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STEP 1 Review > MSK Review > Flashcards

MSK Review Flashcards

1
Q

Epidermis layers from surface to base

A

Stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, statum basale

(californians like girls in string bikinis)

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2
Q

Tight junctions

A

Zonula occludens. Prevents paracellular movement of solutes. Composed of claudins and occludins

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3
Q

Adherens junctions

A

Zonula adherens, below the tight junction, forms a belt connecting actin cytoskeletons of adjecent cells with Cadherins (calcium dependent adhesion proteins). Loss of e-cadherin promotes mets

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4
Q

Desmosomes

A

Macula adherens – spot rivets made of keratin and desmoplakin. Structural support.

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5
Q

Disease with autoantibodies against desmosomes

A

Pemphigus vulgaris

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6
Q

Disease with autoantibodies against hemidesmosomes

A

Bullous pemphigoid

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7
Q

Mcmurray test

A

Pain on external rotation of the knee indicates a medial meniscus tear. Pain on internal rotation indicates a lateral meniscus tear

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8
Q

Unhappy triad

A

ACL, MCL, medial meniscus typically.

But lateral meniscus injury is more likely

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9
Q

What is the landmark of a pudendal nerve block

A

Ischial spine

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10
Q

Where is mcburney’s point

A

Between ASIS and umbilicus. 2/3 to ASIS

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11
Q

Landmark for lumbar puncture?

A

Iliac crest

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12
Q

Rotator cuff muscles

And their innervations

A

Rotator cuff muscles all innervated by c5-c6 roots.

Supraspinatus infraspinatus teres minor subscapularis

Supra and infraspinatus innervated by the suprascapular nerve.

Teres minor innervated by the axillary nerve.

Subscapularis innervated by the subscapular nerve

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13
Q

Prepatellar bursitis

A

Anterior knee problem from kneeling

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14
Q

Baker Cyst

A

not a true cyst, but a communication with the knee bursa. Can cause DVT, seen with RA.

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15
Q

Wrist bone that is prone to avascular necrosis. Why?

A

Scaphoid because of retrograde blood supply.

Most commonly fractured too.

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16
Q

Lunate dislocation causes

A

Carpal tunnel syndrome

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17
Q

Carpal tunnel syndrome

A

Entrapment of the median nerve in the carpal tunnel, which cases paresthesia, pain, and numbness in median nerve distribution

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18
Q

Causes of carpal tunnel syndrome

A

Pregnancy, hypothyroidism, rheumatoid arthritis

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19
Q

Guyon Canal Syndrome

A

Compression of the ulnar nerve at the wrist or hand, classically seen in cyclists from the pressure of their handlebars.

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20
Q

Function of rotator cuff muscles

A

Supraspinatus - abducts arm initially
Intraspinatus - laterally rotates arm (pitching injury)
Teres Minor - adducts the arm and laterally rotates
Subscapularis- adducts and medially rotates

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21
Q

Fall on outstretched hand

A

Damaged hook of hamate and ulnar nerve injury

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22
Q

Erbs palsy

A

Traction or tear of upper trunk C5 - C6. Arm is at side pronated and straight

Caused by a neck injury in infants, and trauma in adults.

Muscle deficits include deltoid and supraspinatus - no abduction. Infraspinatus - no lateral rotation. Biceps - no flexion or supination

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23
Q

Klumke palsy

A

Traction or tear of lower trunk (c8-T1). Claw hand.

In infants due to upward arm traction, in adults due to trauma (grabbing tree branch to brace fall)

Loss of intrinsic hand muscles. Lumbricals cannot flex MCP or extend PIP or DIP

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24
Q

Thoracic outlet syndrome

A

From pancoast tumor or cervical rib injury. Compression of lower trunk and subclavian vessels. Causes pain, weakness of hand, edema. Claw hand

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25
Q

Winged scapula

A

From LTN, happens in mastectomy. Serratus anterior keeps scapula anchored. ALso cannot abduct arm above horizontal

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26
Q

Axillary nerve injury

A

C5-C6. Injured with a surgical neck of the humerus injury or an anterior dislocation. Flattened deltoid, loss of sensation over deltoid and lateral arm

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27
Q

Musculocutaneous nerve injury

A

C5-C7 from compression of upper trunk. Loss of forearm flexion and supination. Loss of sensation over lateral forearm

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28
Q

Radial nerve injury

A

c5-T1. From midshaft fracture of humerus (because runs in spiral groove) or compression of axilla (saturday night palsy).

