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Boards II > Muscle > Flashcards

Muscle Flashcards

1
Q

Cells of bone

  • function
  • formation
  • other things needed to make bone
A
  • osteoblasts (form bone)
  • osteoclasts (multi nucleated macrophage tha breaks down bone)
  • osteoprogenitor cells -> pre-osteoblasts -> osteoblasts -> osteocytes (comm in osteon)
  • Ca, PO4, zinc, copper and Na
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2
Q

Bone formation

  • model: grows in length vs diameter
  • perichondrium
  • periosteum
  • formation of bone collar
  • formation of matrix calcification
  • trabecular formation: who is involved
  • secondary ossification
A
  • hyaline cartilage -> grows in length by cartilage producing cells; diameter growth is in addition of ECM
  • CT that covers cartilage produces periosteum
  • CT that covers bone
  • bony collar
  • osteoblasts peel back periosteum and secrete osteoid on shaft of bone
  • chondrocytes in primary ossification center secrete alkaline phosphatase causing matrix ossification -> will then produce VEGF and apoptose and matrix will deteriorate to form cavity
  • VEGF causes angiogenesis in medullary cavity, blood vessels come from perichondrium moving up and down shaft of bone, also bring hematopoetic and osteoprogenitor stem cells into medullary cavity
  • made with osteoblasts and osteoclasts
  • secondary is at epiphyseal ends, connected to primary by growth plates, doesnt mature until after birth
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3
Q

Fat embolism

  • primary
  • secondary
  • what happens
  • tx
A
  • long bone fracture
  • pancreatitis -> bc auto digestion of fatty organ
  • lipid fat globule will escape from BM and will go into lungs illiciting immune response -> will end up causing decrease surfactant -> ARDS
  • supportive care
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4
Q

Osteon

  • formed by
  • haversion canal
  • canaluculi
A
  • made from osteoblasts, osteoclasts, and osteocytes
  • have central neuro vasc bundle
  • provide nutrition to osteon
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5
Q

Histo of bone cells

  • osteoblast
  • osteoclast
A
  • spherical nuc, prominent golgi (appears like clear zone around nuc)
  • multi-nuc macrophage, adhere to bone via ruffle border
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6
Q

How does maturation occur

  • mononuc
  • quiesent osteoclast
  • active osteoclast
A
  • RANKL binds to osteoclast precursor which turns it into mononuclear osteoclast
  • RANK, IL1, IL6, MCSF
  • RANK L, IL1
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7
Q

Marrow

  • red
  • yellow
A
  • contain hematopoeitic stem cells -> myeloid and lymphoid progenitors
  • contain mesenchymal stem cells -> fat, cartilage, bone
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8
Q

Where does erythropoesis occur?

A
  • flat bones -> skull, sternum, ribs
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9
Q

Ribs

  • true
  • false
  • floating
  • where do they break
A
  • connect straight to sternum
  • connect to cartilage that connect to sternum
  • no connection to sternum
  • mid-axillary line most commonly
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10
Q

osteoporosis

  • what is it
  • involves
  • fracture
  • causes
  • sxs
  • dx osteopenia
  • dx
  • dx for severe
  • tx: 1st line
  • SERM: MOA, AE, specific for this dx
A
  • bone resorption is higher than bone deposition
  • trabecular bone
  • dorsal lumbar vertebral bodies or femoral neck
  • decrease estrogen (inhibit osteoclast activity), lack of activity (inhibits osteoclast activity), elevated cortisol (reduced bone apposition), calcium deficiency, hyperthyroidism (increase bone breakdown)
  • asymptomatic until break
  • 1-2.5 SD below reference
  • > 2.5 SD below RR
  • > 2.5 SD with hx of fragility fracture
  • bisphosphonates -> prevent osteoclast from forming ruffled border
  • estrogen agonist on osteoclasts and antagonist at breast; increased risk thromboembolism, increase risk endometrial CA; raloxifene
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11
Q

