MSK/Skin Flashcards
1
Q
What is the function of t-tubules?
A
To ensure coordinated contraction
2
Q
What is the pathogenesis of Osteogenesis Imperfecta?
A
Can’t make proper triple helix
3
Q
What is the presentation of osteogenesis imperfecta?
A
Blue sclera, bone fragility, dental imperfections, hearing loss
4
Q
What is the progression of Paget’s Disease?
A
Lytic (osteoclastic) –> Mixed (both) –> sclerotic (osteoblastic)
5
Q
Who gets prepatellar bursitis?
A
Carpentars, plumbers etc who kneel a lot get erythema and joint pain
6
Q
What is the MCC of hair loss in men and women?
A
Androgentic alopecia aka male pattern baldness (polygenic inheritance pattern w/ variable penetrance)
7
Q
What does a distal ulnar lesion present with?
A
Can’t undo the fist
8
Q
What does a proximal ulnar lesion present with?
A
Can’t form a fist
9
Q
Distal vs proximal nerve lesion?
A
Distal: you can’t undo the action of the nerve
Proximal: you can’t do the action of the nerve
10
Q
What needs to be monitored in ankylosing spondylitis?
A
Chest wall expansion
11
Q
What does seborrheic keratosis look like?
A
Round, greasy, brown lesion that looks like it can be peeled off
12
Q
What is the major cause of radiation burns?
A
UVB
13
Q
What protects against UV light?
A
PABA
14
Q
What accumulates in gout?
A
Monosodium urate crystals
15
Q
What is the darkest line in a picture of the sarcomere?
A
Z line
16
Q
What are the major hip flexors?
A
Psoas and Iliacus (especially when you sit up)
17
Q
What does acanthosis nigricans look like?
A
Velvety, hyperpigmented thicekning
18
Q
What causes a vertebral crush fracture?
A
Osteoporosis
19
Q
What are your serum Ca and PO4 levels in osteoporosis?
A
Both are normal
20
Q
What are the key traits of mitochondrial myopathy?
A
MERRF: ragged red fibers + myoclonic epilepsy
Leber optic neuropathy
MELAS: encephalopathy with stroke like episodes and lactic acidosis
21
Q
What would be damaged in a anterior dislocation of the humerus?
A
Axillary nerve
22
Q
What would be damaged in a humeral neck fracture?
A
Axillary nerve
23
Q
What would be damaged in a mid-shaft fracture
A
Radial Nerve
24
Q
What are the characteristics of a psoriasis lesion?
A
High mitotic activity above basale layer, reduced/absent granulosum, neutrophils may form spongiotic clusters in supericial dermis and parakeratotic stratum corneum
25
What is the action of Colchicine?
Inhibits LTB4 and microtubule polymerization?
26
What is the histology of Paget's?
Multinucleate cells w/ 100s of nuclei TRAP + (these are osteocytes)
27
What does the sensory innervation of the lateral forearm?
Musculocutaneous (becomes lateral cutaneous after innervating the muscles)
28
What is the inheritance of achondroplasia?
Autosomal dominant
29
What do heterozygotes with achondroplasia look like?
They are short, large relative to head (membranous ossification unaffected)
30
What do homozygotes with achondroplasia look like?
They die at birth
31
Pathogenesis of achondroplasia?
FGFR3 constitutive expression inhibits chondrocyte proliferation
32
What do Gottron's papules look like?
Red papules w/ scales over bony prominence (on knuckles of hands)
33
Where is hematogenous osteomyelitis located?
In the metaphysis
34
Where else do you get sclerosis from fibrin/collagen besides in skin in Scleroderma/CREST
Renal, GI, CV, pulmonary (get pulmonary HTN)
35
In what settings would you see Carpal Tunnel Syndrome?
Hemodialysis related amyloidosis (beta 2 microglobulin deposition); also in pregnancy, hypothyroidism, RA, DM
36
Which gland causes sweat malodor?
Apocrine gland (secrete sweat then smell because of bacteria)
37
What drugs cause drug-induced lupus?
Isoniazid, Procainamide, Hydralazine
38
What would skin where glucocorticoid has been applied look like?
Derma atrophy, drying, cracking, tightening (GC reduce collagen and glycosaminoglycan production)
39
What is the psoas sign?
Pain with extension of the hip?
40
If something on the skin looks comedomal and nodular, what is it?
Acne
41
What is the histological finding of eczematous dermatitis?
Spongiosis
42
What is the diagnosis? Loss of anocutaneous reflex + saddle anesthesia.
Cauda equina syndrome
43
What is made of claudins and occludens?
Tight junctions
44
What is the unhappy triad?
