MSK Flashcards
greenstick fracture
incomplete fracture going part way through bone, bending stress
torus fracture
axial force, buckle fracture of cortex, can be subtle
baker cyst
gastrocnemeus-semimembranous bursa, communicating with synovial space
most common rotator cuff injury
supraspinatus
guyons canal
ulnar nerve compression in cyclists
axillary nerve injury
from anterior dislocation of humerus, problems with deltoid
musculocutaneous nerve injury
from upper trunk compression, loss of biceps and lateral forearm
radial nerve injury
from facture of humerus or crutches, loss of wrist extension and sensation on back of arm/hand
median nerve injury
low fracture of humerus or carpal tunnel, loss of first three finger flexion and sensation in hand
carpal tunnel
spares the thenar eminence because nerve exits earlier
ulnar nerve injury
funny bone or fractured hook of hamate, loss of wrist and finger actions
recurrent branch of median nerve injury
from laceration of palm, loss of thenar muscles
erb palsy
- tear of upper trunk
- arm is adducted, medially rotated and extended
klumpke palsy
- tear of lower trunk (C8-T1)
- damage to intrinsic hand muscles
- claw hand
throacic outlet syndrome
- compression of lower trunk
- due to cervical rib or pancoast tumor
- claw hand
winged scapula
- damage to long thoracic nerve
- no function in serratus anterior
Iliohypogastric never
- sensory over suprapubic
- motor for transverse abdominis and internal oblique
genitofemoral nerve
- sensory in scrotum/labia majora and medial thigh
- motor for cremaster
skeletal vs cardiac muscles (T tubules)
triad in skeletal, dyad in cardiac (T tubule - terminal cisternae)
achondroplasia
- no long bone growth
- constitutively active FGFR3
- inhibits chondrocyte
osteoporosis
- normal lab values
- usually related to estrogen and old age
- diagnosed with DEXA
- can lead to vertebral compression fractures
osteopetrosis
- defect in osteoclasts
- thick and dense bones prone to fracture
- loss of bone marrow with extramed hematopoesis
- carbonic anhydrase II can’t make acidic enviornment
- treat with BM transplant
- thick bones
rickets/osteomalacia
- defect in mineralization of osteoid
- vitamin D deficiency
- bow legs, bead like costochondral junctions and craniotabes
- low Ca and phosphate
- hyperactivity of osteoblasts
Paget disease
- increase osteoclast then increased blast = poor quality bone
- labs are normal (increase in ALP)
- woven and lamellar bone
- chalk stick fractures
- higher risk of heart failure (from blood flow) and osteogenic sarcoma
- hat size increase
osteochondroma
- young males
- bony exostosis with cartilaginous cap
- rarely becomes cancer
giant cell tumor
- epiphysis of long bones
- near knee
- locally aggressive but benign
- soap bubble on xray
- multinucleated giant cells with RANKL
osteosarcoma
- bimodal
- Paget, radiation, RB, p53
- metaphysis of long bones
- codman triangle
ewing sarcoma
- young boys
- diaphysis of long bones
- small blue cell tumor
- onion skin
- 11:22 translocations with fusion protein
osteoarthritis
- mecahnical wear and tear of cartilage
- pain at the end of the day
- osteophytes, joint space narrowing
- no MCP involvement
- treat with pain management
RA
- autoimmune with pannus
- HLA-DR4
- IgM Ab to IgG Fc and anti CCP (more spceific)
- improves with use
- swan neck boutonniere
- no DIP involvement
- treat with DMARDs
Caplan syndrome
RA with pneumoconiosis
Felty syndrome
RA with neutropenia and splenomegaly
gout
- usually underexcretion
- yellow under parallel light, negative bierifringence
- you know the rest
pseudogout
- calcium pyrophosphate
- hemochromatosis and hyperparathyroidism
- knee most common
- calcium calcification in joint
- rhomboid positive crystals
sjogren
- destruction of glands by lymphocytes
- less tea production
- xerostomia
- ANA, RF, SS-A (anti-Ro) and SS-B (anti-La)
- parotid enlargement
- MALT
septic arthritis
- staph, strep and gonorrhoeae, high WBC
common features of seronegative
back pain with activity improvement, peripheral arthritis, enthesitis, dactylitis, uveitis
psoriatic arthritis
skin psoriasis, nail lesions, dactylitis and pencil in cup on xray
Reiter syndrome
- reactive arthritis