Pagets Disease

  • what is it
  • sxs
  • location
  • labs
  • xray
  • tx
A
  • increased osteoclast activity and then osteoblast activity -> formation of weak bone
  • bone pain and deformity in affected area
  • long bones, spine, pelvis
  • elevated alk phos, normal level of Ca and phosphate
  • xrays w/ sclerotic lesions and positive bone scans (increased activity at bone)
  • bisphosphonates and calcitonin
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12
Q

Fibrous dysplasia

  • what is it
  • sxs
  • location
  • McCune - Albright: genetics, sxs
  • tx
A
  • firbous tissue replace normal none
  • bone beformation and patho fx
  • mono or poly (w/ mccune-albright)
  • GNAS gene -> codes for g-protein -> increased production -> increase cAMP; hypothyroid, pit dysfunction, cushing, cafe au-lait spots
  • surgical debulking
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13
Q

Pyogenic Osteomyelitis

  • what is it
  • MCC
  • sickle cell
  • IV drug MCC
  • signs and sxs
  • x-ray
  • gold standard for imaging
  • tx
A
  • bacterial infection of bone
  • S aureus
  • S aureus, salmonella , e coli
  • Pseduomonas
  • bone pain w/ inflamm, hyperpig of skin, swelling of soft tissue
  • periosteal elevation or thickening, osteolysis
  • MRI
  • surgical debridment, antibiotics (4-8 wks bc dont penetrate bone well)
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14
Q

Bone Tumors

  • osteochondroma: epi; location; x ray; tx
  • giant cell: epi, location, xray, tx, prognosis, histo
  • osteosarcoma: epi, location, labs, xray, tx
  • ewings: epi, translocation, location, sxs, histo, tx, prognosis
A
  • males, less than 25; benign; distal femur or prox tibia; looks like cauliflower; surgical excision
  • 20-40 yrs; epiphyseal; benign; soap bubble; excise and radiation; tends to recur ; multinucleated giant cells, necrosis, hemmorrhage, hemosiderin
  • 10-20 yrs, males; distal femur, prox tibia; alk phos increase; sunburst pattern; excision and radiation
  • less than 15; 11:22; diaphysis and pelvis; sweling, erythema and pain; onion skinning, small round blue cells that are PAS+; chemo; early METS
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15
Q

CT disorders

  • RA: caused by; sxs; location; deformities; sequelae; labs; tx
  • Lupus: caused by, epi, DOPAMINE RASH, labs
  • Drug induced lupus
  • Sjogrens syndrome: what is it, antibodies, HLA type, mgmnt
  • Behcets Dx: what is it, sxs, tx
A
  • autoimmune; symmetric inflamm arthritis that is worse in morning and can last for hours, subcu nodules; feet, knees, MCP, PIP; swan neck (DIP flexion and PIP hyperextension); anemia of chronic dx, effusion seruitis; RF (IgM anti - IgG) and anti-citrullinated peptides (mor specific); methotrexate w/ folate supplementation or TNF antagonists (need PDD), leflunomide (pyrimidine synthesis inhibitor
  • systemic AI disorder; females; d: discoid lupus (circular erythematous macules w/ scales), oral ulcers, photosensitivity, arthritis, malar rash, immuno (anti DsDNA), neuro (psychosis, personality changes), elevated SED rate, renal dx, ANA, serusitis (pericarditis, pleuritis), heme (pancytopenia); anti-ANA, anti-DsDNA, anti-smith, falsely increased PTT, pancytopenia, anti-phodpholipid antibody, increased fetal loss\
  • look for anti histone anti-bodies; stop offending agent and give NSAIDs, hydroxychloroquine (interferes with antiget processing), prednisone, cyclphosphamide ( alkylating agent); Methyldopa and hydralazine
  • dry mouth, dry eyes and arthritis; HLA-DR3; anti-RO and anti-LA antibodies, ANA positive; steroids
  • chronic vasc inflam dx; oral and genital ulcers, skin nodules, arthritis, uveitic, vascultisi; prednisone
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16
Q

RA vs OA

  • onset
  • cause
  • joints
  • morning stiffness
  • osteophytes
A
  • RA is in younger, OA after 40
  • AI vs biomechanical
  • symmetric, small joints vs weight bearing joints
  • lots of morning stiffness vs not very much
  • osteophytes are absentvs present
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17
Q

