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MSK/Skin/Connective Tissue Flashcards

1
Q

Cause of axillary nerve damage

A

C5-C6

Fractured surgical neck of humerus; anterior dislocation of humerus

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2
Q

Presentation of axillary nerve damage

A

C5-C6
Flattened deltoid
Loss of arm abduction at shoulder (> 15°)
Loss of sensation over deltoid muscle and lateral arm

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3
Q

Cause of musculocutaneous nerve damage

A

Upper trunk compression

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4
Q

Presentation of musculocutaneous nerve damage

A

C5-C7

Loss of forearm flexion, supination and lateral arm sensation

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5
Q

Cause of median nerve damage

A

C5-T1

Supracondylar fracture of humerus (proximal lesion); carpal tunnel syndrome and wrist laceration (distal lesion)

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6
Q

Presentation of median nerve damage

A

“Ape hand” and “Pope’s blessing”
Loss of wrist flexion, flexion of lateral fingers, thumb opposition, lumbricals of 2nd and 3rd digits
Loss of sensation over thenar eminence and
dorsal and palmar aspects of lateral 31⁄2 fingers with proximal lesion

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7
Q

Cause of ulnar nerve damage

A

C8-T1
Fracture of medial epicondyle of humerus “funny bone” (proximal lesion); fractured hook of hamate (distal lesion) from fall on outstretched hand

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8
Q

Presentation of Ulnar nerve damage

A

“Ulnar claw” on digit extension
Radial deviation of wrist upon flexion (proximal lesion)
Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers (interossei),
actions of medial 2 lumbrical muscles Loss of sensation over medial 11/2 fingers including hypothenar eminence

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9
Q

Cause of recurrent branch of median nerve damage

A

Superficial laceration of palm

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10
Q

Erb palsy (“waiter’s tip”)

A

Traction or tear of upper trunk: C5-C6 roots

Deficit in deltoid, supraspinatus, infaspinatus and biceps brachii: adducted, medially rotated, extended and pronated

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11
Q

Klumpke palsy

A

Traction or tear of lower trunk: C8-T1 root
Deficit lumbricals, interossei, thenar, hypothenar
Total claw hand

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12
Q

Winged scapula

A

LTN; serrates anterior

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13
Q

Thenar eminence

A

Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis, superficial head (deep head by ulnar nerve)

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14
Q

Hypothenar eminence

A

Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi brevis

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15
Q

Dorsal interossei

A

abduct the fingers

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16
Q

Palmar interossei

A

adduct the fingers

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17
Q

Iliohypogastric (T12-L1)

Damage occurs via?

A

Sensory—suprapubic region
Motor—transversus abdominis and internal oblique
Abdominal surgery

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18
Q 
Genitofemoral nerve (L1-L2)
Damage occurs via?
A

Sensory—scrotum/labia majora, medial thigh
Motor—cremaster
Laparoscopic surgery

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19
Q

Lateral femoral cutaneous (L2-L3)

Damage occurs via?

A

Sensory—anterior and lateral thigh

Tight clothing, obesity, pregnancy

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20
Q

Obturator (L2-L4)

Damage occurs via?

A

Sensory—medial thigh (L2-L4)
Motor—obturator externus, adductor longus, adductor brevis, gracilis, pectineus,
adductor magnus
Descends and exits through obturator canal
Pelvic surgery

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21
Q

Femoral (L2-L4)

Damage occurs via?

A

Sensory—anterior thigh, medial leg
Motor—quadriceps, iliopsoas, pectineus, sartorius
Pelvic fracture

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22
Q

Sciatic (L4-S3)

Damage occurs via?

A

Sensory—posterior thigh
Motor—semitendinosus, semimembranosus, biceps femoris, adductor magnus
Herniated disc

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23
Q 
Common peroneal (L4-S2)
Damage occurs via?
A

Sensory—dorsum of foot
Motor—biceps femoris, tibialis anterior, extensor muscles of foot
Trauma or compression of lateral aspect of leg, fibular neck fracture

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24
Q

Tibial (L4-S3)

Damage occurs via?

