Muscles (to be) ________ a contractile [ken’traektail] form of tissue. There (to be) _______ over 600 muscles in the human body. They (to occur) __________ in three different systems. There (to be) _____ three general types of muscles:
• Skeletal muscles or "voluntary muscles" (to anchor, to attach) ____________ by tendons to bones. They (to use) ______________ to effect skeletal movements. Skeletal muscles (to use) ______________ to move various parts of the body. They (to) _____ striped or striated. Each muscle (to contract) __________ or (to strengthen) ________________ when a muscle (to receive) __________ a message from the brain. The individual (to control) ____________ the use of these muscles. That (to be) ______ why the skeletal muscles (to call) _____________ voluntary muscles.
• Smooth muscles or "involuntary muscles" (to find) __________________within structures such as the intestines, throat and blood vessels. For the most part they (not to control) _______________ by the will. That (to be) _____ why they (to know) _______________ as the involuntary muscles.
• Cardiac muscles (to be) _____ a specalized kind of muscles. They (to find) ____________________only within the heart. They (to resemble) ______________ both the smooth muscles and the skeletal muscles. They (to resemble) ________________ the skeletal muscles in being striped. They (to resemble) _____________ the smooth muscles in their involuntary nature.
Cardiac and skeletal muscles (to be) ____________"striated".
Skeletal muscles (to divide) ________________ into two subtypes:
• Type I (to include) ___________ "red" muscles. They (to be) ______ dense with capillaries They (to carry) ______ more oxygen.
• Type II (to consist) ___________ of "white" muscles. They (to be) ______ less dense in myoglobin. They can (to contract) ____________ more quickly and with a greater amount of force than Type I muscles.
Neuromuscular disease (to be) _____ a very broad term. It (to encompasse) _______________ many diseases and ailments that either directly (via muscle pathology) or indirectly (via nerve pathology) (to impair) __________________ the functioning of muscle.
Neuromuscular diseases (to be) ______ those that (to affect) _________________ the muscles and/or their nervous control. In general, problems with nervous control can (to cause) _____________ spasticity or paralysis, depending on the location and nature of the problem. A large proportion of neurological disorders (to lead) _____________ to problems with movement, ranging from cerebrovascular accident (stroke) and Parkinson's disease to Creutzfeldt-Jakob disease.
Symptoms of muscle disease may (to include) ____________ weakness or spasticity/rigidity, spasming and myalgia (muscle pain). Diagnostic procedures that may (to reveal) ______________ muscular disorders (to include) _______________ testing creatine kinase levels in the blood and electromyography (measuring electrical activity in muscles).
Diseases include myasthenia gravis, a form of muscle weakness due to antibodies to the acetylcholine receptor, and its related condition Lambert-Eaton myasthenic syndrome (LEMS). Tetanus and botulism (to be) _______ bacterial infections in which bacterial toxins (to cause) _____________ increased or decreased muscle tone, respectively.
The myopathies (to be) _________ all diseases affecting the muscle itself, rather than its nervous control.
Muscular dystrophy (to be) _______ a large group of diseases, many of them hereditary. It (to lead) _______________ to progressive loss of strength, high dependence and decreased life span.
Inflammatory muscle disorders• Polymyalgia rheumatica (or "muscle rheumatism") (to be) _____ an inflammatory condition that mainly (to occur) ________ in the elderly; it (to associate) __________________ with giant-cell arteritis. It often (to respond) _______ dramatically to glucocorticoids (e.g. prednisolone).
• Polymyositis, dermatomyositis and inclusion body myositis (to be) _____ autoimmune conditions in which the muscle (to affect) ________________.
Rhabdomyolysis (to be) ______ the breakdown of muscular tissue due to any cause. While it may not (to lead) _____________ to any muscular symptoms at all, the myoglobin thus released may (to cause) ____________ acute renal failure.
TumorsTumors of muscle (to include) _________________:
• Smooth muscle: leiomyoma (benign, very common in the uterus), leiomyosarcoma (malignant, very rare)
• Striated muscle: rhabdomyoma (benign) and rhabdomyosarcoma (malignant) - both very rare
• Metastasis from elsewhere (e.g. lung cancer)
Injuries of muscles (to include) _________________ wounds and strains.
Polymyalgia Rheumatica (PMR) – (to be) ______ a disorder associated with pain in the shoulder and hip. It (to consider) ____________________ a seronegative rheumatic disease but the etiology (cause) (not to establish) _________________. It (to respond) ________ well to steroids (prednisone).
It (to associate) ________________ with temporal arteritis (aka giant cell arteritis), which (to be) _______ a more serious condition.
Polymyositis (to be) ______ a type of inflammatory myopathy, related to dermatomyositis and inclusion body myositis. Polymyositis (to mean) ___________ 'many muscle inflammation'.
Polymyositis (to tend) __________ to become evident in adulthood, presenting with bilateral proximal muscle weakness, often noted in the upper legs due to early fatigue while walking. Sometimes the weakness (to present) ______________ itself by the person being unable to rise from a seated position without help, or inability to raise their arms above their head. The weakness (to be)______ generally progressive, accompanied by lymphocytic inflammation (mainly cytotoxic T8 lymphocytes). The cause (to be) _____ unknown, but (to seem) ________ to be related to autoimmune factors, genetics, and perhaps viruses. In rare cases, the cause (to know) _______________ to be infectious, associated with the pathogens that (to cause) _____________ Lyme disease, toxoplasmosis, and others.
Polymyositis, like dermatomyositis, (to strike) ______________ females with greater frequency than males. The skin involvement of dermatomyositis (to be) ______ absent in polymyositis.
Diagnosis (to be) ______ fourfold, including elevation of creatine kinase, signs and symptoms, electromyograph (EMG) alteration, and a positive muscle biopsy. Treatment generally (to involve) ________________ glucocorticoids, especially prednisone. At present, a number of studies (to be) _______ underway to determine whether patients diagnosed with polymyositis (to benefit) ___________ from newer drugs inhibiting the biologic effects of TNF alpha, such as Infliximab ("Remicade").
Sporadic inclusion body myositis (sIBM): IBM _____often (to confuse) ________________ with (misdiagnosed as) polymyositis and polymyositis that (not to respond) ______________ to treatment (to be) _______ likely IBM. sIBM (to come) ________ on over months to years, polymyositis (to come) _________ on over weeks to months. It (to appear) __________ that sIBM and polymyositis (to share) _____________ some common features, especially the initial sequence of immune system activation, however, polmyositis (not to display) _______________________ the subsequent muscle degeneration and protein abnormalities as seen in IBM. As well, polymyositis (to tend) ___________ to respond well to treatments, IBM does not. IBM and polymyositis apparently (to involve) ______________ different disease mechanisms than (to see) ____________ in dermatomyositis.
Dermatomyositis (to be) ______ connective-tissue disease that (to characterize) _________________ by inflammation of the muscles and the skin. Its cause (to be) _____ unknown, but it may (to result) ____________ from either a viral infection or an autoimmune reaction. Up to 50% of the cases may (to be) _______ a paraneoplastic phenomenon, indicating the presence of cancer.
X-ray findings (to include) ________________ dystrophic calcifications in the muscles.
There (to be) ______ a form of this disorder that (to strike) _________ children, known as juvenile dermatomyositis.
