Anatomical Sciences Pt 2 Flashcards

1
Q
During the 4'h week of embryonic development the tongue appears in the
form oftwo lateral lingual swellings and one medial swelling, the so-called:
• fo ramen cecum
• sulcus terminalis
• tubercu lum impar
• epiglottic swelling
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A

tuberculum impar

4th week:
tongue = two lateral swellings and one nedial swelling (tuberculum impar)

all from 1st arch

second median swelling = copula, from 2-3-4 arches

lateral swellings merge –> anterior 2/3 of tongue
posterior 1/3 - 2-4 arches
extreme posterior = 4th arch

V-shaped terminal sulcus
foramen cecum - remnant of thyroglossal duct, apex of sulcus

stomodeum - primitive mouth

branchial arch: core mesenchyme
externally - clefts, internally - pouches

bifid tongue - no fusion of lateral swellings

most tongue mm. - hypoglossal n. (XII) except palatoglossus which is X

6-8 wks salivary begin to develop
parotid develops first, from ectoderm
sublingual and submandibular - from endoderm

median swellings: tuberculum impar (–> body of tongue)
copula –> baase of tongue
epiglottic swelling

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2
Q

The cartilages of first and second branchial arches are derived from mesoderm.
The cartilages of the fourth through sixth branchial arches are derived from
neural crest cells.
• both statements are t rue
• both statements are fa lse
• the fi rst statement is true, the second is fa lse
• the first statement is false, the second is true

A

both false

1-2 ctlges - NC
4-6 ctlges - mesoderm

each arch: ctlg, nervem vascular, muscular

1 arch –> Meckel (disappears mostly), malleus, incus
2 arch –> Reichert’s, stapes, styloid, lesser horns and upper half of hyoid
3 arch –> greater horn and lower half of hyoid
4-6 arches –> laryngeal ctlges

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3
Q

Failure offusion of which ofthefollowing will lead to cleft lip?
• frontonasal process; lateral nasal process
• maxillary process; medial nasal process
•lateral nasal process; medial nasal process
• maxillary process; lateral nasal process
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A

maxillary and medial nasal

nasal placodes (–> pits –> nares) - frontonasal process

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4
Q
During the fourth week of embryonic development, the first branchial arch
divides to form:
• the two medial nasal processes
• the mandibular and maxillary processes
• the two lateral nasal processes
• the lateral and medial nasal processes
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A

mandibular and maxillary during 4th week

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5
Q
The second branchial pouch gives rise to the:
• eustachian tube
• palatine tonsil
• middle ear cavity
• superi or parathyroid gland
ANATOMIC SCIENCES
embryology
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A

palatine tonsil

pharyngeal pouches: endoderm, inside between arches

1 –> tympanic membrane, auditory tube, tympanic cavity, mastoid antrum
(1 cleft –> external meatus)

2 –> palatine tonsil
3 –> inferior parathyroid glands (dorsal) + thymus
4 –> superior parathyroid glands (dorsal)

5 –> C cells of thyroid (make calcitonin)

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6
Q

1 arch derivatives
nerve
pouch

A

Meckel, malleus, incus (neural crest)
V (mastication mm and two tensors) - V2 and V3
tympanic things, mastoid antrum, auditory tube

cleft –> external meatus

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7
Q

2 arch derivatives
nerve
mm
pouch

A

Reichert, stapes, styloid, lesser horns and upper hyoid (neural crest)
VII
facial expression, stylohyoid, posterior digastric
palatine tonsils

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8
Q

3 arch derivatives
nerve
mm
pouch

A

greater horns and lower half of hyoid
IX glossopharyngeal, passes between superior and middle pharyng constrictors
stylopharyngeal (but all other pharynx is X)
inferior parathyroids (dorsal) and thymus (ventral)

DiGeorge - no parathyroids and thymus

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9
Q

4 arch derivatives
nerve
mm
pouch

A
laryngeal cartilages (mesoderm)
superior laryngeal n. 
external branch innervates cricothyroid
also most pharyngeal constrictors
internal branch - sensation above vocal folds, passes between middle and inferior constrictor
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10
Q

6 arch derivatives
nerve
pouch

A
laryngeal cartilages (mesoderm)
recurrent laryngeal n below inferior constrictor
innervates intrinsic mm of laryn (except cricothyroid which is superior laryngeal, external branch)
also sensation below vocal folds
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11
Q

where does stylopharyngeal muscle pass

A

between superior and middle constrictors

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12
Q

The thyroid gland is first identifiable during the fourth week of gestation,
beginning as an endodermal invagination of the tongue at the site of:
• tubercu lum impar
• copula
• terminal sulcus
• fo ramen cecum
• stomodeum

A

foramen cecum
- between tuberculum impar and copula

thyroid then descends via thyroglossal duct

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13
Q
The primary palate or median palatal process is formed by the merging of the
frontonasal process with which other processes?
• lateral nasal processes
• medial nasal processes
• maxillary processes
• mandibular processes
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A

medial nasal

premaxilla = primary palate = medial nasal + frontonasal

secondary palate - palatal shelves;
also soft palate and uvula

palate complete at 12 weeks

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14
Q

when is palate complete

A

12 weeks

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15
Q
All of the following muscles are derived from first branchial arch EXCEPT
one. Which one is the EXCEPTION?
• tensor tympani
• anterior belly of digastric
• temporalis
• masseter
•levator veli palatini
• tensor veli palatini
A

levator veli palatini

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16
Q

stylopharyngeal m innervation

passes where with what

A

IX

between superior and middle constrictors, with IX nerve (YAY)

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17
Q

stylohyoid m innervation

A

VII

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18
Q
The nasal cavities are formed from which embryonic structure?
• stomodeum
• f rontonasal process
• intermaxillary segment
• nasal pits
A

nasal pits, come from nasal placodes on frontonasal process

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19
Q
All of the following are neural crest cells derivatives EXCEPT one. Which one
is the EXCEPTION?
• melanocytes
• dorsal root ganglia
• adrenal medulla
• autonomic ganglia
• adrenal cortex
• schwann cells
• sensory ganglia of cranial nerves
A

adrenal cortex is mesoderm
NC = ganglia, schwann, adrenal medulla, melanocytes

anterior pituitary is ectoderm
parotid also ectoderm

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20
Q
Which two ofthe following are NOT derived from endoderm?
•lung
•liver
• gut tube derivatives
• pancreas
• spleen
• thymus
• dura mater
• parathyroid gland
A

dura mater is NC
spleen is mesoderm?

mesoderm: heart, blood, spleen, dermis, muscles, vessels, adrenal cortex, bones, kidneys + ureter
endoderm: guts, liver, thymus, parathyroids, thyroid, lungs, pancreas, submandibular and sublingual glands,
middle ear and auditory tube

umbilical vein –> ligamentum teres
umbilical arteries –> medial umbilical ligaments
allantois –> urachus (medial umbilical ligament)

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21
Q

derivatives of mesoderm

A

heart, spleen, blood
muscles, vessels, bones
adrenal cortex

KIDNEY

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22
Q

derivatives of endoderm

A

pancreas, guts, liver, lungs
sublingual and submandibular glands
parathyroids, thyroid, thymus
middle ear, auditory tube

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23
Q

kidney origin

A

mesoderm

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24
Q
Which ofthe following arteries accompanies the great cardiac vein?
• ci rcumflex artery
• anterior interventricular artery
• posterior interventricular artery
• right marginal artery
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anterior interventricular artery

great cardiac vein comes from left
middle from posterior interventricular
small cardiac vein comes from right

coronary sinus lies in coronary sulcus = atrioventricular groove; empties into RA

left marginal vein drains into great
anterior cardiac vv drain directly into RA

anterior interventricular a. aka left descending; accompanies great cardiac v
posterior interventricular accompanies middle

branches of left coronary: circumflex and left descending (aka anterior interventricular)
branches of right coronary: sinuatrial, marginal, posterior interventricular

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25
Q

branches of left coronary

A

opens at left posterior aortic sinus, passes between pulm trunk and left auricle
branches: LAD and circumflex

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26
Q

branches of right coronary

A

opend at anterior aortic sinus, passes between pulm trunk and right auricle

sinuatrial branch,
marginal and
posterior interventricular (anastomoses with circumflex)

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27
Q
Sympathetic stimulation will have which direct effect on the heart?
• decreased automaticity
• AV block
• increased vagal response
• bradycardia
• increased stroke volume
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SAADDES
A

increased stroke volume

overvagus can cause AV block

SA at junction of SVC and RA; paccemaker
interatrial septum near coronary sinus

conducting system is myocardium not nerves

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28
Q

Which of the following is the correct conduction pathway through the heart?
• SA node- ventricular muscle- AV node- His bundle- bundle branches- Purkinje fibers
-atri al muscle
• SA node- atrial muscle- AV node- bundle branches- His bundle- Purkinje fibersventricular
muscle
• SA node- atrial muscle- AV node- His bundle- bundle branches- Purkinje fibersventricular
muscle
• SA node- Purkinje fibers- AV node- His bundle- bundle branches- atrial muscleventricular
muscle

