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By H. Ismael. Concordia College, Bronxville, New York. 2018.

The conjunctiva can be palpated as they pulsate in the (a) covers the entire eyeball generic 500mg cyklokapron amex. Varicose veins occur when which of the following become(s) excessively enlarged? Which of the following could not be (a) saphenous veins (b) tibial veins 9 order cyklokapron 500mg online. Describe the locations of the following palpated within the cervix of the neck? Comment on the clinical (c) the trachea (e) all of the above importance of each of these regions order cyklokapron 500 mg mastercard. Palpation of an arterial pulse in the neck each of the following could be observed or is best accomplished at 1 generic 500 mg cyklokapron with visa. List four surface features of the cranium palpated: (a) the distal tendinous (a) the carotid triangle buy 500 mg cyklokapron overnight delivery. Identify the four regions of the face and and small saphenous veins; (d) the (d) the submandibular triangle. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 342 Unit 4 Support and Movement Critical-Thinking Questions 2. A Saturday afternoon athlete crashed to the intensive care physician when possible complication of using the while mountain biking without a helmet. He sustained deep cuts across the front of neck is required for the rapid 3. It is often necessary in the critical care his knee, across the back of his elbow, administration of fluids and medications. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 Nervous Tissue and the Central Nervous System 11 Organization and Functions of the Nervous System 344 Developmental Exposition: The Brain 346 Neurons and Neuroglia 348 Transmission of Impulses 357 General Features of the Brain 358 Cerebrum 363 Diencephalon 372 Mesencephalon 373 Metencephalon 374 Myelencephalon 376 Meninges 378 Ventricles and Cerebrospinal Fluid 381 Spinal Cord 384 Developmental Exposition: The Spinal Cord 390 CLINICAL CONSIDERATIONS 391 Clinical Case Study Answer 396 Chapter Summary 397 Review Activities 398 Clinical Case Study A 56-year-old woman visited her family doctor for evaluation of a headache that had persisted for nearly a month. Upon questioning the patient, the doctor learned that her left arm, as she put it, “was a bit unwieldy, hard to control, and weak. He also found weakness, al- though less significant, of the left lower extremity. Sensation in the limbs seemed to be normal, although mild rigidity and hyperactive reflexes were present. Expressing concern, the doctor told the patient that she needed a CT scan of her head, and explained that there could be a problem within the brain, possibly a tumor or other lesion. After explaining the patient’s case, the doctor remarked parenthetically that he believed he knew where the problem was located. Why did the doctor suggest to the patient that there might be a problem within her brain when the symptoms were weakness of the extremities, and then just on one side of her body? Explain the muscle weakness in terms of neuronal path- ways from the brain to the periphery. FIGURE: Improvements in radiographic imaging have greatly enhanced the Hints: Remember the controlling and integrating function of the brain. Carefully study the in- visualization of anatomical structures, and are formation and accompanying figures concerning the structures and functions of the brain and indispensable aids to diagnostic medicine. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 344 Unit 5 Integration and Coordination with the endocrine system, regulates the functions of the other ORGANIZATION AND FUNCTIONS body systems. The brain, however, does much more than that— OF THE NERVOUS SYSTEM and its potential is perhaps greatly underestimated. It is incompre- hensible that one’s personality, thoughts, and aspirations result The central nervous system and the peripheral nervous system from the functioning of a body organ. Plato referred to the brain are structural components of the nervous system, whereas the as “the divinest part of us. Together have devised the technology for launching rockets into space, they orient the body, coordinate body activities, permit the assimi- curing diseases, mapping the human genome, and splitting atoms. But with all of these achievements, the brain still remains largely Objective 1 Describe the divisions of the nervous system. Neurology, the study of the nervous system, has been re- Objective 2 Define neurology; define neuron. Basic ques- tions concerning the functioning of the nervous system remain Objective 3 List the functions of the nervous system.

