MSK- FA Flashcards
Acute gout: Is allopurinol an option?
NO.
allopurinol is used as a prevention (for chronic gout)
For ACUTE gout attack, first line is NSAIDs and
other anti-inflammatory drugs (glucorcorticoid, colchicinine) are also options for acute gout)
medial epicondyle vs. lateral epicondyle: injury due to what kind of repetitive arm motion?
medial: golfer, forehand shots- flexion
lateral: tennis, backhand shots- extension
* golf swings medially, tennis swings backhand
Which hand bone can be palpated in snuff box? what is special about this bone?
scaphoid
- scaphoid is the most common injury site for avascular necrosis due to retrograde blood supply
(this is UWORLD question)
Myositis ossificans
- what is it?
- cause and location
- x-ray finding
- growth of bone in muscle (heterotrophic ossification)
- trauma, located in traumataized muscle
- bony ossification in muscle
Polymyalgia rheumatica: lab findings
- ESR
- CRP
- CK
- ESR: elevated
- CRP: elevated
- CK: normal (vs. polymyositis/dermatomyositis)
Compare etiologies: femoral nerve damage vs. obturator nerve damage
- femoral n: pelvic fracture
- obturator n: pelvic surgery
- makes sense: femoral n. runs lateral, kinda all over across pelvic bone, while obturator nerve runs medial, and inside of pelvic area (inside=deep= surgery related)
Lumbricals
- innervated what nerve? nerve root?
- motion of MCP
- motion of DIP/PIP
- ulnar (C8-T1)
- MCP flexion
- DIP/PIP extension
*think about clawed hand (lower root, ulnar damage)
: hands can’t flex MCP, and can’t extent DIP/PIP
Compare fracture etiologies: median nerve damage vs. radial nerve damage
median n: supracondylar fracture
radial n: midshaft humerus fracture
MOA of N-acetylcysteine as a antidote for acetoaminophen overdose
regeneration of glutathione
GS-SG -> 2GH
*acetoaminophen causes centrilobular necrosis of liver by generating free radicals
Dislocation of what bone may cause carpal tunnel syndrome
lunate
Amount and usage for each dose of aspirin
- low
- intermediate
- high
- low: <300mg, anti-platelet aggregation
- intermediate: < 300, <2400: antipyretic, analgestic
- high:<2400, <400: anti-inflammatory
Acanthosis nigrans: hyperplasia of what dermal layer
acanthosis: hyperplasia of stratum spinosum
What wrist bone damage is associated with ulnar nerve injury?
hammate
Most common cause of death in osteitis deformans?
osteitis deformans= pagets
hight output HF
Smoker has weak muscle strength, dry mouth and impotence. What’s up?
Lambert-Eaton syndrome (associated with small cell lung cancer)
autonomic symptoms of Lambert-Eaton: dry mouth and impotence
Patient taking probenecid for chronic gout. How penicillin dose needs to be modified? why?
Dose needs to be lowered.
probenecid also limits penicillin secretion, increasing interstitial nephritis
Carpal tunnel syndrome: how is sensation of thenar eminence affected? why?
thenar eminence sensation is intact
recurrent branch of median nerve (which innervates thenar eminence) does not go through carpal tunnel
Sarcoidosis: facial manifestation?
facial palsy
UV- which type mediates sunburn? which type mediates tanning? which type mediates skin aging?
- UVA- Aging
- UVB- sun Burn
A-aging B-burn
cardiac manifestation of anklyosing spondylitis
aortic regurgitation
- aortitis (inflammation) -> dilation of aortic root -> AR
Which autoanitbody in SLE tells about prognosis? which organ is usually involved in the presence of this antibodiy?
anti-dsDNA
renal is usually involved with positive anti-dsDNA
woman with breast cancer had mastetomy. what skin cancer should I worry about?
angiosarcoma
- this is UWORLD question
List 4 drugs that can cause lupus. What autoantibody is specific for drug induced lupus?
proclainamide, INH, phenytoin, and HYDRALYZINE
anti-histone
*pt wit heart condition showing lupus symptoms, think drug induced lupus
Which cell’s activity is impaired in osteopetrosis? which enzyme?
ostetoclast
defective carbonic anhydrase
What type of fracture is common in osteoporosis?
vertebral compression/ fracture
What two insults cause axillary nerve damage?