MCL, medial lemniscus, ACL tear due to contact on a planted foot
45
What adducts the arm?
Subscapularis and teres minor
46
What laterally rotates the arm?
Infraspinatus and teres minor
47
What is it if you have child with extended elbow and pronated forearm?
Nursemaid's
48
What do you see if baby has upward force on arm during delivery?
Horner and klumpke
49
What does proximal lesion look like?
Can't do the action of the nerve
50
What does distal lesion look like?
Can't undo the action of the nerve
51
What is the diagnosis? Saddle anesthesia, bladder and rectum flaccid paralysis, impotence
Conus Medularis Syndrome
52
Which muscle fiber type has more mitochondria and myoglobin?
Type 1
53
Which muscle fiber does sustained contraction
Type 1
54
Which muscle fibers do fast twitch and have white fibers?
Type 2
55
What happens to muscle fibers with weight training?
Type 2 hypertrophies
56
What do osteoblasts orginate from?
Mesenchymal stem cells
57
What is the inheritance pattern of achondroplasia?
AD
58
In what do you have osteoid matrix accumulation around trabeculae?
Rickets, Osteomalacia
59
In what do you have trabecular thinning with?
Osteoporosis
60
In what do you have subperiosteal bone resorption with cystic degeneration?
Hyperparathyroidism
61
In what do you have spongiosa filling the medullary canal with no trabecula?
Osteopetrosis
62
What does the mutation in osteopetrosis cause?
Impaired ability of osteoclast to generate acidic environment necessary for resorption
63
What is it if you see multi nucleate cells with 100s of nuclei positive for TRAP on biopsy?
Paget's; These are osteocytes
64
What do you see high output heart failure with?
Paget's due to increased blood flow from increased AV shunts
65
With what do you see soap bubble appearance on Xray?
Giant cell tumor
66
What is a locally aggressive benign tumor often around the knee?
Giant cell tumor
67
Where does giant cell tumor occur?
Epiphyseal end of long bones
68
What with do you see mature bone with cartilagenous cap/
Osteochondroma
69
What do you see exostosis (new bone forming on surface of existing bone) with?
Osteochondroma (MC benign tumor of bone)
70
Where do you see osteosarcoma?
Metaphysis
71
What age group gets osteosarcoma?
Bimodal distribution (10-20 and >65)
72
What has an onion skin appearance in bone?
Ewing
73
What is the translocation for Ewing?
T(11;22)
74
Where does Ewing's occur?
Diaphysis
75
What looks like an expansile glistening mass within medullary cavity?
Chondrosarcoma
76
Where does chondrosarcoma occur?
Diaphysis
77
With what in RA do you see fibrinoid necrosis from?
Subcutaneous rheumatoid nodules
78
What is a major complication of Sjogren's?
MALToma
79
What glycogen storage disease causes hyperuricemia?
Von Gierke
80
Where/when does uric acid precipitate?
Low pH (distal tubules and collecting ducts)
81
What diseases is associated with pseudogout?
Hemochromatosis, hyperparathyroidism, hypoparathyroidism
82
What is Calcipotriene?
Vitamin D analog that activates nucleus TF that inhibit keratinocyte proliferation and differentiation
83
What enthesopathy?
Limited chest expansion due to costosternal and vertebral pain (due to inflammation of tendon insertion sites)
84
What are the symptoms of infectious arthritis?
Synoviits (knee), tenosynovitis (hand), dermatitis (pustules)
85
How does ankylosing spondylitis affect lungs and heart?
Causes aortic regurgitation and upper lobe interstitial lung disease
86
What causes a false VDRL positive test?
Virus (EBV, hepatitis), drugs, rheumatic fever, lupus and leprosy
87
What immune mediated disease causes bell's palsy?
Sarcoidosis
88
What is heliotrope?
Erythematous periorbital rash
89
What do you see on histology for thymoma?
Epithelial cells and lymphocytes; lobulated whorled pattern
90
What is myositis ossificans?
Metaplasia of skeletal muscle to bone; incidental finding or mass at site of trauma
91
What do you see hypergranulosis with?
Lichen planus
92
What is acanthosis?
Increased spinosum (epidermal hyperplasia)
93
What is melasma?
Hyperpigmentation associated with pregnancy or OCP use
94
What causes verrucae and what do you see on histology?
HBV; hyperkaratosis, koilocytosis, epidermal hyperplasia
95
What do junctional nevi look like?
Flat macules
96
What do intradermal nevi look like?
Papular
97
What are dennie morgan folds and what are they with?
Folds under eye from edema. Seen with atopic dermatitis
98
What is leser - trelat sign?
Sudden apperance of multiple seborrheic keratosis indicating underlying malignancy
99
What are horn cysts?
