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Skin/MS > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Fitzpatrick Scale

A

Sunburns based on skin color (type I: white burns easily, type VI: darkest, doesn’t burn)

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2
Q

Malar rash

A

Lupus, nose and cheeks

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3
Q

Color variation

A

same disease, different baseline skin phenotypes (ex. tinea vesicolor)

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4
Q

Flat description

A

Macule (smaller 0.5-1cm)
Patch (larger, >1cm)

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5
Q

Smooth and raised description

A

cyst, nodule (>5mm), papule (<1cm), plaque (>1cm)

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6
Q

Fluid-filled description

A

wheal, vesicle, bullae, pustule

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7
Q

Secondary changes in skin

A

Crust, Scaly (powdery, greasy, gritty)

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8
Q

Red blanchable

A

erythema, erthyroderma, telangiectasia

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9
Q

Purpuric description

A

ecchymosis, petechiae, palpable purpura

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10
Q

Sunken description

A

atrophy, erosion, ulcer

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11
Q

Necrotic

A

eschar, gangrene (includes purtification)

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12
Q

Main pathology of epidermis

A

Dermatitis (poor differentiation)
Papulosquamous (well-demarcated)
Intraepidermal bullous (erosions)

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13
Q

Main pathology of dermal-epidermal junction

A

Subepidermal bullous
autoimmune disease (lupus)
Pigmentary disorders

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14
Q

Main pathology of the dermis

A

Cellular infiltrates (lymphocytes, histocytes, granulomas)
blood vessels
hair follicles
others: mast cells, eosinophils, neutrophils

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15
Q

Main pathology of fat

A

Deeper, panniculitis (poorly demarcated pink nodules)

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16
Q

Ecchmosis

A

Bruising without indicated pattern (hit it on something, etc)

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17
Q

Acral distrubution

A

Distal body parts, hands and feet

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18
Q

Dermatomal distribution

A

Supplied by a single spinal nerve

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19
Q

Intertriginious/flexural

A

where the skin folds/crevaces

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20
Q

Lymphangitic

A

appears where lymph is in the body

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21
Q

photo distribution

A

where the sun hits

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22
Q

Scattered vs. widespread

A

small areas everywhere vs. covering a large area

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23
Q

Annular:

A

Full circle, circle is a raised ring with normal skin inside

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24
Q

Arcuate

A

half circle, blanching, barely indurated, (seen in lupus)

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25
Q

Linear

A

Straight, thickness/induration, blanching (think scabies or other parasites)

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26
Q

Whorled

A

Follows Blascho’s lines in a twisted pattern

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27
Q

Reticular/morbilliform

A

“lace-y” no blanching, non-indurated, (seen in measles)

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28
Q

Serpiginous

A

Whole pattern is snakey, includes arcuates

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29
Q

Targetoid

A

circular, lymes disease and erythema multiformae

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30
Q

Planar vs cross sectional imaging

A

3 dimensions translated into 2 (chest x-ray), vs composite analysis of 2-D slices (CT)

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31
Q

Standard radiography

A

as though the patient is facing you

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32
Q

Standard in body CT

A

Axial view

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33
Q

Standard in head CT/MRI

A

Coronal view

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34
Q

Central NS cells

A

astrocytes, oligodendrocytes, microglia, ependymal cells

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35
Q

Peripheral NS cells

A

Schwann cells, satellite cells

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36
Q

neuronal staining

A

Golgi method
Nissl staining
Fiber stains
Myelin stain

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37
Q

Pseudounipolar neuron

A

1 process, 1 axon that divides close to the cell body (PNS) into 2 long axons (1 to PNS and 1 to CNS)

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38
Q

Bipolar neuron

A

2 processes, 1 axon and 1 dendrite, 1 cell body (PNS) (RARE: only in retina of eye, cranial nerve VIII of ear)

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39
Q

Multipolar neuron

A

multiple processes, 1 axon and >2 dendrites. Dendrite –> cell body –> axon

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40
Q

Nissl Bodies

A

Groupings of organelles. Not present in axon hillock

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41
Q

Fast axon transport system

A

ATP used
Anterograde: cell body to synapse (Kinesin), 400mm/day
Retrograde: synapse to cell body (dynein), 20mm/day – toxins and viruses travel this way

