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MUSCULOSKELETAL, SKIN, AND CONNECTIVE TISSUE > MUSCULOSKELETAL, SKIN, AND CONNECTIVE TISSUE- Anatomy and physiology > Flashcards

MUSCULOSKELETAL, SKIN, AND CONNECTIVE TISSUE- Anatomy and physiology Flashcards

1
Q

Epidermis Layers

A 
Stratum Corneum 
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum 
Stratum Basale
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2
Q

In which epidermis layer i sthe Keratin?

A

Stratum corneum

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3
Q

Which kind of intercellular conections exist in Stratum spinosim?

A

Desmosomes

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4
Q

Which cells are found in Stratum basale?

A

Stem cell site

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5
Q

Epithelial cell junctions

A 
Tight junction
Adherens junction
Desmosome
Gap Junction
Hemidesmosome
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6
Q

Alternative name for Tight junction

A

Zonula occludens

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7
Q

What is the function of tight junction?

A

Prevents paracellular movement of solutes

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8
Q

What composes Zonula occludens?

A

Claudins and occludins

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9
Q

Alternative name for Adherens junction

A

Zonula adherens

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10
Q

Where are located Adherens junctions?

A

Below tight junction

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11
Q

Which is the function of Zonula adherens?

A

Forms “belt connecting actin cytoskeletons of adjacent cells with CADherins

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12
Q

What are the CADherins?

A

Ca2+ dependent adheison proteins

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13
Q

Loss of E cadherin promotes…

A

Metastasis

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14
Q

Alternative name for Desmosomes

A

Macula adherens

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15
Q

Which is the structural importance of Desmosomes

A

Structural Support via keratin interactions

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16
Q

Which disease is caused by Autoantibodies against desmosomes?

A

Pemphigus Vilgaris

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17
Q

Channel proteins called connexons

A

Gap junction

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18
Q

What is the function of Gap junction?

A

Permit electrical and chemical communication between cells

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19
Q

What is the function of Hemidesmosome?

A

Connects keratin in basal cells to underlying basement membrane

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20
Q

Disease characterized by Autoantibodies against Hemidesmosome

A

Bullous pemphigoid

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21
Q

What is the function of Integrins?

A

Membrane proteins that maintain integrity of basolateral membrane

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22
Q

How do integrins maintain integrity of basolateral membrane?

A

By binding to collagen and laminin in basement membrane

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23
Q

How is knee injury presented?

A

With acute knee pain and signs of joint injuriry/ instability

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24
Q

What does Anterior drawer sign means?

A

ACL (Anterior Cruciate Ligament) injury

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25
Q

What does Posterior drawer sign means?

A

PCL (Posterior Cruciate Ligament) injury

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26
Q

Signs of Joint injury/ instability of Knee

A 
Anterior drawer sign
Posterior  drawer sing
Abnormal passive abduction 
Abnormal passive adduction
McMurray test
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27
Q

Which kind of stress is Abnormal passive abduction?

A

Valgus Stress

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28
Q

Which kind of stress in Abnormal passive adduction

A

Varus Stress

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29
Q

How is Abnormal passive abduction translated?

A

As MCL (Medial collateral ligament) injury

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30
Q

What does Abnormal passive adduction?

A

LCL (Lateral collateral ligament) injury

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31
Q

How is McMurray test evaluated?

A

Pain on external rotation → Medial meniscus

Pain on internal rotation → Lateral meniscus

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32
Q

When is Unhappy triad presented?

A

Common injury in contact sports due to lateral force applied to a planted leg

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33
Q

In what does Unhappy triad consists?

A

Of damage to the ACL, MCL, and medial meniscus (attached to MCL

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34
Q

Which is the most common Meniscus injury?

A

Lateral meniscus injury is more common

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35
Q

Which nerve block relieve pain of delivery?

A

Pudendal nerve block

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36
Q

Where is pudendal nerve?

A

Ischial spine

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37
Q

Where is McBurney point?

A

2/3 of the distance between the umbilicus and the anterior superior iliac spine

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38
Q

Clinically how you identify the point of Lumbar puncture?

A

With iliac crest

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39
Q

Rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres minor
Subscapular

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40
Q

Who innervates Supraspinatus?

A

Suprascapular nerve

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41
Q

What is the function of Supraspinatus?

