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Musculoskeletal and Connective Tissue > Anatomy and Physiology 1 > Flashcards

Anatomy and Physiology 1 Flashcards

1
Q

What are the layers of of the epidermis from surface to base

A

stratum corneum, lucidum, granulosum, spinosum, basalis
Californians Life Girls in String Bikinis

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2
Q

IBS - 2 dz’s

A

crohns and ulcerative colitis

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3
Q

What is below the epidermis

A

the dermis

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4
Q

What is the classic triad of reactive arthritis

A

conjunctivitis and anterior uveitis, urethritis and arthritis

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5
Q

What kind of jxn is the zona occludens andw what is is composed of

A

tight jxn, prevents diffusion across paracellular space, composed of claudins and occludins

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6
Q

What are the common perpetrating infections for Reiters syndrome

A

Post GI infxn or chlamydia

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7
Q

What kind of jxn is in the zona adherens and where is it, what is it composed of, and what ion does it does it depend on

A

intermediate jxn, just below zona occludens, cadherins and actin filaments, cadherins are dependent on Ca2+

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8
Q

epi of SLE

A

female between 14 and 45, mostly black

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9
Q

What disease is caused by autoantibodies to desomosmes, what area of the cell would it occur, and what molecules are connecting

A

pemphigus vulgaris, macula adherens where cadherins attach to intermediate filaments

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10
Q

What are the most common symtpoms of SLE

A

fever, fatigue, weight loss, nonbacterial verruucous (Liebman-Sacks) endocarditis, hilar adenopathy, Raynauds

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11
Q

What happens at the gap jxn and what molecules create them

A

allows adjacent cells to communicate for electric and metabolic fxns, connexons

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12
Q

What are common features of lupus

A

wire-loop lesions in kidney with immune complex deposition, death from renal failure and infxns

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13
Q

What molecule maintatins integrity of basement membrane and what does it bind

A

integrin binds laminin in BM

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14
Q

What do lupus pts falsely test positive for syphillis

A

false positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

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15
Q

What test if specific for lupus but doesn’t indicate prognosis

A

Anti Smith

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16
Q

What does the hemidesmosome do and what disease is caused by autoantibodies to it

A

connects cells to underlying extracellular, bullous pemphigoid

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17
Q

What is the primary screening test for lupus

A

ANA - sensitive but not specific

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18
Q

What is the test for drug induced lupus

A

anti-histone

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19
Q

What is a very specific test for lupus

A

Anti ds DNA - poor prognosis

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20
Q

Damage to what 3 structures is common for the unhappy triad

A

MCL, ACL, lateral meniscus (esp in athletes)

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21
Q

What do anterior and posterior in ACL and PCL refer to

A

sites of tibial attachment

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22
Q

What does the positive anterior drawer sign test indicate

A

tear of the ACL

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23
Q

What does abnl passive abduction of the knee indicate

A

torn MCL

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24
Q

What does I’M DAMN SHARP stand for

A

immunoglobulins, malar rash, discoid rash, ANA, mucositis (oropharyngeal ulcers), neurologic disorders, serositis (pleuritis, pericarditis), hematologic disorders, arthritis, renal, photosensitivity

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25
Q

What is the clinically important landmark for pubendal nerve block and when is it used

A

ischial spine, relieve pain during delivery

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26
Q

immune mediated, widespread, non-caseating granulomas - dz, affected population and elevated serum level

A

sarcoidosis, black females, ACE

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27
Q

Where is McBurney’s point and what is there

A

2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

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28
Q

What associations go along with sarcoidosis

A

restrictive lung disease, bilateral hilar lymphadenopathy, erythema nodosum, Bell’s palsy

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29
Q

What is the landmark for an LP

A

iliac crest

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30
Q

What is contained within epithelial granulomas of pts with sarcoid

A

schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

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31
Q

What muscles of the shoulder form the rotator cuff

A

supraspinatus, infraspinatus, teres minor, subscapularis - SItS

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32
Q

What causes hypercalcemia in pts with sarcoid

A

elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

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33
Q

Which muscle is the most common rotator cuff injury and what does it do

A

supraspinatus, abducts the arm before the deltoid

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34
Q

Sarcoid TX

A

steroids

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35
Q

Which muscle is the pitching injury and what does it do

A

infraspinatus, laterally rotates arm

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36
Q

Pain and stiffness in shoulders and hips, fever malaise and weight loss - no weakness, pts over 50, associated with HA and jaw pain