A

SA –> atrial mm –> AV –> His –> bundle branches –> Purkinje –> ventricular mm

SA: 60-100x/minute
AV - 40-60

sinus rhythm:
P - atrial depol
QRS - ventric depol
T - ventric repol

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29
Q
The apex of the heart is located at the level of the:
• third left intercostal space
• fourth left intercostal space
• fifth left intercostal space
• sixth left intercostal space
ANATOMIC SCIENCES
heart
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SAADDES
A

fifth

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30
Q

Which of the following describes the function of the ductus arteriosus in the
fetus?
• it shunts blood from the aorta to the pulmonary artery
• it shunts blood from the pulmonary artery to the aorta
• it shunts blood from the right atrium to the left atrium
• it shunts blood from the umbilical vein to the inferi or vena cava
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SAADDES

A

shunts from pulmonary a to aorta

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31
Q

A worker in the meat-processing industry comes down with an illness,
presenting with symptoms of fever, headache, and sore throat. A few days
later, he feels chest pain and has pink, frothy sputum. His physician states
that the worker has a viral infection caused by coxsackie B. This patient has inflammation
of which layer of the heart?
• epicardium
• myocardium
• endocardium
• pericardium

A

myocardium

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32
Q

The left atrium and left ventricle receive their major arterial supply from
which artery?
• anterior interventricular branch of the left coronary artery
• circumflex branch of the left coronary artery
• marginal branch of the right coronary artery
• posterior interventri cular branch of the right coronary artery
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SAADDES

A

circumflex of left coronary

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33
Q
Which ofthe following does NOT empty directly into the right atrium?
• azygous vein
• inferior vena cava
• superior vena cava
• coronary sinus
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A

azygous - to SVC

coronary sinus in coronary sulcus = atrioventricular groove

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34
Q

A patient with a “heart-valve problem” comes into the dental clinic for
periodontal therapy. She says that her old periodontist always gave her
antibiotics before treatment, and insisting that the dentist hear the problem,
she places the stethoscope in the left fifth intercostal space medial to the nipple
line. Which heart valve is best heard over the apex of the heart?
• t ricuspid valve
• mitral valve
• pulmonary valve
• aortic valve

A

mitral

A (second right) P (second left)
T (~4th right) M (fifth left)

S1 - AV closure
S2 - semilunar closure
S3 - ventricular filling
S4 - atrial contraction

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35
Q

A 1 0-year-old girl comes into the physician suffering from rheumatic fever.
She is presenting with aortic valve stenosis, which is causing her dizziness
and syncopal episodes. In the healthy heart, after ventricular systole, the aortic
valve:
• prevents reflux of blood into the right ventricle
• prevents reflux of blood into the right atrium
• prevents reflux of blood into the left atrium
• prevents reflux of blood into the left ventricle
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A
prevents reflux from aorta to left ventricle
chordae tendinae (attached to papillary mm) prevent prolapse

trabeculae carneae - mm in ventricles
pectinate mm - in atria

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36
Q

Which of the following structures prevent the AV valves from everting (or
being blown out) back into the atria during ventricular contraction?
• crista terminal is and papillary muscles
• chordae tendineae and papillary muscles
• pectinate muscles and papillary muscles
• chordae tendineae and pectinate muscles
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SAADDES

A

choardae and papillary

crista terminalis - attachment of pectinate mm in RA (runs between SVC and IVC) , along right atrial wall

pectinate in RA and both auricles

SA node at junction of RA and SVC

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37
Q
The diaphragmatic surface ofthe heart is formed by:
• right atrium and right ventri cle
• right atrium and both ventri cles
•left ventricle only
• right ventricle only
• both ventricles
ANATOMIC SCIENCES
heart
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SAADDES
A

both ventricles

front = sternocostal surface, all 4 chambers
diaphragmatic surface = both ventricles
base = left atrium

right border = right atrium?
left border = left ventricle
inferior border = RA, RV, LV

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38
Q
The pituitary gland is composed of two distinct tissue types. These tissue
types have their embryonic origin in what layer(s)?
• ectoderm
• mesoderm
• endoderm
• ectoderm and mesoderm
• ectoderm and endoderm
• all of the above
A

ectoderm

upgrowth from stomodeum (anterior, adeno) = Rathke’s pouch
neuroectoderm from diencephalon (hypothalamus) = neuro, posterior

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39
Q
Diabetes insipidus is characterized by the secretion of large amounts of
dilute urine because of a deficiency in antidiuretic hormone. Antidiuretic
hormone is secreted from the:
• anterior pituitary
• posterior pituitary
• adrenal medulla
• adrenal cortex
• thyroid
• kidney
A

anterior pituitary: GPA (acidophilic, non tropic) and B-FLAT (basophilic, tropic)

posterior: ADH (=vasopressin) and oxytocin
secreted in HT, transported via unmyelinated nerves, stored and released by posterior pituitary

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40
Q

A 5O-year-old female was diagnosed with anaplastic thyroid cancer and
underwent aggressive surgery to remove most of the thyroid. Unfortunately,
the surgeon also excised the parathyroid glands. Which oft he following could
result from the excision of the parathyroid glands?
• strengthening of muscles
• weakening of bones
• muscle convulsions
• decalcification of bones

A

muscle convulsions

PTH increases Ca and decreases P in blood
no Ca –> mm weakness

calcitonin opposes PTH

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41
Q
The innervation to the parotid gland and its sheath comes from all of the following
nerves EXCEPT one. Which one is the EXCEPTION?
• auriculotemporal nerve
• great auricular nerve
• facial nerve
• glossopharyngeal nerve
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SAADDES
A

facial

parotid: purely serous, Stensen
innervated by greater auricular (C2,3) and auriculotemporal (V3)

parasymp from glossopharyngeal (otic ganglion, lesser petrosal)

external carotid terminates in parotid
terminal branches (ST and M) supply
drains into deep cervical
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42
Q
The part of a developing salivary gland destined to become responsible for
its functioning is called the:
• nephron
• fo llicle
• adenomere
•lobule
A

adenomere - functional subunit of lobule (striated, intercalated, secretory cells)

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43
Q

A death-row inmate who was notorious for aggressive and hyperactive
behavior is complaining of abdominal pain. Hospital tests reveal bilateral
tumors that are secreting excessive catecholamines. Which of the following
glands is involved?
• anterior pituitary
• pancreatic islets (Langerhans)
• adrenal medulla
• parathyroids
• adrenal cortex

A

adrenal medulla: 20% norepinephrine, 80% epinephrine
from NC

cortex (from mesoderm!)
= glomer - mineral (Na reabs, aldosterone)
fascic - gluco (breakdown and release of sugars and fats, cortisol)
retic - adrenal hormones

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44
Q
The portion of the pituitary gland that does NOT arise from the hypothalamus
is the:
• neurohypophysis
• pars nervosa
• adenohypophysis
• infundibulum
A

adenohypophysis

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45
Q
Exocrine glands include all of the following EXCEPT one. Which one is the
EXCEPTION?
• sweat glands
• the prostate gland
• bile-producing glands of the l iver
• the pituitary gland
•lacrimal glands
• gastric glands
A

pituitary

of note: pancreas is merocrine (granules)
holocrine - sebaceous
apocrine - sweats

purely acinar - sebaceous
purely tubular - sweats

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46
Q

A young girl presents to the physician with a large, round face, a “buffalo
hump:’ and central obesity. She also has a history of hypertension and
insulin resistance as a result of increased cortisol. Which anterior pituitary
hormone controls the production and secretion of cortisol?
• follicle-stimulating hormone (FSH)
• luteinizing hormone (LH)
• adrenocorticotropic hormone (ACTH)
• thyroid-stimulating hormone (TSH)
• corticotropin-releasing hormone (CRH)

A

ACTH (= corticotropin)

released from pituitary in response to CRH (corticotropin-releasing hormone) from hypothalamus

FSH –> Sertoli, spermatogenesis; or ovaries, estrogen
LH –> Leydig, testosterone; or estrogen/progesteron

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47
Q

A pancreatic cancer patient has a tumor that presses on the ampulla of Vater.
This has been causing him Gl problems because the tumor obstructs the
common bile duct and the main excretory duct of the pancreas which is
known as:
• wharton’s duct
• the duct of Wirsung
• bartholin’s duct
• wolffian duct
• Stenson’s duct

A

Wirsung
–> into ampulla of Vater

somatostatin from delta inhibits alpha and beta islands

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48
Q

On a patient’s panoramic radiograph, the dentist notices a small, well-defined
radiolucency that sits inferior to the mandibular canal. The dentist performs a
sialogram that rules out a true cyst and makes the working diagnosis a static bone
cavity (Stafne bone cyst). Which of the following salivary glands creates the
depression in bone that radiographically gives the above appearance?
• sublingual gland
• von Ebner’s glands
• submandibular gland
• parotid gland

A

submandibular

in digastric trinagle on top of mylohyoid

Wharton’s duct
lingual n. crosses duct, XII parallel
supplied by facial and lingual aa

parasymp from VII (submandibular ganglion, chorda, lingual)

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49
Q

The thymus is a prominent feature of the middle mediastinum during infancy
and childhood.
The thymus is the central control organ for the immune system.
• both statements are t rue
• both statements are false
• the first statement is t rue, the second is false
• the f irst statement is fa lse, the second is t rue
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SAADDES

