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311 Cards in this Set
- Front
- Back
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name fibers involved in stretch reflex (afferent, efferent)
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Ia= afferent, II = efferent
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name fibers involved in golgi tendon contraction reflex (Afferent, efferent)
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Ib = afferent, II= efferent
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describe flexor-withdrawal reflex
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ipsilateral flexion (flex away from stimulus), contralateral extension (for balance)
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spontaneous bone formation without preexisting cartilage
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intramembranous formation
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name some examples of bones in intramembranous formation
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clavicle, face, skull
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ossification of cartilaginous molds
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endochondral bone formation
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name some bones formed with cartilaginous formation
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tibia, femur, fingers
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where would clipping occur in unhappy triad injury?
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from lateral side
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name 3 ligaments torn in unhappy triad
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mcl, medla meniscus, acl
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where is attachment that anterior and posterior in aCL and PCL refer to
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tibial attttachment
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how to test ACL tearing
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positive anterior drawer sign
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how do you know you have torn MCL
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abnormal passive abduction
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name 4 rotator cuff muscles
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supraspinatous, infraspinatous, teres minoir, subscapularis
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function of supraspinatous
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helps deltoid abduct arm
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function of infraspinatous
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laterally rotate arm
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function of teres minor
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aduct and laterally rotates arm
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functoin of subscapularis
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medially rotate and adduct arm
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where is the weakest part of rotator cuff and why?
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inferior part (no rotator cuff muscles)
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most common rotator cuff injury
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anterior (tear supraspinatous)
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what will get damaged in anterior dislocation of humerus
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axillary nerve, artery
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what are the complications of breaking the scaphoid bone and why?
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blood supply from distal end, could necrose
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what is complication of breaking luntae bone?
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compress median nerve
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what is complication of breaking hamate bone?
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can't flex pinky
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describe dupuytren contracture
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think palmar skin - progressive finger flexion (first ring and little fingers go)
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how is psoas major related to appendicitis
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if have appendicits and extend psoas major, will hurt
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function of psoas major
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flex hip and thigh
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function of piriformis muscle
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lateral rotator of hip
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between what muscles does the dorsalis pedis run
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extensor hallicus longus and extensor digitorum longus
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what nerve runs with anterior tibial artery?
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deep peroneal nerve
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what nerve runs with posterior tibial artery?
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tibial nerve
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what nerve and artery are often injured in a car acident
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femoral artery and nerve
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what muscle is innervated by the inferior gluteal nerve
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gluteus maximus
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how do you tell you have a inferior gluteal nerve injury?
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lean backwrad when walk, can't rise from seat
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what muscles are innervated by superior gluteal nerve
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gluteus minimus and medius
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what happens when lesion in superior gluteal nerve?
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trendelenburg gait (drop on side opposite lesion, flex spine towards lesion)
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what is in femoral triangle from medial to lateral
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femoral canal (lymph nodes), femoral vein, femoray artery, femoral nerve
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what is the most common ankle injury
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inversion
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what commonly happens in eversion injury and why?
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fracture fibula because medial ankle ligaments are so strong
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name the steps in skeletal muscle contraction
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first calcium binds to troponin C and atp hydrolyzed, now myosin can bind actin, release P and power stroke, rebind ATP and then detach from actin
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5 characteristics of type I red fiber
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slow twitch, high myoglobin, high mitochondria, low glycgen, aerobic oxiddation
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5 characteristics of type II white fiber
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fast twitch, less myoglobin, less mitochondria, increased glyocgen, anerobic oxidation
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define A band
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where myosin and actin overlap. does not change size
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define I band
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actin only (shortens)
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define myofibers
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large multinucleated skeletal muscle fibers
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define myofibrils
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tandem array sarcomeres
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define Z line
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where actin attaches
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what do the dihydropyridine receptors and ryanodine receptors do
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depolarization gets to dihydropyridine receptor and signals ryanodine to release calcium from sarcoplasmic reticulum
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where does depolariztaion travel down in skeletal muscle?
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t-tubule
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what are steps in smooth muscle contraction?
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smooth muscle depolarization, calcium opens, calcium binds to calmodulin, activate MLCK, cross bridge formation
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how to relax smooth muscle?