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Sebaceous glands and arrectores pilorum muscles (de- scribed previously) are attached to the hair follicle (fig cyklokapron 500 mg discount. People exposed to heavy metals purchase cyklokapron 500mg fast delivery, such as lead buy cheap cyklokapron 500 mg line, mercury discount cyklokapron 500mg without a prescription, ar- senic purchase cyklokapron 500 mg fast delivery, or cadmium, will have concentrations of these metals The arrectores pilorum muscles are involuntary, responding to in their hair that are 10 times as great as those found in their blood thermal or psychological stimuli. Because of this, hair samples can be extremely important pulled into a more vertical position, causing goose bumps. Humans have three distinct kinds of hair: Even evidence of certain metabolic diseases or nutritional defi- ciencies may be detected in hair samples. There is a deficiency of zinc in the hair of mal- ally seen only on premature infants. It Hair color is determined by the type and amount of pigment is especially abundant in children and women just barely produced in the stratum basale at the base of the hair follicle. The more abundant the melanin, the darker in most elderly people), and sometimes curly. Gray or white hair is the result of a lack of pigment production lanugo: L. Integumentary System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 5 Integumentary System 117 Hyponychium Eponychium Nail matrix Free border Body of nail Hidden border Nail groove Nail fold Lunula Eponychium Body of nail Nail bed Free border Creek Hyponychium Hidden border Epidermis Nail root Dermis Pulp Distal phalanx Developing bone (a) (b) FIGURE 5. The free border of the nail extends over a thickened re- grows continuously. It is found on the scalp and on the faces gion of the stratum corneum called the hyponychium (hi'po˘- of mature males. It is the most common An eponychium (cuticle) covers the hidden border of the type of hair. These harder, transparent the nakedness of our skin does lead to some problems. Skin cancer cells are then pushed forward over the strata basale and spinosum occurs frequently in humans, particularly in regions of the skin ex- posed to the sun. Fingernails grow at the rate of approximately related to the fact that hair is not present to dissipate the oily secre- 1 mm each week. The condition of nails may be indicative of a person’s general health and well-being. Nails should appear pinkish, showing the rich vascular capillaries beneath the translucent nail. A yellowish Nails hue may indicate certain glandular dysfunctions or nutritional defi- ciencies. A The nails on the ends of the fingers and toes are formed from the prominent bluish tint may indicate improper oxygenation of the blood. The Spoon nails (concave body) may be the result of iron-deficiency ane- hardness of the nail is due to the dense keratin fibrils running par- mia, and clubbing at the base of the nail may be caused by lung cancer. Dirty or ragged nails may indicate poor personal hygiene, allel between the cells. Both fingernails and toenails protect the and chewed nails may suggest emotional problems. Each nail consists of a body, free border, and hidden bor- Glands der (fig. The platelike body of the nail rests on a nail bed, which is actually the stratum spinosum of the epidermis. The Although they originate in the epidermal layer, all of the glands body and nail bed appear pinkish because of the underlying vas- of the skin are located in the dermis, where they are physically cular tissue. The sides of the nail body are protected by a nail supported and receive nutrients. Integumentary System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 118 Unit 4 Support and Movement Sebaceous gland Sweat gland FIGURE 5. The coiled structure of the ductule portion of the gland (see ar- rows) accounts for its discontinuous appearance. If the ducts of sebaceous glands become blocked for some reason, the glands may become infected, result- ing in acne. Sex hormones regulate the production and secretion of sebum, and hyperactivity of sebaceous glands can result in se- rious acne problems, particularly during teenage years. Sudoriferous Glands Eccrine Commonly called sweat glands, sudoriferous glands excrete per- Apocrine sweat gland spiration, or sweat, onto the surface of the skin. Perspiration is sweat gland composed of water, salts, urea, and uric acid. It serves not only for evaporative cooling, but also for the excretion of certain FIGURE 5.

