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CT/MS Flashcards

1
Q

Crutches–damage which nerve

A

radial nerve

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2
Q

Weakness in forearm, wrist, and finger extensors caused by

A

radial nerve damage (wrist drop)

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3
Q

Cochicine tox

A

GI irritation, agranulocytosis

–inhibits microtubules, affects rapidly growing cells

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4
Q

contraindications to NSAIDs

A

renal failure
peptic ulcer dz
elderly peeps

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5
Q

Ankylosing spondylitis–RF elevated?

A

NO

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6
Q

Sx of ank spon

A
  1. peripheral enthesitis (insertion of tendon to bone)
    - -esp at achilles
  2. Enthesitis of castovertebral junctions–hypoventilation
    - -check chest expansion
  3. aortic regurg
  4. uveitis
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7
Q

First/2nd/3rd line acute therapy for gout

A
  1. ibuprofen
  2. colchicine (if cannot take NSAIDs)
  3. glucocorticoids (if cannot take NSAIDs)
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8
Q

A band in sarcomere

A

same length

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9
Q

H band

A

Only mysoin

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10
Q

I band

A

only actin

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11
Q

How do you stain for muscle cells?

A

Actin, caldesmon, desmin

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12
Q

myasthenia gravis: which part of the NMJ is affected?

A

End motor plate potential decreased. Binding of antibody causes receptor internalization and fewer # of receptors

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13
Q

Perifascicular muscle inflammation

A

dermatomyositis

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14
Q

Anterior should dislocations will hurt which nerve?

A

axillary

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15
Q

What does axillary nerve innervate?

A

deltoid/teres minor with sensory innervation to the skin over the deltoid

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16
Q

Humeral midshaft fracture with swelling and ecchymoses of arm will damage which nerve

A

radial nerve

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17
Q

Describe pathophysiology of muscle repolarization/relaxation

A
  1. L-type calcium channels.
  2. activates (Ryanodine receptors) in junctional SR - Calcium-induced Calcium Release (CICR).
  3. myofibrils to contract.
  4. reuptake of calcium into SR stores
  5. calcium efflux out of the cell via Sodium-Calcium Exchanger (NCX; ~20%) and via sarcolemmal calcium pump (Ca2+-ATPase).
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18
Q

Ryanodine receptors

A

When calcium enters cell through voltage gated Cachannels, ryanodine receptors allow release of calcium from the SR

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19
Q

Calmodulin

A

Activates Ca-ATPase which pumps Ca out of the cell. Also helps to repolarize muscle cell after contraction, although indirectly

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20
Q

typical presentation of reactive arthritis

A

urethritis, conjunctivitis, arthritis of knees, ankles, and feet of young men

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21
Q

achondroplasia

A

impaired cartilage proliferation in the growth plate. Short extremities with normal sized head and chest (dwarfts)
–Problem with endochonral, not membranous bone formation

