Anatomy (Marian Diamond)

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1 Skeletal System
Purpose of bones
- Support the body
- Provide sites for muscle attachment
- Protects vital organs
- Storage of calcium
- Aids in haemopoiesis (formation of blood cells) by storing bone marrow
Red bone marrow

- Appears in most bones during infancy
- In adults, it only exists in the sternum, ribs, body of vertebrae, crest of ilium and proximal end
of long bones
Classification of bones
- Long bones (humerus, radius, ulna, femur, tibia, fibula)
- Short bones (carpals, tarsals)
- Flat bones (scapula)
- Sesamoid bones (patella)
- Irregular bones-vertebrae
Identifying characteristics
- Fossa: depression in bone (e.g. temporal mandibular joint)
- Sinus: cavity in bone (e.g. maxillary sinus)
- Foramen: hole in bone (e.g. foramen magnum at base of skull)
- Meatus: tubular structure in bone (e.g. external auditory meatus)
- Condyle: large smooth curved surface (e.g. distal end of femur)
Axial Skeleton
- Runs through medial axis of body, has 80 bones
- Comprises skull, ear ossicles, hyoid bone, thoracic bones (sternum + ribs), and vertebral
column
Appendicular Skeleton
- Composed of 126 bones
- Comprises upper and lower extremities and their respective girdles
- Pectoral girdle: clavicle + scapula
- Pelvic girdle: ilium + ischium + pubic bone
Skull – Calvarium (skullcap)

- Joints between calvarium bones are called sutures
- Infants have fontanelles (soft membranous gaps) in between cranial bones, to accommodate
the rapid growth of the brain
- Frontal bone (forehead)
o Anterior fossa of base of skull
o Frontal sinus
- Parietal bone
o Two parietal bones at each side of skull, joined together by the midsagittal suture
o Frontal and parietal bones are joined together by the coronal suture
o Parietal and occipital bones are joined together by the lambdoidal suture
- Temporal bone
o Consists of squamous portion, mastoid process (has a sinus which connects to middle
ear), zygomatic process (posterior part of cheek bone), and petrous portion (houses
inner ear)
ME1/13 Foundation Term Anatomy LGZN

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- Occipital bone
o Foramen magnum located here; spinal cord passes through it to attach to brain
o Articulates with first cervical vertebrae (atlas)
- Sphenoid bone
o ‘Keystone’ of skull floor; forms the lateral wall of orbit
o Has a sinus that follows the lateral wall of orbit
o The Turkish saddle (sella turcica) holds the pituitary gland
- Ethmoid bone
o Located posteriorly to frontal bone in base of skull; forms the medial wall of orbit
o Olfactory nerves enter skull through the cribiform plate
Skull – Facial Bones

- Maxilla (2 bones)
o Upper jaw; ‘keystone’ of the face (all facial bones touch the maxilla, save for the
mandible)
o Forms part of zygomatic process (part of cheek bone)
o Forms the anterior portion of hard palate
- Nasal bones (2 bones)
o Forms nose bridge
- Lacrimal bones (2 bones)
o Located at the inferior medial orbit
- Zygomatic bones (2 bones)
o Forms the medial aspect of cheek bone
- Palatine bones (2 bones)
o Forms posterior portion of hard palate
- Inferior conchae (2 bones)
o Located at inferior lateral nasal cavity
- Vomer (1 bone)
o Located at medial nasal cavity
- Mandible
o Lower jaw; only movable joint of skull
o Condyloid process forms the temporal mandibular joint
o Coronoid process provides insertion point to muscles of mastication
o Ramus (vertical portion of mandible)
o Body (horizontal portion of mandible)
Hyoid bone
- U-shaped bone located in anterior of neck, inferior to mandible and superior to larynx
- No bony attachments, only muscles and ligaments
Vertebral Column
- 33 bones in vertebral column; 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae,
5 sacral vertebrae, and 4 coccygeal vertebrae
- Accentuated thoracic curve: kyphosis (hunchback)
- Accentuated lumbar curve: lordosis (swayback)
- Accentuated lateral deviation: scoliosis (usually in thoracic area); occurs more frequently in
females and appears during puberty
- Comprises spinous process, lamina, transverse process, vertebral canal (through which the
spinal cord runs), articular process (for fitting with an adjacent vertebra), and body
- Thoracic area has an additional costal facet for ribs attachment
- Most common site for tumour formation is the thoracic region
- Cervical vertebrae
o C1 (atlas): articulates with the occipital bone and C2; has no body and is ring-like in
structure

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o C2: has a tooth-like process (odontoid process), which is the body of C1 fused to
body of C2; it allows for the rotation of the head
- Thoracic vertebrae
o Has costal facets for attachment of ribs
o Longer spines than adjacent vertebrae
- Lumbar vertebrae
o Has a large body, due to weight bearing nature
- Intervertebral discs
o Located in between adjacent vertebrae
o Consists of an outer annulus fibrosus (rings of fibrocartilage located between bodies
of vertebrae), and an inner nucleus pulposus (a soft gelatinous centre)
o Slipped disc occurs when nucleus pulposus leaks out of the annulus fibrosus
Thoracic Cavity
- Sternum
o Manubrium
 Jugular notch located superiorly to manubrium
 Joined to the body by the sternal angle (most frequently fractured area of
sternum)
o Body
o Xiphoid process
- Costal cartilages
o Attaches the ribs to the sternum
o Second costal cartilage attaches to the sternal angle
- Ribs
o 12 ribs in total, 7 of which are true (their costal cartilage attach directly to sternum)
o First 3 false ribs attach to superior costal cartilage; the other two have no anterior
attachments at all (floating ribs)
Pectoral Girdle
- Consists of clavicle anteriorly and scapula posteriorly
- Clavicle articulates with sternum at the manubrium anteriorly (sternoclavicular joint), and the
scapula posteriorly (acromioclavicular joint)
- Scapula is thin, and lies over the 2nd – 7th ribs posteriorly; it is triangular in shape
o Spine of scapula expands into the acromial process; it divides the scapula into the
supraspinous fossa and infraspinous fossa
o Head of humerus articulates with the scapula at the glenoid cavity
o Short head of biceps originates from coracoid process of scapula
Upper Extremities – Humerus

- Proximal end has a head and a greater tubercle
- Deltoids attach to the humerus at the deltoid tuberosity
- Anatomical neck is located between the head and the greater tubercle
- Surgical neck is located below the greater tubercle; most common site of fracture in humerus
- Distal end has medial epicondyle and lateral epicondyle (tennis elbow: inflammation of
muscle at lateral epicondyle)
Upper Extremities – Radius and Ulna

- Radial tuberosity located beneath head of radius; biceps insertion occurs here
- Olecranon process and coronoid process forms the semilunar notch at the proximal end of the
ulna
- Distal ends of both radius and ulna have the styloid process
Upper Extremities – Hand

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- Consists of 8 carpal bones, 5 metacarpals, and 3 phalanges per finger and 2 phalanges per
thumb
Pelvis Girdle
- Comprises the ilium, ischium and pubic bone, all of which join at the acetabulum (receives
head of femur)
- Ilium
o Anterior iliac spine provides a site for ligaments to attach to
o Sacroiliac joint transfers weight of upper body to pelvic girdle
- Ischium
o Posterior and inferior to ilium
o Ischial tuberosities support body weight while sitting
o Obturator foramen is partly covered with connective tissue; nerves and blood vessels
pass through the opening
- Pubic bone
o Most anterior of pelvic bones
o The two pubic bones meet in the midline at the pubic symphysis, connected by
fibrocartilage; this loosens during childbirth
o Sex differences: males have narrower, heavier and deeper pelvic bones
Lower Extremities – Femur

- Largest and heaviest bone in body
- Muscles attach at the greater and lesser trochanters located lateral of the femur
- Neck of femur is commonly fractured in older people
- Patella is located in between medial and lateral epicondyle of femur, housed in tendon of
quadriceps before insertion in tibia; it stabilizes and protects the knee joint
Lower Extremities – Tibia

- Weight bearing medial bone of lower extremity
- Apex of tibia (shin) has no muscles covering it, only the periosteum beneath the skin (filled
with nerve fibres)
- Articulates with femur and fibula proximally; articulates with talus(ankle bone) and fibula
distally
- Distal end of tibia forms the medial malleolus (bony prominence of ankle)
Lower Extremities – Fibula

- Thin, long and lateral bone in leg
- Articulates with tibia proximally and talus distally
- Distal end of fibula forms the lateral malleolus
Lower Extremities – Feet

- Major tarsals: Calcaneus (heel), where the Achilles tendon attaches; and Talus
- 1st metatarsal is the largest and weight-bearing one
- 5th metatarsal is the smallest one, and thus has the highest probability to fracture (dancers’
fracture)
Wound Healing in Fractures

- Bleeding occurs, and a hematoma (blood clot) forms
- Periosteum tissue (made up of connective tissue) will form osteoblasts
- Osteoblasts (specialized fibroblasts in connective tissue) will then form small fragments of
bone within the clot; this structure is called callus
- Osteoblasts will also form a bony collar around the two fractured ends
Arthrology – the Science of Joints

- Fibrous joints: little connective tissue between bones (e.g. sutures in calvarium)

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- Cartilaginous joints: fibrocartilage found between bones (e.g. intervertebral discs and pubic
symphysis)
- Synovial joints: most common joint in body (e.g. glenoid fossa in pectoral girdle; acetabulum
in pelvic girdle)
o Articular (hyaline) cartilage lines the articular surface of bones to reduce friction
o Synovial membrane surrounds the joint, which produces synovial fluid to fill the
synovial cavity; the fluid moistens and nourishes the cartilage (important since the
cartilage lacks blood vessels)
o Joint capsule made of heavy connective tissue forms the outermost layer of the joint
for stability and protection
o Bursa exists in some synovial joints to reduce friction from surrounding muscles;
inflammation of the bursa is called bursitis
Functional Types of Joints

