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Skin/Musculoskeletal > SM: Week 1 > Flashcards

SM: Week 1 Flashcards

1
Q

Innervation, arterial/venous supply, and action of: trapezius

A

Innervation: Accessory Nerve (CN XI)
A/V: Transverse Cervical A/V
Action: elevate scapula

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2
Q

Innervation, arterial/venous supply, and action of: latissmus dorsi

A

Innervation: Thoracodorsal Nerve
A/V: Thoracodorsal A/V
Action: Extend, adduct, and medially rotate humerus

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3
Q

Innervation, arterial/venous supply, and action of: levator scapulae

A

Innervation: Dorsal Scapular Nerve
A/V: Dorsal Scapular A/V
Action: elevate scapula

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4
Q

Innervation, arterial/venous supply, and action of: rhomboids (major/minor)

A

Innervation: Dorsal Scapular Nerve
A/V: Dorsal Scapular A/V
Action: retract scapula, rotate scapula to depress glenoid cavity

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5
Q

Innervation, arterial/venous supply, and action of: serratus anterior

A

Innervation: long thoracic nerve
A/V: lateral thoracic A
Action: protracts scapula (holds against body); rotation of scapula

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6
Q

Innervation, arterial/venous supply, origin/insertion, and action of: supraspinatus

A 
Innervation: suprascapular nerve
A/V: suprascapular A/V
O: supraspinatus fossa of scapula
I: greater tubercle of humerus
Action: abduction of arm
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7
Q

Innervation, arterial/venous supply, origin/insertion, and action of: infraspinatus

A 
Innervation: Suprascapular nerve
A/V: suprascapular A/V
O: infraspinatus fossa of scapula
I: greater tubercle of humerus
Action: lateral rotation of arm, adduction of arm
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8
Q

Innervation, arterial/venous supply, origin/insertion, and action of: teres minor

A

Innervation: axillary nerve
A/V: circumflex scapular A/V
O: upper 2/3 of lateral border of scapula
I: greater tubercle of scapula
Action: lateral rotation and adduction of arm

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9
Q

Innervation, arterial/venous supply, origin/insertion, and action of: subscapularis

A 
Innervation: upper and lower subscapular nerve (C5, C6)
A/V: subscapular A
O: subscapular fossa of scapula
I: lesser tubercle of humerus
Action: medial rotation of humerus
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10
Q

Innervation, arterial/venous supply, and action of: deltoid

A

Innervation: axillary nerve
A/V: posterior circumflex humoral A
Action: main action is to abduct arm at shoulder

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11
Q

Innervation, arterial/venous supply, and action of: teres major

A

Innervation: Lower subscapular nerve
A/V: circumflex scapular A/V
Action: adducts, medially rotates, and assists with extension of the arm

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12
Q

What is “winged scapula” and how does it result?

A

Winged scapula manifests when the long thoracic nerve is damaged. The long thoracic nerve innervated serratus anterior and results in loss of protraction of the scapula (inability for the scapula to remain close to the ribs).

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13
Q

Innervation, arterial/venous supply, origin/insertion, and action of: omohyoid

A

Innervation: ventral ramus via ansa cervicalis
A/V: transverse cervical A
Origin: superior/medial border of scapula
Insertion: inferior border of hyoid bone
Action: depresses/stabilizes the hyoid bone

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14
Q

What are the boundaries of the triangle of auscultation? What is the significance of this area?

A

Boundaries:

  • Superior: scapula
  • Medial: trapezius
  • Inferior: latissimus dorsi

Significance: clinically useful for listening to lung sounds; overlies the 6th intercostal space

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15
Q

What clinical deficit would be apparent with injury to the thoracodorsal nerve?

A

•The thoracodorsal nerve innervates latissimus dorsi which is responsible for extending, adducting and medially rotating the upper extremity, thus a deficit to the thoracodorsal nerve would result in an inability to extend, adduct, and medially rotate the upper extremity.

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16
Q

How would injury to the dorsal scapular nerve effect the position of the scapula?

A

• The dorsal scapular nerve innervates levator scapulae and the rhomboids. An injury to the dorsal scapular nerve would affect the function of these muscles as follows: elevating the scapula and retracting and rotating the scapula to depress the glenoid fossa, respectively.

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17
Q

What would be the appearance of the patient’s shoulder sometime following axillary nerve injury?

A

• Patient deficits would result in an inability to abduct the shoulder and laterally rotate and adduct the shoulder, respectively.

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18
Q

What is the rotator cuff muscle that initiates abduction?

A

Supraspinatus

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19
Q

What is the most commonly torn rotator cuff muscle?

A

Supraspinatus

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20
Q

What is a dermatome?

A

A dermatome is a unilateral area of skin innervated by the nerve fibers of a single spinal nerve that originated from a single spinal cord segment; considerable overlap exists between adjacent dermatomes

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21
Q

What is a myotome?

A

A myotome is a unilateral muscle mass receiving innervation from the fibers conveyed by a single spinal nerve

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22
Q

What is the dermatome C5 landmark?

A

Shoulder

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23
Q

What is the dermatome C6 landmark?

A

Thumb

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24
Q

What is the dermatome C7 landmark?

A

Middle finger

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25
Q

What is the dermatome C8 landmark?

