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422 Cards in this Set
- Front
- Back
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Cells of Innate Immunity
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Neutrophils, Eosinophils, Basophils
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Cells of Specific Immunity
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T, B, NK Cells (and plasma cells)
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What % of lymphocytes are in circulation
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70%. The rest migrate to target tissues
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T Cell Origin
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Form in bone marrow, mature in thymus
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Helper T cells
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Express CD4+. Interact with NK, B cells and macrophages
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Cytotoxic T cells Function
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Express CD8+, Kills target cells
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Regulatory T cells
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Express CD4 or CD8. Prevent immune system from killing too many cells (hyperactivity)
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Gamma/Delta T cells
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on the surface of skin, oral mucus, intestines. serve as first line of defense
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B cell origin
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Bone marrow and GALT (Gut associated lymphatic tissue)
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B cells create what cells once they are activated
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Plasma cells
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Natural Killer Cell Function
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recognize transformed cells (from virus or tumor) and cause apoptosis using granzymes and perforins
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"Antigen Independent Proliferation and Differentiation" refers to what characteristic of lymphocytes
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Lymphocytes have the ability to recognize a single antigen out of many possibilities
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High Endothelial Venules
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areas where lymphocytes can enter the lymphatic node from blood vessels
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Where are lymphocytes primarily found in tissues?
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Lamina Propria
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How is MALT different from GALT?
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MALT (Mucus associated lymphatic tissue) is found throughout the body. GALT is only in the gut
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What occurs in the germinal center of a lymph node
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lymphocyte proliferation
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Why do tonsils become infected very easily?
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They are the first line of defense
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Why do we have lymphocytes in the intestines
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To build immunity as we eat, especially important in infancy
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Crypts are characteristic of which type of lymph node?
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Tonsilar lymph nodes
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Describe the pathway of lymph through a lymph node. Start with Afferent lymphatic vessel.
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Afferent lymphatic vessel to subcapsular sinus to trabecular sinus to medullary sinus to efferent lymphatic vessel
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What lymphatic vessel passes through the hilum of a lymph node?
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Efferent Lymphatic Vessel, carrying lymph out of the node
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What other vessels pass through the hilum?, besides the efferent lymph vessel
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Arteries and Veins supplying the lymph node
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What types of cells express MHC1?
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All nucleated cells and Platelets
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What type of T cell binds MHC1?
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cytotoxic T cells (MHC1 binds CD8)
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What types of cells express MHC2?
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Macrophages, dendritic cells and B cells (these cells also have MHC1)
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What type of T cell binds MHC2?
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Helper T cells (MHC2 binds CD4)
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Inflammatory Lymphadenitis
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Continual B cell proliferation in germinal center of lymph node during illness. Swelling of lymph node
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What triggers thymus involution?
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Puberty, we make less T cells after puberty. Involution = reduction in size
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Hassal's Corpuscle
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found in Thymus; produce interleukins that stimulate T cell proliferation; large pink concentric rings
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Importance of Blood Thymus Barrier
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Prevents immature T cells from being exposed to antigens in the blood. immature T cells exposed to antigen will die. Lack of barrier will cause all T cells to die before maturity
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During T cell education, what CD antigens are expressed in "pre-T cells"
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CD2 and CD7
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During T cell education, what CD antigen is expressed in "middle stage"
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CD1
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Which CD antigens are expressed during the "double positive stage" of T cell production?
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CD4 and CD8
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Why is it important to have a "double positive stage" of T cell differentiation?
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Allows the T cells to test if they are able to recognize the basic antigens. If they do not, they are killed.
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Why is it important to have a "double negative stage" of T cell differentiation?
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During this stage the T cells are presented with self antigens. If they recognize these self antigens are foreign, they are destroyed. This prevents us from having T cells that kill our own cells.
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What are the 2 possible CD antigens expressed on mature T cells?
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CD4 OR CD8, "single positive stage". CANNOT HAVE BOTH!
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White pulp of spleen contains what
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Lymphatic tissue, lymphocytes etc. Lymphocytes can proliferate here
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Red pulp of spleen contains what
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reticular fibers containing RBCs, macrophages and lymphocytes
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Open Splenic Circulation and its Advantages
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RBCs from capillaries diffuse into Red Pulp reticular fibers and diapedese into red pulp sinus. This allows the RBCs to come in contact with macrophages and increase immunity
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Spleen Immune Functions
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Removal of antigens from blood, B cell proliferation, antibody production
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Spleen Hematopoietic Functions
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RBC formation, RBC maintenance (macrophages kill bad ones)
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3 Components of autonomic nervous system
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Sympathetic, Parasympathetic, Enteric
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Embryonic origin of Autonomic Nervous System
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Neural Crest Cells
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Sympathetic pre-ganglionic neuron body location
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Spinal Intermediolateral horns of T1-L2
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Sympathetic pre-ganglionic neurons use what neurotransmitter
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Acetylcholine, they are cholinergic
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Sympathetic post-ganglionic neurons are found where and use what
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paravertebral column, they use epinephrine
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Do Splanchnic nerves synapse in the paravertebral column
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No, they pass through and synapse in collateral ganglion on viscera
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What is in the white communicating ramus?
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Myelinated axons of pre-ganglionic neurons
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What is in the grey communicating ramus?
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Un-myelinated axons of post-ganglionic neurons
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Ptosis and Miosis (Horner's Syndrome)
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Drooping eyelid and small pupils. Due to damage to the sympathetic system and/or superior cervical ganglion
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Parasympathetic pre-ganglionic neurons are located where.
