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15021998-MSK > week 1 > Flashcards

week 1 Flashcards

1
Q

what is difference between isometric and isotonic contractions in skeletal muscle

A

isometric - length says same and tension changes (supporting object/body posture maintaince)

isotonic - tension stays the same and length changes (moving objects/moving body)

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2
Q

in skeletal muscles is AP longer of shorter than twitch

A

shorter, so repeat AP’s gives stronger contraction

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3
Q

tetanus causes what in muscles

A

sustained contraction

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4
Q

when is skeletal muscle at its optimum length for contraction

A

at rest

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5
Q

what are the three types of skeletal muscle fibres?

A

I - slow oxidative

IIa - fast oxidative

IIb/x - fast glycolytic.

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6
Q

knee jerk reflex tests what nerve

A

femoral (L3-L4)

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7
Q

two types of intrinsic muscle diseases

A

acquired (toxic, endocrine, inflammatory, non-inflammatory) and genetically determined(congenital, chronic degredation, abnormal ion surface membranes.)

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8
Q

symptoms of intrinsic muscle diseases

A

muscle weakness/tiredness, myalgia, stiffness, delayed relaxation after voluntary contraction

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9
Q

investigations for intrincis muscle diseases

A

EMG, muscle enzymes (CK), inflammatory markers (ESR/PV). muscle biopsy. nerve conduction studies.

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10
Q

name differences between skeletal and cardiac muscles

A

SKM - neurogenic, has NMJ, no gap junctions, Ca2+ entitely from S.R
CARDIAC - myogenic, no NMJ, has gap junctions, Ca2+ induced Ca2+ (from ECF to SR).

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11
Q

what is the transmitter at the NMJ (neuromuscular junction) in SKM

A

acetylecholine.

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12
Q

what is a motor unit

A

a single alpha neutron and all the skeletal muscle fibres it innervates.

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13
Q

why is there variation in size of motor units

A

because precision and power needed for different things - power= thigh, fine precision =hands/eye.

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14
Q

what is a sacromere and what is it made up of?

A

a sarcomere is the functional unit of SKM.

made form myosin (thick and darker) and actin (thin and lighter)

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15
Q

difference between ligaments and tendon

A

tendon - attach muscle to bone

ligaments attach bone to bone

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16
Q

difference between strain and sprain

A

sprain - stretching/tearing of ligaments.

strain - stretching/tearing of muscles/tendon

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17
Q

describe type 1 SKM fibres

A

slow oxidative, abundant myoglobin and mitochondria. resist fatigue (red fibres)

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18
Q

describe type IIa SKM fibres

A

fast oxidative, intermediate, uncommon, fast contracting and relatively resistant to fatigue.

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19
Q

describe type 11b/x SKM fibres

A

fast anarobic, great force, tire quick, (white fibres).

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20
Q

SKM description

A

striated, multinucleate, unbraced, voluntary, 3 types

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21
Q

how does cartilage get its nutrition

A

through ECM, as is avascular.

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22
Q

what are chondrocytes and what’s their function

A

cells found in cartilage, live in LACUNA (ECM),

actively secrete and maintain ECM.

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23
Q

describe cartilage

A

semi-rigid, permable and deformable

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24
Q

what is ECM in hyaline cartilage made up off?

A

75% water

25% organic

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25
Q

what are the organic constants of hyaline cartilage

A

organic -
60% type II collagen (finer and 3D meshwork than type 1 (found in skin, bone, tendons etc…)) + 40% proteolytic aggregates.

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26
Q

what are the 3 types of cartilage and how do they differ and where is each found?

A

elastic - ear, light yellow, addition of elastin fibres make more flexible.

hyaline - blue/white in colour, translucent, commonest. Found in articular, physeal growth plates, tracheal rings, costal cartilage.

fibrocartilage - hybrid between tendon and hyaline. densely packed collagen type 1, appears white (pubic symphysis and vertebral discs)

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27
Q

what is bones function?

A

protection, stability, leverage, calcium storage (95%), haemopoiesis.

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28
Q

constituents of bone?

A 
calcium phosphate (bioapatite) and collagen. [+water and non-collagen proteins. 
bone constantly undergoes remodelling.
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29
Q

where is cortical and cancellous bone found

A

cortical - outer layer. makes up shaft

cancellous - end of bone

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30
Q

osteoclasts and osteoblast function?

A

osteoblast - bone forming cells found on surface of developing bone.

osteoclast - responsible for bone reabsorption.

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31
Q

what are osteocytes and osteoprogenitor

A

osteoprogenitor - located on bone surface

osteocytes - bone cell trapped in bone matrix.

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32
Q

what is woven bone

A

quick fix with collagen fibres haphazardly laid down. reformed to normal (lamellar) bone via remodelling with osteoclasts and osteoblasts.

33
Q

what is secreted in making of bone?

A

osteoid.

this then attracts calcium phosphate and turns in to bone.

34
Q

what is osteomyelitis

A

inflammation of bone and medullary cavity (usually in long bone). can be acute or chronic, contiguous or haematogenous.

35
Q

treating osteomyelitis

A

debridement and antimicrobials. biopsy bone for microbiology (avoid empirical treatment)

36
Q

symptoms of osteomyelitis

A

red, swollen, painful, loss of function.

37
Q

common infectant in osteomyelitis is S.aureus. how do you treat?

A

flucloxacillin. step down to doxycycline

vancyomycin if allergic to penicillin.

38
Q

osteomyelitis. open fracture treatment

A

early aggressive debridement, fixation and soft tissue cover. If wound not healing then suggest s.aureus/gram negative aerobic bacteria.