A

Abduct arm initially

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42
Q

After Supraspinatus abduct the arma, who manage the complete abduction of arm?

A

Deltoid

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43
Q

Most common rotator cuff injury

A

Supraspinatus

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44
Q

Who innervates Infraspinatus?

A

Suprascapular nerve

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45
Q

Which muscles are innervated by suprascapular nerce?

A

Supaspinatus

Infraspinatus

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46
Q

Laterally rotates arm

A

Infraspinatus

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47
Q

Muscle affected by pitching injury

A

Infraspinatus

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48
Q

Which nerve innervates Teres minor?

A

Axilalary nerve

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49
Q

What is the function of Teres minor?

A

Adduct and laterally rotate

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50
Q

Structure inervated by Subscapular nerve

A

Subscapularis

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51
Q

Medially rotates and adducts arm

A

Subscapularis

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52
Q

Which nerve branches innervate primarily the rotator cuff muscles

A

By C5-C6

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53
Q

Wrist bones

A

Scaphoid, Lunate, Triquetrum, Pisiform

Hamate, Capitate, Trapezoid, Trapezium

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54
Q

Bone palpated in anatomical snuff box

A

Scaphoid

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55
Q

Most commonly fractured carpal bone

A

Scaphoid

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56
Q

What other risk do Scaphoid bone has?

A

Is prone to avascular necrosis owing to retrograde blood supply

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57
Q

What could be the result of Dislocation of lunate?

A

May cause acute carpal tunnel syndrome

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58
Q

What could be the result of a fall on an outstretched hand that damages the hook of the hamate?

A

Can cause ulnar nerve injury

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59
Q

What happens in Carpal tunnel syndrome?

A

Entrapment of median nercie in carpal tunnel

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60
Q

Pathophysiology of carpal tunnel syndrome. And which are the symptoms?

A

Nerve compression → paresthesia, paim, and numbness in diestribution or median nerve

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61
Q

What is affected in Guyon canal syndrome?

A

Compression of the ulnar nerve at the wrist or hand

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62
Q

In whom is often seen Guyon canal syndrome?

A

In cyclists due to pressure from handlebars

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63
Q

How else is Erb palsy known?

A

Waiter’s tip

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64
Q

What is injure in Erb palsy?

A

Traction or tear of upper trunk

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65
Q

Which roots form Upper trunk, affected in Erb palsy?

A

C5-C6 roots

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66
Q

Cause of Erb palsy in infants

A

Lateral traction on neck during delivery

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67
Q

Cause of Waiter’s tip palsy in adults

A

Trauma

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68
Q

Which are the three possbile muscle affected by Erb palsy?

A

Deltoid, supraspinatus
Infraspinatus
Biceps brachii

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69
Q

Functional deficience in case Deltoid or supraspinatus are affected

A

Abduction (arm hangs by side)

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70
Q

When Infraspinatus is affected what do we see?

A

Lateral rotation (arm medially rotated)

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71
Q

What is seen in Biceps brachii lesion?

A

Flexion, supination (arm extended and pronated)

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72
Q

What is affected in Klumpke palsy?

A

Traction or tear of lower trunk

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73
Q

Which root of nerves form the lower trunk affected in Klumpke palsy

A

C8 and T1

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74
Q

Causes of Klumpke palsy in infants

A

Upward force on arm during delivery

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75
Q

Cause of Klumpke palsy in adults

A

Trauma

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76
Q

Muscle deficit in Klumpke palsy

A

Intrinsic hand muscles:

Lumbricals, interossei, thenar, hypothenar

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77
Q

In which palsy is seen Total claw hand?

A

Klumpke palsy

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78
Q

What is the total claw hand?

A

Lumbrincans normally flex MCP joins and extend DIP and PIP joints

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79
Q

What explains Thoracic outlet syndrome?

A

Compression of lower trunk and subclavian vessels

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80
Q

Cervical rib injury and Pancoast tumor could cause this syndrome

A

Thoracic outlet syndrome

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81
Q

Muscle affected in Thoracic outlet syndrome

A

Same as Klumpke palsy

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82
Q

What is the functional deficit seen in Thoracic outlet syndrome

A

Athrophy of intrinsic hand muscles; ischemia, pain, and edema due to vascular compression

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83
Q

Lesion of long thoraci nerve

A

Winged scapula

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84
Q

Risk of axillary node dissection after mastectomy, and stab wounds

A

Winged scapula

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85
Q

Muscle affected in Wiged scapula

A

Serratus anterior

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86
Q

What is functional deficit seen with winged sacpula?

