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Uworld > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Myotonic dystrophy is caused by inc in _____ (trinucleotide repeat) on the _______ gene. Some symptoms include:

A

CTG, myotonia protein kinase gene, cataracts, frontal balding, gonadal atrophy, muscle atrophy type 1 fibers

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2
Q

The _________ ligament is usually torn in inversion ankle sprains

A

anterior talofibular ligament (lateral ankle sprain)

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3
Q

TYhe 2 most important factors in osteoclast differentiation are ______ and _______

A

macrophage colony stimulating factor (M-CSF) and receptor activator of nuclear factor kappa B ligand (RANK-L)

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4
Q

The interaction of RANK-L with RANK receptor is blocked by _______

A

osteoprotegrin

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5
Q

Low OPG/RANK-L ratio signals what for osteoclasts

A

increased osteoclast activity

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6
Q

High OPG/RANK-L ratio signals what for osteoclasts

A

decreased osteoclast activity

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7
Q

The ______ and the ________ act as the major flexors of the hip

A

ilacus, psoas

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8
Q

what is psoas sign

A

inflammation of the hip when extended

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9
Q

The primary cause of morbidity in acute rheumatic fever is ________

A

pancarditis (inflammation of endo,myo, and epicardium)

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10
Q

_______ presents with CREST syndrome. What is it?

A

scleroderma

Calcinosis
Raynouds phenomenon
Esophageal dysmotility
Sclerodactyl
Telangiectasias
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11
Q

Anti-centromere bodies are most associated with

A

scleroderma

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12
Q

Anti-DNA topoisomerase 1 anitbodies are associated with

A

scleroderma

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13
Q

Anti-histone antibodies are associated with

A

drug induced lupus

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14
Q

Anti-Ro/SSA antibodies are associated with

A

Sjogren syndrome

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15
Q

Ankylosing spondylitis shows fushion of the __________ joints and is associated with HLA_____ which is class ___ serotype

A

sacroilliac, B27, class 1

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16
Q

HLA DR/DQ/DP alleles are expressed by _______ cells and are associated with what class

A

antigen presenting, 2

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17
Q

colchicine can be used in acute gout and it works by inhibiting ____________ and by blocking _________. What is an adverse effect of this med?

A

(inflammation)leukocyte migration and phagocytosis, tubulin polymerization (microtubule formation), diarrhea

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18
Q

Calmodulin and myosin light chain kinase are elements for contractile mechanism in ________ muscle

A

smooth

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19
Q

The contractile mechanism in skeletal muscle depends on what 1 ion and 4 proteins

A

Ca, myosin II, actin, troponin, tropomyosin

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20
Q

Etanercept is a ______ inhibitor and you should test for before starting this drug

A

TNF alpha, TB cause it can promote latent TB infection

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21
Q

HLA B27 is associated with

A

ankyloing spondylitis and reactive arthritis (think young man with knee pain)

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22
Q

The production of ______ in giant cell arteritis seems to be important

A

IL-6

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23
Q

anti-Jo antibodies are the same as______ and signify what condition. What do you see on muscle biopsy?

A

anti-histidyl-tRNA-synthetase, polymyositis, endomysial mononuclear infiltrate and patchy muscle fiber encrosis

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24
Q

osteocytes are connected to each other by

A

gap junctions

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25
Q

________ is a major component of microfibrils that form a sheath around elastin fibers. It is defective in what condition

A

fibrillin-1, marfan

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26
Q

Raloxifine has estrogen _____ activity on bone and estrogen ______ on breast tissue

A

agonist, antagonist

This is how it can dec fracture and breast cancer risk

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27
Q

IL-10 stimulates the production of which helper T cells

A

Th2, inhibits INF gamma

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28
Q

IL-12 stimulates the production of which helper T cells

A

Th1

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29
Q

The ______ and the inferior parathyroid glands are both from the _____ pouch. What diease is associated with hyperplasia of this organ

A

thymus, 3rd, myasthenia gravis

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30
Q

During skeletal muscle contraction, Ca is released from the SR and binds ______ which leads to a conformational change in the ________ complex causing it to displace ________ and expose the ________ binding sites on actin filaments

A

troponin C, troponin, tropomyosin, myosin

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31
Q

Which part of the spine does long standing RA affect and this can lead to?

