Musculoskeletal Flashcards
Myotonic dystrophy is caused by inc in _____ (trinucleotide repeat) on the _______ gene. Some symptoms include:
CTG, myotonia protein kinase gene, cataracts, frontal balding, gonadal atrophy, muscle atrophy type 1 fibers
The _________ ligament is usually torn in inversion ankle sprains
anterior talofibular ligament (lateral ankle sprain)
TYhe 2 most important factors in osteoclast differentiation are ______ and _______
macrophage colony stimulating factor (M-CSF) and receptor activator of nuclear factor kappa B ligand (RANK-L)
The interaction of RANK-L with RANK receptor is blocked by _______
osteoprotegrin
Low OPG/RANK-L ratio signals what for osteoclasts
increased osteoclast activity
High OPG/RANK-L ratio signals what for osteoclasts
decreased osteoclast activity
The ______ and the ________ act as the major flexors of the hip
ilacus, psoas
what is psoas sign
inflammation of the hip when extended
The primary cause of morbidity in acute rheumatic fever is ________
pancarditis (inflammation of endo,myo, and epicardium)
_______ presents with CREST syndrome. What is it?
scleroderma
Calcinosis Raynouds phenomenon Esophageal dysmotility Sclerodactyl Telangiectasias
Anti-centromere bodies are most associated with
scleroderma
Anti-DNA topoisomerase 1 anitbodies are associated with
scleroderma
Anti-histone antibodies are associated with
drug induced lupus
Anti-Ro/SSA antibodies are associated with
Sjogren syndrome
Ankylosing spondylitis shows fushion of the __________ joints and is associated with HLA_____ which is class ___ serotype
sacroilliac, B27, class 1
HLA DR/DQ/DP alleles are expressed by _______ cells and are associated with what class
antigen presenting, 2
colchicine can be used in acute gout and it works by inhibiting ____________ and by blocking _________. What is an adverse effect of this med?
(inflammation)leukocyte migration and phagocytosis, tubulin polymerization (microtubule formation), diarrhea
Calmodulin and myosin light chain kinase are elements for contractile mechanism in ________ muscle
smooth
The contractile mechanism in skeletal muscle depends on what 1 ion and 4 proteins
Ca, myosin II, actin, troponin, tropomyosin
Etanercept is a ______ inhibitor and you should test for before starting this drug
TNF alpha, TB cause it can promote latent TB infection
HLA B27 is associated with
ankyloing spondylitis and reactive arthritis (think young man with knee pain)
The production of ______ in giant cell arteritis seems to be important
IL-6
anti-Jo antibodies are the same as______ and signify what condition. What do you see on muscle biopsy?
anti-histidyl-tRNA-synthetase, polymyositis, endomysial mononuclear infiltrate and patchy muscle fiber encrosis
osteocytes are connected to each other by
gap junctions
________ is a major component of microfibrils that form a sheath around elastin fibers. It is defective in what condition
fibrillin-1, marfan
Raloxifine has estrogen _____ activity on bone and estrogen ______ on breast tissue
agonist, antagonist
This is how it can dec fracture and breast cancer risk
IL-10 stimulates the production of which helper T cells
Th2, inhibits INF gamma
IL-12 stimulates the production of which helper T cells
Th1
The ______ and the inferior parathyroid glands are both from the _____ pouch. What diease is associated with hyperplasia of this organ
thymus, 3rd, myasthenia gravis
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
troponin C, troponin, tropomyosin, myosin
Which part of the spine does long standing RA affect and this can lead to?
cervical-spinal instability and cord compression
Hematogenous osteomyelitis commonly affects the ______ of ______ bones in kids
metaphysis, long
_________ affects the DIP joints
osteoarthritis
The psoas muscle originates from the ______ surface of the tranverse processes and _______ surface of the vertebral bodies at T_-L_
anterior, lateral, T12-L5
Paralysis of the ______ causes scapular winging. What nerve innervates this muscle and how can it be injured
serratus anterior, long thoracic nerve, dissesction of axillary lymph nodes
The _______ causes superior displacement of the medial part of the clavicle
sternocleidomastoid
The _________ causes inferior displacement of the lateral part of the clavicle
pectoralis major
Rickets is characterized by excess of ________ matrix and epiphyseal cartilage
unmineralized osteoid
Osteosarcoma is characterized by excess production of ________
mineralized bone
Myasthenia gravis has ______ amplitude of motor end plate potential
reduced
Glycopyrrolate, hyoscyamine, propantheline are all ________
antimuscarinc agents that can reverse DUMBELS
The _________ is a negative feedback system that regulates muscle tension
golgi tendon circuit
What fibers free endings detect temperature and nocioceptive stimuli
a-delta
-constitute the afferent portion of the reflex arc that mediates withdrawal from noxious stimuli (Ex: hand on stove)
The H band only has _____ filaments
thick (myosin)
The ___ band always remains the same length
A
During muscle contraction, the __ and ___ bands decrease in length
H and I
____ is an inducible enzyme upregulated during inflammation by IL-1 and TNF alpha
COX-2
NSAIDs and _______ provide the most rapid relief for RA. The latter drug works by inhibiting _______. Other DMARDs take _____ for effect
glucocorticoids, phospholipase A2, weeks
During musculoskeletal contraction, ATP binding to myosin causes?
release of myosin head from its binding site on the actin filament, if it didn’t—>rigor mortis
Dermatomyositis is strongly associated with which cancers
LOC: lung, ovarian, colorectal
Antibodies to _____ have a high specificity for RA
citrullinated peptides, more specific that rheumatoid factor
In muscle contraction the ____band doesn’t change in size. The __ band has only actin. The __ band has only myosin.
