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USMLE Step 1 Quick Notes > MSK/Skin > Flashcards

MSK/Skin Flashcards

1
Q

What is the function of t-tubules?

A

To ensure coordinated contraction

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2
Q

What is the pathogenesis of Osteogenesis Imperfecta?

A

Can’t make proper triple helix

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3
Q

What is the presentation of osteogenesis imperfecta?

A

Blue sclera, bone fragility, dental imperfections, hearing loss

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4
Q

What is the progression of Paget’s Disease?

A

Lytic (osteoclastic) –> Mixed (both) –> sclerotic (osteoblastic)

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5
Q

Who gets prepatellar bursitis?

A

Carpentars, plumbers etc who kneel a lot get erythema and joint pain

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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)

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7
Q

What does a distal ulnar lesion present with?

A

Can’t undo the fist

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8
Q

What does a proximal ulnar lesion present with?

A

Can’t form a fist

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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

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10
Q

What needs to be monitored in ankylosing spondylitis?

A

Chest wall expansion

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11
Q

What does seborrheic keratosis look like?

A

Round, greasy, brown lesion that looks like it can be peeled off

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12
Q

What is the major cause of radiation burns?

A

UVB

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13
Q

What protects against UV light?

A

PABA

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14
Q

What accumulates in gout?

A

Monosodium urate crystals

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15
Q

What is the darkest line in a picture of the sarcomere?

A

Z line

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16
Q

What are the major hip flexors?

A

Psoas and Iliacus (especially when you sit up)

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17
Q

What does acanthosis nigricans look like?

A

Velvety, hyperpigmented thicekning

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18
Q

What causes a vertebral crush fracture?

A

Osteoporosis

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19
Q

What are your serum Ca and PO4 levels in osteoporosis?

A

Both are normal

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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

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21
Q

What would be damaged in a anterior dislocation of the humerus?

A

Axillary nerve

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22
Q

What would be damaged in a humeral neck fracture?

A

Axillary nerve

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23
Q

What would be damaged in a mid-shaft fracture

A

Radial Nerve

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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

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25
Q

What is the action of Colchicine?

A

Inhibits LTB4 and microtubule polymerization?

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26
Q

What is the histology of Paget’s?

A

Multinucleate cells w/ 100s of nuclei TRAP + (these are osteocytes)

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27
Q

What does the sensory innervation of the lateral forearm?

A

Musculocutaneous (becomes lateral cutaneous after innervating the muscles)

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28
Q

What is the inheritance of achondroplasia?

A

Autosomal dominant

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29
Q

What do heterozygotes with achondroplasia look like?

A

They are short, large relative to head (membranous ossification unaffected)

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30
Q

What do homozygotes with achondroplasia look like?

A

They die at birth

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31
Q

Pathogenesis of achondroplasia?

A

FGFR3 constitutive expression inhibits chondrocyte proliferation

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32
Q

What do Gottron’s papules look like?

A

Red papules w/ scales over bony prominence (on knuckles of hands)

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33
Q

Where is hematogenous osteomyelitis located?

A

In the metaphysis

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34
Q

Where else do you get sclerosis from fibrin/collagen besides in skin in Scleroderma/CREST

A

Renal, GI, CV, pulmonary (get pulmonary HTN)

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35
Q

In what settings would you see Carpal Tunnel Syndrome?

A

Hemodialysis related amyloidosis (beta 2 microglobulin deposition); also in pregnancy, hypothyroidism, RA, DM

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36
Q

Which gland causes sweat malodor?

A

Apocrine gland (secrete sweat then smell because of bacteria)

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37
Q

What drugs cause drug-induced lupus?

A

Isoniazid, Procainamide, Hydralazine

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38
Q

What would skin where glucocorticoid has been applied look like?

A

Derma atrophy, drying, cracking, tightening (GC reduce collagen and glycosaminoglycan production)

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39
Q

What is the psoas sign?

A

Pain with extension of the hip?

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40
Q

If something on the skin looks comedomal and nodular, what is it?

A

Acne

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41
Q

What is the histological finding of eczematous dermatitis?

A

Spongiosis

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42
Q

What is the diagnosis? Loss of anocutaneous reflex + saddle anesthesia.

A

Cauda equina syndrome

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43
Q

What is made of claudins and occludens?

A

Tight junctions

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44
Q

What is the unhappy triad?

A

MCL, medial lemniscus, ACL tear due to contact on a planted foot

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45
Q

What adducts the arm?

A

Subscapularis and teres minor

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46
Q

What laterally rotates the arm?

A

Infraspinatus and teres minor

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47
Q

What is it if you have child with extended elbow and pronated forearm?

A

Nursemaid’s

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48
Q

What do you see if baby has upward force on arm during delivery?

A

Horner and klumpke

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49
Q

What does proximal lesion look like?

