Week 3 Flashcards

1
Q

Groups of anteiror arm muscle

A

Thenar

Hypothenar

Lumbricals

Interossei

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2
Q

List thenar muscle

List hypothenar muscle

Innervation?

A

Thenar muscles - median

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

Hypothenar muscles - ulnar

Opponens digiti minimi

Abductor digiti minimi

Flexor digiti minimi (brevis)

Ulnar nerve

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3
Q

What passes through the carpal tunnel

A

Medial nerve

Flexor pollicus longus

Flexor digitorum superficialis

Flexor digitorum profundus

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4
Q

Name the compartments

A
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5
Q

Dupuytren’s Contracture

A

A disease of the palmar fascia resulting in thickening and shortening of fibrous bands on the palmar surface of the hand and fingers.

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6
Q

Arrangement of tendon sheats in palm

A

thenar (2)

midpalmar (3+4)

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7
Q

Fibrous Digital Sheaths

Attachement and their location?

Importance?

A

Bands A2 and A4 are on the proximal and middle phalanx respectively

A1,A3, and A5 are near the MP, PIP and DIP respectively

A2 and A4 Bands are most important to prevent bowstringing. A1 band is involved in trigger finger.

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8
Q

Lumbirical muscles

Origin?

Insertion?

Innervation?

Function

A

Originate from the flexor digitorum profundus tendons

Insert in the extensor hoods

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9
Q

Interosseus Muscle

2 types?

Function

Origin?

Insertion?

Innervation

A

Dorsal and palmar

Originate from metacarpals

Insert on the extensor hoods

PaD / DaB

Ulnar

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10
Q

Fracture of Scapoid

Complications?

A

Most common wrist fracture

Non-union

Avascular necrosis

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11
Q

Dermatomes in the upper limb

A
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12
Q

Cutaneous Innervation of the Upper Limb

A
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13
Q

Segmental Innervation of the Upper Limb

A
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14
Q

Innervation to

Anterior arm?

Anterior forearm?

Shoulder?

Posterior arm?

Posterior forearm?

A

Anterior compartment
anterior arm-musculocutaneous
anterior forearm-all median except FCU+2 heads of FDP (ulnar)
anterior hand-all ulnar except thenar comp muscles + lumbricals to the functional midline on radial side (median)

Posterior compartment
Shoulder-axillary (deltoid and teres minor)
posterior arm & forearm-radial

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15
Q

Erb-Duchenne Paralysis

Cause?

Symptoms?

A

Damage to upper trunk of the brachial plexus

Shoulder movements are affected most dramatically

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16
Q

Klumpke’s Paralysis

Cause?

Symptoms?

A

Damage of lower trunk of the brachial plexus

Hand movements are affected most dramatically

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17
Q

Damage to

Axillary?

Musculocutaneous?

Radial?

A

Axillary nerve-severely weakened abduction, weakened lateral rotation

Musculocutaneous nerve- almost no forearm flexion, weakened arm flexion

Radial nerve-no forearm extension, arm may be slightly flexed

(note also has major effect on forearm and hand, see later)

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18
Q

Mid humeral shaft fracture damage to what?

A

Radial Nerve

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19
Q

Elbow fracture damage to what?

A

Median Nerve Damage

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20
Q

Ulnar Nerve Damage

Location?

Phenotype?

A

Fracture of the medial epicondyle can cause trauma to the ulnar nerve.

Hyperextension with flexion

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21
Q

Jersey finger

Tendon injury Flexor Profundus vs. Superficialis?

A

Tear of the FDP off the distal phalanx

Profundus-passively extend MP and PIP while trying to flex the DIP

Superficialis-passively extend unaffected fingers while trying to flex

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22
Q

Extensor Tendon Injuries

Mallet finger?

Boutonniére deformity?