A

cervical-spinal instability and cord compression

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32
Q

Hematogenous osteomyelitis commonly affects the ______ of ______ bones in kids

A

metaphysis, long

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33
Q

_________ affects the DIP joints

A

osteoarthritis

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34
Q

The psoas muscle originates from the ______ surface of the tranverse processes and _______ surface of the vertebral bodies at T_-L_

A

anterior, lateral, T12-L5

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35
Q

Paralysis of the ______ causes scapular winging. What nerve innervates this muscle and how can it be injured

A

serratus anterior, long thoracic nerve, dissesction of axillary lymph nodes

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36
Q

The _______ causes superior displacement of the medial part of the clavicle

A

sternocleidomastoid

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37
Q

The _________ causes inferior displacement of the lateral part of the clavicle

A

pectoralis major

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38
Q

Rickets is characterized by excess of ________ matrix and epiphyseal cartilage

A

unmineralized osteoid

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39
Q

Osteosarcoma is characterized by excess production of ________

A

mineralized bone

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40
Q

Myasthenia gravis has ______ amplitude of motor end plate potential

A

reduced

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41
Q

Glycopyrrolate, hyoscyamine, propantheline are all ________

A

antimuscarinc agents that can reverse DUMBELS

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42
Q

The _________ is a negative feedback system that regulates muscle tension

A

golgi tendon circuit

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43
Q

What fibers free endings detect temperature and nocioceptive stimuli

A

a-delta

-constitute the afferent portion of the reflex arc that mediates withdrawal from noxious stimuli (Ex: hand on stove)

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44
Q

The H band only has _____ filaments

A

thick (myosin)

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45
Q

The ___ band always remains the same length

A

A

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46
Q

During muscle contraction, the __ and ___ bands decrease in length

A

H and I

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47
Q

____ is an inducible enzyme upregulated during inflammation by IL-1 and TNF alpha

A

COX-2

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48
Q

NSAIDs and _______ provide the most rapid relief for RA. The latter drug works by inhibiting _______. Other DMARDs take _____ for effect

A

glucocorticoids, phospholipase A2, weeks

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49
Q

During musculoskeletal contraction, ATP binding to myosin causes?

A

release of myosin head from its binding site on the actin filament, if it didn’t—>rigor mortis

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50
Q

Dermatomyositis is strongly associated with which cancers

A

LOC: lung, ovarian, colorectal

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51
Q

Antibodies to _____ have a high specificity for RA

A

citrullinated peptides, more specific that rheumatoid factor

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52
Q

In muscle contraction the ____band doesn’t change in size. The __ band has only actin. The __ band has only myosin.

A

A (H&I shorten), I=actin, H=myosin

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53
Q

Where are the H bands located?

A

center of sarcomere

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54
Q

Where are the I bands located?

A

near Z discs

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55
Q

What are three components in thin filaments?

A

actin, troponin, tropomyosin

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56
Q

troponin C binds?

A

Calcium

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57
Q

troponin T binds

A

tropomyosin

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58
Q

troponin I does what?

A

inhibits myosin binding to actin

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59
Q

myosin binds ____ at rest

A

ATP, in “cocked position”

60
Q

Dihydropyridine receptors undergo a _______ with depolarization and open ______ on terminal cisterane. These latter receptors function to _____

A

conformational change, ryanodine, release Ca–>initiates contraction

61
Q

SERCA is an ______ that functions to transfer ________

A

ATPase, Ca from the cytosol back into the SR

62
Q

Cause of malignant hyperthermia is abnormal _______ receptors. Tx w/?