A

Can’t do the action of the nerve

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50
Q

What does distal lesion look like?

A

Can’t undo the action of the nerve

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51
Q

What is the diagnosis? Saddle anesthesia, bladder and rectum flaccid paralysis, impotence

A

Conus Medularis Syndrome

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52
Q

Which muscle fiber type has more mitochondria and myoglobin?

A

Type 1

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53
Q

Which muscle fiber does sustained contraction

A

Type 1

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54
Q

Which muscle fibers do fast twitch and have white fibers?

A

Type 2

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55
Q

What happens to muscle fibers with weight training?

A

Type 2 hypertrophies

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56
Q

What do osteoblasts orginate from?

A

Mesenchymal stem cells

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57
Q

What is the inheritance pattern of achondroplasia?

A

AD

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58
Q

In what do you have osteoid matrix accumulation around trabeculae?

A

Rickets, Osteomalacia

59
Q

In what do you have trabecular thinning with?

A

Osteoporosis

60
Q

In what do you have subperiosteal bone resorption with cystic degeneration?

A

Hyperparathyroidism

61
Q

In what do you have spongiosa filling the medullary canal with no trabecula?

A

Osteopetrosis

62
Q

What does the mutation in osteopetrosis cause?

A

Impaired ability of osteoclast to generate acidic environment necessary for resorption

63
Q

What is it if you see multi nucleate cells with 100s of nuclei positive for TRAP on biopsy?

A

Paget’s; These are osteocytes

64
Q

What do you see high output heart failure with?

A

Paget’s due to increased blood flow from increased AV shunts

65
Q

With what do you see soap bubble appearance on Xray?

A

Giant cell tumor

66
Q

What is a locally aggressive benign tumor often around the knee?

A

Giant cell tumor

67
Q

Where does giant cell tumor occur?

A

Epiphyseal end of long bones

68
Q

What with do you see mature bone with cartilagenous cap/

A

Osteochondroma

69
Q

What do you see exostosis (new bone forming on surface of existing bone) with?

A

Osteochondroma (MC benign tumor of bone)

70
Q

Where do you see osteosarcoma?

A

Metaphysis

71
Q

What age group gets osteosarcoma?

A

Bimodal distribution (10-20 and >65)

72
Q

What has an onion skin appearance in bone?

73
Q

What is the translocation for Ewing?

74
Q

Where does Ewing’s occur?

75
Q

What looks like an expansile glistening mass within medullary cavity?

A

Chondrosarcoma

76
Q

Where does chondrosarcoma occur?

77
Q

With what in RA do you see fibrinoid necrosis from?

A

Subcutaneous rheumatoid nodules

78
Q

What is a major complication of Sjogren’s?

79
Q

What glycogen storage disease causes hyperuricemia?

A

Von Gierke

80
Q

Where/when does uric acid precipitate?

A

Low pH (distal tubules and collecting ducts)

81
Q

What diseases is associated with pseudogout?

A

Hemochromatosis, hyperparathyroidism, hypoparathyroidism

82
Q

What is Calcipotriene?

A

Vitamin D analog that activates nucleus TF that inhibit keratinocyte proliferation and differentiation

83
Q

What enthesopathy?

A

Limited chest expansion due to costosternal and vertebral pain (due to inflammation of tendon insertion sites)

84
Q

What are the symptoms of infectious arthritis?

A

Synoviits (knee), tenosynovitis (hand), dermatitis (pustules)

85
Q

How does ankylosing spondylitis affect lungs and heart?

A

Causes aortic regurgitation and upper lobe interstitial lung disease

86
Q

What causes a false VDRL positive test?

A

Virus (EBV, hepatitis), drugs, rheumatic fever, lupus and leprosy

87
Q

What immune mediated disease causes bell’s palsy?

A

Sarcoidosis

88
Q

What is heliotrope?

A

Erythematous periorbital rash

89
Q

What do you see on histology for thymoma?

A

Epithelial cells and lymphocytes; lobulated whorled pattern

90
Q

What is myositis ossificans?

A

Metaplasia of skeletal muscle to bone; incidental finding or mass at site of trauma

91
Q

What do you see hypergranulosis with?

A

Lichen planus

92
Q

What is acanthosis?

A

Increased spinosum (epidermal hyperplasia)

93
Q

What is melasma?

A

Hyperpigmentation associated with pregnancy or OCP use

94
Q

What causes verrucae and what do you see on histology?

A

HBV; hyperkaratosis, koilocytosis, epidermal hyperplasia

95
Q

What do junctional nevi look like?

A

Flat macules

96
Q

What do intradermal nevi look like?

97
Q

What are dennie morgan folds and what are they with?

A

Folds under eye from edema. Seen with atopic dermatitis

98
Q

What is leser - trelat sign?