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Brainstem and sacral spinal cord
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Parasympathetic Post ganglionic neurons are found where?
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In the walls of viscera
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What neurotransmitter do the parasympathetic neurons use
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Acetylcholine
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Fun Fact: The enteric nervous system is reflexive and autonomous
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Does not need spinal cord/brain input
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Submucosal (Meissner's) Plexus Functions
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Regulate epithelial secretions, regulate muscular mucosa, signal Myenteric system
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Myenteric (Auerbach) Plexus Function
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Regulates peristalsis and sphincters
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Events of peristaltic reflex. Start with food entering the intestines
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Bolus distorts mucosa, enterochromaffin cells release serotonin (5-HT), 5-HT stimulates sensory nerves in lamina propria, these sensory nerves have their body in the Myenteric Plexus. Myenteric reflex motor neurons start peristalsis.
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Hirschsprung's Disease
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Aganglionic megacolon. Neural crest cells don't migrate to colon. No peristalsis. Fecal matter backs up in colon.
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Achalasia
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Loss of myenteric neurons of Esophageal sphincter (perhaps auto-immune attack). Esophagus
stays closed because sphincter cannot be activated to open. Surgery, botox or balloon can be used to open the sphincter. Heartburn is common after treatment (sphincter stays open now) |
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Referred Pain
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Visceral pain presents as cutaneous pain (dermatome). For example: appendicitis is characterized T10 pain.
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Why does visceral "referred pain" occur?
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visceral pain afferents (sensory neurons) enter the spinal cord with somatic afferents (sensory neurons). They both enter through the dorsal root ganglion then synapse with same central pain neuron.
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Breast cancer metastases are common in which lymph nodes?
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Axillary
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Excision of the axillary lymph nodes risks damage to what 2 nerves?
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Thoracodorsal and long thoracic nerve
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Excision of axillary lymph nodes can have what 2 side effects
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Lymphedema (can't remove fluid from upper limb) and upper limb nerve damage
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Serratus Anterior Function
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Protract scapula, hold scapula to body wall, rotates scapula during abduction (needed to abduct over 90 degrees)
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Serratus Anterior Innervation
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Long thoracic nerve (C5, C6, C7)
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Why is the serratus anterior dennervated more easily by a stab wound than other muscles?
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The long thoracic nerve passes superficially to the Serratus Anterior muscle. This is unique. most nerve travel deep to the muscle they innervate.
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Winged Scaupla
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Inability to hold scapula to body wall. Poor abduction also
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Pectoralis Major Function
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Adduct and medially rotate humerus
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Pec. Major Innervation
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Lateral and Medial Pectoral nerves (C5-T1)
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Pec. Major Origin
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Sternocostal and Clavicular heads
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Pec. Major Insertion
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Lateral lip of bicipital groove of humerus
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Pec. Minor Function
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stabilize scapula during motion
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Pec. Minor Innervation
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Medial Pectoral nerve
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Pec. Minor Origin
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ribs 3-5
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Pec. Minor Insertion
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coracoid process
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Subclavius Function
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Stabilize clavicle
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Subclavius innervation
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nerve to subclavius
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Subclavius origin
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rib 1
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Subclavius insertion
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middle 3rd of clavicle
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Landmark signaling change from subclavian artery to axillary
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lateral border of rib 1
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branch off part 1 of axillary artery
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supreme thoracic artery
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2 branches off axillary artery part 2
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thoracoacromial and lateral thoracic artery
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3 branches off axillary artery part 3
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ant and post. circumflex humeral, and subscapular
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2 branches of subscapular
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thoracodorsal and scapular circumflex
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The anterior division of arm nerves gives rise to what type of muscle mass (pre or post axial)
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Pre-axial
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Erb's Palsy
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Broken C5, C6 due to high torsion on head during birth. No abduction, poor flexion
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Klumpke Palsy
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Broken C7-T1 nerves due to high strain on arms. Horner syndrome is seen due to damage to T1 white communicating ramus.
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Muscles in anterior compartment of arm (Flexors and Adductors)
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Biceps Brachii, Coracobrachialis, Brachialis (Mainly C6)
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Muscles of Posterior compartment (arm) (Extensors)
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Triceps brachii, anconeous (Mainly C7)
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Biceps Brachii Innervation
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Musculocutaneous nerve
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Biceps Short head attachment
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Coracoid process and radial tuberosity
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Biceps long head attachment
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Supraglenoid tubercle and radial tuberosity
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Motions as a results Biceps
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biceps is most powerful supinator when elbow is flexed. Biceps is weak flexor when arm is pronated. biceps is good flexor when arm is supinated.
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Brachialis Function
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Most powerful flexor,
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Brachialis Innervation
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Musculocutaneous (small lateral part = radial nerve)
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Brachialis Origin
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Distal half of humerus
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Brachialis Insertion
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Ulnar tuberosity and Coronoid Process
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Coracobrachialis Function
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Flex, adduct arm. support glenohumeral joint
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Corachobrachialis Innervation
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musculocutaneous (goes through it also)
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Coracobrachialis Origin
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Coracoid Process
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Coracobrachialis Insertion
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Mid humerus
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Triceps Brachii Origin
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Long head- Infraglenoid tubercle
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Triceps Insertion
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Olecranon of ulna
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Triceps innervation
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Radial
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Anconeous Function
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Abduct ulna during pronation
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Clinical wrist drop Cause
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Injury to radial nerve = extensor paralysis. Wrist remains in flexed position.
