Review for Dental Boards Examination:

Basic Medicine Subjects

Keno-Berneth O. Valenzuela, DMD

General Anatomy and Physiology

General Pathology
General Histology
Microbiology
Pharmacology

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 Foramen Exit Cranial Nerve and other Functions
Structures
cribriform plate CN I (1) Smell
optic canal CN II (2); and Vision
Ophthalmic artery
superior orbital fissure CN III (3); Motor: Muscles of the eyes
Parasympathetic: lacrimal gland, sphincter
pupillae, ciliary lens muscles
CN IV (4); Superior Oblique Muscles
CN V1 (5.1); Cornea, eyes, nose, forehead, and paranasal sinuses
CN VI (6); and Lateral rectus muscle of the eye
Ophthalmic vein
foramen rotundum CN V2 (5.2) Cheeks, lower eyelid, upper lip, nasopharynx,
tonsils, palate, and maxillary teeth
foramen ovale CN V3 (5.3) Sensory: lower cheeks, auditory meatus, TMJ, chin,
lower lip, tongue, floor of the mouth, mandibular
teeth,
Motor: muscles of mastication, anterior belly of
digastric muscle, tensor tympani, tensor veli
palatini, and mylohyoid muscles
stylomastoid foramen CN VII (7) Sensory: taste to the anterior 2/3 of the tongue
Motor: muscles of facial expression
Parasympathetic: sublingual, submandibular, and
lacrimal glands
internal acoustic meatus CN VIII (8) Hearing and balance
jugular foramen CN IX (9) Sensory: posterior 1/3 of the tongue, pharynx,
tonsils, middle ear, carotid sinus
Motor: stylopharyngeus
Parasympathetic: to parotid gland
CN X (10) Motor: laryngeal muscles, pharyngeal muscles
except the stylopharyngeus, and all palatal muscles
except tensor veli palatini
Sensory: heart, abdominal organs, lungs, base of the
tongue
Parasympathetic: heart, abdominal organs, lungs
CN XI (11) To the SCM, and trapezius muscle,
hypoglossal canal CN XII (12) To the intrinsic and extrinsic muscle of the tongue

QUESTIONS: What is the largest cranial nerve that supplies the head and neck?
What is the largest cranial nerve that supplies the body?
What is the longest cranial nerve?

NOTES: Sensory Nerves: I, II, VIII

Motor Nerves: III, IV, VI, XI, XII
Mixed Nerves: V, VII, IX, X
Parasympathetic Nerves: III, VII, IX, X

SKIN
EPIDERMIS (innermost – outermost)
a. Stratum basale – contains keratinocytes.
b. Stratum spinosum – it contains lipids, carbohydrates, and hydrolytic enzymes.
c. Stratum granulosum – keratohyaline granules
d. Stratum lucidum – no cells involve but with enzyme
e. Stratum corneum – contains squames
CELLS in EPIDERMIS
1. melanocytes; chromatophores
2. langerhan cells
3. merkel cells
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Pathology: Vitiligo – deficient in melanin
Albinism – absence of melanin
Melanism – excess in melanin
DERMIS
1. Papillary Layer – moderately dense connective tissue arranged in fine, with THIN collagenous bundles.
2. Reticular Layer – dense connective tissue arranged in THICK interlacing collagenous bundles.
QUESTION: What is the junction of papillary and reticular layers?
Glands
a. sebaceous – produce sebum; found in the entire boduy except palm and sole
b. eccrine - found in entire body
c. apocrine – gives bad odor; axilla, mons pubis, areala, perianal region
Sensory nerve endings
a. free nerve endings – pain
b. pacinian corpuscles – onion- like for pressure
c. meissner’s corpuscles – dermis for pressure
d. ruffini’s – heat
e. end bulb of Krause – cold
HYPODERMIS – attaches to the organs beneath the skin.

EARS
a. Hearing (cochlea)
(external ear) tympanic membrane → (middle ear) malleus (tensor tympani muscle) → incus → stapes → Reissner’s
membrane → cochlea
(inner ear) cochlea → basilar membrane → organ of Corti (hair cells) → Tectorial membrane → brain (temporal)
b. Balance (vestibular)
3 chambers: utricle and saccule  semicircular canals  fluid
NOTE: Rinne’s test
Pathology otitis externa – inflammation of the outer ear and ear canal. “swimmer’s ear”
otitis media – inflammation of the middle ear “glue ear”
otitis interna (labyrinthitis) – inflammation of the inner ear. Vertigo is the most common symptom.

