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Uh oh, yeah. Um, so, yeah, we're going to be covering basic clinical silent sciences. I'm just gonna try and get to the next line, but it's just not letting me. Okay? Yeah, for you. So we're gonna be covering about pituitary gland hormones the spinal cord on. We're going to go over the structure of the C. N s. The PMS we're going to be looking at pain pathways touch and proprioception in, and then we'll cover some brain anatomy and then finally send pharmacology specifically on the eye drugs. Um, so starting off this kind of a heavy session, but we're going to start off with the hypothalamus. So the hypothalamus is the master control center of the endocrine system, and it basically regulates the posterior on the anterior pituitary glands. So another word for posterior pituitary gland is the neuro high for hypothesis on the anterior pituitary gland is called the A dental hypothesis. So both these glands release hormones when they receive a message from the hypothalamus. So the posterior particular pituitary gland stores and releases hormones made by the hypothalamus on, But, um, that, uh, anterior pituitary makes its own hormones. So the posterior pituitary hormones are synthesized in the super optic nuclei of the hypothalamus. That's the S O N. And that's where a D. H is made on. Oxytocin is made in the paraventricular nucleus of the hypothalamus. So oxytocin is, um may so just remember the oxytocin and 8800 in the posterior pretreat land on in the anterior pituitary gland, you have FSH LH a ct hate TSH, prl endorphins. And he hates So there's a good way of remembering this. So flat Peg is how we were taught it so f for FSH. That's follicle stimulating hormones. And this is stimulated in the gonna gonna do troves. You have LH luteinizing hormone, a C T H a dental Kortrijk, a trophic hormone on derived stimulating hormone That's the flat, and then prolactin and dolphins and G h. So now let's take a closer look at the cells of the anterior pituitary. So you have somatic roast, um gonadotroph corticotropin thyrotropin on lacto tro electric roaster. So now I'm going to look at what hormones act on these cells, Um, that I found in the anterior pituitary. So if it has an orange border, they released by the hypothalamus, so somatostatin pain Act on somatotrope on this, in turn inhibits our decreases The production of growth hormone gastrin VIP glucagon insulin tier states and prolactin that g n a hkn stimulates, um Atro tropes to increase both hormone production. There have been some studies that showed that somatic statin can inhibit geo jacket, but that also g n I hate acts on gonadotroph so on that in terms increases luteinizing hormone follicle stimulating hormone release. Um, so going on to corticotropin See, I hate act on corticotropin to release increased the release of a C T. H um trh accent, tired trips to increase TSH and prolactin production. And finally, dopamine inhibits, like to troops on that decreases the production of PERL. Um, so let's look at testosterone specifically so testosterone. It is a steroid hormone on that means it can pass the blood testes barrier on the main function includes muscle hyper hyper trophy, so matter Genesis and secondary sexual characters, and how it works as acts on adjacent to totally cells. And it also is released into the blood and acts on other sites of the body. So, so totally cells produce androgen binding hot protein, which basically acts on storage molecules for testosterone on keeps Test restaurant A really high concentration in the PSA totally cells. So ever state stimulates the PSA totally cells on l. A stimulates that lady excels on inhibit on testosterone work on a negative feedback cycle. So, yeah, let's look at the action off growth hormone, um, from the hypothalamus. So growth hormone is released by somatotrope. So from the anterior pituitary gunned, so it promotes the growth. It promotes growth and its main targets our bones on muscles. So it their fax congrat into both direct on indirect actions. So let's look at the direct first. So muscles, um, it cannot directly on the muscles by decreasing glucose uptake. Increasing protein animal is, um on. It can also increase muscle mass. It can work on the liver by increasing gluconeogenesis iss. But it also increases the production of I GF. And it finally acts on adipose tissue by decreasing glucose uptake, um, increasingly little Liporal isis and decreases fat deposits on day. Finally, I'm just going to look at how it indirectly can act So indirect actions convinced do tid action or incident like growth, growth factor growth factor. So it can work on skeletal muscles where effects cartilage formation on bone deposition. And it can also work on soft tissue growth. So moving on to the structure off the nervous system. So the nervous system basically consists off the brain, the spinal cord, the sensory organs and all of the nerves that basically connect together to bring the body, um, to WIC in one specific way. So you can see here that the nervous system is split into the CNS and the pianist The PMS is further divided into the NS on the somatic nervous system. Um, and the ultimate the autonomic nervous system is and further divided into Paris and pathetic and sympathetic divisions. So that could be a lot to remember. I'm just gonna go into the somatic one because we went to hold that much about it, um, last year. But the somatic never system is associated with activities traditionally thought off as conscious or voluntary, so it carries messages throughout the body in order to initiate and control our bodies movements. So this system processes sensory information from external stimuli, like when you see something when you hear something, when you feel something with your skin on. It also also coordinates motor information, and then it carries the signals two. And from the central nervous system, the brain and spinal cord on then this is so it can interpret what the sensory information means. Um, and it can control the voluntary movements a swell so the somatic nervous system is involved in the relay off sensory and motor information on censoring um neuron or also known as Afrin. Neurons tend to send information to the CNS from internal organs like lands, muscles and skin on from external stimuli. Motor neurons, however, known as effort neurons, transmit signals from the CNS to Scully to muscle to either directly or indirectly to control muscle movements. So this slide just summarizes the embryo logical origin off the CNS for kind of students. I wouldn't say it's as important, but if you just want to look at this after the session, that's when because we have a lot of stuff to cover. So now let's look at the structure off the spinal tract. So the spinal tract begins at the foramen of Magnum. On it ends at the lumbar vertebrae, so it travels between, um through the vertebral canal so There's 30 to 1 mixed nerves and their eyes from the spinal cord. So cervical you have eight of them at the rustic. You have 12 number, you have five and sacral. You have five and cock a jewel, you have one. So good way to remember this is you have breakfast at eight. Lunch at 12 and dinner, um, at five and then snacks at one end. So that's how I would remember it. So ate breakfast. 