MSK Flashcards
1
Q
lateral femoral condyle to anterior tibia
A
ACL
2
Q
medial femoral condyle to posterior tibia
A
PCL
3
Q
unhappy triad of knee due to
A
lateral force on a planted leg
4
Q
unhappy triad =
A
ACL, MCL, medial menuscus
5
Q
what is the most common rotator cuff injury?
A
supraspinatous
6
Q
action infraspinatous
A
lateral rotation (external rotation)
7
Q
teres minor action
A
adduction and lateral rotation
8
Q
action subscapularis
A
internal rotation (medial) adduction
9
Q
what is the rotator cuff innervation?
A
C5-6
10
Q
dislocation of lunate
A
acute carpal tunnel
11
Q
ulnar nerve injury from fall
A
hook of hamate fracture
12
Q
Guyon canal syndrome
A
ulnar nerve compression - seen in cyclists from handlebars
13
Q
Fractured surgical neck of humerus
A
axillary (C5-6)
14
Q
upper trunk compression
A
musculocutaneous (c5-7)
15
Q
loss of forearm flexion and supination, loss of sensation over lateral forearm
A
musculocutaneous
16
Q
shaft fracture of humerus
A
radial (C5-T1)
17
Q
wrist drop, loss of extension, decreased grip strength, loss of sensation over posterior arm/forearm and dorsal hand
A
radial
18
Q
supracondylar fracture of humerus
A
median (c5-t1)
19
Q
loss of wrist flexion, flexion of lateral fingers, thumb opposition
A
median
Pope’s sign
20
Q
fracture of median epicondyle
A
ulnar (c8-T1)
21
Q
recurrent branch of median nerve
what is spared?
A
loss of thenar muscle group: opposition, abduction and flexion of thumb
sensation
22
Q
Erb’s palsy
A
upper trunk
23
Q
Klumpke palsy
A
lower trunk
24
Q
Thoracic outlet syndrome
A
compression of lower trunk
25
Median nerve muscles of the hand
LOAF
| lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollucis brevis
26
decreased thigh sensation, no adduction
obturator (L2-4)
27
decreased thigh flexion and leg extension
femoral (L2-4)
28
foot drop
common peroneal (L4-S2)
29
fibular neck fracture
common peroneal
30
can't curl toes, loss of sensation on sole of foot
| foot at rest...
tibial (L4-S3)
| everted at rest
31
superior gluteal issue
trendelenburg gait
| contralateral drop
32
loss of hip extension, hard getting out of chair
inferior gluteal (l5-s2)
33
innervation by superior gluteal
gluteus medius, minimus, tensor fascia latae
34
inferior gluteal innervates
gluteus maximus
35
sciatic splits into
connom peroneal and tibial
36
weakness of knee extension, decreased patellar reflex
L3-4 disc
37
weakness of dorsiflexion, difficulty heel walking
L4-5
38
weakness of plantarflexion, difficulty in toe-walking, decreased achiles reflex
L5-S1
39
arterial supply surgical neck of humerus
posterior circumflex
40
arterial supply midshaft of humerus
deep brachial
41
disteral humerus/ cubital fossa artery
brachial
42
posterior to medial malleolus artery
posterior tibial
43
muscle triad
found in
made from
skeletal muscle
| 1 T-tubule + 2 terminal cisternae
44
muscle dyad
found in
made from
1 T-tubule + 1 terminal cisterna
| cardiac muscle
45
type I muscle
slow twitch, red fibres
increased mt and myoglobin
sustained contraction
endurance
46
type II muscle
fast twitch, white fibres
anaerobic glycolysis
increased after weight training
47
releases ALP
osteoblast
48
how do osteoclasts dissolve bone?