A

polymyaglia rheumatica associated with temporal (giant cell) arteritis

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37
Q

Which muscle laterally rotates and adducts arm

A

teres minor

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38
Q

What are defining lab findings for polymyalgia rheumatica and what is the TX

A

elevated ESR and nl CK - prednisone

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39
Q

What does subscapularis do

A

medially rotates and adducts arm

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40
Q

progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz, most common area of involvement and pathgnomonic histological finding

A

polymyositis - shoulders, perifasicular inflammation

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41
Q

What causes a lesion in the upper trunk of the brachial plexus

A

trauma

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42
Q

heliotrope rash “shawl and face” rash, Gotton’s papules, “mechanic’s hands”

A

dermatomyositis

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43
Q

What causes compression of the C7 nerve root

A

cervical disk lesion

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44
Q

What are the lab findings and TX in dermatomyositis

A

inc CK, inc aldolase, and positive ANA and anti Jo-1 - steroids

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45
Q

What causes a lesion in the axillary nerve

A

fracture of surgical neck, dislocation of the humerus, intramuscular injections

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46
Q

Dermatomyositis places the pt at inc risk for what malignancy in particular

A

lung

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47
Q

How does the radial nerve in the spiral groove become injured

A

lesioned by midshaft fracture of humerus

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48
Q

What is the most common NMJ disorder, what causes it and what are common symptoms

A

Myasthenia gravis, autoAb against ACH receptors causing ptosis, diplopia, general weakness,

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49
Q

How is the lower trunk of the brachia plexus injured and what results from it

A

compressed by cervical rib or pancoasts tumor, leads to klumpke’s

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50
Q

MG is associated with what neoplasm

A

thymoma

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51
Q

What nerve become injured in the incorrect use of a crutch

A

radial nerve becomes compressed in axilla

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52
Q

What causes the symptoms of MG to worsen, and what is used to diagnose

A

muslce use, nerve stim/compound muscle test

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53
Q

What nerve is compressed by supracondylar fracture of humerus

A

median nerve

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54
Q

Administration of what kind of compound causes reversal of symptoms and what is used to distringuish under from over dosing

A

ACH esterase inhibitors, edrophonium test - improvement of sx after edro means the patient is underdosed

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55
Q

What nerve and branch are stretche by subluxation of the radius

A

deep branch of radial nerve

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56
Q

What syndrome of the NMJ is a paraneoplastic syndrome and what are the antibodies directed against

A

lamber eaton, presynaptic Ca channels, dec ACH release leading to proximal muscle weakness

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57
Q

What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas

A

ulnar nerve

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58
Q

What cancer in particular are associated with LE syndrome, what happens to symptoms with muscle use or ACH esterase inhibs

A

small cell cancer of the lung, improve with muscle use, no change with ACHE inhibs

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59
Q

Which nerve is compressed in deep forearm

A

anterior interosseous nerve

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60
Q

excessive fibrosis and collagen deposition throughout the body, common in skin manifesting as puffy taut skin with absence of wrinkles

A

scleroderma

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61
Q

What nerve is injured by a superficial laceration of the hand

A

recurrent branch of the medain nerve

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62
Q

Besides the skin, what other organ systems are commonly affected by scleroderma and who is primarily affected

A

renal, pulm, CV, GI - 75% female

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63
Q

What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone

A

median nerve, lunate bone

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64
Q

How is diffuse scleroderma characterized

A

widespread skin involvment, rapid progression, early visceral involvement

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65
Q

What nerve is injured in a fracutre of the hook of hamate

A

ulnar nerve

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66
Q

What antibodies is diffuse scleroderma associated with

A

Anti Scl70, anti DNA topoisomerase I antibody

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67
Q

Where is C4 dermatome

A

over deltoid

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68
Q

What is CREST syndrome and what antibody is it associated with

A

calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia - anti centromere antibody

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69
Q

Where is C5 dermatome

A

outer arm

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70
Q

Flat discloration <1cm seen in tinea versicolor

A

macule

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71
Q

Where is C6 dermatome

A

middle bicep down, cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

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72
Q

Macule greater than 1cm

A

patch

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73
Q

Where is C7 dermatome

A

3rd finger

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74
Q

elevated skin lesion <1cm seen in acne vulgaris

A

papule

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75
Q

Where is C8 dermatome

A

4th and 5th finger

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76
Q

papule > 1cm seen psoriasis

A

plaque

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77
Q

Where is T1 dermatome

A

medial forearm and arm to just under the axilla

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78
Q

small fluid containing blister seen in chickenpox

A

vesicle

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79
Q

Where is T2 dermatome

A

axilla

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80
Q

transiet vesicle seen in hives

A

wheal

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81
Q

What do the branches of the deep ulnar nerve innervate

A

interossei and adductor policis

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82
Q

large fluid containing blisters seen in bullous pemphigoid

A

bulla

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83
Q

What supplies innervation to the thenar muscles

A

recurrent branch of the median nerve

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84
Q

irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin, common to african americans see in T. pertenue (yaws)

