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The rior cerebellar peduncle (brachium con- postsynaptic fibers run as reticulocerebellar junctivum) (p eriacta 100 mg with amex. The cerebel- The nucleocerebellar tract (C16) transmits lum receives primary and secondary vesti- tactile impulses of the facial area primarily bular fibers 100 mg eriacta visa. The primary fibers (B5) origi- from the trigeminal nuclei (C17) to the cere- nate from the vestibular ganglion (B6) (pre- bellum cheap eriacta 100 mg fast delivery. The fibers of the arcuatocerebellar dominantly from the semicircular ducts) tract (C18) originate in the arcuate nucleus and run to the cerebellum without synaps- (C19) and run to the floor of the fourth ven- ing discount 100 mg eriacta with mastercard. The secondary fibers (B7) synapse in tricle purchase eriacta 100mg with amex, where they form the medullary striae. Nearly all fibers They run crossed and uncrossed and are terminate in the nodulus, flocculus (B9), thought to terminate in the flocculus. The connection with the The uncinate fasciculus of cerebellum, a cere- vestibular nuclei also contains cerebellofu- bellospinal tract originating in the con- gal fibers (cerebellovestibular tract), which tralateral fastigial nucleus, has not been un- originate from the terminal areas just men- equivocally demonstrated in the human tioned and from the vermis of the anterior brain. Some of them synapse in the lateral vestibular nucleus and extend in the vesti- bulospinal tract (p. Inferior Cerebellar Peduncle 165 10 9 5 7 8 15 18 16 13 2 17 6 14 4 19 B Vestibulocerebellar 11 tract C Reticulocerebellar tract, nucleocerebellar tract, arcuatocerebellar tract 12 1 3 A Posterior spinocerebellar tract, olivocerebellar tract Kahle, Color Atlas of Human Anatomy, Vol. Together with the pyramidal tract and (2) in the dorsal thalamus (B13) from they form the cerebral peduncles (A1) in where the impulses are passed on to the which they occupy the lateral and medial cerebral cortex, mainly to the motor cortex. The cerebral cortex, in turn, second neuron cross from the pontine nu- affects the cerebellum via the corticopon- clei to the opposite side and form as the tocerebellar and cortico-olivocerebellar pontocerebellar tract the middle cerebellar systems. The postsynaptic Superior Cerebellar Peduncle bundles run crossed or uncrossed; however, they do not enter the inferior cerebellar (Brachium conjunctivum) (B) peduncle but extend as far as the upper Most of the efferent cerebellar pathways margin of the pons, where they turn and run through the superior cerebellar enter through the superior cerebellar peduncle. They terminate as mossy tering it is the anterior spinocerebellar tract. The descending fiber bundles originate from the fastigial nucleus (B8) and the globose nucleus (B9). They ter- minate in the medial nuclei of the reticular formation (B10) in pons and medulla ob- longata, where they synapse to form the ret- iculospinal tract. Thus, cerebellar impulses are transmitted to the spinal cord via two pathways, namely, the reticulospinal tract and the vestibulospinal tract. The fibers of the stronger ascending limb originate predominantly from the dentate nucleus (B11), but partly also from the em- boliform nucleus. They terminate in two areas: (1) in the red nucleus (B12), its sur- Kahle, Color Atlas of Human Anatomy, Vol. Middle and Superior Cerebellar Peduncles 167 1313 1212 77 11 22 55 66 33 1414 44 88 99 1111 1010 A Corticopontine tract, pontocere- bellar tract B Cerebelloreticular tract, cerebellorubral tract, cerebellothalamic tract, anterior spinocerebellar tract C Anterior spinocerebellar tract Kahle, Color Atlas of Human Anatomy, Vol. Diencephalon Development of the Prosencephalon 170 Structure 172 Epithalamus 176 Dorsal Thalamus 178 Subthalamus 192 Hypothalamus 194 Hypothalamus and Hypophysis 200 Kahle, Color Atlas of Human Anatomy, Vol. Over the third ventricleandinthemedialwallofthehemi- Brain and spinal cord develop from the sphere, the brain tissue is extremely thin neural tube which forms several brain ves- and becomes invaginated into the ventricu- icles at its anterior segment, namely, the lar cavity by protruding vascular loops rhombencephalon (A1), mesencephalon (A2), (p. The vascular convolutions lying diencephalon (A3), and telencephalon (A4). The developmental process hemisphere is torn away and only the sepa- begins in the rhombencephalon and ration line remains as the choroid line (C12). Development of the telen- exposeduptothisseparationline,whileitis cephalon is greatly delayed. A thin-walled still covered laterally by the thinned wall of vesicle forms on each side so that the telen- the hemisphere. The segment of the cephalon becomes subdivided into three thinned wall of the hemisphere between parts, namely, the two symmetrical hemi- the attachment of the plexus and the spheres (A5) and the unpaired median por- thalamostriate vein (C–E14) is called the tion (A6), which forms the anterior wall of lamina affixa (CD15). As they expand, vein (C–E14), which runs between particularly in caudal direction, the thalamus and caudate nucleus (C–E17), telodiencephalic boundary becomes dis- marks the boundary between diencephalon placed. Initially, it represents the frontal and telencephalon when viewed from border line (A7) but then runs more and above. Telodiencephalic Boundary (B–E) Only the floor of the diencephalon is visible at the surface of the brain; it forms the optic chiasm, the tuber cinereum, and the mamil- lary bodies at the base of the brain (p. The roof of the diencephalon becomes vis- ible only after cutting horizontally to re- move the corpus callosum (B). The entire region is covered by a Kahle, Color Atlas of Human Anatomy, Vol.

