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Block 2 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

3 types of muscle

How many and where are the nuclei?

A

Sk: multinucleated/periferal

C: One/center

Sm: One/center

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2
Q

What tissue give risue to all muscles?

What is an exception?

A

Mesoderm

Exception: iris (derives from ectoderm)

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3
Q

What contractile all muscles contain?

A

Actin and Myosin

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4
Q

Describe the three types of muscles

A

Skeletal muscle is composed of large, elongated, multinucleated fibers.

Cardiac muscle is composed of irregular branched cells bound together longitudinally by intercalated disks.

Smooth muscle is an agglomerate of fusiform cells. The density of the packing between the cells depends on the amount of extracellular connective tissue present.

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5
Q

What cells give rise to muscle cells?

What these cells form to produce muscle cells?

A

Mesenchymal cells -> Myoblasts -> Myotubes -> Mature muscle

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6
Q

Muscle fiber vs. myofibril

A

Muscle fiber = muscle cell

Myofibril = made up of the myofilaments actin and myosin

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7
Q

What is the purpose of the connective tissue in skeletal muscle?

A

Transmits the forces (muscle cells do not extend the length of the musscle)

Transmitting blood vessels

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8
Q

How muscle is organized (subcomponents)?

A
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9
Q

When is the number of muscle fibers steady?

A

14 years old (~puberty)

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10
Q

What might regenerate skeletal muscle cells in an adult?

A

Satellite cells

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11
Q

What is the molecule that regulates number of muscle cells (hormone)?

How does it regulate the number muscle fibers?

A

Myostatin

It suppresses skeletal muscle development.

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12
Q

What determines the strength of the muscle?

A

Total number of muscle fibers (not length)

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13
Q

What is the difference between hypertrophy and hyperplasia?

A

Hypertrophy = Increase in muscle size

Hyperplasia = Increase in number of muscle cells

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14
Q

What is the functional unit of muscle cell?

Where does it extrends from?

What multiple sacromeres from?

A

Sacromere

Z to Z

Myofibrils

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15
Q

What skeletal muscle bands can we see?

A

Actin (7nm) makes up the thin I band (isotropic to polarized light)

Myosin (15nm) makes up the A band (anisotropic to polarized light)

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16
Q

Where are the T-tubules in skeletal muscle cells?

A

A-I band junction

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17
Q

What is triad (skeletal muscle) made of?

What is the function of triad?

A

T tubule + 2 SR (terminal cisterna of sarcoplasmic reticulum)

Calcium for uniform contraction

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18
Q

What are three bands in skeletal muscle?

A

A band made up of actin and myosin

I band made up of actin

H band made up of myosin

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19
Q

How contraction of muscle affects:

A band?

I band?

H band?

Two adjacent Z disks?

A

the A band stays the same length

the I bands and H bands shorten (sliding filament model)

The Z disks are moving closer to one another

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20
Q

What covers neuro-muscular junction?

A

Schwann cell

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21
Q

What is external lamina?

A

A structure similar to basal lamina that surrounds the sarcolemma of muscle cells. It is secreted by myocytes and consists primarily of Collagen type IV, laminin and perlecan (heparan sulfate proteoglycan). Nerve cells, including perineurial cells and Schwann cells also have an external lamina-like protective coating.

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22
Q

What is another name for neuromuscular junctions?

A

Motor end plates

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23
Q

What molecule plays crucial role in muscle contraction?

A

Calcium

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24
Q

Characteristics of cardiac muscle cells

A

Striations

Intercalated disks

1-2 centrally located nuclei per cell

Bifurcating & anastomosing cells

Highly vascular

Have atrial granules

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25
Q

What are atrial granules and where they are found?

A

The are found in cardiac muscle cells

They contain atrial natriuretic peptide (ANP) that acts on kidney to regulate blood pressure through sodium and water reabsorption.

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26
Q

What are the three layers in heart?

A

Endocardium (homologous to tunica intima)

Myocardium (homologous to tunica medai)

Epicardium (homologous to tunica adventitia)

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27
Q

What is a difference between cardiac and skeletal muscle cells in terms of the T-tubules?

A

Skeletal muscle have and cardiac muscle lack cisternae

Skeletal muscle have T-tubule on A/I band border while cardiac muscle have t-tubule on Z-line

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28
Q

What is dyad (cardaiac muscle) made of?

A

T-tubule + sacroplasmic reticulum

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29
Q

What surrounds pericardial cavity?

A

Pericardium (visceral pericardium)

Parietal pericardium

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30
Q

What is an organelle that is excessively present in cardiac muscle?

A

Mitochondria

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31
Q

What are four types of muscle cells in heart?

A

Contractile cardicytes (myocardiocytes) = contraction

Purkinje fibers (modified myocardiocytes) = found deep to endocardium lining the interventricular septum; impulse conducting;

Myoendocrine cardiocytes = producing atrial natriuretic factor

Nodal cardiocytes = control the rhytmic contraction; found in SA and AV node; found deep to endocardium of the interatrial and interventricular septa

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32
Q

How Purkinje fibers can be distinguished from other muscle cells?

A

Location (deep to endocardium)

Size (larger)

Staining (lighter because of glycogen content)

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33
Q

Cardiac tamponade

A

Pericardial sac effusion

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34
Q

Unique cardiomyocytes that can be seen on microscope

A

Purkinje fibers

Myoendocribe cardiocytes

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35
Q

How cardiac muscle cells are connected?

A

Vertical (transverse): fascia (longer strip that goes between cells; wider) adherens and desmosomes

Horizontal (longitudinal): gap junctions.

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36
Q

What is syncytium?

What allows cardiac muscle to act as syncytium?

