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Step 1 > MSK > Flashcards

MSK Flashcards

1
Q

lateral femoral condyle to anterior tibia

A

ACL

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2
Q

medial femoral condyle to posterior tibia

A

PCL

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3
Q

unhappy triad of knee due to

A

lateral force on a planted leg

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4
Q

unhappy triad =

A

ACL, MCL, medial menuscus

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5
Q

what is the most common rotator cuff injury?

A

supraspinatous

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6
Q

action infraspinatous

A

lateral rotation (external rotation)

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7
Q

teres minor action

A

adduction and lateral rotation

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8
Q

action subscapularis

A

internal rotation (medial) adduction

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9
Q

what is the rotator cuff innervation?

A

C5-6

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10
Q

dislocation of lunate

A

acute carpal tunnel

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11
Q

ulnar nerve injury from fall

A

hook of hamate fracture

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12
Q

Guyon canal syndrome

A

ulnar nerve compression - seen in cyclists from handlebars

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13
Q

Fractured surgical neck of humerus

A

axillary (C5-6)

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14
Q

upper trunk compression

A

musculocutaneous (c5-7)

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15
Q

loss of forearm flexion and supination, loss of sensation over lateral forearm

A

musculocutaneous

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16
Q

shaft fracture of humerus

A

radial (C5-T1)

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17
Q

wrist drop, loss of extension, decreased grip strength, loss of sensation over posterior arm/forearm and dorsal hand

A

radial

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18
Q

supracondylar fracture of humerus

A

median (c5-t1)

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19
Q

loss of wrist flexion, flexion of lateral fingers, thumb opposition

A

median

Pope’s sign

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20
Q

fracture of median epicondyle

A

ulnar (c8-T1)

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21
Q

recurrent branch of median nerve

what is spared?

A

loss of thenar muscle group: opposition, abduction and flexion of thumb
sensation

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22
Q

Erb’s palsy

A

upper trunk

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23
Q

Klumpke palsy

A

lower trunk

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24
Q

Thoracic outlet syndrome

A

compression of lower trunk

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25
Q

Median nerve muscles of the hand

A

LOAF

lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollucis brevis

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26
Q

decreased thigh sensation, no adduction

A

obturator (L2-4)

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27
Q

decreased thigh flexion and leg extension

A

femoral (L2-4)

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28
Q

foot drop

A

common peroneal (L4-S2)

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29
Q

fibular neck fracture

A

common peroneal

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30
Q

can’t curl toes, loss of sensation on sole of foot

foot at rest…

A

tibial (L4-S3)

everted at rest

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31
Q

superior gluteal issue

A

trendelenburg gait

contralateral drop

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32
Q

loss of hip extension, hard getting out of chair

A

inferior gluteal (l5-s2)

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33
Q

innervation by superior gluteal

A

gluteus medius, minimus, tensor fascia latae

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34
Q

inferior gluteal innervates

A

gluteus maximus

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35
Q

sciatic splits into

A

connom peroneal and tibial

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36
Q

weakness of knee extension, decreased patellar reflex

A

L3-4 disc

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37
Q

weakness of dorsiflexion, difficulty heel walking

A

L4-5

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38
Q

weakness of plantarflexion, difficulty in toe-walking, decreased achiles reflex

A

L5-S1

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39
Q

arterial supply surgical neck of humerus

A

posterior circumflex

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40
Q

arterial supply midshaft of humerus

A

deep brachial

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41
Q

disteral humerus/ cubital fossa artery

A

brachial

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42
Q

posterior to medial malleolus artery

A

posterior tibial

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43
Q

muscle triad
found in
made from

A

skeletal muscle

1 T-tubule + 2 terminal cisternae

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44
Q

muscle dyad
found in
made from

A

1 T-tubule + 1 terminal cisterna

cardiac muscle

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45
Q

type I muscle

A

slow twitch, red fibres
increased mt and myoglobin
sustained contraction
endurance

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46
Q

type II muscle

A

fast twitch, white fibres
anaerobic glycolysis
increased after weight training

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47
Q

releases ALP

A

osteoblast

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48
Q

how do osteoclasts dissolve bone?

