MSK USMLE Flashcards
soccer player who was kicked in the leg suffered a medial meniscus. What else is likely to have been damaged.
Anterior cruciate ligament (remember the “unhappy triad”
Gymnast dislocates her shoulder anteriorly. What nn is most likely to have been damaged
Axillary nn (C5,C6)
X-ray shows bilateral hilar lymphadenopathy. What is the dx?
Sarcoidosis
Child exhibits weakness & enlarged calves. What is the dz & how is it inherited?
Duchenne’s muscular dystrophy. X-linked recessive
25 y/o woman presents with a low grade fever, a rash across her nose that gets worse when she is out in the sun and widespread edema. What are you concerned about?
SLE
85 y/o man presents with acute knee pain and swelling X-ray shows joint space w/o erosion. What is the dx & what would you find on aspiration
pseudogout; rhomboid calcium pyrophosphate crystals
epidermis layer from surface to base [image p. 313]
stratum Cornium stratum Lucidum stratum Granulosum stratum Spinosum stratum Basalis
mneu: CA Likes Girls w/ String Bikinis
Epithelial cell junctions:
This jx prevents diffusion across intracellular spaces
Zona occludens (tight jx)
Epithelial cell junctions:
This jx uses actin filaments and E-cadherins to surround the perimeter just below the zona occludens.
Zona adherens (intermediate jx)
Epithelial cell junctions:
This jx uses keratin & desmoplakin as small, discrete sites of attachemet
Macula adherens (desmosone)
Epithelial cell junctions:
This jx allows adjacent cells to communicate for electrical and metabolic functions and provides a connection with the central channel
gap jx
Epithelial cell junctions:
This jx connects cells to underlying extracellular matrix
hemidesmosome
Epithelial cell junctions:
This jx maintains the integrity of the basement membrane
integrin
this type of bone formation is spontaneous bone formation w/out preexisting cartilage (endochodral or intramembranous)
intramembranous
this type of bone formation is ossification of cartilaginous molds. Long bones form by this type of ossification at primary and secondary centers(endochodral or intramembranous)
endochodral
this common football injury caused by clipping from the lateral sides is called the unhappy triad and consists of injury to these three things
medial meniscus
medial collateral ligament (MCL)
anterior crutiact ligament
what test would you do to check for tearing of the ACL
anterior drawer sign (+ indicates tear)
abnormal passive abduction indicates a torn this
MCL
PCL stands for
posterior cruciate ligament
LCL stands for
lateral collateral ligament
“anterior” and “posterior” in ACL and PCL refer to the sites of _______ attachment
tibial
Shoulder muscles that form the rotator cuff
SItS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
counterclockwise from the top
In this autosomal-dominant trait failure of longitudinal bone growth results in short limbs. Membranous ossification is not affected (skull, facial bones, and axial skeleton are all normal. Therefore pt presents with a head and trunk of normal size, but limbs much shorter than normal.
Achrondoplasia
this disorder commonly presents in older pts who complain of pain in weight-bearing joints after use (e.g., at the end of the day improving with rest.) There are no systemic symptoms. This disorder results from the mechanical wear and tear of joints and leads to destruction of articular cartilage, subchondral bone formation, sclerosis, ostephytes and eburnation, Heberden’s nodes (DIP) and Bouchard’s nodes (PIP)
Osteoarthritis [image p. 318]
this autoimmune dz affects females more than men. Pts usually complain of morning stiffness improving with use, symmetric joint involvement, and systemic symptoms (fever, fatigue, pleuritis, pericarditis). This dz is an inflammatory d/o affecting synovial joints with pannus formation in the MCP, PIP joints. SubQ nodule, ulnar deviation, and subluxation may be preesent.
rheumatoid arthritis
[image p. 318 RA]
80% of pts w/ RA are positive for this IgG Ab
rhematoid factor
this d/o describes a reduction of bone mass in spite of normal bone mineralization
osteoporosis
osteoporosis most commonly affects this racial group
whites>blacks>asians
this type of osteoporosis strikes women and is due to increased bone resorption due to decreased estrogen llevels. Estrogen replacement is controversial as prophylaxis due to side effects
type I-postmenopausal
this type of osteoporosis affects both men and women >70 7/o
type II-senile osteoperosis
tx for osteoperosis/tx for severe cases
biphosphonates
pulsatile PTH
this desease results when there is a failure of normal bone resorption leading to thickened, dense bones. The bone defect is due to abnormal fx of osteoclasts. Serum Ca++, phosphate, and alkaline phosphatase are normal
Osteopetrosis (marble bone dz)
this dz results form defective mineralization of osteoid resulting in soft bones. Vit D deficiency leads to decreased Ca++ levels, increased secreation of PTH, increased serum phosphate. This d/o is reversible when vit D is replaced.