A

Syncytium is a multinucleated cell that can result from multiple cell fusions of uninuclear cells, in contrast to a coenocyte, which can result from multiple nuclear divisions without accompanying cytokinesis.

Can because of : fascia adherens, desmosomes and gap junctions

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37
Q

Cardiac muscle cells exhibit spontaneous rhythmic contraction

What does this contraction depends on?

What regulates it?

A

Dependent upon gap junctions

autonomic nervous system (ANS) regulation

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38
Q

Smooth Muscle characteristics

A

elongated fusiform cell appearance (relaxed)

one nucleus / centrally located

no striations

Cytoplasmic dense bodies serve as Z lines

Possess caveolae and some SER but not T system

Gap junctions in single-unit smooth muscle

External basal lamina around each cell

Involuntary contraction initiated by several modalities one being the ANS

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39
Q

What is the function of caveolae?

A

Aid in Ca+2 uptake and release.

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40
Q

Different types of smooth muscle

A

Single unit (conntected by gap junction - syncytium; cannot contract independently of one another; found in the wall of hallow visceras)

Multi-Unit (has its own nerve supply and can contract independetly of one another; en passant)

Vascular (mix of single and muti unit)

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41
Q

Examples of single and mulit unit muscle cells

A

SU: intestine, uterus, ureters

MU: iris

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42
Q

En passant ??

(smooth muscle)

A

axonal swellings containing synaptic vesciles

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43
Q

Heart / Thorax 1

A
  1. Mediastinal part of parietal pleura
  2. Axillary vein
  3. Horizontal fissure
  4. Inferior lobe, right lung
  5. Diaphragmatic part of parietal pleura
  6. Fibrous pericardium
  7. Musculophrenic artery and vein
  8. Inferior lob, left lung
  9. Left oblique fissure
  10. Cardiac notch
  11. Costal part of parietal pleura
  12. Internal thoracic artery and vein
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44
Q

Two potential spaces around lungs

A

Costomediastinal recess

Costodiaphragmatic recess

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45
Q

Mediastinum

A

An undelineated group of structures in the thorax, surrounded by loose connective tissue. It is the central compartment of the thoracic cavity. It contains the heart, the great vessels of the heart, the esophagus, the trachea, the phrenic nerve, the cardiac nerve, the** thoracic duct**, the thymus, and the lymph nodes of the central chest.

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46
Q

Heart / Thorax 2

A
  1. Esophagus
  2. T-9 Vertebra
  3. Thoracic aorta
  4. Mediastinal part of parietal pleura
  5. Left phrenic serve, left pericardiacophrenic artery and vein
  6. Pericardium
  7. Central tendom of diaphragm, middle leaflet covered by pericardium
  8. Right costomediastinal recess
  9. Inferior vena cava
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47
Q

Superior mediastinum components

A

Roots of great vessels

Esophagus

Trachea

Vagal, phrenic, and cardiac nerves

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48
Q

Inferior mediastinum

A

(anterior portion) branches of the interal thoracic artery and some thymus in children

(middle) heart and ascending aorta and SVC“everything in the pericardial sac”
(posterior) all other vessels, nerves and visceral structures anterior to vertebrae and between the parietal pleura of both lungs

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49
Q

Heart / Thorax 3

A
  1. Thymic remanant
  2. Internal thoracic artery
  3. Rib 1
  4. Left phernic nerve, left pericardiacophrenic artery
  5. Costal part of parietal pleura
  6. Fibrous pericardium
  7. Line of fusion of fibrous pericardium to diaphragm
  8. Superior epigastric artery
  9. Musculophrenic artery
  10. Line of fusion for fibrous pericardium with superior vena cava
  11. Right axillary artery and vein
  12. Right internal thoracic vein
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50
Q

Heart / Thorax 4

A
  1. Left Vagus
  2. Left subclavian
  3. Left axillary artery
  4. Left brachiocephalic vein
  5. Costal part of parietal pleura
  6. Left costocdiaphragmatic recess
  7. Fibrous pericardium
  8. Right and left phrenic nerves
  9. Right costodiaphragmatic recess
  10. Mediastinal part of parietal pleura
  11. Superior vena cava
  12. Arch of aorta
  13. Right brachiocephalic vein
  14. Right vagus nerve
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51
Q

Heart / Thorax 5

A
  1. Left brachiocephalic vein
  2. Ligamentum arteriosum and left recurrent laryngeal nerve
  3. Left vagus nerve
  4. Mediastinal part of parietal pleura
  5. Transverse pericardial sinus
  6. Fibrous and parietal serous pericardium
  7. Left ventricle
  8. Auricle of left atrium
  9. Right ventricle
  10. Right atrium
  11. Auricle of right atrium
  12. Ascending aorta
  13. Pericardial reflections
  14. Superior vena cava
  15. Right brachiocephalic vein
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52
Q

Heart / Thorax 6

A
  1. Ligamentum arteriousm
  2. Transverse pericardiac sinus
  3. Left superior and inferior pulmonary veins
  4. Oblique pericardial sinus
  5. Parietal layer of serous pericardium (fused to fibrous)
  6. Inferior vena cava
  7. Middle cardiac vein
  8. Coronary sinus
  9. Superior vena cava
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53
Q

Heart / Thorax 7

A
  1. Left vagus nerve
  2. Pulmonary trunk
  3. Transverse pericardial sinus
  4. Left phernic nerve and pericardiacophrenic artery and vein
  5. Left inferior pulmonary vein
  6. Parietal layer of serous pericardium
  7. Fibrous pericardium
  8. Inferior vena cava
  9. Right superior pulmonary vein
  10. Superior vena cava
  11. Ascending aorta
  12. Ligamentum arteriosum
  13. Left recurrent laryngeal nerve
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54
Q

