Introduction to anatomy

Understand and be able to describe the anatomical position

Anatomical position
Standing
Facing anteriorly
Looking forwards
Arms by side
Palms of hands facing anteriorly
Feet together
Toes pointing anteriorly

Understand and be able to apply directional terms

Directions
Superior/inferior
Anterior/posterior
Medial/lateral
Proximal/distal
Superficial/deep

Understand and be able to describe the cardinal planes of the body

Planes:
Sagittal plane
Coronal plane
Axial (transverse) plane

Understand movement terms and be able to describe movements

Movements:
Flexion = decreasing angle between parts
Extension = increasing angle between parts
Dorsi/plantarflexion = at ankle point
Abduction = away from the midline
Adduction = towards the midline
Rotation = moving around long axis
Circumduction = circular movement (combination of flexion/extension/abduction/adduction)
Pronation/ supination = rotation of forearm and hand
Eversion/ inversion = at ankle joint
Retraction/ protrusion = mandible
Elevation/ depression = move superiorly/inferiorly
wrist movements: flexion/ extension, abduction/adduction

Understand basic bony descriptive terms

Terminology to Bones
Condyle = smooth, rounded elevation
Crest = sharp ridge
Epicondyle = elevation above a condyle
Facet = smooth area
Process = localised projection
Trochanter = large rounded elevation
Tubercle = small around elevation
Tuberosity = large rounded elevation
Foramen = hole/opening
Fossa = wide depression
Notch = large groove
Sulcus = groove or furrow
Cardiovascular system 1 - the heart
Cardiovascular system = heart, arteries, veins and capillaries
Circulatory system = cardiovascular system + blood that’s pumped around
Pulmonary circuit = right side of the heart, carries blood to the lungs for gas exchange
Systemic circuit = left side of the heart, supplies blood to all the organs of the body
Myogenic = cardiac muscles that contracts spontaneously without any help (can beats on its own)

Know the location and position of the heart in the thorax

Located slightly to the left in the thorax in the mediastinum between the lungs
Mediastinum = space between the 2 lungs, contains all structures except the lungs. Sternum -> vertebral
column. Inlet - superior thoracic aperture. Outlet - inferior thoracic aperture
Superior mediastinum: above the horizontal plane
Anterior: anterior to pericardium
Middle: contains heart and pericardium
Posterior: posterior to pericardium
Pericardium = sac around the heart
Fibrous pericardium: fibrous sac enclosing the heart
Serous pericardium: lines inner sac (parietal layer) and cover heart (visceral layer = epicardium)
Myocardium = thick muscular layer: fibrous skeleton
Endocardium = smooth lining of the heart

Know the names of the 4 chambers of the heart and the type of blood found in them
Left atrium/ left ventricle = oxygenated blood.
Right atrium/ right ventricle = deoxygenated blood

Know the major external and internal features of the heart

External: Left atrium/ventricle/auricle, right atrium/ventricle/auricle, Right/ left/ inferior/ border of the heart,
apex, ascending aorta, arch of aorta inferior vena cava, superior vena cava, pulmonary trunk, right/ left
pulmonary artery, left/ right pulmonary veins, coronary sinus

Internal: fossa ovalis = open during development of lungs as it allows communication between the atria -
oxygenated blood can be transferred immediatly,
musculi pectinati - muscle in the right atrium
trabeculae carneae - big trunk of muscles > papillary muslces > chordae tendineae > tri/bicuspid
valve, interventricular septum, papillary muscle, bicuspid valve, Semilunar valves (= aortic
valve, pulmonary valve) LABRAT = Left Atrium Bicuspid, Right Atrium Tricuspid

Know the major blood vessels supplying the heart tissue

Arch of aorta, left/ right coronary artery, circumflex branch, anterior interventricular branch

Bypass surgery -> coronary artery

Coronary arteries, but cardiac veins
Bloods goes from the coronary sinus to the right
atrium (the anterior cardiac vein does not drain into
the coronary sinus)
Understand the structure of the heart valves and how this relates to their function
Bicuspid/tricuspid valves open when blood flows from the atria to the ventricles – aorta and pulmonary
semilunar valves are like cups to prevent blood from flowing into the ventricles
When the ventricles contract the papillary and the chordae tendineae make sure the bicuspid and tricuspid
valves stay closed to prevent blood going back into the atria

Know where you would listen to hear the sound of each of the heart valves
First heart sound (S1) is closure of Atrioventricular valves (bi/tricuspid) – ventrical systole
Second heart sound (S2) is closure of Semilunar valves – ventrical diastole

Know the different elements of the cardiac conduction system and how the heart beat is produced
SinoAtrium node -> AtriaVentricle node -> AV bundle -> Right/ left bundle branches -> Apex -> Purkinje
fibers in the ventricles

Know what a normal heart rate is and how it is measured

Heart rate is measured at arterial pressure points (e.g brachial artery, radial artery, common carotid artery).
Normal heart rate: Infants (120 > bpm), young female (72-80 bpm), young male (64-72 bpm), Heart rate
rises again in elderly
Know what a normal blood pressure is and what the different numbers represent i.e. systolic/diastolic
pressure
Systolic pressure is the highest pressure when the heart beats and pushes the blood around the body.
Diastolic is the pressure when the heart relaxes between beats. A normal blood pressure is120/80 mmHg
(heatlhy range is 90-140/ 60-90)

Cardiovascular System 2 - the vessels

Know the path taken by blood as it is pumped around the body/ Know how the classification of vessels
changes with diameter

Heart -> Arteries -> Arterioles -> Capillaries -> Venules -> Veins -> Heart
Blood flows through 2 consecutive capillary networks before returning to the heart.

Know the names of the major branches of the aorta

Brachiocephalic trunk (right common carotid artery, right subclavian artery), left common carotid artery, left
subclavian artery
Left common carotid artery
Left subclavian artery

Know the names of the major arteries of the upper and lower limbs, thorax, abdomen and head and
neck
Upper limb (subclavian artery, axillary artery, brachial artery, radial artery, ulna artery,deep and superficial
palmar arches, digitalis arteries)
Lower limb (external iliac artery, femoral artery, popliteal artery, posterior tibial artery, anterior tibial artery,
dorsalis pedis, medial and lateral plantar arteries)

Thorax (thoracic aorta — branches: oesophagus, pericardium, bronchi, thoracic wall, diaphragm, intercostal
arteries)

Abdomen (coeliac trunk, superior mesenteric artery, inferior mesenteric artery, lateral branches,
posterolateral branches, bifucates – common iliac artery, internal iliac artery, external iliac artery,
Head and neck (common carotid artery, internal artery (neck side)- supplies anterior cerebral a. & middle
cerebral a., external artery (face side) - facial a., posterior occipital a., maxillary a, superficial temporal a.,
basilar artery)

Know the names of the major veins draining the upper and lower limbs, thorax, abdomen and head
and neck
Upper limb (radial and ulnar veins, brachial veins, axillary veins, subclavian veins – cephalic vein, basilic
vein,median cubital vein = in the cubital fossa)

Lower limb (anterior and posterior tibial veins, popliteal veins, femoral veins, external iliac veins, short
saphenous vein, great saphenous vein)
Thorax (subclavian veins, azygos veins, superior vena cava)

Abdomen (internal and external iliac veins, common iliac veins, inferior vena cava, superior mesenteric
veins, inferior mesenteric veins, splenic veins, hepatic portal vein, hepatic veins)
Head and neck (internal and external jugular vein, subclavian vein, brachiocephalic vein)

Know what a portal venous system is and how it differs from normal venous return
Portal venous system is a system where blood flows through 2 consecutive (continiously) capillary networks
before returning to the heart (abdomen, hepatic portal vein

Musculoskeletal
Bones = specialised connective tissue
Function: support, protection, allows movement of structures, production of
blood cells, contains ions for release into blood (e.g. calcium, phosphates)

Fracture: haematoma -> cartilage -> callus -> new bone

List the components of the appendicular and axial skeleton

Appendicular Skeleton: Pelvis and limbs
Axial skeleton: skull, thorax and vertebral column

Differentiate between compact and cancellous bone

Compact bone = the hard outer layer.
Cancellous bone = the loose internal spongy bone

Classify bones, joints and muscles, describing the

characteristic features of each class
Bone: Long, short, flat, irregular, sesamoid

Joints:
- Fibrous: Fibrous material connects bones. Little or
no movement, no joint cavity (e.g. interosseous
membrane, dentineralveolar joint, sutures)
- cartilaginous: cartilage between bones. Little or no
movement, no joint cavity (e.g. pubic
symphysis, intervertebral joint)
- synovial: movement possible, synovial fluid,
membrane and capsule (hinge, pivot, condyloid,
saddle, and ball-and-socket joints)
Muscles: Skeletal (fusiform, broad sheet, pennate (uni = more accurate, bi and multipennate = more power)),
smooth, heart muscle

Fusiform (biceps brachii) broad sheet (abdominal oblique) Pennate (uni, bi, multi)

Function: usually pairs of opposing muscles: agonists (biceps) + synergists - antagonists (triceps) with
stabilisers/fixators (wrist)

Use anatomical terminology to describe the movements of joints

Adduction – abduction
medial – lateral
flexion – extension
dorsi/plantar flexion (foot)
rotation
circumduction
pronation – supination (radius/ulna)
eversion – inversion (ankle)
retraction – protrusion (mandible)

