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Module 102 > Theme 1 : Anatomy > Flashcards

Theme 1 : Anatomy Flashcards

atm : Thoracic cage

1
Q

What is the Thoracic cage made up of?

A

Vertebrae and Intervertebral disc on posterior
Ribs 12 pairs round the lateral side
Sternum
Costal Cartilages for movement

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2
Q

What is the function of the Thoracic cage?

A

Protection of viscera (internal organs) and for Muscle attachment

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3
Q

The thoracic cage is in relation to…

A

Pectoral Girdle

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4
Q

What is the pectoral girdle made up of?

A

The bony structure to which the upper limb structures are attached to. They consist of the clavicle (collar bone) and the scapula (shoulder blades)

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5
Q

Which ribs are typical?

A

3-9

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6
Q

Which ribs are atypical?

A

1,2, 10-12

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7
Q

What does a typical rib consist of?

A

Head with 2 facets, Neck, Tubercle and a body shaft with a costal (subcostal) grove

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8
Q

Give the characteristics of a typical vertebrae

A

Lateral side: Heart shaped body with demi facets
On Transverse process = costal facets
On Spinous process = Inferior pointing

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9
Q

Intervertebral

A

between vertebrae

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10
Q

Costovertebral

A

Head of rib articulates with costal (demifacet) on two adjacent vertebrae and the associated intervertebral disc.

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11
Q

Costotransverse

A

Tubercle of rib articulates (forms a joint) with the transverse process of vertebrae

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12
Q

What is special about ribs 1st, 10, 11th and 12th

A

They only articulate with one vertebrae

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13
Q

Sternoclavicular

A

articulates between the clavicle (collarbone) and the sternum

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14
Q

Sternocostal

A

articulates the sternum with the costal cartilages

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15
Q

Interchondral

A

Joints between the tips of adjacent costal cartilages of ribs 6-10 (False ribs)

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16
Q

Costochondral

A

joints between costal cartilage and rib

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17
Q

Origin/Proximal attachment of the Pectoralis major

A

Clavicle, costal cartilages and sternum

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18
Q

Function of the Pectoralis major

A

Adducts on shoulder and medially rotates humerus

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19
Q

Innervation

A

Supplying nerves to an organ/part of the body

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20
Q

Innervation of the Pectoralis major

A

Lateral and Medial Pectoral nerves

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21
Q

Origin or Proximal attachment of the Pectoralis Minor

A

3-5th rib superiorly upwards

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22
Q

Insertion or Distal attachment of the Pectoralis Minor

A

coracoid process of scapula

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23
Q

What is the coracoid process of scapula?

A

bone structure that projects anteriorly and laterally from the scapular neck

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24
Q

Function of the pectoralis minor

A

Stabilises scapula

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25
Q

Innervation of the pectoralis minor

A

Medial pectoral nerve

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26
Q

What are the Three Layers of intercostal Muscles?

A

External Intercostals
Internal Intercostals
Innermost Intercostals

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27
Q

Origin or Proximal attachment of the Serratus anterior

A

1-8th/9th rib

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28
Q

Insertion or Distal attachment of the Serratus anterior

A

medial border of scapula

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29
Q

Function of the Serratus anterior

A

Protracts (extend) scapula

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30
Q

Innervation of the Serratus anterior

A

Long Thoracic Nerve

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31
Q

Blood supply to the thoracic wall derived from thoracic aorta to…

A

Posterior Intercostal arteries

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32
Q

Blood supply to the thoracic wall derived from the Subclavian artery to…

A

Anterior Intercostal arteries

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33
Q

Which ribs are true

A

1 to 7

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34
Q

Which ribs are false

A

8 to 10

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35
Q

Which ribs are floating

A

11 and 12

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36
Q

Superficial

A

towards the surface

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37
Q

Deep

A

towards the inside

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38
Q

Medial

A

towards the midline of the body

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39
Q

Lateral

A

towards the outer edge

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40
Q

Posterior/Anterior

A

front/back

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41
Q

Dorsal/Ventral

A

On all fours: back/belly surface

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42
Q

Inferior/Superior

A

lower/higher

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43
Q

Caudal

A

towards the tail end

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44
Q

Cranial

A

towards the head end

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45
Q

Proximal/Distal

A

close to the body / away from the body

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46
Q

Flexion

A

decreasing the angle of a joint

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47
Q

Extension

A

increasing the angle of a joint

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48
Q

Abduction

A

take arm away

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49
Q

Adduction

A

bring it back arm

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50
Q

Pronation/Supination

A

Upper limb only: palms facing back/palms facing upwards

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51
Q

Elevation / Depression

A

lift shoulders / bring down

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52
Q

Circumduction

A

circle arm

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53
Q

The inferior tip of the sternum is…

A

xiphoid process

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54
Q

Superior part of the sternum is…

A

manubrium

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55
Q

What are the different types of muscles, briefly explain them. Where they are

A

Smooth- in the gut and viscera
Skeletal- gross muscles, locomotor (musculoskeletal system)
Cardiac- heart beating

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56
Q

What are the functions of skeletal muscles?

A

Locomotion (moving organs/structures and voluntary movement)
And Posture

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57
Q

What allows skeletal muscles to perform these functions?

A

Contractile proteins (myofilaments) arranged as myofibrils in muscle fibres

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58
Q

Describe the microstructure of skeletal muscle (4 things)

A

Elongated, multinucleated cells

Peripheral nuclei

Grouped into bundles called fascicles

Surrounded by connective tissue

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59
Q

Explore the different connective tissues in the microstructure of skeletal muscle

A

Epimysium surround muscle

Perimysium surround a bundle of muscle fibres (fascicle)

Endomysium separate single muscle fibres from another

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60
Q

State the organisation of skeletal muscle (from largest to smallest)

A

Muscle -> Muscle fascicles -> Muscle fibres -> Myofibril -> Microfilaments

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61
Q

Describe what the basement membrane is made of

A

continuous with endomysium

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62
Q

What is sarcolemma to the muscle fibre?

A

the muscle fibre’s cell membrane

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63
Q

What is Sarcoplasm?

A

the fiber’s cytoplasm

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64
Q

What makes up myofibril?

A

Sacromeres

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65
Q

What are satellite cells, what do they do?

A

Myogenic cells that allow skeletal muscle to regenerate

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66
Q

What are the main types of myofilaments?

A

Actin (Thin)
Myosin (Thick)

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67
Q

What is the smallest functional unit of a skeletal muscle fibre?

A

sarcomere

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68
Q

Where are these myofilaments anchored at?

A

Myosin anchored at M
Actin anchored at Z

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69
Q

Complete the sentence:
Contraction occurs as …

A

the Myosin moves along the Actin

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70
Q

Where does shortening of skeletal muscle occur?

A

Between origin and insertion

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71
Q

What is the end result of skeletal muscle contraction?

A

shortening of a sarcomere

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72
Q

What are the FOUR parameters are used to describe skeletal muscles?

A

Origin
Insertion
Action
Innervation or nerve supply

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73
Q

What is the action of pectoralis major?

A

Flexion, adduction and Internal rotation of the shoulder joint

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74
Q

What is the action of pectoralis minor?

A

Protraction of the scapula
Elevates the ribs

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75
Q

What is the nerve supply of Biceps Brachii?

A

Musculocutaneous nerve

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76
Q

What is the action of Biceps Brachii?

A

Flexion of the shoulder joint

Flexion of the elbow joint

Supination of the radio-ulnar joints

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77
Q

What is the insertion of Biceps Brachii?

A

Radius

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78
Q

What is the origin of the long head of Biceps Brachii?

A

head (lateral) : Supraglenoid tubercle of the scapula

= Glenoid fossa

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79
Q

What is the origin of the short head of Biceps Brachii?

A

(medial) : Corocoid process of the scapula

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80
Q

What is the nerve supply of deltoid?

A

Axillary nerve

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81
Q

What is the action of deltoid?

A

Abduction of the shoulder joint

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82
Q

What is the insertion of deltoid?

A

Deltoid tuberosity (tubercle) of the humerus

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83
Q

What is the origin of deltoid?

A

Clavicle, acromion process and spine of the scapula

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84
Q

Acromion process

A

the top outer edge of your scapula (shoulder blade)

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85
Q

Spine of the scapula

A

a prominent ridge of bone on the posterior surface of the scapula

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86
Q

What is the action of Serratus anterior?

A

Protraction of the scapula

Holds scapula flat against the thoracic cage

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87
Q

Flat

A

parellel fibres within an apernosis

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88
Q

Pennate

A

feather like may be unipennate, bipennate or mutilpennate

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89
Q

Fusiform

A

spindle shaped with round bellie and tappered at tendons

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90
Q

Quadrate

A

four sides

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91
Q

What are the different types of muscle fibre arrangement?

