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FirstAID > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What cell type are responsible for the inflammatory response in gout? And what drug targets this inflammatory response?

A

Neutrophils

Colchicine - interferes with microtubule formation necessary for neutrophil chemotaxis.

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2
Q

What are the 5 layers of the epidermis (from surface to base)?

A

“Californians Like Girls in String Bikinis”

  • stratum Corneum
  • stratum Lucidum
  • stratum Granulosum
  • stratum Spinosum
  • stratus Basalis
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3
Q

Where in skin are blood vessels located?

A

in the dermis (below the epidermis)

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4
Q

Which layers of the epidermis are affected in psoriasis?

A
  • stratum granulosum is decreased

- stratum spinosum is increased (get plaque formation in spinosum)

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5
Q

Eccrine glands

A

secrete sweat

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6
Q

Sebaceous glands

A

associated with hair follicles; holocrine secretions of sebum (holocrine secretions = plasma membrane ruptures, destroying cell, thereby secretion product into lumen)

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7
Q

Zona occudens

A

=tight junction

  • ->between cells
  • ->composed of claudins and occludins
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8
Q

Zona adherens

A

=intermediate junction

  • ->between cells
  • ->composed of Cadherins (Calcium-dependent Adhesion molecules) that connect to Actin
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9
Q

Macula adherens

A

=Desmosome

  • ->between cells
  • ->autoantibodies to desmosomes = pemphigus vulgaris
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10
Q

Gap junctions

A

between adjacent cells

–>cardiac cells, osteocytes, neurons (electrical coupling)

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11
Q

Integrin

A

connects basolateral surface of cell to basement membrane

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12
Q

Hemidesmosome

A

connects cell to underlying extracellular matrix (to basement membrane)
–>autoantibodies to hemidesmosomes = bullous pemphigoid

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13
Q

“Unhappy Triad” Knee injury:

A
  • Force from Lateral side, causing damage to:
  • MCL = Medial Collateral Ligament
  • ACL = Anterior Cruciate Ligament
  • Lateral (or Medial) Meniscus
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14
Q

Abnormal passive abduction of the knee?

A

indicates torn MCL (medial collateral ligament)

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15
Q

ACL and PCL attach to what bone?

A

Tibia

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16
Q

Level to do a lumbar puncture?

A

Level of Iliac crest (about L4)

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17
Q

Pudendal nerve block is done where?

A

Ischial spince

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18
Q

4 Rotator Cuff muscles:

A

SItS

  • Supraspinatus
  • Infraspinatus
  • teres minor
  • Subscapularis
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19
Q

Muscle that initiates abduction of the arm (first 10-15 degrees), before deltoid kicks in?

A

Supraspinatus

–>injury to supraspinatus is the most common rotator cuff injury

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20
Q

Common cause of long thoracic nerve injury (and thus winged scapula)?

A

–>Mastectomy (or any trauma/injury to axillary region)

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21
Q

Bones of the wrist (from thumb to pinky)

A

“Some Lovers Try Positions That They Can’t Handle”

  • Scaphoid
  • Lunate
  • Triquetrum
  • Pisiform
  • Trapezium
  • Trapezoid
  • Capitate
  • Hamate
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22
Q

Which nerve innervates the thumb + 2.5 fingers of the palm of the hand?

A

Median nerve

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23
Q

Which nerve innervates the thumb + half of the hand on the dorsum of the hand?

A

Radial nerve

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24
Q

Which nerve innervates the pinky + 1/2 ring finger on both the palm and dorsum of hand?

A

Ulnar nerve

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25
Q

What nerve is lesioned by a fracture of the surgical neck of the humerus or by dislocation of the humerus?

A

Axillary nerve

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26
Q

Nerve injured in a lesion to the shaft of humerus?

A

Radial nerve –> get “wrist drop”

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27
Q

Which nerve may be compressed by the use of crutches in the axilla or by “Saturday Night Palsy”?

A

Radial nerve compression –> get “wrist drop”

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28
Q

Lesioned nerve if fracture hook of hamate?

A

Ulnar nerve

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29
Q

Lesioned nerve if fracture medial epicondyle of humerus?

A

Ulnar nerve

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30
Q

Compressed nerve if fracture supracondylar area of humerus?

A

Median nerve

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31
Q

Part of brachial plexus that is compressed by a Pancoast tumor of the ung?

A

Lower trunk of brachial plexus –> get Kumpke’s palsy (total claw hand - loss of function of all lumbricals, get clawing of all the digits)

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32
Q

Which side of hand is the carpal tunnel?

A

–>flexor retinaculum, on palmar side of wrist

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33
Q

What muscle protects the brachial plexus from injury in a clavicle fracture?

