Term
| A patient has a musculoskeletal lump/mass. What is the first differential you want to make? |
|
Definition
| Is it neoplastic or non-neoplastic? |
|
|
Term
| A patient has a neoplastic mass. What differential do you want to make? |
|
Definition
| Does it arise from bone/cartilage, or soft tissue? |
|
|
Term
| A patient has a neoplastic mass arising from the bone or cartilage. What differential do you want to make? |
|
Definition
| is it benign or malignant? |
|
|
Term
| A patient has a neoplastic mass arising from the soft tissue. What differential do you want to make? |
|
Definition
| is it benign or malignant? |
|
|
Term
| A patient has a non-neoplastic mass. What differential do you want to make? |
|
Definition
| Is it infectious, traumatic, or other? |
|
|
Term
| What are 3 examples of infections that could cause a mass to appear? |
|
Definition
1. osteomyelitis--bone infection
2. pyomyelitis--a bacterial infection of skeletal muscles that results in a pus-filled abscess
3. other soft tissue abscesses |
|
|
Term
| What are 2 examples of ways that trauma could cause a mass to arise? |
|
Definition
1. hematoma
2. reactive tissue growth |
|
|
Term
| What are 2 possible causes of masses that are non-neoplastic, non-infectious, and non-traumatic. |
|
Definition
1. congenital--maybe they're just genetically destined to grow a lump there
2. vascular (thrombosis) |
|
|
Term
| Why would you be concerned about diabetes when examining a lump? |
|
Definition
| Diabetes can compromise blood supply, which can contribute to bacteremia. |
|
|
Term
| What test do you ALWAYS do when you find a lump. |
|
Definition
|
|
Term
|
Definition
| (“pus” + “muscle” + “inflammtation”)—infection of the skeletal muscle that results in a puss-filled abscess |
|
|
Term
| What are some morphological features of benign tumors? |
|
Definition
very well encapsulated (distinct capsule)
Tend to grow equally in all directions unless bone stops it (roughly spherical)
Very homogeneous—all looks the same, same color. Resemble tissues from which the tumor arose (well-differentiated)
Grows slowly and pushes other tissues out of the way--does not infiltrate other tissues. |
|
|
Term
| What are some morphological characteristics of malignant cancer? |
|
Definition
Not encapsulated; poorly defined borders
tend to Replace/destroy other tissues
Not well differentiated--cells don't resemble tissue from which they arose (aka anaplasia)
Loss of architecture--cancer tissue doesn't resemble tissue from which it arose
Pleomorphism--not homogeneous --differently sized & shaped cells & nuclei. Irregular nuclear contours.
Hyperchromasia--nuclei are darker than normal
Lower cytoplasm to nucleus ratio than normal.
More cells are in cell cycle than normal, & mitosis may look weird.
Necrosis |
|
|
Term
| A painless, non-inflamed and growing musculoskeletal mass is suggestive of a |
|
Definition
| sarcoma (malignant connective tissue neoplasm) |
|
|
Term
|
Definition
| malignant connective tissue neoplasm |
|
|
Term
| most common site of soft tissue sarcomas |
|
Definition
|
|
Term
| imaging of choice for head and neck, extremity, parameningeal, and pelvic tumors |
|
Definition
|
|
Term
|
Definition
| a reversion of cancer cells to undifferentiated state (poorly differentiated) |
|
|
Term
|
Definition
| when nuclei are darker than normal; a sign of malignant neoplasm |
|
|
Term
| Why are areas of necrosis common in cancer? |
|
Definition
| Because the cancer masses often outgrow their blood supply |
|
|
Term
| What happens to the ratio of cytoplasm:nucleus in cancer cells? |
|
Definition
|
|
Term
| True or false: it's always better to have a benign tumor than a malignant tumor |
|
Definition
| False: it's much better to have malignant skin cancer (which may be easy to take care of) than an inoperable benign tumor in your brain (which will kill you) |
|
|
Term
| What is reactive tissue growth? |
|
Definition
Tissue starts to repair; grows too much
Reactive tissue growth usually eventually disappear (after a few months), but may stay forever |
|
|
Term
|
Definition
| (“pus” + “muscle” + “inflammtation”) infection of the skeletal muscle that results in a puss-filled abscess |
|
|
Term
|
Definition
|
|
Term
| If a patient has a lump or mass, when do you do a complete blood count? |
|
Definition
|
|
Term
| The _________ __________ of C5, C6, C7, C8, & T1 go into the brachial plexus |
|
Definition
|
|
Term
| The anterior rami of what spinal nerves go into the brachial plexus? |
|
Definition
|
|
Term
| The 5 roots of the brachial plexus merge to form __ (#) __________ |
|
Definition
|
|
Term
| C5 & C6 joint to form the __________ trunk |
|
Definition
|
|
Term
| C7 becomes the _________ trunk of the brachial plexus |
|
Definition
|
|
Term
| C8 & T1 merge to form the __________ trunk of the brachial plexus |
|
Definition
|
|
Term
| Each of the 3 trunks of the brachial plexus divides into a(n) __________ and a(n) _____________ division |
|
Definition
|
|
Term
| The 6 Divisions of the brachial plexus re-group to become ______ (#) _____________ |
|
Definition
|
|
Term
| The 3 cords of the brachial plexus split & re-branch to become ___ (#) ___________ |
|
Definition
|
|
Term
| The posterior cord of the brachial plexus splits to form the _________ & _________ nerves |
|
Definition
|
|
Term
| The 3 cords of the brachial plexus are the _________, ________, and _________ cords. |
|
Definition
|
|
Term
| The lateral cord splits to form the ___________ nerve, then joins with part of the medial cord to form the _________ nerve |
|
Definition
|
|
Term
| The medial cord splits to form the _________ nerve, then joins with part of the lateral cord to form the _________ nerve |
|
Definition
|
|
Term
Explain the following Mnemonic:
Real Texans Drink Cold Beer
(and hold the beer with their arm) |
|
Definition
The divisions of the brachial plexus, from proximal to distal, are
Roots
Trunks
Divisions
Cords
Branches |
|
|
Term
| Where does dorsal scapular nerve arise from? |
|
Definition
| branches directly off C5 root |
|
|
Term
| What 2 muscles does the dorsal scapular nerve innervate? |
|
Definition
rhomboid major
rhomboid minor |
|
|
Term
| What happens if there is a lesion to the dorsal scapular nerve? |
|
Definition
scapula will sag laterally (further from midline than normal)
cannot adduct scapula |
|
|
Term
| Where does the suprascapular nerve arise from? |
|
Definition
| branches off the anterior division of the superior trunk of the brachial plexus |
|
|
Term
| What 2 muscles does the suprascapular nerve innervate? |
|
Definition
supraspinatus
infraspinatus |
|
|
Term
| What happens if there is a lesion to the suprascapular nerve? |
|
Definition
supraspinatus & infraspinatus don't work
can’t abduct arm at shoulder (b/c supraspinatus is sole-ly responsible for first 20 degrees of abduction)
weakness in lateral (external) rotation of arm (because infraspinatus, teres major, & teres minor externally rotate arm)
visible muscular deficit over the scapula |
|
|
Term
| Where does the phrenic nerve arise from? |
|
Definition
| arises from ventral primary rami of C3, C4 C5 |
|
|
Term
| What muscle does the phrenic nerve innervate? |
|
Definition
|
|
Term
| What does a lesion to the phrenic nerve cause? |
|
Definition
| difficulty with abdominal breathing (if nerve is destroyed, diaphragm is paralyzed on that side of the body) |
|
|
Term
| Where does the long thoracic nerve of Bell arise from? |
|
Definition
| arises from the roots of C5, C6, & C7 |
|
|
Term
| What muscle does the long thoracic nerve of Bell innervate? |
|
Definition
|
|
Term
| What does a lesion of the long thoracic nerve of Bell cause? |
|
Definition
paralysis of serratus anterior muscle causes medial border of scapula to move laterally & posteriorly away from thoracic wall, giving a “winged” appearance
upper limb cannot be abducted above the horizontal position |
|
|
Term
Explain the following mnemonic:
“C5, C6, C7 make your wings go up to heaven” |
