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#MedSchool > Msk Final > Flashcards

Msk Final Flashcards

1
Q

Autoimmune disorder attaching schwann cells causing demyelination in the peripheral nervous system

A

Guillian barre

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2
Q

hypaxial/ Extrinsic back muscles are innervated by who

A

CN11 and brachial plexus branches

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3
Q

epaxial/ intrinsic back muscles are innervated by who

A

dorsal rami of spinal nerves

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4
Q

what muscles make up the erector spinae group of intrinsic back muscles? They extend and laterally flex vertebral column.

A

spinalis, longissimus, iliocostalis

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5
Q

what muscles make up the transversospinalis group of intrinsic back muslces

A

rotatores, multifidus, semispinalis

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6
Q

what modalities are carried by dorsal root fibers

A

sensory

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7
Q

what modalities are carried by dorsal ramus of spinal nerve

A

sensory and motor

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8
Q

what modalities are carried by ventral root fibers

A

motor

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9
Q

what modalities are carried by ventral ramus of spinal nerve

A

sensory and motor

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10
Q

insertion, action, and innervation of splenius cervicis (originates at nuchal ligament)

A

transverse process of C-3
extend head/ neck, lateral flexion and rotation of neck
dorsal rami of spinal nerves

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11
Q

insertion, action, and innervation of splenius capitis

A

lateral part of mastoid process
extend head/ neck, lateral flexion and rotation of neck
dorsal rami of spinal nerves

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12
Q

action, blood supply, and innervation of iliocostalis (runs from iliac crest to lumbar, thoracic, and cervical transverse processes)

A

extend and laterally flex vertebral column
posterior intercostal and lumbar aa.
dorsal rami of spinal nerves

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13
Q

action, blood supply, and innervation of longissimus

A

extend/ lateral flex vertebral column
posterior intercostal aa. for thoracis and cervicis portions
occipital a. for capitis portion
nerve: dorsal rami

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14
Q

action, blood supply, and innervation of spinalis m. (thoracis, cervicis, capitis portions)

A

extend and lateral flex vertebral column
posterior intercostal aa.
dorsal rami

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15
Q

blood supply and innervation for semispinalis

A

cervicis and capitis: deep cervical a.
thoracis: posterior intercostal aa.
all are innervated by dorsal rami

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16
Q

muscle running from transverse process of one vertebra to spinous process of the vertebra superiorly

A

multifidus (attach to tip of spinous process)

rotatores (2 bellies attach at base of spinous process)

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17
Q

blood supply, innervation, and action of multifidus

A

posterior lumbar arteries
dorsal rami
stabilize vertebra during localized movement

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18
Q

blood supply, innervation, and action of rotatores

A

posterior intercostal arteries
dorsal rami
extend head and spine and rotate contralaterally

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19
Q

what is the only intrinsic back muscle that receives BOTH ventral and dorsal contribution from spinal nerves

A

intertransversari m.

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20
Q

blood supply to interspinales

A

vertebra, occipital, posterior intercostal aa.

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21
Q

blood supply to intertransversari

A

deep cervical, vertebral, posterior intercostal aa.

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22
Q

blood supply to legator costarum

A

posterior intercostal a.

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23
Q

which ligament surrounds the dens holding it in place

A

transverse ligament of the atlas

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24
Q

ligament holding atlas and axis together posteriorly

A

deep: cruciate ligament
superficial: tectorial membrane

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25
Q

the mm. of the sub occipital region are all innervated by dorsal rami of which spinal nerve?

A

C1: sub occipital nerve

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26
Q

rectus capitis posterior major and minor, obliquus capitis superior and inferior are postural muscles that aid extension and rotation at which joint

A

atlantoaxial joint (they are sub occipital muslces)

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27
Q

what are the borders and contents of sub occipital triangle

A

boarders: obliquus capités superior and inferior and rectus capitis major
contents: suboccipital n. and vertebral a.

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28
Q

which vertebrae have foramina in their transverse process

A

cervical

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29
Q

which vertebrae have bifid spinous process

A

cervical

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30
Q

which vertebrae have facets for ribs

A

thoracic

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31
Q

which vertebrae have greatest ROM

A

cervical

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32
Q

which vertebrae have greatest strain

A

lumbar (dispace energy to pelvis)

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33
Q

where does ligamentum flavum run

A

just anteriorly to the spinous process of vertebra

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34
Q

what structure surrounds nucleus pulpous to help maintain intervertebral joints

A

annulus fibrosus

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35
Q

what supplies blood to the vertebra

A

cervical- vertebral/ cervical aa
thoracic- posterior intercostal as
lumbar- subcostal and lumbar aa
sacral- iliolumbar/ sacral aa

