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Capstone Test 2 > Back Pain > Flashcards

Back Pain Flashcards

1
Q

maximal tension is generated when sarcomere length is

A

optimal

**if given a graph, optimal region is where plateau is seen

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2
Q

force generation […] as sarcomere length […]

A

increases
decreases

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3
Q

force generated by a muscle depends on the number of […] attached

A

cross bridges

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4
Q

what causes rigor mortis?

A

lack of ATP for release of actin from myosin

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5
Q

what bands change in length as the sarcomere contracts?

A

H and I shorten

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6
Q

During the power stroke, the H and I bands [….]

A

shorten

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7
Q

During the power stroke, the A band [….]

A

remains the same

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8
Q

what is the next best step for a patient with generalized weakness if you suspect polymyositis?

A

serum CK
muscle biopsy

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9
Q

treat rhabdomyolysis with […]

A

IV fluids

Naylor: “I like to get a daily urinalysis, and keep the urine specific gravity less than 1.010 with IV fluid”

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10
Q

Suspect […] if urine dipstick is positive for blood in the absence of red blood cells in urine sediment.

A

myoglobinuria

(Myoglobinuria causes a false-positive result for blood on urine dipstick)

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11
Q

rhabdomyolysis can cause […] problems

A

renal

elevated BUN and creatinine on CMP

Naylor: “this is a pigment deposition nephropathy caused by myoglobinuria”

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12
Q

myoglobinuria causes […] colored urine

A

tea

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13
Q

urinalysis may show […] casts in myoglobinuria

A

granular

“muddy brown”

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14
Q

risk factors for low vitamin D

A

exclusively breast fed infants
restrictive diets
CKD
hypoparathyroidism
malabsorptive conditions

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15
Q

Calcitriol supplementation is more costly and less available, why is it used in renal failure, especially chronic renal failure?

A

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

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16
Q

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:

A

Calcium: normal/low
Phosphate: normal/low
PTH: high
ALP: high
25(OH)Vitamin D: low
1,25(OH)2 Vitamin D: normal/high

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17
Q

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:

A

Calcium: low
Phosphate: high
PTH: high
ALP: high
25(OH)Vitamin D: normal
1,25(OH)2 Vitamin D: low

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18
Q

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:

A

Calcium: low
Phosphate: high
PTH: low
ALP: normal
25(OH)Vitamin D: normal
1,25(OH)2 Vitamin D: normal/low

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19
Q

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:

A

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)

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20
Q

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 […]

A

hypoparathyroidism

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21
Q

Cholecalciferol is the 68th most prescribed medication, calcitriol is the 258 mostprescribed medication. Why would that be?

A

cholecalciferol has a longer half life, is cheaper, and available OTC

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22
Q

what type of seronegative spondylitis causes symmetric involvement of the spine and sacroiliac joints causing fusion over time?

A

ankylosing spondylitis

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23
Q

what other symptoms may be associated with ankylosing spondylitis?

A

uveitis
aortic regurgitation

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24
Q

what type of seronegative spondylitis is more common in males, with age of onset between 20-40 years?

A

ankylosing spondylitis

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25
Q

what type of seronegative spondylitis is associated with “bamboo spine” on imaging?

A

ankylosing spondylitis

26
Q

what type of seronegative spondylitis is associated with conjunctivitis, arthritis, and urethritis?

A

reactive

27
Q

infections with chlamydia can cause what type of joint pathology?

A

reactive arthritis

28
Q

HLA-DR4 is associated with […] arthritis

A

rheumatoid

29
Q

what type of arthritis spares the DIP and CMC?

A

rheumatoid

30
Q

polymyalgia rheumatica commonly present in patients with […]

A

giant cell arteritis

31
Q

positive rheumatoid factor and/or anti-CCP antibodies

A

rheumatoid arthritis

32
Q

WBC count greater than 50,000 in synovial fluid indicates

A

septic arthritis

33
Q

gonorrhea causes […] arthritis

A

septic

34
Q

triad of polyarthralgia, tenosynovitis, and dermatitis is associated with […] arthritis

A

gonococcal

35
Q

anti-dsDNA, ANA, and anti-Sm antibodies in the setting of arthritis would indicate

A

lupus

36
Q

in rheumatic arthritis, pain improves with […]

A

use

(morning stiffness greater than 1 hr, improves throughout the day)

37
Q

in osteoarthritis, pain improves with […]

A

rest

38
Q

[…] arthritis typically spares the MCP

A

osteo

39
Q

what type of arthritis is this?

A

osteo

40
Q

In contrast to rheumatoid arthritis, osteoarthritis can affect the […]

A

DIP

41
Q

[…] is a surface antigen that belongs to the MCH Class I.

A

HLA B27

42
Q

HLA-B27 is strongly associated with […] and other autoimmune conditions

A

seronegative spondyloarthropathies

(reactive, ankylosing, psoriatic, IBD)

43
Q

arthritis without rheumatoid factor is called

A

seronegative spondyloarthritis

(highly associated with HLA B27)

44
Q

pain and stiffness in the proximal muscles (shoulders/hips)
w/ fever malaise and weight loss

no weakness

A

polymyalgia rheumatica

45
Q

what lab values would you expect to see with polymyalgia rheumatica?

A

elevated ESR
elevated CRP
normal CK

(differential: polymyositis/dermatomyositis would likely have elevated CK)

46
Q

positive ANA
elevated CK

positive anti-Jo-1, anti-SRP, or anti-Mi-2 antibodies

A

polymyositis/dermatomyositis

47
Q

what interleukin stimulates production of proinflammatory cytokines and chemokines by other immune cells?

A

IL-17

48
Q

Inhibition of […] could disrupt granulomas, releasing intracellular mycobacteria and reactivating latent tuberculosis.

A

TNF-a

49
Q

where is the RER located in neurons?

A

soma and dendrites

(stains with Nissl stain- aka alinine stain)

50
Q

Activation of NOD-like receptors, a type of pattern recognition receptor (PRR), leads to the upregulation of

A

NF-kB

51
Q

[…] ensure coordinated contractions in striated muscle cells

A

t-tubules

52
Q

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

A

t-tubules

53
Q

overexpression of MHC-I on the sarcolemma is an immunohistochemical finding that is classic for […]

A

polymyositis

54
Q

[polymyositis vs dermatomyositis]
CD8+

A

polymyositis

55
Q

[polymyositis vs dermatomyositis]
CD4+

A

dermatomyositis

56
Q

[polymyositis vs dermatomyositis]
endomysial infiltration

A

polymyositis

57
Q

[polymyositis vs dermatomyositis]
perimysial infiltration

A

dermatomyositis

58
Q

what antibodies are specific for polymyositis/dermatomyositis?

A

anti-SRP
anti-Jo
anti-Mi-2

59
Q

female patients with dermatomyositis are at an increased risk for what cancer?

A

ovarian

60
Q

[…] is the first-line therapy for hyperkalemic emergencies, which can develop as a result of crush injury and rhabdomyolysis

A

calcium gluconate

61
Q

[…] is a common complication of rhabdomyolysis

A

AKI

62
Q

Severe vitamin D deficiency can lead to […]calcemia and […]phosphatemia

A

hypo
hypo

(by decreasing the amount of calcium and phosphate absorption in the intestine)

Capstone Test 2 (5 decks)

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