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Cubital Fossa Borders
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line between epicondyles, pronator teres, brachoradialis (roof = bicipital aponeurosis)
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Cubital Fossa Contents
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Brachial Artery and veins, Biceps tendon, median nerve
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Why is the orientation of fibers in the interosseous membrane between the radius and ulna important?
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They are oriented to transfer forces on the wrist from the large head of the radius to the large head of the ulna.
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The annular ligament holds what in place during pronation/supination?
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It holds the radial head in the radial notch of ulna. it moves over the capitulum
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What are the 2 main pronator muscles in the forearm? Innervation?
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Pronator teres and Pronator quadratus. Median nerve
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What are the 2 main supinators in the posterior compartment of the arm/forearm? Innervation?
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Biceps Brachii (Musculocutaneous) and Supinator (Radial nerve)
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4 superficial-most muscles of the anterior forearm. Which one is not innervated by the median nerve?
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Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris (uses ulnar nerve)
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The median nerve runs between the 2 heads of which anterior forearm muscle?
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Pronator teres
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What goes through the carpal tunnel?
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4 tendons of flexor digitorum superficial, 4 tendons of flexor digitorum profundus, 1 tendon of Flexor pollicis longus, median nerve
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What 2 nerves innervates FDP (Flexor digitorum profundus)
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median and ulnar
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What are the 3 deepest anterior forearm muscles?
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Pronator quadratus, Flexor digitorum profundus, Flexor pollicis longus
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If the median nerve was cut, what fingers would lose flexion ability?
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Digits 1-3
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Pronator syndrome
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Median nerve gets compressed between 2 heads of pronator teres as it enters forearm.
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In Pronator's Syndrome, what does the patients hand look like when they try to make a fist? Why?
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"Hand of Benediction". Thumb and digits 4-5 can flex. 2-3 cannot
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Ulnar nerve injury will present in a patient with a hand that looks like what?
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"Clawhand". No flexion of digits 4-5.
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What artery supplies the DEEP palmar arch of the hand?
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Radial artery
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What artery supplies the superficial palmar arch?
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Ulnar artery
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The Basillic and median cubital vein converge to form which vein going up the arm?
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Axillary vein
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The posterior compartment muscles of the arm are all innervated by ...
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Radial nerve
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What are the 3 extensor muscles that extend/abduct/adduct the wrist?
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Extensor carpi ulnaris, carpi radialis longus and carpi radialis brevis
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Arm- What 3 extensors extend the 4 digits?
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Extensor digitorum, extensor indicis, extensor digit minimi
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What 3 extensors extend/abduct/adduct the thumb?
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Extensor Pollicis Longus/Brevis and Abductor pollicis longus
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What are the 2 tendons of the snuff box?
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Extensor Pollicis Longus and Brevis
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What is the function of a retinaculum at tendonous bundles
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Give tension and mechanical advantage
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The ulnar artery branches to form what arteries?
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Common interosseous then ant/post interosseous
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Posterior Interosseous nerve innervates the extensor muscles of the forearm. What nerve must it be a branch of?
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Radial nerve
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What is the function of a synovial sheath?
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Reduce friction in the tendon bundles/retinaculum. makes it "ice-ice" contact
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Name the 8 carpal bones
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Scaphoid, Lunate, Triquetrium, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
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The thumb connects to which carpal bone?
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Trapezium
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Which 3 carpal bones make up the "true wrist joint"
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Scaphoid, Lunate, Triquetrium
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What ligament makes up the carpal tunnel?
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Transverse carpal ligament aka flexor retinaculum
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3 intrinsic thenar muscles and innervations are...
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Abductor pollicis brevis, opponens pollicis, flexor pollicis brevis (all recurrent branch of median nerve)
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Hypothenar muscles are located where. Innervation?
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Inferior to digit 5. Ulnar nerve
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Palmar interosseous muscles do what? Innervation?
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PAD. Palmar= adduct the fingers (3rd digit is reference). Deep Ulnar nerve
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Dorsal interosseous muscles do what? Innervation?
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DAB. Dorsal = abduct the fingers. deep ulnar nerve
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Lumbrical muscles function
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Flex the base of the fingers
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Lumbrical muscles innervations
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Digits 2-3 = median nerve. Digits 4-5 = deep ulnar nerve
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Duputryen's Contracture
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Thickening of palmar fascia. surgical removal of fascia to relieve palm contraction
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Carpal Tunnel Syndrome
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Compressed Median nerve in tunnel. Thenar atrophy and blisters on digits 1-3. Surgical decompression of transverse carpal ligament
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Degenerative arthritis affects the thumb how?
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It becomes painful for the thumb to move on the trapezium. Thumb motion is limited
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Nucleus pulposus is a remnant of what embryological structure?
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Notochord
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Neurulation
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Formation of neural tube
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Anencephaly
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Failure of brain area to close properly after development. Must be open during development to receive nourishment, then normally closes once blood supply is established. Anenecephaly = no closure
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Spinal cord development- Basal plate becomes what part of spinal cord
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Motor (efferent)/Ventral horn
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Spinal cord development- Alar plate becomes what part of spinal cord
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Sensory (afferent)/Dorsal horn
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3 primary Vesicles made during brain formation
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Forebrain, Midbrain, Hindbrain
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5 secondary vesicles made during brain formation
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Telencephalon, Diencephalon, Mesencephalon, Metencephalon, Myelencephalon
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5 types of glia in CNS
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Ependymal cells, Choroid Plexus Cells, Astrocytes, Oligodendroglia, Microglia
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Blood brain barrier is formed by what part of what glial cells?