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36
Q

what are the 2 enlargements of the spinal cord

A

cervical, lumbar

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37
Q

what is the outermost meningeal covering of the spinal cord

A

dura mater

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38
Q

which layer of spinal cord meningeal covering contains circulating CSF

A

arachnoid mater (middle layer)

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39
Q

what is the innermost layer of meningeal covering for the spinal cord and what connects it to the spinal cord

A

pia mater

denticulate ligaments

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40
Q

spinal nerve roots are partially covered by which meningeal layer

A

dura mater

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41
Q

which ribs are considered false ribs since they articulate with the sternum via cartilage rather than bone

A

8-10

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42
Q

which ribs are considered floating since they do not have their own cartilaginous or bony attachment to the sternum

A

11 and 12

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43
Q

what are the 3 components of the sternum

A

manubrium, body, xiphoid

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44
Q

which rib inserts to the xiphosternal joint?

A

7th

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45
Q

which rib inserts to the manubrosternal joint

A

2

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46
Q

mammary glands are classified as what

A

modified sweat glands

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47
Q

the breast rests on what superficial structure

A

pectoral fascia

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48
Q

name the potential space between breast and pectoral fascia

A

retromammary space

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49
Q

breast is innervated by what

A

intercostal nn 4-6

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50
Q

mammary gland lobules condense and drain into what structure before converging on the nipple

A

lactiferous ducts then sinuses

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51
Q

mammary gland lobules are separated by what named structure that also attaches to dermis of overlaying skin

A

suspensory ligament (Cooper’s ligament)

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52
Q

arterial supply to breast tissue comes from where

A

axillary a. (via mammary branches)

internal thoracic a.

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53
Q

what causes rapid metastasis of breast cancer

A

lots of lymph drainage to axillary nodes

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54
Q

lymph from nipple, aerola, and lactiferous lobules drains to what

A

subareolar lymph nodes

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55
Q

75% of breast lymph drains to what

A

axillary nodes (pectoral, central, apical)

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56
Q

what innervates breast tissue

A

supraclavicular nn.

intercostal nn 4-6 (mammary branches)

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57
Q

deltopectoral (clavipectoral) triangle borders

A

deltoid, pec major, middle 1/3 of clavicle

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58
Q

deltopectoral (clavipectoral) triangle contents

A

cephalic vein
deltopectoral lymph nodes
deltoid branch of thoracoacromial a. (from axillary a)

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59
Q

what kind of fascia encloses the pec major

A

pectoral fascia

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60
Q

what kind of fascia encloses the subclavius and pec minor

A

clavipectoral fascia

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61
Q

contents of clavipectoral triangle pierce which layer of fascia

A

clavipectoral fascia

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62
Q

the clavipectoral fascia becomes what inferior to the pec minor

A

suspensory ligament of the axilla

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63
Q

innervation and blood supply to pec major

A

pectoral branch of thoracoacromial arterial trunk

lateral and medial pectoral nn. (C5-T1)

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64
Q

innervation and blood supply to pec minor

A

pectoral branch of thoracoacromial arterial trunk

medial pectoral n (C8-T1)… this also pierces the muscle

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65
Q

innervation and blood supply to subclavius

A

clavicular branches of thoracoacromial trunk

nerve to subclavius (C5-6)

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66
Q

innervation and blood supply to serratus anterior

A

lateral thoracic a

long thoracic n. (C5,6,7)

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67
Q

peau d’orange (skin resembling orange peel) of the breast indicates what

A

blockage of cutaneous lymph vessels

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68
Q

breast elevates when woman places hands on hips and lesses elbows foreword indicates what is happening

A

invasion of pec major by the cancer

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69
Q

finger sized dimple in superiolateral quadrant of breast indicates what condition

A

shortening of suspensory ligaments by cancer in axillary tail of breast

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70
Q

action of pec major

A

adduct, medial rotate, flex, extend humerus

anterior and inferior movement of scapula

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71
Q

action of pec minor

A

stabilize scapula

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72
Q

action of subclavius

A

depress and anchor scapula

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73
Q

action of serratus anterior

A

protraction and upward rotation of scapula

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74
Q

thoracoacromial trunk of axillary artery has what branches

A

acromial, deltoid, pectoral

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75
Q

what muscle is responsible for splitting the axillary artery into its 3 major regions in the clavipectoral region

A

pec minor

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76
Q

what major branch is given off of the axillary artery in part 1 (proximal to p minor)

A

superior thoracic a

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77
Q

what major branch is given off of the axillary artery in part 2 (posterior to p minor)