Seborrheic keratosis: Flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts
100
How does toxin affect skin in SSS?
Destroys keratinocyte attachment in stratum granulosum
101
What disease do you see acantholysis in?
Pemphigus vulgaris
102
What is nikolsky's sign positive?
Nikolsky's sign is splitting of skin upon stroking; Positive in pemphigus vulgaris
103
Which one involves oral mucosa pemphigus vulgaris or bullous pemphigoid?
Pemphigus vuglaris
104
What do you see antibodies around epidermal cells in a reticular net like pattern?
Pemphigus vulgaris
105
What looks like targets with multiple rings and dusky center?
Erythema multiforme
106
Diagnosis? Fever, bulla, sloughing of skin post drug
Stevens-Johnson
107
What are painful inflamamtory lesions of subq fat usually on anterior shins?
Erythema nodosum
108
Which skin thing do histoplasma, TB, leprosy and coccidiodomycosis cause?
Erythema nodosum
109
What is lichen planus associated with?
HCV
110
What is wickham's striae and what is it with?
Reticular white lines in the mucosa seen with lichen planus
111
What do you see a sawtooth infiltrate of lymphocytes at dermal-epidermal junction with?
Lichen Planus
112
Diagnosis? Herald patch followed by christmas tree distribution.
Pityriasis rosea
113
What has plaques with collarette scale?
Pitryasis rosea
114
What two things does BCC appear as?
Non healing ulcer or scaling plaque
115
What does SCC look like?
Ulcerative red lesions with frequent scale?
116
What is chronic draining sinuses associated with?
SCC
117
What is keratoacanthoma?
Variant of SCC that grows rapidly and regresses spontaneously
118
Does SCC metastasize?
No but it can spread to LN
119
What are pink pearly nodules with telangiectasias?
BCC
120
What dose of aspirin do you need for antipyretic and analgesic effects?
Intermediate dose
121
How do COX2 Inhibitors work?
COX2 inhibitors are anti-inflammatory without affecting platelet function. COX2 is only at sites of inflammation. They are associated with increased risk of thrombotic events
122
What are the side effects of bisphosphonates?
Osteonecrosis of the jaw, corrosive esophagitis
123
How do bisophosphonates work?
Bind hydroxyapatite in bone and inhibits osteoclast activity
124
What does OPG do?
Stops osteclastic activity by decreasing interaction of RANK and RANK ligand
125
What type of muscles are usually type 1?
Postural muscles
126
Dermatitis herpeteformis vs atopic dermatitis?
Even though both are associated with food, dermatitis herpeteformis will be in 40-50s on flexural surfaces and buttocks.
127
What is the difference between TEN and SSS?
SSS is superficial so only in stratum granulosum. TEN destroys the epidermal - dermal junction
128
What is Stewart Treves syndrome?
Chronic lymphedema becoming cutaneous angiosarcoma
129
What is the empty can test for?
Supraspinatus injury
130
What is the most commonly injured rotator cuff muscle?
Supraspinatus
131
Diagnosis: knee pain with synovial analysis showing WBC 100,000
Septic arthritis from gonococcus (gout would show WBC
132
What lies underneath the 12 the rib?
Kidney
133
What lies underneath 9-12th ribs?
Spleen on the left, liver on the right
134
Diagnosis: muscle weakness worse in hips and shoulders. Muscle biopsy shows MHC class I over expression on sarcolemma and CD8 lymphocyte infiltration?
Polymyositis
135
What happens if I injure my radial nerve?
Can't extend arm at elbow and can't extend hand/fingers (remember the proximal and distal thing ONLY applies to ulnar & medial nerve)
136
What is acitretin?
Synthetic steroid used to treat psoriasis
| STRONG teratogen!
137
What is tetracycline used for?
Acne and bullous pemphigoid
138
What pulls the acromion (end of clavicle) inferolaterally?
Deltoid
139
What pulls the acromion (end of clavicle) superiomedially?
Trapezius
140
What has a mutation in 9p21 and has atypical cells with irregular nuclear contours, hyperchromasia and are round or spindle shaped, large aggregates of cells that fuse with adjacent cells?
Melonoma (dysplastic nevus)
141
Examination of the chest shows pectus carinatum and bead-like enlargement of the costochondral junctions. What is this?
Rickets!
Pectus carinatum = pigeon chest
Bead like enlargement = rachitic rosary
142
What nerves innervate the internal urethral sphincter?
S3-S4
| do pelvic floor and urogenital diaphragm
143
What is a chronic heaped up ulcerative lesion on sun exposed areas?
Skin cancer!
If keratinocytes: SCC or BCC
If melanocytes: melanoma