Osteomalacia (adults)/rickets (children)
This dz is caused by hyperparathyroidism. It is characterized by “brown tumors” (cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood). Pt presents with high serum Ca++, low serum phosphorus, and high alk phos.
Osteitis fibrosa cystica
this dz results in abnormal bone archhitecture caused by increase in both osteoplastic and osteoclastic activity. Serum Ca++, Phos, and PTH levels are normal. Serum ALK PHOS is ELEVATED.
Paget’s dz (osteitis dformans.
In this d/o bone is replaced by fibroblasts, collagen, and irregular bony trabecula. It affects many bones.
Polyostotic fibrous dysplasia.
This is a form of polyostotic fibrous dysplasia in which there are multiple unilateral bone lesions associated with endocrine abnromalities (precocious puberty) and unilateral pigmented skin lesions
Albrights syndrome
This dz occurs in pts > 50 y/o presents with pain and stiffness in the shoulders and hips, often with fever, malaise, and weight loss. There is no muscular weakness. ESR is increased and it is associated with temporal (giant cell) arteritis. Tx with prednisone
Polymyalgia Rheumatica
This is progressive proximal mm weakness caused by CD8+ T cell induced injury to myofibers. Muscle bx with evidence of inflammation is diagnostic.
Labs show increased CK, aldolase, and positive ANA & anti-Jo-1.
Polymyositis
This dz is similar to polymyositis but it also involves a skin rash and inceased risk of malignany. Labs show increased CK, aldolase, and positive ANA & anti-Jo-1.
Dermatomysitis
female between 40-60 y/o presents with xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia, and arthritis & parotid involvement. What do you suspect
Sjorgrens syndrome
What autoantibodies to ribonucleoprotein Ag would you seen in Sjorgrens syndrome
Anti SS-A (Ro)
Anti SS-B (La)
Sjorgrens syndrome increases risk of what CA
B-cell lymphoma
what autoimmune dz is Sjorgrens syndrome associated with
rheumatoid arthritis
Sjorgrens syndrome often presents with this syndrome which consists of dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, and reflux esophagitis
Sicca syndrome
30 y/o black female presents with malar rash, fever, fatigue, weight loss, nonbacterial verucous endocarditis, hilar adenopathy, and Raynaud’s phenominon. WIRE LOOP lesions are found in the kidney with immune complex deposition (with nephrotic syndrome. Eventially pt dies from renal failure and infections.
Systemic lupus erythematosis
SLE pts may be false positive on this STD test. why
RPR/VDRL for syphilis due to presence of antiphospholipid Ab
given the lab test for SLE describe its usefulness: Antinuclear Ab (ANA)
sensitive but not specific for SLE
given the lab test for SLE describe its usefulness:
Antibodies to double stranded DNA (anti-dsDNA
very specific, indicates a poor prognosis
given the lab test for SLE describe its usefulness:
Anti-smith Ab (anti-sm)
very specific but not prognostic
given the lab test for SLE describe its usefulness:
Antihistone Ab
indicates drug induced lupus
this is an autoimmune-mediated intolerance of gliadin (wheat) which leads to steatorrhea. It is associated with people of northern european descent. Findings inlude blunting of villi, lyphocytes in the lamina propria, and abnormal D-xylose test. It tends to affect the jejunum.
Celiac Sprue
What immune dz is celiac sprue associated with
dermatitis herpetiformis
10-15% of Celiac sprue cases lead to malignancy what is the most common CA
T-cell lymphoma
Man presents with enlarged painful MTP joint in the big toe (podagra). He describes nodules on his external ear and achilies tendon. He describes the pain getting worse after alcohol or eating a big meal. He has a dz that manifests itself in the precipitation of monosodium urate crystals into joints due to hyperuricemia.