Seronegative Spondyloarthrpathies

  • HLA type
  • ankylosing spondylitis: sxs, cycle, dx
  • reiters syndrome: also called, what is it, caused by, sxs, derm findings, tx
  • psoriatic arthritis: what is it, MC finding, tx
A
  • HLA B27
  • sacrilitis, bamboo spine, uveitis, aortitis -> aortic regurg, costo vetebral and costo sternal junction issues -> resp problems; exacerbation and remissions; x-ray; NSAID and PT
  • reactive arthritis; arthritis 1-6 weeks after infection; chlamydia, salmonella, shigella, campylobacter, yersinia; conjunctivits, urethritis, arthritis; circinate balanitis (inflammation and scaling around shaft and glans) and keratoderma blennorrhagica (thick crusty plaque on palm and sole); NSAID and antibiotics
  • arthritis + psoriasis; nail pitting; UV light for skin, NSAIDs, MTX with resistant
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18
Q

OA

  • what is it
  • sxs
  • xray
  • commonly affected
  • tx
A
  • non - inflamm degerative arthritis
  • pain and crepitus, ROM decrease, DIP swelling and PIP swelling
  • osteophytes and asymmetric joint spaces
  • hips, knees, DIP and PIP
  • NSAID, PT, surgery
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19
Q

Scleroderma

  • what is it
  • diffuse
  • limited/benign -> sxs
  • dx
  • TX
A
  • systemic fibrosis of organs;
  • progressive systemic sclerosis
  • CREST; calcinosis, raynauds, esophogeal dysmotility, sclerodactyly, telangiectasia
  • ANA+, anti-centromere, anti-Scl 70
  • MTX for skin and then organ specific tx
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20
Q

Sarcoidosis: epi, sxs, immuno pathogeneis, cardiac problems, CNS problems, visual; pulm; GI; renal; endocrine; heme; derm; DX; tx

A
  • AA, 20-40 yrs
  • hilar adenopathy, dry cough, noncaseating granuloma, ACE elevation
  • TH2 cells produce IL2 -> activate CD8 and gamma IFN -> macrophages -> CD8 and macrophages form granulomas
  • hyper Ca, elevated prolactin, increase CD4/CD8 ratio in the lavage
  • heart block and arrythmias
  • bells palsy
  • uveitis
  • restrictive pulm defects
  • elevated LFT
  • nephrolithiasis 2 to hyper Ca
  • DI;
  • pancytopenia; erythema nodosa; non caseating granulomas, increased ACE levels; prednisone
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21
Q

Mixed CT disorder

  • epi
  • what is it
  • antibodies
  • tx
A
  • women in 20s
  • overlapping fx of scleroderma, SLE, inflam myopathy
  • Anti U1 RNP antibody
  • steroid, symptom dependent tx
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22
Q

Pseudo gout

  • caused by
  • shape
  • affects
A
  • calcium pyrophosphate deposition
  • rhomboid
  • larger and more proximal joints
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23
Q

Septic arthritis

  • what is it
  • caused by
  • fluid findings
  • tx
A
  • monoarticular arthritis
  • gonorrhea or s aureus
  • no crystals; WBC greater than 50,000 is gonorrhea and less is s aureus
  • antibiotics
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24
Q

Polymyalgia Rheymatica

  • epi
  • sxs
  • dx
  • tx
A
  • females younger than 50
  • pain and morning stiffness; torso, hip/sjoulder; weakness myalgia, swelling
  • ESR elevated, MRI or US w/ synovial inflamm
  • low dose steroid
25
Q

Fibromyalgia

  • sxs
  • dx
A
  • widespread MSK and joint pain, mult tender joints, emotional disturbances
  • dx of exclusion, 3 months widespread pain/tenderness in 11 of 118 areas
  • exercise, stress relief, pain relievers ad muscle relaxants
26
Q

