Week 1 Flashcards
(91 cards)
1
Q
Weight-bearing vs. non-weight-bearing x-rays
A
if the X-ray
2
Q
What is a sign of osteoarthritis?
A
narrow joint space
3
Q
Which place can the hips refer pain?
A
To the back
4
Q
What happens to intervertebral discs as we get older?
A
The disks dehydrate and compress [thinner on x-ray]
5
Q
What does increased brightness in bones mean?
A
s
6
Q
True or False prostate cancer can often go to bone
A
True
7
Q
List the red flags for lower back pain
A
trauma, age over 50, fever, weight loss, night/rest pain, history of cancer, _____
8
Q
natural history of back pain
A
___
9
Q
What is the nucleus propulsus mainly made of?
A
water
10
Q
What does it mean if intervertebral discs are darker on X-ray?
A
dehydrated
11
Q
Describe a T1 vs. T2 signal on X-ray
A
T1: T2:
12
Q
In the LAIDback study what was the most important predictor in having future back pain?
A
self-reported depression
13
Q
How should we treat benign back pain?
A
conservative [bedrest, meds, PT, exercise, manipulation, alternative treatments, minimally invasive [injections], invasive [surgery -decompression to relieve pressure on a nerve root and decompression to remove fusion]
14
Q
What is functional restoration?
A
It’s a treatment approach to restore functional capacity [based on PT and sports medicine in the 80s]. It interrupts disability process, returns patient to more productive lifestyle, and _______
15
Q
Biomedical vs. Biopsychosocial model of osteoarthritis
A
__ While we addr
16
Q
True or False. Is bedrest the best treatment for back pain? What’s the best?
A
False. It’s worse! The best is exercise [functional restoration; relatively aggressive - cannot have complete avoidance of pain]
17
Q
passive physical therapy
A
the results don’t last
18
Q
Which type of exercises are appropriate for back pain?
A
resistance exercises
19
Q
Explain the MA for acetylcholine
A
-
20
Q
Explain the MA for nicotine
A
-
21
Q
Explain the MA for succinylcholine
A
d
22
Q
Explain the MA for rocuronium
A
d
23
Q
Explain the MA for varenicline
A
d
24
Q
Explain the MA for trimethaphan
A
d
25
Explain the MA for botulium toxin A [botox]
d
26
Explain the MA for edrophonium
a
27
Explain the MA for neostigmine
d
28
Explain the MA for pyridostigmine
d
29
Explain the MA for sarin
d
30
Explain the MA for malathion
d
31
Explain the MA for pralidoxime
d
32
Explain the MA for atropine
s
33
Which neurotransmitter is used by somatic nerves?
acetylcholine at the neuromuscular junction
34
Which neurotransmitter is used by sympathetic nerves? Preganglionic and postganglionic
pre: NE post: ACh
35
Which neurotransmitter is used by parasympathetic nerves? Preganglionic and postganglionic
pre: ACh post: ACh
36
Which neurotransmitter is used by adrenal medulla? Preganglionic and to circulation
Pre: ACh To Circulation: epinephrine and norepinephrine
37
What is the innervated region of the muscle called?
The end plate
38
Which type of ACh receptor is at neuromuscular junctions?
nicotinic ACh receptors
39
In addition to nicotinic ACh receptors, what is the other type of receptor that recognizes ACh
muscarinic receptor
40
Describe the nicotinic receptor
Binds two molecules of ACh; ligand-gated ion channel; non-selective cation channel [sodium going in, but a little potassium also leaks out]
41
Describe the muscarinic receptor
d
42
Define non-depolarizing blocks of nicotinic receptors. Which drugs are included in this group?
competitive antagonists of nicotinic receptors AT NEUROMUSCULAR JUNCTION ONLY; sometimes called "curare-like" drugs; roscuronium [one of the most commonly used] and cisatracurium [best for people with liver problems] more are also used these are just two examples; effect: not enough stimulation to cause depolarization
43
Define depolarizing blocks of nicotinic receptors. Which drug is included in this group?
agonist for nicotinic receptor at NMJ; use succinylcholine [faster onset of action compared to other drugs; structurally two ACh molecules together]; cannot be degraded the same way; because of prolonged action - will have sustained depolarization; "endplate depolarization prevents resetting of voltage-gated Na+ channels this blocks the action potential generation in muscle [no [propagation]
44
45
Which drug should be used for muscle paralysis if a patient has severe burns or hemiparalysis?
You should use rocuronium since you don't want to increase the risk of hyperkalemia [this would happen if you used succinylcholine]. Denvervation super-sensitivity
46
Define denervation super-sensitivity
is the sharp increase of sensitivity of post-synaptic membranes to a chemical transmitter after denervation. It is a compensatory change.
It can cause hyperkalemia in the case of NMJ.
