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Midterm 1 Book Notes

Biological Systems I (University of Southern California)

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CHAPTER 4: TISSUES
Clinical Impact: Chronic Inflammation
A) Chronic inflammation – inflammatory response that persists when agent responsible for an injury is
not removed or if the healing process is disrupted
(Examples: lung infxns are brief & end in repair, but prolonged infection cause chronic inflammation
that results in tissue destruction/permanent damage to the lung; chronic inflammation of the
stomach/small intestine may lead to ulcer)
B) Chronic inflammation can result from prolonged infxns & irritants or abnormal immune responses
C) WBCs invade areas of chronic inflammation, and healthy tissues are ultimately destroyed and
replaced by fibrous connective tissue  causing loss of organ fxn
D) Chronic inflammation of the lungs, liver, kidneys, or other vital organs can lead to death

Clinical Impact: Molecular Tissue Profiles of Cancer Tissue

A) Most common types of cancer are those from epithelial tissue
B) Carcinoma is a cancer derived from epithelial tissue (ex: carcinomas include lung, breast, colon,
prostate, skin cancers); Basal cell & squamous cell carcinomas are types of skin cancer derived from
epithelial tissue
C) Adenocarcinomas – are types of carcinomas derived from glandular epithelium (ex: most breast
cancers are adenocarcinomas)
D) Sarcoma – rare type of cancer derived from mesodermal tissue (muscle & connective tissue) (ex:
osteosarcoma = bone cancer; chondrosarcoma = cartilage cancer)
E) ID tissue of origin is useful for the diagnosis & treatment of cancer; Molecular markers are commonly
used to ID the type of tumor
F) Advances in nucleic acid technologies have opened the door for even more extensive gene expression
profiling of cancers

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CHAPTER 11: FUNCTIONAL ORGANIZATION OF NERVOUS TISSUE

Clinical Impact: Nervous Tissue Response to Injury
A) When a nerve is cut, either it eventually heals or it is permanently interrupted; final outcome
depends on the injury severity and its treatment
B) Several degenerative changes result when a nerve is cut:
(1) Within 3-5 days, the axons in the part of the nerve distal to the cut break into irregular segments
and degenerate; this occurs bc the neuron cell body produces the substances essential to
maintain the axon, and these substances have no way of reaching parts of the axon distal to the
point of damage
(2) Eventually, the distal part of the axon completely degenerates; As the axons degenerate, the
myelin part of the Schwann cells around them also degenerates, and macrophages invade the
area to phagocytize the myelin
(3) Schwann cells then enlarge, undergo mitosis, and finally form a column of cells along the regions
once occupied once occupied by the axons; columns of Schwann cells are essential for the growth
of new axons
(a) If the end of regenerating axons encounter a Schwann cell column, they grow more rapidly,
and re-innervation of their target is likely; vice versa
(4) The end of each regenerating axon forms several axonal sprouts. It takes ~2 weeks for the axonal
sprouts to enter the Schwann cell columns; however, only 1 of the sprouts from each severed
neuron forms an axon while the other degenerate
C) Treatment strategies: (1) Bringing the ends of the severed nerve close together surgically; (2) Nerve
transplant to replace the severed segment, but the transplanted nerve eventually degenerates.
However, transplanted nerve does provide Schwann cell columns through which axons can grow
D) The regeneration of damaged nerve tracts w/in the CNS is very limited, esp. when compared with the
regeneration of nerves in the PNS
(1) In part, the difference may result from the oligodendrocytes which exist only in CNS & only a few
of them exist in CNS; When the myelin degenerates following damage, no column cells remains in
the CNS to act as a guide for the growing axons

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CHAPTER 12: SPINAL CORD AND SPINAL NERVES