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End feet of astrocytes
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Why is white matter white?
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Myelinated axons
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Is regeneration in the CNS good?
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No, CNS injury = permanent deficits. Astrocytes create scar tissue. Oligodendroglia proteins inhibit axon growth
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What is Gliosis
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Process by which astrocytes form a glial scar during CNS damage
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Why can neurons of the PNS regenerate and CNS can't?
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PNS uses Schwann cells for regeneration, not oligodendroglia. Oligodendroglia have proteins that inhibit regeneration
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Preganglionic sympathetic neurons use what neurotransmitter?
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Ach (cholinergic)
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Postganglionic sympathetic neurons use what neurotransmitter?
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Epinephrine (Adrenergic), except sweat glands which use Ach
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Origin of the CNS
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Neural tube
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Origin of the PNS
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Migratory Neural crest cells
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a group of neurons with related function and connections is called...
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a nucleus
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What cells form myelin in the CNS
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Oligodendroglia
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Looking at a transverse section, is the gray matter the inner or outer part of the cord.
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Inner
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Why do motor neurons stain bright blue?
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High rER activity
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All cells of the CNS are derived form the neural tube except...
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microglia, from the bone marrow. they are phagocytic
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Action potential starts at what part of axon
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Axon Hillock
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All protein synthesis occurs in which part of neuron
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Cell body (soma)
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What is a Nissl Body
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when looking at a stain, a nissl body= rER
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What is the difference between rER and polysomes?
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Polysomes make proteins that stay in the cell. rER makes proteins that leave the cell. (E.g. RBC use polysomes to make hemoglobin for itself)
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Why is a euchromatin nucleus so clearly defined in neurons
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They are VERY active
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When staining pyramidal cells, why do we only see the apical dendrite, and not the entire axon?
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rER and protein synthesis occurs in the cell body, not the axon. rER is not found in the axon so it doesn't stain. Apical dendrite has some residual rER from the body in it, so it stains.
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Dendritic spine
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found on purkinje cells, specialized synaptic contact
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Do dendrites have an axon potential?
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No, they just receive the neurotransmitters.
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Telodendria
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terminal branchings of axons
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Why are axons uniform diameter?
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to maintain the action potential speed. neurofilaments do this
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Slow axonal transport occurs only in which direction?
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Anterograde- away from cell body
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Slow axonal transport carries what elements?
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Structural (tubulin, actin, neurofilaments)
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What does the high [ca] environment at synaptic clefts do with regard to slow axonal transport?
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Breaks down structural polymers being transported so they can be used as monomers. calcium activates enzymes
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How fast is slow axonal transport? (mm/day)
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.2-4 mm/day
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How fast is fast axonal transport? {mm/day}
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20-400 mm/day
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Anterograde fast axon transport carries what?
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Mitochondria, sER, synaptic vesicles away from body
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Retrograde fast axon transport carries what?
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Endocytosed material (virus, toxins, growth factors) towards the cell body
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Fast axonal transport uses what structural proteins as tracks?
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Microtubules
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Anterograde fast axon transport uses what motor protein?
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Kinesin
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Retrograde fast axon transport uses what motor protein?
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Dynein
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If a toxin disrupts microtubule formation, what processes are disrupted?
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Anterograde and Retrograde fast axonal transport, these rely on microtubules as tracks
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Lipofuschin
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accumulation of undigestable material in the neuron body (also seen in cardiac muscle and liver)
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Viruses can take advantage of what type of neuronal transport to infect the body?
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Retrograde fast axon transport
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An influx of what ion causes release of synaptic vesicles at cleft?
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Calcium
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Ependymal Cells Function
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line the inner cavity of the spinal cord. derived from ectoderm, so they resemble epithelium
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Choroid Plexus Function
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create CSF within ependymal cells and spinal cavity
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Where are fibrous astrocytes found?
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white matter of CNS
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Where are protoplasmic astrocytes found?
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grey matter of CNS
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Astrocyte processes contain which structural protein?
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GFAP
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Astrocyte processes have what at the end of them? why are they important
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End feet, form the blood brain barrier.
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Astrocytoma
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glial tumor of astrocytes. quickly become anaplastic and can enter CSF = gets to brain easily. Very bad.
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Oligodendroglia function
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Myelinate the cells of the CNS
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Multiple Sclerosis
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auto-immune disease attacking myelin and oligodendroglia. nerves go quickly (esp. optic nerve)
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Microglia functions
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Phagocytize injured neurons and glia in response to damage. derived from monoytes
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Rod cell (nervous system)
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microglia responding to CNS damage, become elongated
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Gitter cells
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fully phagocytic microglia in response to CNS damage
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3 layers of connective tissue around PNS
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Endoneurium, Perineurium, Epineurium
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Perineurium is significant why?