Causes loss of sensation over dorsum of hand, posterior forearm and arm. Causes wrist drop (loss of extension), decreased grip strength.

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29
Q

Median nerve injury

A

Supracondylar humerus fracture (proximal lesion), carpal tunnel syndrome/wrist laceration (distal lesion).

Proximal lesion causes popes hand when trying to make fist.
Distal lesion causes resting okay sign.

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30
Q

Tinel sign

A

Tingling on percussion in carpal tunnel syndrome

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31
Q

Ulnar nerve injury

A

C8-T1

Proximal injury is medial epicondyle fracture.
Distal lesion is fractured hook of hamate (fall on outstretched hand)

Proximal injury causes inability to make fist without doing the okay sign.

Distal injury causes resting pope hand.

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32
Q

Injury of recurrent median nerve?

A

Causes apes hand – loss of thenar muscle group.

NO LOSS OF SENSATION

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33
Q

Thenar Muscles

A

Innervated by the median nerve.

Include opponens pollicis brevis, abductor pollicis brevis, flexor pollicis brevis.

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34
Q

Hypothenar muscles

A

Innervated by the ulnar nerve

include the opponens digiti minimi, abductor digiti minimi, flexor digiti minimi.

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35
Q

Interosseus muscles

A

Innervated by the ulnar nerve.

Dorsal abduct
Palmar adduct

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36
Q

Obturator nerve (roots, cause of injury, presentation)

A

L2-L4. Injury from pelvic surgery, presents with loss of sensation over medial thigh, no adduction.

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37
Q

Femoral nerve (roots, cause of injury, presentation)

A

L2-L4 Injury from pelvic fracture. Presents with decreased thigh flexion and leg extension

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38
Q

Common peroneal nerve (roots, cause of injury, presentation)

A

L4-S2 Injury from trauma or compression of lateral leg. Fibular neck fracture.

Causes decreased sensation over dorsum of foot, foot drop. No eversion or dorsiflexion

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39
Q

Tibial nerve (roots, cause of injury, presentation)

A

L4-S3. Injury from knee trauma, baker cyst, tarsal tunnel syndrome. Inability to curl toes, no sensation at sole of foot. At proximal lesions, foot is everted at rest, no inversion or plantar flexion

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40
Q

Superior gluteal (roots, cause of injury, presentation)

A

L4-S1 From posterior hip dislocation or polio. Causes trendelenberg gait. Opposite side drops due to loss of ipsilateral medial gluteal muscle.

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41
Q

Inferior gluteal (roots, cause of injury, presentation)

A

L5-S2 Trouble climbing stairs or rising from chair. Can’t extend hip.

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42
Q

Long thoracic nerve neurovascular pair

A

Lateral thoracic artery

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43
Q

Axillary nerve neurovascular pair

A

Posterior Circumflex artery

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44
Q

Radial nerve neurovascular pair

A

Deep brachial artery

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45
Q

Median nerve neurovascular pair

A

Brachial artery

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46
Q

Tibeal nerve at popliteal fossa neurovascular pair

A

Popliteal artery

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47
Q

Tibeal nerve at medial malleolus

A

Posterior tibeal artery

48
Q

Steps of muscle contraction

A

Action potential depolarization opens voltage gated ca channels inducing NT release. NT bind to motor end plate and depolarization occurs. This mechanically opens the ryanodine receptor on SR and causes efflux of calcium, which binds to troponin, slides tropomyosin out of the way. Myosin releases bound ADP and power stroke occurs. ATP binds and Myosin releases.

49
Q

Contraction effect on sarcomere

A

Shortening of H and I bands and between Z lines.

A band is always the same length

50
Q

Type 1 muscle

A

Slow twitch red fibers due to increased mitochondria and myoglobin. Sustained contraction

51
Q

Type 2 muscle

A

Fast twitch, white fibers resulting from decreased mitochondria and myoglobin concentration. Increase in anaerobic glycolysis.