A

first false, second true

superior mediastinum

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50
Q

Mature lymphocytes constantly travel through the blood to the lymphoid organs
and then back to the blood. This constant recirculation insures that the
body is continuously monitored for invading substances. The major areas of
antigen contact and lymphocyte activation are the secondary lymphoid organs.
These include all of the following EXCEPT one. Which one is the EXCEPTION?
• spleen
• lymph nodes
• thymus gland
• tonsils
• mucosal associated lymphoid tissue (MALT)

A

thymus is primary lymphoid

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51
Q
All of the following contain mucus-secreting cells EXCEPT one. Which one is
the EXCEPTION?
• submandibular glands
• sublingual glands
• parotid glands
• glands of the esophagus
• mucosa of the t rachea
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SAADDES
A

parotid

purely serous

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52
Q
Calcitonin is secreted by the:
• thyroid gland
• parathyroid gland
• adrenal glands
• thymus gland
ANATOMIC SCIENCES
endocrine system
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SAADDES
A

thyroid - C-cells (aka parafollicular), opposes PTH

thyroid follicles colloid
thyroxine T4

TSH overproduction - Graves

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53
Q

Hospital tests on a patient identify a tumor in the hypophysis that is excessively
secreting growth hormone. Given that the patient is a 4-year-old male,
what is the expected outcome if no treatment is performed?
• pituitary gigantism
• acromegaly
• pituitary dwarfism
• achondroplasia
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SAADDES

A

pituitary gigantism

before adolescence - gigantism (epiphyses not fused)
after - acromegaly

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54
Q

The arterial blood supply of the adrenal glands comes from 3 sources, with
branches arising from the inferior phrenic artery, the renal artery, and the
aorta.
Venous drainage flows directly into the inferior vena cava on the right side
and into the left renal vein on the left side.
• both statements are t rue
• both statements are false
• the first statement is true, the second is false
• the first statement is fa lse, the second is t rue

A

both true

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55
Q

Meibomian glands (or tarsal glands) are sebaceous glands located at the rim
of the eyelid that function to protect the eyes from drying out. Meibomian
glands, release the entire secretory cell. This type of gland is referred to as:
• merocrine
• apocrine
• holocrine
• endocrine

A

holocrine

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56
Q

Which salivary gland(s) can have either numerous small ducts that open onto
the floor of the mouth or a single main excretory duct (Bartholin’s duct)?
• submandibular gland
• parotid gland
• sublingual gland
• von Ebner glands
[refer to card 174-1, 175-1 for illustration]
ANATOMIC SCIENCES
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SAADDES

A

sublingual

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57
Q
Which portal venous system is critical for proper endocrine function?
• hypophyseal
• renal
• hepatic
ANATOMIC SCIENCES
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SAADDES
A

hypophyseal

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58
Q

A pathologist receives a salivary tissue biopsy of what the dentist believes is
pleomorphic adenoma. However, the dentist forgot to mention the site of the
biopsy. The pathologist identifies certain histological structures that would
indicate that this sample is not from the parotid gland. What structures can
be seen in histologic examination of the submandibular and sublingual
glands but NOT in the adult parotid gland?
• myoepitheli al cells
• serous cells
• intercalated ducts
• serous demilunes
• striated ducts

A

serous demilunes

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59
Q

Thyroid epithelial cells (follicular cells) which are responsible for the synthesis
ofthyroid hormone are arranged in spheres called thyroid follicles.
These follicles are filled with colloid.
• both statements are t rue
• both statements are false
• the f irst statement is t rue, the second is false
• the f irst statement is fa lse, the second is t rue
ANATOMIC SCIENCES
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SAADDES

A

both true

inactive colloid = thyroglobulin + iodine (stains acidophilic)
when activated by thyrotropin, becomes basophilic

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60
Q

After being seen by a neurologist, a patient is diagnosed with a pituitary
adenoma. As the neoplasm increases in size, it will most likely affect which
cranial nerve?
·CNI
·CN II
·CN Ill
·CN IV

A

CN II - close to cavernous

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61
Q

Oxytocin and vasopressin are synthesized in the hypothalamus and are transported
to the pituitary gland for storage by way of:
• myelinated nerve fibers
• both myelinated and unmyelinated nerve fibers
• unmyelinated nerve fibers
ANATOMIC SCIENCES
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SA

A

unmyelinated

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62
Q
Which of the following tracts is responsible for coordinating eye and head
movements?
• tectospinal t ract
• rubrospinal tract
• vestibulospinal tract
• reticu lospinal tract
ANATOMIC SCIENCES
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SAADDES
A

tectospinal

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63
Q

lateral corticospinal

A

aka crossed pyramidal, voluntary mm movements

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64
Q

anterior corticospinal

A

aka direct pyramidal

ipsilateral voluntary mvmts

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65
Q

lateral reticulospinal

A

potentiates motor

reticular formation: pons, medulla, midbrain

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66
Q

medial reticulospinal

A

inhibitory on motor

mainly medulla

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67
Q

rubrospinal

A

coordination of body movement and posture

red nucleus of midbrain

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68
Q

vestibulospinal

A

extensor mm tone

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69
Q

tectospinal = colliculospinal

A

coordination of head, neck and eye

from midbrain tectum

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70
Q

potentiates motor

A

lateral reticulospinal

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71
Q

inhibits motor

A

medial reticulospinal

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72
Q

extensor tone

A

vestibulospinal

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73
Q

coordination of mvmt and posture

A

rubrospinal

red nucleus in midbrain

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74
Q

where is red nucleus

A

midbrain,

coordinates body mvmt and posture

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75
Q

A 56-year-old male patient with type II diabetes comes into the emergency
room with a painful blistering skin rash localized over the left side of his forehead.
The localized area of skin with sensory innervation from a single nerve root
ofthe spinal cord is called what?
• fa sci cui us
• dermatome
• spindle
• bundle

A

dermatome

cranial nerves don’t overlap
spinal nerves overlap ~50%

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76
Q
Wernicke's area is located within which cerebral lobe?
• parietal lobe
• occipital lobe
• temporal lobe
• frontal lobe
A

temporal

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77
Q

motor area

A

frontal

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78
Q

visual area

A

occipital

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79
Q

auditory area

A

temporal

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80
Q

short term memory area

A

temporal

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81
Q

somesthetic

A

parietal

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82
Q

occipital fx

A

visual

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83
Q

temporal fx

A

auditory, Wernicke (interpretation)

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84
Q

Wernicke

A

temporal, interpretation

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85
Q

motor planning

A

prefrontal

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86
Q

frontal fx

A

motor

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87
Q

emotional brain

A

limbic

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88
Q
Which structural component of a neuron sends impulses away from the cell
body?
• neuroglial cell
• perikaryon
• dendrite
• axon
A

axon

cell body is aka perikaryon

neuroglia - astrocytes (attached to vessels); microglial - phagocytes; ependymal - line ventricles

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89
Q

ventricle lining in brain

A

ependymal

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90
Q

brain phagocytes

A

microglia

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91
Q

attached to vessels in brain, for support

A

astrocytes

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92
Q

perikaryon =

A

cell body

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93
Q

A 14-year-old female patient presents to the physician with hyperpigmented
lesions (cafe-au-fait spots), hamartomas of the iris (Lisch nodules), and
axillary freckling (Crowe’s sign). The patient had previously been diagnosed
with neurofibromatosis, but is now complaining of generalized pain and
tingling. The physician discovers multiple neurilemmomas, classifying the
disease as a form of neurofibromatosis. Neurilemmomas are a neoplasm of
myelin producing cells in the peripheral nervous system known as?
• astrocyte
• oligodendrocyte
• schwann cell
• microglial cell
• satellite cell

A

Schwann = neurolemma

in CNS no Schwann, myelin there is by oligodendrocytes

schwann - only one axon
oligodendrocytes - multiple axons

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94
Q

Schwann vs oligodendrocyte

A

Schwann - PNS, only one axon per Schwann

oligo - CNS, can myelinate multiple axons

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95
Q
Which of the following ascending tracts of the spinal cord function to
carry pain and temperature sensory information to the thalamus?
•lateral spinothalamic t ract
• anteri or spinothalamic tract
• fasciculus gracili s
• fasciculus cuneatus
• spinocerebellar t ract
I refer to card 195-1 for illustration]
ANATOMIC SCIENCES
200
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A

lateral spinothalamic tract

ascending tracts sensory, descending motor

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96
Q

lateral spinothalamic tract

A

pain, temperature
opposite side
to thalamus

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97
Q

anterior spinothalamic tract

A

crude touch and pressire

opposite side to thalamus

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98
Q

fasciculus gracili and cuneatus

A

= medial lemniscus
fine touch and pressure
same side, to medulla –> to VPL of thalamus –> to somatosensory cortex

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99
Q

anterior and posterior spinocerebellar

A

kinesthesia, to cerebellum

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100
Q

crude touch and pressure

A

anterior spinothalamic

contralateral

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101
Q

fine touch and pressure

A

gracilis and cuneatus fascicles in medial lemniscus, to medulla –> VPL in thalamus –> somatosensory cortex

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102
Q

unconscious kinesthesia

A

spinocerebellars (both)

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103
Q

pain and temperature

A

lateral spinothalamic, contralateral

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104
Q

medial lemniscus

A

fascicles (gracilia and cuneatus): fine touch and pressure on same side
to medulla –> to VPL in thalamus –> to somatosensory cortex