Heart 1

A
  1. Brachiocephalic artery (trunk)
  2. Right atrium
  3. Inferior vena cava
  4. Coronary sinus
  5. Pulmonary veins
  6. Auricle of left atrium
  7. Right and left pulmonary arteries
  8. Left subclavian
  9. Left common caroitd
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55
Q

Heart 2

A
  1. Left coronary artery
  2. Cricumflex artery
  3. Left marginal artery (obtuse)
  4. Great cardiac vein
  5. Anterior interventricular artery (Left anterior descending, LAD)
  6. Right marginal artery (acute)
  7. Small cardiac vein
  8. Right coronary artery
  9. Atrial branch of right coronary artery
  10. SA artery
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56
Q

Heart 3

A
  1. Sinuatrial node artery
  2. SA Node
  3. Small cardiac vein
  4. Right coronary artery
  5. Middle cardiac vein
  6. Right marginal artery
  7. Posterior interventricular artery (posterior descrnding)
  8. Left marginal artery
  9. Coronary sinus
  10. Great cardiac vein
  11. Circumflex artery
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57
Q

Heart 4

A
  1. Ascending aorta
  2. Auricle of right atrium
  3. Crista terminalis
  4. Pectinate muscles
  5. Septal cuscp of tricuspid valve
  6. Ostium and valve of coronary sinus
  7. Inferior vena cava
  8. Fossa ovalis
  9. Limbus of fossa ovalis
  10. Interatrial septum
  11. Superior and inferior right pulmonary veins
  12. Right pulmonary artery
  13. Superior vena cava
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58
Q

Heart 5

A
  1. Pumonary trunk
  2. Auricle of left atrium
  3. Pulmonary valve
  4. Conus arteriosus
  5. Supraventricular crest
  6. Papillary muscles (septal)
  7. Papillary muscles (anterior)
  8. Papillary muscles (posterior)
  9. Septomarginal trabecula
  10. Trabeculae carneae
  11. Chordae tendineae
  12. Tricuspid valve (posterior cusp)
  13. Tricuspid valve (septal cusp)
  14. Tricuspid valve (anterior)
  15. Ascending aorta
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59
Q

Heart 6

A
  1. Ligamentum arteriosum
  2. Coronary sinus
  3. Inferior vena cava
  4. Cordinae tendineae
  5. Trabeculae carneae
  6. Papillary muscles (anterior/posterior)
  7. Epicardium
  8. Endocardium
  9. Myocardium
  10. Bicuspid valve (anterior)
  11. Bicuspid valve (posterior)
  12. Pulmonary trunk
  13. Auricle of left atrium
  14. Arhc of aorta
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60
Q

Heart 7

A
  1. Aortic valve (left, right, and posterior cusp)
  2. Right coronary artery
  3. Tricuspid valve (anteior, septal, and posterior cusp)
  4. Atrioventricular nodal artery
  5. Posterior intraventricular artery
  6. Middle cardiac vein
  7. Left and right fibrous trigones
  8. Bicuspid valve (anterior and posterior cusp)
  9. Circumflex artery
  10. Left coronary artery
  11. Pulmonary valve (left,right, and anterior?)
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61
Q

Heart 8 Aortic Valve

A
  1. Ostium of left coronary artery
  2. Mitral valve anterior cusp
  3. Interventricular septum muscular part
  4. Interventricular septum membranous part
  5. Nodule
  6. Ostium of right coronary artery
  7. Sinuses of aortic valve
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62
Q

Heart 9 Tricuspid

A
  1. Tricuspid valve (septal, anterior, and posterior)
  2. Chordae tendineae
  3. Papillary muscle (posteior)
  4. Papillary muscle (posteior, septal, and anterior)
  5. Interventricular septum membranous part
  6. Ostium of coronary sinus
  7. Ostium of inferior vena cava
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63
Q

Heart 10

A
  1. Left bundle
  2. Right bundle
  3. Subendocrinal (Purkinje) fibers
  4. Atrioventricular bundle (of His)
  5. Atrioventricular node
  6. Fossa ovalis
  7. Crista terminalis
  8. Sinu-atrial (SA) node
  9. Superior vena cava
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64
Q

Heart / Thorax 8

A
  1. Cervical cardiac vagal branches
  2. Left vagus nerve
  3. Thoracic cardiac vagal branches
  4. Left recurrent largyngeal nerve
  5. Cardiac plexus
  6. Thoracic sympathetic cardiac branches
  7. Sympathetic chain ganglion
  8. Cervical symapthetic cardiac branches
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65
Q

Aortic valve stenosis

What happens during it?

Would be treated immediately?

What this might result in?

A

Opening of the aortic valve is narrowed

Heart hypertrophy to compensate

No because heart is getting stroned

Heart failure

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66
Q

What are the components of innate immunity?

A

Epithelia (physical barrier)

Phagocytic cells (macrophages and neutrophils)

Natrual killer cells

Blood proteins: complement system

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67
Q

What are the components of adaptive immunity?

A

B cells and plasma cells – humoral immunity (antibody mediated)

T cells - cell-mediated immunity (cellular immunity)

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68
Q

3 types of Lymphocytes and their function

A

B cells - respond to cell free and plasma membrane bound antigens

T cells - respond to cell-bound antigens

Natural killer cells - non-specific production of perforins and granzymes

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69
Q

What is a difference between T cells and NK cells?

A

NK cells:

lack T cell recepotr (TCR)

lack CD4 and CD8

do not enter thymus to become immunocompetent

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70
Q

What are accessory cells of immune system?

Their function?

