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MSK Random Flashcards

1
Q

ACL

A

starts laterally

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2
Q

abnormal passive abduction

A

lateral force (valgus)-medial widening MCL injury

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3
Q

abnormal passive adduction

A

medial force (varus)-lateral widening LCL injury

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4
Q

popping external rotation

A

medial meniscus

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5
Q

popping internal rotation

A

lateral meniscus

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6
Q

Greenstick fracture

A

incomplete fracture partway through width of bone

bending stress-bone bent like twig

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7
Q

Torus fracture

A

axial force to immature bone

simple buckle fracture

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8
Q

unhappy triad

A

ACL, MCL, medial meniscus
from lateral force to planted leg
lateral meniscus injury more common

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9
Q

prepatellar

A

front of kneecap

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10
Q

Baker cyst

A

popliteal fluid collection in gastrocnemius-semimembranous bursa
communicates with synovial space (from chronic joint disease)

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11
Q

empty can test

A

supraspinatus

suprascapular nerve innervation

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12
Q

starts abduction

A

supraspinatus

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13
Q

laterally rotates arm

A

infraspiantus

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14
Q

adducts and laterally rotates

A

teres minor

innervated by axillary nerves

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15
Q

medially rotates and adducts

A

subscapularis

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16
Q

arm abduction

A

supraspinatus
deltoid
trapezius >90
serratus anterior >100

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17
Q

repetitive flexion

A

medial epicondylitis

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18
Q

repetitive extension

A

lateral epicondylitis

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19
Q

most commonly fractured carpal bone

A

scaphoid

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20
Q

cause of avascular necrosis and nonunion scaphoid

A

retrograde blood supply

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21
Q

dislocation of lunate

A

acute carpal tunnel syndrome

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22
Q

entrapment of median nerve

A

carpal tunnel

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23
Q

sensation spared in carpal tunnel

A

palmar cutaneous branch external to carpal tunnel

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24
Q

associations carpal tunnel

A

pregnancy, RA, hypothyroidism, diabets, acromegaly, dialysis related amyloidosis

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25
Q

Tinel sign

A

percussion of wrist causes tingling

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26
Q

flexion of wrist causes tingling

A

Phalen maneuver

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27
Q

Guyon canal syndrome

A

compression of ulnar nerve

seen in cyclists

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28
Q

fractured surgical neck and anterior dislocation of humerus

A

axillary-flattened deltoid

loss of shoulder abduction

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29
Q

upper trunk compression

A

musculocutaneous

loss of forearm flexion and supination

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30
Q

midshaft fracture or compression of axilla

A

radial
wrist drop, decreased grip strength
loss of sensation over posterior (including thumb)

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31
Q

supracondylar fracture of humerus, carpal tunnel and wrist laceration

A

median

loss of wrist flexion of lateral fingers

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32
Q

fracture medial epicondyle of humerus, fracture hook of hamate

A

ulnar
radial deviation of wrist upon flexion
loss of wrist flexion medial fingers

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33
Q

superficial laceration of palm

A

recurrent branch of median nerve

loss of thenar group muscle but no loss of sensation

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34
Q

Erb palsy

A

upper
deltoid, supraspinatus, infraspinatus, biceps brachii
abduction, lateral roation, flexion and supination

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35
Q

Klumpke palsy

A

lower
intrinsic muscles of hand
leads to total claw hand

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36
Q

Thoracic outlet syndrome

A

compression of lower tunk and subclavian vessels due to cervical rib and Pancoast tumor
also causes Klumpke palsy

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37
Q

Winged scapula

A

long thoracic nerve lesion
defect to serratus anterior
cannot abduct above horizontal
inability to anchor scapular to thoracic cage

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38
Q

distal ulnar and median lesion

A

clawing

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39
Q

proximal lesions

A

deficits during voluntary flexion of digits

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40
Q

atrophy thenar

A

median nerve

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41
Q

atrophy hypothenar

A

ulnar nerve

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42
Q

thenar muscles

A

opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

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43
Q

hypothenar muscles

A

opponens digiti minimi
abductor digiti minimi
flexor digiti minimi brevis

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44
Q

injury abdominal surgery

A

iliohypogastric
motor to transversus abdominis and internal oblique, sensory to suprapubic region
T12/L1