A

Inability to anchor scapula to thoracic cage → cannot abduct arm above horizontal position

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87
Q

Which nerves could be injure in case of fractured surgical neck of humerus; anterior dislocation of humerus?

A

Axillary

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88
Q

Who forms the axillary nerves?

A

C5-C6

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89
Q

What is the clinical pressentation when axillary nerve is injured?

A

Flattened deltoid
Loss of arm abduction at shoulder (>15 degrees)
Loss of sensation over deltoid muscle and lateral arm

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90
Q

Which nerve is formed by C5-C7?

A

Musculocutaneous

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91
Q

Nerve damaged by upper trunk compression

A

Musculocutaenous

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92
Q

The clinical pressentation of this nerve injure is with loss of forearm flexion and supination, loss of sensation over lateral forearm

A

Musculocutaneous (C5-C7)

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93
Q

Nerve affected by “Saturday nerve palsy”

A

Radial

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94
Q

Who forms the radial nerve?

A

C5-T1

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95
Q

What causes nerve injury of Radial nerve?

A

Midshaft fracture of humerus; compression of axilla (eg. due to crutches of sleeping with arm over chair)

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96
Q

Clinical pressentation of this nerve injured is with Wrist drop: Loss of elbow, wrist and finger extension

A

Radial Nerve injury

97
Q

Which sensations are lost in case of Radial nerve injury?

A

Loss of sensation over posterior arm/forearm and dorsal hand

98
Q

What else is seen in Radial nerve injury?

A

↓ grip strenght (wrist extension necessary for maximal action of flexors)

99
Q

Which branches form Median nerve?

A

C5-T1

100
Q

Nerve affected in carpal tunnel syndrome

A

Median nerve

101
Q

What nerve do you suspect to be injure in case of Wrist laceration (distal)?

A

Median nerve

102
Q

Other situation that could injure median nerve

A

Supracondylar fracture of humerus (proximal lesion)

103
Q

The clinical pressentation of this nerve injure is “Ape hand” and “Pope’s blessing”

A

Median nerve injury

104
Q

Functional loss when median nerve is injured

A

Loss of wrist and lateral finger flexion, thumb opposition, lumbricals of 2nd and 3rd digits

105
Q

Nerve injured when loss of sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2 fingers with proximal lesion

A

Median nerve injury

106
Q

Which sign is seen in median nerve lession in carpal tunnel syndrome?

A

Tinel sign

107
Q

What is the Tinel signs? When is seen?

A

Tingling on percussion, in carpal tunnel syndrome

108
Q

Nerves that form the Ulnar nerve

A

C8-T1

109
Q

Nerve affected in fracture of medial epicondyle of humerus “funny bone” (proximal lesion)

A

Ulnar (C8-T1)

110
Q

Distal lession of Ulnar

A

Fractured of hook of hammate

111
Q

What is seen on digit extension when ulnar nerve is damaged?

A

“Ulnar claw”

112
Q

Clinical presentation of Proximal lession ofr Ulnar nerve

A

Radial deviation of wrist upon flexion

113
Q

Loss of flexion of wrist and medial fingers, abduction and adduction of fingers (interossei), actions of medial 2 lumbrical muscles

A

Ulnar nerve injury (C8-T1)

114
Q

What sensation is loss in Ulnar nerve injury?

A

Loss of sensation over medial 1 1/2 fingers including hypothenar eminence

115
Q

Who forms Recurrent branch of median nerve?

A

C5-T1

116
Q

How is Recurrent branch of median nerve injured?

A

By superficial laceration of palm

117
Q

Clinical presentation of Recurrent branch of median nerve injury

A

“Ape hand”

118
Q

Which muscles function is lost if Recurrent branch of median nerve is injured?

A

Loss of thenar muscle group

119
Q

Which mucles form the thenar muscle group?

A

Opposition, Abduction and Flexion thumb

120
Q

Which sensations are lost in Recurrent branch of median nerve injury?

A

None

121
Q

Which muscles manage the balance on the hand guring rest?