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42
Q

Slow axon transport system

A

Anterograde only, 0.5-3mm/day, mechanism unclear

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43
Q

Gray matter

A

BRAIN: outer layer, deep regions (nuclei)
SPINAL CORD: inner layer

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44
Q

White matter

A

BRAIN: inner layer
SPINAL CORD: outer layer

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45
Q

Cerebrum gray matter layers

A

1: plexiform molecular layer
2-3: small pyramidal layer
4: granular layer
5: large pyramidal layer
6: polymorphic layer

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46
Q

Cerebellum cortex layers

A

Molecular layer: outer layer (light eosin stain)
Purkinje layer: junction of molecular and granular layers
Granular layer: beneath molecular layer (dark hemotoxylin stain)

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47
Q

Endoneurium – PNS fascicle

A

Loose connective tissue surrounding each axon fiber (fibroblasts)

48
Q

Perineurium – PNS fascicle

A

specialized connective tissue surrounding each nerve fascicle (many axons surrounded by endoneurium in here)

49
Q

Epineurium – PNS fascicle

A

dense irregular connective tissue that surrounds a peripheral nerve and fills the spaces between nerve fascicles (surrounds many perineurium)

50
Q

Microglial cells

A

Enter CNS parenchyma from vascular system, fxn as phagocytes (have same progenitor as macrophages; granulocyte/monocyte in bone marrow)

51
Q

Ependymal cells

A

Line central canal of spinal cord and ventricles of brain. simple cuboidal –> columnar epithelial that is ciliated.

Functions: cilia to help move CSF, transport, secretion

52
Q

Satellite cells

A

surround neuron cell body for homeostasis

53
Q

Types of unmyelinated nerves in the PNS

A

1.) Mesaxon: parallel membranes of a schwann cell (line from unmyelinated axon through schwann cell to the outside)
2.) Bundle of Remak: unmyelinated fibers held closely together
3.) C fibers: unmyelinated fiber, low conductance velocity

54
Q

Anterograde nerve injury

A

degeneration proceeds down toward synapse

55
Q

Retrograde nerve injury

A

degeneration proceeds up to cell body

56
Q

Anterograde (Wallerian) degeneration

A

CNS: oligoden apoptosis, BBB removal barrier, astrocyte scar
PNS: dedifferentiation of schwann cells, phagocytosis by schwann cells and macrophages

57
Q

Retrograde degeneration

A

Signaling to cell body causes upregulation of c-Jun transcription factor –> reorganization of cytoplasm and organelles, Chromatolysis (moving of Nissl bodies and nucleus)

58
Q

Sensory ganglia

A

Spinal nerves (dorsal root/posterior root)
Cranial nerve ganglia (CN 5, 7, 8, 9, 10)

59
Q

Autonomic ganglia

A

sympathetic
parasympathetic

60
Q

Peripheral sensory system

A

– Pseudounipolar cells
– Ganglia
– Peripheral and central processes
- AFFERENT, from PNS–>CNS

61
Q

Peripheral motor system

A

– Multipolar cells
– CNS (somatic), CNS and ganglia (visceral)
– Dendrites and axons
– EFFERENT, from CNS–>PNS

62
Q

Osmium

A

stains white matter black

63
Q

Where is the lateral horn present?

A

T1-L2

64
Q

Dorsal horn

A

in all levels of the spinal cord, contains SENSORY interneurons (afferent, PNS–>CNS), cell bodies in dorsal root ganglia

65
Q

Ventral horn

A

motor neurons (efferent, CNS–>PNS), innervates voluntary skeletal muscles

66
Q

Dorsal Rami

A

Epaxial muscles: “true back” muscles, posture head movements,

Ex. splenius capitis, splenius cervicis, erector spinae, transversospinalis

67
Q

Ventral Rami

A

Hypaxial muscles: “extrinsic” muscles, limb movements

Ex. Trapezius, Latissimus dorsi, levator scapulae, rhomboid

(exception: sensory info of trapezius is from ventral rami, motor innervation is from CN 11)

68
Q

Dermatome

A

The area under the skin supplied at a single spinal cord level, or on one side, by a single spinal nerve. Horizontal on trunk, longitudinal on extremities