Clinical Impact: Introduction of Needles into the Subarachnoid Space
A) Several clinical procedures involve inserting a needle into the subarachnoid space at either L3/L4 or
L4/L5 level
B) Spinal anesthesia (or spinal block) drugs that block action potential transmission are introduced into
the subarachnoid space to prevent pain sensations in the lower half of the body
C) There are advantages and disadvantages to spinal vs. epidural anesthesia:
(1) In spinal anesthesia, the drugs are delivered directly to the CSF, so anesthesia is stronger & takes
effect faster than epidural anesthesia
(2) Epidural anesthesia, the needle does not penetrate the dura mater, so the drugs must first diffuse
into the CSF; however, an advantage is that the drugs can be readministered via a catheter to
maintain longer anesthesia
(3) Some instances, combination of spinal and epidural anesthesia is used
D) Lumbar puncture (or spinal tap) where CSF is removed from the subarachnoid space in order to
examine it for infectious agents (meningitis) or presence of blood (hemorrhage) or to measure CSF
pressure
(1) Sometimes clinicians inject a radiopaque substance into this area and take a myelogram
(radiograph of the spinal cord) to visualize spinal cord defects or damage

Clinical Impact: Knee-Jerk Reflex

A) Knee-jerk reflex (or patellar reflex) is a classic example of stretch reflex
(1) Clinicians use this reflex to determine whether the higher CNS centers that normally influence this
reflex are functional
(2) When patellar ligament is tapped, the tendons & muscles of quadriceps femoris muscle group
Stretch  muscle spindle fibers w/in these muscles also stretch  stretch reflex activates 
contraction of the muscles extend the leg, producing the characteristic knee-jerk response
B) A greatly exaggerated stretch reflex indicates the neurons w/in the brain that innervate the gamma
motor neurons & enhance the stretch reflex are overly active
C) A suppressed or absent stretch reflex indicates the neurons that innervate the gamma motor neurons
are depressed or reflex pathway is not intact

Clinical Impact: Spinal Cord Injury

A) Damage to spinal cord can disrupt ascending tracts to the brain, resulting in loss of sensation
B) Disruption of the descending tracts from the brain to motor neurons in the spinal cord can result in
the loss of motor functions
C) The primary mechanisms causing spinal cord injury: (1) concussion; (2) contusion (injury resulting in
hemorrhage); (3) laceration
(1) Spinal cord injuries often involve excessive flexion, extension, rotation, or compression of the
vertebral column
(2) Most spinal cord injuries are acute contusions of the cord due to bone or disk displacement into
the cord & involve a combination of excessive directional movement, such as simultaneous flexion
and compression
D) Spinal cord injury is classified according to the vertebral level at which the injury occurred, whether
the entire cord or only a portion is damaged at that level, and the mechanism of injury
(1) Most spinal cord injuries occur in the cervical region or at the thoracolumbar junction and are
Incomplete
(2) Injuries in the cervical region above T1 are the most severe & can result in paralysis of all 4 limbs
(quadriplegia or tetraplegia), w/ abdominal & chest muscles also affected
(3) Injuries at or below T1 can result in varying degrees of paralysis of the legs (paraplegia) & the
abdomen, while retaining full function of the upper limbs
E) At the time of spinal cord injury, 2 types of tissue damage occur: (1) primary, mechanical damage;

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(2) secondary, tissue damage extending into a much larger region of the cord than the primary
damage
(3) Secondary spinal cord damage begins w/in minutes of the primary damage & is caused by
ischemia, edema, ion imbalances, the release of “excitotoxins” (such as glutamate), and
inflammatory cell invasion; Secondary damage is the primary focus of current research
F) Once an accident occurs, little can be done about the primary damage; However, secondary damaged
can be prevented if promptly treated
(1) Treatment with large doses of anti-inflammatory steroids (such as methylprednisolone) w/in 8
hours of injury can dramatically lessen the secondary damage to the cord by reducing
inflammation & edema
(2) Additional treatments: Structural realignment; Vertebral column stabilization & decompression of
spinal cord; Rehabilitation to retrain whatever residual connections exist across the site of
damage
G) Before researchers thought the spinal cord cannot regenerate after a severe damage. But now
learned that most neurons of the adult spinal cord survive the injury & begin to regenerate, growing
~1mm into the site of damage  neurons then regress to an inactive, atrophic state
(H) Major disruption to adult spinal cord regeneration is formation of scar, consisting of myelin &
astrocytes at the site of injury
(1) Myelin and other inhibitory factors, such as the protein Nogo, in the scar inhibit regeneration
(2) Implantation of stem cells or other cell types, such as olfactory ensheathing glia & Schwann cells
can partially bridge the scar and stimulate some regeneration
(3) Certain growth factors can also stimulate regeneration, and block inhibitory factors may be able
to prevent the formation of glial scar to allow axon regeneration

