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Step 1 Flash Cards > MSK, Skin and Connective Tissue > Flashcards

MSK, Skin and Connective Tissue Flashcards

1
Q

Epidermis Layers (from surface to base)

A

stratum Corneum, Lucidum, Granulosum, Spinosum (desmosomes), Basale (stem cell site)

  • Californias Like Girls in String Bikinis
  • calluses are thickened stratum corneum only
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2
Q

Epithelial cell junctions in order

A
  • tight junctions - zonula occludens (claudins and occludens)
  • adherens junction - zonula adherins, cadherins (Ca dependent)
  • desmosome - macula adherins (keratin interactions)
  • gap junction
  • hemidesmosomes - conects keratin in basal cells to underlying Bm
  • integrins - membrane proteins that bind collagen and laminin in the basement membrane (maintain tissue integrity)
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3
Q

injury associated with chronic kneeling

A 
prepatellar bursitis ("housemaids knee")
- knee pain , swelling, redness, crepitance, fluctuant edema
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4
Q

rotator cuff muscles

A

SITS

- supra/infraspinatus, teres minor, subscapularis

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5
Q

supraspinatus function

A
  • most common rotator cuff injury (empty can test)
  • abducts the arm initially
  • innervated by suprascapular nerve
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6
Q

infraspinatus function

A
  • laterally rotates the arm

- innervated by suprascapular nerve

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7
Q

teres minor function

A
  • adducts and laterally rotates the arm

- innervated by the axillary nerve

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8
Q

subscapularis function

A
  • medially rotates and adducts the arm

- innervated by subscapular nerve

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9
Q

carpal bone injuries

A
  • scaphoid most commonly fracture - avascular necrosis
  • dislocation of the lunate –> carpal tunnel syndrome
  • FOOSH damages hook of hamate –> ulnar nerve injury
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10
Q

radial head subluxation

A
  • nursemaids elbow

- tear of annular ligament

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11
Q

erbs palsy

A

C5-6 injury

  • infants due to lateral traction on neck during delivery, adults due to trauma
  • muscle deficits: deltoid, supraspinatus (abduction), infraspinatus (lateral rotation), biceps brachii (flexion, supination)
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12
Q

klumpke palsy

A

lower trunk injury (C8-T1)

  • infants due to upward force on arm during delivery, adults trauma
  • deficit in intrinsic hand muscles leads to total claw hand
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13
Q

winged scapula

A
  • lesion of the long thoracic nerve
  • axillary dissection after mastectomy, stab wounds
  • affects the serratus anterior
  • cannot abduct arm above horizontal, winged scapula
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14
Q

Axillary (C5-C6) injury

A
  • fractured surgical neck of humerus
  • anterior dislocation of humerus
  • presentation: flattened deltoid, loss of arm abduction at shoulder, loss of sensation over deltoid and lateral arm
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15
Q

Musculocutaenous (C5-C7) injury

A
  • injury due to upper trunk compression

- loss of forearm flexion and supination, loss of sensation over lateral forearm

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16
Q

Radial nerve (C5-T1) injury

A
  • midshaft fracture of humerus, compression of axilla (crutches or saturday night palsy)
  • writs drop, dec grip strength, loss of sensation of posterior arm/forearm and dorsal hand
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17
Q

Median nerve (C5-T1) injury

A
  • supracondylar fracture of humerus (proximal lesion, carpal tunnel syndrome and wrist laceration
  • “Ape hand” and “Pope’s blessing”
  • loss of writs and lateral finger flexion, thumb opposition, lumbricals of 2nd and 3rd digits
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18
Q

Ulnar nerve (C8-T1) injury

A
  • fracture of medial epicondyle of the humerus “funny bone”, fractured hook of hamate
  • “ulnar claw” on digit extension, radial deviation on write flexion, loss of flexion of wrist and medial fingers
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19
Q

recurrent branch of the median nerve injury (C5-T1)

A
  • superficial laceration of palm
  • “Ape hand”, loss of thenar opposition, abduction, flexion of thumb
  • no sensation loss
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20
Q

obturator (L2-L4) nerve injury

A
  • pelvic surgery, ant hip dislocation
  • travels through the obturator foramen
  • decreased medial thigh sensation and decreased adduction
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21
Q

femoral (L2-L4) nerve injury

A
  • pelvic fracture, mass involving the ilopsoas
  • decreased thigh flexion and leg extenion
  • decreased patellar reflex
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22
Q

common peroneal (L4-S2) nerve injury

A
  • trauma or compression of lateral aspect of leg, fibular neck fracture
  • foot drop with loss of eversion and dorsiflexion
  • “steppage gait”
  • PED = Peroneal Everts and Dorsiflexes, if injured foot dropPED
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23
Q