12 lunch, five PM dinner and then one AM um, snacks. Uh huh. So going back to the list. So it's not uniformed throughout, so there's an enlargement in the cervical and lumbar region, so you can see on the diagram. That's because it supplies the upper and lower limbs, respectively. So the Conus medullaris is in the spinal cord ends at L1 or two, and the cord cardiac winner is the origin of spinal nerves, inferior to the Conus medullaris. Okay, so spinal nerves are called mixed notes because it's a mix off Afrin and effort fibers, like I said earlier. So there's two types of neurons this Afrin new ones, like we said for info from the periphery to the central on this F rinse so in for from the central to the periphery on the peripheral nerves. Origin originate from the cranial. So that's 12 lbs of those and the spinal that to one Pez. So center information travels through the door so route. So this just followed this diagram through the dorsal root and the effort nerve cell body that could be found in the dorsal, um, ganglion. So effort neurons travelling through the ventral route and they have a motor function. They can either be somatic or autonomic on. The somatic nervous system is for voluntary movement on the contraction off skeletal muscle. Where is the autonomic nervous system controls involuntary muscle contractions? That would be your heart beating on, um, stuff like that said. These neurons work sign ups to another neuron and eventual root ganglion or somewhere else, and that will carry the impulse to the target tissue. So this diagram is just assumed inversion of the other one, and it might look a bit confusing, but basically there's pyramidal tract, and these were involved in voluntary control off the body in the face Onda, the corticospinal tract supplies the musculature of the body And you just need to remember that the cortical bulb attracts supplies the musculature of the head and neck. So we're gonna go into some similar to Genesis. So each of us a mites divide into three parts the dermato, um, the sclera term and the myotome. Um, I find these really hard to remember, but I've got some new Monix to help that on the dermatomes innovate the skin, the sclerotome innovate the cartilage and the bone compartments on the Meyer terms innovate the skeletal muscle. So the each dermatomes they might be like, what? Dermatitis, innovator. And it basically an area off the skin supplied by a cutaneous branch off a nerve of the spinal nerves. So you'll know that at this level, dismantle work there. So, um, his use diagnose a level of spinal injury on a good way to remember these. If you're of the question is this diagram is a way of remembering, because it kind of goes systematically around it. So 12, um, 12345 along here and also want to tear 12345 Down here, all you can remember. I see. For the color, um, c for color, and then you have to for tits. So that's around the nipple area. Um, Alpha, um, for little word in the leg is knee said that would be where the near supplied s for You sit on your bum. So as for here on T 10 belly button, that's not the way of remembering it. Um, that that's just ah way I would go about Romberg so that to 10 is the umbilicus, So moving onto some key terms I'll be using So you have proprioception. So that's, um, sense where your body limbs are. So that's how you know that your arm, even when you close your arms, I mean, close your eyes. You know where your arm is in your legs. It's sort of like where you perceive your body is in a time in a certain time or space around you, and it's involved in balance. Um, so that's because our muscles and attend on a tendons contain proprioceptor is that tell us where that limits so conscious proprioception is conveyed via the dorsal column pathway. So the posterior spinal cerebella tract on day anterior spinous terrible attract carries proprioceptor information from the lower limbs the roster. Oh, Spinal cerebral attract and the Q Know Cerebella tract carries purpose active information from the upper limb. So to say that again, the posterior on the anterior spinal spine Oh cerebella from the lower limb and the rostral and cuneus cerebella from the, uh, pill, um so non purpose active neurons would be extra receptors, which I'll go on to after, but you also have no sir section. So that's when there's an indication off tissue damage so you'd get pain. So how I know that there's something wrong here, they might be a stinging feeling. There might be a feeling of pain on that's cause nearest transmitters for this, um, like substance. P and glutamate would be released here on Wed. No, I'll go into the pathway later, but that's how you know there's pain on pain is defined as the subjective, unpleasant sensory experience associated with most reception on the Each patient, if they say they're helpin, will probably have pain, even if you doubt it, because obviously it's a subjective, unpleasant sensory experience, and each person will experience it differently. Um, so I'm gonna go into extra receptors, but they basically respond to stimuli outside of the body. Like perhaps it does monitor the internal body, um, temperature and the stretch off muscles on if a muscle is moving or not. So these are the extra receptors of the skin. So I hope this diagram is okay, but this is a nice summary of it. So you could have naked endings. The's a fast, freaking pain, slow burning pain and touch and pressure. You could have the hair follicle, So if you move your hand, you're has conduct techtv touch of I had deflection and you could have the Merkel discs. Um, so that could be slow adopting touch and pressure. The Meisner is call puzzle here on that's fast acting touch on pressure on the Pekinese in pork. If you remember that, as I think, like you know, like, um, some mice a cold like McKinney in mice or something occurring with the exact No, But they have really big ears. And if you think like in here, the vibrations. So that's how you can remember that on roof, Any carpets all share stress. They kind of I drew this because it kind of looks like the part tree. So this diagram doesn't really show it. But love diagrams will show them looking like calm trees. So moving on to this, um, we're going to look at a promoter and lower motor neurons. So on a promoter, neuron pathology