A
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23
Q

Axis of Rotation for Upper Limb Joints

A
  • *Glenohumeral**-AP (ab and adduction), vertical (rotation), transverse (flex and extend)
  • *Humeroulnar**-transverse (flex and extend)
  • *Humeroradial**-transverse (flex and extend), vertical, rotation (pronate and supinate)
  • *Radioulnar**-vertical, rotation (pronate supinate)
  • *Radiocarpal**-transverse (flex and extend), AP (ab and adduct
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24
Q

Axis of rotation

Fingers?

Thumb?

Often arthiritis where?

A

Thumb

Carpometacarpal multiaxi

MP uniaxial

Finger

MP biaxial

1st CMC

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25
Q

Join definition

A

UNION BETWEEN TWO OR MORE RIGID ELEMENTS OF THE SKELETON – BONE OR CARTILAGE

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26
Q

Two types of joints

A

SYNOVIAL: the skeletal elements are separated by a joint cavity or space that contains synovial fluid.

        “freely movable”

NONSYNOVIAL: the skeletal elements are directly connected or continuous with each other.

           “non-movable”
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27
Q

Types of non-synovial joints: fibrous joints

Connection by?

Types/Examples?

Movemement?

A

Connective tissue

Suture, tooth, interosseous membrane

No movement (except interosseus membrane)

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28
Q

Nonsynovial: Cartilaginous Joints

Connection by?

Types/Examples?

Movemement?

A

Cartilage

Pubic symphisis, intervertebral disks

Slight movements

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29
Q

Joint ligaments types

A

Extracapsular

Capsular

Intracapsular

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30
Q

Name the structure

A
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31
Q

Name the sturcutre

A
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32
Q

Common of bursitis in glenohumeral cavity?

Name?

A

Bicipital tenosynovitis

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33
Q

Elbow joints parts

A

Humeroulnar

Humeroradial

Proximal radioulnar

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34
Q

Ligaments of Elbow

Name?

Function?

A

Radial collarteral - prevents adduction of forearm

Unlar collateral - prevents abduction

Annular ligaments - surrounds radius head

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35
Q
A
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36
Q

Disclocation of radius in elbow

A
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37
Q

Three joints between radius and ulna

A
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38
Q

Does ulna articulates with carpals

A

No it is separated by a disc

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39
Q

Where does transverse carpal ligament attaches to?

A

Scaphoid and trapezium laterrall

pisiform and hamate medially

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40
Q

Carpals

A

Proximal Row

S scaphoid (oid first in the 1st row)

L lunate

T triquetrum

P pisiform

Distal Row

T trapezium (by the thumb)

T trapezoid (oid second in the 2nd row)

C capitate

H hamate

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41
Q

Function of transverse metacarpal ligaments

A

Transverse metacarpal ligaments stabilize the hand in single metacarpal fractures

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42
Q

Mesoderm sublayers in embryo

A

paraxial - somites

intermediate - GU

lateral - splanchnic and sometic

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43
Q

Skeletal derivatives from:

Somites

Neural crest cells

Lateral plate mesoderm

A

Vertebra and ribs, skull behind prechordal plate (rostal end of notochord)

Skull in front of precordal plate

Long bones, pelvic and shoulder girdles

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44
Q

Which becomes bone sclerotome/dermotome?

What makes dermis?

What somtimes differentiate into?

A

Sclerotome

Dermatomyotome

Sclerotome/dermatomytome

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45
Q

Spina bifida

A
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46
Q

Genes that control limbs development?

The day of the formation of limb buds in lateral plate somatic mesorderm?

Direction of progression?

A

HOX genes

24 upper limb 28 lower limb

To caudal / distal

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47
Q

What is the type of bone formation of the gridles minus clavicle? From where?

Where does limb muscularture is derived from?

A

Endocondral ossification from lateral plate mesoderm

Somitic mesoderm

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48
Q

How is dermatomyotome divided?

Differentiations?