A

Subclavius muscle

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34
Q

How to test for an axillary nerve injury?

A

Test sensation over deltoid

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35
Q

5 nerves that come off the brachial plexus? Which are extensors? Flexors?

A

“MARMU”

  • Musculocutaneous
  • Axilary
  • Radial
  • Median
  • Ulnar
  • Extensors = Axillary and Radial
  • Flexors = Musculocutaneous, Median, Ulnar
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36
Q

Lesion to upper trunk of brachial plexus (C5, C6):

  • what’s this called?
  • symptoms?
  • what may cause this?
A

Erb’s palsy = “waiter’s tip”
–> can’t abduct arm; arm is medially rotated; and hand is out behind back, like waiting for a tip

–>may be caused by trauma to shoulder (like in a car accident) or trauma during child delivery

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37
Q

Injury to Long Thoracic Nerve?

A

–>Winged Scapula

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38
Q

Injury to Lower trunk of Brachial Plexus (C8,T1):

  • what’s this called?
  • symptoms?
  • what may cause this?
A
  • ->”Klumpke’s palsy” = “Claw Hand” of ALL digits
  • ->symptoms = all fingers form a claw (vs ulnar nerve injury claw hand–>only 4th and 5th digits can’t extend, form claw)

–>may occur d/t an embryologic or childbirth defect

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39
Q

Injury to Posterior Cord of Brachial Plexus?

A

Can’t extend hand, so get “wrist drop” (can’t extend, so hand just hangs flaccidly)
*makes sense, b/c posterior cord gives rise to the axillary and radial nerves, which are the extensors

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40
Q

Injury to axillary nerve:

  • causes?
  • symptoms?
A
  • caused by fracture to surgical neck of humerus or dislocation of humerus
  • symptoms:
  • paralysis of deltoid, so can’t abduct arm at the shoulder (can still do initial abduction)
  • decreased sensation over deltoid
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41
Q

Injury to Radial nerve:

  • causes?
  • symtpoms?
A
  • causes:
  • crutches compressing radial nerve at axilla or compression from saturday night palsy
  • fracture of midshaft of humerus
  • symptoms:
  • wrist drop; can’t extend with brachioradialis, extensors of wrist and fingers, supinators, triceps… all extensors :(
  • also: loss of sensation over posterior arm, dorsal hand (the part supplied by radial) and dorsal thumb
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42
Q

Injury to Musculocutaneous nerve:

-symptoms?

A
  • decreased flexion of arm at the elbow (b/c musclocutaneous innervates the flexors: biceps, brachialis, coracobrachialis)
  • decreased sensation at lateral forearm
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43
Q

Distal lesion to Median Nerve:

  • cause?
  • symptoms?
A
  • Causes:
  • carpal tunnel syndrome
  • dislocated lunate
  • Signs:
  • “Pope’s blessing” –> can’t extend 2nd and 3rd digits, so they are both clawed
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44
Q

Proximal lesion to Median Nerve:

  • cause?
  • symptoms?
A
  • Cause = fracture of supracondylar humerus
  • symptoms:
  • “Ape Hand” –> can’t oppose/abduct thumb d/t atrophy of thenar muscles (so thumb is basically glued to other fingers, laterally)
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45
Q

Distal lesion to Ulnar nerve:

  • cause?
  • symptoms?
A
  • Cause = fractured hook of hamate (like if fall onto outstretched hand)
  • Symptoms:
  • Clumsiness of hands
  • Ulnar “claw hand” –> can’t extend 4th and 5th digits, so they are both in a claw (pinky and ring finger)
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46
Q

Sensory defect over Lateral Forearm?

A

Injury to Musculocutaneous nerve

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47
Q

Sensory defect over Posterior arm?

A

Injury to Radial nerve

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48
Q

Proximal lesion to ulnar nerve:

  • cause?
  • symptoms?
A
  • fracture at medial epicondyle (funny bone)

- problems with flexion; decreased sensation over the hypothenar eminence, medial 1.5 fingers.

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49
Q

Waiter’s tip position of hand: injury to?

A

Upper Trunk of brachial plexus (C5, C6)

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50
Q

Claw hand, involving all digits: injury to?

A

Inferior Trunk of Brachial Plexus (C8, T1)

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51
Q

Function of Lumbricals?

A
  • Flex MCP joints
  • Extend DIP and PIP joints

*so make an “L” with fingers/hand

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52
Q

Claw Hand, but of only the pinky and ring finger (4th and 5th digits): injury to?

A

Distal Ulnar Nerve injury: loss of medial lumbrical function

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53
Q

“Pope’s Blessing” - can’t extend the 2nd and 3rd digits: injury to?