A

A balance between the extrinsic flexors and extensors of the hand, as well ad the instrinsic muscles of the hand

122
Q

Which are the particular muscles related to the balance of the hand?

A

Lumbrical muscles

123
Q

What is the function of Lumbrical muscles?

A

Flexion of metacarpophalangeal (MCP), extension of Distal and proximal Interphalangeal joints (DIP and PIP)

124
Q

When is “clawing” of the hand seen?

A

Seen best with distal lesions of median or ulnar nerves

125
Q

What else is seen in “clawing” hand?

A

Remaining extrinsic flexors of the digits exaggerate the loss of the lumbricals

126
Q

Presentation of “clawing hand”

A

Extension of metacarpophalangeal (MCP), flexion of Distal and proximal Interphalangeal joints (DIP and PIP)

127
Q

Which distortions of the hand is less pronunced between distal and proximal lesions?

A

Proximal

128
Q

How is proximal lesion of the hand seen?

A

Deficits present during voluntary flexion of the digits

129
Q

Which is the sign seen in Distal ulnar nerve lesion?

A

“Ulnar claw”

130
Q

What is found in “Ulnar claw?

A

Extending fingers /at rest

131
Q

In “Pope’s blessing” which nerve is damege?

A

Proximal median nerve

132
Q

Sign found in median nerve injury

A

“Median claw”

133
Q

If proximal ulnar nerve is damage, which sign may you find?

A

“OK gesture” (with digis 1-3 flexed)

134
Q

What is found in Atrophy of the thenar eminence?

A

Unoposable thumb → “ape hand”

135
Q

When is Atrophy of the thenar eminence seen?

A

In median nerve lesions

136
Q

Atrophy of the hypothenar eminence is seen during…

A

Ulnar nerve lesions

137
Q

Nerve related to Thenar eminence

A

Median

138
Q

Which is the function of both hypothenar and thenar eminences?

A

OAF
Oppose
Abduct
Flex

139
Q

Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis

A

Thenar eminence

140
Q

Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi

A

Hypothenar eminence

141
Q

Abduct the fingers

A

Dorsal interosseous muscles

142
Q

Adduct the fingers

A

Palmar interosseous muscles

143
Q

Muscle that manage Flexion of metacarpophalangeal (MCP), extension of Distal and proximal Interphalangeal joints (DIP and PIP)

A

Lumbrical muscles

144
Q

Who composes Obturator nerve?

A

L2-L4

145
Q

Cause of injury of Obturator nerve

A

Pelvic surgery

146
Q

The clinical presentation of this nerve injury is ↓ thigh sensation (medial) and ↓ adduction

A

Obturator nerve injury

147
Q

Which branches form Femoral Nerve?

A

L2-L4

148
Q

When can femoral nerve get injured?

A

Pelvic fracture

149
Q

Clinical presentation of Femoral nerve injury

A

↓ thigh flexion and leg extension

150
Q

L4 - S2 composed this nerve

A

Common peroneal nerve

151
Q

Risk of trauma or compression of lateral aspect of leg, fibular neck fracture

A

Common peroneal nerve injury

152
Q

“Steppage gait” is seen in…

A

Common peroneal nerve injury

153
Q

Clinical presentation of Common peroneal nerve injury

A

Foot drop- inverted and plantarflexed at rest, lost of eversion and dorsiflexion

154
Q

Which sensation is lost when common peroneal nerve is injured?

A

Loss of sensation on dorsum of foot

155
Q

Which branches form the Tibial nerve?

A

L4-S3

156
Q

Proximal Causes of injury of tibial nerve

A

Knee trauma, Baker cyst (proximal lesion)

157
Q

Distal causes of injury of tibial nerve

A

Tarsal tunnel syndrome

158
Q

Presented as inability to curl toes and loss of sensation on sole of foot

A

Tibial nerve injury

159
Q

What is seen in proximal tibial nerve lesion?

A

Foot everted at rest with loss of inversion and platarflexion

160
Q

Branches that become Superior gluteal nerve

A

L4-S1

161
Q

A posterior hip dislocation have this risk

A

Superior and inferior gluteal nerve lesion

162
Q

Polio causes damage mainly to this nerve

A

Superior gluteal nerve damage

163
Q

Trendelenburg sign/gait is seen in this situation

A

Superior gluteal nerve damage

164
Q

Characteristics of Trendelenburg sign/gait

A

Pelvis tilts because weight bearing leg cannot maintain alignment of pelvis through hip abduction (superior nerve → medius and minimus)

165
Q

Where is the lesion in case of Superior gluteal nerve damage?