A

Flat
Pennate
Fusiform
Quadrate
Circular
Multi-headed/bellied

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92
Q

Give an example of a muscle with circular muscle fibres

A

Orbicularis Oculi

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93
Q

Give 2 examples of a muscle with pennate muscle fibres

A

Deltoid and felxor digitorum

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94
Q

Give an example of a muscle with multi headed muscle fibres

A

Biceps Brachii

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95
Q

Give an example of a muscle with flat muscle fibres

A

External Oblique

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96
Q

Give an example of a muscle with quadrate muscle fibres

A

pronator quadratus

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97
Q

Describe how the contraction of muscles is stimulated by motor nerves

A

Nerve impulses travel through the motor endplate and the neuromuscular junction with the help of acetylcholine release to enter the muscle fibres

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98
Q

What happens when the nerve impulses enter the muscle fibres?

A

Nerve impulse will attach to the sarcolemma and enter into the t-tubules that go down into the depth of the muscle for simultaneous contraction

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99
Q

Where is calcium stored and released from?

A

The sarcoplasmic reticulum

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100
Q

What is the role of calcium in the sliding filament theory?

A

calcium ions bind to the troponin, which alters the shape pulling the tropomyosin aside which exposing the myosin-binding sites

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101
Q

Where are satellite cells located?

A

Between the sarcolemma and basement membrane of muscle fibers

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102
Q

Describe the actions of satellite cells (2 points)

A

Normally dormant in adult muscle, but act as a reserve population of cells - Give rise to regenerated muscle and to more satellite cells

Able to proliferate and then fuse with existing muscle fibers to lay down new proteins and hypertrophy (increase in cell size)
in response to injury

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103
Q

What is the Jugular notch?

A

at the center of the superior border of the manubrium of sternum

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104
Q

What is the Lower costal margin?

A

an arch formed by the medial margin of the seventh rib to the tenth rib

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105
Q

What is the name of the connective tissue that all muscles of the body are surrounded by?

A

Fascia

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106
Q

Where do the breasts lie?

A

lie within the superficial fascia of the anterior chest wall between ribs 2 to 6

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107
Q

Where and how are breasts formed?

A

formed in the embryo by an ingrowth of ectodermal cells

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108
Q

Describe the breasts (externally)

A

circular profile with a prolongation, the axillary tail, which extends up into the axilla

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109
Q

Where does the nipple lie?

A

On the pigmented areola

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110
Q

What happens to the breast during puberty?

A

under the influence of oestrogen, there is the deposition of fat (stored in white adipose cells) in the connective tissue of the breast

Also growth in length and branching of the duct system

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111
Q

The breast mainly consists of fatty fibrous tissue, where is fat found?

A

In the connective tissue, covers the superficial surface of the gland, beneath the skin, and gives the smooth contour of the breasts

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112
Q

What happens to the breasts after menopause?

A

decrease in fat and atrophy of glandular tissue

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113
Q

Describe the anatomy of the breasts internally (before the menopause)

A

subdivided into about 20 lobes with lobules by fibrous connective tissue which contains deposits of fat

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114
Q

What does the fibrous connective tissue help the breasts with?

A

attach the breast to pectoralis major

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115
Q

Explain the system in the breasts

A

The duct system of each lobe drains through a single lactiferous duct to the nipple

Up to about 20 lactiferous ducts open separately through each nipple

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116
Q

Where does the breast get it’s blood supply?

A

Mainly from branches of the internal thoracic artery, also supplied by branches from the lateral thoracic artery and thoraco-acromial artery

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117
Q

What usually accompanies the distribution of the arteries in the breast?

A

Lymphatic vessels that drain the breast

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118
Q

Describe the breasts in males

A

Rudimentary (underdeveloped) and are formed of small ducts without lobules

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119
Q

What are the 2 portions of the skeletal system?

A

Axial and appendicular

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120
Q

What are the functions of the skeletal system?

A

Protection of organs
Supports the body
Movement
Metabolic reservoir
Production of new red blood cells

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121
Q

What is the skeletal system comprised of?

A

bone and cartilage

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122
Q

What are the 3 layers of the embryonic disc

A

ectoderm, mesoderm , endoderm

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123
Q

When does Bone Development (ossification) occur?

A

week 8 and finishes ~ 20 years

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124
Q

Intramembranous Ossification

A

The direct conversion of mesenchymal tissue into bone

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125
Q

Endochondral Ossification

A

start with a cartilaginous template (Hyaline cartilage) made from the mesenchyme is replaced by bone

Epiphyseal cartilage (type of hyaline cartilage) = allows bone to continue to grown

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126
Q

Bone is comprised of 4 cell types:

A

Osteoprogenitor cells
Osteoblasts (laying down new material)
Osteocytes (trapped within bone, maintenance of bone)
Osteoclasts = bone resorption

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127
Q

Bone maintenance is regulated by a dietary intake of:

A

Calcium
Phosphorous
Vitamins, A, C and D

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128
Q

What do the vitamins do to bones?

A

Vitamin A is essential for bone remodelling
Vitamin C is essential for connective tissue
Vitamin D is essential for calcium absorption

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129
Q

Bones Can be classified by their shape, embryology or region as either (5):

A

Long bones
Flat bones
Irregular bones
Short bones
Sesamoid bones

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130
Q

How many bones at birth, how many bones in adulthood?

A

270 Bones at birth, 206 by adulthood

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131
Q

What connective tissue covers the skeletal system except where articulation occurs

A

Periosteum

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132
Q

What connective tissue surrounds the cartilage

A

perichondrium

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133
Q

What is the Spongy Bone also known as?

A

Cancellous bone
Trabecular bone

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134
Q

Describe the spongy bone (3)

A

Irregular bony plates called trabeculae
Surrounded by red marrow
Highly vascularised

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135
Q

Describe the anatomy of compact bone (4)

A

Lamellae (concentric layers) are laid down by osteoblasts

Osteoblasts eventually become trapped in the osteoid matrix and turn into osteocytes occupying their own lacunae

Canaliculi radiate from each lacunae in which nutrients travel to the osteocytes

The haversian canal contains the neurovascular supply

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136
Q

what are the 3 types of joints?

A

Synovial, fibrous, cartilaginous

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137
Q

What are Synovial joints and what do they allow?

A

a joint capsule and a synovial cavity, they permit movement.

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138
Q

what are Fibrous joints connected and what does it cause?

A

connected by collagen and do not permit movement

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139
Q

What are connect Cartilaginous joints and what does it enable?

A

are connected by cartilage to allow some movement

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140
Q

Why can bone heal well?

A

They are vascularised tissue

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141
Q

What are stratified epithelium?

A

Cells pile on top of each other

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142
Q

What kind of mucous membrane is the oesophagus lined with?

A

White mucosa

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143
Q

What are squamous epithelium?

A

cells are flat

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144
Q

Where are stratified epithelium cells necessary at and why?

A

At sites of friction with the risk of mechanical damage

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145
Q

Where can squamous epithelium be found in?

A

Internal organs

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146
Q

How do squamous epithelium appear under naked eye examination?

A

White

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147
Q

Where is keratin present and what produces them?

A

In skin cells, by keratinocytes

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148
Q

What does keratin do to the skin?

A

Makes the skin impervious (not allowing fluid to pass through)

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149
Q

What connects muscle to bone?

A

Skeletal muscle in continuity with the tendon

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150
Q

What do fibroblasts produce?

A

Produce the protein collagen

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151
Q

What do fibrous tissue consist of?

A

long fibres containing collagen

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152
Q

Why is fibrous tissue important?

A

To form scars in healing wounds - able to do this due to its strength

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153
Q

What does the microscopy of fat look like after processing it in different chemicals?

A

Fat leaches out to leave behind the honeycomb shaped cells called adipocytes

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154
Q

What is the end-product of the break down of the muscle?

A

Brown pigment called lipofuschin

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155
Q

Why are intercalated discs important?

A

For the contractile function of the heart

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156
Q

Where are cells of the cardiac muscle joined together at?

A

Irregular junctions called intercalated discs

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157
Q

What is cardiac muscle also called?

A

Myocardium

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158
Q

What is the myometrium is made up of?

A

smooth muscle fibres ; no striations

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159
Q

Why are striations important in skeletal muscle?

A

The contractile function of the muscle cells

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160
Q

Where are cuboidal cells found in?

A

Glands which secrete specialised fluids e.g. salivary glands

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161
Q

Why are they called Pseudostratified Ciliated Columnar Epithelium?

A

all nuclei do not reach the surface

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162
Q

What are the larynx, trachea and bronchi lined with?

A

Pseudo-stratified columnar epithelium

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163
Q

Columnar epithelium of the large intestine consists of test tube like structures termed…

A

crypts (deep pit that protrudes down into the connective tissue surrounding the small intestine)

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164
Q

What kind of epithelium is the large intestine lined with?