A

median nerve injury–> loss of lateral lumbrical function

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54
Q

“Ape Hand” - can’t abduct the thumb: injury to?

A

Proximal median nerve injury (like if fracture the supracondylar humerus)

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55
Q

2 Complications of Mastectomy?

A

1) Winged Scapula (injury to Long thoracic nerve, and thus Serratus Anterior)
2) Lymphedema (which may lead to Lymphangiosarcoma)

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56
Q

Long Thoracic Nerve innervates what muscle?

A

Serratus Anterior

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57
Q

Muscles of the Thenar Eminence? Innervation?

A

Meat lOAF:

  • Median Nerve
  • Opponens pollicis
  • Abductor pollicis brevis
  • Flexor pollicis brevis
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58
Q

Muscles of the Hypothenar Eminence?

Innervation?

A
  • Ulnar nerve
  • Opponens digiti minimi
  • Abductor digiti minimi
  • Flexor digiti minimi
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59
Q

Functions of the Dorsal vs Palmar Interosseous Muscles:

A

“DAB PAD”

  • Dorsal–> ABduction of fingers
  • Palmar–> ADduction of fingers
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60
Q

Where should intramuscular injections into butt be done? Why?

A
  • ->Inject into supero-lateral quadrant of but
  • ->to avoid “gluteus medius gait”
  • if inject into superomedial quadrant–>may injure gluteal nerves
  • if inject into inferomedial quadrant–> may injure sciatic nerve
  • if inject into inferolateral quadrant–> lots of muscles have tendinous insertions here
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61
Q

Positive Trendeleburg sign

A
  • ->when standing on one leg, shift weight to opposite side of body than the standing leg
  • ->d/t injury to the the superior gluteal nerve; so injury to gluteus medius and minimus muscles
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62
Q

Can’t evert or dorsiflex foot?

A

–>injury to common peroneal nerve; get “foot drop”

“PED” - “Peroneal Everts and Dorsiflexes; if injured, the foot is dropPED”

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63
Q

“Foot drop”

A
  • d/t injury of common peroneal nerve

- can’t dorsiflex foot

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64
Q

Can’t invert or plantarflex foot?

A

Injury to Tibial Nerve

“TIP” - “Tibial nerve Inverts and Plantarflexes; if injured, can’t stand on TIP toes”

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65
Q

Sciatic Nerve

A

on posterior thigh; splits into common peroneal and tibial nerves

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66
Q

Deep Peroneal Nerve:

-innervates?

A

-innervates Anterior compartment of leg

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67
Q

Superficial Peroneal Nerve:

innervates?

A

innervates Lateral compartment of leg

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68
Q

Tibial Nerve:

  • innervates?
  • if injured?
A

Posterior compartment of leg

  • if injured:
  • can’t invert of plantarflex foot (inversion = moving sole foot towards medial plane; plantarflexion = standing on tiptoes; so, can’t do either of these things)
  • decreased sensation at sole of foot
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69
Q

In skeletal muscle contraction, which parts of the sarcomere change length?

A

I-band and H-band both shorten in muscle contraction

  • I-band = Thin filaments ONLY
  • H-band = Thick filaments ONLY
  • Z-lines will move closer together (b/c entire sarcomere contracts, gets shorter)
  • **note: A-band is the entire length of the thick thilament, regardless of overlap by thin filament; so, it’s length does not change during contraction
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70
Q

Drugs that act at the Dihydropyridine receptor? What’s the effect?

A

Dihydropyridine Calcium-Channel Blockers (ie Nifedipine and Amlodipine
-by binding to the dihydropiridine receptor, can’t get conformational change, so don’t get Calcium release from sarcomplasmic reticulum (so, it blocks muscle contraction)

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71
Q

Dantrolene mechanism and use?

A

Dantrolene binds the Ryanodine receptor on the sarcoplasmic reticulum; so, prevents conformational change and release of Calcium from Sarcomplasmic Reticulum (so, blocks skeletal muscle contraction)

  • Uses for dantrolene:
  • Malignant hyperthermia (from inhalation anesthetics and succinylcholine)
  • Neuroleptic malignant syndrome (toxicity of anti-psychotic drugs)
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72
Q

Dihydropyridine and Ryanodine receptors:

A 
Dihydropyridine = voltage-dependent Calcium channels in T-tubules
Ryanoide = Calcium release channels in sarcoplasmic reticulum

***in close proximity to each other…

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73
Q

Type 1 vs Type 2 muscles:

A
  • Type 1:
  • Red fibers (b/c lots of mitochondria and myoglobin; so increased oxidative phosphorylation)
  • slow twitch
  • for sustained conraction
  • Type 2:
  • white fibers (b/c fewer mitochondria and myogobin; more in anaerobic glycolysis)
  • fast twitch
  • get hypertrophy of fast-twitch, type 2 fibers in weight training
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74
Q

Which type of muscle fibers are hypertrophied in weight trainers?