A

secrete H+ and collangeases

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49
Q

development of osteoclast

A

fusion of monocyte/mpg precursors

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50
Q

development of osteoblast

A

mesenchymal stem cells in periosteum

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51
Q

PTH on bone
low
high

A

low - build bone

high - can catabolise bone

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52
Q

estrogen on bone

A

inhibits osteoblast apoptosis

induces osteoclast apoptosis

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53
Q

Rx OP

A

bisphosphonates, teriparatide, SERMs, calcitonin, denosumab

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54
Q

osteopetrosis

A

thick bone, from lack of osteoclasts

bone fills marrow space

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55
Q

mutation in osteopetrosis

A

carbonic anhydrase II

OCs can’t make H+ for breakdown

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56
Q

Looser zones

A

osteomalacia/ rickets

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57
Q

defective mineralization of osteoid

A

osteomalacia

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58
Q

paget disease

blood tests

A

increased OCs then increased OB

raised ALP

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59
Q

loss of hearing, hat doesn’t fit

A

paget disease

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60
Q

causes of AVN

A 
CAST Bent LEGS
Corticosteroids
Alcoholism
Sickle cell
Trauma
the Bends
LEgg-Calve-Perthes
Gaucher
Slipped capital femoral epiphysis
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61
Q

bone tumour <25 male

A

osteochondroma

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62
Q

osteochondrome

A

benign bony exostosis with chondroid cap

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63
Q

20-40 yr bone tumour

A

giant cell tumour

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64
Q

osteoclastoma/ giant cell tumour

A

locally agressive benign tumour

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65
Q

soap bubble on XR

A

giant cell tumour

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66
Q

10-20 yr; >65 yr bone tumour

A

osteosarcoma

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67
Q

RF for osteosarcoma

A

paget disease, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome

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68
Q

where is osteosarcoma commonly found?

A

metaphysis of long bone, around knee

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69
Q

sunburst pattern/ Codman triangle

A

osteosarcoma

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70
Q

<15yr male bone cancer

A

Ewing sarcoma

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71
Q

common places of Ewing sarcoma

A

pelvis, scapula, ribs

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72
Q

anaplastic small blue cell

A

Ewing sarcoma

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73
Q

t(11:22) translocation bone

A

Ewing sarcoma

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74
Q

onion skin bone

A

Ewing sarcoma

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75
Q

pannus

A

proliferative granulation tissue

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76
Q

RA RF

A

silica exposure

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77
Q

fibrinoid necrosis with palisading histioctes

A

rheum nodules

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78
Q

Caplan syndrome

A

rheum nodule in lung + pneumoconiosis

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79
Q

drug causing gout

A

Thiazides

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80
Q

overproduction of uric acid

A

Lesch-Nyhan, PRPP excess, increased cell turnover, von Gierke disease

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81
Q

true gout

A

negative birefringent
yellow under parallell light
blue under perpendicular

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82
Q

tophus formation area

A

external ear, olecranon bursa, achilles tendon

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83
Q

pseudogout

A

calcium pyrophosphate deposition disease

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84
Q

Sjogren’s is

A

destruction of exocrine glands by lymphatic infiltrates

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85
Q

bilateral parotid enlargement

A

Sjogrens

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86
Q

complications of Sjogren’s

A

dental caries, MALT

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87
Q

septic arthritis organisms

A

s. aureas, strep, neissera gonorrhoea

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88
Q

polyarthritis, tenosynotivits, dermatitis

A

gonococcal arthritis

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89
Q

reactive arthritis triad

A

conjunctivitis, urethritis, arthritis

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90
Q

pathogens reactive arthritis

A

shigella, salmonella, yersinia, campylobacter, chlamydia

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91
Q

The 6 A’s of AS

A 
aortitis + aortic regurg
anterior uveitisapical lung fibrosis
amyloidosis
atlanto-axial subluxation
autoimmune bowel disease
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92
Q

SLE symptoms

A 
RASH OR PAIN
Rash
Arthritis
Serositis
Hematological
Oral ulcers
Renal disease
Photosensitivity
ANA
Innunologic disorder
Neurologic disorder
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93
Q

