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Miscellaneous Flashcards

1
Q

What is lymph

A

Plasma like fluid
It is interstitial fluid that has been removed by the lymphatic vessels

Once interstitial fluid enters the lymph capillaries it is called lymph

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2
Q

Why do we return fluid to the blood

A

To prevent oedema and maintain normal blood pressure/ volume

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3
Q

Give the plan of the lymphatic system

A

Capillary network-> afferent vessels —> lymph node —> efferent vessels —> lymph trunk —> terminal vessels (thoracic duct/ right lymphatic trunk) —> great veins

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4
Q

Which lymph vessels Carey fluid to the tissue

A

NONE

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5
Q

What are lymph capillaries

A

Smallest lymphatic vessels which begin in tissue spaces as blind ended sacs

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6
Q

Where are lymph capillaries not found

A 
Bone marrow
Bone
Teeth
CNS
tissue that lack a blood supply eg epidermis
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7
Q

What is the lymph capillary wall made of

A

Endothelium in which simple squamous cells overlap to form a simple one way valve (allowing fluid to enter but not exit)

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8
Q

What do lymphatic capillaries merge to form

A

Lymphatic vessels

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9
Q

Differences between lymphatic vessels and veins

A

Lymphatic vessels are thinner, have more valves and anastomose more frequently

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10
Q

Where do we think lymphatic vessels initially derived from in the embryo

Why do we think that

A

From the embryonic venous system

There is an intimate relationship between them

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11
Q

What do lymphatic vessels join to form

A

Lymphatic Trunks

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12
Q

Name the 5 lymphatic trunks

A 
Paired lumbar
Paired bronchomediastinal
Paired subclavian
Paired jugular trunks
A single small intestinal trunk
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13
Q

What does the right lymphatic duct drain

A

Lymph from the upper right quadrant of the body

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14
Q

What does the thoracic duct drain

A

Everything other than the right upper quadrant of the body

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15
Q

What is the right upper quadrant of the body

A

Right half of head and neck, right upper limb, and right hemithorax

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16
Q

What does the lymphatic duct do with lymph after

A

Empties it into the venous circulation at the junction of the IJV and subclavian vein

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17
Q

Where does the thoracic duct extend from

What is the adult variation in length

A

L2 to the root of the neck

38-45cm

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18
Q

What happens if the thoracic duct is damaged

What is this called

A

Often it’s fine Cos it has so Many anastomoses

But if it becomes damaged by disease, lymph can leak into the pleural cavity (chylothorax)

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19
Q

All Lymph vessels have powerful contractile abilities. True or false?

A

False

Initially They rely on extrinsic forces for propulsion (a mix of muscle contraction, pressure pulse, and respiratory movement)

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20
Q

How is lymph flow direction maintained

A

Funnel shaped valves

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21
Q

What is the unit between lymph valves called

A

A lymphangion

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22
Q

How do collecting lymphatic propel lymph

A

They are contractile and the flow between lymphangions is maintained against a pressure gradient

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23
Q

Superficial Lymph drain in parallel to arteries. True or false?

A

False

They drain parallel to veins

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24
Q

Where are the lymph nodes

A

Axilla
Inguinal
Superficial cervical

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25
Q

What happens to superficial lymph drainage

A

Drains into deep system

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26
Q

What do deep lymphatics do

A

Drain organs and run parallel with arteries

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27
Q

Describe the structure of a lymph node

A

Convex surface to receive afferent lymph vessels and a convex one from which efferent leave

Each mode has a connective tissue capsule and is divided into an outer cortex and inner medulla

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28
Q

How does lymph travel through the nose

A

Enters via afferent vessel

Travels through a large sub capsular sinus and smaller sinuses to exit at the hilus through the efferent vessels

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29
Q

How do the number of afferent and efferent lymphatic vessels compare

Why is this

A

More afferent than efferent

This slows flow of lymph allowing lymphocytes and macrophages time to carry out function

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30
Q

What is the general pattern of lymphatic drainage in the head and neck

A

Superficial vessels run with superficial veins in the superficial fascia

These drain into nodes at the collar at the upper attachment of the deep cervical fascia. These nodes drain to deep cervical nodes around the IJV

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31
Q

What is the group of lymph nodes in the neck

A 
Sub mental
Submandibular 
Parotid
Mastoid
Occipital
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32
Q

Where do lymphatics draining the intestine run

A

Along arterial tree to reach coeliac, superior or inferior mesenteric para- aortic nodes