A

Columnar epithelium

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165
Q

What is the function of mucus?

A

Protects the mucosa/lining
Traps dust particle
Acts as lubricant

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166
Q

What is the action of columnar epithelium?

A

Secretes mucus

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167
Q

What do columnar epithelium appear like in organs on naked eye examination?

A

pink/red

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168
Q

Name at least three of the organs squamous epithelium lines

A

Skin
Mouth and tongue
Oesophagus
Anal canal
Vagina
Cervix

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169
Q

What makes the skin protected by UV light?

A

Keratinised stratified squamous epithelium

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170
Q

What kind of stratified squamous epithelium is the oesophagus lined with?

A

Non-keratinised

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171
Q

What kind of mucous membrane is the stomach lined with?

A

Pink mucosa

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172
Q

What kind of mucous membrane is the oesophagus lined with?

A

White mucosa

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173
Q

The oesophagus joins the stomach at what junction?

A

Oesophago-gastric junction (OGJ)

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174
Q

What makes skin waterproof?

A

Superficial part of the skin consists of dead keratinised cells

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175
Q

What are the Systemic consequences of injury and inflammation?

A

Fever, leucocytosis, acute phase proteins

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176
Q

What are the local consequences of injury and inflammation?

A

A mass of dead (necrotic) tissue
Remnants of inflammatory cells
Remnants of initial stimulus

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177
Q

What options are available to sort out the consequences of injury and inflammation?

A

Resolution (scavenging) of the inflammatory response

Regeneration

Repair (or incomplete regeneration) by connective tissue deposition (fibrosis) resulting in a fibrotic scar

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178
Q

Describe the process of Resolution (scavenging) of the inflammatory response

A

Resolution occurs always and is sometimes enough to clear the area of inflammation/damage

Complete restoration of the tissue to its normal state is called ‘restitutio ad integrum’

Achieved by macrophages

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179
Q

Describe how macrophages are formed and what do they act as/do?

A

Circulating blood monocytes migrate into tissues as macrophages / histiocytes

Some monocytes go to specialised capillary areas in the liver, bone marrow and spleen called sinusoids
Here, the macrophages act as a filter tissue to remove abnormal molecules or cells (e.g. old red blood cells)

Macrophages clear offending stimuli, dead tissue and produce growth factors for the proliferation of various cells in the healing response

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180
Q

Where can I find macrophages?

A

Mostly at sites of inflammation (acute or chronic)

All normal tissues contain macrophages / histiocytes

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181
Q

List and explain the 5 activities of macrophages

A

Chemotaxis
=Migration towards damaged tissues

Hypertrophy
=Histiocytes become larger and accumulate more cell organelles and enzymes

Pseudopodia
=Active movement

Pinocytosis
=Ingest fluid from their surroundings

Phagocytosis
=Ingest larger particles, molecules or cells

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182
Q

What do activated macrophages/histiocytes develop?

A

receptors for abnormal molecules or abnormal cells (foreign or own)

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183
Q

What happens if resolution and scavenging does not heal injury?

A

healing by
option B. regeneration or by
option C. repair becomes necessary

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184
Q

Describe regeneration, which tissues can do this?

A

Regeneration of surface epithelium
May result in restitutio ad integrum
Cannot regenerate complex structures like hands

Using adult stem cells

Labile tissues e.g. skin, mucosa of GI tract
Stable tissues e.g. liver, kidney, endothelium

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185
Q

Describe repair, where can it occur?

A

Does NOT result in restitutio ad integrum but in scarring

Permanent tissues e.g. heart

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186
Q

What determines the mechanism of healing in regeneration

A

The type of tissue (and the type and extent of injury)

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187
Q

What is regeneration dependent on?

A

on limited damage and the preserved integrity of the extracellular matrix (scaffolding) or basement membrane.

Otherwise, regeneration is usually impossible and healing by repair (scarring) occurs.

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188
Q

Where can I find adult stem cells?

A

Stem cell pools in tissues (e.g. crypts of the colonic epithelium, bone marrow, hair follicles, epidermis)

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189
Q

What kind of capacity and replication does adult stem cells have?

A

Prolonged self renewal capacity and asymmetric replication

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190
Q

What can bone marrow stem cells transdifferentiate into?

A

neurons, liver cells and others

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191
Q

What is the condition that allows Liver tissue to regenerate from stem cells ?

A

if the stromal reticulin scaffolding remains intact

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192
Q

How can Epithelial tissues replenish themselves ?

A

by increasing in stem cell divisions and shortening of cell cycle time

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193
Q

.

A

.

194
Q

Why does healing by repair result in scarring?

A

A response by fibroblasts to patch the damage with fibrosis thus forming a fibrotic scar

195
Q

Describe the basic sequence of repair of tissues

A

Haemostasis and blood clotting

Inflammation

Formation of granulation tissue (angiogenesis + fibroblast prolif.)

Formation of connective tissue/scar

Remodeling of the scar

Final scar

196
Q

What is angiogenesis?

A

the development of new blood vessels

197
Q

What are the processes of angiogenesis? (6)

A

Vasodilatation (acute inflammatory response, histamine, NO)

Degradation of the BM of adjacent local blood vessels - sprout

Migration of endothelial cells and recruitment of endothelial precursor cells from the bone marrow

Proliferation of endothelial cells

Maturation of endothelial cells into tubes

Development of blood vessel walls

198
Q

Describe the formation of granulation tissue

A

Angiogenesis + proliferation of fibroblasts (via TGF-beta)

Resulting in granulation tissue formation composed of new blood vessels, fibroblasts and remaining inflammatory cells (usually neutrophils)

New vessels are leaky contributing to oedema/swelling/tumour

199
Q

Why does granulation tissue need collagen?

A

To give it strength before the formation of granulation tissue

200
Q

list systemic impairments of healing

A

Age
Anaemia
Infection / sepsis
Drugs (steroids, cytotoxics, antibiotics)
Soft tissue genetic disorders (Ehler’s Danlos, Marfan’s, …)
Diabetes mellitus (many blood cells shrink owing to altered osmotic pressure)
Malignancy
Malnutrition
Obesity
Vit C deficiency
Trace mineral deficiencies
Trauma and shock
Uraemia

201
Q

What local factors impair healing?

A

Local infection

Foreign body

Haematoma - a collection of blood which is located outside the blood vessels. They can be found under the skin within a soft tissue and display as a purple coloured bruise.

Denervation - a procedure that aims to permanently stop a nerve transmitting pain.

Poor blood supply or perfusion (the passage of fluid through the lymphatic system or blood vessels to an organ or a tissue.)

Mechanical stress or iatrogenic (relating to illness caused by medical examination or treatment) stress

Necrotic tissue

Site (lip vs foot)

202
Q

What problemscan cause impede healing?

A

Local and systemic factors may impede healing

203
Q

.

A

.

204
Q

Describe the process of scar remodeling

A

Interactions of collagen deposition and degradation by matrix metalloproteinases (MMPs)

Collagen changes to type I collagen

The blood vessels disappear

Contraction of the scar tissue

205
Q

What do fibroblasts produce during scar formation? What is it controlled by?

A

ECM proteins (e.g. collagen, elastin)
Mainly controlled by transforming growth factor beta (TGF-beta)

206
Q

What does growth factors from macrophages induce?

A

migration and proliferation of fibroblasts into the granulation tissue
Mainly controlled by fibroblast growth factors (FGFs)

207
Q

Granulation tissue is…

A

weak and oedematous (relating to or affected with edema : abnormally swollen with fluid)

208
Q

What are the complications of wound healing? (4)

defiecient, excessive

A

Deficient scar formation leading to dehiscence or ulceration

Excessive scar formation (e.g. keloid)

Abdominal adhesions (e.g. Crohn’s disease, appendicitis)

Contractures (often in burns)

209
Q

Describe the cardiovascular system and its circulations

A

Some arteries carry deoxygenated blood
Arteries carry blood away from the heart
Veins carry blood towards the heart

pulmonary circulation (heart and lungs)
systemic circulation (heart and body)

210
Q

List the major chambers of the heart

A

Right atrium to right ventricle – pulmonary circulation

Left ventricle to left atrium – systemic circulation

211
Q

Describe the Heart Wall’s Microstructure

A
  1. Epicardium (visceral pericardium) - outside
  2. Myocardium - cardiac muscle – m for middle
  3. Endocardium - lines the chambers – endoskeleton (inside)
212
Q

Describe the structure of cardiac muscle

A

Striated appearance – formed by sarcomeres

Intercalated discs

Normally 1 nucleus per cell - humans

Branching pattern

213
Q

What are the 2 intercalated discs found in the myocardium?