A

keloid

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85
Q

What other muscle in the thenar eminence adducts the thumb

A

adductor policis brevis

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86
Q

blister containing pus

A

pustule

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87
Q

On the palmar and dorsal sides of the hand, what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger

A

ulnar

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88
Q

dried exudates from a vesicle, bulla or pustule seen impetigo

A

crust

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89
Q

On the palmar side of the hand, what dermatone covers the most of the thumb, 2nd, 3rd, and medial half of the 4th digits and what does it cover on the dorsal side

A

median nerve, same fingers but not on the hand

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90
Q

inc thickness of stratum corneum seen in psoriasis

A

hyperkeratosis

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91
Q

What are the borders of the superficial branch of the radial nerve dermatone

A

dorsal side of lateral hand, most of lateral surface of the thumb - no digits

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92
Q

hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis

A

parakeratosis

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93
Q

What lesions causes Erb’s palsy

A

upper trunk of brachial plexus

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94
Q

separation of epidermal cells

A

acantholysis

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95
Q

What lesion causes total claw (klumpke’s hand)

A

lower trunk of brachial plexus

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96
Q

epidermal hyperplasia (inc spinosum)

A

acanthosis

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97
Q

What lesion causes wrist drop

A

posterior cord

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98
Q

inflammation of the skin

A

dermatitis

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99
Q

What lesion causes winged scapula

A

long thoracic nerve

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100
Q

Warts, soft, tan-colored, cauliflower type lesions, epidermal hyperplasia, hyperkeratosis, koilocytosis

A

verrucae

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101
Q

What lesion causes deltoid paralysis

A

axillary nerve

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102
Q

warts on hands

A

verrucae vulgaris

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103
Q

What lesion causes Saturday night wrist drop

A

radial nerve

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104
Q

warts on genitals

A

condyloma acuminatum, caused by HPV

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105
Q

What lesion causes difficulty flexing elbow with variable sensory loss

A

musculocutaneous

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106
Q

common mole, benign

A

nevocellular nevus

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107
Q

What lesion causes dec in thumb fxn “ape hand”

A

median nerve

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108
Q

hives, intensely pruritic wheals that form after mast cell degranulation

A

urticaria

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109
Q

What lesion causes claw hand and what are the muscles involved

A

ulnar nerve - intrinsic muscles of hand

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110
Q

freckle, normal number of melanocytes, inc melanin pigment

A

ephelis

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111
Q

What protects the brachial plexus in clavicle fracture

A

subclavius

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112
Q

pruritic eruption, commonly on skin flexures, of associated with asthma, allergic rhinitis

A

atopic dermatitis, eczema

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113
Q

In a fractured surgical neck of humerus or dislocation of humeral head, what is the nerve injury, motor deficit, sensory deficit

A

axillary, deltoid, skin over deltoid, flattened deltoid

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114
Q

papules and plaques with silvery scaling, especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum, nail pitting and arthritis

A

psoriasis

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115
Q

In a fracture of the midshaft of the humerus, or extended compression of axilla, nerve, motor, sensory, sign

A

radial, BEST extensors, posterior arm and dorsal hand/thumb, wrist drop

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116
Q

what changes are seen in stratum spinosum and granulosum in psoriasis

A

inc spinosum, dec granulosum

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117
Q

fracture of a supracondylar humerus - nerve, motor, sensory, sign and more distal lesion causing the same nerve

A

median, lateral finger and wrist flexion, dorsal palmar aspects of lateral 3.5 fingers/thenar eminence, ape hand - carpal tunnel syndrome

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118
Q

What is the Auspitz sign

A

in psoriasis, bleeding spots when scales are scraped off

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119
Q

What are the motor, sensory deficits and sign of carpal tunnel syndrome

A

opposition of thumb, dorsal/palmar 3.5 fingers sensory, ulnar deviation upon wrist flexion

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120
Q

flat, greasy, pigmented, squamous epithelial proliferation with keratin-filled cyts (horn cysts) - looks pasted on

A

seborrheic keratosis

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121
Q

What nerve is injured in a fracture of the medial epicondyle of humerus, and what is a more distal lesion injuring the same nerve

A

ulnar nerve, fracture of hook of hamate

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122
Q

Where do sebhorrheic keratosis lesions occur and in who

A

head, trunk, extremities - common benign neoplasm in older persons

123
Q

What are the motor defs of a proximal ulnar nerve injury

A

medial finger flexion, wrist flexion

124
Q

What is the sign of Leser - Trelat

A

sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions, GI or lymphoid

125
Q

What and where are eccrine glands?

