MSS Final - Questions

146 flashcards · Other · by Jared Blackwell

1. What does Hexokinase do?

   Glucose --> Glucose-6-P -ATP --> ADP.

2. What does PFK do?

   Fructose-6-P --> Fructose-1,6-BP. -ATP --> ADP.

3. What is the end result of Phase Two of Glycolysis?

   2 molecules of Glyceraldehyde-3-P.

4. Which step of glycolysis is dependent on NAD+?

   Phase 3: The conversion of Glyceraldehyde-3-P --->1,3-Bisphosphoglycerate. *NEED NAD+

5. How do you regenerate NAD+?

   Anaerboic conditions from lactate. Aerobic conditions uses glucose from glycogen.

6. Where is NAD+ derived from? What does a deficiency of this do?

   NAD+ from Niacin. Pellagra "4Ds" Diarrhea Dermatitis Dementia Death *Only new cells affected with high turnover like GI, Skin, Brain cells.

7. What is the allosteric regulator of hexokinase?

   Glucose-6-P

8. Describe the allosteric regulation of phosphofructokinase (PFK).

   Rate-limiting step. Fructose-6P--->Fructose-1,6-BP. ATP and H+ NEGATIVE AMP POSITIVE AMP NEGATIVE for reverse.

9. What does Fructose-1-6 bisphosphatase do?

   Helps make glycogen from lactate. Fructose1-6,BP-->Fructose-6-P.

10. What is the regulated step enzyme of glycogenesis?

    Glycogen synthase

11. What is the regulated step enzyme of glycogenolysis?

    Glycogen phosphorylase

12. Describe Epinephrine affects on glycogen.

    EPI bind G-protein. Activates adenylyl cyclase converts ATP-->cAMP. cAMP activates PKA. PKA phosphorylates Phosphorylase kinase-b to phosphoyrlase kinase-a. Phosphorylase kinase-a phosphorylates Glycogen phosphorylase to break down glycogen to glucose.

13. Difference in phosphorylation of glycogen phosphorylase and glycogen synthase?

    If glycogen synthase is phosphorlyated it is INACTIVE. Glycogen phosphorylase active with phosphorylation.

14. How is phosphorylase kinase regulated?

    Hormonally via epinephrine. Allosteric via Calcium. Both with activate phosphorylase kinase-b. Glucose-6-P inhibits phosphorylase kinase-a

15. What does adenylate kinase (myokinase) do?

    2 ADP <---> ATP + AMP Enhances energy, e.g. 250 meter sprint. Activates glycogen phosphorylase and PFK. Two pathways on.

16. What does glucose-6-P do?

    Negative feedback Hexokinase. Activates glycogen synthase. Inhibits glycogen phosphorylase and phosphorylase kinase-a.

17. What does AMP do?

    Activates glycogen phosphorylase. Activates PFK.

18. What does insulin do?

    Activates protein phosphatase to de-phosphorylate and activate glycogen synthase.

19. What are the tense and relaxed states of phosphorylase kinase?

    Tense is inactive Relaxed is active.

20. What muscles would be injured with a fracture at lesser trochanter?

    Psoas major and iliacus. *Greater trochanter gluteus medius/minimus, piriformis, obturator.

21. What does the recurrent branch of median nerve innervate?

    Thenar Eminence Opponens Abductor pollicis brevis Flexor pollicis brevis. *Lateral to medial

22. Tendons from what make the extensor hood?

    Extensor digitorum tendons.

23. How do palmar muscles perform extension?

    Tendons of flex. digi profundus and superficialis are posterior to axis of rotation and extend at IP and MCP joints.

24. What muscles make up Hypothenar Eminence?

    Abductor digiti minimi Flexor digiti minimi brevis Opponens digit minimi *Opponens deep to flexor digiti minimi brevis. Abductor digiti minimi:

25. What innervates the hypothenar eminence muscles?

    Deep ulnar nerve. Abductor digit minimi:

26. What innervates the adductor pollicis?

    Deep ulnar nerve.

27. What innervates and action of the Lumbricals?

    Radial side is median nerve. Ulnar pinky side is deep ulnar nerve. Flex MCP Extend IP

28. Describe the location of lumbricals

    NO attachment to bone. Originate from edge of FDP tendons and insert on radial side of extensor hood.

29. Does the middle finger have palmar interossei and dorsal interossei?

    Middle finger has TWO dorsal interossei. NO palmar interossei.

30. Describe the blood supply of palm

    Superficial radial artery. Deep ulnar artery.