A

Little finger

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26
Q

What is the dermatome T4 landmark?

A

Nipple

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27
Q

What is the dermatome T10 landmark?

A

Umbilicus

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28
Q

What is the dermatome L1 landmark?

A

Groin

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29
Q

What is the dermatome L5 landmark?

A

Medial foot

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30
Q

What is the dermatome S1 landmark?

A

Lateral leg/foot

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31
Q

What is the dermatome S 2,3,4 landmark?

A

Anal area

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32
Q

What are the myotome muscles affected by C5?

A

Upper extremity abductors (biceps brachii, deltoid)

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33
Q

What are the myotome muscles affected by C5/6?

A

Forearm flexors (biceps brachii, brachioradialis), forearm pronators

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34
Q

What are the myotome muscles affected by C7?

A

Forearm extensors (triceps brachii), wrist extensors, finger extensors

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35
Q

What are the myotome muscles affected by C8/T1?

A

Intrinsic muscles of hand (radial, median, ulnar nerves)

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36
Q

What are the myotome muscles affected by L2?

A

Thigh flexion (iliopsoas)

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37
Q

What are the myotome muscles affected by L3/4 and what is its associated reflex?

A

Leg extension (quadriceps) – knee jerk reflex

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38
Q

What are the myotome muscles affected by L4/5?

A

Foot dorsiflexion, toe extensors (anterior tibial muscles)

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39
Q

What are the myotome muscles affected by S1/2 and its associated reflex?

A

Foot plantar flexors, toe flexors (posterior tibial muscles) – Achilles tendon reflex

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40
Q

What are the myotome muscles affected by S 2,3,4?

A

Anal contraction

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41
Q

How are joints innervated?

A

Overlying larger nerves supply skin and muscle that move the joint and provide it with a rich nerve supply for proprioception and pain (Hilton’s Law)

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42
Q

What are the two main types of joints? How do they differ?

A

Synarthroses (together joints) and Diarthroses (synovial joints)
- they differ based on degree of joint movement

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43
Q

Synarthroses

A

separated by connective tissue which permits limited movement

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44
Q

Diarthroses

A

moveable joints due to presence of synovial fluid and an articular surface

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45
Q

What are the different types of synarthroses?

A

syndesmosis, synchondrosis, and synostosis

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46
Q

Syndesmosis (fibrous joint)

A

opposed bones are joined by intervening fibrous tissue, i.e. interosseus membrane, sutures

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47
Q

Synchondrosis (cartilaginous joint)

A

two bones are separated from each other by cartilage, i.e. epiphyseal plate, intervertebral disc, symphysis

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48
Q

Synostosis

A

two bones are joined together by bone, i.e. ossified sutures, epiphyseal plates

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49
Q

What are some features of diarthroses that differentiate them from synarthroses?

A

• Synovial space – articular cavity or discontinuity between participating bones
• Synovial fluid – joint lubrication
• Fibrous capsule
• Synovial membrane/sac – lines capsule
• Articular surface – composed of hyaline cartilage that caps underlying bones
• Others:
- Menisci, fat pads, ligaments, bursae (fluid-filled sacs)

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50
Q

What are some main types of synovial joints?

A
  • plane joints
  • hinge joints
  • saddle joints
  • condyloid joints
  • ball and socket joints
  • pivot joints
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51
Q

What is a bursa?

A

fluid-filled sac consisting of serous membrane

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52
Q

What are synovial tendon sheaths?

A

serous membranes that consist of an inner layer (visceral layer) attached to the tendon and an outer layer (parietal layer) with synovial fluid found within the sac or cavity

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53
Q

What are the different epidermal layers?

A
  • stratum germinativum (stratum basal)
  • stratum spinosum
  • stratum granulosum
  • (stratum lucidum) – only in thick skin
  • stratum corneum
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54
Q

What are some features of stratum germinativum and where is it located, its structure, and status of mitotic activity?

A
  • Features: cells are cuboidal or columnar, form hemidesmosomes and desmosomes, cytoplasm has multiple polyribosomes and intermediate filaments
  • Location: adjacent to basal lamina (deepest layer)
  • Structure: single layer of cells
  • Mitotic Activity: yes
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55
Q

What are some features of stratum spinosum and where is it located, its structure, and status of mitotic activity?

A
  • Features: cells are polygonally shaped, have a “prickly” appearance, desmosomes, has intermediate filaments (tonofibrils), membrane-coating granules (keratinosomes) in cytoplasm
  • Location: immediately above the stratum germinativum
  • Structure: variable thickness, several cell layers deep
  • Mitotic activity: some, less than germinativum
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56
Q

What are some features of stratum granulosum and where is it located, its structure, and status of mitotic activity?

A
  • Features: flattened polygonally-shaped cells (parallel to basement membrane), keratohyalin granules appear in cytoplasm, nucleus becomes pyknotic (small, dense)
  • Location: above stratum spinosum
  • Structure: three to five layers thick
  • Mitotic activity: none
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57
Q

What are some features of stratum corneum and where is it located, its structure, and status of mitotic activity?

A
  • Features: cells appear dead and flattened, cytoplasm becomes keratinized (eleidin from stratum lucidum becomes keratin in thick skin)
  • Location: outermost layer of epidermis
  • Structure: thickness and number of cells vary considerably
  • Mitotic activity: none
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58
Q

What are the two dermal layers?