A

Type 2 muscle fibers –> white, fast-twitch fibers; involved in anaerobic gycolysis

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75
Q

Effect of Nitric Oxide on Smooth Muscle Contraction (mechanism):

A

Nitric Oxide –> Guanylate Cyclase –> increased cGMP –> inhibits MLCK –> Smooth muscle Relaxation

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76
Q

MLCK (Myosin Light Chain Kinase) and MLCP (Myosin Light Chain Phosphatase)

A

*both are involved in mechanism of smooth muscle contraction/relaxation:

  • MLCK–> phosphorylates myosin to myosin-P –> get smooth muscle contraction
  • MLCK is activated by Calcium binding to Calmodulin

*MLCP –> dephosphorylates myosin-P to myosin –> get smooth muscle Relaxation (stimulated by Nitric Oxide, Sildenafil, etc… increased cGMP)

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77
Q

Calmodulin

A

Calcium-binding messenger protein
*in smooth muscle contraction: Calcium binds calmodulin –> activates MLCK –> phosphorylates myosin –> smooth muscle contraction

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78
Q

Endochondral ossification: what kind of bone growth?

A
  • ->Longitudinal bone growth
  • first have a cartaliginous bone model made by chondrocytes
  • defect in endochondral ossification in achondroplasia; so short limbs
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79
Q

Membranous ossification: what kind of bones grow this way?

A
  • ->flat bone growth (skull, face, axial skeleton)

- functional in achondroplasia; so, have large head…

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80
Q

Continuous activation of FGFR3 (Fibroblast growth factor receptor)?

A

–>inhibits chondrocyte proliferation; leads to Achondroplasia

81
Q

Genetic inheritance of Achondroplasia:

A
  • associated with increased paternal age
  • Autosomal dominant inheritance
  • if homozygous dominant –> lethal in utero
82
Q

What type of bone loss in osteoporosis?

A

Trabecular/spongy bone loses mass

83
Q

Type 1 vs Type 2 osteoporosis:

A

Type 1 = postmenopausal women

Type 2 = senile; affects men and women >70 yo

84
Q

Treatment of choice (and other trtmnts) for osteoporosis?

A
  • Bisphosphonates = treatment of choice
  • other options:
  • SERMs
  • Calcitonin
  • Pulsatile PTH in severe cases
85
Q

Colles’ fracture

A

fracture of distal radius; see in osteoporosis

86
Q

Erlenmeyer flask on x-ray

A

=bones flare out on x-ray

–>see in osteopetrosis

87
Q

Osteopetrosis:

  • cause?
  • presentation?
  • lab values of serum Ca, P, ALP, PTH?
A
  • abnormal function of osteoclasts d/t a genetic deficiency of carbonic anhydrase II –> have failure of bone resorption, so get really thick, dense bones that are prone to fracture;
  • NORMAL levels of Ca, P, ALP, and PTH
  • have decreased marrow space, b/c bone fills it up; so, have pancytopenia (anemia, thrombocytopenia), and have extramedullary hematopoiesis
  • can also cause cranial nerve impingement and palsies, because of narrowed foramina
88
Q

Cause of osteomalacia?

Lab values of Ca, P, ALP, PTH?

A

=Rickets in kids

  • ->d/t vitamin D deficiency
  • decreased Ca, elevated PTH, decreased P, normal ALP
89
Q

Paget’s disease of bone:

  • cause?
  • Presentation?
  • Lab values of Ca, P, ALP, PTH?
A

*Cause: Increase in both osteoclasts and osteoblasts; FIRST get increase in Osteoclast activation; followed by increase in osteoblasts

  • Get mosaic bone pattern
  • increased hat size
  • hearing loss d/t auditory foramen narrowing
  • may lead to osteogenic sarcoma
  • may be viral in origin (paramyxovirus)
  • may get high output heart failure
  • Labs:
  • elevated ALP (really elevated), but normal Ca, P, PTH
90
Q

“brown tumors” of bone:

A

see with osteitis fibrosa cystica (primary hyper-parathyroidism)

91
Q

Polyostotic fibrous dysplasia:

A

bone’s replaced by fibroblasts, collage, irregular bony trabeculae
–>get this with McCune-Albright syndrome (+endocrine probs/precocious puberty + cafe-au-lait spots)

92
Q

bone replaced by fibroblasts and collagen + precocious puberty/endocrine abnormalities + cafe au lait spots

A

McCune Albright Syndrome

–> a form of polyostotic fibrous dysplasia (where bone is replaced by fibroblasts, collagen, etc…)

93
Q

colon polyps + lipomas + osteomas?