would affect the nerves running from the brain into the spinal cord. Onda lower motive you're on pathology would affect the nerves that originate in the spine on going to muscles. Um, so, generally, an upper motor pathology increases something on the lower motor neuron pathology would decrease something. So first ordinary owns from the body has it's cell body in the dorsal root ganglion on, in a sense, or descendants. Um, sorry. I'm just gonna just makes me and a sense of Descents from one off two spinal levers levels in the louses first facility fasciculus. And after which it's sign APS is to another in the dorsal horn of grey matter of the gray matter. So the second ordered neuron begins in the substantia gel. A gelatin osa, um on the deck is it's decadent. Just means coursing over across by the anterior white commissioner, and then it makes its way up to the thalamus. I'll go into our what this means in a bit more depth later on. But this is where our signals are split between the anterior and the lateral. Um, tracks. So third order neuron would be traveling from the thalamus to the primary Smarter sensory cortexes that would be throughout the brain. So you'd go from my red marker here. Maybe this to this first order second order and then through the brain would be third order. So that owner and troubles and thalamus to the primary smarter sensory cortexes. This is the same as the media lemon isco's pathway, as they both ah, sensory pathways. So let's look at their sending tracks. So ascending tracks receive sensory information from the periphery. So the cerebellar or to the cerebellum cortex entering by the conscious track. So that will be the dorsal column, medial meniscus tract or the spine at the Lamictal back. So I'll go into those in the next line, but they both have three in your own pathways. Discriminative, uh, conscious. Um, discriminative would be fine. Touch vibrations on purpose separative on. But that's when the stimuli detected by beta and alpha fibers. I'll, um, I'll go into that in the next few slides. But discriminative touch would be detective here, conscious on appropriate section would also be detected here. And the Meisner. This sells, I said, would detect the vibrations a swell on long axon. Done signals would also be detected here, so pain is really important in our body because that's the only way we know when something's wrong. So if there's a flame near our hands are body would twitch. You ate because we'd get that feeling of pain. Or if there's a swelling that's compressing something because of infection. We know there's something wrong because of the pain, um, or damage to tissue on basically it just. Or if you are starting to really uncomfortable position all day, staring at a screen like most of us will be, um, there's a reason you're feeling pain because of that bad cost you that you're having or you're putting stress on to a certain area. So there's different types of pain. There's visceral, somatic referred and cutaneous, so visceral pain would be autonomic sensations from visceral organs, so sensations perceived by its own ascending pathway, the spine Oh, ridiculous tract on which runs to the reticular formation in the in the brain stem and it's often referred. That mean referred just means something. So in heart pain an example, this is a teaser into a case. Um, if you're a card, if that, um, if you have a heart problem, you might get referred pain in the arm, so the problem is in the heart, but the pain will be in your arm, so that would be an example of referred pain. Um, so go into offensive pain from the viscera appears to come from the surface. Often it's very distinct characteristics Off referred from three Children is different so hard you learned more about this in the case for the heart that her pain will come will be like in the arm in the neck, in the stomach, in the jaw, are in in the lower back as well. Um, so somatic pain originates within the body so likely to be caused by trauma or degenerative changes or inflammatory conditions like an infection. Catania's would be superficial on the surface, like if you have a cut and it stings. So we're gonna have an SBA, um, so which of the following nerve fibers is responsible for conducting the fast, sharp pain so the options are a delta C fibers, a Balfa, a beater or none of the above. Um, if you guys just want to answer the polls, I think the police up. Yeah, um, don't worry, and I can't see who's I can't see who has voted, so, um, just having a go is fine. This topic's quite hard. So I understand that. Just have a girl. Will see, Um um, I'll give it a few more seconds and then will Shall we stop it? That just so just the time. So it was, um, kind of a mix, but most of you went for a which was the correct answer. Um, if it's gonna let me change slides Oh, no. Yeah. So a was the correct answer. So a delta fibers are responsible for really fast stabbing pains. So let me go through that. So a alpha fibers are nerve fibers that curry information related to proprioception. So that's the sense where muscle is. Remember Aybe to fibers. Ah, car information related to touch A Delta fibers carry information related to pain and temperature on D C. Nerve fibers carry information related to pain, temperature and, um, feelings like itches. a swell, Um so specifically, I'm gonna cover these three. So a delta fibers, A simple naked nerve endings with a high threshold because of mechanic receptors. And they're responsible on this mechanic receptors present on day respond to intense mechanical stimuli. So that's first. There's fast my latest fibers, and I response will fast, fast shop Well, localized pain. Um, so a beta fibers. There's many different never endings here, like the misers corpuscle is and the reference I endings on there for very fast. They have very faster mile a native on they're responsible for deep, superficial touch on vibration and proprioception. Um c fibers there from the simple night naked nerve endings responds to intense mechanical stimulation and temperature on DC'd, um, ical irritants as well on their unmyelinated. So they're much slower on this Means they're responsible for slow, secondary, poorly localized pain says I could dull ache often associated bone, um, injuries. So this is just a summary off the different pathways that I mentioned earlier. So, um, this two major ascending tracks, the dorsal on the spine, atomic, the dorsum column, pathway on the cortical spinal injuries would be it's electoral desensitization on spinothalamic could be contralateral. Um de sensitize is I'll go into this a bit later when I talk about different syndromes. The going into this So the media Lemonis skull docile column pathway is responsible for discriminative to touch vibrations and conscious proprioception. Um, so