A

Macrophages (APC or phagocytic)

Dendritic cells (fibroblast-like cells forming the stroma of lymphatic tissue)

Epithelial reticular cells - found exclusively in the thymus

APCs (express MHCI & MHCII; present antigen; produce cytokines)

* many APCs belong to mononuclear phagocytic system

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71
Q

T cells

Where do they originate?

Where do they become immunocompetent?

Where they can be easily found?

What “test” do they need to pass?

A

Bone marrow

Thymus

Paracortical regions of the lymph nodes & Periarterial sheaths of the spleen (vasculature)

Ability to differentiate between self and antigen

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72
Q

What is Naive T cell?

A

Immunocompetent T cell that must be activated

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73
Q

2 types of mature T cells

A

Memory T cells

Effector T cells

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74
Q

Three types of effector T cells

A

T helper cells (recognition of foreign antigens)

Cytotoxic T Cells (responsible for killing foreign cells, tumor cells, and and virus infected cells)

Suppressor T cells (suppresses the immune response of other T lymphocytes)

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75
Q

B cells

General function?

Origin?

In order to become plasma cells what cell they need to interact?

When do B cells proliferate and differentiate?

Are they found in all lymphoid tissue?

A

Humoral immunity

Bone marrow

T-helper

When they encouter antigen

In all except thymus (very little)

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76
Q

B cells

Types?

Function?

Where B memory cells are found?

A

Plasma cells (clock face): synthesize / secrete Ab; responsible for primaryresponse

B Memory cells: responsible for secondary response

Mante layer of lymph node

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77
Q

What is important about IgG and IgA?

A

IgG is most abundant in serum, fetal aquired immunity

IgA most abundant in glandular secretions (digestive, respiratory, and integument)

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78
Q

What is the name of the protein that is attached to IgA and prevents them from degradation in mucosal linings?

A

J protein

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79
Q

Stroma vs. Parenchyma

A

Stroma

supportive tissue = connective tissue fiber e.g. reticular fibers in lymph node; could be also dendritic cells; epithelial-reticular cell, but all have tight junctions

Parenchyma

functional unit = sits in the stroma = T, B, Ma, hepatocyte (liver)

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80
Q

Lymphocytes undergo ____ differentiation in the primary lymphatic organs

Lymphocytes undergo ____ activation in the secondary lymphatic organs

A

antigen-independent

antigen-dependent

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81
Q

Lymphatic System

A

Concentrate and eliminate antigens

Production and maturation of lymphocytes

Addition of antibodies

Provides a means for returning tissue fluid

Absorption of chylomicrons from the small intestine

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82
Q

Lymphoid Organs

Primary?

Secondary?

A

PRIMARY

Bone marrow

Fetal liver

Thymus

SECONDARY

Diffuse Lymphatic Tissue

Tonsils

Lymph nodes

Spleen

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83
Q

What cells/componets (4) are usually found in lymphoid organs?

A

Reticular fibers

Dendritic cells (APC)

Macrophages (APC/phagocytic)

Lymphatic vessels

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84
Q

What captures antigens in intestinal walls?

What are these cells are adjacent to?

What layer are lymphocytes located in?

A

M cells (mucosa/microfold)

Peyer’s patches

Lamina propia

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85
Q

What is lymphatic nodule

Examples?

Primary composition?

Is it pernament?

Connective tissue (capsule)?

A

basic structural unit of diffuse lymphatic tissue

tonsils, lymph nodes, spleen ,GALT (gut associated lymphatic tissue), B (bronchus) ALT and M (mucosa) ALT

B cells, lymphoblasts, plasma cells, memory cells

Not always pernament; can be transitory

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86
Q

Types of lymphatic nodules (differentiation stage)

Color?

A

primary nodule = one that has not seen antigen

secondary = one with a germinal center in response to antigen

(light cells inside that undergo mitosis – lymphoblasts)

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87
Q

Are there germline centers in fetus?

A

No, there are none because fetus has not seen any antigen.

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88
Q

Waldeyer’s Ring

A

Anatomical term collectively describing the annular arrangement of lymphoid tissue in the pharynx

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89
Q

How infections originating in pharynx is separated from the rest of the body?

A

Tonsils possess an incomplete capsule of connective tissue which acts as a protective barrier against leakage of antigen into pharyngeal CT spaces

90
Q

Tonsils

what is it?

what chracteristic cells do they contain?

A

Aggregate of nodules grouped around crypts

They contain M cells and APCs

91
Q

How to distinguish different tonsils?

A

Palatine – stratified squamous

Lingual – stratified squamous

Nasopharyngeal - respiratory

92
Q

Lymph nodes

Where are they found?

Function?

Where T cells are found in lymph nodes?

A

situated in course of lymph vessels

allows for lymph to pass through before entering blood stream (filters) ; mantain / produce B and T cells

paracortical regions

93
Q

Name of the passage for passage of arterioles, venules and efferent lymphatics in lymph node

A

Hilum

94
Q

What is the differece between septum and trabeculate?

A

Septum go from the capsular surface through the organ

Trabeculae end in the organ

95
Q

What is the histological difference between medulla and cortex of the lymph node?

A

Medulla has no nodules

96
Q

What are two routes of the lymphoctes back to the bloodstream from lymph node?

A

By high endothelial venule (spread out endothelium that allow passage of lymphocytes)

Efferent lymphatic vessel

97
Q

Subcapsular vs. paratrabecular sinus of lymph node

A

The subcapsular is just under the capsule while the paratrabecular is perpendicular toward the capsule and goes toward the efferent

98
Q

From which layer are all of the lymphatic organs derived?

Exception?

A

Mesoderm

Thymus’ epithelial reicular cells are derived from endoderm

99
Q

Thymus

Function?

How long does it grow (age)?

