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Patho > Week 12: Skin, Muscle and Bone > Flashcards

Week 12: Skin, Muscle and Bone Flashcards

1
Q

Describe the following tests of damage: CK; myoglobin

A

Serum creatinine kinase: diseased or damaged muscle fibers leak CK into serum
Myoglobin: detectable in urine after crush/traumatic muscle injury, associated with ischemic disorders or extreme exertion

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2
Q

Describe the following tests of muscle function: EMG; strength/range of motion

A

EMG: records summation of APs of the muscle fibers in each motor unit, abnormalities help differentiate muscle, peripheral nerve disorders or neuromuscular junction disorders
strength/range of motion: done manually or with myometers

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3
Q

Describe the following tests of muscle metabolism: forearm ischemic test

A

forearm ischemic test: helps determine integrity of glycolytic pathways and enzyme systems that function during intense exercise

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4
Q

Describe the following tests of muscle structure: biopsy, genetics

A

Biopsy: histological exam that helps define myopathic and neuropathic disorders
Genetics: discovers genetic changes associated with a variety of muscle disorders

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5
Q

How does muscle hypertrophy vs. atrophy occur?

A

Hypertrophy: caused by excessive stress to muscle

Atrophy: caused by insufficient stimulation to muscle

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6
Q

How does endurance vs. strength training change muscle fibers?

A

Endurance: low intensity, long duration - increased mitochondria and capillaries, decreased fiber diameter

Strength: high intensity, short duration - increased glycolytic activity, fiber diameter, muscle strength

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7
Q

Define sarcopenia

How much of skeletal muscle mass and strength is lost and when?

A

Sarcopenia = age-related loss of skeletal muscle, causes decrease in strength

30-40% of skeletal muscle mass and strength lost in third to ninth decade

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8
Q

What are the major ways skeletal muscle disorders can occur (6)?

A 
Alteration of nerve supply or conduction: 
Trauma
Defect in muscle structure
Energy utilization
Psychogenic
Unrelated to the muscle
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9
Q 
Give an example(s) of:
Alteration of nerve supply/conduction (3)
Trauma (1)
Defect in muscle structure (1)
Energy Utilization (1)
A

Alteration of nerve supply or conduction: denervation atrophy, myasthenia gravis, periodic paralysis
Trauma: myoglobinuria
Defect in muscle structure: muscular dystrophy
Energy utilization: McArdle’s disease

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10
Q

Define weakness vs. fatigue

A

Weakness: failure to generate force
Fatigue: failure to sustain force

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11
Q

Primary hyperkalemic periodic paralysis: etiology, what does the affected gene normally do?

A

Etiology: autosomal dominant genetic disorder affecting sodium channels in muscle cells, typically SCN4A gene

SCN4AA gene: encodes voltage-gated sodium channel in the NMJ

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12
Q

Primary hyperkalemic periodic paralysis. What is the major s/s? What are some triggers (5)?

A

S/S: periodic paralysis

Triggers: Rest after exercise, potassium-rich foods, stress, fatigue, fasting

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13
Q

Patho of primary hyperkalemic periodic paralysis

A
  • Sodium normally enters voltage-gated channels in NMJ and depolarizes muscle fiber
  • Mutations result in failure to inactivate channels, which prevents potassium efflux and depolarization
  • Muscle fiber cannot relax, new signals have no effects, resulting in paralysis
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14
Q

Treatment of primary hyperkalemic periodic paralysis

A

Glucose or other carbs

Avoid unknown triggers

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15
Q

Define muscular dystrophy, etiology

A

genetically caused myopathies with progressive degeneration of skeletal muscle fibers
Etiology: Gene for dystrophin absent or nonfunctional

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16
Q

What is the most common and severe type of muscular dystrophy? What is the inheritance pattern?