A

Gardner’s syndrome

94
Q

Which bone tumor is associated with Retinoblastoma?

A

Osteosarcoma (Rb)

95
Q

Most common benign tumor of bone?

A

Ostochondroma

  • see in men <25 years of age
  • rare for it to become malignant
96
Q

onion skin appearance in bone

A

Ewing’s sarcoma

–>anaplastic small blue cell malignant tumor; seen in boys <15 yo

97
Q

11;22 translocation, associated with what bone tumor?

A

Ewing’s sarcoma

–>anaplastic small blue cell malignant tumor; seen in boys <15 yo

98
Q

Malignnat bone tumor in men b/w 30-60 years old?

A

Chondrosarcoma (all other bone tumors, benign and malignant, seem to affect younger pts)

99
Q

Codman’s triangle (elevation of periosteum) on x-ray?

A

Osteosarcoma (associated with Paget’s disease, familial retinoblastoma…)

100
Q

“soap bubble” or “double bubble” on bone x-ray?

A

Giant cell tumor = Osteoclastoma; a benign bone tumore (osteoma)

101
Q

noninflammatory pain in joints at the end of the day?

A

Osteoarthritis

–>affects DIP and PIP

102
Q

Heberden’s nodes

A

DIP –> affected in Osteoarthritis

103
Q

Bouchard’s nodes

A

PIP –> affected in osteoarthritis

104
Q

joint space narrowing from destruction of articular cartilage, and sclerosis on x-ray of joint?

A
  • ->Osteoarthritis

- also have subchondral cysts, osteophytes, eburnation

105
Q

Eburnation

A

polished, ivory-like appearance of bone; see in osteoarthritis

106
Q

What type of hypersensitivity reaction is Rheumatoid Arthritis?

A

Type III hypersensitivity

107
Q

pannus formation in joints?

A

Rheumatoid arthritis

108
Q

Baker’s cyst

A

behind the knee; see in Rheumatoid arthritis

109
Q

Rheumatoid Factor:

A

IgM antibody that is anti-IgG
–>secreted by B-cells

***Cartilage components act as autoantigens –> activate CD4 T-cells –> B cells secrete RF, which is specific for the Fc component of IgG

110
Q

morning stiffness that lasts >30 mins, improves with use + symmetric joint involvement + systemic symtpoms?

A

Rheumatoid arthritis

111
Q

Treatment options for Rheumatoid Arthritis:

A
  • NSAIDs
  • COX-2 inhibitors
  • Glucocorticoids
  • Methotrexate, Sulfasalazine, Hydroxychloroquine (all are disease-modifying drugs)
112
Q

“can’t see, can’t spit, can’t climb up shit”

A
  • -> Sjogren’s:
  • xerophthalmia (dry eyes, conjunctivitis)
  • xerostomia (dry mouth, dysphagia)
  • arthritis
113
Q

Strong association with HLA-D4?

A

Rheumatoid Arthritis

note: DM I is also associated with HLA-D4

114
Q

anti-SS-A (anti-Ro) and anti-SS-B (anti-La)

A

Sjogren’s syndrome

115
Q

negatively-birefringent needle-shaped yellow crystals + PRPP excess + hyperuricemia?

116
Q

Podagra

A

=painful MTP joint (big toe)

–> Gout

117
Q

Tophus formation on ear, olecranon bursa, Achilles tendon

118
Q

Why gout exacerbations after alcohol consumption?

A

b/c alcohol metabolites compete for same excretion sites in kidney as uric acid; so, get decreased uric acid secretion –> hyperuricemia –> goutttttt

119
Q

Acute and Chronic treatments for Gout:

A
  • Acute:
  • NSAIDs (ie indomethacin, naproxen) = drug of choice for acute gout
  • Colchicine
  • Chronic:
  • Allopurinol
  • Febuxostat (inhibits xanthine oxidase)
  • Probenecid (inhibits reabsorption of uric acid in PCT)
120
Q

Calcium Pyrophosphate, rhomboid crystals, weakly positive-birefringent

A

Pseudogout

121
Q

swollen, red, painful joints; monoarticular , migratory arthritis with asymmetrical pattern; unprotected sex…

A

Gonococcal arthritis (septic infectious arthritis)

122
Q

Causes of septic arthritis:

A
  • Gonorrhea
  • S. aureus
  • Streptococcus
123
Q

Causes of chronic infectious arthritis?