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105
Q
Which of the following spinal nerve structures is exclusively composed of
sensory fibers?
• ventral root
• dorsal root
• ventral rami
• dorsal rami
A

dorsal root

sensory neuron bodies in DRG
motor - ventral root

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106
Q

A student dozing off in class is unexpectedly called on by the professor to
answer a question. Not knowing the answer, the hair on the back of the
student’s neck stands up, his pupils dilate, and his heart starts to race. This
fight-or-flight response is controlled by the:
• somatic nervous system
• autonomic nervous system
• central nervous system
• sensory nervous system

A

autonomic nervous

neurotransmitters: somatic - ACh; autonomic - ACh and NE

somatic denervation - flaccid paralysis; autonomic denervation - hypersensitivity

no ganglia in somatic

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107
Q

diencephalon

A

thalamus + hypothalamus

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108
Q

midbrain

A

tectum + tegmentum

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109
Q
Which ofthe following separates the occipital lobe and the cerebellum?
• fa lx cerebri
• fa lx cerebelli
• tentorium cerebell i
• corpus callosum
ANATOMIC SCIENCES
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A

tentorium cerebelli

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110
Q

epidural hemorrhage

A

MMA

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111
Q

subdural hemorrhage

A

veins

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112
Q

subarachnoid hemorrhage

A

circle of Willis

berrys aneurysm

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113
Q

MMA hemorrhage

A

epidural

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114
Q

Willis aneurysms

A

subarachnoid

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115
Q

choroid plexus fx

A

CSF production

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116
Q

CSF production

A

choroid plexus

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117
Q
Which of the following cranial nerves arise in the pons?
Select all that apply.
• trochlear nerve (CN IV)
• trigeminal nerve (CN V)
• abducens nerve (CN VI)
• facial nerve (CN VII)
ANATOMIC SCIENCES
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A

V, VI, VII – pons

I, II, III and IV - anterior portion
VIII - inner ear, to pons
IX, X, XI, XII attached to medulla oblongata

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118
Q

CNs attached to medulla oblongata

A

9-12

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119
Q

respiratory centers in brain

A

pons

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120
Q

reflexes in brain

A

medulla oblongata

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121
Q

medulla oblongata

A

reflexes, reticular formation (sleep/arousal, pain, breathing, heart)

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122
Q

substantia nigra where?

A

midbrain, motor control (Parkinson)

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123
Q

Parkinson

A

substantia nigra

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124
Q
Which of the following meningeal structures is a ring-shaped fold that allows
the passage of the infundibulum of the pituitary gland?
• tentorium cerebelli
• falx cerebri
• falx cerebelli
• diaphragma sellae
ANATOMIC SCIENCES
205
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A

diaphragma sellae

dura layers - periosteal and meningeal

falx cerebri contains inferior and superior sagittal sinuses
falx cerebelli contains occipital sinus

tentorium cerebelli contains straight, transverse and superior petrosal sinuses

dural sinuses are between periosteal and meningeal layers of dura

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125
Q

sinuses in tentorium cerebelli

A

transverse, straight, superior petrous

126
Q

sinuses in falx cerebelli

A

occipital

127
Q

sinuses in falx cerebri

A

sagittals

128
Q

sagittal sinuses where

A

falx cerebri

129
Q

superior petrous sinus where

A

tentorium cerebelli

130
Q

layers of dura

A

periosteal and meningeal

131
Q
The diencephalon lies beneath the cerebral hemispheres and contains which
of the following?
Select all that apply.
• thalamus
• pons
• medulla
• hypothalamus
A

thalamus and hypothalamus

132
Q
Which type of neuroglial cells form myelin in the CNS?
• astrocytes
• oligodendrocytes
• microglia
• ependymal cells
ANATOMIC SCIENCES
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A

oligodendrocytes

133
Q

Cell bodies of preganglionic sympathetic fibers to the head are located in the:
• superior and middle cervical ganglia
• lateral gray horns of segments Tl to T4 of the spinal cord
• anterior gray horns of segments Tl to T4 of the spinal cord
•lateral gray horns of segments 52 to 54 of the spinal cord
ANATOMIC SCIENCES
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A

• lateral gray horns of segments T1 to T4 of the spinal cord

sympathetic is T1- L2

preganglionic - relatively short, myelinated; cell bodies in lateral horns;
exit ventral into white ramus, synapse ACh

postganglionic - unmyelinated, relatively long; cell bodies in peripheral ganglia to visceral ganglia; transmitter NE (except adrenal medulla and sweat glands)

134
Q

sympathetic preganglionic transmitter

A

ACh

short

135
Q

sympathetic postganglionic transmitter

A

long

NE except adrenal medulla and sweats

136
Q

parasympathetic preganglionic

A

myelinated
synapse with postganglionic close to organs, relatively long
ACh

137
Q

parasympathetic postganglionic

A

unmyelinated
relatively short
ACh

138
Q
The lateral ventricles communicate with each other by:
• the two foramina of Luschka
• the interventricular foramen
• the cerebral aqueduct
• septum pellucidum
• the foramen of Magendie
ANATOMIC SCIENCES
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SAADDES
A

septum pellucidum

lateral ventricles in hemispheres

interventricular foramen (Monro) –> to III ventricle in diencephalon

cerebral aqueduct between III and IV, runs through midbrain

IV is dorsal to pons and medulla, ventral to cerebellum
median aperture = Magendie
lateral apertures (Luschka) - from IV to subarachnoid space

absorption of CSH in arachnoid granulations

139
Q

absorption of CSF

A

arachnoid granulations

140
Q

arachnoid granulations fx

A

absorption of CSF

141
Q

production of CSF

A

choroid plexus

142
Q

lateral ventricles location

A

hemispheres

143
Q

aqueduct location

A

between III and IV in midbrain

144
Q

III location

A

in diencephalon

145
Q

IV location

A

dorsal to pons and medulla, ventral to cerebellum

146
Q

Magendie and Luschka

A

openings of IV: median and two laterals, into subarachnoid

147
Q

Monro

A

from lateral to III

148
Q

from lateral to III opening

A

Monro

149
Q

openings of IV

A

Magendie and Luschka

150
Q
The spinal cord terminates at the:
• conus medullari s
• subarachnoid space
• f ilum terminale
• arachnoid space
• cauda equina
• central canal
A

conus medullaris

end at L1-L2
dura and arachnoid continue to S2 as filum terminale

151
Q

where does spinal cord end

A

L1-L2

152
Q

filum terminale

A

up to S2, dura + arachnoid

153
Q

The dorsal root ganglion is a collection of cell bodies for afferent nerve fibers
(mostly sensory) that exists just outside of the spinal cord.
There is no ventral root ganglion because the motor efferent fibers have their
cell bodies in the ventral horns (anterior portion of the grey matter) of the
spinal cord.
• both statements are true
• both statements are fa lse
• the first statement is true, the second is fa lse
• the first statement is fa lse, the second is t rue

A

both true

154
Q
In the peripheral nervous system, which fibers carry impulses to smooth and
cardiac muscle as well as to glands?
• somatic afferent f ibers
• visceral afferent fibers
• somatic efferent fibers
• visceral efferent fibers
ANATOMIC SCIENCES
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A

visceral efferent

155
Q

The ciliary, pterygopalatine, submandibular, and otic ganglia are all:
• sympathetic ganglia
• parasympathetic ganglia
• both sympathetic and parasympathetic ganglia
• neither sympathetic nor parasympathetic ganglia
ANATOMIC SCIENCES
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A

parasympathetic

CNIII - ciliary ganglion - eye, ciliary m (lens accomodation), sphncter of pupil

CN VII - pterygopalatine ganglion - lacrimal, oral and nasal mucosa; submandibular ganglion - subm and subl salivary glands

CN IX - otic ganglion - parotid

CN X - organs in thorax and abdomen

S2-S4 0 large intestin, rectum, genitalia, ureters and bladder

parasymp NT is ACh at both pre and postganglionic

156
Q

neurotransmitters for sympathatic

A

preganglionic ACh, postganglionic NE (except adrenal medulla and sweats)

157
Q

neurotransmitters for parasympathetic

A

ACh both pre and postganglionic

158
Q

parotid parasymp

A

otic ganglion of IX

159
Q

ciliary ganglion

A

III, eye things but not lacrimal!

postganglionics on short ciliary nn

symps from internal carotid plexus

160
Q

lacrimal parasymp

A

pterygopalatine of VII

161
Q

pterygopalatine ganglion

A

VII parasymp, lacrimal, nasal oral mucosa

symps internal carotid plexus

162
Q

submandibular ganglion

A

VII parasymp to salivaries (via chorda tympani and lingual nn)

163
Q

sympathetic ganglia: what’s the transmitter?

A

paravertebral chains: 3 cervicals and T, L, S

prevertebral: celiac, SMA + IMA, inferior hypogastric

NT is NE!