|
Definition
The long thoracic nerve of bell arises from the roots of C5, C6, and C7, and innervates the serratus anterior muscle
a lesion of the long thoracicnerve of bell leads to paralysis of serratus anterior muscle causes medial border of scapula to move laterally & posteriorly away from thoracic wall, giving a “winged” appearance |
|
|
Term
| Why is the long thoracic nerve of Bell vulnerable, and when? |
|
Definition
| nerve goes along superficial part of serratus anterior, making it vulnerable when the arms are elevated as in a knife fight (that is, if you're stabbed in the back) |
|
|
Term
| Where does the medial pectoral nerve arise from? |
|
Definition
| branches off of the medial cord of the brachial plexus |
|
|
Term
| What 2 muscles doe the medial pectoral nerve innervate? |
|
Definition
pectoralis minor
part of pectoralis major |
|
|
Term
| Where does the lateral pectoral nerve arise from? |
|
Definition
| branches off the lateral cord of the brachial plexus |
|
|
Term
| What muscle does the lateral pectoral nerve innervate? |
|
Definition
| (part of) the pectoralis major |
|
|
Term
| Where does the upper suprascapular nerve arise from? |
|
Definition
| branches off the posterior cord of the brachial plexus |
|
|
Term
| What muscle does the upper subscapular nerve innervate? |
|
Definition
| subscapularis muscle (along with the lower subscapular nerve) |
|
|
Term
| What does a lesion of the upper subscapular nerve cause? |
|
Definition
| weakness in adducting arm at shoulder |
|
|
Term
| Where does the lower subscapular nerve arise from? |
|
Definition
| branches off the posterior cord of the brachial plexus |
|
|
Term
| What 2 muscles does the lower subscapular nerve innervate? |
|
Definition
subscapularis muscle (along with upper subscapular nerve)
teres major |
|
|
Term
| What does a lesion in the lower subscapular nerve cause? |
|
Definition
weakness in adducting arm at shoulder
weakness in medial (internal) rotation of arm |
|
|
Term
| Where does the thoracodorsal nerve arise from? |
|
Definition
| branches off the posterior cord |
|
|
Term
| What muscle does the thoracodorsal nerve innervate? |
|
Definition
|
|
Term
| What does a lesion of the thoracodorsal nerve cause? |
|
Definition
| paralysis of latissimus dorsi—inability to raise the trunk with the upper limbs (such as during climbing); an inability to effectively row |
|
|
Term
| Why is the thoracodorsal nerve vulnerable during surgery on the back or underarm? |
|
Definition
passes along posterior wall of axilla (makes it vulnerable during surgery)
also vulnerable to surgery on scapular nodes because it terminates just anterior to them & to the suprascapular artery |
|
|
Term
| Where does the medial cutaneous nerve of the arm arise? |
|
Definition
| branches off the medial cord of the brachial plexus |
|
|
Term
| When area of skin is the sensory territory of the medial cutaneous nerve of the arm? |
|
Definition
| medial surface of arm (upper arm) |
|
|
Term
| What does a lesion of the medial cutaneous nerve of the arm cause? |
|
Definition
| numbness on medial surface of arm (upper arm) |
|
|
Term
| The disk diffusion test to find Minimum Inhibitory Concentration (MIC) is aka _________________________ |
|
Definition
|
|
Term
| In the Kirby-Bauer test, what does a bigger clear zone around a disk mean? |
|
Definition
| that the substance impregnated in the disk has a smaller Minimum Inhibitory Concentration (MIC) |
|
|
Term
| What is the purpose of the Kirby-Bauer test? |
|
Definition
| to find the Minimum Inhibitory Concentration (MIC) of a substance |
|
|
Term
| the lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation |
|
Definition
| Minimum Inhibitory Concentration (MIC) |
|
|
Term
| What are the 3 steps of acid fast staining? |
|
Definition
Bacteria are stained red with Carbol fuchsin stain
Bacteria are decolorized with an acid (only non-acid-fast bacteria declorize)
Bacteria are counter-stained blue with methylene blue counterstain |
|
|
Term
In acid-fast staining, bacteria are stained _______ (color) with __________ stain
Bacteria are decolorized with an acid (only non-acid-fast bacteria declorize)
Bacteria are counter-stained _______ (color) with ___________ counterstain |
|
Definition
red
Cartbol fuchsin
blue
methylene blue |
|
|
Term
| What do acid-fast bacteria look like after acid-fast staining? What do non-acid-fast bacteria look like? |
|
Definition
acid-fast bacteria stain red
non-acid-fast bacteria stain blue |
|
|
Term
| What is the most important genus of acid-fast bacteria? |
|
Definition
|
|
Term
| Mycobacteria are acid-fast because they have a lot of acid-fast ___________ in their ___________ |
|
Definition
|
|
Term
| What genus of bacteria causes tuberculosis & leprosy? |
|
Definition
Mycobacteria
(Mycobacteria tuberculosis
Mycobacteria leprae) |
|
|
Term
| What are the advantages of using acid-fast staining to test for TB? |
|
Definition
cheap
fast (only takes a few hours to go from drawing the sample to getting the results) |
|
|
Term
| What are the dis-advantages of using acid-fast staining to test for TB? |
|
Definition
| It has low sensitivity for TB (high false negative) and poor positive predictive value for TB (high false positive) |
|
|
Term
| What bacterium causes tuberculosis? |
|
Definition
| Mycobacterium tuberculosis |
|
|
Term
| What does a positive skin-prick test for TB mean? |
|
Definition
that they have TB, had TB, or were immunized against TB
More testing is needed |
|
|
Term
| If respiratory TB is suspected, what does the CDC recommend that you do with a sputum sample? |
|
Definition
| CDC recommends nucleic acid amplification (NAA) or polymerase chain reaction (PCR) testing on sputum sample |
|
|
Term
| If a person has TB, what do they need to have before they can be cleared to return to work by a physician? |
|
Definition
| minimum of three sputum samples negative for acid fast bacteria (AFBs) must be recorded before the patient should be cleared to return to work by the physician. |
|
|
Term
| If you suspect respiratory TB, what kind of imaging might you do? |
|
Definition
|
|
Term
| What kind of TB is resistant to the most effective anti-TB drugs (but not to 2nd-line drugs)? |
|
Definition
| Multi-Drug Resistant TB (MDR-TB) |
|
|
Term
| What kind of TB is resistant to the most effective anti-TB drugs and to 2nd-line drugs? |
|
Definition
| Extensively Drug Resistant TB (XDR-TB) |
|
|
Term
| Are Multi-Drug Resistant TB (MDR-TB) and Extensively Drug Resistant TB (XDR-TB) are endemic to the US? Are they a concern? |
|
Definition
| Both have been found in the U.S., though they are not endemic. There is concern that TB could enter the U.S. via immigration. |
|
|
Term
| Describe the process of Indirect Immunofluroescence |
|
Definition
Fix specimen cells to a microscope slide. Expose cells to antibody for specific pathogen you suspect. Expose to a fluorescently-labeled antibody for the Fc region of the first antibody. Look for fluorescence
(easier to use than direct fluorescence because you only need one kind of fluorescently-labeled antibody) |
|
|
Term
| What are some microorganisms for which Indirect Immunofluorescence is commonly used for detection? |
|
Definition
M. tuberculosis (know this one!)
Borrelia
HSV
Bartonella (cat-scratch fever)
Cryptosporidium parvum
Malaria
Filariasis
Trichomonas vaginalis
Chlamydia trachomatis |
|
|
Term
| A benign tumor composed of mature adipocytes (no fetal or anaplastic weirdness) with uniform nuclei |
|
Definition
|
|
Term
| Most common soft tissue tumor |
|
Definition
|
|
Term
| Where do lipomas most commonly occur? |
|
Definition
| Mostly subcutaneous: in back, shoulder, neck, abdomen, or proximal extremities |
|
|
Term
| Describe the histomorphology of lipomas |
|
Definition
slow growing, soft & fleshy, asymptomatic
well-circumscribed
similar density to fat
encapsulated (that’s what makes it palpable)
normal cell appearance |
|
|
Term
|
Definition
Mostly, leave them alone.
