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EBSE > MSK > Flashcards

MSK Flashcards

1
Q

epidermis layers (external to internal)

A 
corneum
lucidum
granulosum
spinosum
basale
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2
Q

tight jxn proteins

A

claudin and occludin

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3
Q

adherent jxn protein

A

cadherins

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4
Q

unhappy triad knee injury

A

tear of ACL, MCL, and meniscus (medial classically, but lateral more common)

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5
Q

landmarks for pudendal nerve block and lumbar puncture (separate)

A

pudendal block - ischial spine

LP - iliac crest

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6
Q

MC rotator cuff injury

A

supraspinatus

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7
Q

which rotator cuff muscle is injured in a pitching injury

A

infraspinatus

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8
Q

spinal level for innervation of rotator cuff muscles

A

C5-6

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9
Q

wrist bones

A

scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate

Some Lovers Try Positions That They Can’t Handle

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10
Q

which wrist bone is most prone to avascular necrosis?

A

scaphoid

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11
Q

which wrist bone has tendency to get dislocated and cause acute carpal tunnel syndrome?

A

lunate

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12
Q

Erb’s and Klumpke’s - where are the lesions

A

Erb - upper trunk (C5,6)

Klumpke - lower trunk (C8, T1)

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13
Q

winged scapula caused by lesion of what nerve? what muscle is affected?

A

long thoracic nerve

serratus anterior

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14
Q

radial nerve innervates (motor)

A

brachioradialis, extensors of wrist and fingers, supinator, triceps

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15
Q

lesion of median nerve causes what sign

A

papal benediction

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16
Q

muscles innervated by musculocutaneous nerve

A

biceps, brachialis, coracobrachialis

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17
Q

obturator nerve does what motor fn?

A

thigh adduction

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18
Q

femoral nerve motor fn

A

thigh flexion and leg extension

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19
Q

lesion of common peroneal nerve causes what motor deficit

A

foot drop and steppage gait

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20
Q

trendelenburg sign is from what nerve lesion?

A

superior gluteal

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21
Q

what does Ca do in muscle contraction?

A

binds to troponin C > conformational change that moves tropomyosin out of myosin binding groove on actin filaments

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22
Q

what corresponds with the power stroke in muscle contraction?

A

myosin release of ADP

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23
Q

type 1 vs type 2 muscle fibers

A

1 - slow twitch, red fibers

2 - fast twitch, white fibers

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24
Q

estrogen action on bone

A

inhibits apoptosis of osteoblasts / induces apoptosis in osteoclasts

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25
Q

type 1 vs 2 osteoporosis

A

1 - postmenopausal (dec estrogen)

2 - senile (>70)

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26
Q

osteopetrosis

A

inadequate osteoclast activity (can’t make env acidic enough) > thickened dense bones prone to fracture
drive bone marrow out > pancytopenia and extramedullary hematopoiesis
BMT potentially curative since osteoclasts are monocyte derivs

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27
Q

what are the bones like in osteomalacia/rickets?

A

soft, bow outwards

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28
Q

what is the cause of osteomalacia/rickets?

A

vit D def

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29
Q

Paget’s disease

A

inc remodeling of bone (osteoblast and clast activity inc). woven bone > more prone to fracture. inc alk phos and risk of osteogenic sarcoma

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30
Q

polyostotic fibrous dysplasia

A

bone replaced by fibroblasts, collagen, and irreg bony trabeculae

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31
Q

McCune Albright syndrome

A

polyostotic fibrous dysplasia + endocrine abnlmalities (precocious puberty) + cafe au lait spots

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32
Q

giant cell tumor (osteoclastoma)

A

20-40 yo
locally aggressive benign tumor, usually in distal femur/prox tibia
spindle shaped cells w/ multinucleated giant cells

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33
Q

“double bubble” or “soap bubble” appearance on x ray

A

giant cell tumor (osteoclastoma)

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34
Q

MC benign primary tumor of bone

A

osteochondroma

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35
Q

who does osteochondroma usually affect?

A

males <25 yo

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36
Q

2 MC primary malignant bone tumors

A

1 - multiple myeloma

2 - osteosarcoma

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37
Q

who tends to get osteosarcoma and where in their body?

A

male > female, 10-20 yo

knee

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38
Q

Codman’s triangle or sunburst pattern on xray

A

osteosarcoma

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39
Q

who gets Ewing’s sarcoma and where?