A

Fascia adherins and desmosomes – anchor cells together

Gap junctions – cardiac action potentials

214
Q

Describe the function of cardiac muscle

A

Involuntary control
Beat in unison by ID
Coordinated movement
Spread of excitation

215
Q

Describe the structure of smooth muscle

A

Not striated

One central nucleus per cell

Found in walls of tubular structures and hollow viscera

216
Q

Describe the function of smooth muscle

A

Involuntary control

Regulates the diameter of blood vessels

Propels liquids and solids – responsible for peristalsis

Expels contents

217
Q

List the major lobes of the lungs

A

Left:
2 lobes
Oblique (diagonal/slanting) fissure – between lobes

Right:
3 lobes
horizontal and oblique fissures

Left smaller than right

218
Q

Describe the respiratory tree

A

Trachea

Main bronchi

Secondary (lobar) bronchi – into different lobes

Tertiary (segmental) bronchi

Bronchioles

Alveoli

219
Q

Distinguish what are branches and tributaries

A

arteries createbranchesand veins are created fromtributaries

e.g. (branch different to tributary - tributes into the thoracic cage instead of branching out of veins)

220
Q

Is the right subclavian vein a branch or tributary and to what?

A

The right subclavian VEIN is a TRIBUTARY of the brachiocephalic vein

221
Q

Is the left subclavian artery a branch or tributary and to what?

A

The left subclavian ARTERY is a BRANCH of the aorta

222
Q

What is the micro structure of blood vessels?

A

Tunica intima
Tunica media
Tunica adventitia (externa)

223
Q

Describe the structure and function of Tunica intima

A

Lined by endothelium – monolayer of squamous epithelial cells that covers entire vascular system

Connective tissue
Reduces friction for blood flow

224
Q

Describe the structure and function of Tunica media

A

Primarily smooth muscle
Connective tissue- elastic and collagen fibres
Controls size and shape of artery

225
Q

Describe the structure and function of Tunica externa (adventitia)

A

Outer connective tissue layer- primarily collagenous

Can contain nerves and vessels (nevi vasorum – nerves of the vessels and vasa vasorum – vessels of the vessels)

Connects artery to surrounding structures

226
Q

What are large elastic arteries?

A

conducting = Those nearest the heart (aorta and pulmonary arteries)

227
Q

What is the main feature of large elastic arteries?

A

contain much more elastic tissue (elastin) in the tunica media than muscular arteries

228
Q

What is the size of a large elastic artery?

A

Large diameter (>10mm)

229
Q

What is the function of a large elastic artery?

A
  • accommodates surges (powerful forward or upward movement) in blood
230
Q

Give examples of large elastic arteries

A

the aorta, subclavian, and common carotid arteries

231
Q

What are Medium Muscular Arteries?

A

Distributing arteries - other arteries (smaller) that are not large elastic arteries

232
Q

What is the size of medium muscular arteries?

A

Smaller diameter (0.5mm-10mm)

233
Q

What is the main feature of medium muscular arteries?

A

Tunica media contains a thick layer of smooth muscle (lots)

234
Q

What is the function of the medium muscular artery?

A

Vasoconstriction and vasodilation send the blood where it needs to go in the body

235
Q

What are the examples of medium muscular arteries?

A

femoral and popliteal arteries

236
Q

What are the sizes of Small Arteries and Arterioles?

A

small arteries: (0.3mm-0.5mm) arterioles: microscopic - ≤0.3 mm

237
Q

What is the main feature of small arteries and arterioles?

A

Tunica media predominantly smooth muscle, 1-2 cell layers in thickness

238
Q

What is the function of small arteries and arterioles?

A

Tonus (the constant low-level activity of a body tissue) dictates degree of filling of capillary beds

239
Q

What is the size of Capillaries?

A

Microscopic (5-10µm)

240
Q

What is the main feature of capillaries?

A

Endothelial layer only (no tunica media or externa)

241
Q

What is the function of capillaries?

A

Allow exchange between blood and extracellular fluid

242
Q

What are the 2 types of capillaries?

A

Continuous- uninterrupted endothelium = most common

Fenestrated- pores (fenestrae) – high amount of exchange
e.g., endocrine glands, the intestines, pancreas and kidney

243
Q

What is the size of the venules?

A

Microscopic (8-100µm)

244
Q

What is the main feature of venules?

A

Very thin tunica externa and media

245
Q

What is the function of venules?

A

Drain capillary beds

246
Q

What is the size of a vein?

A

1mm -> 10mm

247
Q

What is the main feature of veins?

A

Tunica media thinner and large veins have well developed tunica adventitia/ externa

248
Q

Give 3 examples of veins

A

femoral, popliteal and great saphenous veins

249
Q

What are Venous Valves?

A

Inward projection of intima, strengthened by collagen and elastic fibres

Semi lunar cusps attached to the venous wall

250
Q

Where can’t you find venous valves?

A

Absent in thorax and abdomen

251
Q

What can the dilation of veins lead to?

A

Dilation of veins can mean valves don’t close, resulting in varicose veins (swollen and enlarged veins)

252
Q

Superficial veins do not have corresponding…

A

arteries e.g., great saphenous vein.

253
Q

Arteries and veins work together to…

A

Turn blood against gravity

254
Q

Give me an example of when arteries and veins are incorporated together

A

Smaller arteries in the middle to propel venal blood flanked by 2 veins enclosed in a sheath e.g., brachial artery and brachial veins

255
Q

What are the 2 veins found flanked with smaller arteries called?

A

Venae comitantes

256
Q

Why are arteries in the middle of brachial and arteries and veins?

A

The external forces support the venous blood vessels from the arteries andthe muscles contractingto help propel the blood against gravity.

257
Q

What factors aid the return of blood against gravity?

A

Valves
Arteriovenous pump
Respiratory pump
Musculovenous pump

258
Q

What is Deep Vein Thrombosis?

A

a blood clot that develops within a deep vein in the body

259
Q

What causes deep vein thrombosis?

A

Long periods of inactivity are one cause of venous stasis (slow blood flow in the veins)

260
Q

.Where arteries are surrounded by multiple veins this can act as…

A

a counter-current mechanism to heat regulation

261
Q

What is the connections of vessels?

A

Anastomoses

262
Q

What can anastomosis do?

A

Uniting of arteries or veins
Creates un-interrupted circulation
Can provide collateral circulation

263
Q

What can you find at the end of arteries? And give examples for each

A

Anatomic (true) end artery - no anastomoses. E.g., the Central artery of retina

Functional (potential) end artery - ineffectual anastomoses. E.g, Coronary arteries of the heart

264
Q

What is occlusion?

A

the blockage or closing of an opening, blood vessel, or hollow organ due to necrosis

265
Q

what can occlusion cause?2 places with 2 concequences

A

Central artery of retina
Occlusion = blindness

E.g., Coronary arteries of the heart
Occlusion can cause myocardial infarction (heart attack)

266
Q

Describe the Venous (Hepatic) Portal System

A

Venous blood high in products of digestion

Veins from the spleen, stomach and intestines drain into the liver via the hepatic portal vein

Filtered by the liver, blood then drains into the hepatic veins and into Inferior Vena Cava to be returned to the heart

267
Q

Where can I find Eccrine sweat glands?

A

occur over most of the body and open directly onto the skin’s surface

268
Q

.

A

.

269
Q

What are the 3 ways tissue can grow?

maa

A

Multiplicative:
Increase in cell number by mitotic division

Auxetic:
Increase in cell size

Accretionary:
Increase in extracellular tissue

270
Q

Explain what growth is? (formula)

A

Increase in cell number – Decrease (cell death)

271
Q

What does cell turnover permit?

A

maintenance of continuously growing tissues (e.g. skin, intestinal mucosa) and healing (injury, disease)

272
Q

What happens our proliferative ability as we grow older?

A

Fetal development shows rapid growth and constant programmed cell death (apoptosis)

In adults, many tissues loose proliferative ability (permanent cells)

273
Q

Describe the ability of a labile cell to proliferate and give examples of labile cells

A

continuous proliferation
high cell turnover
short lifespan

epithelial cells
white blood cells

274
Q

Describe the ability of a stable cell to proliferate and give examples of stable cells

A

good regeneration ability
low cell turnover
longer lifespan

Hepatocytes can go back to the cell cycle

facultative divider

275
Q

What does ‘facultative divider’ mean?

A

Some cell undergoing this Go phase may have the option of coming out of it to undergo mitosis

276
Q

Describe the ability of a permanent cell to proliferate and give examples of permanent cells

A

little / no regeneration
very low / no cell turnover
long lifespan, cannot go back to cell cycle

neurons
cardiac / skeletal muscle
red blood cells

terminal differentiation

277
Q

What is differentiation?

A

selective expression of genes that determine this journey that May occur in several stages to acquire a specialized function or morphology

278
Q

What does Injury generally depend on?

