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Skin/Muscoskeletal Final Review > Week 1 > Flashcards

Week 1 Flashcards

0
Q

Proximal

A

Nearer to the attachment of an extremity (limb) to the trunk or a structure; nearer to the point of origin

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1
Q

Distal

A

Farther from attachment of an extremity (limb) to the trunk or structure, farther from point of origin

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2
Q

Sagittal plane

A

vertical plane that divides body into left & right sides

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3
Q

Coronal (frontal) plane

A

Vertical plane that divides body into anterior and posterior portions

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4
Q

Horizontal (transverse) plane

A

plane that divides body into superior and inferior portions

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5
Q

Where is the X-ray image less distorted?

A

For portion of body closer to the detector - the farther away a tissue is, the larger it will appear (ex: heart in AP projection is much larger than in standard PA projection of chest)

PA projection - goes from posterior to anterior - standard
AP projection - goes from anterior to posterior - not standard, heart looks larger

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6
Q

What are air filled structures?

A

Stomach & colon - air has atoms far apart, radio-lucent

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7
Q

How lucent are body fluids (blood) and tissues?

A

Similar density, with fat slightly more lucent (more dense than air, less dense than bone)

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8
Q

CT Scans

A

Multiple X-rays of the body are performed very rapidly- amt of radiation atleast 100 fold X-rays - more details than X-rays, but use should be minimal

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9
Q

How does ultrasound work?

A

High freq. sound waves (sonar) are differentially reflected by surfaces separating structures of different densities
-Safe for pregnancy, can be performed at bedside

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10
Q

How does MRI work?

A
  • Use magnetic fields to produce images - patient is pulse with radiofrequency waves in a powerful magnetic field that causes nuclei of atoms to emit a radiosignal that can be detected, stored and reproduced as an image
  • NOT DAMAGING (Ionizing radiation of X-rays)
  • Better images of soft tissues than CT
  • Expensive & cannot be used with patients who have metal in body
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11
Q

How does nuclear medicine imaging work?

A
  • Radioactive material that is injected is taken up selectively by different body organs
  • Used to evaluate the physiological function of organ or structure
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12
Q

What is a colles fracture? What causes it?

A

It is usually caused by a fall onto a hard surface and the patient catching themselves with their wrist.
-Fracture of distal radius - diagnosed in osteoporosis often and post menopausal women

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13
Q

Extension

A

an increase in the angle between two bones

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14
Q

What innervates the Trapezius?

What innervates the Lat. dorsi?

A 
Accessory nerve (CNXI) & cranial nerves C3 & C4
Thoracodorsal nerve
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15
Q

What innervates the rhomboid muscles?

A

Dorsal Scapular nerve

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16
Q

What is the function of the trapezius? What does damage to the Accessory nerve cause?

A

Elevation, retraction & depression of the scapula

-Damage causes trapezius muscle not to function - “Droopy Shoulder”

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17
Q

What is the function of the latissimus dorsi?

A

Extends, adducts, medially rotates the humerus at the shoulder joint

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18
Q

What muscle of the back connects the upper limb to the thoracic wall? What is its nerve supply?

A

Serratus anterior, long thoracic nerve, injury to it produces ‘winged scapula’
-Allows anteversion (bent elbow and twisting it) of the arm & pulls scapula forward

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19
Q

What is the function of the deltoid? What innervates it?

A
  • Roundness of shoulder, anterior fibers flex & medially rotate it, middle fibers are chief abductor of humerus, posterior fibers extend laterally and rotate the humerus
  • Supplied by the axillary nerve
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20
Q

When is the axillary nerve usually damaged?

A

Improper use of crutches, fracture to humerus

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21
Q

How to test deltoid muscle?

A

Abduct the arm starting from 15 degrees.

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22
Q

What muscles form the armpit? What are the innervations?

A

Latissimus dorsi & teres major!
Long thoracic nerve
Lower subscapular nerve - teres major

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23
Q

What muscle form the rotator cuff?

A

SITs
Supraspinatus, Infraspinatus, Teres minor, Subscapularis
-stabilizes shoulder joint during abduction and rotation of the upper limb (also involved in adduction)

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24
Q

What vessels are involved in establishing collateral circulation in the shoulder region?

A

Anastomosis of arteries - located on the dorsum of the scapula

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25
Q

Where does the omohyoid muscle attach? What innervates it?

