Upper Body Flashcards
(171 cards)
1
Q
A
2
Q
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3
Q
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4
Q
Pronator Teres
Orgin
Insertion
Innervation
action
A
Medial Epicondyle - Humerus and Ulnar Head
Middle lateral surface of radius
Median n.
Pronates forearm and hand; flexes forearm
5
Q
Flexor carpi radialis
orgin
insertion
innervation
A
Medial epicondyle - humerus
Base of 2nd metacarpal
Median n
Flexes and abducts hand
6
Q
Palmaris longus
orgin
insertion
innervation
action
A
Medial epicondyle - humerus
Flexor retinaculum and palmar aponeurosis
Median n.
Flexes hand and tenses palmar aponeurosis
7
Q
Flexor carpi ulnaris
orgin
insertion
innervation
action
A
Humeral head - Medial epicondyle and Ulnar head - Olecrannon process (medial edge)
Pisiform, hook of hamate and 5th metacarpal
Ulnar n.
Flexes and adducts hand
8
Q
Flexor digitorum superficialis
orgin
insertion
innervation
action
A
Humeroulnar head and Radial head
Middle phalanges of 4 fingers
Median n.
Flexes PIP, MCP of 4 fingers and wrists
9
Q
Flexor digitorum profundus
orgin
insertion
innervation
action
A
Anterior ulna and interosseous membrane
Distal phalanges of 4 fingers
Anterior interosseous br. of median for radial half
ulnar n. for ulnar half
Flexes DIP, MCP, PIP of 4 fingers; flexes wrists
10
Q
Flexor pollicis longus
orgin
insertion
innervation
action
A
Anterior radius and interosseous membrane
Distal phalanx of thumb
Anterior interosseous br. of median n.
Flexes thumb MCP and carpometacarpal joints
11
Q
Brachioradialis
orgin
insertion
innervation
action
A
Lateral supracondylar ridge of humerus
lateral surface of distal radius
Radial n.
flexes forearm
12
Q
Extensor carpi radialis longus
orgin
insertion
innervation
action
A
Lateral supracondylar ridge of humerus
Base of 2nd metacarpal
Radial n.
Extends and abducts hand
13
Q
Extensor carpi radialis brevis
orgin
insertion
innervation
action
A
Lateral epicondyle
Base of 3rd metacarpal
Deep radial n./Post. interosseous n.
Extends and abducts hand
14
Q
Extensor digitorum
orgin
insertion
innervation
action
A
Lateral epicondyle
Dorsal surface of the distal and middle phalanges of 4 fingers
Deep radial n./Post. interosseous n.
Extends fingers at MCP and interphalangeal joints
15
Q
Extensor carpi ulnaris
orgin
insertion
innervation
action
A
Lateral epicondyle and posterior ulna
Base of 5th metacarpal
Deep radial n./Post. interosseous n.
Extends and adducts hand
16
Q
Supinator
orgin
insertion
innervation
action
A
Lateral epidondyle, radial collateral and annular ligaments, post. ulna
Lateral, anterior/posterior radius
Deep radial n./Post. interosseous n.
Supinates forearm
17
Q
Abductor pollicis longus
orgin
insertion
innervation
action
A
Posterior ulna, interosseous membrane and post. radius
Base of 1st metacarpal
Deep radial n./Post. interosseous n.
Abducts and extends thumb
18
Q
Extensor pollicis brevis
orgin
insertion
innervation
action
A
Posterior radius and interosseous membrane
Base of proximal phalanx of thumb
Deep radial n./Post. interosseous n.
Extends thumb at MCP and CM joints
19
Q
Extensor pollicis longus
orgin
insertion
innervation
action
A
Posterior ulna and interosseous membrane
Base of distal phalanx of thumb
Deep radial n./Post. interosseous n.
Extends thumb at IP, MCP and CM joints
20
Q
boundaries of the ‘anatomical snuff box’ (medial, lateral, floor)
What nerve passes through it?
A
Extensor pollicis longus (EPL) tendon - medially
Extensor pollicis brevis (EPB) tendon - laterally
Abductor pollicis longus (APL) tendon - laterally
floor - scaphoid (most frequent fractured carpal) and trapezium
radial artery
superficial radial n.
21
Q
Carpal tunnel
What are its contents?
