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BMSC > RA week 1 > Flashcards

RA week 1 Flashcards

1
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5
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main types of joint?

A

fibrous

cartilagenous

synovial

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6
Q

fibrous joints found where?

A

Between bones of skull = sutures

Fibrous sheet between radius and ulna = syndesmosis

Fibrous joint that anchors tooth into its socket = gomphosis

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7
Q

types of cartilagenous joint?

where are they found?

A

2 types - primary + secondary

  • 1* = found during bone development (epiphyseal plates at distal ends of long bones)
    • disappear as shaft and epiphyses fuse at end of bone growth
    • primary cartilagenous joint remains in an adult between 1st rib and sternum
  • 2* found between bodies of certebrae + between bodies of pubic bones at pelvis
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8
Q

purpose of 2* cartilaginous joint?

difference between 1* ad 2*?

A

2* cartilaginous joints allow shock absorption

1* = small layer of cartilage between bones of joint surface

2* = thin layer of cartilage but also have fibrous or cartilaginous disc

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9
Q

stable joints?

A

fibrous + cartilaginous (1* and 2*)

allow little or no movement

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10
Q

synovial joint features?

purpose?

A

capsule lined with synovium which releases synovial fluid = lubricates joint

hyaline cartilage on surface of bones themselves

allows smooth movement between the bones

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11
Q

which joints can rotate?

A

rotation only possible at ball+socket joints and pivot joints (both synovial joints)

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12
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A

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13
Q

special movements

A

thumb has special saddle joint that allows opposition of the thumb

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14
Q

types of synovial joint?

A

plane

saddle

hinge

ellipsoid

pivot

ball + socket

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15
Q

least mobile synovial joint?

movement?

e.g.?

A

plane synovial joint

only allows sliding/gliding between the bones

e.g. carpal bones of the wrist (limited movement protects structures in carpal tunnel)

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16
Q

where are saddle joints in human body?

sometimes called?

A

There are 2 saddle joints in human body - one between clavicle and sternum and one at base of thumb (thumb opposition)

Sometimes called “double planar” joint because it allows small gliding movements in 2 planes

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17
Q

synovial hinge joint mobility?

e.g.?

movements?

A

Synovial hinge joints = more mobile than plane or saddle

E.g. elbow joint

Allows large movements in one plane - flexion + extension

  • Extension of elbow limited by interlocking of humerus and ulna
  • Flexion limited by muscle mass of biceps brachii and forearm muscles
  • Abducion + adduction does not occur at the elbow joint (or hinge joints in general) - prevented by joint shape and collateral ligaments on medial and lateral sides of the joint
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18
Q

which joint is more mobile than hinge but less mobile than pivot and ball+socket?

movements?

e.g.?

A

More mobile than hinge = ellipsoid (or condyloid) joint

  • Allows flexion, extension, abduction + adduction
  • This means circumduction is also possible at an ellipsoid joint

E.g. wrist joint

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19
Q

what are the 2 types of joint that allow rotation?

A

synovial pivot joint and ball and socket joint

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20
Q

pivot joint movements?

e.g.?

A

Pivot = allows axial rotation

  • E.g. head of radius - allows rotation of head to allow supination and pronation of forearm
  • E.g. in pic is atlantoaxial joint - between C1 and C2 - allows you to shake your head (the “no” movement)
    • By rotating dens of axis around bony arch and transverse ligament of the atlas
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21
Q

most mobile joints of the body?

movements?

e.g.?

A

Ball and socket joints = most mobile joints of the body

  • Allow flexion, extension, abduction, adduction, circumduction and rotation
    • E.g. hip = more stable due to deep socket formed by hip bone (the innominate bone) that houses ball-shaped end of femur
    • e.g . shoulder (glenohumeral) = less stable due shallow socket formed by scapula and relatively large ball formed by humeral head

(this means shoulder joint is more prone to dislocation than hip joint in adults)

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22
Q

what is lymph?

colour?

A

Fluid lost from capillary bed collects in tissues

Drains into lymphatic vessels (structure similar to very small veins)

Clear (lymph)

Milky lymph from small intestine (due to fats) called chyle

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23
Q

how does lymph move around the body?

