Pyramidally-shaped cells bodies
- Inner granular layer:
- Smaller cells and nerve fibres
- Internal (inner) pyramidal layer:
- Pyramidal cells bodies
- Very large in the motor cortex and known as Betz-cells
- Polymorphic layer:
- Cells with many shapes
Cerebellar Cortex:
Consists of three layers
Connections are mainly inhibitory
From superficial to deep
- Outer molecular layer:
- Few cells and many fibres
- Purkinje layer:
- Huge flask-shaped cells that are arranged next to one another
- Inner granular layer:
- Many small nerve cells
Motor endplate:
Seen in periphery on striated muscle fibres
- known as boutons
- has no continuous myelin covering from the Schwann cells
- passes through perimysium of muscle fiber to "synapse"
- multiple synaptic gutter (fold) in sarcoplasma of muscle fiber beneath bouton
- contains numerous synaptic vesicles and mitochondria
Ganglia:
- Sensory Ganglia:
(e.g. trigeminal nerve, ganglia and dorsal root ganglia)
- No synapse (trophic unit)
- pseudo-unipolar neurons
- centrally located nucleus
- spherical smooth border
- conspicuous axon hillock
- Surrounded by cuboidal satellite cells (Schwann cells)
- Covered by spindle shaped capsular cells of delicate collagen which forms the endoneurium
- Visceral and Motor Ganglia (Sympathetic and Parasympathetic):
- Synapse present
- Ratio of preganglionic: postganglionic fibres
1. Sympathetic 1:30
Therefore excitatory and catabolic
2. Parasympathetic 1:2
Therefore anabolic
Except in Meissner and Auerbach's plexuses where ratio is 1:1000 '2 because of parasympathetic component's involvement in digestion
- Preganglionic axons are myelinated (e.g. white communicating rami)
- Postganglionic axon are non-myelinated (e.g. gray communicating rami)
- small multipolar cell body
- excentrally located nucleus
- Inconspicuous axon hillock
- satellite cells few or absent
- few capsular cells
The Orbital Vessels
- The orbital contents are supplied chiefly by the ophthalmic artery.
- The infraorbital artery, the continuation of the maxillary, also contributes blood to this region.
- Venous drainage is through the superior orbital fissure to enter the cavernous sinus.
The Ophthalmic Artery
- This artery arises from the internal carotid artery as it emerges from the cavernous sinus.
- It passes through the optic foramen within the dural sheath of the optic nerve and runs anteriorly, close to the superomedial wall of the orbit.
The Central Artery of the Retina
- This is the one of the smallest but most important branches of the ophthalmic artery.
- It arises inferior to the optic nerve until it approaches the eyeball.
- It then pierces the optic nerve and runs within it to emerge through the optic disc.
- The central artery of the retina spreads over the internal surface of the retina and supplies it.
The Ophthalmic Veins
The Superior Ophthalmic Vein
- The superior ophthalmic vein anastomoses with the facial vein.
- It has no valves and blood can flow in either direction.
- It crosses superior to the optic nerve, passes through the superior orbital fissure and ends in the cavernous sinus.
The Inferior Ophthalmic Vein
- This begins as a plexus on the floor of the orbit.
- It communicates with the inferior orbital fissure with the pterygoid plexus, crosses inferior to the optic nerve, and ends in either the superior ophthalmic vein or the cavernous sinus.
Smooth Muscle
Light microscopic Structure:
cells - long - spindle shaped, nucleus lies in the widest widest part of the fiber, when the fiber contract the nucleus become folded, 30 - 200 µm long,between fibres lie endomycium
Electron microscopic structure:
Mitochondria, ribosomes, golgi, rough EPR, myofilaments are present but no sarcomeres and no Z lines,thin filaments - actin and tropomyosin (7nm), thick filaments - myosin (17nmØ)
- intermediate filaments (10 nm)
- actin and myosin overlap more than in skeletal muscle and can therefore contract more
A rudimentary sacroplasmic reticulum is present in the form of invaginations on the surface called caveolae , So there are no T-tubules, Cells communicate through gap junctions.
Dense bodies
Filaments are attached to dense bodies which take the place of the Z line in skeletal muscle
There are two types of dense bodies - cytoplasmic and membrane
contains a percentage actinin (like the Z line)
dense bodies transmit contractile force to adjacent fibres
Arrangement:
Fibres can be single or in groups, normally arranged in sheaths, In the GIT are 2 or 3 layers
Nerve supply:
2 types:
Where it is arranged in layers a few fibres are innervated together
impulse spread through the gap junctions between fibres (slow contraction)
In the iris and the vas deferens each fiber is individually supplied (quick contraction)