69
Q

Myotome

A

The skeletal muscles supplied by a single spinal cord level, or on one side, by a single spinal nerve

70
Q

Plexus

A

Branching network of intersecting nerves of blood vessels, all white matter no cell bodies

71
Q

Autonomic NS innervations

A

– Cardiac and smooth muscle and glands
– Adrenal medulla functions as a postganglionic sympathetic “neuron”

72
Q

Parasympathetic preganglionic cell bodies located:

A

“Cranial outflow”
Cranial nerves 3, 7, 9, 10 (in the cervical area)
S2-S4 (sacral)

73
Q

Sympathetic preganglionic cell bodies located:

A

“thoracolumbar outflow”
T1-L2
Lateral horn (IML cell column)

74
Q

Parasympathetic postganglionic cell bodies located:

A

CN: ganglia along CN 3, 7, 9 OR embedded in target organs

SACRAL: embedded in target organs

75
Q

sympathetic postganglionic cell bodies located:

A

45-49 paravertebral ganglia: found in the sympathetic trunk chain (runs head to coccyx)

5-7 prevertebral ganglia: all in abdomen, paired or not, variable)

76
Q

Cervical ganglia

A

1.) superior cervical
2.) Middle cervical
3.) Stellate/inferior cervical

^ inferior and 1sy thoracic paravertebral and merged

77
Q

Sympathetic pre and post ganglion lengths:

A

short pre in the CNS, long post in the PNS

78
Q

Parasympathetic pre and post ganglion lengths:

A

long pre in the CNS, short post in the PNS

79
Q

White rami vs grey rami locations

A

grey is lateral (closer to spinal cord) than white

^ Exception is at T1

80
Q

Preganglionic sympathetic neuron pathway

A

lateral horn (T1-L2)–> ventral root–> ventral rami–> white rami

81
Q

paravertebral vs prevertebral pathways

A

para: Synapse with same level, superior (cranial), inferior (caudal) ganglia

pre: Synapse with postganglionic neurons in prevertebral ganglia or the adrenal gland

82
Q

Splanchnic nerves

A

autonomic nerves that supply the internal organs

83
Q

Cervical and upper thoracic trunk levels

A

Symp nerve: cardiopulmonary nerves (heart/lung)

Fiber type: postganglionic from paravertebral ganglia

84
Q

Lower thoracic trunk level

A

Symp nerve: thoracic splanchnic (abdominal organs)

Fiber type: preganglionic to prevertebral ganglia

85
Q

L1-2 trunk level

A

Symp nerve: Lumbar splanchnic (abdominal organs)

Fiber type: preganglionic to prevertebral ganglia

86
Q

Sacral

A

Symp nerve: Sacral splanchnic (pelvic organs)

Fiber type: preganglionic to prevertebral

87
Q

Mechanical, chemical, thermal, and some nociceptive (pain) information travels via

A

the vagus nerve to the brainstem

–80% of vagus nerve fibers are sensory nerve processes
–20% are preganglionic parasympathetic

88
Q

Nociceptive signals from the viscera may travel with:

A

sympathetic axons to DRG and the spinal cord to join somatosensory pain pathwayd

symp gang–> DRG–> spinal cord–> brain

89
Q

Categories of autonomic drugs

A

1.) parasympathomimetics
2.) parasympathetic antagonists
3.) sympathomimetics
4.) sympathetic antagonists

90
Q

Cholinergic systems

A

1.) Nicotinic receptors–> N1/Nm –> neuromuscular junction
1.) Nicotinic receptors–> N2/Nn –> Autonomic ganglia, CNS

2.) Muscarinic receptors –> M1, M2, M3, M4

91
Q

Agonists of autonomic system

A

Muscarine (M1-4), Nicotine (N1-2)

92
Q

Antagonists of autonomic system

A

Atropine (M1-4), Hexamethonium (N2)

93
Q

Muscarinic receptors

A

GCPRs 4 steps:
1.) 1 ACh binds receptor, changing configuration
2.) G protein is activated
3.) effector protein is activated
4.) ion channel opens or closes (or some other intracellular protein is affected)

94
Q

Effector receptor subtypes:

