Back Pain Flashcards by Felicia Jones

maximal tension is generated when sarcomere length is

optimal

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

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force generation […] as sarcomere length […]

increases
decreases

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

cross bridges

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what causes rigor mortis?

lack of ATP for release of actin from myosin

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what bands change in length as the sarcomere contracts?

H and I shorten

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

shorten

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

remains the same

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

serum CK
muscle biopsy

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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”

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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)

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rhabdomyolysis can cause […] problems

renal

elevated BUN and creatinine on CMP

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

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myoglobinuria causes […] colored urine

tea

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urinalysis may show […] casts in myoglobinuria

granular

“muddy brown”

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risk factors for low vitamin D

exclusively breast fed infants
restrictive diets
CKD
hypoparathyroidism
malabsorptive conditions

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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

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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

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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

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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

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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)

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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

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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

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

ankylosing spondylitis

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what other symptoms may be associated with ankylosing spondylitis?

uveitis
aortic regurgitation

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

ankylosing spondylitis

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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)