Block 1 Flashcards
What accompanies downward and lateral displacement of scapula?
Narrowing of inferior scapulohumeral angle
Injury to what nerve causes weakness of rhomboids?
dorsal scapular nerve
What nerve is injured if weakness during medial rotation and adduction of humerus?
thoracodorsal nerve (latissimus dorsi injury)
complication of cisternal puncture procedure
injure vertebral artery, compress greater occipital nerve, compress suboccipital nerve
Large tumor in suboccipital region compresses nerves that do what?
parasthesia of skin over neck and head
What protein is likely missing in skeletal contraction if tropomyosin can not be removed?
troponin
What disorder blocks ACh receptors at neuromuscular junctions?
Myasthenia Gravis
Presentation of Myasthenia Gravis
droop of eyelid, double vision, swallow difficulty
What disease causes muscles to undergo destructive atrophy (change to fat and connective tissue)?
Muscular Dystrophy
What disease presents in early childhood and involves a mutation for dystrophin?
Duchenne muscular dystrophy
Defect of dystrophin in DMD cause what to occur?
sarcolemma tears in muscle
calcium influx causes cell degeneration/death
myocytes get replaced with fat and connective tissue
Characterization of Becker’s Muscular Dystrophy
slow progression of pelvic & leg muscle weakness
Positioning of lumbar puncture/spinal cord & dangers
recumbent or sit with spine flexion @L3
hemorrhage or traumatic tap cause blood in sample
Indication of bacterial infectionn in CSF
reduced glucose, increased protein, elevated lymphocyte, cloudy appearance
indication of viral infection in CSF
increased protein, increased lymphocytes
indication of fungal infection CSF
reduced glucose, increased protein, increased lymphocytes, filaments in solution
What typically cause vertebral arch fractures
lateral forces compress lateral mass between occipital condyles
can also rupture transverse ligament
Hangman fracture
bony column (superior and inferior artiuclar processes of axis)
Spondylosis C2
defect/stress fracture in pars interarticularis
hyperextension of head on neck
Caudal Epidural anesthesia location
fat of sacral canal surround proximal portion of sacral nerve
sacral cornua & inferior to S4 spinour process
where do osteophytes often occur in vertebrae
margins of vertebral body
Spondylolisthesis
dislocation between adjacent vertebrae
press on or injure spinal cord/nerves
Spondylolisthesis common where
L5-S1 of IV joint
area prone due to downward tilt
pressure on spinal nerve of cauda equina
herniation of nucleus pulposus
common low back/limb pain
lower lumbar & lower cervical most common
posterolateral through annulus fibrosis
compress spinal nerve roots one number below involved disk
Dowager hump
excessive thoracic kyphosis in older women from osteoporosis
Clinical significamce of axonal transport
PNS neuropathies spread (chicken pox, shingles, rabies, herpes)
neurodegrnerative disease
can deliver gene therapy
Common demyleinating disorders
peripheral neuropathy, multiple sclerosis, B12 deficiency, re-hydrate too fast
muscle action during clavicular fraction
SCM pulls medial aspect superior
Trapezius attach to humerus pulls inferior
deltoid can pull inferior
subclavius serves as protection for subclavian nerve
clavicular fracture can injure what surrounding structures?
subclavian nerve, axillary artery
Humerus greater tubercle fractures involve what muscles
supraspinatus, infraspinatus, teres minor
humerus lesser tubercle fracture involve what muscles and complications
subscapularis muscle
posterior dislocation & bone fragmentation
fracture of anatomical neck of humerus complication
damage axillary nerve, posterior humeral circumflex artery & vein (quadrangular space)
Midhumeral shaft fracture consideration
injure radial nerve & deep brachial artery
do not paralyze tricep
supracondylar humerus fracture consideration
displacement of fragment
injure median nerve & radial nerve
Wrist drop injury due to what
radial nerve palsy
compression of radial nerve
Decreased reflex response indicates problem in what?