Can be surgically removed, if necessary |
|
|
Term
| malignant tumor composed of mature adipocytes |
|
Definition
|
|
Term
| Most common of all malignant soft tissue tumors (though still rare) |
|
Definition
|
|
Term
| At what age do liposarcomas mostly appear? |
|
Definition
|
|
Term
| Where do liposarcomas usually appear? |
|
Definition
Usually deep-seated masses (ex. Middle of thigh, retroperitoneum)
(as oppposed to lipomas, which are usually subcutaneous) |
|
|
Term
| Are liposarcomas well-circumscribed or infiltrative? |
|
Definition
| Can be either. Infiltrative are more aggressive. |
|
|
Term
| A fatty tumor contains a cell that looks like circles within circles. What is this cell called, and what does it indicate? |
|
Definition
this kind of cell is a lipoblast
it indicates the the fatty tumor is probably a liposarcoma (which tend to have a lot of lipoblasts), not a lipoma (which don't) |
|
|
Term
| Describe the histomorphology of liposarcoma. |
|
Definition
can be well-circumscribed or infiltrative
contains many lipoblast cells (looks like smaller circles within a bigger circle)
cells may be all of same shape(ex., all round), or pleomorphic
nuclei of different sizes & shapes
loss of architecture |
|
|
Term
| What is the treatment for liposarcoma? |
|
Definition
Surgical removal
If borders are clear, that’s it
If not, post-surgical radiation |
|
|
Term
|
Definition
Normal scarring
An ill-defined lesion of scar tissue that replaces normal architecture and is isolated to site of injury |
|
|
Term
| a type of scar with overgrowth of granulation tissue such that fibrosis extends beyond site of injury |
|
Definition
|
|
Term
| In whom do keloid scars more often occur? |
|
Definition
|
|
Term
| Is surgical removal of a keloid scar likely to be successful? |
|
Definition
| No. More than half grow back. |
|
|
Term
| benign, non-neoplastic, process that occurs in reaction to trauma. Composed of fibroblasts & myofibroblasts, mostly in superficial fascia, ill-defined like a scar |
|
Definition
|
|
Term
| What treatment is used for Nodular Fascitis (NF)? |
|
Definition
None needed; usually goes away on its own in a few weeks & rarely causes problems
Can surgically remove if they want |
|
|
Term
| Benign soft tissue tumors consisting of proliferating, well-differentiated fibroblasts; ill-defined like a scar; can be superficial or deep |
|
Definition
|
|
Term
| How likely is fibromatosis to metastasize? |
|
Definition
| fibromatosis never metatasizes |
|
|
Term
| Describe superficial vs. deep fibromatosis |
|
Definition
Superficial—tend to be small & non-aggressive, but can be painful & disfiguring
deep--tend to be larger & more locally aggressive (but never metastasize) |
|
|
Term
| A painful, fibrous placque on the penis that causes the penis to bend in the direction of the plaque is a type of |
|
Definition
|
|
Term
| Who is most likely to get nodular fascitis? |
|
Definition
|
|
Term
| Why is it not easy to surgically remove a fibromatosis? |
|
Definition
| because it is ill-defined (like a scar) |
|
|
Term
| malignant spindle cell (a type of neuron) neoplasm that exclusively exhibits fibroblastic differentiation without production of osseous or chondroid matrix by the neoplastic cells |
|
Definition
|
|
Term
| How does fibrosarcoma look similar to fibromatosis? How does it look different? |
|
Definition
fibromatosis & fibrosarcoma both appear as proliferation of fibroblasts
fibrosarcoma is darker in color than fibromatosis b/c more nuclei, less cytoplasm
fibrosarcoma shows a herring-bone pattern of fibroblasts |
|
|
Term
| While not diagnostic, a herring-bone pattern of fibroblasts means you should consider __________ |
|
Definition
|
|
Term
| How do you treat fibrosarcoma? |
|
Definition
Mostly surgical removal
Possible radiation |
|
|
Term
| a tumor of fibroblasts & mononuclear or multinuclear cells that resemble histiocytes (macrophages) |
|
Definition
| Benign fibrous histiocytoma (BFH) |
|
|
Term
| What does Benign Fibrous Histiocytoma (BFH) have to do with histiocytes? |
|
Definition
| Nothing. It is a tumor of fibroblasts & mononuclear or multinuclear cells that RESEMBLE histiocytes (macrophages), but macrophages are not involved. |
|
|
Term
| At what age do people typically get Benign Fibrous Histiocytoma (BFG)? |
|
Definition
| Almost any age. Patients range from 5-75 years of age |
|
|
Term
| Cells that look like macrophages with "foamy" cytoplasm tend to occur in _______________________ |
|
Definition
| Benign fibrous histiocytoma (BFH) |
|
|
Term
| Macroscopically, how does Benign fibrous histiocytoma (BFH) appear? |
|
Definition
well-circumscribed mass
often yellow because of lipid-filled cells |
|
|
Term
| How do you treat benign fibrous histiocytoma (BFH)? Is the prognosis usually good or bad? |
|
Definition
Nothing, or surgically remove
Usually very good prognosis |
|
|
Term
| a sarcoma of fibroblasts, myofibroblasts, and cells resembling histiocytes under light microscopy |
|
Definition
| Malignant fibrous histiocytoma (MFH) |
|
|
Term
| At what age does Malignant fibrous histiocytoma (MFH) typically occur? |
|
Definition
| Equally distributed throughout adulthood (20-100) |
|
|
Term
| Where does Malignant fibrous histiocytoma (MFH) typically often occur? |
|
Definition
Mostly in deep tissue
Often occurs in epiphysis of long bones |
|
|
Term
| How does the histomorphology of Malignant fibrous histiocytoma (MFH) compare to that of Benign fibrous histiocytoma (BFH) |
|
Definition
like BFH, MFH shows
fibroblasts & histiocyte (macrophage) -looking cells
lipid-filled cells can often be seen (appears yellow on macro images)
Unlike, BFH, MFH shows
an ill-defined mass
cells have malignant features (such as variety in cell and nuclear appearance) |
|
|
Term
| How is malignant fibrous histiocytoma treated? Is the prognosis usually good or bad? |
|
Definition
Surgical removal
radiation treatment
possible chemotherapy if metastasis occurs.