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45
Q

injury laproscopic surgery

A

cremaster motor and sensory to scrotum and medial thigh

absent cremasteric reflex L1/L2

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46
Q

anterior and lateral thigh sensation

A

lateral femoral cutaneous

L2/L3

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47
Q

pelvic surgery

A

obturator
sensory medial thigh
motor to obturator externus, adductor longus and brevis, gracilis, pectineus, adductor magnus
L2/L4

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48
Q

pelvic fracture

A

femoral
motor to quad, iliopsoas, pectineus, sartorius
sensory-anterior and medial thigh
L2/L4

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49
Q

herniated disc

A

sciatic
motor to semitendinous, semimembranous, biceps femoris, adductor magnus
sensory-posterior thigh
L4/S3

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50
Q

fibular neck fracture

A 
common peroneal 
motor to biceps femoris, tibialis anterior, extensor of foot
sensory dorsum
everts and dorsiflexes 
foot drop
L4/S2
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51
Q

knee trauma, baker cyst and tarsal tunnel syndrome

A 
tibial
motor to triceps surae, plantaris popliteus, flexor muscles of foot
sensory sole of foot
inverts and plantar flexes
L4/S3
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52
Q

injection to upper medial region

A

superior gluteal
motor to gluteus medius and minimus, tensor fascia latae
L4/S1

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53
Q

Trendelenburg

A

lesion is contralateral to side of hip that drops

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54
Q

posterior hip dislocation

A

motor to gluteus maximus

inferior gluteal L5/S2

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55
Q

stretch injury during childbirth

A

external urethral and anal sphincters

pudental S2/S4

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56
Q

nerve block

A

ischial spine as landmark

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57
Q

internal rotators of hip

A

gluteus medius, minimus, tensor fascia latae

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58
Q

external rotators of hip

A

iliopsoas, gluteus maximus, piriformis, obturator

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59
Q

cause of herniation

A

posterolateral due to thin posterior longitudinal ligament

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60
Q

L3-L4 herniation

A

decrease patellar reflex

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61
Q

L4-L5 herniation

A

difficulty in heel walking

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62
Q

L5-S1 herniation

A

decrease achilles reflex

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63
Q

with long thoracic

A

lateral thoracic

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64
Q

with axillary

A

posterior circumflex

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65
Q

with radial

A

deep brachial

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66
Q

with median

A

brachial

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67
Q

with tibial at popliteal

A

popliteal

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68
Q

with tibial at medial malleolus

A

posterior tibial

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69
Q

T tubules

A

extension of plasma membrane with terminal cisternae of sarcoplasmic reticulum

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70
Q

dyad

A

cardiac

1 T tubule and 1 terminal cisterna

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71
Q

triad

A

skeletal

1 T tubule and 2 terminal cisternae

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72
Q

binds to troponin C

A

Ca

causes conformational change that moves tropomyosin

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73
Q

shortening in contraction

A

H and I bands
between Z lines
A remains same length

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74
Q

type 1 muscle

A

slow twitch; red fibers

increase mitochondria and myoglobin

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75
Q

type 2 muscle

A

fast twitch; white fibers

anaerobic glycolysis

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76
Q

smooth muscle

A

calmodulin to MLCK contraction

NO cGMP to MLCP relaxation

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77
Q

endochondral ossification

A 
axial skeleton
cartilage first (woven then lamellar)
defective in achondroplasia
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78
Q

membranous ossification

A

calvarium, facial bones, clavicle

without cartilage first

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79
Q

origin osteoblast

A

mesenchymal stem cells in periosteum

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80
Q

markers osteoblastic activity

A

ALP, osteocalcin, type I procollagen

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81
Q

chronically increase PTH

A

osteitis fibrosa cystica

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82
Q

cause closure of epiphyseal plate

A

estrogen

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83
Q

failure of endochondral ossification

A

achondroplasia

AD

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84
Q

genetics achondroplasia

A

FGFR3 (gain of function)