52
Q

Steps of smooth muscle contraction

A

Action potential leads to calcium influx. Ca binds calcmidulin and phosphorylates MLCK. MLCK phosporylates myosin and cross linking occurs.

Nitric oxide increases cGMP and causes activation of MLKPhosphatase, which removes P from myosin and causes relaxation

53
Q

Endochondral ossification

A

Bones of the axial and appendicular skeleton. Cartilagenous model of bone is made first by chondrocytes, then osteoclasts and osteoblasts replace woven bone with lamellar bone.

54
Q

Where is woven bone in adults?

A

Always pathological, seen in fractures and pagets disease

55
Q

Membranous ossicfication

A

Seen in bones of calvarium and face. Woven bone is formed directly without cartilage and is later remodeled to lamellar bone

56
Q

Osteoblasts

A

Build bone by secreting collagen and catalyzing mineralization. Differentiate from mesenchymal stem cells in periosteum

57
Q

Osteoclasts

A

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

58
Q

Parathyroid hormone at low intermittant levels

A

Can actually build bone

59
Q

How does estrogen affect osteoblasts/osteoclasts

A

Induces apoptosis in osteoclasts

60
Q

Achondroplasia

A

Activating mutation of FGFR3 causes failure of long bone growth. Membranous ossification not affected. Normal life span and fertility

61
Q

Normal activity of FGFR3

A

Inhibits chondrocyte proliferation, so activation in FGFR3 means no chondrocyte proliferation.

62
Q

Inheritance pattern of achondroplasia

A

Sporadic associated with advanced paternal age, but also can be autosomal dominant.

63
Q

Osteoporosis labs

A

Normal Ca, PO4, PTH.

64
Q

Pathogenesis of osteoporosis

A

Spongy bone loss and interconnection loss despite normal lab values. Diagnose with DEXA scan and with a T score of

65
Q

Osteoporosis type I

A

Due to decreased estrogen levels. Can cause femoral neck fracture or colles fracture.

66
Q

Type II osteoporosis

A

Senile osteoporosis affects males and females >70. Prevent with exercise, adequate calcium and vitamin D intake. Also treat with bisphosphonates.

67
Q

Osteopetrosis

A

Failure of normal bone resorption due to defective osteoclasts. No carbonic anhydrase so no acidic enviroment to resorb bone. Bone fills the marrow space causing pancytopenia and extramedullary hematopoesis.

Can cause cranial nerve impingment and palsies.

68
Q

How to treat osteopetrosis

A

Bone marrow transplant because osteoclasts are derived from monocytes

69
Q

Systemic consequence of osteopetrosis

A

Renal tubular acidosis. No bicarb regenerated so metabolic acidosis ensues.

70
Q

Osteomalacia/rickets

A

Lack of vitamin D. Defective mineralization and calcification of osteoid causes soft bones that bow out. Decreased Vit D means decreased serum calcium, increased PTH, and decreased PO4. Osteoblasts are overactive too which causes increased alkaline phosphatase.

71
Q

Findings of rickets in children

A

rachitic rosary, soft bones with varus defect

72
Q

Paget Disease of Bone

A

A localized disease of bone that is caused by increased osteoclastic activity, followed by a mixed osteoblastic/clastic, then osteoblastic phase. Ca, PTH, and phosphorus levels are normal but alk phos increased. Mosaic pattern with cement lines. Also av shunts cause high output cardiac failure. Also an increased risk of osteosarcoma.

Hat size may increase with hearing loss.

73
Q

Osteonecrosis

A

Infarction of bone and marrow frequently in femoral head. Caused by trauma, high dose corticosteroids, alcoholism, sickle cell. Due TO DEFICIENCY IN MEDIAL CIRCUMFLEX FEMORAL ARTERY.

74
Q

Caisson’s DIsease

A

Nitrogen bubbles leading to osteonecrosis

75
Q

Labs in osteomalacia

A

Decreased vit D, vit C, increased PTH, decreased phos

76
Q

Labs in hypervitaminosis D

A

Increased D, increased C, decreased PTH, increased phos

77
Q

Labs is osteocitis fibrosa cystica

A

Primary hyperparathyroidism – increased pth, increased ca, increased alk phos, decrease po4

ESRD - Decreased serum calcium, increased PTH, increased PO4.