A

Sensory—sole of foot
Motor—triceps surae, plantaris, popliteus, flexor muscles of foot
Knee trauma, Baker cyst (proximal lesion); tarsal tunnel syndrome (distal lesion)

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25
``` Superior gluteal (L4- S1) Damage occurs via? ```
Exits pelvis via greater sciatic foramen (above piriformis) Motor—gluteus medius, gluteus minimus, tensor fascia latae (abduction) Iatrogenic injury during intramuscular injection to upper medial gluteal region
26
``` Inferior gluteal (L5-S2) Damage occurs via? ```
Exits pelvis via greater sciatic foramen below piriformis Motor—gluteus maximus (extension) Posterior hip dislocation
27
Pudendal (S2-S4) | Damage occurs via?
Sensory—perineum Motor—external urethral and anal sphincters Stretch injury during childbirth
28
Abductors of the hip
Gluteus medius, gluteus minimus
29
Adductors of the hip
Adductor magnus, adductor longus, adductor brevis
30
Extensors of the hip
Gluteus maximus, semitendinosus, semimembranosus
31
Flexors of the hip
Iliopsoas, rectus femoris, tensor fascia lata, pectineus
32
Internal rotation of the hip
Gluteus medius, gluteus minimus, tensor fascia latae
33
External rotation of the hip
Iliopsoas, gluteus maximus, piriformis, obturator
34
Osteitis fibrosa cystica
Primary hyperparathyroidism Incr: Ca, ALP, PTH Decr: PO4 Brown tumors (fibrous bone replacement)
35
Osteochondroma
Most common benign bone tumor | Bony exostosis with cartilaginous (chondroid) cap
36
Giant cell tumor
Benign; 20–40 years old. Epiphysis of long bones Locally aggressive; “Soap bubble” express RANKL
37
Osteosarcoma
Most common malignant bone tumors Codman triangle (Rb and Li Fraumeni)
38
Ewing sarcoma
Boys < 15 years old. Commonly appears in diaphysis of long bones, pelvis, scapula, ribs. “Onion skin” periosteal reaction
39
Presentation of osteoarthritis
Pain in weight-bearing joints after use
40
Joint finding in osteoarthritis
Osteophytes, joint space narrowing, subchondral sclerosis and cysts
41
Presentation of Rheumatoid arthritis
Pain, swelling, and morning stiffness lasting > 1 hour, improving with use
42
Joint finding in Rheumatoid arthritis
Erosions, juxta-articular osteopenia, soft tissue swelling, subchondral cysts, joint space narrowing.
43
Sjögren syndrome
Autoimmune destruction of exocrine glands
44
Antiphospholipid syndrome
1° or 2° autoimmune disorder Dx clinically: hx of thrombosis or spontaneous abortion w/ lab findings of lupus anticoagulant, anticardiolipin, anti-β2 glycoprotein antibodies
45
Sarcoidosis
Characterized by immune-mediated, widespread noncaseating granulomas ↑: ACE, CD4 and 8
46
Polymyositis/dermatomyositis markers
↑ CK, ⊕ ANA, ⊕ anti-Jo-1, ⊕ anti-SRP, ⊕ anti-Mi-2 antibodies
47
Polymyositis presentation
Progressive symmetric proximal muscle weakness w/ endomysial inflammation and CD8
48
Dermatomyositis presentation
Like polymyositis but w/ mallar rash, Grotton papule, heliotrope rash, shawl and face rash, mechanics hands
49
Scleroderma
Triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition with fibrosis
50
Appearance of scleroderma
Sclerosis of skin, manifesting as puffy, taut skin without wrinkles, fingertip pitting
51
Albinism
Decreased melanin d/t decreased tyrosinase activity
52
Glomus tumor
Benign, painful, red-blue tumor, commonly under fingernails | Derived from thermoregulatory cells
53
Pyogenic granuloma