They also penetrate into the lower in- of neurons that originate in the supraoptic nuclei and par- fundibular stem cheap 500 mg cyklokapron with amex, where they form another important capil- aventricular nuclei of the hypothalamus purchase cyklokapron 500 mg line. The capillaries of this network converge into these neurons are large compared to those of other hypo- short hypophyseal portal vessels purchase cyklokapron 500 mg on line, which also deliver blood thalamic neurons; hence cyklokapron 500 mg, they are called magnocellular neu- into the sinusoids of the anterior pituitary generic 500 mg cyklokapron amex. The hormones arginine vasopressin (AVP) and oxy- blood supply to the anterior lobe of the pituitary gland is tocin are synthesized as parts of larger precursor proteins known as the hypophyseal portal circulation. Prohor- When a neurosecretory neuron is stimulated to secrete, mones are then packaged into granules and enzymatically the releasing hormone is discharged into the hypophyseal processed to produce AVP and oxytocin. Releasing hormones travel transported down the axons by axoplasmic flow; they accu- only a short distance before they come in contact with their mulate at the axon terminals in the posterior lobe. Only the amount of releas- Stimuli for the secretion of posterior lobe hormones may ing hormone needed to control anterior pituitary hormone be generated by events occurring within or outside the secretion is delivered to the hypophyseal portal circulation body. These stimuli are processed by the central nervous by neurosecretory neurons. Consequently, releasing hor- system (CNS), and the signal for the secretion of AVP or mones are almost undetectable in systemic blood. Secretory granules containing the hor- synthesis and secretion of a particular anterior pituitary CHAPTER 32 The Hypothalamus and the Pituitary Gland 583 M hormone. Corticotropin-releasing hormone (CRH), thy- rotropin-releasing hormone (TRH), and growth hor- 2 Hypothalamus mone-releasing hormone (GHRH) stimulate the secretion Third and synthesis of ACTH, TSH, and GH, respectively ventricle (Table 32. Luteinizing hormone-releasing hormone 1 (LHRH), also known as gonadotropin-releasing hormone Superior (GnRH), stimulates the synthesis and release of FSH and hypophyseal LH. In contrast, somatostatin, also called somatotropin artery release inhibiting factor (SRIF), inhibits GH secretion. All Median of the releasing hormones are peptides, with the exception eminence of dopamine, which is a catecholamine that inhibits the Long portal synthesis and secretion of PRL. Releasing hormones can be Stalk vessels produced synthetically, and several are currently under Anterior study for use in the diagnosis and treatment of diseases of lobe the endocrine system. For example, synthetic GnRH is Posterior Hormone- now used for treating infertility in women. These signals are gen- Hormone Hormone erated by external events that affect the body or by changes occurring within the body itself. For example, sensory nerve excitation, emotional or physical stress, biological rhythms, changes in sleep patterns or in the sleep-wake cy- cle, and changes in circulating levels of certain hormones or Vein metabolites all affect the secretion of particular anterior pi- Short portal Vein tuitary hormones. Signals generated in the CNS by such vessels events are transmitted to the neurosecretory neurons in the Inferior hypothalamus. Depending on the nature of the event and hypophyseal the signal generated, the secretion of a particular releasing artery hormone may be either stimulated or inhibited. In turn, this response affects the rate of secretion of the appropriate an- terior pituitary hormone. M represents a magnocellular neuron releasing AVP or oxytocin at its axon terminals into capillaries that give HORMONES OF THE POSTERIOR PITUITARY rise to the venous drainage of the posterior lobe. Neurons 1 and 2 are secreting releasing factors into capillary networks that give Arginine vasopressin (AVP), also known as ADH, antidi- rise to the long and short hypophyseal portal vessels, respec- uretic hormone, and oxytocin are produced by magnocel- tively. Releasing hormones are shown reaching the hormone-se- lular neurons in the supraoptic and paraventricular nuclei of creting cells of the anterior lobe via the portal vessels. This action of AVP works to counteract the conditions that stimulate its secretion. For example, re- Proteolytic cleavage ducing water loss in the urine limits a further rise in the os- molality of the blood and conserves blood volume. Low blood AVP levels lead to diabetes insipidus and the exces- AVP + NP-II + GP sive production of dilute urine (see Chapter 24). Oxytocin Stimulates the Contraction of Smooth AVP, arginine vasopressin; NP-II, neurophysin II; GP, glycoprotein. Muscle in the Mammary Glands and Uterus Two physiological signals stimulate the secretion of oxy- tocin by hypothalamic magnocellular neurons. The axons of these neurons form ing stimulates sensory nerves in the nipple. Afferent nerve the infundibular stem and terminate on the capillary net- impulses enter the CNS and eventually stimulate oxytocin- work in the posterior lobe, where they discharge AVP and secreting magnocellular neurons. Oxytocin stimulates the contraction of myoepithe- each consisting of nine amino acid residues. Two forms of lial cells, which surround the milk-laden alveoli in the lac- vasopressin, one containing arginine and the other con- tating mammary gland, aiding in milk ejection.