Gout
what inherited enzyme deficiencies can result in gout (give 2)
lesch-nyhan syndrome
PRPP excess
glucose 6 phosphate deficiency
give an iatrogenic cause of gout
thiazide diuretics
describe the crystals in gout
needle shaped and NEGATIVELY BIREFRINGENT
give 2 tx medications for gout
allopurinol, probenecid, colchicine, and NSAIDS
this dz effects men and women over the age of 50 equally. It is caused by deposition of calcium pyrophosphate crystals within the joint space. It usually affects large joints like the knee.
pseudogout
describe the crystals in pseudogout.
basophilic, rhomboid crystals that are weakly positively birefringant.
what are the crystals made of in pseudogout? gout?
calcium pyrophosphate
uric acid
IM DAMN SHARP mneumonic for lupus stands for
Immunoglobins (anti-dsDNA, anti-sm, antiphospholiid) Malar rash Discoid rash Antinuclear Ab Mucositis (oropharyngeal ulcers Neurologic d/o Serositis (pleuritis, pericardiitis) Hematologic d/o Arthritis Renal d/o Photosensitivity
Man 20-40 y/o presents with hemoptysis from pulmonary hemorrhages, hematuria, anemia, and crescentric glomarulonephritis due to renal lesions. Anti-glomerular basement membrane Ab produce linear staining on immunoflurescence.
Goodpasture’s syndrome
mneu: There are 2 Good Pastures for this dz: Glomerulus & Pulmonary.
Goodpasture’s syndrome is this type of hypersensitivity dz
type II
this dz common in black females is characterized by immune-mediated, widespread noncaseating granulomas.
sarcoidosis
what lab test will show elevated levels in sarcoidosis
elevated ACE levels
Give 5 dz or findings associated with sarcoidosis
restrictive lung dz, bilateral hilar lympadenopathy, erythema nodosum, Bell’s palsy, epothelial granulomas containing microscopic Schaumann & asteroid bodies, uveoparotitis,, and hypercalcemia (due to its active form in the epithelioid macrophage)
What does the mneumonic for Sarcoidosis GRAIN stand for
Gammaglobinemia Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas
Name 2 Seronegative spondyloarthropathies (arthritis with no rheumatoid factor [no anti-IgG Ab)
Ankylosing spondylitis
Reiter’s syndrome
Seronegative spondyloarthropathies have a strong association for this gene that codes for HLA MHC I
HLA B27
Seronegative spondyloarthropathies occur more often in males or females
males
this is a chronic inflammatory dz of the spine and sacroiliac joints which leads to ankylosis (stiff spine), uveitis, and aortic regurgitation
ankylosing spondylitis
pt with the dz often presents post GI or chlamydia infectins with the classic triad of urethritis, conjunctivitis, and anterior uveitis, and arthritis
Reiter’s syndrome
mneu: can’t see (anterior uveitis/conjunctivitis), can’t pee (urethritis), can’t climb a tree (arthritis)
this dz is excessive fibrosis and collagen deposition throughout the body. It commonly effects females and is most often seen in the skin but also effects the CV, GI and renal systems
Scleroderma (progressive systemic sclerosis-PSS)
give the 2 types of Scleroderma
1) diffuse
2) crest
this type of Scleroderma has widespread skin involvement, rapid progression, and early visceral involvement
diffuse scleroderma
what Ab is diffuse scleroderma associated w/
Scl-70
this type of Scleroderma includes Calcinosis, Raynaud’s phenominon, Esophageal dysmotility, Sclerodactyly, and Telagiectasia. There is limited skin involvement (often confined to fingers and face) and a more benign clinical course.
