Anatomy and Physiology Flashcards
1
Q
Extends from lateral femoral condyle to anterior tibia
A
ACL
2
Q
Incomplete fracture extending partway through width of bone
A
Greenstick fracture
3
Q
Common injury in contact sports from lateral force applied to a planted leg
A
“Unhappy triad”
4
Q
“Unhappy triad” consists of injury to what structures
A
ACL, MCL, and medial meniscus
5
Q
Which meniscus in the knee is more commonly injured in “Unhappy triad”
A
Lateral meniscus
6
Q
Extends from medial femoral condyle to posterior tibia
A
PCL
7
Q
Rotator cuff muscles
A
Supraspinatus, Infraspinatus, Teres minor, Subscapularis
8
Q
Innervation for supraspinatus muscle
A
Suprascapular nerve
9
Q
Most common rotator cuff injury
A
Supraspinatus muscle
10
Q
How is supraspinatus injury assessed
A
Empty/full can test
11
Q
Action of supraspinatus
A
Abduction of arm to 15 degrees
12
Q
Innervation for infraspinatus
A
Suprascapular nerve
13
Q
Muscle commonly injured in pitching injury
A
Infraspinatus
14
Q
Action of infraspinatus
A
Laterally rotates arm
15
Q
Innervation to teres minor
A
Axillary nerve
16
Q
Action of teres minor
A
Adducts and laterally rotates arm
17
Q
Innervation of subscapularis
A
Upper and lower subscapular nerve
18
Q
Action of subscapularis
A
Medially rotates and adducts arm
19
Q
Muscle that abducts arm from 15 to 100 degrees
A
Deltoid
20
Q
Innervation to deltoid
A
Axillary nerve
21
Q
Abducts arm to more than 90 degrees
A
Trapezius
22
Q
Innervation to trapezius
A
Accessory nerve
23
Q
Abducts arm to more than 100 degrees
A
Serratus anterior
24
Q
Innervation to serratus anterior
A
Long thoracic nerve
25
Repetitive flexion of elbow causes what injury
Golfer's elbow
26
Golfer's elbow is what injury
Medial epicondylitis
27
Repetitive extension of elbow causes what injury
Tennis elbow
28
Tennis elbow is what injury
Lateral epicondylitis
29
What is the most commonly fractured carpal bone
Scaphoid
30
Complications of scaphoid fracture
Avascular necrosis and nonunion
31
Mechanism of avascular necrosis and nonunion in scaphoid fractures
Retrograde blood supply
32
Dislocation of what wrist bone may cause acute carpal tunnel syndrome
Lunate
33
90 degree flexion of wrist causing tingling
Phalen maneuver
34
Percussion to wrist causing tingling
Tinel sign
35
Classically seen in cyclist due to pressure from handlebars
Guyon canal syndrome
36
Guyon canal syndrome
Compression of ulnar nerve at wrist or hand
37
Entrapment of median nerve causing paresthesia, pain, and numbness in distribution of median nerve
Carpal tunnel syndrome
38
Axillary nerve spinal levels
C5-C6
39
Musculocutaneous nerve spinal levels
C5-C7
40
Radial nerve spinal levels
C5-T1
41
Median nerve spinal levels
C5-T1
42
Ulnar nerve spinal levels
C8-T1
43
Recurrent branch of median nerve spinal levels
C5-T1
44
Nerve commonly injured in anterior dislocation of humerus
Axillary nerve
45
Nerve commonly injured in upper trunk compression
Musculocutaneous nerve
46
Nerve commonly injured in carpal tunnel syndrome and wrist laceration
Median nerve
47
Nerve commonly injured in fracture of surgical neck of humerus
Axillary nerve
48
Nerve commonly injured in supracondylar fracture of humerus
Medial nerve
49
Nerve commonly injured in midshaft fracture of humerus
Radial nerve
50
Nerve commonly injured in fracture of medial epicondyle of humerus
Ulnar nerve
51
Nerve commonly injured in superficial laceration of palm
Recurrent branch of the median nerve
52
Nerve commonly injured in fracture of hamate from fall on outstretched hand
Ulnar nerve
53
Bone fractured from fall on outstretched hand commonly injuring ulnar nerve
Hook of hamate
54
Ape hand and Pope's blessing are common presentations of what nerve injury
Median nerve
55
Flattened deltoid with loss of sensation over deltoid muscle and lateral arm indicates injury to what nerve
Axillary nerve
56
Loss of elbow, wrist and finger extension indicates injury to what nerve
Radial nerve
57
Loss of sensation over posterior arm/forearm and dorsal hand indicates injury to what nerve
Radial nerve
58
Loss of wrist flexion, flexion of lateral fingers, and thumb opposition indicates injury to what nerve
Median nerve
59
Loss of opposition, abduction and flexion of thumb with no loss of sensation indicates injury to what nerve
Recurrent branch of the median nerve
60
Nerve commonly injured due to crutches or sleeping with arm over chair
Radial nerve
61
Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers with loss of sensation over medial 1-1/2 fingers indicates injury to what nerve
Ulnar nerve
62
Loss of sensation over Thenar eminence and dorsal and palmer aspects of lateral 3-1/2 fingers with proximal lesion indicates injury to what nerve
Median nerve
63
Loss of flexion to lumbricals of 2nd and 3rd digits
Median nerve
64
Saturday night palsy is injury to what nerve
Radial nerve
65
Loss of action to medial 2 lumbricals indicates injury to what nerve
Ulnar nerve
66
Lateral traction on neck during delivery causing adduction, medial rotation, extension and pronation of arm may injure to what part of the brachial plexus
Upper trunk
67
Nerve roots in upper trunk of brachial plexus
C5-C6
68
Upward force on arm during delivery may injure what part of the brachial plexus
Lower trunk
69
Nerve roots in lower trunk of brachial plexus
C8-T1
70
Erb palsy or "waiter's tip" is injury to what part of the brachial plexus
Upper trunk
71
Muscles affected with injury to upper trunk of brachial plexus
Deltoid, supraspinatus, infraspinatus, biceps brachii
72
Klumpke palsy is injury to what part of the brachial plexus
Lower trunk
73
Nerve roots in lower trunk of brachial plexus
C8-T1
74
Compression of lower trunk and subclavian vessels causes which syndrome
Thoracic outlet syndrome
75