A

boys <15 yo

diaphysis of long bones, pelvis, scapula, ribs

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40
Q

properties of Ewing’s sarcoma

A

anaplastic small blue cell malignant tumor

very aggressive, but responsive to chemo

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41
Q

“onion skin” appearance in bone

A

Ewing sarcoma

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42
Q

translocation of Ewing Sarcoma

A

t(11;22)

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43
Q

who gets chondrosarcomas?

A

men 30-60 yo

44
Q

joint findings in osteoarthritis

A

subchondral cysts, sclerosis, osteophytes, eburnation (polished appearance), Heberden’s and Bouchard’s nodes (DIP and PIP). NO MCP involvement

45
Q

what type hypersensitivity is RA?

A

3

46
Q

joint findings in RA

A

pannus formation (fluffiness), subq rheumatoid nodules, ulnar deviation in fingers, Baker’s cyst. NO DIP involvement

47
Q

blood markers for RA

A

rheumatoid factor, anti-cyclic citrullinated peptide is more specific

48
Q

Sjogren’s syndrome - cause, sx, who gets it

A

lymphocytic infiltration of exocrine glands
triad of xerophthalmia, xerostoma, arthritis
females 40-60 yo

49
Q

antibodies involved in Sjogren’s syndrome

A

anti-SS-A and SS-B

50
Q

what do gout crystal look like under microscope?

A

needle shaped

negatively birefringent - yellow crystals under parallel light

51
Q

allopurinol drug class

A

xanthine oxidase inhibitors

52
Q

pseudogout - what precipitates and what do the crystals look like

A

calcium pyrophosphate

rhomboid crystals, weakly pos birefringent, blue when parallel to light

53
Q

causes of avascular necrosis

A

trauma, high dose corticosteroids, alcoholism, sickle cell

54
Q

what is meant by “seronegative spondyloarthropathies”?

A

arthritis w/o rheumatoid factor

55
Q

dactylitis with “pencil in cup” deformity on xray

A

psoriatic arthritis

56
Q

reactive arthritis (Reiter’s) - triad of sx, what infxns does it occur after

A

“can’t see, can’t pee, cant climb a tree” - conjunctivitis, urethritis, arthritis
after GI or chlamydia infxns

57
Q

Libman Sacks endocarditis

A

assoc w/ SLE

verrucous sterile vegetations on both sides of valve

58
Q

antibodies assoc w/ SLE and which are useful for what?

A

ANA - sensitive but not specific
anti-dsDNA - very specific, poor prognosis
anti-Smith - very specific, but not prognostic
anti-histone - more sensitive for drug induced lupus

59
Q

2 hallmarks of sarcoidosis

A

noncaseating granulomas all over

elevated serum ACE levels

60
Q

how does sarcoidosis often present?

A

asymptomatic w/ bilat hilar LAN

61
Q

polymyalgia rheumatica

A

pain and stiffness in shoulder and hips, fever, malaise, wt loss. older women. assoc w/ giant cell (temporal) arteritis
responds well to low dose steroids

62
Q

type of inflammatory cells involved in polymyositis vs dermatomyositis

A

polymyo - CD8 T cells

dermatomyo - CD4 T cells

63
Q

antibody assoc w/ polymyositis and dermatomyositis

A

anti-Jo-1

64
Q

myasthenia gravis assoc w/ what other conditions

A

thymoma / thymic hyperplasia

65
Q

differences in pathophys and clinical features of myasthenia gravis vs lambert eaton syndrome

A

MG - ab to post synaptic ACh receptor, weakness worsens w/ muscle use
lambert eaton - ab to presynaptic Ca channel > less ACh released. improves w/ muscle use

66
Q

myositis ossificans

A

metaplasia of skeletal muscle to bone following trauma

67
Q

general path process of scleroderma

A

excessive fibrosis and collagen deposition throughout body

68
Q

diffuse scleroderma vs CREST syndrome - assoc abs

A

diffuse - anti-Scl-70 (anti DNA topoisomerase I)

CREST - anti-centromere

69
Q

CREST syndrome - presentation/course

A 
type of scleroderma with more benign, limited course
Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
70
Q

macule vs papule

A

macule is flat, papule is elevated

71
Q

acanthosis definition

A

epidermal hyperplasia (inc spinosum)

72
Q

melasma

A

hyperpigmentation (usu on face) assoc w/ pregnancy and OCP use

73
Q

ephelis is

A

a freckle

74
Q

where does atopic dermatitis tend to appear?