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myosin light chain phosphatase to dephosphorylate myosin and relax
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birbeck granules in cytoplasm (tennis racket)
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histiocytosis X
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skull lesion, diabetes insipidus, exophthalamus
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chronic histiocytsis X
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infants: hepatosplenomegaly, pancytopenia, recurrent infection, lymphadenopathy
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acute histiocytosis X
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solitary bone lesion, extraskeletal involvement only to lung
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eosinophilic granuloma
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type of atrophy with target fibers
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denervation atrophy
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what occurs after reinnervation of denervation atrophy?
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cluster of type I next to cluster of type II fibers (Discrete)
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what is normal type I and type II fiber arrangement in muscle
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all mixed together
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atrophy where here is prolonged immobilization and type II fibers lost
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disuse atrophy
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weakness of face, scapula, humerues
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facioscapulohumeral dystrophy
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weakness in shoulder and pelvic gridle
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limb-girdle dystrophy
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define myotonia
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can't relax muscles once contract
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myotonia, testicular atrophy, cataracts
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myotonic dystrophy
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what genetic inheritance is myotonic dystrophy?
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autosomal dominant
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muscle weakness, hypotonia in child
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central core disease
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what is path of central core disease
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loss of mitochondria in type I fibers
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weakness in child with tangles of rod-shaped granules
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nemaline myopathy
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what genetic inheritance is achondroplasia?
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autosomal dominant
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disease: head and trunk normal size, limbs much shorter
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achondroplasia
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when is ALP elevated in bone lesion?
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only with fracture and release of material
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most common cause dwarfism
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achondroplasia
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what process is not affected in achondroplasia?
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membranous ossification
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older patient: no systemic symptoms, pain in weight bearing joints that improve with rest
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osteoarthritis
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is osteoarthritis assymetrical or syymetrical?
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assymetrical
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where are common areas of osteoarthritis?
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lower vertebrae, pelvis
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define osteophyte
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bone sput in perimeter of articulation
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arthritis: primary pathology is ulcerated, narrow cargilage
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osteoarthritis
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herbeden's nodes and bouchard's nodes
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osteoarthritis
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pannus formation in mcp and pip
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rheumatoid arthritis
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morning stiffness, symmetric joint involvement, fever, pleuritis, pericarditis, fatigue
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rheumatoid arthritis
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what type of HSE is rheumatoid arthritis?
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type III
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define ulnar deviation
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fingers deviated toward pinky
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define boutonniere deformity
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hyperflexion PIP, hyperextension DIP
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define swan-neck deformity
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hyperextension PIP, hyperfelxion DIP
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disease: bone and cartilage erosion, increased synovial fluid
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rheumatoid arthritis
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define osteoid
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protein mixture secreted by osteoblast that needs to be calcified
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what are the bone enzymes like in osteoporosis?
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all normal
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diffuse radiolucency of bone
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osteoporosis
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3 causes of osteoporosis
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hypercortisol, hyperthyrodsim, calcium deficiency
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mechanism of Type I osteoporosis
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increased bone resporption due to decrease in estrogen
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mechanism of type II osteoporosis
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physical inactivity in old people
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define osteoporosis
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reduction of bone mass despite normal bone mineralizatoin
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treatment for severe osteoporosis
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bisphosphonates or pulsatile PTH
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acute back pain, loss of height, kyphosis, colle's fractures, vertebral wedge fractures
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osteoporosis (weight bearing joint problems)
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disease with mixed osteomalacia and osteitis fibrosa cystica
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renal osteodystrophy
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thickened, dense bones with failure of normal bone resorption
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osteopetrosis
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mechanism of osteopetrosis
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abnormal osteoclast function
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enzymes in osteopetrosis
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all normal
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3 complications of osteopetrosis
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increased fractures, anemia, cranial nerve involvement (blindness, deafness)
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general thinning of spicules in adults
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osteomalacia
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mechanism of osteomalacia
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defective osteoid mineralization due to vitamin D deficiency