Often poor prognosis |
|
|
Term
| benign tumor of smooth muscle |
|
Definition
|
|
Term
| What is the most common leiomyoma? |
|
Definition
| uterine fibroids (these are quite common) |
|
|
Term
| malignant tumor of smooth muscle |
|
Definition
|
|
Term
| benign tumor of cells that arises from skeletal muscle; striated like skeletal muscle |
|
Definition
|
|
Term
| What does Rhabdomyoma look like? |
|
Definition
| striated like skeletal muscle |
|
|
Term
| What does rhabdomyosarcoma look like? |
|
Definition
very pleomorphic (looks quite different than skeletal muscle)
One type resembles skeletal muscle of very young embryo
Another type resembles skeletal muscle of slightly older embryos
A third type resembles adult skeletal muscle, but more pleomorphic |
|
|
Term
| malignant tumor of cells that arise from skeletal muscle |
|
Definition
|
|
Term
| Most common soft tissue sarcoma in children |
|
Definition
|
|
Term
| What is unsual about the epidemiology of rhabdomyoma vs. rhabdomyosarcoma. |
|
Definition
| While both are rare, rhabdomyoma is actually MORE rare than rhabdomyosarcoma (it's very unusual for the benign version to be less common than the malignant version) |
|
|
Term
| benign proliferation of blood vessels in skin or internal organs |
|
Definition
|
|
Term
| Most common childhood tumor |
|
Definition
|
|
Term
| Who is most likely to get hemangiomas? |
|
Definition
Caucausion newborns
~10% of Caucasians are born with this kind of tumor (usually disappear eventually) |
|
|
Term
| Describe the histomorphology of hemangiomas |
|
Definition
if it's on the on skin: raised lesion; red to reddish-purple
many are asymptomatic
well circumscribed; strong uptake of contrast |
|
|
Term
| Where on the body do most hemangiomas occur? |
|
Definition
| 80% occur on the face & neck |
|
|
Term
| What is the treatment for hemangiomas? |
|
Definition
| Mostly, it will go away on its own |
|
|
Term
| low grade clonal endothelial proliferation with a variably vasoformative or spindle cell growth as a result of infection with human herpes virus 8 (HHV8) |
|
Definition
|
|
Term
| What virus causes Kaposi sarcoma? |
|
Definition
| human herpes virus 8 (HHV8) |
|
|
Term
| In whom does classic Kaposi Sarcoma (KS) most commonly occur? In whom does endemic Kaposi Sarcoma most commonly occur? |
|
Definition
Classic KS: elderly men from Mediterraneoun or Eastern Europe
Endemic KS: young AIDS patients from sub-Saharan Africa |
|
|
Term
| Why do AIDs patients often get Kaposi Sarcoma? |
|
Definition
human herpes virus 8 (HHV8), which causes Kaposi Sarcoma, is an STD that's often comorbid with AIDs
(also, AIDs inhibits the body's ability to fight Kaposi Sarcoma; but AIDs doesn't cause Kaposi Sarcoma) |
|
|
Term
| Describe the histomorphology of Kaposi Sarcoma (KS) |
|
Definition
| spindle-like vessels may not be well-formed, so may bleed into tissues |
|
|
Term
| malignant neoplasm derived from blood or lymphatic vessels |
|
Definition
|
|
Term
| malignant neoplasm derived from blood vessels |
|
Definition
|
|
Term
| malignant neoplasm derived from lymph vessels |
|
Definition
|
|
Term
| What pre-existing conditions can increase the risk of angiosarcoma? |
|
Definition
radiation exposure
AIDS
chronic lymphedema
environmental carcinogens
foreign body material in the body |
|
|
Term
| soft tissue sarcoma arising from unknown source cells in which cells resemble synovium (synovial membrane) |
|
Definition
|
|
Term
| almost always unilocular (one place) intramedullary (in the bone marrow) cavity filled with clear or bloody fluid |
|
Definition
| Solitary (unicameral) bone cyst |
|
|
Term
| While most of these are asymptomatic, this condition is the most frequent cause of pathologic fractures in children |
|
Definition
| Solitary (unicameral) bone cyst |
|
|
Term
| Where do solitary (unicameral) bone cysts most often occur? |
|
Definition
| Most occur in metaphysis (line between epiphysis at end, & diaphysis, in middle) |
|
|
Term
| How do solitary (unicameral) bone cysts appear in radiographs? |
|
Definition
Radiolucent (dark)
Well-circumscribed within cortical bone |
|
|
Term
| How are solitary (unicameral) bone cysts typically treated? How successful is this treatment usually? |
|
Definition
curettage—surgical scraping with a curette
Followed by insertion of bone chips
Usually successful
Recurrences are very rare |
|
|
Term
| Benign, hemorrhagic (filled with blood) cavity that often presents as rapidly expanding, locally destructive, multicystic lesion |
|
Definition
| Aneurysmal Bone Cysts (ABC) |
|
|
Term
| What is the microscopic histomorphology of Aneurysmal Bone Cysts (ABC) |
|
Definition
| a lot of fibrosis, scar tissue, may have a giant cells or a tiny bit of bone formation |
|
|
Term
| What is the typical treatment for Aneurysmal Bone Cysts (ABC)? How successful is this treatment? |
|
Definition
Most required treatment: curettage & stuff with ground bone
20-70% have recurrence
But 90% ultimately have very good prognosis |
|
|
Term
| A tumor-like mass of abnormally dense, microscopically normal bone occurring almost exclusively in the skull, paranasal sinuses, and facial bones. They are rounded tumors that project from the subperiosteal surfaces of the cortex. |
|
Definition
|
|
Term
| benign, highly vascular, sharply defined osteoblastic proliferation that is usually <1cm (always <2cm) |
|
Definition
|
|
Term
| The pain associated with osteoid osteoma typically responds to _________ |
|
Definition
|
|
Term
| A benign, highly vascular, sharply defined osteoblastic proliferation that is >1 cm in size. |
|
Definition
|
|
Term
| How is the pain from osteoid osteoma different than the paint form osteoblastoma? |
|
Definition
| pain from osteoid osteoma typically responds to NSAIDs, while pain from osteoblastome does not. |
|
|
Term
| a malignant neoplasm of bone that demonstrates at least focal osteoid production by neoplastic ccells |
|
Definition
|
|
Term
| Cell Cycle Specific (CCS) |
|
Definition
| anti-cancer treatments that are only toxic to cells that are undergoing the cell cycle (mitosis or meiosis) |
|
|
Term
| Cell Cycle Non-Specific (CCNS) |
|
Definition
| anti-cancer treatments that kill cells whether they’re in cell cycle or not |
|
|
Term
| Do Cell Cycle Specific (CCS)or Cell Cycle Non-Specific (CCNS)cancer treatments have higher selective toxicity, and why? |
|
Definition
• Selective toxicity—ability of drug to kill the chosen cell (microbe or cancer cell) without harming the patient
Cell Cycle Specific (CCS) have higher selective toxicity because tumor cells are more likely to be in-cycle than most normal cells |
|
|
Term
| Explain the selective toxicity of cancer treatments vs. antimicrobial treatments |
|
Definition
Selective toxicity—ability of drug to kill the chosen cell (microbe or cancer cell) without harming the patient
o Anti-cancer drugs typically have lower selective toxicity than antimicrobials b/c there are fewer differences between human cancer cells & normal cells than between microbial cells & human cells |
|
|
Term
| What are some features of cancer cells that can be taken advantage of by anti-cancer treatments so that they are more selectively toxic? |
|
Definition
Rapidly dividing (more likely to be in mitosis or meiosis)
Less selective about things they uptake (could give a drug that’s a “faulty” version of a normal component)
Express abnormal proteins (ex., fetal proteins, proteins that immune system cells aren’t screened against in bone marrow/thymus) |
|
|
Term
| What are some differences between cancer cells and normal cells that help selectively kill cancer cells |
|
Definition
cancer cells rapidly divide (more likely to be in mitotic phase)
Cancer cells are less selective about things they uptake (could give a drug that’s a “faulty” version of a normal component)
Cancer cells may express abnormal proteins (ex., fetal proteins, proteins that immune system cells aren’t screened against in bone marrow/thymus) |
|
|
Term
| What are 3 or 4 areas of the body that suffer (typically) reversible ill effects from Cell Cycle Specific (CCS) cancer treatments, and what do happens in those areas? |
|
Definition
Bone marrow-->neutropenia, anemia
Hair follicles-->hair loss
Gut lining-->gut sores
Oral mucous membranes-->mouth ulcers |
|
|
Term
| Why are mouth ulcers a serious problem in cancer patients? |
|
Definition
| they can get infected (most cancer patients are immunocompromised because of bone marrow side effects) and can not-uncommonly cause death |
|
|
Term
| What is the best thing to do to reduce the risk of death by infected mouth ulcer in cancer patients? |
|
Definition
| before starting chemotherapy, pre-treat with keratinocyte growth factor |
|
|
Term
| What are some irreversible effects from Cell Cycle Specific (CCS) cancer treatments? |
|
Definition
Damage to gonadal tissue-->irreversible infertility
irreversible damage to fetus |
|
|
Term
| Why are Cell-Cycle Non-Specific (CCNS) cancer treatments often used before Cell-Cycle Specific (CCS) cancer treatments? |
|
Definition
| Many CCNS drugs can induce cancer cells to enter the cell cycle, increasing their vulnerability to CCS agents |
|
|
Term
| Is increasing the doseage more likely to increase the efficacy or CCNS or CCS drugs? |
|
Definition
More CCNS-->more death of all kinds of cells
CCS kills cycling cells quickly; doesn’t affect non-cycling drugs. Increasing concentration may have little effect |
|
|
Term