A

Lesion is contralateral to the side of the hip that drops, ipsilateral to extremitiy on which patient stands

166
Q

Branches that become Inferior gluteal nerve

A

L5- S2

167
Q

What you must suspect when a patient has difficulty climbing stairs, rising from seated position?

A

Inferior gluteal nerve injury

168
Q

What is seen in Inferior gluteal nerve injury?

A

Loss of hip extension (inferior nerve → maximus)

169
Q

Who forms Sciatic nerve?

A

L4-S3

170
Q

Sciatic nerve mainly innervates…

A

Posterior thigh

171
Q

Sciatic nerve splits into…

A

Splits into common peroneal n tibial nerves

172
Q

Nerve of the surgical neck of humerus

A

Axillary

173
Q

Artery of surgical neck of humerus

A

Posterior circumflex

174
Q

Nerve of Axila/lateral thorax

A

Long thoracic

175
Q

Artery of Axila/lateral thorax

A

Lateral thoracic

176
Q

Nerve of Midshaft of humerus

A

Radial

177
Q

Artery of Midshaft of humerus

A

Deep Brachial

178
Q

Nerve of Distal humerus/ cubital fossa

A

Median

179
Q

Artery of Distal humerus/ cubital fossa

A

Brachial

180
Q

Nerve of popliteal fossa

A

Tibial

181
Q

Artery of popliteal fossa

A

Popliteal

182
Q

Nerve of posterior to medial malleolus

A

Tibial

183
Q

Artery of posterior to medial malleolus

A

Posterior tibial

184
Q

From where to where does a Sarcomere includes?

A

From Z line to Z line

185
Q

Which is the mid line of Sarcomere?

A

M line

186
Q

Where are the mitochondrion found in muscle cells?

A

In Sarcoplasm

187
Q

Where is sarcoplamic reticulum in muscle cells?

A

Peripheral to myofibril

188
Q

Who conforms I band?

A

Actin

Thin filaments

189
Q

What forms A band?

A

Myosin and Actin

Thick and Thin filaments superimpossed

190
Q

What is H band?

A

Myosin

Just thick filaments

191
Q

In the first step of muscle contraction, what is the effect of Action potential depolarization?

A

Opens presynaptic voltage gated Ca2+ channles

192
Q

What does the open of presynaptic voltage gated Ca2+ channles induces?

A

Neurotransmitter release

193
Q

During the second step of muscle contractio, after neurotransmitter relase, what is next?

A

Postsynapting ligand binding leads to muscle cell depolarization in the motor end plate

194
Q

In the third step of muscle contraction, what is happens during depolarization?

A

Depolarization travels along muscle cell and down T tubule

195
Q

During the fourth step of muscle contraction, what happens next to T tubule depolarization ?

A

Depolarization of the voltage sensitive dihydropyridine receptor

196
Q

What is mechanically coupled to dihydropyridine receptor?

A

Ryanidine receptor on the sarcoplasmic reticulum

197
Q

Wht does the Depolarization of the voltage sensitive dihydropyridine receptor mechanically coupled to Ryanidine receptor, lead to?

A

Induces conformational change, causing Ca2+ release from sarcoplasmic reticulum

198
Q

During the fifth step of muscle contraction, what happens to the release Ca2+?

A

Binds to troponinC, causing conformational change that moves tropomyosin out of the myosin binding groove on actin filaments

199
Q

During the last step of muscle contraction, what happens to the myosin?

A

Mysoin releases bound ADP and subsequently, inorganic PO4 3-

200
Q

What is the effect of Mysoin releases bound ADP and subsequently, inorganic PO4 3-?

A

Displacement of myosin on the actin filament (power stroke)

201
Q

What is the result of muscle contraction?

A

Shortening of H and I bandsand between Z lines (HIZ shrinkage)

202
Q

What happens A band in muscle contraction?

A

Remains the same lenght (A band is always the same lenght)

203
Q

Types of muscle fibers

A

Type 1 muscle

Type 2 muscle

204
Q

Also known as red fibers

A

Type 1 muscle

205
Q

Which are the slow twitch muscle fibers?