Types of Fx

  • compound/open
  • closed/simple
  • compression
  • complete
  • incomplete
  • linea
  • transverse
  • oblique
  • spiral
  • comminuted
  • impacted
A
  • bone sticking through skin; heightened risk infection
  • skin remains intact
  • form of crush injury
  • bone separate completely
  • partially joined bone fragments
  • parallel to axis
  • right angle to axis
  • diagonal to axis
  • rotating forces along axis
  • broken into several pieces
  • done driven into each other
27
Q

Distal Radial Fx

  • colles
  • Smith
  • tx
A
  • fall on out stretched hand -> can also cause lunate dislocation and scaphoid fx (w/ nerve impingement and avascular necrosis)
  • fall on flexed hand
  • minor and non displaced then just cast; if displaced will need hardware
28
Q

Ulnar Fx

  • called
  • caused by
  • dx
  • tx
A
  • night stick fx
  • direct blow to ulna
  • x-ray
  • immobolize for 2-4 wks and then brace
29
Q

Scaphoid Fx

  • caused by
  • sxs, snuff contains
  • sequelae
  • dx
  • tx
A
  • FOOSH
  • point tenderness in anatomical snuff box (radial a, radial n and cephalic v)
  • avascular necrosis
  • x ray
  • thumb splint for 10 weeks
30
Q

Carpal Tunel

  • what is in it
  • whats inflammed
  • sxs
  • dx
  • phalens
  • tx
A
  • flexor tendons and median n
  • transverse carpal ligament
  • pain, numbness, tingling in fingers supplied by median and weakness in thumb abduction
  • tinnels test -> tap along carpal tunnel and will have sensory issues
  • flex wrist against each other and will produce sensory issues
  • avoid causative activity, wrist brace (slight extension), steroid injections, of surgical release of carpal tunnel pressure
31
Q

rotator cuff

  • sits
  • most commonly injured; why; normal function
  • infra motion
  • teres motion
  • subscap motion
  • dx
  • tx
A
  • supra, infra, teres minor, subscapularis
  • supraspinatus; bc tendon gets pinched between acromial process and humeral head; first 10 degrees of abduction
  • lateral rotation
  • lateral rotation
  • medial rotation
  • beer can test
  • NSAID, PT, steroid injections, arthroscopic surgery
32
Q

Shoulder dislocation

  • what is it
  • diff from subluxation
  • caused by
  • anterior: percentage, caused by, sxs; worry about
  • posterior: percentage, caused by, sxs, tx
A
  • dislocation of entire humeral head from glenoid fossa
  • symptomatic translation of humeral head relative to glenoid articular surface
  • weakness rotator cuff muscles or direst blow
  • most common; direct trauma or external rotation and ABduction; flat deltoid prominence, protrusion of acromin process, ant axillary folice; injury to ax n -> motor to deltoid and teres minor and cutaneous over delt
  • rare; grand mal seizure or electrocution; pain and cant move arm, flat deltoid prominence, prominence of coricoid process, post axillary focus; reduction, avoid physical activity, PT
33
Q

Division of sciatic N

  • 1st split
  • 2nd
  • sup supplies
  • deep supplies
  • tibial supplies
A
  • common fibular and tibial N
  • common fibular into superficial fibular (lat compartment of leg) and deep fibular
  • peroneus longus, peroneus brevis –> plantar flexion and eversion of foot
  • tibialis ant –> dorsiflexion of foot, Ext Digi Longus & EHL –> toe extension, peroneus tertius –> dorsiflexion and eversion; sensory innervation between 1st and 2nd toe web space -> imp bc most commonly affected nerve in compartment syndrome (ant compartment)
  • SUP: gastroc, soleus (plantar flexion), plantaris (plantar flexion and flexion of leg), DEEP: popliteus (flexes and medial rotates leg), FDL (flexes toe, plantar flexion, inversion of foot), FHL (plantar flexion, inversion foot, flexion of first toe), tibialis post (inversion of foot)
34
Q

Femoral N innervation

  • motor
  • movement
A
  • rectus femoris, vastus medialis, vastus lateralis, vastus intermedius
  • extension of knee
35
Q

Sartorius

  • O and I
  • motion
A
  • ASIS and goes lateral to medial where it join tendons of gracilus and fuse to form pen ancorenis
  • flexes hip, ABducts, lat rotation of thigh
36
Q