Location relative to chest?

Are there germinal centers?

Shape?

A

T cells maturation

Mid-teens (then undergoes involution with fat accumulation)

Superior mediastinum

No germinal centers ~100% T cells

Bilobular and subdivided into lobules

100
Q

What cells are involved in stroma of thymus?

Parenchyma?

A

Epithelial reticular cells (not connective tissue) which contain tingible body macrophages

P: T cells and thymocytes

101
Q

Epithelial-reticular cells

Adhesions?

Importance?

What else do they produce?

Types?

A

Possess desmosomes and tonofilaments

Participate in the blood-thymic barrier (no antigen pass)

Hormones for T cell maturation (no other organ produces hormones)

Type 1-3 in cortex and Type 4-6 in medulla

102
Q

What is one histological hallmark of thymus?

A

Hassall’s corpuscles in medulla

103
Q

What is the function of medulla and cortex in Thymus?

A

Cortex = Maturations for T-cell (tangle body macrophages chew up; eliminate intolerant T cells)

Medulla = Thymic corpuscle (possibly worn out reticular epithelial cells)

104
Q

What are the layers of Blood Thymic Barrier?

A

capillary endothelium

capillary basal lamina

CT sheath of the capillary

epithelial reticular cell basal lamina

epithelial reticular cell

105
Q

Spleen

Size?

Location (old)?

A

Largest lymphoid organ in the body

106
Q

Functions of spleen

A

Immunological filter of blood

Blood reservoir

Phagocytossi

Proliferation of B and T cells

Antibody production

107
Q

Where can be T cells found in spleen?

A

periarteriole sheath (blood vessels that feed the central arterioles)

108
Q

Red pulp vs. White pulp function (spleen)

A

Both red and white pulp are parenchyma

Red pulp is the blood filter splenic sinusoids (capillaries that get blown up) separated out by splenic cords (lymphocytes, APCs, reticular fibers, blood cells WBC, most importantly macrophages. Macrophage is before the sinusoids. This arrangement is to remove old RBCs.

White pulp is the immunological filter (lymphatic nodules, has blood vessels associated, centric arteriors, lymphatic nodules with germinal centers including lymphatic nodules, periarterial sheets with T lympocytes, eccentric arteriols.

109
Q

Spleenic sinusoids (Cords of Billroth)

What are they?

Hypothesis?

Location?

Purpose for this arrangement?

A

consisting of fibrils and connective tissue cells with a large population of monocytes and macrophages

Both open and close are present

Red pulp

This arrangement is to remove old RBCs.

110
Q

Which of the following contains epithelium?

Tonsil / Lymph Node / Thymus / Spleen

A

Tonsil

111
Q

Which one contains capsule and where is it?

Tonsil / Lymph Node / Thymus / Spleen

A

Tonsil - uderlying

Lymph node - capsule & trabeculae

Spleen - capsule

Thymus - capsule & septa

112
Q

Main produces of these organs?

Tonsil / Lymph Node / Thymus / Spleen

A

Tonsil B/T cells

Lymph Node B/T cells

Thymus T cells

Spleen B cells

113
Q

Which one has efferent and afferent lymphatic vessels?

Tonsil / Lymph Node / Thymus / Spleen

A

All have efferent

Only lymph node has afferent

114
Q

Where are lymph nodules found?

Tonsil / Lymph Node / Thymus / Spleen

A

All except Thymus

115
Q

What is route taken by antigen?

Tonsil / Lymph Node / Thymus / Spleen

A

Tonsil - Epithelum

Lymph Node - Afferent

Thymus - No antigen

Spleen - Blood vessels

116
Q

Organized in cortex and medulla?

Tonsil / Lymph Node / Thymus / Spleen

A

Lymph Node and Thymus YES

Tonisl and Spleen NO

117
Q

Phagocytic capacity of macrophages (strongest to weakest)

Tonsil / Lymph Node / Thymus / Spleen

A

Tonsil +

Lymph Node ++

Thymus ++++

Spleen ++++

118
Q

Plasma cells

Tonsil / Lymph Node / Thymus / Spleen

A

Tonsil - Outer layer of Germinal Center

Lymph Node - Outer layer of Germinal Center & medulla

Thymus - None

Spleen - Outer layer of Germinal Center

119
Q

Site of lymphocyte recirculation

Tonsil / Lymph Node / Thymus / Spleen

A

All have efferent

Lymph node has also high endothelial venule

120
Q

What happens to the blood if there is a left heart failure?

A

It accumulates in veins then goes to tissue.

121
Q

How is the chest divided?

A

Chest is divided intop three cavities:

1 pulmonary for each lung

and

mediastinum between

122
Q

How is the diaphgram connected to pericardiac sac?

A

Central tendom of diaphgram is fued to the fibrous portion pericardium

123
Q

The hole in the left lung where the heart lies

A

Cardiac notch

124
Q

The “bottom” posterior-inferior part of the heart

What is the importance of it?

Is the bottom of the heart at T9 level?

A

Diaphragmatic surface of heart

Heart and diaphgram moves together

Only theoretically

125
Q

Where is the pericardiacophrenic artery and phrenic located at the heart level?

A

Between parietal pleura and fibrous pericardium

126
Q

Why proximity of the escophagus to heart might be clinically important?

A

Can do ultrasounds of the heart

127
Q

Where is the right costomediastinal recess with respect to the lung pleura?

A

Relfection of a parietal pleura from its costal surface onto its pericardial surface.

This creates a space

128
Q

What is the top limit for superior mediastinum?

At what level is the mediastinum is divided?

What is the lower limit for inferior mediastinum?

