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Skin Muscle and Bone > SMB Week 3 > Flashcards

SMB Week 3 Flashcards

1
Q

A classic chest x-ray involves which two views?

A
  • PA (posterior - anterior)

- Lateral

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2
Q

True or false: a PA view x-ray over-represents the size of the heart due to greater shadowing.

A

False: an AP view produces greater shadowing

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3
Q

What does an “apple core lesion” suggest?

A

Colon cancer

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4
Q

Which imaging modality has the best soft tissue contrast?

A

MRI

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5
Q

The terminal ends of a sarcomere:

A

Z line

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6
Q

The striations seen in skeletal muscle are due to what?

A

Alternating bands of thick and thin filaments

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7
Q

Thick filaments in skeletal muscle are composed of what?

A

Myosin

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8
Q

Thin filaments in skeletal muscle are composed of what?

A

Actin

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9
Q

How does contraction of skeletal muscle happen?

A

Actin filaments bind to globular heads of myosin filaments, which causes a conformational change in the myosin heads, bringing the actin filaments closer together.

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10
Q

What are the transverse tubules in a muscle fiber?

A

Invaginations of the sarcolemma, which is the plasma membrane surrounding a muscle fiber

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11
Q

What is the function of the transverse tubules in a muscle cell?

A

Allows action potentials to reach the interior myofibrils of the cell.

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12
Q

Action potentials in muscle cells are initiated by what neurotransmitter at the neuromuscular junction?

A

Acetylcholine

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13
Q

Sites for blocking neuromuscular transmission:

A
  • Presynaptic: Block the release of ACh
  • Synaptic cleft: Block breakdown of ACh
  • Postsynaptic: Block binding of ACh
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14
Q

Example of a presynaptic toxin:

A

C. botulinum

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15
Q

Example of a synaptic cleft toxin:

A

Fasciculin peptides in venom, nerve gas

Therapeutic use: myasthenia gravis

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16
Q

Example of post synaptic toxin:

A

Suxamethonium (ACh receptor agonist)

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17
Q

Definition of a “twitch”

A

Response of muscle fiber to a single action potential

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18
Q

Definition of sustained muscle contraction:

A

Many action potentials trigger multiple contractions. If frequency is high enough, muscle will respond with a “fused tetanus” response.

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19
Q

Definition of isotonic vs. isometric contraction:

A

Isotonic: tension is constant, length changes
Isometric: length is constant, tension changes

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20
Q

Types of isotonic contraction:

A

Concentric: muscle shortens (upward part of curl)
Eccentric: muscle lengthens (downward part of curl)

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21
Q

What is the test for De Quervain tenosynovitis?

A

Finklestein’s test

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22
Q

What are the two tests for carpal tunnel syndrome?

A
  • Tinnel test (tap)

- Phalen’s test (dorsum of hands together)

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23
Q

Most common muscle involved in tennis elbow:

A

Extensor carpi radialis brevis

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24
Q

What digit can you test to isolate the extensor carpi radials brevis?

A

3rd (middle finger)

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25
Q

What is the Adson test used for?

A

To test for subclavian artery compression

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26
Q

What does the Yergason test indicate?

A

Stability of the long head of the biceps tendon in the bicipital groove

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27
Q

Most commonly injured rotator cuff muscle:

A

Supraspinatus

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28
Q

What does a positive Neer test indicate?

A

Subacromial bursitis

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29
Q

What other test is used to detect subacromial bursitis?

A

Hawkins test

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30
Q

What sort of curvature is the Adams forward bend test measuring?

A

Axial rotation, not medial/lateral curvature

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31
Q

What muscle does the Trendelenburg test test?

A

Gluteus medius

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32
Q

What does the pelvic rock test indicate?

A

Sacroiliac joint stability

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33
Q

What is the Hoover test?

A

Test to see if a pt is faking a lower back injury. If they’re trying to raise their leg, they’ll counter this motion with an opposite motion in the other leg.

34
Q

What does a ballotable patella indicate?

