DSF wk 1 obj Flashcards
Define components of the skeletal system, including major supportive structures
206 bones Living CT Vascular and innervated Functions: Support, protection, storage, mechanical basis for movement, blood cell production Cartilage: Avascular
Describe the classification of bones and their features/markings
All bones has superficial thin layer of cortical bone (strength; weight-bearing) around a central mass of spongy bone
Some have medullary (marrow) cavity
Classified according to shape: long, short, flat, irregular, sesamoid (protect tendons from excessive wear, often change angle of tendons as they pass to attachments)
Periosteum: external, fibrous CT, tough and highly vascular, helps anchor muscles to bone, reacts to trauma
Endosteum: internal, ill-defined largely cellular membrane
Describe parts of the axial and appendicular skeleton
Axial: Midline structures of skeleton - bones of head, neck, trunk
Appendicular: Bones of the arms, legs, pelvic and pectoral girdles (all paired)
Describe organization of the NS into anatomic divisions (CNS, PNS) and functional divisions (somatic, autonomic)
CNS: brain and spinal cord
PNS: cranial nerves (12 pairs), spinal nerves (31 pairs), autonomic nerves
Somatic NS: voluntary. Sensory inputs from skin surface, skeletal muscle, bone, tendon, joints. Motor outputs to skeletal muscles
Autonomic NS: Visceral - involuntary. Sensory inputs from viscera and blood vessels (autonomic reflexes, pain signals from viscera). Motor output to cardiac muscle, glands, smooth muscle in walls of organs and vessels.
ANS subdivisions - Sympathetic (fight or flight) and Parasympathetic (rest and digest).
Somatic and Autonomic both contain sensory (afferent) fibers and motor (efferent) fibers
Describe the structure of typical neurons, the different functional types and their targets for innervation
See diagram on slides for structures
Oligodendrocytes: glial cells of CNS
Schwann cells: glial cells of PNS
Describe the gross anatomy of the spinal cord and its anatomic relations to vertebrae
(Except in upper cervical spinal cord) the vertebral body closest to a spinal cord segment is at least 1 level higher, and often many more (ex: lumbar cord: T10-T12 vertebrae)
Discuss how spinal nerves and spinal cord segments are named and numbered
31 pairs of spinal nerves: named for section of spinal cord from which they arise
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
In cervical spinal cord: spinal nerves exit above the corresponding vertebra
Rest of spinal cord: spinal nerves exit below the corresponding vertebrae
Spinal nerves exit vertebral column via intervertebral foramen
Draw and label a cross-section of the spinal cord including dorsal and ventral horns, gray and white matter, dorsal and ventral roots, DRG, spinal nerve, dorsal and ventral rami
Draw out
A spinal cord segment is comprised of a pair of spinal nerves
Nerve rootlets from the spinal cord converge to form 2 roots: Anterior (contains motor fibers whose cell bodies are in spinal cord gray matter - anterior and lateral horns) and Posterior (contains sensory fibers whose cell bodies located in spinal ganglion, DRG, outside of spinal cord)
Anterior and posterior roots unite to form a spinal nerve, which contains both motor and sensory fibers
Spinal nerve immediately divides into Anterior ramus and Posterior ramus
Anterior ramus: innervates muscles of anterior and lateral trunk, upper and lower limbs and overlying skin (stay as separate nerves to innervate trunk - intercostal nerves, form plexus to supply limbs)
Posterior ramus: innervates joints of the vertebral column, deep muscles of the back, and overlying skin (stay as separate nerves)
Draw the pathway and fiber content of a typical intercostal nerve
Sensory receptors - pseudounipolar sensory neuron - DRG - posterior root of spinal nerve
Anterior root of spinal nerve - somatic multipolar motor neuron - effector organ (skeletal muscle)
Anterior root of spinal nerve - presynaptic and postsynaptic autonomic multipolar motor neurons (synapse w/in autonomic ganglion) - synapse on glands/cardiac muscle/smooth (involuntary) muscle of organs
Define the concept of a dermatome and its relationship w/ a spinal cord segment (segmental innervation)
Each spinal cord segment has somatic and autonomic components