A
  • papillary layer

- reticular layer

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59
Q

What is the location and structure of the papillary layer of dermis?

A
  • Location: superficial layer of dermis immediately beneath basement membrane
  • Structure: composed of loose areolar CT (collagen, reticular, elastic fibers), more cellular than reticular layer (fibroblasts, mast cells, macrophages, smooth/skeletal muscle)
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60
Q

What are the two types of papillae and what makes them significant?

A
  • Vascular – papillae contain capillary loop projections, are the only source of nourishment for epithelial cells, have thermoregulatory devices
  • Nervous - contain special nerve terminations such as meissner’s corpuscles and pacinian corpuscles (encapsulated nerve endings)
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61
Q

What is the location, structure, and some features of the reticular layer of the dermis?

A
  • Location: deep layer of dermis
  • Structure: composed of dense irregular CT (type I collagen fibers, some reticular and many elastic fibers, less cellular than papillary layer)
  • Features: the predominant direction of all fibers is parallel to surface (Langer Lines)
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62
Q

What is the process of keratinization?

A

There are two phases:
• Synthetic phase: intermediate filaments, keratohyalin granules, membrane-coating granules (MCGs) and filaggrin and trichohyalin proteins found in large numbers
• Degradative phase: MCGs lipid contents discharged into intercellular space, lysosomal enzymes degrade synthetic organelles, filaments and keratohyalin condense into a fibrous-amorphous mass

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63
Q

What are three factors that influence skin pigmentation?

A
  • Presence of carotene in skin
  • Blood capillaries impart a reddish hue
  • Melanin pigment imparts shade(s) of brown
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64
Q

How is melanin produced?

A
  • Melanin is produced by melanocytes which are usually present in the stratum basal layer of the epidermis. Melanocytes are highly branched, dendritic cells which insinuate themselves between other epidermal cells (these branches contain pigment granules that eventually are released into the epidermis giving rise to colored skin). These pigment granules are made from melanosomes.
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65
Q

What is the process for melanosome granule formation?

A

First, the rough ER forms enzymes with tyrosinase activity. The golgi then packages these tyrosinase enzymes into membrane-bound vesicles that contain tyrosinase and melanin. As the pre-melanosome matures, there is a gradual decline in tyrosinase activity until the pre-melanosome has become a melanin granule which can bud off from the dendritic process and go into surround epidermal cells.

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66
Q

What is the difference between skin pigmentation for white and black people?

A

• Blacks: melanosomes are larger, more numerous, and dispersed throughout keratinocyte cytoplasm
• Whites: melanosomes are smaller, fewer, and close to nucleus
- Difference in number due to how fast the melanosomes are degraded, not on initial number

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67
Q

Describe the structure and function of hair.

A

• Structure: hair shaft (medulla, cortex, and hair cuticle), follicle (internal root sheath, external root sheath), hair bulb (matrix, dermal papilla)
- Note: hair cuticle and the internal root sheath cuticle layer interdigitate to keep hair shaft in follicle
• Function: provide warmth

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68
Q

Describe the structure and function of nails.

A
  • Structure: nail plate, nail bed, nail matrix (most proximal portion of nail bed, site of mitotic activity), eponychium, hyponycium, lunula
  • Function: protect finger tips
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69
Q

Describe the structure and function of eccrine glands.

A

• Structure: simple coiled tubular glands
- Secretory portion – secretes KCl, NaCl, ammonia, and urea, has dark (mucous secretion), clear (watery secretion), and myoepithelial cells (contractile properties)
- Excretory portion – passes through epidermal portion of skin, reabsorb K, Na, and Cl
• Function: empty secretions into epidermal ridges

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70
Q

Describe the structure and function of apocrine glands.

A

• Structure:
- Secretory portion: lumen is large, myoepithelial cells present, probably do not lose portion of cell during secretion
- Excretory portion: ducts empty into hair follicle
• Function: found in restricted body regions: axilla, areola of nipple, anogenital region; secretory product is odorless unless encounters cutaneous bacteria to make it odoriferous

  • Note: Have sympathetic innervation (neurotransmitter = ACh)
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71
Q

Describe the structure and function of sebaceous glands.

A
  • Structure: simple, branched alveolar gland; short duct empties holocrine secretion product into hair follicle
  • Function: lubricate hair follicle, source of oil associated with hair
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72
Q

Describe the structure and function of arrector pili muscles.

A
  • Structure: bundles of smooth muscle associated with hair follicles; one end anchored to CT sheath of follicle and other end anchored to papillary layer of dermis
  • Function: constrict due to sympathetic innervation forming goose bumps or secretions from sebaceous glands on skin
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73
Q

What are the two different types of nerve endings (sensory structures)?

A
  • Free nerve endings (naked)

- Encapsulated nerve endings

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74
Q

Describe the structure and function of free nerve endings.

A
  • Structure: endings wrap around CT sheath of hair follicles

* Function: carry sensations of touch (Merkel) and pain, hot and cold

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75
Q

What are two different types of encapsulated nerve endings?

A
  • Meissner’s corpuscles

- Pacinian corpuscles

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76
Q

Describe the structure and function of Meissner’s corpuscles.