Axillary node dissection after mastectomy or stab wounds can injure what nerve
Long thoracic nerve
76
Grabbing a tree branch to break a fall can damage what part of the brachial plexus
Lower trunk
77
Functional deficits seen in winged scapula
Inability to anchor scapula to thoracic cage leading to inability to abduct arm above horizontal plane
78
Inability to abduct arm above the horizontal is injury to what nerve and muscle
Long thoracic nerve and serratus anterior
79
Atrophy of intrinsic hand muscles, ischemia, pain and edema due to vascular compression is seen in what syndrome
Thoracic compression syndrome
80
Mechanism of thoracic compression syndrome
Compression of lower trunk and subclavian vessels
81
Conditions that commonly cause thoracic compression syndrome
Pancoast tumors and cervical rib
82
Most common shoulder dislocation
Anterior dislocation
83
Blood vessel most commonly injured in anterior shoulder dislocation
Posterior circumflex artery
84
Function of lumbricals
Flexion of MCP, extension of PIP and DIP joints
85
Ulnar claw is seen with what nerve injury
Distal ulnar nerve injury
86
Pope's blessing is seen with what nerve injury
Proximal median nerve injury
87
What is the deficit in distal ulnar nerve injury
Cannot extend 4th and 5th fingers
88
What is the deficit in proximal median nerve injury
Cannot flex 1st, 2nd, and 3rd fingers
89
Median claw is seen in what nerve injury
Distal median nerve injury
90
OK gesture is seen in what nerve injury
Proximal ulnar nerve injury
91
What is the deficit in distal nerve injury
Cannot extend 1st, 2nd, and 3rd fingers
92
What is the deficit in proximal ulnar nerve injury
Cannot flex 4th and 5th digits
93
Hand cannot do what in proximal median and ulnar nerve injuries
Flex fingers (make a fist)
94
Hand cannot do what in distal median and ulnar nerve injuries
Extend fingers (open hand)
95
Which Thenar muscle receives dual innervation
Flexor pollicis brevis
1. superficial head - median nerve
2. deep head - ulnar nerve
96
What are the Thenar muscles
Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
97
What nerve mainly innervates the Thenar muscles
Median nerve
98
What nerve mainly innervates the Hypothenar muscles
Ulnar nerve
99
What are the Hypothenar muscles
Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi
100
Function of palmar interossei muscles
Adduct muscles (PAD)
101
Function of dorsal interossei muscles
Abduct muscles (DAB)
102
Nerve for sensory to sole of foot
Tibial
103
Nerves roots to tibial nerve
L4-S3
104
Nerve for motor to triceps surae, plantaris, popliteus, and flexor muscles of foot
Tibial
105
Function of Tibial nerve
Invert and Plantarflex foot (TIP)
106
Inability to flex toes with loss of sensation on sole of foot indicates injury to what nerve
Tibial nerve
107
Loss of sensation to dorsum of foot indicates injury to what nerve
Common peroneal nerve
108
Nerve roots to common peroneal nerve
L4-S2
109
Foot eversion at rest with loss of inversion and plantarflexion indicates injury to what nerve
Tibial nerve (L4-S3)
110
Function of Peroneal nerve
Evert and Dorsiflex foot (PED)
111
Inability to stand on tippy toes indicates injury to what nerve roots
L4-S3
112
Foot drop indicates injury to what nerve roots
L4-S2
113
Nerve for motor to biceps femoris, tibialis anterior, and extensor muscles of foot
Peroneal nerve
114
Inversion and plantarflexion at rest with foot drop while walking indicates injury to what nerve
Peroneal nerve (L4-S2)
115
Nerve for sensory to suprapubic region
Iliohypogastric
116
Nerve roots to Iliohypogastric nerve
T12-L1
117
Abdominal surgery can result in damage to what nerve
Iliohypogastric
118
Knee trauma or Baker cyst can result in damage to what nerve
Tibial nerve
119
Knee trauma or Baker cyst presents with what deficits
Foot eversion at rest with loss of plantarflexion
120
What does the sciatic nerve split into
Common peroneal and tibial nerves
121
Nerve roots to sciatic nerve
L4-S3
122
Sensory to posterior thigh
Sciatic nerve (L4-S3)
123
Common cause of sciatic nerve injury
Herniated disc
124
Common cause of common peroneal nerve injury
Trauma or compression of lateral aspect of leg
125
Fibular neck fracture damages what nerve
Common peroneal nerve
126
Nerve for motor to semitendinosus, semimembranosus, biceps femoris, and adductor magnus
Sciatic nerve
127
Burning or tingling sensation in surgical incision site radiating to inguinal and suprapubic region indicate injury to what nerve
Iliohypogastric (T12-L1)
128
Nerve commonly injured in laparoscopic surgery
Genitofemoral nerve
129
Findings in genitofemoral nerve damage
Decreased anterior thigh sensation below inguinal ligament and absent cremasteric reflex
130
Nerve commonly damaged with tight clothing and obesity
Lateral femoral cutaneous nerve
131
Nerve roots to genitofemoral nerve
L1-L2
132
Nerve for sensory to anterior thigh and medial leg
Femoral nerve
133
Nerve roots to femoral nerve
L2-L4
134
Common cause of injury to obturator nerve
Pelvic surgery
135
Decreased medial thigh sensation and adduction indicates injury to what nerve
Obturator nerve
136
Nerve roots to obturator nerve
L2-S4
137
Decreased anterior and lateral thigh sensation indicates injury to what nerve
Lateral femoral cutaneous nerve
138
Nerve roots to lateral femoral cutaneous nerve
L2-L3
139
Nerve for motor to adductor longus and brevis, gracilis, pectinus and adductor magnus
Obturator nerve
140
Nerve commonly injured in pelvic fracture
Femoral nerve
141
Nerve for motor to quadriceps, iliopsoas, pectinus and sartorius
Femoral nerve
142
Findings in femoral nerve injury
Decreased thigh flexion and leg extension
143
Nerve for motor to gluteus maximus
Inferior gluteal
144
Nerve roots to inferior gluteal
L5-S2
145