Dermatome: map of segmental sensory innervation
Each spinal cord segment is responsible for cutaneous innervation of a particular region
C1-C8: dorsal head, neck, shoulders, arms, hands
T1-T12: anterior trunk and abd, medial arms
L1-L5: posterior lower back, anterior and lateral legs, soles of feet
S1-S5: genitals, posterior legs
Describe in general terms, the structure of the vertebral column and the components of a typical vertebra
See diagrams on slides
Define the primary and secondary curvatures of the spine and differentiate b/w abnormal curvatures
Primary curvatures: Sacral, Thoracic - form during fetal development
Secondary curvatures: Lumbar, Cervical - develop after birth (from walking and lifting head, respectively)
Kyphosis - can be caused by compression fxs (elderly) - outward rounding of upper back, “hunchback”
Lordosis - excessive inward curve of the spine
Scoliosis - sideways curvature of the spine
Describe the location and function of the intervertebral discs and major supporting ligaments of the spinal column
Intervertebral discs: connect adj vertebrae, shock absorption
Disc reinforced by anterior and posterior longitudinal ligaments
Disc herniation most often occurs in posterolateral region - annulus fibrosus is thinner and has fewer lamellar in posterior aspect
Ligaments connecting adj vertebrae: resist hyperflexion
Define and list examples of extrinsic and intrinsic back muscles
Intrinsic: Deep muscles (Splenius-capitis and cervicus, Erector spinae-Spinalis, Longissimus, Iliocostalis, Transversospinales-Semispinalis capitis, Multifidus, Rotatores)
Extrinsic: Intermediate (Serratus posterior superior and inferior - Respiratory) and Superficial (Trapezius, Latissimus dorsi, Rhomboid major and minor, Levator scapulae - Appendicular)
Describe the location, function, and innervation of the superficial (appendicular), intermediate (respiratory), and deep (intrinsic) back muscles
x
Describe the pattern of arterial supply and venous return within the back
x
Review the gross anatomy of the spinal cord and supporting meningeal structures
Meningeal spaces of the brain and spinal cord are continuous w/ one another
Dura mater, archnoid mater, pia mater
Pia mater: Denticulate ligaments (attach spinal cord to superficial meningeal layers) and Filium terminale (connects spinal cord to coccyx, provides tension to stabilize spinal cord)
Formulate the stages of prenatal development with emphasis on their relative vulnerability to teratogens.
0-2 wks Germinal period: not sensitive usually, high rate of lethality can occur
3-8 wks Embryonic period: period of greatest sensitivity, each organ system will also have a peak sensitivity
9-38 wks Fetal period: decreasing sensitivity, period of functional maturation
Compare and contrast b/w embryonic/fertilization and gestational/menstrual age.
During a regular menstrual cycle, ovulation occurs at day 14. Assuming fertilization to occur ~during same time, embryo is already 2 wks old when the mother misses her next period.
Gestational (menstrual) age [counted from the 1st day of the LMP] is always 2 wks greater than the embryonic (fertilization, counted from day of fertilization) age.
Construct the development of the embryo from a zygote to a blastocyst.
W/in 24 hrs zygote formation, embryo undergoes series mitotic divisions (cleavage) in which the cell #s increase at expense of size (no cytoplasm synthesis) - loosely packed, increasingly smaller cells - blastomeres.
~3 days after fertilization, embryo divides to form a 16-cell morula, that enters uterine cavity.
Morula eventually differentiates into a blastocyst, in which cells organize into an inner (embryoblast) and outer (trophoblast) cell mass.
Embryoblast - embryo
Trophoblast - placenta
Illustrate the stages, duration, and molecular regulation of the preimplantation phase.
Degeneration of zona pellucida
Adplantation - Initial adhesion of blastocyst to uterine epithelium - slows in motility, “rolls” on surface, aligns w/ the inner cell mass closest to the epithelium, and, stops
Initial attachment mediated by L-selectin on trophoblast cells and its carbohydrate receptors on the uterine epithelium
Critique the microstructure of the uterine endometrium and the phase of the menstrual cycle at implantation.
