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USMLE > Musculoskeletal and Derm > Flashcards

Musculoskeletal and Derm Flashcards

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USMLE® Step 1 flashcards
1
Q

What type of mutation and in what gene causes achondroplasia?

A

Activating mutation in FGFR3

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2
Q

What is the probability two heterozygous achondroplasia parents will have a child with the disease?

A

50% because homozygous dominant dies in utero

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3
Q

What bone tumor appears as a peduncle with a cartilage cap?

A

Osteochondroma

“osteoCHondroma = CHunk of bone”

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4
Q

What bone tumor has a soap bubble appearance on X ray?

A

Osteoclastoma (giant cell tumor)

“osteoCLastoma = CLean = soap bubbles”

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5
Q

What bone tumor has Codman’s triangle and sunburst appearance on X ray?

A

Osteosarcoma

“osteoSarComa = Sunburst, Codman’s triangle”

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6
Q

What bone tumor is found in the diaphysis and has an onion skin appearance?

A

Ewing sarcoma

“chicken wings (ewing) and onion rings (onion skin)”

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7
Q

What translocation is associated with ewing sarcoma?

A

t(11;22)

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8
Q

What is the average age of presentation for the 4 primary bone tumors?
Osteochondroma, osteoclastoma, osteosarcoma, ewing sarcoma

A

Osteochondroma:

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9
Q

What metastatic cancers are found in bone?

“Permanently Relocated Tumors Like Bone”

A

Prostate, renal cell, testes/thyroid, lung, breast

GU association - kidney, prostate, testes

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10
Q

What GI drugs can increase risk for osteoporosis?

A

PPIs or H2 blockers - need acid to absorb Ca

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11
Q

What are the 2 side effects of bisphosphonates?

A

Erosive esophagitis and osteonecrosis of the jaw

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12
Q

What is the mechanism of Teriparatide?

A

PTH analog that when given as pulsitile stimulates osteoblast bone formation

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13
Q

What is the mechanism of Denosumab?

A

Monoclonal antibody against RANKL (blocks osteoclast stimulation)

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14
Q

What gene mutation causes osteoporosis?

A

Carbonic anhydrase 2 (osteoclasts cannot make the acidic environment needed to resorb minerals)

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15
Q

What is the pathogenesis of Paget’s disease of the bone?

A

Lytic - osteoclasts overstimulated
Mixed - osteoblasts activated to catch up
Sclerotic - osteoclasts burn out

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16
Q

Increased hat size and hearing loss

A

Paget’s disease of the bone

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17
Q

How is ALP affected in osteoporosis, osteoporosis, and Paget’s disease of the bone?

A

ALP is a marker of osteoblasts
Osteoporosis (decreased osteoblasts) - normal
Osteopetrosis (decreased osteoclasts) - normal
Paget’s disease (increased osteoblasts and clasts) - increased

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18
Q

What causes Osteitis Fibrosa Cystica?

What 4 changes are seen in the bone?

A 
High PTH
Brown tumors (cysts lined with fibrous tissue and filled with blood = due to fast osteoclast breakdown), subperiosteal bone resorption in middle fingers, tapered distal clavicles, salt and pepper skull
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19
Q

What is McCune Albright Syndrome?

A

Precocious puberty + cafe au lait spots + polyostotic fibrous dysplasia

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20
Q

What is polyostotic fibrous dysplasia?

A

Bone is replaces with fibroblasts and collagen

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21
Q

What is Albright Hereditary Osteodystrophy (pseudohypoparathyroid)?
What bone pathology is associated?

A

Renal PTH resistance - high PTH + low Ca/high PO4

Causes Osteitis fibrosis cystica

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22
Q

What 4 structures may be injured in a posterior hip dislocation?

A

Circumflex femoral arteries (medial and lateral)
Femoral vein
Femoral nerve
Head of the femur

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23
Q

What ligament is most commonly damaged in an ankle sprain?

What other two are also common?

A

The 3 lateral ligaments are more common than the medial deltoid ligament.
Most common - anterior talo-fibular ligament
“Always Tears First”
Other lateral ligaments - calcaneo-tibular, posterior talo-fibular

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24
Q

What 2 antibodies are most useful in diagnosing RA?

A

RF and ACPA (anti-citrullinated protein Ab)

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25
Q

What HLA gene is associated with RA?

A

HLA-DR4

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26
Q

What two ways can NSAIDs cause renal damage?

A

Ischemia (loss of PGs that dilated the afferent arteriole and control RBF) and interstitial nephritis

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27
Q

What joint disease can lactic acidosis cause?

A

Gout - organic acids compete for the same renal transporter as uric acid

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28
Q

What is the most common trigger for an acute gout attack?

A

Alcohol consumption - competes for the same renal transporter as uric acid

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29
Q

Allopurinol can increase the toxicity of what two drugs?