A (H&I shorten), I=actin, H=myosin
Where are the H bands located?
center of sarcomere
Where are the I bands located?
near Z discs
What are three components in thin filaments?
actin, troponin, tropomyosin
troponin C binds?
Calcium
troponin T binds
tropomyosin
troponin I does what?
inhibits myosin binding to actin
myosin binds ____ at rest
ATP, in “cocked position”
Dihydropyridine receptors undergo a _______ with depolarization and open ______ on terminal cisterane. These latter receptors function to _____
conformational change, ryanodine, release Ca–>initiates contraction
SERCA is an ______ that functions to transfer ________
ATPase, Ca from the cytosol back into the SR
Cause of malignant hyperthermia is abnormal _______ receptors. Tx w/?
ryanodine–> excessive Ca release–>in ATP consumption –> heat–> tissue damage, dantrolene (blocks Ca release from SR by antagonizing ryanodine receptors)
Slow twitch fibers have high ______ content to resist fatigue and are what color? What muscles typically?
O2/myoglobin/ lots of mitochondria, red, postural spinal muscles
Fast twitch fibers are what color? What do they primarily metabolize? Example muscle
white, glucose and glycogen, less mitochondria and less myoglobin, eye muscles
_____ muscle has dyads and ____ muscle has triads
cardiac, skeletal
One way the heart can increase contraction is by having more _____ enter the cell
calcium
Non-dihydropyridine Ca channel blockers ______ contractility because they block Ca entry into the cell
decrease–> slower conduction and lower HR
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
G, inc, inc, inc
Lusitrophy means. What does it always accompany? What is it mediated by? What is the key regulatory protein?
myocardial relaxation, always accompanies increases in contractility, SERCA channel, phospholamban
What does phospholamban do?
It is an inhibitor of SERCA, when phosphorylated by Beta 1 stimulation–>stops inhibiting SERCA–> inc Ca reuptake and myocardial relaxation
Do smooth muscle cells depend on action potentials
No, typically have slow & sustained contraction
Skeletal muscle is ____ filament regulated and smooth muscle in _____ filament regulated
thin, thick
In smooth muscle, myosin light chain kinase allows what?
phosphorylates myosin to interact with actin=contraction
_______ binds calcium in smooth muscle cells and activates myosin light chain kinase–>contraction
calmodulin
Dihydropyridine drugs (amlodipine, nicardipine) block what and lead to vascular smooth muscle _______
L type Ca channels, relaxation(b/c blocking Ca), used to lower HTN
IP3–>___ release from SR–>
Ca, contraction
cAMP–>MLC kinase inhibition–>
relaxation
cGMP–>MLC phosphatase activation–>
relaxation
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
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
How do Gs, Gi, Gq affect smooth muscle
Gs–>cAMP (inhibi MLCK)–>relaxation
Gi–>dec cAMP–>contraction
Gq–>phospholipase C–>IP3–>contraction
Receptors and their 2nd messangers?
“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
What is the periosteum
the outer membrane that covers the surface of bones and has blood vessels and sensory nerves
_____ bone is the hard compact, exterior bone
cortical
____ bone is spongy bone thats soft, flexible, and has lots of surface area. Where is it found?
trabecular, at the end of long bones
Epiphysis is the? What is it covered by?
end of a long bone, cartilage
Metaphysis is the
widening before the epiphysis
Diaphysis is the?
shaft of bone
osteoclasts are specialized ______ and come from what cell lineage?
macrophages, monocytes
Bone matrix is made up of what type of collagen?
type 1
Endochondral ossification occurs during _______. ___ bones develop from hyaline cartilage. This is secreted by_____
embryogenesis, long, chondrocytes
-achondroplasia is a disorder of this (why they have shortened long bones)
Osteoblasts lay down matrix and primary and secondary ossification sites. What does this mean
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
The growth plate contains ______ cartilage
hyaline
_____ bone is the first type of bone formed. It consists of ______ collagen fibers and is weaker
woven, disorganized
-seen in adults after injury
_______ bone is layered bone that is organized
lamellar
In _______ossification, bone matrix is formed directly and not from cartilage. This is how we make ______ bones
membranous, flat bones (skull, facial bones), use woven-
–>lamellar bone
Alk phosphatase can be a marker for osteo____ as it creates an alkaline environment for ______
blasts, calcium deposition
_____osis stimulates osteoclasts
acidosis as osteoclasts need acidic environment to break down bone
Osteo____ contain PTH receptors
blasts, clasts don’t have any
Ankylosing spondylitis can involve the thoracic spine and lead to ________, involve the heart and lead to______, and affect the eye and lead to?
