1. What are the three isoenzymes of creatine kinase?
    • 1. CK-MB = heart muscle damage
    • 2. CK-MM = skeletal muscle damage
    • 3. CK-BB=   brain damage
  2. Osteoblasts from the bone matrix which is composed of what?
    • Osteoid - nonmineralized
    • Organic- Collagen I & V, proteoglycan, glycoproteins
    • Inorganic- Ca2+ & phosphorous
  3. What is an osteocyte?
    • It is an osteoblast that has been trapped in the same matrix that it has created.
    • Space occupied by osteocyte is called lacuna
    • Connected via cannaliculi to gap junctions
  4. What are the derivatives from which arise the smooth muscle of the gut tube, blood vessels, and eye?
    Splanchnic mesoderm -> gut tube

    Somatic mesoderm -> blood vessels

    ectoderm -> eye
  5. Image Upload 2
    What abnormality in musculoskeletal development leads to the above presentation in an infant?
    This is Prune belly syndrome which is a result of the lack of myotome migration.
  6. What stimulates the somites to differentiate into sclerotome and dermomyotome?
    Wnts & Shh
  7. What is the general mechanism of endochondral ossification?
    • The hyaline cartilage grows
    • osteoblasts invade -> death of chondrocytes and calcification of matrix -> large marrow spaces

    osteoblasts produce primary bone on top of the calcified cartilage.

    Osteoclasts come and break down for formation of secondary bone.
  8. What vitamins are necessary for bone?
    Vitamin D -> Ca2+ absorption

    Vitamin C -> collagen formation

    Vitamin A -> proper bone formation
  9. Hyaline cartilage
    What is it composed of?
    Is there perichondrium?
    Where is it located?
    • - type II collagen, basophilic matrix, chondrocytes in isogenous groups.

    PERICHONDRIUM: Present except on articular surfaces

    • - articular ends of long bones, nose, larynx, trachea, bronchi, ventral ends of ribs, template for endochondral bone formation.
  10. What is Genu varum and what causes it?
    small Q angle which is caused by arthrosis of medial collateral ligament which will lead to stress on the Lateral collateral ligament.
  11. What does the unhappy triad consist of?
    • Anterior cruciate ligament
    • Medial collateral ligament
    • medial meniscus
  12. The anterior cruciate ligament's function.
    To prevent hyperextension of the knee.

    Tested with the anterior drawer test or Lachman's test
  13. What are the passive and dynamic components of the arch of the foot?
    PASSIVE: bones, aponeurosis, plantar ligament, plantar calcaneocuboid ligament, plantar calcaneonavicular ligament.

    • DYNAMIC: Intrinsic muscles, long tendons
    • - Longitudinal- Flexor hallucis longus, Flexor digitorum longus
    • - Transverse- Fibularis longus and Tibialis posterior
  14. At what level is the Xiphoid process and what is it a landmark for?
    • 10th vertebrae
    • - inferior limit of thoracic cavity
    • - Superior border of liver
    • - Central tendon of diaphragm
    • - inferior border of heart
    • - esophagus into the diaphragm
  15. What does the parietal pleura consist of?
    • Image Upload 4
    • Costal pleura
    • Cervical pleura (cupular pleura)
    • mediastinal pleura
    • Diaphragmatic pleura
  16. What is the difference between the intercostals nerves and phrenic nerves in relation to the pleural of the lungs?
    • Intercostals (T1-T11)
    • - costal pleura and diaphragmatic pleura
    • - pain is sensed to originate from chest wall

    • Phrenic Nerves (C3,4,5)
    • - Mediastinal and rest of diaphragmatic
    • - pain is sensed to come from the neck +/or shoulder (referred)
  17. What is the costomediastinal recess?
    Potential pleura space where heart can touch posterior thoracic wall.
  18. What is the triad of skeletal muscle?
    • Image Upload 6
    • Terminal cisternae
    • T tubules
    • Terminal cisternae
  19. What are the bands of skeletal muscle?
    Image Upload 8
  20. What is the action of skeletal muscle stimulation
    Ap -> Ca influx -> Ach release -> sarcolemma deplolarization -> T tubules -> ca released from Sarcoplasmic reticulum -> cytosol troponin -> tropomyosin shift -> contraction
  21. What are the NT responsible for the EPSP?
    Glutamate and Acetylcholine -> Na+ in, Ca2+ in
  22. Name the 2 receptors that Ach can bind to with regards to NMJ
    Ionotropic - faster - Na influx

    Metabotropic - slower - G protein - K efflux
  23. What muscle type uses creatinine phosphate and glycolysis as its main source of energy?
    • Fast Twitch glycolytic
    • - fast fatigue
    • - Fast velocity
    • - large diameter
  24. What are the components of tension of muscle in relation to length?
    Image Upload 10
  25. What determines the # of active muscle fibers
    # of fibers per unit

    # of active motor units
  26. What are the 5 states of contraction in smooth muscle?
    • contracted
    • partially contracted(tone)
    • phasically active
    • relaxed
  27. What is the difference between single unit smooth muscle vs multi unit smooth muscle?
    • Single unit has gap junctions and relies on 1 cell to produce the spontaneou AP to affect multiple cells.
    • - small blood vessels, urinary, reproductive, GI tract