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The pelvic girdle and its as- Proximal phalanx sociated ligaments support the weight of the body from the verte- bral column buy generic eriacta 100mg line. The pelvic girdle also supports and protects the III Proximal lower viscera buy eriacta 100 mg on-line, including the urinary bladder cheap eriacta 100mg visa, the reproductive or- V IV II phalanx gans buy eriacta 100mg overnight delivery, and in a pregnant woman eriacta 100mg, the developing fetus. Metacarpal The pelvis is divided into a greater (false) pelvis and a bone Sesamoid I bone lesser (true) pelvis (see fig. These two components are Hamate divided by the pelvic brim, a curved bony rim passing inferiorly Capitate Trapezoid from the sacral promontory to the upper margin of the sym- Triquetrum Trapezium physis pubis. The greater pelvis is the expanded portion of the Pisiform Scaphoid pelvis, superior to the pelvic brim. The pelvic brim not only di- vides the two portions but surrounds the pelvic inlet of the Lunate Radius Ulna lesser pelvis. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 Chapter 7 Skeletal System: The Appendicular Skeleton 181 TABLE 7. Each os coxae (“hipbone”) actually consists of three sepa- ceives the head of the femur. Although both ossa coxae are sin- rate bones: the ilium, the ischium, and the pubis (figs. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 182 Unit 4 Support and Movement Fifth lumbar vertebra Ilium Sacral promontory Sacrum Sacroiliac joint Coccyx Pelvic inlet Anterior inferior iliac spine Head of femur Acetabulum Neck of femur Greater trochanter of femur Pelvic brim Obturator foramen Pubis Lesser trochanter Ischium Symphysis pubis FIGURE 7. Ilium Anterior Iliac crest Ilium gluteal line Iliac tuberosity Iliac crest Posterior gluteal line Anterior superior Anterior Auricular iliac spine superior surface Posterior iliac spine superior iliac spine Inferior Posterior superior gluteal line Anterior iliac spine inferior Posterior Anterior iliac spine Posterior inferior inferior inferior iliac spine iliac spine Arcuate line iliac spine Greater Superior sciatic notch Greater ramus of Superior sciatic notch ramis of pubis Spine of ischium pubis Lesser sciatic notch Spine of ischium Pubic Pubis tubercle Obturator foramen Lesser sciatic notch Inferior ramus Symphysial Ischium Ischium of pubis surface Obturator foramen Pubis Ischial Inferior ramus Inferior ramus Ischial tuberosity tuberosity Inferior ramus of pubis of ischium of ischium Acetabulum FIGURE 7. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 Chapter 7 Skeletal System: The Appendicular Skeleton 183 TABLE 7. The obturator foramen is cov- ered by the obturator membrane, to which several muscles attach. The body contributes to the formation of the symphysis pubis—the joint between the two ossa coxae. At the lateral end of the anterior border of the body is the pubic tubercle, one of inferior iliac spine. The posterior termination of the iliac crest is the attachments for the inguinal ligament. The weight of the viscera may weaken the surface of the ilium is the roughened auricular surface, which walls of the lower abdominal area and cause hernias. The iliac fossa is the smooth, con- problems of childbirth are related to the structure of the mother’s cave surface on the anterior portion of the ilium. Finally, the hip joint tends to deteriorate with age, so that muscle originates from this fossa. The iliac tuberosity, for the at- many elderly people suffer from degenerative arthritis (osteoarthrosis). Three roughened ridges are present on the gluteal surface of the posterior aspect of the ilium. These ridges, which Sex-Related Differences in the Pelvis serve to attach the gluteal muscles, are the inferior, anterior, Structural differences between the pelvis of an adult male and and posterior gluteal lines (see fig. In a vaginal delivery, a Ischium baby must pass through its mother’s lesser pelvis. Diameters may be deter- the ischium is the projection immediately posterior and inferior mined by vaginal palpation or by sonographic images. The ischial tuberosity is the bony projection that supports the weight of the body in the Thigh sitting position. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 184 Unit 4 Support and Movement Head of femur Greater trochanter Greater trochanter Fovea capitis femoris Intertrochanteric crest Intertrochanteric line Neck of femur Gluteal tuberosity Lesser trochanter Linea aspera Body of femur Lateral epicondyle Lateral epicondyle Medial epicondyle Intercondylar fossa Patellar surface Medial condyle Lateral condyle (a) (b) FIGURE 7. Femur The body of the femur has a slight medial curve to bring the knee joint in line with the body’s plane of gravity. The body of the femur has several distinguishing features femur articulates with the acetabulum of the os coxae. On the proximolateral side of the body is roughened shallow pit, the fovea capitis femoris, is present in the greater trochanter, and on the medial side is the lesser the lower center of the head of the femur. It Lateral also articulates both proximally and distally with the fibula. Two epicondyle of femur slightly concave surfaces on the proximal end of the tibia, the medial and lateral condyles (fig. The condyles are separated by a slight up- Patella ward projection called the intercondylar eminence, which pro- vides attachment for the cruciate ligaments of the knee joint (see Head of figs.