in the, uh, pill, um, you have the fasciculus connect our Canadians, too. I can never pronounce his Canadians to the nucleus. Continuated of the medulla oblongata on down in the lower limit have the facilities grassless to the nucleus of the gross. A list of the middle on Glatter on within the medal, um, guided the fibers desiccate so they cross over and they travel in contralateral um, ways so that two of the medial limitus cus to the thalamus on the thalamus to the it's electoral primary sensory cortex, um, for the spine at the Lamictal. Last way that's involved in pain, temperature on simple touch on. That's from the sensory receptors in the periphery. On they end to the spinal cord and assent 21 to 2 vertebral levels and they sign ups at the substantia gelatin osa for time. I'm going to move on, but I'm just This is a really good summary. If you guys want to come back and make notes on it from the feedback form, um, just to quickly specifically look at the dorsal column. Medial meniscus. The also has two tracks. The physical is continuing it Canadians, Like I said earlier, sensory axons enter above the level of T six on the first, less crusty list where the sensory accent and to below the level of t six. And that's why you have the difference between the upper limit. The lower limb I'm so proud of reference Neuron is the first to carry the impulse to the medulla on the it's electro side. So that's the same side. Um, you know, in, um, isotonic, it's electoral I the same concentration the same side of the body on a second order, a neurons, internal arcuate fibers desiccate. So cross over to the other side at the medulla at the media Lemonis, cas and sign ups at the problem is on. After the thalamus, they performed the third of said, or the neuron, the thalamocortical neuron, which ascends through the internal catcher in terminates at the Somatosensory cortex. Remember what I said? The third ordinaries go through the brain um so, yeah, these are the lesions I spoke about earlier that you may need to know about brands of cards, but I included the others as well. So the web desiccate means crossing over. So like I said earlier, some nerves will come from this side, but then cross over to the other side and go to the brain on this side. Um, that's what it means that when an accident in this day and ask cause from one side to the other. Um, Contralateral loss of sensation would mean if you had a lesion on this side. But because the nerve across over to the other side, before or after the pain will be on the loss of sensation will be on the opposite side. Um, so it's electoral be loss of sensation on the same side. So if you had a lesion on this side, you lose the sensation on the same side. So, um, in browns a card syndrome, it's commonly caused by a tumor or a penetrating injury. So if you had, like something like you really hard on the side and you get really penetrate the injury, that would cause it, um, Onda for the door. So, um, Darcel cord syndrome is commonly caused by trauma to the neck or occlusion off the spinal artery to miss as well on disk, um, freshen and also can be caused by vitamin B 12 deficiencies. Other diseases could be multiple sclerosis that can cause that and also syphilis has been known to cause it to, um, ventral card syndrome, also known as anterior spinal artery syndrome, commonly caused by is associated with the compression of the anterior spinal artery on for burst. Fractures for the central spinal cord syndrome is commonly caused by damages to the vertebrae in the neck and herniation of the virtual discs. By did the main one to look as this because I think you were visited later on. So let's have another SBA. So which of the following no transmitters is involved in the US ascending pain pathway? Is it glutamate? Is it noradrenergic in substance P adrenaline or 80 hitch? Um, remember, I put see who and said so just feel free to call whatever you like. Um, I'll give it a few more seconds on D. Um, it's fine to give it a go. Um, there's not really see if I would it happen in this, um as also, uh huh. So just have a go if you want. Um, I think I'm going to close it. That, um I might end up whole, uh, on D Hi. Sorry about that. I think my wife I just cut out. Um, but I think that would have given everyone enough time to answer. This question is early. I'm going to continue that in. The recording has continued, but the answer was substance. Um P So I'll get into why in a second. So I was going to change the slide. Okay, So, um, damaging on area in our body can lead to the release of prostaglandins you'll get. This is really important for case one for people in Cardiff, but the damage American release prostaglandin clendinen in that area, which is a type of cytokine. And this stimulates the Afrin sensory fibers, which then relay this impulse to the C n s s o. First order neurons from the body has hit cell body in the dorsal root ganglion on. It basically ascends or descends Oh, to, um, Tuesday and levels in the list. So the facilities iss, particularly after which it sign ups is to a dorsal horn off the Graeme Matter. So second or a second order neuron begins in the substantia substance, uh, July the second or the nerve begins the substantia gelatin osa, and it desiccate crosses over across via the anterior white commissioner, and then it makes its way up to the thalamus via the lateral spinal thalamic tracks. So the third or dinner and travels from the thalamus to the primary somatosensory cortex on stuff like non steroidal anti inflammatory. So and said's are painkillers like aspirin and ibuprofen and block enzymes like cyclo oxygen, a XYZ so cox enzymes that produce these prostaglandin so you don't have that pain. So that's why I'm I'm approved. Then we'll stop you getting pain from stuff because it stops the initial release off prostaglandin. It's on, but it's not triggering this pathway. They're sending pain pathway. Um, so now let's move on to the descending pain pathway so the periaqueductal gray or the pack from the mid brain sends a signal to the rough I nuclear smugness on this basically stimulates five hit junior on to release noradrenergic on serotonin. Um, this serotonin inhibits the presynaptic membrane from releasing more substance p like we said earlier in the question on that stimulates the Interneuron to release and cephalothin on endogenous opioids for analgesia. Um, this stops the presynaptic membrane from releasing the neuro transmitter on the postsynaptic membrane from depolarizing as well. You guys may have heard off gait three. So that's when a non painful stimuli triggers and impulse Buy a beta $5 on this signal basically overrides the initial painful stimuli by occupied, occupying that second order neuron. Hence stopping, um, the pathway. So I've got another