164
Q

white rami communicantes

A

only where preganglionic symps are (T1 - L2)

165
Q

gray rami

A

everywhere, postganglionic symps

166
Q

Neurulation is the stage of organogenesis in vertebrate embryos, during
which the neural tube is transformed into the primitive structures that will
later develop into the central nervous system. When does the neurulation
begin?
•1 “ week
• 3’d week
• S’h week
• 7’hweek

A

3 week

167
Q

An endodontist is performing root canal therapy on his anxious dental
patient. His anesthesia has been successful throughout the access preparation,
cleaning, and shaping. Just before he starts to obturate, he sticks a paper
point in the first canal to dry it out. The patient jumps up in pain from the stimulus.
Which type of primary afferent fiber carries information related to sharp
pain and temperature?
• A-alpha f ibers
• A-beta f ibers
• A-delta fibers
• C -nerve fibers

A

A-delta

all A - myelinated, C - unmyelinated

A-alpha - proprioception
A-beta - touch
A-delta - pain and temperature
C - pain, temperature and itch

168
Q

proprioception fibers

A

A-alpha

169
Q

touch fibers

A

A-beta

170
Q

A-beta

A

touch

171
Q

A-alpha

A

proprioception

172
Q
Which ofthe following cells is the only excitatory cell in the cerebellum?
• basket cells
• stellate cell s
• granule cells
• purkinje cells
• golgi cell s
A

granule cells

fxx of cerebellum: coordination, equilibrium, mm tone

173
Q

layers of cerebellum

A

molecular (axons of granule, basket [inhibitory, GABA, inhibit Purkinjes], stellate)
purkinje (inhibitory, GABA)
granular (deepest, granule; glutamate, excitatorym excite Purkinjes)

174
Q

molecular layer of cerebellum cortex

A

axons of granule (excitatory) + basket (inhibitory) and stellate

175
Q
Preganglionic parasympathetic fibers reach the otic ganglia through
which of the following nerves?
• greater petrosal nerve
• lesser petrosal nerve
• mandibular branch of t rigeminal nerve
• vagus nerve
A

lesser petrosal (also tympanic)

otic ganglion assoc with glossopharyngeal (IX)
located in infratemporal fossa

tympanic + lesser petrosal of IX carry pregangl to otic
postganglionics = piggy on auriculotemporal

176
Q

preganglionic of otic

A

lesser petrosal and tympanic of IX

177
Q

gag reflex

A

efferent vagus, afferent IX

178
Q

Your most 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)
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A

auriculotempotal - from V3, supplies posterior TMJ

also carries some otic postganglionics

179
Q

When walking to his car late at 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:
• superior cervical ganglion
• middle cervical ganglion
• inferi or cervical ganglion
• ganglion impar

A

superior cervical gaglion

ganglion impar is coccygeal unpaired symp ganglion

180
Q
Which of the following trigeminal nuclei is involved with the proprioception
oftheface?
• spinal nucleus
• masticatory nucleus
• mesencephalic nucleus
• chief nucleus
A

mesencephalic nucleus

main sensory = chief = pontine - discriminates touch
spinal nucleus - pain and temperature from head and neck

181
Q

discriminative touch of face

A

pontine/chief/main sensory ganglion of trigeminal, in pons

182
Q

temperature and pain from head and neck

A

spinal nucleus of trigeminal

183
Q

mesencephalic nucleus of trigeminal

A

proprioception of face

184
Q

pontine nucleus of trigeminal

A

discriminative touch of face

aka chief and main sensory

185
Q

masseteric nucleus of trigeminal

A

motor to mastication mm

186
Q

spinal nucleus of trigeminal

A

pain and touch of face

187
Q

Preganglionic parasympathetic axons are associated with all oft he following
cranial nerves EXCEPT one. Which one is the EXCEPTION?
• oculomotor
• facia l
• t rigeminal
• glossopharyngeal
• vagus

A

trigeminal

III - ciliary
VII - submandibular + pterygopalatine
IX - otic

188
Q
Which of the following cranial nerves is the only nerve that emerges from the
dorsal aspect ofthe brainstem?
• t rochlear nerve (CN IV)
• abducens nerve (CN VI)
• oculomotor nerve (CN Ill)
• optic nerve (CN II)
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A

IV

Edinger-Westphal nucleus:to pupillary sphincter

189
Q

pupillary reflex

A

afferent II, efferent III

190
Q
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)
ANATOMIC SCIENCES
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A

thoracic symp chain

greater splanchnic - T5-T9 –> celiac ganglion
lesser splanchnic T10-11 –> aorticorenal ganglion
least - T12 –> renal plexus

191
Q

greater splanchnic nerve

A

T5-T9 –> to celiac plexus

192
Q
Which ofthe following nerves penetrates the cricothyroid membrane?
Select all that apply.
• recurrent laryngeal nerve
• facial nerve
• accessory nerve
• internal laryngeal nerve
ANATOMIC SCIENCES
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SAADDES
A

recurrent laryngeal nerve
below inferior constrictor

all mm of larynx except cricothyroid which is by external branch of superior laryngeal

all sensation below vocal folds (above is internal branch of superior laryngeal)

right recurrent laryngeal hooks around subclavian

193
Q

The hypoglossal nerve travels from the carotid triangle into the
submandibular triangle of the neck.
This nerve is a motor nerve supplying all of the intrinsic and extrinsic
muscles of the tongue, except the palatoglossus, which is supplied by the
facial nerve.
• both statements are t rue
• both statements are false
• the first statement is t rue, the second is false
• the first statement is fa lse, the second is true

A

first is true, second is false

hypoglossal: hypoglossal canal
carotid triangle to submandibular triangle

palatoglossus is X

194
Q

unilateral lesion of XII

A

deviation towards affected side (genioglossus fx)

195
Q

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 anesthetized by the second
bolus?
• hypoglossal nerve
• long buccal nerve
• inferi or alveolar nerve
• lingual nerve
• glossopharyngeal nerve

A

lingual nerve

descends deep to lateral pterygoid, joined by chorda tympani

196
Q
The lesser petrosal nerve carries preganglionic parasympathetic fibers to
which of the following ganglia?
• otic ganglia
• geniculate ganglia
• submandibular ganglia
• sublingual ganglia
I refer to card 217-1 for illustration]
ANATOMIC SCIENCES
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A

otic

STYLOPHARYNGEUS IS THE ONLY M SUPPLIED BY IX

197
Q

IX fxs

A

motor - only stylopharyngeus!
afferent of gag reflex (efferent is vagus)
sensory + taste to posterior 1/3 of tongue
baroreceptor of carotid sinus and chemo of carotid body
(aortic is chemo+baro and X)

198
Q

The cervical plexus consists of anterior rami from Cl - C4; some ofthese fibers
reach the hyoid muscles by running concurrently with which cranial nerve?
• phrenic nerve
• vagus nerve
• glossopharyngeal nerve
• spinal accessory nerve
• hypoglossal nerve

A

XII

199
Q

ansa cervicalis

A

C1-C3, all infrahyoid except thyrohyoid which is C1 via XII

200
Q

phrenic nerve

A

C3-C5, diaphragm

201
Q

great auricular nerve

A

C2-C3, sensory in the area

202
Q
The branch of the trigeminal nerve that innervates the midface, palate and
paranasal sinuses exits the cranial cavity through which structure?
• superior orbital fissu re
• optic canal
• fo ramen rotundum
• pterygomaxillary fissu re
• fo ramen ovale
ANATOMIC SCIENCES
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SAADDES
A

foramen rotundum

203
Q

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?
• anteri or digastric
• geniohyoid
• stylohyoid
• genioglossus

A

anterior digastric

204
Q
Which of the following nerves innervates the medial rectus muscle of the
eyeball?
• optic
• olfactory
• oculomotor
• trochlear
•abducens
• ophthalmic (Vl)
A

III

205
Q
The principal types of nerves found in the dental pulp are:
• parasympathetic and efferent fibers
• sympathetic and afferent fibers
• sympathetic and efferent f ibers
• parasympathetic and afferent fibers
ANATOMIC SCIENCES
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A

symps and afferents

206
Q
Which ofthe following cranial nerves has visceral sensory innervation?
• t rigeminal nerve
• facial nerve
• vagus nerve
• hypoglossal nerve
I refer to card 224-1 for illustration]
ANATOMIC SCIENCES
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A

vagus - to thoracic and abdominal organs

207
Q
Which ofthe following is a component ofthe optic disc or papilla?
• central artery
• cones
• sensory efferent fibers
• myelinated nerve fibers
• oculomotor nerve
ANATOMIC SCIENCES
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A

central artery - branch of phthalmic

optic disc is blind spot on surface of retina; no photoreceptors; ummyelinated axons

optic tracts synapse in geniculate nuclei –> to calcarine sulcus in primary visual cortex

208
Q

optic tracts synapse where

A

geniculate nuclei –> then to calcarine of occipital

209
Q

calcarine

A

visual, occipital

210
Q

Which of the following ganglia 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
ANATOMIC SCIENCES
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SAADDES

A

geniculate

greater petrosal carries sensory and preganglionic parasymps (pass to pterygopalatine)

chorda tympani joins lingual n

211
Q

greater petrosal

A

branch of facial after geniculate nucleus, carries sensory and parasymps to pterygopalatine nucleus

212
Q

The left optic tract contains:
• fibers from the left eye only
• fibers from the right eye only
• fibers from the nasal half of the left eye and temporal half of the right eye
• fibers from the temporal half of the left eye and nasal half of the right eye

A

• fibers from the temporal half of the left eye and nasal half of the right eye

fibers from temporal halves don’t cross over, continue on same side
nasal crosses over

213
Q

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 f ibers
• it contributes to the anterior esophageal plexus