A

M1: CNS, GI tract, lymphcytes
M2: CNS, heart, smooth muscles (stomach, bladder, airways)
M3: CNS, GI tract, smooth muscle
M4: CNS
M5: CNS, esophageal smooth muscle, lymphocytes, salivary gland

95
Q

alpha receptors

A

norepinephrine and epinephrine

96
Q

beta receptors

A

epinephrine&raquo_space; norepinephrine

97
Q

Gs is beta adrenergic and

A

increased cAMP/ Ca2+ release

98
Q

Gi is alpha2 adrenergic (mAChR) and

A

decreases cAMP/ Ca2+ release

alpha2 is unique in that is can also act PREsynaptically to inhibit norepinephrine

99
Q

Gq is alpha1 adrenergic (mAChR) and

A

activates PLC-IP3 to increase Ca2+ release

100
Q

4 actions of norepinephrine

A

1.) Alpha2 presynaptically to decrease NT release
2.) Alpha1 postsynaptically to increase Ca2+
3.) Beta1 postsynaptically to increase cAMP
4.) Alpha2 postsynaptically to decrease cAMP

101
Q

Skin blood flow

A

pressure= flow x resistance

102
Q

Antagonists of Alpha1 and 2

A

Prazosin, Yohimbine

103
Q

Antagonists of Beta 1-3

A

Beta blockers, “olols”

104
Q

Apical skin

A

– sympathetic activity for vasoconstriction
– AVA (glomus body)
– capillary sphincter
– no capacity for dilation, must use sphincter to prohibit flow through capillaries and make it go through AVA

105
Q

Nonapical skin

A

– Sympathetic activity for vasoconstriction
– Sympathetic activity for vasodilation (cholinergic, ACh/bradykinin)
– NO AVA !

106
Q

Vasoconstrictions is

A

Sympathetic adrenergic

Mech: Release NE from postgang symp nerves –> binding alpha1 and 2 –> smooth muscle contraction –> vasoconstriction –> reduce heat loss

107
Q

Vasodilation is

A

Sympathetic cholingergic

Mech 1: release of ACh from postgang symp nerves –> bind M3 in endothelial –> release NO –> smooth muscle relaxation –> vasodilation –> increase heat loss

Mech 2: release of ACh from postgang symp nerves –> bind M3 in sweat glands –> release bradykinin –> vasodilation –> increase heat loss

108
Q

Raynaud’s Phenomenon

A

Spasms in skin blood vessels in response to cold, stress, or emotional upset. Mostly in hands, especially apical skin

Pattern:
1.) pallor (less pink) as blood flow stops
2.) Cyanosis (blue) as O2 levels drop in the tissue
3.) Rubor (red) as vessels reopen

109
Q

Sweat step 1.) Secretion

A

1.) Na/K ATPase sets up sodium gradient
2.) Na/K/2Cl transporter moves Na out of cell
3.) CLCA move Cl out of cell into lumen of gland
4.) H2O follows via aquaporins

110
Q

Sweat step 2.) reabsorption of NaCl

A

1.) Na/K/ ATPase sets up sodium gradient
2.) apical Na absorption via ENaC
3.) Cl absorption via CFTR
4.) H2O CANNOT follow due to tight junctions

^^ this is why sweat is hypotonic

111
Q

Eccrine sweat (thermal)

A

Since birth, located everywhere, opening via pores, secretes water and viscous fluid, CHOLINERGIC (M)

112
Q

Apocrine (emotional)

A

Since puberty, restricted to the axilla, areolae, and external genitalia, opening near hair follicles, secretes viscous fluid that becomes odored when acted on by bacteria, ADRENERGIC (beta)

113
Q

Hyperhydrosis

A

excessive secretion of thermoregulatory sweat. Treatment includes anticholinergic such as atropine (M antagonist), furosemide (blocks NKCC1), or botulinum toxin injection (BOTOX, blocks ACh release)

114
Q

Bromhidrosis

A

excessive malodorous (apocrine) sweating. Treatment includes acting on the bacteria, so antibacterial and antiperspirants

115
Q

Piloerection

A

Goosbumps, mediated by alpha1 adrenergic receptors

Stimuli includes: cold temperatures, intense emotions, medications

Skin/MS (5 decks)

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