| Why would you want to debulk a cancer via surgery, radiation, or Cell-Cycle Non-Specific (CCNS) drugs before using Cell-Cycle Specific (CCS) drugs on a cancer? |
|
Definition
| Cancers often outgrow their blood flow. Debulking the cancer gives the remaining cells more access to nutrients, which makes them more likely to enter the mitotic cycle, which makes them more suscepticle to CCS drugs. |
|
|
Term
Describe the 3 fractions of cancer cells:
Growth fraction
Clonogenic fraction
Terminal fraction |
|
Definition
Growth fraction—actively undergoing cell cycle
Clonogenic fraction—G0; can re-enter cell cycle
Terminal fraction—terminally differentiated & dead cells |
|
|
Term
| You need X drug to reduce a tumor of size Y to half its size in time Z. How much drug to you need to reduce a tumor of size 2Y to half its size in the same amount of time? |
|
Definition
X
Half-life of tumor cells depends on drug dose, but not on tumor size |
|
|
Term
| Why do you give the maximum effective dose to cancer cells, rather than the minimum tolerated dose as in nearly all other pharmacology? |
|
Definition
| Cancer is very rapidly dividing & evolving. Given half a chance, it will develop resistance, so you need to kill that sucker ASAP. |
|
|
Term
| What are the 3 stages of cancer treatment? |
|
Definition
Recruitment/induction/neoadjuvant phase
CCS to kill cells that are currently cycling (leave more nutrients for clonogenic cells)
CCNS to recruit clonogenic cells
Intensification phase
Attempt to achieve remission by
Adding more drugs
Increasing dosage
Reducing interval between cycles
Increasing duration of therapy
Consolidation phase
Maintain remission |
|
|
Term
| Cancer grows ___ (rate) until it runs into problems like _____________. If it "figures out" ________________, it will begin growing very fast! |
|
Definition
exponentially
vascularization (blood supply)
angiogenesis |
|
|
Term
| What are 2 ways that antibiotics can interfere with cancer DNA? |
|
Definition
intercalating (squeezing between base pairs without covalent or electrostatically binding)
generating free-radicals that cause breaks in DNA |
|
|
Term
| an abnormal mass of tissue with cells the exceed normal cell growth and don’t need external stimuli to grow |
|
Definition
|
|
Term
| The 2nd & 3rd most common cancers in men & women are: |
|
Definition
|
|
Term
| The most common cancer in men is _________, while in women its _________ |
|
Definition
prostate cancer
breast cancer |
|
|
Term
| The most common cause of cancer death in men & women is __________, and the third most common cause of cancer death is ___________ |
|
Definition
lung cancer
colorectal cancer |
|
|
Term
| The 2nd most common cause of cancer death is ________ in men and _________ in women. |
|
Definition
prostate cancer
breast cancer |
|
|
Term
| describe benign neoplasms |
|
Definition
don’t metastasize—spread to non-adjacent tissues via movement of cells
usually encapsulated by a thin layer of fibrosis
grow slowly
usually don’t invade surrounding tissues (slowly push them aside rather than permeating through)
well-differentiated—closely resemble tissue of origin
usually better prognosis than malignant
but not always—ex., benign intracranial tumors can be deadly |
|
|
Term
| malignant neoplasms are aka |
|
Definition
|
|
Term
|
Definition
| reversion of differentiation in cells (daughter cells are less differentiated than parent cells); characteristic of malignant neoplasms (malignant cells don’t resemble tissue from which they arose) |
|
|
Term
|
Definition
| multiple shapes & sizes; malignant cells are pleomorphic and have pleomorphic nuclei |
|
|
Term
|
Definition
| nuclei are more pigmented than normal (common in malignant cells) |
|
|
Term
| what kind of cells often have increased nuclear-cytoplasmic ratio? |
|
Definition
| malignant cells (that is, nuclei are big & cytoplasm is small) |
|
|
Term
| In malignant cells, nucleoli are __________ (prominent/difficult to discern) |
|
Definition
|
|
Term
|
Definition
| tumor infiltrates into surrounding tissues |
|
|
Term
|
Definition
| tumor enters lymphatic system, metastasizes to a different site |
|
|
Term
| Metastasis by Hematogenous spread |
|
Definition
| tumor enters blood, metastasizes to a different site |
|
|
Term
| spread to non-adjacent tissues via movement of cells |
|
Definition
|
|
Term
| Malignant neoplasms are defined by doing one or both of what 2 things? |
|
Definition
invade surrounding tissue and/or
metastasize (spread to non-adjacent tissue) |
|
|
Term
| benign neoplasm of squamous epithelium (such as on skin, esophagus, or vaginal lumen) |
|
Definition
|
|
Term
| typical macroscopic appearance of papilloma |
|
Definition
| a raised, projecting lesion |
|
|
Term
| malignant neoplasm of squamous epithelium |
|
Definition
|
|
Term
| benign neoplasm of glandular epithelium (such as in GI tract or prostate gland) |
|
Definition
|
|
Term
| raised projecting lesions of adenoma in benign colon tumors |
|
Definition
|
|
Term
| malignant neoplasm of glandular epithelium |
|
Definition
|
|
Term
| Where does transitional epithelium occur? |
|
Definition
| urinary tract: Bladder, ureters, superior urethra, gland ducts of prostate |
|
|
Term
| benign neoplasm of transitional epithelium |
|
Definition
| Transitional cell papilloma |
|
|
Term
| malignant neoplasm of transitional epithelium |
|
Definition
| Transitional cell carcinoma |
|
|
Term
| benign neoplasms of cartilage |
|
Definition
|
|
Term
| bone, cartilage, skeletal muscle, smooth muscle, connective tissues arise from the _________ layer in the embryo |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| benign tumor of fibrous tissue |
|
Definition
|
|
Term
| malignant tumor of fibrous tissue |
|
Definition
|
|
Term
| There are no _________ hematopoietic neoplasms |
|
Definition
|
|
Term
| malignant neoplasm of lymphocytes |
|
Definition
|
|
Term
| malignant neoplasm of granulocytes in bone marrow (neutrophils, eosinophils, basophils) |
|
Definition
|
|
Term
| Malignant neoplasm of lymphocytes in bone marrow |
|
Definition
|
|
Term
| Malignant neoplasm of plasma cells |
|
Definition
|
|
Term
| Tumors that arise from progenitors of gametes. Can occur in men & women. Can be benign or malignant. Classification is based on histology |
|
Definition
|
|
Term
| __________ tumors exist at the same site where they arose while a ________ tumor tumor that has traveled to another noncontiguous site or organ. |
|
Definition
|
|
Term
| any abnormal tissue found on or in an organism, usually damaged by disease or trauma |
|
Definition
|
|
Term
| a mass formed by faulty development so that histologically normal tissue develops in an abnormal place; can be confused with a neoplasm |
|
Definition
| Choristoma (“separate” + “body”) |
|
|
Term
|
Definition
|
|
Term
| a benign mass of tissue elements that are normally found at that site, but which are growing in a disorganized mass. Unlike a benign neoplasm, it grows at the same rate as the surrounding tissues. |
|
Definition
| Hamartoma (“flawed” + “body”) |
|
|
Term
| How is a hamartoma like a neoplasm? How is it different? |
|
Definition
like a benign neoplasm a benign mass of tissue elements that are normally found at that site, but which are growing in a disorganized mass
Unlike a benign neoplasm, it grows at the same rate as the surrounding tissues. |
|
|
Term
| word for moderately differentiated tissue (not exactly like the the differentiated tissue from which it arose, but not completely ill-defined, either) |
|
Definition
|
|
Term
| What are "reactive changes" reacting to? |
|
Definition
| trauma; reactive changes are part of the normal healing process |
|
|
Term
| Hyperplasia is increased proliferation of cells in which cells remain subject to: |
|
Definition
| normal regulatory control mechanisms |
|
|
Term
| What 4 changes characterize dysplasia? |
|
Definition
cells of unequal size
abnormally shaped cells
hyperchromatism
an unusual proportion of cells which are currently dividing
dysplasia is pre-cancer and is less severe than anaplasia, which is a sign of advanced cancer |
|
|
Term
| Dysplasia is a sign of ____, while anaplasia is a sign of __________ |
|
Definition
pre-cancer or early cancer
advanced cancer |
|
|
Term
|
Definition
| an early form of carcinoma defined by the absence of invasion of surrounding tissues |
|
|
Term
| If left untreated, what will carcinoma in situ typically do? |
|
Definition
| if left untreated, carcinoma in situ will eventually invade & become a malignant neoplasm |
|
|
Term
|
Definition
| wasting (common in malignant neoplasms) |
|
|
Term
| A clinical presentation with symptoms that are caused by a tumor or tumors, but occur systemically or not in the same place as the tumor. |
|
Definition
|
|
Term
| What are the 2 main types of paraneoplastic syndrome? |
|
Definition
imbalance of hormones or hormone-like chemicals because a tumor that is not near the normal hormone-producing tissue produces the hormone or hormone-like chemical
Auto-immune defects caused by immune system “getting confused” while it’s fighting the cancer
A paraneoplastic syndrome is a clinical presentation with symptoms that are caused by a tumor or tumors, but occur systemically or not in the same place as the tumor. |
|
|
Term
| Describe the 3 or 4 parameters used to determine TNM pathologic stage |
|
Definition
T—Tumor size/extent of invasion
N—are any lymph Nodes positive for metastatic tumor?