Adductors of thigh

  • location
  • innervation
  • what do they do
  • muscles
A
  • medial side of thigh
  • obturator n
  • bring thigh back to midline
  • adductor longus, brevis, magnus, gracillus, –> ADduct, flex and medially rotate thigh; pectineus, obturator externus –> ADucts and laterally rotates thigh
37
Q

Hamstrings

  • muscles
  • what do they do
  • innervation
A
  • bicep femoris, semitendinosus, semi membranosus
  • flexion of knee and ext of hip
  • sciatic
38
Q

Sciatic N

  • safe injection zone
  • upper inner quadrant
  • lower quadrant
  • sciatica: innervation from pain
  • sciatica: weakness, sensation, reflex, causes
  • piriformis syndrome
A
  • upper outter quadrant
  • sup gluteal
  • sciatic N
  • L4-S1 -> impingement
  • post muscle weakness and muscles distal to knee; shooting electric pain in post thigh, pain or decreased sensation in post thigh, loss sensation on plantar surface of foot; diminished achilles while patellar remains intact; herniated disk, spinal stenosis, osteophytes, piriformis syndrome
  • sits next to sciatic and job is ABduction and stabilization of hip joint
39
Q

Sup gluteal n

  • supplies
  • action
  • trandelenburg gait
A
  • glut med and min
  • ABductor of thigh and stabilize pelvis when walking
  • affected side will allow for superior movement of pelvis and hip will drop on contralateral side when contralateral leg is lifted
40
Q

Hip dislocation

  • how
  • most commonly
  • dx
  • need to do
  • ant
  • tx
A
  • significant trauma
  • posterior, leg will be shortened and internally rotated
  • x-ray
  • neuro eval of sciatic N
  • longer and externally rotated
  • emergency situation, urgent reduction under sedation and may need open reduction
41
Q

Femoral Neck Fracture

  • how: normal, osteo
  • sxs
  • dx
  • tx
  • sequelae
A
  • lots of trauma; patho fx
  • hip and groin pain w/ externally rotated leg
  • x-ray or MRI
  • surgery
  • avascular necrosis of femoral head -> bc medial circumflex femoral a is susceptible to injury w/ femoral neck fracture; severe hip pain exacerbated by weight bearing, w/o swelling or erythema
42
Q

ACL

-

A
  • popping on injury, significant swelling, non stability of knee
  • painful
  • rapid deceleration and change in direction, stiff legged while landing
  • anterior drawer, lachman test- ant drawer but at 30 degrees, MRI
  • RICE or surgical retachment
43
Q

PCL

  • how
  • dx
A
  • someone falls on flexed knee, or dashboard injury

- posterior drawer test, x-ray to r/o fracture, MRI to confirm

44
Q

MCL

  • caused by
  • epi
  • tx
  • terrible triad
A
  • blow to lateral side of knee
  • most common
  • hinge brace -> prevent medial movement of knee
  • MCL + ACL + medial meniscus
45
Q

Menisci

  • function
  • how
  • epi
  • sxs
  • tx
A
  • cushioning for condyle of femur and tibial plateau
  • trauma (twisting motion while foot planted firmly into ground) or joint degeneration in elders
  • males
  • swelling and pain (flexion of knee), clicking/locking sensation decreasing ROM
  • conservative
46
Q

Bursitis

  • what is it
  • normal function
  • knee
  • how
  • sxs
  • tx
A
  • inflammation of bursa
  • reduce friction between muscle/tendon when moving against skin and bones
  • housemaids/clergymans knee; supra, pre, infra
  • repetitive motion or positions
  • pain, swelling, decreased ROM
  • NSAIDs, steroids, antibiotics if infection
47
Q

Bakers Cyst

  • location
  • what is it
  • sxs
  • dx
  • tx
A
  • popliteal fossa
  • synovial fluid that has formed mass at pop fossa
  • pain/ tightness; worse w/ full flexion and extension of knee
  • us to r/o popliteal aneursym
  • drain, steroid, or NSAID
48
Q