A
  • TB (after mycobacterial dissemination)

- Lyme disease

124
Q

Seronegative Spondyloarthropathies:

  • Why “seronegative”?
  • HLA associated with them?
  • List them
A
  • Seronegative b/c no RF
  • HLA-B27
  • PAIR:
  • ->Psoriatic arthritis
  • ->Ankylosing spondylitis
  • ->IBD
  • ->Reactive Arthritis (Reiter’s syndrome)
125
Q

seronegative spondyloarthropathy that involves sacroiliac joints?

A

Ankylosing spondylitis

126
Q

Seronegative spondylarthropathy with “pencil-in-cup” deformity on x-ray + dactylitis?

A

Psoriatic arthritis

127
Q

“bamboo spine”

A

ankylosing spondylitis

128
Q

“can’t see, can’t pee, can’t climb a tree”

A
  • ->Reactive Arthritis (follows chlamydia or GI/Shigella infections)
  • conjunctivitis + anterior uveitis
  • urethritis
  • arthritis
129
Q

Reactive arthritis usually follows what kinds of infections?

A
  • Shigella (GI)

- Chlamydia

130
Q

anti-phospholipid antibodies

A

SLE

–>may cross-react with cardiolipin on syphilis tests, giving a false (+) RPR/VDRL

131
Q

anti-dsDNA antibodies

A

SLE

–>associated with renal disease (so, specific and poor prognosis)

132
Q

Anti-histone antibodies

A

Drug-induced Lupus

  • SHIPP
  • Sulfonamides
  • Hydralazine
  • Isoniazid
  • Procainamide
  • Phenytoin

***have increased risk of drug-induced lupus in pts who are slow acetylators of drugs in the liver…

133
Q

anti-Smith antibodies

A

SLE

–>specific, but not prognostic

134
Q

Signs/Symptoms of SLE:

A
  • Malar rash (worse in sun)
  • Discoid rash
  • antibodies (anti-nuclear = ANA, anti-dsDNA, anti-Smith, anti-Histones (drug-induced), anti-phospholipid (cross-react with Syphilis tests))
  • Mucositis (oropharyngeal ulcers)
  • Neurologic symptoms
  • Libman-Sacks endocarditis
  • Hilar lymphadenopathy
  • Wire-loop lesions in kidneys with immune complex deposition
  • Serositis–> Pericarditis, Pleuritis
  • Arthritis
135
Q

Non-caseating granulomas, hilar lymphadenopathy, hypercalcemia, interstitial fibrosis (restrictive lung disease), erethyma nodosum, Bell’s palsy, black women…

A

Sarcoidosis

136
Q

Why hypercalcemia in Sarcoidosis?

A

–>have elevated vitamin D activation in epithelioid macrophages –> elevated vitamin D

137
Q

Treatment for sarcoidosis?

138
Q

What type of lymphocyte is elevated in broncho-alveolar lavage fluid in Sarcoidosis?

A

CD4 T-cells

139
Q

Joint pain and stiffness, but no muscle weakness; elevated ESR; normal CK (b/c no muscle weakness); associated with Temporal/Giant Cell Arteritis:

A

Polymyalgia Rheumatica

140
Q

Treatment for Polymyalgia Rheumatica?

A

Prednisone (also treat Temporal/Giant Cell Arteritis with high-dose steroids…)

141
Q

Treatment for Fibromyalgia?

A

TCAs/Anti-depressants

142
Q

Progressive muscle weakness caused by CD8 T-cell-induced injury to myofibers; usually in shoulders; positive ANA, anti-Jo-1, and elevated CK, elevated aldolase?

A

Polymyositis

  • ->associated with increased risk of malignancy
  • **note: if rash + polymyositis –> Dermatomyositis
143
Q

progressive symmetric muscle weakness caused by CD8 T-cell-induced injury to myofibers + Rash (malar rash, heliotrope rash, shawl-and-face rash, etc), + positive ANA, anti-Jo-1, elevated CK, elevated aldolase?

A

Dermatomyositis

–>associated with increased risk of malignancy

144
Q

Myasthenia Gravis:

  • autoantibodies to?
  • how does muscle use affect symptoms?
A
  • autoantibodies to post-synaptic ACh receptors
  • symptoms worsen with muscle use
  • reverse symptoms with AChE inhibitors (Edrophonium test…)
145
Q

Lambert-Eaton syndrome:

  • autoantibodies to?
  • how does muscle use affect symptoms?
A
  • autoantibodies to presynaptic Calcium channels, so get decreased ACh release –> proximal muscle weakness)
  • symptoms improve with muscle use
146
Q

What paraneoplastic disease is associated with Lambert-Eaton syndrome?

A

Small cell lung cancer

147
Q

Affect of AChE-inibitors on Myasthenia Gravis? Lambert Eaton?