A

Duchenne muscular dystrophy

X-Linked trait

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17
Q

Patho and s/s (3) of muscular dystrophy

A

Patho: dystrophin protein absence or decreased levels leads to issues with mechanical stabilization and calcium regulation within the muscle fibers

S/S: calf muscles enlarged due to fat cell infiltration, cardiac failure, pulmonary infection

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18
Q

Define rhabdomyolysis, patho

A

acute muscle destruction associated with myoglobinuria

Patho: excessive myoglobin excretion damages renal tubule, leading to ATN which can lead to renal failure

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19
Q

Traumatic vs. nontraumatic causes (5) of rhabdomyolysis

A

Traumatic: extensive trauma with crush injuries
Non-traumatic: increased muscle O2 consumption, decreased muscle energy production, muscle ischemia, infection, direct toxins

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20
Q 
What are some causes of:
Increased muscle O2 consumption (3)
Decreased muscle energy production (3)
Muscle ischemia (3)
Infection (2)
A

increased muscle O2 consumption: heat stroke, severe exercise, seizures

Decreased muscle energy production: hypokalemia, hypophosphatemia, genetic enzymatic deficiencies

Muscle ischemia: arterial insufficiency, drug overdose with coma and muscle compression

Infection: influenza, Legionnaires’ disease

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21
Q

What is the hallmark sign of rhabdomyolysis?

A

Elevated creatinine kinase levels

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22
Q

Define fibromyalgia

A

poorly characterized chronic disorder associated with general pain, stiffness, dysfunctional sleep, fatigability

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23
Q

What do we know about fibromyalgia? (5)

A
  1. Chronic pain in muscles and surrounding structures
  2. Does not appear to be inflammatory process
  3. Etiology unknown but believed to involve psychological, genetic, neurobiological and environmental factors
  4. Frequent comorbidity of depression, anxiety, stress-related disorders (PTSD)
  5. Treatment focuses on alleviating sx
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24
Q

Define glycogen storage disorders

A

group of defects in processing, synthesis or breakdown of glycogen

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25
Q

McArdle’s disease: definition and characteristics

A

McArdle’s: defect in muscle glycogen phosphorylase
Characteristics: Muscle energy disorder characterized by muscle pain, exercise intolerance, myoglobinuria, susceptibility to fatigue

26
Q

Cori disease: definition and characteristics

A

Cori disease: defect in glycogen debranching enzyme

Characteristics: progressive skeletal weakness and atrophy and/or cardiomyopathy

27
Q

Von Gierke’s disease: definition and characteristics

A

Von Gierke’s disease: defect in glucose-6-phosphatase

Characteristics: causes growth failure and lactic acidosis

28
Q

What is the difference in bone marrow between adults and infants

A

Adults: yellow marrow or medullary cavity
Infants: Red marrow or hematopoietic tissue

29
Q

What is the role of osteoclasts vs. osteoblasts?

A

Osteoblasts: bone-building cells
Osteoclasts: bone-chewing cells

30
Q

Define lacunae

A

arranged in concentric circles called lamellae around central Haversian canals

31
Q

Describe the feedback regulation loop for calcium

A
  1. Low calcium levels stimulates PTH which stimulates osteoclasts to break down bone to release calcium into plasma
  2. High calcium levels stimulates calcitonin which stimulates uptake of calcium by osteoblasts
32
Q

Which joint type is associated with most pathology? How can they be impacted by arthritis?

A

Synovial joints: between articulating bones, separated by a fluid-containing joint cavity
Arthritis: inflammation of the synovial sac between the joints

33
Q

Basic steps of bone repair (4)

A
  1. hematoma forms when blood vessels rupture
  2. fibrocartilage callus forms to splint break
  3. bony callus made of spongy bone forms, replacing fibrocartilage as more osteoclasts and osteoblasts move to area
  4. bone remodeling - occurs in response to mechanical stresses, forming a strong, permanent patch
34
Q

Define the 3 types of alterations in bone union

A

Delayed union: increased healing time, inadequate immobilization, breakdown in hematoma formation, infection
Nonunion: failure to unite, infection, mobility
Malunion: union in abnormal position, compromise in function, deformity at fracture site

35
Q

What is a fat embolism; how do they form; what are the risks?

A

Fat embolism: microemboli that lodge in small vessels

Formation: fat globules released into circulation from stores in fractured bone, globules attract platelets and create microemboli that lodge in small vessels

Risks: Injury to vasculature, ARDS, DIC, cerebral edema

36
Q

How can nerve damage result from bone fracture?

What is compartment syndrome and how can this lead to amputation of a limb?

A

Nerve damage: bone fragments can rupture and compress nerves

Compartment syndrome: fascia and skin internally encapsulate compartments of leg and forearm, compressing the blood supply resulting in nerve damage and functional loss

37
Q

How can pyogenic infection occur and result in bone damage?