A
  • Structure: found in hairless skin within the dermal papillae
  • Function: senses touch
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77
Q

Describe the structure and function of Pacinian corpuscles.

A
  • Structure: thick fibrous capsule, has many layers, looks like an onion; found in hypodermis
  • Function: senses deep pressure
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78
Q

What are the functions of Merkel cells?

A

senses touch, associated with unmyelinated sensory nerves

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79
Q

What are the functions of Langerhans cells?

A

APC, derived from monocytes, has immunological function – Fc and complement receptors, phagocytose and process foreign antigens

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80
Q

What are the functions of melanocytes?

A

produce melanin granules (melanosomes) to give skin color

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81
Q

What are the functions of keratinocytes?

A

provide protection for underlying tissue

82
Q

What are the functions of the vascular supply to the dermal layers?

A
  • nourishment to tissue (rete systems)

- thermoregulation (AVA)

83
Q

What is the rete subpapillare system?

A

It is the vascular network between papillary and reticular layers of dermis.

84
Q

What is the rete cutaneum system?

A

It is the vascular network that send branches in two directions: subcutaneous and dermal.

85
Q

What is an arteriovenous anastomosis?

A

It is a capillary network involved in thermoregulation due to the multiple loops present. In cold conditions, blood flow primarily goes through the closest loop to the vein. In hot conditions, blood flow goes to the closest loop to the surface to release heat.

86
Q

What is the process of wound healing?

A
  1. Fibrin clot forms at bottom of cut
  2. Epidermis extends down sides of incision until both epidermal extensions meet
  3. Fibroblasts and capillaries repair connective tissue
    • Fibroblasts come from hypodermis
  4. New dermal tissue pushes cleft to surface until surface is level
87
Q

What are the two different types of skin grafts?

A
  • Split-skin grafts

- full thickness grafts

88
Q

What is a split-skin graft?

A

It involves a piece of skin cut at level halfway down the dermis, placed in denuded area where needed, tissue eventually becomes revascularized, donor site is able to proliferate due to remaining epidermal cells (preferred method).

89
Q

What is a full thickness graft?

A

It requires the removal of all the dermis and epidermis from the donor and the donor site cannot re-epithelialize itself.

90
Q

What are some general functions of skin?

A
  • Shield the body from: organism invasion, excessive fluid loss
  • Temperature regulation
  • Has endocrine and exocrine functions
91
Q

Cutaneous blood flow involves _______________ innervation.

A

sympathetic

92
Q

When the body is hot, what is the action of the sympathetic nerves?

A

Both the pre- and post-ganglionic nerves release ACh as their neurotransmitter.

Mechanism: pre-ganglionic nerve – (release ACh) –> nicotinic receptor on post-ganglionic nerve – (release ACh) –> muscarinic receptor on blood vessel –> –> vasodilation

93
Q

What is different about the way sympathetic nerves work on the skin and sweat glands compared to other sympathetic innervation?

A

Typically, the post-ganglionic nerve releases norepinephrine instead of ACh as seen in skin and sweat gland activation.

94
Q

How are sweat gland secretions regulated?

A

Control of sweat gland secretions is ultimately regulated by temperature sensors in the hypothalamus which then act on sympathetic nerves to release:

  • ACh from post-ganglionic nerve on muscarinic receptors to increase sweat production (eccrine)
  • NA from post-ganglionic nerve on a1 and ß receptors to increase sweat production (apocrine)
95
Q

After being stimulated by sympathetic innervation, describe the processes of secretion and reabsorption for sweat glands.

A

• Secretion: Na, Cl, and K are actively secreted by sweat glands involving NKCC
- CLCA and CFTR allow Cl into the sweat gland lumen
- Na and H2O follow by electrochemical gradient and osmosis
• Reabsorption: once ions and water are in lumen of sweat duct, Na and Cl can be reabsorbed by ENaC and CFTR, respectively. H2O remains in lumen due to lack of aquaporins

96
Q

What are two types of sensory ganglia and what type of neuron is found in these ganglia?

A
  • Spinal ganglia, such as the dorsal root ganglia (DRG)
  • Cranial ganglia (V, VII, VIII, IX, X)
  • All of these ganglia are pseudounipolar, except VIII sensory ganglia are bipolar
97
Q

What are the different types of cranial sensory ganglia?

A
  • Trigeminal (V): trigeminal (semilunar or Gasserian)
  • Facial (VII): geniculate
  • Vestibulocochlear (VIII): spiral (cochlear), vestibular (Scarpa’s)
  • Glossopharyngeal (IX): superior, inferior (petrosal)
  • Vagus (X): superior (jugular), inferior (nodose)
  • Remember: all of these ganglia have pseudounipolar neurons except VIII which has bipolar neurons
98
Q

In the spinal cord, what composes the gray matter?

A

Gray matter is composed of cell bodies and synapses.

99
Q

What are the three different sections of the gray matter in the spinal cord and what types of neurons do they contain?

A

o Dorsal Horn: contains multipolar neurons
o Lateral Horn (only T1 - L2): contains multipolar neurons and an intermediolateral cell column
o Ventral Horn: contains alpha (lower motor) and gamma motor neurons, both are multipolar; innervate extrafusal skeletal muscle fibers and intrafusal muscle fibers, respectively

100
Q

In the spinal cord, what composes the white matter?