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33
Q

Where are the para aortic nodes

A

Lying around the Origin of the arteries in the abdomen

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34
Q

What are the nodes in the thorax

A

Mediastinal and lateral aortic

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35
Q

What is the chief means by which fat is absorbed from the intestine

A

Lymph which drain the alimentary canal

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36
Q

What do the alimentary canal lymphatics look like after a meal

What is the lymph called

A

Milky with fat

Chyle

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37
Q

Where do lymphatics from the lower limb and pelvis pass to

A

Lower limb: external iliac node

Pelvis: internal iliac node

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38
Q

Where do the external and internal iliac nodes drain to

A

Upwards into a chain of paravertebral and retroperitoneal nodes which lie laterally to vertebral bodies

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39
Q

What do the para vertebral and retroperitoneal nodes drain

A

Suprarenal glands
Kidneys
Gonads
Posterior abdominal wall muscles

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40
Q

What are the key nodes the limbs drain to

A

Upper: axillary
Lower: inguinal

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41
Q

What might be used as a contrast medium for x-rays

A

Iodine or barium

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42
Q

What are the five basic radiographic densities

A
  1. Black due to air eg air in lungs, gas in bowel
  2. Dark grey due to fat
  3. Light grey due to soft tissue or water
  4. White due to bone or calcification
  5. Bright white due to metal
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43
Q

What is the most important characteristic for definition in an x-ray

What does this mean

A

The presence of boundaries between densities

X-ray is good for the chest and skeletal system

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44
Q

Give two main advantages of radiography

A

They

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45
Q

What is the upper limit of human hearing

how does this compare to other animals

What frequency does diagnostic ultrasound work at

A

20kHz

Bats: 120kHz
Dolphins: 200kHz

Between 2 and 20 MHz

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46
Q

What is central to the theory behind diagnostic ultrasound

A

The piezoelectric effect

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47
Q

Who discovered the piezoelectric effect

What did they show

A

Pierre and Jacques Curie (1880) through their work on crystals eg quartz

Mechanical stress not only induced an electric current in such material but that the reverse also held true that for the emitter could also be the receiver

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48
Q

What principle does ultrasound technique rely upon

A

Ultrasound waves are either transmitted through tissues of similar acoustic quality or reflected that there is a significant difference this is called acoustic impedance

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49
Q

What is acoustic impedance a function of

A

Tissue compress ability and the speed of sound through it

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50
Q

How does calcified tissue react to ultrasound

What about fluid?

A

It is highly reflective and casts and acoustic shadow (with no information beyond)

Fluid volume is transmit sound brilliantly causing acoustic enhancement beyond them

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51
Q

True or false

a probe cannot be placed within blood vessals

A

False

they can be placed almost anywhere

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52
Q

What is the essential trade-off in ultrasound

A

Between depth penetration and spatial resolution

I.e. higher frequencies get better resolution but Are more easily attenuated

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53
Q

Other than the Piezoelectric affect what effect does the ultrasound technique take advantage of

Explain this effect in medicine

A

The Doppler effect

It causes a shift in the frequency of reflected sound according to whether there is motion towards (increase) or motion away (decrease) from its source

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54
Q

What are the advantages of ultrasound

A

It is widely available,
portable so can be used in the ITU,
safe as no ionising radiation

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55
Q

Give some disadvantages of ultrasound diagnosis

A

It is operator dependent and not good for all structures e.g. bones

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56
Q

When was the first CT scan performed and where

Who won the prize for it and when

A

1971 in Wimbledon

Hound field and McCormack
Noble prize in physiology or medicine 1979

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57
Q

How does a CT scan work generally

A

The x-ray tube rotates around the patient to pass x-rays through the body from every direction although only 180° is required for a single image

The line of a single beam passed through a body gives a numerical value representing how much it has been attenuated from the original level

These values are reconstructed to form the final 2-D image

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58
Q

How is the resultant axial image of a CT scan viewed by convention

When is it different

A

As if the observer were standing at the patient’s feet and looking towards the head as in clinical bedside examination

It was originally the other way around the neurosurgeons with their drills at the ready

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59
Q

True or false

single whole body scans take days to perform with CT

A

False

can be performed within a single breath to yield a detailed 3-D and multiplanar reconstruction

60
Q

What are vital part of CT to increase the inherent contrast between structures

Why are these also useful

A

Iodine-based intravenous or oral contrast media

Tissues that an inflamed or malignant have abnormal vasculature with increase bloodflow and leaky vessels

61
Q

How much radiation does a CT scan of the abdomen and pelvis expose the patient to

A

Radiation dose as high as three years of background radiation or approximately 100 chest x-rays

62
Q

What are the three fundamental principles of MRI

A
  1. A large proportion of the body is fat or water
  2. Fat and water contain a lot of hydrogen nuclei
  3. Hydrogen nuclei have spin that interacts with magnetic fields and RF radiation
63
Q

How strong is the magnetic field generated by MRI scanner?