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Uptake of calcium by active transport predominates 15% is excreted in the urine purchase eriacta 100mg visa. Phosphate reabsorption occurs in the duodenum and jejunum; in the ileum cheap eriacta 100 mg on line, simple diffu- via active transport generic eriacta 100mg fast delivery, mainly in the proximal tubule where 65 sion predominates buy eriacta 100mg on line. The relative importance of active trans- to 80% of filtered phosphate is reabsorbed buy generic eriacta 100 mg online. Parathyroid hor- port in the duodenum and jejunum versus passive diffusion mone inhibits phosphate reabsorption in the proximal tubule in the ileum depends on several factors. At very high levels and has a major regulatory effect on phosphate homeostasis. With moderate or low calcium intake, however, ac- tive transport predominates because the gradient for diffu- Substantial Amounts of Calcium and Phosphate sion is low. Enter and Leave Bone Each Day Active transport is the regulated variable in controlling calcium uptake from the small intestine. Metabolites of vi- Although bone may be considered as being a relatively inert tamin D provide a regulatory signal to increase intestinal material, it is active metabolically. Under the influence of 1,25-dihydrox- calcium and phosphate both enter and exit bone each day, ycholecalciferol, calcium-binding proteins in intestinal mu- and these processes are hormonally controlled. Mature bone can be simply de- The small intestine is also a primary site for phosphate ab- scribed as inorganic mineral deposited on an organic frame- sorption. The mineral portion of bone is composed largely of sion, but active transport is the primary mechanism. As indi- calcium phosphate in the form of hydroxyapatite crystals, cated in Figure 36. However, phosphate absorption from the prises about 25% of its volume, but because of its high den- small intestine is regulated very little. To a minor extent, ac- sity, the mineral fraction is responsible for approximately tive transport of phosphate is coupled to calcium transport. Bone contains considerable Therefore, when active transport of calcium is low, as with vi- amounts of the body’s content of carbonate, magnesium, tamin D deficiency, phosphate absorption is also low. The Kidneys Play an Important Role in Regulating The organic matrix of bone on which the bone mineral is deposited is called osteoid. Type I collagen is the pri- Plasma Concentrations of Calcium and Phosphate mary constituent of osteoid, comprising 95% or more. Col- As a result of regulating the urinary excretion of calcium lagen in bone is similar to that of skin and tendons, but and phosphate, the kidneys are in a key position to regulate bone collagen exhibits some biochemical differences that the total body balance of these two ions. The remaining non- important signal to the kidneys to direct the excretion or collagen portion (5%) of organic matter is referred to as retention of calcium and phosphate. Ground substance consists of a mixture of various proteoglycans, high-molecular-weight com- Renal Handling of Calcium. As discussed in Chapter 24, pounds consisting of different types of polysaccharides filterable calcium comprises about 60% of the total calcium linked to a polypeptide backbone. This eralized bone, they lose much of their bone-forming ability orderly association of hydroxyapatite crystals with the colla- and become quiescent. At this point they are called osteo- gen fibers is responsible for the strength and hardness char- cytes. A loss of either bone mineral or organic teoblast stage are maintained into the osteocyte stage. These connections become visible channels or canaliculi Complete demineralization of bone leaves a flexible collagen that provide direct contact for osteocytes deep in bone framework, and the complete removal of organic matrix with other osteocytes and with the bone surface. It is gen- leaves a bone with its original shape, but extremely brittle. The three principal cell types involved in bone Osteoclasts are cells responsible for bone resorption. Osteoclasts promote bone resorption by secreting Osteoblasts are located on the bone surface and are re- acid and proteolytic enzymes into the space adjacent to sponsible for osteoid synthesis. Surfaces of osteoclasts facing bone are tively synthesize proteins for export, osteoblasts have an ruffled to increase their surface area and promote bone abundant rough ER and Golgi apparatus. First, gaged in osteoid synthesis are cuboidal, while those less ac- osteoclasts create a local acidic environment that in- tive are more flattened. Numerous cytoplasmic processes creases the solubility of surface bone mineral.