- Hinge joint (e.g. elbow; knee): works to increase and decrease angle
- Ball and socket joint (e.g. glenoid cavity; acetabulum): head in fossa
- Pivot (e.g. head of radius around ulna)
- Saddle joint (e.g. 1st metacarpal): concave part of bone over convex part of bone
Joint Movement
- Flexion (decrease angle) VS Extension (increase angle)
- Adduction (towards the midline) VS Abduction (away from the midline)
- Circumduction (circular motion)
Arthritis
- Rheumatoid arthritis (rheum: discharge)
o Due to disorder of immune system brought about by emotional stress
o Synovial membrane gets inflamed, increasing amount of synovial fluid
o Joint becomes swollen, painful and stiff
- Osteoarthritis
o Most common form of arthritis; induced by trauma or injury
o Articular cartilage is broken down; viscosity of synovial fluid is also reduced
o Bone rubs against bone, causing pain and reduced mobility
Cartilage
- Cartilage, like bone, has a connective tissue with cells and fibres. However, instead of the
calcified matrix (hydroxyapatite) found in bone, cartilage has a firm pliable matrix
(glycosaminoglycans)
- Since cartilage has no blood vessels, it obtains its nutrients by diffusion
- Fibres can be made up of collagen or elastin
- Hyaline cartilage
o Glassy, shiny appearance
o Located at articular surfaces in joints, costal cartilages, embryonic skeleton, as well as
in the respiratory system (nose, larynx, trachea, bronchi
- Elastic cartilage
o Matrix is made up of elastin fibres
o Located in the external ear, Eustachian tube (connects nasopharynx with middle ear),
and epiglottis
- Fibrocartilage
o Has lots of collagen fibres
o Located in the vertebral discs and pubic symphysis
Intramembranous Ossification

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- Bone develops in connective tissue membrane of embryo (mesenchyme)

- This occurs in the calvarium
Endochondral Ossification
- Develops from the hyaline cartilage model of skeleton; cartilage is broken down first before
bone is laid down, and this occurs at the ossification centres
- Primary ossification centres are located at the epiphysis, while the secondary ossification
centre is located at the diaphysis
- All hyaline cartilage is gradually broken down, with the remnants located at the articular
cartilages and the epiphyseal disc (site of growth of long bones)
- During childhood, the epiphyseal disc is continually broken down on one end to form bone,
while the other end is replicating simultaneously, such that its dimensions remain the same;
this results in lengthening of the bone
- In late teens, the epiphyseal disc is broken down without being replaced, and gradually the
whole cartilage is replaced by bone, leaving the epiphyseal line
Structural and Functional Units of Compact Bone

- Compact bone forms the outermost region of bones; it surrounds the spongy bone, which
contains haemopoietic tissue
- Blood vessel enters bone in the middle, and runs parallel to surface
- Haversian system (osteons)
o Fundamental function unit of compact bone
o Haversian canal contains an artery and nerves
o Surrounding the Haversian canal are lamellae (concentric rings of bone)
o Little cavities in the lamellae are called lacunae, and they contain osteocytes
o Canaliculi provides blood supply to the osteocytes from the Haversian canal
o Volkmann’s canal supplies the Haversian system with blood and connects one
Haversian system to another; it runs perpendicular to the Haversian canals

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2 Muscular System
Function of Muscles
- Move skeleton and control openings
- Stabilize joints to maintain posture
- Produce heat with exercise
- Produce facial expressions
- Protection
Nomenclature of Muscles
- Shape (e.g. deltoid muscles, which resembles the Greek letter delta)
- Number of heads (e.g. biceps; triceps; quadriceps)
- Length (longus: long; brevis: short)
- Location (e.g. biceps brachii; biceps femoris; intercostals)
- Attachments (e.g. sternocleidomastoid muscle)
Terms
- Prime Movers: main muscle carrying out function
- Antagonists: opposing muscle which relaxes when motion is carried out
- Origin: fixed end of muscle; located proximally in limbs
- Insertion: moving end of muscle; located distally in limbs
Head Muscles
- Occipitalis: origin at occipital bone and mastoid process of temporal bone, insertion at galea
aponeurotica (thin, tough layer of connective tissue which stretches from the frontal to
occipital bones)
- Frontalis: origin at galea aponeurotica, insertion at muscles in superior orbit (e.g. orbicularis
oculi) instead of bony attachment; lifts eyebrows and wrinkles forehead
- Levator palpebrae: origin at superior orbit, insertion at upper eyelid; raises eyelid
- Orbicularis oculi: origin at medial palpebrae ligament, insertion at lateral palpebrae ligament;
closes eyelid
- Buccinator: origin at maxilla and mandible, insertion at angle of mouth; allows for smiling,
enables compression of cheeks to force air out of mouth, and keeps food between teeth
crowns during chewing
- Orbicularis oris: origin at cheek muscles including buccinator, insertion at contralateral angle
of mouth; closes mouth
- Temporalis: origin at squamous process of temporal bone, insertion at coronoid process of
mandible; contracts and closes jaw
- Masseter: origin at zygomatic process of maxilla, insertion at ramus and angle of mandible;
closes jaw with great force
Muscles Attaching Upper Extremities to Trunk

- Trapezius: origin at occiput and ligamentum nuchae (ligament that runs between cervical to
thoracic spines), insertion at spine of scapula and lateral third of clavicle; adducts, raises and
depresses scapula, as well as extending head
- Latissimus dorsi: origin at thoraco-lumbar fascia (layer of strong connective tissue attached to
the crest of ilium, sacrum, lumbar and lower thoracic spines), insertion at intertubercular
groove of humerus; adducts, depresses and medially rotates humerus
- Pectoralis major: origin at sternum, medial clavicle, and 2nd-6th costal cartilages, insertion at
outer lip of intertubercular groove; adducts and medially rotates humerus
- Deltoid: origin at lateral clavicle and spine of scapula, insertion at deltoid tuberosity; gives
shoulders their shape, abducts humerus, assists biceps and triceps
- Rotator cuffs: group of muscles stretching from scapula to humerus which acts to stabilize the
shoulder; insertion at humerus; adducts, abducts, medially and laterally rotates humerus

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o Supraspinous muscle
o Infraspinous muscle
o Subscapularis muscle
o Teres minor muscle
Muscles in Arm and Forearm

- Arm is designed for strength, while forearm is designed for dexterity
- Biceps: short head origin at coracoid process, long head origin at superior lip of glenoid fossa,
insertion at radial tuberosity; powerful supinator and flexor
- Triceps: origins at infraglenoid tubercle, medial and lateral posterior humerus, insertion at
olecranon process of ulna; extends forearm and stabilizes elbow joint
- Brachioradialis muscle: gives shape to lateral forearm
- Thenar eminence: group of muscles on palm at base of thumb
Abdominal Muscles
- Supports and protects abdominal and pelvic viscera, flexes vertebral column, aids breathing,
vomiting, defecating and childbirth, enables us to laugh, cough and sneeze
- Rectus abdominis: origin at 5th-7th costal cartilages and xiphoid process, insertion at pubic
bone and its symphysis
- External oblique: origin at lower 8 ribs, insertion at linea alba (connective tissue that runs
from xiphoid process to pubic symphysis; no blood vessels are located here); aponeuroses
covers rectus abdominis anteriorly in both regions superior and inferior to umbilicus; the
aponeuroses also folds in on itself to attach at anterior iliac spine and pubic tubercle, forming
the inguinal ligament (this ligament contains the inguinal canal; the vas deferens runs through
its superficial ring located medially out of the deep ring located laterally into the pelvic
viscera in males; in females the inguinal canal contains the round ligament, which connects
the uterus to external genitalia)
- Internal oblique: aponeuroses covers rectus abdominis anteriorly and posteriorly in region
superior to umbilicus, and only anteriorly in region inferior to umbilicus
- Transversus: aponeuroses covers rectus abdominis posteriorly in region superior to umbilicus,
and anteriorly in region inferior to umbilicus
Muscles of Pelvic Floor

- Levator ani: origin at pubic bone and ischium, insertion at coccyx and median raphe (ridge of
tissue between pubic bone and anus); it runs from anterior to posterior; in females, it has three
openings – urethra, vagina and anus
- Superficial transversus: it runs transversely (in the medial-lateral axis)
Muscles of Hip
- Flex, extend, adduct, abduct and circumduct hip joint
- Gluteal muscles: located posterior surface of pelvis; in females, fat is deposited over the
gluteal muscles, forming the secondary sex characteristics
o Gluteus maximus: origin at posterior ilium, insertion at proximal femur and iliotibial
band (thick lateral band of fascia lata, thin, strong encasement of connective tissue
around thigh muscles); extends thigh
o Gluteus medius and gluteus minimus: origin at ilium, insertion at greater trochanter;
abducts and medially rotates thigh
- Thigh muscles
o Sartorius: origin at anterior iliac spine, insertion at medial proximal tibia; flexes hip
and knee
o Quadriceps: consists of rectus femoris (at ilium), vastus lateralis, vastus intermedius,
and vastus medialis (all three at proximal femur), insertion at quadriceps tendon
(which surrounds patella; patellar ligament inserts on tibial tuberosity)
o Femoral triangle: bounded by inguinal ligament, sartorius and adductor longus
muscle; contains nerves, arteries, veins, and lymphatic tissue

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o Hamstrings: consists of biceps femoris (origin at ischium and distal femur),

semimembranosus (origin at ischium), semitendinosus (origin at ischium), insertion at
proximal medial tibia; extends the hip and flexes the knee
o Gracilis (medial thigh muscle): origin at pubic bone, insertion at medial proximal
tibia; adducts thigh and flexes knee
Leg Muscles
- Tibialis anterior: origin at lateral proximal tibia, insertion at 1st metatarsal and 1st tarsal;
inverts and dorsi flexes foot
- Gastrocnemius muscle: origin at medial and lateral epicondyles of femur, insertion at
calcaneus via Achilles tendon; superficial muscle of posterior leg which plantar flexes
- Soleus muscle: origin at proximal tibia and fibula, insertion at calcaneus via Achilles tendon;
deep muscle of posterior leg which plantar flexes
Histology of Muscle
- Three layers of connective tissue layers around muscles
o Epimysium: surrounds the whole muscle
o Perimysium: surrounds each muscle fascicle
o Endomysium: surrounds each individual muscle fibre
- Smooth muscle (also known as visceral or involuntary muscle)
o Made up of single cells which are tapered and have central nuclei
o Exists in sheets and covered with connective tissue, enabling them to act in mass
o Non-striated, but instead possesses contractile proteins (actin, myosin, desmin)
o Largest mass of smooth muscle in body is uterus; mostly found in gastrointestinal
tract to produce slow rhythmic contractions; also found in pupil, where its
tremendous endurance aids in precise control of pupil dilation and constriction
- Skeletal muscle
o Longest skeletal muscle is the sartorius; shortest one found in internal ear
o Cells have multiple nuclei situated peripherally, with sarcolemma as membrane
o Myofibrils, made up of myofilaments (actin and myosin), fill the sarcoplasm
o A bands (dark) are made up of myosin while I bands (light) are made up of actin,
tropomyosin and troponin; H zones lie in the middle of A bands; Z discs (attachment
between thin fibres) bisect I bands while M lines (attachment between thick fibres)
bisect H zones
o The region between two Z bands is called a sarcomere, the structural and function
unit of the skeletal muscle; during contraction, nerve impulses to the sarcolemma is
transmitted to the sarcoplasmic reticulum, discharging Ca2+ ions and triggering Z
bands to approach each other
o Sliding filament theory: during relaxation, thick and thin muscle fibres overlap
slightly; during contraction, then filaments slide centrally, and I bands are shortened
while H zones disappear
o At junctions of A and I bands, sarcoplasmic reticulum tubules will be dilated to form
two parallel terminal cisternae on each side of a T-tubule (deep invagination of
sarcolemma), which transmits electrical impulses from the sarcolemma to terminal
cisternae; this arrangement is called a triad
- Cardiac muscle
o Made up of tubular cells which have central nuclei; striation is present
o Branching with intercalated discs, which facilitate the spread of contractions through
gap junctions; they bind adjacent cells together by desmosomes
o Contracts about 72 times per minute
o At Z discs are diads of a T-tubule with a terminal cisternae
- Innervation of muscles takes place at neuromuscular junctions; sarcolemma is highly folded
to increase surface area of contact
- Muscle spindles are receptors in the muscle belly which detect changes in its length and
maintain muscle tone; made up by intrafusal fibres within connective tissue capsule