A

ryanodine–> excessive Ca release–>in ATP consumption –> heat–> tissue damage, dantrolene (blocks Ca release from SR by antagonizing ryanodine receptors)

63
Q

Slow twitch fibers have high ______ content to resist fatigue and are what color? What muscles typically?

A

O2/myoglobin/ lots of mitochondria, red, postural spinal muscles

64
Q

Fast twitch fibers are what color? What do they primarily metabolize? Example muscle

A

white, glucose and glycogen, less mitochondria and less myoglobin, eye muscles

65
Q

_____ muscle has dyads and ____ muscle has triads

A

cardiac, skeletal

66
Q

One way the heart can increase contraction is by having more _____ enter the cell

A

calcium

67
Q

Non-dihydropyridine Ca channel blockers ______ contractility because they block Ca entry into the cell

A

decrease–> slower conduction and lower HR

68
Q

SNS inc heart contractility by using __ proteins that __ cAMP levels via adenyl cyclase–> ___ in protein kinase A that phosphorylates Ca channels which leads to ____ Ca into the cell

A

G, inc, inc, inc

69
Q

Lusitrophy means. What does it always accompany? What is it mediated by? What is the key regulatory protein?

A

myocardial relaxation, always accompanies increases in contractility, SERCA channel, phospholamban

70
Q

What does phospholamban do?

A

It is an inhibitor of SERCA, when phosphorylated by Beta 1 stimulation–>stops inhibiting SERCA–> inc Ca reuptake and myocardial relaxation

71
Q

Do smooth muscle cells depend on action potentials

A

No, typically have slow & sustained contraction

72
Q

Skeletal muscle is ____ filament regulated and smooth muscle in _____ filament regulated

A

thin, thick

73
Q

In smooth muscle, myosin light chain kinase allows what?

A

phosphorylates myosin to interact with actin=contraction

74
Q

_______ binds calcium in smooth muscle cells and activates myosin light chain kinase–>contraction

A

calmodulin

75
Q

Dihydropyridine drugs (amlodipine, nicardipine) block what and lead to vascular smooth muscle _______

A

L type Ca channels, relaxation(b/c blocking Ca), used to lower HTN

76
Q

IP3–>___ release from SR–>

A

Ca, contraction

77
Q

cAMP–>MLC kinase inhibition–>

A

relaxation

78
Q

cGMP–>MLC phosphatase activation–>

A

relaxation

79
Q

Nitric oxide is synthesized by _____ cells from what amino acid. What is it also called? What are 4 stimulators?What 2nd messanger does it activate

A

endothelial, L-Arginine, EDRF: endothelial derived relaxing factor

(these 4 NEED endothelial cells to work)

  • blood flow/shear stress
  • Ach
  • bradykinin
  • substance P

cGMP–>MLC phosphatase–>relaxation

80
Q

How do Gs, Gi, Gq affect smooth muscle

A

Gs–>cAMP (inhibi MLCK)–>relaxation

Gi–>dec cAMP–>contraction

Gq–>phospholipase C–>IP3–>contraction

81
Q

Receptors and their 2nd messangers?

A

“qiss qiq siq super qinky sex”

alpha1: q
alpha2: i
beta1: s
beta2: s

M1:q
M2:i
M3:q

D1:s
D2:i
H1:q

H2:s
V1:q
V3:s

82
Q

What is the periosteum

A

the outer membrane that covers the surface of bones and has blood vessels and sensory nerves

83
Q

_____ bone is the hard compact, exterior bone

A

cortical

84
Q

____ bone is spongy bone thats soft, flexible, and has lots of surface area. Where is it found?

A

trabecular, at the end of long bones

85
Q

Epiphysis is the? What is it covered by?

A

end of a long bone, cartilage

86
Q

Metaphysis is the

A

widening before the epiphysis

87
Q

Diaphysis is the?

A

shaft of bone

88
Q

osteoclasts are specialized ______ and come from what cell lineage?

A

macrophages, monocytes

89
Q

Bone matrix is made up of what type of collagen?

