MSK Flashcards
1
Q
epidermis layers (external to internal)
A
corneum lucidum granulosum spinosum basale
2
Q
tight jxn proteins
A
claudin and occludin
3
Q
adherent jxn protein
A
cadherins
4
Q
unhappy triad knee injury
A
tear of ACL, MCL, and meniscus (medial classically, but lateral more common)
5
Q
landmarks for pudendal nerve block and lumbar puncture (separate)
A
pudendal block - ischial spine
LP - iliac crest
6
Q
MC rotator cuff injury
A
supraspinatus
7
Q
which rotator cuff muscle is injured in a pitching injury
A
infraspinatus
8
Q
spinal level for innervation of rotator cuff muscles
A
C5-6
9
Q
wrist bones
A
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
Some Lovers Try Positions That They Can’t Handle
10
Q
which wrist bone is most prone to avascular necrosis?
A
scaphoid
11
Q
which wrist bone has tendency to get dislocated and cause acute carpal tunnel syndrome?
A
lunate
12
Q
Erb’s and Klumpke’s - where are the lesions
A
Erb - upper trunk (C5,6)
Klumpke - lower trunk (C8, T1)
13
Q
winged scapula caused by lesion of what nerve? what muscle is affected?
A
long thoracic nerve
serratus anterior
14
Q
radial nerve innervates (motor)
A
brachioradialis, extensors of wrist and fingers, supinator, triceps
15
Q
lesion of median nerve causes what sign
A
papal benediction
16
Q
muscles innervated by musculocutaneous nerve
A
biceps, brachialis, coracobrachialis
17
Q
obturator nerve does what motor fn?
A
thigh adduction
18
Q
femoral nerve motor fn
A
thigh flexion and leg extension
19
Q
lesion of common peroneal nerve causes what motor deficit
A
foot drop and steppage gait
20
Q
trendelenburg sign is from what nerve lesion?
A
superior gluteal
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
22
Q
what corresponds with the power stroke in muscle contraction?
A
myosin release of ADP
23
Q
type 1 vs type 2 muscle fibers
A
1 - slow twitch, red fibers
2 - fast twitch, white fibers
24
Q
estrogen action on bone
A
inhibits apoptosis of osteoblasts / induces apoptosis in osteoclasts
25
type 1 vs 2 osteoporosis
1 - postmenopausal (dec estrogen)
| 2 - senile (>70)
26
osteopetrosis
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
27
what are the bones like in osteomalacia/rickets?
soft, bow outwards
28
what is the cause of osteomalacia/rickets?
vit D def
29
Paget's disease
inc remodeling of bone (osteoblast and clast activity inc). woven bone > more prone to fracture. inc alk phos and risk of osteogenic sarcoma
30
polyostotic fibrous dysplasia
bone replaced by fibroblasts, collagen, and irreg bony trabeculae
31
McCune Albright syndrome
polyostotic fibrous dysplasia + endocrine abnlmalities (precocious puberty) + cafe au lait spots
32
giant cell tumor (osteoclastoma)
20-40 yo
locally aggressive benign tumor, usually in distal femur/prox tibia
spindle shaped cells w/ multinucleated giant cells
33
"double bubble" or "soap bubble" appearance on x ray
giant cell tumor (osteoclastoma)
34
MC benign primary tumor of bone
osteochondroma
35
who does osteochondroma usually affect?
males <25 yo
36
2 MC primary malignant bone tumors
1 - multiple myeloma
| 2 - osteosarcoma
37
who tends to get osteosarcoma and where in their body?
male > female, 10-20 yo
| knee
38
Codman's triangle or sunburst pattern on xray
osteosarcoma
39
who gets Ewing's sarcoma and where?
boys <15 yo
| diaphysis of long bones, pelvis, scapula, ribs
40
properties of Ewing's sarcoma
anaplastic small blue cell malignant tumor
| very aggressive, but responsive to chemo
41
"onion skin" appearance in bone
Ewing sarcoma
42
translocation of Ewing Sarcoma
t(11;22)
43
who gets chondrosarcomas?
men 30-60 yo
44
joint findings in osteoarthritis
subchondral cysts, sclerosis, osteophytes, eburnation (polished appearance), Heberden's and Bouchard's nodes (DIP and PIP). NO MCP involvement
45
what type hypersensitivity is RA?
3
46
joint findings in RA
pannus formation (fluffiness), subq rheumatoid nodules, ulnar deviation in fingers, Baker's cyst. NO DIP involvement
47
blood markers for RA
rheumatoid factor, anti-cyclic citrullinated peptide is more specific
48
Sjogren's syndrome - cause, sx, who gets it
lymphocytic infiltration of exocrine glands
triad of xerophthalmia, xerostoma, arthritis
females 40-60 yo
49
antibodies involved in Sjogren's syndrome
anti-SS-A and SS-B
50
what do gout crystal look like under microscope?
needle shaped
| negatively birefringent - yellow crystals under parallel light
51
allopurinol drug class
xanthine oxidase inhibitors
52
pseudogout - what precipitates and what do the crystals look like
calcium pyrophosphate
| rhomboid crystals, weakly pos birefringent, blue when parallel to light
53
causes of avascular necrosis
trauma, high dose corticosteroids, alcoholism, sickle cell
54
what is meant by "seronegative spondyloarthropathies"?
arthritis w/o rheumatoid factor
55
dactylitis with "pencil in cup" deformity on xray
psoriatic arthritis
56
reactive arthritis (Reiter's) - triad of sx, what infxns does it occur after
"can't see, can't pee, cant climb a tree" - conjunctivitis, urethritis, arthritis
after GI or chlamydia infxns
57
Libman Sacks endocarditis
assoc w/ SLE
| verrucous sterile vegetations on both sides of valve
58
antibodies assoc w/ SLE and which are useful for what?