A

Secretes sweat. Found throughout the body.

126
Q

What is the sensory def of an ulnar nerve injury

A

medial 1.5 fingers, hypothenar eminence

127
Q

normal melanocyte number with dec melanin production due to inactivity of tyrosine

A

albinism

128
Q

What are the signs of ulnar nerve injury

A

radial deviation of wrist upon flexion, ulnar claw hand - pope’s blessing

129
Q

What development failure can results in albinism

A

NC migration

130
Q

What nerve controls ab and adduction of the interossei muscles and what does it for the thumb and 4th and 5th lumbricals

A

ulnar nerve, adduction of thumb, extension of 4th and 5th fingers (lumbricals)

131
Q

irregular areas of complete depigmentation - condition and cause

A

vitiligo, dec number in melanocytes

132
Q

What injury causes injury to the MC nerve and what motor and sensory defs dose it cause

A

upper trunk compression, biceps, brachialis, corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

133
Q

hyperpigmentation associated with pregnancy or OCP

A

melasma (chloasma)

134
Q

What are the the common causes of Erb palsy, and what are the associated findings

A

blow to the shoulder, trauma during delivery; limb hangs by side, medially rotated, forearm is pronated

135
Q

Very superfiicial skin infection, honey colored crusting, very contagious - condition and organisms

A

impetigo, s aureus, s pyogenes

136
Q

Loss of what muslces in Erbs causes the limb to hang by side

A

paralysis of abductors

137
Q

acute painful spreading infxn of dermis and subQ tissues - condition and orgs

A

cellulitis - s aureus, s pyogenes

138
Q

loss of what muscles in Erbs causes the medial rotation

A

paralysis of lateral rotators

139
Q

deep tissue injury, crepitus from methane and CO2 production “flesh eating bacteria” - condition and orgs

A

necrotizing fasciitis, anaerobic bacteria or S. pyogenes

140
Q

Loss of what muscles in Erbs causes the forearm to be pronated

A

biceps

141
Q

exotoxin destroys keratinocyte attachments in the stratum granulosum, fever, generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children

A

Staph scalded skin syndrome

142
Q

What are the causes of inferior trunk plexus compression and what are the findings

A

embryologic, childbirth defect, cervical rib compression - atrophy of the thenar and hypothenar eminences, atrophy of interosseous muscles, sensory deficits of the medial side of the forearm and hand, disappearance of the radial pulse upon moving head toward ipsilateral side (thoracic outlet syndrome)

143
Q

white painless plaques on the tongue that cannot be scraped off - dz, population, implicated virus

A

hairy leukoplakia, HIV population, EBV mediated

144
Q

What do lumbricals do

A

flex the MCP joints and extend both the DIP and PIP joints

145
Q

potentially fatal autoimmune disorder with IgG antibody against desmosomes

A

pemphigus vulgaris

146
Q

What does injury to the distal ulnar nerve cause

A

loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand, pinky and ring finger stay clawed

147
Q

What does IM reveal in pemphigus vulgaris

A

antibodies around cells of the epidermis in a reticular or netlike pattern

148
Q

What other lesion can cause the appearnce of the ulnar claw

A

making fist with a proximal median nerve lesion

149
Q

What does acantholysis show in pemphigus vulgaris

A

intraepidermal bullae involving the skin and oral mucosa

150
Q

What does injury to the distal median nerve cause

A

loss of lateral lumbrical fxn, 2nd and 3d digits are clawed and can’t extend

151
Q

What is a positive Nikolsky’s sign

A

in pemphis vulgaris, separation of epidermis upon manual stroking of skin

152
Q

What causes ape hand

A

proximal median nerve lesion, loss of opponens pollicis muscle fxn leading to unopposoble thumb

153
Q

Autoimmune disorder with IgG antibody against hemidesmosomes - dz, IM, other findings

A

bullous pemphigoid, linear immunofluorescence, eosinphils within blisters, similar to but less severed thatn pemphigus vulgaris- spares oral mucosa, negaitve nikolsky’s sign

154
Q

What causes total claw

A

lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals, forearm finger flexors, finger extensors are unopposed (radial nerve)

155
Q

pruritic papules and vesicles, deposits of IgA a the tips of dermal papillae, associated with celiac

A

dermatitis herpetiformis

156
Q

What muscle the long thoracic nerve innervate, what does it do, and when can it be injured