Libman-Sacks Endocarditis

A

verricous thrombi on mitral/aortic - SLE

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94
Q

immune complex formation in SLE decreases

A

C3, 4, CH50

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95
Q

anti-B2- glycoprotein

A

Antiphsopholipid syndrome

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96
Q

mixed connective tissue disease

A

SLE + systemic sclerosis +/ polymyositis

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97
Q

sarcoidosis

A

immune mediated noncaseating granulomas

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98
Q

elevated ACE, CD4/8

A

sarcoidosis

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99
Q

population most commonly with sarcoid

A

female african american

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100
Q

CXR bialteral adenopathy, coarse reticular opacities

A

sarcoidosis

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101
Q

endomysial inflammation with CD8 cells

A

polymyositis

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102
Q

symmetric proximal muscle weakness

A

polymyositis

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103
Q

increased risk after dermatomyositis

A

occult malignancy

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104
Q

gottron papules
found
associated with

A

hand MCP joint

dermatomyositis

105
Q

MG worse with

A

muscle use

106
Q

MG asociated with

A

thmomoa, thymic hyperplasia

107
Q

Rx MG

diagnosis

A

pyridostigmine

edrophonium

108
Q

Lambert-Eaton myasthenic syndrome

A

proximal muscle weakness, improves with use

dry mouth, impotence

109
Q

Lambert- Eaton associated with

A

small c lung ca

110
Q

myositis ossificans

A

hypertrophic ossification after trauma

111
Q

scleroderma triad

A

autoimmunity
noninflammatory vasculopathy
collagen deposition with fibrosis

112
Q

diffuse scleroderma

A

early visceral involvement

anti-Scl-70

113
Q

Limited scleroderma

A 
CREST
Calcinosis
Raynaud's
Eosophageal dismotliity
Sclerodactly
Telangiectasia
more beingn
114
Q

Telangiectasia

A

small dilated superficial blood vessels

115
Q

What causes Raynaud’s?

A

arteriolar vasospasm from stress or cold

116
Q

Raynaud syndrome

A

when secondary to another CTD

117
Q

Rx Raynaud syndrome

A

Ca channel blockers for relaxation

118
Q

Laters of the skin

A

epidermis, dermis, subcut fat

119
Q

subcut fat can be divided into

A

hypodermis, subcutis

120
Q

What are the layers of the epidermis?

A 
Calafornians Like Girls in String Bikinis
Corneum
Lucidum
Granulosum
Spinosum
Basale
121
Q

tight junction

A

claudins and occlundins

prevents paracellular movement of solutes

122
Q

Adherens junction

A

connects actin cytoskeletons of adjacent cells with Cadherins

123
Q

What does loss of E-cadherin promote?

A

metastasis

124
Q

desmosome

A

intermediate filaments, structural support

125
Q

autoantibodies to desmosomes

A

pemphigus vulgrais

126
Q

Gap junctions are made up of

A

connexons

127
Q

Integrins

A

maintain basolateral membrane

bind collagen and laminin in basement membrane

128
Q

hemidesmosome

A

connects keratin in basal cells to basement membrane

129
Q

autoantibodies to hemidesmosome

A

bullous pemphigoid

130
Q

flat lesion with well-circumscribed change in skin colour

A

macule
< 1cm
freckle

131
Q

macule >1cm

A

patch

large birthmark

132
Q

elevated solid skin lesion < 1cm

A

mole, acne

papule

133
Q

papule > 1cm

A

plaque

psoriasis

134
Q

small fluid-containing blister < 1cm

A

vesicle

chickenpox, shingles

135
Q

large fluid-containing blister > 1cm

A

bulla

bullous pemphigoid

136
Q

transient smooth pauple or plaque

A

wheal

hives

137
Q

flaking off of stratum corneum

A

Scale

eczema, psoriasis, SCC

138
Q

dry skin exudate

A

crust

impetigo

139
Q

Hyperkeratosis

A

increased thickness of stratum corneum

psoriasis, callus

140
Q

parakeratosis

A

hyperkeratosis with retention of nuclei in statum corneum

psoriasis

141
Q

hypergranulosis

A

increased thickness of stratum granulosum

lichen planus

142
Q

spongiosis

A

epidermal accumulation of edematous fluid in intercellular spaces
eczematous dermatitis

143
Q

acantholysis

A

seperation of epidermal cells

pemphigus vulgaris

144
Q

acanthosis

A 
epidermal hyperplasia (increased spinosum)
acanthosis nigricans
145
Q

albinism

A

decreased melanin from decreased tyrosinase/ tyrosine transport

146
Q

melasma

A

hyperpigmentation associated with pregnancy/ OCP

147
Q

vitiligo

A

areas of depigmentation

autoimmune destruction of melanocytes

148
Q

Rx acne

A

retinoids, benzoyl peroxide, antibiotics

149
Q

atopic dermatitis

A

eczema

150
Q

melanocytic nevus

A

common mole

151
Q

interdermal nevi

A

papular mole

152
Q

junctional nevi

A

flat macular mole

153
Q

munro microabscesses

A

psoriasis

154
Q

increased stratum spinosum, decreased stratum granulosum

A

psoriasis

155
Q

Auspitz sign

A

psoriasis - plaque bleeds when scales scraped off

156
Q

phymatous rosacea can cause

A

bulbous deformation of nose - rhinophyma

157
Q

horn cysts seen in

A

seborrheic keratosis

158
Q

what is seborrheic keratosis?