A
flexor retinaculum spans the lateral-most and medial-most carpal bones of the proximal and distal rows
- 4 Flexor digitorum superficialis tendons
- 4 Flexor digitorum profundus tendons
- Flexor pollicis longus tendon
- Median nerve
22
Q
What is high-energy phosphate transfer potential?
name 1 example
A
Breaking the terminal phosphate bond of ATP releases energy –> drives rxns in the cell
example: phosphocreatine and ATP reaction; phosphocreatine
23
Q
The creation of ATP without oxygen is called?
A
substrate-level phosphorylation
24
Q
High energy compounds found in the Glycolytic pathway that have high-energy phosphate transfer potential? (4)
A
Phosphoenolpyruvate >> phosphocreatine (creatine phosphate) > 1,3-bisphosphoglycerate >> ATP (gamma-phosphate)
25
How does the **mass action effect** facilitate the reformation of _creatine phosphate_ in muscle during rest after exercise?
depends on [products/substrates] in cell
log of ratio \< 1 = negative delta G
26
Hexokinase Features
Product?
Cofactor?
Phosphorylation by use of ATP traps glucose in cell forming **Glucose-6-P**
ATP high energy and G6P low energy = irreversible
Cofactor is **Mg2+**
27
Phosphofructokinase features
product?
Phosphorylates Fructose-6-P ⇒ Fructose-1,6-biphosphate using ATP
is the rate-determining step of glycolysis
irreversible
28
What is the rate-determing step of glycolysis?
Fructose-6-phosphate ⇒ Fructose-1,6-biphosphate
**Phosphofructokinase**
irreversible
29
Features of Glyceraldehyde-3-P
what is the coenzyme?
Glyceraldehyde-3-P (1st half glycolysis) ⇒ 1,3-Bisphosphoglycerate
NAD+ is the coenzyme that is reduced to NADH by oxidizing G-3-P; phosphate comes from Pi
NAD+ cofactor must be continuously replenished by oxidizing NADH; otherwise glycolysis will stop
30
What is NAD+ derived from?
niacin
31
Phosphoglycerate Kinase features?
1,3-Biphosphoglycerate ⇒ 3-Phosphoglycerate
1st site of ATP production; 2 ATP
substrate-level phosphorylation
32
What enzyme is responsible for the 1st site of ATP production in Glycolysis?
Phosphoglycerate Kinase
33
Pyruvate kinase features?
Phosphoenolpyruvate ⇒ Pyruvate
2nd site of ATP production; 2 ATP
substrate-level phosphorylation
end of glycolysis
34
How is NAD+ regenerated anaerobicaly in glycolysis?
what enzyme is it feeding?
Pyruvate ⇒ Lactate (lactate dehydrogenase)
NADH + H+ ⇒ NAD+
**glyceraldehyde-3-P dehydrogenase**
35
Niacin defiecieny name?
characterized by 4 D's
**Pellagra**
* diarrhea*
* dermatitis*
* dementia*
* death*
36
Outline the pathway of glycogenesis
Glucose ⇒ G-6-P (*hexokinase; ATP*)
G-6-P ⇒ G-1-P (*phosphoglucomutase*)
G-1-P ⇒ UDP-glucose (*Glucose-1-P Uridyl-Transferase*) (UTP ⇒ PPi)
UDP-glucose ⇒ Glucose-branched (*Glycogen synthetase*)
37
What is the principal, regulated enzyme of glycogenesis?
**glycogen synthase**
regulated by phosphorylation to hormonal signals
UDP-glucose ⇒ glucose-branched
38
Outline the path of glycogenolysis
Glycogen ⇒ G-1-P (*glycogen phosphorylase)*
G-1-P ⇒ G-6-P (*phosphoglucomutase)*
G-6-P ⇒ Pyruvate (glycolysis)
w/o O2 ⇒ lactate (*lactate dehydrogenase*)
w/ O2 Pyruvate ⇒ Acetyl-CoA ⇒ CO2
39
the principal enzyme of glycogenolysis?
**glycogen phosphorylase**
40
what is the principal enzyme of glycogenolysis?
what is its cofactor?
**glycogen phosphorylase**
pyridoxal phosphate
41
Overview of Fatty Acid Degradation
FFA into muscle cell (albumin) ⇒ fatty-acyl-CoA (*acyl CoA synthetase*)
fatty-acyl-CoA (Palmitate) cant be transported to mit. matrix directly ⇒ carnitine transporter ⇒ palmitoyl CoA
Thru oxidation/hydration steps ⇒ **FADH2 **(2 ATP) and **NADH** (3 ATP) via respiratory chain
Product = acetyl CoA and a fatty acyl CoA molecule that is two carbons shorter; in this case a 14-carbon fatty acyl CoA
42
How many times does the 16-carbon palmitoyl CoA cycle through in the Beta-oxidation pathway?