A

duration and the severity of the stimulus

279
Q

Irreversible cell injury can lead to …

A

necrosis or apoptosis

280
Q

Name the 4 adaptive processes

A

hypertrophy
hyperplasia
atrophy
metaplasia

281
Q

What is hypertrophy?

A

Increase in cell size owing to increase in structural components

The only adaptive response available to permanent cells

282
Q

What does the increased workload from hypertrophy activate?

A

PI3K/AKT and G-coupled pathways

283
Q

Give examples of physiological hypertrophy

A

Hypertrophy of skeletal muscle through training

Uterine hypertrophy owing to hormone stimulation

Hypertrophic smooth muscle in pregnancy

284
Q

Give examples of Pathological hypertrophy

A

Cardiac hypertrophy owing to hypertension or valvular disease

Bladder hypertrophy owing to prostatic enlargement

285
Q

What is hyperplasia?

A

the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells, often as an initial stage in the development of cancer

286
Q

What are the requirements for hyperplasia to occur?

A

Requires cells to be able to divide = labile or stabile cells

Permanent cells cannot undergo hyperplasia

287
Q

Often hyperplasia and hypertrophy occur together, what are the mechanisms of hyperplasia?

A

Growth factor and stem cell activation?

288
Q

What are the 2 types of physiological hyperplasia?

A

HORMONAL
hyperplasia which increases the functional capacity (e.g. breast development and breast feeding)

COMPENSATORY
hyperplasia when tissue was lost (e.g. partial liver resection or bone marrow hyperplasia in bleeding)

289
Q

What usually causes Pathological hyperplasia?

A

excess hormonal stimulation of the cells

290
Q

Give examples of Pathological hyperplasia

A

Endometrial hyperplasia owing to excess oestrogen

Prostatic hyperplasia owing to excess androgens

Virus induced hyperplasia in warts (HPV)

291
Q

What causes pathological hyperplasia to develop into neoplasia?

A

increased cell turnover increases the risk of genetic aberrations/mutations and thus neoplasia

292
Q

What is atrophy?

A

Reduction of the size of cells (and cell organelles)
Reduction of cell numbers (apoptosis)
Usually both at the same time

293
Q

What is the mechanism involved in atrophy?

A

Degradation of cellular organelles/proteins by ubiquitin-proteasome pathways

294
Q

Describe what Pathological atrophy can cause (5)

A

Denervation of muscle (e.g. trauma, poliomyositis)

Vascular atrophy of the brain

Malnutrition / starvation

Disuse atrophy of muscle or bone in immobilisation

Pressure atrophy owing to adjacent mass effect (e.g. tumour)

295
Q

What is Metaplasia?

A

Reversible change where one differentiated cell type/tissue is replaced by another differentiated cell type/tissue

Adaptive response to a change in environment

296
Q

Where can metaplasia occur?

A

Seen in epithelium but possible in mesenchymal tissues (soft tissues)

It’s NOT a change of phenotype/morphology of an already differentiated cell

297
Q

What is the mechanism involved in causing metaplasia?

A

Stem cells differentiate along a different pathway owing to a change in the local microenvironment and/or colonization by differentiated cells from nearby tissues

298
Q

Describe Physiological metaplasia in the cervix

A

The cervix changes its shape over the monthly cycle (fluid content of the stroma).

The vagina has an acidic microenvironment.

Thus: Metaplasia of cervical endocervical simple columnar epithelium to…

ectocervical stratified squamous epithelium (can deal with acid conditions better)

299
Q

Give examples of pathological metaplasia

A

Metaplasia from bronchial ciliated columnar epithelium to
stratified squamous epithelium in response to smoking

Metaplasia from oesophageal stratified squamous epithelium to
columnar epithelium in response to acid reflux (Barrett’s oesophagus)

Osseous metaplasia within muscles after trauma (myositis ossificans)

300
Q

describe Pathological bronchial metaplasia

A

The ciliated pseudostratified columnae epithelium of the bronchus changes into (keratinizing) stratified squamous epithelium. Reduces columnar and replaced to squamous =
In the wrong place

The protective functions of mucin production and ciliary motion are lost

Increased risk of neoplasia

301
Q

What are the process examples of Reversible cell injury

A

Reduced oxydative phosphorylation and depletion of ATP

Changes in ion concentrations and osmotic influx of water result in cell swelling

Changes in intracellular organelles (e.g. mitochondria) and the cytoskeleton

Increasing eosinophilia

302
Q

Give examples of irreversible cell injuries

A

Lysosome rupture and autodigestion

Denaturation of proteins

Membranes rupture

Nuclear changes: Karyolysis/karyorrhexis and pyknosis – changes and breaks up to small nuclei

303
Q

What can irreversible cell injury result to?

A

This results in cell death – rupture of the surface of the cell leads to:

Leakage of cellular components into the blood allow detection of injured tissues:
e.g. troponin (heart), transaminases (liver)

304
Q

What are the Principal pathways of cellular death which differ in morphology, mechanism and role in disease?

A

Apoptosis:
Programmed cell death (normal, but may be abnormally high in disease), no inflammation

Necrosis:
ALWAYS PATHOLOGICAL, inflammation

Necroptosis:
Shows features of both (very new concept)

Pyroptosis:
Apoptosis with fever and IL-1 signalling (new conc)

305
Q

What is necroptosis?

A

Shows features of both necrosis and apoptosis

306
Q

What is pyoptosis?

A

Apoptosis with fever and IL-1 signalling

307
Q

Name the properties of necrosis (5)

A

Regional
Cells swell
Nuclei shrink (pyknosis)
Cell membrane ruptures
Cell contents leak

308
Q

Name the properties of apoptosis (5)

A

Local
Cells shrink
Nuclei fragment
Membrane intact but altered
Apoptotic bodies (blebs)

309
Q

What causes necrosis and what does it cause?

A

Pathogens
Causes inflammatory response

310
Q

What causes apoptosis and what does it cause?

A

Physiological or pathological causes
Causes no inflammation

311
Q

What is the Mechanism of necrosis?

A

ATP depletion Causes Mitochondrial damage
= Influx of calcium

Since the Accumulation of oxygen radicals causes Increased membrane permeability
= DNA and protein damage
= Drop in ph (lactic acid)

312
Q

What can the mechanism of necrosis cause?

A

This acidic environment can cause saponification of fatty acids and accumulation of Ca2+

= calcifications as a long term concequence

313
Q

What does the macroscopic pattern of Coagulative necrosis look like?

A

Shape and architecture of necrosis are preserved for some time - maintained
E.g. ischaemic infarction of the kidney
Yellow bit – abnormal = necrosis

314
Q

What does the macroscopic pattern of Liquefactive necrosis look like?

A

Shape quickly lost, liquified, viscous, soft lesion

E.g. ischaemic infarction of the brain – abscess formation

Also in bacterial infection/abscess formation owing to lytic enzymes of the acute inflammatory response

315
Q

What does the macroscopic pattern of caseous necrosis look like?

A

Cheese-like appearance
Usually mycobacterial (TB) in the lung (the photo)

316
Q

What is gangrene?

A

a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body causing tissues to die

317
Q

What are the 2 types of gangrene?

A

Dry gangrene caused by ischaemia and Wet gangrene caused by bacteria

318
Q

Why is ischaemia worse than hypoxia?

A

Because in hypoxia alone, anaerobic glycolysis can continue.

In ischaemia, no metabolites are available and no waste metabolites are removed

319
Q

What is ischaemia?

A

absence of oxygen because blocked blood flow

320
Q

What does hyperthermia do?

A

Hypothermia reduces the metabolic needs of tissues and reduces inflammation and cell swelling

321
Q

What is ‘ischaemia reperfusion injury’ ?

A

Where restoration of blood flow exacerbates (worsens) tissue damage

322
Q

Give 5 examples of Physiological apoptosis

A

Programmed apoptosis in embryogenesis

Involution of hormone dependent tissues after hormone withdrawal (e.g. menstrual cycle)

High turnover tissues (e.g. intestinal epithelium)

Elimination of self-reactive/ autoimmune lymphocytes

Programmed apoptosis of inflammatory cells at the end of the inflammatory response (e.g. neutrophils)

323
Q

What is the speed of a Human cell turnover?

A

~1.000.000 cells per second

324
Q

.

A

.