Skull
To understand and be able to recognize the bones of the neurocranium and viscerocranium, in both
disarticulated and articulated forms. To recognize the bones that make up the orbit, and to understand
the location of air sinuses within the skull.
Skull = most complex region of the axial skeleton. 22 bones + hyoid (7 single elements, 8 paired bones, do
not include the (6) ossicles). Insertion of muscles of facial expression and mastication
Function: Support and protection

Neurocranium: (frontal bone, parietal bones, occiptal bone, temporal bone, Sphenoid bone, ethmoid bone)
Viscerocranium: (maxilla, mandible, zygomatic bones, nasal bone, lacrimal bones, hyoid, palatine bones,
inferior nasal concha, vomer)
Two Frontal bones fuse to 1 around the age of 2
Tears pass through the lacrimal bone
Vomer is right in the middle of your nose and is part of the nasal septum

Cranial sutures = articulations between bones of the skull. Initially clearly visible seperations, but may
obliterate with age.
Coronal suture: between parietal and frontal bone
Sagittal suture: between the parietal bones
Lamboid suture: between parietal and occipital bone
Squamosal suture: between parietal and temporal bone
Frontonasal suture: between frontal and nasal bone
Metopic suture: between the left and right frontal bone. Non-existent in adults
Median palatine suture: between the left and right palatine bones
Basilar suture: is completely fused, between sphenoid and occipital

Buttressing system = Reinforced pathways designed to transmit and withstand a variety of biochemical
forces. Viscerocranium is reinforced to transmit the forces associated with mastication. Forces
generated by upper teeth are passed through the maxilla. Light bone comprised of large air (maxillay
sinus). 3 specific reinforced craniofacial butturesses
- Frontal
- Zygomatic
- Pterygoid

Air sinuses = mucous-lined, air-filled cavities within the bones of the skull. Connected to the lateral walls of
the nasal cavity. Frontal sinus pattern is unique. Pituitary gland is right next to the sphenoid sinus

To have a basic understanding of the role of fontanelles in the growth of the neurocranium and to
know when the anterior fontanelle becomes closed in infancy.
Allows the head to pass through the birth canal during birth and the brain to grow during infancy. The
anterior fontanelle closes around the age of 2.

Neurocranium of the neonate is relatively well developed

Viscerocranium comparatively less mature (in adult 1/3 of skull size, in newborn 1/8)
Note the presence of fontanelles
Fibrous tissue separations between flat bones of the neurocranium
Allow growth of neurocranium

To be able to delineate on the skull the anterior, middle and posterior cranial fossae and to have a
basic understanding of how these relate to brain structures.
Anterior (frontal lobe), middle (temporal lobes), posterior (parietal and occipital lobe)

To understand the basics of dentition: the number, types and positions of adult teeth.
32 teeth in total, 8 incisors, 4 canines, 8 pre molars, 12 molars.
- Mesial = towards midline
- distal = away from midline
- Labial = towards lips
- Buccal = towards cheeks
- lingual = towards tongue

To understand the large muscle groups of the head (muscles of mastication, muscles of facial
expresssion and the tongue), and to understand the basic roles and innervation of these groups.
Mastication (CN V, trigeminal): 3 elevators (masseter, temporalis, medial pterygoid) 1 depressor (lateral
pterygoid)
Facial expression (CN VII, facial nerve): Frontalis, Orbicularis oculi, Nasalis, Orbicularis oris, Levator labii
superioris, Levator anguli oris, Zygomaticus major, Zygomaticus minor, Risorius, Depressor anguli oris,
Depressor labii inferioris, Mentalis
Tongue (CN XII, hypoglossal): intrinsic muscles - change shape, extrinsic muscles- change position
To have a basic understanding of the major arteries that supply the head and the major veins that
drain it.
Arteries: Basilar artery (vertebral artery), common carotid artery, internal and external carotid artery, middle
meningual artery, scalp (supratrochlear artery, supraorbital artery, superficial temporal artery, posterior
auricular artery, occiptal artery)
Veins: Basilar veins, internal/ external/ anterior jugular veins, retromandibular veins

To understand the basic structure of the scalp.

The scalp is highly vascularised and connected. Blood supply from the arteries in the neck and intracranial
arteries. Extensive anastomoses (=connection) between vessels - deep lacerations can be dangerous
Bones of the neurocranium are primarily supplied by the middle meningeal artery
Arises from a branch of the external carotid
Enters skull through Foramen Spinosum. - Forms grooves on the internal surface of the neurocranium, -
Look for these in the practical
5 layers = SCALP
S: Skin
C: connective Tissue
A: aponeurosis = connective tissue that joints between fibres
L: loose connective tissue
P: pericranium - periosteum

To be familiar with the major role of each of the 12 cranial nerves and to have a basic understanding
of the course of the nerve.
CN1 – olfactory = nose
CN2 – optic = eye
CN3 – oculomotor = all eye muscles except those supplied by IV and VI
CN4 – trochlear = superior oblique muscle
CN5 – trigeminal = face, sinuses, teeth etc (sensory), muscles of mastication (motor)
CN6 – abducent = external rectus muscle
CN7 – facial = muscles of the face
CN8 – vestibulocochlear = inner ear
CN9 – glossopharyngeal = pharyngeal musculature (motor), posterior part of tongue, tonsil, pharynx
(sensory)
CN10 – vagus = heart, lungs, bronchi, trachea, larynx, pharynx, gastrointestinal tract, external ear (sensory),
heart, lungs, bronchi, gastrointestinal tract (motor)
CN11 – (spinal) accessory = sternocleidomastoid and trapezius muscles
CN12 – hypoglossal = muscles of the tongue

To understand the basic location of the auditory apparatus within the skull.
External ear (pinna, auricle), middle ear, inner ear (3 ossicles: malleus, incus, stapes)

Eye: 6 extrinsic muscles. Exquisite control of directionality. 3 Cranial Nerves (III, IV, VI)

Upper and Lower limbs

To understand and be able to recognize the bones of the upper and lower limbs.
Upper limb: Pectoral girdle (Clavicle, scapula), humerus, radius, ulna, carpals (scaphoid, lunate, triquetral,
pisiform, trapezium, trapezoid, capitate, hamate) metacarpals, proximal/intermediate/distal phalanges
Arm = brachium (humerus)
Forearm = antibrachium (radius&ulna)
Pentadectyl limb = 2 bones in forearm/leg component, 1 bone in leg/arm component

Lower limb: Pelvis, femur, patella, tibia, fibula, tarsals, metatarsals, phalanges
patella = largest sesamoid bone, develops within the tendon of the quadriceps
Only the tibia articulates with the femur.
Cannot pronate and supinate the tibia around the fibula. Set joint.

Adult foot:
Functions: to support the weight of the body whilst standing. to act as a mechanism of
propulsion in locomotion.
Foot must be able to dissipate forces and act as a strong lever, whilst maintaining pliability.
Achieved by:
- Segmentation of the foot structure
- Presence of arches (support and elasticity). Unique to man and visible early in
development (2yrs).
Medial arch = Calcaneus, talus, navicular, medial cuneiform, medial three metatarsals
Lateral arch = calcaneus, cuboid, lateral two metatarsals
Transverse arch = cuboid, cuneiforms
- Presence of tie and beam connections via ligaments and muscles
3 Segments:
Forefoot = metatarsals and phalanges
Midfoot = cuneiforms and cuboid
Hindfoot =talus, calcaneus, navicular

To have a basic understanding of the joints of the upper and lower limbs, including the range of
movement which each joint allows.
Upper limb
- Glenoidhumeral joint: synovial joint (Abduction, Adduction, Flexion, Extension, 360 degree rotation
(circumduction))
- Elbow joint: synovial hinge joint (flexion, extension, pronation, supination)
- Wrist joint: synovial joint (flexion, extension, abduction, adduction), Ulna does not take part in the joint,
radius does
- Metcarpal/interphalangial joint: synovial joint (flexion, extension)
Carpals: Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
“Sally Lowers Tim’s Pants Then Things Can Happen”

Lower limbs:
Hip joint: synovial ball and socket joint. Designed for weight bearing and stability (Flexion/ extension,
Abduction/adduction, medial/lateral rotation)
Knee joint: synovial hinge joint. Very complicated. Kept stable by extensive ligamentous attachments
(flexion/extension with limited rotation)
Ankle: synovial hinge joint. Joint between distal tibia and talus. Some movement allowed but ensures
stability. (dorsiflexion, plantar flexion, eversion, inversion)
To understand the principal muscle groups of the upper and lower limbs.
Upper limbs: rotator cuff (subscapularis, supra/infraspinatus, teres minor), deltoid, latissimus dorsi,
pectoralis major, teres major, anterior muscle group (flexors: biceps brachii), posterior muscle group
(extensors: triceps brachii)
(http://www.wou.edu/~lemastm/Teaching/BI334/Appendicular%20Body%20-%20Muscles%20(Upper
%20Limb).pdf )

Lower limbs: those that move the thigh, those that move the lower leg, and those that move the ankle, foot,
and toes.
(http://www.wou.edu/~lemastm/Teaching/BI334/Appendicular%20Body%20-%20Muscles%20(Lower
%20Limb).pdf)

To have a basic understanding of the major arteries that supply the upper and lower limbs and the
major veins that drain them.
Upper limbs: - Subclavian – axillary – brachial – radial/ulnar – deep/superficial palmar arches - Deep/
superficial palmar venous arch – radial/ulnar – brachial – basillic – axillary – subclavian veins

Lower limbs: - Internal/external iliac artery – deep artery of the thigh - femoral – popliteal –
posterior/anterior tibial – dorsal artery - dorsal venous arch – posterior/anterior tibial – popliteal – femoral –
deep veins of the thigh – internal/external iliac veins – great/small saphenous vein

To understand the basic structure of the nerve plexuses which innervate the upper and lower limb.
Upper limb: brachial plexus (anterior rami C5-T1, terminal branches: musculocutaneous/axillary/ radial/
ulna/median nerve)
Lower limb: lumbosacral plexus (femoral nerve L2 – Sciatic nerve S3)
Vertebral Column
The vertebral column = 33 bones, 5 regions which extend from the skull to the pelvis.
Function: pathway for transfer of weight. Protection of spinal cord. Support head and trunk. Movement of
joints. Attachment site of soft tissues. haematopoeisis = making of blood cells (bone marrow). Calcium store.