47
True or false there is redundancy at neuromuscular junctions [aka "safety factor"]
True. More ACh is produced than needed to make sure the muscle contracts
48
What percent of receptors need to be blocked at the NMJ to prevent/decrease muscle contraction?
about 75% of the receptors
49
myasthenia gravis
auto-antibodies destroy nAChR on the muscle endplate
50
lambert-eaton myasthenic syndrome
auto-antibodies block calcium channels and lower ACh release
51
Drug targets related to neurotransmission
synthesis, vesicular packaging, vesicular release, receptors [pre or post synapse], and degradation/removal
52
Which enzyme is always present with ACh?
acetylcholineesterase
53
Which drug cleaves SNARE proteins in cholinergic nerves? How is function restored?
botulium toxins [specific for cholinergic nerves and will destroy the signal] so the localization of the injection is very important]; the nerve sprouts [forms a new connection to the motor end plate]
54
Describe acetylcholinesterase
* this is thee "true" cholinesterase
* it's selective for ACh
* it's abundant at synpatic cleft, and present on RBCs
* it's inactivated by by anti-cholinesterases
55
Describe butyryl or plasma cholinesterase
* family of related enzymes to acetylcholinesteraes
* extensive distribution in the body - liver, brain, plasma
* relatively nonselective - metabolize ester containing drugs
* inactivated by anti-cholinesterases
56
Describe the interaction between acetylcholine and acetylcholinesterase
d
57
Describe the interaction between anticholineesterases and acetylcholinesterases
d
58
Describe the MA of anticholinesterases
Types:
1. very short acting [over within minutes]
* edrophonium [tensilon]
2. intermediate acting [several overs]
* neostigmine and pyridostigmine
* mainstay for clinical use - treating myasthenia, reversing neuromuscular block etc.
* DOES NOT cross the blood-brain barrier [if it were to cross you'd be at risk for seizures]
3. irreversible [need to synthesize new enzyme]
* sarin and other chemical warfare agents
* lipophilic and readily absorbed
59
Describe thiphosphate insecticides
,
60
When should we infuse acetylcholine verus using anticholinesterase?
Review the symptoms from lecture
61
If an X-ray says upright on it, why is this significant?
If an X-ray says upright it means the image is weight-bearing. Weight-bearing images may make it difficult to determine whether or not the joint space is actually narrowed
62
True or false: facet joint arthritis can cause back pain
true
63
Define myelopathy
a myelopathy is a disease of the spinal cord [diseases that affect the anterior horn - motor neuron disease]
64
Define radiculopathy
disease of spinal nerves
65
Define paresthesias
Pins and needles (paraesthesia) is a pricking, burning, tingling or numbing sensation that's usually felt in the arms, legs, hands or feet.
66
What is the difference between propioception and kinesthesia
propioception = sense of body position
kinesthesia = sense of body movement
check over again
67
Define tendon
tendon is connective tissue [collagen] that [usually] connects muscle to bone
68
Define ligament
ligaments are connective tissue [collagen] that connect bone to bone
69
How can we differentiate between a UMN and LMN problem on physical exam?
UMN: increased muscle contraction [spascicity], increased reflexes [hyperreflexia], no atrophy
LMN: decreased muscle contraction [flaccid], decreased reflexes [hyporeflexia], localized atrophy
70
Define UMN and LMN
UMN: central ns [brain and spinal cord]
LMN: peripheral ns
Mixed Central and Peripheral [UMN and LMN]: motor neuron disease [patients will have hyperreflexia and localized atrophy]
71
72
Define plexopathy
problems with plexus [brachial or LS]
73
Define neuropathy or polyneuropathy
problem/disease of nerves
74
define NMJ disorder
problem at NMJ
75
Define myopathy
problem/disease of the muscle
76
True or false: both nerves and muscle are excitable
true
77
true or false: sensory and motor neurons are meters long
true
78
true or false every muscle has a NMJ?
true
79
Do the nerves have a mix of afferent and efferent nerve fibers?
Yes
80
define muscle spindle fiber organ
specialized group of muscle fibers [intrafusal]
81
Intrafusal vs. extrafusal
intrafusal: muscle fibers within the muscle spindle fiber organ
extrafusal: contacticle muscle fibers
82
The larger the diameter of a nerve fiber, the faster they are. True or false?
true
83
Define trophic interactions
Trophic interactions are the interactions between the producers and consumers in an ecosystem
84
Define dermatome
area of skin innervated by a bilateral pair of spinal nerves and their spinal ganglia
85
Which type of neurons innervate the dermatome?
sensory neurons
86
Which type of neurons innervate the myotome?
motor neurons
87
Define myotome
88
CNS
brain and spinal cord
89
PNS
* Cranial nerves [12 pairs]
* Spinal nerves [31 pairs; includes D/V rootlets and roots]
* Sensory Ganglia [8 cervical pairs and 31 spinal pairs [DRG]
* Autonomic ganglia [sympathetic, parasympathetic, and enteric]
90
What is the difference between cranial nerves and spinal nerves?
Cranial nerves come from the brain stem [there are 12 pairs of cranial nerves]. Spinal nerves come from the spinal cord [there are 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal]
91