A

Sudden apperance of multiple seborrheic keratosis indicating underlying malignancy

99
Q

What are horn cysts?

A

Seborrheic keratosis: Flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts

100
Q

How does toxin affect skin in SSS?

A

Destroys keratinocyte attachment in stratum granulosum

101
Q

What disease do you see acantholysis in?

A

Pemphigus vulgaris

102
Q

What is nikolsky’s sign positive?

A

Nikolsky’s sign is splitting of skin upon stroking; Positive in pemphigus vulgaris

103
Q

Which one involves oral mucosa pemphigus vulgaris or bullous pemphigoid?

A

Pemphigus vuglaris

104
Q

What do you see antibodies around epidermal cells in a reticular net like pattern?

A

Pemphigus vulgaris

105
Q

What looks like targets with multiple rings and dusky center?

A

Erythema multiforme

106
Q

Diagnosis? Fever, bulla, sloughing of skin post drug

A

Stevens-Johnson

107
Q

What are painful inflamamtory lesions of subq fat usually on anterior shins?

A

Erythema nodosum

108
Q

Which skin thing do histoplasma, TB, leprosy and coccidiodomycosis cause?

A

Erythema nodosum

109
Q

What is lichen planus associated with?

110
Q

What is wickham’s striae and what is it with?

A

Reticular white lines in the mucosa seen with lichen planus

111
Q

What do you see a sawtooth infiltrate of lymphocytes at dermal-epidermal junction with?

A

Lichen Planus

112
Q

Diagnosis? Herald patch followed by christmas tree distribution.

A

Pityriasis rosea

113
Q

What has plaques with collarette scale?

A

Pitryasis rosea

114
Q

What two things does BCC appear as?

A

Non healing ulcer or scaling plaque

115
Q

What does SCC look like?

A

Ulcerative red lesions with frequent scale?

116
Q

What is chronic draining sinuses associated with?

117
Q

What is keratoacanthoma?

A

Variant of SCC that grows rapidly and regresses spontaneously

118
Q

Does SCC metastasize?

A

No but it can spread to LN

119
Q

What are pink pearly nodules with telangiectasias?

120
Q

What dose of aspirin do you need for antipyretic and analgesic effects?

A

Intermediate dose

121
Q

How do COX2 Inhibitors work?

A

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
Q

What are the side effects of bisphosphonates?

A

Osteonecrosis of the jaw, corrosive esophagitis

123
Q

How do bisophosphonates work?

A

Bind hydroxyapatite in bone and inhibits osteoclast activity

124
Q

What does OPG do?

A

Stops osteclastic activity by decreasing interaction of RANK and RANK ligand

125
Q

What type of muscles are usually type 1?

A

Postural muscles

126
Q

Dermatitis herpeteformis vs atopic dermatitis?

A

Even though both are associated with food, dermatitis herpeteformis will be in 40-50s on flexural surfaces and buttocks.

127
Q

What is the difference between TEN and SSS?

A

SSS is superficial so only in stratum granulosum. TEN destroys the epidermal - dermal junction

128
Q

What is Stewart Treves syndrome?

A

Chronic lymphedema becoming cutaneous angiosarcoma

129
Q

What is the empty can test for?

A

Supraspinatus injury

130
Q

What is the most commonly injured rotator cuff muscle?

A

Supraspinatus

131
Q

Diagnosis: knee pain with synovial analysis showing WBC 100,000

A

Septic arthritis from gonococcus (gout would show WBC

132
Q

What lies underneath the 12 the rib?

133
Q

What lies underneath 9-12th ribs?

A

Spleen on the left, liver on the right

134
Q

Diagnosis: muscle weakness worse in hips and shoulders. Muscle biopsy shows MHC class I over expression on sarcolemma and CD8 lymphocyte infiltration?

A

Polymyositis

135
Q

What happens if I injure my radial nerve?

A

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
Q

What is acitretin?

A

Synthetic steroid used to treat psoriasis

STRONG teratogen!

137
Q

What is tetracycline used for?

A

Acne and bullous pemphigoid

138
Q

What pulls the acromion (end of clavicle) inferolaterally?

139
Q

What pulls the acromion (end of clavicle) superiomedially?

140
Q

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?

A

Melonoma (dysplastic nevus)

141
Q

Examination of the chest shows pectus carinatum and bead-like enlargement of the costochondral junctions. What is this?

A

Rickets!

Pectus carinatum = pigeon chest
Bead like enlargement = rachitic rosary

142
Q

What nerves innervate the internal urethral sphincter?

A

S3-S4

do pelvic floor and urogenital diaphragm

143
Q

What is a chronic heaped up ulcerative lesion on sun exposed areas?

A

Skin cancer!

If keratinocytes: SCC or BCC

If melanocytes: melanoma

USMLE Step 1 Quick Notes (17 decks)

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