Distinguish between the axial and appendicular divisions of the skeleton and identify the components
of the axial skeleton
Axial skeleton: Skull + vertebral column + pelvis
Appendicular skeleton: lower + upper limbs

Describe the basic components of a vertebra

Vertebral body – notch – arch, vertebral canal, transverse/spinous process, articular facets, pedicle = ‘small
foot’, lamina = thin plate runs from pedicle to spinous process.
- Cervical vertebrae: vertebral body, transverse foramen, vertebral foramen, spinous process, articular facets
- Thoracic vertebrae: vertebral body, transverse process, spinous process, articular facets, demifacets
- Lumbar vertebrae: large vertebral body, transverse process, spinous process
- Sacrum: Sarcal ala, sacral foramina, articular facet

Cervical Thoracic

Lumbar Sacral

List the 5 regions of the vertebral column

Cervical (C1-C7) – thoracic (T1-T12) – lumbar (L1-L2) – sacral (S1-S5, fused) – coccygeal (4 fused)
C1-C1 joint = Atlanto-occipital joint (yes joint, flexion/extension of the neck). Atlanto-Axial joint (no joint,
lateral rotation around the dens.
Vertebral disc: between each vertebrae.
Anulus fibrosus = Outer fibrous ring
Nucleus pulposus = fibrogelatinous centre. Slipped disc; nucleus pulposus impinge on the spinal cord

Describe soft tissue structures associated with the vertebral column and relate this to bone
morphology
Spinal cord: Runs from foramen magnum (skull) through vertebral canal, persists until +- L1, 8 cervical
nerves, 12 Thoracic, 5 Sarcal, 1 coccygeal.
- 3 layers cover the spinal cord: Pia, arachnoid, dura
Muscles:
- Superficial muscles: Connects to AP skeleton, movement of upper limb (e.g. trapezius).
- Intermediate muscles: Extrinsic layer. Attach indirectly from vertebrae to ribs, respiratory function (elevate/
depress ribs) - serratus posterior superior/ inferior
- Deep muscles: Intrinsic muscles. Keep the spine erect, extension/ flexion of the vertebral column.
3 columns
- Iliocostalis Ce/T/L
- Logissiums Ce/Ca/T
- Spinalis Ce/Ca/T

Ligaments: Stabilise joints and discs during movement (Anterior/posterior longitudinal ligament support the
length of the column). Below/between transverse/spinous process: ligamentum flavum, interspinous
ligament, supraspinous ligament (expansion C7-skull). Ligamentum nuchae attaches the Posterior of the
skull and spinous process

- Cardiovascular system: Anterior/posterior/segmental(feeder vessels) spinal arteries, various veins running

along and through the Vertebral column

Name and briefly describe common vertebral curvatures and pathologies

Vertebral curvatures: Kyphosis: affecting the thoracic vertebraes (hunchback), Lordosis: affects
the lumbar vertebraes (pregnancy), scoliosis: lateral deviation

The Girdles
Distinguish between the axial and appendicular divisions of the skeleton and identify the components
in each part.
Axial skeleton: Skull (hyoid, ossicles), vertebrae, sternum, ribs
Appendicular skeleton: Pectoral girdle, pelvic girdle, upper limbs, lower limbs. Derives from a completely
different part than the axial structure in the embryo.

Describe the components of the pectoral and pelvic girdles.

Pectoral girdle: Clavicle and scapula. Weak and unstable connection - able to move shoulder. Joint is
bilateral
- Glenohumeral joint: Synovial joint
- Acromioclavicular joint: Not a lot of movement. Function = shock absorber
- Sternoclavicular joint = Manubrioclavicular joint
Pelvic girdle: pelvis (2 innominate bones, joining anteriorly at the pubic symphysis) and sacrum
- Pelvis: Ilium (superior), Ischium (posterior), Pubis (anterior). Fuse to form whole bone: 16-18 yrs

List the basic functions of the girdles and relate this to functional morphology
Function:
- Connecting the upper and lower limbs to the axial skeleton.
- Allowing movement of the arm and leg (glenohumeral joint & iliofemoral joint)
- Bearing weight - pelvic floor
There is no joint between the scapula and the axial skeleton: just muscles.
Clavicle has medial and lateral articulations to connect the axial skeleton


Relate soft tissue anatomy to bony morphology/Name major muscle groups, nerve plexuses and other
soft tissue anatomy associated with the girdles
Pectoral girdle:
- Lots of muscle attachment to the scapula (rotator cuff: subscapularis, supraspinatus, infraspinatus, teres
minor. Teres major. Trapezius. Deltoid. Rhomboid minor/major(retracts the scapula). Levator
scapulae. Pectoralis minor/major. Latissimus dorsi.
- Brachial plexus of nerves supplying the brachium (arm). Posterior of the clavicle. C5-T1 level. When
people cut their wrist they often cut the median nerve - lose function of the thumb
- Blood vessels (e.g. subclavian artery, axillary artery)
- Lympathics
Pelvic girdle:
- Muscles (Iliacus. Psoas major. Rectus femoris. Adductor magnus/brevis/longus. Gluteus maximus/medius/
minimus. Sartorius. Obturator internus/externus. Gemelli. Piriformis). Many bony landmarks.
Earliest ossification of pelvis as a result of musculature
- Sacral plexus: intertwinning of nerves which provides innervation to the pelvis and lower limbs (L4-Co1)
- Blood vessels (inernal/external iliac artery/vein)
- ligaments = fibrous bands or sheets of connective tissue linking 2 or more bones. Confer strenght. Provide
anatomical boundaries
- lymphatics

List the basic sex differences observed in the pelvis

- Narrowness of the greater sciatic notch
- Pubic angle
- Obturator foramen
- Overal outline
- Iliac fossa
- Pelvic inlet

Pectoral girdle Pelvic girdle

Epithelia Histology

Epithelium = covers surface; where the outside meets the inside

Surface epithelia = cover or line surfaces, cavities and tubes. Very common. Sheet like in their arrangement;
if you bundle them together you can produce a solid organ (e.g. the liver, pancreas, anterior pituitary
gland, salivary gland)

To understand the characteristics which define epithelia and the common features of epithelia.
Epithelia = Closely aggregated, polyhedral cells. Minimal intercellular space. Strong adhesion.
Common features:
- Polarized
- Basal lamina: Basal surface of extracellular matrix components
- Non-vascular
- Bind together in sheets
Epithelial cells stand on a basal lamina (on top of a thin sheet of connective tissue) prevent from blood
vessels to go through. Exception; Cochlea (ear)

To develop an understanding of where epithelia are found in the body.

Protective outer layer. Everywhere where the outer part of the body meets the inner part of the body (e.g.
conducting part of the respiratory system, skin)

Define the embryological origins of epithelia.

Epithelial tissues are derived from all of the embryological germ layers: from ectoderm (e.g., the epidermis);
from endoderm (e.g., the lining of the gastrointestinal tract); from mesoderm (e.g., the inner linings of body
cavities).

To acquire an understanding of the specialized functions of epithelia.

Mechanical barrier (skin), chemical barrier (lining of stomach), absorption (lining of intestine), secretion
(salivary gland), containment (lining of bladder), locomotion (oviduct), sensation (tastebuds), contractiliy
(myoepithelial cells).
To understand the role of the cytoskeleton in maintaining cell and tissue integrity, and to be familiar
with the 3 main cytoskeletal elements.
Cytoskeleton function: maintains structure
- Microfilaments (strands of the protein actin, dynamic, function: anchorage, movement, extension
cell membrane)
- Intermediate filaments (function: bind intracellular elements together and to the plasmalemma, 50>
types)
- Microtubules (hollow tube with α&β tubulin subunits, dynamic, function: movement of
components in the cell)

To understand the basic morphology of intercellular junctions and understand their roles in
maintaining cell-to-cell attachments, cell-to-extracellular matrix attachments, and intercellular
communication.
Intercellular junctions
- Occluding junctions (link cells to form diffusion barrier, appear as a focal region) = tight junctions/ zonula
occludens
- Anchoring/ adherent junctions (mechanical strength, link submembrane α actinin bundles of adjacent cells)
= zonula adherens
Desmosomes: link submembrane intermediate filaments of adjacent cells, common in the skin for
mechanical stability
- Communicating junctions (allow movement of molecules between cells, allow selective diffusion, each
junction is a circular patch with hundred of pores, found in mostly epithelia) = gap junctions

To understand, and be able to utilize, the system for classifying covering epithelia base on cell shape,
numbers of cell layers, cell and tissue surface specializations, and the presence of specialized cells.
Classifying
- Cell shape (squamous, cuboidal, columnar)
- Number of layer of cells (simple, stratified, pseudostratified)
- Cell/tissue surface (prominent microvilli = brush border, cilia, keratinized)
- Presence of any specialized cell types (goblet cells)
Squamous cuboidal columnar

Simple Stratified pseudostratified

microvilli cilia keratinized

Connective Tissue Histology

To understand the characteristics that define connective tissue and the common features of connective
tissue.
Unlike other major tissues (e.g. epithelia) that are made up mainly of cells, with relativity little extracellular
space, connective tissue consists of cells imbedded in large quantities of extracellular matrix. This matrix
is composed of protein, fibres, amorphous ground substance and tissue fluid

Consists of cells and mostly extracellular matrix

Soft connective tissue: tendons, ligaments, mesentery, stroma of organs, dermis of the skin
Hard connective tissue: bone and cartilage

To understand the major functions of connective tissue.

