Pain that originates in the limb is called?

A. Referred

B. Intrinsic

C. Articular

D. Non-articular

Neurological

Vascular

Lymphatic

if doctor lifts up arm and it hurts the same as when patient lifts their own arm this would be?

A. Vascular

B. Referred

C. Articular

D. Non-Articular

C. Articular

Pain primarily originates in the joint.

If doctor lifts arm and it doesn’t hurt but it does hurt when patient lifts it, what type of pain is this?

A. Articular

B. Non-articular

C. Vascular

D. Lymphatic

B. Non-articular pain does not primarily originate in a joint.

pain associated with blocked arteries, occurs with exercise.  Can be neurological or vascular, differentiate by listening to vessels.

A. Claudication

B. Neurological

C. Articular

D. Non-articular

What type of muscle pushes fluids and solids along the digestive tract?

Excitation-contraction coupling:

The action potential flows down the T-tubules to reach the ____1_____ Receptor.  When the __1__ receptor is depolarized, the ___2___ receptor is activated and the Ca2+ flows out of the sarcoplasmic reticulum.

1. DHP (dihydropyridine)

2. Ryanodine

Ca²⁺ binds to troponin and causes a conformational change.

SERCA 

Sarcoplasmic and endoplasmic reticulum Ca²⁺ ATPase

_______ is the state where the muscle does not have a chance to relax.

What is a single contraction in a muscle called?

How do you increase the force a muscle can generate?

(2 ways)

Increase frequency of activation

Recruitment of other motor units

recruit weaker units first for more fine touch.

Explain the role Ca2+ plays in synaptic transmission. 

Ca2+ is involved in the mobilizing and docking of synaptic vesicles.

Mimick ACh

Block choline uptake

Stop ACh release

Inactivate ACh esterase

Block the ACh receptor

Myasthenia Gravis

Autoimmune disease in which antibodies are developed that destroy or block their own ACh receptors.

Treated with neostigmine

In an excitatory synapse you ______ the membrane potential at the synapse.

A. depolarize

B. hyperpolarize

In an inhibitory synapse you ______ the membrane potential at the synapse.

A. depolarize

B. hyperpolarize

1. la

2. alpha

1. lb

2. disynaptic

3. alpha

In a golgi tendon relex the ______ is activated and the _____ is inactivated.

Choices: antagonist or agonist

control muscle fibers attached to sensory organs.  Send information to muscle fibers to allow them to contract as needed to adjust the sensitivity.

_____  myosin head is the low energy conformation.

Options: bent, straight

_______ myosin heads are the high energy cocked position.

Options: bent straight.

1. 38

2. 30

Type I  muscle fiber relies mostly on ___1____ metabolism and are also called _____2______.

1. options: Aerobic or anaerobic

2. options: fast or slow

1. Aerobic

2. Slow twitch

Type II  muscle fiber relies mostly on ___1____ metabolism and are also called _____2______.

1. options: Aerobic or anaerobic

2. options: fast or slow

1. anaerobic

2. fast twitch

why does anaerobic metabolism requires the production of lactate?

Pyruvate + NADH <=>Lactate + NAD+

[image]

Cori Cycle

Muscles (glycolysis): Glucose>Pyruvate+ NADH> Lactate+NAD

Liver(Gluconeogenesis): Lactate +NAD (from the muscle) > Pyruvate> glucose

Then the glucose goes back to muscles and the cycle continues.

2 ADP <=> ATP+ AMP

Creating phostphate + ADP

<=(Creatine kinase)=>

Creatine + ATP

What enzyme regulates degradation of glycogen? 

Type I glycogen storage disease

Liver stores too much glycogen. fatty liver

1. originate from ischial tuberosity

2. Cross the hip and knee joints

3. innervated by the tibial division of the sciatic nerve

pectineus

gracilis

obturator externus

adductor ____

         Longus

        Brevis

          Magnus

Staphylococcus aureus and Streptococcus pyogenes 

Acute spreading infection of the deeper dermis and subcutaneous fat. causes pain, erthema, edema, warmth, indistinct border

streptococcus pyrogenes and staphylococcus aureus Other streptococci gram (-) bacteria.

What bacteria am I?

causes soft tissue infection

Catalase +           

catalase test is best way to ID. Grows on mannitol salt agar

Found on anterior nares, skin, mucous membranes; sometimes throat, perineum, vagina

Has a capsule

coagulase positive

Staphylococcus aureus

________ has protein A on surface, binds to the Fc region on IgG

Staph aureus

Who am I?

Loves water, soil, and plants. encapsulated(alginate capsule), Oxidase +, Gram –,  nonenteric rods, lactose fermentation -, ubiquitous, puncture wounds to feet.  Turns green and blue.  Has spreading factors.  Makes exotoxin A.  Intrinsic and acquired antibiotic resistance.