78
Q

Giant cell tumor

A

Bubble sign in epiphysis. Benign. Locally agressive though. generally in knee. Has multinucleated giant cells, mostly in females

79
Q

Osteoblastoma

A

Large osteoid osteoma, generally bigger than 2cm. Pain doesn’t respond to aspirin

80
Q

Osteoma

A

Benign tumor of facial bones seen in gardner’s syndrome

81
Q

Osteoid osteoma

A

Benign tumor of osteoblasts surrounded by sclerotic bone. Occurs in

82
Q

Osteochondroma

A

Most common benign tumor. In males

83
Q

Osteosarcoma

A

Second most common malignant bone tumor after multiple myeloma. Occurs in metaphysis region. Bimodal distribution in teens and older adults (especially due to pagets.) Pleomorphic cells making osteoid, lifts the periosteum and forms codman’s angle with a sunburst appearance. Treat with en block resection and chemotherapy.

Predisposing factors: pagets, li-fraument (germline p53 mutation), retinoblastoma, radiation.

84
Q

Ewing Sarcoma

A

Neuroectodermal cells that are malignant and appear in the diaphysis of long bones. Starts in medulla and lays down periosteum in an onion skin pattern. Can present with FEVER.

Anaplastic small blue cell malignant tumor. Looks like lymphoma or wilm’s tumor. Treat with dactinomycin.

Associated with 11;22 translocation

85
Q

Chondrosarcoma

A

Rare malignant bone tumor seen in medulla and diaphysis. Seen in men 30-60.

86
Q

Chondroma

A

Benign mass in medulla of small bones of hands and feet

87
Q

Metastatic tumors

A

More common than primary tumors. From breast, lung, thyroid, kidney, prostate (blastic).

88
Q

Osteoarthritis

A

Mechanical joint wear and tear. Causes eburnation of joints with production of osteophytes and subchondral cysts. Heberdens and bouchards nodes (PIP and DIP).

Predisposing factors are age, obesity, joint deformity, traums.

Presents with pain in weight baring joints that gets worse as the day goes on. Knee cartilage loss begins medially

Treat with NSAIDS or intraarticular glucocorticoids

89
Q

RA antibody markers

A

HLA DR4. Rheumatoid factor (not specific) is an IgM anti Fc IgG. ANTI CYCLIC CITRULLINATED PEPTIDE IS MOST SPECIFIC!!!!!

90
Q

Rheumatoid arthritis

A

Autoimmune destruction of synovial joints mediated by cytokines and type III/IV HSR. Synovitis with pannus formation. Involvement of the wrist but sparing of the DIP.

Ulnar deviation of fingers due to myofibroblasts. Baker cyst formation. C1/C2 subluxation.

Morning stiffness lasting about 30 minutes and improving with use.

Often with systemic symptoms, fever, fatigue, pleuritis, pericarditis.

Can also cause anemia of chronic isease with amyloidosis

91
Q

Sjogren Syndrome antibody markers

A

Anti Ro anti La. Also known as SSA and SSB.

These are ribonucleoproteins

92
Q

Sjogren syndrome

A

Autoimmune destruction of exocrine glands, especially lacrimal and salivary. Lymphocytic sialadenitis. Dry eyes, dry mouth, dental caries. Bilateral parotid enlargement due to destruction of submandibular glands.

Can cause MALT lymphoma.

93
Q

What can present with sjogren’s like symptoms

A

Sarcoidosis, amyloidosis

94
Q

Gout

A

Acute inflammatory monoarthritis with negatively birefringent needles depositing in joints. Can be precipitated by underexcretion of uric acid (can be exacerbated by thiazides), or overproduction of uric acid from tumor lysis syndrome, lesch nyhand syndrome, and von gierke’s disease

Joint is red swollen and painful. There is tophus formation on ear, olechranon bursa or achilles. Acute attack tends to occur after a large meal or alcohol

95
Q

Why does alcohol exacerbate gout?