Functions: space filler, mechanical support, attachment, protection, highway for nutrients and innervation,
main fat/ calcium store, site of many immunological defence reactions.

To define the cell types found in connective tissue.

Resident cells/ soft connective tissue:
- Fibroblasts (elongated cells, with tapered ends, wildly distributed, important for wound repair, SCT)

- Adipose cells (fat cells, single giant fat droplet, provide energy for other cells by the release of fatty acids,
adipocytes scattered in SCT),

- Osteocytes (bone)
- Chondrocytes (cartilage)
Transient cells found in connective tissue
- Marcophages
- Mast cells
- Plasma cells
- Neutrophils
To understand the components of the extracellular matrix in connective tissue, including the various
fibres present and the components of ground substance.
Extracellular matrix:
- Fibres (collagen, reticular, elastic fibres)
Collagen: most abundant protein in the human body (25%), mostly synthesised by fibroblasts. Many
forms, but most common, Type I is inelastic and has a tensile strength similar to mild steel, giving a
tissue that is both flexible and strong
Reticular fibres: this fibres made of a collagen Type III. it forms a support network in many organs
Elastic fibres: Provides elasticity to tissue. Made up of the proteins elastin & the microfibril fibrillin
and forms random coils

Type I Collagen fibres Reticular fibres stained black (liver) Elastic fibres stained black (aorta)

- Ground substance (amorphous, space occupying material made of glycosaminoglycans – bound to protein
cores)
- Tissue fluid

To define the different types of connective tissue including: adipose tissue, loose connective tissue,
dense regular connective tissue and dense irregular connective tissue, and to be able to recognise these
in a micrograph.
Soft connective tissue: (Tendons, ligaments, mesentery, stroma of organs, dermis of the skin)
- Loose SCT: Most common. Loosely packed fibres separated by abundant ground substance. Quite a lot of
cells. (e.g. mesentery, adipose tissue)
- Dense SCT: densely packed bundles of collage fibres.
- dense regular CT; fibres are aligned (e.g. tendon)
- dense irregular CT; fibre bundles run in many directions (e.g. dermis of the skin)

Elastic fibres (purple lines) Dense regular CT

Bundles of collagen fibres (light pink) Bundles of collagen fibres (light pink)
fibroblast nuclei (dark spots) fibroblast nuclei (dark spots) Dense irregular CT

To understand the characteristics that define cartilage and bone.

Cartilage: deformable, permeable, growth, cell nourished by diffusion
Bone: rigid, not permeable, growth (appositional only), cells nourished by blood vessels

To understand the major components of cartilage and understand the different types of cartilage.
Cartilage: semi-rigid connective tissue. Scattered cells (chondrocytes within their lacunae) surrounded by
amorphous appearing extracellular matrix. 75% water, 25% organic material (60 % type II collagen - forms a
3-meshwork, 40% Proteoglycan made up of GAGs(keratan sulfate&chonroitin sulfate)),
 - Hyaline Cartilage: most common, blue/white and translucent in life (e.g. articular surfaces, tracheal
rings, costal cartilage, epiphyseal growth plates, precursor in fetus to many bones)
- Elastic Cartilage: similar to hyaline cartilage, but the extracellular matrix has elastic fibres, flexable,
more cellular than hyaline cartilage (e.g. pinna of the ear, epiglottis, auditory tube)
- Fibrocartilage: mixture dense regular connective tissue and islands of cartilage cells and matrix (e.g.
intervertebral disc, where tendon inserts to bone, pubic symphysis)

Hyaline cartilage Elastic cartilage Fibrocartilage

To know what the perichondrium is and what it is made up of.

Perichondrium surrounds the cartilage.
2 layers: outer fibrous layer of dense connective tissue + associated fibroblasts & inner chondrogenic layer
which provides new chondroblasts to afjecent cartilage.
Contains blood vessels to supply nutrients to cartilage

To understand the major components of bone.

Functions: support, levers for movement, protection, calcium store, haemopoiesis
Bone undergoes remodelling throughout life
An outer shell of dense cortical bones makes up the shaft (diaphysis)
65% mineral (calcium hydroxyapaptite crystals) 23% Type I collagen, 2% non-
collagen proteins, 10% water
Cortical bone (in the diaphysis)
- Compact/cancellous bone: fine meshwork of bone (epiphysis)
- Trabecular bone (epiphysis)

To understand the microscopic architecture of bone, including the osteon, and how nutrients are
delivered to the osteocytes within bone.
Cells:
- Osteoblasts: bone forming cells, on the surface of developing bone. Secrete osteid (=collagen, GAGs,
proteoglycans, other organic compounds) has an affinity for Ca.
- Osteocytes: cell trapped in the bone matrix, ellipsoid with their long axis
- Osteoclasts: large multinucleated cells, on the surface of the bone, bone reapsorption,
Derived from macrophages. Several will fuse to form a giant cell.
Howship’s lacuna: area excavated under the osteoclast
osteocytes receive nutrients from the canaliculus's attached to the central canal, that brings in
through the small microtubular tunnel and goes to osteocytes via gap junctions
- Osteoprogenitor cells: on surface, under the periosteum, serve as a pool of reserve osteoblasts
Transverse section through cortical bone
Osteoblasts producing new bone osteoclasts osteocytes Inactive/active periosteum

To know what the periosteum and endosteum are, what they are made up of and where they are found.
Periosteum: a dense layer of vascular connective tissue enveloping the bones except at the surfaces of the
joints.
Endosteum: is a thin vascular membrane of connective tissue, found on internal bone surface, covers
trabeculae bone, in marrow cavities

Histology of Muscle
To understand the terms muscle, muscle tissue and muscle cells.
All cells contain some contractile fibres in their cytoskeleton, but in muscle cells the cytoplasm is packed
with such fibres and the cells are highly specialised for the production of contractile force. Force is
produced by the movement of actin fibres over myosin fibres, with the aid of a number of proteins
- muscle: large and complex organs, they contain blood vessels, nerves, lymphatics, connective tissue and
specialised sense organs.
- muscle tissue: formed from muscle cells and associated connective tissue and forms the bulk of muscles
- muscle cells: makes up muscle tissue and executes muscle contractions. Within the mesenchyme, cells
will align and eventually lose their separating cell membranes (sarcolemma’s)
- Muscle fibres: develop from myotubes. Has stripes, because the myofibrils are striped
To understand the structure of the three types of muscle and to be able to compare and contrast the
morphological characteristics and functional differences of each type.

- Skeletal muscle: (voluntary, striated, unbranched, multinucleate-forms a syncytium). Nuclei at the end of
the fibre under the sarcolemma (cell membrane), 40% body weight. Not all attached to skeleton.
No gap junctions in skeletal muscle as you don't want to over-contract those muscles

Longitudinal section though a skeletal muscle Transverse section. C=epimysium. P=fibre Section through muscle (fig 1+2)

Triad = T-tubules + Terminal Cisternae of the sarcoplasmic reticulum + Sarcoplasmic reticulum

T-tubulus = Transverse tunnels that go through the cells, extend from the sarcolemma into the cell.
Ramifying (branching out) and surrounding each myofibril roughly at the A-I junction of each
sarcomere.
Sarcoplasmic reticulum = Labyrinth of specialised smooth ER in the muscle cell. high calcium levels, lies on
either side of the T-tubules
Stimulus-contraction coupling = action potential arrives at neuromuscular junction -> acetylcholine is
released -> action potential in the muscle cell -> travels rapidly along the sarcolemma & invades the T-
tubules -> Triads release Calcium from SR -> causes myosin fibrils to ‘ratchet’ across the actin fibrils,
shortening the sarcomere = contraction
Myotendinous junction = The collagen attached to the ends of the muscle fibres. Join muscle fibres to
tendons. The muscle fibre is tightly anchored to the collagen by complex interdigitations. Tendons have
poor blood supply
Muscle spindles = special sense organs to provide information on the amount of stretch and tension in the
muscle. They contain special muscle fibres = intrafusal fibres. Normal contractile muscle fibres =
extrafusal fibres.

- Cardiac muscle: (less prominent striations, shorter than skeletal muscle, single nucleus near the centre,
intercalated discs = end-to-end attachment between adjacent cells, highly specialised with intracellular
juntions)
Cardiac myocytes (= cardiac muscle cells): have an intrinsic rhythmic contraction. Gap junctions in the
intercalated discs allow for synchronization of contraction & allow waves of electrical excitation to
sweep through the tissue.
This rhythm is independent of the autonomic nervous, but is modulated by it.