~Days 6/7-13: blastocyst implantation
Occurs in the functional (compact) layer of the endometrium during the secretory phase of the ovarian cycle
Decidua: specialized, highly modified endometrium of pregnancy.
Transformation of endometrial stromal cells, occurring initially at site of implantation: become polyhedral, loaded w/ glycogen and lipids, intercellular spaces filled w/ extravasate.
Decidualization: transformation of secretory endometrium to decidua, dependent on estrogen and progesterone and factors secreted by the implanting blastocyst.
Outline the normal types of implantation and predict the clinical outcomes of extra-uterine pregnancies.
Normal: Implantation hemorrhage - varies in amount/duration/character from regular menstrual bleeding - around days 13-14 (days 27-28 of menstrual cycle)
Cells of syncytiotrophoblasts erode through endothelial lining of maternal capillaries
Ectopic pregnancy: (extra-uterine implantation) most common in the uterine tube. Can be caused by PID. Ruptured tubal pregnancy is surgical emergency - hemorrhage
Mother presents during 1st trimester w/: abd pain, vaginal bleeding, signs of internal hemorrhage/shock (hypotension, tachycardia, rapid and feeble pulse)
Design the development of the bilaminar germ disk, amnion, chorion, amniotic and chorionic cavities, and the yolk sac during the 2nd week of embryonic development.
Day 8: Trophoblast differentiates into cytotrophoblast and syncytiotrophoblast (secrete hCG: maintain decidua and corpus luteum)…Embryoblast differentiates into epiblast and hypoblast
Day 9: At embryonic pole, vacuoles appear in synctium and fuse, forming Trophoblastic lacunae. Flattened cells from hypoblast form thin exocelomic membrane - Heuser’s Membrane - lines exocoelomic cavity, primitive yolk sac. Cavity formed w/in cells of epiblast - Amniotic cavity.
Days 11-12: new cells derived from yolk sac appear b/w cytotrophoblast and Heuser’s membrane - extra-embryonic mesoderm…cavities develop w/in newly formed mesoderm; coalesce to form extra-embryonic coelom - Chorionic cavity.
Design the process of gastrulation w/ emphasis on the morphogenetic role of the primitive streak in forming the trilaminar embryo.
Gastrulation: 3rd wk - process that establishes the 3 definitive germ layers of the embryo (ectoderm, intra-embryonic mesoderm, endoderm), forming a trilaminar embryonic disk
Primitive streak forms day 15, caused by proliferation of epiblast cells.
Predict the consequences of ineffective gastrulation (caudal dysgenesis) and failure of regression of the primitive streak (sacrococcygeal teratoma).
Caudal dysgenesis: occurs if gastrulation stops too soon - head and thoracic regions of embryo are well developed, but insufficient cells available to form normal pelvis, GU organs, and lower limbs. Death usuallu from defective kidney formation. Rare but mostly observed in fetuses of diabetic mothers.
Sacrococcygeal teratoma: Common congenital germ cell tumor, develops from abnormal remnants of primitive streak. Tumor consists of derivatives of all 3 germ layers. Polyhydramnios common b/c increased fetal CO - often preterm labor and premature membrane rupture. Severe cases - Maternal Mirror Syndrome - mother develops HTN, hyperemesis, pulmonary edema, proteinuria.
Critique the formation of the notochord and its role in the differentiation of nerve tissue.
Some mesenchymal cells that have ingressed through the primitive streak migrate cranially from the primitive node and pit, forming a median cellular cord, the notochordal process - which grows cranially b/w the ectoderm and endoderm until it reaches the prechordal plate.
As differentiation continues, the cells of the notochord plate detach from the hypoblast and form a continuous line of cells called the notochord - critical for establishing the midline and axis of embryo - important signaling center for inducing axial skeleton.
Eventually forms the nucleus pulposus of each intervertebral disc.
Discuss the fate of the notochord in adult human being and predict consequences of its incomplete involution (chordoma).
