Ketchum BSC

Question 1

what is the term describing the general effect this injury would have on sensation of the patients hand

he has a deep laceration and completely severs the ulnar nerve where it is most superficial at the elbow joint?

Answer 1

anesthesia

total or partial loss of sensation especially tactile

Question 2

what is synesthesia

Answer 2

one type of sensation evokes a sensation of another

feel a color

Question 3

what is paraesthesia

Answer 3

skin sensation, burning, prickling, itching, or tingling with no apparent physical cause

Question 4

what is kinesthesia

Answer 4

detection of bodily position, weight or movement of the muscles, tendons and joints

Question 5

hypersensitivity to cold?

Answer 5

cryesthesia

Question 6

what is the term describing the general effect this injury would have on motor funciton of the patients hand?

Answer 6

paralysis
nerve paralysis
myoparalysis
motor paralysis

Question 7

what effect would loss of innervation have on the muscle cell?

Answer 7

atrophy- shrinking

muscle cells get smaller
actin and myosin are the cytoskeletal elements that are lost in muscle cells

Question 8

apoptosis and necrosis difference?

Answer 8

apoptosis is planned

Question 9

denervation causes

Answer 9

no myonecrosis
no rhabdomyelosis b/c cells aren’t dying

loss and disarry of myofilaments inside the muscle cell

Question 10

what is dystrophy

Answer 10

form of atrophy that specifically results from wasting process that is disease related

Question 11

what is myopathy

Answer 11

muscular disease in which muscle fibers do not function

Question 12

what is the primary cause of myofilament degradation in denvervation atrophy?

Answer 12

Increased proteosome activity

NOT suppresion of protein synthesis (some but not main cause)
NOT enhanced lysosomal enzyme activity
b/c lysosomes degrade…
NOT expanded metalloproteinase activity b/c these function mainly in the ECM
NOT increased activity in caspase b/c these play a role in apoptosis and necrosis

Question 13

what is the ubiquitin proteosome system

Answer 13

primary means of degrading muscle cells

involves target protein is polyubiquitinated
then 26S proteasome recognizes ubiquitin and degrades substrate

Question 14

case two lady with fatigue when she chews (progressively weaker as she uses her muscles)
diplopia (double vision) 
facial muscles weak
she is a gymnast
ptosis (droopy eye lids)
sneering when smiling

is this a neuropathy or myopathy

Answer 14

myopathy

EMG shows progressive weakness
contraction amplitude is decreasing –> this tells us that muscles aren’t able to recapture their functionality as quick as they should be able to

myesthenia gravis

see a smoothing of the membrane in the cleft

Question 15

symptoms and EMG reversed after IV administration of an acetylcholinesterase inhibitor what does this mean?

also she has anti-AChR antibodies

Answer 15

myesthenia gravis

NOT amyetrophic lateral sclerosis (b/c this is damage to spinal cord which will cause muscle atrophy and weakness due to abnormal nerves!) NOT Immune so wouldn’t have antibodies, wouldn’t have normal nerve condction test

NOT MS b/c
the antibodies seen in this would not be antiAChR antibodies, wold not have normal NCV test (it would be slow)

NOT WNV polio-like syndrome- neurotoxic, death of central motor neurons, not autoimmune, wouldn’t have normal nerve conduction test

Question 16

myesthenia gravis and the eyes??

Answer 16

acetylcholine release is binding up small available ACh receptors

as it continues to be released there are fewer receptors for it to bind to

as this happens the ACh that are bound, open and allow ions to chanell through, but then it takes them a while to recover

so channels tend to stay open and you get progressive fatigue

ACh receptors in the eyes muscles are reduced compared to the rest of the body***

Question 17

why does she have diplopia

Answer 17

b/c their musculature isn’t working in her eyes in myesthenia gravis

2 major clinical forms of myesthenia gravis
occular MG- ocular symptoms
-85 percent of ocular MG patients progress to general MG within two years

general MG- generalized weakness

Question 18

case with 5 year old boy
no progression in speech
CK level of >10, 000 (normal is under 200)
walked funny (trendelenburg gait and gower’s maneuver to stand up)

diagnosis

Answer 18

most likely diagnosis is primary myopathy

(not denervation- no wound)
not MS- age of onset is usually greater
not nutritional deficiency (no evidence to support this)
NOT rhabdomyolysis ( no mention of kidney failure)

Question 19

trendelenburg gait

Answer 19

lost abductors at the hip

gluteus minimus and medius

Question 20

what is gower’s maneuver

Answer 20

don’t have enough hip strength to rise from sitting position

so he straightens legs, puts hands out in front of him and then tries to stand up

Question 21

Duchenne muscular dystrophy

Answer 21

Primary myopathy

costamere (ties filaments to the cell membrane)
this compex tranverses the cell membrane, containes the protein dystrophin

dystrophin is mutated - becomes a nonfunctional protein and don’t get transmission of force out of the cell and into the connective tissue, tendons transmitted to the muscle

cells atrophy and are replaced by fat

x-linked recessive genetic disease