A

3 Tesla

64
Q

What is MRI good at imaging

A

Brain

Musculoskeletal system

Abdomen and pelvis

65
Q

What is MRI not good at imaging

A

The chest unless cardiac gating is used to reduce movement artefact from the beating heart

66
Q

Why does acquiring MRI images take longer than CT

What does this mean

A

Due to the multiple changes of magnetic fields required

Patients need to be able to cooperate and keep still to obtain a diagnostic image

67
Q

True or false

MRI is completely safe.

A

False.

Anything within the body that can be magnetised may heat up or even move e.g. metallic foreign bodies such as surgical clips or prostatic heart valves

Pacemakers will stop working when they are placed inside the magnetic field produced by the MRI scanner to a patient with a cardiac pacemaker cannot go into the scanner and will have to be imaged using a different imaging modality

68
Q

Generally what does nuclear medicine involve

Give an example

A

Administration of radiolabelled agents that undergo radioactive decay in the body which is then picked up by special cameras in 2-D or 3-D

PET

69
Q

What is the most common agent used in nuclear medicine

A

18-FDG

70
Q

What is 18-FDG

A

18 - fluorodeoxyglucose

71
Q

Describe the course of imaging for a patient with trauma in the emergency department

A

X-ray initially thought fractures

May proceed to CT in more severe trauma to assess extent of bony injury and if associated soft tissue or organ is injured

72
Q

How would you image someone with chest pain

A

Chest x-ray initially

May proceed to CT for further anatomical detail

73
Q

Describe the course of imaging for abdominal pain

A

Ultrasound

May use CT depending on clinical question

74
Q

What imaging would you use for cancer diagnosis

A

X-ray and ultrasound initially

May proceed to CT and/or MRI depending on disease type

75
Q

Give the six steps when describing an image

A
  1. State the region of the body being imaged
  2. State the imaging modality
  3. State to view orientation
  4. Check the patient’s details if present
  5. Describe any abnormalities
  6. Give a diagnosis or possible list of causes
76
Q

What happens if bone is understressed for long periods of time

A

Bone wastage occurs and the bone will become thinner

77
Q

What happens if bones are suddenly subjected to high levels of stress

A

An increase in bone mass occurs

78
Q

Describe the general structure of a bone

A

A hard outer casing of cortical bone and an inner trabecular bone

79
Q

How much of the bone mass is cortical bone

A

80%

80
Q

What is another name for trabecular bone

What does it consist of

A

Cancellous or Spongey bone

Delicate bars and sheets of bone (trabeculae) which branch and intersect to form a sponge like network

81
Q

What is the structure of compact bone and where is it found

A

It is dense and more regular than trabecular bone and forms a thick walled tube of the shaft (or diaphysis) of long bones which surrounds a marrow cavity

A thin layer also covers the epithesis of long bones

82
Q

What covers bones

Describe the vessels and nerves in this layer

A

And outer layer of dense connective tissue: the periosteum

It is highly vascular and densely innervated

83
Q

What lines the surface of the bone facing the marrow cavity

A

I thin-layer of sale rich connected tissue: The endosteum

84
Q

Which layers of bone possess osteogenic potency

What does this mean

A

The periosteum and endosteum

Following injury cells in these layers may differentiate into bone forming cells to aid in the repair of damage to the bone

85
Q

Other than having osteogenic potency why is the periosteum useful

A

It acts as an anchoring point for tendons and ligaments

86
Q

True or false:

The compressional strength of bone is greater than that of a reinforced concrete

A

True

The tensile strength also approaches that of reinforced concrete

87
Q

True or false
Bone has a high level of torsional strength

What does this mean

A

False

Fractures often occur as a result of torsional forces that are exerted upon the limbs