A

type 1

90
Q

Endochondral ossification occurs during _______. ___ bones develop from hyaline cartilage. This is secreted by_____

A

embryogenesis, long, chondrocytes

-achondroplasia is a disorder of this (why they have shortened long bones)

91
Q

Osteoblasts lay down matrix and primary and secondary ossification sites. What does this mean

A

They secrete primary at the center (diaphysis) and at ends (epiphysis) and trap a layer of cartilage in between and when they meet, is how you have the growth plate

92
Q

The growth plate contains ______ cartilage

A

hyaline

93
Q

_____ bone is the first type of bone formed. It consists of ______ collagen fibers and is weaker

A

woven, disorganized

-seen in adults after injury

94
Q

_______ bone is layered bone that is organized

A

lamellar

95
Q

In _______ossification, bone matrix is formed directly and not from cartilage. This is how we make ______ bones

A

membranous, flat bones (skull, facial bones), use woven-

–>lamellar bone

96
Q

Alk phosphatase can be a marker for osteo____ as it creates an alkaline environment for ______

A

blasts, calcium deposition

97
Q

_____osis stimulates osteoclasts

A

acidosis as osteoclasts need acidic environment to break down bone

98
Q

Osteo____ contain PTH receptors

A

blasts, clasts don’t have any

99
Q

Ankylosing spondylitis can involve the thoracic spine and lead to ________, involve the heart and lead to______, and affect the eye and lead to?

A
  • decreased chest expansion (should be monitored in ALL pts with AS)
  • ascending aoritis–>dilated aortic ring and aortic insufficiency
  • anterior uveitis
100
Q

________ disorders inc risk for gout

A

myeloproliferative (Polycythemia vera)

101
Q

_________ is characterized by pain, erythema, swelling, reduced motion in a joint and when acute with leukocytosis, best way to diagnose is ________

A

Synovitis, synovial fluid analysis for crystal analysis, cell count and gram stain

102
Q

the supraspinatus muscle _____ the shoulder

A

abducts first 15 degrees

103
Q

the infraspinatus ________ rotates the arm

A

externally

104
Q

the subscapularis ________ rotates the arm

A

internally

105
Q

Man comes in with lumpy bone protuberance and hearing loss. Think _______. What are the 2 most important factors for osteoclastic differentiation.

A

Paget’s disease, M-CSF, RANK-L

-can 100s of multinucleate giant cells

106
Q

The uniform distribution of T-Tubules allows what?

A

ensures that each myofibril contracts at the same time

-so if you have dec T tubulues–> uncoordinated contraction

107
Q

Posterior drawer tests PCL and what motion to test if abnormal

A

pushing back on knee to check for posterior displacement

108
Q

Anterior drawer tests ACL and what motion to test if abnormal

A

pull knee forward for anterior displacement

109
Q

digital clubbing you see _______ of the nail folds

A

flattening, can be form bronchiectasis or any hypoxic problem

110
Q

Alkaptonuria is a benign childhood disorder that presents with ______ later in life. It is caused by a deficiency in what? Accumulated _______ leads to pigment deposits in connective tissue throughout the body and what is a sx? Urine turns what color when exposed to air

A

severe arthritis, homogenistic acid dioxygenase, homogenistic acid, blue-black deposits in sclera and can deposit in joints, black

111
Q

The axillary nerve is commonly injured in ________ dislocation of the humerus

A

anterior

112
Q

The ________ is innervated by the thoracodorsal nerve and helps with internal rotation of the arm

A

latissimus dorsi

113
Q

Ehlers Danlos syndrome is associated with abnormal _________ formation–>hyper mobile, flexible skin

A

COLLAGEN

114
Q

Ehlers Danlos syndrome is categorized by defective _______ synthesis and what specific part?

A

collagen, procallagen peptidase deficiency—> impaired cleavage of terminal peptides in extracellular space

115
Q

lateral epicondlyitis does what function of the hand

A

wrist extension

116
Q

scaphoid fractures are at inc risk of __________

A

avascular necrosis

-fall on outstretched hand

117
Q

osteonecrosis (avascular necrosis) is from ________ blood supply to a bone. The _______ is the most common location. What are four common causes?