A

serratus anterior, connects scapular to thoracic cage, abduction above horizontal position, injured in mastectomy, winged scapula and lymphedema

157
Q

Associated with M. pneumonia, HSV, sulfa drugs, B lactams, phenytoin, cancers and autoimmune dz - skin disorder and description

A

erythema multiforme, can be macules, papules vesicles, target lesions,

158
Q

Thenar eminence - nerve and muscles

A

median, opponens pollicis, abductors pollicis brevis, flexor pollicis brevis

159
Q

fever, bulla formation and necrosis, sloughing of skin and high mortality - syndrome and associations

A

stevens johnson syndrome - associated with adverse drug reactions, more severe version called toxic epidermal necrolysis

160
Q

hypothenar eminence - nerve and muscles

A

ulnar, opponens digiti minimi, abductor digiti minimi, flexor digiti mimini

161
Q

pruritic, purple, polygonal papules - sawtooth infiltrate of lymphocytes at dermal-epidermal jxn, associated with hep C

A

lichen planus

162
Q

What do dorsal interosseous muscles do

A

abduct the fingers

163
Q

premalignant lesions caused by sun exposure, small rough, erythematous or brownish papules - cutaenous horns - name and risk of carcinoma

A

actinic keratosis, risk proportional to epithelial dysplasia

164
Q

What do palmar interosseous muscles do

A

adduct the fingers

165
Q

hyperplasia of stratum spinosum, associated with hyperinsulinemia (cushings, DM) and visceral malignancy

A

acanthosis nigcricans

166
Q

What do the lumbrical muscles do

A

flex at the MCP

167
Q

inflammatory lesions of subQ fat, usually on anterior shins, associated with coccidioidomycosis, histoplasmosis, TB, leprosy, streptoccocal infxn, sarcoid

A

erythema nodosum

168
Q

What causes golf or tennis elbow

A

degenerative injury due to repeated use, tiny tears in the tendons and muscles, may be inflammatory - lateral epicondyle is tennis, medial epicondyle is golf

169
Q

herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously

A

pityriasis rosea

170
Q

Anterior hip dislocation causes injury to what nerve and what are the motor and sensory defs

A

obturator - thigh adduction, medial thigh

171
Q

first few weeks of life, grows rapidly and regresses spontaneously at 5 to 8 yrs of age

A

strawberry hemangioma

172
Q

pelvic fracture can cause injury to which nerve, and what are the motor and sens def

A

femoral, thing flexion and leg extension, anterior thigh and medial leg

173
Q

appreas in 30s to 40s, does not regress

A

cherry hemangioma

174
Q

Trauma to lateral aspect of leg or fibula neck fracture - nerve, motor and sens def

A

common peroneal, foot eversion and dorsiflexion, toe extention, foot drop, foot slap, stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

175
Q

skin cancer associatd associated with excessive exposure to sunlight and arsenic

A

squamous cell carcinoma

176
Q

knee trauma - nerve, motor and sensory def

A

tibial, foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

177
Q

What is a precursor to squamous cell carcinoma

A

actinic keratosis

178
Q

What nerve is injured in a posterior hip dislocation or polio and what are the motor defs

A

superior glut, thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

179
Q

where does squamous cell carcinoma of the skin typically appear, what is the histo, prognosis, and associations

A

hands and face, ulcerative red lesion, locally invasive bur rare metastasis, associated with chronic draining sinuses and keratin pearls

180
Q

What kind of injury can cause damage to the inferior gluteal nerve and what can it cause

A

posterior hip dislocation - can’t jump, climb stairs or rise from seated positions

181
Q

What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously

A

keratoacanthoma

182
Q

what does PED and TIP stand for

A

peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can’t stand on TIP toes

183
Q

locally invasive but rarely mets skin cancer, rolled edges, with central ulceration - cancer and gross path

A

basal cell carcinoma, pearly papules, commonly with telangiectasias

184
Q

What signal initiates a muscle contraction

A

AP depol opens voltage gated Ca channels, inducing NT release

185
Q

What kind of nuclei do basal cell tumors have

A

palisading

186
Q

What happens at the postsynaptic motor end plate

A

ligand binding leads to muscle depol

187
Q

What is the tumor marker for melanoma, who is at risk, what correlates with risk of metastasis and what is the gross path

A

S100, associated with sunligh exposure, fair skinned at risk, depth of tumor correlates with risk of mets, dark with irregular borders

188
Q

Where does the muscle contraction travel after leaving the motor end plate

A

down T tubule

189
Q

What is the precursor to melanom

A

dysplastic nevus

190
Q

Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change in what structure, releasing what