EYES
Cornea (camera lens)– clear front surface of the eyes
NOTE: Accomodation – reflex of the eye in response to focusing on a near object and far objects
Iris (diaphragm of a camera) – controls the amount of light by adjusting the pupil
Pupil – the center opening of iris; constrict and dilate
Retina – photosensitive region; inner lining of the eyeball
NOTE: Refraction – it is the mechanism allowing us to focus an accurate image
Fovea centralis – vision acuity
Optic disc – optic nerve exits (no photoreceptor)
QUESTION: What is blind spot?
Aqueous humor – thin, watery fluid that fills the space between the cornea and the iris (anterior chamber).
NOTE: increased in pressure = Glaucoma (“tunnel-vision”)
Vitreous humor – a clear gel that fills the space between the lens and the retina (posterior chamber)

Muscles of the Eyes: SO4 – LR6- R3

Orbital cavity (7 bones) – it is somewhat four-sided pyramid
roof – frontal
lateral – zygomatic and temporal
floor – maxilla
medial – ethmoid and lacrimal
posterior – sphenoid
Pathology
Myopia – nearsightedness
Hyperopia – farsightedness
Presbyopia – the after “40 vision”
Astigmatism – blurry vision
Strabismus (crossed-eye) – disorder which the two eyes do not line up in the same direction.

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Amblyopia (lazy eye) – the loss of the ability to see clearly through one eye.
Diplopia (double vision) – condtion in which a single object appears as two objects.
QUESTION: What is the most common eye condition in children?
What is the most common eye condition in adult?

NOSE
Nasal septum – determines the shape of the nose
Nasal cavity – supplied by sphenopalatine artery and anterior ethmoidal artery.
Conchae and meatus
a. superior concha – opens the posterior ethmoidal sinus
b. middle concha – hiatus semilunaris and ethmoid bulla
Hiatus semilunaris – opens into the frontal, anterior ethmoid and maxillary sinus
Ehtmoid bulla – opens the middle ethmoidal sinus
c. inferior concha – opens the nasolacrimal duct.
NOTE: Innervations a. external nasal nerve (V1) – dorsum of the nose, ala, and tip of the nose.
b. infraorbital nerve (V2) – lateral aspect of the nose

TONGUE
Sulcus terminalis – V-shaped depression that separates the anterior 2/3 and posterior 1/3 of the tongue
Foramen cecum – small pit located at the tip of the sulcus terminalis, location of the thyroglossal duct
NOTE: point of origin of thyroid gland
Main blood supply : lingual artery  external carotid artery
Receptors:
a. filiform – most numerous found on the dorsal surface of the tongue
NOTE: DOES NOT contain taste buds.
overgrowth – hairy tongue
undergrowth – glossitis
b. foliate – found on the side of the tongue.
c. fungiform – mushroom-shaped.
d. circumvallate – largest papilla (8-12). Found anterior to the V-shaped depression.
NOTE: contains MINOR SALIVARY GLAND

EXTRINSIC MUSCLES INTRINSIC MUSCLES

a. genioglosus – protrudes a. longitudinal – shortens
b. styloglossus – retracts b. transverse – narrows
c. hyoglossus - depresses c. vertical - flattens

Question: What muscle elevates the tongue?

Pathology:
Ankyloglossia (tongue tied) – where the lingual frenum tethers the tongue to the floor of the mouth.
Caviar tongue – dilated veins underneath the tongue.
Strawberry tongue – present in scarlet fever and Kawasaki disease
Beefy tongue – present in Vitamin B12 deficiency
Luetic glossitis – present in syphilis
Geographic tongue “benign migratory glossitis”

NERVOUS SYSTEM
CNS – Brain and Spinal Cord
PNS – Somatic and Autonomic (Parasympathetic and Sympathetic)
BRAIN
Primary Brain vesicles
1. Prosencephalon
a. Telencephalon – cerebral cortex and basal nuclei
b. Diencephalon – retina, thalamus, and hypothalamus
2. Mesencephalon – midbrain, superior and inferior colliculi
3. Rhombencephalon
a. Metencephalon – pons and cerebellum
b. Myelencephalon – medulla
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Meninges (outermost –innermost)
dura mater → arachnoid space → subarachnoid space → pia mater
QUESTION: What is subdural space?