A

flat, greasy pigmented squamous epithelial proliferation

159
Q

keratin filled cysts

A

seborrheic keratosis

160
Q

Leser-Trelat sign

A

sudden appearance of multiple seborrheic keratoses

underlying GI/ lymph malignancy

161
Q

cauliflower like

A

warts

162
Q

epidermal hyperplasia, hyperkeratosis, koilocytosis

A

verrucae/ warts

163
Q

condyloma acuminatum

A

genital warts

164
Q

urticaria

A

mast cell degranulation

165
Q

angiosarcoma

found in

A

blood vessel malignancy

head, neck, breast

166
Q

associated with sub exposed area, radiation, mastectomy lymphaedema

A

angiosarcoma

167
Q

vinyl chloride and arsenic exposure skin

A

hepatic angiosarcoma

168
Q

bacilary angiomatosis

A

benign capillary skin pauples

AIDS

169
Q

bartonella henselae

A

bacillary angiomatosis

170
Q

difference between bacillary angiomatosis and kaposi sarcoma

A

angiomatosis has neutrophil infiltrate

171
Q

cherry hemangioma

A

benign, capillary, frequency increases with age

172
Q

cystic hygroma associated with

A

Turner syndrome

173
Q

Glomus tumour

A

beingn
red-blue tumour under fingernail
from modified smooth muscle cells of thermoregulatory glomus body

174
Q

Kaposi sarcoma

A 
endothelial malignancy associated with HHV-8 and HIV
lymphocytic infiltrate (not neutrophilic)
175
Q

pyogenic granuloma

A

polypoid lobulated capillary hemangioma

ulcerate and bleed

176
Q

pyogenic granuloma associated with

A

trauma and pregnancy

177
Q

large birthmark, grows just after brith

A

strawberry hemangioma

178
Q

honey-coloured crusting

caused by

A

impetigo

S aureas, S pyogenes

179
Q

infection of upper dermis and superficial lymphatics
called
caused by

A

erysipleas

s pyogenes

180
Q

cellulitis affects

A

deeper dermis, subcutaneous tissue

181
Q

cellulitis common organisms

A

s pyogenes, s aureas

182
Q

necrotizing fasciitis pathogen

A

anaerobes or s pyogenes

183
Q

what does necrotizing fasciitis produce?

A

methane and CO2

184
Q

scalded skin syndrome caused by

due to

A

staph

exotoxin destroys keratinocyte attachment in strtum granulosum

185
Q

nikolsky sign

A

skin sloughs off on rubbing

186
Q

herpetic whitlow

A

on the finger

187
Q

umbilicated papules

A

mollescum contagiosum

188
Q

what causes hairy leukoplakia?

A

EBV

189
Q

autoimmune skin disorder

A

pemphigus vulgaris

IgG against desmoglein

190
Q

flaccid intraepidermal bullae

A

pemphigus vulgaris

191
Q

reticular pattern of antibodies around epidermal cell

A

pemphigus vulgaris

reticular = net like

192
Q

tense blisters containing eosinophils

A

bullous pemphigoid

193
Q

immunofluorescense reveals liner pattern at epidermal-dermal junction

A

bullous pemphigoid

194
Q

IgA deposition at tips of dermal papillae

A

dermatitis herpetiformis

195
Q

pruitic pauples, celiac disease

A

dermatitis herpetiformis

196
Q

Rx dermatitis herpetiformis

A

dapsone, gluten free diet

197
Q

erythema multiforme associated with which pathogens

A

mycoplasma pneumoniae, HSV

198
Q

drugs inducing erythema multiforme

A

sulfa drugs, B lactams, phenytoin

199
Q

conditions associated with erythema multiforme

A

cancer, autoimmune disease

200
Q

target lesions, dusky centre, vesicles

A

erythema multiforme

201
Q

fever, bullae formation and necrosis with positive Nikolsky sign

A

Stevens-Johnson syndrome

202
Q

what does Stevens-Johnson syndrome affect?

A

2 mucous membranes

203
Q

What is it called if Stevens-Johnson syndrome affects over 30% of the body surface?

A

toxic epidermal necrolysis

204
Q

what is Steven’s Johnson syndrome caused by?

A

adverse drug reaction

205
Q

dark patches under axilla and neck

A

acanthosis nigricans

206
Q

what is acanthosis nigricans associated with?