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It is the blood nerve barrier
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|
Guillan- Barre Syndrome
|
Auto-immune inflammation of PNS, affects PNS myelin
|
|
|
PNS Regeneration
|
Schwann cells become phagocytic and synthesize growth factors
|
|
|
Rate of axon regeneration in the PNS (mm/day)
|
1-3 mm/day
|
|
|
Rate of axon regeneration in the CNS?
|
No axon regeneration in the CNS!
|
|
|
Axotomy
|
Severed axon
|
|
|
Axonal Reaction
|
response to damage in the PNS. Swelling body, chromatolysis, eccentric nucleus
|
|
|
Chromatolysis
|
dissolution of rER/Nissl body
|
|
|
Why are actin and tubulin up-regulated during PNS axonal regeneration?
|
they form the tracks for the new neurons; required for growth cone
|
|
|
Why are neurofilaments initially down-regulated for PNS axonal regeneration
|
neuron doesn't want to grow width until it grows the length first. put all its energy in lengthening so it can start firing again.
|
|
|
Describe retrograde axon degeneration in response to PNS damage
|
axon degenerates to the most proximal node of ranvier
|
|
|
Wallerian (Anterograde) axon degeneration in PNS
|
distal part of broken axon is useless and has no machinery.
|
|
|
What is the general survival time for patients with astrocytomas?
|
8-10 months; "death sentence"
|
|
|
5 layers of epidermis in thick skin (Starting with the deepest)
|
Germinativum, Spinosa, Granulosa, Lucidum, Corneum
|
|
|
Stratum germinativum are attached to the basal lamina by what?
|
Hemidesmosomes
|
|
|
What are the 2 actively dividing layers of the epidermis
|
Germinativum and spinosum
|
|
|
What makes the stratum spinosum spiny?
|
intracellular bridges of desmosomes, these create the cohesiveness of the epidermis
|
|
|
Malphigian Layer
|
Germinativum and Spinosum together.
|
|
|
Keratinocyte proliferation occurs where
|
Malphigian layer (Germinativum and Spinosum)
|
|
|
Membrane coating granules
|
in stratum granulosum; contain GAGs and phospholipids to create barrier to water and microorganisms
|
|
|
Keratohyaline granules
|
basophilic, create keratin
|
|
|
Why are many skin creams dissolved in DMSO?
|
To get active ingredients past the hydrophobic barrier created by the stratum granulosum
|
|
|
Stratum Lucidum
|
clear layer due to lack of organelles in cells; acidophilic
|
|
|
Stratum corneum
|
flattened keratinized cells; horny/squamous cells
|
|
|
3rd degree burns can penetrate what layers?
|
Epidermis, dermis and even hypodermis
|
|
|
What can occur due to loss of body fluids in 3rd degree burns
|
Hypovolemia and shock
|
|
|
Why can the epidermis reform after 2nd degree burns?
|
Sweat glands and hair follicles can regenerate epidermis
|
|
|
Melanocytes are derived from what?
|
Neural crest cells
|
|
|
Basal Cell carcinoma stains
|
we see nest of basal cells; don't normally metastasize
|
|
|
Squamous cell carcinoma
|
epithelium replaced with pleomorphic cells. sometimes metastasize
|
|
|
Langerhans cells are in which stratum
|
in stratum spinosum
|
|
|
Langerhans cells
|
Dendritic macrophages in epidermis with anitgen presenting capabilities; are NOT anchored by desmosomes in spinosum
|
|
|
Relationship between Langerhans cells and HIV-1
|
Langerhans cells can act as a reservoir for HIV particles in HIV patients
|
|
|
What type of stain is used to see langerhans cells?
|
Gold
|
|
|
Malignant melanoma is caused by an increase of what enzyme activity in melanocytes?
|
tyrosinase; leads to high melanin production
|
|
|
Are melanocytes anchored in epidermis by desmosomes?
|
No, they are VERY motile. Dangerous for metastasis
|
|
|
Why are some people darker skinned than others?
|
Slower breakdown of melanin; some is still present when it gets to the surface of skin
|
|
|
Cytocrine secretion
|
Melanin granules being squeezed into keratinocytes
|
|
|
What cells contain most melanin in the epidermis?
|
Keratinocytes
|
|
|
What is melanin's function?
|
To protect the nucleus of dividing keratinocytes from UV
|
|
|
Malignant melanoma penetrates what to enter the circulation
|
Dermis
|
|
|
Merkel Cells Function
|
Found in thick skin; touch sensors
|
|
|
Papilary layer of dermis has what type of Connective tissue?
|
Loose
|
|
|
What type of connective tissues are in the dermal reticular layer
|
Dense irregular (collagen 1)
|
|
|
Where is thick skin found?
|
Palms of hands, no hair
|
|
|
Eccrine sweat glands use which neurotransmitter, even though they are post ganglionic?
|
Ach
|
|
|
Eccrine sweat glands use what types of cells for secretion from acini?
|
Myoepithelial cells
|
|
|
Sebaceous glands develop in association with what other structure?
|
Hair Follicles
|
|
|
What type of secretion occurs in the sebaceous glands?
|
Holocrine
|
|
|
How can you tell a sebaceous gland from adipose tissue?
|
Sebaceous glands have a central nucleus
|
|
|
Meissner's Corpuscle
|
Involved in discriminative touch, in thick skin
|
|
|
Pacinian Corpuscle
|
Senses pressure and vibratory sense
|
|
|
Radiculopathy
|
Damage to 1 spinal nerve. presents as 1 dermatome/myotome deficit. Dermatomal deficits, test autonomous zones
|
|
|
Neuropathy
|
Damage to a peripheral nerve, multiple dermatomes/myotomes are affected/weakened
|
|
|
Lower motor neurons are in what part of spinal cord
|
anterior horn
|
|
|
Anterior horn somatotopy
|
Lateral horn area controls more distal regions. dorsal areas control flexors etc.