Longitundinal/ transverse Longitudinal D = intercalated discs, C = capillaries Transverse

Black spots are huge numbers of mitochondria as these cells needs a lot of energy to contract every time

EM of intercalated disc
D = desmosome
N = gap junction
M = mitochondrion
G = glycogen
FA = adherent junction = intercalated disc

- Smooth muscle: (involuntary, visceral (found in organs), no striations, cigar-shaped nucleus near the
centre)
Smooth muscle cells contain many actin and myosin filaments that allow contraction, but are not as well
organised as in skeletal/cardiac muscle. They do converge on focal densities at the periphery of the cell
longitudinal section transverse section

Myoepithelial cells = contractile myoepithelium, thin layer found in the glandular epithelium.
Myofibroblasts = a cell that is in between the state of a fibroblast and a smooth muscle cell
Pericytes = Perivascular cells. contractile cells that wrap around the endothelial cells of capillaries and
venues throughout the body.

To relate the structure to the contractile function of muscle.

Unit of contraction: sarcomeres -> myofibril -> (sarcolemma) -> musclefibre -> (endomysium) -> fasicle ->
(perimysium) -> muscle -> (epimysium)
Sharks End Penguins Existence = Sarcolemma - Endomysium - Perimysium - Epimysium

Muscle fibres are grouped into bundles called fascicles and a muscle contains several fascicles.
Epimysium = The connective that surrounds the muscle as a whole is called.
Perimysium= The connective tissue around a single fascicle.
Endomysium = The connective tissue around a single muscle fibre

Dark: myofilaments, A = band Light: I band M=myofibrils Mt=mitochondria N=nucleus

Sarcomere = Unit’s of contraction of the muscle cell.

The smallest contractile elements in the striated muscle cell.
hundreds/ thousands from a myofibril
extends from on Z-line to the next Z-line (light grey areas).
Contain of actin- and myofilaments.

Myofilaments = the sarcomeres in one and the adjacent are held together in one position
Cardiac myocytes have an intrinsic rhythmic contraction, gap junctions in intercalated discs allow electrical
waves through the tissue

Organisation of a Skeletal Muscle Fibre: Sarcomeres

By definition, the sarcomere extends
from one Z-line to the next Z-line.

To understand the structure and function of the motor unit.

The motor unit = the motor neuron + all muscle fibres that it innervates
The fewer the muscle fibres the finer the control of movement. The motor fibres are scattered in the muscle
- Most control over the extra-ocular muscles in the eye

Motor end plate = where motor neuron ends in a synapse -> neuromuscular junction: release of acetylcholine
(& initiate action potential in the sarcolemma).

To have a basic understanding of the development and regenerative capacity of muscle.

If you damage skeletal muscle you find satellite cells on the edge which gives access to stem cells to produce
new cells
Satellite cells = myoblasts: Small, quiescent cells which are pressed against the outer surface of the
sarcolemma. Structures are not very strong in humans, therefore you still get scar tissue. Few stem cells
in cardiac muscle = no muscle regeneration
To be able to identify the different muscle types and to have knowledge of where each type is found in
the body.
Skeletal muscles: most muscles that allow voluntary movement.
Smooth muscle: found in the walls of tubes: the gut, the respiratory tract, blood vessels, the uterus
Cardiac muscle: the heart
The digestive system 1 - foregut
Describe the basic layout and functions of the digestive system
Oral cavity, oesophagus, stomach, deodenum, gall bladder, (spleen), liver, pancreas: Breakdown of ingested
food and fluid + Absorption of required nutrients and water, waste removal system.

Identify and describe the digestive system in the head, neck and thorax
Oral cavity and pharynx: start of digestion.
Teeth break up food -> tongue helps to form bolus to swallow salivary glands release amylase (to break
down starch) -> pharynx funnels the bolus towards the oesaphagus -> passes through oesophagul opening (at
T10) -> small intra-abdominal section before joining the stomach.

Define what is meant by ‘foregut’

Every organ/tissue that is supplied by the coeliac axis: Left gastric artery, hepatic artery, splenic artery)

Identify and describe the organs of the foregut/ Link structure to function
Oral cavity/ pharynx/ oesphagus = travels chewed food towards the stomach while adding amylase by
salivary glands
Stomach = Fundus, body (greater/lesser curvature),
pylorus,
pyloric valve = churns food with digestive acid -> chyme.
Stomach can change shape.
Rugae = Folds on the inner surface, stretched out when stomach fills with food.
Surrounded by lesser/greater omentum. Greater omentum = “policeman of the abdomen” trying to
prevent the spread of infection/disruption through the abdominal cavity
Deodenum = C-shaped tube between pyloric valve and jejenum.
1st part: duodenal cap
2nd part: loop around pancreas, Duodenal papilla/Hepatopancreatic ampulla = Entrance of bile and
pancreatic duct,
3rd part: transverse crossed by superior mesenteric vessels
4th part: joining the jejenum. Junction between forgut-midgut.
Galbladder = Stores bile produced by the liver.
Releases bile via the cystic and bile ducts -> deodenum.
Too much/concentrated bile in gall bladder causes gall stones – get stuck in the ducts.
Spleen = Same size as kidneys, posterior and lateral to the stomach.
Protected by left ribs 9,10
Breaks down old RBC’s + forms immune T/B-cells.
Rupture results in heavy bleeding.
Liver = Anterior: right lobe, left lobe, gall bladder, falciform ligament.
Posterior: left lobe, caudate lobe, quadrate lobe, right lobe, IVC (part of systemic circulation), fall
bladder, Porta Hepatis (hepatic artery, portal vein, bile duct).
Multiple metabolic functions.
Pancreas = Head in loop of deodenum, tail extends to spleen.
Endocrine and exocrine organ (insulin&digestive enzymes).
Main pancreatic duct empties enzymes -> duodenal papilla.
Splenic artery/vein run along. posterior/superior surface.

The digestive system 2 - Midgut and Hindgut

Identify and describe the digestive system in the abdomen and pelvis
The digestive organs of the lower torso include lower gastrointestinal (GI) tract, which consists of the small
intestine, large intestine, and anus. Several accessory organs, such as the liver and pancreas, assist the lower
GI tract with the digestion of food to release many essential nutrients.

Describe peritoneal structures

Peritoneum = lining of the abdominal cavity. Holds organs to abdominal wall. Intraperitoneal (e.g. jejenum)
may be on a mesentery (double layer of peritoneum)/ Retroperitoneal (e.g. ascending colon) = stuck to the
posterior abdominal wall  
mesentery = Blood vessels, lymphatics and autonomic nerves that supply the small intestine. Allows the
small intestine to move within the abdominal cavity during peristalsis.

Define what is meant by ‘midgut’

Distal deodenum -> 2/3rd of the transverse colon. Contains small and large intestine. Supplied by the superior
mesenteric artery (aorta L1). Blood drains into the hepatic portal vein (superior mesenteric vein+splenic
vein)

Identify and describe the organs of the midgut

Jejenum -> (distal duodenum) -> ileum = peyer’s patches fight infections, attached to mesentery -> (ilio-
caecal junction) -> caecum (1st part of large intestine) -> // Appendix (retrosaecal) // -> ascending colon:
right side of the abdominal cavity, ends at the hepatic flexure, contains Haustra (sacs), Teniae coli
(longitudinal muscle bad. Absorption of nutrients), Appendices epiplocae (fatty bits next to teniae coli) ->
transverse colon: hepatic flexure – splenic flexure, junction midgut/ hindgut

Define what is meant by ‘hindgut’

The final part of the digestive tract: splenic flexure -> anal canal.
Distal transverse colon, descending colon, sigmoid colon, rectum, anal canal.
Function mostly water absorption.
Blood supply from inferior mesenteric artery (aorta L3). Blood drains into portal vein unit mid-rectum, distal
rectum drains into IVC.

Identify and describe the organs of the hindgut

Descending colon (splenic flexure-sigmoid colon), features of ascending colon, left side of the abdominal
cavity -> sigmoid colon: passes over the pelvic brim -> rectum: junction between portal vein and IVC
drainage -> anal canal: in the pelvis, pierces the pelvic floor. Smooth and skeletal muscle – voluntary control
of defecation.
Caput medsae = portal/systemic anastomoses: pressure change in vessels in portal system.

The urogenital system

Define the structures that compose the urinary system
Kidneys, Ureters, Bladder, Urethra.
Functions: filter the blood, Conserve/release water and ions, create and store urine, release urine as a waste
product.

Describe and identify the structures of the urinary system

Kidneys: Filter blood to create urine.
Smooth outer appearance because of capsule.
Supra-renal gland at apex (inferior of kidney, under rib 11/12).
Hilus = entrance to kidney (renal vessels and ureter)
Internal: Capsule, cortex (medulla and bowman’s capsule), renal pelvis (->minor/major calyx, fat
packing around renal pelvis), ureter.
Suprarenal glands: Endocrine function (e.g. adrenaline, nor-adrenaline)
At the top of each kidney
Right suprarenal = pyramidal shape, Left suprarenal = crescent moon shape.
Surrounded by fat.
Turn orange by Thiel-method
Ureters: Smooth muscle tube (1-2mm) passing from renal pelvis -> urinary bladder
Urinary bladder: Store of urine, drained by urethra
 Behind pubic bones, posterior to peritoneum.
Muscular bag that can expand.
Trigone = where urine enters/exits (2 ureters, 1 urethra)
Urethra: muscular tube that passes from pelvic cavity -> into perineum.
Females; short straight tube, urinary and genital tracts are separate. Males; longer tube, union of
urinary and genital tracts
Urinary stones (calculi): solid or crystal form (uric acid). Block urinary system in kidney/ureter/bladder

Define the structures of the male reproductive system

Testes, vas deferens, seminal vesicles, prostate gland, penis

Describe and identify the structures of the male reproductive system

Testes: Develop in abdominal cavity - too warm for spermatogenesis -> descend through inguinal canal
(=The inguinal canal is a tubular structure that runs inferomedially and contains the spermatic cord in
males and the round ligament in females) and into scrotum.
Vas deferens: (ductus deferens) is a small muscular tube. Carries sperm (adds fluid to) from testis -> (joins
duct with seminal vesicle-contains fructose) = ejaculatory duct in the prostate gland.
Prostate gland: releases fluid to support the sperm. Ejaculatory duct joins with the prostatic urethra.
Urethra: unites reproductive and urinary systems
Penis: carries sperm into female genital tract. Erectile tissue (corpus spongiosum) = spongy structure fills
with blood. Penile/spongy urethra.