88
Q

What are the four types of bone cell

A

Osteoprogenitor cells

Osteoblasts

Osteocytes

Osteoclasts

89
Q

What are osteoprogenitor cells

Where are they pound and what do they do

A

Stem cells of bone

They are located in the periosteum and endosteum and differentiate into osteoblasts

90
Q

What are osteoblasts

What do they form

A

Bone producing cells

A low columnar epitheloid layer at sites of bone deposition
As they become trapped in the form and bone they differentiate into osteocytes

91
Q

What are osteocytes

Where are they found

A

Quiescent osteoblasts That connect with each other through canaliculi

In lacunae

92
Q

What are osteoclasts

Where do they come from

A

Very large multinucleated bone resorbing cells

They arise from macrophage precursors in the blood

93
Q

How big are osteoclasts

A

Up to 100μm

94
Q

What are the organic components of bone matrix

A

Collagen fibres with type one collagen

Aim of this material including glycosaminoglycans that are associated with proteins

95
Q

How much of a matrix is type one collagen

A

95%

96
Q

What do collagen fibres do in bone

A

Confer tensile strength

97
Q

Describe the inorganic components of bone

A

50% dry weight of bone matrix

Composed of calcium and phosphorus with small amounts of HCO3, citrate, magnesium, potassium and sodium

Calcium forms hydroxyapatite crystals with phosphorus

Calcium salts which are similar in physical properties to marble confer compressional strength

98
Q

How are the collagen fibres in bone laid down

What do these form

A

Laid down by osteoblasts around the tunnels created by osteoclasts

These form concentric arrays of lamellae

99
Q

What do the concentric arrays of lamellae in bone form

A

Osteons

100
Q

What do osteons surround

A

The initiating blood vessel in the Haversian canal

101
Q

What does the osteon and the Haversian canal together form

A

Haversian system

102
Q

Name 2 disorders of bone matrix

A

Osteogenesis imperfecta

Osteomalacia

103
Q

Describe osteogenesis imperfecta

A

This is a group of inherited diseases associated with mutations affecting collagen

Causes brittle bone that breaks easily, often the little or no apparent cause

104
Q

Describe osteomalacia

A

A loss of skeletal mass caused by inadequate mineralisation of the normal osteoid tissue after the closure of growth plates

In children the condition is commonly known as Ricketts

Both are caused by vitamin D deficiency

105
Q

What are the two mechanisms by which bone can be formed

A

Intramembranous ossification

Endochondral ossification

106
Q

Which bones are formed by intramembranous ossification (name 3)

A

Bones of the skull, part of the mandible and clavicle

107
Q

Name three steps for endochondral ossification

A

Initiates with condensation that forms a cartilage model of the bone

First visible step in ossification is hypertrophy and death of chondrocytes in the centre of the cartilage. This enables invasion by blood vassals which allow osteoprogenitor cells to enter the cartilage. He is differentiate into osteoblasts and secrete own matrix. They secrete osteoid, and ECM that binds to calcium and becomes more mineralise.Initially collagen fibres have a hazard arrangement

Differentiation of osteoblasts depend on Runx2 and Osx2. In mice where either is knocked out there is no bone made. Defects in Runx2 lead to a condition known as cleidocranial dysplasia

108
Q

What are the two genes associated with endochondral ossification

A

Runx2

Osx2

109
Q

What is the epiphyseal growth plate

A

I can’t imagine this region that remains at the junction between the epiphysis and diaphysis

110
Q

As the bone continues to grow, how are the cartilage cells are arranged

A

Into zones:

Quiescent zone/stem cells

Proliferative zone of cell division

Hypertrophic zone

111
Q

Which gene regulates the transition of cartilage to bone

A

Indian hedgehog (IHH)

112
Q

Where is Indian hedgehog expressed

A

In pre-– hypertrophic cells and axe to promote proliferation and prevent hyperTrophy

113
Q

What happens to mice that lack Indian hedgehog

A

They have decreased chondrocyte proliferation and short stubby bones

114
Q

Which hormones act on bone growth and how

A

Growth hormone

Thyroid hormones

IGF-1

By acting on the germinal zone stem cells

115
Q

Which hormone is deficient in Pygmies

A

IGF-1 levels during puberty drop to 1/3 of normal in Pygmies

116
Q

How does FGF3 affect bone growth

Where is the FGF3 receptor present in bones

A

FGF3 inhibits growth and promotes differentiation

On chondrocytes

117
Q

Achondroplasia associated with what mutation

Is it dominant or recessive

A

And activating mutation in the FGF3R

Dominant

118
Q

When do you growth plates ossify

A

At the end of puberty

119
Q

Give five things bone remodelling is important for

A

Making compact bone

Calcium homeostasis

Response to mechanical stress

Removal and replacement of ageing bone

Fracture repair

120
Q

What do osteoclasts do

A

They are large multinucleate cells derived from haemopoietic lineage that cling to the bone matrix and erode