325
Q

Describe the extrinsic pathway of apoptosis

A

Name : death receptor mediated pathway

Receptor-ligand interactions with ligands Fas or TNF receptor activate a cascade of adaptor proteins which activates Initiator caspases – caspase 3

Which leads to the substrate cleavage and formation of a cytoplasmic bleb

326
Q

Describe the intrinsic pathway of apoptosis

A

Name: the mitochondrial pathway

Cell injury causes: growth factor withdrawal, DNA damage, and protein misfolding (ER stress)

This is sensed by BCL2 family receptors which activate processes in the mitochondria to activate initiator caspases – caspase 3

Which leads to the substrate cleavage and formation of a cytoplasmic bleb

327
Q

What are the 3 mechanisms of acute inflammatory

acute inflammation cannot be achieved without these 3 components

A

1 Vascular dilatation (vasodilatation)

2 Increased vascular permeability and extravasation of fluid – leakiness of the vessels, creating gaps, cells can go through

3 Emigration of leukocytes, primarily neutrophil polymorphs

328
Q

What is the aim of the pathophysiology of acute inflammation?

A

To maximise the movement of plasma proteins and leukocytes out of the circulation and into the site of the insult

329
Q

How does Vascular smooth muscle relax rapidly in Vascular dilation of acute inflammation?

A

mediated by histamine and nitric oxide

330
Q

Describe what vasodilatation does in acute inflammation.

A

Increased amount of blood BUT slower flow in the area of vasodilatation

neutrophil emigration

This results in stasis of blood and an increase in hydrostatic pressure beyond normal levels - oedema

331
Q

What is oedema

A

a build-up of fluid in the body which causes the affected tissue to become swollen

332
Q

What are the signs of Vascular dilation acute inflammation?

cardinalrules

A

Rubor (redness)
Tumour (swelling, oedema)
Calor (heat)

333
Q

What do Histamine and nitric oxide also activate?

typesof cells not in inflammation, in angiogenesis

A

endothelial cells

334
Q

Describe what vascular permeability does in acute inflammation.

A

= Injurous stimuli like thermal burns or some microbial toxins cause endothelial damage
= contraction of endothelium
= vascular permeability increases
= cells, proteins, and mediators leak
= increase in tissue osmotic pressure
= more oedema
= rapid/long-lived

335
Q

What is exudate

A

Endothelium cells change configuration

= increased interendothelial spaces

Exudate is fluid that leaks out of blood vessels into nearby tissues and may ooze from cuts or from areas of infection or inflammation

vasodilation and stasis still occur

336
Q

What is transudate

A

fluids that pass through a membrane or squeeze through tissue or into the extracellular space of tissues

increased hydrostatic pressure

Decreased colloid osmotic pressure

337
Q

What are the diseases caused because of transudate? and why

A

increased hydrostatic pressure (venous outflow obstruction e.g congestive heart failure)

Decreased colloid osmotic pressure (decreased protein synthesis e.g. liver disease and protein loss e.g. kidney disease)

338
Q

What is the difference between the fluid content of exudate and transudate?

A

Exudate – high protein content and may contain some white and red blood cells

Transudate – low protein content and few cells

339
Q

What is difference between exudate and transudate?

A

“Transudate” is fluid buildup caused by systemic conditions that alter the pressure in blood vessels, causing fluid to leave the vascular system.

“Exudate” is fluid buildup caused by tissue leakage due to inflammation or local cellular damage.

340
Q

Phagocytic leukocytes (mainly neutrophils but also macrophages) leave the vasculature in the following 3 steps:

A

Margination and rolling along the vessel wall

Adhesion to the activated endothelium

Emigration through the vessel wall into the surrounding tissues

341
Q

Describe the process of Margination and rolling along the vessel wall

A

Leukocytes are displaced peripherally by a central axial column of erythrocytes.

In stasis, more leukocytes assume a peripheral position next to the endothelium (margination).

Transient connections occur between the leukocytes and the endothelial cells (rolling).

Proteins involved: Selectins which may be upregulated by Tumour necrosis factor (TNF) and Interleukin 1 (IL-1).

342
Q

What mediates and upregulates Adhesion to the activated endothelium?

A

Mediated by integrins (VCAM-1, ICAM-1) which are also upregulated by TNF and IL-1.

343
Q

What mediates Emigration through the vessel wall into the surrounding tissues?

A

Mediated by CD31/PECAM-1

344
Q

How does a leukocyte move?

A

Contractile cytoplasmic microtubules
and Changes in cytoplasmic fluidity

345
Q

Where does the movement of leukocytesgo towards (think of chemicals) and where do they tend to move to? (more…)

A

Movement occurs towards high concentrations of chemical mediators = chemotaxis

Move to direction with more mediators

346
Q

What are the mediators of Vasodilatation in acute inflammation?

A

Histamine, Nitric oxide, prostaglandins

347
Q

What are the mediators of Increased vascular permeability in acute inflammation?

A

Histamine, Complement C3a and C5a, bradykinin, leukotrienes

348
Q

What are the mediators of Chemotaxis and leukocyte recruitment in acute inflammation?

A

Tumor necrosis factor (TNF), Interleukin 1 (IL-1), Complement C3a and C5a

349
Q

What are the mediators of fevers in acute inflammation?

A

TNF, IL-1, prostaglandins

350
Q

What are the mediators of pain in acute inflammation?

A

Prostaglandins, bradykinin

351
Q

What are the mediators of Tissue and cell damage in acute inflammation?

A

Lysosomal enzymes from leukocytes, ROS, Nitric oxide

352
Q

What are the beneficial effects of inflammation? (8)

A

Degradation of bacteria and toxins

Fever (pyrexia) via hypothalamus thermoregulation

Stimulation of immune response

Haematological changes (leukocytosis, anaemia)

Facilitation of transport of drugs

Delivery of nutrients and oxygen

Initiating healing

Fibrin formation

353
Q

What are the harmful effects of inflammation? (6)

A

Digestion of normal tissues

Constitutional symptoms (malaise, nausea, anorexia)

Swelling

Weight loss

Inappropriate inflammatory response

Fever

354
Q

What are the clinical effects of acute inflammation?

A

Serous inflammation and effusion (in excess)

Fibrinous inflammation

Purulent inflammation and abscess formation

Ulceration

355
Q

What are the 3 outcomes of acute inflammation?

A

Complete resolution/restoration = restitutio ad integrum

Healing by scarring

Progression to chronic inflammation

356
Q

What is chronic inflammation?

A

As a consequence of acute inflammation
= often Primary chronic inflammation in autoimmunity

Long-lasting inflammation

357
Q

What are the symptoms of chronic inflammation?

A

Persistent infections (e.g. viral or fungal infections)

Inability to heal (e.g. chronic peptic ulcer of the stomach)

Immune-mediated inflammatory diseases (e.g. Crohn’s disease, glomerulonephritis)

Prolonged exposure to toxic agents (e.g. silicosis of the lung)

358
Q

What are the cells of chronic inflammation?

A

T-lymphocytes (CD3 positive)
B-lymphocytes (CD20 positive)

Plasma cells
Macrophages
Eosinophil polymorphs
Mast cells
Fibroblasts
Antibodies
Complement
Mediators

Few neutrophil polymorphs
Little fluid exudation (leakiness of the vessel)

359
Q

What is granulomatous inflammation?

A

A distinctive pattern of chronic inflammation

collection of activated epithelioid (epithelium-like) macrophages

It may be surrounded by lymphocytes or not (naked granulomas e.g. in sarcoidosis)

It may show central necrosis (e.g. mycobacterium) or not

360
Q

What could epithelioid macrophages do in granulomatous inflammation?

A

Epithelioid macrophages may fuse to form multinucleated giant cells

361
Q

What are Glands formed from?

A

Glands are formed from specialised cuboidal/columnar epithelial cells with a secretory ability/function.

Glands are never squamous.

362
Q

What are the 2 types of glands?

A

Some glands have a duct or they secrete onto a surface = exocrine glands

Some don’t have a duct and Secretion into the blood
= endocrine glands

363
Q

Give examples of endocrine glands

A

Anterior pituitary
Thyroid
Parathyroid
Pancreas (Islets of Langerhans)
Adrenal glands

364
Q

In the thyroid what do the blood capillary and thyroid follicles look like?

A

blood capillaries - white-looking irregular shapes

thyroid follicles - big pink circular structures

365
Q

In the anterior pituitary, what do the blood capillary and secretory cells (different types) look like?

A

Blood capillary - pink blobs
Secretory cells - cells with purple nuclei

366
Q

What are the properties of Skin?

A

The largest organ of the body

About 5kg (around 15% of body weight)

2m2 surface area

Covers the entire surface with continuity at mucocutaneous junctions (e.g. eyes, mouth, anus, vulva/vagina, urethra)

Continuously renewing and repair

367
Q

What are the properties of the skin?

A

Mechanical barrier
Waterproofing
Protection from injury
Protection from infection
Cushioning and insulation
Sensory functions

368
Q

What are the functions of the skin?