A

White matter is composed of myelinated axons which form tracts.

101
Q

What are the different sections of white matter in the spinal cord?

A
  • dorsal column/funiculus
  • lateral column/funiculus
  • ventral column/funiculus
  • anterior white commissure
102
Q

What are some features of the dorsal column/funiculus?

A

o Dorsal column/funiculus: cell bodies located in the DRG, carry discriminative touch and proprioception

  • Funiculus gracilis (only above T6)
  • Funiculus cuneatus (only above T6)
103
Q

What are some features of the lateral column/funiculus?

A

o Lateral column/funiculus: has ascending sensory and descending motor tracts

  • Sensory fibers have cells of origin in gray matter of dorsal horn
  • Motor fibers have cells of origin in upper levels of neuraxis (brain stem or cerebrum)
104
Q

What are some features of the ventral column/funiculus?

A

o Ventral column/funiculus: has ascending sensory and descending motor tracts

  • Sensory fibers have cells of origin in gray matter of dorsal horn
  • Motor fibers have cells of origin in upper levels of neuraxis (brain stem or cerebrum)
105
Q

What are six differences in the gray and white matter columns at different cord levels?

A

o Cord gets smaller caudally.
o Progressive decrease in white matter at lower levels: number of nerve fibers decreases caudally as descending tracts gradually terminate and ascending tracts aren’t yet complete.
o Shape of cord: cervical segments are large and oval, while lumbar and sacral segments are smaller and rounder.
o Gray matter larger at cervical (C4-T1) and lumbosacral (L2-S3) levels: due to larger number of nerve cells associated with innervation of the limbs.
o Lateral horn present in T1-L2 segmental levels (aka intermediolateral cell column): contains the cell bodies of preganglionic sympathetic neurons.
o Dorsal or posterior funiculus divided into two fasciculi (f. gracilis and f. cuneatus) above T6.

106
Q

Where do the cell bodies of upper and lower motor neurons originate and terminate?

A
  • Upper motor neurons originate (cell bodies) in the CNS and terminate (synapse) in the CNS
  • Lower motor neurons originate (cell bodies) in the CNS and terminate (synapse) in the PNS
107
Q

What are the two divisions of nerve types in the PNS?

A

Somatic and Visceral

108
Q

Both somatic and visceral components of the PNS are divided further into ___________ and __________. Which can also be called _________ and ___________.

A

sensory, motor; afferent, efferent

109
Q

Where are the nerve cell bodies for somatic sensory nerve located? Where are the nerve fibers located for the general and special somatic sensory divisions.

A
  • Nerve cell bodies are located in the cranial and spinal sensory ganglia
  • general somatic sensory (GSA) - nerve fibers are from the body and head to the CNS
  • special somatic sensory (SSA) - cranial nerve fibers from “special” body parts such as eye and ear to CNS.
110
Q

Where are the nerve cell bodies for somatic motor nerve located? Where are the nerve fibers located for the general and special somatic motor divisions.

A
  • Nerve cell bodies located in the CNS (brain stem and spinal cord)
  • general somatic motor (GSE) - nerve fibers terminate on skeletal muscle
  • special somatic motor – DON’T EXIST!!!
111
Q

Where are the nerve cell bodies for visceral sensory nerve located? Where are the nerve fibers located for the general and special visceral sensory divisions.

A
  • Nerve cell bodies located in the cranial and spinal sensory ganglia
  • general visceral sensory (GVA) - nerve fibers from viscera to the CNS
  • special visceral sensory (SVA) - cranial nerve fibers from olfactory epithelium and taste buds to CNS
112
Q

Where are the nerve cell bodies for visceral motor nerve located? Where are the nerve fibers located for the general and special visceral motor divisions.

A
  • have two different efferent neurons - 1) located in CNS, 2) located in autonomic/visceral ganglion (sympathetic chain ganglion)
  • general visceral motor (GVE) - nerve fibers of ANS (two neuron system - 1) in CNS, 2) in motor ganglion)
  • special visceral motor (SVE) - cranial nerve fibers terminating on skeletal muscle derived from branchial or pharyngeal arches
113
Q

The visceral motor division of the PNS has other names. What is the most important synonymous name?

A

Autonomic Nervous System (ANS)

114
Q

What are the three divisions of the ANS?

A
  • sympathetic (thoracolumbar)
  • parasympathetic (craniosacral)
  • enteric nervous system (GI tract)
115
Q

What are the differences between the dorsal and ventral roots and where do their cell bodies located?

A
  • Dorsal root has sensory fibers entering from the DRG (pseudounipolar neurons – central and peripheral processes)
  • Ventral root has motor fibers from the ventral horn (multipolar neurons - peripheral process)
116
Q

What are the differences between the dorsal and ventral rami and what structures do these nerve groups supply?

A
  • Ventral rami – gives rise to the nerve plexi and intercostal nerves that supply the limbs and remainder of the body wall; supplies muscular and cutaneous branches to the skin and skeletal muscles of lateral and anterior aspects of the trunk, and the skin and muscles of the limbs
  • Dorsal rami – supplies muscular and cutaneous branches to the deep muscles and skin of the back and posterior head
117
Q

Cranial nerves can be either sensory, motor, or carry both types of fibers. What is the denotation of all 12 cranial nerves?