Define the structures of the female reproductive system

Ovaries, uterine (fallopian) tubes, uterus, vagina

Describe and identify the structures of the female reproductive system

Ovaries & uterine tubes: Ovaries release one ovum each menstrual cycle (alternating L/R). Ovum passes into
the fallopian tube -> uterus. Fertilisation occurs in fallopian tube. Implantation occurs in uterus.
Ectopic pregnancy = pregnancy outside the uterus (e.g. fallopian tube or peritoneal cavity).
Uterus: Epimetrium/myometrium/endometrium (lining for implantation or shed during menstrual cycle).
Covered in peritoneum- the broad ligament. Support ligaments attached to cervix NOT broad ligament.
Vagina: Muscular tube. Ability to stretch. Passes through the pelvic floor (=urogenital diaphragm) ->
perineum. Opening surrounded by erectile tissue.

Respiratory System
Understand the importance of respiratory system in allowing gaseous exchange to occur
The respiration system is important for the inhalation (O2), gaseous exchange (O2-CO2) and expiration
(CO2). When breathing stops, death follows within 3-6min.

Know the names of the different parts of the respiratory tract and the functions of each part
Nasal cavity: Function = filters, warms & mostions air. Passage to pharynx
(superior/middle/inferior) Cochae: folds of tissue on the lateral wall of the nasal fossa. Mucous
membranes supported by thin, scroll-like turbinate bones.
Paranasal sinuses: Function = mucus production, resonance, lighten skull
Frontal sinus, ethmoid sinus, sphenoid sinus, maxillary sinus
Pharynx: Nasopharynx, Oropharynx, Laryngopharynx
Larynx: Epiglottic cartilage (posterior of the hyoid), thyroid cartilage (inferior of hyoid), arythenoid cartilage
(posterior of thyroid cartilage, inferior of epiglottic cartilage), cricoid cartilage (inferior of all)
Trachea: Has C-shaped cartilages anteriorly. From below to larynx (C6/7) -> Carina (T4/5) = where trachea
bifurcates to left and right bronchi.
Lungs: Principle organ of respiration.
Surface anatomy: rounded apex, costal(lateral)/ diaphragmatic(inferior)/ mediastinal(medial) surfaces. Right
lung - 3 lobes(superior/middle/inferior lobe). Left lung - 2 lobes(superior/inferior lobe). Oblique
fissure = Inferior-superior lobe, Horizontal fissure = superior - middle lobe
Hilum: Pulmonary veins (inferior/anterior), pulmonary arteries (superior/anterior), bronchus (superior/
posterior), pulmonary ligament = sleeve of pleura, allows expansion of pulmonary vessels(inferior of
the hilum)
Pleura: Parietal pleura (cervical, costal, diaphragmatic, mediastinal parts), Visceral pleura: covers the surface
of the lung. Parietal and visceral pleura join at the lung root/hilum
Bronchi, Bronchioles: Transport air. Trachea -> Main bronchi -> Lober Bronchi -> Segmental bronchi ->
bronchioles
Alveoli: Where gaseous exchange takes place. Alveolar walls have thin Respiratory epithelium for optimum
exchange. Surrounded by capillaries.

Be able to name the major cartilages of the larynx and know their relationship with the vocal folds and
vocal fold movements
Larynx: thyroid/ arythenoid/ cricoid cartilage
The free margins of the vocal folds are attached to: thyroid/ arythenoid cartilage
Posterior cricoarythenoid muscle = abducts vocal folds

Know the position of the trachea relative to the oesophagus

The trachea lies anteriorly to the oesophagus

Know the external features of the lungs and the arrangement of structures at the lung hilum
Surface anatomy: rounded apex, costal(lateral)/ diaphragmatic(inferior)/ mediastinal(medial) surfaces. Right
lung - 3 lobes(superior/middle/inferior lobe). Left lung - 2 lobes(superior/inferior lobe). Oblique
fissure = Inferior-superior lobe, Horizontal fissure = superior - middle lobe
Hilum: Pulmonary veins: oxygenated/arterial blood (inferior/anterior)
Pulmonary arteries: deoxygenated blood (superior/anterior)
Bronchus: air (superior/posterior)
Bronchial artery: oxygenated blood
Bronchial vein: deoxygenated blood
Lymph nodes
Pulmonary ligament (inferior of the hilum)
Right lung impressions: SVC, oesophagus, small cardiac impression
Left lung impressions: Arch of aorta, descending aorta, large cardiac impression

Know where in the lung gaseous exchange takes place

In the alveolar walls of the alveolar sacs by capillaries.

Be able to distinguish between left and right lungs

Left lung: 2 lobes, arch of aorta/ descending aorta, large cardiac impressions
Right lung: 3 lobes, SVC/ oesophagus/ small cardiac impressions

Know the movements of the thoracic wall that allow inspiration and expiration to take place
Anterior-posterior: sternum moves anterior and superior = inhalation/inspiration
lateral: lower ribcage moves laterally = inhalation/inspiration
vertical: diaphragm descends = exhalation/expiration

Know the muscles that produce these movements

External intercostal muscles: raises the ribs (2-12) = inhalation. Direction: medial-inferior
Internal intercostal muscles: lowers the ribs = exhalation
Innermost intercostal muscles: lowers the ribs = exhalation
Contraction flattens diaphragm = inhalation
Accessory muscles: Scalenes (neck muscles), pectoralis minor, sternocleidomastoid, erector spinae muscles
passive expiration: achieved by elasticity of the lungs and thoracic cage. After inspiration, phrenic nerves
stimulate diaphragm to produce a braking action
Forced expiration: internal intercostal muscles + contraction abdominal muscles -> forces diaphragm
upwards

Anatomy and Histology of the Nervous System

To understand the function of the nervous system
Senses the body’s internal/external environment through peripheral nerves, sends these impulses within the
nerve fibres -> central nervous system-> brain -> sends appropriate motor response. Can be voluntary or
involuntary.
Afferent; towards the CNS (sensory nerves)
Efferent; away from the CNS (motor nerves)

To understand the anatomy and roles of the central and peripheral nervous system.
Central nervous system (CNS) = brain + spinal cord (Cervical cord and enlargement, thoracic cord, lumbar
cord and enlargement, sacral and coccygeal cord); posterior root carries only sensory information,
motor function comes out the anterior root.
Peripheral nervous system (PNS) = Everything else + 12 pairs of cranial nerves + 31 paris of spinal nerves.
Nerve cell body, short dendrites, long axons with myelin sheath (produced by Schwann cell) and nodes
of Ranvier.
Nerve plexus = one spinal nerve contributing efferents/ afferent to several peripheral/ spinal nerves.
Sensory and motor information gets segregated when coming into the spinal cord.

To understand the anatomy and roles of the autonomic nervous system.

Somatic nervous system (‘the body (wall)’) = VOLUNTARY. Responds to the external environment.
Supplies almost everything other than the organs contained within the body cavities. Sensory nerves
from skin, bones & joints. Motor nerves to skeletal (striated) muscle (+ diaphragm)
Autonomic nervous system (‘self, law’) = INVOLUNTARY. Responds to internal environment (e.g. heart
rate, blood pressure, digestion, glandular secretions). Sensory nerves (organs). Motor nerves (e.g.
cardiac and smooth muscle, glands).
- sympathetic nervous system = “fight or flight” (e.g. increases heart rate, dilates arterioles, produces
sweat, makes hair stand up, dilates bronchioles, dilates pupils, reduces gut motility, liver releases
glucose.
Nerve fibres will leave the spinal cord only in certain regions (T1-L2 = thoraco-lumbar outflow) and
distribute by the sympathetic chain. Splanchnic nerves ignore the ganglia near the Sympathetic chain
and go directly to another ganglion.
- parasympathetic nervous system = “rest and digest” supplies the same organs (except the skin and
arterioles), opposes the sympathetic nervous system
Cranio-sacral outflow. Cranial nerves III (oculomotor), VII (facial), IX (glossopharyngeal) and X
(vagus)
Elements of the Somatic and Autonomic nervous system can be in both CNS and PNS.