Shuts down protein synthesis in host cells.

P. aeruginosa

X and V factor in the chocolate agar is a give away that we are dealing with what bacteria?

Haemophilus influenza B

Who am I?

Gr- coccobacillus

capsule (Quellung reaction +)

X and V growth factors

Polyribitol phosphate (PRP) capsular type

LPS and IgA1 protease virulence factors

Who am I?

Normal microbiota in the mouth. Gr- rods, normal microbiota oropharynx, opportunist…septic arthritis. Human bites are at significant risk for infection.  Bleach like odor, some strains pit agar.

Eikenella corrodens

Who am I?

Gr+ filamentous bacillus, found in soil, weakly acid fast, beaded/speckled appearance, lesions

Who am I?

Sulfur granules, Gr+ filamentous bacillus, normal oropharynx microbiota, non-acid fast

Anergy (functional inactivation)

Deletion

Supression by T regulatory cells

Once self-tolerance is broken and autoimmune process is initiated what determines the pathology?

Choices: antibody or antigen

Antibodies to cell surface antigens (autoimmune hemolytic anemia, myasthenia gravis) describes what type of hypersensitivity?

choices: I, II, III, IV

Immune complex disease (Systemic lupus erythematosus) describes what type of hypersensitivity?

choices: I, II, III, IV

T cell mediated (Rheumatoid arthritis) describes what type of hypersensitivity?

choices: I, II, III, IV

Inappropriate immune response to self antigens. Can be benign or pathogenic.  Can be systemic or organ specific.

Choices: autoimmunity, immunologic tolerance and autoimmune disease

A lack of a response (antibody or cell mediated) to an antigen which is normally immunogenic is reffered to as?  

Examples: Pig insulin in diabetics, organ transplants, blood transfusions, marrow transplants

Choices: autoimmunity, immunologic tolerance and autoimmune disease

False.

Self tolerance is not inherited or genetically coded for.  Tolerance must be learned by each individual.  

Systemic lupus erythematosus is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

Rheumatoid arthritis is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

Sjogrens syndrome is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

inflamatory muscle disease is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

small and medium vessel vasculitis is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

Large vessel vasculitides is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

thyroiditis is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

Multiple sclerosis is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

Myasthenia gravis is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

type 1 diabetes is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

pericious anemia is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

Autoimmune hemolytic anemia is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

Rheumatic fever is an example of a _______ autoimmune disease

Choices: systemic or organ-specific

inflamation of the endomysium

Muscle fiber necrosis

fibrosis

Proximal muscle weakness

Presence of CD8+ T cells in muscle biopsy

These CD8+ T cells release inflamatory cytokines and perforin which activates the apoptosis pathway.

Maintenance of immunological tolerance is the responsibility of?

Choices: B-cells, T-cells, macrophages, neutrophils

P53 is a ____

choices: protooncogene or tumor suppressor

Once genes act ______

choices: dominantly or recessivly

Loss of cellular checkpoints

a signal to divide (usually a mitogenic signal from within)

List five molecular mechanisms that viruses use to contribute to malignant transformation

Inhibiting apoptosis

Deregulating cell cycle

Blocking senescence

Inducing genetic instability

Promoting angiogenesis

What virus am I?

Circular dsDNA, non-enveloped, nuclear replication, most common STD

transmitted sexually

What virus am I?

Large linear dsDNA, enveloped, nuclear replication, c-myc translocation, latency genes.

Causes Burkitt and Hodgkin's lymphoma

transmitted by saliva

What virus am I?

Large linear dsDNA, nuclear replication, lytic and latent genes

causes Kaposi sarcoma

Transmitted sexually

What virus am I?

Linear diploid ssRNA, enveloped, nuclear replication, causes adult T-cell leukemia/lymphoma

Transmitted sexually, or by breastfeeding

What virus am I?

Cytoplasmic replication, linear ssRNA, enveloped

transmitted by blood

Muscles that cross ___ joints are most vulnerable to muscle tears

options: 1, 2

Malignant tumor derived from endothelial cells.  

HHV8 may contribute

Begins as painful purple or brown nodule in skin.

When dealing with soft tissue tumors, superficial tumors tend to be _____ , and deep lesions are more often ______

Choices: malignant, and benign

Benign are relatively avascular

malignant are hypervascular

Kaposi Sarcoma is derived from ________ cells

Options: ectoderm, endothelial, epithelial, mesoderm

What tumor do I describe?

A rare, highly malignant tumor composed of masses of malignant endothelial cells.  Commonly seen in the liver, after exposure to arsenic, vinyl chloride, and thorotract.

What is this type of tumor called?

Benign smooth muscle tumor.  Usually arises in uterus, subcutaneous tissue or from the walls of blood vessels

What tumor am I?