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child: thick epiphyseal plate, thin occipital/paritel bone (craniotabes), protrusion sternum, decrased height
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rickets
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enzyme/mineral problems in osteomalcia/rickets
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decrease vitamin D, decrease calcium, increased PTH, incrase serum phosphate
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what can osteomalaica be secondary to
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renal osteodystrophy
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cystic spaces lined by osteoclasts and filled with fibrous stroma
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osteitis fibrosa cystica
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mechanism of osteitis fibrosa cystica
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hyperparathyroidism
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enzyme, mineral problems in osteitis fibrosa cystica
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high calcium, low phosphporus, high ALP
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mosaic pattern of bone (abnormal bone architecture)
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paget's disease
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increased skull size, hearing loss, and bone pain
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paget's disease
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bone problem in elderly with hihg output cardiac failure due to AV Shunts in lesions
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paget's disease
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mechanism of paget's disease
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increase in osteoblastic and osteoclastic activity)
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enzyme defects in paget's disease
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all normal except elevated ALP
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cancer with lytic and blastic lesions of bone
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breast cancer
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multiple localized whorls of collagen within bone
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polyostotic fibrous dysplasia
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girls with short stature, unilateral pigmented skin lesions, precocious puberty
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albright's syndrome
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mechanism of albright's syndrome
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bone replaced by fibroblasts, collagen, irregulat bony trabeculae
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pain and stiffness in shoulders and hips with fever, weight loss, malaise
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polymyalgia rheumatica
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is there muscule weakness in polymyalgia rheumatica?
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no
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what is associated with polymyalgia rheumatica?
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temporal arteritis
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progressive proximal muscle weakness with muscle biopsy showing inflammation
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polymyositis
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mechanism of polymyositis
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CD8 attack muscle
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progress proximal muscle weakness + skin rash
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dermatomyositis
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mechanism of dermatomyositis
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type III HSE
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increased serum CK, increase aldolase, anti-JO1 antibody
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polymyositis/dermatomyositis
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raynaud's, arthralgias, myalgias, fatigue, esophageal hypomotility
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mixed connective tissue disorde
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what is a disorder which is never found in mixed connetive tissue disorder?
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renal problems
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antibodies to U1-RNP
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mixed connective tissue disorder
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sand in eyes, parotid enlargmenet, dental carries
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sjogren's syndrome
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dysphagia, conjunctivitis, dry mougth
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sjogren's syndrome
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mechanism of sjogren's
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progressive lymphocytic destruction of exocrine glands
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what 2 complications is sjogren's strongly associated with
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rheumatoid arthritis and B cell lymphoma
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ani-SSA, anti-SSB
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sjogren's syndrome
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nasal and vaginal dryness, chronic bronchitis, reflux esophagitis
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sicca snydrome (subset of sjogrens)
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what population do you normally see lupus in?
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black females
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fever, fatigue, weight loss, vegetations on both sides of mitral valve, renal failure
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lupus
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what caues wire loop lesions and nephrotic syndorme in lupus?
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immune complex deposition
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why do you have false positives in syphilis tests with lupus?
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presence of antiphopholipid antibodies
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what HLA association is lupus
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HLA-DR2
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what type of hypersensitiviy is lupus
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type III HSE
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what difference does drug-induced lupus have from regular lupus?
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uncommon renal problems
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where are the renal deposits in lupus?
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subendothelial (huge so can't cross basement membrane)
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anti-histone antibodies
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drug-induced antibodies
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anti-smith antibodies
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specific lupus but not diagnostic
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anti-dsDNA antibodies
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specific, poor prognosis lupus
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ANA
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sensitive but not specific SLE
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arthritis, 100% anemia, mucositis, pericarditis
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lupus
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HLA-B8 association
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celiac sprue
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steatorrhea, blunted villi, abnormal D-xylose test, lymphocytes in laminia propria
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celiac sprue
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what population is celiac sprue most common
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northern european
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what part of intesting most affected by celiac sprue
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jejunum
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what skin disorder is associated with celiac sprue
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dermatitis herpatiformis
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what type of maliganncy is associated with celiac sprue?