secrete H+ and collangeases
49
development of osteoclast
fusion of monocyte/mpg precursors
50
development of osteoblast
mesenchymal stem cells in periosteum
51
PTH on bone
low
high
low - build bone
| high - can catabolise bone
52
estrogen on bone
inhibits osteoblast apoptosis
| induces osteoclast apoptosis
53
Rx OP
bisphosphonates, teriparatide, SERMs, calcitonin, denosumab
54
osteopetrosis
thick bone, from lack of osteoclasts
| bone fills marrow space
55
mutation in osteopetrosis
carbonic anhydrase II
| OCs can't make H+ for breakdown
56
Looser zones
osteomalacia/ rickets
57
defective mineralization of osteoid
osteomalacia
58
paget disease
| blood tests
increased OCs then increased OB
| raised ALP
59
loss of hearing, hat doesn't fit
paget disease
60
causes of AVN
```
CAST Bent LEGS
Corticosteroids
Alcoholism
Sickle cell
Trauma
the Bends
LEgg-Calve-Perthes
Gaucher
Slipped capital femoral epiphysis
```
61
bone tumour <25 male
osteochondroma
62
osteochondrome
benign bony exostosis with chondroid cap
63
20-40 yr bone tumour
giant cell tumour
64
osteoclastoma/ giant cell tumour
locally agressive benign tumour
65
soap bubble on XR
giant cell tumour
66
10-20 yr; >65 yr bone tumour
osteosarcoma
67
RF for osteosarcoma
paget disease, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome
68
where is osteosarcoma commonly found?
metaphysis of long bone, around knee
69
sunburst pattern/ Codman triangle
osteosarcoma
70
<15yr male bone cancer
Ewing sarcoma
71
common places of Ewing sarcoma
pelvis, scapula, ribs
72
anaplastic small blue cell
Ewing sarcoma
73
t(11:22) translocation bone
Ewing sarcoma
74
onion skin bone
Ewing sarcoma
75
pannus
proliferative granulation tissue
76
RA RF
silica exposure
77
fibrinoid necrosis with palisading histioctes
rheum nodules
78
Caplan syndrome
rheum nodule in lung + pneumoconiosis
79
drug causing gout
Thiazides
80
overproduction of uric acid
Lesch-Nyhan, PRPP excess, increased cell turnover, von Gierke disease
81
true gout
negative birefringent
yellow under parallell light
blue under perpendicular
82
tophus formation area
external ear, olecranon bursa, achilles tendon
83
pseudogout
calcium pyrophosphate deposition disease
84
Sjogren's is
destruction of exocrine glands by lymphatic infiltrates
85
bilateral parotid enlargement
Sjogrens
86
complications of Sjogren's
dental caries, MALT
87
septic arthritis organisms
s. aureas, strep, neissera gonorrhoea
88
polyarthritis, tenosynotivits, dermatitis
gonococcal arthritis
89
reactive arthritis triad
conjunctivitis, urethritis, arthritis
90
pathogens reactive arthritis
shigella, salmonella, yersinia, campylobacter, chlamydia
91
The 6 A's of AS
```
aortitis + aortic regurg
anterior uveitisapical lung fibrosis
amyloidosis
atlanto-axial subluxation
autoimmune bowel disease
```
92
SLE symptoms
```
RASH OR PAIN
Rash
Arthritis
Serositis
Hematological
Oral ulcers
Renal disease
Photosensitivity
ANA
Innunologic disorder
Neurologic disorder
```
93
Libman-Sacks Endocarditis
verricous thrombi on mitral/aortic - SLE
94
immune complex formation in SLE decreases
C3, 4, CH50
95
anti-B2- glycoprotein
Antiphsopholipid syndrome
96
mixed connective tissue disease
SLE + systemic sclerosis +/ polymyositis
97
sarcoidosis
immune mediated noncaseating granulomas
98
elevated ACE, CD4/8
sarcoidosis
99
population most commonly with sarcoid
female african american
100
CXR bialteral adenopathy, coarse reticular opacities
sarcoidosis
101
endomysial inflammation with CD8 cells
polymyositis
102
symmetric proximal muscle weakness
polymyositis
103
increased risk after dermatomyositis
occult malignancy
104
gottron papules
found
associated with
hand MCP joint
| dermatomyositis
105
MG worse with
muscle use
106
MG asociated with
thmomoa, thymic hyperplasia
107
Rx MG
| diagnosis
pyridostigmine
| edrophonium
108
Lambert-Eaton myasthenic syndrome
proximal muscle weakness, improves with use
| dry mouth, impotence
109
Lambert- Eaton associated with
small c lung ca
110
myositis ossificans
hypertrophic ossification after trauma
111
scleroderma triad
autoimmunity
noninflammatory vasculopathy
collagen deposition with fibrosis
112
diffuse scleroderma
early visceral involvement
| anti-Scl-70
113
Limited scleroderma
```
CREST
Calcinosis
Raynaud's
Eosophageal dismotliity
Sclerodactly
Telangiectasia
more beingn
```
114
Telangiectasia
small dilated superficial blood vessels
115
What causes Raynaud's?