A

voltage sens - dihydropiridine R coupled to ryanodine recpetor, conformational change in the SR, releasing Ca2+

191
Q

Ca2+ released from the SR binds what structure and what does it cause

A

troponin C, conformational change that moves tropomyosin out the myosin binding groove on actin filaments

192
Q

What is the power stroke of muscle contraction

A

myosin releases bound ADP and is displaced on the actin filament

193
Q

Contraction results in shortening of what bands, and what band remains the same length

A

HI shrinks, A stays same

194
Q

What are the thin lines along the Z line

A

actin

195
Q

What runs the distance of the A band

A

myosin

196
Q

Which muscle fiber type is slow twitch and why are fibers red

A

type 1 - inc mitochondria and myoglobin conc, inc OXPHOS leading to sustained conctraction

197
Q

which muscle type is fast twitch and why are fibers white

A

type 2 - dec mitochondria and myoglobin, inc anaerobic glycolysis

198
Q

Which type of muscle fiber is hypertrophied during weight training

A

type 2

199
Q

In skeletal and smooth muscle contraction, when Ca2+ enters the cytoplasm, what does it do

A

binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

200
Q

What happens in the power stroke of skeletal muscle contraction

A

phosphate is liberated from the myosin head

201
Q

What does ATP do in skeletal muscle contraction

A

binds myosin head and releases actin filament allowing cross-bridge cycling and shortening to occur

202
Q

What does lack of ATP cause

A

rigor mortis

203
Q

In smooth muscle contraction, what does Ca bind and what is the purpose

A

calmodulin, complex activates myosin light chain kinase

204
Q

What does MLCK do in smooth muscle contraction

A

phosphorylates myosin light chain which leads to cross bridge formation

205
Q

What enzyme is necessary for smooth muscle relaxation after contraction

A

myosin light chain phosphotase

206
Q

In which form is myosin light chain active

A

phosphorylated

207
Q

Through what pathway does NO work and what is the downstream effect

A

GC and cGMP and inhibition of MLCK

208
Q

In longitudinal bone growth, what model is made first (and by what cell) and what is it later replaced by (and by what cells) - process name

A

cartilaginous by chondrocytes first, osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

209
Q

When does membranous ossification occur and what is the difference between membranous and endochondrial

A

flat bone (skul, facial bones, axial skeleton) woven directly formed, no cartilage, later remodeled to lamellar

210
Q

What is the source of osteoblast cells

A

mesenchymal stem cells in periosteum

211
Q

Achondroplasia is a failure of what process which results in which characteristic findings

A

failure of longitudinal growth (endochondrial ossification) leading to short limbs, membranous is unaffected, large head

212
Q

What receptor is constitutively activated in achondroplasia and what does it do

A

fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

213
Q

What percent of these mutations occur sporadically and what parental feature are they associated with

A

85%, advanced paternal age, or auto dominant inheritance

214
Q

Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values

A

Osteoporosis

215
Q

What causes osteoporosis type 1 and when does it typically occur

A

dec estrogen causes inc bone resorption, postmenopausal

216
Q

Who does osteoporosis type 2 effect

A

men and women > 70, senile osteporosis

217
Q

What are the classic fractures in pts with osteoporosis

A

vertebral crush fractures, femoral neck fractures, distal radius (Colles’) fracture

218
Q

What clinical features in vertebral crush fractures

A

acute back pain, loss of height, and kyphosis

219
Q

What TX prophylax against osteoporisi

A

exercise and Ca ingestion before age 30

220
Q

What is TX for osteoporosis

A

SERMs, calcitonin, bisphosphates or pulsatile PTH for severe cases

221
Q

What medication is contraindicated in osteoporosis

A

glucocorticoids

222
Q

thickened, dense bones that are prone to fracture - dz and primary defect

A

osteopetrosis, abnl fxn of osteoclasts

223
Q

What are the bone mineralization lab findings in osteopetrosis

A

serum ca, phos, alk phos are NL

224
Q

Decrease marrow space in osteopetrosis leads to what

A

anemia, thrombocytopenia, infection, extramedullary hematopoiesis

225
Q

What enzyme defect in responsible for osteopetrosis

A

carbonic anhydrase II

226
Q

What do xray show in osteopetrosis and what do potential CN abnl result from

A

erlenmeyer flask bones that flare out, narrowed foramina

227
Q

What does soft bones result from and what is the dz called in adults and children

A

defective mineralization/calcification of osteoid, osteomalacia in adults and ricketts in kids

228
Q

What causes osteomalacia/ricketts, why, and what therapy can reverse the symptoms