Orbit

  • made of
  • roof and lateral wall
  • medial and floor
  • sxs
  • tx
A
  • frontal bone, zygomatic bone and maxilla
  • extremely strong
  • extremely weak
  • swelling and echymoses, difficulty moving eye bc entrapment of EO muscles (dropping of affected eye), blood in maxillary sinus, paresthesia or numbness in v2 distribution
  • needs to be fixed, but non emergent -> will give decongestant so that pt does not blow out clot
49
Q

Le fort fractures

  • what are they
  • 1
  • 2
  • 3
  • tx
A
  • fracture to maxilla
  • only maxilla
  • zygoma and maxilla
  • zygoma, frontal bone
  • surgical repair
50
Q

Basilar skull fracture

  • how
  • signs
  • dx
  • tx
A
  • injury to base of skull
  • bruising behind ear on mastoid process bc of damage to posterior auricular a, periorbital ecchymosis, blood from ears, CSF from nose (cribiform plate fracture and ng tube could go into brain)
  • xray
  • supportive
51
Q

Muscle Fibers

  • type 1: called, action, examples
  • type 2: called, action, resp, examples
  • 2a: how fast, resistance, used for, power priduced, mito density, fuel
  • 2b
  • 2c
A
  • slow twitch; not a lot of power but not fatigued; postural muscles, eye muscles
  • fast twitch; produce lots of power; anaerobic respiration; biceps, triceps, pecs, quads
  • moderately fast, high resistance to fatigue, long term anaerobic activity, medium power produced, high mito, creatine phose and glycogen,
  • fast, moderate resistance to fatigue, short term anaeroic, high power, medium mito, ATP and creatine phos
  • very fast, low resistance to fatigue, short term anaerobic, very high power, low mito, ATP and creatine phos
52
Q

Striated vs non

  • striated
  • non
A
  • contain sarcomeres, cardiac and skeletal

- smooth

53
Q

Sarcomere

  • a band
  • i band
  • h zone
  • m line
  • junction of i and a band
  • contraction
A
  • where actin and myosin overlap each other
  • actin only
  • myosin only
  • middle of a band
  • where t tubules are located
  • m line moves toward mid line and I and H and no longer exist
54
Q

Skeletal muscle

  • micro
  • function as
  • what is used for contraction
  • recruitment
A
  • straited
  • motor unit -> 1 nerve stimulate all fibers it innervates
  • Ca
55
Q

Cardiac Muscle

  • contraction vs trigger
  • controlled by
  • needs
A
  • intracellular Ca for contraction but extracellular Ca for trigger
  • complete autonomics and syncytial activity (coordinate contraction. all muscle cells act together)
  • gap junctions to help comm
56
Q

Smooth muscle

  • contraction vs stimulation
  • controlled by
  • contract as
  • do not have
  • actin and myosin bound by
  • how
A
  • intracellular Ca for contraction and extra Ca to stim 2nd messenger
  • full autnomics
  • partial synctitial
  • no troponin or sarcomeres,
  • latching mech
  • increase Ca will phosphorylate MLCK which causes contraction
57
Q

Skeletal muscle contraction pathway

A
  • Ca binds to troponin C -> activates troponin t -> troponin t binds to tropomyosin -> troponin-tropomysoin complex causes confirmation change exposing actin to myosin -> trpoonin I binds to actin to hold troponin- tropomyosin complex in place -> actin and myosin cross bridge is formed -> ADP and p released and myosin head pivots (contraction) -> ATP binds to myosin and it releases actin -> ATP turned into ADP and P and relaxes myosin head.
58
Q

Golgi tnedon

  • location
  • function
  • how
A
  • muscle insertions
  • ensures sarcomeres kept safe by preventing max tension on muscles
  • will send sensory via 1v afferent axon -> through inhibitory interneuron-> inhibit alpha motor neuron -> force muscle to relax
59
Q

Muscle

  • strain: what is it, tx
  • sprain: what is it, tx
A
  • over stretch muscle -> will bleed into muscle bed and muscle will spasm and hurt -> need muscle relaxant
  • tear to tendon or ligament due to over stretch; RICE

Boards II (20 decks)

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