A

impaired, femoral head, sickle cell disease, alcoholic, glucocorticoid therapy, vasculitis

118
Q

_________ typically presents 7-14 days after exposure to a drug/antigen. It presents with fever, prussic skin rash, arthralgias. What type of hypersensitivity reaction is it and what levels are decreased? What does histo show?

A

acute serum sickness, type 3, complement, fibrinoid necrosis with intense neutrophil infiltration

119
Q

transmural fibrinoid necrosis of medium size arteries with joint and abdominal pain and what is it associated with?

A

polyarteritis nodosa, hepatitis B

120
Q

Supracondylar fractures that lead to anterolateral displacement of humerus cause _______ nerve injury

A

radial

121
Q

Supracondylar fractures that lead to anteromedial displacement of humerus cause ________, _________ nerve injury

A

brachial, median

122
Q

The ______ passes through the greater sciatic foramen and is involved with ______ hip rotation. Muscle injury can damage the _______ nerve in the foramen

A

piriformis, external, sciatic

123
Q

peroneal nerve injury leads to loss of

A

dorsiflexion, and loss of sensation over dorsum of foot

124
Q

pseudogout is characterized by ____________ crystals and neutrophilic predominance. It characterized by pain, joint swelling, erythema, and warmth

A

calcium pyrophosphate

125
Q

A longitudinal incision through the _________ can relieve carpal tunnel pressure

A

transverse carpal ligament

126
Q

thoracic outlet syndrome is due to compression of the __________ in the ________ triangle. Sx include

A

lower brachial plexus, scalene

-upper extremity numbness, tingling, weakness

127
Q

Prepatellar bursitis causes anterior ______ pain

A

anterior knee and is due to prolonged or repetitive kneeling

128
Q

How does spinal stenosis present? And what is thickened? How is it typically relieved?

A

Postural dependent lower extremity pain/numbness, and weakness
-ligamentum flavum
-

129
Q

Tredelenburg gait is form injury to the __________ and where is this located. So where is it safe to inject

A

contralateral superior gluteal nerve, superior medial gluteal region
-safe to inject in superiorlateral region

130
Q

leuflonamide inhibits _______ preventing pyrimidine synthesis

A

dihydroorate dehydrogenase

-suppresses T cell proliferation

131
Q

What cells mediate wound contraction

A

myofibroblasts

132
Q

epidermal cells lead to _______ scarring

A

negligible

133
Q

collagen type ____ is the primary component of granulation tissue and this is temporary and then is replaced by type ____

A

Type 3, 1

134
Q

During long exercise for one hour ______ can increase and lead to new blood vessels to the distance of diffusion decreases between muscle and capillaries. Long periods of exercise overtime can lead to an inc number of _______ but not only after 1 hour of exercise or v short term

A

VEGF, mitochondria

135
Q

fibers that serve as sensory organs to detect static and dynamic changes in muscle length and are innervated by gamma neurons

A

intrafusal fibers

136
Q

fibers that are innervated by alpha motor neurons and serve to generate tension by contraction

A

type 1 extrafusal fibers

-found in the heart (muscles that contract often)

137
Q

fibers that detect muscle tension

A

golgi tendon organs

138
Q

fast twitch fibers

A

type 2 extrafusal

139
Q

treat symptomatic baker’s cyst with

A

glucocorticoid injection

140
Q

unhappy triad

A

ACL, MCL, meniscus,

141
Q

what is piriformis syndrome

A

piriormis can piece the sciatic nerve–>pain shooting down back of thigh to leg to foot
-running or cycling

142
Q

bow legged is to

A

varus

-test LCL

143
Q

knock kneed is to

A

valgus

-test MCL

144
Q

What bone pain is received by leaning forward?

A

spinal stenosis

145
Q

Ankylosis spondylitis is associated with what heart problem

A

Aortic regurgitation

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