SBA. Hopefully, I don't come out again. Um, but yes. So which of these cells takes up the access glutamate? Okay, um, in just for time, in a few seconds, I'm gonna cut two after, like, a minute. So just have a go. I really can't see who has answered. What? So you honestly just guess? So, which of these would take up that excess fluid to May? There's maybe just a neuro transmit to, by the way, um, the pain and stuff on sensory similar. Um, I think, Yeah. So most of you is a split between C and D. Um, So you guys were quite close, but the answer waas astrocyte It's, um if it's gonna let me change the slide. Um, okay, Yeah, Sudan. PSA was astrocyte. So this is just a summary off the cells of the CNS and the Penis so you can have a pin down more cells. The's create the barrier between the compartments and they're also source of neural stem cells can also have astrocyte. So So this is what we just talked about. They are also source of neuro some cells and they take up to the absorb. They kind of looked like a sponge. I was imagined, but they take up potassium water and other neuro transmitters like glutamate. Um, microglia, which was what Some of you I said, they're the scavengers. So they kind of look like, ah, an insect sort of thing they saw scavenge on day. Um, the kind of like, um if there's a good pathogen, they'll seek them out and find them and eat and just sort of like the immune system of the brain. Sort of like thing. Um, but as you can see, it's astrocyte so that do the most. So they take up this. They secrete neurotrophic factors they help form the blood brain barrier, but they also provide substrates for a TB production. So if you just remember, they do these I functions. That's a good thing to remember. A little tender sites also form the mile in sheets, so in the pianist, you have Schwann cells, Onda satellite cells. But that's more about, um, the nerve structure on D. I were going to that today, so let's move on to brain anatomy. So these the lobes of the brain. So you have the occipital lobe at the back for the brain. The frontal lobe coincidentally called the frontal lobe because it's at the front of the brain, the temporal and the parietal, um so the brain, although it has loves it's also for the split up into functional areas. So you have the sensory area here, and the motor area here on the higher the front of the brain is for higher mental functions. But let's specifically look at the brokers and the verticals. Erica's their clinically significant. So that's this bit on this bit so broke his area. So this is for this is the anterior speech. This is the interior. So towards the front speech area, and it's found in the frontal cortex, just anterior to the facial region off the primary motor cortex. And it controls speech production so that if you have damage to this area's say the blood supply was called Do two stroke, you could have stuff like Braca aphasia. So this will come into play when you come to, I think Case five. Um, but it's important to know. So um, Broca's aphasia said our expressive stage. So this is when you retain speech comprehension but have broken speech related important content. So functional words, which have only grammatical significant significance, will be left out. So you understand what people are saying. You can't convey what you're trying to say, so you'll have broken speech. Now let's look up vertical area. So this is the posterior speech area, so that's normally found in the superior temporal got gyrus. Soon it's one. It's responsible for the comprehension off speech. So this one you understand, but you can't say it. This one. You do understand, um so damage here Canaries, ult in verticals, aphasia or receptive aphasia, And this will result in a patient who conspicuity. But their words were like any meaning. So this one that they understand. But they can't communicate this one. They don't understand that they can communicate. Um, so there's a connection between these two, so the actual it fasciculus connects the bronchus area to the vertical area so you can tell how important these are clinically if there's a stroke or blood supply, like lacking there or damage. So this is just the cross section of the brain. So say you sliced in half. Um, so you can clearly see the thalamus here, the hypothalamus, the picture Triglides like we talked about earlier. You have ventricles on the cerebrum, which is just this round bit so as you saw in that diagram, you, um, the limbic system until basically there's a lot of function. So it's involved in emotion, behavior, motivation, long term memory and also all faction. So this is really important again for case five. So this is, um, um, this topic, MP says, is really good to visit for your case. Five. Original few. The brain topic. So the limbic system is kind of I call it the memory system. Who is really it's really involved in memory. But the thalamus, the hypothalamus. The pituitary gland, the hippocampus that Magdala the prefrontal cortex. Singular gyrus. The ventral Trajan mental area on the basal ganglia are involved. So basically most of these, um, but let's look at the basal nuclei. So, um, you might get asked to label this. We usually get this in, like an x ray form. Are that the I thought this diagram most quite good. So you have the card. Eight Nuclear slicking, like on eyebrow is being the lateral ventricle. Because the the gray and white matter as well, quite clearly s. So you have the putem in here? The globus had pallidus here, Um, the subtelomeric on the substantia in a nigra here. Um, this round bit here is a columnist. When you cut it in half, you can see that, Um, so just remember these ventricles trouble. I just gaps and they travel around the brain. Um, clinically won't be important, is the substantia nigra. So in Parkinson's disease, there's a loss of dope in, um, does dope in, um, Najid neuron in the substantia nigra, um, so that can affect in Parkinson's disease. So the basal nuclear together are involved in motor functions, controlled landing and behavior and also emotions. So there's love and asked me to remember during, um, this case. So this is just the circle of Willis. So you have the anterior cerebral artery, which is this is you looking up from the brain from above. So this is the brain strep that would lead down to the spinal cord. So you're kind of looking up at the brain. So, um, the pleasure antirougeurs communicating artery in between these two communicating between the two until it's Arabella arteries, the internal carted the posterior cerebral. These are all just a basic ones. That temporal artery, the interest final artery and the posterior communicating artery. This one's conveniently also called the Middle Cerebral Artery, cause it's in the middle, but on the inside, it's called the internal