Cerebrospinal Fluid Pathway

Lateral ventricles  Foramen Monroe  Third ventricle  Aqeuduct of Sylvius  Fourth ventricle  2 lateral foramen
(Luschka) and 1 median foramen (Magendie)  subarachnoid space

Dura has different infoldings:

1. Falx cerebri – largest and it separates the cerebral hemispheres
2. Tentorium cerebella – separates the cerebellum to occipital bone
3. Falx cerebella – separates the cerebellar hemispheres
4. Diaphragm sellae – covers the pituitary gland

Neurons (86 - 100B) – INCAPABLE of mitosis.

NOTE: myelinated (120m/sec) : unmyelinated (1.2m/sec)
Neuroglias (84B) – came from neural crest cell that support the neurons. CAPABLE of mitosis.
Types:
1. Satellite cells – maintains homeostasis
2. Ependymal cells – secretes CSF
3. Astrocytes – support and give blood supply
4. Schwann cells – secretes myelin in the PNS.
5. Oligodendrocytes – secretes myelin in the CNS.

Cerebral cortex (covers with gray mater and white mater)

a. frontal lobe – problem solving, judgment and motor
 Broca’s area (left) – producing speech
b. parietal lobe – sensation, handwriting, body position
c. temporal – storage of memory and hearing
 Wernicke’s area (left) – comprehension of speech
 amygdala – emotions and motivations
 hippocampus – establishing long-term memory.
d. occipital - visual
Hypothalamus – endocrine, water regulation and body temperature
Thalamus – arousal and focuses attention
Cerebellum– posture and coordination
Brainstem
RAS – system that keeps us awake.
medulla oblongata (respiratory center) – blood pressure, breathing, swallowing, cough and vomit
pons varolli – rate of respiration, hearing, taste

SPINAL CORD
31- typical
2- atypical (C1 and C2)
NOTE: anterior horn – motor and posterior – sensory (AMPS)

(7) Cervical -main function is to support the head (concave)

(12) Thoracic – “heart shape” main function is to hold the rib cage and protect the heart and the lungs (convex)
(5) Lumbar – “kidney shape” main function is to bear the weight of the body (concave)
NOTE: first 24 – movable vertebrae
(5) Sacrum – fused 5 bones, main function is to connect the spine to the hip bones (convex)
(4) Coccyx – fused 4 bones “tailbone”
QUESTIONS What is C1 fracture?
What is C2 fracture?
What is atlanto-occipital joint?
What is atlanto-axial joint?
Pathology

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 Scoliosis – an abnormal curve from side-to-side
Kyphosis – abnormal curvature from front-to-back and it is usually at the thoracic. “hunchback”
Lordoisis – abnormal curvature with no regular pattern and it is usually at the lumbar. “sway back”

Autonomic Nervous System – involuntary regulation of visceral organs, highly integrated by hypothalamus but reflexes
often involve only the medulla or spinal cord
PARASYMPATHETIC SYMPATHETIC
Neurotransmitter: acetylcholine Neurotransmitter: norepinephrine
Receptors: Receptors:
Nicotinic –skeletal muscles, and chromaffin cells Alpha 1 – vascular smooth muscle
Muscarinic – smooth muscles, cardiac, and glands Alpha 2 – GIT
Beta 1 – heart, salivary glands
Beta 2 – lungs, skeletal muscles

MUSCULAR SYSTEM
1. Skeletal muscles – incapable of mitosis
-fastest contraction
2. Smooth muscles - capable of mitosis.
-longest duration of contraction
3. Cardiac muscle – incapable of mitosis.
-gap junctions – areas of communication between the cells that allow electrical currents to travel through them.
-presence of intercalated disc
Question: What are the two colors of the muscle?

