NEET MDS Lessons
Anatomy
The Laryngopharynx
- The laryngeal part of the pharynx lies posterior to the larynx.
- It extends from the superior border of the epiglottis to the inferior border of the cricoid cartilage, where it narrows to become continuous with the oesophagus.
- Posteriorly, the laryngopharynx is related to the bodies of C4 to C6 vertebrae.
- Its posterior and lateral walls are formed by the middle and inferior constrictor muscles, with the palatopharyngeus and stylopharyngeus internally.
- The laryngopharynx communicates with the larynx through the aditus or inlet of the larynx.
- The piriform recess is a small, pear-shaped depression of the laryngopharyngeal cavity on each side of the inlet of the larynx.
- The six muscles rotate the eyeball in the orbit around three axes (sagittal, horizontal and vertical).
- The action of the muscles can be deduced by their site of insertion on the eyeball.
| Muscle | Action(s) on the Eyeball | Nerve Supply |
| Medial Rectus | Adducts | CN III |
| Lateral Rectus | Abducts | CN VI |
| Superior Rectus | Elevates, adducts, and medially rotates | CN III |
| Inferior Rectus | Depresses, adducts, and laterally rotates | CN III |
| Superior Oblique | Depresses, abducts, and medially rotates | CN IV |
| Inferior Oblique | Elevates, abducts, and laterally rotates | CN III |
Superior Constrictor Muscle
- Origin: Hamulus, pterygo-mandibular raphe, and mylohyoid line of the mandible.
- Insertion: Median raphe of the pharynx.
- Nerve Supply: Vagus nerve via the pharyngeal plexus.
- Arterial Supply: Ascending pharyngeal artery, ascending palatine artery, tonsillar branch of the facial artery, and dorsal branch of the lingual artery.
- Action: Constricts the wall of the pharynx during swallowing.
Levator Palpebrae Superioris Muscles
- This is a thin, triangular muscle that elevates the upper eyelid.
- It is continuously active except during sleeping and when the eye is closing.
- Origin: roof of orbit, anterior to the optic canal.
- Insertion: this muscle fans out into a wide aponeurosis that inserts into the skin of the upper eyelid. The inferior part of the aponeurosis contains some smooth muscle fibres that insert into the tarsal plate.
- Innervation: the superior fibres are innervated by the oculomotor nerve (CN III), and the smooth muscle component is innervated by fibres of the cervical sympathetic trunk and the internal carotid plexus.
Illnesses involving the Levator Palpebrae Superioris
- In third nerve palsy, the upper eyelid droops (ptosis) and cannot be raised voluntarily.
- This results from damage to the oculomotor nerve (CN III), which supplies this muscle.
- If the cervical sympathetic trunk is interrupted, the smooth muscle component of the levator palpebrae superioris is paralysed and also causes ptosis.
- This is part of Horner's syndrome.
The Rectus Muscles
- There are four rectus muscles (L. rectus, straight), superior, inferior, medial and lateral.
- These arise from a tough tendinous cuff, called the common tendinous ring, which surrounds the optic canal and the junction of the superior and inferior orbital fissures.
- From their common origin, these muscles run anteriorly, close to the walls of the orbit, and attach to the eyeball just posterior to the sclerocorneal junction.
- The medial and lateral rectus muscles attach to the medial and lateral sides of the eyeball respectively, on the horizontal axis.
- However, the superior rectus attaches to the anterosuperior aspect of the medial side of the eyeball while the inferior rectus attaches to the anteroinferior aspect of the medial side of the eye.
The Oblique Muscles
The Superior Oblique Muscle
- This muscle arises from the body of the sphenoid bone, superomedial to the common tendinous ring.
- It passes anteriorly, superior and medial to the superior and medial rectus muscles.
- It ends as a round tendon that runs through a pulley-like loop called the trochlea (L. pulley).
- After passing though the trochlea, the tendon of the superior oblique turns posterolaterally and inserts into the sclera at the posterosuperior aspect of the lateral side of the eyeball.
The Inferior Oblique Muscle
- This muscle arises from the maxilla in the floor of the orbit.
- It passes laterally and posteriorly, inferior to the inferior rectus muscle.
- It inserts into the sclera at the posteroinferior aspect of the lateral side of the eyeball.
The Skeleton of the Nose
- The immovable bridge of the nose, the superior bony part of the nose, consists of the nasal bones, the frontal processes of the maxillae, and the nasal part of the frontal bones.
- The movable cartilaginous part consists of five main cartilages and a few smaller ones.
- The U-shaped alar nasal cartilages are free and movable.
- They dilate and constrict the external nares when the muscles acting on the external nose contract.
The Nasal Cavities
- The nasal cavities are entered through the anterior nares or nostrils.
- They open into the nasopharynx through the choanae.
The Roof and Floor of the Nasal Cavity
- The roof is curved and narrow, except at the posterior end.
- The floor is wider than the roof.
- It is formed from the palatine process of the maxilla and the horizontal plate of the palatine bone.
The Walls of the Nasal Cavity
- The medial wall is formed by the nasal septum; it is usually smooth.
- The lateral wall is uneven owing to the three longitudinal, scroll-shaped elevations, called the conchae (L. shells) or turbinates (L. shaped like a top).
- These elevations are called the superior, middle and inferior conchae according to their position.
- The superior and middle conchae are parts of the ethmoid bone, whereas the inferior conchae are separate bones.
