MSK & Derm Flashcards
1
Q
What changes occur in collagen with aging?
A
Decreased production
NOT decreased cross-linkage
2
Q
Small, white, scaly lesions on sun-exposed areas
Sandpaper texture
Hyperkeratosis (increased stratus corneum)
Parakeratosis (increased nuclei in corneum)
Atypical keratinocytes (pleomorphic + mitoses)
A
Actinic Keratosis
3
Q
Actinic Keratoses are precursors to…
A
Squamous cell carcinoma
4
Q
Brown, “stuck on” lesions
A
Seborrheic Keratoses
“Barnacles of old age”
5
Q
Flaccid bullae that spread laterally with pressure
New bullae form with traction (Nikolskly sign)
A
Pemphigous vulgaris
6
Q
Pemphigous vulgaris involves autoantibodies to…
A
Desmosomes
7
Q
Edema in intercellular spaces as a result of contact dermatitis
A
Spongiosis
contrast superficial dermal edema of hives
8
Q
Type of sunscreen that absorbs UVB only
A
PABA
9
Q
Type of sunscreen that blocks UVA
A
Avobenzone
10
Q
Glands that mature at puberty, secreting sweat into hair follicles from dermis/fat of breast, axilla, genitals
A
APocrine (At Puberty)
Smelly secondary to bacteria in these areas
11
Q
Glands found through the body that secrete watery NaCl onto skin
A
Eccrine (Everywhere)
12
Q
Glands that discharge entire cell, breaking it to release
A
Holocrine
13
Q
What nerve does Nursemaid’s Elbow (extension and pronation of the arm) injure?
A
Deep branch of Radial Nerve
- Innervates extensor compartment of forearm
- Wrist drop or inability to extend results
- No sensory deficit (superficial br. of radial)
14
Q
What is the technical term for Nursemaid’s Elbow?
A
Radial Subluxation
- Extension and pronation of the arm
15
Q
Small, tender, blue proliferation under the nail bed
A
Glomus Tumor
16
Q
From what type of cell is a glomus tumor derived?
A
Smooth muscle cells that control the thermoregulatory function of dermal glomus bodies
17
Q
Rx for general skin and soft tissue infection
A
Nafcillin
Naf for Staph (usual cause of folliculitis and abscesses)
18
Q
What is Pellagra?
A
Vitamin B3 (Niacin) deficiency
- Dermatitis
- Diarrhea
- Dementia
-Death
19
Q
From where is B3 (Niacin) derived?
A
Diet and synthesized endogenously from tryptophan
20
Q
What does B3 produce?
A
NAD and NADP, coenzymes for fat, carb, and aa metabolism, as well as HMP shunt of glucose metabolism
21
Q
Salmon colored plaque with silver scales
Associated with arthritis
A
Psoriasis
22
Q
Prolonged, repetitive muscle contractions
Commonly of neck, eyelid, or hand
A
Dystonia
Cervical dystonia, blepharospasm, writer’s cramp
23
Q
Presents with ptosis + diplopia
Worse with activity and at end of day
Associated with thymoma
A
Myasthenia Gravis
24
Q
From where does the tibial nerve descend?
A
Popliteal fossa
25
What is the motor fx of the tibial nerve?
Plantar flexion and inversion of the foot
26
What is the sensory fx of the tibial nerve?
Divides into medial and lateral plantar nerves, supplies skin on plantar foot
27
What is the MOA of Etanercept?
Decoy receptor that grabs TNF-a
28
What is the indication for Etanercept?
RA in those who have seen no improvement with MTX alone
29
Explain "An Interesting Zoo Must Have Mammals"
Actin in the I band attaches at the Z line.
| Myosin in the H band attaches at the M line.
30
What hand joints does osteoarthritis affect?
PIP + DIP (Heberden's and Bouchard's nodes)
31
What hand joints does RA affect?
MCP + PIP
32
How is glycogen degraded during skeletal muscle contraction?
Increased Ca activates phosphorylase kinase >
Glycogen phosphorylase >
Glycogen is de-P and degraded
Note: Epi and NE also degrade glycogen through activating phosphorylase kinase
33
What is the most commonly injured rotator cuff muscle?
Supraspinatous
34
Injury to Supraspinatous/rotator cuff makes it difficult to...
ABduct the arm
35
How are collagen fibrils inked?
Covalently linked by lysyl oxidase after being secreted into extracellular space
36
What is the Rx for RA?
Glucocorticoids for short term/immediate relief
Sulfasalazine, Minocycline, Hydroxychloroquine for mild
MTX for moderate-severe
37
What is the short term Rx for RA?
Glucocorticoids
38
What is the long term Rx for mild or seronegative RA?
Sulfasalazine, Minocycline, Hydroxychloroquine
39
What is the long term Rx for moderate-severe RA?
MTX, but effect takes weeks
40
Trouble lifting quads, knee buckling, patellar reflex lost
Loss of sensation over ant/medial thigh, medial leg
What nerve is injured?