- anterior transolocation of humeral head
- humeral neck fracture
What two insults cause radial nerve damage?
- midshaft fracture of humerus
- axillary compression (crutch)
What two insults cause median nerve damage?
one in arm, one in wrist
- suprcondylar fracture
- lunate fracture
What two insults cause ulnar nerve damage?
one in arm. one in wrist
- lateral epicondyle fracture
- hammate fracture
Two dermatologic processes in psoriasis?
- hyperkaratosis
- parakaratosis (retained nuclei in startum corenum)
Achondroplasia
- what gene, what is function of this gene
- what mutation
- inheritance pattern
- most sporadic? or inherited?
- phenotype of homozygosity?
- FGFR3, inhibition of chondrocyte
- constitutive activation -> inhibition of chondrocyte
- autosomal dominant
- most cases are sporadic
- homozygote lethal
Which nerve innervates each rotator cuff muscle?
- supra/infrasipnatous: suprascapular nerve
- teres minor: axillary
- subscapularis: subscapular nerve
function of dorsal interossei? palmar interossei? what is pneumonic for it? (there is pneumonic for this)
PAD DAB
Palmar interossei- finger adduction
Dorsal interossei - fingeer abduction
abduction- kinda like stretch - backside (dorsal)
adduction- kinda like flexion - frontside (palmar)
What is melasma?
hyperpigmentation in preganants
Describe pathologic findings (2) in osteitis fibrosa cystica
- cystic lesions in bone
- brown fibrous tissue
Three side effects of NSAIDs
- anti-inflammtory
- anti-pyretic
- analgestic
neurologic manifestation in osteopetrosis? why?
cranial impingement due to narrowing of foramina
Thenar vs. Hypothenar eminence: innervated by what nerve in each?
- thenar eminence: recurrent branch of median
- hypothenar eminence: ulnar
Which disc level herniation is responsible for
- femoral n. compression
- peroneal n. compression
- tibial n. compression
- L4 (L3-L4)
- L5 (L4-L5)
- S1 (L5-S1)
nerve root for
- femoral n.
- obturator n.
- peroneal n.
- tibial n.
- femoral and obturator: L2-L4 (3)
- peroneal: L4-S2 (4)
- tibial: L4-S3 (5)
How does estrogen works for bone?
estrogen -> OPG -> decoy receptor for RANKL
-> inhibition of osteoclast activity
Which nerve and artery have increased risk for damage in humeral neck fracture?
posteior circumflex
What is common theme of drugs for acute gout management? List their names (3)
anti-inflammatory
- NSAID
- colchinine
- glucorcorticoid
Sarcoidosis: skin manifestation?
erythema nodosum
Which muscle of rotator cuff is commonly injured in pitcher? what about nerve?
infraspinatous
musculocutaneous nerve is also frequently damaged in pitcher
Name 3 diseases that predispose development of osteosarcoma
- retinoblastoma
- Li-Furafani
- pagets
Rosacea: describe dermatologic finding
erythematous papules, skin flushing after external stimuli (alcohol)
Sciatic nerve splits into what two nerves
peroneal and tibial
What is bony land mark for injection for knocking down pudendal nerve?
ischial spine
- this is UWORLD question
nerve root for pudendal nerve
S2-S4
prognosis of Ewing sarcoma? treatment option?
- bad prognosis, aggresive
- well respond to chemotherapy
What does TXA2 do to vasculature?
- vasoconstriction
* this is different to other COX cytokines (prostacycline, prostaglandin)
What mutation on what gene is associated with melanoma?
BRAF V600E
Erysipelas and Cellulitis are skin manifestations (also impetigo) of GAS infection. What is main difference between two?
- Erysipeals: superficial epidermis
- Cellulitis: deep including dermis
SLE manifestation in oral / pharyngeal area?
oralpharyngeal ulcer
What infection is associated with hairy leukoplakia? how is it different from thrush?