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t-cell lymphoma
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assymetric joint distriution, acute, super-painful after meal, MTP joint in big toe
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gout
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tophus formation in external ear and achilles tendon
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gout
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mechanism of gout
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precipitation of monosodium urate due to hyperuricemia
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define tophus
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mass of urate surroudned by inflammatory reaction
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negatiely birefringent,needle shaped crystals
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gout
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4 treatments for gout
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allopurino, probenecid, colchicine, NSAIDS
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weakly positively birefringent crystals
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pseuogout
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basophilic, rhoomboid crystals
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pseudogout
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what type of crystals in pseudgout?
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calcium pyrophosphate
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what joints affected in pseudogout?
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large joints (knee)
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HLA in goodpastures's
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HLA-DR2
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hemoptysis, hematuria, anemia, crescentic lesions
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goodpasture's
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mechanism of goodpasture's
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type II HSE with anti-collagen IV antibodies
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what type of staining will you see in goodpasture's
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linear staining
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noncaseating granuloma
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sarcoidosis
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two elevated enzymes in sarcoidosis?
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ACE elevation, increased vitamin D activation
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what population is associated with sarcoidosis
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black females
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restrictive lung disease, bilateral hilar lymphadenopathy, bell's palsy, erythema nodosum
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sarcoidosis
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shortness of breath, cough, hemoptysis, fever, weight loss, night sweat
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sarcoidosis
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laminated concretions of calcium/protein and stellate inclusions in giant cells
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sarcoidosis
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interstial fibrosis and gammaglobulinemia
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sarcoidosis
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HLA association of seronegative spondyloarthropathies
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HLA-B27
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stiff spine, uveitis, aortic regurgitation
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ankylosing spondylitis
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urethritis, conjunctivitis, arhtirtis
|
reiter's syndrome
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x-ray: fusion of discs
|
ankylosing sponydylitis
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acute onset arthritis, lower extremity joints, diffuse swelling of solitary finger and toe, after GI or chlamydial infection
|
reiter's syndrome
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5 complications of ankylosing spondylitis
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AV block, bladder+bowel dysfunction, pulmonary fibrosis, IBD, psioriasis
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skin sclerosis, cardiovascular sclerosis, GI sclerosis
|
diffuse scleroderma
|
|
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anti-SCL70 antibody
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diffuse scleroderma
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what is the speed of progression of diffuse scleroderma?
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very fast
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fixed facial expression is first sign
|
diffuse scleroderma
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localized thickening of fingers and toes, telangiectasias, esophageal dysmotility, raynaud's phenomenon, calinosis
|
CREST syndrome
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what is skin involvement in CREST syndrome
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limited skin, confined to fingers and face
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anticentromere antibody
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CREST snydrome
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what is systemic sclerosis strongly associated with?
|
primary biliary sclerosis
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clubbing, associated with lung cance, mesothelioma, hepatic cirrhosis
|
hypertrophic osteoarthropathy
|
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athlete after trauma, no bone damage, radiolucent center, painless hard mass
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myositis ossificans
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intermittend calduication, raynaud's, severe pain, heavy smokres
|
buerger's disease
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treatment for buerger's
|
stop smoking
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asian female <40, fever, arthritis, night sweat, skin nodules, ocular disturbances
|
takayasu's arteritis
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weak pulses in upper extremities
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takayasu's arteritis
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mechanism of takayasu's arteritis
|
thickening of aortic arch and/or proximal great vessels
|
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what is ESR best for
|
vasculitis
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most common vasculitis
|
temporal arteritis
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unilateral headache, jaw claudication, impaired vision
|
temporal arteritis
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vasculitis of elderly females
|
temporal arteritis
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abdominal pain, melena, cutaneous eruptions, neurologic dysfunction
|
polyarteritis nodosa
|
|
|
p-ANCA
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polyarteritis nodosa
|
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what association is seen w/ polyarteritis nodosa
|
hepatitis B
|
|
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what is the mechanism of polyarteritis nodosa
|
ischemia/infarct of vessels
|
|
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what will you see on ateriogram in polyarteritis nodsosa
|
multiple aneurysms and constrictions
|
|
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what type of necrosis in vasculitis
|
fibrinoid necrosis
|
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perofratoin of nasal septum, otitis mdia, chronic sinusitis, cough, dyspnea, hemoptysis with granulomas
|
wegenere's granulomatosis
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|
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what is prognosis for wegener's
|
80% die in 1 year
|
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C-ANCA
|
wegeners's
|
|
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red cell casts, hematuria, large pulmonary nodules on CXR
|
wegener's granulomatosis
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perofratoin of nasal septum, otitis mdia, chronic sinusitis, cough, dyspnea, hemoptysis without granulomas. p-ANCA/C-ANCA negative
|
miscroscopic polyangiitis
|
|
|
vasculitis affecting only kidneys
|
primary pauci-immune crescentic glomerulonephritis
|
|
|
granulomatous vasculitis with eosinophilia in lung and heart in patient with eczema and allergies
|
churg-strauss syndrome
|
|
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most common form of childhood vasculitis
|
henoch-schonlein
|
|
|
non-blanching purpura on legs and arms progressing to trunk in child
|
henoch-schonlein purpura
|
|
|
arthralgia, abdominal pain, melena in kids
|
henoch-schonlein purpura
|
|
|
#1 cause acquired heart idsease in kids
|
kawaski's disease
|
|
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kid with fever, erythema, congested conjunctiva, coronary aneurysm
|
kawasaki's disease
|
|
|
name parts of brachial plexus
|
roots, trunks, divisions, cords, branches
|
|
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where are roots of brachial plexus?