A

insulin resistance, visceral malignancy

207
Q

small rough patches, red/brown pauple/plaque

A

actinic jeratosis

caused by sun exposure

208
Q

conditions associated with erythema nodosum

A 
CHILS ST
coccidioidomycosis
histoplasmosis
IBD
Leprosy
Sarcoidosis
Strep
TB
209
Q

6 Ps of lichen planus

A 
pruitic
purple
polygonal
planar pauples
plaques
210
Q

reticular white lines =

condition

A

whickham striae

lichen planus

211
Q

sawtooth infiltrate of lymphocytes at dermal-epidermal junction

A

lichen planus

212
Q

associated with lichen planus

A

Hep C

213
Q

Herald patch

A

Pityriasis rosea

214
Q

chrostmas tree distribution

A

pityriasis rosea

215
Q

UV-B

A

burn

216
Q

most common skin cancer

second most common skin ca

A

basal cell carcinoma

squamous cell ca

217
Q

rolled boarder, central crust/ulcer, pink and pearly

A

basal cell carcinoma

218
Q

palisading nuclei

A

basal cell ca

219
Q

non healing ulcer with infiltrating growth

A

basal cell ca

220
Q

RF squamous cell ca

A

sunlight, immunospuression, arsenic exposure

221
Q

keratin pearls

A

squamous cell ca

222
Q

actinic keratosis

A

scaly plaque precursor to squamous c ca

223
Q

keratoacanthoma

A

type of squamous cell ca

grows quickly, may regress spontaneously

224
Q

which skin cancer poses risk of spread?

A

melanoma

225
Q

S-100 tumour marker

A

melanoma

226
Q

types of melanoma

A

superficial spreading, nodular, lentigo maligna, acral lentiginous

227
Q

BRAF kinase activation

A

melanoma

228
Q

vemurafenib

A

BRAF kinase inhibitor

used for BRAF V600E mutated melanoma

229
Q

selective COX-2 inhibitor

A

celecoxib

230
Q

irriversable COX inhibitor

A

aspirin

231
Q

NSAIDs in general

A

reversible COX 1 and 2 inhibitors

232
Q

PGE2

A

increase uterine tone

233
Q

PGE1

A

decrease vascular tone

234
Q

factors increasing bronchial tone

A

LTC/D/E 4

235
Q

LTB4

A

increases neutrophil chemotaxis

236
Q

PGI2

A

decreased plt aggregation, decreased vascular tone

237
Q

thromboxane

A

increased plt aggregation

increased vascular tone

238
Q

acetaminophem mechanism

A

reversible cyclooxygenase inhibitor

239
Q

what is the acetaminophen metabolite and what does it do in the liver?

A

NAPQ1

depleats glutathione

240
Q

how does aspirin affect bleeding?

A

increased bleeding time

no affect on PT or aPTT

241
Q

different aspirin levels

A

low - plt aggregation
medium - antipyretic, analgesic
high - anti-inflam

242
Q

s.e. aspirin

A

tinnitus, ulcers, acute renal failure, interstitial nephritis, GI bleed

243
Q

what does celecoxib stop?

A

no COX-1 effect, spares mucosa and plt function

244
Q

use celecoxib

s.e.

A

RA, OA

increased thrombosis risk, sulfa allergy

245
Q

s.e. NSAIDs

A

intersitital nephritis, gastric ulcer, renal ischemia

246
Q

leflunomide

A

inhibits dihydroorotate dehydrogenase, prevents pyrimidine synth, supressing T cells

247
Q

use leflunomide

s.e.

A

RA, psoriatic A

diarrhoea, htn, hepatotoxicity, teratogenic

248
Q

bisphosphonates

A

-dronate

249
Q

mechanism bisphosphoonates

A

bind hydroxyapatite, inhibits OCs

250
Q

use bisphosphonates

s.e.

A

OP, hyperCa, Paget’s, metastatic bone disease, osteogenesis imperfecta
esophagitis, jaw osteonecrosis, atypical stress fractures

251
Q

teriperatide action

s.e.

A

PTH analog, increases OB activity

transcient hypercalcemia

252
Q

mechanism allopurinol

A

competitive inhibitor xanthine oxidase

253
Q

febuxostat

A

inhibits xanthine oxidase

254
Q

pegloticase

A

recombinant uricase

uric acid –> allantoin (water soluble)

255
Q

probenecid

s.e.

A

inhibits uric acid reabsorption in proximal converluted tubule
can precipitate uric acid calculi

256
Q

colchicine mechanism

A

binds and stabilizes tubulin to inhibit microtubule polymerisation

257
Q

TNF-a inhibitors

A

adalimumab, etanercept, infliximab

258
Q

rasburicase

A

recombinant uricase

uric acid –> allantoin

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