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3 Haematology
Blood Vascular System
- Blood is a connective tissue that has a fluid matrix (plasma), cells, corpuscles (free floating
biological cell), and cell fragments
- Blood is formed in the liver and bone marrow during foetal period, and in adults, it is formed
in the bone marrow and lymphatic tissue
- Transports formed elements, nutrients, gases, waste, hormones, enzymes, and buffers
- Helps maintain body temperature
General Review of Formed Elements

- White Blood Cells (leukocytes): true cells with nucleus
- Red Blood Corpuscles (erythrocytes): no nucleus
- Cell fragments (platelets): fragments from megakaryocytes; no nucleus
- 45% formed elements : 55% plasma
Plasma
- 90% water; 7%-9% plasma proteins, such as albumin, fibrinogen (both of which are formed
in the liver), and globulin (formed in mast cells)
o Albumin: regulates osmosis and maintains water balance
o Fibrinogen: for the clotting of blood
o Globulin: plays a role with antibodies
- Calcium ions
o When calcium concentration is low, the parathyroid gland releases parathormone,
which then acts on osteoclasts to break down bone and release calcium
Erythrocytes
- Small, flexible, biconcave discs
- ~5 million per mm3; slightly more in males and slightly less in females
- Count rate can be increased with exercise and increased altitude
- Erythropoiesis: normoblasts in bone marrow loses their nuclei just before entering the
bloodstream, turning into reticulocytes (which possess a reticular network of ribosomes in
cytoplasm); reticulocytes circulate for 24 hours before maturing into erythrocytes
- Elevated reticulocyte count indicates polycythemia
- 2 million erythrocytes are produced per second, and they have a lifespan of 120 days
- Destroyed in spleen and liver
Leukocytes
- Forms part of the body’s defence mechanism
- 4000 – 10,000 per mm3 for adults; 18,000 – 20,000 per mm3 for newborns
- Live outside blood vessels in connective tissue proper (cells and fibres)
- Classified as either granular (polymorphonuclear leukocytes) or agranular (mononuclear
leukocytes)
- Neutrophil: granulocyte which absorbs neutral dyes; most common leukocyte; possesses 3-5
masses of chromatin which are connected to each other, with a Barr body (representing the
inactive X chromosome) for females; neutral granules contain alkaline phosphatase to break
down phagocytized substances; faster moving compared to monocytes, thus first to arrive at
sites of infection; pus comprises dead neutrophils and bacteria
- Monocyte: agranulocyte with kidney-shaped nucleus; it is a phagocytic cell in connective
tissue, which migrates to sites of infection slowly
- Eosinophil: granulocyte which absorbs acid dyes; nucleus is bi-lobed with large granules
containing acid phosphatase; involved in allergy and asthma reactions; secretes histaminase
- Basophil: granulocyte which absorbs basic dyes; nucleus is S-shaped with numerous granules;
secretes heparin (anticoagulant) and histamine (increases permeability of blood vessels)

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- Lymphocyte: agranulocyte with a large nucleus (it almost fills the entire cell, and has an
indentation) and a simple cytoplasm around it; deals with antigen-antibody reactions
o B cells: attack bacteria; formed in bone marrow and mature in lymph nodes; some
differentiate into plasma cells, which secrete antibodies and globulins
o T cells: attack substances larger than bacteria, such as cells with nuclei; formed in
bone marrow and mature in thymus, obtaining an antigen marker in the process
 Examples include killer T cells, helper T cells, memory T cells
 T4 cells (4 receptors) aid T8 cells (8 receptors) in destroying invaders; T4:T8
ratio important in AIDS
Platelets
- Also known as thrombocytes, or cell fragments
- Originates from megakaryocytes, an irregularly shaped cell with a large irregular nucleus;
platelets bud off the megakaryocyte before breaking away from the main cell
- Platelets form thromboplastin and aids in blood clotting

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4 Cardiology
Circulation System and the Heart
- Foetal heart starts off as a modified blood vessel in the embryo
- Can be classified as pulmonary circulation (heart-lungs-heart) and systemic circulation (heart-
body-heart)
- Size of heart is approximately the size of fist
- Base of heart is inferior to sternal angle (2nd intercostal space), and the inferior portion of the
heart reaches the 6th intercostal space; 1/3 lies right of midline, 2/3 lies left of midline; apex of
heart is located at the fifth intercostal space, inferior to the left nipple
- Located in the mediastinum (area between lungs)
- Has three walls – the epicardium (outer layer, attached to diaphragm), myocardium (middle
layer), and endocardium (inner layer made of endothelial cells, similar to blood vessels)
- Has three layers of coverings – the outer layer of fibrous pericardium (made of tough fibrous
connective tissue), the parietal pericardium (made of mesothelial cells and adheres to the
fibrous layer), and the visceral pericardium (made of mesothelial cells and attached to the
epicardium); pericardial cavity between the parietal and visceral pericardium contains serous
fluid to reduce friction when the heart beats
Heart Chambers
- Posterior walls of atria are smooth, while the anterior walls have folds of myocardium (also
known as pectinate muscles)
- Attached to each of the atria is an auricle, a small conical muscular pouch
- Interatrial septum separates both atria in the heart; a depression exists in the right atria,
forming the fossa ovale (remnant of the foetal foramen ovale)
- Superior vena cava brings in blood from areas superior to the diaphragm, while inferior vena
cava brings in blood from areas inferior to the diaphragm; they open into the right atrium; in
between these two vena cava, there is the coronary sinus, which drains blood from the
myocardium of the heart itself
- Four pulmonary veins bring in oxygenated blood from the lungs to the left atrium
- The pulmonary trunk exits the right ventricle and branches off into the right and left
pulmonary arteries
- The ascending aorta exits the left ventricle to supply the rest of the body with blood
- Both ventricles possess irregular muscular projections on the inner surface, called trabeculae
carneae
- The left ventricular wall is much more thicker and muscular compared to the right
- Interventricular septum separates left ventricle from the right ventricle
Heart Valves
- Atrioventricular valves prevent the backflow of blood from ventricles to atria; tricuspid
valves are on the right while bicuspid valves are on the left
- Cusps are connective tissue covered by endothelial cells, attached to the papillary muscles
(projections off the muscular wall) by chordae tendineae
- Semilunar valves prevent the backflow of blood from the pulmonary trunk and aorta to
ventricles; they are covered by three cusps each, with a node of dense connective tissue in the
middle to make a ‘tight’ valve, preventing leakage
- Murmurs occur when there is a leakage at the atrioventricular valves due to incomplete
closure, while prolapses occur when the atrioventricular valve protrudes into the atrium when
the ventricle is undergoing systole
Heart Sounds
- Closure of atrioventricular valves produces the ‘lub’ sound; since the AV valves are much
larger, this ‘lub’ sound is much stronger and longer
- Closure of semilunar valves produces the ‘dub’ sound

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Cardiac Cycle
- During diastole (expansion) of the ventricles, the atrioventricular valves are open while the
semilunar valves are closed
- During systole (contraction) of ventricles, the atrioventricular valves are closed while the
semilunar valves are open
- Blood flows into the right atrium from the superior vena cava, inferior vena cava, and the
coronary sinus; it passes through the tricuspid valve into the right ventricle; then, it passes
through the semilunar valve into the pulmonary trunk, where it goes to the lungs to be
oxygenated; after being oxygenated, blood flows back into the left atrium through the four
pulmonary veins; it passes the bicuspid valve into the left ventricle; the left ventricle then
pumps the blood into the ascending aorta for circulation to the rest of the body
Conduction mechanism
- Heart has its own intrinsic conduction mechanism to contract heart and pump blood
- Electrical signals are conducted by the Purkinje fibres, modified cardiac muscle fibres which
lie between the myocardium and endocardium; these fibres are larger than cardiac muscles,
and are rich in glycogen
- The “pacemaker” (also known as the sinoatrial node) is situated in the right atrium, just
inferior to the entrance of the superior vena cava; it initiates the signal for heart to beat,
sending the signal to the atrioventricular node located in the interatrial septum; from the AV
node, the electrical signal then travels down the bundle of His (Purkinje fibres in the
interventricular septum) and spreads out in the ventricular walls, causing systole
Nerve Supply to the Heart