A

thoracoacromial trunk

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78
Q

what major branch is given off of the axillary artery in part 3 (distal to p minor)

A

subscapular a (circumflex scapular and thoracodorsal branches)
anterior circumflex humeral
posterior circumflex humoral

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79
Q

what are the anastomosing arterial branches of the scapula

A

suprascapular, dorsal scapular, posterior intercostal aa, circumflex scapular, thoracodorsal a

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80
Q

what are the 2 superficial venous contributions to axillary vein in the pectoral region

A

cephalic v

basilic v

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81
Q

what are the boundaries of axilla

A

anterior: pec major and minor
posterior: scapula and subscapularis
lateral: humerus (intertubercular sulcus and biceps tendon)

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82
Q

what all is contained in the axillary sheath

A

axillary v
axillary a
brachial plexus

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83
Q

shoulder joints are held together by which ligaments

A

coracoclavicular (trapezoid and conoid)
coracoacromial
glenohumeral (superior, middle, inferior)

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84
Q

what are the rotator cuff muscles of the shoulder

A

subscapularis
supraspinatus
infraspinatus
teres minor

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85
Q

long thoracic n (C5, 6, 7) innervates which muscle

A

serratus anterior

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86
Q

blood supply and innervation to deltoid

A

deltoid branch of thoracoacromial arterial trunk

axillary n

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87
Q

blood supply and innervation to trees major

A

circumflex scapular a

lower sub scapular n

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88
Q

the transverse ligament of the humerus wraps around what holding it in the inter tubercular groove of the humerus

A

biceps tendon

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89
Q

what articulates with the greater tubercle of the humerus

A

supraspinatus, infraspinatus, teres minor

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90
Q

what articulates with the lesser tubercle of the humerus

A

subscapularis

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91
Q

blood supply and innervation to supraspinatus

A

suprascapular a

suprascapular n

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92
Q

blood supply and innervation to subscapularis

A

subscapular a

upper and lower subscapular nn

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93
Q

largest and strongest rotator cuff muscle

A

subscapularis

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94
Q

injuries to which rotator cuff muscle can lead to occipital tendon instability and biceps tendonitis

A

subscapularis

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95
Q

blood supply and innervation to infraspinatus

A 
suprascapular a
suprascapular n (C5-6)
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96
Q

blood supply and innervation to trees minor

A

circumflex scapular a

axillary n

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97
Q

what arterial branches come from the subclavian artery medial to the anterior scalene m

A

internal thoracic a
vertebral a
thyrocervical arterial trunk

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98
Q

what are the 4 branches of the thyrocervical arterial trunk

A

transverse cervical a
inferior thyroid a
ascending cervical a
suprascapular a

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99
Q

what arterial branches come from the subclavian artery posterior to the anterior scalene m

A

costocervical arterial trunk (supreme intercostal and deep cervical artery)

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100
Q

this special artery can arise from subclavian artery or from the transverse cervical artery (30% of the time)

A

dorsal scapular a (always runs along vertebral border of scapula

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101
Q

the most superficial “space” of the posterior shoulder

A

triangle of auscultation

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102
Q

trees major, trees minor, and the long and lateral heads of triceps brachii all converge at the posterior shoulder to make what 3 spaces

A 
triangular space (circumflex scapular a)
quadrangular space (axillary n, post circumflex humeral a)
triangular interval (deep brachial a, radial n)
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103
Q

first long bone to completely ossify (can present as congenital pseudoarthrosis or poorly healed fracture if ossification fails)

A

clavicle

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104
Q

what muscles abduct humerus

A

deltoid

supraspinatus

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105
Q

what muscles adduct humerus

A

teres major

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106
Q

what muscles flex humerus

A

deltoid

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107
Q

what muscles extend humerus

A

deltoid

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108
Q

what muscles lateral rotate humerus

A

infraspinatus, teres minor, deltoid

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109
Q

what muscles medial rotate humerus

A

trees major, subscapularis, deltoid

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110
Q

what muscles protract scapula

A

serratus anterior

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111
Q

what muscles depress scapula

A

serratus anterior

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112
Q

what muscles upward rotate scapula

A

serratus anterior

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113
Q

impingement syndrome in the shoulder can involve what two structures

A

subacromial bursitis

supraspintaus tendonitis

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114
Q

which tendon likely tears in a “rotator cuff tear”

A

supraspinatus tendon

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3
4
5
Perfectly
115
Q

size of quadrangular space is reduced compressing what structure

A

axillary n (or posterior circumflex humeral artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what nerve supplies the skin over the forearm