Muscles of Mastication (TIME)

ELEVATORS DEPRESSORS
Temporalis External pterygoid
anterior fiber and middle fiber: elevates -Bennett movement
posterior fiber: retracts -protrudes
Internal pterygoid – most common involve in
trismus Others: ________________ and
Masseter - clenching ___________________.
QUESTIONS: What is the main muscle that depresses the mandible?
What is the strongest muscle?

Muscles of the Hyoid

SUPRAHYOID INFRAHYOID
geniohyoid sternohyoid
stylohyoid omohyoid
mylohyoid thyrohyoid
digastric, sternothyroid
anterior belly
posterior belly QUESTION: What is the other name?

Muscles of the Soft Palate Muscles of the Pharynx

palatoglossus superior constrictor
palatopharyngeus middle constrictor
levater veli palatini inferior constrictor
tensor veli palatine stylopharyngeus
uvula salpingopharyngeus
Question: What muscles form the isthmus of fauces? Question: What muscles form the pterygomandibular raphe?

LARYNGEAL MUSCLES (SCAR)

superior laryngeal nerve – cricothyroid muscle (forceful voice)
all laryngeal muscles – recurrent laryngeal nerve
thyroarytenoid – relaxes and for softer voice
posterior cricoarytenoid – sole abductor of the vocal cords
lateral cricoarytenoid – modulator of the tone and volume of speech

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 transverse and oblique arytenoids – narrows the laryngeal inlet

Rotator Cuff Muscles (SITS)

supraspinatus abducts
infraspinatus adducts
teres MINOR rotates laterally
subscapularis rotates medially

ANTERIOR THIGH MUSCLES POSTERIOR THIGH MUSCLES

rectus femoris semitendinosus
vastus semimembranosus
medialis biceps femoris
intermedius
lateralis Question: What is the other name?
Questions: What is Swimmer’s muscle?
What is Boxer’s muscle?
What is Tailor’s muscle?
What is Trumpeter’s muscle?

RESPIRATORY SYSTEM
1. Conducting zone - responsible for bringing air into and out of the respiratory zone.
Nasal passages → Pharynx → Trachea →Bronchi → Bronchioles → Terminal bronchioles
2. Respiratory zone (gas exchange)
Respiratory bronchioles → alveolar ducts → alveolar sacs
Three cell types:
a. pneumocyte I or alveolar cells
b. pneumocyte II or septal cells – surfactants
c. alveolar macrophages
QUESTION: What is Herring-Breuer reflex?

Terminologies:
Tidal Volume (VT) - quantity of air drawn into and exhaled from the lungs during each breath
NOTE: 0.5L(male); 0.4L(female)
Inspiratory Reserve Volume (IRV) – maximum inspiration
NOTE: 3.1L(male); 2.4L(female)
Expiratory Reserve Volume (ERV) – maximum expiration
NOTE: 1.2L(male); 0.9L(female)
Residual volume (RV) – the volume of air remaining in the lungs after a maximal exhalation
NOTE: 1.2L(male); 0.9L(female)
Total lung volume (TLV) – total volume of air in the lungs after maximal inspiration;
NOTE: TLV = IRV + VT + ERV + RV
NOTE: 6L(male); 4.6(female)

Mechanism of Respiration
INSPIRATION EXPIRATION
Contracts: _______________ Contracts: _______________
Expands: ________________ Expands: ________________
Muscles: diaphragm and accessory muscles Muscles: internal intercostalis and abdominal muscles
In heavy activity: external intercostalis (COMPLIANCE) (ELASTANCE)

NOTE: Phrenic nerve is the main blood supply of diaphragm.

CARDIOVASCULAR SYSTEM
Right atrium → Tricupsid valve → Right Ventricle → Pulmonary valve → Lungs –Gas exchange →
Left atrium → Bicuspid valve → Left ventricle → Aortic valve → Aorta  Aortic arch
Branches of Aortic arch
1. Brachiocephalic  Right subclavian and Right common carotid  Right internal and external carotid arteries
2. Left common carotid artery  Left internal and external carotid arteries

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 3. Left subclavian artery
ELECTRIC IMPULSES: SA Node → AV Node → Bundle of His → Purkinje fibers

Frank-Starling law– increase stretching of cardiac muscle, resulting in a more forceful contraction.
Bainbridge reflex – produces an increased heart rate due to stretching of the right atrium.
Baroreceptors – respond to increased blood pressure.
NOTE: Located in aortic arch and carotid sinus.