Cartage. So another SBA so say you're heavier. Kept craniotomy surgery. What's the first meningitis layer that you would need to drill past? Would it be a the p a mater? The Iraq? Would it be be there recognized space? See the superior sagittal Sinus D the oh, it's going to say in furious agita. Sinus. Um, sorry. The alcohol that type of or either durum eight Oh, so if everyone just wants to answer? No, I think by computer just fell. I'll give it a few more seconds, but, um, I think I'll ended that just so that we can keep the pace up. Okay, So most of you said he and that is the correct answer. So the answer is durum a ta if it's gonna let me move slides. Yeah. So the dura mater. Um so this is just a diagram If any of you can't read this, um, just messes me. Honestly, I I could You could just let me whenever. But this is the skin are, um Layer, This is the peri or Stimlje. This this kind of spongy holy layer is the cranium. So that's the skull, The bone of the skull. And now you've reached that later you're gonna hit the dura mater. So now these are the meninges now, so the dura mater, then you have the rock arachnoid mater. And if you think of, um, you know arachnophobia spiders, So spider webs. So there's less a spider webs under there recognized may tough. So there's loads of these green spiderweb things that are still a green. But in this diagram. They look kind of like spider Web type things. And then you have the PM eight er which is where the arachnoid space stuff attach is, um, these red and blue circles just blood vessels traveling along the brain to supply the different parts. So in this space that see CSF, so that's cerebrospinal fluid. Um, so, yeah, this is just a cross section. You might be able to, um, ask you that label this diagram. So you have the scalp, this mucusy these finger like projections. That's the subarachnoid space Where the CSF um, this is the P m. A two layer around here. So the dura mater, um here is that thick layer of dense, irregular tissue and that's the outermost layer of the meninges. Um, then you have the arachnoid mater. So that's in the seborrheic node space for the CSF. So there's a rich blood supply here. See conceive vessels and stuff traveling, and you have the PM eight. Oh, so that's the really delicate layer. And it's the innermost layer, and that's permissible toe water and salutes and allows blood to pass through. So this is a really thin fibers, connected tissue and that's really important for exchange. So the meningitis basically just acts as a predicted protective layer around the CNS. Okay, these are just the bones of the skull. Say, conceal the frontal parietal temporal occipital, just like the lobes of the brain. Um, what's harder would be these bones here. So you have this Dilaudid process mastoid process this around the ear. There's that external auditory canal of quite easy to remember this the annoyed pick that space here, Um, zygomatic like the cheek bone area here, Um, the maxilla, um, and the mandible as well. There's also these suggested the Coronas a choice. So I think that's where your crown would sit like around here. Such and they have the sagittal on the occipital, so it's clinically relevant. Would be. You see where these four, um, plates, um, meet that area is called the tarry on on. It's kind of clear significant because all those plates meet that that area here is really weak. So if you have a hit in the head there, that's the week is part of the skull because it's it's where all these borders me on. If you have a hit that coincidentally, the meningea artery runs directly below that. So you could have a hemorrhage. Um, because of the men in jail bleed so you might see like a CT scan. Well, there's, like a meningioma bleed. This is again, um, important. Clinically, because of cerebral hemorrhage is so you can have epidural hemorrhages. So, um, this is the door on the schools, and normally it's not terribly. So that could be due to the middle middle meningea artery, cause of damage to the terry on region. Or it's common in skull fractures on you. Present with lack of consciousness, a headache and also vomiting, you can have a subdural one, um, which you couldn't see here. These kind of looked like a banana That looks like a lemon. That's how you can tell the difference. I was told once in another revision session. But, um, head trauma so subdural can because I had trauma or of motor vehicle accident, off falls or assault. So, um, this is in the door between the dura and they're acknowledged space. Um, and his clinical presentation would be you'd be in a coma, or you'd be having a lucid interval I/O of consciousness. You'd have a progressive decline or you just be fully just not conscious. So let's look at the sub arachnoid hemorrhage that's here. Um, so this is what within the arachnoid space within those figure likes projection areas. So that's often do to an aneurysm. So that's a rupture, often artery or invested. That could be a rupture of the cerebral artery. And you present with nausea, vomiting, like thunderclap headaches. So you have a really sudden, severe headache. Ah, um, like seizures as well. So you might have a stiff neck. Um, that can also be due to meningitis. For if you have a stick that you have a reaction to let you have headaches without any information as well on you can have an intercerebral. A hemorrhage. That's right here. So that's within the cerebrum itself. On a common cause could be stroke, um, caused by drugs, bleeding disorders, hypertension, CVD Um, that was in the other case we did with the cardio case, but ah, a clinical presentation. Be loss of consciousness. Neurological signs on symptoms would like headaches, nausea, all of that stuff. So may be gone. Um, so I couldn't find a good enough diagram for this, but I kind of drew on. So here would be the mid brain. That's where um, Creon that was one and two would be these red. I've labeled the cranial nerves us, so you have the midbrain here that's associated with vision and hearing a motor control sleep on wake cycles on also the level of alertness you are or the temperature regulation to, um, you'll see why, because the cranial nerves are relevant to these are also rise from that. But this round is the ponds, and it contains a nuclei that relay signals from the floor brain to the cerebellum along the nuclear that deal primarily with sleep and also respiration, swelling, bladder control, hearing equilibrium, taste I movements, station expressions and facial sensations in posture. I've put most information on this lives because it's good for making notes on. But medulla is the lower part here, and that's the half of the brain stem that contains the cardiac respect tree vomiting based so motor centers and regulates autonomic involuntary functions such as breathing