Clinical Impact: Radial Nerve Damage

A) Radial nerve lies near humerus (bone of the arm) of the axilla (underarm/armpit) can be damaged if
pressed against the humerus
(1) Improper use of crutches can result in crutch paralysis (pushing the crutch tightly into the axilla)
(2) Wrist drop –major symptom of crutch paralysis, in which the elbow, wrist, fingers are constantly
flexed bc the extensor muscles of the wrist & fingers, which are innervated by the radial nerve, fail
to function. There is also a loss of sensation over the back of the forearm & hand
B) Crutch paralysis is usually temporary as long as the patient fixes the wrong usage

Clinical Impact: Ulnar Nerve Damage

A) Ulnar nerve is the most EASILY damaged of all the spinal nerves, but usually damage is always
temporary
B) Ulnar nerve passes posterior to the medial epicondyle of the humerus & can be felt just below the skin at
this region
C) If the elbow is banged against a hard object, we would feel the sensation known as “funny bone or
crazy bone”

Clinical Impact: Median Nerve Damage

A) Carpal tunnel syndrome is the result of damaging the median nerve where it enters through the wrist
(1) the tunnel is created by the concave organization of the carpal bones & the flexor retinaculum on
the anterior surface of the wrist
B) Symptoms: numbness, tingling, pain in fingers; function of the thenar muscles, which are innervated
by median nerve, is reduced  resulting weakness in thumb flexion & opposition
C) Women are likely to have carpal tunnel syndrome (3x higher risk than men….rule of 3’s) bc of smaller
carpal tunnels prone to nerve compression
(1) other risk factors: wrist fractures, swelling during pregnancy, or RA (rheumatoid arthritis);
repetitive movement with hand and wrist

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D) Treatment of carpal tunnel syndrome: (1) immobilization, (2) reduction of inflammation, and (3)
surgery to relief pressure

Clinical Impact: Sciatic Nerve Damage

A) Sciatic nerve damage is due to sitting on a hard surface for a considerable time, where the nerve gets
compressed against the ischial portion of the coxal bone
(1) When the person stands up, he/she feels a tingling sensation as “pins and needles” throughout
the lower limb & often remarks that the limb has “gone to sleep.”
B) Although the condition can be temporary, but the sciatic nerve seriously injured in a numbers of way:
(1) Ruptured intervertebral disk; (2) Pressure from the uterus during pregnancy may compress the
roots of sciatic nerve; (3) Hip injury; (4) Compression of the nerve by the piriformis muscle; (5)
Improperly administered injection in the hip region

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CHAPTER 13: BRAIN AND CRANIAL NERVES

Clinical Impact: Traumatic Brain Injuries and Hematomas
A) Head injury are classified as open (when some of the cranial cavity contents are exposed to the
outside) or closed (when cranial cavity remains intact)
B) Closed injuries are more common and usually result from the head striking a hard surface or an object
striking the head
(1) Such injuries may cause brain trauma –either coup (occurring at site of impact) or contrecoup
(occurring opposite side of the brain from the impact due to brain moving w/in the skull)
(2) Traumatic brain injury is 3x (rule of 3’s again) more common in Men > Women
(3) Common traumatic brain injury is concussion (75-90%), characterized by immediate, but
transient, impairment of neural function, such as loss of consciousness or blurred vision
C) Traumatic brain injury may be diffuse or local
(1) Diffuse brain injury results from shaking (ex: child is shaken or get thrown about in an automobile
accident)
(a) The injury is not localized to one focal point but involves damage to many small vessels &
nerves, esp. around the brainstem
(2) Focal traumatic brain injury may involve cortical contusions (bruisings), caused by direct impact
to the brain, or hemorrhage in or around the brain
(a) Contusions are usually superficial & involve ONLY the gyri
D) Hemorrhagic brain injury is characterized by bleeding outside the dura (extradural or epidural),
between the dura & the brain (subdural), or w/in the brain (intracerebral)
(1) A hemorrhage (bleeding) results in a hematoma (an accumulation of blood)
(2) Extradural hemorrhages (or epidural hemorrhages) occur in ~1-2% of major injuries; they usually
affect the middle cranial fossa & involve a tear in the middle meningeal artery (85%) or in the middle
meningeal vein or dural sinus (15%)
(3) Subdural hematomas are more common, occurring in ~10-20% of major head injuries; they most
commonly involve tears in the cortical veins or dural venous sinuses, occur in the superior protion of
the cranial cavity, and appear w/in hours of head injury
(4) Chronic hematomas are slow bleeding over an extended period of time (weeks to months), are
common in elderly people & people who abuse alcohol
(5) Intracerebral hematomas occur in ~2-3% if major head injuries & are often associated w/ contusions;
they involve damage to small vessels w/in the brain itself & are most common in the frontal and
temporal lobes; they occur within 3-10 days of head trauma