Nerve for motor to gluteus medius, gluteus minimis and tensor fascia latae
Superior gluteal
146
Nerve roots to superior gluteal
L4-S1
147
Nerve commonly injured in posterior hip dislocation
Inferior gluteal nerve
148
Nerve commonly injured in stretch injury during childbirth
Pudendal nerve
149
Side lesion is located in Trendelenburg sign/gait
Contralateral to the side of dropped hip
150
Most common cause of superior gluteal nerve injury
Iatrogenic during IM injection to upper medial gluteal region
151
IM injections should be given in what gluteal region to avoid injuring superior gluteal nerve
Superolateral quadrant
152
Difficulty climbing stairs, rising from seated position or loss of hip extension indicate injury to what nerve
Inferior gluteal nerve
153
Nerve for motor to external urethral and anal sphincters
Pudendal nerve
154
Muscles that abduct hip
Gluteus medius, gluteus minimis
155
Nerve for sensory to perineum
Pudendal nerve
156
Muscles that adduct hip
Adductor magnus, longus, and brevis
157
Muscles that extend hip
Gluteus maximus, semitendinosus, semimembranosus
158
Fecal or urinary incontinence with decreased sensation to perineum indicate injury to what nerve
Pudendal nerve
159
Nerve roots to pudendal nerve
S2-S4
160
Muscles that flex hip
Iliopsoas, rectus femoris, tensor fascia latae, pectineus
161
Muscles that internally rotate hip
Gluteus medius, gluteus minimis, tensor fascia latae
162
Muscles that externally rotate hip
Iliopsoas, gluteus maximus, piriformis, obturator
163
Function of gluteus medius
Abduct and internally rotate hip
164
Function of gluteus minimis
Abduct and internally rotate hip
165
Function of gluteus maximus
Extend and externally rotate hip
166
Function of semitendinosus
Extend hip
167
Function of semimembranosus
Extend hip
168
Function of iliopsoas muscle
Flex and externally rotate hip
169
Function or rectus femoris
Flex hip
170
Function of tensor fascia latae
Flex and internally rotate hip
171
Function of pectineus
Flex hip
172
Function of piriformis
Externally rotate hip
173
Function of obturator muscle
Externally rotate hip
174
Intervertebral disc generally herniate in which direction
Posterolaterally
175
In an L3/L4 disc herniation which nerve is usually affected
L4 (inferior nerve)
176
Disc level damaged in weakness of plantar flexion, difficulty in toe-walking with decreased Achilles reflex
L5-S1
177
Disc level damaged in weakness of knee extension with decreased patellar reflex
L3-L4
178
Disc level damaged in weakness of dorsiflexion with difficulty in heel-walking
L4-L5
179
Artery commonly damaged with long thoracic nerve
Lateral thoracic artery
180
Artery and nerve commonly damaged in surgical neck of humerus fractures
Axillary nerve and Posterior circumflex artery
181
Artery and nerve commonly damaged in midshaft humerus fractures
Radial nerve and deep brachial artery
182
Artery and nerve commonly damaged in distal humerus or cubital fossa trauma
Median nerve and Brachial artery
183
Artery and nerve commonly damaged in popliteal trauma
Tibial nerve and Popliteal artery
184
Artery and nerve commonly damaged in posterior to medal malleolus trauma
Tibial nerve and Posterior tibial artery
185
Triad of 1 T-tubule + 2 terminal cisternae is in what type of muscle
Skeletal
186
Action potential depolarization opens what type of channels allowing NT release
Presynaptic voltage-gated Calcium channels
187
What leads to muscle cell depolarization in the motor end plate
Postsynaptic ligand binding
188
Depolarization travels along the muscle down what structure
T-tubule
189
Dyad of 1 T-tubule + 1 terminal cisterna is found in what type of muscle
Cardiac
190
The dihydropyridine receptor is coupled to what, allowing release of calcium from sarcoplasmic reticulum
Ryanodine receptor
191
How are the dihydropyridine and ryanodine receptor coupled?
Mechanically coupled
192
What does binding of calcium to troponin cause in myocytes
Moves tropomyosin exposing myosin-binding groove on actin filaments
193
Myosin releasing ADP and Pi leading to displacement of myosin on the actin filament is what?
Power stroke
194
Which band in muscle contraction remains the same
A-band
195
What bands in muscle contraction shrink
H, I, Z bands
196
Sarcomere extends from which two bands
I-band to I-band
197
The center of the sarcomere is what band
M-line
198
The thick filaments are composed of what protein
Myosin
199
Thin filaments are composed of what protein
Actin
200
What causes detachment of myosin head from actin filament
Binding of a new ATP molecule
201
Hydrolysis of bound ATP causes myosin head to adopt which position
High-energy position (cocked)
202
What gives type 1 muscle fibers its red color
Increased mitochondria and myoglobin concentrations
203
Which muscle fibers increase in proportion after weight, resistance training, or sprinting
Type 2 (fast twitch) muscle fibers
204
What gives type 2 muscle fibers their color
Decreased mitochondria and myoglobin concentrations
205
Fast twitch muscle fibers use energy through what process
Anaerobic glycolysis
206
What muscle fibers increase in proportion after endurance training
Type 1 (slow twitch)
207
Slow twitch muscle fibers use energy through what process
Oxidative phosphorylation
208
In smooth muscle, membrane depolarization opens what channels
L-type voltage-gated Calcium channels
209
What does calcium bind to in smooth muscle
Calmodulin
210
What does calcium-calmodulin complex activate
Myosin-light-chain kinase (MLCK)
211
What is the function of MLCK
Phosphorylate myosin-light-chain for muscle contraction
212
How is muscle contraction stopped in smooth muscle
Dephosphorylation of myosin-light-chain by myosin-light-chain phosphatase (MLCP)
213
Increase in NO in smooth muscle leads to what?