A

Immune functions
UV protection
Thermoregulation
Vitamin D metabolism
Personal, social and sexual significance
Storage of calories/energy

369
Q

Describe the layers the skin

A

Epidermis (epithelium of ectodermal origin)

Dermis (connective tissue of mesodermal origin)

Subcutaneous adipose tissue

370
Q

Describe the structure of hair-bearing skin

A

Epidermis = epithelium
Dermis = supportive stroma
Subcutaneous tissue = subcutaneous fat

Meissner corpuscle = fine touch sensation (top of dermis)
Pacinian corpuscle = vibration sensation (middle of dermis)

Sweat glands (exocrine)
Sebaceous glands (exocrine)
next to it is = arrector muscle of hair

The hair follicle holds the hair shaft
With hair matrix and papilla of hair follicle with blood vessels = subcutaneous artery, vein and nerve

371
Q

Where can you find thick, glabrous and hairless skin?

A

Fingers, palms, toes, soles, lips, labia minora, glans penis

372
Q

Where can you find Thin, hairy skin?

A

Everything else

373
Q

What is Pilosebaceous units?

A

The hair follicle, hair shaft and sebaceous gland

374
Q

Describe the structure of hair-less skin

A

Thick keratin layer

Epidermis = epithelium
Dermis = supportive stroma
Subcutaneous tissue = subcutaneous fat

Meissner corpuscle = fine touch sensation (top of dermis)
Pacinian corpuscle = vibration sensation (middle of dermis)

Sweat glands (exocrine)
Sebaceous glands (exocrine) except palms of the hands and soles of the feet.

375
Q

Describe the Epidermis

A

Keratinising stratified squamous epithelium

Composed of keratinocytes undergoing terminal differentiation (approx. 1 month)

376
Q

What is in between the epidermis and dermis?

A

Basement membrane (collagen layer) at the junction with the dermis

377
Q

What are the four layers of the epidermis?

A

Horn cell layer (stratum corneum, no nuclei) - waterproofing

Granular cell layer (statum granulosum) - bits of nuclei

Prickle cell layer (stratum spinosum) - mechanical strength

Basal cell layer (stratum basale) - replenishing

378
Q

What are the cell types in the epidermis? What is their functions?

A

Keratinocytes
: Mechanical protection, waterproofing, keratinocyte-derived endogenous antibiotics (defensins and cathelicidins)

Melanocytes
: UV-light protection for DNA = melanin pigment

Langerhans cells
: Immune function (sentinel cells)

Merkel cells
: Sensory function (light touch)

379
Q

How do keratinocytes mature in the epidermis?

A

Basal cell layer -> Prickle cell layer as spinous cells -> granular cell layer -> horn cell layer as cornified cell

380
Q

What helps the cells of the epidermis to be held together between layers?

A

Desmosomes

381
Q

What is Squamous cell neoplasia?

A

Non-melanoma skin cancer is a group of common skin cancers that are usually easy to treat.

Symptoms of non-melanoma skin cancer include a red lump or a flat, scaly patch = too much exposure to the sun

382
Q

What is the precursor of squamous cell neoplasia?

A

Dysplasia (an increase in abnormal cell growth or development) of

squamous carcinoma in-situ (the earliest form of squamous cell skin cancer in the epidermis)

383
Q

Where is the origin of melanocytes?

A

the neural crest (S-100+ proteins)

384
Q

What are melanocytes?

A

Melanocyte is a highly differentiated cell that produces a pigment melanin inside melanosomes
They are not epithelial cells
Stuck to the basement membrane

385
Q

Describe the action of melanocytes

A

Melanin, formed in melanosomes
One melanocytes delivers melanin to
36 keratinocytes via dendrites

Keratinocytes are pigmented

Keratinocytes phagocytose the tips of melanocyte dendrites

Melanin provides protection against UV

386
Q

What is Melanoma?

A

A type of skin cancer. It develops from melanocytes.

often a new mole or a change in the appearance of an existing mole due to over exposure of the sun

387
Q

Where do Langerhans originate from?

A

Originate from the bone marrow (CD1a + marker)

  • not easily seen on HE stained slides
388
Q

What are Langerhans cells?

A

Dendritic (like melanocytes)

Antigen-presenting cells, immune sentinels surveying the microbiome of the skin

389
Q

What are Merkel cells?

A

Merkel cells mediate tactile sensation/light touch

Associated with sensory nerve endings
Not recognizable in normal sections

390
Q

What are Meissner corpuscules?

A

mechanoreceptors of “glabrous” (smooth, hairless) skin
Located in the dermal papillae
Tactile sensation

391
Q

What is the Basement membrane comprised of?

A

Collagen type IV

392
Q

What is the function of the basement membrane?

A

Resistance to shearing forces

Interdigitating pattern = mechanical resilience and strength

Control of epithelial – mesenchymal/stromal interactions (e.g. invasion in neoplasia)

tying together epidermis and dermis

393
Q

What does it mean to be invasive?

A

Invasive if breaks through the basement membrane

394
Q

Why is the basement membrane important in disease?

A

Without it = Increased skin fragility and impaired wound healing

Control of invasion in SCC (Squamous cell carcinoma) and melanoma

Integral in development and healing

395
Q

Name a Blistering disease of the skin that targets the basement membrane

A

Bullous pemphigoid

396
Q

Name an autoimmune disease of the skin that targets the basement membrane

A

Dermatitis herpetiformis

397
Q

Name a genetic disease of the skin that targets the basement membrane

A

Epidermolysis bullosa

398
Q

What is the Dermis?

A

Dense connective tissue (collagen, elastin, extracellular matrix)

399
Q

What is in the dermis?

A

Papillary dermis - the superficial layer, lying deep into the epidermis

Mostly extracellar matrix - Nerves, blood vessels, lymphatics, histiocytes, mast cells, plasma cells, lymphocytes

Mechanoreceptors, thermoreceptors, Meissner and Pacinian corpuscles (sensory)
Subcutaneous fat

Epidermal appendages

Reticular dermis - the bottom layer of your dermis

400
Q

What is the Epidermal appendages?

A

Pilosebaceous units

Sweat glands

Apocrine glands

401
Q

What does the papillary dermis (also known as dermal papillae) influence?

A

Ridges form the fingerprints

Mainly from Interdigitating pattern = mechanical resilience and strength

402
Q

What does overexposure of the sun cause?

A

increase in elastin

403
Q

Describe what is composed in the Skin appendages

A

Pilosebaceous unit
= hair + sebaceous glands + smooth muscle / arrector pili muscles

Sweat glands: eccrine or apocrine

Nails

404
Q

Where is hair made?

A

Hair follicle

405
Q

What do sebaceous glands do?

A

lubricates hair to grow in the appendage

Natural moisturizer from secreted oils from sebaceous glands – sebum

406
Q

What is Basal cell carcinoma?

A

Most common malignant skin cancer

Tumour of hair follicle origin

Invasive and locally destructive but very unlikely to metastasize

Will continue to grow locally

Related to sun exposure (UV light)

Local destructive growth

407
Q

What is Eccrine spiradenoma?

A

an uncommon benign tumor of skin adnexa originating from eccrine glands

Nodules - round and quite big

408
Q

Where can I find Apocrine sweat glands?

A

Axilla
Groin
Nipple
Eyelids
External ear canal

409
Q

What is the difference between the secretion of eccrine and apocrine sweat glands?

A

apocrine - Fatty oil secretion not the same as sebum, less watery more oily

410
Q

.

A

.

411
Q

What happens to the embryo at week 3?

A

the embryo (bilaminar disc) develops further by forming 3 distinct layers (this process is known as gastrulation) Initiated by primitive streak

412
Q

What does the epiblast become at week 3?

A

all three germ layers

413
Q

What happens to the hypoblast at week 3?

A

replaced by cells from the epiblast and becomes endoderm then degenerates

414
Q

Describe what happens at the start of week 3 when the embryo (bilaminar disc) develops further by forming 3 distinct layers (this process is known as gastrulation)

A

Initiated by primitive streak.

Two layers have already formed (epiblast and hypoblast).

The epiblast becomes known as ectoderm

The hypoblast is replaced by cells from the epiblast and becomes endoderm

The epiblast gives rise to the third layer the mesoderm.

The hypoblast degenerates. The epiblast gives rise to all three germ layers.

415
Q

What does the Paraxial Mesoderm differentiate into?

A

further differentiation into paired blocks of tissue- somites

42-44 pairs eventually formed

416
Q

What do somites differentiate into?

A

form dermomyotomes and sclerotomes

417
Q

What do Dermomyotomes form?

A

connective tissue and skeletal muscle

418
Q

What do Sclerotomes form?

A

bone and cartilage- vertebral arch

419
Q

What does the Intermediate Mesoderm develop into?

A

Urogenital system – kidneys, gonads, urogenital ducts and associated glands

420
Q

Describe the composition of the mesoderm from nearest to the notochord to the furthest away

A

Paraxial, Intermediate, Lateral plate

421
Q

What is the lateral plate mesoderm continuous with?