A

DML (drosomedial lip) => epimere => expasial musculature (back muscles)

Dermatome (intermediate)

VLL (ventrolateral lip) => hypomere => hypaxial muscules (limbs and anterior and lateral body wall)

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49
Q

How muscles become innervated? Why not simple?

A

Nerves follow the muscle

Signalling from adjacent connective tissue

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50
Q

AER (Apical Epidermal Ridge) gene function?

ZPA (only on caudal) gene function?

A

Regulates continued growth

Cephaic and caudal organization

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51
Q

Syndactyyl?

Meromelia?

Suspetible time to teratogens to limbs?

Associated symptoms?

Amniotic bands?

A

Fused fibers

Short limbs

4-5th week

Cardio, GI, cranio-facial

Can cause amputations

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52
Q

Limb abnormality

A
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53
Q

Prune-belly

A

Lateral and anterior muscle not migrating properly

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54
Q

Level of:

Femoral/Obturator

Sciatiatic

A

L2,3,4

L4,5+S1,2,3

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55
Q

Anteior (flexor) division nerves?

Posterior (extensor) division nerves?

A

tibial (thigh, leg, foot); obturator (thigh)

femoral (thigh); gluteals (hip); peroneal (fibular) (thigh, leg, foot)

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56
Q

Medial rotaiton of the limb

A
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57
Q

Nerves and compartments

Posterior vs. Anterior

Upper / Lower limb

A
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58
Q

Spinal cord segments estimates to upper and lower limb

A
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59
Q

Dermatome of the little toe

Dermatome of the big toe

A

S1

L4/5

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60
Q

Name the structures:

A
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61
Q

Naming fractures of femur

A
62
Q

Compartments of thigh

A
63
Q

Fascia lata

A
64
Q

What travels along great saphanous verin?

What travesl along small saphanous vein?

A

Saphanous nerve

Sural nerve

65
Q

What supplies posterior compartment of the thigh?

A

Profunda femoris

66
Q

Cruciate anastomosis members (collateral circulation arounbd the hip joint)

A

Inferior gluteal

Medial femoral circumflex

Lateral femoral circumflex

1st profunda femoris

67
Q

Origin / insertion of

Sartorius

Rectus femoris

Vastus

A

Iliac spine / Patella

Illium / Patella

Femur / Tibia

68
Q

Where do all posterior thigh muscle attach to?

What attaches to tibia?

What attaches to fibula?

A

Ischial tuberosity

T: ST, SM

F: BF

69
Q

Where do all medial muscles begin?

Conntect?

A

Pubis

Linea aspara: AL, AB, AM

Gracialist connects to Tibia

70
Q

Order of vessels in femoral sheath

Femoral nerve?

A

Artery, vein, lymphatics

Lateral to the sheath

71
Q

Femoral trianble

A

Ingual ligament

Sartorius

Adductor longus

72
Q
A
73
Q

How femoral artery gets access to posterior compartment?

A

Adductor foramen

74
Q

Where does the psoas and illiacus muscle attach to?

Functions of psoas and iliacus

A

Lesser trochanter

Flexion (flexion) and lateral rotation

75
Q

Sartorius function

A

Flexion of knee

Medial rotation of knee (only when it if flexed)

Flexion of hip joint

Lateral rotation of hip joint

76
Q

Tendon Fasia lata function

innervation

A

Flexes

Medial rotator

77
Q

Medial thigh muscles function

A

Adduction

Medial rotation

78
Q

Adductors vs. Hamstrings of adductor magnus

What is special about obturator externul?

Where is the insertion?

A

Obturator - adductors, hamstrings - sciatic

Medial muscle but lateral rotator

Interchochanter

79
Q

Innervations of the butt

A
80
Q

Gluteal muscles

A

Gluteus maximus

Guteus medius

Gluteus minimus

Tensor fasciae latae

81
Q

Where do gluteal muscle originate/insert?