M—is is Metastatic?
G—histopathologic Grade (how well differentiated; applies to most, but not all tumors) |
|
|
Term
| What 2 pieces of information are typically used to estimate 5-year prognosis for cancer? |
|
Definition
1. type of cancer
2. TNM stage of cancer |
|
|
Term
|
Definition
| chemicals typically released into the blood by a specific type of cancer (have varying specificities & sensitivities, but none are diagnostic) |
|
|
Term
| The medial cutaneous nerve of the forearm arises from: |
|
Definition
| Branches off the medial cord of the brachial plexus |
|
|
Term
| Where is the sensory territory of the medial cutaneous nerve of the forearm? |
|
Definition
| the median (pinkie) of the forearm (both antero-medial & postero-medial) |
|
|
Term
| The lateral cutaneous nerve of forearm is a sensory branch of the ___________ nerve |
|
Definition
|
|
Term
| Where is the sensory territory of the musculocutaneous nerve? |
|
Definition
| lateral compartment of forearm |
|
|
Term
| What 3 muscles does the musculocutaneous nerve innervate? |
|
Definition
Biceps brachii
Coracobrachialis
Brachialis muscle |
|
|
Term
| Tiny muscle that originates from coracoid process of scapula (the bit that sticks through to the front ofthe shoulder) & inserts on front of humerus. Draws the humerus forward (shoulder flexion) and towards the torso (shoulder adduction) |
|
Definition
|
|
Term
| What muscle attaches to middle of anterior humerus & top of ulna? |
|
Definition
|
|
Term
| What does the brachialis do? |
|
Definition
| strongest flexor of the elbow |
|
|
Term
| What 3 things does a lesion of the musculocutaneous nerve cause? |
|
Definition
Weakness of bicep-->weakness of supination (turning palm up)
Weakness of brachialis & biceps-->weakness of forearm flexion
Numbness of lateral compartment of forearm |
|
|
Term
| What does the biceps brachii do? |
|
Definition
| Flexes elbow & supinates forearm (turns palm up) |
|
|
Term
| A lesion of the musculocutaneous nerve weakens elbow flexion & forearm supination (turning palm up) but does not cause loss of those abilities because the ___________ nerve also contributes to those abilities. |
|
Definition
|
|
Term
| What nerve innervates the pronator teres, flexor carpi radialis, palmaris longus, flexor policis, flexor digitorum superficialis, pronator quadratus, flexor digitorum profundis to digits 2&3, lumbricals to digits 2&3, & thenar muscles? |
|
Definition
|
|
Term
| Anterior to the elbow (at the cubital fossa), the _____________ branches into ________________ and _________________ |
|
Definition
median nerve
anterior interosseous branch of median nerve median nerve proper |
|
|
Term
| What compartment does the anterior interosseus branch innervate? |
|
Definition
| Deep compartment of forearm |
|
|
Term
| What compartment does the median proper nerve innervate? |
|
Definition
| Superficial Compartment of forearm |
|
|
Term
| What 3 muscles does the anterior interosseus branch of the median nerve innervate? |
|
Definition
Lateral ½ flexor digitorum profundus
Pronator quadratus
Flexor pollicis longus |
|
|
Term
| What 4 muscles does the median nerve proper innervate? |
|
Definition
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis |
|
|
Term
| The anterior sides of the thumb, index, middle, lateral side of ring finger are the sensory territory of what nerve? |
|
Definition
|
|
Term
| What 3 muscles does the recurrent branch of the median nerve innervate? |
|
Definition
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis |
|
|
Term
| What syndrome is caused by a high median nerve neuropathy (that is, close to the origin of the median nerve)? |
|
Definition
|
|
Term
| Pain in Forearm, weakness in Hand Grip, and benediction attitude are symptoms of ____________ syndrome, caused by a lesion where? |
|
Definition
pronator teres
high median nerve neuropathy |
|
|
Term
|
Definition
| limp to avoid putting weight on a painful limb (ex., splinter in sole; neoplasm in knee, etc.) |
|
|
Term
| Trenelenberg sign is caused by a decreased ability to ________ the hip. |
|
Definition
| abduct (that is to pull the leg out laterally, which would pull the hip in) |
|
|
Term
| In trendelenberg sign the pelvis tilts _____________ the affected side |
|
Definition
| away from (the affected side is high &the non-affected is low) |
|
|
Term
|
Definition
| walk on toes of short limb |
|
|
Term
|
Definition
high steps to compensate for dropfoot due to peroneal injury or
gastrocnemeus contracture |
|
|
Term
| Steppage gait involves high steps to compensate for dropfoot due to injury to ___________ nerve (most commonly) or contracture of _____________ |
|
Definition
peroneal (aka deep fibular)
gastrocnemius |
|
|
Term
|
Definition
gait in which trunk sways from side to side with each step due to lack of stabilization in hips—weight-bearing hip bulges outward while opposite side of pelvis drops
caused by bilateral dislocated hips or neurological disease |
|
|
Term
|
Definition
| to clear foot from floor, must pull pelvis up & circumduct leg because knee won’t bend |
|
|
Term
| gait typical of cerebral palsy--stiff looking, often dropped toes; worse when running |
|
Definition
|
|
Term
|
Definition
| the muscles closest or proximal to the trunk of the body (i.e., limb girdles, neck, and pharynx). |
|
|
Term
| Proximal muscle weakness gait is seen in _____________ |
|
Definition
|
|
Term
| Proximal muscle weakness gait (Muscular Dystrophy) |
|
Definition
increased lumbar lordosis
Gower’s sign |
|
|
Term
| standing up by walking the hands up the thighs (with upper body weight supported on legs & arms) because proximal muscles of legs are too weak to stand up |
|
Definition
|
|
Term
| The classic presentation of this disease is night pain in the bones relieved by NSAID’s |
|
Definition
|
|
Term
| Who is most likely to get osteoid osteoma (age)? |
|
Definition
|
|
Term
| ½ of instances of osteoid osteoma involve the _________ or __________ bones |
|
Definition
|
|
Term
| What would you use to diagnose osteoid osteoma? |
|
Definition
| X-rays, bone scan, CT or MRI |
|
|
Term
| angle between the ball & shaft of the femure is more acute than it should be (<120 degrees) |
|
Definition
|
|
Term
| Coxa vara predisposes _____________________ to stress fractures |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What gait does bilateral coxa vara cause? |
|
Definition
|
|
Term
| What gait does unilateral coxa vara cause? |
|
Definition
| trendelenberg gait (affected side high; unaffected side low) |
|
|
Term
| What causes slipped capital femoral epiphysis? |
|
Definition
obesity in children
(femur is normal, but too much weight causes the head of the femur to separate from the neck at the growth plate) |
|
|
Term
| Even if the femur is completely normal, excessive weight in childhood can cause what problem with the femur? (describe) |
|
Definition
| the head of the femur separates from the neck at the growth plate (slipped capital femoral epiphysis) |
|
|
Term
| What do you do to fix slipped capital femoral epiphysis, and why is this not a simple solution? |
|
Definition
You put in a pin to hold the head of the femur to the neck of the femur
This closes the growth plate and the child may need surgery later on to lengthen the neck of the femur |
|
|
Term
| What disease is characterized by avascular necrosis of the femoral head? |
|
Definition
| Legg-Calve perthes (the lack of vascularization is often idiopathic) |
|
|
Term
| avascaular necrosis of subchondral bone leads to cracks in unsupported cartialge |
|
Definition
| Osteochondritis dissecans |
|
|
Term
| anterior spinothalamic tract carries: |
|
Definition
|
|
Term
| lateral spinothalamic tract carries: |
|
Definition
|
|
Term
| When do nerves for the anterior spinothalamic tract & lateral spinothalamic tract cross over? |
|
Definition
| shortly after they enter the spinal cord they begin crossing over (cross over at a slant; dont' reach the opposite side for a few vertebral levels) |
|
|
Term
| If you severed the anterior spinothalamic tract, what would you lose and where? |
|
Definition
pain & temperature
contralateral to lesion, starting a few segements down from the lesion |
|
|
Term
| a spine operation to remove the portion of the vertebral bone called the lamina |
|
Definition
|
|
Term
| a slow bilateral degeneration of sensory nerves in the dorsal column |
|
Definition
|
|
Term
| The posterior (dorsal) column-medial leminiscus system is the pathway for transmitting: |
|
Definition
fine touch
conscious proprioception
vibratory sense |
|
|
Term
| Where does the posterior (dorsal) column-medial leminiscus system cross over? |
|
Definition
|
|
Term
| What loss does a lesion to the posterior (dorsal) column-medial leminiscus system in the spine cause, and where? |
|
Definition
| ipsilateral loss of fine touch, conscious proprioception, vibratory sense from the lesion down |
|
|
Term
| What loss does a lesion to the posterior (dorsal) column-medial leminiscus system in the brain above the medulla cause, and where? |
|
Definition
| contralateral loss of fine touch, conscious proprioception, vibratory sense for the whole half of the body |
|
|
Term
| What is stamp & stick gait? What illness shows stamp & stick gait? |
|
Definition
stamp feet on ground b/c no proprioception
need to use a stick because unbalanced
occurs in tabes dorsalis |
|
|
Term
| Will a person with a dorsal column-medial leminiscus lesion have a positive or negative Romberg test & why? |
|
Definition
dorsal column-medial leminiscul lesion leads to lack of proprioception
without visual input, the patient becomes unstead, so they will have a positive Romberg test |
|
|
Term
| Describe the Romberg test. |
|
Definition
Ask patient to stand with feet together. Stand near ready to catch. Ask to close eyes.