A

Major effusion

35
Q

Describe the McMurray and Apley tests:

A
  • McMurray: with knee flexed, internally and externally rotate tibia.
  • Apley: with pt prone and knee bent at 90 degrees, press down on foot and rotate (compression test for meniscal tear) or pull on foot and rotate (distraction test for ligament damage).
36
Q

Stages of bone healing:

A
  • Inflammation (1 - 3 days)
  • Repair (3 - ? days, soft and hard callus formation)
  • Remodeling (removal and replacement of bone)
37
Q

What is another name for the growth plate?

A
  • Physis

- Also called the epiphyseal plate

38
Q

What does the term “volar” mean?

A

Same side as the palm or sole

39
Q

How is “angulation” used to describe a fracture?

A

Specifies the direction and amount of displacement from the normal axis of the DISTAL fragment.

40
Q

Define Impaction, Depression and Compression

A

Impaction: fractured bones jammed together
Depression: localized area of collapse
Compression: global collapse (usually a vertebral body)

41
Q

What is an avulsion fracture?

A

Where a piece of bone is displaced due to a tendon or ligament pulling on it.

42
Q

Salter-Harris 1

A
  • Physis visibly separated, OR

- Localized pain with normal x-ray

43
Q

Salter-Harris 2

A

Fx involves metaphysis, extending into physis

44
Q

Salter-Harris 3

A

Fx involves epiphysis, extending into physis

45
Q

Salter-Harris 4

A

Fx involves metaphysis, physis and epiphysis

46
Q

Salter-Harris 5

A

Physis is compressed

47
Q

Fractures that need special attention:

A
  • Scaphoid
  • Femoral head
  • 5th metatarsal (Jones)
48
Q

Why do scaphoid, femoral head, and 5th metatarsal fractures need special attention?

A

Poorly vascularized and at risk for necrosis

49
Q

How do you treat a scaphoid fx?

A

Thumb spica cast or splint for 8-10 weeks

50
Q

What is a Jones fx?

A

Transverse fx through the base of the 5th metatarsal. Caused by trauma or stress

51
Q

Management of a Jones fx?

A

Short cast vs. ORIF (open reduction internal fixation)

52
Q

Smith’s vs. Collie’s fx:

A
  • Smith’s: volar displacement of the distal fragment

- Collie’s: dorsal displacement of the distal fragment

53
Q

Red flags for lower back pain:

A
  • age > 50 (soft red flag)
  • Hx of cancer (hard red flag)
  • Other Sx of cancer (weight loss, fever, etc.)
54
Q

Of strength, endurance and flexibility, which is the most important thing to work on for lower back pain?

A

Strength

55
Q

Medical term for bunion:

A

Hallux valgus

56
Q

Tx for hallux valgus

A
  • wide toe box
  • splint
  • surgery
57
Q

Difference between a corn and a callus:

A
  • Corn: painful keratotic lesion over bony prominence.

- Callus: Diffuse thickening of skin from repeated pressure or friction

58
Q

Etiology, SSx and management of onychocryptosis:

A
  • Ingrown toenail
  • Trimming nails too short, bad shoes, deformity
  • Pain, swelling, drainage
  • Abx if infected; excision if persistent
59
Q

Causes of plantar fasciitis:

A
  • fat pad atrophy
  • heel spurs
  • overuse
60
Q

Etiology, SSx and Tx of Mortons neuroma:

A
  • inflamed nerve ganglioon in the foot
  • pain in forefoot, sensation of pebble in shoe, sensation changes
  • tender between 2nd-3rd or 3rd-4th metatarsal heads/necks
  • NSAIDS, metatarsal support, injections
61
Q

What are the Ottawa ankle sprain rules?

A

Get an x-ray for

  • Malleolar pain and tenderness
  • Inability to take 4 steps
  • AP, lateral, Mortise view
62
Q

Exam for suspected ankle fx:

A
  • Point of tenderness
  • Stability
  • Neurovascular status
  • Examine the knee
63
Q

What do you look for in a Mortise view that would indicate surgery?