A

Gluteal surface & lines of ala (wing) of ilium & Gluteal tuberositytuberosity - gluteal maximum

Ilium, sacrum, sacrotuberous ligament - Greater trochanter - gluteus medius and minimus

82
Q

Most power extensor

A
83
Q

Tensor fasciae latae

A

Medial rotation

Flexion

84
Q

Trandelenburg gait

A
85
Q

What is innervated by

superior gluteal nerve?

inferior gluteal nerve?

A

above piriformis: gluteaus medius, minimus and tensor fasciae latae

below the piriformis innervates gluteus maxium

86
Q

What are lateral rotators innervated by?

A

Lumbosacral plexus branches

87
Q

Innervation of hamstring muscle

A

biceps group peronial (common fibular)

semi group tibial

88
Q

Superior border of popliteal fossa

A

sup (L) Biceps femoris (M) Semi

inf (L) Gastrocnemius.lateral (M) medial

89
Q

Order of vessels in popliteal fossa

lat->med

A

nerve, vein, artery

90
Q

Mallet finger

Location of injury?

Result?

Treatment

A

DIP

Lack of flexion at DIP

Splint 8wks

91
Q

What felxes

MCP

PIP

DIP

A

Lumbrical

FDS

FDP

92
Q

Boutonniere Deformity

Result?

Treatment

A

Volar migration of lateral bands (Boutonniere Deformity)

Extension of PIP joint

93
Q

Swan neck deformity

Cause?

A

Autoimunne or injury (losing ligament collateral ligament between metacarap and proximal phalanx)

94
Q

Trigger figner

tenosynovitis?

pully?

cause?

Treatment?

Aggrevating factors?

Feeling?

A

Inflamation of a tendon (flexor tenosynovitis)

A1 @ MP

nodeule on flexor

rest, NSAIDs, corticosteroid, surgical release

am, activity, female, diabete, gout, RA, ring

@ PIP

95
Q

DeQuervain’s Tenosynovitis

Location?

What gets inflamed?

A

First dorsal compartment

EPB APB (same concept as tibialis interior extensor digitorum_

96
Q

Hand infections:

Paronychia

Felon

A

Skin infection involving fingernail folds

infection involving the digital pulp

—Septic tenosynovitis

97
Q

What are four Kanavel’s sign?

If not treated?

A
  1. Sausage digit
  2. Pain with passive extension
  3. Pain along tendon sheath
  4. Flexed resting posture

Scaring and LOF

98
Q

Septic Tenosynovitis

Cause?

Spread of infection?

Treatment?

A

Trauma or bite wound

Tendon sheath (osseofibrous tunnel)

Surgery

99
Q

Compartment Syndrome

Space?

A

Thenar, HypoThenar, Adductor,

100
Q

FOOSH

A

Fall on outstreched hand

101
Q

Describing the bone fracture

If aligned? If all displaced?

A

View, bone, displacement

Nondisplaced / 100% displaced

102
Q

Where is the radius head pointed at?

A

Capitilum

103
Q

Galeazzi Injury

A

Displaced radial shaft fracture with dislocated distal radioulnar joint

104
Q

Monteggia Injury

A

displaced ulnar shaft fracture with dislocated proximal radioulnar joint

105
Q

Elbow stability

Osseus part?

Soft tissue?

A

Coronoid (posterior/anterior medial displacement)

Radial (varus, PLRI)

Ulnar collateral (Varus, PLRI)

Medial collateral (Valgus) AB

106
Q

Terrible traid

A

elbow dislocation
radial head fracture
coronoid fracture

107
Q

—Clavicle fractures
—Acromioclavicular joint injuries
—Glenohumeral dislocations
—Rotator cuff injuries
—Proximal biceps tendon rupture
—Adhesive capsulitis

A
108
Q

AC joint importance?

Cause?

Symptoms?

Treatment?