31. How does the median nerve enter carpal tunnel?

    Prior to entering tunnel, median n. gives off its palmar branch.

32. What innervates the palmar and dorsal interossei?

    Deep ulnar nerve.

33. What's the difference between Claw Hand and Pope's Blessing?

    Claw Hand: Fist ask to extend. Loss of lumbricals and interossei muscles. Pope's Blessing: Ask to make a fist, flex. Loss of FDS and FDS.

34. What type of arthritis is this?

    Psoriatic arthritis. *Pencil-in-cup deformity.

35. What is this and what disease?

    Normal synovium. RA synovium. Many inflammatory cells. *Almost form germinal centers

36. RA w/ joint narrow spacing.

37. RA w/ and periarticular osteopenia and marginal erosions.

38. Tocilizumab Infliximab, Etanercept, Adalimumab Tofacitinib Abatacept Rituximab

39. Back pain with uveitis or aortitis?

    Ankylosing spondylitis May also have sacroilitis.

40. Describe clinical presentation of ankylosing spondylitis

    Back pain, axial. Symmetric SI involvement. Enthesitis (achilles) Unilateral uveitis Lung fibrosis Aoritis Kyphosis

41. Describe clinical presentation of Psoriatic Arthritis

    Peripheral joint. Asymmetric SI invovement. Dactylitis Nail pitting Onycholysis Unilateral uveitis.

42. Difference in peripheral and axial Enteropathic Arthritis?

    Enteropathic peripheral arthritis Related to Crohn's/UC NO HLA-B27 Responds to traditional DMARDs Axial Not related to crohn's/UC HLA-B27 Biologic DMARDs.

43. What arthritic disease is associated with Erythema Nodosum?

    Enteropathic Arthritis. IBD associated.

44. 25 year old had chlamydia and 1-3 weeks later got arthritis. What type?

    Reactive arthritis

45. ANA test shows centromere?

    Limited Scleroderma

46. ANA test shows SCL-70 (topoisomerase)

    Diffuse Scleroderma

47. ANA test shows histone

    Drug induced lupus

48. Black female presents with low-grade fever, rash, and inflammatory joint pain.

    Lupus

49. What are risk factors and hematologic signs in Lupus?

    Thrombosis Leukopenia Anemia Low platelets

50. Difference in how polymyositis and dermatomyositis affects muscle?

    Polymyositis muscle ONLY with endomysial inflammation. Dermatomyositis is muscle and skin with perimysial inflammation.

51. Disease with proximal muscle weakness, elevated creatine kinase and ESR?

    Polymyosisits / Dermatomyositis Polymyalgia Rheumatica ONLY increased sedimentation rate. 2:1 female-male.

52. Dermatomyosisits Heliotropic rash Gottron papules (erythemia over hands and knuckles). Shawl rash

53. What are the positive ANA test for Myositis?

    ANA against tRNA. Anti Jo-1 "Mechanic hands" Anti-SRP Polymyositis Anti Mi-2 Classic dermatomyositis.

54. What disease is associated with Sjogren's Syndrome?

    Non-hodgkin's lymphoma and MALT lymphomma.

55. Lymphomatic destruction of lacrimal and salivery glands?

    Sjogren's syndrome

56. Inflammatory muscle condition with proximal muscle weakness?

    Polymyositis / Dermatomyositis.

57. What does Xanthine Oxidase and HGPRT do?

    Uric acid production. HGPRT converts hypoxanthine and guanine to IMP and GMP instead of Xanthine.

58. What is Lesch-Nyhan syndrome?

    Over production of uric acid. No HGPRT.

59. What is Kelley-Seegmiller syndrome?

    Over production of uric acid. No HGPRT.

60. Which cytokine plays a central role in Gout?

    IL-1, inflammasome.

61. Gout Negative yellow birefringent. "yellow when parallel."

62. Gout Destructive bone. "Overhanging edges" "Punches out appearance" Joint space usually preserved.

63. Control Gout Pseudogout

64. Control Gout Pseudogout

65. What does Pegloticase do?

    Treats gout. Converts Uric acid to Allantoic acid.

66. Difference in presentation of gout and pseudogout?

    Pseudogout affects wrist > knees > hands. Attacks longer. Gout affects big toe > ankle, knee > wrist > finger.

67. What does Alloprinol do and side effects?

    Treats gout. Blocks Xanthine oxidase. Side effects: Serious infxn.