A
  • widening on either side of the talus

- indicates an unstable ankle

64
Q

Maisonneuve fx:

A

Spiral fibular fx of proximal 1/3 of fibula with associated medial malleolus injury.

65
Q

MOA, indication, contraindication, AE’s, dosing, monitoring, pt ed for acetaminophen:

A

MOA:

  • Inhibits heat regulating center in hypothalamus
  • weak antagonist of cyclo-oxygenase. MOA for analgesia unclear

Indications:
- Analgesic and antipyretic, good for non-injury pain

AEs:
- Low GI effects, hepatotoxicity

Dosing:

  • Adults 325 - 650 mg q 4-6 hrs or 1g q 6-8 hrs
  • Max 4g/day (2g/day with liver disease)
66
Q

MOA, indication, contraindication, AE’s, dosing, monitoring, pt ed for aspirin:

A

MOA:

  • Acetylates platelets, removing them from circulation

Indications:
- Analgesic, anti-inflammatory and antipyretic

AEs:
- GI effects, skin rashes, bleeds, possible Reye’s syndrome in children during febrile illnesses.

Dosing:

  • Adults 325 - 650 mg for analgesia, antipyretic effect.
  • 4-6 g/day for anti-inflammatory
  • 81-325 mg/day for anti platelet
67
Q

MOA, indication, contraindication, AE’s, dosing, monitoring, pt ed for NSAIDS:

A

MOA:

  • Inhibits cycle-oxygenase, so inhibits prostaglandins and leukotrienes
    - Cox 1 enzymes (lower gastric acid, increased mucus viscosity and gastric blood flow; also happens in kidneys)
    - Cox 2 enzymes induced during/by inflammation, cytokines

Indications:
- Analgesic, anti-inflammatory and antipyretic

AEs:
- GI effects, renal insufficiency

Dosing:
- Depends on drug used. Efficacy similar but different potencies.

68
Q

Celecoxib (Celebrex)

A

Cox II selective inhibitor

69
Q

MOA, indication, contraindication, AE’s, dosing, monitoring, pt ed for opiates:

A

MOA:

  • Opiate receptors in spinal cord, brain stem and higher centers
  • Mimics action of endogenous endorphins
  • Inhibit release of Substance P
  • Inhibit transmission of nociceptive input to spinal cord, as well as descending inhibitory pathways.

Indications:
- Moderate to severe pain

AEs:
- Somnolence, respiratory depression, N/V, constipation

Dosing:
- Start with low dose and short acting formulations until pain well-controlled.

70
Q

Diagnosing tendinitis:

A
  • Pain with palpation
  • Pain with passive stretch
  • Pain with contraction against resistance
71
Q

H zone

A

The region straddling the M line, occupied only by thick filaments

72
Q

A band

A

The area between I bands, occupied by both thick and thin filaments

73
Q

I band

A

The area straddling the Z line, occupied only by thin filaments

74
Q

The 3 types of muscle fibers and their strength/endurance properties:

A
  • Slow oxidative fibers: weak but high endurance
  • Fast oxidative glycolytic fibers: intermediate strength and endurance
  • Fast glycolytic fibers: high strength but low endurance
75
Q

True or false: many rotator cuff tears are asymptomatic, especially in older adults.

A

True

76
Q

What sort of movements are likely to be limited in someone with a rotator cuff tear?

A

Overhead motion, abduction and internal rotation.

77
Q

Test for torn supraspinatus

A

Empty can test: 70 degrees abduction, 30 degrees forward flexion, internal rotation. Press down on arm against resistance.

78
Q

Management of torn rotator cuff:

A

Surgical referral in individuals 60.

79
Q

Test for acromioclavicular strain:

A

Cross arm adduction test.

80
Q

Ottawa rules for ankle injury:

A
  • bony tenderness at distal, posterior malleoli
  • inability to bear weight
  • pain with palpation of navicular or 5th metatarsal
81
Q

Osgood-Schlatter disease

A

Involves inflammation of the patellar tendon where it attaches to the tibial tuberosity

Skin Muscle and Bone (7 decks)

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