J Ultrasound Med 17:157 In plantar fasciitis buy cyklokapron 500mg lowest price, the fascia is thickened (>4 mm) and 6 buy 500mg cyklokapron visa. Martinoli C cheap 500mg cyklokapron otc, Derchi LE buy generic cyklokapron 500 mg online, Pastorino C et al (1993) Analysis of becomes hypoechoic order 500mg cyklokapron fast delivery. Radiology 186:839 Fibromatosis of the plantar fascia appears as hypoe- 7. Kalebo P, Allenmark C, Peterson L et al (1992) Diagnostic val- choic fusiform avascular nodules without acoustic en- ue of ultrasonography in partial ruptures of the Achilles ten- don. Khan KM, Bonar F, Desmond PM et al (1996) Patellar tendi- The US signs of degenerative or inflammatory joint dis- nosis (jumpers knee): findings at histopathologic examination, eases of the foot and ankle are similar to those of the hands. Diaz GC, van Holsbeeck M, Jacobson JA (1998) Longitudinal split of the peroneus longus and peroneus brevis tendons with disruption of the superior peroneal retinaculum. Prato N, Derchi LE, Martinoli C (1996) Sonographic diagno- sis of biceps tendon dislocation. Magnano GM, Occhi M, Di Stadio M et al (1998) High-reso- lution US of non-traumatic recurrent dislocation of the per- oneal tendons: a case report. Silvestri E, Martinoli C, Derchi LE et al (1995) Echotexture of peripheral nerves: correlation between US and histologic find- ings and criteria to differentiate tendons. Wiener SN, Seitz WH (1993) Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options. Torn anterior talofibular ligament (arrowhead), joint ef- depiction of partial-thickness tear of the rotator cuff. Jacobson J, Lancaster S, Prasad A et al (2004) Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis. Hollister MS, Mack LA, Patten RM et al (1995) Association of sonographically detected subacromial/subdeltoid bursal ef- fusion and intraarticular fluid with rotator cuff tear. Bachmann GF, Melzer C, Heinrichs CM et al (1997) Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens. Sauramps poechoic nodule is seen in the intermetatarsal space Medical, Montpelier, France 166 S. Hammar M, Wintzell G, Äström K et al (2001) Role of US in management of developmental dysplasia of the hip. Pediatr the preoperative evaluation of patients with anterior shoulder Radiol 25:225-227 instability. Martinoli C, Bianchi S, Gandolfo N et al (2000) Ultrasound of of sonography. Arch Orthop Trauma Surg 102:248-255 nerve entrapments in osteofibrous tunnels. Richardson ML, Selby B, Montana MA et al (1988) 20:199-217 Ultrasonography of the knee. Skeletal Radiol 33:63-79 Seminars in musculoskeletal radiology 2:245-270 24. Skeletal Radiol 30: 605-614 nosis (jumper’s knee): findings at histopathologic examination, 25. Van Holsbeeck M, Introcaso JH (1991) Musculoskeletal ultra- US and MR imaging Radiology 200:821-827 sound. Miller T, Adler R, Friedman L (2004) Sonography of injury of friction syndrome: sonographic findings. Bianchi S, Martinoli C, Zamorani MP et al (2002) Ultrasound Radiology 2:223-235 of the joints. De Maeseneer M, Lenchik L, Starok M et al (1998) Normal amination of lateral epicondylitis. AJR 176:777-782 and abnormal meniscocapsular structures: MR imaging and 29. Marcelis S, Daenen B, Ferrara MA, edited by RF Dondelinger sonography in cadavers. Lee JI, Son GIS, Yung YB et al (1996) Medial collateral liga- New York ment injuries of the knee: Ultrasonographic findings. Jacobson JA, Jebson PJL, Jeffers AW et al (2001) Ulnar nerve sound Med 15:621-625 dislocation and snapping triceps syndrome: diagnosis with dy- 53.

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