Chordomas: malignant neoplasms from cellular remnants of the notochord . Frequently affects sacrum - rare, slow-growing, primary bone tumor.
Notochord eventually forms the nucleus pulposus of each intervertebral disc.
Formulate the stages of neurlation and the initial steps in the genesis of the CNS and PNS.
Notochord and prechordal plate induce the overlying ectoderm to thicken and form neural plate - initiation of Neurulation.
Occurs in cranial-to-caudal sequence.
Neural folds - elevated lateral edges of neural plate - fuse to form neural tube.
Design the genesis of the neural crest cells and outlines its derivatives.
Neural crest cells originate from edges (crests) of neural folds as neurulation proceeds. Form along entire length of neural tube in neuroectoderm cells.
Migrate away from neural tube to form many different tissues - PNS, Pia and Arachnoid mater, CT, dermis, some bones of head and neck, melanocytes, cardiac septa, medulla of adrenal gland, parafollicular cells of thyroid
Neural crest cells are incredibly sensitive to insults from teratogens.
Critique the differentiation and derivatives of intra-embryonic mesoderm.
Mesoderm differentiates into 3 parts: paraxial mesoderm along neural tube axis that forms somites; intermediate mesoderm that forms the gonads and parts of the UG system; lateral plate mesoderm that will line body cavities.
Lateral plate mesoderm splits into 2 layers: visceral (splanchic) and parietal (somatic).
Visceral mesoderm associated w/ organs, parietal mesoderm associated w/ body wall.
Space b/w these layers (intraembryonic coelom) constitutes the body cavity.
Correlate the microscopic structure of skin w/ its functions.
x
Correlate the histological layers and cell types of epidermis with their functions.
x
Analyze the transformation of keratinocytes from the basal to superficial layers, ultimately resulting in keratinization.
x
Describe the process of melanin synthesis and donation by melanocytes.
Melanocytes originate from neural crest.
Melanin synthesized by melanocytes in Stratum basale.
Melanin produced by oxidation of Tyr (Tyrosinase key) and packaged in melanosomes.
Keratinocytes take up melanin by cytocrine secretion: they phagocytose the tips of dendritic processes.
Most melanin is found in keratinocytes.
Melanin found above nucleus of basal cells - protecting DNA from radiation.
Skin pigmentation determined by amount, type, packaging of melanin in epidermis - melanin breakdown rate (faster in lighter-skinned individuals).
Correlate the histological organization and cell types of the following epidermal derivatives with their locations and functions: sebaceous glands, eccrine sweat glands, apocrine sweat glands.
x
Correlate the microstructure of the sensory receptors in the skin w/ their locations and functions.
x
Compare thick and thin skin in terms of histological organization, distribution of epidermal derivatives, locations, and functions.
x
Correlate underlying defects in the following disease processes that result from structural and functional alterations of skin: psoriasis, albinism, diabetic neuropathy, vitiligo.
x
Describe normal dev of integumentary system (including skin appendages) w/ primary focus on:
Epidermal layers and cells, keratinization, hair, mammary glands
x
Identify common birth defects of integumentary system
Congenital bulbous disorders (EBS, JEB, DEB)
Icythyosis (IV, LI, Harlequin. XLR)
Hypopigmentation disorders (OCA, Waardenburg’s syndrome, Piebaldism)
Hypohidrotic ectodermal dysplasia
Congenital bulbous disorders (EBS, JEB, DEB)
x
Icythyosis (IV, LI, Harlequin. XLR)
x
Hypopigmentation disorders (OCA, Waardenburg’s syndrome, Piebaldism)
x
Hypohidrotic ectodermal dysplasia
x
Describe classification of joints and identify examples of each
x
Describe components of a synovial joint
x
Discuss the different types of synovial joints and the movements they permit
x
Discuss the importance of peri-articular synovial structures: bursae and tendon sheaths.
x
Identify types of musculoskeletal injuries
x
Identify bones of the shoulder region and major features including muscle attachment sites and articular surfaces
Scapula
Clavicle
Proximal Humerus
Describe the movements permitted by the shoulder joint (glenohumeral joint)
x
Describe the attachments, actions, innervations of the rotator cuff, pectoral and posterior shoulder muscles
x
Describe the anatomic structures (ligaments, cartilage, capsule) which act as static stabilizers and dynamic constraints of the shoulder
x
Correlate the clinical presentation of disorders of the shoulder region w/ structural and functional alterations
x
Describe the blood supply and venous drainage of the shoulder region including the vessels providing collateral circulation in the scapular anastomosis
x
Describe the organization of the brachial plexus in terms of roots, trunks, divisions, cords, major branches.