tibial nerve (L4-S3) nerve injury

A
  • knee trauma, Baker cyst, tarsal tunnel syndrome
  • inability to curl toes, loss of sensation on sole of foot, loss of inversion and plantar flexion
  • TIP = Tibial Inverts and Plantarflexes, if injured, cannot stand on TIP toes
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24
Q

superior gluteal (L4-S1) injury

A
  • post hip dislocation, buttocks injection, polio
  • trendelenburg sign/gait – pelvis tilts due to weak hip abduction, lesion is contralateral to side of hip that drops, ipsilateral to leg they stand on
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25
Q

inferior gluteal (L5-S2) injury

A
  • post hip dislocation or buttocks injection
  • difficulty climbing stairs/rising from seated position
  • loss of hip extension
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26
Q

Type 1 muscle fubers

A
  • slow, red (more mito and myoglobin), oxidative phosphorylation
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27
Q

Type 2 muscle fibers

A
  • fast, white, anaerobic glycolysis
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28
Q

Smooth muscle contraction cascade

A
  • depolarization causes L type Ca channels to open, Ca enters and binds to calmodulin, Ca-calmodulin complex binds myosin light chain kinase, which stimulates myosin-actin binding
  • NO/cGMP causes relaxation
29
Q

endochondral ossifcation

A
  • bones of axial and appendicular skeleton

- catilage made by chondrocytes and then osteoclasts/blasts replace with woven bone, gets remodeled to lamellar bone

30
Q

membranous ossification

A
  • bones of the calvarium and facial bones, woven bone formed directly without cartilage, later remodeled to lamellar boen
31
Q

achondroplasia

A

failure of endochondral ossification due to constitutive activation of fibroblast growth factor (FGFR3) on short arm of chromosome 4

  • > 85% of mutations are sporadic, 2/2 advanced paternal age
  • AD inheritance
32
Q

osteoporosis

A
  • loss of bone mass and interconnections
  • normal bone mineralization and labs
  • treat with bisphosphonates, PTH, SERMs, rarely calcitonin, densumab (RANKL monoclonal Ab)
33
Q

osteopetrosis

A
  • defective osteoclasts
  • thickened dense bones prone to fracture
  • pancytopenia, extramedulalry hematopoiesis
  • nerve impingement and palsies
34
Q

osteomalacia

A
  • rickets in kids
  • defective mineralization/calcification of osteoid
  • Vit D defect, dec Ca, inc PTH, inc ALP
35
Q

Pagets disease of bone

A

increased osteoblastic and osteoclastic activity

  • normal labs, inc ALP
  • inc risk of osteosarcoma
  • mosaic pattern of woven and lamellar bone
  • hat size increase and hearing loss
36
Q

giant cell tumor

A
  • 20-40 years old, epiphyseal end of long bones
  • locally agressive benign tumor
  • “soap bubble” appearance
  • multinucleated giant cells
37
Q

osteochrondroma

A
  • most common benign tumor
  • males < 25 years old
  • mature bone with cartilaginous cap
  • rarely transforms to chondrosarcoma
38
Q

osteosarcoma

A

2nd most common primary malignant bone tumor (after multiple myeloma)

  • bimodal distribution 10-20 years old and > 65
  • predisposing factors: Paget disease of bone, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni (germline p53)
  • metaphysis of long bones, sunburst pattern, Codman triangle
39
Q

Ewing Sarcoma

A
  • boys < 15 years old
  • commonly appears in diaphysis of long bones, pelvis, scapula, and ribs
  • anaplastic small blue cell malignant tumor, aggressive but responsive to chemo
  • “onion skin”
  • 11:22 translocation
40
Q

Chondrosarcoma

A
  • rare, malignant, cartilaginous tumor
  • Men 30-60 years old
  • usually located in pelvis, spine, scapular, humerus, tibia or femur
  • may be primary or from osteochondroma
  • expansile glistening mass within the medullary cavity
41
Q

rheumatoid arthritis

A
  • mediated by cytokines
  • Type IV HS reaction
  • 80% + RF, anti-CCP more specific
  • association with HLA-DR4
  • no DIP involvement
42
Q

Sjogren syndrome

A
  • AI destruction of exocrine glands
  • anti SSB and anti SSB (anti-Ro and anti-La) are antiribonucleoprotein antibodies
  • complications include dental caries, MALT lymphoma (unilateral parotid enlargement)
43
Q

causes of gout

A
  • under-excretion

- overproduction of uric acid - Lesch-Nyan, PRPP excess, inc cell turnover, von Gierke disease

44
Q

psuedogout

A
  • calcium pyrophosphate crystals
  • basophilic, rhomboid crystals
  • associated with hemochromatosis, hyper and hypo PTH
45
Q

psoriatic arthritis

A
  • asymmetric, patchy involvement
  • dactylitis (“sausage fingers”)
  • pencil-in-cup deformity on xray
46
Q

ank spon

A
  • ankylosis, uveitis, and aortic regurg

- inflammation at tendon insertion sites (costo-chondral junctions –> monitor chest expansion)

47
Q

SLE antibodies - which are specific, sensitive?

