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Step 1 > MSK Random Facts > Flashcards

MSK Random Facts Flashcards

1
Q

Baker cyst

A

Popliteal fluid collection commonly related to chronic joint disease

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2
Q

Most commonly involved ligament in an ankle sprain

A

Anterior talofibular

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3
Q

What innervates the teres minor?

A

Ancillary nerve

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4
Q

Injury classically seen in cyclists

A

Guyon canal injury to ulnar nerve

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5
Q

What supplies sensation to the lateral forearm?

A

Musculocutaneous nerve (C5-7)

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6
Q

What can you get with a superficial laceration of the Palm?

A

Injury to the recurrent branch of the median nerve, loss of thenar muscle group, no loss of sensation

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7
Q

Klumpke palsy

A

Lower trunk damage (C8-T1), loss of the intrinsic muscles of the hand, total claw hand-lumbricals normally flex MCP joints and extend DIP and PIP joints

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8
Q

Thoracic outlet syndrome

A

Compression of lower trunk and subclavian vessels

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9
Q

What do the interossei do

A

Dorsal interossei-abduct the fingers, Palmer interossei- adduct the fingers

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10
Q

What can cause an inferior gluteal nerve injury?

A

Posterior hip dislocation, nerve is L5-S1

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11
Q

What’s in the anterior compartment?

A

Anterior tibial artery and deep peroneal nerve

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12
Q

What occurs during the power stroke?

A

Myosin releases bound ADP and PO4 causing displacement of the myosin and actin filament

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13
Q

What is ATP used for in the muscle contraction?

A

Myosin releasing actin

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14
Q

What is a type 1 muse fiber?

A

Slow twitch, red fiber, increased mitochondria and myoglobin concentration, used for sustained contraction

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15
Q

What is a type 2 muscle fiber?

A

Fast twitch fiber, white fiber, more anaerobic glycolysis, weight training results in hypertrophic of fast-twitch muscle fibers

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16
Q

McMurray test

A

External rotation and extension causing pain->medial meniscal tear; internal rotation and extension->lateral meniscal tear

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17
Q

How is contraction stimulated in smooth muscle?

A

AP opens L-type voltage gated Ca channel-> increased Ca in the cell binds to calmodulin-> Ca-calmodulin complex enhances myosin-light chain kinase, which phosphorylates myosin and leads to contraction

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18
Q

What do osteoblasts come from?

A

Differentiate from mesenchymal stem cells in the periosteum

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19
Q

What do osteoclasts come from and how do they work?

A

Differentiate from monocytes, macrophages. Multinucleated cells that dissolve bone by secreting acid and collagenases

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20
Q

Estrogens effects on bone

A

Estrogen inhibits apoptosis in bone-forming osteoblasts and induces apoptosis in bone-resorbing osteoclasts

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21
Q

Genetics of achondroplasia

A

Autosomal dominant (but >85% are sporadic), constitutive activation of fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

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22
Q

Osteoporosis histo and labs

A

Trabecular (spongy) bone loses mass and interconnections despite NORMAL mineralization and lab values

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23
Q

What is denosumab?

A

Monoclonal antibody against RANK-L

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24
Q

MOA of osteopetrosis

A

Mutations (eg, carbonic anhydrase II) impair ability of osteoclast to generate acidic environment necessary for bone resorption. Leads to thickened, dense bones that are prone to fracture. Pancytopenia and extramedullary hematopoeisis

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25
Q

What’s wrong in rickets/osteomalacia?

A

Defective mineralization/calcification of osteoid

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26
Q

Lab values in rickets

A

Low vit D, low Ca, high PTH, low phos

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27
Q

Lab values in Pagets

A

Normal Ca, phos, and PTH. Elevated ALP.