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22
Q

mutation achondroplasia

A

activating mutation in FGFR3

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23
Q

Inheritance of achondroplasia

A

auto dom

most mutations are sporadic tho

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24
Q

osteogenesis imperfecta defect

A

collagen type I

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25
osteogenesis imperfecta inheritance
autosomal dominant
26
OI presentation
fractures, blue sclera, and hearing loss. (bones of hearing fracture)
27
Why do OI pts have blue sclera?
exposure of the choroidal veins
28
osteopetrosis
abnormally thick heavy bone that fractures. Inherited defect of bone resorption
29
defect in osteopetrosis
carbonic anhydrase II. Creates acidic environment needed to leech Ca from bone
30
presentation of osteopetrosis
anemia, thrombocytopenia, leukopenia (replaces medulla of bone). - -hydrocephalus (bone builds up in skull) with hearing problems - -renal tubular acidosis (carbonic anhyrase deficiency)
31
Tx: osteopetrosis
bone marrow tranplant
32
pidgeon breast deformity, frontal bossing, rachitic rosary, and bowing of legs
Rickets
33
alkaline phosphatase
osteoblast activation. Need alkaline environment to add calcium to bone
34
Lab findings in osteomalacia
Low serum Ca, low phosphate, increased PTH and alkaline phosphatase
35
What protects against weight loss after age 30?
Diet exercise estrogen
36
osteoporosis labs
`NORMAL LABS
37
What is contraindicated in osteoporosis?
Glucocorticoids--these increase bone loss
38
Paget disease of bone-pathophys
osteoclast goes rogue and starts eating up bone unregulated by blasts. Blast compensates by laying down bone improperly as fast as possible. then osteoclast burns out Involves ONLY one or two bones!! not systemic
39
histology of paget's disease
mosaic pattern of lamellar bone. MOSAIC=bone not fused. Haphazard instead of concentric cement lines
40
bone pain, increased hat size, lion-like faces and hearing loss in age 60
paget's disease of the bone
41
lab finding in paget's disease of the bone
elevated alkaline phosphatase. EVERYTHING ELSE (including serum calcium) is normal
42
treatment for paget's
calcitonin and bisphosphonates
43
complications of paget's disease
high output cardiac failure | osteosarcoma
44
osteomyelitis in kids
metaphysis
45
osteomyelitis in adults
epiphysis
46
osteomyelitis in IV drug abuser
pseudomonas
47
osteomyelitis in dog/cat scratch
pasteurella
48
vertebral osteomyelitis
TB
49
osteoma
benign tumor in facial bone. associated with gardner's syndrome
50
osteoid osteoma
benign tumor of osteoblasts in cortex of long bones in young adults
51
bone pain that resolves with aspirin. X ray shows a bony mass with a radiolucent core
osteoid osteoma
52
osteoblastoma vs osteoid osteoma
over 2 cm arises in vertebra bone pane that does NOT respond to aspirin
53
most common benign tumor of bone
osteochondroma sticks out from bone surface, continues from medullary
54
osteosarcoma
proliferation of osteoblasts
55
age of osteosarcoma pts
teenagers and elderly
56
High risk for osteosarcoma in teenagers
familial retinoblastoma
57
High risk for osteosarcoma in elderly
paget's disease of the bone. radiation
58
Where do you usually see osteosarcoma?
metaphysis of long bones, distal femur or proximal tibia
59
X ray finding in osteosarcoma
Codman's angle: raising of periosteum.
60
histology of osteosarcoma
pleomorphic cells producing osteoid
61
soap bubble appearance of bone on X-ray
giant cell tumor
62
epiphyseal tumor
giant cell tumor
63
ewing sarcoma derived from
neuroectoderm
64
ewing grows in
medullary cavity
65
Onion skin appearance on X-ray
ewing sarcoma
66
ewing histology
Small round blue cells with an 11,22 translocation
67
chondroma shows up in