A

Small lymphatic vessels join to form larger vessels which pass through nodes (nodes contain lymphocytes and macrophages)

Lymph moves from periphery towards the midline and eventually the upper thorax

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24
Q

primary lymphoid organs?

secondary lymphoid organs?

A

Primary lymphoid organs = bone marrow, thymus

Secondary lymphoid organs = spleen, tonsils, lymph nodes, Peyer’s patches, GALT, BALT, MALT

(Gut, Bronchiolar, Mucosa Associated Lymphoid Tissue)

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25
Q

why is lymph important?

A

Collects interstitial fluid, proteins and cells and returns them to blood stream

Lymph nodes help remove damaged cells and pathogens

Possible transport route for infection and cancer

Lymph node swelling = indication of a problem

Slow lymph flow through node may lead to cancer cells forming secondary tumours within nodes

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26
Q

drainage to lymphatic ducts?

A

Lymph from lower limbs and pelvis = drains into lumbar trunks

  • Join with end of thoracic duct at a swelling called cisterna chyli
  • (Cisterna not present in all individuals)

Lymph from intestinal tract (via an intestinal trunk) also drains into the cisterna chyli

Right lymphatic duct not usually present

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27
Q

lymph drainage on right side of body?

right lymphatic duct present?

A

Lymph drainage on right side of body:

  • Right jugular trunk - drains right side of head and neck
  • Right subclavian trunk - drains right upper limb and superficial structures of upper part of thorax and abdominal walls on right side
  • Right bronchomediastinal trunk - drains deep thoracic structures on right side

In most individuals - drain independently into junction of right jugular and right subclavian veins but in 1/5th of people…

  • Jugular and subclavian trunks unite to form right lymphatic duct that drains into the junction of the veins instead
  • bronchomediastinal trunk usually drains into junction of jugular and subclavian veins independently
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28
Q

does lymph from right side of body drain into throacic duct?

A

lymph from right side of head and neck, the right upper limb and thoracic structures on the right side drains back to venous system without passing through the thoracic duct

29
Q

lymph drainage left side of body?

A

Lymph drainage on left side:

  • left jugular trunk - drains left side of head and neck
  • left subclavian trunk - drains left upper limb and superficial structures of upper part of thorax and abdominal walls on left side
  • left bronchomediastinal trunk - drains deep thoracic structures on left side
  • Thoracic duct - lymph from other trunks and thoracic wall
    • It is a continuation of lymphatic pathways in the abdomen (at cisterna if present) so it also carries lymph from left side of abdomen, both sides of pelvis and both lower limbs
    • Empties into junction of left subclavian and left jugular veins
30
Q

where does throacic duct empty?

what drains into it?

A

Empties into junction of left subclavian and left jugular veins

left jugular trunk, left subclavian trunk, left bronchomediastinal trunl

31
Q

what is equivalent to right lymphatic duct?

where is it found?

A

Thoracic duct is equivalent to right lymphatic duct

  • However larger and more extensive

Can be seen during dissection passing through posterior mediastinum between aorta and azygos vein

32
Q

main groups of lymph nodes?

A
33
Q

nodes of the thorax?

A

Main nodes at bifurcation of trachea and lateral to sternum

Axillary nodes important in drainage of breast tissues

(will be able to see thoracic duct as it passes along vertebral bodies in posterior mediastinum of thorax between azygos vein and aorta)

34
Q

nodes of the abdomen?

A

Nodes clustered around anterior surface of aorta at superior mesenteric artery drain the midgut structures (pre-aortic - drain parts of digestive tract)

There are also para-aortic lymph nodes such as those that drain lymph from the kidneys

(cisterna chyli can be seen very close to the diaphragm)

35
Q

nodes of the upper limb?

A

Clusters of nodes in axilla in fat surrounding brachial plexus and axillary vessels

  • Drain upper limb but also lateral sides of breast and thoracic wall

Small nodes in cubital fossa at elbow but usually too small to see in cadavers

36
Q

nodes of the pelvis?

A

Lymph drainage of pelvis is quite complicated with some organs e.g. uterus draining to several different groups of nodes

37
Q

nodes of lower limb?

A

Superficial and deep nodes drain structures of the lower limb

  • Not easy to see smaller groups like popliteal nodes
  • But larger groups like superficial inguinal nodes can be identified during dissection

Lymph from lower limb will pass to nodes within pelvis (iliac nodes)

38
Q

nodes of the head and neck?

brain?