|
|
|
Areflexia
|
No relfexes
|
|
|
Radiculopathy
|
Damage to 1 spinal nerve. presents as 1 dermatome/myotome deficit
|
|
|
Neuropathy
|
Damage to a peripheral nerve, multiple dermatomes/myotomes are affected/weakened
|
|
|
Lower motor neurons are in what part of spinal cord
|
anterior horn
|
|
|
Anterior horn somatotopy
|
Lateral horn area controls more distal regions. dorsal areas control flexors etc.
|
|
|
Areflexia
|
No relfexes
|
|
|
Hyporeflexia
|
Weak reflexes
|
|
|
Cremasteric Reflex tests....
|
T12, L1, L2
|
|
|
Plantar reflex
|
heel to toe stroke. Test L4-S2
|
|
|
Anal Wink
|
tests S2-S5
|
|
|
Deep tendon reflexes are used to test what part of the body?
|
Limbs
|
|
|
Achilles Reflex tests...
|
S1
|
|
|
Patellar reflex tests...
|
L4
|
|
|
Biceps reflex tests...
|
C6
|
|
|
Triceps reflex tests...
|
C7
|
|
|
1a afferent neuron
|
senses deep tendon reflex, synapse directly on alpha motor neurons. Direct synapse = reflex
|
|
|
If leg flexor is stimulated due to reflex, what else must happen
|
Extensors on same side must be relaxed, Extensors on opposite side must be activated to stabilize body
|
|
|
Lateral Corticospinal tract crosses where?
|
medulla area
|
|
|
Lateral Corticospinal tract controls what?
|
motor function
|
|
|
Damage to lateral corticospinal tract below the medulla leads to motor deficits on which side? (ipsi or contra)
|
same side ( ipsi)
|
|
|
Damage to lateral corticospinal tract above the medulla leads to motor deficits on which side? (ipsi or contra)
|
contralateral, opposite side
|
|
|
Anterolateral sensory tracts carries information on ...
|
crude touch, pain, temp
|
|
|
Anterolateral sensory tracts cross ...
|
at the spinal level they exit
|
|
|
Dorsal sensory tracts carry info on ...
|
discriminative touch, proprioception and vibration
|
|
|
Dorsal sensory tracts cross where?
|
caudal medulla
|
|
|
Damage to an anterolateral tract causes pain, temp, touch loss on which side?
|
Contralateral
|
|
|
Damage to a dorsal tract (below medulla) causes proprioception, vibration, disc. touch loss on which side?
|
ipsilateral
|
|
|
Dura mater
|
outer most meninges layer
|
|
|
Arachnoid mater
|
under dura mater
|
|
|
Pia mater
|
attached to cord, forms denticulate ligament and internal filum terminale
|
|
|
Pachymeninx
|
Dura mater, dense CT
|
|
|
Leptomeninx
|
Pia+ arachnoid mater, derived from neural crest, these contain blood vessels
|
|
|
Dural sac
|
extends past the spinal cord and carries CSF; Ends at S2
|
|
|
Neutrophils in the CSF indicates what?
|
meningitis
|
|
|
Artery of Adamkiewicz
|
Large artery to spinal cord from T12. Surgical mistakes cut this and can cause ischemia in spinal cord
|
|
|
Clinical relevance of Batson's (Epidural) Plexus
|
Veins that drain the spinal cord have no valves, reflux of blood form organs can carry metastatic cells cranially
|
|
|
What are the 5 roots of the brachial plexus?
|
C5-T1 anterior rami
|
|
|
Brachial Plexus- What nerve comes off of C5?
|
Dorsal Scapular
|
|
|
Brachial Plexus- What nerve comes directly off of C5, C6, C7?
|
Long thoracic nerve
|
|
|
Brachial Plexus- What 2 nerves branch off the superior trunk?
|
Nerve to subclavius, Suprascapular nerve
|
|
|
Brachial Plexus- What nerve comes from the lateral cord?
|
Lateral pectoral nerve
|
|
|
Brachial Plexus- What nerves come from the posterior cord?
|
Inferior subscapular, medial subscapular (thoracodorsal), superior subscapular (and axillary)
|
|
|
Brachial Plexus- What nerves com off the medial cord?
|
Medial pectoral, medial brachial cutaneous, medial antebrachial cutaneous
|
|
|
Brachial Plexus- 5 terminal nerves
|
Musc, Axillary, Median, Radial, Ulnar
|
|
|
Osgood Schlatter Disease
|
fracture of epiphyseal plate during growth, enlarged tibial tuberosity due to swelling; pain during teen years
|
|
|
6 muscles of anterior thigh
|
Sartorius, vastus lateralis, vastus medialis, rectus femoris, rectus intermedialis, iliopsoas
|
|
|
Anterior thigh muscle innervation
|
Femoral nerve
|
|
|
Sartorius Function
|
flex thigh, flex knee, laterally rotate thigh
|
|
|
Sartorius Origin
|
ASIS
|
|
|
Sartorius Insertion
|
Medial tibia
|
|
|
Rectus Femoris Origin
|
AIIS
|
|
|
Quadriceps Insertion
|
Quadtriceps tendon above patella
|
|
|
Iliacus function
|
flex thigh
|
|
|
Pectineus Function
|
adduct, flex thigh
|
|
|
Quadriceps function
|
Extend knee
|
|
|
6 muscles of medial anterior thigh
|
Gracilis, Pectineus, Adductor Longus, Adductor Brevis, Adductor Magnus, Obturator externus
|
|
|
2 Nerves that innervate adductor magnus
|
obturator mainly, sciatic innervates hamstring portion
|
|
|
What are Riders Bones?