Femoral
41
Injury to femoral nerve results in what motor impairment?
Trouble lifting quads, knee buckling, loss of patellar reflex
42
Injury to femoral nerve results in what sensory impairment?
Loss of sensation of anterior/medial thigh, medial leg
43
Child holding elbow pronated at side indicates injury to...
Annular ligament
Nursemaid's elbow, radial subluxation
44
Myasthenia gravis involves antibodies to...
ACh Rs on motor endplate
45
The amount of acetylcholine in Myasthenia Gravis is...
normal, but the Ach has less ability to bind
46
Decreased compound muscle AP amplitude with repeated stimulation
Rapid restoration with rest
Increased strength with AchE-Is
Myasthenia Gravis
47
What is the Rx for Myasthenia Gravis?
Pyridostigmine
48
What are the 3 phases of Paget's Disease of bone?
1. Osteolytic
2. Mixed
3. Osteosclerotic
49
What occurs in the Osteolytic Phase of Paget's?
Increased RANK signaling and NF-KB activation > osteoclast activation
50
What occurs in the Mixed Phase of Paget's?
Blasts + Clasts active
51
What occurs in the Osteosclerotic Phase of Paget's?
Mostly blast activity
Mosaic Pattern
Cement lines
52
What is the function of ATP in muscle contraction?
Required to *release* myosin from its bindign spot on actin (not contraction itself)
53
What is the effect of no ATP on muscle contraction?
No ATP = rigor mortis
Constant contraction
54
Direct blow to anterior tibia and posterior drawer sign
PCL injury
55
What is heteroplasmy?
Different organellar genomes in a single cell (ex. mut and WT mitochondria in one cell)
56
What is mosaicism?
Some cell mutant, others wild type
57
What indicates the severity of a mitochondrial disese?
% defective mitochondrial genomes in a given cell
58
What is the most abundant aa in collagen?
Glycine (> proline > lysine)
59
What is the structure of collagen?
(Gly-X-Y)333
60
What part of the brachial plexus supplies the hand?
Lower trunk
61
With knee dislocation, must consider injury to:
Popliteal artery (highest risk)
Tibial Nerve
Common peroneal nerve
62
Wing scapula indicates injury to what nerve and muscle?
Long thoracic
| Serratus anterior
63
Fall on outstretched hand often results in fracture of the...
Lunate
- Medial of the 2 carpal bones that articulate with the radius
64
Fall on outstretched hand + avascular necrosis injures the...
Scaphoid
65
What is the MOA of Colchicine
Inhibits microtubule polymerization in leukocytes > decreases neutrophil chemotaxis
66
What is the use of Colchicine?
Gout (2nd line)
67
What are the adverse effects of Colchicine?
N/V/D, abdominal pain
68
Injury to what artery in a femoral neck fracture results in avascular necrosis?
Medial circumflex artery, provides most blood to femur
69
Fracture to what part of the femur results in avascular necrosis?
Femoral neck
70
What is the MOA of Allopurinol?
XO inhibitor
71
What is the use of Allopurinol?
Chronic tophaceous gout
1st line, and safer that uricosurics in renal disease
72
Characterized by loss of epidermal melanocytes
| Autoimmune correlation
Vitiligo
73
Autoimmune condition (anti-Jo) associated with overexpression of MHC class I on the sarcolemma, which is attacked by CD8+ T cells, causing myocyte damage
Polymyositis
74
Symmetrical proximal muscle weakness with inflammation, regeneration, and regrowth of muscle fibers on biopsy
Polymyositis
75
Bilateral stiffness in shoulder and pelvic girdle muscles
Fever, weight loss, increased ESR
Associated with temporal arteritis
Polymyalgia Rheumatica
76
What are the levels of Ca, Phos, and PTH in Osteoporosis
ALL NORMAL
77
Muscle closely associated with vertebral body + transverse processes
Combines with iliacus inferiorly to flex hip
Psoas
78
What bone disease involves cells:
- With up to 100 nuclei
- Staining for tartarate resistant acid phosphatase (TRAP)
- From the mononuclear phagocytic lineage
- Stimulated by MCSF
Paget's Disease of Bone
Osteoclasts!
79
Fibers that do aerobic metabolism (ox phos)
| Red because of increased myoglobin and mitochondria
Type I, Slow Twitch
80
Slow Twitch fibers are mostly found in what kind of muscles?
Structural muscles
81
Fibers that do anaerobic metabolism
| Forceful movement
Type II, Fast Twitch
82
An activating mutation in phosphoribosyl pyrophosphatase (PRPP) synthase causes...
Gout
- Increased purine production & degradation
- Hyperuricemia
83
Main type of invasive cell seen in gout:
Neutros
84
Rx for Gout:
NSAIDs + Colchicine
- Both inhibit neutrophil chemotaxis
- Colchicine also prevents phagocytosis by preventing microtubule formation
85
Anti-CCP (citrullinated peptides) are specific for what immunologic disease?