- The autonomic nervous system consists of both sympathetic and parasympathetic nervous
systems; the sympathetic system speeds up the heart with cardiac nerves, while the
parasympathetic system slows the heart with the vagus nerve (X cranial nerve)
5 Angiology
Angiology – the Science of Blood Vessels
- Systemic circulation: heart-artery-arteriole-capillary-venule-vein-heart
- Each type of blood vessel has three layers, except the capillary which only has the
endothelium and the basement membrane (also known as basal lamina)
Arteries
- Can be classified as elastic (found in ascending aorta, which then branches off into the right
and left coronary artery, brachiocephalic artery, right subclavian artery, right common carotid,
arch of aorta, left common carotid, and left subclavian artery) or muscular (the rest of the
arteries, e.g. internal carotid, which branches off into ophthalmic artery, anterior cerebral
artery and middle cerebral artery)
- Blockage of the coronary arteries result in heart attacks; when there is a build up of
cholesterol, atherosclerosis (arterial plaque) begins in tunica intima, and must be removed
through angioplasty (a radio-opaque substance is injected into the femoral artery in the
femoral triangle, so that blood vessels can be outlined by an X-ray to locate obstructed artery;
a balloon catheter with a stent is then inserted through the femoral artery to reach the affected
area, and the balloon is inflated to compress the plaque against the arterial walls; the stent is
left behind to hold the artery open)
- The layers of arteries are called tunics, while the opening is called the lumen
o Tunics of elastic artery:
 Tunica intima: innermost layer made of endothelial cells and elastic
connective tissue fibres
 Tunica media: middle layer made predominantly of elastic fibres, as well as
some smooth muscle

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 Tunica adventitia: outermost layer made of connective tissue made of elastic

fibres, as well as collagenous fibres for strength; has vasa vasorum, small
blood vessels which supply large blood vessels
o Tunics of muscular artery:
 Tunica intima: made of endothelial cells and connective tissue, with an extra
internal layer of elastic membrane
 Tunica media: filled with smooth muscle
 Tunica adventitia: made of connective tissue with collagenous fibres, with an
extra external layer of elastic membrane
- Vertebral Arteries
o They branch from the subclavian arteries right after the common carotid arteries
o Proceed up the neck to the brain, passing through the foramen in the transverse
processes of the cervical vertebrae before reaching the foramen magnum
- Subclavian Arteries
o Progresses to the axilla (armpit), after which it is called the axillary artery, and then in
the arms, brachial artery
o The brachial artery further branches into the ulnar and radial arteries 1 cm below the
elbow, palmar arch in the palm, and finally, digital arteries
- Descending aorta
o Called the thoracic aorta superior to diaphragm
 1st branch: oesophageal artery, which supplies the oesophagus
 2nd branch: intercostal arteries, which supply the intercostal muscles
 3rd branch: bronchial arteries, which supply the lungs
o Called the abdominal aorta inferior to diaphragm
 1st branch: celiac artery, which supplies liver, stomach, spleen, and pancreas
 2nd branch: superior mesentery artery, which supplies small intestine,
ascending colon, and half of transverse colon
 3rd branch: inferior mesentery artery, which supplies the other half of
transverse colon, descending colon, sigmoid colon, and rectum
 4th branch: renal arteries, which supply the kidney
 5th branch: gonadal arteries, which supply either the ovaries or testes
 Divides into two common iliac arteries at L4, which then branch into internal
iliac arteries (supplies pelvic organs) and external iliac arteries (becomes the
femoral artery once past the inguinal ligament)
 Femoral artery becomes the popliteal artery at posterior of knee, and then
branches into the anterior and posterior tibial arteries
Veins
- Possess three coats similar to arteries, except that they are thinner, have larger lumen, and
have valves
- Blood in veins is pushed along by contractions of skeletal muscles
- In the brain, venous blood enters veins, then venous sinuses, and leaves brain through the
internal jugular vein outside skull
o Venous sinuses: channels for venous blood in ‘folds’ of dura mater (thick connective
tissue covering brain
o The superior longitudinal sinus is located along the superior border of the falx cerebri,
while the inferior longitudinal sinus is located along its inferior border
o The straight sinus connects the two longitudinal sinuses to one another
o The transverse sinus runs along the base of the tentorium cerebelli (dura between
cerebrum and cerebellum), and drains into the sigmoid sinus
o The sigmoid sinus exits the jugular foramen to become the internal jugular vein
o A cavernous sinus lies on each lateral side of the pituitary gland
- Median cubital vein: located in anterior elbow, where blood is drawn or infused

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- Deep femoral vein: located in the femoral triangle; susceptible to phlebitis (inflammation of
the vein, causing formation of clots)
- Saphenous vein: longest vein in body; located in medial arch of foot and empties into the
femoral vein at femoral triangle; can be used for bypass surgery
Disorders of blood vessels

- Aneurysm: weakening or swelling of a vessel wall; treated by removing aneurysm and
replacing area with a Dacron sleeve
- Hypertension: high blood pressure, defined as above 140/90
- Varicose veins: swelling of superficial veins in lower extremities; possible causes include
obesity, pregnancy, or heredity factors

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6 Lymphatic System
Lymphatic Vessels
- Conveys lymph (tissue fluid mostly made up of water; contains proteins, sugars and fat)
- Protein exits capillaries to enter lymphatic vessels; they are then conveyed to tissue and back
into the capillaries by these vessels
- Fat is absorbed in small intestines by small lymph capillaries (lacteals), which connect to
lymph vessels and then cysterna chyli; the thoracic duct takes the lymph up from the cysterna
chyli to the junction of the internal jugular with the left subclavian vein, distributing fat into
the venous system
- Circulation consists of lymph capillaries, lymph veins, lymph ducts, internal jugular and
subclavian veins
Lymphatic Tissue
- Spleen
o Largest mass of lymphatic tissue in body, as large as the heart
o Sits between the fundus of the stomach and the diaphragm
o Filters blood and destroys old red blood cells; produces lymphocytes as well
o Has a layer of peritoneum (serous membrane of mesothelial cells), on top of a
connective tissue capsule made up of collagenous and elastic fibres; internally, the
thymus has collagenous trabeculae for support, as well as a reticulum for filtering
o Macrophages are located on the reticular fibres to destroy pathogens in blood; there is
also white pulp (central artery surrounded by masses of lymphocytes, located at the
cortex) and red pulp (blood sinuses with lymphocytes, makes up the majority f the
spleen) on the reticulum
- Lymph nodes
o Small oval bodies located in the cervical region (medial border of the
sternocleidomastoid), the axillary region, and the inguinal region (medial to the
femoral vein)
o Filters lymph, produces lymphocytes and plasma cells
o Has a layer of connective tissue capsule with internal trabeculae and reticulum; at
large curvature, afferent lymph vessels bring lymph into the nodes, while efferent
lymph vessels at the small curvature drain lymph from the nodes; lymphocytes are
produced at the lymph nodules
- Thymus
o Largest in size when young, but greatly reduces in size once adulthood is reached
o Located on heart vessels (pulmonary trunk, ascending aorta); bi-lobed
o Gives lymphocytes antigen markers, thus producing T cells
- Tonsils
o Masses of lymphocytes which form a ring around the beginning of the respiratory and
digestive systems; covered by stratified squamous epithelium
o Only produces lymphocytes; do not filter lymph
o Consists of palatine tonsils (at posterior of oral cavity), lingual tonsils (at base of the
tongue), and pharyngeal tonsils (at nasopharynx)
- Peyer’s patches
o Masses of lymphocytes in the ileum (last part of small intestine)

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7 Respiratory System
Structure and Function of Nasal Cavity
- Cleans, moistens and warms air; gives resonance to voice; houses the olfactory nerves
- Made up of pseudostratified columnar ciliated epithelium with goblet cells
- Cilia conveys trapped dust to nasopharynx
- Goblet cells produce mucus, which serves to moisten the air
- The venous sinus lies beneath the epithelium lining the nasal cavity, warming the air
- Roof of nasal cavity made up of nostrils, ethmoid and sphenoid; floor of nasal cavity made up
of hard palate (maxilla and palatine bones) and soft palate (mucous membrane and muscles);
uvula at the end of the soft palate blocks entrance to nasopharynx
- The medial septum separates the right and left nasal cavity, and is formed by the vomer, the
perpendicular plate of the ethmoid, and hyaline cartilage
- The lateral wall of the nasal cavity is formed by the superior, middle and inferior conchae
- The spaces beneath the conchae are called meatus; the middle meatus receives secretions
from the maxillary and frontal sinuses, while the lacrimal glands drain into the inferior meatus
through the nasolacrimal duct
Structure and Function of Pharynx

- Fibromuscular tube which extends from the base of the skull to C6
- The nasopharynx lies posteriorly to the nasal cavity; the Eustachian tube originates from this
area to the middle ear, and it equalizes pressure on the tympanic membrane; pharyngeal tonsil
located here; lined by pseudostratified columnar ciliated epithelium with goblet cells
- The oropharynx lies posteriorly to the oral cavity; palatine and lingual tonsils located here;
lined by stratified squamous epithelium
- The laryngopharynx lies posteriorly to the larynx; lined by stratified squamous epithelium
Structure and Function of Larynx

- Located in anterior of neck; surrounded by cartilage to keep lumen open
- Has 9 cartilages, 3 paired (arytenoid, corniculate, cuneiform) and 3 unpaired (thyroid, cricoid,
epiglottis); all are hyaline in nature, except for epiglottis, which is elastic in nature
- Thyroid cartilage is the largest laryngeal cartilage; commonly known as Adam’s apple
- Cricoid cartilage is inferior to thyroid cartilage; it expands posteriorly
- Epiglottis is located just above the vocal folds; covers the trachea when food is swallowed
Structure and Function of Trachea

- Connects larynx and bronchi
- Has 16-20 C-shaped hyaline cartilages which are incomplete posteriorly; smooth muscle joins
the incomplete ends together, allowing for the posterior oesophagus to expand to
accommodate large boluses
Structure and Function of Bronchi, Bronchioles, and Alveoli

- Trachea divides into the right and left primary bronchi; the right primary bronchus is larger
and straighter than the left one
- Continues dividing into secondary bronchi, bronchioles, terminal bronchioles, respiratory
bronchiole, and finally, alveoli
- Terminal bronchioles have no cartilages; constriction of lumen here causes asthma
- Respiratory bronchioles are the structural and functional unit of the lungs, and branch into
alveolar ducts lined with alveoli
- Alveoli are lined by simple squamous epithelium; they have secretory cells which produce
surfactant lipoproteins to prevent alveoli from sticking to each other, as well as macrophages
(‘dust cells’) to remove unwanted foreign particles; alveoli have elastic fibres, to aid in
expansion during inspiration and recoil during expiration
- Lack in elasticity of alveoli causes emphysema

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- To get from the atmosphere into the body, gases have to pass through the surfactant layer,
simple squamous epithelium of the alveoli, basement membrane of the alveoli, interstitial
space, basement membrane of the blood capillaries, endothelium of blood capillaries, and
finally the membrane of erythrocytes
Gross Anatomy of Lungs