A

lateral and medial antebrachial cutaneous n

117
Q

the main arterial supply for the superficial palmar arch comes from what a

A

ulnar a

118
Q

the main arterial supply for the deep palmar arch comes from what a

A

radial a

119
Q

superficial muscles of the forearm (lateral to medial)

A

pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris

120
Q

intermediate (layer 2) muscles of the forearm (lateral to medial)

A

flexor digitorum superficialis

121
Q

deep muscles of the forearm (lateral to medial)

A

flexor pollicis longus, flexor digitorum profundus, pronator quadratus

122
Q

blood supply and innervation for pronator teres

A

anterior ulnar recurrent a

median n

123
Q

blood supply and innervation for flexor carpi radialis

A

ulnar a

median n

124
Q

blood supply and innervation for palmaris longus

A

ulnar a

median n

125
Q

blood supply and innervation for flexor carpi ulnaris

A

ulnar a

ulnar n

126
Q

blood supply and innervation for flexor digitorum superficialis

A

ulnar a

median n

127
Q

blood supply and innervation for flexor digitorum profundus

A

anterior interosseous a

median and ulnar nn

128
Q

blood supply and innervation for flexor pollicis longus

A

anterior interosseous a

median n via anterior interosseous n

129
Q

blood supply and innervation for pronator quadratus

A

anterior interosseous a

median n via anterior interosseous n

130
Q

which nerve runs just superficial to the medial epicondyle of the humerus before supplying intrinsic hand mm

A

ulnar nerve

131
Q

the median n pierces which forearm m

A

pronator teres

132
Q

which nerve runs through the carpal tunnel making it susceptible to compression during carpal tunnel syndrome

A

median n

133
Q

the anterior interosseous n and a run just deep to what muscle

A

pronator quadratus

134
Q

What cutaneous innervations of the dorsum of the hand contain?

A

Ulnar nerve- lateral 2.5 fingers and lateral metatarsals/carpals

Radial nerve- thumb, index, and half. Of middle finger and skin proximal to those fingers

Median nerve- index and middle fingers distal to PIP joint

135
Q

What muscles make up the radialis group

A

Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis

136
Q

Which muscles make up the superficial layer of the posterior forearm

A

extensor carpi ulnaris
Extensor digiti minimi
Extensor digitorum

137
Q

Which muscles make up the deep layer of the posterior forearm

A 
Extensor indicus
Extensor pollicis longus
Extensor pollicis brevis
Adductor pollicis longus
Supinator
138
Q

What is the common extensor origin of the forearm

A

Lateral epicondyle of humerus

139
Q

All muscles of the posterior forearm are innervated by who

A

Radial nerve (deep branch or posterior interosseous n)

140
Q

Superficial branch of the radial nerve does what

A

Cutaneous innervation in lateral hand

141
Q

Blood supply and innervation to brachioradialis

A

Radial collateral and recurrent radial aa

Radial n

142
Q

What is the action of brachioradialis

A

Flex forearm when pronated

143
Q

Blood supply and innervation to extensor carpi radialis longus

A

Radial collateral, radial recurrent, radial interosseous aa

Radial n

144
Q

Blood supply and innervation to extensor carpi radialis brevis

A

Radial collateral, radial recurrent, recurrent interosseous aa
Deep branch of radial n

145
Q

Blood supply and innervation to extensor digitorum

A

Posterior interosseous, recurrent interosseous, perforating branches aa

Posterior interosseous n

146
Q

Blood supply and innervation to extensor digiti minimi

A

Posterior interosseous, recurrent interosseous, perforating branches aa

Posterior interosseous n

147
Q

When extensor digitorum contracts it. Pulls what structure causing IP joints to extend?

A

Extensor expansion (extensor hood mechanism)

148
Q

Blood supply and innervation to extensor carpi ulnaris

A

Radial collateral, radial recurrent, recurrent interosseous aa
Posterior interosseous n

149
Q

Blood supply and innervation to supinator

A

Radial, posterior interosseous, radial recurrent aa

Deep branch of radial n

150
Q

Blood supply and innervation to extensor indicus

A

Posterior interosseous and perforating branch aa

Posterior interosseous n

151
Q

Blood supply and innervation to adductor pollicis longus

A

Posterior interosseous a

Posterior interosseous n

152
Q

Blood supply and innervation to extensor pollicis brevis

A

Posterior interosseous and perforating branch aa

Posterior interosseous n

153
Q

Blood supply and innervation to extensor pollicis longus

A

Posterior interosseous a

Posterior interosseous n

154
Q

What is the anastomosis in the hand

A

Radial artery contributes to both deep palmar arch and dorsal carpal arch

155
Q

The deep branch of the radial nerve continues as the posterior interosseous nerve. After passing through what structure

A

Supinator m

156
Q

Which artery and bone lie deep to the anatomical snuff box

A

Radial a

Scaphoid bone

157
Q

Which structures are ruptured in a shoulder separation but not a shoulder dislocation

A

Acromioclavicular ligament (and sometimes other shoulder ligaments as well)

158
Q

What nerve is most commonly injured with shoulder dislocation

A

Axillary n

159
Q

When do upper limbs form? Lower limbs?