|
ossification of adductor tendons due to chronic inflammation
|
|
|
Medial thigh muscles are generally innervated by ...
|
obturator nerve
|
|
|
Which medial thigh muscle can be transplanted into the forearm if needed?
|
Gracilis
|
|
|
Obturator externus function
|
external rotator of femur
|
|
|
Damage to the obturator nerve significantly hinders what movement?
|
Adduction of thigh
|
|
|
What 4 muscles cross both the hip and knee
|
Sartorius, Rectus femoris, Gracilis, Hamstrings
|
|
|
What 3 muscles make the Pes Anserinus
|
semitendonosus, gracilis, sartorius
|
|
|
Where is the pes anserinus located?
|
medial knee
|
|
|
Fun Fact: Saphenous nerve runs through the adductor canal, but not the adductor hiatus
|
now you know
|
|
|
Fun Fact: Only blood vessels go through adductor hiatus
|
now you know
|
|
|
4 vessels of the Cruciate anastomoses in the femur
|
1st perforating artery, medial and lateral femoral circumflex arteries, obturator artery
|
|
|
Contents of Femoral triangle
|
NAVEL. Femoral nerve, artery, vein, lymph. (nerve is not in femoral sheath though)
|
|
|
Contents of the femoral canal
|
Just lymphatic vessels
|
|
|
Contents of the femoral sheath
|
Femoral artery, vein and lymphatic vessel
|
|
|
Why is the femoral triangle clinically beneficial?
|
Can use to get a clear pulse, can be used in interventional cardiology (catheterization) to get to heart easily
|
|
|
What are the negatives to the femoral triangle?
|
Easily punctured, no strong roof.
|
|
|
What are the borders of the femoral triangle?
|
Sartorius, adductor longus, inguinal ligament
|
|
|
Fun Fact: Femoral vein is used to get to right side of heart
|
boom
|
|
|
Adductor Canal Borders
|
Vastus medialis, Sartorius, Adductor longus
|
|
|
What is a Femoral Hernia?
|
pieces of intestines enter lymphatic system and protrude through saphenous opening/femoral canal. ischemia and infection can occur
|
|
|
What is the general nerve for the posterior thigh compartment?
|
Sciatic
|
|
|
3 arches of the foot
|
Medial longitudinal arch. Lateral longitudinal arch. Transverse arch
|
|
|
What 3 ligaments support the arch of the foot passively?
|
Plantar Calcaneonavicular, Long plantar, plantar aponeurosis
|
|
|
What 3 tendons/muscles actively support the arch of the foot?
|
Fibularis longus, tibialis anterior and posterior
|
|
|
Halux Valgus
|
lateral deviation of big toe. medial deviation of metatarsal 1. caused by poor footwear. bunion develops
|
|
|
Plantar Fasciitis
|
inflammation of plantar fascia, can lead to heel spur, caused by running on sand (and other things)
|
|
|
Morton's Neuroma
|
excess running can cause the toes to pinch the nerve between them. nerve can swell
|
|
|
Dorsalis pedis artery is found between what 2 leg extensors?
|
Extensor hallucis longus and extensor digitorum longus
|
|
|
Congenital Clubfoot Features
|
Inversion of feet at birth, walk on ankles
|
|
|
Pelvic bone is which 3 bones fused?
|
Ischium, Ilium, pubis
|
|
|
Gerdy's Tubercle
|
lateral condyle of tibia
|
|
|
Gluteus maximus innervation
|
Inferior gluteal nerve
|
|
|
Gluteus maximus is used during what common activities?
|
Climbing stairs, getting out of chair
|
|
|
Gluteus Maximus Insertion
|
Gluteal tuberosity of femur
|
|
|
Tensor fascia lata origin
|
ASIS
|
|
|
Tensor fascia lata innervation
|
superior gluteal nerve
|
|
|
Tensor fascia lata function
|
abduct and medially rotate thigh
|
|
|
Gluteus medius Function
|
abduct thigh, keep pelvis straight during walk
|
|
|
Gluteus medius innervation
|
superior gluteal nerve
|
|
|
Trendelenburg Sign/Gait
|
pelvic drop during walk; gluteus medius is unable to hold up pelvis (superior gluteal nerve injury perhaps)
|
|
|
Quadratus femoris attachments
|
Ischial tuberosity to intertrochanteric crest
|
|
|
Quadratus femoris innervation
|
nerve to quadratus femoris
|
|
|
Obturator Internus innervation
|
nerve to obturator internus
|
|
|
Superior gemellae innervation
|
nerve to obturator internus
|
|
|
Inferior gemellae innervation
|
nerve to quadratus femoris
|
|
|
The sciatic nerve normally comes out from under what muscle?
|
Piriformis
|
|
|
3 hamstring muscles
|
biceps femoris, semitendinosus, semimembranosous
|
|
|
Hamstring muscle origin
|
ischial tuberosity
|
|
|
Semitendinosus and Semimembranosus insertion
|
medial condyle of tibia
|
|
|
Biceps femoris insertion
|
lateral side of fibula
|
|
|
Piriformis innervation
|
nerve to piriformis
|
|
|
Sartorius innervation
|
femoral nerve
|
|
|
obturator externus innervation
|
obturator nerve
|
|
|
Hip joint components
|
femur head in acetabulum
|
|
|
What ligaments limit extension of the femur
|
Iliofemoral ligament (aka Y ligament) and Ischiofemoral ligament
|
|
|
What ligament limits abduction of the femur?