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28
Q

Histo of pagets

A

Mosaic pattern of woven and lamellar bone

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29
Q

What are rheumatoid nodules

A

Fibrinous necrosis

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30
Q

“Soap bubble appearance”

A

Giant cell tumor. Epiphyseal end of long bones. Locally aggressive benign tumor

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31
Q

Osteochondroma

A

Mature bone with a cartilagenous cap

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32
Q

Codman triangle

A

Osteosarcoma

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33
Q

Sunburst pattern

A

Osteosarcoma

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34
Q

Predisposing factors for osteosarcoma

A

Paget disease, bone infarcts, radiation, familial retinoblastoma, Li-Fraumenti syndrome (germline p53 mutation)

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35
Q

Where does an osteosarcoma most commonly occur?

A

Metaphysis of long bones, often around the knee

36
Q

Onion skin periosteal reaction

A

Ewing sarcoma

37
Q

Genetics of Ewing srcoma

A

t(11;22) translocation causing fusion protein EWS-FLI 1

38
Q

Where does Ewing sarcoma occur?

A

Diaphysis of long bones

39
Q

Histology of Ewing sarcoma?

A

Anapestic small blue cell malignant tumor

40
Q

What do you see with osteoid osteomas?

A

Nighttime pain, central nidus, in the diaphysis

41
Q

Antibodies in Sjogrens

A

SS-A (anti-Ro) and/or SS-B (anti-La)

42
Q

Complications of Sjogrens

A

Dental caries, mucosa-associated lymphoid tissue (MALT) lymphoma (may present as parotid enlargement)

43
Q

What drugs can precipitate a gout attack

A

Niacin, hydrochlorothiazide, cyclosporine, and pyrazinamide

44
Q

What are the crystals in pseudo gout?

A

Calcium pyrophosphate

45
Q

How do you monitor disease progression in anklyosing spondylitis?

A

Chest expansion

46
Q

What do you see with ankylosing spondylitis?

A

Ankylosis, uveitis, aortic regurgitation

47
Q

Triad of reactive arthritis

A

Conjunctivits, arthritis, urethritis (post-GI: shigella, salmonella, yersinia, campylobacter or chlamydia infections)

48
Q

What dermal findings might you see in reactive arthritis?

A

Keratoderma blennorrhagicum (hyperkeratotic vesicles on the palms and soles) or circinate balanitis (serpiginous annular dermatitis of the glans penis)

49
Q

What causes lupus nephritis?

A

Type III hypersensitivity reaction (nephritic: diffuse proliferative glomerulonephritis; nephrotic: membranous glomerulonephritis)

50
Q

What causes the cytopenia in lupus?

A

Type II hypersensitivity reaction

51
Q

Drugs indicated for drug-induced lupus

A

Procainamide, hydralazine, isoniazid, minocycline, TNF-alpha inhibitors

52
Q

Which patients may be more likely to get drug-induced lupus?

A

Slow acetylators

53
Q

What would you see in labs in sarcoid

A

Elevated ACE levels, elevated CD4/CD8 ratio

54
Q

What causes the hypercalcemia in sarcoid

A

Increased 1-alpha-hydroxylase-mediated vitamin D activation in macrophages

55
Q

What might you see in acute sarcoid?

A

Fever, parotid enlargement, anterior uveitis, and facial nerve palsy (Heerfordt-Waldenstrom syndrome)

56
Q

Antibodies in polymyositis/dermatomyositis

A

anti-Jo-1 (anti-histidyl-tRNA synthetase), anti-SRP, anti-Mi-2 antibodies

57
Q

What causes the inflammation in polymyositis and dermatomyositis?

A

Poly- endomysial inflammation with CD8 cells. Dermato-perimysial inflammation with CD4 cells

58
Q

What is myositis ossificans?