A

Day 26- arms

Day 27/28- Legs

160
Q

What layer gives rise to limbs

A

Somatic layer of lateral plate mesoderm

161
Q

Mesenchyme thickens at the surface to direct limb bud formation at what named structure

A

Apical ectodermal ridge

162
Q

What signal causes mesenchyme to migrate and proliferate?

A

FGF8

163
Q

What genes direct limb bud formation proximal to distal? What takes over as they get farther from the axial skeleton?

A

HOX genes until

RA takes over (tells mesenchyme which bones to form from proximal)

FGF8 signals at distal end

164
Q

First cells to be exposed to RA become humerus and femur and are called what

A

Stylopod

165
Q

cells that when exposed to RA become radius/ulna or tibia/fibula and are called what

A

Zeugopod

166
Q

Last cells to be exposed to RA become carpels, metacarpals, tarsals, metatarsals, digits and are called what

A

Autopod

167
Q

When do hand and foot plates appear along with chondrification centers appear in developing embryo?

A

Week 5

168
Q

When do digital rays of hands appear in developing embryo? (Entire limb skeleton is cartilage)

A

Week 6

169
Q

What occurs that removes webbing between our digits? When does this occur in developing embryo?

A

Apoptosis

Week 8

170
Q

When do digital rays of feet form in developing embryo (and osteogenesis of long bones begins along with limb rotation)

A

Week 7

171
Q

Limb musculature is derived from what

A

Dorsolateral cells of somites

172
Q

During week 7, upper limbs rotate 90 degrees in which direction

A

Lateral rotation

173
Q

During week 7, lower limbs rotate 90 degrees in which direction

A

Medial rotation

174
Q

Cranial surface (preaxial/anterior) surface of the upper limb includes what features

A

Thumb and radius

175
Q

Caudal surface (postaxial/posterior) surface of the upper limb includes what features

A

Ulna and little finger

176
Q

Motor axons from spinal cord enter limb buds when during development

A

Week 5

177
Q

What generates first motor or sensory axons?

A

Motor

178
Q

Neural crest cells are doing what with the PNS during week 5 of development

A

Making sensory axons and schwann cells (myelination)

179
Q

In the developing embryo what is the main blood. Supply. To the lower limb (before it gets taken over. By femoral a)

A

Deep femoral a (profunda femoris a)

180
Q

Most common musculoskeletal defect: sole of foot turned medially and foot is inverted (more common in males) fixed usually by casting

A

Club foot

181
Q

Musculoskeletal defect occurs more in females and involves under development of acetabulum of hip bone and joint laxity

A

Developmental hip dysplasia

182
Q

Patterning and positioning of limbs along craniocaudal axis is regulated by what genes

A

HOX (also control type and shape of the bones in limbs)

183
Q

Proximodistal growth and patterning of limbs occurs at what area and requires what type of signalling

A

Apical ectodermal ridge, FGF signalling

184
Q

Dorso-ventral patterning helps us form flexor and extensor surfaces of limbs. The ventral surface is maintained by ___ signaling and dorsal is maintained by ___ signaling. These signals set up the apical ectodermal ridge

A

BMPS (ventral)

Wnt7 (dorsal)

185
Q

Anterior posterior patterning of the limb is controlled by establishing what zone on posterior side of limb? What signal signals this posterior region?

A

Zone of polarizing activity

Shh and RA

186
Q

Loss of ZPA (zone of polarizing activity) results in what

A

Loss of posterior elements (digits 3-5 or ulna) and you WILL have a thumb

187
Q

Upregulation of ZPA (zone of polarizing activity) results in what

A

Polydactyly (extra digits) and you WILL have a thumb

188
Q

Duplication of ZPA (zone of polarizing activity) results in what

A

Polydactyly::: Duplication of posterior elements (digits 3-5 mirrored on both sides of the “thumb” but may not have fingers with only 2 phalanges)

189
Q

Which elements form first: posterior (little finger/ ulna) or anterior elements (thumb/ radius)

A

Posterior forms first!