Clinical Impact: CSF and Skull Fractures

A) Open head trauma involves a fracture or hole in the skull, which exposes the contents of the cranial
activity (brain, blood, and/or CSF) to the exterior
(1) Head injuries involving scalp lacerations or damage to the eye, ear, or nose should be carefully
evaluated for the possibility of open head trauma
B) In skull fractures in which the meninges are torn, CSF may leak from the nose if the fracture is in the
frontal area or from the ear if the fracture is in the temporal area
(1) Leakage of CSF indicates serious mechanical damage to the head & presents a risk for meningitis
bc bacteria may pass from the nose or ear through the tear & into the meninges
C) A skull fracture involving the base of the skull may result in cranial nerve damage where the nerves
exit the skull

Clinical Impact: Hydrocephalus

A) The cerebral aqueduct may be blocked at the time of birth or may become blocked later in life bc of a
tumor growing in the brainstem
(1) Internal hydrocephalus (noncommunicating hydrocephalus) –the apertures of the fourth ventricle
or the cerebral aqueduct are blocked & CSF can accumulate within the ventricles

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B) The production of CSF continues, even when the passages that normally allow it to exit the brain are
blocked  fluid builds inside the brain causing pressure  compresses the nervous tissue & dilates
the ventricles  irreversible brain damage
(1) If the skull bones are not completely ossified when the hydrocephalus occurs, the pressure may
also severely enlarge the head
C) Treatment: Drainage tube (shunt) between the brain ventricles & the abdominal cavity to eliminate
the high internal pressures
(1) Cons: (i) Risk of infections; (ii) Shunts must be replaced as the person grows
D) A subarachnoid hemorrhage may block the return of CSF to the circulation
(1) External hydrocephalus – CSF accumulates in the subarachnoid space; In this condition, pressure
is applied to the brain externally, compressing neural tissues & causing brain damage
(a) Treatment: Condition usually resolves w/o treatment

Clinical Impact: Drugs and the Blood-Brain Barrier

A) Permeability characteristics of BBB are an important consideration when developing drugs to affect
the CNS
B) Ex: Parkinson disease is caused by lack of neurotransmitter DOPAMINE  resulting in decreased
muscle control & shaky movements
(1) However, administering dopamine is not helpful bc dopamine cannot cross the BBB; So
LEVODOPA (L-dopa) is a precursor to dopamine is used to cross the BBB, where the CNS convert L-
dopa to Dopamine

Clinical Impact: Pain

A) Pain –a sensation characterized by a group of unpleasant & complex perceptual & emotional
experiences that trigger autonomic, psychological, and somatic motor responses
B) Pain has 2 components:
(1) Rapidly conducted action potentials carried by large-diameter, myelinated axons, resulting in
sharp, well-localized, pricking or cutting pain followed by,
(2) More slowly propagated action potentials, carried by smaller, less heavily myelinated axons,
resulting in diffuse burning or aching pain
(3) Research indicates that pain receptors have very uniform sensitivity, which does not change
dramatically from one instant to another
(a) The variations in pain sensation that we experience result from the mechanisms by which pain
receptors are stimulated, differences in the integration of action potentials from the pain
receptors, and complex interactions in the cerebral cortex, cingulate gyrus, and thalamus,
where the emotional component of pain is registered
(b) Neurons in the cerebral cortex respond to pain stimuli selectively based on prior experience &
context (Ex: stress can reduce pain perception)
C) The dorsal-column/medial-lemniscal system contains no pain fibers, tactile & mechanoreceptors are
often activated by the same stimuli that affect pain receptors
(1) Action potentials from tactile receptors provide information that allows the pain sensation to be
localized. Superficial pain highly localized bc of the simultaneous stimulation of pain receptors &
mechanoreceptors in the skin
(2) Deep, or visceral, pain is diffused (not highly localized) bc of fewer mechanoreceptors in the
deeper structures
D) Gate-control theory –Pain control involves dorsal-column/medial-lemniscal system neurons
(1) Primary neurons of the dorsal-column/medial-lemniscal system send out collateral branches that
synapse w/ interneurons in the posterior horn of the spinal cord
(a) These interneurons have an inhibitory effect on secondary neurons of the spinothalamic tract
(b) Pain action potentials traveling through the spinothalamic tract can be suppressed by action
potentials that originate in neurons of the dorsal-column/medial-lemniscal system