arteriolar vasospasm from stress or cold
116
Raynaud syndrome
when secondary to another CTD
117
Rx Raynaud syndrome
Ca channel blockers for relaxation
118
Laters of the skin
epidermis, dermis, subcut fat
119
subcut fat can be divided into
hypodermis, subcutis
120
What are the layers of the epidermis?
```
Calafornians Like Girls in String Bikinis
Corneum
Lucidum
Granulosum
Spinosum
Basale
```
121
tight junction
claudins and occlundins
| prevents paracellular movement of solutes
122
Adherens junction
connects actin cytoskeletons of adjacent cells with Cadherins
123
What does loss of E-cadherin promote?
metastasis
124
desmosome
intermediate filaments, structural support
125
autoantibodies to desmosomes
pemphigus vulgrais
126
Gap junctions are made up of
connexons
127
Integrins
maintain basolateral membrane
| bind collagen and laminin in basement membrane
128
hemidesmosome
connects keratin in basal cells to basement membrane
129
autoantibodies to hemidesmosome
bullous pemphigoid
130
flat lesion with well-circumscribed change in skin colour
macule
< 1cm
freckle
131
macule >1cm
patch
| large birthmark
132
elevated solid skin lesion < 1cm
mole, acne
| papule
133
papule > 1cm
plaque
| psoriasis
134
small fluid-containing blister < 1cm
vesicle
| chickenpox, shingles
135
large fluid-containing blister > 1cm
bulla
| bullous pemphigoid
136
transient smooth pauple or plaque
wheal
| hives
137
flaking off of stratum corneum
Scale
| eczema, psoriasis, SCC
138
dry skin exudate
crust
| impetigo
139
Hyperkeratosis
increased thickness of stratum corneum
| psoriasis, callus
140
parakeratosis
hyperkeratosis with retention of nuclei in statum corneum
| psoriasis
141
hypergranulosis
increased thickness of stratum granulosum
| lichen planus
142
spongiosis
epidermal accumulation of edematous fluid in intercellular spaces
eczematous dermatitis
143
acantholysis
seperation of epidermal cells
| pemphigus vulgaris
144
acanthosis
```
epidermal hyperplasia (increased spinosum)
acanthosis nigricans
```
145
albinism
decreased melanin from decreased tyrosinase/ tyrosine transport
146
melasma
hyperpigmentation associated with pregnancy/ OCP
147
vitiligo
areas of depigmentation
| autoimmune destruction of melanocytes
148
Rx acne
retinoids, benzoyl peroxide, antibiotics
149
atopic dermatitis
eczema
150
melanocytic nevus
common mole
151
interdermal nevi
papular mole
152
junctional nevi
flat macular mole
153
munro microabscesses
psoriasis
154
increased stratum spinosum, decreased stratum granulosum
psoriasis
155
Auspitz sign
psoriasis - plaque bleeds when scales scraped off
156
phymatous rosacea can cause
bulbous deformation of nose - rhinophyma
157
horn cysts seen in
seborrheic keratosis
158
what is seborrheic keratosis?