CREST Syndrome
What Ab is CREST Syndrome associated with
anticentromere Ab
Skin disorders:
This describes a group of inflammatory pruritic skin d/o. The etiology involvves allergy (usually type IV hypersensitivity), chemical injury, or infection.
dermatitis
Skin disorders:
this describes a pruritic eruption, commonly on the flexor surfaces. It is often associated with other atopic dz like asthma, or allergic rhinitis
Atopic dermatitis (eczema)
Skin disorders:
this describes a type IV hypersensitivity reaction that follows exposure to an allergen (e.g., poison ivy, poison oak, nickel, rubber, chemicals) lesions occur at the site of contact
allergic contact dermatitis
Skin disorders:
this descrribes epidermal hyperlasia (acanthosis with parakeratoic scaling (nucleii still in stratum corneum) especially on knees and elbows. There is an increase in stratum spinosum BUT A DECREASE IN STRATUM GRANULOSUM. You may see the Auspitz sign
psoriasis
Skin disorders:
this presents with pruritic papules and vesicles. It is associated with celiac dz
dermatitis herpetiformus.
Skin disorders:
This describes pruretic, purple, polygonal papules with infiltrates of lymphocytes at dermoepidermal jx
lichen planus
Skin disorders:
This is associated with infections, drugs, cancers, and autoimmune dz. Pt presents with multiple types of lesions, including macules, papules, vesicles, and TARGET LESIONS (red papules with pale central area
erythema multiforme
this is the major form of erythema multiform. It is characterized by high fever, bulla formation and necrosis, ulceration of skin, and a high mortality rate
Stevens-Johnson syndrome
Skin disorders:
this describes flat, pigmented squamous epithelial proliferation with keratin-filled cysts (HORN CYSTS)
this is a BENIGN d/o
Seborrheic keratosis
Skin disorders:
This is caused by sun exposure. It is a small, rough erythematous or brownish papule. It is a premalignant lesion. The risk of carcinoma is proportional to epithelial dysplasia
Actinic keratosis
Skin disorders:
This is a tumor of connective tissue elements of dermis that causes raised, thickened scars. It follwos trauma to the skin, especially in African Americans
Keloid
Skin disorders:
This is an autoimmune d/o with IgG Ab against epidermal basement membrane (linear immunofluorescence). It is similar to but less severe than pemphigus vulgaris in that it affects the skin but spares the oral mucosa.
Bullous Pemphigoid
Skin disorders:
This is a potentially fatal autoimmune skin d/o. It causes intradermal bullae involveing the oral mucosa and skin. Findings include acantolysis (breakdown of epithelial cell-to cell jxns) and IgG Ab against epidermal cell surface (immunofluorescence throughout epidermis)
pemphigus vulgaris
This very common skin cancer is associated with excessive exposure to sunlight and to arsenic exposure. Lesions commonly appear on hands and face. It is locally invasive but rarely metastasizes.
squamous cell carcinoma
what is the precursor to squamous cell carcinoma
actinic keratosis
what is the key histopathologic finding of squamous cell carcinoma
keratin “pearls”
This skin cancer is most common in sun exposed areas of the body. It is locally invasive but almost never metastasizes. Gross pathology shows pearly papules
Basal cell carcinoma
Basal cell tumors have this type of nucleii
palasading
This skin cancer is a common tumor with significant risk of metastisis. It is associated with sinlight exposure and light skined persons are at increased risk. Incidence is rapidly increasing.
melanoma
what factor of a melanoma primary coorelates with increased risk of metastasis
depth
this is a precursor to melanoma
dysplastic nevus
This tumor occurs most commonly at the epiphyseal end of long bones. Peak incidence is 20-40 y/o. It is a locally agressive benign tumor often found around the distal femur or proximal tibial region. It has a characteristic “double bubble” or “soap bubble” appearance on ex-ray. Microscopically you sse spindle shaped cells with multinucleated giant cells
giant cell tumor
this is the most common benign bone tumor it usually occurs in men < 25 y/o. It commonly originates from the metaphysis. Maliggnant transformation to chondrosarcoma is rare.
Osteochondroma
this is a benign cartilaginous neoplasm found in the intramedullary bone. It usually occurs in the distal extremities
Enchondroma
This is the most common primary malignant tumor of the bone. Peak incindence is in men 10-20 y/0 it is commonly found in the metaphysis of long bones. Predisposing factors include Paget’s dz of the bone, bone infarcts, radiation, and familial retinoblastoma. You often see Codman’s triange (from elevation of the periosteum) on x-ray.