39
Q

what to do for diabetes/venous insufficeny osteomyelitis

A

“poke to bone”, if reached the have osteomyelitis (often polymicrobial).

40
Q

what to do if If unsure if infected ulcer or osteomyelitis

A

MRI

41
Q

who is likely to get a haematogenous osteomyelitis?

A

PWID, pre-pubertal children, central lines, elderly, dialysis.

42
Q

osteomyelitis in vertebrae

A

usually haematogenous, assocaited with psoas and epidural accesses. commoner in PWID, post-GU infections, IV site infections, post-op and soft skin infection

43
Q

signs/symptoms and investigations of vertebrae osteomyelitis

A

fever, insideous pain and tenderness, neurological symptoms, inc ESR and CRP. normal WBC not unusual.
investigate with MRI

44
Q

TB can be infecting organism in osteomyelitis. what extra investigation is indicated if this is the case?

A

HIV test

45
Q

when should strep.epidermis be considered bad in osteomyelitis

A

prosthetic joint infection. - may need removal due to biofilm around prothesis.

46
Q

risk factors for prosthetic joint infection.

A

RA, obesity, immunosuppression, diabetes, malnutrition.

47
Q

what is septic arthritis

A

infection of joint space causing inflammation.

48
Q

common organisms in septic arthritis.

A

s.aurues, strep, neisseria gonorrhoea (sexual active), h.inflenzae (use ceftraxone). coagulative negative staph.

mimic is gout

49
Q

PVL s.aureus - what is it and complications

A

panton valentine leukocidin (toxin) causes actue sickness

skininfections, necroitising pneumonia, invasive infection (septic arthritis, bacteraemia).

50
Q

what is pyomyositis?

A

‘pus-muscle-inflammation’. 90% staph infection causing redness and severe pain. needs debridement.

51
Q

myositis

A

inflammed muscle cause by many things (viral post-flu, fungal, parasites.)

52
Q

tetanus pathogenesis

A

clostridium tetani is G +ive stritly anarobic rod/spore. it is noninvasive but toxin is highly deadly.

neurotoxin causes spastic paralysis. (onset 4 days to several weeks). first symptom is “lockjaw”.

53
Q

tetanus treatment

A

debridement, antitoxin, supportive therpay (BB, intubate prematurely, ) antibiotics (contraversial), booster vaccination.

check is have had prevention vaccination (which is a routine toxoid vaccine)

54
Q

what is the function of the synovial membrane

A

to continually replenish and absorb synovial fluid.

55
Q

name the three types of joints

A

fibrous, cartilaginous and synovial

56
Q

synovial fluid is made of what

A

mucin and lubricin (hyaluronic acid and glycoprotein)

57
Q

synovial membrane is made of what

A

vascular connective tissue with capillaries and lymphatics fibroblasts.

58
Q

SF affected by septic arthritis and inflammation

A

inc WBC greater than 200 and straw/yellow colour

59
Q

SF affected by haemorragic arthritis

A

red coloured SF

60
Q

normal SF colour and WBC

A

colourless and less than 200

61
Q

constituents of articular cartilage

A

70% water, 20% collagen type 2 (elastic), 10% proteoglycans. (all reduced with age)

62
Q

cartilage is avascular and gets what from synovial fluid

A

o2 and nutrients

63
Q

what is the catabolic mechanism in cartilage

A

TNF alpha + Il-1 (proteolytic enzymes, breakdown)

64
Q

what is anabolic mechanism in cartilage

A

TGF-Beta and IGF-1 causing reduced Il-1 (and inc proteoglycans, synthesis)

65
Q

markers of cartilage degradation

A

inc serum and synovial keratin sulphate.

inc in type 2 collagen in SF

66
Q

what is the pathogenesis of Gout, OA, RA.

A

Gout - uric acid crystals deposition.

OA - wear and tear

RA - synovial cells inflammation and proliferation

67
Q

what are the three types of pain

A

nociceptive, inflammatory and pathological

68
Q

name some common BT in MSK system

A

giant cells tumour, fibrzomatosis, ganglion cyst.

69
Q

ganglion cyst

A

derived from synovial surfaces, common around wrist.
usually asymptomatic and can be removed.
thick-walled fibrotic lesion.
peripheral and near joint capsule.

70
Q

superficial fibromatoses

A

common EG dupytren’s contractor, plantar fascia, knuckle pads and penile also affected.
risk factors = male and alcohol.

71
Q

giant cell tumours

A

joints, maybe neoplastic mainly inflammatory in nature. Can get in bone, tendon sheath or PVNS (same disease in larger joints.)
easily resected.

72
Q

name the two types of BT concerning fat

A

lipoma - histoligcally normal fat, asymptomatic.

angiolipomas - multiple and peripheral lesions, painful, young age group

73
Q

BT causing pain

A

angiolipoma, necroma (traumatic), glomus tumour, eccrine Spiradenoma, cutaneous leiomyoma.

ANGEL

74
Q

what is found on biopsy of liposarcoma

A

lipoblasts

75
Q

what is the prefix for tumours from smooth muscle, SKM, cartilage, bone

A

leiomyo- ma, sarcoma
chondro -enchondroma/chrondosarcoma
rhabdomyo - ma, sarcoma
osteo - osteoma (cranial bones), osteoid osteoma + osteoblastoma also BT.

76
Q

multiple osteomas means what syndrome?

A

garner’s syndrome.

77
Q

malignant bone tumour and details about

A

osteosarcoma.
paediatrics, long bones,
“Codman’s triangle” on radiology

78
Q

how to test for tumours

A

biopsy
genetic testing
Hx + examination/clinical picture
histology

(if something doesn’t make sense rethink it!!!)

15021998-MSK (19 decks)

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