muscle spindle
clincal apply of golgi tendon organ reflex
isometric contraction of hypertonic muscle engage inhibitory reflex circuit of spinal cord, inhibits low motorneusons
What shoulder muscle more vulnerable to tears and impingement?
supraspinatus
Rotator cuff muscle that injury to causes significant bleed
subscapularis
supply by subscapular artery
Jobe Test
abduction of arm to 90, internal rotation
assess rotator cuff injury (supraspinatus) if pain/weakness
rotator cuff tear
repetitive overhead activity or acute trauma
pain, weakness, limited ROM
shoulder impingement syndrome
compress RC tendon betwen humeral head & acromion
inflammation, pain, decreased function
frozen shoulder (adhesive capsulitis)
progressive stiffness & loss of motion
freeze, frozen, thaw stages
trauma, stresss, laxity of
glenohumeral instability
excess movement
lead to subluxation or dislocation
from trauma, stress, laxity congenitally
Poland syndrome
congenital absence of pectoralis majoor, often with hand defect
Thoracoacromial artery clinical significance
collateral vessel in case of axillary artery obstruction
Lateral thoracic artery clinical significance
Accompanied by long thoracic nerve and both can be damaged during surgery, especially breast reconstruction
subclavius muscle clinical significance
Protect the vascular and nerve underneath
auxiliary vein clinical importance
Central Venus catheter, can be involved in upper limb DVT
clinical significance of pectoral nerves
Injury occurs during mastectomy, or auxiliary, no dissection, results in weakness of pectoral muscles, which affects adduction and internal rotation
clinical significance of thoracic nerve
Injury to nerve paralyzes muscle and causes winging of scapula
intercoastal, brachial nerve clinical significance
Sacrificed and auxiliary, lymph node, dissection, causing numbness and upper inner arm and causes pain post mastectomy
what vein typically allows breast cancer to spread
Auxiliary vein as most Venus drainage flows through it
Effect of lymphedema
Swelling thickened leather, like skin with dimple, orange peels, deviation of nipple
nerve for sucking reflex
Fourth in coastal nerve into nipple and Ariola
pathogenesis of osteoarthritis
Age related decline formation of articular cartilage.
Loss of pro gin, content, and less fluidity next sentence contra trigger, excessive activation of met low protein, aces in increased degradation
where does osteoporosis occur?
In the cancellous bone or spongy bone
repair of fracture pathology
1) formation of hematoma
2) reinvasion of blood vessels formation of fibrocartilage callus
3) osteoblast form new compact bone
4) osteoclast form new cancellous bone
Osteomalacia
Calcium deficiency, causing soft bones and deformation due to paired remodeling
rickets
Calcium deficiency and kids due to diet deficient of vitamin D
osteogenesis imperfecta
Genetic disorder with defective or insufficient, collagen integration into bone matrix
osteoporosis/Albers Schoenberg disease
Defective regulation and impaired function of osteoclast, causing ossification
fibroplasia ossican progressive
Ectopic bone formation, subcutaneously, or conversion of connective tissue or muscle to bone
osteosarcoma
Osteoprogenitor cells become cancerous
osteoarthritis
Articular cartilage worn down by inflammation or overuse with limited repair mechanism
rheumatoid arthritis
Auto immune inflammation of synovial membrane causes increased collagenase and metalloprotease, enzyme, and damage, articular, cartilage, and joint
Bicipital meiotic reflex
Deep tendon reflex to evaluate spinal cord motor nerve, Afrin nerve and descending motor pathway should be involuntary bicep contraction
Integrity of muscular cutaneous nerve
Biceps tendinitis, and tendinosis symptom
Tendinitis is inflammation tendinitis is degradation
From repetitive micro trauma, accompany by rotator cuff or slap tears most men for bicipital groove tenderness with 10° of internal rotation can use corticosteroid injection or surgery
Rupture of long head of biceps tendon
Popeye deformity
Long head tendon near attachment of super glenoid tubercle
Clinical significance of brachial artery
Main or supply to the arm and continuation of auxiliary artery
Blood pressure and pulse
Most commonly injured upper limb artery, can cause occlusion, limb, claudication, and limb loss
cubital fossa clinical significance
Common site for sampling, transfusion of blood, IV
Median cubital vein is most commonly selected
Medium cubit vein for cardiac catheters