A

• it contains parasympathetic postganglionic fibers

vagus contains parasymp preganglionics to viscera

214
Q
Which of the following nerves penetrates the thyrohyoid membrane?
• facia I nerve
• internal laryngeal nerve
• accessory nerve
• recurrent laryngeal nerve
ANATOMIC SCIENCES
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A

internal laryngeal

recurrent laryngeal penetrates criothyroid

215
Q
Which cranial nerve supplies the derivatives ofthe hyoid arch?
• glossopharyngeal
• t rigeminal
• vagus
• facial
A

hyoid is second arch – VII

216
Q

A lesion of the facial nerve just after it exits from the stylomastoid foramen
would result in:
• an ipsilateral loss oftaste to the anterior tongue
• a decrease in saliva production in the f loor of the mouth
• a sensory loss to the tongue
• an ipsilateral paralysis offacial muscles
• a contralateral paralysis of facial muscles
ANATOMIC SCIENCES
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A

• an ipsilateral paralysis of facial muscles

217
Q
The spinal part of accessory nerve enters the skull through \_\_\_\_ and
then it joins the cranial root. Together they leave the skull through the \_\_\_\_\_
• carotid canal, jugular foramen
• carotid canal, foramen magnum
• jugular fo ramen, foramen magnum
• foramen magnum, jugular foramen
ANATOMIC SCIENCES
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SAADDES
A

• foramen magnum, jugular foramen

spinal root - upper 5 cervical segments

exits with vagus via jugular

spinal part - SCM and trap

218
Q
Which ofthe following nerves innervates the lower lip?
• mental nerve
• incisive branch of IAN
• facial nerve
•lingual nerve
A

mental

219
Q
Which of the following nerves is derived from both the medial and lateral
cords ofthe brachial plexus?
Select all that apply.
• musculocutaneous
• axillary
• ulnar
• median
• radial
A

median

220
Q
Which sensory receptor is most sensitive to linear acceleration?
• cri sta
• utricle
• saccule
• macula
• organ of cort
A

macula

maculae of utricle and saccule - line of linear acceleration relative to position of head
semilunar ducts - rotational acceleration

organ of corti - hearing

221
Q
Which of the following organs is retroperitoneal?
Select all that apply.
• stomach
• kidneys
•liver
• gallbladder
• inferi or vena cava
• spleen
A

kidney, IVC

SPLEEN IS INTRA!
S in SAD is suprarenal (adrenal)

222
Q

A 1 5-year-old 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 greater rebound pain when the pressure is
released. The diagnosis is appendicitis. The appendix is located in which abdominal
region?
• umbilical
• epigastri c
• hypogastric
•lumbar
• hypochondriac
• iliac

A

iliac

segments are hypochondriac and epigastric on top
lumbars and umbilical in the middle
iliacs and hypogastric on the bottom

223
Q

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 ofthe mediastinum?
• anterior mediastinum
• middle mediastinum
• posterior mediastinum
ANATOMIC SCIENCES
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A

anterior

224
Q
The diaphragm is located in the:
• pelvic cavity
• thoracic cavity
• abdominal cavity
• vertebral cavity
body cavities and regions
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ANATOMIC SCIENCES
SAADDES
A

thoracic

225
Q
Extracellular fluid comprises \_\_\_ of the amount of total body water.
·25%
·33%
·50%
·66%
A

33%
extracellular is interstitial, plasma and transcellular

intracellular is 2/3

226
Q
All of the following are anatomic structures of the auricle EXCEPT one. Which
one is the EXCEPTION?
• tragus
• helix
• antrum
• concha
A

antrum

227
Q

what is macula of retina

A

most sensitive part

center = fovea

228
Q

The ovaries are homologous with the testes in the male.
Each ovary lies in a shallow depression, named the ovarian fossa, on the
lateral wall of the pelvis; this fossa is bounded above by the external iliac
vessels, in front by the obliterated umbilical artery, and behind by the ureter.
• both statements are t rue
• both statements are false
• the first statement is t rue, the second is false
• the first statement is fa lse, the second is true

A

both true

female ovaries contain primary oocytes –> one final ovum, three polar bodies

in males, every spermatogonium –> 4 sperm

ovulation: follicle ruptures, releases ocum to uterine tube
empty follicle –> corpus luteum
if ovum fertilized, luteum persists and secretes progesteron to maintain pregnancy
if not, shrinks into albicans

229
Q

Consider the following structures:
1. Spongy urethra 2. Ductus deferens 3. Prostatic urethra 4. Epididymis
Name the path that sperm travels upon ejaculation.
•1, 2, 3, 4
• 2, 4, 1, 3
• 4, 2, 1, 3
• 4, 2, 3, 1

A

• 4,2, 3, 1 (epididymis, ductus deferens, prostatic urethra, spongy urethra)

sperm formed in testes,
passes along ductus deferens, joins duct of semina vesicle –> ejaculatory duct
combines secretions from prostate gland and seminal vesicles

230
Q
Cooper's ligaments are fibrous bands attached to musculature and function to
support:
• each testis
• each ovary
• each body of the epididymis
• each breast
A

each breast

231
Q

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

A

ejaculatory duct

inguinal canal contains spermatic cord and iliinguinal nerve

spermatic cord: three layers of fascia; begins at deep inguinal ring and ends at testis

232
Q

contents of spermatic cord

A

spermatic cord = - ductus deferens (sperm from epidydimis to ejaculatory duct, which is union of vas deferens and seminal vesicle ducts, and opens into prostatic urethra)

  • testicular artery
  • testicular veins (pampiniform plexus)
  • lymps vessles
  • autonomic nerves
233
Q

Cystitis is a term that refers to urinary bladder inflammation. It is most commonly
caused by a urinary tract infection. It affects females more than males.
This is mainly due to the difference in length of the:
• ureter
• urethra
• theca intern a
• fa llopian tube
• renal pelvis

A

urethra

234
Q
Where does the fertilization of an oocyte occur?
• vagina
• ovary
• peritoneum
• ampulla
• uterus
A

ampulla (part of fallopian tube)

parts of fallopian tube: fimbriae, infundibulum. ampulla, isthmus

bartholins lubricate vag

235
Q
The two tubes on the top side of the penis are called the:
• the erectile tissue
• spongy tubes
• corpus cavernosum
• corpus spongiosum
• urethra
A

cavernosum

urethra runs through spongiosum

236
Q

When sperm cells are formed, they migrate in an immature state to the long,
narrow structure attached to the back of each testicle called the:
• vas deferens
• prostate
• rete testis
• seminal vesicles
• epididymis

A

epidydimis

sperm is produced is seminiferous tubules and stores in epidydimis until ejaculated

237
Q
Surrounding the gingival portion ofthe root of each tooth is a specialized epithelium
known as the:
• connective t issue attachment
• periodontal ligament attachment
• junctional epithelium
• external basal lamina
ANATOMIC SCIENCES
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SAADDES
A

junctional epithelium

with hemidesmosomes
nonkeratinized squamous
no rete pegs (free gingiva has pegs)

238
Q
Which of the following gingival fibers extend between the cementum of
approximating teeth?
• circular fibers
• dentogingival fibers
• transseptal fibers
• alveologingival fibers
• dentoperiosteal fibers
A

transseptal

239
Q
The mucosa found on the hard palate is known as:
•lining mucosa
• masticatory mucosa
• specialized mucosa
• none of the above
ANATOMIC SCIENCES
periodontium
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SAADDES
A

masticatory

many rete pegs

240
Q

Scaling and root planning are periodontal treatments that can remove calculus
and also stimulate the gingiva. Usually, a periodontist waits four to six
weeks after a scaling and root planning procedure for reevaluation of therapy.
This allows healing of the connective tissue by what main cellular component
of the gingival connective tissue?
• osteoblast
• odontoblast
• fibroblast
• ameloblast
ANATOMIC SCIENCES
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SAADDES

A

fibroblasts

241
Q
Which structure below is NOT a derivative of the dental follicle?
• pulp
• cementum
• periodontal ligament
• alveolar bone
A

pulp - derivative of papilla

follicle - same as sac –> dementum, PDL and bone

242
Q
Which periodontal ligament fiber group mainly resists movements of a tooth
in an occlusal direction?
• alveolar crest group
• horizontal group
• apical group
• interradicular group
• oblique group
A

apical group

243
Q
Which ofthe following is the most common cell found in the PDL?
• cementoblasts
• undifferentiated mesenchymal cells
• osteoblasts
• f ibroblasts
A

fibroblasts

nerve endings in PDL: free (pain) and encaps (pressure)

244
Q
Which of the following epithelia lines the endothelium of the aorta and the
mesothelium ofthe peritoneal cavity?
• simple squamous epithelium
• stratified columnar epithelium
• stratified cuboidal
• transitional epithelium
ANATOMIC SCIENCES
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SAADDES
A

simple squamous

245
Q
Which of the following cell layers of the epidermis contains keratohyalin
granules?
• stratum corneum
• stratum lucidum
• stratum granulosum
• stratum spinosum
• stratum basale
A

granulosum

layers: come get sun burned

lucidum - in palms and solesl right below corneum

langerhans in spinosum
melanocytes in basale

246
Q

What is the main difference between parakeratinized and orthokeratinized
epithelium?
• para keratinized epithelium has keratohyalin granules
• parakeratinized epithelium has nuclei
• parakeratinized epithelium has more prominent RER
• para keratinized epithelium are rich in mitochondria
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SAADDES