A 
CN I -- Sensory
CN II -- Sensory
CN III -- Motor
CN IV -- Motor
CN V -- Both
CN VI -- Motor
CN VII -- Both
CN VIII -- Sensory
CN IX -- Both
CN X -- Both
CN XI -- Motor
CN XII -- Motor

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118
Q

Of the sensory cranial nerves, only five have at least one sensory ganglion. What are these cranial nerves and their ganglion(a)?

A
  • Trigeminal (V): trigeminal (semilunar or Gasserian)
  • Facial (VII): geniculate
  • Vestibulocochlear (VIII): spiral (cochlear), vestibular (Scarpa’s)
  • Glossopharyngeal (IX): superior, inferior (petrosal)
  • Vagus (X): superior (jugular), inferior (nodose)
119
Q

Are sensory ganglia sympathetic or parasympathetic or both?

A

ONLY parasympathetic!

120
Q

What are the three cranial nerves that have parasympathetic ganglia?

A

Oculomotor
Facial
Glossopharyngeal

121
Q

macule

A

A flat, circumscribed region of skin with different color or texture (example: freckle)

122
Q

patch (macule)

A

A large macule (> 1 cm) or a coalescence of macules (example: vitiligo)

123
Q

papule

A

A palpable, circumscribed change in consistency or contour of the skin (example: acne vulgaris)

124
Q

nodule

A

A papule larger than 1 cm in diameter (example: neurofibroma)

125
Q

tumor

A

A large nodule (example: lymphoma)

126
Q

plaque

A

A coalescence of papules (example: psoriasis)

127
Q

cyst

A

An encapsulated nodule filled with soft material (example: epidermal cyst)

128
Q

vesicle

A

A circumscribed, clear fluid filled lesion; a blister (example: Herpes simplex)

129
Q

bulla

A

A large vesicle (example: bullous pemphigoid)

130
Q

pustule

A

A vesicle filled with inflammatory cells, typically white (example: acne vulgaris, pustular psoriasis)

131
Q

wheal

A

A palpable, circumscribed, area of edema with central pallor and peripheral erythema (example: hives) that usually disappears relatively quickly.

132
Q

purpura

A

Discoloration of the skin due to the presence of blood in the tissue, outside of blood vessels; will not blanch with pressure (example: vasculitis)

133
Q

petechiae

A

A punctate region of purpura (tiny dots)

134
Q

comedo

A

A plug within a hair follicle canal which is composed of keratin and sebum; a blackhead (example: acne vulgaris)

135
Q

milium

A

A white papule composed of whorls of keratinized epidermal cells beneath the skin surface (example: milia)

136
Q

burrow

A

A horizontal tunnel in the stratum corneum produced by a parasite (example: scabies)

137
Q

scaly

A

Characterized by exfoliation of surface keratin cells (example: psoriasis)

138
Q

hyperkeratotic

A

having very thick scale (example: icthyosis)

139
Q

crusted

A

Displaying dried exudate of fluid and/or cellular components on the skin surface

140
Q

serous crust

A
  • Composed of serum or tissue fluid (example: contact dermatitis)
141
Q

purulent crust

A

Containing pus (example: infection)

142
Q

hemorrhagic crust

A

Containing red cells; a scab (example: healing herpes zoster)

143
Q

eroded

A

Showing a superficial defect in the skin surface which does not penetrate through the epidermis (example: abrasion)

144
Q

ulcerated

A

Showing a skin defect which penetrates through the epidermis (example: diabetic foot ulcer)

145
Q

excoriated

A

Eroded or ulcerated, often in a linear fashion, due to scratching (example: dermatitis factitia)

146
Q

fissure

A

split horizontally (example: chronic dermatitis)

147
Q

erythematous

A

Reddened; due to vasodilation with increased blood flow. Blanches with pressure (example: viral exanthem)

148
Q

edematous (edema)

A

Swollen; due to extravasation of serum and lymph into tissue (example: urticaria)

149
Q

pigmented

A

Showing changes in color due to melanin pigment

150
Q

hyperpigmentation

A

Dark; due to increased amount of melanin (example: nevus)

151
Q

hypopigmentation

A

Light; due to decreased amount of melanin (example: vitiligo)
- occurs due to the loss of melanocytes amongst other things…

152
Q

lichenified

A

Showing thickening with accentuation of the normal skin markings; usually a sign of chronicity associated with scratching or rubbing (example: atopic dermatitis)

153
Q

verrucous

A

Characterized by velvety or roughened wart-like change (example: verruca vulgaris)

154
Q

telangiectatic

A

Showing dilated small arterioles or capillaries coursing parallel to the skin surface (example: spider telangiectasia)

155
Q

atrophic

A

Emaciated or thinned (example: striae)

156
Q

scarred

A

Showing fibrous connective tissue replacement; a result of dermal injury (example: keloid)

157
Q

What are the most prominent causes of bacterial skin infections?

A
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Pseudomonas aeruginosa
  • Lyme disease (Borrelia burgdorferi)
  • RMSF (Rickettsia rickettsii)
158
Q

What are some distinguishing characteristics, attributes of pathogenicity, and specific prevention/treatment procedures for stapylococcus aureus?