use of angiography
Image of blood vessels with x-ray dye
arteriography use
Areas of stenosis, occlusions, aneurysms, traumatic injuries, blood, clots, blood vessel abnormalities
clnical significance of auxiliary artery
When profuse bleeding occurs can compress third part against humorous
Can find arterial pulse for arterial line cardiac surgery
arterial anastomosis clinical significance
Allow blood flow if there is injury or occlusion
aneurysm degeneration of auxiliary artery
Repetitive trauma
Can compress trunks of brachial plexus
auxiliary vein in central line placement
Major Venus system for long-term vascular access
Subclavian vein puncture, using infra clavicular approach
Venipuncture lateral to curvature of middle of clavicle with needle, horizontal to sternal notch
Centennial lymph node biopsy
Main lymph node is identified removed and examined to determine if this cancer is metastasized or the original and where it will spread
risk of auxiliary, node dissection
Damage to long thoracic nerve, causing winged scapula, damage to subscapular vein, damage to lateral thoracic artery, damage to the dorsal nerve, causing weak medial rotation and adduction
Brachial plexus injuries
Affect movement and cutaneous sensation of upper limb
Signs and symptoms dependent on part of plexus
Test ability to perform movements to assess loss of function
Ability to feel pain loss of sensory function
injury to superior trunk/C5 and C6
From excessive increase in the angle between neck and shoulder
Referred to as Erb Duchenne palsy
Parisis/paralysis of shoulder and arm muscles lateral upper limb loses sensation, waiters tip
acute brachial plexus neuritis
Parsonage turner syndrome, neurologic amyotrophy
Sudden, severe burning pain in shoulder and upper arm
Typically superior trunk
Pain at night, followed by muscle weakness, and sometimes atrophy
Commonly affects middle-aged men, incident can be higher in pediatrics
consequence of prolonged hyper abduction
Thoracic outlet syndrome
Chords and vessels of brachial plexus, impinged or compressed core cord process and peck Miner tendon
Pain down the arm, numbness, tingling, redness, weakness of hand
Klumpke paralysis
Injury to inferior trunk
Upper limbs suddenly pulled superiorly
Injury or avulsion of C8 and T1 roots
Short muscles of hand, causing claw hand
Nerve injury leading to flexion of fourth and fifth fingers
interscalene nerve block
Alternative to general anesthesia for upper limb surgery
Level of C6 vertebral body
Inter scaling groove deep to lateral head of SCM
Supra clavicular nerve block
Inter scaling groove superior to clavicle lateral to subclavian artery
Trunks
Anesthesia for entire arm and hand
Highest incident of pneumothorax
Infra clavicular nerve block
Chords
Delta pectoral groove below clavicle
Anesthesia distal to elbow
auxiliary nerve block
Superior to pulse of auxiliary artery
Anesthesia distal to elbow
Minimal complication
locatioin simple squamous
posterior cornea, line blood vesels & lymph, surface of body cavities
simple cuboidal locatoin
tubules of kidney
simple columnar locatoin
GI tract,fallopian tubes, ductuli efferentes testis
pseudostratified locatioin
respiratory tract
nonkeratinized stratifies squamous locatoin
mouth, oral pharynx, esophagus, vocal cord, vagina
stratified cuboidal locatoin
salivary glands
stratified columnar location
larger ducts of exocrine, palpebral conjunctiva of eyelid
transitional epithelium location
urinary tract
barrett syndrom
complication of GERD, stratified squamous of esophagus becomes simople columnar with goblet cells (metaplasia)
consequence of genetic defect of voltage gated Na channel
hyperkalemic periodic paralysis (excess potassium inserum) causing liimb weakness after exercise of food high in K
paramyotonia congenita is periodic paralysis due to cold weather causing abnosmal repeat fire of muscle
factors induce hypokalemia
T3, T4 thyroid hormone
B adrenergic stimulation
Hyperinsulinemia
causes increase in Na-K-ATPase
metabolic effect hyperkalemia
depolarization
easuer generate AP (esp heart)
close inactivation gate of Na
most ccommon cause of muscle tetany
hypocalcemia
lowers threshold potential
calcium is a cofactor forNa channel gating
factorrs afect conduction velocity of AP
increased cytoplasm area = easier current
thick nerve conduct faster
myelination amount
Guillan Barre disease
demyelination in PNS
ion channels that cause IPSP
K & Cl
ion channels cause EPSP
Ca & Na
Drug induced seizure ,mechanism