A
  • ANA sensitive
  • anti-histone sensitive for drug-induced lupus (procainamide, hydralazine, INH)
  • anti-DNA and anti-Smith specific
48
Q

sarcoidosis

A
  • can be distinguished from other restrictive lung diseases by CD4:CD8 ratio > 2:1
  • erythema nodosym, Bell palsy, uveitis and hypercalcemia due to inc alpha-hydroxylase-mediated Vit D activation
49
Q

polymyalgia rheumatica

A
  • associated with TCA

- inc ESR, CRP, normal CK

50
Q

polymyositis

A
  • proximal muscle weakness
  • characetrized by endomysial inflammation with CD8 T cells and macrophages
  • most often involves the shoulders
  • inc CK, + ANA, + Anti-Jo, + Anti-SRP, + Anti-Mi-2 Abs
51
Q

dermatomyositis

A
  • polymyositis + malar rash
  • Cottron papules, heliotrope rash, mechanics hands
  • inc risk of occult malignancy
  • CD4 T cells
  • inc CK, + ANA, + Anti-Jo, + Anti-SRP, + Anti-Mi-2 Abs
52
Q

myositis ossificans

A
  • metaplasia of skeletal muscle to bone following muscular trauma
  • “mass” at site of known trauma
53
Q

Scleroderma antibody

A

Anti-Scl 70

- anti DNA topoisomerase I

54
Q

CREST

A

Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly and Telangiectasia
- anti Centromere Ab

55
Q

albinism

A

normal melanocyte number with decreased melanin production due to decreased tyrosinase activity or defective tyrosine transport
- can also be due to failed neural crest migration

56
Q

psoriasis

A
  • increased stratum spinosum, decreased stratum granulosum

- Auspitz sign - pinpoint bleeding spots from exposure of dermal papullae when scales are scraped off

57
Q

Leser-Trelat sign

A
  • sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy
58
Q

pemphigus vulgaris

A
  • potentially fatal AI skin disorder with IgG Ab against desmoglien (component of desmosomes)
  • flaccid intraepidermal bullae caused by acatholysis (separation of epidermal cells)
  • oral mucosa is involved
  • immuno shows reticular pattern
    +ve Nikolsky sign
59
Q

bullous pemphigoid

A
  • IgG against hemidesmosomes
  • Abs “bullow” the epidermis
  • tense blisters containing eosinophils affect skin
  • no oral mucosal involvement
  • immuno shows linear pattern at epi-dermal junction
  • ve Nikolsky sign
60
Q

dermatitis herpetiformis

A
  • pruritic papules, vesicles and bullae
  • deposits of IgA at tips of dermal papillae
  • celiac disease
61
Q

erythema nodosum

A
  • painful inflammatory lesions of subQ fat

- sarcoid, coccidiomycosis, histo, TB, strep infections, leprosy, and Crohn disease

62
Q

lichen planus

A
  • pruritic, purple polygonal planar papules and plaques
  • sawtooth infiltrate of lymphocytes at dermal-epidermal junction
  • associated with Hep C
63
Q

pityriasis rosea

A

“herald patch” then christmas tree

  • multiple plaques with collarette scale
  • self-resolving in 6-8 weeks
64
Q

sunburn

A
  • UVA – tanning and photoaging
  • UVB – sunburn
  • PABA esters are potent UVB radiation absorbers and are in sunscreen
65
Q

basal cell carcinoma

A
  • most common skin cancer, locally invasive but almost never mets
  • telangiectasias, rolled borders, central crusting or ulceration
  • “palisading” nuclei
66
Q

squamous cell carcinoma

A
  • 2nd most common
  • exposure to sunlight, immunosuppression, arsenic exposure
  • locally invasive, may spread to lymph nodes and rarely mets
  • histo: “keratin pearls”
67
Q

keratoacanthoma

A
  • variant of SCC that grows rapidly (4-6 weeks) and may regress spontaneously over months
68
Q

melanoma

A
  • S-100 tumor marker
  • BRAF mutation
  • vemurafenib (BRAF kinase inhibitor) may help those with BRAF V600E mutation

Step 1 Flash Cards (36 decks)

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