- conjunctivitis, urethritis and arthritis
SLE
- lupus nephritis can be nephritis or nephrotic (worst is diffuse proliferative)
- death = CVD, infections, renal
- ANA, anti-dsDNA (specific and bad), anti-Smith (specific, not prognostic), antihistone (sensitive for drug induced), low complement
libman sacks endocarditis
- nonbacterial verrucous thrombi on mitral or aortic valves
- usually on undersurface
antiphospholipid
- usually in SLE
history of thrombosis or abortion - lupus anticoagulant, anticardiolipin, anti beta glycoprotein antibodies
cardiolipin antibodies
can be false positive for VDRL/RPR and lupus anticoagulant can cause prolonged PTT that is not corrected
anti-UI RNP antibodies
mixed connective tissue disease
sarcoidosis
- noncaseating granulomas
- elevated ACE and high CD4/CD8 in bronchoalveolar lavage
- African Americans
- bilateral adenopathy and reticular opactiies
hypercalcermia in sarcoidosis
- increase in 1alpha-hydroxylase-mediated vitamin D activation in macrophages
polymyalgia rheumatica
- high ESR and CRP, normal CK
- pain and stiffness with no weakness
- giant cell arteritis
fibromyalgia
- tender points, fibrofog
- treat with exercise and antidepressants
polymyositis
- increased CK, ANA, anti-Jo-1, anti-SRP, anti MI2
- endomysial inflammation with CD8 T cells in shoulders
dermatomyositis
- increased CK, ANA, anti-Jo-1, anti-SRP, anti MI2
- malar rash, Gottron papules, heliotrope rash
- increase in malignancy
- perimysial inflammation and atrophy with CD4 cells
what can be confused with SLE
dermatomyositis with malar rash
myesthenia gravis
- antibodies to Ach receptor
- worsens with use
- improvement iwth edrophonium test
- associated with thymoma and thymic hyperplasia
- AchE inhibitor helps
Lambert Eaton
- antibodies to calcium channels
- proximal muscle weakness
- improves with use
- small cell cancer
Raynaud
- primary if idiopathic
- less blood flow with arteriolar in fingers
- mixed connective tissue, SLE and lupus
- treat with CCB
scleroderma
- pulmonary is most causes of death
- diffuse = widespread, associated with anti SCL 70 (topo 1)
limited = CREST and fingers
adherens
uses cadherins (loss of cadherins promostes metastasis)
integrins in skin
bind to collagen and laminin in BM
hyperkeratosis
- thickening of stratum corneaum
- in psoriasis and calluses
parakeratosis
- hyper keratosis with retention of nuclei
- psoriasis
hypergrnaulosis
- increase in stratum granulosum
- lichen planus
spongiosis
epidermal accumulation of edematous fluid in intercellular spaces
- eczematous dermatitis
acantholysis
sepearation of epidermal cells
- pemphigus vulgaris
acanthosis
- epidermal hyperplasia (increase in spinosum)
- acanthosis nigricans
albinism
less melanin production due to enzyme deficiency
melasma
- hyperpigmentation with OCP or pregnancy
vitiligo
autoimmune destruction of melanocytes
pseudofolliculitis barae
- foreign body inflammation
- hyperpigmented papules and pustules
- result of shaving, in african americans
psoriasis
- acanthosis with parakeratotic scaling
- micro abscesses
- more spinosum, less granulosum
- Auspitz sign from pinpoint dermal bleeding
rosacea
- no comedones
- phymatous rosacea causes nose deformities
seborrheic keratosis
- keratin filled cysts
- stuck on lesions
- Leser-Trelat - many meaning underlying malignancy
angiosarcoma
- elderly in sun exposed areas
- radiation and chronic postmastectomy lymphedema
- in liver - vinyl chloride and arsenic
bacillary angiomatosis
bening capillary papules in AIDS
- caused by Bartonella henselae
- not Kaposi, has neutrophils
cherry hemangioma
- elderly, does not regress
cystic hygroma
cavernous lymphangioma of neck, in Turners
glomus tumor
- painful, red-blue tumor under fingernail
- modified smooth muscle of thermoregulatory glomus body
kaposi sarcoma
- HHV8 in AIDS
- has lymphocytic infiltrate
pyogenic granuloma
- polypoid lobulated capillary hemangioma
- trauma and pregnancy
strawberry hemangioma
- in infants, will regress
erysipelas
- strep pyongenes
- upper dermis and superficial lymphatics
- well defined borders
molluscum contagiosium
poxvirus
hairy leukoplakia
while lesions on tongue that cant be scraped
- EBV mediated
- precancerous and associated with AIDS