Increase in cGMP activating MLCP causing smooth muscle relaxation
214
Type of bone formation in bones of axial skeleton, appendicular skeleton and base of skull
Endochondral ossification
215
What is required for endochondral ossification to occur
Cartilage bone model made by chondrocytes
216
Type of bone formed directly without cartilage
Membranous bone
217
What does the cartilage bone model on endochondral ossification get converted to next
Into woven bone and then lamellar bone by osteoblasts and osteoclasts
218
A person with achondroplasia has a defect in what type of bone formation
Endochondral ossification
219
Type of bone that occurs after fractures and in Paget disease
Woven bone
220
What type of environment is required for osteoblast to function
Alkaline environment
221
Function of osteoblast
Build bone by secreting collagen and catalyzing mineralization
222
What activates osteoblasts
Increased ALP and alkaline environment
223
How are osteoclast made
From mesenchymal stem cells in periosteum
224
Function of osteoclast
Dissolve bone by secreting H+ and collagenases
225
How are osteoclasts made
From fusion of monocyte/macrophage lineage precursors
226
What type of environment is required for osteoclasts to function
Acidic environment
227
At what levels does PTH exert anabolic effects
Low, intermittent levels
228
What condition do chronically increased PTH levels cause
Osteitis fibrosa cystica
229
What PTH levels cause catabolic effects on bone
Chronically high PTH levels
230
What effect do low estrogen levels have on bone
Osteoporosis
231
What does estrogen cause during puberty
Closure of epiphyseal plate
232
What inhibits apoptosis in osteoblasts and induces apoptosis in osteoclasts
Estrogen
233
Failure of longitudinal bone growth and membranous ossification leading to short limbs and large head
Achondroplasia
234
Constitutive activation of what inhibits chondrocyte proliferation
Fibroblast growth factor receptor 3 (FGFR3)
235
What is the inheritance pattern of achondroplasia
Autosomal dominant with full penetrance
236
What is the most common cause of dwarfism
Achondroplasia
237
Screening for osteoporosis is recommended at what age
> 65 years
238
What T-score value indicates osteoporosis
T-score of less than or equal to 2.5 or fragility fracture of hip or vertebra
239
Medical conditions that may cause osteoporosis
Hyperparathyroidism, hyperthyroidism, multiple myeloma or malabsorption syndromes
240
Drugs that may cause osteoporosis
Steroids, alcohol, anticonvulsants, anticoagulants, thyroid replacement therapy
241
Most common cause of osteoporosis
Decreased estrogen levels
242
Lab values associated with osteoporosis
Normal serum calcium and phosphate
243
What part of bone loss is seen in osteoporosis
Trabecular (spongy) and cortical bone lose mass and interconnections
244
Treatment for osteoporosis
Bisphosphonates, Teriparatide, SERMS, denosumab
245
Monoclonal antibody used in osteoporosis
Denosumab
246
Mechanism of action of bisphosphonates like alendronate
Inhibit osteoclast bone resorption
247
Prophylactic to prevent osteoporosis
Weight-bearing exercise, adequate calcium and vitamin D intake
248
Risk factors associated with osteoporosis
Female, increased age, smoking and glucocorticoid use
249
Failure of normal bone resorption due to defective osteoclasts causing thickened, dense bones prone to fractures
Osteopetrosis
250
Complications of osteopetrosis
Pancytopenia and extramedullary hematopoiesis
251
Treatment for osteopetrosis
Bone marrow transplant (curative)
252
What do defective osteoclasts in osteopetrosis cause
Overgrowth and sclerosis of cortical bone
253
Cause of pancytopenia in osteopetrosis
Bone fills marrow space
254
Neurological complications of osteopetrosis
Cranial nerve impingement and palsies
255
Cause of cranial nerve impingement and palsies in osteopetrosis
Narrowed foramina
256
Enzyme defective in osteopetrosis
Carbonic anhydrase II
257
How are osteoclasts impaired in osteopetrosis
Cannot generate acidic environment necessary for bone resorption
258
Vitamin D deficiency in adults causes what disease
Osteomalacia
259
Vitamin D deficiency in children causes what disease
Rickets
260
Defective mineralization of osteoid or cartilaginous growth plates
Osteomalacia - kids
| Rickets - adults
261
Common lab findings in osteomalacia/rickets
Low vitamin D, calcium, and phosphorus
| High PTH and ALP
262
Common findings in osteomalacia
Osteopenia and pseudofractures
263
Epiphyseal widening, metaphyseal cupping/fraying, genu varum, bead-like costochondral junctions, and craniotabes
Common findings in rickets
264
Cells involved in lytic stage of Paget disease
Osteoclasts
265
Lab findings in Paget disease
High ALP
| Normal serum calcium, phosphorus, and PTH levels
266
Treatment for Paget disease of bone
Bisphosphonates (-dronates)
267
Paget disease increases risk of what complication
Osteogenic sarcoma
268
Mosaic pattern of woven and lamellar bone with long chalk-stick fractures is seen in what disease
Paget disease of the bone
269
Cells involved in Quiescent stage of Paget disease
Minimal osteoclast/osteoblast activity
270
Cells involved in Sclerotic state of Paget disease
Osteoblasts
271
Cells involved in Mixed stage of Paget disease
Osteoblasts + Osteoclasts
272
Cardiovascular complication in Paget disease
High-output heart failure from increased blood flow from increased AV shunts
273
Most common site of osteonecrosis
Femoral head
274
Cause of avascular necrosis to femoral head
Insufficiency of medial circumflex femoral artery
275