A

vit D def, dec Ca, inc PTH, dec serum phos, reversible when vit D is replaced

229
Q

What is the defect in Paget’s disease

A

increase in both osteoblast and osteoclast activity

230
Q

What are the possible origins of the paget’s disease

A

viral, maybe paramyxovirus

231
Q

What are the bone mineral lab findings in paget’s disease

A

serum ca, phos, PTH are nl alk phos elevated

232
Q

What are the characteristic bone findings in paget’s disease

A

mosiac bone pattern, long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

233
Q

What causes heart failure in with Paget’s disease

A

inc blood flow from AV shunts can cause high output heart failure

234
Q

Patients with pagets disease can develop what cancer

A

osteogenic carcinoma

235
Q

What are the lab findings in osteoporosis

A

nl, decreased bone mass

236
Q

What are the lab findings in osteopetrosis

A

nl, thickened dense bones

237
Q

what are the lab findings in osteomalacia/rickets

A

dec Ca, dec phos, nl alk phos, inc PTH - soft bones

238
Q

what are the lab findings in osteitis fibrosa cystica

A

inc Ca, dec phos, inc alk phos, inc PTH - brown tumors

239
Q

what are the lab findings in pagets disease

A

inc alk phos - abnl bone architecture

240
Q

bone replaced by fibroblasts and irregular bony trabeculae affecting many bones

A

polyostotic fibrous dysplasia

241
Q

what form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - café au lait or coast of maine spots

A

McCune -Albright syndrome

242
Q

What kind of endocrine abnl are associated with McCune Albright

A

precocious puberty

243
Q

What kind of bone tumor is associated with FAP and what is the finding

A

osteoma (gardners syndrome), new piece of bone grows on another bone, often skull

244
Q

interlacing trabeculae of woven bone surrounded by osteoblasts

A

osteoid osteoma

245
Q

Where are most osteoid osteoma found and in what population

A

< 2mc found in proximal tibia and femur, men < 25

246
Q

larger osteoid osteoma found in vertebral column

A

osteoblastoma

247
Q

Tumor occuring mostly at epiphyseal end of long bones, occuring btw 20 and 40, locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings

A

giant cell tumor (osteoclastoma) - double bubble or soap bubble

248
Q

What are the histo findings in an osteoclastoma

A

spindle shaped cells with multinucleated giant cells

249
Q

most common benign tumor, mature bone with cartilaginous cap, men <25, origintate froms long metaphysis

A

osteochondroma, exostosis

250
Q

osteochondrosis has rare malignant transformation into what cancer

A

chondrosarcoma

251
Q

bening cartilaginous neoplasm found in intramedullary bone, usually distal extremities

A

endochondroma

252
Q

2nd most malignant tumor of bone, men 10-20 - cancer, and primary malignant tumor bone

A

osteosarcoma, multiple myeloma

253
Q

Where is osteosarcoma found in the bone

A

metaphysis of long bones, distal femur

254
Q

What are predisposing factors for osteosarcoma - xray finding

A

pagets dz, bone infarcts, radiation, familial retinoblastoma, codman’s triangle or sunburst pattern from elevation of periosteum, poor prognsosis

255
Q

anaplastic small blue cell malignant tumor, most common in boys < 15 - dz and prognosis

A

ewings sarcoma, aggressive with early mets, but responsive to chemo

256
Q

What is the characteristic appearance of bone, the common translocation, area of, and bones affected

A

onion skin, 11:22, diaphysis of long bones, pelvis, scapula, ribs

257
Q

malignant cartilaginous tumor in men 30 to 60 - name and common location

A

chondrosarcoma, pelvis, spine, scapula, humerus, tibia, or femur

258
Q

How is chondrosarcoma described

A

expansile glistening mass within the medullary cavity

259
Q

mechanical wear and tear of joints leading to destruction of articular cartilage

A

osteoarthritis

260
Q

subchondreal cysts, sclerosis, osteophytes, joint space narrowing, eburnation, hebereden’s nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz

A

osteoarthritis

261
Q

what are the predisposing factors for osteoarthritis

A

age, obesity and joint deformity

262
Q

What is the classic presentation of osteoarthritis

A

pain in weight bearing joints at the end of the day and improving with rest

263
Q

Where does cartilage loss begin in osteoarthritis

A

medial aspect

264
Q

inflammatory disorder affective synovial joints with pannus formation in joints

A

rheumatoid arthritis

265
Q

What are the characterstic joints affected in RA

A

MCP, PIP - no DIP

266
Q

What are the subQ rheumatoid nodules made of

A

fibrinoid necrosis surrounded by palisading histiocytes

267
Q

Other than characteristic joints and subQ nodules, what are the other findings classicly in RA