Thus disruption of anteroposterior patterning= loss of anterior elements

190
Q

Congenital joint contractures of 1 or more joints possibly caused by neurologic defect, muscular abnormalities, fetal crowding

A

Arthrogryposis

191
Q

Vascuature remodeling occurs in the forearm and most people lose this artery but it canremain in some people

A

Median a

192
Q

Abnormal short digits due to week 6 malfunction

A

Bradydactyly

193
Q

Fusion of digits because apoptosis fails in week 8

A

Syndactyly

194
Q

Development of limbs close to the body is called __ and can occur after mama bear takes what med?

A

Phocomelia , Thalidomide

195
Q

MOA for phocomelia

A

FGF does not signal AER correctly causing the short limbs

196
Q

Absence of limbs

A

Amelia (wk 4 upper limbs, wk 5 lower)

197
Q

Absence of part of limb and the two sub types

A

Meromelia (hemimelia is missing a bone like ulna, phocomelia is limb develop close to body)

198
Q

Which stage of limb development is most affected in hemimelia

A

Zeugopod

199
Q

what are the steps involved in neurotransmission at the neuromuscular junction

A

ACh synthesis, storage, release, destruction leads to muscle contraction

200
Q

enzyme that combines acetyl coA and choline to form ACh

A

choline acetyltransferase (ChAT)

201
Q

alzheimer patients have reduced cerebral production of what ACh forming enzyme?

A

ChAT

202
Q

by what mechanism is ACh shuttled into storage vesicles after synthesis

A

ACh vesicular transporter + ATP

203
Q

upon depolarization, what kind of voltage gated channels open?

A

Ca++ channels open and calcium flows in

204
Q

what is the role of calcium in NMJ transmission

A

promotes vesicle fusion to the presynaptic membrane

205
Q

what are the vesicular and plasma membrane proteins that initiate vesicle plasma membrane fusion to release ACh

A

VAMP and SNAP (they are SNAREs)

206
Q

what is known to block the snare complex thus inhibiting release of ACh from the presynaptic neuron

A

botulinum toxin (BOTOX)

207
Q

enzyme that cleaves ACh into cholineand acetate so that choline can go back to motor neuron for reuse

A

acetylcholinesterase

208
Q

sodium potassium pumps in the presynaptic membrane of the NMJ create a sodium gradient that is used to bring what into the cell for recycling in making neurotransmitter

A

choline

209
Q

what is the effect of an acetylcholinesterase inhibitors

A

increase ACh

210
Q

what type of ACh receptor do you find in skeletal muscle

A

nicotinic

211
Q

where do we often find muscarinic ACh-R’s

A

smooth muscle mostly but also cardiac muscle

212
Q

what type of channel is a nicotinic ACh-R?

A

ligand gated na+ channel

213
Q

what type of channel is a muscarinic ACh-R?

A

GPCR

214
Q

what lines the pore of the nicotinic ACh-R?

A

negatively charged AA side chains (Asp, Glu)

215
Q

what are the 3 types of nAChRs?

A

skeletal, peripheral neuronal, central neuronal

216
Q

what agonists bind to muscular nicotinic ACh receptors

A

nicotine
ACh
succinyl choline

217
Q

what antagonists bind to muscular nicotinic ACh receptors

A

atracurium
vecuronium
d-tubocurarine
pancuronium

218
Q

how can drugs target only one subtype of nicotinic ACh receptors

A

each subtype is made up of different subunits and these are the target for drugs that allow us to target only one subtype

219
Q

how many molecules of ACh have to bind in order to activate a nAChR and allow Na+, K+ or Ca++ to pass through down their concentration gradient

A

2

220
Q

while the motor end plate cannot perform this action itself, if enough Na+ comes in the adjacent muscle membrane can do what

A

depolarize (gotta reach threshold)

221
Q

the presence of an action potential in the neuron at the NMJ causes the opening of what type of channel

A

voltage gated Ca++ (the calcium helps with vesicle fusion)

222
Q

Tetrodotoxin (puffer fish) can cause weakness, dizzy, paresthesia, reflex loss, hypotension, paralysis by what MOA?

A

inhibiting voltage gated Na+ channels thus blocking axonal conduction

223
Q

Local anesthetics like lidocaine, bupivacaine, procaine are used to control pain during procedures by what MOA?

A

inhibiting Na+ channels to inhibit axonal conduction

especially sensory neurons

224
Q

batrachotoxin (poison dart frog) is potent and causes paralysis by what MOA?