A

Inferior attachment of the muscle is to superior boarder of the scapula - on the suprascapular notch. Superior attachment is on the hyoid bone.
It is innervated by cranial nerves I, II and III. It’s function is to depress, retract & steady the hyoid bone.

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26
Q

What does the dorsal scapular nerve innervate?

A

rhomboid muscles, levator scapulae

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27
Q

What originates on the acromion?

A

Deltoid!

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28
Q

In which direction does dislocation of the glenohumeral joint usually occur?

A

Anterior

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29
Q

What does the dorsal horn contain?

A

Sensory information/sensory neurons - sensory neuron cell bodies lie here!

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30
Q

What innervates the teres minor?

A

Axillary nerve

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31
Q

What does the supraspinatus do?

A

Abducts the arm!! and stabilizes the humerus

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32
Q

What muscle/nerve is involved in chin ups/arm adduction?

A

Latisssimus dorsi & thoracodorsal nerve

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33
Q

What is a pseudounipolar neuron & where are they usually located?

A

Dorsal horn - usually sensory - have short, apparently single process extending from the body

  • Conductions from receptor organ to a cell body in the CNS
  • Located outside the CNS in sensory ganglia & part of PNS
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34
Q

What is a mutlipolar neuron?

A

Usually motor - has two or more dendrites & a single axon

-Most common type of neuron in CNS & PNS

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35
Q

What type of neurons are all motor neurons that control skeletal muscle & those comprising the ANS?

A

Multipolar neurons

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36
Q

What is the difference between a nucleus & a ganglion?

A

A nucleus is a collection of nerve cell bodies in the CNS while a ganglion is a collection of nerve cell bodies within the PNS.

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37
Q

How is a peripheral nerve different than a tract?

A

A peripheral nerve is part of the PNS, not the CNS. Peripheral nerve fibers travel in bundles. A bund of nerve fibers (axons) in the CNS connecting nuclei of the cerebral cortex is a tract.

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38
Q

What are afferent and efferent nerves?

A

Afferent (sensory) fibers - convey neural impulses to the CNS from the sense organs and from sensory receptors
Efferent (motor) fibers - convey neural impulses from the CNS to effector organs

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39
Q

Anterior (ventral) nerve root

A

motor (efferent) fibers passing from nerve cell bodies in the anterior horn of the spinal cord gray matter to effector organs

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40
Q

Posterior (dorsal) nerve root

A

Sensory (afferent) fibers from cell bodies in spinal sensory or posterior root ganglion that extend to sensory endings & centrally to the posterior horn of the spinal cord gray matter

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41
Q

What are the two rami and what do they innervate?

A

The large ramus is the anterior primary ramus (anterior & lateral trunk along with extremities) while the smaller branch is the posterior primary ramus that goes toward the back (muscles of back, vertebral column, overlying skin)

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42
Q

What are somatic sensory & motor fibers?

A

Sensory - transmit sensations from body to CNS

Motor - transmit impulses to the skeletal (voluntary muscles)

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43
Q

Where do visceral motor fibers go?

A

They transmit impulses to smooth (involuntary) muscle and glandular tissues. [pre and post synaptic muscles work together to conduct impulses from the CNS to the smooth muscle or glands]

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44
Q

What does the somatic nervous system control?

A

Voluntary muscle control

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45
Q

What does the autonomic nervous system control?

A

[Motor/Visceral areas] It is made up of the sympathetic & parasympathetic ganglia

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46
Q

What is the gray matter of the spinal cord?

A

Made up of dorsal/posterior horn, lateral horn & ventral horn. It contains nerve cell bodies & synapses

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47
Q

What forms the white matter of the spinal cord?

A

Contains the axons of nerves which form tracts (from dorsal, lateral & ventral columns

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48
Q

How does the shape of the spinal cord change as you move down the back?

A

At the top, cervical segments are large, oval while lumbar and sacral segments are smaller and rounder.

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49
Q

Where is the lateral horn present?

A

At T1-L2 segmental levels - it contains cell bodies of preganglionic sympathetic neurons
(also called intermediolateral cell column)

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50
Q

Describe the white & gray matter in the spinal cord as you move down:

A

The cord gets smaller caudally.
White matter decreases at lower levels because the number of nerve fibers decreases caudally as descending tracts gradually terminate and ascending tracts aren’t yet complete

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51
Q

Where is gray matter larger?