medulla of small bones of hands and feet
68
chondrosarcoma shows up in
medulla of pelvis or central skeleton
69
osteolytic lesions
metastatic tumors. most common
70
prostatic carcinoma in bone
osteoblastic lesion (bone sclerosis)
71
RA associated with
HLA-DR4
72
pannus
granulation tissue in synovium. destroys cartilage and ankylosis (fusion) of joints.
73
complications of RA
anemia of chronic disease | secondary amyloidosis
74
complication of ank spon
aortitis-->aortic regurg
75
sausage finger/toe
psoriatic arthritis
76
Reiter's occurs after
chalmydia infection
77
infectious arthritis
S aureus | gonorrhea
78
Causes of secondary gout
Leukemia Lesch-Nyhan Renal insufficiency
79
negatively birefringent crystals
Yellow when parallel and under polarized light
80
psuedogout
rhomboid shaped crystals with weak positive birefringence
81
dermatomyositis associated with
underlying carcinoma, usually GI
82
malar rash seen in lupus and
dermatomyositis. Will also have gottron lesions and heliotrope rash
83
antibodies in dermatomyositis
Positive ANA and anti-Jo-1. Make sure you don't jump to Lupus! Get Anti-Jo-1 or Anti dsDNA
84
perimysial inflammation and perifascicular atrophy of muscle
dermatomyositis
85
endomysial inflammation with CD8+ cells
polymyositis
86
biopsy of skeletal muscle shows a lot of fat
Duchenne's
87
inheritance of duchenne's
X linked
88
dystrophin
allows cell to links muscle cytoskeleton to ECM
89
calf pseudohypertrophy with proximal muscle weakness
duchennes
90
lab in duchenne's
creatinine kinase elevated
91
cause of death in duchenne's
cardiac respiratory failure
92
Becker
mutation (not deletion) of dystrophin
93
lipoblast
liposarcoma
94
most common malignant soft tissue tumor in children
rhabdomyosarcoma
95
desmin positive tumor
rhabdomyosarcoma
96
site of rhabdomyosarcoma
head and neck. Vag in young girls
97
apocrine gland
milky fluid, axilla, genitalia and areolae
98
sebaceous glands found in
hari follicle. holocrine secretion.
99
tight junction made up of
claudins and occludins
100
adherens junction made of
cadherins.
101
loss of which cadherin causes metastasis?
E cadherin
102
desmosomes made up of
keratin and desmoplakin
103
gap jnction protein
connexons
104
antibodies to desmosomes
pemphigus vulgaris
105
antibodies to hemidesmosomes
bullous pemphigoid
106
integrins
strengthens BM, binds laminin
107
hemidesmosome binds
keratin in basal cell to BM.
108
autoantibodies to hemidesmosome
bullous pemphigoid
109
rotator cuff innervated by
C5/6
110
most common rotator cuff injury
supraspinatus
111
action infraspinatus
laterally rotates arm
112
action teres minor
adducts arm and laterally rotates
113
action subscap
medially rotates and adducts
114
dislocation of lunate
carpal tunnel
115
common wrist fracture
avascular necrosis
116
intramuscular injection
damage to axillary nerve
117
supracondylar fracture of humerus
median nerve damage. Pain with pronation
118
falling and hitting heel of the hand
ulnar nerve damage.
119
medial forearm skin supplied by
T1
120
lateral forearm skin supplied by
C6
121
which nerves travel above flexor retinaculum?
palmar cutaneous branch of median nerve | ulnar nerve
122
innervates thenar muscles
abductor pollicis brevis
123
axillary nerve roots
C5,6
124
Radial nerve roots
C5-T1
125
Muscles radial nerve
``` BEST extensors Brachioradialis Extensors of wrist and fingers Supraspinator Triceps ```
126
wrist drop
radial nerve
127
"ape hand" or pope blessing when asked to make a fist
median nerve damage
128
loss of opposition of thumb, lateral finger flexion and wrist flexion
median nerve
129
medial finger and wrist flexion deficit
ulnar
130
radial deviation of wrist with flexion
ulnar nerve damage
131
median nerve roots
C5-8, T1
132
ulnar nerve roots
C8, T1
133
MC nerve roots
C5-7
134
Upper trunk compression
MC damage
135
cannot flex arm at elbow