A

Thoracic outlet / Superior thoracic aperture

T4/T5 level

T9

129
Q

Great vessels

A

Large vessels that bring blood to and from the heart

130
Q

What is the precurosor of ligamentum arteriosus?

A

ductus arteriosus

131
Q

Angiogram

A

an X-ray photograph of blood or lymph vessels

132
Q

Where does the coronary sinus enters the heart?

What is the name of that entrance?

A

Right atrium

Ostium and valve of coronary sinus

133
Q

Smooth areas vs. Muscular areas of atrium

Names for each?

Reason?

A

Smooth (interatrial septum) develops along vessels

Muscular (pecinate muscles) remenant of primitive atria

134
Q

What is the name of muscles that pull cusps down?

What are the name of the ropes?

A

Trabeculae carneae

Chordae tendineae

135
Q

What specific muscular structure carries right bundle branch of the AV?

What is another name?

A

This septomarginal trabecula is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle.

Moderator band

136
Q

What is the name of the area inferior to pulmonary valve?

A

Conus arteriosus

137
Q

Two parts (types of the wall) in intraventricular septum

A

Muscular & fibrous (thinner)

138
Q

The name of the region in the same plane where all four valves sit

A

Fibrous skeleton of the heart

139
Q

During which phase do coronary arteries fill?

A

Diastole

140
Q

Where do vagus’ fibers go to?

A

Reccurent laryngeal branch

Branch that goes to cardiac plexus

141
Q

Where is the referred pain from heart coming from?

A

Same region where the others synapse C5-T1

Like upper limb

142
Q

Pericardial effusion - Why it might be due to? What is the cost?

What is hemopericardium?

What is cardiac tamponade?

What is pericardiocentesis?

A

Pericardial effusion = abnormal accumulation of fluid in the pericardial cavity

Due to penetrating chest wounds and cardiac injuries

Reduces blood volume that is pumped

Hemopericardium = blood in pericardium

Cardiac Tamponade = compression on the heart

Pericardiocentesis = Drainage of fluid from the pericardial cavity = pericardial tap (diagnostic and decompressive).

143
Q

Difference between aortic and mitrial valve

A
144
Q

Valvular heart disease due to cusps function deterioration

Stages?

A

Damage to or a defect in one of the four heart valves.

Rheumatic vegetation (thickening of the valve)

Thickening cusps (blood growth) = insufficiency

145
Q

Valvular Heart Disease

General types?

A

Rheumatic vegetations / Thickening cusps

Mitral Stenosis: Thromboembolic Complications

146
Q

Valvular Heart Disease

Mitral Stenosis: Thromboembolic Complications

A

Susceptibility of the left atrium (due to auricle) to develop thrombi in mitral stenosis

147
Q

Atherosclerosis

Coronary artery disease (CAD)

Coronary bypass

Coronary angioplasty

A

Atherosclerosis = characterized by irregularly distributed lipid deposits in the intima of large and medium-sized arteries, causing narrowing of the arterial lumen and eventual fibrosis and calcifications. Recanalization of the artery may occur (with some improvement of the symtoms).

Coronary artery disease develops when your coronary arteries — the major blood vessels that supply your heart with blood, oxygen and nutrients — become damaged or diseased.

Coronary angioplasty (AN-jee-o-plas-tee), also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery.

148
Q

Heart Transplantation

A
149
Q

Facial palsy

A

Facial paralysis

150
Q

Lymphedema

A

Refers to swelling that generally occurs in one of your arms or legs

151
Q

Pitting endema

A

Indicate of heart failure

Skin does not rebound

152
Q

Can cardiac muscle form tetanus?

A
153
Q

Primary and Secondary/Latent Pacemakers

A

Primary - SA node

Latent - other structures along conduction sytem

154
Q

Two types of conduction cells in heart and their subsets

A

Conduction cells: SA node cells, internodal conduction track, AV node, bundle of Hiss, Purkinje cells

Contraction and relxation cells: atrial and ventricular

155
Q

Where is the SA node located?

A

Lateral portion of right atrium

Near vena cava

156
Q

What is the delay at AV node?

How long is plateau in ventricular cells (no plateau in SA)?

A

Delay: About 130 ms

Plateau: 100-200 ms

157
Q

Why SA nodes fires quicker than Purkinje fiber?

A

It has higher RMP

Higher permiability to sodium in SA node than in other cells in heart

158
Q

Difference of action potential in skeletal muscle vs. cardiac muscle

A

Fast few miliseconds

300ms with large plateau

Cardaic cells are not permeable to Cl- ions

159
Q

What RMP gives the highest maximum upstroke velocity?

A

about -80mV

160
Q

What is the relationship between [K+]o and RMP

A
161
Q

Action potential in ventricular cell.

Treshold?

What happens if some Na+ channels are not inactivated? What does it lead to?

What channels play a role?

Phases?

When Ito activate?

When ICa++ abd IK activate?

Which phase detemines the strength of muscle contraction?

A

-65 mV

Long QT possibly leads to EAD then to Torsades de Pointes, ventricular tachycardia, and fibrillation

INa, ICa, Ito (transient outward), IK (delayed recitfier), IK1 (inward rectifier)

  1. Depolarization/overshoot ; 1. Quick repolarization ; 2. Plaetau ; 3. Final phase of repolarization ; 4. Diastolic

Ito -30 mV ; ICa++ -20mV ; IK -40mV

Pleaeau

162
Q

Three types of ion channels classification based on how they are controlled

A

Channels activated or suppressed by a ligand (e.g. ACh)
Voltage-dependent channels

Background “leak” channels

163
Q

Rate of depolarization during phase 0

A

upstroke velocity

dV/dt max

Vmax

164
Q

Why high [K+]o might lead to smaller overshoot and Vmax?

Example?