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85
Q

osteoporosis

A

trabecular and cortical bone loss and interconnections

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86
Q

drugs osteoporosis

A

steroids, alcohol, anticonvulsants, anticoagulants, thyroid replacement therapy

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87
Q

medical conditions osteoporosis

A

hyperparathyroidism
hyperthyroidism
MM
malabsorption syndromes

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88
Q

T score osteoporosis

A
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89
Q

screening recommendation osteoporosis

A

> 65 years old

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90
Q

osteopetrosis

A

due to defective osteoclasts

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91
Q

mutation osteopetrosis

A

CA II

impair ability of osteoclast to generate acidic environment

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92
Q

treatment osteopetrosis

A

bone marrow transplant

osteoclasts derived from monocytes

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93
Q

x ray osteopenia

A

looser zones

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94
Q

rickeys x ray

A

epiphyseal widening

metaphyseal cupping/fraying

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95
Q

labs osteomalacia

A

decrease Ca increase PTH decrease PO4

increase ALP

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96
Q

Paget

A

osteoclastic

followed by osteoblastic

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97
Q

labs paget

A

only increase ALP

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98
Q

fractures paget

A

chalk-stick fractures

99
Q

results paget

A

AV shunts may cause high-output heart failure

risk of osteosarcoma

100
Q

femoral head avascular necrosis

A

due to insufficiency of medial circumflex femoral artery

101
Q

causes avascular necrosis

A

corticosteroids, alcoholism, sickle, trauma, bends, legg-calve-perthes, gaucher, slipped capital femoral epiphysis

102
Q

Brown tumors

A

subperiosteal thinning

increase Ca, increase PTH and ALP

103
Q

secondary hyper-PTH

A

compensation for CKD

increase PO4

104
Q

labs hypervitaminosis D

A

decrease PTH
increase Ca and PO4
seen in granulomatous disease

105
Q

bony exostosis with cartilaginous cap

A

osteochondroma

106
Q

multinucleated giant cells that express RANKL

A

giant cell-in epiphysis

soap bubble

107
Q

most common location giant cell

A

distal femur and proximal tibia

108
Q

predisposing factors osteosarcoma

A

Paget, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni

109
Q

Codman traingle or sunburst pattern on x-ray

A

osteosarcoma

110
Q

treatment osteosarcoma

A

surgical en block resection

chemotherapy

111
Q

location Ewing

A

diaphysis of long bones, belvis, scapular, ribs

112
Q

anaplastic small blue cell

A

Ewing sarcoma

113
Q

onion skin periosteal reaction

A

Ewing sarcoma

114
Q

t(11;22)

A

fusion protein EWS-FLI1

115
Q

tumor metaphysis

A

osteosarcoma

116
Q

Heberden

A

Dip

117
Q

Bouchard

A

PIP

118
Q

treatment osteoarthritis

A

acetaminophen, NSAIDs, glucocorticoids

119
Q

formation of pannus (proliferation of granulation tissue)

A

RA

120
Q

predisposing RA

A

HLA-DR4, smoking, silica exposure

121
Q

rheumatoid factor

A

IgM that targets IgG Fc region

122
Q

mores specific Ab RA

A

anti-cyclic citrullinated peptide antibody

123
Q

cervical subluxation

A

RA

124
Q

not DIP

A

RA

125
Q

DMARDs

A

methotrexate, sulfasalzine, hydroxychloroquine, leflunomide

126
Q

fibrinoid necrosis with palisading histiocytes

A

rheumatoid nodules

127
Q

Caplan

A

RA and pneumoconiosis

128
Q

Felty syndrome

A

interstitial lung disease, pleuritis, pericarditis, anemia of chronic diease, neutropenia, splenomegaly, RA

129
Q

other associations RA

A

AA amyloidosis, Sjogren syndrome, scleritis, carpal tunnel syndrome

130
Q

underexcretion uric acid

A

renal failure

thiazides

131
Q

overproduction

A

Lesch-Nyhan, PRPP excess, increase turnover, von Gierke

132
Q

sites tophus

A

external ear, olecranon bursa or achilles tendon

133
Q

acute treatment gout

A

NSAIDs, glucocorticoids, colchicine

134
Q

associations pseudogout

A

hemochromatosis, hyper PTH, joint trauma

135
Q

site pseudogout

A

knee

136
Q

xray pseudogout

A

chondrocalcinosis

137
Q

crystals pseudogout

A

rhomboid and weakly + birefringent

138
Q

histology Sjogren syndrome

A

destruction of exocrine glands by lymphocytic infiltrates

139
Q

labs sjogren

A

rheumatoid factor, antiribonucleotide Ab (Ro and La)