5 roots: anterior rami of spinal nerves C5, C6, C7, C8, T1
3 trunks: upper (C5+C6), middle (C7), lower (C8, T1)
6 divisions: (anterior + posterior)
3 cords: Lateral (C5-C7 anterior), Medial (C8-T1 anterior), Posterior (C5-T1)
5 major branches: Musculocutaneous n. C5-C7 (anterior), Median n. C6-T1 (anterior), Ulnar n. C8-T1 (anterior), Axillary n. C5-C6 (posterior), Radial n. C5-T1 (*posterior)
Describe the spatial relationship of the parts of the brachial plexus to the cervical region and axilla
Spinal nerves C5-T1 come from intervertebral foramina, go through interscalene groove (b/w anterior and middle scalene muscles) and costoclavicular space (b/w clavicle and 1st rib), go through axilla, to innervate upper limb
Supraclavicular portion: 5 roots, 3 trunks, 6 divisions
Infraclavicular portion: 3 cords, 5 major branches
Describe the motor and sensory functions of the branches of the brachial plexus
Musculocutaneous n. C5-C7 (from medial and lateral cords): Anterior arm muscles (coracobrachialis, biceps brachii, brachialis), skin of lateral forearm
Median n. C6-T1 (from medial and lateral cords): Most anterior forearm muscles, most thenar muscles, 2 lumbricals (intrinsic hand), skin of palm, 1-3 digits, 1/2 of 4th digit
Ulnar n. C8-T1 (from medial and lateral cords): 1/2 anterior forearm muscles (flexor carpi ulnaris, flexor digitorum profundus, most intrinsic hand muscles, skin of medial hands, 5th digit, 1/2 of 4th digit
Axillary n. C5-C6 (from posterior cord): Deltoid and teres minor, skin of lower deltoid region
Radial n. C5-T1 (from posterior cord): Muscles of posterior arm and posterior forearm, skin of posterior forearm, dorsum of hand, dorsum of most digits)
Describe the course of the 5 major branches (musculocutaneous, median, ulnar, axillary, radial nerve) , noting their relationships to joints and muscles
Draw out
Explain the distribution of dermatomes on the upper limb
x
Identify sites where parts of the brachial plexus are vulnerable and prone to injury
Surgical neck of humerus - Axillary n.
Radial groove (mid-shaft) of humerus - Radial n.
Medical epicondyle of humerus (Ulnar n.
Describe the structure of the breast
Parenchyma: mammary glands - modified sweat glands
Stroma: fibrous tissue and adipose tissue
Held together by suspensory ligaments (mostly located superior) that attach to overlying dermis
Describe the position of the breast in relation to skin, superficial fascia and pectoral muscles
Breast = subcutaneous organ, located directly beneath the skin Overlies pectoralis major fascia Retromammary space (potential space)
Discuss the lymphatic drainage of the breast and its significance in the spread of CA
75% of breast drainage is to lymph nodes of axilla
Remaining 25% drains to nodes along sternum or to opposite breast
Axillary nodes also drain upper limb
Describe the blood supply, venous drainage and innervation of the breast
Venous blood drains primarily to the axillary vein, but also to the internal thoracic vein
Innervated by 4th-6th intercostal nerves
Blood supply from Anterior intercostal a. (branch of Subclavian a.), Thoracoacromial trunk (branch of Axillary a.), and Lateral thoracic a. (branch of Axillary a.)
