Back Pain Flashcards
maximal tension is generated when sarcomere length is
optimal
**if given a graph, optimal region is where plateau is seen
force generation […] as sarcomere length […]
increases
decreases
force generated by a muscle depends on the number of […] attached
cross bridges
what causes rigor mortis?
lack of ATP for release of actin from myosin
what bands change in length as the sarcomere contracts?
H and I shorten
During the power stroke, the H and I bands [….]
shorten
During the power stroke, the A band [….]
remains the same
what is the next best step for a patient with generalized weakness if you suspect polymyositis?
serum CK
muscle biopsy
treat rhabdomyolysis with […]
IV fluids
Naylor: “I like to get a daily urinalysis, and keep the urine specific gravity less than 1.010 with IV fluid”
Suspect […] if urine dipstick is positive for blood in the absence of red blood cells in urine sediment.
myoglobinuria
(Myoglobinuria causes a false-positive result for blood on urine dipstick)
rhabdomyolysis can cause […] problems
renal
elevated BUN and creatinine on CMP
Naylor: “this is a pigment deposition nephropathy caused by myoglobinuria”
myoglobinuria causes […] colored urine
tea
urinalysis may show […] casts in myoglobinuria
granular
“muddy brown”
risk factors for low vitamin D
exclusively breast fed infants
restrictive diets
CKD
hypoparathyroidism
malabsorptive conditions
Calcitriol supplementation is more costly and less available, why is it used in renal failure, especially chronic renal failure?
CKD patients have decreased a-1-hydroxylase and are unable to activate vitamin D.
Supplementing with activated vitamin D corrects the deficiency, increasing calcium absorption and suppressing PTH
what would you expect the following lab values to be in vitamin D deficiency?
Calcium:
Phosphate:
PTH:
ALP:
25(OH)Vitamin D:
1,25(OH)2 Vitamin D:
Calcium: normal/low
Phosphate: normal/low
PTH: high
ALP: high
25(OH)Vitamin D: low
1,25(OH)2 Vitamin D: normal/high
what would you expect the following lab values to be in secondary hyperparathyroidism?
Calcium:
Phosphate:
PTH:
ALP:
25(OH)Vitamin D:
1,25(OH)2 Vitamin D:
Calcium: low
Phosphate: high
PTH: high
ALP: high
25(OH)Vitamin D: normal
1,25(OH)2 Vitamin D: low
what would you expect the following lab values to be in hypoparathyroidism?
Calcium:
Phosphate:
PTH:
ALP:
25(OH)Vitamin D:
1,25(OH)2 Vitamin D:
Calcium: low
Phosphate: high
PTH: low
ALP: normal
25(OH)Vitamin D: normal
1,25(OH)2 Vitamin D: normal/low
what would you expect the following lab values to be in pseudohypoparathyroidism?
Calcium:
Phosphate:
PTH:
ALP:
25(OH)Vitamin D:
1,25(OH)2 Vitamin D:
Calcium: low
Phosphate: high
PTH: high
ALP: high
25(OH)Vitamin D: normal
1,25(OH)2 Vitamin D: normal/low
(Persistent hypocalcemia despite high PTH due to defective Gs unit)
Associate a pediatric vignette with cranial facial abnormalities (an atomic terms to describe this include “bossing”, “brachial, cleft abnormalities “, older terms, include descriptions, like box shaped head) with […]
hypoparathyroidism
Cholecalciferol is the 68th most prescribed medication, calcitriol is the 258 mostprescribed medication. Why would that be?
cholecalciferol has a longer half life, is cheaper, and available OTC
what type of seronegative spondylitis causes symmetric involvement of the spine and sacroiliac joints causing fusion over time?
ankylosing spondylitis
what other symptoms may be associated with ankylosing spondylitis?
uveitis
aortic regurgitation
what type of seronegative spondylitis is more common in males, with age of onset between 20-40 years?
ankylosing spondylitis
what type of seronegative spondylitis is associated with “bamboo spine” on imaging?
ankylosing spondylitis
what type of seronegative spondylitis is associated with conjunctivitis, arthritis, and urethritis?
reactive
infections with chlamydia can cause what type of joint pathology?
reactive arthritis
HLA-DR4 is associated with […] arthritis
rheumatoid
what type of arthritis spares the DIP and CMC?
rheumatoid
polymyalgia rheumatica commonly present in patients with […]
giant cell arteritis
positive rheumatoid factor and/or anti-CCP antibodies
rheumatoid arthritis
WBC count greater than 50,000 in synovial fluid indicates
septic arthritis
gonorrhea causes […] arthritis
septic
triad of polyarthralgia, tenosynovitis, and dermatitis is associated with […] arthritis
gonococcal
anti-dsDNA, ANA, and anti-Sm antibodies in the setting of arthritis would indicate
lupus
in rheumatic arthritis, pain improves with […]
use
(morning stiffness greater than 1 hr, improves throughout the day)
in osteoarthritis, pain improves with […]
rest
[…] arthritis typically spares the MCP
osteo
what type of arthritis is this?
osteo
In contrast to rheumatoid arthritis, osteoarthritis can affect the […]
DIP
[…] is a surface antigen that belongs to the MCH Class I.
HLA B27
HLA-B27 is strongly associated with […] and other autoimmune conditions
seronegative spondyloarthropathies
(reactive, ankylosing, psoriatic, IBD)
arthritis without rheumatoid factor is called
seronegative spondyloarthritis
(highly associated with HLA B27)
pain and stiffness in the proximal muscles (shoulders/hips)
w/ fever malaise and weight loss
no weakness
polymyalgia rheumatica
what lab values would you expect to see with polymyalgia rheumatica?
elevated ESR
elevated CRP
normal CK
(differential: polymyositis/dermatomyositis would likely have elevated CK)
positive ANA
elevated CK
positive anti-Jo-1, anti-SRP, or anti-Mi-2 antibodies
polymyositis/dermatomyositis
what interleukin stimulates production of proinflammatory cytokines and chemokines by other immune cells?
IL-17
Inhibition of […] could disrupt granulomas, releasing intracellular mycobacteria and reactivating latent tuberculosis.
TNF-a
where is the RER located in neurons?
soma and dendrites
(stains with Nissl stain- aka alinine stain)
Activation of NOD-like receptors, a type of pattern recognition receptor (PRR), leads to the upregulation of
NF-kB
[…] ensure coordinated contractions in striated muscle cells
t-tubules
The dense organization of […] within the sarcoplasmic reticulum allows for optimal cardiac excitation-contraction coupling to occur and facilitates the synchronous activation of rapid calcium release among the cardiomyocytes
t-tubules
overexpression of MHC-I on the sarcolemma is an immunohistochemical finding that is classic for […]
polymyositis
[polymyositis vs dermatomyositis]
CD8+
polymyositis
[polymyositis vs dermatomyositis]
CD4+
dermatomyositis
[polymyositis vs dermatomyositis]
endomysial infiltration
polymyositis
[polymyositis vs dermatomyositis]
perimysial infiltration
dermatomyositis
what antibodies are specific for polymyositis/dermatomyositis?
anti-SRP
anti-Jo
anti-Mi-2
female patients with dermatomyositis are at an increased risk for what cancer?
ovarian
[…] is the first-line therapy for hyperkalemic emergencies, which can develop as a result of crush injury and rhabdomyolysis
calcium gluconate
[…] is a common complication of rhabdomyolysis
AKI
Severe vitamin D deficiency can lead to […]calcemia and […]phosphatemia
hypo
hypo
(by decreasing the amount of calcium and phosphate absorption in the intestine)