inadequate amount of inhibitory influence or excessive excitatory stimulation
normal blood pH adult
7.4 +/- 0.05
respiratory acidosis
decrease ventilatoin, increased PCO2, partial renal compensation; very common
metabolic acidosis
decrease extracellular HCO3- concentration`decrease PCO2, partial respiratory compensation
respiratory alkalosis
increase ventilation, decrease PCO2, partial renal compensation
metabolic alkalosis
increase extracelluilar HCO3-, increase PCO2, partial respiratory compensation
glycine clinical significance
collagen
smallest AA
inhibitory (release block by tetanus toxin)
leucine, isoleucine, valine clinical significance
maple syrup urine disease
phenylalanine clinical significance
PKU
tryptophan clinical significance
serotonin
Niacin/B3
Hartnup disease
Serine/threonine clinical significance
O link glycolysation
phosphorylation
tyrosine clinical significance
phosphorylation
asparagine clinical significancae
N link glycolysation
Cysteine clinical significance
disulfide boind
glutathione
glutamic acid significance
excitatory NT
GABA derived from (inhibitory NT)
lysine significance
histone methylation & acetylation
arginine significance
ADP ribosylation
Kwashiorkior
kid malnutrition with large liver fdue to fat, edema
protein deprivation grater than total Kcal
Marasmus
calorie deprivation greater than reduction in protein
cachexia
weakness/wasting boidy from chronic illness
beta sheet in fiber proteins, causing neurological disorder
Amyloid, protein deposits and brains of Alzheimer’s patients with twisted beta pleated sheet fibers it leads to protein aggregation
Protein aggregation through the beta sheet with poly glutamine strands of Huntington protein is Huntington disease
misFolded prion protein
CJD, unknown prions induced formation of an amid fold protein polymerizes into aggregated, packed beta sheets
disorder caused by mutation in beta globin gene
Sickle cell disease
Position six of beta chains glutamic acid becomes veiling, which increases aggregation of HB leading to fibers is oxygen cannot be carr
disease caused buy vitamin C deficiency
Bruises on limbs, gum, disease, loosen teeth, lethargy, myalgia
Risk factor of poor diet and alcohol and smoking and dialysis
cross-linking of Lysol oxidize requires
Cofactor of copper
Coenzyme of PLP also known as vitamin B6
common disorder of type one collagen
Osteogenesis imperfecta and Ehlers-Danlos syndrome
common disorder of type three collagen
Ehlers-Danlos syndrome
common disorder of type four collagen
Alport syndrome and good pasture syndrome
common disorder of type five collagen
Ehlers-Danlos syndrome
clinical significance of osteogenesis imperfecta
Brittle bone disease, multiple fractures,, hearing loss, delayed wound healing
From mutations of type one collagen miss folding of pro peptides
Clara is from Clara being thinner
clinical significance of Dan syndrome
Hyper elasticity of skin, hyper mobility of joints, aortic aneurysm, colon rupture, skin hemorrhage
From mutations in alpha or alpha two chain of type one three or five collagen
Can Lysol hydroxy sufficiency or collagen deficiency
Alports syndrome clinical significance
Mutations and alpha three or five chain of collagen
Leads to kidney issues, ocular defects, hearing loss
Goodpasture syndrome, clinical significance
Antibodies against alpha chain of type four collagen
Auto immune towards basement membrane of pulmonary and glomerular capillaries
Establishes a protein in the urine
Menke disease clinical significance
Steely hair, arterial tortuosity, and rupture, anemia, cerebral degeneration, osteoporosis,
Recessive disorder
Deficient cross-linking of Lysol oxidase with a functional copper deficiency
emphysema clinical significance
Excess air in the lung
Mutation in A1 ATT
Marfan syndrome clinical significance
Elongated bones, dislocation of lens of eye, cardiovascular abnormality
From mutation in fiber and one which is in the ECM
epidermolysis Bullosa simplex clinical significance
Blister formation at Dermo epidermal junction
Mutation gene for keratin five or 14
alpha Thalassemia clinical significance
HBH disease
Microcytic and hypochromic anemia
beta thalassemia clinical significance
Thalassemia major
Microcytic and hypochromic anemia
lactate dehydrogenase classification
Oxidoreductase
Pyruvate kinase classification
Transferase
alpha amylase classification
Hydrolase
Aldolase A classification
lyase
phosphoglucose isomerase classification
isomerase
pyruvate carboxylase classification
ligase
where does phosphorylation occur amino acid?