A

Metaplasia of skeletal muscle into bone following muscular trauma

59
Q

Zonula occludens

A

Tight junction, composed of claudins and occludins

60
Q

Zonula adherens

A

Adherents junction, forms belt connecting actin cytoskeletons of adjacent cells with CADherins (Ca dependent adhesion proteins). Loss of E-cadherin promotes metastasis

61
Q

Macula adherins

A

Desmosome- structural support via keratin interactions

62
Q

What is spongiosis

A

Epidermal accumulation of edematous fluid in intercellular spaces, seen in eczematous dermatitis

63
Q

What is acantholysis?

A

Separation of epidermal cells, seen in pemphigus vulgaris

64
Q

What causes lack of pigment in albinism vs vitiligo?

A

Albinism- normal melanocyte number with decreased melanin production due to decreased tyrosinase activity or defective tyrosine transport. Can also be caused by failure of neural crest cell migration during development. Vitiligo is due to autoimmune destruction of melanocytes

65
Q

Merocrine glands

A

Cells secrete via exocytosis. Ex. salivary, eccrine sweat, apocrine sweat

66
Q

Apocrine glands

A

Cells secrete via membrane-bound vesicles. Ex. mammary glands

67
Q

Holocrine glands

A

Cell lysis releases entire contents of the cytoplasm and cell membrane. Ex. sebaceous glands, meibomian glands

68
Q

What is rhinopehyma?

A

Bulbous deformation of the nose from chronic inflammatory changes in rosacea

69
Q

Difference between cellulitis and erysipelas?

A

Cellulitis is an infection of the deeper dermis and subcutaneous tissues (usually s. pyogenes or s. aureus), erysipelas is an infection involving upper dermis and superficial lymphatics (usually s. pyogenes)

70
Q

Staphylococcal scaled skin syndrome

A

Exotoxin destroys keratinocyte attachements in stratum granulosum only (vs TEN which destroys dermal-epidermal junction)

71
Q

Erythema migrans vs. multiforme vs. nodosum

A

Migrans- lyme; multiforme- dusky circles (often HSV but can be others); nodosum- subcutaneous nodules (sarcoid, coccidioidomycosis, hystoplasmosis, TB, strep, leprosy, Crohn)

72
Q

Sawtooth infiltrate of lymphocytes at dermal-epidermal junction

A

Lichen planus

73
Q

What is lichen planus associated with?

A

Hep C

74
Q

Which UV light is dominant in sunburn

A

UVB (UVA dominant in tanning and photoaging)

75
Q

What is melanoma often driven by?

A

Activation mutation in BRAF kinase. Patients with BRAF V600E mutation may benefit from vemurafenib, a BRAF kinase inhibitor)

76
Q

Which COX is platelet function dependent on?

A

COX-1 (produces TXA2)

77
Q

MOA of bisphosphonates

A

Pyrophosphate analogs; binds hyroxyapatite in bone, inhibiting osteoclast activity

78
Q

SE of bisphosphonates

A

Corrosive esophagitis (patients are advised to take with water and remain upright for 30 min); osteonecrosis of the jaw

79
Q

MOA of teriparatide

A

Recombinant PTH analog given subcutaneously daily. Increases osteoblastic activity. Causes increased bone growth compared to antiresorptive therapies

80
Q

What are topical vitamin D analogs used for?

A

Psoriasis (bind to and activate the vit D receptor, a nuclear transcription factor that causes inhibition of keratinocyte proliferation and stimulation of keratinocyte differentiation

81
Q

What drugs have their concentrations increased if administered with allopurinol?

A

Azathioprine and 6-MP

82
Q

MOA of Febuxostat

A

Inhibits xanthine oxidase

83
Q

MOA of Pegloticase

A

Recombinant uricase that catalyze metabolism of uric acid to allantoin (a more water soluble product)

84
Q

MOA of probenecid

A

Inhibits reabsorption of uric acid in proximal convoluted tubule (also inhibits secretion of penicillin)

85
Q

What should you not give in an acute gout attack?

A

Salicylates. All but the highest doses depress uric acid clearance

86
Q

Wickham striae (reticular white lines)

A

Mucosal involvement of lichen planus

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