MUSCULOSKELETAL Flashcards
what consists of the internal anal sphincter
smooth muscle
under autonomic control
not affected by kagel exercises
which muscles do pelvic floor exercises target
puborectalis
pubococcygeous
ileococcygeous
spinal osteomyelitis
osteodiscitis
TB
Potts disease
TB of the spine
other extrapulmonary manifestations:
dermatologic TB
meningitis
airbone
often ‘homeless’ for TB in question vingette
disorganised woven bone
fractures
lytic/sclerotic lesions
cranial nerve compression
paget disease
disorder osteoclast/blast
50yo
malignant
from mesenchymal cells
produce cartilage
axial skeleton - pelvis
pain, neural dysfunction
chondrosarcoma
‘disruption of cortex’
‘diaphysis thickening’
‘cysts, calcification’
lobules
hyaline like cartilage
nests malignant chondrocyte-like cells
disorganised calcifications - rings/arcs
posterior calf and dorsolateral foot drain into what LN
popliteal LN
‘pop-lateral’
what area drains into superficial inguinal LN
skin below the umbilicus
lower back
perianal region (below pectinate line)
distal vagina, vulva, scrotum, urethra
lower extremity
exception: posterior calf / dorsolateral foot
lower extremity below umbilicus incl up to pectinate line
superficial LN –> deep LN –> external iliac LN
internal iliac LN drainage
cervix
proximal vagina
corpus cavernosum
prostate
inferior bladder
lower rectum (above pectinate line)
upper rectum - inf meseneric LN
below pectinate line - sup inguinal LN
lower rectum above pectinate line = ‘middle rectum’
internal iliac LN drain what part of the anal canal
above pectinate line
(middle rectum)
superficial inguinal drains below pectinate line
cervix
proximal vagina
corpus cavernosum
prostate
inferior bladder
lower rectum (above petinate line)
drain to what LN
internal iliac LN
prostate drains to what LN
internal iliac LN
where does the inferior vs superior bladder drain (LN)
superior = external iliac
inferior = internal iliac
where does the body of uterus, cervix and superior bladder drain (LN)
external iliac LN
where does the body vs fundus of uterus drain
body = external iliac
fundus = para-aortic (lumbar)
what drains to para-aortic LN
testes
fundus uterus
ovaries
kidneys
fallopian tubes
metastasis
what structures drain: celiac LN
liver
stomach
spleen
pancreas
upper dodenum
What drains superior mesenteric LN
lower duodenum
jejunum
ileum
colon to splenic flexure
what drains inferior mesenteric LN
from splenic flexure (colon) to upper rectum
left colic, sigmoid, superior rectal artery
trachea and oeseophagus drain to
mediastinal LN
pulmonary TB (unilateral hilar)
sarcoidosis (bilateral hilar)
lung cancer
granulomatous disease
above also applies to lungs –> hilar LN
which areas to left vs right supraclaviulcar LN drain
right: right hemithorax
left: left hemithorax, pelvis, abdomen
kawasaki, infectious mononucleosis, URTI and head malignancies affect what LN
deep cervical LN
ruptuer of thoracic duct can cause
chylothorax
i.e. central line into L internal jugular vein
venous drainage of rectum (above pectinate line)
superior rectal ->
inferior mesenteric ->
splenic ->
hepatic portal
portal HTN can cause internal haemorrhoids
part of portal circulation
first pass metabolism (initial drug metabolism) higher - if drains via superior rectal - hepatic circulation
venous drainage of rectum (above pectinate line)
inferior rectal ->
inferior pudendal ->
internal iliac ->
IVC
systemic circulation
external haemarrhoids
symmetric proximal ms weakness
anti-nuclear autoantibodies
anti-tRNA synthetase (anti-Jo) autoantibodies
anti-SRP autoantibodies
anti-Mi-2 (helicase) autoantibodies
ms biopsy: patchy endomysial inflammatory infitrate, CD8 cells
polymyositis
Progressive symmetric proximal muscle weakness, endomysial inflammation with
CD8+ T cells. Most often involves shoulders.
perifasicular inflammation (dermatomyositis)
symmetric proximal ms weakness
anti-nuclear autoantibodies
anti-tRNA synthetase (anti-Jo) autoantibodies
anti-SRP autoantibodies
anti-Mi-2 (helicase) autoantibodies
helitrope rash
“shawl and face” rash
hand hyperkeratosis (mechanic)
risk of occult malignancy.
ms biopsy: Perimysial inflammation and atrophy with CD4+ T cells.
dermatomyositis
osteoarthirtis is associated with what type of collagen
type II
(hyaline cartilage)
can wear out and result in bone cysts, narrowing of joint space, osteophytes, subchondral bone sclerosis
osteoarthritis main issue is:
osteoporisis main issue is:
loss of cartilage
loss of bone mass
what are minature end plate potentials
mepp
small depolarisations
from release of
single vesicle of Ach into NMJ
not sufficient to reach AP threshold
occur sporadically
mepp: caused by ligand gated nonspecific cation channels (na+, K+) as well as calcium)
mepp not vary much with calcium concentration
acute botilism affected muscle will show the following effects:
epp amplitude
mepp amplitute
response to 1uM Ach
end plate potential
minature end plate potential
epp = decreased
mepp = unchaged
1uM Ach = unchaged
Ca conc affected release of vesicles at NMJ -> affecting Ach amount released -> affecting end plate potential (epp) (calcium dependant process)
botulism prevents release presynaptic Ach -> decreases epp & not affect mepp or exogenous Ach response
what bone cells are crucial in bone repair process i.e. post fracture #
periosteal cells
endosteal cells
periosteum