A

the amniotic sac and yolk sac

422
Q

What Are the 2 layers that the mesoderm splits into?

A

Amniotic sac mesoderm- Somatic layer = Parietal layer

Yolk sac mesoderm- Splanchnic layer = visceral layer

423
Q

What do mesodermal cells become?

A

bones,muscles connective tissue

424
Q

What happens in day 1 of fertilization? (5)

A

Sperm and Ovum meet in Uterine Tube (usually ampulla) 12-24 hours after ovulation.

Penetration of Corona radiate and Zona pellucida

Fusion and 2nd meiotic division

Acrosome reaction makes ovum impermeable to other sperm

End- Zygote- has diploid (46 chromosomes)

425
Q

What happens in days 2-3 of fertilization? (5)

A

Cleavage is the rapid process of mitotic divisions

First mitotic division is around 30 hours post fertilization.

By day 3, 16 cell embryo

Each cell is known as a blastomere.

Solid sphere is known as a morula.

426
Q

What happens in days 6-7 of fertilization? (5)

A

Bilaminar Disc- As the embryo starts to implant it forms two layers.

Inner cell mass differentiates into two layers: epiblast and hypoblast.

These two layers are in contact.

Hypoblast forms extraembryonic membranes

Epiblast forms embryo

Amniotic cavity develops within the epiblast mass

427
Q

What is a morula?

A

Solid sphere of blastomeres

428
Q

Describe the structure of the cavity morula that develops

A

Cavity – blastocyst

The outer layer of the blastocyst thins out and becomes the trophoblast

The rest of the cells move (are pushed up) to form the inner cell mass.

Inside is the blastocoele

429
Q

What does trophoblast help with?

A

form the placenta

430
Q

.

A

.

431
Q

What is the Bilaminar Disc?

A

formed when the inner cell mass forms two layers of cells, separated by an extracellular basement membrane. The 2 layers

432
Q

What are the 2 layers the Inner cell mass differentiates to?

A

Hypoblast forms extraembryonic membranes

Epiblast forms embryo

433
Q

What develops within the epiblast mass?

A

Amniotic cavity

434
Q

What is derived from the hypoblast?

A

exocoelomic membrane

435
Q

What does the Extraembryonic hypoblast/membrane (exocoelomic membrane) create?

A

The Yolk Sac contains nutrients that supply the embryo before the placenta functions.

436
Q

What happens in week 2 of fertilization?

A

Blastocyst has reached the uterine cavity

Need for oxygen, nutrients and removal of waste

Corpus luteum produces progesterone to maintain endometrium

Go through 4 stages of implantation

437
Q

What are the 4 stages of implantation

A

1.Shredding/Hatching of the zona pellucida

  1. Apposition to ensure embryonic pole is in contact
  2. Adhesion via molecular communication
  3. Invasion into the maternal uterine tissue (maternal decidua)
438
Q

What does implantation initate?

A

Implantation initiates a decidual reaction which causes the maternal cells to contribute to the placenta

439
Q

What does the Outer layer of cells of the blastocyst become?

A

trophoblast

440
Q

What does the trophoblast differentiate to?

A

differentiates into cytotrophoblast and the syncytiotrophoblast

441
Q

What is the cytotrophoblast?

A

a single layer of cells and is the inner part.

442
Q

What is the syncytiotrophoblast?

A

the outer layer and where it invades becomes known as the syncytium. Syncytiotrophoblasts secrete HCG

443
Q

What happens at week 4 of development of a foetus?

A

the flat disc has to fold into 2 directions

Fold Longitudinally (cephalocaudal) (day 21) = begins so that head and tail are brought closer.

Fold Laterally (transverse) (day 18) = brings the amniotic cavity down, creating the future gut tube inside the peritoneal cavity.

444
Q

What does the ectoderm form?

A

Forms the external surfaces, and how the body interacts with its external environment.

It forms the nervous system and the epidermis of the skin.

445
Q

What does the mesoderm form?

A

Mesoderm-Forms the major part, the bones, muscle, connective tissue, forming most of the cardiovascular system, lymphatic system, reproductive system, kidneys, linings of the body cavities and the dermis of the skin.

446
Q

What does the endoderm form?

A

Forms the lining of tracts, e.g. the GI tract, in the lungs and respiratory passages and organs such as the pancreas and liver, urethra, bladder and some glands e.g. thymus, thyroid.

447
Q

Where is the mesoderm found/formed?

A

Either side of the notochord (an embryonic midline structure - circlular)

448
Q

What are the 3 parts of the mesoderm?

A

paraxial, intermediate and lateral plate

449
Q

Explain the ability of a liver cell in terms of regeneration and repair.

A

Stable - high turnover cells

450
Q

terminology - Tumour

A

‘Swelling’, now commonly a synonym for ’neoplasm’ or ‘cancer’

451
Q

Neoplasia

A

AUTONOMOUS ‘new growth’ of ABNORMAL cells

452
Q

Carcinoma

A

malignant neoplasm of epithelial tissue

453
Q

Sarcoma

A

malignant neoplasm of connective tissue or muscle

454
Q

Lymphoma

A

malignant neoplasm of lymphocytes

455
Q

Leukaemia

A

malignant neoplasm of leukocytes (or other blood cells)

456
Q

Melanoma

A

malignant neoplasm of melanocytes

457
Q

‘-oma’

A

= neoplasm (may be benign or malignant)

squamous cell papilloma = benign squamous cell neoplasm

squamous cell carcinoma (SCC) = malignant squamous cell neoplasm

458
Q

Neoplasia:

A

Clonal, abnormal, excessive, disorganized cellular proliferation which is
non-responsive to normal growth controls owing to genetic abnormality
= autonomous growth

459
Q

Clonal - describe its process in terms of neoplasms

A

This process begins with one (or more) cells becoming abnormal and all further cell generations are clones of this original one. Over time neoplasms however can change!

460
Q

.

A

.

461
Q

.

A

.

462
Q

What are the classifications of cancer?

A

Behaviour - benign, borderline, malignant

Histogenesis - cell of origin

Differentiation and transdifferentiation - how well does the tumour resemble the cell/tissue of origin?
does the tumour show other tissues as well?

Molecular classification - specific genetic or molecular abnormality

463
Q

Are tumours clones? Are they individuals? What does their histology/morphology correlate with?

A

Yes, Yes, clinical behavior

464
Q

What are the three sub-classifications of behaviour of tumours?

A

benign
= no metastasis, no invasion, no destruction BUT pressure

borderline
= local invasion and destruction BUT no metastasis

malignant
= invasion and risk of metastasis

465
Q

Describe borderline neoplasms

A

Limited invasion and local destructive growth
Very unlikely to metastasize
Often curable

465
Q

2 examples of borderline neoplasms

A

Serous borderline tumour of the ovary
Basal cell carcinoma of the skin

466
Q

Describe what are malignant neoplasms

A

Invasion of surrounding tissues
Infiltrative, poorly defined borders
Usually grow relatively rapidly
Variable differentiation (similarity to tissue of origin)

METASTASIS (the ultimate proof that a tumour is malignant)

467
Q

Give examples of malignant carcinomas

A

colonic adenocarcinoma
breast adenocarcinoma
renal clear cell adenocarcinoma

468
Q

What is haematogenous metastasis?

A

Spread by way of veins or rarely arteries
Metastasis is what causes most mortality from neoplasms

469
Q

What is lymphatic metastasis?

A

Spread by way of lymphatic channels
This often involves lymph nodes

470
Q

Describe direct spread of metastisis using an example

A

E.G carcinomas of the ovary
mesothelioma of the pleura(lining of lungs)

471
Q

At any site, a malignant neoplasm may be …

A

primary or secondary

472
Q

Give an example of haematogenous metasis

A

haematogenous liver metastasis

473
Q

Give an example of lymphatic metastasis

A

colonic lymph node metastasis

474
Q

.

A

.

475
Q

Describe the colorectal adenoma carcinoma sequence

A

Normal epitheliu to initial adenoma caused by APC gene

Initial adenoma to Intermediate Adenoma caused by K-RAS gene

Intermediate adenoma to Late adenoma caused by Loss of long arm of chromosome 18 (DCC gene mutation)

Late adenoma to Cancer caused by Loss of short

476
Q

.

A

.

477
Q

Carcinosarcoma

A

Malignant neoplasm with both - endometrial carcinoma and sarcoma

478
Q

Teratoma

A

Neoplasm comprises many different tissues not normally present at the site

479
Q

Adenoma

A

a benign (noncancerous) tumor. Adenomas start in the epithelial tissue, the tissue that covers your organs and glands.

480
Q

Adenocarcinoma

A

a malignant tumour formed from glandular structures in epithelial tissue.

Module 102 (11 decks)

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