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
2 hallmarks of sarcoidosis
noncaseating granulomas all over
| elevated serum ACE levels
60
how does sarcoidosis often present?
asymptomatic w/ bilat hilar LAN
61
polymyalgia rheumatica
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
type of inflammatory cells involved in polymyositis vs dermatomyositis
polymyo - CD8 T cells
| dermatomyo - CD4 T cells
63
antibody assoc w/ polymyositis and dermatomyositis
anti-Jo-1
64
myasthenia gravis assoc w/ what other conditions
thymoma / thymic hyperplasia
65
differences in pathophys and clinical features of myasthenia gravis vs lambert eaton syndrome
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
myositis ossificans
metaplasia of skeletal muscle to bone following trauma
67
general path process of scleroderma
excessive fibrosis and collagen deposition throughout body
68
diffuse scleroderma vs CREST syndrome - assoc abs
diffuse - anti-Scl-70 (anti DNA topoisomerase I)
| CREST - anti-centromere
69
CREST syndrome - presentation/course
```
type of scleroderma with more benign, limited course
Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
```
70
macule vs papule
macule is flat, papule is elevated
71
acanthosis definition
epidermal hyperplasia (inc spinosum)
72
melasma
hyperpigmentation (usu on face) assoc w/ pregnancy and OCP use
73
ephelis is
a freckle
74
where does atopic dermatitis tend to appear?
face in infancy and antecubital fossa afterward
| skin flexures
75
papules and plaques w/ silvery scaling
psoriasis
76
Auspitz sign
assoc w/ psoriasis
| pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off
77
flat, greasy, pigmented squamous epithelial prolif w/ keratin filled cysts that look "stuck on"
seborrheic keratosis
78
Leser-Trelat sign
sudden appearance of multiple seborrheic keratoses indicating underlying malignancy
79
pemphigus vulgaris - what is wrong, what does it look like
anti-desmoglein 3 - attacks desmosomes
| acantholysis - intraepidermal bullae causing flaccid blisters. involves oral mucosa too
80
Nikolsky's sign
separation of epidermis on stroking of skin seen in pemphigus vulgaris
81
bullous pemphigoid - what is wrong, what does it look like
antibody against hemidesmosomes
| eosinophils w/ in tense blisters, spares oral mucosa
82
dermatitis herpetiformis
pruritic papules, vesicles, bullae caused by deposits of IgA. assoc w/ celiac dz
83
erythema multiforme
multiple types of lesions assoc w/ infections, drugs, cancers and autoimmune disease
84
stevens johnson syndrome - presentation
fever, bulla formation, necrosis, sloughing of skin, high mortality rate. lesions may appear like targets
85
toxic epidermal necrolysis
more severe form of Stevens Johnson syndrome
86
acanthosis nigricans - what is it assoc w/
hyperinsulinemia and visceral malignancy
87
actinic keratosis
premalignant lesions from sun
| small rough erythematous or brownish papules/plaques
88
what is erythema nodosum assoc w/
sarcoidosis, cocci, histo, TB, strep, leprosy, Crohn's
89
lichen planus - what does it look like, assoc w/
pruritic, purple, polygonal planar papules/plaques
| Hep C
90
"herald patch" followed by "christmas tree distribution" of plaques. self resolving
pityriasis rosea
91
which UV type causes tanning/photoaging and which causes sunburn?
A - tanning/photoaging
| B - sunBurn
92
2 MC skin cancers
1 - basal cell
| 2 - squamous cell
93
basal cell CA - behavior and appearance
locally invasive but almost never metastasizes
| pink pearly nodules, rolled borders, central crusting/ulceration, "palisading nuclei"
94
precursor to SCC of skin
actinic keratosis
95
appearance of SCC of skin
ulcerative red lesions w/ frequent scale. on histo, "keratin pearls"
96
tumor marker for melanoma
S-100
97
gene mutation assoc w/ melanoma
BRAF kinase (activating mutation)
98
arachidonic acid goes through the ____ pathway to make leukotrienes
lipoxygenase
99
effects of leukotrienes
LTB4 - neutrophil chemotactic factor
| LTC4, D4, E4 - bronchoconstriction, vasoconstriction, contraction of smooth muscle, inc vasc permeability
100
celecoxib - mech, adv/disadv
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
acetaminophen is toxic in overdose b/c it depletes _____. antidote is ____
glutathione
| n-acetylcysteine
102
bisphosphonates - mech and tox
bind hydroxyapatite in bone, inhib osteoclast activity
| tox - corrosive esophagitis and osteonecrosis of jaw
103
febuxostat
another xanthine oxidase inhibitor
104
drugs c/i with allopurinol
AZA and 6-MP - increases their conc
| salicylates - depress uric acid clearance
105
probenecid
inhibits reabs of uric acid in PCT - used for chronic gout
106
colchicine mech
inhibits MT polymerization impairing leukocyte chemotaxis and degranulation
107
TNF alpha inhibitors
etanercept - soluble receptor
| infliximab and adalimumab - monoclonal ab