MC nerve
136
sensory deficit over lateral forearm
MC damage
137
muscles supplied by MC nerve
biceps, brachialis, coracobrachialis
138
presentation: erb-duchenne
infant with trauma during delivery
139
Erb duchenne damages
C5-C6, axillary and musculocutaneous affected
140
Klumpke's palsy
embryologic defect in C8, T1
141
atrophy of thenar/hypothenar, interosseous, with sensory deficit on medial forearm/hand
klumpke's palsy
142
disappearance of radial pulse when moving head to ipsilateral side
klumpke
143
long thoracic nerve roots
C5-C7
144
ulnar claw=damage to which muscles
medial lumbrical function. Cannot extend digits 4 and 5
145
Median claw
caused by carpal tunnel - loss of lateral lumbricals. 2/3 digit claw when extension - distal median nerve damage
146
pope's blessing
proximal median nerve lesion | -loss of opponens pollicis
147
situation causing long thoracic nerve damage
mastectomy
148
Thenar muscles
opponens pollicis abductor pollicis brevis flexor pollicis brevis
149
Hypothenar muscles
opponens digiti minimi abductor digiti minimi flexor digiti minimi
150
Dorsal interosseous muscles
abduct fingers (DAB)
151
palmar interosseous muscles
adduct fingers (PAD)
152
Peroneal nerve
everts and dorsiflexes
153
tibial nerve
inverts and plantarflexes
154
oBTURATOR INJURY
ANTERIOR HIP DISLOCATION
155
obturator motor deficit
thigh adduction
156
obturator sensory
medial thigh
157
femoral injury
pelvic fracture
158
femoral motor
thigh flexion and leg extension
159
femoral sensory
anterior thigh and medial leg
160
common peroneal injury
fibula neck fracture
161
common peroneal motor
foot eversion and dorsiflexion with foot drop/slap
162
sensory loss in anterolateral leg and dorsal foot
peroneal
163
knee trauma
tibial nerve
164
loss of sense on sole of foot
tibial
165
posterior hip dislocation
superior gluteal nerve or inferior gluteal nerve
166
positive trendelenburg
superior gluteal
167
can't climb stairs, jump, rise from seated position or push downward
inferior gluteal
168
L2-L4
femoral obturator
169
L4-S2
common peroneal
170
L4-S3
tibial
171
L4-S1
superior gluteal
172
L5-S2
Inferior gluteal
173
slow twitch muscle with red fibers
type 1
174
fast twitch muscles with white fibers
type 2 muscle
175
Parathyroid hormone effect low dose vs high dose
low dose: builds bone | high dose: breaks down bone --> osteitis fibrosa cystica
176
How does estrogen affect bone
inhibits apoptosis in blasts | increases apoptosis in clasts
177
Type I osteoperosis
postmenopausal.
178
Fractures in type I osteoporosis
``` femoral neck fracture distal radius (colles' fracture) ```
179
treatment for osteoperosis
pulsatile PTH SERMS calcitonin bisphosphon
180
osteopetrosis labs
low calcium, high ALP
181
osteitis fibrosa cystica labs
high calcium low phosphate high ALP high PTH
182
Osteomalacia labs
low calcium, phosphate | high ALP, PTH
183
Bone replaced by fibroblasts, collagen, and irregular bony trabeculae
polyostotic fibrous dysplasia
184
McCune albright
cafe au lait precocious puberty polyostotic fibrous dysplasia
185
Histol: giant cell tumor
spindle shaped cells with multinucleated giant cells
186
benign tumors of the bone
giant cell tumor and osteochondroma
187
Expansile glistening mass within medullary cavity
chondrosarcoma
188
Codman's triangle (periosteum elevation) and sunburst pattern on x-ray
osteosarcoma
189
Treatment osteosarcoma
surgical resection and chemo
190
disease modifying agents in RA
methotrexate, sulfasalazine, TNF-alpha inhibitors
191
biopsy of sjogren's glands
lymphocytic infiltration
192
sjogren's assoc'd with
RA
193
Sjogren's at risk for
B cell lymphoma
194
Diseases causing gout
Lesch NyHan and von Gierke's disease
195
Why do you get gout after alcohol?
metabolites compete for same excretion sites as kidney
196
pseudogout--men or women?