7 times
to produce 8 molecules of acetyl CoA from palmitoyl CoA.
each cycle produces FADH2 and NADH, which are then oxidized in the respiratory chain, forming ATP
43
How is **Hexokinase** allosterically regulated?
Why is this advantageous?
The product, G-6-P will inhibit Hexokinase if the cell has too much glucose.
excessive glycolytic intermediates ⇒ limit free Pi for synthesis of ATP
44
What are the allosteric regulators of Phosphofructokinase-1 (PFK)?
PFK is a physiologically irreversible rxn (rate-determining step)
under certain conditions (exercise), a **phosphatase** (fructose-1,6-biphosphatase) will provide glucose-6-P for glycogen stores
High ATP inhibits PFK
High [H+] (high metabolic activity) inhibits PFK
High AMP activates PFK; inhibits fructose-1,6-BP
45
Activator of Phosphofructokinase
AMP
46
Inhibitors of Phosphofructokinase
ATP
H+
47
Inhibitor of Fructose-1,6-bisphosphatase
AMP
48
What is AMP a signal of in the cell?
Low Energy
49
Overall why is Fructose-1,6-BisPhosphatase activated in the cell?
reverse glycolysis to provide G-6-P for the replenishment of glycogen stores from circulating lactate.
50
How does Epinephrine increase glucose?
GPCR → cAMP → PKA → Phosphorylase kinase**-P** → Glycogen phosphorylase **-P**
PKA → Glycogen synthase**-P** (inactive)
51
What is an allosteric activator of Phosphorylase kinase?
Ca2+
52
What is an allosteric activator of Glycogen Phosphorylase?
What other pathway does this signal substrate work on?
Why?
AMP
(Glycogen Phosphorylase: tense to relaxed form)
AMP signals the cell to mobilize more glucose, and at the same time, stimulates phosphofructokinase to catalyze the reaction of fructose-6–P to fructose- 1,6–bisphosphate (advancing to the next steps of glycolysis to produce more energy).
mobolize glucose
53
Besides inhibiting Hexokinase, G-6-P can inhibit and activate which substrates in Epi pathway?
Inhibit ⇒ Glycogen Phosphorylase**-P**
Activate ⇒ Glycogen Synthase**-P** (inactive)
54
How does insulin reverse the cyclic AMP-mediated cascade?
What phosphatase does it activate?
Phosphodiesterase = cAMP ⇒ AMP
inactivates PKA
activates **protein phosphatase** (removes **P** from phosphorylase kinase and glycogen phosphorylase to inactivate)
55
How does G-6-P inhibit glycogenolysis and activate glycogenesis?
Inhibits **phosphorylase kinase**
Turns **glycogen phosphorylase** to its tense (inactive) state. In this state glycogenolysis is inhibited
_allosteric activator_ to **glycogen synthase-d**, allowing override of hormonal input. Glycogen synthase may be inactive - d form (phosphorylated)
56
E1 for pyruvate dehydrogenase complex
cofactors?
classification (coenzyme, prosthetic)?
vitamin source?
function?
Deficiency leads to what?
Cofactor: thiamine diphosphate
Type: Prosthetic group
Vitamin source: Thiamine
Function: carries acetate carbons to E2
Deficiency: leads to **Beri Beri** and is associated with muscle weakness, heart failure. Insufficient energy production.
57
E2 for pyruvate dehydrogenase complex
cofactors?
classification (coenzyme, prosthetic)?
vitamin source?
function?
Deficiency leads to what?
Coenzyme A
Cosubstrate
Pantothenic acid
Activates acetate group
Lipamide
Prosthetic group
none, dietary
Oxidizes product from E1
_Cofactor for alpha-ketoglutarate dehydrogenase._
58
E3 for pyruvate dehydrogenase complex
cofactors?
classification (coenzyme, prosthetic)?
vitamin source?
function?
Deficiency leads to what?
Cofactor: FAD
Type: Prosthetic group
Vitamin source: riboflavin
Function: Reoxidizes lipoate
Cofactor: NAD+
Type: Co-substrate
Dietary source: niacin
Function: Reoxidizes FAD
Deficiency: Niacin deficiency (pellagra) is characterized by the 4 Ds: diarrhea, dermatitis, dementia, and death.