Caisson or decompression sickness is a risk factor for what
Avascular necrosis
276
Lab values in osteopetrosis
High serum calcium
| Normal phosphorous, ALP, PTH
277
Brown tumors due to fibrous replacement of bone, subperiosteal thinning indicate what disease
Osteitis fibrosa cystica
278
Lab values in primary hyperparathyroidism
High serum calcium, ALP, PTH
| Low phosphorus
279
Lab values in secondary hyperparathyroidism
Low serum calcium
| High phosphorus, ALP, PTH
280
Common cause of primary hyperparathyroidism
Idiopathic, parathyroid hyperplasia, adenoma, carcinoma
281
Common cause of secondary hyperparathyroidism
CKD (low phosphorus excretion and production of activated vitamin D)
282
Lab values in hypervitaminosis D
High calcium, phosphorus
| Low PTH
283
Most common benign bone tumor
Osteochondroma
284
Bony exostosis with cartilaginous cap on metaphysis of long bone in young male < 25 years
Osteochondroma
285
Locally aggressive benign bone tumor with soap bubble appearance on x-ray
Giant cell tumor
286
Common location of giant cell tumor
Epiphysis of long bones (near knee)
287
Bone tumor that arises mostly at distal femur and proximal tibia that has cells expressing RANKL
Giant cell tumor
288
One of the most common malignant bone tumors
Osteosarcoma
289
Common location of osteosarcoma
Metaphysis of long bones near knee
290
Treatment for osteosarcoma
Surgical en bloc resection and chemotherapy
291
Bone tumor with bimodal distribution and Codman triangle or sunburst pattern on x-ray
Osteosarcoma
292
Bone tumor common in boys < 15 years that appears in diaphysis of long bones with anaplastic small blue cells on biopsy
Ewing sarcoma
293
Translocation associated with Ewing sarcoma
t(11;22) causing fusion protein EWS-FLI-1
294
Bone tumor with onion skin periosteal bone reaction that is extremely aggressive with early metastases, but responsive to chemotherapy
Ewing sarcoma
295
Bone tumor derived from neuroectoderm and onion skin appearance on diaphysis of long bone
Ewing sarcoma
296
Benign cartilage tumor of small bones of hands and feet
Chondroma
297
Malignant cartilage tumor in pelvis or central skeleton
Chondrosarcoma
298
Common cause of osteoarthritis
Mechanical wear and tear of articular cartilage
299
Cells that mediate degradation and inadequate repair in osteoarthritis
Chondrocytes
300
Treatment for osteoarthritis
Acetaminophen, NSAID, intra-articular glucocorticoids
301
Joint disease that presents with pain, swelling, and morning stiffness lasting > 1 hour, improving with use
Rheumatoid arthritis (RA)
302
Common cause of RA
Pannus formation which erodes articular cartilage and bone
303
Risk factors for RA
Female, HLA-DR4, smoking, silica exposure
304
Treatment for RA
NSAIDs, glucocorticoids, disease modifying agents, biologic agents
305
Biologic agents used for treatment of RA
TNF-alpha inhibitors
306
Disease modifying agents used for treatment of RA
Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide
307
RA involves which joints of the hand
MCP, PIP and wrist
308
Joint findings in osteoarthritis (OA)
Osteophytes, joint space narrowing, subchondral sclerosis, and cysts
309
Joint disease that presents with pain in weight-bearing joints after use and improving with rest
OA
310
Joint disease that presents with symmetric joint involvement, systemic symptoms and extra-articular manifestation
RA
311
Synovial fluid findings in RA
Inflammatory with neutrophils and protein
312
Cervical subluxation, ulnar finger deviation, swan neck, and boutonniere are common findings in which joint disease
RA
313
Joint disease that presents knee cartilage loss beginning medially, asymmetric joint involvement with no systemic symptoms
OA
314
Synovial fluid findings in OA
Non-inflammatory with WBC count < 2000
315
Wrist joints affected in OA
DIP, PIP, 1st CMC
316
What is positive rheumatoid factor
IgM antibody that targets IgG Fc region
317
What test is more specific for RA
Anti-citrullinated peptide antibody
318
Monosodium crystals causing acute inflammatory monoarthritis
Gout
319
Medications that exacerbate uric acid
Thiazide diuretics
320
Lab findings in gout
Needle-shaped crystals, appear yellow under parallel light and blue under perpendicular light
321
Acute treatment for gout
NSAIDs, glucocorticoids, colchicine
322
Chronic treatment for gout
Xanthine oxidase inhibitors
323
Xanthine oxidase inhibitors
Allopurinol, febuxostate
324
Conditions associated with gout
Lesch-Nyhan syndrome, von Gierke disease, PRPP excess, tumor lysis syndrome
325
Condition with rhomboid, weakly positive birefringent under polarized light crystals
Calcium pyrophosphate deposition disease
326
Acute treatment for Calcium pyrophosphate deposition disease
NSAIDs, colchicine, glucocorticoids
327
Prophylaxis for Calcium pyrophosphate deposition disease
Colchicine
328
Autoimmune destruction characterized by destruction of exocrine glands by lymphocytic infiltrate
Sjogren's syndrome
329
Complications associated with Sjogren's syndrome
Dental caries, MALT lymphoma, parotid enlargement
330
Confirmation of Sjogren's syndrome
Labial salivary gland biopsy
331
Antiribonucleotide antibodies associated with Sjogren's syndrome
Anti-Ro and Anti-La
332
Inflammatory joint pain with decreased tear production and presence of antinuclear antibodies (ANA) indicates what disease
Sjogren's syndrome
333
Common causes of septic arthritis
S. aureus, Streptococcus and N gonorrhoeae
334
Synovial fluid findings in septic arthritis
Purulent synovial fluid with WBC count > 50,000
335
Triad of polyarthralgia, tenosynovitis, and dermatitis indicate what?