Polypoid lobulated capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy.
54
Pemphigus vulgaris
IgG antibody against desmoglein Flaccid intraepidermal bullae caused by acantholysis Type II hypersensitivity reaction Nikolsky sign ⊕
55
Bullous pemphigoid
IgG antibody against hemidesmosomes | IF: linear pattern at epidermal-dermal junction
56
Dermatitis herpetiformis
Deposits of IgA at tips of dermal papillae. | Associated with celiac disease
57
Lichen Planus
Pruritic, Purple, Polygonal Planar Papules and Plaques Sawtooth infiltrate of lymphocytes at dermal-epidermal junction Associated with hepatitis C
58
Basal cell carcinoma
Most common skin cancer Waxy, pink, pearly nodules, commonly with telangiectasias, rolled borders, central crusting or ulceration “Palisading” nuclei
59
Squamous cell carcinoma
Ulcerative red lesions with frequent scale | keratin “pearls”
60
Leflunomide
Reversibly inhibits dihydroorotate dehydrogenase, preventing pyrimidine synthesis; suppresses T-cell proliferation Use: RA and psoriatic arthritis SE: Diarrhea, hypertension, hepatotoxicity, teratogenicity
61
Bisphosphonates
Pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity SE: Esophagitis, osteonecrosis of jaw, atypical stress fractures
62
Teriparatide
Recombinant PTH analog given subq; increases osteoblast activity Use: osteoporosis SE: increased risk of osteosarcoma
63
Etanercept
TNF-α inhibitor: Fusion protein (receptor for TNF-α + IgG1 Fc), produced by recombinant DNA Use: RA, psoriasis, ankylosing spondylitis
64
Anti-TNF-α monoclonal antibody
Infliximab, adalimumab, certolizumab, golimumab
65
Mixed connective tissue disease
Features of SLE, systemic sclerosis, and/or polymyositis | Associated with anti-U1 RNP antibodies (speckled ANA)
66
Polymyalgia rheumatica Sx and treatment
Pain and stiffness in shoulders and hips, often with fever, malaise, weight loss; NO weakness Low-dose corticosteroids
67
Polymyalgia rheumatica labs
Incr ESR, Incr CRP, normal CK
68
McMurray test
Pain w/ external rotation of knee: medial meniscus tear | Internal: lateral
69
Prepatellar bursitis
Repeated trauma or pressure from excessive kneeling (also called “housemaid’s knee”)
70
Baker cyst
Popliteal fluid collection in gastrocnemius-semimembranosus bursa
71
Arm abduction
Supraspinatus, deltoid, serrates anterior
72
Measurements of osteoblast activity
ALP, osteocalcin, propeptides of type I procollagen
73
Lab changes in osteoporosis
None (dx via DEXA)
74
Stages of pagets dx of bone
Lytic (clasts) Mixed Sclerotic (blasts; clasts have burnt out)
75
anti-Scl-70 antibody
aka anti-DNA topoisomerase I antibody | Diffuse scleroderma
76
Vitiligo
autoimmune destruction of melanocytes
77
Cherry hemangioma
Benign capillary hemangioma of the elderly
78
Cystic hygroma
Cavernous lymphangioma of the neck (Turner)
79
Strawberry hemangioma
Benign capillary hemangioma of infancy; grows then spontaneously regresses
80
Pityriasis rosea
“Herald patch” followed by scaly erythematous plaques, often in a “Christmas tree”distribution on trunk Self-resolving
81
Radial nerve damage presentation
Wrist drop: loss of elbow, wrist, and finger extension ↓ grip strength Loss of sensation over posterior arm/forearm and dorsal hand
82
Cause of radial nerve damage
C5-C7 | Midshaft fracture of humerus; compression of axilla (crutches or arm over chair)

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