Limbs and Back: Week Four Flashcards
1
Q
What is the function of the Palmaris Brevis?
A
Improve Grip
2
Q
What is the function of the lumbricals?
A
Extends the PIP and DIP
3
Q
Name the intrinsic muscles of the hand (All For One And One For All)? This is lateral to medial
A
- Abductor pollicis brevis
- Flexor pollicis brevis
- Opponens pollicis
- Adductor pollicis
- Opponens digiti minimi
- Flexor digiti minimi brevis
- Abductor digiti minimi
4
Q
Name the three thenar muscles. What is their origin blood supply and innervation?
A
- Abductor pollicis brevis
- Flexor pollicis brevis
- Opponens pollicis
They originate from the flexor retinaculum, and tubercles of the scaphoid and trapezium. They are innervated by the recurrent branch of the median nerve and supplied by the superficial branch of the radial artery.
5
Q
Name the three hypothenar muscles. What is their origin blood supply and innervation?
A
- Opponens digit minimi: hook of hamate
- Flexor digiti minimi brevis: hook of hamate
- Abductor digit minimi: pisiform
They are supplied by ulnar artery and the deep branch of the ulnar nerve.
6
Q
What is the difference between the dorsal and palmar interossei muscles?
A
The palmar are involved in adduction and the dorsal are involved in the abduction.
7
Q
The majority of the muscles of the hand are supplied by the ulnar nerve, which muscles do not?
A
LOAF:
- lateral lumbricals and thenar muscles
8
Q
What three nerves supply the hand?
A
Radial (just sensory), Median and Ulnar
9
Q
How does the ulnar nerve travel to the hand?
A
This travels above the flexor retinaculum and into the Guyon’s canal.
10
Q
The ulnar nerve hives rise to a superficial and deep branch. Which one is motor and which one is sensory?
A
The deep is motor and the superficial is sensory.
11
Q
Which nerve passes over the anatomical snuffbox?
A
The radial nerve
12
Q
What are the two branches of the median nerve?
A
The recurrent branch and palmar digital branch
13
Q
What branch of the median nerve supplies the thenar muscles?
A
The recurrent branch
14
Q
What forms the medial and lateral base of the Carpal tunnel?
A
Medially: pisiform and hook of hamate
Lateral: Tubercles of scaphoid an trapezium
15
Q
What are the structures that pass through the carpal tunnel?
A
- 4 flexor digitorum profundus tendons
- 4 flexor digitorum superficialis tendons
- Tendon of flexor pollicis longus
- Median nerve
16
Q
Does the tendon of the flexor pollicis longus travel through the carpal tunnel?
A
Yes.
17
Q
Which artery enters the hand superior to the flexor retinaculum?
A
Ulnar artery
18
Q
What are the two branches of the ulnar artery?
A
- Deep palmer branch
- Superficial palmar arch
The palmar digital arteries arise first and this anastomoses with the radial artery branch
19
Q
What muslce does the radial artery pass between?
A
In-between adductor pollicis heads
20
Q
What arch does the radial artery form?
A
Deep palmer arch
21
Q
What are bones of the proximal carpal row?
A
Scaphoid, Lunate, Triquetrum and Pisiform
22
Q
What are bones of the distal carpal row?
A
Trapezium, Trapezoid, Capitate and Hamate
23
Q
Which carpal bone is a sesamoid bone?
A
The pisiform bone: in the flexor carpi ulnaris
24
Q
Which carpal bones have a tubercle?
A
Scaphoid and Trapezium
25
Which carpal bone is the largest?
Capitate
26
What forms the distal radioulnar joint?
The ulnar notch of the radius and the ulnar head
27
What kind of joint is the wrist joint?
Condyloid
28
What bones are involved in the wrist joint?
The radius scaphoid, lunate and triquetrium
29
What prevents the ulna bone from being a part of the wrist joint?
The articular disc
30
What are the four ligaments of the wrist joint?
- Palmar radiocarpal
- Dorsal radiocarpal
- Ulnar collateral
- Radial collateral
31
What is the function of the palmar and dorsal radiocarpal ligaments?
The palmar allows the hand to follow the arm during supination. The dorsal allows the hand to follow the arm during pronation.
32
What are the functions of ulnar and radial collateral ligaments?
They prevent lateral joint displacement.
33
What kind of joints are the intercarpal joints?
These are plane joints.
34
What kind of joints are the metacarpophalangeal joints?
Condyloid joint. These are reinforced by the palmar and collateral ligaments.
35
What kind of joints are the interphalangeal joints?
Hinge joints. The thumb only has one.
36
What kind of joints are the carpometacarpal joints?
Thumb and Trapezium: Saddle Joint
| Fingers: Synovial ellipsoid
37
What type of infection is seen in B cell deformities?
Bacterial infections
38
What type of infection is seen in T cell deformities?
Viral, Fungal, Protozoal
39
What is Bruton Agammaglobulinemia?
Mutation in Brutons tyrosine kinase gene. This is a B cell defect that results in the inability of B cells to mature.
40
What is mutated in Hyper IgM syndrome?
The CD40L on the T cell
41
What is X-linked SCID (Bubble-boy disease)?