same. gout affects more men
197
Tx for pseudogout
steroids, NSAIDs, colchicine
198
Causes of avascular necrosis
High dose steroids, alcoholism, sickle cell
199
pencil in cup deformity
psoriatic arthritis
200
Most common cause of death in SLE
nephritis
201
dsDNA
Lupus: specific, poor prognosis
202
anti-smith
Lupus: specific
203
false positive on syphilis tests
SLE--b/c of antiphospholipid antibodies
204
antihistone antibodies
SLE--drug induced
205
Lupus nephritis
diffuse proliferative
206
Lupus nephrotic syndrome
membranous glomerulonephritis
207
levels of what enzyme is high in sarcoidosis
ACE
208
Findings in sarcoidosis
1. bilateral hilar adenopathy 2. restrictive lung disease 3. erythema nodosum 4. bell's palsy 5. granulomas with schaumann and asteroid bodies 6. hypercalcemia
209
Polymyalgia rheumatica associated with
temporal cell arteritis
210
lab findings in PMR
high ESR, normal CK
211
myositis ossificans
metaplasia of muscle to bone after trauma
212
Most likely cause of death in scleroderma
pulmonary fibrosis
213
Scl-70
scleroderma (anti-DNA topoisomerase)
214
anti-centromere antibody
CREST
215
Parakeratosis
hyperkeratosis with retained nuclei in stratum corneum
216
Acanthosis
epidermal hyperplasia
217
acantholysis
separation of epidermal cells (tombstoning in pemphigus vulgaris)
218
Causes of albinism
decreased melanin production from reduced tyrosinase activity OR neural crest cell migration problem
219
melasma
hyperpigmentation with pregnancy
220
melanocyte # in albinism vs vitiligo
albinism: normal melanocyte count vitiligo: decrease in melanocytes
221
papular nevi
intradermal
222
flat nevi
junctional--btw dermis and epidermis
223
Ephelis
freckle. Has normal # melanocytes, more pigment
224
Which layers of skin are abnormal in psoriasis?
Increased stratum spinosum | Decreased stratum granulosum
225
auspitz sign
pinpoint bleeding spots from exposure of dermal papillae when scales are pulled
226
Leser-trelat sign
sudden appearance of multiple seborrheic keratoses which indicate an underlying malignancy
227
positive nikolsky sign
pemphigus vulgaris
228
reticular immunofluorescence
pemphigus vulg
229
IgG to desmoglein 1/3
pemphigus vulg
230
IgG against hemidesmosomes
bullous pemphigoid
231
linear immunofluorescence
bullous pemphigoid
232
eosinophils with tense blisters
bullous pemphigoid
233
pruritic papules, vesicles, and bullae with deposits of IgA at the tips of dermal papillae
dermatitis herpetiformis
234
Dermatitis herpetiformis is associated with
celiac disease
235
fever, bullae, necrosis, sloughing of skin and high mortality rate after giving a drug
Stevens Johnson
236
What causes erythema multiforme?
Infections Drugs Cancers Autoimmune
237
Cause of acanthosis nigracans
visceral malignancy (and hyperinsulinemia)
238
erythema nodosum is caused by
TB Leprosy Crohn's Histoplasmosis Coccidioides Strep Sarcoid
239
collarette scale
pityriasis rosea
240
sawtooth infiltrate of lymphocytes at dermal/epidermal junction
Lichen planus
241
Lichen planus associated with:
hepatitis C
242
UVA vs UVB
UVB=sunburn | UVA=tanning/photoaging
243
Staph scalded skin histology:
Exotoxin destroys kertinocyte attachment in the stratum granulosum
244
Toxic epidermal necrolysis histology
Destroys epidermal-dermal junction cells
245
Gas produced in necrotizing fasciitis
CO2 and methane
246
pink, pearly tumor with telangiectasias and rolled borders
BCC
247
palisading nuclei histology
BCC
248
SCC associated with
arsenic exposure chronic draining sinuses These cancers rarely metastasize
249
keratin pearls
SCC
250
keratoacanthoma
SCC variant that grows rapidly then spontaneously regress
251
Melanoma tumor marker
S-100
252
Treatment for melanoma
excision with appropriately wide margins
253
Risk of metastasis with melanoma
Breslow Depth!
254
Which factors tell you if a nevus could be melanoma?