- Apex of lungs located just above the clavicle, while base is on diaphragm
- Costal surface is that which lies against the ribs and intercostal muscles
- Mediastinum surface is that which surrounds the mediastinum
- Root of lungs (consisting of bronchi, pulmonary blood vessels and nerves) enter lungs at the
hilum (depression above the cardiac notch); only place where lungs are attached to body
- Parietal pleura lines the thoracic cavity, while visceral pleura covers the lungs; pleura fluid
fills this pleural cavity, so as to reduce friction while lungs are expanding and recoiling;
inflammation of the pleura is called pleurisy
- The right lung has three lobes, while the left only has two
Disease of the Lungs

- Lung cancer begins in the bronchi; smoking increases probability by 20 times
- Emphysema is caused by swelling of the alveoli; patients with this condition tend to be barrel-
chested
- Tuberculosis occurs when bacterial infection destroys alveoli, causing scarring
Neural Innervation
- Controlled rhythm of breathing regulated by pons and medulla
- Signals go down the spinal cord and exits at C3-C5, to stimulate contraction of diaphragm
8 Nervous System
Types of Nervous System
- Central nervous system: consists of brain and spinal cord, which are protected by the skull
and vertebrae respectively
- Peripheral nervous system: consists of cranial nerves (12 pairs) and spinal nerves (31 pairs);
each pair of spinal nerves comprises an afferent (sensory) nerve and an efferent (motor) nerve,
while a pair of cranial nerves can be either both afferent, both efferent, or one of each type
- Autonomic nervous system: involuntary system supplying viscera or hollow organs, such as
smooth muscles, cardiac muscles, and glands
o Sympathetic: speeds up reaction
o Parasympathetic: slows down reaction
Neurohistology – Neurons
- Functions include sensory, motor, conduction of impulses, as well as storage and retrieval of
information
- Made up of a cell body (soma) and two kinds of processes, axons and dendrites
- Axons convey impulses away from the soma
o Attached to soma by axon hillock, which is characteristically free of Nissl substance
(rough endoplasmic reticulum) available in the rest of the neuron
o Contains neurotubules and neurofilaments, which provide structure and direct
axoplasmic flow
o Covered by myelin sheath, which speeds up impulses; the more myelin, the more
rapid the impulse transmission
o Myelin is formed by Schwann cells in the peripheral nervous system and by
oligodendrocytes in the central nervous system

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o There are multiple Schwann cells per axon, and the impulse ‘jumps’ from one nodes
of Ranvier (spaces between two adjacent Schwann cells) to another
o An oligodendrocyte, on the other hand, can cover many axons
o Multiple sclerosis occurs when neurons are demyelinated
- Dendrites convey impulses to the soma
o A single neuron can have up to a thousand dendrites
o Dendritic spines increase the surface area of the dendrite
Neurohistology – Neuroglials
- Metabolic and structural support cells for the neurons
- Macroglia include astrocytes and oligodendroglia; they are derived from ectoderm
o Astrocytes are star-shaped and have many processes that are all alike
 Initiate formation of blood brain barrier (tight junction between endothelial
cells in brain capillaries)
 Help form the pial-glial membrane (meningeal envelope which adheres to
CNS surface, made up of foot processes of astrocytes and pial membrane)
 Pick up excess potassium after firing of neurons
 Serve as a scaffolding for neural migration during development
o Oligodendroglia form myelin and serve as satellite cells to blood vessels and neurons
- Microglia are derived from mesoderm, and migrate from the bone marrow along blood
vessels to the central nervous system; they are usually very small, until activated by injury to
become phagocytes
Synapses
- Structural and functional unit of the nervous system
- Junction between the axon and dendrite, where impulses are transmitted from one neuron to
another
- Electrical impulses move down the axon and reach the pre-synaptic terminal, where there are
a lot of vesicles with neurotransmitters and neuromodulators; neurotransmitters are produced
in the pre-synaptic terminal while neuromodulators are formed in the soma and conveyed to
the terminal by the axoplasmic flow
- Calcium ions enter the pre-synaptic terminal and set up substructures to guide vesicles to pre-
synaptic membrane
- Vesicles merge with the membrane, releasing their contents into the synaptic cleft
- The neurotransmitters then react with the receptors on the post-synaptic membrane, opening
ion channels into the post-synaptic terminal to propagate the signal; the influx of ions also
activate enzymes and switch on genes for protein formation, strengthening neuronal structure
of the synapse
- After passing on the signal, neurotransmitters are either hydrolysed or recycled back into the
pre-synaptic terminal by their respective carriers
Structural Classification of Neurons

- Unipolar cells: found primarily in embryo; consists of a soma and a process
- Pseudo-unipolar cells: found in dorsal root ganglia; consists of a soma, a myelinated
peripheral process which conducts impulses from peripheral nervous system towards the
soma, and a myelinated central process which conducts impulses away from the soma to
central nervous system
- Bipolar cells: found in retina, olfactory nerves, and auditory ganglion; consists of a soma,
axon and dendrite
- Multipolar cells: most neurons are of this type; consists of a soma, axon and many dendrites
Functional Classification of Neurons

- Can be classified as motor neurons (e.g. anterior horn cell of spinal cord), sensory neurons
(e.g. dorsal root ganglia) and interneurons (most neurons; connects motor and sensory)

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Chemical Classification of Neurons

- Cholinergic neurons: use acetylcholine as neurotransmitter
- Adrenergic neurons: use adrenaline as neurotransmitter
- GABAergic neurons: use GABA (gamma aminobutyric acid) as neurotransmitter
Development of Nervous System

- Started off from a neural tube with a central canal, which is lined with ependyma
- Central canal at head of neural tube will form ventricles of brain
- The sulcus limitans (lateral projections of the central canal) separates the neural tube into the
dorsal segment, which forms the alar plate (sensory), and the ventral segment, which forms
the basal plate (motor); coding gene for protein which produces this arrangement is the sonic
hedgehog
- Roof plate is located in the dorsal segment at the tip of the sulcus limitans groove
- The neural tube can be divided into the forebrain, midbrain, and hindbrain
o Forebrain (prosencephalon): separates into telencephalon and diencephalon
 Telencephalon makes up 85% of the brain, and consists of basal ganglia and
cerebral hemispheres
 Main components of basal ganglia are the caudate nucleus, putamen,
globus pallidus, and subthalamic nucleus
 Basal ganglia is surrounded by an internal capsule
 Archicortex of cerebral hemisphere has three layers, found in the
hippocampal complex (which comprises hippocampus and dentate
gyrus) located in the temporal lobe; the hippocampus is involved in
short term memory processing and visual spatial acuity
 Neocortex of cerebral hemisphere has six layers, and can be divided
into the frontal (refined motor), parietal (general sensory), occipital
(vision) and temporal (hearing) lobes
 Broca’s area in the frontal lobe allows for speech production
 Prefrontal cortex is uniquely human; it allows for planning ahead,
sequencing events, initiative, judgment, and working memory
 The corpus callosum is a wide, flat bundle of neural fibres which
connects the right and left cerebral hemispheres together
 Diencephalon forms the third ventricle, and is the origin of cranial nerve II;
consists of epithalamus, thalamus, and hypothalamus
 Epithalamus is a thin layer located at the top of the diencephalon, and
includes the pineal gland (neuro-endocrine gland which maintains
Circadian rhythms)
 Thalamus is a mass of nuclei through which all sensory input (except
olfaction) passes to go to the cerebral cortex; massa intermedia
connects the left side of the thalamus to the right side
 Hypothalamus lies below the thalamus; it is the control centre for the
autonomic nervous system, regulating body temperature, thirst,
appetite, emotions, mating behaviour, sleep mechanism, and memory;
it also produces anti-diuretic hormone, to be stored in the posterior
pituitary; the pituitary gland protrudes off the bottom of the
hypothalamus, and it secretes hormones, linking the nervous system
to the endocrine system
o Midbrain (mesencephalon): remains the same; origin of cranial nerves III and IV
 On dorsal side of mesencephalon are the corpora quadrigemina (also called
tectum); the top two, (superior colliculi) controls visual motion while the
bottom two (inferior colliculi) controls auditory reflexes
 On ventral side of mesencephalon are the cerebral peduncles
 In between the peduncles and corpora quadrigemina is the substantia nigra,
which projects up into the basal ganglia, modifying motor behaviour; it is

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black due to the pigment melanin, and its fibres are rich in dopamine;
Parkinson’s disease is characterized by death of neurons in this area
 Central canal in mesencephalon is called the cerebral aqueduct; canal is the
smallest in size here
o Hindbrain (rhombencephalon): separates into metencephalon and myelencephalon
 Metencephalon forms cerebellum (dorsal side) and pons (ventral side); pons
is a bridge of fibres connecting cerebral cortex to cerebellar cortex, while
cerebellum controls balance, coordination, learning and fine movements;
cranial nerves V to VIII originate here
 Myelencephalon forms medulla oblongata, part of fourth ventricle and origin
of cranial nerves VIII to XII; it is the centre for cardiovascular and
respiratory functions
Cranial Nerves
- I: olfactory nerve for smell
- II: optic nerve for vision
- III: occulomotor nerve for eye movement; controls 4 out of 6 extra ocular eye muscles, the
superior rectus, inferior rectus, medial rectus, and inferior oblique
- IV: trochlear nerve for eye movement; controls superior oblique (extra ocular eye muscle)
- V: trigeminal nerve for motor of mastication muscles (masseter and temporalis), as well as
sensory of face, nose and oral cavity; there are three branches, ophthalmic, maxillary and
mandibular nerves
- VI: abducens nerve for eye movement; controls lateral rectus (extra ocular eye muscle)
- VII: facial nerve for motor of muscles of facial expression, as well as sensory of taste buds
and anterior two thirds of tongue; also controls salivary glands (submandibular and
submaxillary )
- VIII: vestibulocochlear nerve for balance and hearing
- IX: glossopharyngeal nerve for motor of muscles of pharynx and larynx; functionality is
tested by asking patient to swallow
- X: vagus nerve for control of viscera in thoracic and abdominal cavities; slows heart
- XI: spinal accessory nerve for motor of neck muscles (sternocleidomastoid and trapezius);
comes from upper cervical segment of spinal cord, and joins with medulla oblongata
- XII: hypoglossal nerve for motor of tongue; tongue deviation occurs to injured side
Spinal Cord – Grey Matter