140
Q

complications Sjogren

A

dental caries, MALT lymphoma

141
Q

septic arthritis causes

A

staph, strep, neisseria

142
Q

purulent arthritis or polyarthralgia, tenosynovitis, dermatitis

A

gonococcal arthritis

143
Q

pencil in cup of DIP

A

psoriatic arthritis

144
Q

joints ankylosing spondylitis

A

spine and sacroiliac joints

145
Q

lungs ankylosing

A

restrictive lung disease due to limited chest wall expansion

146
Q

causes reactive arthritis

A

shigella, yersinia, chlamydia, campylobacter, shigella

147
Q

causes death in SLE

A

cardiovascular
infections
renal disease

148
Q

drug induced lupus

A

anti-histone Ab

149
Q

specific Ab SLE

A

anti-smith, anti-dsDNA

150
Q

treatment SLE

A

NSAIDs, steroids, immunosuppressants, hydroxychloroquine

151
Q

antiphospholipid Ab

A

lab findings of lupus anticoagulant, anticardiolipin anti-B2 glycoprotein Ab

152
Q

false labs in antiphospholipid syndrome

A

PTT and VDRL

153
Q

mixed connective tissue disease

A

features of SLE, systemic sclerosis, and polymyositis

154
Q

Ab mixed connective tissue disease

A

anti-U1 RNP antibodies

155
Q

labs sarcoidosis

A

increase ACE and CD4/8 ratio

156
Q

associations sarcoidosis

A

restrictive lung disease, eryhtema nodosum, Bell palsy, epithelioid granulmas, Schaumann and asteroid bodies, uveitis, hypercalcemia (due to increase 1alpha hydroxylase activation in macrophages)

157
Q

polymyalgia rheumatica

A

pain and stiffness in shoulders and hips

158
Q

association polymyalgia rheumatica

A

tempral arteritis

159
Q

labs polymyalgia

A

increase ESR CRP

160
Q

treatment fibromyalgia

A

exercise, antidepressants (TCA, SNRI), anticonvulsants

161
Q

labs polymyositis/dermatomyositis

A

increase CK +ANA +anti-Jo1 + anti-SRP +anti-Mi2

162
Q

endomysial inflammation with CD8 T cells, symmetric proximal weakness

A

polymyositis

163
Q

increase risk occult malignancy

A

dermatomyositis

164
Q

perimysial inflammation with atrophy of CD4

A

dermatomyositis

165
Q

shawl and face rash, Gottron papules, heliotrope

A

dermatomyositis

166
Q

worse with use

A

myasthenia

167
Q

causes myasthenia

A

thymoma

thymic hyperplasia

168
Q

cause lambert eaton

A

small cell lung cancer

169
Q

white blue red Raynaud

A

ishemia, hypoxia, reperfusion

170
Q

treatment Raynaud

A

Ca channel blockers

171
Q

diffuse scleroderma

A

early visclera

anti-Scl70

172
Q

cause of death scleroderma

A

pulmonary sclerosis

173
Q

CREST

A

calcinosis, anti-centromere Ab

Raynaud, esophageal dysmotility, sclerodactyly, telangiectasia

174
Q

skin layers

A 
corneum (keratin)
lucidum
granulosum
spinosum (desmosomes)
basale (stem cells)
175
Q

claudins and occludins

A

tight junction

176
Q

calcium dependent adhesion

A

cadherins in adherens junctions

177
Q

intermediate filament interactions

A

desmosomes

178
Q

hyperkeratosis

A

increase corneum

in psoriasis and calluses

179
Q

parakeratosis

A

retention of nuclei in corneum

psoriasis

180
Q

increase thickness granulosum

A

hypergranulosis

in lichen planus

181
Q

epidermal accumulation of edematous fluid

A

eczematous dermatitis

spongiosis

182
Q

acanthosis

A

epidermal hyperplasia

seen in acanthosis nigricans

183
Q

albinism causes

A

decrease tyrosinase activity or defective tyrosine transport

risk of cancer

184
Q

melasma

A

hyperpigmenation

associated with pregnancy and OCP

185
Q

vitiligo

A

autoimmune destruction of melanocytes

186
Q

associations atopic dermatitis

A

asthma, allergic rhinitis, food allergies

187
Q

histology psoriasis

A

acanthosis, parakerototic scaling

increase spinosum and decrease granulosum

188
Q

association psoriasis

A

nail pitting and psoriatic arthritis

189
Q

SK

A

squamous proliferation with keratin filled cyst, appears stuck on

190
Q

epidermal hyperplasia, hyperkeratosis, koilocytosis

A

verrucae

condyloma acuminatum on genitals (HPV associated)