|
anterior triangle neck
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where are trunks of brachial plexus
|
posterior triangle neck
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where are divisions of brachial plexus
|
behind clavicle
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where are cords of brachial plexus
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axilla
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where are branches of brachial plexus
|
arm
|
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how are parts of brachial plexus named
|
in relation to axillary artery
|
|
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what muscle is just medial to brachial artery?
|
biceps brachii
|
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vein between deltoid and pec major in anterior/lateral arm
|
cephalic vein
|
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part of brachial plexus runs with axillary artery that can be compressed with aneurysm
|
medial cord
|
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what protects brachial plexus from clavicle fracure
|
subclavius muscle
|
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4 muscles innervated by radial nerve
|
brachioradialis, extensors of wrists/fingers, supinator,triceps
|
|
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where and what with artery does radial nerve run?
|
with deep brachial artery behind humerus
|
|
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3 thenar muscles
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flexor pollicus brevis, abductor pollicus brevis, opponens pollicus
|
|
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3 hypothenar mucles
|
flexor digit minimi, abductor digiti minimi, opponens digiti minimi
|
|
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where to do pudendal nerve block?
|
ischial spine
|
|
|
mcburney's point is for what?
|
appendix
|
|
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what is 2/3 from umbilicius to anterior superior iliac spine
|
appendix
|
|
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landmark where do lumbar puncture
|
iliac crest
|
|
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what will you see with radial nerve palsy
|
wrist drop
|
|
|
long thoracic nerve injury
|
winged scapula
|
|
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where is long thoracic nerve
|
roots of C5, C6, C7
|
|
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dermatome C2
|
posterior half of skull cap
|
|
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dermatom C3
|
high turleneck
|
|
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dermatome C4
|
low collar shirt
|
|
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dermatome T4
|
nipple
|
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dermatome T7
|
xiphoid proces
|
|
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dermatoid T10
|
umbilicus
|
|
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deramtome L1
|
inguinal ligament
|
|
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dermatome L4
|
kneecaps
|
|
|
dermatome S2, S3, and S4 function
|
erection and sensation of penis and anus
|
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pain in right shoulder via phrenic nerve is due to what?
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gallbladder pain
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nerve root for biceps reflex
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C5
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nerve root for triceps reflex
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C7
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nerve root for patella reflex?
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L4
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nerve root for achilles reflex
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S1
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what happens in babinski?
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dorsiflexion big toe, fan other toes, sign UMN lesion
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muscle innervated by long thoracic nerve
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serratous anterior
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clinical disablity of paralyzing long thoracic nerve
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can't abduct past horizontal position
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what is purpose of golgi tendon organ
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senses tension and provides inhibitory feedback to alpha motor neurons
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describe gamma loop
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CNS stimulates gamma motor neuron, contract inftrafusal fibres, modulate sensitivity of reflex arc
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describe muscle spindle
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muscle stretch = intrafusal stretch = stimulate Ia afferent = stimulate alpha motor neuron - reflex contraction (Extrafusal)
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reflex: extension of limbs when startled
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moro reflex
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reflex: nipple seeking
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rooting reflex
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reflex: grasps objects in palm
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palmar reflex
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when can primitive reflexes appear again?