- Found in vertebral canal with its meninges
- Fills the entire length of canal in embryonic neural tube; it extends to L3 at birth and L1-L2
once adulthood is reached, due to different rates of growth of the vertebrae and spinal cord
- Cauda equina consists of nerves and nerve roots from L2-C, and originates from the conus
medullaris (tapered, lower end of spinal cord)
- Meninges comprise the pia mater (layer adherent to CNS), arachnoid (layer filled with
trabeculae; cerebrospinal fluid flows in sub-arachnoid space), and dura mater (outermost thick
connective tissue layer); the dura mater extends to S2, forming the dural sac (space between
end of spinal cord, L2, and end of dura mater, S2) filled with cerebrospinal fluid, and spinal
taps and anaesthesia are done here
- In the embryonic spinal cord, there is the mantle layer, which is made up of nerve cell bodies
(grey matter), and the marginal layer, which is made up of myelinated fibres (white matter);
the central canal is lined with ependyma
- In the adult spinal cord, the mantle layer morphs from a circular shape to an X-shape with
posterior horns (sensory portion) and anterior horns (motor portion)
- During a reflex arc, the stimulus travels from the sensory receptor through the dorsal root
ganglion (a pseudo-unipolar neuron) to the dorsal root into the posterior horn of the spinal
cord; an interneuron then passes the information to the anterior horn cell, which goes through
the anterior horn to the ventral root before reaching the effector muscles

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- Ventral root has alpha efferent (somatic motor component) as well as gamma efferent (muscle
spindles which function as stretch receptors)
- Each nerve fibre is covered by a layer of connective tissue called endoneurium; they are
bundled into groups called nerve fascicles, which is covered by the perineurium; several
fascicles in turn are bundled together with a blood supply and fatty tissue with yet another
sheath, the epineurium
- Spinal nerves recombine outside the spine to form plexi (e.g. brachial plexus, lumbosacral
plexus); the brachial plexus is made up of C5-T1, and innervates muscles of the upper limb
Nerve Regeneration
- When a nerve is cut, degeneration will occur at the proximal end of the cut back to the first
node of Ranvier, while the cell body undergoes chromatolysis, where the soma takes in water
and swells, causing the nucleus and Nissl substances to be displaced to the periphery
- In the distal portion of the cut, the axon will break up while the Schwann cells will multiply
- The proximal axon will then send out sprouts to reconnect with the Schwann tube, and the
nerve fibre is rebuilt
- If none of the sprouts are able to find the Schwann tube, neuroma will result; if scar tissue
blocks the connection between the proximal axon and Schwann tube, surgery to remove the
scar tissue and place a Dacron tube to bridge them together
- An alternative to chromatolysis is to grow collaterals, where the axon branches off at the
nodes of Ranvier; the collateral can be either ascending or descending
Spinal Cord – White Matter

- White matter at periphery of spinal cord is grouped into funiculi (bundles of nerve fibres);
funiculi can be broken down into smaller functional groups called fasciculi
- Posterior funiculi can be divided into fasciculus gracilis (medial portion coming from lower
body) and fasciculus cuneatus (lateral portion coming from upper body); sensory modality
carried by these fibres up to the cortex is conscious proprioception (sense of relative position
of neighbouring parts of body)
Ascending Pathway – Pain & Temperature

- Primary neuron in dorsal root ganglion will enter spinal cord at Lissauer’s fasciculus, then
rise a few segments before entering dorsal horn and reaching substantia gelatinosa of dorsal
horn, where it synapses with secondary neuron
- Secondary neuron crosses to anterior white commissure and ascends in lateral funiculus to
thalamus, forming lateral spinothalamic tract
- Tertiary neuron in thalamus completes ascending pathway by connecting to post-central gyrus
in cerebral cortex, where there is refined interpretation of pain (body is represented at post-
central gyrus in upside-down manner)
Descending Pathway – Motor

- Corticobulbar tract: motor pathway from pre-central gyrus in cortex to brainstem (midbrain
and hindbrain)
- Corticospinal Tract: motor pathway from pre-central gyrus in cortex to spine
- Corticospinal tract begins with perimeter cell in pre-central gyrus, and their axons descend
through internal capsules, forming corona radiata
- It continues through middle of cerebral peduncles, pyramidal tract of upper medulla, and
undergoes decussation (crossing to opposite side) in lower medulla
- Uncrossed fibres remain in anterior horn of spinal cord to form medial corticospinal tract,
while crossed fibres enter lateral horn to form lateral corticospinal tract
- Crossed fibres involved in fine movements will then synapse with anterior horn cell, while
those involved in crude movements will synapse with an interneuron before synapsing with
anterior horn cell
- Uncrossed fibres will cross in segment of spinal cord where they exit

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- An upper motor neuron lesion will immediately result in flaccid paralysis (weak feeble
paralysis) before turning into spastic paralysis (continuous contained paralysis); superficial
reflexes will be lost and deep tendon reflexes will be exaggerated; Babinski reflex (plantar
reflex) is positive, meaning toes will fan out
- A lower motor neuron lesion will result in loss of reflexes, atrophy of muscle and paralysis,
for example in poliomyelitis
Cerebral Hemispheres
- Frontal lobe – largest lobe, and includes (using Brodmann’s numerical designation):
o Precentral gyrus (area 4): gives rise to corticospinal tract, in charge of refined motor
o Premotor cortex (area 6): situated anterior to precentral gyrus; in charge of less
specific motor; on its medial surface lies the supplementary motor area, which plans
motor activity
o Frontal eye fields (area 8): situated anterior to premotor cortex; in charge of conjugate
eye movements
o Orbitofrontal cortex (areas 10, 11, 47): situated in between olfactory tracts on ventral
side of frontal lobe; deals with emotions and has rich connections with amygdala,
which deals with fear, and hypothalamus, to produce emotional response
o Prefrontal cortex has an inhibitory function, which is reduced with aging
- Parietal lobe – separated from frontal lobe by central sulcus
o Post-central gyrus (3, 1, 2): inferior portion processes taste; superior portion
processes touch, pressure, pain, temperature and kinaesthetic sense
o Supramarginal gyrus (40): situated at end of lateral fissure and inferior to intra-
parietal sulcus; in charge of tactile recognition; lesions here will cause astereognosis,
the lack of ability to identify objects with touch
o Superior parietal (5, 7): involved in spatial orientation; lesion on right portion will
cause neglect syndrome on left side of body
- Temporal Lobe
o Angular gyrus (39): lies immediately posterior to supramarginal gyrus at the end of
superior temporal sulcus (first sulcus inferior to lateral fissure); deals with logic and
mathematics, as well as integration of information from visual, auditory and general
sensory cortices
o Primary auditory cortex (41): situated on superior temporal gyrus
o Auditory association cortex (42): Surrounds primary auditory cortex
o Rest of superior temporal gyrus (22): also has auditory association functions;
posterior 22 is for vestibular input
o Wernicke’s area: located at posterior of lateral fissure; for understanding of words
- Occipital Lobe – demarcated by the imaginary line between pre-occipital notch and
parietaloccipital fissure
o Occipital pole (17): primary visual cortex
o Visual association cortices (18, 19): memory of visuals is stored here
o Calcarine fissure: fissure on medial surface of occipital lobe
- Cells of the cerebral cortex
o Pyramidal cells: most common cerebral cortical cell; pyramidal in shape with long
axons (Golgi type I); has apical, oblique and basal dendrites which receive input from
subcortical axons, contralateral hemisphere, and intracortical (ipsilateral) axons
respectively
o Stellate cells: second most common cerebral cortical cell; star shaped with short
axons (Golgi type II); functions within local circuit

24
9 Ophthalmic Sense
Innervation of the Eye
- 6 out of 12 cranial nerves are dedicated to the eye
- II (optic) for vision, III (occulomotor) for raising eyelids and 4 ocular eye muscles, IV
(trochlear) for superior oblique muscle, V (trigeminal) for sensory of eye, VI (abducens) for
lateral rectus muscle, and VII (facial) for orbicularis oculi muscle
Development of the Eye

- Nerve cells will migrate from diencephalon floor to form two optic cups
- The optic cup has two parts, the pigmented retina (outer), and the neural retina (inner)
o Pigmented retina prevents diffusion of light to adjacent rods and cones
o Neural retina can be further split into five layers; the topmost is the photoreceptor
layer, comprising rods and cones; the second layer is made up of horizontal cells, for
lateral integration; the third layer is made up of bipolar cells, which carries impulses
to the fourth layer of amacrine cells; amacrine cells also deal with lateral integration,
but they have no axons; the last layer is made of ganglion cells, and their axons will
form the optic nerve
Components of the Eye

- Fovea centralis: spot on the retina where light is focussed; only has cones, and thus produces
the most acute vision
- Macula lutea: yellow spot surrounding fovea
- Optic disc: also known as blind spot; located medial to fovea
- Meyer’s loop: optic nerves will synapse in thalamus, and interneurons loop forward to form
Meyer’s loop before going to visual cortex
- Uvea: second layer covering retina; made up of choroid (primarily vascular), ciliary body
(which holds on to lens made of epithelial cells), and iris (structure controlling pupil size)
- Sclera: outermost layer of eye made of dense collagenous fibres; becomes transparent at
anterior of eye to form cornea

25
10 Digestive System
Mouth
- Lips: formed by orbicularis oris, covered by keratinized stratified squamous epithelium
- Teeth: hardest structure in body; made up of enamel, dentin and cementum layers; teeth are
kept in their sockets by the gingival, cementum and periodontal membrane
- Tongue: covered by stratified squamous epithelium; has papillae, which houses taste buds;
aids in chewing by pushing food between jaws, as well as swallowing and speaking;
innervated by trigeminal nerve (V), facial nerve (VII), glossopharyngeal nerve (IX) and
hypoglossal nerve (XII)
- Salivary glands produce and discharge secretions into oral cavity to moisten food, aid
swallowing and add enzymes to saliva; they also aid in speaking by moistening oral cavity
o Parotid glands: largest of the three, located anterior inferior to external auditory
meatus, and anterior to sternocleidomastoid; ducts enter oral vestibule opposite
second molar of upper jaw
o Submandibular glands: walnut-sized, located inferior to body of mandible
o Sublingual glands: smallest of the three, located in floor of mouth
o Ducts of submandibular and sublingual glands combine and enter floor of mouth
lateral to the lingual frenulum
Layers of digestive system