``` asymmetry border color diameter > 6 Evolution ```
255
how to tx melanoma metastatic in pts with BRAF V600E mutation?
Vemurafenib, a BRAF kinase inhibitor
256
LTC/D/E4
bronchoconstriction vasoconstriction contraction of smooth muscle increased vascular permeability
257
PGI2
inhibits platelet aggregation and promotes vasodilation
258
Prostacyclin effect
``` decreased: platelet aggregation vascular tone bronchial tone uterine tone ```
259
Prostaglandin effects
Increased uterine tone decreased vascular tone Decreased bonchial tone
260
aspirin mechanism
Irreversibly inhibits COX through acetylation, decreasing thromboxane A2 and prostaglandins
261
aspirin overdose
respiratory alkalosis with metabolic acidosis
262
aspirin tox
tinnitus, acute renal failure
263
NSAID tox
interstitial nephritis and renal ischemia (PGs dilate afferent arteriole)
264
COX-1
maintains gastric mucosa | Produces TXA2
265
Indications for bisphosphonates
hypercalcemia | paget's disease of bone
266
tox: bisphosphonates
corrosive esophagitis | osteonecrosis of the jaw
267
Contraindications in gout
salicylates (probenicid). These depress uric acid clearance.
268
other allopurinol uses
extends life of Azathioprine and 6-MP which are metabolized by xanthine oxidase
269
febuxostate
inhibits xanthine oxidase
270
probenicid
Inhibits reabsorption of uric acid in PCT
271
colchicine
binds and stabilizes tubulin to inhibit polymerization and inhibit leukocyte chemotaxis
272
colchicine tox
massive diarrhea
273
Drugs for acute gout
NSAIDs and glucocorticoids
274
Entanercept
Fusion of TNF-alpha receptor and IgG1Fc | --binds up TNA alpha which is then phagocytosed
275
Infliximab/adalimumab
anti-TNF alpha monoclonal antibody
276
TNF-a indications
Crohn's, rheumatoid arthritis, ankylosing spondylitis, psoriasis
277
A young child has his arm pulled and injures:
C8-T1 roots of the brachial plexus - -Damages median and ulnar nerves - -Total hand weakness
278
Sciatic nerve branches
common fibular | tibial
279
superficial fibular nerve
innervates lateral leg, foot eversion
280
deep fibular nerve innervates
anterior compartment of leg: dorsiflexors
281
deep fibular provides sensory to
between first and second toes
282
presentation of damage to common peroneal
foot drop
283
tibial nerve actions
plantar flexion and inversion
284
anterior to medial malleolus
saphenous and great saphenous vein
285
posterior to the medial malleolus
posterior tibial artery tibial nerve tendons of the flexor digitorum longus, flexor hallucis longus, tibialis posterior
286
matrix metalloproteases role in healing
Scar contractures
287
Postitive trendelenberg sign indicates
Weakness of gluteus medius/minimus on the leg which they are standing on. ---these are innervated by superior gluteal nerve
288
Inferior gluteal muscle innervates the
gluteus maximus muscle. Difficulty climbing stairs and rising from seated position
289
inheritance of duchenne's
X linked.
290
calf pseudohypertrophy, replaced by fat
DUCHENNE. Begins with muscle hypertrophy, then changes to fat later on.
291
Acanthosis
Thickening of the stratum spinosum. Think psoriasis
292
dyskeratosis
abnormal permature keratinization. Think squamous cell cancer.
293
hyperparakeratosis
Retention of nuclei in stratum corneum - -actinic keratosis - -normal on mucous membranes
294
Hypergranulosis
lichen planus
295
Synovial fluid of gout vs septic arthritis
WBC<20,000 in gout, over 100K in septic arthritis
296
What gives elastin is elasticity?
cross linking of desmosine. | --Elastin is not hydroxylated and does not form a triple helix like collagen
297
Osteoma arises on
surface of facial bone
298
Osteoma associated with
gardner syndrome
299
osteoid osteoma shows up in what part of the bone
arises in cortex of diaphysis

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