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frontal lobe lesion
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between what 2 muscles does ulnar nerve run at risk?
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flexor carpi ulnaris, flexor digitorum profundus
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between what 2 muscles does median nerve run at wrist
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palmaris longus, flexor carpi radialis
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nerve that abducts thumb
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median nerve
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nerve that adducts thumb
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ulnar nerve
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what innervates the lumbrical muscles
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ulnar nerve
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what is purpose of lumbrical muscles?
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flex MCPs
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break at shaft of humerus
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radial nerve injury
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what reflexes are lost in radial nerve palsy?
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brachioradialis reflex, triceps reflex
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where is the sensory loss in radial nerve problem
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posterior arm, posterior forearm, dorsal/lateral hand (up to fingertips)
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supracondyle fracture of humerus
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median nerve
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nerve that leads to thenar atrophy, sign of papal benidiction
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median nerve
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what muscles does the median neve pass through?
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pronator teres
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what muscles does the radial nerve pass through
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supinator
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what is loss of sensation with meidan nerve
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palm of index, middle, thumb, 1/2 ring, dorsal/lateral fingertips
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fracture of medial epicondyle
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ulnar nerve problem
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clawed hand and impaired adduction of thumb
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ulnar nerve
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paralysis of adduction and abduction of fingers
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ulnar nerve
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what difference between ulnar nerve palsy in arm and at wrist
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at wrist: severe claw hand because spare flexor digitorum profundus so can flex DIP
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difference between median nerve problem at arm and at wrist
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at wrist - spare flexor pollicus longus so can flex thumb
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fracture at surgical neck of humerus
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axillary nerve
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no abduction of arm possible
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axillary nerve
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loss of deltoid action
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axillary nerve
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where is loss of sensation in axillary nerve?
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lateral side of arm
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what muscle does the ulnar nerve pass through?
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flexor capri ulnaris
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what muscle does the musclocutaneous nerve pass through?
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coracobrachialis
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what 3 mucsles are effected by musculocutaneous dysfunction
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coracobrachilais, biceps, brachilias
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what reflex is loss in musculocutaneous dysfunction
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biceps reflex
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paralysis of abductors, medial rotation of arm, forearm is pronated
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C5 and C6 roots torn
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no eversion and dorsflexion, foot drop
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common peroneal nerve
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where are nerve roots for common peroneal nerve
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L4-S2
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where is loss of sensation for common peroneal nerve
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anterolateral leg, dorsum of foot
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what innevates anterior leg?
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deep peroneal nerve
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what innervates lateral leg?
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superficial peroneal nerve
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fracture neck of fibula
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loss of common peroneal nerv
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function of tibial nerve
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invert and plantar flex
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lesoin here loses plantar flexion, no inversion
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tibial nerve
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where is loss of sensation of tibial nerve
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soles of foot
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lose knee extension, knee jerk
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femoral nerve
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nerve roots for tibial nerve
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L4-S3
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lose hip adduction
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obdurator nerve
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nerve roots femoral nerve
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L2-L4
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nerve roots obturator nerve
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L2-L4
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where is loss of sensation of femoral nerve?
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anterior thigh, medial leg
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what muscles does obdurator nerve innervate?
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adductor magnus, adductor longus, adductor brevis
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where is loss of sensation of obdurator nerve
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medial thigh
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what nerve is responsbile for thigh abduction
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superior gluteal nerve
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posterior femur displacement in car accident
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injur sciatic nerve
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poor gluteal injection leads to fotdrop, lose all sensation below leg except small medial strip, paralyze hamstrings, all muscles below knee
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sciatic nerve injury
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embryologic defect that compresses subclavian and C8, T1 of brachial plexus
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thoracic outlet syndrome (klumpke's palsy)
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atrophy of interosseous muscles, sensory problems medial side of forearm and hand, atrophy of thenar and hypothenar muscles, disappear radial pulse when move head to opposite side, claw hand
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C8-T1 root problem
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