CIRCULATORYand LYMPHATICS
Artery – large vessels containing layers of elastin and collagen, capable of elastic recoil.
NOTE: There is a little resistance to flow.
Arterioles – less elastic and more muscular.
NOTE: It provides the greatest resistance to blood flow.
Capillaries – location of the exchange of fluid and substance between blood and interstitial fluid.
NOTE: increased capillary permeability will result to ___________.
Veins – presence of valves.
Artery Vein
carries oxygenated blood except pulmonary artery carries unoxygenated blood except pulmonary vein
thickest layer: tunica media (smooth muscle) thickest layer: externa (loose fibrous connective
tissue)
*Innermost – outermost
tunica intima  tunica media (elastin)  tunica externa  serosa *No serosa
no valves with valves (mostly in limbs)

Questions: What is the largest artery?

What is the largest vein?
What is the main blood supply of the arteries and veins?

Blood
Composition:
1. (55%) Plasma – mostly water (90-95%), Proteins (6-8%) like albumin, globulins, and fibrinogen, glucose, clotting factors,
electrolytes like Na, Ca, Mg, Cl, and HCO3, and carbon dioxide
Intracellular fluid – 2/3 of the body weight
Extracellular fluid – 1/3 of the body weight
NOTE: Hypertonic  shrinkage of cell
Hypotonic  swelling of cell
Isotonic  no change in cell
2. (45%) Elements of blood
Questions: What is the universal donor?
What is universal recipient?

Elements of Blood
1. RED BLOOD CELLS - anucleated; biconcave
PRODUCTION MALE: 5-6million mm3 FEMALE: 4-5million mm3
HEMATOCRIT – percentage of RBC MALE: 42% - 52% FEMALE: 36% - 48%
mass in the blood
HEMOGLOBIN (A) MALE: 14-16g/dL FEMALE: 12-14g/dL
NOTE: 7 days – for RBC to mature
120 days – lifespan of RBC
2. WHITE BLOOD CELLS
Production: 4,000-11,000 mm3
Granulocytes: BEN!
basophil 0-2%
eosinophil 1-6%
neutrophil 40-75%
Agranulocytes: ML!
monocyte 2-10%  macrophage
lymphocyte 15-40%  B cell and T cell
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Note: Based on population: Never Let Monkey Eat Banana!
MACROPHAGES
Skin Langerhan cells
Bone Histiocytes, Osteoclast
Kidney Mesangial cells
Brain Microglia
Blood vessel Monocytes
Lungs dust cells and heart failure cells
Pulp (tooth) Wandering rest cells
Placenta Hofbauer cells
Liver Kupffer cells (litorial cells)
3. PLATELETS - anucleated; 12-14days life span
Production: 150,000 – 450,000 mm3
NOTE: contains histamine and heparin
I- Fibrinogen Factor VIII – Antihemophilia Factor (Hemophilia A)
II- Prothrombin Factor IX – Christmas Factor (Hemophilia B)
III- Tissue Factor X– Stuart-Prower Factor
IV- Calcium ions XI – Plasma Thromboplastin Antecedent Factor (Hemophilia C)
V- Labile Factor XII – Hagemann Factor
VI – no name XIII – Fibrin Stabilizing Factor
VII – Stable Factor *von Willebrand factor – produces temporary plug

Lymphoid organs:
Primary – bone marrow and thymus gland
Secondary – spleen, tonsils, and lymph nodes.
NOTE: Lymphatic duct – empties at junction of right internal jugular vein and right subclavian vein.
Thoracic duct – empties into junction of left internal jugular and subclavian veins.
Cisterna chylii – most inferior part of thoracic duct
a. TONSILS (adenoids, tubal tonsils, palatine tonsils, and lingual tonsils)
QUESTION: What is Weldeyer’s ring?
b. SPLEEN – it filters blood by removing pathogens and destroying defective or old RBC.
Note: It is the largest lymphatic organ
1. White pulp – site of lymphocyte expansion and storage.
2. Red pulp (Cords of Billroth) – site of blood filtration
Vertebral level: T10 – L1