A
  • ->reverses Myasthenia Gravis (b/c problem is with the ACh receptors)
  • does not reverse Lambert-Eaton (b/c problem with ACh release)
148
Q

Which neuromuscular jxn disease is associated with a thymoma?

A

Myasthenia Gravis

149
Q

Proximal vs Distal weakness?

A 
Proximal = muscle problem (like with Lambert-Eaton)
Distal = neuro problem (has longer path to get there; more room for errors!)
150
Q

What is scleroderma?

A

–>excessive fibrosis and collagen deposition throughout the body

151
Q

anti-DNA topoisomerase I antibody (=anti-Scl-70 antibody)

A

Diffuse scleroderma

152
Q

anti-Centromere antibody

A

CREST scleroderma

153
Q

which has worse clinical course: diffuse or CREST scleroderma?

A
  • ->Diffuse = faster progression, early visceral involvement

- ->CREST - more benign clinical course

154
Q

CREST scleroderma:

A
  • Calcinosis (subepithelial calcium deposits)
  • Raynaud’s
  • Esophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
155
Q

What is hyperkeratosis?

A

increased thickness of stratum corneum (see with psoriasis)

156
Q

What is urticaria?

A

Hives; get pruritic wheals after mast cell degranulation

157
Q

Atopic Dermatitis:

A

=Eczema

  • ->pruritis; often associated with other atopic diseases (asthma, allergic rhinitis)
  • ->also seen in Wiskott-Aldrich syndrome (deletion of B and T-cells; elevated IgE and IgA, but decreased IgM; also have: thrombocytopenic purpura and infections)
158
Q

What type of hypersensitivity rxn is allergic contact dermatitis (ie from nickel, poison ivy…)?

A

=type IV hypersensitivity

159
Q

salmon-colored plaques with silvery scaling; plaques bleed if scales are scraped off:

A

=Psoriasis

“Auspitz sign” = bleeding when scales scraped off

160
Q

Changes in epidermis layers in Psoriasis:

A
  • increased stratum spinosum; decreased stratum granulosum
  • also: hyperkeratosis = increased thickness of stratum corneum; and parakeratosis = retention of nuclei in stratum corneum
161
Q

Seborrheic keratosis:

A
  • ->squamous epithelial proliferations, look like they are pasted on and can easily be peeled off
  • ->commonly seen in older people
  • ->benign, but should have melanoma as part of dd
162
Q

Vitiligo?

A

Have areas of skin with decreased pigmentation; d/t decrease melanocytes

163
Q

Melasma/Chloasma

A

Hyperpigmentation of skin associated with pregnancy or OCP use

164
Q

Contagious, honey-colored crusting of skin

A

Impetigo

–>S. aureus or S. pyogenes (GAS)

165
Q

White, painless plaques on tongue that CANNOT be scraped off; often in HIV pts?

A

–>Hairy Cell Leukoplakia
*EBV-mediated
(not to be confused with hairy cell leukemia; a B-cell neoplasm with TRAP as a tumor marker)

166
Q

autoimmune skin disorder with IgG antibodies; blisters on skin and oral mucosa; epidermis separates when stroke skin

A

–> Pemphigus Vulgaris
anti-ephithelial cell antibody = IgG anti-Desmosome antibody

***potenitally fatal

167
Q

Autoimmune skin disorder with IgG antibodies; blisters on skin, but not on oral mucosa; skin does not separate when stroked

A

–> Bullous pemphigoid = anti-hemidesmosome antibodies = antibodies against the epidermal basement membrane

–>less severe than pemphigus vulgaris

168
Q

Pruritis + GI/malabsorption?

A

Celiac:

  • pruritis/rash = Dermatitis Herpetiformis
  • ->have deposits of IgA at the tips of dermal papillae
169
Q

Fever + Bulla formation and necrosis + sloughing of skin; often associated with adverse drug reaction; high mortality rate

A

Stevens-Johnson syndrome

associated with seizure drugs, etc

170
Q

Toxic epidermal necrolysis

A

=more severe form of Stevens-Johnson syndrome

171
Q

Pruritic, Purple, Polygonal Papules?

A
  • ->Lichen planus

- associated with Hepatitis C!

172
Q

Skin disorder associated with Hepatitis C?

A

–>Lichen Planus (pruritic, purple, polygonal papules)

173
Q

Actinic Keratosis

A

premalignant lesions associated with sun exposure; risk of progression to squamous cell carcinoma

174
Q

Lichen Planus

A

Pruritic, Purple, Polygonal Papules

–>associated with Hepatitis C

175
Q

Acanthosis nigricans:

  • what part of skin is effected?
  • associated with?
A
  • hyperplasia of stratum spinosum

- see with hyperglycemia (ie Cushing’s, Niacin use, Diabetes) and visceral malignancies (like gastric adenocarcinoma)

176
Q

S-100 tumor marker

177
Q

Keratin pearls on histopathology

A

Squamous cell carcinoma

178
Q

actinic keratosis is a precursor to what type of skin cancer?