This is a T cell defect. There is a mutation in the cytokine receptor IL-2R gamma.
42
What is chronic granulomatous disease?
Mutation in phagocyte NADPH oxidase. There is an increase in bacteria/fungi infections.
43
What are some treatments of primary deficiency?
Antibody replacement, stem cell replacement and gene therapy.
44
Define immunodeficiency
Inability to make protective immune response
45
Describe primary immunodeficiency and give examples
```
This is congenital and is a result from a genetic defect.
- Hyper IgM syndrome
- Bruton Agammaglobulinemia
- MHC I deficiency
- MHC II deficiency
- IgA deficiency
- Dendritic cell deficiency
- Complement deficiency
- DiGeorge's syndrome
- Wiskott-aldrich syndrome
-
```
46
Describe secondary immunodeficiency and give examples
This is acquired through out life and is a result of other diseases.
- HIV
- Protein/calorie malnutrition
- Irradiation/ chemotherapy
- Cancer spread to bone marrow
- Spleen removal
- Corticosteroids
- Leukaemia
- Stress/emotion
- Aging
47
Define autoimmunity.
Breakdown of self-tolerance leading to aberrant immune response against self-tissue
48
Define organ-specific autoimmunity and give examples
This is the attack of a given organ.
- Hashimoto thyroiditis
- Thyrotoxicosis
- Addison's disease
- Atrophic gastritis
- MS
- Type one diabetes
- Guillain-barré syndrome
- Goodpastures syndrome
- Graves disease
- Myasthenia gravis
- Idiopathic thrombocytopenic purpula (ITP)
49
Define non-organ-specific autoimmunity and give examples
This is widespread damage of antigens.
- Systemic lupus
- RA
- Scleroderma
- Dermatomyotisis
- Mixed connective tissue disease
- Sjogren syndrome
50
What is the target of Graves disease?
TSH receptor: The thyroid hormones are regulated by TSH (thyroid stimulating hormone) and this binds to receptors, stimulating TH. in graces, there is over activation.
51
What is the target for Myasthenia Gravis?
Acetylcholine receptor: the receptor are degraded and this means there is no sodium influx.
52
What is the target for ITP?
Platelets
53
What is the target for Guillain-barré syndrome?
Gangliosides. There is molecular mimicry of infectious agents and there is the production of anti-ganglioside antibodies.
54
What are cytokines?
Messenger molecules of the immune system
55
What does DMARDs stand for?
Disease modifying anti-rheumatic drugs
56
What nerve supplies the thenar muscles?
Median Nerve
57
What nerve supplies the hypothenar muscles?
Ulnar nerve
58
Where is Lister's tubercle?
The radius
59
What is the medial border of the anatomical snuffbox?
Extensor pollicis longus
60
What is the lateral border of the anatomical snuffbox?
Tendons of the abductor pollicis longus and extensor pollicis brevis.
61
What is the proximal border of the anatomical snuffbox?
Styloid process
62
What nerve is deep to the Palmaris longus?
Median nerve
63
What ligaments support the thumb MCP joint?
Ulnar and Radial collateral
64
What carpal bone is susceptible to avascular necrosis?
Scaphoid
65
What metacarpal is broken in Boxer's fracture?
Fifth
66
What are the two layers of the articular capsule in a synovial joint?
- Outer fibrous membrane which has tough, dense, irregular tissue
- Inner synovium which is loose and contains the cells
67
What are the two cells of the synovium?
```
Type A (macrophage-like): phagocytosis
Type B (fibroblast): secrete hyaluronic acid and mucin
```
68
What cells produce hyaluronic?
Type B (fibroblast-like synovial cells)
69
Name the six types of Synovial joints
- Hinge
- Plane
- Saddle
- Ball-and-Socket
- Condyliod
- Pivot
70
Which synovial joints are uniaxial?
Hinge (flexion and extension), Plane (gliding) and Pivot (rotation)
71
Which joint has a ring of ligament around it?
Pivot
72
Which synovial joints are biaxial?
Saddle and Condyloid
73
Which synovial joints multi-axial?
Ball-and-Socket
74
Name the five signs of inflammation
Rubor, Calor, Dolor, Tumor and Function lease
75
Vasoconstriction is the first stage of inflammation. Why is it overcome?
Injured cells release histamine, prostaglandins, leukotrienes and bradykinin and nitric oxide which cause vasodilation.
76
Describe the normal blood flow and explain the change in inflammation
There is normally axial flow where the leukocytes and red cells are in the centre and the plasma is on the outside. When there is inflammation, the plasma leaks out due to the increase permeability. This causes the leukocytes to be at the side of the wall.
77
What causes endothelial cells to express for E-selectin of endothelial cells?
IL-1 and TNF are released from macrophages, mast cells and endothelial cells when they encounter damaged of infected cells. This causes more selectin.
78
What is unique about P-selectin?
P-selectin normally stays within granules, in places known as Weibel-Palade bodies. They are activated by histamine and thrombin.
79
What do selectin bind to?
Glycoproteins on leukocytes
80
What causes the binding of Integrin's?