A

increased Na+ permeability (persistent depolarization)

225
Q

Botulinum toxin causes flaccid paralysis by what MOA

A

cleave SNARE components so neuron cannot release ACh

226
Q

tetanus toxin causes muscle spasms and rigid paralysis by what MOA

A

cleave SNARE components to block vesicle fusion and travel up the spinal cord (retrograde movement)

227
Q

curare alkaloids (like d-tubocurarine) are used during anesthesia to relax muscles (flaccid paralysis) by inhibiting Ach binding to receptor. whats the MOA

A

compete with Ach for the receptor

228
Q

this Ach agonist is used as an induction agent for anesthesia and acts by binding nAChRs causing first depolarization which continues until receptor blockade and paralysis

A

succinylcholine

229
Q

which of the Ach agonists is a depolarizing blocker?

which of the Ach agonists is a nondepolarizing blocker?

A 
succinylcholine 
Curare alkaloids (non)
230
Q

whats the function of cholinesterase inhibitors and when do we use them?

A

they increase ACh at the NMJ

parkinson, alzheimer, myasthenia gravis, nerve gas, reverse neuromuscular blockade during anesthesia

231
Q

what drug inhibits ryanodine receptors in SR blocking release of ca++? when do we use it?

A

dantrolene

malignant hypothermia, upper motor nerve disorders

232
Q

Property of muscles : Capacity to respond to stimulus

A

Excitability

233
Q

Property of muscles : ability to shorten and generate pulling force

A

Contratility

234
Q

Property of muscles : can strech back to original length

A

Extensibility

235
Q

Property of muscles : can recoil to original resting length after stretched

A

Elasticity

236
Q

Muscle fibers are surrounded by what structures that deliver oxygen and nutrients

A

Capillary beds

237
Q

Each skeletal muscle Fiber contains several nuclei. As well as what to maintain energy required for contraction

A

Lots of mitochondria, myoglobin

238
Q

How and when does the troponin-tropomyosin complex move to expose actins myosin binding site?

A

When calcium binds to troponin C, it causes the troponin-tropomyosin complex to release from the myosin binding site

239
Q

Which myofilament has ATPase activity

A

Myosin (thick filament)

240
Q

If the. Power stroke. Generated by actin/myosin interaction is strong enough to move the load what type of muscle contraction results?

A

Isotonic (muscle shortens)

241
Q

If the. Power stroke. Generated by actin/myosin interaction is NOT strong enough to move the load what type of muscle contraction results?

A

Isometric (no shortening of muscle)

242
Q

What type of Ach receptors. Do you. Find at the. Neuromuscular junction

A

Nicotinic

243
Q

Where. Does an action potential propagate to in a muscle cell

A

Through sarcolemma and down t tubules

244
Q

Voltage gated ca++ channels allow calcium out of the sarcoplasmic Reticulum and open in response to binding of what molecules

A

Ryanodine, DHPP

245
Q

Renal failure, blood. Clotting, and cardiac arrhythmias can result from leakage of ca++, K+, phosphate, urate, myoglobin, or lactate dehydrogenase into circulation as a result of what condition

A

Rhabdomyolysis (unaccustomed physical excersize)

246
Q

When bound to actin, myosin heads pull causing sarcomere to shorten. What “bands disappear” as the thin filament moves toward the center

A

H and I

247
Q

Which “band” in the sarcomere remains the same length during contraction

A

A band (myosin)

248
Q

During contraction myosin forms a bond with an actin molecule. What do we call this bond

A

Crossbridge

249
Q

Once a cross bridge is formed, myosin head bends and pulls itself along the actin filament. What is this motion called

A

Power stroke

250
Q

What happens when ATP binds to myosin during power stroke

A

It releases from the actin

251
Q

How do we. Restore calcium. Levels. After contraction

A

Active transport in the SR

252
Q

After you die the cytosolic concentration of calcium rises because the muscle membrane is no longer active. calcium leaks out and moves troponin complex aside letting actin and myosin form cross bridges. Since no ATP is being generated, they cannot detach so dead muscles remain stiff. What do we call this?

A

Rigor Mortis

253
Q

What mechanisms control strength of a muscle contraction

A
  1. Motor unit recruitment

2. Individual fiber contractility manipulation (frequency of stimulation)

254
Q

What makes up a motor unit

A

1 neuron + all muscle fibers it supplies

255
Q

What happens if two action potentials reach one muscle fiber at the same time

A

Summation - tension of the two is added (more time is needed for ca++ to leave after and muscle to relax)

256
Q

What do you call it when repeated stimulation to muscle results in a plateau of tension and the muscle stays there

A

Tetanus

257
Q

A decline in muscles ability to maintain a constant force of crontraction in the face of long term repetitive stimulation

A

Fatigue

258
Q

Type of periodic paralysis caused by decreased blood K+ during paralytic episodes