59
How is the pyruvate dehydrogenase complex regulated allosterically?
Acetyl CoA ⇒ E2
NADH ⇒ E3
Remember: these are products; pool of NAD+ is limited; do not want to waste energy
60
How is the pyruvate dehydrogenase complex regulated via phosphorylation of E1?
Phosphorylation of E1 _deactivates_ the enzyme
Pyruvate Dehydrogenase Kinase (PDH Kinase) is activated by Acetyl-CoA and NADH
PDH Kinase is inhibited by Pyruvate, NAD+, CoA-SH
PDH phosphatase works on E1 = activation
61
isocitrate → alpha-ketoglutarate
enzyme?
cofactors?
Isocitrate dehydrogenase
NAD+ → NADH
62
alpha-ketoglutarate → Succinyl CoA
enzyme?
cofactors?
alpha-ketoglutarate dehydrogenase
CoA, NAD+ → NADH, CO2
cofactors:
NAD+ = cosubstrate
FAD = Prosthetic group
Lipoic acid = prosthetic
thiamine diphosphatase
CoA-CO = substrate
63
Succinyl CoA → Succinate
enzyme?
cofactors?
Succinyl CoA Synthetase
GDP → GTP → ADP → ATP + GDP
64
Succinate → Fumarate
enzyme?
succinate dehydrogenase (attached to membrane)
FAD → FADH2
65
Malate → Oxaloacetate
enzyme?
Malate dehydrogenase
NADH → NAD+
66
What does NADH inhibit in the Citric Acid Cycle?
the 2 enzymes that produce it
**alpha-ketoglutarate**
**isocitrate dehydrogenase**
67
What inhibits alpha-ketoglutarate dehydrogenase?
NADH (product)
succinyl CoA (product)
ATP, GTP (do not need more energy)
68
What signals low cellular energy levels that activates isocitrate dehydrogenase?
ADP
69
What is preemptive analgesia?
_pre-incisional local anesthesia_ will help block pain impulses
70
Why do we use _multiple levels_ of analgesia for pain management?
to facilitate rehabilitation and a return to normal function.
Accomplished by *reducing pain* and *inflammation* at both the central and the peripheral nerve levels.
71
phenanthrene alkaloids opiods
morphine
codeine
72
semisynthetic opioids
hydrocodone
oxycodone
73
synthetic opioids
meperidine
fentanyl
sufentanil
methadone
74
advantage of opioids
act both centrally and peripherally
75
Opioids mechanism of action
mimic endogenous opioid peptides (enkephalins and endorphins)
mu-GPCRi
1. inhibit voltage gated Ca2+ channels
2. open K+ channels → neuronal hyperpolarization
76
Where do opioids work in general?
mu GPCRi in the brainstem on GABA neurons resulting in disinhibition to "turn-on" neurons resulting in activation of the descending brainstem pain inhibition pathways as well as activation of dopamine cells in the VTA to release dopamine in the nucleus accumbens resulting in rewarding behavior
77
How are opioids best used for treatment?
**PCA machine** (Patient-Controlled Analgesia)
**Scheduled dose regimen**
acute- used for moderate-severe; fracture, soft-tissue injury
chronic - cancer, inflammatory arthritis
78
Opioid adverse effects?
CNS depression
sedation
urinary retention
constipation
nausea
vomitting
Reversible w/ **naloxone**
79
advantages of NSAIDs
used perioperatively, combined w/ opioids, they tend to decrease narcotic consumption
fewer adverse SE's
80
NSAID mechanism of action
prevent enzyme cyclooxygenase from contributing to prostaglandin production
81
Issues w/ NSAID use?
COX-1 constitutionally expressed in GI tract = **ulcers**
COX-2 is induced by cytokines, GF's and endotoxins = **cardiovascular issues**
decrease in bone healing time (osteoblast/-clast effect)
82
Actetaminophen
What does it do?
CNS
increase pain threshold
central inhibiton of prostaglandin production
83
Tramadol (tapentadol) is a synthetic analogue of what?
What is its mechanism of action?
codeine
acts centrally w/ weak affinity for mu opioid receptors
inhibitor of NE and serotonin re-uptake
84
Why is tramadol and NSAIDs used together?
Where are they normally used?
Combination: rapid analgesia from acetaminophen, longer duration from tramadol
regional neural blockade for mild-moderate pain
85
What is used for regional anesthetic nerve blocks and neuraxial anesthesia?