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(i) the arrangement may act as a “gate” for pain action potentials transmitted in the
spinothalamic tract; increased activity in the dorsal-column/medial-lemniscal system tends
to close the gate & reducing pain action potentials; Descending pathways from the cerebral
cortex or other brain regions can also regulate this “gate”
E) The gate-control theory may explain the physiological basis for the following methods that have been
used to reduce the intensity of chronic pain:
(1) Electrical stimulation of the dorsal-column/medial-lemniscal neurons
(2) Transcutaneous electrical stimulation (applying a weak electrical stimulus to the skin)
(3) Acupuncture
(4) Massage
(5) Exercise
F) The frequency of action potentials that are transmitted in the dorsal-column/medial-lemniscal system
is increased when the skin is rubbed vigorously and when the limbs are moved
(1) This may explain why vigorously rubbing a large area around the source of prickling pain tends to
reduce the intensity of the pain; Exercise reduce pain, esp. managing chronic pain; Acupuncture
may lessen pain through the action of a gating mechanism that inhibits pain transmission upward
in the spinal cord
G) Analgesics are pain-relieving sensation that act in much the same way as gate control
(1) Some analgesics act in the periphery to reduce inflammation & the activation of peripheral
nerves; others block the transmission of pain sensations in the spinal cord from primary neurons
to neurons of the ascending pathways
(2) Other analgesics function at the level of the cerebral cortex to modulate pain

Referred Pain
A) Referred pain –a painful sensation in a region of the body that is not the source of the pain stimulus
(1) Patients sense referred pain in the skin or other superficial structures when internal organs are
damaged or inflamed
(2) This sensation occurs bc both the area of skin to which the pain is referred & visceral area that is
damaged are innervated by neurons that project to the same area of the cerebral cortex; The
brain cannot distinguish between the 2 sources of painful stimuli, and the painful sensation is
referred to the most superficial structures innervated by the converging neurons
(3) This referred may occur bc the number of receptors is much greater in superficial structures than
in deep structures & the brain is more “accustomed” to dealing w/ superficial stimuli
(4) Referred pain is clinically useful in diagnosing the actual cause of a painful stimulus
(a) Ex: Heart attack victims feel cutaneous pain radiating from left shoulder down to the arm; Look
on page 473, Fig. 14A to see other types!

Phantom Pain
A) Phantom pain –occurs in people who have had appendages amputated or a structure, such as a
tooth, removed. They perceive pain or other sensations in the amputated structure as if it were still
in place
(1) If a neuron pathway that transmits action potentials is stimulated at any point along that pathway,
action potentials are initiated & propagated toward the CNS  integration results in the
perception of pain that is projected to the site of the sensory receptors, even if those sensory
receptors are no longer present
(2) A similar phenomenon can be easily demonstrated by bumping the ulnar nerve where it crosses
the elbow (the funny bone)  even though the neurons are stimulated at the elbow, the
sensation of pain is in the 4th and 5th digits (fingers)
B) A factor that may be important in phantom pain is lack of touch, pressure, and proprioceptive
impulses from amputated limb

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(1) When a limb is amputated, the inhibitory effect of sensory information (explained by the gate-
control theory of pain) is removed  consequently, the intensity of phantom pain may increase
C) Another factor may be that the cerebral cortex retains an image of the amputated body part