Serine, throninee and tyrosine
ADP ribosylation location AA
Arginine
methylation location AA
lysine and arginine
cholera
cholera toxin (bacteria) ADP ribosylates G protein
pertussis
pertussis toxin (bacteria) ADP ribosylates G protei
hemoglobin S disease
Red cell sickling, hemolytic anemia
glutamic acid becomes valine (charge to no charge)
Hemoglobin C disease
Glutamic acid becomes lysine at position six of beta chain (positive to negative)
Hemoglobin SC disease
significant red cell sickle
methemoglobinemia disease
increased ferric hemoglobin in blood
reduce oxygen bind ability
treat with methylene blue
iron overload
hemochromatosis
polycythemia
increaseed RBC
anemia
decreased RBC
leukocytosis
high WBC
leukopenia
low WBC
thrombocytosis
high platelet
thrombopenia
low platelet
pancytopenia
low all types
anisocytosis
varied size RBC
poikilocytosis
varied shape RBC
schistocytes
damaged RBC
gray platelet syndrome
bleeding fisorder with absence alpha granules
storage pool deficincy
reduced or absence of delta granules
prolong nosebleed
hemophilia
rare inherited blood disorder where decrease ability to clot
indication of prone lumbar soft tissue technique
thoracic/lumbar paraspinal muscle tension with back oain, chest wall paain
indication of lumbosacral prone 2 hand traction soft tissue technique
lumbosacral tension causing back pain, Si pain, pelvic pain
indication of thoracic prone 2 handed traction soft tissue tetchnique
reduce muscle hypertonicity, muscle tension, fascial tension, muscle spasm
indication of prone regional thoracic myofascial release technique
reduce muscle tension, fascial tension, increase eleasticity of short or fibrotic myofascia
indication of mid & low toracic region soft tissueh
reduce muscle hypertonicity, muscle tension, fascial tesion, muscle spasm
indication of scapulothoracic myofascial release
increase of shortene, inelastic or fibrotic myofascia, improve regional ROM of paraspinal & shoulder, increase lymph and venous drainage, alleviate congestion with poor respiration
indication of pectoral traction
increase venous and lymph drain to alleviate congestion, improve excess shoulder protraction, release tension of clavipectoral fascia
indication of thoracic inlet/sibson’s fascia myofascial release
reduce tension, incresae venous and lymph drain to decrease local/distal swell, improve overall immune & circulation to area
indication of suboccipital tension release
reduce tension of suboccipital triangle, vascular headache, prep for cervical correction
indication of cervical soft tissue
reduce muscle hypertonicity, tension, soasm, streth and increas elasticity to improvr ROM, reduce patient guarding
indication of stretching cervical technique
stretch myofascial of cervical and upper thoracic, promote venous and lymph drainage
Type I mechanics
neutral
sidebend and rotation opposite direction
only thoracic or lumbar spine
Type II mechanics
extended or flexed
sidebend and rotation same direction
Only thoracic or lumbar spine
appearance of 5 densities on radiography
metal - whitest
calcium - white, appear in bones mostly
soft tissue/fluid - denser it is = greyer, less dense = blacker
fat - lighter shade of grey
air - appears blackest
pannicular fascia
loose & dense irregular
variable fat
axial & appendicular fascia
muscles & torso, fibers run direction of muscle
meningeal fascia
dural & other CNS membranesv
visceral fascia
mediastinum, around organs
subserous fascia
loose, elastic tissue
organ covering
elasticity of fascia
elastic deformation
recoverable deformation
plasticity of fascia