68. What is associated with Pseudogout?

    Hyperparathryoidism High iron, copper. Low Mg, phosphorus.

69. Pseudogout Chondrocalcinosis

70. What is pseudogout?

    Calcium deposits in cartilage. Alkaline phosphatase can't convert pyrophosphate (PPi) to phosphate. Instead makes calcium deposits.

71. Describe polymyalgia rheumatica

    Fatigue, fever, weight loss. Pain in shoulder/chest and hip/thigh area. Normal CK but elevated ESR and CRP.

72. Dorsal slippage of lateral bands of extensor hood at PIP?

    Swan neck deformity

73. Rupture of central tendon attaching to the middle phalanx?

    Boutonniere Deformity Can't extend PIP. Unopposed flexion of PIP pulls DIP into hyperextension.

74. Rupture of central tendon attaching to the distal phalanx?

    Mallet finger Can't extend DIP DIP is stuck in FLEXION.

75. What muscle does extension at MCP?

    Extensor digitorum *Strong extensor MCP, NOT PIP or DIP

76. What muscles do extension at PIP and DIP?

    Lumbricals

77. What does the superficial nerve do and innervate?

    Fibularis longus & fibularis brevis. Sensory to anterior leg and toes, NOT pinky toe or web space between big toe 2nd toe

78. Describe Tom Dick N Harry

    Medial foot. Tibularis anterior Flexor digitorum longus Posterior tibialis nerve Flexor hallucis longus *Medial to lateral.

79. Where does the small saphenous vein come from and go?

    Popliteal vein --> small saphenous vein over calf and goes to medial ankle.

80. Which artery goes deep into the hamstrings?

    Deep femoral artery.

81. What is the most common cause of knee pain in adolescent?

    Osgood-Schlatter Disease More common in males.

82. What is the cause of Osgood-Schlatter Disease?

    Bone growth in teens with stress on patella attaching to tibial tubercle.

83. What is the clinical presentation of Osgood-Schlatter Disease?

    Dull ache and prominence over tibial tubercle. Exacerbated with activity.

84. What is Legg Calve Perthe Disease LCPD

    Avascular necrosis of epiphysis of femoral head. Chlidren 3-7. Boys 4:1.

85. What is an accepted theory for Legg Calve Perthe Disease (LCPD)?

    The ligamentum femoris is constricted, not allowing the medial circumfelx artery time to supply femoral head.

86. Clinical presentation of Legg Calve Perthe Disease?

    Pain in groin which radiates to thigh and knee. Limping, limited hip rotation and abduction.

87. What is developmental dysplasia of the hip (DDH)?

    Structural abnormality of growing hip. Breech position significant risk factor. 80% female.

88. What is the Ortolani and Barlow test?

    Tests for developmental dysplasia of hip. Dislocated femoral head reduced into acetabulum. Most important test. Barlow test: dislocate the unstable hip from acetabulum. *Cannot use either after 3 months.

89. What is Slipped Capital Femoral Epiphysis (SCFE)?

    Epiphyseal plate widened. Abnormal cartilage maturation and endochondral ossification. Need to diagnosis early to prevent avascular necrosis of femoral head. Obesity is major risk factor.

90. Type 2 fiber atrophy (ATPase 9.4) Atrophy more common type II. ATPase stains type 2 darker. Smaller with varying size.

91. What are features for denervation of atrophy?

    Angular fibers, atrophic. Type 1 and type 2 grouping. Clump of condensed muscle fiber.

92. Denervation in infant. Round atrophic fibers. Nuclei spread out. Children NO angular fibers.

93. Dystrophy Variable size Fibrosis Hypertrophy X-linked; rarely symptomatic in females.

94. Regeneration of muscle: Blue cytoplasm.

95. McArdle's disease PAS stain for glycogen. Aggregation of glycogen. Abnormal myophosphorylase.

96. Normal fat (red). Excess fat (oil red O). Lipid storage myopathies.

97. Mitochondrial myopathy. Ragged red fiber: too much mitochondria.

98. Adults women > men. Proximal weakness. Elevated creatine kinase

    Inflammatory myopathy: Polymyositis Necrosis, regeneration, WBC infilitrate. Responds to corticosteroids.

99. This disease is in adults, sometimes children. Skin lesions. Increased risk of visceral cancer.

    Dermatomyositis Proximal weakness. Elevated CK. Red rash

100. Disease in middle-aged/elderly men> women. Distal and proximal weakness. Unresponsive to corticosteroids.

     Inclusion Body Myositis.