- Mucosa: mucous epithelial membrane with connective tissue, glands, blood vessels and
smooth muscle
- Sub-mucosa: epithelial membrane with loose connective tissue, blood vessels and nerves;
allows swelling of the tube
- Muscularis: made up of two layers of smooth muscles, an inner circular and outer longitudinal,
both of which aid in peristalsis; stomach has a third layer for churning
- Serosa: epithelial membrane with connective and adipose tissues with blood vessels
- Peritoneum: abdominal wall is covered by parietal peritoneum, while viscera is covered by
visceral peritoneum; peritoneal cavity lies between these two membranes
Oesophagus
- Extends from C6 (oropharynx) to T11 (stomach)
- Located anterior to bodies of thoracic vertebrae and posterior to trachea
- Covered by stratified squamous epithelium
- Muscularis layer has skeletal muscle in the first third, a mixture of smooth and skeletal
muscles in the second third, and smooth muscle in the last third
- Reflux of hydrochloric acid from the stomach into the oesophagus results in heartburn
Stomach
- Located inferior to diaphragm, skewed to left of midline
- Can be divided into the cardia, fundus, body and pylorus segments
- At the pylorus is the pyloric sphincter, which controls movement of chyme into duodenum
- Little absorption occurs here; examples of substances absorbed include alcohol, aspirin
Small intestine
- Begins with pyloric sphincter at L1 and ends with ileocecal valve
- Consists of the duodenum, jejunum, and ileum
- Mucosa layer is highly folded, with finger-like projections (villi) to increase surface area; on
the villi are microvilli, which contain acid phosphatase to aid absorption of calcium ions
- At the base of the folds are crypts of Lieberkuhn, which has cells of Paneth that secretes
enzymes for digestion of carbohydrates and fats; cells of the villi are also produced here
- Duodenum has Brunner’s glands to neutralize hydrochloric acid from the stomach and return
pH to 7.6; this is characteristic of the duodenum

26
- Ileum has masses of lymphocytes called Peyer’s patches to combat any incoming bacteria
- Most absorption in the stomach occurs in duodenum and jejunum
- Hydrochloric acid releases vitamin B12 in the stomach, and it is absorbed in the ileum
Large intestine
- Consists of cecum, ascending colon, transverse colon, descending colon, and sigmoid colon
- Receives undigested and unabsorbed food; water is reabsorbed here
- The cecum is a blind pouch beginning in right lower abdominal quadrant, and its opening
from the ileum is controlled by the ileocecal valve; its wall has many lymphocytes similar to
the ileum; the appendix is situated here
- Faeces is stored in the sigmoid colon; colon cancer is most prevalent here
Rectum & Anus

- Rectum is a straight tube lined with simple columnar epithelium, while anus is lined with
stratified squamous epithelium
- There are two muscle sphincters at the anus, one smooth and the other skeletal (for voluntary
control)
Liver
- Largest gland in body, weighs 3 pounds
- Located inferior to diaphragm, and has four lobes (right, left, quadrate, caudate)
- Right lobe is located at right abdominal upper quadrant, and is separated from the left lobe by
the falciform ligament; caudate lobe is superior to quadrate lobe, and both are posterior to
right and left lobes
- Rich in blood supply; hepatic artery and hepatic portal vein brings blood to liver from heart
and stomach, small intestine, spleen and pancreas respectively, while hepatic vein drains
blood from liver
- Structural and functional unit of liver is the lobule; it is hexagonal in shape, with a central
vein in the middle; plates of hepatocytes radiate from vein towards outer regions of lobule
- Hepatic triads, consisting of hepatic artery, hepatic portal vein, and bile duct, are found at
each point of the hexagon; hepatic artery and hepatic portal vein liberate their contents to flow
between hepatocytes through sinusoids into central vein
- Phagocytic cells, called Kupffer cells, line the sinusoids to remove worn out erythrocytes
- Central veins drain into the hepatic vein, which leads to the inferior vena cava
- Hepatocytes absorb nutrients from sinusoids and produce bile, which is carried by bile
capillaries between lateral faces of hepatocytes; bile is then either stored in gallbladder
(located on inferior surface of right liver lobe) or secreted directly into duodenum
- Fat in duodenum liberates cholecystokinin, which acts on gallbladder to contract, releasing
bile into duodenum to emulsify fat
- Liver stores glycogen, which can be converted to glucose to ‘feed’ brain, as well as vitamins
(A, D, E, K, and B12); it also modifies carbohydrates, fats and proteins for body to utilize
- Other functions include erythropoiesis in foetal stage, formation of fibrinogen, prothrombin
(for blood coagulation) and Kupffer cells, as well as detoxify nitrogenous waste
Pancreas
- Second largest gland after liver, located between stomach and duodenum
- Has exocrine and endocrine cells
- Acinar cells: exocrine cells which secrete enzymes into ducts that join bile duct and
eventually empty into duodenum; majority of cells in pancreas are acinar cells; examples of
enzymes include chymotrypsinogen and trypsinogen (both zymogens)
- Islets of Langerhans: endocrine cells that are scattered in groups amongst acinar cells; highest
concentration found in tail of pancreas
o Alpha islets secrete glucagon, which raises blood sugar
o Beta islets secrete insulin, which lowers blood sugar
o Delta islets secrete somatostatin, which inhibits other pancreatic hormones

27

28
11 Urinary System
Kidneys
- Located at posterior abdominal wall, posterior to parietal peritoneum (retroperitoneal)
- Left kidney is between T12 and L3, while right kidney is lower, due to large right liver lobe
- Indentation on kidney is called hilus; renal artery, renal vein and renal pelvis (proximal part
of ureters) enter kidney here
- Can be divided into cortex and medulla
- Made up of tubular structures which are either secretory or excretory
- Nephrons are the structural and functional unit of the kidney
o Renal corpuscle, made up of Bowman’s capsule and glomerulus
 Bowman’s capsule: outer parietal layer is made of simple squamous
epithelium, inner visceral layer is made of podocytes to allow for filtration
 Glomerulus: filters plasma to get glomerular filtrate (formed when plasma
travels through capillary endothelium past podocytes and basement
membrane), which eventually becomes urine
 Afferent arteriole which brings blood into nephron becomes capillary bed
(glomerulus) in Bowman’s capsule, and remaining blood is carried away by
efferent arteriole
o Renal tubules, comprising proximal convoluted tubule, loop of Henle and distal
convoluted tubule
 Proximal convoluted tubule: makes up most of cortex; lined by cuboidal cells
with brush border (microvilli to increase surface area); absorbs water, glucose,
amino acids, sodium ions and vitamin C
 Loop of Henle: descending limb reabsorbs water, while ascending limb
reabsorbs sodium and chloride ions
 Distal convoluted tubule: reabsorbs calcium, phosphate and sodium ions, as
well as water; hydrogen and potassium ions will also be secreted into tubule
o Renal pyramids, made up of collecting ducts (base at cortex, apex at medulla)
 Urine from pyramids drain into minor calyces (structures surrounding apex of
renal pyramids), which then lead to major calyces, renal pelvis and eventually,
ureters
- Anti-diuretic hormones (ADH, also known as vasopressin) act on collecting ducts to increase
uptake of water; reduced secretion of ADH causes diabetes insipidus
Ureters
- Conveys urine from kidney to urinary bladder; retroperitoneal, similar to kidney
- Lined by transitional epithelium; it changes shape depending on flow of urine
- Has two smooth muscle layers to produce intermittent contractions every 2-3 minutes, passing
urine along ureter
Urinary Bladder
- Ureters enter bladder in inferior posterior segment; important to note location, especially
during hysterectomies, so as to avoid nicking it and causing constant urine flow in patient
- Trigone is the triangular region formed between two ureteral orifices and internal urethral
orifice; it is sensitive to expansion, and once stretched beyond a certain degree, will signal
brain to empty bladder
- There are folds of membranes over both ureteral orifices, to prevent reflux of urine into ureter
when the bladder contracts
- Lined with transitional epithelium to facilitate expansion and contraction
- Has smooth muscle called detrusor muscle, which has stretch receptors to indicate time to
urinate (micturate)
Urethra

29
- Longer in males compared to females

- Females
o Smooth muscle surrounds whole urethra, and is called internal sphincter; external
sphincter, a skeletal muscle, is located at the opening of urethra
- Males
o Internal sphincter lies between bladder and prostate gland; external sphincter is
represented by the urogenital diaphragm
o Can be divided into the prostatic (surrounded by prostate gland), membranous
(surrounded by external sphincter), and cavernous (located in penis) urethra
o Prostatic urethra is lined by transitional epithelium, membranous urethra is lined by
stratified columnar epithelium, while cavernous urethra is lined by stratified
squamous epithelium

30
12 Endocrine System
Basic Characteristics
- Consists of individual ductless glands which are rich in capillaries
- Form and secrete hormones that have specific target organs (e.g. aldosterone acts on distal
convoluted tubule)
- Each gland has its unique cytology (cell structure)
- Comprises pineal gland, gonads (testes and ovaries), thyroid, parathyroid, adrenal gland, and
the pituitary gland
Pineal Gland
- Located posterior to epithalamus
- Produces melatonin (can inhibit gonadal development) to regulate Circadian rhythm
Gonads
- Ova originate in yolk sac and mature in the ovaries; other than housing ova, ovaries also
produce oestrogen and progesterone
- Testes produce sperm and testosterone
Thyroid
- Thyroid cartilage is located around trachea; immediately inferior to it is the cricoid cartilage
- Thyroid gland is a bi-lobed gland made up of follicles and connected by the isthmus; the
isthmus covers the 2nd to 4th tracheal cartilages
- Thyroid follicles are lined with cuboidal epithelium and filled with colloids; they contain the
storage form of thyroid hormone, thyroglobulin; the circulating form is called
triiodothyronine (T3)
- Thyroid stimulating hormone (TSH) is released from the anterior pituitary to act on thyroid
follicles to produce thyroid hormones; if the body lacks iodine, thyroid hormones cannot be
formed, and this will cause more TSH to be released, and eventually, overstimulation of the
follicles will result in goitre (enlargement of thyroid gland)
- The thyroid hormone regulates metabolic rate of all tissues, and helps in the development of
the nervous system
- Hypothyroidism in children is called cretinism, and this can cause severe stunted mental and
physical growth; in adults, it is called myxedema, and this can cause decreased mental and
physical activity
- Calcitonin, which lowers blood calcium, is also produced in thyroid
Parathyroid Glands
- Located on posterior surface of thyroid glands; there are usually four of them
- Parathormone raises blood calcium by activating osteoclasts to break down bone
Adrenal Glands
- Located on superior pole of each kidney; right gland is triangular shaped, while left gland is
semilunar shaped; retroperitoneal
- Can be divided into adrenal medulla (inner portion) and adrenal cortex (outer portion)
- Adrenal medulla is of neural origin, developing from neural crest cells; it produces
catecholamines (e.g. epinephrine, which acts on sympathetic nervous system; norepinephrine,
which is a vasoconstrictor)
- Adrenal cortex forms majority of adrenal gland; it produces glucocorticoids (e.g. stress
hormones like cortisol and hydrocortisone) and mineralocorticoids (hormones which regulate
water and electrolytes, e.g. aldosterone); excess glucocorticoids can reduce immune function
and cerebral cortical structure
- Addison’s disease occurs when there is hypofunction of adrenal cortex, resulting in low blood
pressure and pigmented skin, amongst other symptoms