plastic deformation
nonrecoverable deformation
viscosity
measure of rate of determination of material under load & capability of yielding under stress
stress
effect of force over area
strain
change in shape as result of sstressc
creep
continue deformatoin of viscoeleastic material under constant load (relate to viscosity)
Hooke Law
applied stretch or compression to tissue result in proportional change in length
Wolff Law
form follow function
direct fascial release
engage and move towards restrictive barrier
indirect fasciall release
move away from restrictive barrier
TART
tenderness, asymmetry, ROM, texture
isolytic contraction
external forces overcome muscle contraction (muscle lengthens)
isotonic contraction
tone stays same, length changes
Isometric contraction
force can vary but muscle length stays samae
muscle spindle OMT
reduce firing of muscle proprioceptors to decrease hypertonicity
golgi tenson OMT
activate golgi tendon organ to produce muscle relaxation
oculocephalic refelex
cause reflex muscle contraction use eye motion to affect cervical muscle
Sherrington law
muscle receive nerve impulse to contract, antagonist receive impulse to relax
Crossed extensor reflex
flexor muscle in non-treatment extremity contracts
opposite extremity flexor relaxes by involuntary contraction
muscle energy principles of treatment
1 - postition part into restrictive barrier
2 - direct patient to contract correct muscle
3- phyisican apply counterforce equal to contraction, maintain force until appropriate contraction
4 - patient relax & physician match
5 - take up slack (move more restrictive)
6 - repeat steps untill restrictive barrier removed
7 - last contraction by patient takes patient into barrier on last time and go to neutral
8 - reevaluate original dysfunction
clinical indicatuion of HbH disease
low Hb, decrease MCV, decrease MCH, decrease MCHC
microcytic anemia (jaundice, palpaple spleen)
suggested by low HbA2
clinical indication og HbS
anemia after exercise
iron deficiency anemia clinical signs
low ferritin
history of bleed/malnutriton
B Thalassemia major clinical sign
increased HbA2
test for differentiating hemoglobinopathies
pH rate of travel towards electrode
in alkaline - HbS more slow that HbA
in acidic - HbS faster
lower than normal activity of Lysl oxidase
Menkes disease
due to deficiency in copper
lower than noirmal cleavage of procollagen due to
decreased Nprocollagen peptidase
lower enzyme activity of what that is related to cleaveage of procollagen
C procollagen peptidase
scurvy due to what enzyme’s decreased activity?
lysyl hydroxylase
Effect of ATP inhibiting enzyme (noncompetitive) on michaelis menten graph
hyperbolic graph decreased Vmax
last layer of tissue needle passes during spinal tap
arachnoid
CSF is in the subarachnoid space
safest location/direction for epidural
After L2, around L3 in epidural space from dorsal surface travelling ventrally
can also be done in sacral hiatus
bacteria in posterior venous plexus travels to what if spinal stenosis
epidural space with internal venous plexus
central herrniation of cervical vertebrsae mechanism
compress both ventral roots, weakness bilateral arm, normal sensory
functional consequence damage SC at S2-S4
impair parasympathetic innervation
functional consequence damage SC L2-S2
weakness & sensory loss lower limb
functional consequence damage SC C5-T1
weakness & sensorly loss upper limb
functional consequence damage SC C2-C4
weakness of neck muscle & sensory loss in neck dermatomes
functional consequence damage SC T1-L2
impaired sympathetic innervation