A

face in infancy and antecubital fossa afterward

skin flexures

75
Q

papules and plaques w/ silvery scaling

A

psoriasis

76
Q

Auspitz sign

A

assoc w/ psoriasis

pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off

77
Q

flat, greasy, pigmented squamous epithelial prolif w/ keratin filled cysts that look “stuck on”

A

seborrheic keratosis

78
Q

Leser-Trelat sign

A

sudden appearance of multiple seborrheic keratoses indicating underlying malignancy

79
Q

pemphigus vulgaris - what is wrong, what does it look like

A

anti-desmoglein 3 - attacks desmosomes

acantholysis - intraepidermal bullae causing flaccid blisters. involves oral mucosa too

80
Q

Nikolsky’s sign

A

separation of epidermis on stroking of skin seen in pemphigus vulgaris

81
Q

bullous pemphigoid - what is wrong, what does it look like

A

antibody against hemidesmosomes

eosinophils w/ in tense blisters, spares oral mucosa

82
Q

dermatitis herpetiformis

A

pruritic papules, vesicles, bullae caused by deposits of IgA. assoc w/ celiac dz

83
Q

erythema multiforme

A

multiple types of lesions assoc w/ infections, drugs, cancers and autoimmune disease

84
Q

stevens johnson syndrome - presentation

A

fever, bulla formation, necrosis, sloughing of skin, high mortality rate. lesions may appear like targets

85
Q

toxic epidermal necrolysis

A

more severe form of Stevens Johnson syndrome

86
Q

acanthosis nigricans - what is it assoc w/

A

hyperinsulinemia and visceral malignancy

87
Q

actinic keratosis

A

premalignant lesions from sun

small rough erythematous or brownish papules/plaques

88
Q

what is erythema nodosum assoc w/

A

sarcoidosis, cocci, histo, TB, strep, leprosy, Crohn’s

89
Q

lichen planus - what does it look like, assoc w/

A

pruritic, purple, polygonal planar papules/plaques

Hep C

90
Q

“herald patch” followed by “christmas tree distribution” of plaques. self resolving

A

pityriasis rosea

91
Q

which UV type causes tanning/photoaging and which causes sunburn?

A

A - tanning/photoaging

B - sunBurn

92
Q

2 MC skin cancers

A

1 - basal cell

2 - squamous cell

93
Q

basal cell CA - behavior and appearance

A

locally invasive but almost never metastasizes

pink pearly nodules, rolled borders, central crusting/ulceration, “palisading nuclei”

94
Q

precursor to SCC of skin

A

actinic keratosis

95
Q

appearance of SCC of skin

A

ulcerative red lesions w/ frequent scale. on histo, “keratin pearls”

96
Q

tumor marker for melanoma

A

S-100

97
Q

gene mutation assoc w/ melanoma

A

BRAF kinase (activating mutation)

98
Q

arachidonic acid goes through the ____ pathway to make leukotrienes

A

lipoxygenase

99
Q

effects of leukotrienes

A

LTB4 - neutrophil chemotactic factor

LTC4, D4, E4 - bronchoconstriction, vasoconstriction, contraction of smooth muscle, inc vasc permeability

100
Q

celecoxib - mech, adv/disadv

A

reversible COX2 inhib (unlike NSAIDs which are COX1 and 2). spares gastric mucosa and platelet fn, but inc risk of thrombosis and sulfa allergy

101
Q

acetaminophen is toxic in overdose b/c it depletes _____. antidote is ____

A

glutathione

n-acetylcysteine

102
Q

bisphosphonates - mech and tox

A

bind hydroxyapatite in bone, inhib osteoclast activity

tox - corrosive esophagitis and osteonecrosis of jaw

103
Q

febuxostat

A

another xanthine oxidase inhibitor

104
Q

drugs c/i with allopurinol

A

AZA and 6-MP - increases their conc

salicylates - depress uric acid clearance

105
Q

probenecid

A

inhibits reabs of uric acid in PCT - used for chronic gout

106
Q

colchicine mech

A

inhibits MT polymerization impairing leukocyte chemotaxis and degranulation

107
Q

TNF alpha inhibitors

A

etanercept - soluble receptor

infliximab and adalimumab - monoclonal ab

EBSE (18 decks)

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