ENDOCRINE SYSTEM
1. PITUITARY GLAND
a. anterior: GH, prolactin, FSH, LH, ACTH, TSH (GPA – B:FLAT)
Acidophils – GH and Prolactin
Basophils – FSH, LH, ACTH and TSH
b. posterior: oxytocin and ADH
Note: Hypothalamo-hypophyseal tract
2. THRYOID GLAND - largest endocrine gland
-Located anterior to the trachea, around the level of cricoids cartilage
-Follicular cells – T4  T3 (active form)
-Parafollicular cells - secrete Calcitonin that plays an important role in the regulation of calcium and phosphate.
Main blood supply: cricothyroid artery
3. PARATHYROID GLAND - located just posterior to the thyroid gland
-secretes parathyroid hormone by chief cells.
4. PANCREAS- contains both exocrine and endocrine gland
LOCATION: L1 – L2
Contains Islet of Langerhan cells found mostly in the tail.
alpha cells – glucagon
beta cells – insulin
delta cells – somatostatin
f cells – pancreatic polypeptide
5. ADRENAL GLAND - located superior and medial to the upper pole of each kidney

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 adrenal cortex: GFR
a. zona glomerulosa (outer) – mineralocorticoids (Aldosterone)
b. zona fasciculata – glucocorticoids (Cortisol)
c. zona reticularis – androgens
adrenal medulla
a. chromaffin cells – produce epinephrine, norepinephrine, and dopamine
QUESTION: What is catecholamine family?
6. PINEAL GLAND (epiphyseal gland) - a very small gland located along the roof of the third ventricle.
-It secretes the hormone melatonin
NOTE: Circadian fluctuance – blood melatonin levels are three times higher at night than during the day.
QUESTIONS: Where is the production of Serotonin?
What is the opposite hormone of Serotonin?

Gastro–intestinal System
also known as alimentary tract (lips to anus)
Extramural glands (salivary glands, liver and gallbladder)
Major Layers of GIT
a. mucosa – lines the lumen of the GIT.
NOTE: GALT - coated with secretory IgA (Peyer’s patches and Weldeyer’s ring)
b. submucosa – contains autonomic plexuses.
c. muscularis externa – contains myenteric autonomic plexus between the layers of muscles.
d. serosa – it forms the visceral peritoneum.
1. ORAL CAVITY– amylase (ptyalin)
NOTE: presence of bolus
2. ESOPHAGUS (gullet) – nonkeratinized stratified squamous epithelium.
NOTE: 20-25 cm long
NOTE: cardia – connection of esophagus to stomach
3. STOMACH - simple columnar epithelium
NOTE: Presence of chyme LOCATION: ULQ
Most common in gastric ulcers.
Parts: body (largest)  fundus  pylori (connects to duodenum)
a. mucous neck cells secrete mucus
b. chief cells (zymogenic cell) - secrete pepsinogen
c. parietal cells (oxyntic cell) - it secretes intrinsic factor for absorption of B12 and HCL
d. enteroendocrine cells – secrete hormone toward capillaries in the lamina propia.
4. SMALL INTESTINE
Parts: duodenum (L1–L2)  jejunum (ULQ)  ileum (LRQ)
a. Brunner’s gland – found in submucosal layer in duodenum that secretes alkaline mucus.
b. crypts of Lieberkuhn
c. paneth cells –secrete digestive enzyme (lysozyme)
d. plicae circulares – circular folds of the small intestine (jejunum)
NOTE: most common in peptic ulcers.
5. LARGE INTESTINE
Parts: caecum – connects to the appendix (LRQ)
colon: ascending (liver)  transverse (stomach)  descending (spleen)
sigmoid – forms the feces by bacteria
rectus  anus (defacation)
NOTES: Main functions are to absorb water and electrolytes and lubricate feces with mucus.
Auerbach’s plexus are located in teniae coli

QUESTIONS: Where is the storage of feces and fart?

What is the pigment of feces?