A

Only one bony connection

direct blow, fall on shoulder or outstretched arm

Point tenderness, deformity

—Treatment- middle 1/3 immobilization, some ORIF, distal 1/3 with coracoclavicular ligament tear- surgical repair

109
Q

Acromioclavicular Joint Injuries

A

—Type I- sprain acromioclavicular ligaments, X-ray wnl

—Type II- tear ACL, sprain coracoclavicular ligaments, wide AC on X-ray

—Type III- tear ACL, tear CCL

110
Q

Rotator cuff disorders

Cause?

Treatment?

Most common site of injury?

A

—Very common, insidious (ganglion cyst - infraspinatus) or traumatic

rest, PT, NSAIDs, injection, surgical reapair

Superaspinatus

111
Q

Proximal Biceps Tendon Rupture

A

Tear in the long head

112
Q

Adhesive Capsulitis

What is it?

Cause?

Stages?

A

—Painful restricted shoulder ROM

—Idiopathic, diabetes mellitus, trauma, immobilization, thyroid disorder

Freezing, frozen, thawing

113
Q

Function of interossi

A

Palmer Adduct(PAD)
Dorsal Abduct(DAB)
MP flexion
PIP extension

114
Q

Guyon’s Canal

Zone of damage?

Effect?

A

Zone I:Proximal to bifurcation - Mixed motor and sensory

Zone II: distal to bifurcation deep motor - Motor only

Zone III:Distal to bifurcation superficial - Sensory only

115
Q

Carpal Tunnel Syndrome

Symptoms?

Treatment?

A

Thenar Wasting

Paresthesias and numbness aching pain in Median Nerve

Bracing, steroid, release

116
Q

Posterior Interosseous nerve palsy

A

—Radial head or elbow dislocation
—Traction injury
—Loss of thumb and finger extension
—Wrist extension intact as radial nerve branches proximal to PIN

117
Q

Creatine I

Location? Requirement? Function? Edurance? Cost?

Creatine II

Function?

A

95% in muscle. 2g, ATP regenration, no impact, 10-15/day

Enhances recovery and training intensity, variable response, side effects (GI/muscle cramping, water retention, weight gain)

118
Q

Caffeine

Effect?

Intake?

No effect in?

A

increased lipolysis, glycogen sparing, FFA mobilization

100-300mg (3-15mg/kg)

No benefit in untrained, recreational athlete

119
Q

Ergogenic Supplements

A

Anabolic steroids
HMB (beta-hydroxy-beta-methylbutyrate)
Human growth hormone
Erythropoietin
Stimulants (amphetamines)

120
Q

Anabolic steroids

Effectivenes?

Side effect?

A

Yes (strenght, power, recover)

Dangerous (acne, testicular atrophy, liver cancer, rage and depression)

121
Q

Dehydroepiandrosterone (DHEA)

Legality?

Function?

Effectivenss?

A

Banned as drug by FDA, sold as supplement

May be converted to testosterone/estrogen, increased IGF-1 nad GH secretion,

increased muscle mass, decreased fat (if exercise)

122
Q

Beta-Hydroxy-Beta-Methylbutyrate (HMB)

What is it?

Function?

Effect?

A

Metabolite of leucine

Decreased catabolism, regulates protein metabolism

Increased muscle mass but no evidence for perforamce or strength increase (bodybuilding)

123
Q

Human Growth Hormone

Effectiveness?

Is synthetic version availible?

Side effects?

A

Effective (increased muscle mass, stregnth, and decreased body fat)

Yes

Dangerous (acromegaly, cardiomyopathy, diabetes)

124
Q

Erythropoietin (EPO)

Effectiveness?

Side effects?

A

Stimulates red blood cell formation, increased oxygen carrying capacity

Dangerous (stroke, myocardial infarction)

125
Q

Amphetamines

Effective?

Side effects?

A

Effective (physical power, mental edge, loss of body fat)

Headaches, sleep loss, anxiety; Dangerous (myocardial infarction, hyperthermia

126
Q

Ergogenic supplements

Sodium citrate/bicarbonate?