A

At cervical (C4-T1) and lumbosacral (L2-S3) levels - due to large number of nerve cells associated with innervation of the limbs

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52
Q

What is the difference between upper and lower motor neurons?

A

Upper means the cell body starts in the CNS and ends in the CNS (can terminate on a lower neuron)
Meanwhile, lower means the neuron (cell body) starts in the CNS and terminates in the PNS (peripheral motor neurons are always lower neurons)

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53
Q

How many neurons in the somatic and autonomic nervous system?

A

Somatic - voluntary - one neuron

Autonomic or visceral (involuntary) - two neurons before reaching target

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54
Q

What does the dorsal (posterior) root hold?

A

Sensory nerve cell bodies (somatic & visceral)

Pseudounipolar neurons

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55
Q

What does the ventral root contain?

A

Motor or efferent nerves - it joins the dorsal root to make the spinal nerve

56
Q

What are first, second & third order neurons?

A

First - cell body in ganglia - located in dorsal root ganglion (sensory)
Second - always starts in CNS & ends up in thalamus
Third - goes from thalamus to cerebral cortex

57
Q

Where are sensory nerve cell bodies located?

A

Sensory ganglia - dorsal - located outside the CNS

58
Q

Where do multipolar neurons of the dorsal horn send their axons?

A
  1. higher levels in the CNS
    OR
  2. Ventral or anterior horn (interneurons)
59
Q

What makes up the lateral horn?

A

Preganglionic cell bodies (multipolar neurons) of Autonomic nervous system (ANS) - found only in thoracic & upper lumbar spinal cord segments

60
Q

What are alpha motor neurons?

A

They are present in the ventral horn (motor horn) and send their axons to innervate extrafusal skeletal muscle fibers - “lower motor neurons”

61
Q

Where are autonomic (motor) nerve cell bodies located?

A

In motor or visceral ganglia found outside the CNS - Autonomic or Motor ganglia

62
Q

What muscles - C5?

A

Upper extremity abductors (deltoid, biceps brachii)

63
Q

What muscles - C5/C6?

A

Forearm flexors (biceps brachii, brachioradialis) forearm pronators

64
Q

What muscles C7?

A

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

65
Q

What muscles L3/L4?

A

Leg extension - quadriceps - knee jerk reflex

66
Q

What muscle L4/L5?

A

Foot dorsiflexors and toe extensors (anterior tibial muscles)

67
Q

What muscles S1/S2?

A

Foot plantarflexors and toe flexors (posterior tibial muscles) (Achilles tendon reflex)

68
Q

What spinal cord segments supply the intrinsic hand muscles?

A

C7/T1

69
Q

What are synarthrotic joints?

A

together joints, fibrous (sutures in brain), cartilaginous (intervertebral discs & femurs), bony (replaced by bone)

70
Q

What are diarthrotic joints?

A

Moveable or synovial joints - has fibrous capsul, synovial membrane (composed of cell making the synovial fluid) & articular surface or hyaline cartilage

71
Q

What are the 3 synarthrodial joints?

A

Syndesmosis, Synchondrosis, Synostosis

72
Q

What are syndesmosis joints?

A

Fibrous joints, suture in skull, interosseous membrane

73
Q

What are synchondrosis joint?

A

Cartilaginous joints
Primary - temporary joint - hyaline cartilage (disappears with age)
Secondary - permanent joints - fibrocartilage in intervertebral discs
[symphysis - secondary cartilaginous joint composed of fibrocartilage found between 2 pubic bones}

74
Q

What is a synostosis joint?

A

Bony joint - in the skull - may have existed in development as a fibrous or cartilaginous joint but was replaced by bone upon cessation of growth (ex: epiphyseal plate or frontal bones)

75
Q

What are the features of a diarthrodial joint?

A

Moveable/Synovial joint - two bones separated from one another with synovial space (joint cavity) containing synovial fluid
-the fibrous capsule covers the synovial membrane

76
Q

What are arthritis, synovitis, bursitis?

A

inflammation of the joint, synovial membrane of a joint & bursa

77
Q

What is Albinism?

A

Inability to produce melanin - lack of tyrosinase activity (99% of cases)

78
Q

What is vitiligo?