Which phase / varaible does this change affect?

What is fast-depressed response?

Slow response?

What pathology can result from this?

A

Na+ channels will become gradually inactivated until membrane potential reaches a level at which they are completely inactivated (~ −50 mV)

Phase 0 (Vmax and overshoot)

Ischemia

fast-depressed response: Some sodium channels are inactivated, but there are some open durig the beginning of action potential

slow response: only Ca++ channels because all Na+ channels are inactive

abnormal reentrant excitation and ventricular arrhythmias (e.g. heart attack during coronary block)

165
Q

By what channels is the fast response and slow response determined?

A

Na+ channels

Ca+ channels

166
Q

Are Ca+ channels conductivity affected by the increasing RMP?

A

Usually not because they are regulated by the voltage above -50mV

167
Q

Why there is an immediate drop of voltage after the action potential in ventricular cells?

Which potassium channel regulates RMP, but it is not involved in during most of action potential?

A

Ito channels.

The permeability of K+ is high due to IK1but drops dramatically to almost 0 during Phase 0 of the action potential when Na+ channels open. It is regulated by Mg2+ and intracellular polyamines spermine it is inactivated during beginning of action potential.

168
Q

What ionic currents determine the action potential in SA node?

Which current is not significat?

What is the treshold of SA node?

A

The activation of two classes of Ca2+ channels, one being activated at slightly more negative potentials than the other.

Voltage-gated Na+ channels DO NOT contribute by any means to Phase 0 or any other phase of the SA nodal action potential.

-40 to -50 mV

169
Q

How is the action potential in SA node different?

A

Ca+ dependent

slow, displaying maximum upstroke velocities of ~ 15-20 Volts/sec.

No phase 1 or 2

Repolarization activates Ifunny or If (activated by hyperpolarization / allow Na+/K+ to flow equally)

170
Q

Excitability

A

The capacity of a cardiac cell to initiate an action potential in response to an external stimulus

171
Q

Maximum Diastolic Potential (MDP)

A

Most negative membrane potential achieved during diastole in cardiac cycle.

172
Q

Automaticity

A

Ability of cardiac cell to spontaneously depolarize and initiate propagated response

173
Q

Decremental Conduction

A

In most cardiac fibers, conduction spreads without decrement (i.e. constant conduction velocity, however in some areas, conduction spreads with decrement (i.e., decrease in conduction velocity).

174
Q

Conduction Velocity

A

The rate at which the wave of excitation spreads through the functional syncytium of the heart (domino effect by spread of local circuit currents). Depends upon: (i) fiber diameter, (ii) maximum upstroke velocity of the action potential (dV/dt), and (iii) overshoot of the action potential.

175
Q

Ion currents in action potential in SA node

A

IK (rectifier) causes quick repolarization

hypolarization and activateion of If leads to prevention in further repolarization

If leaks mainly sodium leading to another AP

If is inactivated during AP

176
Q

Parasympathetic effect on:

SA? Atria? AV? Ventrcle?

Sympathetic effect on:

SA? Atria? AV? Ventrcle?

A

Parasympathetic

SA: ↓MDP (ACh → (+) K+ channels) → ↓ SA

Vmax → ↓ SA

Atria: similar to SA

AV: ↓ in excitbaility

Ventricle: antagonizing β-adrenergic stimulation

Sympathetic

**SA: **↑ICa++ & ↑ If → ↑ Vmax

No effect on MDP

Atria: ↑ICa++

**AV: **↑ Excitability

**Ventricle: **

177
Q

Hyperkalemia (high [K+]o) effects on

SA? Atria? AV? Ventrcle?

Hypokalemia (low [K+]o) effects on

SA? Atria? AV? Ventrcle?

A

Hyperkalemia

**SA: **Depresses automaticity

V, A, and P: RMP depolarization, reduces maximum rate, reduces conduction velocity, decreases duration

Hyperkalemia

V, A, and P: Increases potential duration

SA node: Enhances automaticity

178
Q

Why the Na+/K+ pump is electrogenic?

A

It Participates in Determining the Resting Potential

179
Q

How is the changes in permiability of K+ cardiac muscle different from skeletal muscle during the initial phase of action potential?

A

It goes down in cardiac muscle and goes up in skeletal muscle

180
Q

Causes (external) for Arrhythmia

Causes (mechanism- abnormal impulse formation) for Arrhythmia

Causes (mechanism- impulse conduction) for Arrhythmia

Consequences of Arrhythmias

Classification of Arrhythmias

Occurence of Arrhythmias

A

Causes: Ischemia (pH/electrolyte), fiber strech, autonomic misregulation, chemicals (e.g. digitalis)

Causes (AIF): no change of pacemaker location brady/tachycardia, changes in pacemaker site (latent pacemaker, injury current, oscillatory after-depolarization)

Causes (IC): slowed without reentry (AV Block), slowed with reentry

Consequences: lower mechanical performance, gets worse, formation of thrombi

**Classficiation: **Abnormal implusle formation (Tiggered activity EAD/DAD), Spontaneous automaticity) and Reentrant (Reflection, circus movement, phase 2 reentry)

Occurence: MI 80-90%, General Anastesia 20-50%, Digitalis 10-20%

181
Q

Factors favoring the development of reentry of signal

A

Long reentrant pathway

Slow conduction

Short effective refractory

182
Q

DAD vs. EAD

Causes for each?

What is EAD associated with on EKG?