- decreased chest expansion (should be monitored in ALL pts with AS)
- ascending aoritis–>dilated aortic ring and aortic insufficiency
- anterior uveitis
________ disorders inc risk for gout
myeloproliferative (Polycythemia vera)
_________ is characterized by pain, erythema, swelling, reduced motion in a joint and when acute with leukocytosis, best way to diagnose is ________
Synovitis, synovial fluid analysis for crystal analysis, cell count and gram stain
the supraspinatus muscle _____ the shoulder
abducts first 15 degrees
the infraspinatus ________ rotates the arm
externally
the subscapularis ________ rotates the arm
internally
Man comes in with lumpy bone protuberance and hearing loss. Think _______. What are the 2 most important factors for osteoclastic differentiation.
Paget’s disease, M-CSF, RANK-L
-can 100s of multinucleate giant cells
The uniform distribution of T-Tubules allows what?
ensures that each myofibril contracts at the same time
-so if you have dec T tubulues–> uncoordinated contraction
Posterior drawer tests PCL and what motion to test if abnormal
pushing back on knee to check for posterior displacement
Anterior drawer tests ACL and what motion to test if abnormal
pull knee forward for anterior displacement
digital clubbing you see _______ of the nail folds
flattening, can be form bronchiectasis or any hypoxic problem
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
severe arthritis, homogenistic acid dioxygenase, homogenistic acid, blue-black deposits in sclera and can deposit in joints, black
The axillary nerve is commonly injured in ________ dislocation of the humerus
anterior
The ________ is innervated by the thoracodorsal nerve and helps with internal rotation of the arm
latissimus dorsi
Ehlers Danlos syndrome is associated with abnormal _________ formation–>hyper mobile, flexible skin
COLLAGEN
Ehlers Danlos syndrome is categorized by defective _______ synthesis and what specific part?
collagen, procallagen peptidase deficiency—> impaired cleavage of terminal peptides in extracellular space
lateral epicondlyitis does what function of the hand
wrist extension
scaphoid fractures are at inc risk of __________
avascular necrosis
-fall on outstretched hand
osteonecrosis (avascular necrosis) is from ________ blood supply to a bone. The _______ is the most common location. What are four common causes?
impaired, femoral head, sickle cell disease, alcoholic, glucocorticoid therapy, vasculitis
_________ 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?
acute serum sickness, type 3, complement, fibrinoid necrosis with intense neutrophil infiltration
transmural fibrinoid necrosis of medium size arteries with joint and abdominal pain and what is it associated with?
polyarteritis nodosa, hepatitis B
Supracondylar fractures that lead to anterolateral displacement of humerus cause _______ nerve injury
radial
Supracondylar fractures that lead to anteromedial displacement of humerus cause ________, _________ nerve injury
brachial, median
The ______ passes through the greater sciatic foramen and is involved with ______ hip rotation. Muscle injury can damage the _______ nerve in the foramen
piriformis, external, sciatic
peroneal nerve injury leads to loss of
dorsiflexion, and loss of sensation over dorsum of foot
pseudogout is characterized by ____________ crystals and neutrophilic predominance. It characterized by pain, joint swelling, erythema, and warmth
calcium pyrophosphate
A longitudinal incision through the _________ can relieve carpal tunnel pressure
transverse carpal ligament
thoracic outlet syndrome is due to compression of the __________ in the ________ triangle. Sx include
lower brachial plexus, scalene
-upper extremity numbness, tingling, weakness
Prepatellar bursitis causes anterior ______ pain
anterior knee and is due to prolonged or repetitive kneeling
How does spinal stenosis present? And what is thickened? How is it typically relieved?
Postural dependent lower extremity pain/numbness, and weakness
-ligamentum flavum
-
Tredelenburg gait is form injury to the __________ and where is this located. So where is it safe to inject
contralateral superior gluteal nerve, superior medial gluteal region
-safe to inject in superiorlateral region
leuflonamide inhibits _______ preventing pyrimidine synthesis
dihydroorate dehydrogenase
-suppresses T cell proliferation
What cells mediate wound contraction
myofibroblasts
epidermal cells lead to _______ scarring
negligible
collagen type ____ is the primary component of granulation tissue and this is temporary and then is replaced by type ____
Type 3, 1
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
VEGF, mitochondria
fibers that serve as sensory organs to detect static and dynamic changes in muscle length and are innervated by gamma neurons
intrafusal fibers
fibers that are innervated by alpha motor neurons and serve to generate tension by contraction
type 1 extrafusal fibers
-found in the heart (muscles that contract often)
fibers that detect muscle tension
golgi tendon organs
fast twitch fibers
type 2 extrafusal
treat symptomatic baker’s cyst with
glucocorticoid injection
unhappy triad
ACL, MCL, meniscus,
what is piriformis syndrome
piriormis can piece the sciatic nerve–>pain shooting down back of thigh to leg to foot
-running or cycling
bow legged is to
varus
-test LCL
knock kneed is to
valgus
-test MCL
What bone pain is received by leaning forward?
spinal stenosis
Ankylosis spondylitis is associated with what heart problem
Aortic regurgitation