flat, greasy pigmented squamous epithelial proliferation
159
keratin filled cysts
seborrheic keratosis
160
Leser-Trelat sign
sudden appearance of multiple seborrheic keratoses
| underlying GI/ lymph malignancy
161
cauliflower like
warts
162
epidermal hyperplasia, hyperkeratosis, koilocytosis
verrucae/ warts
163
condyloma acuminatum
genital warts
164
urticaria
mast cell degranulation
165
angiosarcoma
| found in
blood vessel malignancy
| head, neck, breast
166
associated with sub exposed area, radiation, mastectomy lymphaedema
angiosarcoma
167
vinyl chloride and arsenic exposure skin
hepatic angiosarcoma
168
bacilary angiomatosis
benign capillary skin pauples
| AIDS
169
bartonella henselae
bacillary angiomatosis
170
difference between bacillary angiomatosis and kaposi sarcoma
angiomatosis has neutrophil infiltrate
171
cherry hemangioma
benign, capillary, frequency increases with age
172
cystic hygroma associated with
Turner syndrome
173
Glomus tumour
beingn
red-blue tumour under fingernail
from modified smooth muscle cells of thermoregulatory glomus body
174
Kaposi sarcoma
```
endothelial malignancy associated with HHV-8 and HIV
lymphocytic infiltrate (not neutrophilic)
```
175
pyogenic granuloma
polypoid lobulated capillary hemangioma
| ulcerate and bleed
176
pyogenic granuloma associated with
trauma and pregnancy
177
large birthmark, grows just after brith
strawberry hemangioma
178
honey-coloured crusting
| caused by
impetigo
| S aureas, S pyogenes
179
infection of upper dermis and superficial lymphatics
called
caused by
erysipleas
| s pyogenes
180
cellulitis affects
deeper dermis, subcutaneous tissue
181
cellulitis common organisms
s pyogenes, s aureas
182
necrotizing fasciitis pathogen
anaerobes or s pyogenes
183
what does necrotizing fasciitis produce?
methane and CO2
184
scalded skin syndrome caused by
| due to
staph
| exotoxin destroys keratinocyte attachment in strtum granulosum
185
nikolsky sign
skin sloughs off on rubbing
186
herpetic whitlow
on the finger
187
umbilicated papules
mollescum contagiosum
188
what causes hairy leukoplakia?
EBV
189
autoimmune skin disorder
pemphigus vulgaris
| IgG against desmoglein
190
flaccid intraepidermal bullae
pemphigus vulgaris
191
reticular pattern of antibodies around epidermal cell
pemphigus vulgaris
| reticular = net like
192
tense blisters containing eosinophils
bullous pemphigoid
193
immunofluorescense reveals liner pattern at epidermal-dermal junction
bullous pemphigoid
194
IgA deposition at tips of dermal papillae
dermatitis herpetiformis
195
pruitic pauples, celiac disease
dermatitis herpetiformis
196
Rx dermatitis herpetiformis
dapsone, gluten free diet
197
erythema multiforme associated with which pathogens
mycoplasma pneumoniae, HSV
198
drugs inducing erythema multiforme
sulfa drugs, B lactams, phenytoin
199
conditions associated with erythema multiforme
cancer, autoimmune disease
200
target lesions, dusky centre, vesicles
erythema multiforme
201
fever, bullae formation and necrosis with positive Nikolsky sign
Stevens-Johnson syndrome
202
what does Stevens-Johnson syndrome affect?