A
  • Distinguishing characteristics: produce several toxins, localized skin infection (impetigo, cellulitis, folliculitis, furuncles, carbuncles)
  • AoP: evade host defense mechanisms: protein A (binds to Fc portion of IgG), coagulase (forms a fibrin coat around organism), hemolysins/leukocidins –> neutrophil localization
  • Treatment: cephalosporins, naficillin, dicloxacillin, IV vancomycin (reserved for severe cases)
159
Q

What are some distinguishing characteristics, attributes of pathogenicity, and specific prevention/treatment procedures for streptococcus pyogenes?

A
  • Distinguishing characteristics: localized infection (impetigo, erysipelas, cellulitis), toxin-mediated (TSS, necrotizing fasciitis)
  • AoP: colonize on skin which leads to inflammation and pusular lesions and honeycomb-like crusts (impetigo), deeper infections result in erysipelas and cellulitis
  • Treatment: penicillin, amoxicillin; penicillin allergy? use cephalosporin, clarithromycin, azithromycin, clindamycin
160
Q

What are some distinguishing characteristics, attributes of pathogenicity, and specific prevention/treatment procedures for pseudomonas aeruginosa?

A
  • Distinguishing characteristics: burn wound infection (cellulitis) and folliculitis (hot tub infection)
  • AoP: inhabits soil, water, and large intestine; infection arises due to breach of host defense barriers
  • Treatment: ticarcillin (clavulanate), piperacillin (tazobactam)
161
Q

What are some distinguishing characteristics, attributes of pathogenicity, and specific prevention/treatment procedures for lyme disease (Borrelia burgdorferi)?

A
  • Distinguishing characteristics/AoP:
    • Stage 1 (10 days after bite): erythema chronicum migrans
    • Stage 2 (weeks later): affects different systems – CNS, CV, Skin, Joints
    • Stage 3 (months to years later): chronic arthritis, encephalopathy, acrodermatitis chronicum atrophicans
  • Treatment:
    • Adults/children older than 8 – doxycycline
    • Adults, younger children, pregnant women – amoxicillin or cefuroxime (2nd gen cephalosporin)
    • if spread to CNS – IV antibiotics for 14-28 days
162
Q

What are some distinguishing characteristics, attributes of pathogenicity, and specific prevention/treatment procedures for Rocky Mountain Spotted Fever (Rickettsia rickettsii)?

A
  • Distinguishing characteristics: rash, fever, headache
  • AoP: bacteria carried in dogs, rodents; inflammation of endothelial lining of small blood vessels, maculopapular rash on palms and soles, widespread vasiculitis, headache and CNS changes, renal damage
  • Treatment: doxycycline (fever should resolve within 24-72 hrs following administration, if not then it probably wasn’t RMSF)
163
Q

What are the virulence factors associated with Staphylococcus aureus?

A 
o Hyaluronidase (breaks down connective tissue)
o Staphylokinase (lyses formed clots)
o Lipase (breaks down fat)
164
Q

What are the virulence factors associated with Streptococcus pyogenes?

A

o Streptokinase (converts plasminogen to plasmin)
o M protein (resists phagocytosis)
o Hyaluronidase (breaks down connective tissue)
o DNase (digests DNA)
o Superantigen
o Streptolysin O (destroys RBCs)
o Streptolysin S (destroys WBCs)
- Streptokinase and hyaluronidase are encoded by a lysogenized prophage

165
Q

Describe maculopapular rash.

A

This is a skin condition wherein the sufferer may have either macules, papules or both. Thus, it is named after the fusion of these words. Macules usually appear as flat, small, non-elevated and discolored regions of the epidermal layer of the skin; whereas, papules are small and swollen bumps on the skin. In the medical world, this is otherwise known as HIV rash.

166
Q

Describe vesicular rash.

A

Blisters arise on the skin as a result of viral infection. It appears on almost all areas of the skin of human body. These rashes can also arise on skin regions where the mucous membrane is present.

167
Q

Folliculitis

A

infection of the hair follicles = small, erythematous, often puritic lesions. Local therapy is typically sufficient treatment

168
Q

Furuncles and carbuncles

A

Usually develop from folliculitis. Carbuncles involve deeper tissues and may have systemic symptoms but rarely involve bacteremia. Antibiotic therapy and sometimes surgery are needed.

169
Q

Impetigo

A

superficial infection involving the epidermis usually due to group A streptococcus (GAS) infection. Presents as a purulent discharge with crusting and is highly contagious

170
Q

Erysipelas

A

acute inflammation of the dermis involving lymphatic vessels. Usually caused by group A strep. Fever and leukocytosis may occur. Butterfly wing rash on face

171
Q

Cellulitis

A

involves all layers of skin to the subcutaneous tissue. Causes fever and leukocytosis and sometimes bacteremia. Group A strep and Staphylococcus aureus most common

172
Q

Abscess

A

localized collection of purulent material (pus), formation is caused by host defenses trying to wall off the infection

173
Q

Gangrene

A

advanced stage of cellulitis that has led to significant tissue necrosis and gas in the soft tissues. Typical organisms are streptococci, mixed infection with anaerobes, and clostridial infection (classic gas gangrene)

174
Q

Necrotizing fasciitis

A

rare but life-threatening infection of subcutaneous tissues. Commonly caused by group A strep.