Local anesthetics
lidocaine (3-4 hrs)
bupivacaine (4-6 hrs)
ropivacaine (less cardiotoxicity than bupivacaine)
86
How do Regional Anesthetics work?
local anesthetic injected around the peripheral nerves from region involved in surgery to the CNS.
Blocks peripheral nerves for 6-8 hrs
use Ultrasound-guided regional anesthesia
87
Most efficacious way to administor opioids for Neuraxial blocks?
intrathecal
epidural
88
TCA's used to treat chronic pain
amitriptyline
nortriptyline
desipramine
89
SSRI's used to treat chronic pain
sertraline
paroxetine
fluoxetine
90
Anti-epileptics used to treat chronic pain
gabapentin
pregabalin
carbamazepine
lamotrigine
91
Most common Corticosteroid used to treat chronic pain?
Prednisolone
92
What Nociceptor fiber detects pain 1st?
Wht stimuli does this fiber detect?
A-delta (med. diameter, thinly myelinated)
detect noxious, mechanical and **thermal** stimuli
93
What type of stimuli do C-fibers detect?
noxious mechanical, thermal and _Chemical_ stimuli
94
Trapezius
orgin
insertion
innervation
action
superior nuchal line
Ext. occipital protuberance
Ligamentum nuchae
Spinous processes C7-T12
Lateral clavicle
Acromion
Spine of scapula
Accessory n.
Elevates, depresses/retracts scapula
tilts glenoid upwards in abduction of arm
95
Levator scapulae
orgin
insertion
innervation
action
transverse processess C1-C4
Upper part of medial border of scapula
Dorsal scapular n.
Elevates scapula
tilts glenoid downward
96
Rhombodieus major and minor
orgin
insertion
innervation
action
Minor: spinous processes C7-T1
Major: Spinous processes of T2-T5
Vertebral border of scapula
Dorsal scapular n.
Retract and elevate scapula
tilts glenoid downward in adduction of arm against resistance
97
Serratus anterior
orgin
insertion
innervation
action
ribs 1-8
Anterior surface of medial border of scapula
Long thoracic n.
Protracts scapula
rotates glenoid upward
holds scapula against thorax
98
Pectoralis minor
orgin
insertion
innervation
action
Coracoid process
Ribs 3-5
Medial and Lateral pectoral n.
Protracts and depresses scapula
99
Subscapularis
orgin
insertion
innervation
action
subscapular fossa
lesser tubercle
upper and lower subscapular n.
medially rotates arm
stabilizes shoulder joints
100
Supraspinatus
orgin
insertion
innervation
action
Supraspinous fossa
greater tubercle (highest facet)
Suprascapular n.
Abducts arm (initiates abduction)
stabalizes shoulder joint
101
infraspinatus
orgin
insertion
innervation
action
infraspinous fossa
greater tubercle (middle facet)
suprascapular n.
Laterally rotates arm
stabalizes shoulder joint
102
Teres Minor
orgin
insertion
innervation
action
Lateral border of scapula
Greater tubercle (lowest facet)
Axillary n.
Laterally rotates arm
stabilizes shoulder joint
103
Latissimus dorsi
orgin
insertion
innervation
action
spinous processes T7-T12
Thoracolumbar fascia
lumbar spinous processes, iliac crest, lower ribs
Intertubercular groove
Thoracodorsal n.
Adducts
Extends
Medially rotates arm
104
Teres major
orgin
insertion
innervation
action
inferior angle of scapula
intertubercular groove
Lower subscapular n.
Adducts
extends
medially rotates arm
105
Pectoralis Major
orgin
insertion
innervation
action
clavicle, sternum, costal cartilages, ext oblique aponeurosis
intertubercular groove
lateral pectoral n.
Adducts and medially rotates humerus
upper fibers flex arm
lower fibers extend arm from flexes position
106
Deltoideus
orgin
insertion
innervation
action
spine of scapula, acromion process, clavicle
deltoid tuberosity
Axillary n.
Flexes, abducts, extends arm
107
Triceps brachii
orgin
insertion
innervation
action
long head - infraglenoid tubercle of scapula
lateral head - posterolateral humeral shaft
medial head - posteromedial humeral shaft
Olecrannon process
Radial n.
Extends arm and forearm
108
Biceps brachii
orgin
insertion
innervation
action
short head - coracoid process
long head - supraglenoid tubercle of scapula
Radial tuberosity
Musculocutaneous n.