A

Hypokalemic periodic paralysis

259
Q

Type of periodic paralysis caused by normal or increased blood K+ during paralytic episodes

A

Hyperkalemic periodic paralysis

260
Q

Which skeletal muscle type is comprised for slow twitch fibers (high blood flow, lots of mitochondria, fatigue resistant)

A

Type I

261
Q

Which skeletal muscle type is comprised for fast twitch fibers that receive HIGH blood flow and HIGH mitochondrial content (relatively fatigue resistant)

A

Type IIa

262
Q

Which skeletal muscle type is comprised for fast twitch fibers that receive LOW blood flow and LOW mitochondrial content (fatigue rapidly)

A

Type IIb

263
Q

Disorder where patient creates autoantibodies against nicotinic acetylcholine receptors creating muscle weakness mostly in eyelids and mouth region is called what? What do we use to treat it?

A

Myasthenia gravis

Treat with acetylcholinesterase inhibitor

264
Q

how are mtDNA inherited differently from nuclear DNA

A

we got it from our MAMA (also we have multiple copies per cell)

265
Q

most common mitochondrial disease: subacute loss of vision in young adults (mostly men) due to mutation in gene encoding for complex I subunits

A

Leber’s Hereditary Optic Neuropathy (LHON)

266
Q

this disease can be caused by mutations in nuclear or mitochondrial DNA that code for complex I or IV presenting as developmental delay, respiratory abnormality, recurrent vomiting, nystagmus, ataxia, dystonia, early death

A

Leigh’s Syndrome…. 90% of mtDNA contains mutation

267
Q

multisystem mitochondrial disorder where brain, muscle, endocrine are involved leading to death in young adulthood. symptoms include stroke like episodes (infarct in temporal and occipital lobes). this is an angiopathy. Treat with L-arginine to decrease stokes.

A

mitochondrial encephalomyopathy, lactic acidosis, and stroke like episodes (MELAS)

268
Q

mitochondrial disorder where mutations occur in tRNA for lysine. symptoms: cervical lipomas, myoclonus, epilepsy, COX negative

A

Myoclonus epilepsy and ragged red fibres (MERRF)

269
Q

what are canonical features of mitochondrial OXPHOS disorders?

A

recessive inheritance, reduction in cellular oxygen consumption and ATP synthesis, increased resting lactic acid, overproduction of ROS, sometimes induce autoimmune response

270
Q

all mtDNA is encoded to create what

A

OXPHOS system

271
Q

who carrie sub threshold levels of potentially harmful mtDNA mutations

A

normal humans like you and me - we get more as we age

272
Q

what type of mutation auses MELAS

A

A to G in gene for tRNA for leucine

273
Q

what type of mutation auses MERRF

A

A to G in gene for tRNA Lys

274
Q

what tissues are most likely to accumulate mtDNA mutations

A

postmitotic tissue (brain, heart, muscle)

275
Q

what important cancer causing gene also regulates respiratory chain function and glycolysis via regulating transcription and making SCO2 (loss of this gene stimulates glycolysis and TCA cycle)

A

p53

276
Q

whats the crabtree effect

A

p53 mutation causes cancer cells to prefer glycolysis and TCA cycle and suppress OXPHOS

277
Q

Warburg hypothesis states that mutation in nDNA encoding which two TCA cycle intermediates can lead to cancer

A

succinate dehydrogenase, fumarase

278
Q

a defect in the gene product of MELAS patients

A

tRNA for leucine or ND1

279
Q

a defect in the gene product of MERRF patients

A

tRNA for lysine

280
Q

a defect in the gene product of LHON patients

A

NADH ubiquinone oxidoreductase (N1)

281
Q

how are transmitochondiral lines created for studying mitochondrial disease and mutation load of mitochondrial mutations

A

making cybrids: injecting mtDNA of sick pt into empty mitochondria

282
Q

what is the phenotypic threshold value for mtDNA deletions? for mtDMA mutations?

A

60% for deletions

90% for mutations

283
Q

different tissues have different thresholds for phenotype of mtDNA mutations. which has a higher threshold: brain or heart tissue?

A

heart!

284
Q

What medication do we give in emergent situation of malignant hypothermia?

A

Dantrolene (blocks Ryanodine receptor)

285
Q

cox positive mt disease

A

melas

286
Q

cox negative mt disease

A

merrf

287
Q

mt disease that has the red ragged fibers

A

merrf

288
Q

mt disease with strokes due to angiopathy

A

melas

289
Q

complex I mutation mt disease leads to blindness

A

lhon

#MedSchool (17 decks)

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