175
Q

Arthropod-borne infections

A

common and often have multisystem involvement. Rocky mountain spotted fever (RMSF) is the most severe of the tick-borne infections (30% mortality). Lyme disease is also common (especially in Minnesota).

176
Q

Vitiligo

A

partial or complete loss of melanocytes causes by an autoimmune attack of lymphocytes on melanocytes

177
Q

Albinism

A

no melanin is produced (or is decreased) due to an inherited defect in tyrosinase (have normal melanocytes, but cannot produce melanin)

178
Q

Melasma

A

melanocytes have enhanced pigment transfer to keratinocytes or macrophages; occurs due to pregnancy or drug – resolves upon cessation

179
Q

Solar lentigo

A

hyperpigmentation of basal epidermis due to excess melanin production; sun protective mechanism of melanocytes

180
Q

Lentigo simplex

A

not sun related, localized hyperplasia of melanocytes

181
Q

Common Nevi

A
  • most common pigemented lesion
  • most start life within epidermis
  • congenital = large nevi that have an increased risk of developing into melanoma
182
Q

Junctional Nevi

A

melanocytes that grow along the junction of the epidermis and dermis

183
Q

Compound Nevi

A

nevi that enters the dermis and becomes more nodular

184
Q

Halo Nevi

A

have an area of hypopigmentation around the nevus caused by an immune reaction to nevus

185
Q

Spitz Nevi

A

bright red dome-shaped nodule that usually has abrupt growth associated with it (must be excised!!!)

186
Q

Blue Nevi

A

non-invasive dark blue/brown papules that are benign but are a concern for potential melanoma

187
Q

Nevus of Ota/Ito

A
  • Ota: peri-ocular, intra-ocular dermal melanocytic nevus

- Ito: Mongolian spot, same type of lesion, different site

188
Q

Dyspastic Nevi (DPN)

A
  • Multiple DPN is a marker for increased risk of melanoma

- Isolated DPN is probably at no or minimal risk of melanoma

189
Q

Malignant Melanoma

A
  • malignant neoplasm of melanocytes
  • risk factors: fair skin, sun exposure, many DPN
  • usually asymptomatic but may bleed, itch, or ulcerate
  • look for changes in the ABCD’s (>6mm)
  • Two growth phases:
    • radial growth (in situ) - superficial, cannot metastasize
    • vertical growth - dermal invasion, nodule formation, potential to metastasize
190
Q

Breslow Depth Test

A
  • best method to test probability of metastasis
  • Usually for melanoma >1mm thickness:
    • 4mm: 5-year survival is 37-50%
191
Q

Actinic Keratosis

A
  • Benign neoplasm of epidermis (may precede SCC if untreated)
  • Risk factors: sunlight, ionizing radiation, etc.
  • Characterized by: rough spots less than 1cm
  • Histology: atypical cells tend to line up at the basal layer
  • Produce an abnormal stratum corneum
  • Treatment: liquid nitrogen, curettage, topical chemo
192
Q

Squamous Cell Carcinoma (SCC)

A
  • Malignant counterpart to actinic keratosis
  • Risk factors: sunlight, carcinogens, chronic ulcer, XP, etc
  • In situ: contained about basement membrane
  • Invasive: invades basement membrane and dermis
193
Q

Basal Cell Carcinoma (BCC)

A
  • Most common human malignancy
  • Risk factors: sun exposure, light pigment, XP
  • Characterized by: pearly papule with telangiectasia (dilated blood vessels)
  • Arise from base of epidermis
194
Q

Cowden’s Syndrome

A

• Hereditary condition due to mutation in PTEN (tumor suppressor gene)
• Clinical presentation:
o Skin – multiple trichilemmomas (face), benign keratosis on acral skin, mucosal papules, cobblestoning tongue
o Internal – breast, endometrial, and thyroid carcinoma

195
Q

Muir-torre Syndrome

A

• Hereditary condition due to germline mutations in DNA mismatch repair proteins: MLH1, MSH2, MSH6, PMS2
• Clinical presentation:
o Skin – sebaceous adenoma and carcinoma, keratoacanthomas
o Internal – colon/rectal, endometrial, ovarian cancers

196
Q

Sebaceous hyperplasia

A

acquired, localized increase in sebaceous glands, not neoplastic; yellow papule

197
Q

Sebaceous adenoma

A

benign neoplasm, lobular proliferation of sebocytes

198
Q

Sebaceous carcinoma

A

malignant neoplasm, most are periocular; extraocular forms more common with Muir Torre syndrome

199
Q

Dermatofibroma

A
  • benign
    o Dermal proliferation of histiocytes and fibroblasts
    o Tan brown firm papules
    o Pinch test – will dimple
200
Q

Shave biopsy

A

use for superficial lesions (many BCC, AK, SCC in situ, pigmented macules)
• Better cosmetics, no sutures, electrocautery

201
Q

Punch biopsy

A

use for neoplasms involving the dermis (nodular BCC, SCC, melanoma, etc.) and most rashes
• Requires sutures
• Various sizes 1.5 mm – 8 mm

Skin/Musculoskeletal (5 decks)

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