A

An autoimmune disorder in which melanocytes are destroyed - secondary to autoimmune dysfunction, leading to depigmentation

79
Q

What are the four layers of the epidermis?

A

Stratum Germinativum, Stratum Spinosum, Stratum Granulosum, Stratum Corneum

80
Q

What is the stratum germinativum (stratum basal)?

A

Basal layer, mitotically active, hemidesmosomes, desmosomes - form intermediate filaments

81
Q

What are the anchoring elements in hemidesmosomes?

A

Lamins!

82
Q

What is the stratum spinosum?

A

2nd layer - ‘prickle’ cell layer (spiny cells), mitotically active, MANY DESMOSOMES, MAKES LAMINAR BODIES

83
Q

What is the stratum granulosum?

A

No mitotic activity, keratohyalin cells dying, discharges lamellar bodies, keratohyalin granules

84
Q

What is the stratum corneum?

A

Outermost layer, cells are dead & flat, completely ‘keratinized’

85
Q

What’s the difference between secretory portions and ducts of eccrine glands? Where are eccrine glands located?

A

Secretory portions of eccrine glands look pink, mushy & filled in. Meanwhile, ducts of eccrine glands look open and empty.
-All over the body

86
Q

Where are apocrine glands found? What do their glands/secretory units look like?

A

They are ‘stinky’ sweating glands found in the groin, axilla, around nipple, etc.
-Very large, open

87
Q

What cells line apocrine and eccrine sweat glands?

A

Myoepithelial cells

88
Q

What are the outer layers of the finger under the nail plate?

A

hyponychium

89
Q

What do sebaceous glands look like?

A

Clumps of fat!

90
Q

Where are pyramidal cells located?

A

The cerebral cortex

91
Q

What is the blue staining substance in nerve cells?

A

RER - Nissl Substance

92
Q

What surrounds peripheral nerve cells?

A

epineurium

93
Q

What is in the middle (inner part) of the cerebellum?

A

Nerve fiber tracts (white matter)

94
Q

Macule

A

flat, circumscribed region of skin with different color or texture

95
Q

What causes Melasma (cheeks, forehead, temples, facial hyperpigmentation)?

A

Pregnancy, oral contraceptives, hydantoin

96
Q

What is Lentigo simplex?

A

-Localized hyperplasia of melanocytes, not sun releated, small brown macules

97
Q

What is a benign neoplasm?

A

Can be destructive or symtomatic - this does not define malignancy. (neoplasm with no capacity for metastasis)

98
Q

What is a malignant neoplasia?

A

Neoplasm with potential for metastasis and subsequently growth/proliferation at distant site - often locally destructive but may not be

99
Q

What’s a spitz nevi?

A

Red, dome shaped papule (benign but should be removed bc its unpredictable)
-Starts in melanocytes

100
Q

How do you determine if a skin lesion is a melanoma?

A

ABCDEs!
A- symmetry
B- normal, nice circumscribed boarder
C - Color - color is variegated/uneven
D - Dimension (larger than 1 cm >10 mm - greater than pencil eraser)
E - Elevation, Evolution, Enlargement - changes in size, growth of mole - EVOLUTION IS MOST IMP!

101
Q

What does melanoma diagnosis rely on?

A

Depth of biopsy (needs to go through the lower skin layers)

102
Q

What is spinal stenosis?

A

Narrowing of the spinal column that causes pressure on the spinal cord or narrowing of openings where the spinal nerves leave the spinal column

103
Q

What do meissner’s corpuscles sense?

A

Touch (high numbers in very sensitive areas)

104
Q

What do pacinian corpuscles sense?

A

Pressure (in deeper dermis)

105
Q

What do free nerve endings sense?

A

Touch, tactile, pain - peritrichial nerve endings - non-encapsulated

106
Q

What are the 3 different types of burns?

A

First - involves epidermal damage, occasional blistering but you usually don’t get any blistering
Second - blistering, epidermal & dermal damage, typically not permanent
Third - destruction of the dermis & epidermis, severe chemical burns = electrical burns

107
Q

What is Breslow depth?

A

An important prognostic parameter in evaluating a primary tumor - It is the size of specimen that is adequate to determine the histologic depth of lesion penetration

108
Q

What happens if the Breslow depth is 1.0 mm or greater?