and heart rate and BP. So your respiratory center would be here as well, I thought. This diagram also clearly shows the Colonel made position. Safety. A good way to go is 1234567 So six is here. 123456789, 10, 11 and 12. So let's look at these cranial nerves. So this is another diagram. So midbrain pons brain stem. So how They're awesome. Crude ways off Remembering this, um, the crude a is usually the better way, but we I remembered as oh, to touch and feel a very good girls. Um vagina ah, have been. But then to remember the modality you could remember, as some say, marry money. But my mother says boobs matter more so some sensory sensory. Um, some say marry Motta. Um, money. Both, um, you know, like like that. So some same. Are you money? But my brother says so be sun for both S s. Some so sensory motor would be married. So, um olfactory. So that would be involved in the smell. Optic could be vision. So that's around here and the mid brain or kill a motor. So that's, um, said that is, uh, the elevator palpebra a a swell the superior medial and inferior erecti. It would do I'll get into this later because I've got a few good slides on the eye, but also the inferior oblique muscles and the parasympathetic innovation to the sillier muscle on the sphincter people. A So you have the trochlea um oh, to touch on. Probably a somatic motor superior oblique trigeminal had a neck paranasal, Sinuses, meninges, and external surface is off the tympanic membrane muscles off mastication. Um, Abdu, since so that's the lateral, um, rectus muscle Feel so, um, a run tympanic membrane taste toe until two thirds of the tongue of the muscle and the facial expressions as well. And you also have the sympathetic to all the glands of the head except the parotid gland. Um, this w o clock. Leah So cochlea, You know, you have the copy in the year, so hearing and balance glossopharyngeal prostrate that of the tongue. Um, I just think like glossy foods. I don't know, but I was think tongue for that, um, internal surface of the tympanic membranes. Well courted body taste like to party membrane is in the year taste uncrossed. You're that the term stylopharyngeus muscle and the person departed gland Vegas XT another important one So that's the external ear firing. Slurring viscera taste in the epiglottis. Muscles of the pharynx and larynx Paris inventing in the neck and thorax and abdomen. Spinal accessory. So that's the trapezium on the standard, standard kind of bastard. So if you're testing that know you'd ask them to shrug. And if there if there's something wrong with that nerve, they can't move that trapezius muscle, um, to shrugs. Also the hypoglossal. So all of the muscles of the tongue except the pellet a glass is So now we're gonna look at the eye. So, um, this is quite scary I to make it clear this is the right. I guess I put a nose here, but, um, I highly recommend drawing out this table on drawing out this cause it really, really helps if you just practice drawing up. So this says in fear, oblique, you know, lateral rectus. This just tells you the direction in which they go. So if you just practice drawing this out quite a few times, you'll kind of nail what you to the muscles do that? Um, I'm just gonna talk through each of the muscles off the eyeball, so you have four rectum muscles 1234 on each of them originate from a con common tenderness ring. So that's a tissue around that optic canal on the back of the orbit. So the superior rector's attach is to the superior Onda anterior aspect off the sclera. Um, so the movement off that would be, um adduction. So I'm just trying to find it. So addiction on medial rotation So a good way of remembering the difference between if this is where the nose is? Um, this is medial so adduction towards the middle. When you abduct someone, you take them away from home. If you have middle as home, abduction would be away from the center. So moving a limb abducting it would be away from the medial. So yeah, so this does adduction and medial rotation. Um, the envy erectus attach is to the inferior and anterior aspect of the sclera. So that's movement and depression. A little adduction as well. Um, a natural rotations or down and in Yeah, on the medial rector's would be attach is to the Antara medial aspect of the sclera. On that would be movement would be adductors the eye so towards the nose. Um added, add it was the nurse a duct. The lateral rectus attach is to the anterola lateral aspect of the sclera. On the movement would be abduct so it away, so abducts it away from the middle, away from the nose. That way, you also have a bleak muscle. So these muscles that take an angular approach to the eyeball said attach. These kind of go in an angle, not the fall, um, top side and top side. So it comes in an uncle, and these muscles attach to the posture surface of the ice that, unlike these, the's kind of come from behind my diagrams, all that good. But you look at another doctor and we can see clearer. But superior oblique would be this one. So it from the body of the steroid bone. So, like I said earlier, there's that depression, um, passes through the top top. Clear on attach is to the square of the eye behind the superior rectus muscle. Um, so just behind here, it touches on the movement. Would be it depress? Is it, um, depress is it? Abducts it away from the midline and medially rotates the I sit down. I'm sorry. I'm not down. It would go. Yeah. Down and out. So superior Oblique. Sorry I was here. Superlatively abducts it away. Um, else, um depress. Is it on? Right. Medially rotates it that way, down and out. So the invariably, um, would be here. So that's the from the anterior aspect of the orbital floor. It comes from an attach is to the square of behind that lateral rectus on it. The elevates the eye and abducts it. So that's away from the nose on laterally rotates the eyeball. So up and out. So they kind of going the opposite ways. So invariably, that way, superior oblique That way. So the my movements, my eye movements in these diagrams look kind of creepy That a good way of remembering these movements would be s 04 l r. Six rest three. So it kind of looks like a chemical formula. So let's dissect that s so far down and out, so s so far. So sfr would be superior of bleak. That's what the S. O stands for. On day number four would be the cranial nerves. So that's the trochlea November. Oh, to touch and feel so s 04. Super oblique cranial nerve. Far down and out. So you look down. So a last six up and out. So lateral rector's Ella six character No love would be Abdus since, um and then the next. That was a good transition. So lest three so up and in. So that's all you Basically just the rest are all the third cranial nerves, So that would be ocular motor nerve, and they all move it up in it. So, um