A sagittal MRI of a 23-year-old woman is located at generic eriacta 100mg amex, or immedi- (B) Glossopharyngeal (IX) ately adjacent to order eriacta 100mg with visa, the midline buy 100mg eriacta fast delivery. Which of the following spaces or (C) Hypoglossal (XII) structures would be in the image and would indicate a midline (D) Trigeminal (V) plane? The labyrinthine artery is an important source of blood supply to (C) Interpeduncular fossa the inner ear buy eriacta 100 mg with amex. Which of the following arteries represents the ma- (D) Interventricular foramen jor vessel from which this branch usually arises? A 20-year-old man is brought to the emergency department from (C) Posterior inferior cerebellar the site of a motorcycle accident buy cheap eriacta 100mg on-line. He is unconscious and has a bro- (D) Superior cerebellar ken femur, humerus, and extensive facial injuries. Axial CT shows (E) Vertebral a white layer on the lateral aspect of the left hemisphere that is ap- proximately 5 mm thick and extends for 12 cm. The quadrigeminal artery in a 20-year-old man is occluded by a fat most likely represents: embolus originating from a compound fracture of the humerus. Which of the following portions of the ventricular system does not (E) Superior and inferior colliculi contain choroid plexus? MRI reveals a large tumor (3 cm in diameter) at the cere- (E) Third ventricle bellopontine angle, most likely a vestibular schwannoma (sometimes incorrectly called an acoustic neuroma). A 47-year-old man presents with an intense pain on his face aris- ing from stimulation at the corner of his mouth. MRI shows a vessel (A) Anosmia compressing the root of the trigeminal nerve. Which of the fol- (B) Hemianopsia lowing vessels would most likely be involved? A lumbar puncture, commonly called a “lumbar tap,” consists of a ferent limbs of the corneal reflex? Which (B) III, IV, VI (oculomotor, trochlear, abducens) of the following is the most likely level for the insertion of the nee- (C) V and VII (trigeminal, facial) dle? A 73-year-old man is brought to the emergency department after (D) S1–S2 being found in his garage in a state of confusion. CT shows an in- (E) T12–L1 farct involving much of the superior frontal gyrus. An MRA (A) Angular artery (Magnetic Resonance Angiography) shows an aneurysm in the in- (B) Callosomarginal artery terpeduncular fossa (and cistern) arising from the basilar tip. The MRI of a 49-year-old woman shows a tumor located immedi- (C) Optic (II) ately superior to the corpus callosum. This lesion is most likely lo- (D) Trigeminal, V1 (V) cated in which of the following lobes? As this lesion expands, due (D) Parietal to edema, and impinges on the immediately adjacent cortical ar- (E) Temporal eas, which of the following deficits would most likely be seen? The examination reveals that the woman has a non- (D) Weakness of facial muscles fluent (Broca) aphasia. A sagittal MRI shows a lesion in which of (E) Weakness of the upper extremity the following gyri? A 47-year-old woman presents with seizures and ill-defined neu- (B) Inferior frontal rologic complaints. The examination reveals a bruit on the lateral (C) Lateral one-third of the precentral aspect of the head immediately rostral and superior to the ear. A (D) Middle frontal CT shows a large arteriovenous malformation in the area of the lat- (E) Supramarginal eral sulcus. Which of the following Brodmann areas represents the primary (A) Inferior sagittal sinus somatosensory cortex? The collection of posterior and anterior roots that occupy the lum- bar cistern are collectively known as which of the following? A 64-year-old man awakens with a profound weakness of his right (A) Cauda equina hand. The man is transported by ambulance to a major medical (B) Conus medullaris center, a distance of 240 miles and taking several hours.

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