A

Because alcohol metabolites compete for same excretion sites in kidney as uric acid.

96
Q

How to treat gout

A

Acute: give nsaids, glucocorticoids, or colchicine
Chronic: allopurinol, febuxostat, probenecid

97
Q

Pseudogout

A

Presents with pain and effusion in a joint, caused by deposition of calcium pyrophosphate crystals within the joint space. Rhomboid cristals that are positively birefringent. Usually affects large joints and can be seen with hemochromatosis, hyperparathyroidism, and hypoparathyroidism.

98
Q

Infectious arthritis

A

Red hot joint that is painful. Affects knees hands and skin.

Usually caused by S. aureus, N. gonorrheae, and streptococcus

99
Q

Psoriatic arthritis

A

Pencil in cup bone deformity. Joint pain and stiffness. Patchy involvement that is asymmetric. Dactylitis. Seen in fewer than 1/3 of patients with psoriasis.

100
Q

Ankylosing spondylitis

A

Sacroileitis that causes bamboospine. Can also cause aortic regurgitation and upper lobe pulmonary fibrosis

101
Q

Reactive arthritis

A

Seen with campylobacter, shigella, salmonella, yersinia, or chlamydia infections.

Conjunctivitis/uveitis
Urethritis
Arthritis

102
Q

SLE

A

Rash, joint pain, fever. Usually in african american female.

Rash (malar/discoid)
Arthritis
Serositis (pericarditis, pleuritis)
Hemolytic anemia (pancytopenia due to type II attack)
Oral/nasopharyngeal ulcers
Renal disease (membranous, or diffuse proliferative)
Photosensitivity/Positive VDRL
Anti-phospholipid syndrome/ANA/ AntidsDNA
Immunosuppressants for treatment
Neurologic involvement (seizures/psychosis)

103
Q

Serology in SLE

A 
ANA
Anti-dsDNA
Anti-Smith (snRNP)
Anticardiolipin antibodies 
Decreased C3, C4, and CH50
104
Q

Drug induced lupus

A

Caused by hydralazine, procainamide, isoniazid

Generally no CNS/renal issues. Antihistone antibodies

105
Q

Antiphospholipid syndrome

A

Seen in lupus due to antibodies against cardiolipid (false positive VDRL)
Anti beta 2 microglobulin
Anticoagulant (will increase PTT) but actually predispose to emboli

106
Q

Sarcoidosis

A

Immune mediated widespread noncaseating granulomas.

Elevated serum ace, elevated vitamin D. Restrictive lung disease, erythema nodosum, schaumann and asteroid bodies, uvitis, hypercalcemia. Can appear to be sjogrens.

107
Q

polymyalgia rheumatca

A

pain/stiffness in sholders/hips assoc w/ giant cell art. elevated esr an crp, but normal ck.

108
Q

Fibromyalgia

A

Mostly seen in females 20-50. Chronic, widespread musculoskeletal pain associated with stiffness, paresthesias, poor sleep, and fatigue. Treat with regular exercise, TCA, SNRI, anticonvulsants

109
Q

Duchenne’s MD

A

X-linked deletion of dystrophin gene. Proximal muscle weakness leads to fibrofatty replacement of muscles. Increased CK. Death due to cardiac or respiratory failure.

110
Q

Becker MD

A

Mutated dystrophin, milder disease

111
Q

Polymyositis

A

Weakness of shoulder and pelvic muscles. Characterized by endomesial inflammation and CD8 mediated damage.

112
Q

Dermatomyositis

A

Weakness of proximal muscles, but includes skin findings like malar rash, gottron’s papules, shawl sign, heliotrope,

Increased risk of occult malignancy especially gastric cancer.

Perimysial imflammation and cd4 cell predominance.

113
Q

Serology of Poly/dermatomyositis

A

Increased CK, ANA, anti-jo-1, anti- SRP

114
Q

Scleroderma

A

Fibrosis and collagen deposition everywhere. Can cause renal crisis, pulmonary findings (most common cause of death), CV, and GI symtpoms. Diffuse scleroderma associated with anti-scl 70 (which is a DNA TOPOISOMERASE I antibody)

115
Q

CREST

A

You know this, associated with centromere.

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