Extramural glands
1. SALIVARY GLANDS (parotid gland)
- amylase – begins the digestion
2. LIVER - it produces bile and storage of iron (ferritin)

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 - lined with space of Disse – found between the sinusoids that contains lipocytes.
Note: Portal triad
Location: URQ
3. GALLBLADDER -it is lined by simple columnar epithelium
Cholecystokinin – released by enteroendocrine cells for hunger supressant
REMEMBER: it releases bile in the response to the presence of fat in the duodenum
NOTE: glands of Luschka, spiral valve of Heister

Genitourinary System
1. Male Reproductive System
Testes – produce male gametes
NOTE: Tunica albuginea – lining of testes
Specialized glands produce and release secretions that provide nutritive and lubricative elements to semen:
a. seminal vesicles
b. prostate glands
c. bulbourethral glands or ____________________.
FSH → Sertoli cells - it supports and protects the germ cells. It secretes inhibin and androgen-binding protein.
LH → Leydig cells – it synthesizes and secretes the hormones.
Leydig cells → Testosterone
Sertoli cells → ABP
Note: SPERM CELL PATHWAY  SEVEn Up!

Questions: What maintains the blood-testis barrier?

What is vasectomy?

2. Female Reproductive System

a. BREASTS - each gland has 15-25 lobes.
NOTE: Cooper’s ligament
Question: Where is the lymph drainage located?
b. Vagina  Cervix  Uterus  Fallopian tube  Ovaries
Graffian follicle (Ampulla of oviducts) – region of fertilization
Note: If not = Ectopic pregnancy
Note: Human Chorionic Gonadotrophin – hormone produced in placenta.
*Female: Normal- Pregnant Abnormal increased- Hydatidiform mole
*Male: Testicular cancer
Questions: What hormone is elevated in menstruation?
What is the surgical incision of the perineum and the posterior vaginal wall during stage of labor?
What is hysterectomy?

HOMOLOGOUS
Testis Ovary
Epididymis Gartner’s duct
Cowper’s gland Bartholin’s gland
Scrotum Labia major
Penis Clitoris

Urinary System
1. KIDNEYS  nephron (1, 000, 000) – functional unit of the kidney (RPLD!)
NOTE: Vertebral level : T12 – L3
a. Renal corpuscle - consists of glomerulus and bowman’s capsule
glomerulus –where phagocytic cells are found
bowman’s capsule – where podocytes are formed.
b. PCT - simple cuboidal epithelium, abundant microvilli
c. Loop of Henle - composed of simple squamous and simple cuboidal.
d. DCT - composed of simple cuboidal epithelium.
NOTE: it maintains the blood pressure
NOTE: Renin-Angiotensin Aldosterone System

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 e. Collecting tubules - lined by simple cuboidal epithelium
Papillary ducts of Bellini – large collecting tubules with simple columnar epithelium.
2. URETERS (25-30cm)
3. URINARY BLADDER (transitional epithelium)
Relax – squamous
Stretched – cuboidal or columnar
NOTE: 400-600mL normal capacity
Question: What is the pigment of urine?
4. URETHRA– shorter: female
Male Urethra (15-25cm)
a. prostatic urethra – lies in prostate gland
b. membranous urethra – shortest and least distensible
c. spongy – longest urethra

OTHERS
Middle cerebral artery “lenticulostriae artery”– most common during strokes
Subclavian and common carotid arteries – main blood supply of the head and neck
Internal jugular vein – major source of venous drainage of the head and neck

Shoulder girdle – scapula and clavicle

Shoulder joint – scapula and humerus
(humerus) Trochlea – articulates with ulna
(humerus) Capitulum – articulates with radius
CARPALS (8 bones)
PROXIMAL DISTAL
Scaphoid (most lateral) Trapezium
Lunate Trapezoid
Triquetrium Capitate
Pisifirom (most medial) Hamate
NOTE: Lunate – largest carpal bone; most common area for dislocation

Hip joint – acetabulum and femur

Femur  patella, tibia, and fibula
TARSALS (7 bones)
PROXIMAL INTERMEDIATE DISTAL
Talus (the most superior) Navicular Cuboid (the most lateral)
Calcaneus Cuneiform (3 bones)
NOTE: Calcaneus – largest tarsal bone; most common in fracture
Hallux or ______________.