A

Superficial nodes e.g. submental nodes

Deep nodes such as deep cervical nodes that help to drain lymph from head and neck

There are no lymph nodes associated with the brain as it is protected by blood-brain barrier

39
Q
A

…

40
Q

each spinal nerve composed from?

A

Each spinal nerve composed from anterior and posterior roots that unite to form one spinal nerve on each side at every spinal level

41
Q

most of the nerves you see in disection will be?

e.g?

what do they do?

A

Most of the nerves you’ll see in dissection are somatic nerves with spinal nerve roots

  • E.g. axillary nerve formed from spinal nerves C5 and C6 in brachial plexus

Somatic nerves carry motor fibres to muscle and sensory fibres from the skin

  • Axillary nerve supplies efferent (motor) innervation to deltoid muscle and carries afferent (sensory) fibres from skin on upper lateral surface of the arm
42
Q
A

…

43
Q

what does each spinal nerve divide into?

most nerves you dissect will be?

A

Each spinal nerve divides into dorsal ramus that supplies posterior body wall and a larger ventral ramus that supplies anterolateral body wall and the limbs

Most nerves you’ll dissect are ventral rami e.g. intercostal nerve sin thorax, axillary, median, musculocutaneous nerves

  • Some dorsal rami nerves - e.g. erector spinae muscles of back supplied by dorsal rami nerves
44
Q

what do somatic nerve innervate?

A

Somatic nerves innervate skeletal muscles for voluntary movements and carry sensory innervation from the skin

  • They do not supply cardiac or smooth muscle or carry sensory innervation to internal structures of the body
  • This reqs a different type - autonomic nerves
45
Q

autonomic nervous system innervates?

features?

divided into?

A

Innervates:

  • Viscera, glands, blood vessels
  • Smooth muscle (also influence cardiac muscle)

Non-conscious control

Motor and sensory

Sympathetic and parasympathetic divisions

46
Q

example of organs that ANS controls?

A

ANS controls movement of organs that you do not consciously control

  • E.g. peristalsis of intestine

Controls secretions from glands and allows sensation for organs and vessels

  • E.g. sensitive to mechanical stretching and is source of feeling of intestinal discomfort when walls are stretched during constipation
47
Q

parasympathetic division of ANS?

specific nerves?

A

Cranial and sacral

Rest and digest

Cranial nerves 3, 7, 9 and 10

48
Q

function of parasympathetic NS?

A

Generally acts to slow down body processes

  • E.g. lower HR
  • Also acts to stimulate smooth muscle of the digestive tract

“rest and digest”

49
Q

which cranial nerves are part of parasympathetic NS?

A

There are 12 cranial nerve pairs in total but only 4 of them carry parasympathetic fibres

III, VII, IX and X

50
Q

occulomotor nerve is part of parasympathetic NS

what does it do?

A

Carries motor fibres to extraocular muscles

Also provides parasympathetic fibres to the eye

  • Allows accommodation (changing shape of the lens) and decrease in size of pupil (via sphincter pupillae smooth muscle of the iris)
  • (easy test to see if oculomotor nerve is functioning is to shine light into the eye and see if pupil contracts)
51
Q

facial nerve (CN VII) is part of parasympathetic NS

what does it do?

A

Secretomotor (parasympathetic fibres) to lacrimal, nasal, palatine, sublingual and submandibular glands

Also supplies muscles of facial expression with motor innervation and can be seen passing across the face

52
Q

glossopharyngeal nerve is part of parasymp NS

what does it do?

A

Secretomotor (parasympathetic) to parotid gland

Sensory innervation to posterior 1/3rd of the tongue

53
Q

vagus nerve is part of parasymp NS

what does it do?

A

Visceral motor fibres to heart, lungs and abdominal viscera

Only cranial nerve that “wanders” from head and neck to the rest of the body

Carries parasympathetic sensory fibres and motor fibres to smooth muscle of organs in thorax and abdomen

  • only supplies the foregut and midgut regions of the digestive tract
54
Q

sacral outflow for parasympathetic NS?

A

from nerve roots S2, S3, S4

They form structures called the pelvic splanchnic nerves (splanchnic refers to organs)

55
Q

digestive tract innervation?