|
Pubofemoral joint
|
|
|
What does the entire leg look like with a dislocated hip joint?
|
Shortened and medially rotated leg
|
|
|
What does the limb look like with a broken femoral head?
|
Shortened and laterally rotated
|
|
|
Fun Fact: Medial femoral circumflex is the most important vessel for femoral head anastomoses
|
boom
|
|
|
Total hip arthroplasty replaces what two major joint components?
|
Acetabulum and femoral head
|
|
|
What type of joint is the knee?
|
Modified Hinge Joint
|
|
|
When does the knee joint lock?
|
When the knee is fully extended with foot on the ground
|
|
|
How does the knee joint lock?
|
The femoral condyles rotate medially
|
|
|
Why does the knee joint lock?
|
When standing for long periods, it stabilizes the knee joint without quadriceps force. If knee didn't lock, we would not be able to stand for long. (quadriceps muscle fatigue)
|
|
|
Popliteus muscle function
|
unlocks the knee, by laterally rotating the femoral condyles
|
|
|
Menisci of the knee
|
between the femur and tibia
|
|
|
What bone or bones does the patella articulate with?
|
Just the femur, not the tibia
|
|
|
Fun Fact: For the strongest grip, wrist must be extended
|
boom
|
|
|
Pre-patellar Bursitis Cause
|
Friction between skin and patella causes inflammation. swelling of anterior knee
|
|
|
Fun Fact: ACL is weaker than the PCL
|
boom
|
|
|
Fun Fact: The ACL/PCL are inside the fibrous joint capsule, but are outside the synovial cavity
|
yea
|
|
|
Drawer Test
|
Tests if ACL/PCL are torn. Push leg anterior/posteriorly, check for excessive motion and compare to normal side
|
|
|
What is the miserable triad?
|
tearing of the medial collateral ligament, medial meniscus, and anterior cruciate ligament
|
|
|
The subtalar joint is between what bones?
|
Talus and Calcaneous
|
|
|
What 2 joints make up the midtarsal joints?
|
talocalcaneonavicular and calcaneocuboid joints
|
|
|
What is the most commonly sprained ligament in the foot ("sprained ankle")?
|
inversion sprain of anterior talofibular ligament
|
|
|
What is Avulsion?
|
When a tendon is so strong, that instead of the tendon breaking when force is exerted on it, it rips out a piece of bone.
|
|
|
Severe ankle Eversion would damage what collection of ligaments?
|
Deltoid ligaments (likely avulsion)
|
|
|
Vincula Longus and Brevis
|
tendonous blood vessels in extensor hood
|
|
|
Popliteal fossa contents
|
Popliteal Artery, vein and tibial nerve (from deep to superficial)
|
|
|
What nerve wraps around the head of the fibula?
|
Common fibular, very vulnerable to damage here
|
|
|
What is the strongest dorsiflexor of the foot?
|
Tibialis anterior
|
|
|
Anterior leg muscle blood supply
|
anterior tibial artery
|
|
|
Anterior leg muscle innervation
|
deep fibular nerve
|
|
|
Fibularis tertius function
|
aid in dorsiflexion and eversion
|
|
|
Cause of a "steppage gait"
|
Common fibular nerve injury. loss of anterior and lateral leg compartment muscles. No dorsiflexion. Patient must lift leg to avoid tripping
|
|
|
3 muscles of the achilles heel
|
Gastrocnemius, soleus, plantaris
|
|
|
Achilles tendon function
|
Plantarflexion
|
|
|
Name the things posterior to the medial malleolus at the ankle.
|
Tibialis posterior tendon, flexor Digitorum tendon, posterior tibial artery, vein, tibial nerve, flexor hallucis longus (Tom, Dick, And, Very, Nervous, Harry)
|
|
|
Intermittent claudication
|
Caused by Artherosclerotic disease of leg arteries. Blockage of arteries causes oxygen debt and cramps after running.
|
|
|
Compartment Syndrome
|
increased pressure in leg compartments. can compress nerves and arteries = decreased perfusion. Fasciotomy is performed to relieve pressure.
|
|
|
Pathway of Great Saphenous vein
|
Medial malleoulus up to femoral triangle.
|
|
|
Varicose Veins
|
Incompetent vein valves lead to pooling of blood in veins. superficial veins become dilated. common during pregnancy
|
|
|
Which vertebrae is the center of gravity when standing in anatomical position?
|
S2
|
|
|
Sciatic nerve exits the pelvis through which foramen?
|
Greater sciatic foramen
|
|
|
Femoral nerve exits the pelvis through which foramen?
|
Gap between inguinal ligament and pelvis
|
|
|
Obturator nerve exits the pelvis through which foramen?
|
Obturator foramen
|
|
|
Crural fascia
|
deep fascia of leg
|
|
|
What is the advantage of having veins accompany the arteries in a tight sheath?
|
The pulse of the arteries compress veins. veins don't have muscles
|
|
|
External iliac lymph nodes follow which vein?
|
External iliac vein
|
|
|
Fun Fact: Lymphatic drainage in the leg drains into the inguinal node
|
now you know
|
|
|
Lymphadenopathy
|
Enlarged inguinal lymph nodes due to toxins
|
|
|
The femoral nerve is an anterior or posterior division. (Think pre-axial or post-axial)
|
Posterior (remember the lower limb turns during development)
|