A

ulnar deviation, subluxation, bakers cysts (behind knee)

268
Q

What kind of hypersens rxn is RA, and what serum marker is present in 80% of RA pts

A

type III, RF

269
Q

What antibody is less sensitive than RF but more specific and what is the HLA association

A

anti-CCP, HLA-DR4

270
Q

What is the classic presentation of RA

A

morning stiffness for > 30 min improving with use, symmetry, systemic sx

271
Q

What are the systemic symptoms found in RA

A

fever, fatigue, pleuritis, pericarditis

272
Q

What deformities of the hand are common in RA

A

boutonniere, swan neck, zthumb

273
Q

What is the classic traid of sjogrens syndrome

A

xeropthalmia, xerostomia, arthritis

274
Q

What are the associations for sjogrens syndrome

A

parotid enlargement, inc risk of B cell lymphoma, dental caries

275
Q

What autoantibodies are formed in sjogrens syndrome

A

ribonucleoprotein antigents - SS-A and SS-B (Ro and La)

276
Q

What is the Sicca syndrome

A

dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis and No arthritis

277
Q

precipitation of monosodium urate crystals into joints due to hyperuricemia

A

gout

278
Q

What are the potential causes of gout

A

lesch-nyhan, PRPP excess, dec exretion of uric acid (thiazide) inc cell turnover, von Gierke’s dz - 90% due to underexcretion, 10% to overproduction

279
Q

In which gender is gout more common and what does the crystals appear like microscopically

A

men, needle shaped and negatively birefringent = yellow crystals under parallel light

280
Q

What are characteristic findings of gout

A

asymmetric, swollen, red, painful joint, often MTP (podagra), tophus formation on external ear, olecranon bursa, achilles tendon

281
Q

When do acute attacks of gout typically occur

A

after a large meal or EtOH conspumption

282
Q

Why does EtOH consumption precipitate gout

A

EtOH metabolites compete for same excretion site in kidney as uric acid, causing dec uric acid secretion and subsequent buildup

283
Q

What is the TX for acute gout

A

NSAIDs (indomethacin) colchicine

284
Q

What is the TX for chronic gout

A

allopurinaol, uricosurics (probenicid)

285
Q

Deposition of calcium pyrophosphate cyrstals within the joint space

A

pseudogout

286
Q

What do pseudogout crystals appear like microscopically

A

basophilic, rhomboid crystals, weakly birefringent

287
Q

In which joints does pseudogout typically occur

A

large goints (knee)

288
Q

yellow when parallel and blue when perpendicular

A

gout

289
Q

yellow when perpendicular and blue when parallel

A

pseudogout

290
Q

How does gonococcal arthritis present

A

STD presents as a monarticular, migratory arthritis with an asynmetrical pattern - affected joint is painful, red and swollen

291
Q

Other than N. gono, what organisms can cause infectious, septic arthritis

A

S. aureus, streptococcus

292
Q

What organisms can cause chronic infectious arthritis

A

TB from dissemination and lyme dz

293
Q

Seronegative spondyloarthropathis have what HLA association, and why are they seronegative, and who do they more often occur in

A

B27, no RF, males

294
Q

dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain

A

psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

295
Q

chronic inflammatory disease of sacroiliac joints and spine - dz, associations

A

ankylosing spondylitis, uveitis, aortic regurg and bamboo spine

296
Q

What are where are apocrine glands?

A

Milky viscid secretions that become odorous from bacterial action. In axillae, genitalia and areolae. Do not become functional until puberty.

297
Q

What do sebaceous glands secrete?

A

Holocrine secretion of sebum. Associated with hair follicles.

298
Q

Where are zona occludens and what are they composed of?

A

(tight junction)-
prevents diffusion across paracellular space;
composed of claudins and occludins

299
Q

Zona adherens: location

A

(intermediate junction)surrounds
perimeter just below zona occludens;
cadherins connect to actin (CADherins are .l Ca2+-dependent ADhesion molecules)

300
Q

Macula adherens. Location

A

(desmosome)-
small, discrete sites of attachment; cadherins }-connect to intermediate filaments; autoantibodies
–> pemphigus vulgaris

301
Q

Hemidesmosomes. Functions

A

connects cells to
underlying extracellular matrix;
autoantibodies –> bullous pemphigoid

302
Q

Functions of Gap Junctions

A

allows adjacent cells to communicate for electric and metabolic functions

303
Q

Integrins. Function

A

maintains integrity
of basement membrane;
binds to laminin i n BM

Musculoskeletal and Connective Tissue (4 decks)

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