A

caused by microorganisms introduced during trauma, surgery or bloodstream from other sources
Growth of microorganism causes cell death, inflammation and bone destruction

38
Q

Define osteomyelitis. causes, common pathogen

A

acute or chronic pyogenic infection of bone and marrow
Causes: direction extension or contamination of open fracture or wound, seeding from blood or skin
Common pathogen: Staph aureus

39
Q

Define osteomalacia

A

softening of bone due to inadequate mineralization of bone matrix, caused by deficiency of calcium or phosphate

40
Q

Define rickets, what is the common sign?

A

inadequate calcium absorption and impaired mineralization of bone
Bowing legs in children - due to growth at the epiphyseal plate

41
Q

Define Rheumatoid arthritis

A

systemic inflammatory disease, immune complexes deposit in synovium, immune cells attack and destroy cartilage and subchondral bone

42
Q

What is rheumatoid factor

A

reacts with a fragment of IgG to produce immune complexes

43
Q

Define osteoarthritis

A

Imbalance between mechanical stress and joint’s ability to resist stress causes articular cartilage to deteriorate

44
Q

Causes of osteoarthritis

A 
Post inflammatory disorders
Posttraumatic disorders (fracture)
45
Q

Prevention of osteoarthritis (4)

A

weight loss, injury prevention, muscle strengthening, task modifications

46
Q

What are the basic considerations of skin lesions? (6)

A
  1. Characteristics
  2. Distribution/configuration
  3. Length of time present and recurrence
  4. Medications
  5. Family hx
  6. Environmental exposures
47
Q

Define impetigo, what is the typically infectious organism

A

superficial skin infection with vesicles/pustules that rupture and leave golden brown crust, may result in ecthyma
Staph aureus

48
Q

Define folliculitis, what is the typically infectious organism (2)

A

infection of hair follicles with erythematous papules and pustules

Staph aureus, P.aeruginosa

49
Q

Define furunculosis

A

deeper infections of hair follicle, inflammatory nodules with pustule drainage can coalesce to form carbuncles

50
Q

Define cellulitis, what is the typically infectious organism

A

cutaneous skin infection that is warm, tender, erythematous, rapidly spreading; can become necrotic if untreated
Staph aureus

51
Q

Define necrotizing fasciitis, what is the typically infectious organism

A

rare infection of subcutaneous tissue and fascia that causes necrosis
S. pyogenes

52
Q

What are common fungal infections (6)

A
  1. tinea pedis (athlete’s foot)
  2. tinea cruris (jock itch)
  3. tinea capitis (scalp)
  4. tinea corporis (body)
  5. c. albicans - causes skin infection, vaginal yeast infection, thrush
  6. tinea versicolor - skin infection occurring in hot, humid climates
53
Q

What are common viral infections (3)

A

Herpes simplex
Herpes zoster
HPV

54
Q

What are the different kinds of dermatitis? (5)

A 
contact dermatitis
drug-related eczematous dermatitis
photoeczematous dermatitis
primary irritant dermatitis
atopic dermatitis
55
Q

What is atopic dermatitis?

A

heritable condition, erythematous plaques, associated with family hx of asthma/hay fever

56
Q

What is psoriasis?

A

chronic, genetic disease of epidermal proliferation

57
Q

Define seborrheic keratosis, risk factors

A

keratinocytes become raised and light brown with sharp border demarcation
Risk factors = age, sun exposure

58
Q

Define hemangioma, when do these usually resolve by?

A

idiopathic tumor of newly formed blood vessels

Often resolves by age 10

59
Q

Define keratoacanthoma, what are risk factors, what percentage becomes malignant?

A

originates from neck of hair follicle, firm, raised nodule with central keratin plug

Risk factors = sun exposure, age
6% become squamous cell carcinoma if untreated so usually removed

60
Q

Define Actinic keratosis, characteristics, risk factors.

A

most common premalignant tumor
characteristics: sharp border demarcation, rough, red, yellow, brown or gray
Risk factors = sun exposure, age

61
Q

What are the major types of skin cancer and what skin layer to they affect (3)?

  1. Which one is most invasive and metastatic?
  2. Which is more common?
A

Basal cell carcinoma - stratum basale
Squamous cell carcinoma - stratum spinosum
Malignant melanoma - melanocytes

  1. Malignant melanoma
  2. basal cell carcinoma
62
Q

What does ABCDE stand for when evaluating skin tumors?

A 
Asymmetry
Border irregularity
Color
Diameter
Evolving over time

Patho (14 decks)

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