Describe the location, boundaries, and general contents of the axilla
4-sided pyramidal space, inferior to the glenohumeral joint and superior to the axillary fascia at the junction of the arm and thorax
Apex (formed by cervicoaxillary/costoclavicular space), base/floor (axillary fascia and skin b/w upper arm and lateral thoracic wall), 4 walls (anterior, posterior, medial, lateral)
Contents: Fat, axillary sheath, axillary artery and branches, axillary vein and tributaries, cords and terminal nerves of Brachial plexus, axillary lymph nodes
Describe the course and major branches of the axillary artery
Axillary artery begins at the lateral border of the 1st rib as continuation of the Subclavian artery
Axillary a. ends at inferior border of the teres major as the Brachial a.
Axillary a. divides into 3 parts: Proximal, Middle, Distal
Branches:
Proximal - Superior thoracic a. (supplies muscles of 1st intercostal space)
Middle - Thoracoacromial a. (deltoid, pectoral, clavicular, acromial branches) and lateral thoracic a. (supplies the lateral thoracic wall, including the serratus anterior and the breast)
Distal - subscapular a. (provides Thoracodorsal a. supplying latissimus dorsi and circumflex scapular a. supplying muscles of the scapula), anterior and posterior circumflex humeral a. (both encircle humeral neck to supply deltoid region)
Describe the superficial and deep venous drainage of the upper extremity, including the course of the axillary, basilic and cephalic veins
Axillary vein begins at the inferior border of teres major
Contributions from: lateral chest wall and thoracoepigastric vein
Axillary vein divides into 3 parts
Brachial veins - deep
Cephalic and basilic veins - superficial
Describe the lymphatic drainage pattern to axillary lymph nodes
Lymphatic vessels of the upper limb drain toward the axilla, usually accompany the superficial veins (cephalic and basilic)
Embedded in axillary fat, external to sheath
5 principal groups
Nodes of lower axillary group (pectoral, subscapular, humeral) drain to the central nodes - drains to apical nodes (along w/ other lymphatic vessels) - unite to form subclavian lymph trunks
Excision of axillary lymph nodes often necessary for staging - this removal may impede lymphatic drainage, resulting in lymphedema
Brachial Plexus
Somatic nerve plexus formed by the anterior rami of cervical spinal nerves C5-C8 and thoracic spinal nerve T1
Provides motor and sensory innervation for muscles, skin and joints of the upper limb
List common Imaging Modalities used to evaluate clinical anatomy and physiology
Radiographs (x-rays) Fluoroscopy Angiography CT MRI Ultrasound Nuclear imaging/PET
Explain basic process of how x-rays create an image of internal body structures
When x-ray meets body, x-ray can be: deflected/scattered, absorbed, pass through
X-rays passing through tissue produces the 2D image
X-rays that pass through the body to the detector - dark (BLACK) *Ex: air, low atomic #
X-rays that are totally blocked do not reach the detector - light (WHITE) *Ex: metal, high atomic #
Identify and describe the 5 basic radiographic densities
Metal: Absorbs nearly all x-rays - WHITE Calcium: Bone - NEARLY WHITE Soft tissue: Fluid and soft tissue (equal) - GRAY Fat - DARK GRAY Air: absorbs the least x-ray - BLACK
Describe and contrast: Radiographs, CT, MRI, Ultrasound
Radiographs: Electromagnetic energy (x-rays) no charge, no mass. Ionizing radiation. Primary/initial modality for acute pulmonary disease, many abd. complaints, skeletal abnormalities/injuries. When x-ray meets body, x-ray can be: deflected/scattered, absorbed, pass through - produces 2D image.
CT: Gantry w/ rotating x-ray beam and detector. Ionizing radiation. Connected to computer that processes data to produce slice-like images. HU densities: air least, bone most dense.
MRI: Images produced using a high-field strength magnet and radio-frequency signals. No ionizing radiation.
Ultrasound: Images created using reflected sound waves. No ionizing radiation. No harmful effects. Highly operator dependent. Grayscale and Doppler Imaging - can directly assess blood flow and vascular patency. Echogenic (white) vs. anachoic (black) ~ echoes.