A

**DAD: **Ca2+ release after repolarization

DAD causes: ischemia (intracellular Ca2+ overload), cardiac glycosides (digitalis), catecholamines, UP HR, low [K+]o or high [Ca2+]o, caffeine, hypoxia, cardiac hypertrophy

EAD: opening Ca2+ occurs during relative refrecatory period

**EAD causes: **most often aquired (drugs/genetic), hypoxia, acidosis, cahnges in the ionic environment, catecholamines, current injections, pharamcological agents, antiarrhtyhmic agents

EAD & EKG: Long QT syndrome

183
Q

How the height and Rate of Rise of the Upstroke on Conduction Velocity

A

Faster conduction rate = faster propagation

Faster conduction velocity = faster propagation

184
Q

Modified Goldman-Hodgkin-Katz (GHK) Equation

A
185
Q

What are the slow responses in Ventricular cells similar to?

A

action potentials in SA node

186
Q

Long QT (LQT) Syndrome

Causes?

What it might lead to?

A

Inherited or congenital (rare): Genetic mutations affecting the expression and/or function of voltage-gated ion channels determining the cardiac action potential

Acquired (more common): –Drug-induced but could involve a ill-defined genetic predisposition

Torrades des pointes: Torsade de pointes is an uncommon and distinctive form of polymorphic ventricular tachycardia (VT) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line

187
Q

Tension vs. [Ca2+]

A

Tension increases with calcium concentration.

Thre graph has sigmoidal shape.

During diastole pCa = 7 (10 nM)

During normal contraction pCa = 6 to 5.3 (1 to 5 uM)

Maximum force can be evoked by 30 uM.

188
Q

What are T-tubules make a close contact with at relatively regular intervals?

A

SR

189
Q

Does skeletal muscle or cardiac muscle require Ca2+?

A

Skeletal does not

Cardaic does

190
Q

Ca2+ transient

A

The surge of calcium going through the its channel

191
Q

Which source of calcium provides main part required for contraction?

A

Sarcoplasmic Reticulum

Extracellular (only 10%)

192
Q

CICR

Why does it occur?

A

Ca2+ induced Ca2+ release

The way that calcium is released in muscles

juxtaposition of Ca2+ channels in the T-tubules and ryanodine receptors a Ca2+ channels present in the SR

193
Q

How T-tubules Ca++ channels are activated?

How RyR channels are activated?

A

Voltage

Calcium

194
Q

What is responsible for relaxation in cardiac muscle?

A

Ca2+-ATPase activated by Ca++ (main)

Na+/Ca++ exchanger (main for extracellular and needed for balance)

195
Q

What changes in action potential increase ventricular contraction and higer Ca2+ release

A

Lengthening of the action potential

Elevation of the level of the plateau

This effect is mediated by CICR

196
Q

Cardiac glycosides e.g. digitalis action

A

Inhibits Na+/Ca2+ exchanger

This leads to buildup in cell

Ca2+-ATP can store more Caclium in SR

More calcium can be released by CICR

197
Q

EC coupling

A

Exitation Contraction Coupling

198
Q

b1 sympathetic stimulation on heart mechanism

A

Gs

  1. PKA enhace probability of Ca2+ channels opening (phosoporylation) both in plasma membrane and SR (most important)
  2. RyR stimulation increases influx and facilitates termination
  3. Phospholamban (Ca2+ inhibitor) inactivation by phosphorylation
  4. Phosphorylation reduces troponin affinity for Ca++ facilitates relaxation
199
Q

Tropomyosin function

A

is ultimately responsible nbfor allowing or preventing the interaction of actin and myosin during the cardiac cycle

200
Q

Troponin Complex

A

Troponin I C T

201
Q

Troponin C

A

Ca++ binding protein

202
Q

Troponin I

A

TnI inhibits the interaction between myosin and actin although it is much
weaker than tropomyosin when exposed alone to these two proteins in vitro.

Can be phosphorylated to increase the rate of relaxation.

203
Q

Troponin T

A

Integrity of the complex

204
Q

The term that describes smooth muscle shape when relaxed.

A

Fusiform

205
Q

What are myofilaments?

A

Actin and myosin

206
Q

Term that describes a heart functioning as a one unit.

A

Syncytium

207
Q

Axonal swellings containing synaptic vesicles

A

en passant

208
Q

What is a difference in histological composition of large and small arteries?

A

Small have more smooth muscle and can be regulated

Large have more elastic tissue

209
Q

Where is the most blood in systemic and pulmonary circulartion?

A

Veins - systemic

Equalliy distributed - pulmonary

210
Q

Which organs are predominantly T cells?

Which organs are predominantly B cells?

Which organs are equal in B & T cells?

A

T cells: Thymus, Blood

B cells: Lymh nodes, Bone marrow

Equal: Spleen

211
Q

Name the cords that surround splenic sinuses

What do they contain?

A

Billroth cords

Macrophages

212
Q

Name the macrophages that destroy T cells in thymus

A

Tingible body macrophages

213
Q

What is the name of the conducting system that connect SA node to left atrium?

A

Bachmann bundle

214
Q

Three types of leads in EKG

A

Standard bipolar leads: I, II, and III

Augumented unipolar leads: aVf, aVr, and aVf

Precordial chest leads

215
Q

Normal EKG intervals

P

P-R

QRS

T

Q-T (beggining of Q to end of T)

A

P 60-110

P-R 120-210

QRS 30-100

T Varies

Q-T (beggining of Q to end of T) 260-490

216
Q

What insulates atrium from ventricle?

What structure only passes

A

Fibrous skeleton

conducting fibers

217
Q

ERP

A

Absolute refractory period also refered as effective refractory period

218
Q

Which artery is obtuse?

A

The left margin artery

219
Q

Where does the SA node lies?

A

At the top of the sulcus terminalis

220
Q

Sulcus terminalis

A

Groove in the right atrium of the heart

Separates right atrial pectinate muscle from the sinus venarum

Block 2 (7 decks)

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