A

has nuclei in top layer

basement membrane - two layers; basal and reticular lamina

247
Q
Which type of collagen is found mainly in dentin and bone?
• type I
• type II
• type Ill
• type IV
A

I

II is ctlg
III - reticular
IV - basement membrane

attachment mechanism: heidesmosomes

in collagen, every third AA is glycine
Vit C required for hydroxylation of proline and lysine (no Vit C –> scurvy)
lysyl oxidase for cross-linking

248
Q
Which of the following epithelial tissues is most often specialized for diffusion
and filtration?
• simple columnar epithelium
• stratified cuboidal epithelium
• simple squamous epithelium
• pseudostratified epithelium
I refer to card 267-1 for illustration]
ANATOMIC SCIENCES
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SAADDES
A

simple squamous

249
Q
Which of the following cells is the most abundant cell type found in
connective tissues?
• osteoblast
• chondroblast
• mast cell
• fibroblast
• macrophage
A

fibroblast

250
Q
Intervertebral discs are made up of:
• elastic cartilage
• periosteum
• fibrocartilage
• hyaline carti lage
ANATOMIC SCIENCES
tissue
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A

fibrocartilage

hyalin - in joints
elastic - epiglottis and external ear

growth of ctlg - appositional and interstitial

251
Q
All of the following bones are formed completely by intramembranous ossification
EXCEPT one. Which one is the EXCEPTION?
• clavicles
• mandible
• maxilla
• frontal bone
A

mandible - condyle is endochondral

252
Q

A patient in the dental clinic states in his medical history that he has heart
disease and occasionally takes nitroglycerin for his pain. During treatment,
the patient clutches his chest and frantically points to his jacket pocket. The
dentist obtains the nitroglycerin bottle from his jacket, removes one tablet,
and places it:
• on the soft palate
• on the gingiva
• on the oral vestibule
• on the floo r of the mouth
• on the buccal tissue
• any of the above

A

sublingually

most permeable

253
Q
Which of the following is the principle component of ground substance of
the cartilage?
• fibroblasts
• collagen fibers
• reticular fibers
• chondroitin sulfate
ANATOMIC SCIENCES
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A

chondroitin sulfate - PGs, GAGs

all GAGs are sulfated and have protein core except hyaluronic acid (which binds them into large aggregates)

254
Q

At the gymnastics center, a 22-year-old male doing flips on the trampoline
lands incorrectly on his ankle and dislocates it. In the emergency room, the
physician provides traction to correctly relocate the ankle. The patient is told
that although there are no fractures the bands of fibrous connective tissue
that connect bone to bone are almost definitely torn. These bands are called:
• tendons
• bursae
•ligaments
• menisci

A

ligaments

attaching fibers of tendons and ligaments are called Sharpeys

255
Q
Which type of connective tissue is most commonly observed in ligaments
and tendons?
• loose connective tissue
• dense irregular connective t issue
• dense regular connective tissue
• elastic connective t issue
ANATOMIC SCIENCES
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A

dense regular CT

256
Q
The greatest resistance to the movement of the molecules between cells is
mainly achieved by which of the following intercellular junctions?
• desmosomes
• hemidesmosomes
• adherens junctions
• gap junctions
• zonula occludens
ANATOMIC SCIENCES
279
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SAADDES
A

occludens

desmosome - spot welds between ells
hemidesmosomes - cell to noncellular surface

occludens = tight, barrier
gap jxns - channels, connexons

257
Q

In contrast to tight and adherens junctions, gap junctions do NOT seal
membranes together, nor do they restrict the passage of material between
membranes.
Gap junctions allow electrical and metabolic coupling among cells so that
signals initiated in one cell can readily propagate to neighboring cells.
• both statements are t rue
• both statements are false
• the f irst statement is t rue, the second is false
• the f irst statement is fa lse, the second is t rue

A

both true

258
Q

components of jxnal complex

A

tight, intermediate, desmosome

259
Q
Where would you expect to find the fewest matrix-embedded elastic fibers?
• nasal cartilage
• epiglottis
• auricle
• eustachian tube
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A

nasal - hyaline

260
Q
Which layer of skin is mainly composed of areolar connective tissue and adipose
tissue?
• epidermis
• hypodermis
• dermis
A

hypodermis

main depository of FAT

261
Q

dermis layers and origin

A

papillary and reticular (dense irregular CT)

mesoderm

262
Q

meissner

A

tactile

263
Q

Ruffini

A

stretch

264
Q
When we look at our fingers, we can see fingerprints. Which of the following
layers of skin are we looking at in order to see the fingerprints?
• papillary layer of the dermis
• stratum corneum of the epidermis
• reticular layer of the dermis
• stratum lucidum of the epidermis
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A

papillary layer of dermis – forms dermal ridges that interdigitate with rete pegs of epidermis

265
Q

A 17-year-old man falls down and chips the incisal edge of his maxillary central
incisor, reducing the length of the crown. The dentist informs him that the
tooth may erupt a little to compensate for the loss. Which of the following
structures will be deposited in the apex of the tooth when the tooth continues
to erupt?
• cementum
• bundle bone
• dentin
• pulp
• enamel
• periodontal ligament

A

cementum

compensates for wear on apical third

acellular cementum - coronal 2/3 of root, thinnest at CEJ
ellular (secondary) - faster, contains cementocytes

266
Q

Intertubular dentin is formed in peripheral parts oft he mineralized dentin inside
the walls of dentin tubules.
Peritubular dentin is highly mineralized and it also contains little collagen.
• both statements are t rue
• both statements are false
• the first statement is t rue, the second is false
• the f irst statement is fa lse, the second is t rue
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A

• the first statement is false, the second is t rue

267
Q
Which of the following areas of the pulp is also known as the "zone of Wei I?"
• f ibroblastic layer
• odontoblastic layer
• cell-rich zone
• cell-free zone
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SAADDES
A

cell free
contains Korff

raschkow is in cell-rich (Hohle)

accessory canals form when HERS encouters blood vessel; root forms around vessel

268
Q
All of the following are stages of amelogenesis EXCEPT one. Which one is the
EXCEPTION?
• presecretory
• secretory
• transitional
• morphogenic
• maturation
• post-maturational
A

morphogenic

269
Q

Pulpal involvement of a carious lesion in a young child is much more likely
because:
• caries progress faster in primary teeth
• caries can enter primary teeth from the enlarged apical foramen
• the pulp chamber is larger in primary teeth compared to permanent teeth
• reparative dentin is not as functional in primary teeth as it is in permanent teeth

A

pulp chamber is larger

270
Q
The main function of cementum is to:
• maintain the width of the PDL
• supply nutrition to the pulp
• stimulate formation of dentin
• attach sharpey's fibers
ANATOMIC SCIENCES
tooth components
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A

attach sharpeys

271
Q

An irritating or painful response to cold, hot or pressure stimuli is usually
caused by sensitivity of which oral tissue?
• dentin
• cementum
• pulp
• enamel

A

dentin

272
Q
Generally, as the dental pulp ages, the number of cells \_\_\_ , and the number
of collagen fibers \_\_\_ .
• decreases, decreases
• decreases, increases
• increases, decreases
• increases, increases
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SAADDES
A

decreases, increases

273
Q
Which ofthe following has the least amount of collagen?
• bone
• dentin
• enamel
• cementum
A

enamel

oldest enamel at DEJ under cusp or cingulum

274
Q
All of the following age changes in enamel are true EXCEPT one. Which one is
the EXCEPTION?
• attrition
• discoloration
• flatten ing of grooves and fissu res
• modifications in the surface layer
• increased permeability
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A

increased permeability (reduces actually)

275
Q

Enamel tufts and lamellae may be likened to geologic faults and have no
known clinical significance.
The striae of Retzius often extend from the DEJ to the outer surface of enamel,
where they end in shallow furrows known as perikymata.
• both statements are t rue
• both statements are fa lse
• the fi rst statement is true, the second is fa lse
• the fi rst statement is false, the second is true

A

both true

276
Q
You would expect to see all oft he following in dentin EXCEPT one. Which one
is the EXCEPTION?
• incremental l ines of von Ebner
• contour lines of Owen
• striae of Retzius
• granular layer ofTomes
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A

retzius

277
Q
The organic phase of dentin is about 90% collagen, mainly type \_\_ with
small amounts of types \_\_ .
•I, II and IV
• I, Ill and V
•Ill, I and IV
• IV, I and Ill
A

I, some III and V

278
Q

In orthodontic tooth movement, bone remodeling is forced. The bands,
wires, or appliances put pressure on one side of the tooth and adjacent
alveolar bone, creating a zone of __ in the POL This leads to bone __ .
On the opposite side of the tooth and bone, a __ zone develops in the POL
and causes the of bone.
• tension, deposit ion, compression, resorption
• compression, resorption, tension, deposit ion
• compression, deposit ion, tension, resorption
• tension, resorption, compression, deposition