Gonococcal arthritis
336
Cause of septic arthritis in older adults and children
Staph aureus
337
Cause of septic arthritis in sexually young adults
N. gonorrhoeae
338
Treatment for gonococcal arthritis
Ceftriaxone plus azithromycin for possible chlamydial infection
339
Xerostomia
Decreased salivary production seen in Sjogren's syndrome
340
Disease more common in males with bamboo spine on x-ray with involvement of sacroiliac joints
Ankylosing spondylitis
341
HLA molecule is associated with seronegative spondyloarthritis
HLA-B27
342
Disease characterized by conjunctivitis, urethritis, and arthritis
Reactive arthritis
343
Common causes of reactive arthritis
Shigella, Yersinia, Chlamydia, Campylobacter, Salmonella
344
HLA-B27 associated seronegative spondyloarthritis that presents with uveitis, aortic regurgitation and ankylosis
Ankylosing spondylitis
345
Associated with asymmetric and patchy skin psoriasis and lesions with "pencil-in-cup" deformity on x-ray
Psoriatic arthritis
346
Respiratory complication of ankylosing spondylitis
Restrictive lung disease
347
Diseases characterized by morning stiffness that improves with exercise, strong association with HLA-B27 and presents with dactylitis and uveitis
Seronegative spondyloarthritis
348
Common cause of death in SLE
Cardiovascular disease, renal disease, infections
349
SLE antibody that is specific with poor prognosis
Anti-dsDNA antibody
350
Antibodies sensitive for drug-induced SLE
Anti-histone antibodies
351
Complement that is deficient in Lupus nephritis
C3, C4
352
Glomerular deposits seen on EM in lupus nephritis
Subendothelial with IgG and sometimes C3
353
Light microscopy findings in lupus nephritis
Wire-looping of glomerular capillaries
354
Immunofluorescent findings in lupus nephritis
Granular appearance
355
Antibodies that are sensitive but not specific for SLE
Antinuclear antibodies (ANA)
356
Treatment for SLE
NSAIDs, steroids, immunosuppressants, hydroxychloroquine
357
Drugs commonly associated with drug-induced SLE
Hydralazine and procainamide
358
Nonbacterial verrucous thrombi on underside of mitral or aortic valve are indications of what disease
Libman-Sacks Endocarditis
359
Populations commonly affected by SLE
African-American women of reproductive age
360
Common presentation of SLE
Malar rash, joint pain, and fever
361
Women positive for ANA and lupus anticoagulant is at risk for what complication
Spontaneous abortion
362
Diagnosis of patient with history of thrombosis and anticardiolipin with prolonged PTT
Antiphospholipid syndrome
363
Treatment for antiphospholipid syndrome
Hydroxychloroquine with SLE and Warfarin plus ASA; possible Rituximab
364
Disease associated with anti-U1 RNP antibodies with features of SLE and/or polymyositis
Mixed connective tissue disease
365
Disease associated with anti-beta2 glycoprotein and prolonged PTT not corrected by addition of normal platelet-free plasma
Antiphospholipid syndrome
366
Disease characterized by immune-mediated, non-caseating granulomas, elevate ACE levels and CD4+/CD8+ ratio on bronchoalveolar lavage
Sarcoidosis
367
Sarcoidosis is more common in what population
African-American women
368
Chest x-ray findings in sarcoidosis
Bilateral adenopathy and coarse reticular opacities with hilar and mediastinal adenopathy
369
Cause of hypercalcemia in sarcoidosis
Increased 1-alpha-hydroxlase-mediated vitamin D activation of macrophages
370
Disease with epithelioid granulomas containing Schaumann and steroid bodies in African-American female
Sarcoidosis
371
Treatment for sarcoidosis
Steroids if symptomatic
372
Disease associated with giant cell arteritis with increased ESR, CRP, normal CK and does not cause muscle weakness
Polymyalgia rheumatica
373
What age group is more commonly affected with Polymyalgia rheumatica
Women over 50 years
374
What vasculitides is associated with Polymyalgia rheumatica
Giant temporal arteritis
375
Treatment for polymyalgia rheumatica
Low-dose corticosteroids
376
Disease that typically presents with pain and stiffness in shoulders and hips, often with malaise, fever, and weight loss in postmenopausal women
Polymyalgia rheumatica
377
Disease most commonly seen in premenopausal women associated with paresthesias, poor sleep, non-specific pain and cognitive disturbance
Fibromyalgia
378
Treatment for fibromyalgia
Regular exercise, antidepressants and anticonvulsants
379
Disease characterized by endomyseal inflammation with CD8+ T cells, with progressive proximal muscle weakness of the shoulders
Polymyositis
380
Disease with malar rash, Gottron's papules, heliotrope rash, shawl and face rash, mechanic's hands with increased risk of occult malignancy
Dermatomyositis
381
Dermatomyositis is associated with what type of T-cells and inflammation
Perimysial inflammation and atrophy with CD4+ T-Cells
382
Lab findings associated with polymyositis and dermatomyositis
Increased CK, positive ANA, anti-Jo-1, anti-SRP, and anti-Mi-2 antibodies
383
Treatment for polymyositis and dermatomyositis
Steroids plus methotrexate
384
Most common NMJ disorder
Myasthenia gravis
385
Pathophysiology of Myasthenia gravis
Autoantibodies to postsynaptic ACh receptors
386
Diseases associated with myasthenia gravis
Thymoma and thymic hyperplasia
387
Diagnosis of myasthenia gravis
Edrophonium
388
Presentation of myasthenia gravis
Ptosis, diplopia, weakness that worsens with muscle use
389
Treatment for myasthenia gravis
Pyridostigmine
390
Pathophysiology of Lambert-Eaton syndrome
Autoantibodies to presynaptic calcium channels decreasing ACh release
391
Presentation of Lambert-Eaton syndrome
Proximal muscle weakness, dry mouth, impotence that improves with muscle use
392
Disease associated with Lambert-Eaton syndrome
Small cell lung cancer
393
Primary disease with decreased blood flow to skin due to arteriolar vasospasms in response to cold or stress
Raynaud disease
394
Treatment for Raynaud syndrome
Calcium channel blockers
395
CREST syndrome is characterized by what?
Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias
396
Raynaud's syndrome is associated with what diseases?
SLE, CREST syndrome, or mixed connective tissue disease
397
Limited form of systemic sclerosis
CREST syndrome
398
Disease with triad of autoimmunity, non-inflammatory vasculopathy, and collagen deposition with fibrosis
Scleroderma
399
Disease manifesting as puffy, taut skin without wrinkles, fingertip pitting with limited skin involvement and CREST syndrome
Limited scleroderma
400
Disease manifesting as puffy, taut skin without wrinkles, fingertip pitting with widespread skin involvement and associated with anti-Scl-70 antibody
Diffuse scleroderma
401
Three layers of skin
Epidermis, dermis, subcutaneous fat
402
How many layers does the epidermis have
5 layers
403
What are the 5 layers of epidermis
Corneum, Lucidum, Granulosum, Spinosum, Basale
404
Epithelial junction that prevents paracellular movement of solutes and composed of claudins and occludens
Tight junctions
405
Tight junctions are located above what?