Osteosarcoma (osteogenic carcinoma)
This is an anaplastic small blue cell malignant tumor. It is most common in boys appearance in bone. It commonly appears in the diaphysis of long bones, teh pelvis, scapula and ribs. It is associated with a 11;22 translocation
Ewing’s sarcoma
mneu:going out for eWINGS & ONION rings
this is a malignant cartilaginous tumor. It is most common in men aged 30-60 y/o. It is usually located in the pelvis, spine, scapula, humerus, tibia or femur. It may be of primary origin or from a osteochondroma.
Chondrosarcoma
this dz is seen in heavy smokesr. It is ideopathic and presents with thrombosing vasculitis of intermediate and small peripheral arteries and beins. On exam you may see intermittent claudication, superficial nodular phlebitis, cold sensitivity (raynaud’s phenomenon) and severe pain in the effected part. It may lead to gangrene. The tx is to stop smoking
Buerger’s dz (AKA thromboangiitis obliterans)
this dz primarily affects Aisian females They may show symptoms of Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, Weak pulses in upper extremities. It is a granulomatous thickening of the aortic arch and/or proximal great vessels it is associated with an elevated ESR.
Takayasu’s arteritis
mneu: Symptoms: FAN MY SKIN On Wednesday
Takayasu’s arteritis affects these sized arteries
medium and large
This dz usually affects elderly females. It is the most common vasculitis that affects medium and small arteries– usually branches of the carotid arteries. It is focal and granulomatous. Findings include unilateral headache, jaw claudication, impared vision (occlusion of opthalmic artery, which can lead to blindness. Half of pts have systemic involvement and polymalgia rheumatica (proximal mm pain and periarticular pain
Temporal arteritis (giant cell arteritis)
What lab value is elevated in Temporal arteritis (giant cell arteritis)
ESR
How do you tx Temporal arteritis (giant cell arteritis)
steroids
this dz is characterized by necrotizing immune complex inflammation of medium sized muscular arteries typically involving renal and visceral vessels. Symptoms include fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, hypertension, neurologic dysfunction and cutaneous eruptions. Multiple aneurisms and constrictions on arteriogram.
Polyarteritis nodosa
30% of Polyarteritis nodosa pts are seropositive for this.
Associated with ANCA?
Hep B
No
Tx of Polyarteritis nodosa
corticosteroids, cyclophosphamide
this dz is characterized by a triad of focal necrotizing vasculitis, necrotizing granulomas in the lung and uppeer airway, and necrotizing glomerulonephritis. Symptoms include perforation of the nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, hematuria, and red cell casts. Chest X-ray may reveal large nodular densities
Wegener’s granulomatosis
This is a strong antibody marker for Wegener’s granulomatosis
C-ANCA
tx for Wegenner’s granulomatosis
cyclophosphamide and corticosteroids
This P or C-ANCA positive vasculitis is like Wegners but lacks granulomas
microscopic polyangitis
This ANCA positive vasculitis is limited to the kidney
primary pausi-immune crescentic glomerulonephrits
This ANCA positive vasculitis is granulomatous vasculitis with eosinophilia. It involves the lung, heart, skin, kidneys, enrves. It is often seen in atopic pts.
Churg-Strauss syndrome
this is an acute self-limiting dz of infants/kids. It is an acute necrotizing vasculitis of small/medium sized vessels. It presents with fever, congested conjunctiva, changes in lips/oral mucosa, and lymphadenitis. Child may develop coronary aneuriysms.
Kawasaki dz
This is the most common form of childhood systemic vasculitis. It presents with skin rash, arthralgia, intestinal hemorrhag,e abdominal pain, and melana
Henoch-Schonlein purpura
This tumor occurs most commonly at the epiphyseal end of long bones. Peak incidence is 20-40 y/o. It is a locally agressive benign tumor often found around the distal femur or proximal tibial region. It has a characteristic “double bubble” or “soap bubble” appearance on ex-ray. Microscopically you sse spindle shaped cells with multinucleated giant cells
giant cell tumor
this is the most common benign bone tumor it usually occurs in men < 25 y/o. It commonly originates from the metaphysis. Maliggnant transformation to chondrosarcoma is rare.
Osteochondroma
this is a benign cartilaginous neoplasm found in the intramedullary bone. It usually occurs in the distal extremities
Enchondroma