so a stimulus. So this is just about how your I would actually detect a stimulus. So stimulus is detected in the eye and the impulse basically travels along the optic nerve through the optic cup to the optic chiasm on It continues via the optic track to the lateral geniculate nucleus. So that's these yellow, um, spots here on at the lateral geniculate nucleus. It continues along that optic Brady along the optic Brady a shin to the back of all the way to the back of the head to the optic, these primary visual cortex of the back of the brain, like we labeled earlier. So it comes in. So imagine this is that visual field. The pink is the side. So it goes to the back of the eye. And, um, this diagram just to sort of tells you different lesions. So let's look at that. I'm just going to talk through it. So if you had a lesion at here, so say something damaged this tract here, you would have this type of visual defects, so the black area would be where you can't see. See, let's follow that red. So here it doesn't dexity rumba deck is it means crossing over this red. Um, we're following a by the way, this red keeps on this side, so that doesn't affect this eye. Um, let's look at be so you have that crossing. So this, um, if you look at the pink in the red, that affects both of these nerves. So that's why both, um, this is fully blind on that one. Um, looking at by temporal. So that would be See. So that's a a lesion here, so you can see that half of this blue one crosses over here. Half of this red one crosses over here, but this one stays on this side and the blue stays on this side. And that's why it can lead to your vision being lost on these parts. But you can still see the middle. It's kind of hard to imagine it, but that's how that type of vision loss would be. And if you just look at this diagram so on follow the tracks, you can really easily explains it. I hope that made sense. I'm happy to go over this at the end if it needs bit more explanation. Okay. I'm just going to look at your eyes dilating on DCA nstic ting. So you have radial dilator muscles and they're innovated by the sympathetic nervous system. And you have circular constrictor muscles, and they're innovated by the parasympathetic innovation. So just think. Read e o dilate. You know, like circles dilate on sympathetic that sympathetic is there like, chill dilate. Oh, sorry. I'm just going to plug this in. Um um yeah, so just think rodeo muscles are innovated sympathetically. Eso they attached to ciliary muscles by the since the suspensory ligament on ciliary muscles and they're relaxed by since menstrual muscles. So they're taught. So they pulled the lens into the thin structure and it doesn't bend or refract light so they can focus on far away things. So when the pianist causes serially ciliary muscles to contract the lance fat is fat and round, so it goes out and it reflects, like to focus on things close. So I'm at the end, basically. So I'm just going to talk about pharmacology pharmacological terms. So farmer dynamics, What is that? So that is just how the drug works. Farmer kinetics. That is just the movement off the drug. So kinetic movement, the drug within the body And what are the four stages of farmer kinetics? So you have absorption when the drug is absorbed, distribution when the drug is taken around the body and metabolism when it's digested, and then the drug is excreted just like anything else in the body. So this is just a quick summary off the drugs of the eye that I'll let you guys look over in your own free time so they're overrun. But I'm just know, um, for, you know, my friend is and I don't know, receptor agonist. Um, if you have any questions, just you can post it on the community page of whiskies e a swell, but I think I mentioned something about glaucoma here. So yes, of pilocarpine stimulates pianist prolonged people constriction it helps with the glaucoma, said that, uh, glaucoma would just be an increase in intraocular pressure. So just to look at the tongue innovation and tasting back to me So the facial nerve would innovate the anterior two thirds on the soft palate, the glossopharyngeal, the posterior third and the pharynx on the vagus nerve. Well, with Innovator and the hypoglossal now innovates the intrinsic on the extrinsic tongue muscles. So there's different types of taste you have so convenient popular, which tastes sour things fully. It popular on fund you from her play, which would distinguish the different different tastes. Um, so they travel along the censoring your own. So salt and acids have sodium on proton channels for bitter sweet a new mommy on. They have receptors for secondary molecules, to sense those tastes. Um, so, yeah, I tried to fit everything in, um, that if we could just siad the feedback form. Um, but that's the section. If you guys have any questions, I'm happy to go back over my slides. Um, but yeah, I think the feedback forms being posted into the chat. Onda. Um, just for those still here, there's gonna be a really, really in depth SBA session for especially really important if you're quite of student, because it will really be a really good talk through the F one. So there's gonna be loads of us teaching on going up. The SBA is for the F one. So if you guys 12 big crash costs overview of all the topics we've done so far, we're gonna have a really big summary session with loads and loads of STDs and questions on that will be happening on the 10th of January. So if you're a card a student, that's the day before the exam. So you can really, like, learn a lot. They're on for everyone else. It's so useful because it's a big crash course with loads of questions and answers. And we'll just go over all the explanations as a group so you can answer and we'll answer questions alive if you have any extra questions. Um, also, we're looking for a year one publicity's lid. So if any of you are interested in taking part in our ski see, it's such a good organization to be involved in, and you really get a lot of skills from it. So if you want to be involved, I think my friend street was shared that feed, but the form to apply it really, really encourage you guys to take part. Um, but we'll see you in the new year. We're gonna be posting stuff throughout, and I think we have a really exciting session. Been in Jeanette. Let's just which really saved me for a lot of like, stressful situations. Like he has a really good you to channel on. He is collaborating with your skis yet, so if you guys want to have that session, um, I think it's 20th of January. Right street? Uh, yeah, it could be on the spot there. I got the date in my condo because I really want to go. I'm excited to I think someone asked a question. Please go through the rest 30 again. Oh, yeah. Um, um, I'll go back to that slide. Could I, uh, must