Primarily supinates and flexes forearm
109
Coracobrachialis
orgin
insertion
innervation
action
Coracoid process
humeral shaft
musculocutaneous n.
Flexes and adducts arm
110
Brachialis
orgin
insertion
innervation
action
humeral shaft
ulnar tuberosity
musculocutaneous n.
flexes and adducts arm
111
Brachialis
orgin
insertion
innervation
action
humeral shaft
ulnar tuberosity
musculocutaneous n. and radial n.
Flexes forearm
112
What are the boundaries of the Triangular space?
contents?
(black dashes)
teres minor (axillary edge of scapula)
teres major
triceps brachii - long head
contents: circumflex scapular a.
113
Boundaries of Quadrangular space?
Contents?
(white dashes)
teres minor
teres major
triceps brachii - long head
humerus
contents: axillary n.
posterior circumflex humeral a.
114
Boundaries of Suprascapular notch
(gray circle)
contents?
suprascapular notch
superior transverse scapular ligament
contents: suprascapular n. (suprascapular a. passes above notch)
115
Deltopectoral triangle boundaries?
contents?
deltoid, pectoralis major, clavicle
contents: cephalic vein
br. of thoracoacromial artery
lateral pectoral n.
116
How does coordinated motion of the scapula and humerus result in full ROM of shoulder abduction
As the humerus abducts, the greater tubercle hits the acromion. This limits range of motion.
trapezius - retracts scapula; superiorly rotates glenoid fossa
serratus anterior - protracts scapula; superiorly rotates glenoid fossa
teres minor/infraspinatus externally rotate humerus
deltoid/suprspinatus abduct humerus
117
Explain the sequence of movement from 0-180º
0-60º: deltoid/supraspinatus abduct humerus
60-120º: trapezius/serratus ant. rotate glenoid superiorly
deltoid/supraspinatus abduct humerus
around 90º - teres minor/ infraspinatus laterally rotate humerus clearing greater tubercle form acromion
120-180º: deltoid/supraspinatus abduct humerus
118
What are chronic pain conditions where there is evidence to treat with acupuncture?
low back pain
knee osteoarthritis
migraine headaches
labor pain
119
What aspects of yoga have an effect in management of chronic pain?
Asana - posture
lower stress levels (leads to muscle spasms)
improves sleep (poor sleep worsens pain)
breathing → PNS
120
what are the mind-body medicine modalities used to treat chronic pain?
meditation and mindfulness
Cognitive Behavioral Therapy
Hypnosis
Relaxation (training to relax)
121
internal validity
the study design performance at measuring differences, if they exist, between groups, i.e. intervention and control, that are due only to the hypothesized effect.
122
Critical appraisal
The process of assessing and interpreting evidence systematically, considering its validity, results, and relevance.
123
Randomized Controlled Trial
Essentially an experiment in which individuals are randomly allocated to receive or not receive an experimental preventive, therapeutic, or diagnostic procedure and then followed to determine the effect of the intervention.
124
Eligibility criteria
Exclusion criteria
the set of criteria used to determine who can participate in a study
factors that exclude patients from participating in a study
125
What are the fundamental characteristics of the RCT within a scientific article?
Patients randomly assigned to control or study treatment using an outside source
Study participants and caregivers do not know which group the patient belongs to
126
Explain why concealment is important for Internal Validity
If the patient knows which group he/she belongs to, then this will bias their thinking towards the effectiveness of the treatment and may skew the results (the brain is very powerful and can influence the effectiveness of treatment)
Concealment attempts to remove a confounding factor, i.e. knowledge of received treatment, in order to more accurately assess whether or not the treatment works.
127
Demonstrate a general understanding of how Internal Validity is presented and discussed in a Journal Club setting
Examine sample size, single/double blindedness, how the procedures or drugs were given (to indicate if they may be able to tell the difference between them), and whether or not the study went back to prove that patients didn't know which treatment they were receiving.
Also examine if safety committees/review committees were involved to approve the study and to monitor its progress.
128
What is the function of the Palamar Aponerurosis
Creates compartments
anchors flexed tendons
protection
129
nerve that innervates Thenar compartment
Reccurent branch of median n.
130
How would I perform a sensory test to localize carpel tunnel syndrome?
muscular test?
palmar branch good
numbness over cutaneous lateral 3.5 digits
opposition test (opponens pollicis)
131
Guyon's canal
b/w pisiform and hook of hamate
where ulnar n. enters
132
Handlebar Neuropathy
causes: cysts
clot in ulnar a.
fracture of hamate
arthritis of wrist
pressure from pussy bicycle = "handlebar palsy"
= decreased feeling in medial 5th digit and weakness in hand muscles
133
What is the optimal position of the wrist for gripping objects?