Sodium phosphate?

Glutamine?

NO?

Dimethylamylamine (DMAA)

A

Buffers for acidosis

Shifts oxygen dissociation curve to right

Cellular repair, ehanced immunity

Arginine + alpha ketoglutarate, muscle pump

127
Q

Genes

GW1516

AICAR

A

peroxisome-proliferator-activated receptor agonist (Conversion of type II to type I myofibers)

AMP-activated protein kinase, increases adenosine availability (Increased levels of glycogen, GLUT4, mitochondrial enzymes)

128
Q

Supplement Use in Women

A

Anabolic-androgenic steroids (0.1 – 4.8%)

DHEA

Tamoxifen (53% of bodybuilders)

hGH (0.1 – 0.2%)

Ephedra (26%, higher than men, weight loss)

Creatine (0.4%)

129
Q

Inadvertent Doping

A

Ephedra, Ma Huang
Methylhexaneamine (same as DMAA)
Anabolic steroids (15%)
Clenbuterol
Selective androgen receptor modulators (SARMs)
NY attorney general data recent studies of amphetamine contamination

Hepatoxicity

130
Q

Pyknosis

Karorrhexis

Karyolysis

A

Shrunken and dark nucleus

Fragmentation of nucleus

Dissolution of nucleus

131
Q

Examples

Cagulative necrosis locations?

Liquifactive necrosis? Where tipical?

Fat necrosis?

Caseous necrosis?

Gangrenous

A

Heart, kidney

Lung (where lots of lipid e.g. Brain or abscess with lots of inflammatory cells)

Pancreas

Lung (tuberculosis) cavity formation

132
Q
A

Mallory’s bodies (hyaline)

Present in liver dur to alcoholism

Intermediate fillaments

133
Q
A

Neurofibrillary Tangles

Cytoskeletal filaments are grouped together in elongated pink tangles

134
Q
A

Fatty Change

Deranged lipoprotein transport from injury (most often alcoholism) leads to accumulation of lipid in the cytoplasm of hepatocytes

135
Q
A

Cirrhosis

136
Q
A

Amyloid

137
Q
A

Lipid ((Glycosylceremide))

Gaucher disease

Fat accumulation in spleen

no glucocerebrosidase enzyme

most common lysozomal storage disease

138
Q
A

Lipochrome (Lipofuscin)

Accumulation in heart liver / heart - wear and tear

Autophagocytosis - intracellular debris sequestered

139
Q
A

Hemosiderin

Material in macrophages here - clear up and recycle

breakdown of RBCs

140
Q
A

Hemosiderin

On iron stain, in hepatocytes and Kupffer cells - iron recycling

141
Q
A

Bilirubin Cholestasis

In small bile ductules – hepatic cholestasis

142
Q
A

Anthracotic Pigment

Accumulation in lungs (macrophages)

143
Q
A

Dystrophic Calcification

Calcium deposits in damaged tissues

144
Q
A

Fibrin Mesh

causes
“tumor”

145
Q

Types of effusions

A

•Serous: a transudate with mainly edema fluid and few cells.

•Serosanguinous: an effusion with red blood cells.

•Fibrinous (serofibrinous): fibrin strands are derived from a protein‐rich exudate.

•Purulent: numerous neutrophils are present. Also called “empyema” in the pleural space.

146
Q
A

Chylous peritoneal Effusion

Accumulation of lymph

147
Q
A
148
Q

Abscess

A

Localized collection of neutrophils

149
Q

Ulceration

A

Loss of epithelium

150
Q

Components of granulomatous inflammation

A

epithelioid macrophages, giant cells, lymphocytes, plasma cells, and fibroblasts

151
Q

Carpal Tunnel Syndrome

A

Increase in size of the nine (9) structures or their coverings [e.g., inflammation of synovial sheaths].