A

Usually the patient receives a sentinel node biopsy (first node where cancer is likely to spread from primary tumor)

109
Q

What are 3 critical features related to staging & ultimate prognosis of a patient’s disease?

A

Breslow depth, ulceration & mitotic rate

110
Q

Why should non-excisional (shave/punch) biopsies be avoided?

A

They underestimate the final Breslow depth.

111
Q

Multipolar cell bodies of somatic motor neurons innervating skeletal muscle are located. . .

A

. . .in the gray matter of the spinal cord & brainstem

112
Q

Where do upper motor neurons originate?

A

cerebral cortex or brainstem

113
Q

What does ACh cause in the body?

A

Excessive sweating, flushing, activation of eccrine glands (great sweating), causes dilation of blood vessels

114
Q

When should you use a punch biopsy?

A

Rashes or blisters involving the dermis layer of skin (pemphigoid, pemphigus, lupus erythematosus, erythema multiforme - circular red lesions (itchy blotches of unknown cause possibly mediated by immune complex (mostly IgM)

115
Q

What is ET-B?

A

An exfoliating toxin associated with SSSS in young children. (ET-A is associated with bullous impetigo)

116
Q

What organism causes lyme’s disease and how does the rash present?

A

Red, erythematous periphery

Borrelia Burgdorferi

117
Q

What are the properties of pseudomonas auruginosa?

A

Gram -, bacilli, oxidase +, hot tubs, red, round bumpy itch/blister

118
Q

What are Lamellar granules?

A

They are membrane-coating granules (MCGs) filled with lipid

119
Q

What is a precursor to cutaneous squamous cell carcinoma?

A

Actinic Keratosis

120
Q

What is the most common skin cancer?

A

Basal Cell Carcinoma

121
Q

What can CT IV contrast material cause?

A

Transient decrease in renal function

122
Q

What is ultrasound commonly used for?

A

To assess abdominal pain in females & gallbladder disease

123
Q

What has intense tyrosinase activity?

A

Melanocytes

124
Q

What is the shoulder muscle over the humerus shown in the MRI?

A

Supraspinatus

125
Q

How is blood flow decreased to the hands?

A

Norepinephrine is released around cutaneous blood vessels and causes constriction.

126
Q

What types of channels are nicotinic receptors?

A

ACh from preganglionic neurons binds here.

-They are Na+ channels/depolarizing channels

127
Q

How does Botulinum toxin work?

A

It prevents ACh release from nerves to suppress sweating

128
Q

What catalase?

  1. Staph aureus
  2. Strep pyogenes
A
  1. Catalase +

2. Catalase -

129
Q

What is cellulitis and what causes it?

A

Fast spreading - pain, tenderness, warmth, almost any organism can cause this in immunocompromised patients
-Strep. pyogenese or Staph. aureus

130
Q

What happens in a catalase test?

A

Catalase converts hydrogen peroxide to water and oxygen - if catalase +, bubbles form

131
Q

What happens in a coagulase test?

A

Can be used to diff. between Strep (+) and Staph (-). Coagulase is bound to the wall & reacts with fibrinogen, resulting in clumping/precip.

132
Q

Pseudomonas aeruginosa

A

Bacterial skin infections - “hot tube folliculitis” - usually burn wound infection - organism inhabits soil, water & large intestine

133
Q

Clostridium perfringens

A
  • Non-motile, found in soil, skin, intestine & vagina
  • Cellulitis, gas gangrene, food poisoning
  • Can cause crepitus infections (gas production)
134
Q

What is the cause of and treatment for gas gangrene?

A

Clostridium perfringens - pick up spores from soil where they get into deep lacerations

  • Black fluid can leak, shock is possible
  • Surgical removal of infected areas, hyperbaric oxygen to kill anaerobic organisms
  • Usually not blood flow to site to deliver antibiotic
135
Q

Propionibacterium acnes - How does it cause inflammation?

A

Gram (+) rod, releases lipases to digest the surplus of trapped oil. The presence of bacterial metabolism in the clogged pore results in local inflammation.

136
Q

What are the bacterial properties of Staph aureus?

A

Catalase +, Coagulase +, gram (+), cocci - most common skin infection

137
Q

What are the virulence factors of Staph aureus?

A

Protein A, Coagulase, Hemolysins & leukocidins

Skin/Muscoskeletal Final Review (8 decks)

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