31
- Cushing’s syndrome occurs when there is hyperfunction of adrenal cortex, resulting in high
blood pressure and obesity
Anterior Pituitary
- Located at sella turcica in sphenoid
- Has two components, the neurohypophysis (posterior pituitary) and the adenohypophysis
(anterior pituitary)
- Neurohypophysis comes from floor of diencephalon; secretes ADH and oxytocin (which acts
on uterus to induce contractions for birthing in females and smooth muscle of vas deferens for
strong contractions during ejaculation in males); hormones are produced in hypothalamus and
stored in pituitary
- Adenohypophysis comes from roof of mouth; made up of five types of cells
o Somatotropes, which secrete growth hormones
o Corticotropes, which secrete adrenocorticotropic hormone
o Gonadotropes, which secrete follicle stimulating hormone (FSH) and luteinizing
hormone (LH); FSH acts on ovarian follicles to release oestrogen in females and
seminiferous tubules in testes to produce sperm in males; LH acts on corpus lutem to
produce progesterone in females and interstitial cells in testes to produce testosterone
in males
o Thyrotropes, which produce thyroid stimulating hormone (TSH)
o Mammotrophs, which produce prolactin; prolactin acts on mammary glands to secrete
milk

32
13 Female Reproductive System

Basic Constituents
- 2 ovaries, which house maturing ova
- 2 Fallopian tubes, which transport ova from ovary to uterus
- 1 uterus, which houses and nourishes embryo and foetus
- 1 vagina, which receives secretions from uterus as well as penis during copulation; also
pathway for expelled foetus at birth
- Vulva, which are the external genitalia of females
- Ligaments related to reproductive system
o Ovarian ligament: attaches ovary to uterus
o Mesosalpinx: attaches ovarian ligament to Fallopian tube
o Mesovarium: attaches ovary to Fallopian tube
o Broad ligament: attaches uterus to body wall
o Round ligament: attaches uterus to labia majora; goes through deep inguinal ring into
inguinal canal and out from superficial inguinal ring
Ovaries
- Consists of connective tissue bed with follicles and developing ova
- At 7th month, foetus will already have all the ova it will ever have (~400,000 ova)
- Ovulation occurs between ten and fifty years of age
- Follicle with ova due to ovulate will grow in size, and develop an theca interna membrane;
FSH and LH acts on the theca interna to produce oestrogen
- The follicle will continue to grow in size, becoming a Graafian follicle
- Ovulation then occurs when the wall of the Graafian follicle breaks down and expels the
ovum out of the ovary into the Fallopian tube
Fallopian tubes
- Made up of simple columnar epithelium, with cilia lining the walls
- Fimbria, the finger-like projections on Fallopian tubes, will be engorged in blood during
ovulation, grasping the ovaries so that oocyte will enter Fallopian tube
- Fertilisation usually takes place in the tube; fertilized ovum then moves down to uterus to
embed and develop; ectopic pregnancy occurs if fertilized ovum embeds in Fallopian tubes or
peritoneal cavity
Uterus
- Largest mass of smooth muscle in female body
- Has three layers
o Parietal peritoneum, also called perimetrium, which is loose connective tissue around
the uterus
o Myometrium, which is a layer of smooth muscle
o Endometrium, which consists of blood vessels, glands, connective tissue, and simple
columnar epithelium
- Menstrual fluid is the product of the breaking down of the endometrium; if the implantation
of the ovum in the uterine wall is unsuccessful, it will slough off each month
Menstruation Cycle
- One cycle is roughly 28 days long
- Day 1 – 4: period of menstrual flow
- Day 5 – 14: proliferative stage, where the endometrium is rebuilt, with blood vessels and
glands to nourish the potential embryo
- Day 14: ovulation occurs
- Day 15 – 27: secretory (luteal) phase, where the glands enlarge and are filled with nutrients

33
- Day 27 – 28: ischemic phase, where the coiled arteries constrict, depriving endometrium of
blood supply and weakening the tissue; the arteries then open again to flood tissue with blood
and discharge outer endometrium lining
- Amenorrhoea is the absence of a menstrual period in a woman of reproductive age
Vulva
- Mons pubis: superficial fat pad over pubic symphysis
- Labia: folds of skin to protect clitoris, urethra and vagina
o Labia majora: has fat, muscle, glands and connective tissue; also has hair
o Labia minora: folds of skin with glands, no hair
- Clitoris: represents two erectile bodies which create a single projection, and will increase in
dimension with stimulation; homologous to the male penis
Breasts
- Covers 2nd to 6th rib, and attached to fascia of pectoralis major
- Has connective tissue surrounding and partitioning it
- Space between two adjacent connective tissue partitions is called a lobe, and it contains
secretory glands from alveolar cells; the ducts from these glands converge at the nipple
- Size is dependent on amount of fat

34
14 Male Reproductive System

Testes
- Primary sex organs (gonads)
- Forms sperm and produce testosterone
- Housed in scrotum away from body, as its optimal functioning temperature is lower than that
of the body; at cold temperatures, the cremasteric muscle will contract, raising the testes to
the body wall
- Originates from stem cells formed by yolk sac, and will migrate to site of testes formation
- Covered in a connective tissue capsule, and divided into lobules by connective tissue
partitions; each lobule will contain 2-3 seminiferous tubules which form spermatozoa
- Sertoli cells in seminiferous tubules supply nutrients and maintain hormonal level of
androgen and oestrogen for the sperm; also forms the blood testes barrier and phagocytises
cytoplasm cast off during formation of spermatozoa
- Luteinizing hormones act on interstitial cells (which are between seminiferous tubules) to
produce testosterone; follicle stimulating hormones act on seminiferous tubules to produce
sperm and Sertoli cells
Spermatozoa
- Head: contains nucleus of 23 chromosomes
o Acrosome: contains enzymes which allow sperm to penetrate ovum
- Body: contains spiral mitochondria, which provide energy for movement of tail
- Tail: propels the sperm
Testosterone Effects During Puberty

- Enlarges thyroid cartilage and affects vocal cords within it
- Activates prostate gland and seminal vesicles
Ducts and Glands

- Epididymis: sits upon testes; stores and nourishes sperm, allowing them to mature
- Vas deferens: strong muscular tube that contracts with ejaculation to propel sperm forward
- Seminal vesicles: produces the fructose in semen to nourish sperm after leaving epididymis
- Prostate gland: produces acid secretions to activate sperm
- Bulbourethral glands: found in urogenital diaphragm; neutralizes acid in urethra
Urethra
- Seminal vesicles are located on posterior surface of urinary bladder
- Vas deferens joins with ducts from seminal vesicles to form ejaculatory duct, which then
penetrates prostate gland to bring contents into prostatic urethra
- Internal sphincter is located above ejaculatory duct to close off urinary bladder during
ejaculation, separating urine from semen
Penis
- Made up of three cavernous bodies – a pair of corpora cavernosa penis and corpus cavernosa
urethra (also called corpus spongiosum penis)
- With parasympathetic stimulation, arterial blood will rush into these cavernous bodies, and
venous flow from the penis is blocked simultaneously, causing an erection
Semen
- Contains secretions from seminal vesicles, prostate gland, and bulbourethral glands, as well as
spermatozoa
- A male is considered sterile when the sperm count is below 20 million; average sperm count
is 200 million

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1

Red bone marrow

Skull – Calvarium (skullcap)

ME1/13 Foundation Term Anatomy LGZN

Skull – Facial Bones

ME1/13 Foundation Term Anatomy LGZN

Upper Extremities – Humerus

Upper Extremities – Radius and Ulna

Upper Extremities – Hand

ME1/13 Foundation Term Anatomy LGZN

Lower Extremities – Femur

Lower Extremities – Tibia

Lower Extremities – Fibula

Lower Extremities – Feet

Wound Healing in Fractures

Arthrology – the Science of Joints

ME1/13 Foundation Term Anatomy LGZN

Functional Types of Joints

ME1/13 Foundation Term Anatomy LGZN

- Bone develops in connective tissue membrane of embryo (mesenchyme)

Structural and Functional Units of Compact Bone

ME1/13 Foundation Term Anatomy LGZN

Muscles Attaching Upper Extremities to Trunk

ME1/13 Foundation Term Anatomy LGZN

Muscles in Arm and Forearm

Muscles of Pelvic Floor

ME1/13 Foundation Term Anatomy LGZN

o Hamstrings: consists of biceps femoris (origin at ischium and distal femur),

ME1/13 Foundation Term Anatomy LGZN

General Review of Formed Elements

ME1/13 Foundation Term Anatomy LGZN

ME1/13 Foundation Term Anatomy LGZN

ME1/13 Foundation Term Anatomy LGZN

Nerve Supply to the Heart

ME1/13 Foundation Term Anatomy LGZN

 Tunica adventitia: outermost layer made of connective tissue made of elastic

ME1/13 Foundation Term Anatomy LGZN

Disorders of blood vessels

ME1/13 Foundation Term Anatomy LGZN

ME1/13 Foundation Term Anatomy LGZN

Structure and Function of Pharynx

Structure and Function of Larynx

Structure and Function of Trachea

Structure and Function of Bronchi, Bronchioles, and Alveoli

ME1/13 Foundation Term Anatomy LGZN

Gross Anatomy of Lungs

Disease of the Lungs

ME1/13 Foundation Term Anatomy LGZN

Structural Classification of Neurons

Functional Classification of Neurons

ME1/13 Foundation Term Anatomy LGZN

Chemical Classification of Neurons

Development of Nervous System

ME1/13 Foundation Term Anatomy LGZN

Spinal Cord – Grey Matter

ME1/13 Foundation Term Anatomy LGZN

Spinal Cord – White Matter

Ascending Pathway – Pain & Temperature

Descending Pathway – Motor

ME1/13 Foundation Term Anatomy LGZN

ME1/13 Foundation Term Anatomy LGZN

Development of the Eye