They can tunnel deep into the matrix, forming cavities

121
Q

Name 4 key regulators of osteoclast development

A

Cytokines

RANKL

OPG

Calcitonin and PTH

122
Q

What is RANKL

How does it affect osteoclast activity

A

RANK ligand

Binds to receptor RANK and promotes osteoclast activity

123
Q

What is OPG and how does it affect osteoclast activity

A

Osteopregin

It acts as a decoy receptor binding with RANKL and inhibits osteoclast activation

124
Q

How do calcitonin and PTH affect osteoclasts

A

Calcitonin inhibits osteoclasts when calcium is high

parathyroid hormone stimulates osteoclasts when calcium is low

125
Q

How do you stimulators bone resorption affect osteoclast formation

A

They increase osteoclast formation by stimulating production of RANKL

126
Q

Name to stimulators of bone resorption

A

PTH

interleukin-1 (IL-1)

127
Q

How fats do groups of osteoclasts move

A

At 50μm a day

128
Q

How are bones remodelled

A

Groups of osteoclasts form a cutting cone

This is followed by osteoblasts which deposit new osteoid matrix concentrically around a centrally ingrowing blood vessel. The pattern and extent of the modelling is dictated by the mechanical loads applied to the bone

129
Q

What is osteoporosis

A

It means porous bones

Says when bones become more fragile and susceptible to fracture

An adequate supply of calcium is needed to optimise peak bone mass in early adult hood in order to protect against osteoporosis later in life

130
Q

How many women have low bone density

What does this mean

A

About 20% of women over 50

This predisposes them to osteoporotic fractures especially of the wrist and hip and vertebrae

131
Q

What is Paget’s disease of bone

A

Access activity of osteoclasts

A lot of women bone at the expense of compact bone

132
Q

Is there a familial link in Paget’s disease of bone

What is it linked to

A

Familial history of it in up to 40% of patients

Linked to mutations in RANK and OPG

133
Q

What are the four stages of bone healing after fracture

A
  1. Inflammation and formation of haematoma
  2. Formation of fibrocartilage callus
  3. Replacement of cartilage with lamellar bone (a bony callus)
  4. Remodelling of bone to normal contour
134
Q

Give three factors that affect bone healing

A

Poor blood supply

Non-union

Infection

135
Q

Give 5 bone functions

A

Support

Protection

Movement

Mineral/calcium storage

Hematopoiesis

136
Q

What is hydroxyapatite

A

Calcium phosphate crystals

137
Q

Which genes does brittle bones disease affect

A

Type 1 collagen genes

COL1A1 and COL1A2

138
Q

Why all the different severities of osteogenesis imperfecta?

A

Null mutations in collagen genes cause a quantitive decrease in type one collagen leading to milder forms

Dominant negative mutations disrupt the triple helix structure leading to more severe forms

139
Q

Give seven common symptoms of osteogenesis imperfecta

A

Bone fractures and limb deformities

Scoliosis

Macrocephaly

Hearing loss

Defective denition

Joint laxity

Growth retardation

140
Q

Which disease do you children who are lactose intolerant to have a higher chance of getting

A

Osteomalacia

141
Q

Give signs and symptoms of Ricketts/osteomalacia

A

Diffuse bone pain, tenderness and muscle weakness

X-rays commonly show decreased bone density with thinning of the cortex then maybe concavity of vertebral bodies and bowed legs

Looser’s zones

142
Q

What are looser’s zones

A

Fractures or cracks that may appear in osteomalacia

These are incomplete fractures that are filled with unmineralised osteoid seams

143
Q

True or false

More proximal limb structures commence ossification earlier

A

True

Phalanges and metacarpals will be late

144
Q

What is Hunter Thompson Grebe type Maroteaux

A

When all skeletal elements are present but have abnormal growth

145
Q

Why are growth plate fractures twice as frequent in boys

A

Female bones finish growing earlier

FAB (10 decks)

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