A

Type 1

206
Q

Why are type 1 muscle red?

A

Resulting from ↑ mitochondria and myoglobin concentration (↑ oxidative phosphorylation)

207
Q

What is the result of ↑ mitochondria and myoglobin concentration (↑ oxidative phosphorylation) in type 1 muscle?

A

Sustained contraction

208
Q

Which are the fast twitch muscle fibers?

A

Type 2

209
Q

Also known as white fibers

A

Type 2 muscle

210
Q

Explain the white color of Type 2 muscle fibers

A

Resulting from ↓ mitochondria and myoglobin concentration (↑ anaerobic glycolysis)

211
Q

Which muscle fibers have hyperthrophy as a result of weight training?

A

Fast twitch muscle fibers

Type 2 muscle

212
Q

Main element to detonate smooth Muscle contraction

A

↑ Ca2+

213
Q

Main element that manage smooth muscel relaxation

A

Nitric oxide

214
Q

Ca2+ channels in smooth muscle

A

L type voltage gated Ca2+ channel

215
Q

Once the membrane of smooth muscl is depolarized, what is next?

A

↑ Ca2+

216
Q

After Ca2+ is increased in smooth muscle cells, what happens next?

A

↑ CA2+ -calmodulin complex

217
Q

What is the effect of ↑ CA2+ -calmodulin complex in smooth muscle cell?

A

Positively stimulates Myosin light chain kinase (MLCK)

218
Q

Final result of Positively stimulated Myosin light chain kinase in smooth muscle cell

A

Stimulates Myosin P+ actin which leads to contraction (via cross bridging)

219
Q

In order to relax the smooth muscle, what is the effect of Nitric oxid?

A

Positively stimulates Guanylate cyclase

220
Q

What is the effect of Guanylate cyclase in smooth muscle cell?

A

Converts GTP to cGMP

221
Q

Once cGMP is made in smooth muscle relaxation, what happens next?

A

cGMP positively stimulates Myosin light chain phosphatase (MLCP)

222
Q

What is the final result of stimulated Myosin light chain phosphatase (MLCP)?

A

From Myosin P+ actin, change to Myosin+ actin, which leads to smooth muscle relaxation

223
Q

Types of Bone formation

A

Endochondral ossification

Membranous ossification

224
Q

Which bones present endochondral ossification?

A

Bones of axial and appendicular skeleton, and base of the skull

225
Q

Which is the model of endochondral ossification?

A

Cartilaginous model of bone is first made by chondrocytes

226
Q

What happens after the cartilaginous model of bone in endochondral ossification?

A

Osteoclasts and osteoblasts later replace with woven bone and the remodel to lamellar bone

227
Q

In adults when does woven bone occur?

A

After fractures and in Paget disease

228
Q

Which bones present Membranous ossification?

A

Bones of calvarium and facial bones

229
Q

How is woven bone formed in Memebranous ossification?

A

Directly without cartilage. Later remodeled to lamellar bone

230
Q

How do osteoblasts build bone?

A

By secreting collagen and catalyzing mineralization

231
Q

From which cells do osteoblasts differentiate? and where?

A

From Mesenchymal stem cells in periostum

232
Q

What are the osteoclasts? What is their function?

A

Multinucleated cells that dissolve bone by secretting acid and collagenanses

233
Q

From which cells do osteoclasts differentiate? and where?

A

Monocytes/ macrophages

234
Q

What is the effect of PTH in bone cells?

A

At low, intermitettent levels , exerts anabolic effects (building bone) on osteoblasts and osteoclasts (indirect)

235
Q

Cause of chronic high PTH levels

A

Primary hyperparathyroidism

236
Q

What is the effect of Chronic high PTH levels?

A

Catabolic effects (osteitis fibrosa cystica)

237
Q

What is the effect of Estrogen at bone?

A

Inhibits apoptosis in bone forming osteoblasts and induces apoptosis in bone resorbing osteoclasts

238
Q

What is the effect of estrogen deficiency in bone?

A

Excess remodeling cycles and bone resoption lead to osteoporosis

MUSCULOSKELETAL, SKIN, AND CONNECTIVE TISSUE (3 decks)

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