    • Multi-unit involves specific innervation.
    • - lung airways, blood vessels, eyes, hair follicles
  28. What does MLCK and MLCP lead to
    MLCK leads to contracted state

    MLCP leads to uncontracted state
  29. Where does the Spinal cord, dura mater, and filum terminale end?
    • Spinal cord - L2
    • Dura mater- S2
    • Filum terminale - Coccyx 2
  30. Layers encountered before you reach spinal cord with a stab from the back.
    • Supraspinous
    • interspinous
    • ligamentum flavum
    • posterior longitudinal ligament
    • Dura mater
    • Arachnoid mater
    • Pia mater
  31. Explain disc herniation
    Posterior fibrous annulus is the most common site for disc herniation where gelatin from the nucleus pulposus can escape leading to a pinched nerve that passes through and ends at a lower level.
  32. What are 2 contractile non-muscle cells?
    Myoepithelial - glandular secretory units

    Myofibroblast- decrease wound opening
  33. What do smooth muscle lack?
    T-tubules, sarcomeres, and troponin
  34. Treatment for Myasthenia Gravis?
    • Anticholinesterases
    • corticosteroids
    • azathioprine (immunosuppressive)
    • thymectomy
  35. What should be avoided in a patient with myasthenia gravis?
    • Stress
    • extreme temperatures
    • fever
    • illness
    • hypokalemia
    • relaxants
    • overexertion
  36. Damage to the radial nerve results in what?
    • Wrist drop
    • sensory loss of the lower part of the dorsal aspect of the thumb, and proximal dorsal aspect of all the fingers except for the little finger and half of the ring finger.
  37. Describe the flexor digitorum longus?
    Arises from the middle of the posterior tibia to the distal phalanges of 2-5.

    • Flexes the toes and foot
    • invert ankle
  38. What is innervated by the obturator nerve?
    Adductor longus, adductor brevis, anterior portion of the adductor magnus, and gracillis
  39. Describe the lumbrical muscles
    • Innervated by the ulnar nerve(3 and 4) and the median nerve (1 and 2)
    • - extend fingers at the interphalangeal joints
  40. Describe GOUT
    Caused by deposition of monosodium urate crystals in the joints and soft tissue(tophi)

    Aspiration of the joint shows negatively birefringent crystals, which are yellow in color when viewed parallel to the polarizer and blue when viewed perpendicular.

    Casues: enzyme def, lifestyle, or drugs (chemotherapy)
  41. What nerve is damaged with Charcot Marie Tooth disease?
    • Deep peroneal nerve
    • - supplies tibialis anterior, extensor hallucis, extensor digitorum, and peroneus tertius.
    • - Action = dorsiflexion and digit extension.
  42. What protects the subclavian vessels and brachial plexus in clavicle fractures?
    Subclavius (occupies small groove on the undersurface of the clavicle)
  43. What does C6 nerve root provide?
    Wrist and elbow flexion, elbow extension, and arm abduction.

    Sensory innervation of the palmar surface of the first 3 digits and over the deltoid.
  44. What are the branches of the facial nerve on the lateral aspect of the face?
    • Posterior auricular
    • Temporal
    • Zygomatic
    • Buccal
    • Marginal Mandibular
    • Cervical

    Please tell Ziggy Bob Marley called
  45. If you want to anesthetize the median nerve at the wrist where you do this?
    Between the palmaris longus tendon and the flexor carpi radialis tendon.
  46. What cord does the ulnar nerve arise from?
    The medial cord of the brachial plexus
  47. What is steroid myopathy?
    • Caused by exogenous corticosteroid use or Cushing disease.
    • Chronically characterized by the insidious onset of muslce weakness of the thighs and upper arms.
    • Preferential atrophy of type II fibers.
  48. What is Pagets disease of the bone?
    • Repetitive cycles of osteolysis and disorganized osteoblastic activity -> thickened bone with haphazard lamellar orientation.
    • Affects skull and axial skeleton
    • Histologic jigsaw puzzle appearance of bone llamellae is pathognomonic.
    • Presentation = pain, bone deformities, and chalkstick fractures.
  49. Describe the structure of dystrophin?
    • Rod like structure with globular strcutres at end
    • amino terminal end binds to actin filaments of myofibrils
    • cysteine carboxy end binds to beta-dystoglycan (anchors complex to basal lamina via laminin.)
  50. Describe osteogenesis imperfecta.
    • Disorder of type I collagen synthesis
    • multiple fractures in the absence of overt soft tissue damage
    • blue tinged sclera present in some types of OI
  51. How would Rickets present
    bony changes to lower ends of the radius and ulna, where the diaphyseal ends become fuzzy, cup-shaped, and may develop a spotty rarefaction.

    • deformity of chest wall
    • bowing of legs
    • fractures
  52. Where do the following muscles insert?
    Psoas major
    Gluteus maximus
    gluteus medius
    gluteus minimus
    • Psoas major - lesser trochanter
    • Gluteus maximus - gluteal tuberosity
    • Gluteus medius, minimus, piriformis - greater trochanter
Card Set