191
Q

superficial dermal edema and lymphatic channel dilation

A

urticaria

192
Q

associations angiosarcoma

A

radiation and chronic postmastectomy lymphedema

193
Q

hepatic angiosarcoma

A

vinyl chloride and arsenic

194
Q

cherry hemangioma

A

in elderly

195
Q

cystic hydroma

A

cavernous lymphangioma of neck

associated with Turner syndrome

196
Q

glomus tumor

A

modified smooth muscle of thermoregulation

painful red-blue tumor

197
Q

pyogenic granuloma

A

polypoid lobulated capillary hemangioma

associated with trauma and pregnancy

198
Q

bulloua impetigo

A

usually staph

could be strep

199
Q

abscess

A

staph

200
Q

exotoxin destroys keratinocyte attachments in statum granulosum only

A

staph scalded skin

201
Q

TEN

A

destroys dermal-epidermal junction

202
Q

staph scalded skin

A

seen in children and adults with renal insufficiency

203
Q

hairy leukoplakia

A

lateral
EBV
cannot be scraped off

204
Q

hairy leukoplakia patients

A

HIV and transplants

205
Q

involvement of mouth

A

pemphigus vulgaris

type II HSR

206
Q

contents blisters bullous pemphigoid

A

contain eosinophils

Nikolsky negative

207
Q

often site dermatitis herpetiformis

A

elbows

208
Q

histology dermatitis herpetiformis

A

IgA at tips of dermal papillae

209
Q

> 30% skin involvement

A

toxic epidermal necrolysis

210
Q

actinic keratosis

A

premalignant

risk of SCC

211
Q

erythema nodosum associations

A

sarcoidosis, coccidio, histoplasmosis, TB, strep, leprosy, IBD

212
Q

pruritic, polygonal, purple, planar papules and plaques

A

lichen planus

213
Q

mucosal involvement lichen planus

A

Wickeham stria (reticular white lines)

214
Q

histology lichen planus

A

sawtooth infiltrate of lymphocytes at dermal-epidermal junction

215
Q

association lichen planus

A

hep C

216
Q

dominant in sunburn

A

UVB

217
Q

prominent in tanning and photoaging

A

UVA

218
Q

most comon skin cancer

A

basal cell

219
Q

waxy pink pearly nodules with telangiectasias and rolled borders

A

BCC

220
Q

palisading nuclei

A

BCC

221
Q

associations SCC

A

sunlight, immunosuppression, chronically draining sinuses, arsenic

222
Q

keratin pearls

A

SCC

223
Q

AK

A

precursor to SCC

224
Q

keroacanthoma

A

variant that grows rapidly and spontaneously regresses

225
Q

S-100

A

melanoma

226
Q

mutation melanoma

A

activation BRAF kinase

227
Q

inhibits platelet aggregation and promotes vasodilation

A

PGI2

228
Q

overdose acetaminophen

A

hepatic necrosis due to NAPQI depletion of glutathione

229
Q

inactivation acetaminophen

A

peripherally inactivated

not anti-inflammatory

230
Q

dose aspirin

A

low-anti platelet
intermediate-analgesic
high-anti inflammatory

231
Q

aspirin toxicity

A

respiratory alkalosis early

then mixed metabolic acidosis and respiratory alkalosis

232
Q

celecoxib

A

reversible and selective inhibitor of COX2

233
Q

adverse effects celecoxib

A

risk of thrombosis

sulfa allergy

234
Q

adverse effects NSAID

A

interstitial nephritis, gastric ulcer, renal ischemia, aplastic anemia

235
Q

cause of renal ischemia NSAID

A

loss of prostaglandins to vasodilate afferent arteriole

236
Q

MOA leflunomide

A

inhibits dihydroorotate dehydrogenase

prevents pyrimidine synthesis and suppresses T cell proliferation

237
Q

adverse leflunomide

A

diarrhea, HTN, hepatotoxicity, teratogenicity

238
Q

teriparatide

A

recombinant PTH

increases osteoblastic activity

239
Q

adverse effects teriparatide

A

osteosarcoma (avoid in paget)
transient hypercalemia
avoid in patients with prior cancers or radiation

240
Q

pegloticase

A

recombinant uricase that catalyzes metabolism of uric acid to allantoin (more water soluble)

241
Q

probenecid

A

inhibits reabsorption of uric acid

can precipitate uric acid calculi

242
Q

NSAID in gout

A

avoid salicylates

may decrease uric acid excretion

243
Q

side effects colchicine

A

GI side effects

Step One (19 decks)

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