Adherens junctions
406
Zona occludens
Tight junction
407
Adherens junction
Belt desmosome or zona adherens
408
Epithelial junction below tight junction, forms a belt connecting actin cytoskeletons of adjacent cells with cadherins
Adherens junctions
409
Loss of which adhesion molecule promotes metastasis
E-cadherins
410
Pemphigus vulgaris has autoantibodies to which epithelial junction
Desmosomes
411
Channel proteins that permit electrical and chemical communication between cells
Gap junction
412
Membrane proteins that maintain integrity of basolateral membrane by binding to collagen and laminin in basement membrane
Integrins
413
Epithelial junction that provides structural support via intermediate filament interactions
Desmosomes
414
Bullous pemphigoid has autoantibodies to which membrane protein
Hemidesmosomes
415
Stem cells are located in what layer of the epidermis
Stratum basale
416
Which epidermis layer has cells with no nucleus or organelles
Corneum (keratin)
417
Flat lesion with well-circumscribed change in skin color < 1 cm
Macule
418
Freckle is what type of lesion
Macule
419
Macule > 1 cme
Patch
420
Elevated solid skin lesion < 1 cm
Papule
421
Papule > 1 cm
Plaque
422
Small fluid-containing blister < 1 cm
Vesicle
423
Large fluid-containing blister > 1 cm
Bulla
424
Vesicle containing pus
Pus
425
Transient smooth papule or plaque
Wheal
426
Flaking off of stratum corneum
Scale
427
Dry exudate
Crust
428
Increased thickness of stratum corneum
Hyperkeratosis
429
Hyperkeratosis with retention of nuclei in stratum corneum
Parakeratosis
430
Increased thickness of stratum granulosum
Hypergranulosis
431
Epidermal accumulation of edematous fluid in intercellular spaces
Spongiosis
432
Separation of epidermal cells
Acantholysis
433
Epidermal hyperplasia (increased spinosum)
Acanthosis
434
Normal melanocyte number with decreased melanin production
Albinism
435
Risk increased in albinism
Skin cancer
436
Mechanism of albinism
Decreased tyrosine activity or defective tyrosine transport
437
Hyperpigmentation associated with pregnancy or OCP use
Melasma
438
Irregular areas of complete depigmentation
Vitiligo
439
Cause of vitiligo
Destruction of melanocytes
440
Structure consisting of hair, hair follicle, arrector pili muscle, and sebaceous gland
Pilosebaceous unit
441
Bacteria that causes acne
P. acnes
442
Causes of acne
Increased sebum/androgen production, abnormal keratinocyte desquamation and P. acnes
443
Treatment for acne
Retinoids, benzoyl peroxide, antibiotics
444
Pruritic eruption commonly on skin flexures associated with atopic diseases
Eczema
445
Ig associated with eczema
IgE
446
Site of eczema in infants
Face
447
Site of eczema in children and adults
Antecubital fossa
448
Type IV hypersensitivity reaction that usually follows exposure to allergen
Allergic contact dermatitis
449
Cells involved in direct cell cytotoxicity
CD8+ T-cells
450
Cells involved in delayed-type hypersensitivity
CD4+ T-cells
451
Melanocyte nevus that is a flat macule
Junctional nevus
452
Melanocyte nevus that is papular
Intradermal nevi
453
Common mole that is benign but melanoma can arise in congenital or atypical moles
Melanocyte nevus
454
Melanocyte nevus common in kids
Junctional nevus
455
Foreign body inflammatory facial skin disorder characterized by firm, hyperpigmented papules and pustules that are pruritic and painful common in African-Americans
Pseudofolliculitis barbae
456
Bacteria associated with pseudofolliculitis barbae
Staph and Strep
457
Treatment for pseudofolliculitis barbae
Mupirocin and warm compresses
458
Papules and plaques with silvery scaling on knees and elbows
Psoriasis
459
Pinpoint bleeding spots from exposure of dermal papillae when psoriatic scales are scraped off
Auspitz sign
460
Collection of neutrophils in stratum corneum seen in psoriasis
Munro microabscesses
461
Inflammatory facial skin disorder characterized by erythematous papules and pustules, no comedomes and bullous deformation of nose
Rosacea
462
Common benign neoplasm in older persons with "stuck on" appearance
Seborrheic keratosis
463
Sudden appearance of multiple stuck on lesions should raise concern for what underlying disease
Malignancy of GI or lymphoid
464
Sudden appearance multiple seborrheic keratoses
Lese-Trelat sign
465
Warts on genitals
Condyloma acuminatum
466
Common cause of Condyloma acuminata
HPV 6 or 11
467
Soft, tan colored, cauliflower-like papules with epidermal hyperplasia, hyperkeratosis, and koilocytosis
Verrucae
468
Pruritic wheals that form after mast cell degranulation
Urticaria
469
Rare blood vessel malignancy in head, neck, and breasts common in elderly on sun-exposed areas
Angiosarcoma
470
Chemical exposure associated with hepatic angiosarcoma
Vinyl chloride and arsenic
471
Benign capillary skin papules found in AIDS patients caused by Bartonella infections
Bacillary angiomatosis
472
Skin papule with neutrophilic infiltrate commonly mistaken for Kaposi sarcoma in AIDS patients
Bacillary angiomatosis
473
Benign capillary skin papule in elderly that increases with age and does not regress
Cherry hemangioma
474
Cavernous lymphangioma of the neck associated with Turner syndrome
Cystic hygroma
475
Benign, painful, red-blue tumor under nails from smooth muscle cells of glomus body
Glomus tumor
476
Endothelial malignancy associated with HHV-8 and HIV with lymphocytic infiltrate
Kaposi sarcoma
477
Polypoid lobulated capillary hemangioma that can ulcerate and bleed associated with trauma and pregnancy
Pyogenic granuloma
478
Benign capillary hemangioma of infancy appearing in first few weeks of life, grows rapidly and regresses by 5-8 years old
Strawberry hemangioma
479
Honey-colored superficial skin infection associated with Staph or Strep that is high contagious
Impetigo
480
Bacteria that causes bullous impetigo
Staph aureus
481
Superficial infection of the upper dermis and superficial lymphatics that presents with well-defined demarcation between infected and normal skin