To have and understanding of the meningeal coverings of the central nervous system.
White matter: Axon (myelinated) and support cells. Brain = inside, Spinal cord = outside
Damage would lose function of the entire region below point of injury
Grey matter: Huge numbers of neurons, cell processes, synapses and support cells. Brain = outside and
innermost side (deep in the cerebral hemispheres). Spinal cord = inside
Damage would lose function for one single region

Meninges: Coverings of the brain filled with spinal fluid to let the brain ‘float’
Brain has no connective tissue, therefore very fragile
3 layers: Pia mater; attached to the brain, shiny surface
Arachnoid mater; full of spinal fluid, underneath the mater are little wisps of connective
tissue - look like spiderwebs
Dura mater; very thick tough coating, attached to the bone of the skull

To have a basic understanding of the arterial supply to the brain and the venous drainage from the
brain + cerebrospinal fluid
Arterial supply
Posteriorly: Left/ right vertebral arteries (wrap around atlas into the magnus foramen) + basilar artery
supplies (e.g. cerebellum, posterior part of the brain)
Left/ Right common carotid arteries: internal carotid arteries (lateral view: one most towards the vertebraes)
+ middle cerebral arteries
Connected by the Willis Switch

Venous drainage
Blood is not drained by veins but by sinuses = dural venous sinuses (with tunnels of dura mater). reaches
from frontal bone/ midbrain -> occipital bone (confluence of the sinuses)
Brain has veins, but once deoxygenated bloods leaves the brain it goes into sinuses and then into the internal
jugular vein.
Cerebrospinal fluid
Secreted by the choroid plexus in the ventricular system of the brain (volume ~120ml, 400/500ml/day)
Circulates around the brain + spinal cord from the 4 ventricles to the subarachnoid space
Reabsorbed into the dural venous sinuses by arachnoid granulations
Cushions the brain like a waterbed, internally (ventricles full of CSF) and externally (subarachnoid space full
of CSF)
Lateral ventricles (1&2) = in the hemispheres
3rd ventricle = in the midbrain
4th ventricle = anterior of the cerebellum
subarachnoid spaces = underneath the dural venous sinuses (frontal - occipital, inferior of the cerebellum,
around the spinal cord). Ends at level S2
Cerebrospinal is tapped level of L2 (end of spinal cord)

To have an understanding of the basic histological structure of the brain, including the basic structure
and roles of neurons and glial cells.
Brain =
The control centre of the nervous system:
Somatic & autonomic nervous system + endocrine function (pituitary gland).
Connects inferiorly with the spinal cord.
Foraminae through which cranial nerves/ blood vessels enter/exit the skull
Cranial nerves:

I = Olfactory
II = Optic
III = Oculomotor: Big nerve, comes out of the midbrain
IV = Trochlear: fragile
V = Trigeminal: large nerve, for chewing food and feeling your face
Midbrain
VI = Abducens: move the eye
VII = Facial: main function moving the muscles of the face
Pons VIII = Vestibulocochlear
IX = Glossopharyngeal
X = Vagus: violates that CN only serves above the neck, goes through
thoracic and abdominal region
XI = Accessory: upper part of the brain stem, into the cranial cavity
and then comes back out. 2 muscles: Sternoclavicomastoid & deltoid
XII = hypoglossal: not for taste, but for movement of the tongue
I bulb, II and XI do not attach to the brain stem
“O, O, O, To Touch And Feel Very Good Velvet, Actually Heaven”
Motor fibres cross the midline, thus the right cortex controls muscles on the left side of the body and
vice versa.

Anatomical and functional subdivisions:

Cerebral hemisphere = half sphere of the brain,
gyrus = fold of the brain tissue
sulcus = groove on the surface of the brain, cerebellum = little brain (precise motor activity), brain
stem: midbrain, pons (circle that bulks out), medulla oblongata (anteriorly of the spinal cord).
Bones name the lobes (frontal, parietal, temporal, occipital)
Longitudinal fissure = deep sulcus between right and left cerebral hemispheres
Lateral fissure = deep sulcus between temporal lobe - frontal/parietal lobe
Central sulcus = sulcus between frontal - parietal lobe. First to develop during the embryonic cycle
Corpus callosum = region in the middle of the brain. Thalamus (grey matter inside the butterfly),
hypothalamus, internal capsule (white matter, putamen/globus pallidus (grey matter outside the
butterfly), hippocampus outside the corpus callosum

Structures and its function:

Cerebellum = coordinate movement
Thalamus = relay station fro sensory information coming from the peripheral nervous system and
going to the cortex
Brainstem = houses most of the cells associated with the cranial nerves
Precentral gyrus = initiates movement (frontal lobe, before the central sulcus)
Postcentral gyrus = processes sensory information (parietal lobe, after the central sulcus)

Primary motor cortex and the motor cortical homunculus.

somatopic organisation: the body is mapped onto the cortex, with each part of the cortex controlling a
particular part of the body (hand and face are a large part of the motor strip)

Histology of nervous tissue

Neurons = the ‘great communicators’ Receive information, chiefly via synapses, integrate the
information and then transmit electrical impulses to another neuron or effector cell.
Multipolar neuron: many short dendrites and one long axon.
Bipolar neuron: Cell body in the middle of the axon
Pseudo-unipolar neuron: cell body attached to axon.
Axon Hillock = decision point, poor area
Cortical neurons = grey matter in the cerebral cortex
Spinal white matter: white hole = axon, purple sheet around it = myelin, big white holes = blood
vessel
Proprioception = knowing where your bones are: fastest axon in the body
Spinal grey matter: neuropil = mat of neuronal and glial cell processes that occupy most of grey
matter
Ganglion: sensory neurons surrounded by satellite cells
Glial cells (‘glue’) = 10 times more numerous in the CNS than neurons. 4 major types.
Glial cell type Cell morphology Functions

Astrocyte Often star-shaped with Physical support,

(black star shaped) many cell processes. maintenance of the
Cell processes often end blood-brain barrier,
in feet that interact with ionic homeostasis,
blood vessels or nodes uptake of certain
of Ranvier neurotransmitters at
synapses
 Oligodendrocytes Small round cells with Production and
prominent nucleus maintenance of the
myelin sheath in the
CNS

Microglia Small cells with multiple Immune monitoring and

branching processes antigen presentation.
with thorn-like endings These cells become
phagocytes when
activated. They stay for
the rest of your life

Ependymal cells Ciliated cuboidal or Form a single-cell thick

columnar cells lining of the CSF filled
spaced in the CNS
(ventricles of the brain
and central canal of the
spinal cord). Movement
of the cilia may facilitate
flow of CSF
(small white holes)

Cerebellum;

Look for the 3 cell layers

- Granula cell layer (most inner layer)
- Molecular cell layer (most outer layer) original word for molecular = point, dots represents axon and
dendrites
- Purkinje cell layer (inbetween layer) single layer, triangular

The integumentary system

No learning outcomes, only notes.

The skin: largest organ of the body (15% body weight, 2 sq m)

Epidermis = outer epithelium; thin keratinised stratified squamous epithelium, 5 layers, no blood vessels
Dermis = connective tissue layer, processed for leather
Hypodermis = subcateneous layer (deep layer), rich blood supply, fat layer

Mechanism Function
Stratified epithelium Protection against mechanical abrasion
Keratin of epithelium Protection against water loss
Continuous epithelium
Pigment melanin
Collagen & elastin in dermis
Receptors for nervous system
Blood flow, fat, hair&sweat
Protection against micro organism that give you infection
Protection against UV
Protection against stretching, Old age skin is less stretchable
Conveying information
Temperature regulation

Cell types:
- Keratinocytes = 90% of epidermis - produce the protein keratin which is a touch fibrous protein
- Melanocytes = produce pigment melanin
- Langerhans Cells = arise in bone marrow and migrate to epidermis where they work to protect against
microbes
- Merkel Cells = least numerous - located in the deepest part of the epidermis where they contact the
sensory neurones and detect touch sensations
Layers:
The cells within the epidermis move from the deepest layer to the outermost layer throughout their life cycle
and gradually change in shape as the go flattening and undergoing apoptosis by the time they reach the outer
layer. Form up to 25-30 layers of flattened dead keratinocytes enclosed in keratin which gradually slow off.

-Stratum basale = deepest layer, single layer of

columnar keratinocytes with some stem cells
interspersed within them. New cells from in this
layer.
-Stratum spinosum = thicker layer of keratinocytes
which continue to move towards the surface
-Stratum granulosum = keratinocytes gradually
flatten and undergo apoptosis in this layer
-Stratum lucidum = layer present only in thick skin
of the palms, fingertips and soles
-Stratum corneum = final layer of flattened dead
keratinocytes

Skin coordinates loss of moisture and retention to

keep the blood supply away - coated with keratin

Cleavage lines = local characterisitics of creasing. Caused partly by orientation of collagen in dermis. Cuts
made across a cleavage line causes puckering that is slow to heal = more scar tissue

Epidermal ridges = a thick epidermis with ridges - give a larger surface area for more sense and better grip.
(e.g. palms, soles and fingertips).
Mirrors on the DERMIS, help to ensure epidermis and dermis are firmly attached. Decomposition can
cause these links to break down.
Degloving = loss of the epidermis as a whole. Can be used in forensic situations to capture fingerprints
Fingerprints are unique in every individual. Friction ridges form during embryonic development.

Pigmentation: skin colours

Haemoglobin = red pigment of red blood cells: visible through dermal collagen fibres
Carotene = yellow pigment of vegetables and egg yolks: concentrates in stratum corneum (dead skin cell
layer) and subcutaneous fat
Melanin pigment = produced by melanocytes. Pigment synthesis stimulates by UV radiation from sunlight.
Darker skin has higher levels of melanin than pale skin. 2 types of melanin
1. pheomelanin = yellow/red (asians/ redheads)
2. eumelanin = brown/black; very efficient
Pink colouration is from the structures that lay underneath the skin.
Skin colour change with age, conditions and medical conditions. Hair, skin and nails are in the same
(integumentary system) system. Therefore certain skin types come with certain hair styles.