Romberg is positive if patient is more unsteady with eyes closed than opened. |
|
|
Term
| spinal cord hemisection is called _________________________ syndrome |
|
Definition
|
|
Term
| What sensory losses does Brown-Séquard syndrome cause, and where? |
|
Definition
loss of pain & temp contralateral to lesion, from a few levels below the lesion down
loss of fine touch, conscious proprioception, & vibratory sense ipsilateral lesion, from level of lesion down |
|
|
Term
| Brown-Séquard syndrome involves loss of pain & temperature because the ________________ is severed & loss of fine touch, conscious proprioception, & vibratory sense because the ____________________ is severed. |
|
Definition
lateral spinothalamic tract
dorsal column |
|
|
Term
| In the medulla, the pyramidal tract contains the motor neurons for |
|
Definition
| the entire contralateral half of the body |
|
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Term
| medial medullary syndrome of Déjerine |
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Definition
pyramidal tract (upper motor neuron)
at this level, the pyramid contains all the upper motor neuron axons for the entire contralateral half of the body
(contralateral hyperreflexia, hypertonia, Babinski sign)
medial leminiscus-->contralateral loss of fine touch, conscious proprioception, & vibratory sense
(note: medial leminiscus crosses over in the bottom of the medulla; is crossed over for this)
lower motor neuron lesion of hypoglossal nerve (CN XII)--> contralateral flaccid paralysis of tongue with fissures on contralateral side of tongue due to muscle wasting |
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Term
| o a neuromuscular disease characterized by degeneration of motor neurons, resulting in progressive muscular atrophy (wasting away) and weakness. |
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Definition
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Term
“frog-like”posture with abduction and external rotation of the thigh at the hip
Weak intercostals; diaphragmatic breathing
Can more arms & hands
Normal facial expressions |
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Definition
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Term
| is poliomyelitis an upper motor neuron lesion or lower motor neuron lesion? |
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Definition
| upper motor neuron lesion |
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Term
Depolarization that opens a few voltage-sensitive sodium channels
Magnitude is proportional to stimulus strength
Propagation is not maintained (There is a decay in magnitude as you move away from the site of origin)
Not self-regenerating |
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Definition
| graded potentials (aka receptor potentials) |
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Term
| Where in the body are graded potentials important? |
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Definition
Sensory receptors.
Intensity of graded potential (aka receptor potential) determines frequency of action potentials traveling to the nervous system. (individual muscle fibers are all-or-nothing, but sensory receptors are not) |
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Term
| When the depolarization threshold in a cell is reached, all voltage-gated _________ channels within the depolarized zone open up |
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Definition
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Term
| How does a nerve give a stronger or weaker signal? |
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Definition
| by stimulating more frequently or less frequently (not by changing the quality of the stimulation itself, which is all-or-none) |
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Term
| What causes depolariztion of a cell after it reaches the depolarization threshold? |
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Definition
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Term
| What ion movement causes repolarization of a cell? |
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Definition
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Term
| Depolarization causes sodium & potassium channels to open. So why does sodium flow in before potassium flows out? |
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Definition
| because the potassium channels take longer to open |
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Term
| when the voltage of a cell is more negative than usual |
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Definition
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Term
| After an action potential, a cell temporarily hyperpolarizes, which contributes to the _________ period |
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Definition
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Term
| when membrane potential rises above 0mV |
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Definition
overshoot
Above 0mV the direction of the electrical gradient changes. The chemical gradient of Na+ is still pushing Na+ in, but the electrical gradient is pushing it out, so Na+ influx begins to slow down (soon it will stop because the sodium channels will close) |
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Term
| a membrane is excitable if |
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Definition
| it has voltage-gated ion channels |
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Term
| What 2 factors increase conduction velocity? |
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Definition
wider nerve diameter
myelination |
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Term
| What intrinsic quality of the nerves causes local anesthetics to produce numbness without paralysis? |
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Definition
| sensory nerves are narrow (have higher surface area-to-volume ratio) than motor nerves &, thus, are more sensitive to drugs |
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Term
| Overall, proteins have ________ (positive/negative) charge |
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Definition
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Term
| The intracellular environment is _____________ (more negative/more positive) than the extracellular environment. |
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Definition
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Term
| Is the concentration of proteins higher inside or outside of the cell? |
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Definition
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Term
| Resting membrane potential depends on 2 things: |
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Definition
Electrochemical gradients
Membrane permeability to each ion |
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Term
| What are the concentrations of sodium inside & outside of the cell? |
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Definition
inside: 14 mM
outside: 140 mM |
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Term
| What are the concentrations of potassium inside & outside of the cell? |
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Definition
inside: 140 mM
outside: 4 mM |
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Term
Sodium is being pushed ________ the cell by the chemical gradient, which would make cell voltage more ________
Potassium is being pushed _________ the cell by the electrical gradient, which would make the cell voltage more _________ |
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Definition
into; positive
into; positive |
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Term
Potassium is being pushed:
________ the cell by the chemical gradient, which would make cell voltage more ________
_________ the cell by the electrical gradient, which would make the cell voltage more _________ |
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Definition
out of; negative
into; positive |
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Term
| membrane potential when the concentration gradient and the electrical gradient for a given ion are equal and opposite. |
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Definition
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Term
| If you know the equilibrium potential of 2 ions in a 2-ion system, why can't you find the overall equilibrium by adding the equilibrium potential of each of the ions? |
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Definition
Membrane is more permeable to some ions then other (not an even playing field)
Like having a wire with different resistance for different electrons |
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Term
| Na+ K+ ATPase moves _____ Na+ out for ever _______ K+ it moves in. |
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Definition
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Term
| What does a greater potassium concentration outside of the cell cause |
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Definition
depolarizes cell by reducing potassium leakage out of the cell
(cell membrane is much more permeable to potassium than sodium; potassium constantly leaks out of the cell)
moves cell closer to depolarization threshold, which makes cell more likely to have an action potential |
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Term
| Is the cell more permeable to potassium or sodium? |
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Definition
| much more permeable to potassium |
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Term
| Which one is more dangerous to inject: sodium or potassium? |
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Definition
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Term
| If you inject sodium into a person, does that depolarize or hyperpolarize their cells? |
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Definition
depolarize
sodium leaks into cell & depolarizes cell slightly (much less dramatic effect than injected potassium b/c cell is much more permeable to potassium & injected potassium keeps cell's potassium from constantly leaking out like it normally does) |
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Term
| tiny muscle twitches caused by hyperexcitable state of dying muscle that can only be seen through electromyographic studies |
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Definition
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Term
| muscle twitches caused by hyperexcitable state of dying muscle that can be seen with the naked eye |
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Definition
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Term
| Do upper motor neuron or lower motor nueron lesions directly cause muscle atrophy? |
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Definition
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Term
| Nerves leave the spine as _______________________, joint to form the _______________________, and split again to form the _________________________ |
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Definition
dorsal & ventral roots
mixed spinal nerve
dorsal & ventral rami |
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Term
| The ventral root of the spine carries ___________ information, while the dorsal root carries ___________ information |
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Definition
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Term
Explain this mnemonic:
sensory signals come back to the spine |
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Definition
| the back (dorsal) root of the spine carries sensory information |
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Term
| An opening between vertebrae through which nerves leave the spine and extend to other parts of the body |
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Definition