Erysipelas
482
Bacteria that causes erysipelas
Strep pyogenes
483
Acute, painful, spreading infection of deeper dermis and subcutaneous tissue that starts with a break in the skin or another infection
Cellulitis
484
Bacteria that causes cellulitis
Strep pyogenes or Staph aureus
485
Collection of pus from a walled-off infection within deeper layers of skin
Abscess
486
Bacteria that mostly causes abscesses
Staph aureus
487
Deeper tissue infection with pain out of proportion with crepitus causing bullae and purplish skin color
Necrotizing fasciitis
488
Cause of crepitus in necrotizing fasciitis
Methane and CO2 production
489
Bacteria that causes necrotizing fasciitis
Strep pyogenes
490
Skin infection that destroys keratinocyte attachments in stratum granulosum only and characterized by fever, erythematous rash with positive Nikolsky sign
Scalded Skin Syndrome (SSS)
491
Cause of SSS
Staphylococcus exfoliative toxin
492
Umbilicated papules caused by poxvirus frequently seen in children and may be sexually transmitted in adults
Molluscum contagiosum
493
Presents with multiple crops of lesions in varying stages from vesicles to crusts
Varicella virus
494
Presents as rash in dermatomal distribution
Zoster virus
495
Irregular, white, painless plaque on lateral tongue that cannot be scraped off, is EBV mediated and is common in HIV patients and organ transplant recipients
Hairy leukoplakia
496
Scrapable white plaque on tongue associated with HIV patients
Oral thrush
497
Component of desmosomes which connect keratinocytes in the stratum spinosum
Desmoglein
498
Antibody that targets desmoglein
IgG antibody
499
Potentially autoimmune skin disorder with IgG antibody against desmoglein
Pemphigus vulgaris
500
Hypersensitivity reaction in pemphigus vulgaris
Type II
501
What do keratinocytes resemble in pemphigus vulgaris
Row of tombstones
502
What does IF reveal in pemphigus vulgaris
Antibodies around epidermal cells in a net-like pattern
503
Pemphigus vulgaris is positive for what sign
Nikolsky sign
504
Target of IgG antibody in bullous pemphigoid
Hemidesmosomes
505
Description of blisters in bullous pemphigoid
Tense blisters with neutrophils that spare oral mucosa
506
What does IF show in bullous pemphigoid
Linear pattern at dermal-epidermal junction
507
Description of blisters in pemphigus vulgaris
Flaccid intraepidermal bullae caused by acantholysis involving skin and oral mucosa
508
Pruritic papules, vesicles, and bullae around elbows and associated with celiac disease
Dermatitis herpetiformis
509
Treatment for dermatitis herpetiformis
Dapsone and gluten-free diet
510
What antibodies are deposited at tips of dermal papillae in dermatitis herpetiformis
IgA antibodies
511
Presents with macules, papules, vesicles, target lesions with necrotic center associated with drug reactions and infections
Erythema multiforme
512
Associated with severe drug reactions characterized by fever, bullae formation, necrosis and targetoid skin lesions with sloughing of skin
Steven-Johnson syndrome (SJS)
513
More severe form of SJS with > 30% of body surface involvement
SJS-TEN
514
Epidermal hyperplasia with skin thickening and hyperpigmentation in axilla or neck associated with insulin resistance and visceral malignancy
Acanthosis nigricans
515
Premalignant skin lesion caused by sun exposure with increased risk of squamous cell carcinoma
Actinic keratosis
516
Painful, raised inflammatory lesions usually on shins associated with sarcoidosis, cocci, histo, TB, strep infections, leprosy and IBD
Erythema nodosum
517
Pruritic, Purple, Polygonal, Planar Papules and Plaques with Wickham striae and hypergranulosis
Lichen planus
518
Skin disorder with saw-tooth infiltrate of lymphocytes at dermal-epidermal junction associated with hepatitis C with mucosal involvement showing reticular white lines
Lichen planus
519
Skin disease with "Herald" patch followed by other scaly erythematous plaques in "Christmas tree" pattern
Pityriasis rosea
520
UV light that is dominant in sunburns
UVB light
521
UV light that is dominant in tanning beds
UVA light
522
UV light that is dominant in photoaging
UVA light
523
Exposure to UVA and UVB light increases risk of what?
Basal cell carcinoma, squamous cell carcinoma, and melanoma
524
Most common skin cancer
Basal cell carcinoma
525
Second most common skin cancer
Squamous cell carcinoma
526
S-100 positive tumor with significant risk of metastasis
Melanoma
527
Tumor that appears as non-healing ulcer with infiltrating growth or a scaling plaque and "palisading" nuclei
Basal cell carcinoma
528
Common location of BCC
Face and upper lip
529
What conditions increased risk of BCC
Albinism and Xeroderma pigmentosum
530
Skin cancer with waxy, pink, pearly nodules commonly with telangiectasias, rolled borders and central crusting or ulceration
BCC
531
Common location of SCC
Face, lower lip, ears and hands
532
Locally invasive skin cancer that rarely metastasizes
BCC
533
Skin cancer with ulcerative red lesions with frequent scales and keratin "pearls"
SCC
534
Scaly plaque that is a precursor to SCC
Actinic keratosis
535
Variant of SCC that grows rapidly and may regress spontaneously over months
Keratoacanthoma
536
Skin cancer associated with excessive sun exposure, immunosuppression, chronically draining sinuses, and arsenic exposure
SCC
537
Skin cancer associated with sun exposure, dysplastic nevi with increased risk in fair-skinned persons
Melanoma
538
Mutation that drives melanoma
BRAF kinase mutation
539
Patients with melanoma who benefit from vemurafenib have what type of mutation
BRAF V600E mutation
540
Mechanism of vemurafenib
BRAF kinase inhibitor
541
Primary treatment of melanoma
Excision with appropriately wide margins
542
Types of melanoma
Superficial spreading, Nodular, Lentigo maligna, and Acral lentiginous
543
What characteristic of melanoma correlates with risk of metastasis
Depth of tumor (Breslow thickness)
