The Patient Exam 1

Plasma Cell (specialized lymphocyte)

Produces antibodies and has eccentric nuclei with "clock-face" chromatin

Lymphocyte photo → makes antibodies + condensed chromatin

Mast Cells

Contain granules rich in histamine and heparin (+ release to start inflammatory response)

Macrophages

Phagocytic cells involved in tissue defense

Fibroblasts

Synthesis of extracellular matrix components, including collagen and ground substance

specific alpha chains (α1 and α2)

What are 1 and 2?

1= collagen fibers; 2 = elastic fibers

Collagen molecules; these fibers provide tensile strength (maximum stretch a fiber can withstand) and resist stretching forces.

Elastic fibers, often seen branching, consist of an electron-dense amorphous elastin core surrounded by fibrillin-containing microfibrils and function to allow tissues to stretch (up to 150%) and recoil. 

Basophil

Produce histamine during allergic reaction

Large black areas are storage of histamine and heparin

Dendritic Cell

Neutrophils

Phagocytosis and destruction of microorganisms

Osteogenesis Imperfecta

History of recurrent fractures after minor trauma and evidence of discolored teeth. OI is a genetic bone disorder that results from defects in collagen synthesis, most commonly in the COL1A1 or COL1A2 genes. Most patients with OI have an autosomal-dominant mutation leading to decreased production of normal type I collagen. Type I collagen is found in bone, skin, tendons, dentin, and the corneas. In addition to skeletal fractures, patients can develop blue sclerae, secondary to translucent connective tissue covering the choroidal veins, and opalescent (discolored) teeth due to lack of dentin (dentinogenesis imperfecta).

Type IV Collagen

basement membrane of epithelium

alpha chains (α1 and α2)

Type III Collagen

Reticular fibers in lymphoid organs and healing tissue.

Type 1 Collagen

bone, tendon, and dermis.

Monocyte

No specific granules, indented nucleus

Migrate into tissues and differentiate into macrophages or dendritic cells, which phagocytose material and present processed antigens to T cells

Eosinophil

dual-colored specific granules

bi-lobed nucleus

Inflammation of Common Flexor Origin

Medial epicondylitis

Golfer’s elbow from overactivity of the flexor muscles

Inflammation of common extensor origin

Lateral epicondylitis

“Tennis elbow” from overactivity/use of these muscles

What can be palpated in floor of the anatomical snuff box?

Radial artery and scaphoid bone

Thenar compartment

Opponents Pollicis, abductor pollicis brevis, flexor pollicis brevis

Recurrent branch of the median nerve

Lumbricals

#1 and #2 are median nerve innervated

#3 and #4 are ulnar nerve innervated

Flex the MCPs and help extend the PIPJs and DIPJs of fingers 2-5

What is injured in midshaft humeral fractures?

The radial nerve

B → brachoradialis

E → extensors

S → supinators

T → triceps

Ulnar nerve passes posterior to the medial epicondyle in the _____

Also passes through a groove ____ on the anterior aspect of the wrist/hand

cubital tunnel

canal of Guyon (on anterior aspect of the wrist, common site of ulnar nerve compression)

Adductor pollicis is innervated by the deep branch of the ulnar nerve

Median nerve then passes beneath the _______ and enters the hand

flexor retinaculum (through the carpal tunnel)

Symptoms include paresthesia, hypothesis, or anesthesia of lateral 3 ½ digits along the palmar surface. Weakness with opposition of thumb and motor loss of thenar muscles

Carpal Tunnel Syndrome