- EBV
- not scrapable
Gaucher disease: bone manifestation?
avascular necrosis
Two most common bacteria for septic arthritis?
- S. auerus
- N. gonorrhoeae
Three antibodies for anti-phospholipid syndrome?
- cardiolipin
- lupus anticoagulant
- beta 2 glycoprotein
midshaft of humerus fracture- what nerve and artery are getting damaged
- raidal n.
- deep brachial artery
Describe histology of basal cell carcinoma. what about gross appearance?
purlent (shiny)
palisading nuceli
- pathoma p.205
median nerve runs with which artery? through what fossa?
brachial artery
low dose aspirin vs. high dose aspirin: different effect on gout?
- high dose: inhibit uric acid reabsorption
- low dose: inhibit uric acid secretion
- needs HIGH dose to be beneficial
weakness in dorsiflexsion, difficulty with heel walking: what disc herniation?
- peroneal, L4-L5
weakness of knee extension, decreased patellar reflex: what disc herniation?
- femoral, L3-L4
weakness of plantarflexion, difficulty in toe walking: what disc herniation? what reflex will be diminished?
- tibial, L5-S1
reduced archillis tendon reflex
Base of skull: endochondral ossification? or membranous ossification?
endochonral ossification
- facial bone is membranous ossification, which is not same as base of skull
gap junction: what protein?
connexons
- gap junction CONNEcts between two cells, allowing communication
adhesion junction: what protein?
Cadherine
*cADHERine
tight junction: what proteins (2)?
- occludin
- claudin
dermatologic term for pemphigus vulgaris? (positive Nilkosky sign?)
acantholysis
Name three diseases/conditions that can lead to pseudogout
- hemochromatosis
- joint trauma
- hyperparathyroidism
- MCP deposition of calcium pyrophosphate in hemochromatosis => Don’t get confused with RA!!
basement membrane: what protein?
integrin
- integrity of basement membrane
benign, painful, red-blue tumor under fingernails. what tumor is this?
glomus tumor
Describe finding in immunmofluoresecne in pemphigus vulgaris? vs. bullous pemphigoid?
pemphigus vulgaris: fish net (all over epidermis)
bullous pemphigoid: linear (along basement membrane)
which cell is in the blisters of bullous pemphigoid?
eosiniphils
Which drug is used to diagnose myasthenia gravis?
edrophonium (tensilon)
- edrophonium is rapid acting AchE inhibitor. positive edrophonium test means transient improvement of muscle strength after edrophonium
What two bugs are associated with erythema multiforme?
- mycoplasma bacteria
- HSV (UWORLD)
umbilicated papule. what infection?
poxvirus
*umbilicated: central depression
Which amino acid is precursor for NO synthesis?
L-Ariginine
Grabbing a tree branch to break a fall: what nerve root injury?
This is classic case for Klumpke palsy, so lower trunk of brachial plexus
Ulnar nerve penetrates through what structure in elbow?
cubital fossa
What is PGI2? its functions (2)? From where is it released?
- prostacyclin
- inhibits platelet aggregation and vasoconstriction
- exactly opposite to TXA2
- endothelial cells release PGI2
MOA of aspirin? vs. acetoaminophen?
aspirin: IRREVERSIBLE COX1 and 2 inhibitor via ACETYLATION
acetoaminophen: REVERSIBLE COX inhibitor, mostly in CNS => why it is not anti-inflammatory, rather analgestic and antipyretic
During delivery, anesthetic is injected to nerve that runs between sacrospinus ligament and ischial spine. what nerve is this?
pudendal (S2-S4)
pudendal nerve is somatic nerve.
* also remember this nerve is associated with ejacuation in male (point, shoot, spoon)
- keyword: delivery, ischial spine = pudendal
Which nerve innervates biceps?
musculocutaneous
nerve root of long thoracic?
C5-C7
- I thought it is C5-T1, but no. JUST FIRST THREE
paget disease: how levels get changed?
- Ca2+
- phosphate
- ALP
- PTH
everything is normal EXCEPT ALP (high)