A

Vagus nerve sends motor and sensory fibres to abdominal viscera but it does not supply the entire digestive tract - only the foregut and midgut organs

Approx 2/3rds of the way along the transverse colon the innervation switches from the vagus nerve to the pelvic splanchnic nerves

  • Pelvic splanchnic nerves also supply organs of the pelvis (e.g. bladder)
56
Q

do parasymapthetic nerves innervate body wall structures?

A

Unlike sympathetic nerves, there are no parasympathetic nerves to the body wall structures from either cranial or sacral nerves

57
Q

sensory component of parasympathetic system?

A

Sensory component of parasympathetic system helps to monitor the internal environment of the body

e.g. it detects changes in pressure in arteries of the neck and issues such as distention or torsion of the digestive tract

58
Q

sympathetic nerves function?

found?

what about other areas?

how do they reach body wall?

A

“Fight and flight”

  • Generally speeds up processes in the body - e.g. increase HR

Cell bodies in lateral horn of spinal cord

  • Only between T1 and L2
  • However, still need to supply areas beyond T1-L2 (sweat glands and blood vessels) - so sympathetic chain of ganglia

Sympathetic fibres can pass into the spinal nerves between T1-L2 to pass into the dorsal or ventral rami to reach anterior, lateral and posterior body walls of thorax and upper abdomen

59
Q

what are the sympathetic chains?

where do they end?

A

linked group of paravertebral ganglia from cervical to sacral regions

The two chains fuse to form ganglion impar on the coccyx - ends here

60
Q

what does each chain communicate with?

A

Each chain communicates with spinal nerves on is side of the body and with ganglia that lie anterior to the vertebral bodies (prevertebral ganglia)

61
Q

how does sympathetic chain communicate with spinal nerves?

types?

A

Communicates with spinal nerves via rami communicantes (communicans)

White rami communicans (WRC) found only at T1-L2 - they are sympathetic output to chain

  • Sympathetic fibres pass from their origin in spinal cord to enter spinal nerve then pass into sympathetic chain
  • Presynaptic nerve fibres pass from spinal nerve into sympathetic chain via white rami communicans (appear white due to myelin sheath)

To reach the body wall, fibres need to re-enter a spinal nerve

  • Pathway between sympathetic chain and spinal nerves is called grey rami communicans
  • Found between T1 and L2 but also at vertebral levels above and below this to allow innervation of the skin outwith thorax and abdomen

Grey rami communicans (GRC) are pathway back from chain to spinal nerve

62
Q

courses taken by presynaptic sympathetic fibres in sympathetic chain? (4)

A

1 - ascend and then synapse for innervation of the head, neck and upper limb

2 - synapse at level of entry to the chain for innervation of thoracic viscera and body wall

3 - descend then synapse for innervation of lower limb

4 - pass through chain without synapsing for innervation of abdominal and pelvic viscera via abdominopelvic splanchnic nerves

63
Q

how do sympathetic fibres reach target organs?

e.g.?

A

Sympathetic fibres form plexi (plexuses lol) on arterial vessels to pass to target organs

  • e.g. preaortic ganglia help spread innervation to digestive tract
64
Q

“pain” from viscera caused by?

explain

A

“Pain” from viscera via sympathetic afferent nerves - due to stretch or lack of oxygen

Brain interprets pain as from the spinal segment i.e. body wall not the organ

= Referred pain!!

If part of intestine becomes twisted (tosion) or distended - or if arterial vessel become blocked = this causes feeling of discomfort/pain via autonomic nerves (sympathetic afferents)

65
Q
A

referred pain

66
Q

where does appendix refer pain?

A

Appendix is part of the midgut and specifically refers pain to around umbilicus

  • Spinal nerves T 10 and 11
  • This means patient feels diffuse pain around umbilicus if appendix is swollen due to infection
  • If infection continues and appendix becomes very swollen it can brush against and start to irritate surface of body wall
  • Once it does that it will cause pain response in body wall (somatic nerves) - pain will localise to right lower quadrant of the abdomen
67
Q
A

…

68
Q
A

Branch of axillary nerve - badge patch (superior lateral cutaneous nerve of the arm)

BMSC (17 decks)

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