RA
86
What substances are responsible for wound contraction?
Matrix metalloproteinases (MMPs) and myofibroblasts
87
What is responsible for wound contracture (excessive contraction)?
Excessive matrix metalloproteinases (MMPs)
88
```
Inflammation at tendon insertions (pain, swelling, tenderness, esp. at Achilles)
Limited chest wall expansion (+/- lung fibrosis)
Ascending aortitis (> insufficiency)
```
Ankylosing Spondylitis
89
What is the pathogenesis of osteomalacia?
Decreased MINERALIZATION of osteoid
| Decreased Vitamin D, therefore decreased Phosphate
90
Increased WBCs in large joint fluid + absent crystals indicates...
Septic Arthritis
91
What is the most common cause of Septic Arthritis?
Gonococcus
92
What is the empiric Rx for Septic Arthritis?
Ceftriaxone
Prevent jt destruction, osteomyelitis, and sepsis
93
Substance that accumulates in pseudogout
Calcium pyrophosphate
94
Substance that accumulates in gout
Monosodium urate
95
Crystal arthropathy that usually first affects the knee
Pseudogout
96
Crystal arthropathy that usually first affects the big toe
Gout
97
Crystal arthropathy with (+) birefringence
Pseudogout
98
Crystal arthropathy with (-) birefringence
Gout
99
Presents as difficulty combing hair
| Proximal muscle weakness
Polymyositis
100
What muscles are most important to performing Valsalva?
Rectus abdominis
101
IgM antibody against Fc portion of self IgG
Rheumatoid Factor
102
Antibody secreted by B cells responding to T cells that attack cartilage components
Rheumatoid Factor
103
Succinylcholine is a deplolarizing NMJ blocker ... by Neostigmine in Phase I.
Augmented
104
Succinylcholine is a deplolarizing NMJ blocker ... by Neostigmine in Phase II.
Reversed
105
The duration of Succinylcholine blockade depends on proteins called...
Plasma Cholinesterase
- Succinylcholine is usually very short acting
- Can be prolonged to 1-3hrs due to atypical PC
106
What is the MOA and use of Calcipotriene?
Vitamin D analog used in Rx of Psoriasis
Binds Vitamin D receptors >
Inhibits keratinocyte proliferation >
Stimulates differentiation
107
Muscles that arise from the pubis + ischium and insert on the femur perform what function?
Adduction
108
What causes muscle atrophy (ex. in broken leg immobilized for a long time)?
Increased protein degradation
109
What are the components of CREST syndrome?
```
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia
```
110
Tretinoin is an analog of...
Vitamin A
111
What is the MOA of Tretinoin in reducing wrinkles?
Binds nuclear Rs > Increased gene expression of collagen
112
What are the levels of IL-1 in osteoporosis?
Increased
IL-1 activates osteoclasts >
Bone resorption >
Vertebral collapse
113
What nerves innervate the anterior and medial compartments of the leg (distal anterior thigh, knee, medial leg, foot)?
Femoral (L2-4)
| Obturador (L2-4)
114
Face rash with telangiectasia and papules
Intermittent flushing
Maybe triggered by spicy foods (histamines)
Rosacea
115
Rash and dry skin with flaking on face and scalp
Pityriasis Rosea (dandruff)
116
Herald Patch following URI and then scattered rash
| Self-limited, 6-8 wks
Seborrheic Dermatitis
117
"Water warts" spread via person to person contact
Firm, smooth, umbilicated papules 2-4mm, in clusters
May have eczema surrounding
Molluscum contagiosum
118
What is the cause of Molluscum contagiosum?
Poxvirus
119
What are the two collagen defects in Ehler-Danlos?
Lack of:
- Procollagen peptidase (more soluble collagen that doesn't cross link)
- Lysyl hydroxylase (decreased hydroxyl lysine in tissue)
120
What is housemaid's knee?
Prepatellar bursitis
- Also seen in gardeners
- This is a subcutaneous bursa
121
What is the MOA of cyclosporine?
Inhibits calcineurin > decreased IL-2
Immunosuppressant used in RA
122
Why do osteoclasts need carbonic anhydrase?
Provide H+ to acidify and resorb bone
123
What is a synthetic retinoid that is used as systemic therapy for Psoriasis?
Acitretin
124
What is the MOA of Acitretin?
Synthetic retinoid that promotes cell differentiation
| - Teratogen
125
What muscles attach at the lateral clavicle?
Deltoid (inferolateral movement) and trapezius (superomedial movement)
126
What bone disease presents with bony prominences at costochondral jx, indentations in lower ribs, softening of skull, and "osteoid matrix accumulation around trebeculae"?
Ricketts, vit. D def.
127
What are the lab findings in Ricketts?
Hypocalcemia, hypophosphatemia, because of vit. D def.