20-30º extension
134
Why is 20-30º wrist extension optimal for gripping objects?
what position are the fingers in?
Max tension formed
MAX number of cross-bridges (2-2.2 µm)
wrist in ext./fingers slight flexion
135
What are the **motions** of the MCPs, IPs when grasping an object?
The MCP joints are in slight flexion and the fingers are in flexion (DIP and PIP) to prepare to grasp the object.
136
What are the muscle actions needed to grasp an object?
Open the hand: the wrist moves into the functional position via the extensor digitorum muscle. Other extrinsic muscles help to stabilize the wrist.
Shape the hand around the object: The lumbricals activate to flex the MCP and extend the PIPs and DIPs.
Fingers close around the object: lumbricals can flex the MCP, but flexor digitorum superficialis and profundus are needed to flex the DIPs and PIPs. The flexor force from FDS and FDP are stronger than the extension force from the lumbricals and extensor digitorum at the DIPs and PIPs.
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List the muscles and ligaments that make up the extensor mechanism
extensor hood
central tendon of the extensor digitorum tendon
2 lateral bands on each finger of the extensor digitorum tendon
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How does the extensor mechanism provide coordination of phalangeal motion and coordination of intrinsic and extrinsic muscle action
The extensor hood is a fibrous extension of the extensor digitorum tendons. It forms a tent of connective tissue across the proximal phalanx.
The lateral bands and the central tendon extend distally from the extensor hood.
Lumbrical and interosseus muscles attach to the extensor hood, allowing these muscles to have the ability to extend the DIP and PIP while flexing the MCP joint.
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**Mallet Finger**
rupture of the dorsal attachment to the distal phalanx
- unable to extend the DIP joint
- unopposed flexion of DIP joint
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**Boutonniere Deformity**
unable to extend PIP joint
unopposed flexion of PIP pulls DIP into hyperextension
- lateral bands slip to ventral side of joint axis
- rupture of central tendon
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What is happening at median nerve injury at MCP and IP joints?
unable to flex 2nd and 3rd MCP and IP joints
_unopposed ext_ of MCP leads to hyperextension of MCP joints ⇒ pulls PIP and DIP into passive flexion
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Claw hand - ulnar n. injury
MCP hyperextension ⇒ ext. digitorum decreased sarcomere length (ineffective for PIP/DIP)
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**Monteggia Fracture**
Ulnar fracture w/ radial head dislocation
could bring avascular necrosis of radial head
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**Galeazzi Fracture**
radial fracture w/ distal ulnar dislocation
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MUGR
**M**onteggia - Ulnar (fracture)
**G**aleazzi - Radius (fracture)
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**CPPD** Arthropathy (Pseudogout)
weakly positive birefringent crystals
Ca2+ pyrophosphate in bone/soft tissue
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Boxer's Fracture
occurs when punching
transverse fracture of 5th metacarpal
common in young adult males
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**Rheumatoid Arthritis**
periarticular osteopenia
bilateral and symmetric
joint space destruction
MCP joint subluxation
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**Gout**
Monosodium Urate Crystals
marginal erosions
overhanging edges
sclerotic borders
joint spaces relatively preserved
ST tophi (soft tissue dense)
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6 components of the Chronic Care Model
1. **Organization of Health Care** - commitement to chronic care model
2. **Delivery system design** - multiple visits, multiple people helping patient
3. **Decision support** - latests guidelines, continual education for physicians
4. **Clinical information systems** - can track chronic patients
5. **Patient self management** - patient set goals
6. **Community Resources**
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Role of healthcare team in acute care models
role of patient
health team: select and conduct therapy
patient: follow orders
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Role of healthcare team in chronic care models
role of patient
health team: Teach/coach/partner
patient: Partner/daily manager
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What is complex 1 and 3 of the respiratory chain linked by?
coenzyme Q
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Complex I contains?
**NADH-Q reductase**
NADH dehydrogenase
Fp (iron-containing flavoprotein)
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Contents of Complex III in respiratory chain?
**cytochrome reductase**
b cytochromes
cytochrome c1
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What are complexes II and III linked by in the respiratory chain?
coenzyme Q
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prosthetic groups of cytochromes?
heme irons
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contents of cytochrome IV?
what type of poisoning occurs here?