Chronic Pain
A) Chronic pain –long-lasting pain with known cause, such as tissue damage (ex: arthritis) or unknown
cause w/ tissue damage too
B) Pain is important in warning us of potentially injurious conditions, but chronic pain (ex: migraine,
localized facial pain, or back pain) can be debilitating & loses its value of providing information about
the condition of the body
C) Chronic Pain Syndrome –patients exhibit symptoms of major depression, frustration, or anger due to
chronic pain
D) Treatment: (1) Surgery or (2) Psychotherapy or (3) Drug therapy (but this is mainly to manage pain)
like opiates

Sensitization in Chronic Pain

A) Peripheral sensitization –tissue damage w/in an area of injury, such as the skin, can cause increased
sensitivity in the nerve endings in the area of damage
(1) One class of pain receptors is not activated by traditional noxious stimuli but is recruited ONLY
when tissues become inflamed
B) Central sensitization –CNS may respond to tissue damage by decreasing its pain threshold

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CHAPTER 15: THE SPECIAL LENSES

Clinical Impact: Ophthalmoscopic Examination of the Retina
A) Using ophthalmoscopic to examine the posterior retina can reveal some general body disorders:
(1) HTN (“nicking” or compression of the retinal veins where the abnormally pressurized arteries
cross them)
(2) Increased CSF Pressure (associated with hydrocephalus causing optic disc to swell  condition is
known as papilledema) Note: edema means swelling!
(3) Cataracts (opacity of the lenses)

Clinical Impact: Visual Acuity

A) Visual acuity –eye’s ability to focus an image on the retina so that a clear image is perceived
(1) Factors that affect visual acuity: shape of eyeball, flexibility of lens
B) Some common visual acuity defects: (1) Myopia, (2) Hyperopia, (3) Presbyopia, (4) Astigmatism
C) Myopia –nearsightedness; can see close objects clearly, but distant objects appear blurry
(1) the defect is due to the focusing system, the cornea and lens, is optically too powerful, or the
eyeball is too long (axial myopia)  resulting in the focal point is too near the lens, and the image
is focused in front of the retina
(2) Can be corrected by a CONCAVE lens that counters the refractive power of the eye  the light rays
coming to the eye diverge thanks to the concave lens (aka “minus” lenses)
(3) Can be corrected, for mild myopia, by radial keratotomy –making a series of 4-8 radiating cuts in
the cornea, to weaken the dome of the cornea slightly so it becomes flattened and eliminates
myopia
(a) Cons: (1) it is difficult to predict how much flattening the technique will cause; (2) Some
patients are bothered with glare bc the slits do not heal evenly
(4) Lasix (laser corneal sculpturing) –laser surgery procedure in which a thin portion of the cornea is
etched away to make the cornea less convex with predictable results than radial keratotomy
D) Hyperopia –farsightedness; can see distant objects clearly, but close objects appear blurry
(1) the defect is due to the cornea & lens system is optically too weak or the eyeball is too short 
the image is focused behind the retina
(2) Can be corrected by a CONVEX lens causing light to converge as they approach the eyes
(“plus” lenses)
E) Presbyopia –normal, unavoidable degeneration of the accommodation power of the eye associated
with aging due to the lenses becoming sclerotic & less flexible
(1) Eye is presbyopic when the near point of vision has increased beyond 9 inches; Average age of
onset is mid-40s & avid readers and people who engage in fine, close work may develop the
symptoms earlier
(2) Can be corrected by wearing “reading glasses” or bifocals (different top & bottom lenses) or
graded lens (graded lens)
F) Astigmatism –a type of refractive error that affects the quality of focus; Cornea or lens is not
uniformly curved, the light rays do not focus at a single point, but fall as a blurred circle
(1) Can be corrected by glasses formed w/the opposite curvature gradation
(2) In irregular astigmatism, the abnormal form of the cornea fits no specific pattern & is very difficult
to correct with glasses

Clinical Impact: Function of the Chorda Tympani

A) Chorda tympani –structure found in the middle ear; a branch of the facial nerve carrying taste
impulses from the anterior two-thirds of the tongue
(1) It crosses over the inner surface of the tympanic membrane
(2) It has nothing to do w/ hearing but is just passing through
B) When this nerve get damaged during ear surgery or by a middle ear infection  resulting in loss of
taste sensation from the anterior two-thirds of the tongue

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