A

precursor to squamous cell carcinoma

179
Q

What skin cancer is associated with arsenic exposure?

A

Squamous cell carcinoma

also, of course, associated with excessive sunlight exposure

180
Q

Atypical skin mole is a precursor to what type of skin cancer?

181
Q

Effect of Aspirin on BT, PT, PTT?

A
  • Increased Bleeding Time

- No effect on PT, PTT

182
Q

Naproxen

A

NSAID (alleve!)

183
Q

Ketorolac

A

an NSAID, given by IV

184
Q

Benefit of COX-2 inhibitors over other types of NSAIDs?

A

–>less corrosive effects of NSAIDs on the gastric mucosa (still have some though, just less!)

185
Q

How does Acetaminophen differ from NSAIDs?

A

–>also reversibly inhibits COX-1 and COX-2 (like NSAIDs), BUT, mostly acts in the CNS. It’s inactivated peripherally, so is not used as an anti-inflammatory analgesic drug

186
Q

Antidote of Acetaminophen? What’s it’s mechanism?

A

antidote = N-acetylcysteine –> regenerates glutathione (which is depleted in acetaminophen overdose)

187
Q

Consequences of Acetaminophen overdose?

A
  • ->Hepatic necrosis; acetaminophen metabolite depletes glutathione, so forms toxic tissue adducts in liver
  • ->treat by giving N-acetylcysteine, which regenerates glutathione
188
Q

Bisphosphonates:

  • mechanism?
  • all end in what suffix?
  • cinical uses?
  • toxicities?
A
  • all end in “-dronate” (Etidronate, Pamidronate, Alendronate, Risedronate, Zoledronate)
  • Mechanism = inhibit osteoclast activity (analog of pyrophosphate, which is a component of hydroxyapatite, so reduces both formation and resorption of hydroxyapatite
  • clinical uses:
  • paget’s disease
  • menopausal osteoporosis
  • malignancy-associated hypercalcemia
  • toxicities:
  • errosive esophagitis (NOT Zoledronate though); so should take drug upright, not before bed
  • osteonecrosis of jaw!
  • nausea, diarrhea, blah blah
189
Q

Probenicid

A

used to treat chronic gout

  • inhibits reabsorption of uric acid in the PCT
  • ->ALSO: inhibits secretion of penicillin! (so, makes penicillin last longer!)
190
Q

Allopurinol:

  • use?
  • mechanism?
  • what 2 drugs have increased concentrations when taken with allopurinol? and why?
A
  • treatment for chronic gout
  • inhibits xanthine oxidase (so decreased conversion of xanthine to uric acid)
  • can also in lymphoma and leukemia
  • Allopurinol increases concentrations of:
  • Azathioprine (anti-metabolite precursor of 6-MP; used for kidney transplants and autoimmune disorders)
  • 6-Mercaptopurine (anti-metabolite; inhibits purine synthesis)
  • ->b/c these both are normally metabolized by xanthine oxidase!
191
Q

Febuxostat

A

chronic treatment of gout

–>inhibits xanthine oxidase

192
Q

Colchine mechanism? side effects?

A
  • ->used for acute treatment of gout
  • binds and stabilizes tubulin, inhibiting polymerization; this impairs leukocyte chemotaxis and degranulation!
  • Side effects:
  • ->GI: Diarrhea
193
Q

Drug of choice in treatment of acute gout?

A

1 choice = NSAIDs (Naproxen, Indomethacin…)

*can also use colchicine or steroids to treat acute gout

194
Q

List the 3 TNF-alpha inhibitors:

A
  • Etanercept
  • Infliximab
  • Adalimumab
195
Q

Etanercept mechanism?

A

–>Recombinant form of the TNF receptor, so binds TNF

–>uses: RA, psoriasis, ankylosing spondylitis

196
Q

Infliximab mechanism?

A

anti-TNF antibody

–>uses: Crohn’s, RA, ankylosing spondylitis

197
Q

Adalimumab mechanism?

A

anti-TNF antibody

–>uses: RA, psoriasis, ankylosing spondylitis

198
Q

Main thing that must be checked before initiating therapy with TNF-alpha-inhibitors?

A

–>Do PPD to check for latent TB; because if inhibit TNF-alpha –> can get activation of macrophages and reactivation of latent TB infection.

FirstAID (24 decks)

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