2 mucous membranes
203
What is it called if Stevens-Johnson syndrome affects over 30% of the body surface?
toxic epidermal necrolysis
204
what is Steven's Johnson syndrome caused by?
adverse drug reaction
205
dark patches under axilla and neck
acanthosis nigricans
206
what is acanthosis nigricans associated with?
insulin resistance, visceral malignancy
207
small rough patches, red/brown pauple/plaque
actinic jeratosis
| caused by sun exposure
208
conditions associated with erythema nodosum
```
CHILS ST
coccidioidomycosis
histoplasmosis
IBD
Leprosy
Sarcoidosis
Strep
TB
```
209
6 Ps of lichen planus
```
pruitic
purple
polygonal
planar pauples
plaques
```
210
reticular white lines =
| condition
whickham striae
| lichen planus
211
sawtooth infiltrate of lymphocytes at dermal-epidermal junction
lichen planus
212
associated with lichen planus
Hep C
213
Herald patch
Pityriasis rosea
214
chrostmas tree distribution
pityriasis rosea
215
UV-B
burn
216
most common skin cancer
| second most common skin ca
basal cell carcinoma
| squamous cell ca
217
rolled boarder, central crust/ulcer, pink and pearly
basal cell carcinoma
218
palisading nuclei
basal cell ca
219
non healing ulcer with infiltrating growth
basal cell ca
220
RF squamous cell ca
sunlight, immunospuression, arsenic exposure
221
keratin pearls
squamous cell ca
222
actinic keratosis
scaly plaque precursor to squamous c ca
223
keratoacanthoma
type of squamous cell ca
| grows quickly, may regress spontaneously
224
which skin cancer poses risk of spread?
melanoma
225
S-100 tumour marker
melanoma
226
types of melanoma
superficial spreading, nodular, lentigo maligna, acral lentiginous
227
BRAF kinase activation
melanoma
228
vemurafenib
BRAF kinase inhibitor
| used for BRAF V600E mutated melanoma
229
selective COX-2 inhibitor
celecoxib
230
irriversable COX inhibitor
aspirin
231
NSAIDs in general
reversible COX 1 and 2 inhibitors
232
PGE2
increase uterine tone
233
PGE1
decrease vascular tone
234
factors increasing bronchial tone
LTC/D/E 4
235
LTB4
increases neutrophil chemotaxis
236
PGI2
decreased plt aggregation, decreased vascular tone
237
thromboxane
increased plt aggregation
| increased vascular tone
238
acetaminophem mechanism
reversible cyclooxygenase inhibitor
239
what is the acetaminophen metabolite and what does it do in the liver?
NAPQ1
| depleats glutathione
240
how does aspirin affect bleeding?
increased bleeding time
| no affect on PT or aPTT
241
different aspirin levels
low - plt aggregation
medium - antipyretic, analgesic
high - anti-inflam
242
s.e. aspirin
tinnitus, ulcers, acute renal failure, interstitial nephritis, GI bleed
243
what does celecoxib stop?
no COX-1 effect, spares mucosa and plt function
244
use celecoxib
| s.e.
RA, OA
| increased thrombosis risk, sulfa allergy
245
s.e. NSAIDs
intersitital nephritis, gastric ulcer, renal ischemia
246
leflunomide
inhibits dihydroorotate dehydrogenase, prevents pyrimidine synth, supressing T cells
247
use leflunomide
| s.e.
RA, psoriatic A
| diarrhoea, htn, hepatotoxicity, teratogenic
248
bisphosphonates
-dronate
249
mechanism bisphosphoonates
bind hydroxyapatite, inhibits OCs
250
use bisphosphonates
| s.e.
OP, hyperCa, Paget's, metastatic bone disease, osteogenesis imperfecta
esophagitis, jaw osteonecrosis, atypical stress fractures
251
teriperatide action
| s.e.
PTH analog, increases OB activity
| transcient hypercalcemia
252
mechanism allopurinol
competitive inhibitor xanthine oxidase
253
febuxostat
inhibits xanthine oxidase
254
pegloticase
recombinant uricase
| uric acid --> allantoin (water soluble)
255
probenecid
| s.e.
inhibits uric acid reabsorption in proximal converluted tubule
can precipitate uric acid calculi
256
colchicine mechanism
binds and stabilizes tubulin to inhibit microtubule polymerisation
257
TNF-a inhibitors
adalimumab, etanercept, infliximab
258
rasburicase
recombinant uricase
| uric acid --> allantoin