- The inferior and middle conchae project medially and inferiorly, producing air passageways called the inferior and middle meatus (L. passage). Note: the plural of "meatus" is the same as the singular.
- The short superior conchae conceal the superior meatus.
- The space posterosuperior to the superior concha is called the sphenoethmoidal recess.
The Parotid Glands
- The parotid glands are the largest of the three pairs of salivary glands.
- Each gland is wedged between the mandible and the sternocleidomastoid muscle and partly covers them.
- The parotid gland is wrapped with a fibrous capsule (parotid fascia) that is continuous with the deep investing fascia of the neck.
- Viewed superficially, the parotid gland is somewhat triangular in shape.
- Its apex is posterior to the angle of the mandible and its base is along the zygomatic arch.
- The parotid gland overlaps the posterior part of the masseter muscle.
- The parotid duct (Stensen's duct) is about 5 cm long and 5 mm in diameter.
- It passes horizontally from the anterior edge of the gland.
- At the anterior border of the masseter muscle, the parotid duct turns medially and pierces the buccinator muscle.
- It enters the oral cavity opposite the second maxillary molar.
Blood Vessels of the Parotid Gland
- This gland is supplied by branches of the external carotid artery.
- The veins from the parotid gland drains into the retromandibular vein, which enters the internal jugular vein.
Lymphatic Drainage of the Parotid Gland
- The lymph vessels of this gland end in the superficial and deep cervical lymph nodes.
Nerves of the Parotid Gland
- These nerves are derived from the auriculotemporal nerve and from the sympathetic and parasympathetic systems.
- The parasympathetic fibres are derived from the glossopharyngeal nerve (CN IX) through the otic ganglion.
- Stimulation of these fibres produces a thin watery (serous) saliva to flow from the parotid duct.
- The sympathetic fibres are derived from the cervical ganglia through the external carotid plexus.
- Stimulation of these fibres produces a thick mucous saliva.
Hip
Constitutes the pelvic girdle
United with the vertebral column
Union of three parts that is marked by a cup shaped cavity (acetabulum) Ilium
• Prominence of the hip
• Superior border is the crest
• Anterosuperior spine-projection at the anterior tip of the crest
• Corresponding projections on the posterior part are the posterosuperior and posteroinferior iliac spines
• Greater sciatic notch-located beneath the posterior part
• Most is a smooth concavity (iliac fossa)
• Posteriorly it is rough and articulates with the sacrum in the formation of the sacroiliac joint
Pubic bone
Anterior part of the innominate bone
Symphysis pubic-joining of the two pubic bones at the midline
Body and two rami
• Body forms one fifth of the acetabulum
• Superior ramis extends from the body to the median plane: superior border forms the pubic crest
• Inferior ramus extends downward and meets with the ischium
• Pubic arch is formed by the inferior rami of both pubic hones
Ischium
Forms the lower and back part of the innominate bone
Body
• Forms two fifths of the accrabulum
• Ischial tuberosiry-supports the body in a sitting position
• Ramus-passes upward to join the inferior ramus of rhe pubis; known as rhe obturator foramen
Pelvis
Fanned by the right and left hip bones, sacrum, and coccyx
Greater pelvis
o Bounded by the ilia and lower lumbar vertebrae
o Gives support to the abdominal viscera
Lesser pelvis
o Brim of the pelvis corresponds to the sacral promontory
o Inferior outlet is bounded by the tip of the coccyx, ischial tuberosities, and inferior rami of the pubic bones
Female pelvis
o Shows adaptations related to functions as a birth canal Wide outlet
o Angle of the pubic arch is obtuse
Male pelvis
o Shows adaptations that contribute to power and speed
o Heart-shaped outlet
o Angle of the pubic arch is acute
Thigh
Femur-longest and strongest bone of the body
Proximal end has a rounded head that articulates with the acetabulum
Constricted portion-the neck
Greater and lesser trochanters
Slightly arched shaft; is concave posteriorly
o Linea aspera-strengthened by this prominent ridge
o Site of attachment for several muscles
Distal end has two condyles separated on the posterior side by the intercondyloid notch
Knee cap
Patella-sesamoid bone
Embedded in the tendon of the quadriceps muscle
Articulates with the femur
Leg
Tibia-medial bone
o Proximal end has two condyles that articulate with the femur
o Triangular shaft
Anterior-shin
Posterior-soleal line
Distal-medial malleolus that articulates with the latus to form the ankle joint
Fibula-lateral bone
o Articulates with the lateral condyle of the tibia but does not enter the knee joint
o Distal end projects as the lateral malleolus
Ankle, foot, and toes
Adapted for supporting weight but similar in structure to the hand
Talus
o Occupies the uppennost and central position in the tarsus
o Distributes the body weight from the tibia above to the other tarsal bones
Calcaneus (heel)-Iocated beneath the talus
Navicular-located in front of the talus on the medial side; articulates with three cuneifonn bones distally
Cuboid-lies along the lateral border of the navicular bone
Metatarsals
o First, second, and third p1etatarsals lie in front of the three cuneifonn bones
o (2) Fourth and fifth metatarsals lie in front of the cuboid bone
Phalanges
o Distal to the metatarsals
o (2) Two in the great toe; three in each of the other four toes .
Longitudinal arches in the foot (2)
o Lateral-fonned by the calcaneus, talus, cuboid, and fourth and fifth metatarsal bones
o Medial-fonned by the calcaneus, talus, navicular, cuneifonn, and first, second, and third metatarsal bones
Transverse arches-formed by the tarsal and metatarsal bones