Malignant smooth muscle tumor. Normally seen in extremities and in the walls of blood vessels.

What tumor type am I?

Benign tumors composed of vascular channels.

Usually seen in skin or inside internal organs.

What tumor am I?

Soft tissue tumor that contains foci of histiocytic (macrophage) differentiation.  Histologically displays spindle shaped tumor cells.

What tumor am I?

Malignant tumor of striated (skeletal) muscle.  Most common soft tissue tumor of children and young adults.  broken into 4 histological categories.

What tumor am I?

arises in the joint capsule, tendon, or bursae.  Exibits a translocation between chromosomes 18 and X.  Histologically has a biphasic pattern.

What tumor am I?

Composed of well-differentiated adipocytes. Most common soft tissue tumor.  Soft yelow lesions that may be large.

What broad type of tumor am I?

fibroblasts will have broad collagen around them.

AKA desmoid tumor

A=Tibial nerve

B=common fibular nerve

A= anterior intermuscular septum

B= interosseous membrane

C=posteriour intermuscular septum

[image]

No – they have to cross a joint to act on it

A= superior cluneal nerve

B= middle cluneal nerve

C= inferior cluneal nerve

A= greater sciatic foramen

B= lesser sciatic foramen

C= sacrospinous ligament

D= sacrotuberous ligament

Which foramen does the pudenal nerve pass through

Choices: greater or lesser sciatic foramen

______ syndrome = entrapment neuropathy caused by an impinging of the piriformis muscle on the sciatic nerve.

______ = set of symptoms that may be caused by general compression or irritation of the sciatic nerve or its components

Fascia Lata

popliteal fascia

crural fascia

A= semimembranosus

B=semitendenousus

A= plantaris

b=lateral head of gastrocnemius

trendelenburg gait- runway model walking.

Outer fibrous layer- composed of connective tissues containing blood vessels, lymphatics, and nerves that pass into bone.

Inner Osteogenic layer-  Elastic fibers, osteoblasts, forms new bone and repairs.

non-enzymatic random linking of sugars to protein, excessive crosslinking in diabetics or in olderly leads to brittle bones and to stiff bones, ligaments, and cartiledge.

enzymatic linking of sugars to protein to serve as recognition or linkage sites for other proteins.

_________ and ________ are common three way junctions formed by chemical reactions

between modified amino acid side chains with AGEs

Such reactions increase the brittleness of bone, stiffness of tendons

Hydroxylysylpyridinoline and Lysylpyridinoline

What is this?

[image]

What is this?

[image]

Prolyl hydroxylase and Vitamin C play an important indirect role in _______ biosynthesis.

It’s role is needed for consistent formation of hydroxyproline.

Explain why a mutation that leads to a substitution for glycine in collagen leads to osteogenesis imperfecta.

Glycine alone is small enough to pack into the core of tropocollagen.  Any other sidechain will bump into the other strands and prevent formation of the triple helix.

Three collagen peptides are folded together into a triple helix and linked by disulfide bonds to make one collagen molecule. They are all shifted one amino acid from the others in parallel.

The three peptides are aligned in parallel.

Explain why a collagen fibril has a banding pattern that repeats every 67 nm

Gap overlap region as the tropocollagen molecules pack together in a staggered overlap pattern.

Estimate the fraction of human protein that is composed of collagen.

In bone, ______is the amino acid that most constrains peptide backbone flexibility, because it puts a closed ring in the backbone that allows no rotation around that bond.  

In bone, ______ is the amino acid that least constrains peptide backbone flexibility because it has the smallest of all side chains (a hydrogen atom).

What disease am I?

Deep-seated infection of subcutaneous tissue that results in progressive destruction of fascia and fat but may spare the skin.  Pain out of proportion.  Can cause blue bullae.

What disease am I?

Myonecrosis caused by Clostridium perfingens usually. Usualy seen in knife of gun wounds.  gas in soft tissue.  See rectangular Gr+ rods without inflamatory cells because the toxins killed them.

What bacteria am I?

Hyaluronic acid capsule.

β hemolytic

sensitive to bacitracin

Gr+ coccus chains

catalase -

ScpC (=spyCEP) cell envelope proteinase

 C5a peptidase

M protein in cell wall

superantigen exotoxin B

DNases A-D

Who am I?

Gr+ endospore forming rectangle shaped rod

Normally found in soil and GI tract

Wound and soft tissue infection.

Can cause cellulitis, gas gangrene, and pyomyositis

α- toxin (lecithinase) and θ-toxin

makes spreading factors

What bacteria am I?

Gr-

wave like pattern of fevers.

osteomyelitis, or septic arthritis

Zoonotic (farmers or vets)

What disease am I

Gr- coccobacillus

typically from dog or cat bite.

leads to osteomyelitis( especially cat bites)

What bacteria am I?