Chemokines produced will bind to proteoglycans on endothelial cells and activate rolling leukocytes, causing them to express integrin's. They bind to ICAM.
81
What is the process called whereby leukocytes migrate across the vessel wall and how do they break the BM?
Diapedesis. They secrete collagenases.
82
What is the main interleukin for chemotaxis?
IL-8
83
What is swan neck deformity?
DIP flexed, PIP hyperextended
84
What is boutonniere deformity?
DIP hyperextended, PIP flexed
85
What are the two susceptibly genes in RA?
HLA-DR1 and HLA-DR4
86
Describe Citrullination.
Environmental factors cause modification of molecules like IgG, Type II collagen of Vimentin. This is citrullination whereby the argine is switched by citrulline. The immune cells, due to susceptibly genes , don't recognise them.
87
What do T cell release that cause recruitment of more inflammatory cells?
IL-17 and IL-gamma
88
What is the effect form TNF-alpha, IL-1 and IL-6?
These are released from macrophages and they increase the number of inflammatory cells and causes synovial cell proliferate. These cell will also produce proteases which degrades bone.
89
What two cells will start to produce RANKL?
T cells and fibroblasts-like synovitis.
90
What do neutrophils produce?
ROS and protease that degrades bone and cartilage.
91
What are immune complexes?
Antibodies biding together
92
How does the pannus form?
There is an increase in synovial and inflammatory cells. There is a swelling of fibroblasts, inflammatory cells and myofibroblasts in granulation tissue. This will causes damage.
93
What is the function of GM-CSF?
Macrophage development.
94
What is Rheumatic factor?
This is an IgM antibody which targets the Fc on IgG.
95
What is Anti-CCP?
This is a target for citrullinated proteins, eg fibrin and fillagrin.
96
Give some examples of extra-articular involvement of RA
- Cardiovascular disease
- Osteoporosis
- Malignancy
- Depression
- Chronic lung disease
- Anaemia (increased hepcidin in liver)
- Carpal tunnel syndrome
- Nodules in skin
- Fatigue
- Muscle weakness
- Sjogren syndrome
97
Give some examples of DMARDs.
Most Suffers Can Get Appropriate Pain Control.
- methotrexate
- sulfasalazine
- cyclosporine
- gold
- azathioprine
- penicillamine
- hydroxychloroquine (cell communication)
98
What is the mechanism of action of methotrexate?
This is an analogue of folic acid. This inhibits the action of dihydrofolate reductase which interferes with DNA synthesis.
99
Give some examples of Biologic agents that inhibit TNF-alpha
etanercept, infliximab, adalimumab, certalizumab
100
Give some examples of Biologic agents that inhibit IL-6
Toalizumab
101
What is the difference between COX-1 and COX-2 enzymes?
COX-1: cytoprotective prostaglandin which have a protective role in gastric mucosa.
COX-2: inflammatory cytokines
102
What protien is the Glucocorticoids receptor linked to?
Hsp56-90. Glucocorticoids affect protein transcription.
103
What are the effects of Glucocorticoids
Up-regulates annexin-1 which blocks the arachidonic pathway.
Down-regulates Cytokines, enzymes and adhesion molecules.
104
Give some side effects of glucocorticoids
Moor face, increased abdominal fat, poor wound healing, euphoria, buffalo hump and skin and muslce thinning
105
How many tonsils are there?
Two lingual and two palatine. One pharyngeal.
106
What is the difference between aureus and albus?
Aureus is golden and albus is white.
107
What is the difference between Straphylo and Strepto?
Straphylo is clusters and Strepto is a twisted chain.
108
What is the function of GSCF (granulocytes colony stimulating factor)?
Stimulates neutrophil proliferation
109
What three antibodies are monomers?
IgG, IgE and IgD
110
What shape is IgA and what is its function?
Dimer. This is found in most of the body's secretions, including saliva, milk and tears.
111
What is Chrons disease?
Gut inflammation
112
What side is the hook of hamate on?
Ventral
113
Where does the brachioradialis insert?
Radial styloid process
114
What would tenderness in the anatomical snuffbox indicate?
Injury to radial styloid process
115
What vein is blood taken from in the cubital fossa?
medial cubital vein
116
Describe the classical pathway of the complement cascade
This is activated by anti-body coated microbial surface (IgG or IgM). This activates C3/5 convertase and this form C3a and C5a. These activate peptide inflammatory mediators and causes cell lysis.
117
Describe the lectin pathway of the complement cascade
This is activated by the binding of mannose-binding lectin to mannose residues on the pathogen. This cause the formation of C3b an this causes opsonisation.
118
Describe the alternative pathway of the complement cascade
This is activated by the microbial cell surface. This forms a membrane-attack complex and causes cell lysis.
119
What is the function of C3b?
This binds to antigens and provides a mechanism for uptake by dendritic cells an recognition from B cells. It also allows coating of phagocytes (activated by C3a)
120
What are the functions of complement?
- pathogen lysis
- inflammatory cell recruitment
- histamine release
- macrophage stimulation
- bacteria lysis
121
What is clumping?
Clumping of antigen-bearing agents
122
What would be a possible reason for levels of IgM to be high?
New infection or last infection as levels persist for a long time