Sternum (breast bone) – manubrium, body and xiphoid

Ribs – true and false
QUESTIONS: What rib that can’t be palpated?
What are the floating ribs?
Larynx or ________________ – composed of 9 cartilages 3 paired and unpaired
Unpaired: ETC
Paired: Arytenoid, Cuneiform, Corniculate
Note: Cricothyroid ligament is frequently pierced in emergency situations to open the airway
Laryngospasm (stridor voice) – use succinylcholine

Cranial Sutures
1. False sutures – HS
Harmonia – Parietal and occipital
Squamosa –Temporal and Occipital
2. True sutures – DS
Dentata – between parietal bones
Serrata – between frontal bones

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 Questions: What is Pterion?
What is Asterion?
CRANIAL BONES: ethmoid, frontal, occipital, parietal, sphenoid, and temporal (8 bones)
FACIAL BONES: inferior concha, lacrimal, mandible, maxilla, nasal, palatine, vomer, zygoma (14 bones)

Amino Acids – basic structural unit of proteins (CHON)

ESSENTIAL NON-ESSENTIALS
Histidine Tryptophan Alanine Glycine
Isoleucine Valine Arginine Glutamic acid
Leucine Asparagine Glutamine
Lysine Aspartic Acid Omithine
Methionine Cysteine Proline
Phenylalanine Selenocysteine Serine
Threonine Tyrosine
NOTE: Methionine – the first amino acid produced by the body
Glutamine – the most abundant amino acid.

Classification of Amino Acids

Class Amino Acids
Aliphatic Glycine, Alanine, Valine, Leucine, Isoleucine
Hydroxyl or Sulfur Serine, Cysteine, Selenocysteine, Threonine, Methionine
Cyclic Proline
Aromatic Phenylalanine, Tyrosine, Tryptophan
Basic Histidine, Lysine, Arginine
Acidic Aspartate, Glutamate, Asparagine, Glutamine

PROTEINS

CARBOHYDRATES – it is essential for the sugar in the body that serves as the immediate source.
Sugar or ___________.
a. single carbohydrates or monosaccharide – glucose, fructose
b. two monosaccharide or disaccharide – sucrose, maltose
c. three – nine monosaccharide or oligosaccharide – galactose

LIPIDS

VITAMINS - are organic substances that must be provided in small quantities in the diet for the synthesis, by tissues, of
co-factors essential for a variety of metabolic reactions.
VITAMIN A (Retinol)  nyctalopia (night blindness)
Pathognomonic sign: Bitot sign
B1 – THIAMINE  beriberi
B2 - RIBOFLAVIN  angular cheilitis and sore throat
B3 - NIACIN (Nicotinic acid)  Pellagra (4Ds: Dermatitis, Dementia, Diarrhea, DEATH)
B5 – PANTHOTENIC ACID
B6- PYRIDOXINE glossitis
B7 – BIOTIN  atrophic glossitis
B9 – FOLIC ACID  megaloblastic anemia (macrocytic)
B12 – CYANOCOBALAMINE  pernicious anemia (microcytic)
VITAMIN C (ASCORBIC ACID) - essential for synthesis of collagen
Note: Vitamin C deficiency: scurvy
Clinical features: poor wound healing, rupture of capillaries leading to petechiae and ecchymoses, gingival
bleeding.
VITAMIN D (CALCIFEROL)  D2 (ergocalciferol) and D3 (cholecalciferol)
Note: Vitamin D deficiency: rickets (children) and osteomalacia (adult)
VITAMIN E (TOCOPHEROL) – essential for nervous system development
VITAMIN K - essential for the synthesis of several factors required for clotting (II, VII, IX, X)

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 Note: Vitamin K deficiency: hypoprothrombinemia
Phytomenadione is the natural Vitamin K in our body

MINERALS
BORON (B) – necessary for brain and memory and for activation of Vitamin D
CALCIUM (Ca) – for bones and muscles
CHLORINE (Cl) – major anion in the body fluid.
CHROMIUM (Cr) – master regulator of insulin and for metabolism of food (CHO, CHON, and FATS).
COBALT (Co) – essential for Vitamin B12 production
COPPER (Cu) – synthetsis of hemoglobin
IRON (Fe) – essentials for hemoglobin production (RBC).
MAGNESIUM (Mg) – necessary for metabolism of ATP.
SODIUM (Na) – major cation in the body fluid.
ZINC (Zn) – essential for the immune system.

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