**cytochrome oxidase**
cytochrome c
cyt a-a3
cyanide
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What would be seen clinically with respiratory chain defects?
Lactic academia (High NADH favors formation of lactate from pyruvate)
High NADH inhibits _PDH_ → blood pyruvate elevated
elevated pyruvate increases production of _alanine_
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What happens to ATP production if the ATPase (F1) does not have a proton gradient?
ATPase would cleave ATP in the matrix
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What happens when you inhibit the respiratory chain?
Prevents ATP synthesis causing all electron flow to cease. The mitochondrion is unable to pump protons so that mitochondrial respiration and ATP synthesis both cease.
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How is respiration controlled?
ADP increases in the mitochondrial matrix, ADP opens the proton channel.
As protons move thru channel down pH gradient, respiration increases to componsate for the decline in the pH gradient
matrix ADP is low, ATP synthesis ceases, the pH gradient builds up, and oxygen use diminishes.
These events correlate w/ the change in lung respiration during exercise
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uncoupling of ETC produces?
ETC operates at a high rate of respiration becasue protons are pumped out rapidly in an attempt to restore the pH gradient.
Instead energy is released as **heat** and body temp rises
citric acid cycle and PDH continues at a rapid rate as NADH is maximally oxidized (processes do not get inhibited)
Excessive oxidation of NADH restricts the formation of lactate since NADH is needed to reduce pyruvate to lactate
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MOA of Oligomycin
antibiotic
binds to the F0 component preventing proton flow to the F1-ATPase
proton pumping ceases because size of the pH gradient prohibits the pumping out of additional protons (respiration decreases)
Respiration will decrease even w/ plenty of ADP and phosphate
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Components of the ATP synthase complex
transmembrane component (F0) - proton channel
the stalk
F1-ATPase
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What causes 'the stalk' F0 to open in the ATP synthase complex?
increased levels of ADP in the matrix cause it to open
the stalk regulates the proton channel
F1-ATPase catalyzes synthesis of ATP
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How does the malate-aspartate channel work during respiration?
Overall: **recycles NADH** inside of matrix
* NADH cant be moved into the mitochondria (made by glycolysis)
* In the cytoplasm, malate dehydrogenase can reduce oxaloacetate to malate, which also regenrates NAD+ for glycolysis. Malate is shuttled into the matrix via an antiporter with alpha-ketoglutarate (electroneutral transporter).
* (Matrix) oxaloacetate is regenerated via malate dehydrogenase in the citric acid cycle, which also generates NADH as a product by reducing NAD+.
* Oxaloacetate is returned to the cytoplasm by moving an amino group onto oxaloacetate from glutamate (aspartate aminotransferase), producing aspartate and alpha-ketoglutarate. Alpha-ketoglutarate is transported out in exchange for malate, as above, and aspartate is transported out in exchange for glutamate. This second translocase iselectrogenic and only operates in one direction.
* Cytoplasmic aspartate aminotransferase moves the amino group from aspartate to alpha-ketoglutarate, regenerating oxaloacetate (which will be reduced to malate) and glutamate (which will be transported into the matrix in exchange for aspartate).
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What is electrogenic transport? How does this transport benefit the release of ATP from the mitochondrial matrix?
Electrogenic transport relies on charge to move substances across the mitochondrial membrane. For example, an ADP molecule from the intermembrane space (charge —3) is switched with an ATP molecule from the matrix (charge —4); this works because charge is relatively more negative in the matrix than in the membrane space, and the transport has a net movement of —1 to the intermembrane space, which is favored under these conditions. The transports are not reversible because of this.
This type of transport allows ATP to be immediately removed from the mitochondrial matrix. If ATP were left inside, it would be broken back down by ATP Synthase.
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What is the function of the Complexes of the respiratory chain?
NADH dehydrogenase takes electrons from NADH and passes them to the FMN, creating FMNH2. This process pumps hydrogen ions into the intermembrane space.
Electrons are transferred to coenzyme Q, which transfers electrons to cytochrome b and then to c1 (complex III). This process also pumps protons into the intermembrane space.
Cytochromes contain heme prosthetic groups.
Cytochrome c1 passes the electrons to cytochrome c, then to cytochrome a (copper-containing complex IV). Cytochrome a3 accepts electrons from cytochrome a. Transfer through this complex also pumps hydrogen ions into the intermembrane space.
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What does each complex overall do ?
Each complex increases both the pH and charge gradient across the inner mitochondrial membrane.
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