A

• compression, resorption, tension, deposition

permanent teeth move occlusally and facially when erupting

279
Q
Apical abscesses of which teeth have a marked tendency to produce cervical
spread of infection most rapidly?
• mandibular central and lateral incisors
• mandibular canine and first premolar
• maxillary first and second molars
• mandibular second and third molars
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A

cervical as in to actual neck

• mandibular second and third molars

280
Q
The bone directly lining the socket (inner aspect of the alveolar bone) specifically
is referred to as:
• bundle bone
• cancellous bone
• osteoid
• trabecular bone
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SAADDES
A

bundle bone

281
Q
A newly erupted tooth has a membranous covering. It is derived from which
structure?
• perikymata
• dental papilla
• dental follicle
• oral epithelium
• gubernaculum
A

oral epithelium
= nasmyth’s membrane, secondary enamel cuticle

pellicle - salivary proteins

primary cuticle - binding epithelium to tooth during development

282
Q
Dentin is considered a living tissue because of odontoblastic cell processes
known as:
• triacetate f iber
• Tomes' fiber
• tag f iber
• Korff's f iber
A

Tomes

v. Korff is in cell-free zone of pulp

283
Q

Secondary Dentin comes in attrition, caries, or a restorative dental procedure.
Tertiary dentin is produced only by those cells directly affected by the
stimulus.
• both statements are t rue
• both statements are fa lse
• the first statement is true, the second is fa lse
• the first statement is false, the second is true
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SAADDES

A

first false, second true

tertiary = reactive or reparative; reactive - by preexisting, reparative - by newly differentiated odontoblasts

primary dentin - before completion of apical foramen

secondary dentin - after completion of apical foramen (slower, less mineralized)

junction between primary and secondary - sharp change in direction

284
Q

The dental lamina, a thickening of the oral epithelium that produces the
swellings of the enamel organs, is first seen histologically around the:
• second week in utero
• sixth week in utero
• tenth week in utero
• fourth month in utero
I refer to AS card 303-1, 308 B-1, 308 C-1 for illustration I
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SAADDES

A

6th week

3rd week - formation of stomodeum (also neurulation)

285
Q
When enamel maturation is completed, the ameloblast layer and the adjacent
papillary layer regress and together constitute the:
• cervical loop
• epitheli al root sheath
• reduced enamel epithelium
• junctional epithelium
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SAADDES
A

REE

cervically becomes junctional epithelium

JE: apical extent to CEJ, to tooth via hemidesmosomes

286
Q
Epithelial cells of the inner and outer epithelium proliferate from the cervical
loop of the enamel organ to form a double layer of cells known as:
• dental lamina
• dental papilla
• reduced enamel epithelium
• Hertwig's epitheli al root sheath
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SAADDES
A

HERS

287
Q

Tooth development is dependent on a series of sequential cellular
interactions between epithelial and mesenchymal components of the tooth
germ.
Once the ectomesenchyme influences the oral epithelium to grow down into
the ectomesenchyme and become a tooth germ, the histogenesis of a tooth
occurs.
• both statements are true
• both statements are false
• the first statement is t rue, the second is false
• the first statement is fa lse, the second is true

A

both true

288
Q
Which ofthe following forms the middle part ofthe enamel organ?
• outer enamel epithelium
• inner enamel epithelium
• stratum intermedium
• stellate reticu lum
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stellate

lots of intercellulaar fluid

289
Q

Put the following developmental stages of a tooth in the correct sequence:
(1) Bell stage (2) Bud stage (3) Cap stage
• 1,2,3
• 3,2, 1
• 2,3,1
• 2, 1,3

A

2, 3, 1

initiation - 6-7 wk = induction
bud stage - 8 wk, proliferation
cap stage - 9-10 wks: proliferation, differentiation, morphogenesis
bell stage - 11-12 wk, histo and morphodifferentiation

then: apposition, calcification, eruption and attrition

dentino- and amelogenesis imperfecta occur dyring bell stage (histodifferentiation)

290
Q

initiation of tooth

A

6 week, induction

291
Q

bud stage

A

7-8 wk, proliferation

292
Q

cap stage

A

9-10 wk, proliferation differentiation and morphogenesis

293
Q

bell stage

A

11-12 wk: histo and morphodifferentiation

294
Q

In adults the epithelial cell rests of Malassez persist next to the root surface
within the periodontal ligament.
Although apparently functionless, they are the source of the epithelial lining
of dental cysts that develop in reaction to inflammation of the periodontal
ligament.
• both statements are t rue
• both statements are fa lse
• the first statement is true, the second is fa lse
• the fi rst statement is fa lse, the second is t rue

A

both true

295
Q
Histologically, the dentin of the root is distinguished from the dentin of the
crown by the presence of:
• incremental lines of Retzius
• rete pegs
• granular layer ofTomes
• sharpey's fibers
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SAADDES
A

granular layer of Tomes

just below cementum, globular calcification

296
Q
Which ofthe following products is NOT ectodermal in origin?
• junctional epithelium
• enamel
• hertwig's epithelial root sheath
• pulp
• ameloblasts
A

pulp - ectomesenchyme of papilla

297
Q

The portal vein is about 2 inches long and is formed behind the neck of the
pancreas by the union of the:
• left gastric and the left colic veins
• appendicular and the inferior mesenteric veins
• superior mesenteric and the splenic veins
• right gastri c and the right colic veins
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SAADDES

A

• superior mesenteric and the splenic veins

tributaries of portal vein:
splenic, IMA, SMA, gastric veins

298
Q
The right posterior intercostal vein drains blood into:
• azygos vein
• hemiazygos vein
• accessory hemiazygos vein
• none of the above
ANATOMIC SCIENCES
veins
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SAADDES
A

azygos

azygos = right ascending lumbar vein and right subcostal vein; goes up to fifth thoracic vertebra, drains into SVC

SVC = union of two brachiocephalic veins, left is longer

299
Q
The subclavian vein is located anterior to the:
• scalenus anterior muscle
• scalenus middle muscle
• scalenus posterior muscle
• none of the above
ANATOMIC SCIENCES
veins
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A

• scalenus ante rior muscle

vein anterior to anterior scalene, artery + brachial plexus between anterior and middle

brachiocephalic vein = internal jugular + subclavian

300
Q
Oxygenated blood leaves the placenta and enters the fetus through the:
• foramen ovale
• ductus venosus
• umbili cal arteries
• ductus arteriosum
• umbili cal vein
ANATOMIC SCIENCES
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SAADDES
A

umbilical vein (becomes round ligament of liver)

301
Q
The exchange of gases in the lungs takes place between the alveoli and the:
• bronchial arteries
• pulmonary veins
• pulmonary arteri es
• capillaries
A

capillaries

302
Q
All of the following nerves are embedded in the lateral wall of the cavernous
sinuses EXCEPT one. Which one is the EXCEPTION?
• trochlear nerve (CN IV)
• ophthalmic nerve (CN Vl )
• oculomotor nerve (CN Il l)
• maxillary nerve (CN V2)
• mandibular nerve (CN V3)
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SAADDES
A

V3 is not

cavrnous sinuses empty into superior petrosal sinuses (in tentorium) –> transverse –> sigmoid –> via jugular foramen to internal jugular vein

inferior petrosal also into internal jugular vein

contents of cavernoud sinus: III, IV, V1 and V2 + internal carotid + VI

303
Q
Which oft he following veins are found within the marrow spaces oft he skull?
• cerebral venules
• diploic veins
• emissary veins
• brachiocephalic veins
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SAADDES
A

diploic vv

emissaries connect dural sinuses with scalp; valveless

304
Q

Which of the following veins join within the parotid gland to form the retromandibular
vein?
• the facia l and maxillary veins
• the facia l and superficial temporal veins
• the maxillary and superficial temporal veins
• the facia l and mandibular veins
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SAADDES

A

• the maxillary and superficial temporal veins

subclav + int jug –> brachiocephalic

vein supfcl to artery and deep to facial nerve, \

305
Q
Which of the following are considered to be primary resistance vessels?
• large arteries
• arterioles
• capillaries
• large veins
• venules
A

arterioles

306
Q
At the level of the inferior border of the 1st right costal cartilage, the brachiocephalic
veins unite to form the:
• external jugular vein
• internal jugular vein
• retromandibular vein
• superi or vena cava
• subclavian vein
• thoracic duct
A

SVC

IVC = junction of common iliacs at L5

307
Q

Because the facial vein and its tributaries have no valves extracranial infections
arising within an area bounded by the bridge of the nose and the angles
of the mouth (danger triangle of the face) will reach which of the
following sinuses?
• cavernous sinus
• sigmoid sinus
• inferior petrosal sinus
• superior petrosal sinus

A

cavernous

308
Q
Which dural venous sinus lies in the convex attached border of the falx
cerebri?
• cavernous sinus
• transverse sinus
• superi or sagittal sinus
• straight sinus
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A

superior sagittal

confluence of sinuses = sup sagitt + straight + occipital
from here to transverse, which become sigmoid, exit through jugular and become internal jugular vein

inferior petrosal also through that hole

309
Q
All of the following are characteristic features of veins EXCEPT one. Which
one is the EXCEPTION?
• muscular tunica media
• thick tunica adventit ia
• larger lumen
• valves
• vasa vasorum
A

muscular tunica media

is characteristic of smaller arteries

310
Q

Stomodeum

A

4th week

311
Q

Neurulation

A

3rd week

312
Q

Dental lamina

A

6th week