Abnormal skin colours:

Cyanosis = blueness resulting from deficiency of oxygen in the circulating blood (e.g. cold weather)
Erythema = redness due to dilated cutaneous vessels (e.g. anger, sunburn, embarrassment)
Jaundice = yellowing of the skin and sclera (white outer layer of the eyeball) due to excess of bilirubin in
blood (e.g. liver disease)
Pallor = pale colour form lack of blood flow
Albinism = Complete lack of melanin pigment in skin, hair and eye. Eyes are red as they reflect the blood
supply - sometimes the iris is spared and has its colour. Are sometimes subjects of public curiosity
Haematoma = a bruise; visible clotted blood (blue/red-purple-green-yellow)
Hemangiomas = birthmarks: discoloured skin caused by benign tumours of dermal blood capillaries
(strawberry birthmarks disappear in childhood, port wine birthmarks last for life, ‘beauty spots’ raised
aggregation of melanocytes = mole)

Skin diseases
Most vulnerable organ to injury and disease
common in old age
Skin cancer: induced by UV rays of the sun. Most common in fair-skinned and elderly
- Basal cell carcinoma: arises from stratum basale & invades dermis. Treated by surgical removal &
radiation
- Squamous cell carcinoma: arises from keratinocytes in the stratum spinosum (layer above the stratum
basale). Metastasis to lymph nodes can be lethal
- Malignant melanoma (most deadly cancer): arises from melanocytes of a preexisting mole. ABCD-
asymmetry, border is irregular, colour mixed & diameter over 6mm
Acne vulgaris: common along adolescents and males. Affect the face, chest, upper back and shoulders.
Caused by increased hormonal activity with excessive skin secretions. Plugged follicles become
infected forming acids that irritate the skin.
Decubitus ulcers (bed sores): Produced in areas where the skin is close to the bone and going constant
pressure. Pressure caused the blood vessels to compress - depriving the tissue of oxygen and nutrition.
Warts: benign epithelia tumours caused by viruses. Most common in the area of the hands and genital region.
Transmitted by direct contact.

Burns
Causes: hot water, sunlight, radiation, electric shock, acid & bases etc.
Causes of death: fluid loss, infection and effects of dead tissue (eschar)
Degrees of burns.
1st degree: only the epidermis (red, painful and edema)
2nd degree: epidermis and part of dermis (blistered); epidermis regenerates from hair follicles & sweat
glands
3rd degree: epidermis, dermis and more is destroyed. Often requires grafts or fibrosis and
disfigurement may occur
4th degree: Extends through entire skin and underlying fat, muscle and bone. Painless. Prognosis =
amputation, significant functional impairment and in some cases death
Treatment = fluid replacement and infection control. Debridement and IV proteins, nutrients and fluids
Lund-Browder method = The seriousness of burns can be gauged by the extend/ depth of the damage to
certain parts of the body. The percentages include both anterior and posterior portions. Therefore,
burning to both upper limbs in an adult would constitute 19% burns. Minor = <10%, Serious = >15%.
Severe = >20%. 


Skin grafts & artificial skin: 3rd degree burns require skin grafts
Graft options:
- Autograft = tissue from different region of patient
- Isograft = skin graft tissue from identical twin
- Cultured keratinocyte patches
Temporary graft options (immune system)
- homograft (allograft) = graft from unrelated person
- heterograft (xenograft) = tissue from another species
- amnion from an afterbirth
 - artificial skin from silicone and collagen
- 3D printed

Identification purposes: tattoos, piercings, other body modifications, even vein patterns

The Endocrine System

A system of ductless glands that regulate bodily function via hormones secreted in the bloodstream
Location: widely scattered, no anatomical continuity, different modes of stimulation

A ‘control’ system that is mainly concerned with 3 functions:

- Maintenance of homeostasis = by regulating activities such as the concentration of chemicals in the
body fluids and the metabolism of proteins, lipids and carbohydrates
- Help the body react to stress properly
- Major regulator of growth and development
- controls the physical and behaviour activities (metabolism, reproduction, growth , sleep)

Stimulation occur in 3 ways:

- Hormonal = through hormones secreted in one area stimulating a gland which may stimulate another
gland
- Humoral = via the blood stream acting directly on the target gland
- Neural = via direct neural stimulation

Hormone = specialised chemical messenger. Produced and secreted by an endocrine tissue. When released
into the bloodstream -> travel to all parts of the body BUT are only effective at specific target cells.

Endocrine glands = Hormones secrete chemicals into extracellular spaces from which they enter the
bloodstream and circulate throughout the body to their target areas
- Central endocrine glands: Pineal gland, Pituitary gland
- Peripheral endocrine glands: Thyroid, parathyroid glands, thymus, (supra)adrenal, pancreas

Central endocrine glands

Pineal gland:
Situated in roof of 3rd ventricle.
Cells (pinealocytes) arranged in compact cords (bewteen cells are dense particles containing calcium
salts = brain sand).
Major secretory product = melatonin
Receives input from visual pathways concerning intensity and duration of daylight
Considered to be involved in regulating day/night cycles (biological clock/ circidian rhythms)
Melatonin can be used as a dietary supplement to aid sleep
SAD (seasonally affected disorder) = increased melatonin levels
Pituitary gland:
Sits in the hypophyseal fossa of the sella truck of the sphenoid bone
- Anterior pituitary: Glandular tissue. Manufactures and releases hormones via hypophyseal portal
system
- Hormones;
Growth hormone (GH) = Regulated by Growth Hormone Releasing Hormone and Growth Hormone
Inhibiting Hormone. Targets liver, muscle, bone and cartilage. Indirect: liver -> IGF-I-> bone and
soft tissue. Direct: Adipose, muscle, liver (metabolic). Lack = dwarfism. Too much = gigantism. A
prescribed drug.
Thyroid Stimulating Hormone (TSH) = Regulated by Thyroid Releasing Hormone and feedback. <
cretinism (hypothyroidism). > Graves disease, goitre (lump on thyroid), exophtalmus (bulging eyes-
hyperthryoidsim. Regulates metabolism
Adrenocortico-thropic hormone (ACTH) = Regulated by Corticotroping-releasing hormone and
feedback. Acts on adrenal cortex to release cortisol. < rare. > Cushing’s disease (tumour). Produced
by stress and increases production and release of corticosteroids.
Follicle Stimulating Hormone (FSH) = Regulated by Gonadotroping Releasing Hormone and
feedback. Target testes/ovaries. < Failure of sexual maturation. > ?. FSH regulates the development,
growth, maturation and reproductive processes of the body.
 Luteinising hormone (LH) = Regulated by Gonadotroping Releasing Hormone and feedback. Targets
overies/testes. < Failure of sexual maturation. > ?. Stimulates the production of testorone, ovulation
and development of the corpus luteum.
Prolactin (PRL) = Regulated by Prolactin Releasing Hormone and Prolactin Inhibiting Hormone.
Targets Secretory breast tissue (mammary glands). < poor milk production. > inappropriate milk
production, impotence (males).


- Posterior pituitary: Neural tissue. Releases neurohormones made in the hypothalamus. Acts a storage
area
Hormones;
Oxytocin = Regulated from hypothalamus by uterine stretch, suckling. Targets, uterus and breast.
<,> unknown. Stimulates birth and milk production. Positive feedback system
Antidiuretic hormone (ADH) (vasopressin) = Regulated from the hypothalamus by blood osmolarity
and volume. Target kidneys. < diabetes insidious. > Syndrome of inappropriate antidiuretic hormone
secretion. Releases when body dehydrated to conserve water.

Peripheral endocrine glands

Thyroid gland: Calcitonin produced by parafollicular cells. Direct antagonist of the parathyroid hormone by
lowering blood Ca++ levels.
Thymus: secretes peptide hormones (thymopoietins, thymic factor and thymosins). Essential for normal
development of T lymphocytes and the immune response.
(Supra)Adrenal glands: Outer cortex (glandular tissue) and inner medulla (part of sympathetic nervous
system).
Adrenal cortex = long term stress response - cortisol.
Retention of sodium and water by kidneys.
Increased blood volume and pressure
Proteins and fats converted to glucose/ broken down for energy
Increased blood sugar
Suppression of the immune system
Appears to protect body against certain stress factors
Synthesis over 24 corticosteroids. All are synthesised from cholesterol and fall into 3 categories:
- mineralocorticoids: control electrolyte balance e.g. aldosterone which acts on the kidneys to retain
sodium and excrete potassium. It therefore helps to maintain blood volume and pressure. Synthesised
by zona glomerulosa.
- Glucocorticoids: secreted in response to Adrenocorticotropic hormone). They stimulate fat and
protein catabolism and release fatty acids and glucose into the blood. Synthesised by zona fasciculata
and zona reticularis.
- sex steroids: these are weak androgens and small amounts of oestrogen. Synthesised by zona
fasciculata and zona reticularis.
Adrenal medulla = chromaffin cells synthesise adrenaline and noradrenaline [80%:20% A:N stored and
released]
Short term stress response
Increased heart rate
Increased blood pressure
Liver converts glycogenn to glucose and releases glucose to blood
Dilution of bronchioles
Change in blood flow patterns leading to increased alertness, decreased GIT activity and reduce urine
output
Increased metabolic rate
Pancreas: Islets of Langerhans (Glucagon: synthesising alpha cells - raise blood glucose, Insulin:
synthesising beta cells - lower blood glucose).
Type 1 diabetes: destruction of beta cells, no insulin production.
Type 2 diabetes: Reduce sensitivity of insulin target cells.