Gr- rod

cat scratch disease

induces angiogenesis

causes lymphadenopathy

Bartonella is a rod

PAsteurella is coccobacillus

A= bacerial cell wall.

B= transpeptidase

If an organism is resistant to a penicillin because it  makes beta-lactamase, sensitivity to the penicillin may be restored by giving the penicillin along with a _________.

Name two penicillins that are the drugs of choice for Group A streptococcal infections 

Penicillin G (IV, IM depot)

Penicillin V  (oral only)

________ Binds to ALA-ALA  on peptide chain and prevents peptidoglycan cross-linking

A= C diff

B= MRSA

Marble bone disease, AKA Albers-Schonberg disease.

inherited disease

Which type of osteoporosis is related to an identifiable cause?

choices: primary and secondary.

Which type of bone does osteoporosis affect?

Choices: cortical, and spongy.

What type of Osteogenesis Imperfecta is this?

mildest type, characterized by multiple fractures after birth, blue sclera, sometimes hearing and teeth abnormalities.  Callus formation of these fractures may resemble tumors, but as the child grows these fractures decrease in severity and frequency.  Progressive hearing loss can eventually lead to total deafness as an adult.

Choices: Type I, II, III, IV

What type of Osteogenesis Imperfecta is this?

Lethal, perinatal disease in which infants are either stillborn or die within a few days due to birth canal trauma or crushing during uterine contractions. 

Choices: Type I, II, III, IV

What type of Osteogenesis Imperfecta is this?

The most progressive and severely deforming type, characterized by many bone fractures from birth, growth retardation, and severe skeletal deformaties. 

Choices: Type I, II, III, IV

What type of Osteogenesis Imperfecta is this?

Similar to type I but the sclera is normal.  May be dental disease and the frequency of fractures decreases over a long period. 

Choices: Type I, II, III, IV

Osteomalacia is in Adults characterized by inadequate mineralization of newly formed bone matrix.

Rickets is in Children whom the growth plates are open.  Affects bone matrix and also cartilaginous matrix of growth plate.

What disease is this?

Irritable Child with short attention span presents with an epiphyseal plate which does not become adequately mineralized.  Cartilage growth plate is thick and irregular. The underlying woven bone over the trabeculae is also unmineralized and easily fractured.  Chest has a classic "Rachitic Rosary", a beaded appearance.  Outward curving sternum.  Short deformed limbs.

What disease is this?

Adult patient has non-specific complaints such as muscle weakness, aches and pains.  Bones are sensitive to pain.  Causes walking problems.  

What disease is this?

Too much osteoclast activity.  Osteoblasts try to keep up and cement lines are formed making bones thick and heavy yet weak.  Outer cortices become exaggerated compared to the inside.  Osteoclasts have hundreds on nuclei instead of under a dozed like normally.

an increased incidence of Osteomyelitis due to Salmonella typhimurium, due to possible impairment of splenic function

Peripheral smears.  They induce sickling in cells in a test tube with low oxygen.

Hemoglobin Electrophoresis because Hgb S migrates differently than Hgb A.

Trisomy 7

9:22 translocation

1. Osteosarcoma

2. metastasis

codman triandle

sunburst look

force applied down the length of the bone 

a forceful contraction of the muscle that tears its bony attachment loose

Sideways motion of the fracture, Amount  of movement measured in millimeters or % apposition

In children what is stronger?

Ligaments/tendons or bone

____________ ossification stops a few years after puberty.

___________ arise from osteoprogenitorcells in the deep periosteum and bone marrow

1= cathepsins

2= H+

What type of dwarfism is this?

Normal torso, short limbs

What type of dwarfism is this?

Normal proportions, but short stature.

Lack of hGH

________ causes excess excitability of muscles, spasms and tatany.

Options: hypocalcemia or hypercalcemia

________ promotes intestinal absorption of Ca2+ and phosphate.  Promotes resorption and mineralization.  Stimulates osteoclasts by increasing RANKL formation by osteoblasts.  Made from cholesterol as active Vitamin D. 

(T/F)Bone will grow where it is uncovered by periosteum or articular cartilage

Characterized by the presence of osteoclastic, multinucleated giant cells, distributed in a back-ground of proliferating mononuclear cells.  Usually occurs between the metaphysis and epiphysis of long bones.  Soap bubble appearance on x-rays.  Diagnosis of malignancy is based on the morphology of the mononuclear cells.

Malignant tumors of plasma cells. 

secrete cytokines that recruit osteoclasts that causes lytic bone lesions

Bones most commonly involved are the skull (punched-out lesions) spine, ribs, pelvis and femur..

Microscopically, there are sheets of plasma cells showing varying degrees of maturity.