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Term
| a type of neuropathy in which the entire nerve cell dies (could be all at once, or the cell body could die first) |
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Definition
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Term
| What would a posterior radiculopathy cuase? |
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Definition
| loss of sensory innervation to one dermatome |
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Term
| What would a ventral radiculopathy cause? |
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Definition
| loss of innervation to one myotome |
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Term
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Definition
| the motor nerve equivalent of a dermatome (each spinal nerve innervates one myotome); each myotome arises from the same embryonic area |
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Term
| bone spurs formed in response to joint damage |
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Definition
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Term
| a type of neuropathy that affects at the level of the plexus (often doesn’t affect the whole plexus) |
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Definition
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Term
| In "upper brachial plexus lesion", what does "upper" mean |
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Definition
| a lesion that affects the upper and middle trunks of the brachial plexus; “upper” does NOT mean "high" as in “close to the spine”) |
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Term
| What causes Erb-Duchenne Syndrome? |
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Definition
| caused by too much of an angle between the neck & shoulder during birth or injury; stretches or avulses (forcibly disengages) roots of the plexus from the spinal cord, esp. C5, C6, and possibly C7 |
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Term
| What 4 muscles does Erb-Duchenne syndrome cause paralysis of ? |
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Definition
Deltoid
Biceps
Brachialis
Brachioradialis |
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Term
| Describe an arm affected by Erb-Duchenne syndrom (Erb's palsy). |
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Definition
The affected arm hangs down & is internally rotate
Hand may show waiter’s tip position (wrist if flexed with fingers pointing behind the person, as though to sneakily accept a tip from someone behind) |
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Term
| Erb-Duchene syndrome is a(n) ________ (upper/lower) brachial plexus lesion |
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Definition
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Term
| Déjerine-Klumpke Syndrom is a(n) _______________ (upper/lower) brachial plexus lesion |
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Definition
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Term
| What does the "lower" mean in lower brachial plexus lesion |
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Definition
| a lesion that affects the lower and middle trunks of the brachial plexus; not “lower” as in “far from the spine”) |
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Term
| A woman is laboring on her back when her baby has shoulder dystocia. The baby's head is forcibly pulled out and up from the vagina. What is the baby at risk for? |
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Definition
| Erb-Duchenne Syndrome (upper brachial plexus lesion) |
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Term
| A man falls head-first from the roof and land on his shoulder with his had pushed to the side. What is the man at risk for? |
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Definition
| Erb-Duchenne Syndrome (upper brachial plexus lesion) |
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Term
| A woman falls from a tree and catches herself on a branch. What is she at risk for? |
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Definition
| Déjerine-Klumpke Syndrom (lower brachial plexus injury) |
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Term
| A baby is born arm first and the doctor pulls forcefully on the arm to help get the head through the pelvis. What is the baby at risk for? |
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Definition
| Déjerine-Klumpke Syndrome (lower brachial plexus lesion) |
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Term
| What causes Déjerine-Klumpke Syndrome? |
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Definition
| the arm forcefully being pulled above the head; causes avulsion of C8 & T1 |
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Term
| an extra rib above the normal first rib |
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Definition
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Term
| What is it called when the brachial plexus is compressed between anterior scalene & middle scalene as it leaves the neck (can be caused by cervical rib syndrome)? What lesion can this cause? |
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Definition
| scalene (thoracic outlet) syndrome Déjerine-Klumpke Syndrome (lower brachial plexus lesion) |
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Term
| What kind of muscles does Déjerine-Klumpke Syndrome affect? |
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Definition
| the intrinsic muscles of hand (that is, muscles whose bellies are in the hand, not the forearm) on the ulnar side of the hand |
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Term
| describe “claw hand” or “ulnar claw” |
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Definition
Ring & little fingers are fixed with hyper-extended MetaCarpoPhalangeal joints (at junction of finger & palm) & flexed Proximal InterPhalangeal (PIP) & Distal Interphalangeal (DIP) joints
(finger itself is curved)
thumb, index, and middle fingers are normal |
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Term
| "claw hand" or "ulnar claw" is seen in what plexus lesion? It can also be seen in lower lesions in the _________ nerve |
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Definition
Déjerine-Klumpke Syndrome (upper brachial plexus lesion)
ulnar |
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Term
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Definition
| radial (lateral) half of arm (upper arm) |
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Term
| What 3 muscles are part of the C5 myotome? |
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Definition
Deltoid
Brachioradialis
Biceps brachii (also C6) |
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Term
| thumb & radial side of forearm are the dermatome of |
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Definition
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Term
| C5 & C6 innervate the _______________ muscle and C6 innervates the _________________ (type of muscle) |
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Definition
Biceps brachii
Radial wrist extensors |
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Term
| What happens to the wrist if C6 is damaged? |
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Definition
| wrist will deviate ulnar-ly when extended |
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Term
| pointer & middle fingers; middle of back of hand are the dermatome of |
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Definition
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Term
| C7 innervates 1 large muscle & 2 classes of smaller muscles. What are they? |
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Definition
Triceps
Wrist flexors
Finger extensors |
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Term
| The ring finger, pinkie finger, & ulnar side of hand & wrist are the dermatome of |
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Definition
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Term
| What class of small muscles does C8 innervate? |
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Definition
| Finger flexors (pull fingers to palm) |
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Term
| The ulnar side of forearm is the dermatome of |
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Definition
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Term
| What 2 classes of small muscles are innervated by T1? |
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Definition
Finger abductors (spread fingers)
Finger adductors (bring fingers together) |
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Term
| What radiculopathy could be indicated by failure of the dollar bill test? |
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Definition
T1
can you hold your fingers together tight enough to provide resistance when someone tries to pull a piece of paper thru
T1 innervates finger adductors (and abductors) |
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Term
| symptoms of an L5/S1 disk lesion |
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Definition
Loss of muscle strength for plantar flexion
Loss of circumference of calf
Loss of Achilles tendon reflex
Anesthesia over little toe & lateral surface of the foot (L5 dermotome) |
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Term
| What kind of nerve lesion causes dermatomal/myotomal patterns of loss? |
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Definition
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Term
| compare symptoms of sciatica and deep peroneal nerve lesion |
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Definition
sciatica causes back pain that radiates down into the lower extremity. Painful foot drop. Denervation of the anterior compartment of the leg, yielding loss of ability to extend (dorsiflex) the foot at the ankle, producing an anterior foot drop.
Compare with lesion of the deep fibular nerve, which produces a painless foot drop together with loss of cutaneous sensation between the first and second toes, rather than involving the L5 dermatome. |
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Term
| What is another name for the peroneal nerve? Deep peroneal nerve? |
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Definition
common fibular nerve
deep fibular nerve |
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Term
| Describe bendiction attitude. |
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Definition
| When you try to flex all of the fingers, the thumb, index, and middle finger will not flex (caused by Pronator Teres Syndrome, a high median nerve lesion) |
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Term
Explain the mnemonic
dejerine-kLumpke
Lower
uLnar cLaw |
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Definition
| Dejerine-Klumpke is an injury of the lower brachial plexus, which causes loss of intrinsic muscles of the ulnar side of the hand, leading to ulnar claw |
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Term
Explain the following mnemonic
erb-dUchenne
Upper
Underhanded |
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Definition
Erb-Duchenne is caused by a lesion of the upper brachial plexus.
It causes inability to flex & supinate arm and (often), inability to extend wrist, leading the "waiter's tip position" (arm supinated & wrist flexed so that fingers point behind body as though underhandedly accepting a tip from someone behind) |
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Term
Loss of muscle strength for plantar flexion
Loss of circumference of calf
Loss of Achilles tendon reflex
Anesthesia over little toe & lateral surface of the foot
These are symptoms of a disk lesion where? |
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Definition
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