A

6-mercaptopurine and azathioprine

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30
Q

What is the mechanism of Febuxostat?

A

Xanthine oxidase inhibitor

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31
Q

What is the mechanism of Probenecid?

A

Inhibits uric acid resorption in the kidneys

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32
Q

What effect does Colchicine have on microtubules?

A

Stabilizes them

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33
Q

What pathology is associated with chonedrocalcinosis?

A

Pseudogout

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34
Q

What pathology is associated with a pencil-in-cup deformity of the DIP joints?

A

Psoriatic arthritis

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35
Q

What type of arthritis is associated with dactylics?

A

Psoriatic arthritis

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36
Q

What type of arthritis is associated with uveitis, aortic regurgitation, and conduction abnormalities?

A

Ankylosing spondylitis

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37
Q

What is reactive arthritis?

What triggers an episode?

A

Conjunctivitis, urethritis, and arthritis
“Cant see, can’t pee, can’t climb a tree”
Post GI infection (shigella, salmonella, yersinia, campylobacter) or chlamydia

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38
Q

What is used to treat the seronegative spondyloarthropathies?

A

TNFa inhibitors (etanercept, infliximab, and adalimumab)

39
Q

Child

A

Systemic-onset Juvenile idiopathic arthritis (initially looks like leukemia, then the arthritis comes)

40
Q

What type of arthritis is caused by gonorrhea?

What other finding is associated with gonococci arthritis?

A

Septic migratory arthritis

Pustules on the skin

41
Q

Painless oral ulcers + non-erosive arthritis + pericarditis + psychosis + low blood cells or hemolytic anemia

A

SLE

42
Q

ANA+ (6 conditions)

A

Sjogrens syndrome, scleroderma, polymyositis/dermatomyositis, RA, juvenile idiopathic arthritis, and mixed CT disease

43
Q

anti-dsDNA Abs

A

Lupus nephritis

44
Q

anti-Smith Abs

A

Specific for SLE

45
Q

anti-histone Abs

A

Drug-induced SLE

46
Q

What drugs cause drug-induced lupus?

“SHIPP”

A

Sulfonamides, hydralazine, isoniazid, phenytoin, procainamide

47
Q

anti-phospholipid (anti-cardiolipin) Abs

A

Hypercoagulability in SLE

48
Q

What immunologic change is seen in SLE?

A

Decreased C3 and C4 = increased risk for infection

49
Q

What can be used to treat SLE?

A

Glucocorticoids, cyclophosphamide, NSAIDs, hydroxychloroquine (antimalarial and DMARD)

50
Q

Ulcerated fingers with telangectasias

A

Sclerodermas

51
Q

anti-DNA topoisomerase 1 (anti-scl-70) Abs

A

Diffuse scleroderma

52
Q

anti-centromere Abs

A

CREST

53
Q

What is seen in CREST syndrome?

A

Calcinosis (subepithelial Ca), raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangectasias

54
Q

What triad of symptoms is seen in Sjogrens syndrome?

A

Dry eyes + dry mouth + arthritis

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

55
Q

anti-Ro, anti-La

A

Sjogren syndrome (Ro = SSA, La = SSB)

56
Q

What third autoAb is seen in Sjogrens?

A

RF

57
Q

Proximal joint pain without weakness + systemic symptoms (fever, malaise, weight loss) in a little old lady
Labs - elevated ESR, normal CK

A

Polymyalgia rheumatica

58
Q

What other condition is associated with polymyalgia rheumatica?

A

Temporal (Giant cell) arteritis

59
Q

Proximal joint pain with weakness + systemic symptoms (fever, malaise, weight loss)

A

Polymyositis

60
Q

What is the pathogenesis of polymyositis?

A

CD8+ T cell inflammation of endomysial muscle

61
Q

anti-Jo1 Abs

A

Polymyositis

62
Q

Purple heliotrope rash, shawl rash, and gottrons papules

A

Dermatomyositis

63
Q

What 2 other conditions are associated with fibromyalgia?

A

Depression and anxiety

64
Q

What is parakeratosis?

What condition is associated with it?

A

Nuclei retained in the stratum corneum

Psoriasis

65
Q

What is the pathogenesis of psoriasis?

A

Overproduction of new skin cells

66
Q

What skin pathology is described as “stuck on”?

A

Seborrheic keratosis

67
Q

Keratin filled cysts

A

Seborrheic keratosis

68
Q

Horn growing from the skin

A

Seborrheic keratosis

69
Q

What is the Leser-Trelat sign?

A

Sudden appearance of multiple seborrheic keratoses that signified an underlying visceral malignancy (classically GI)

70
Q

What pathology is associated with decreased melanin?

What pathology is associated with decreased melanocytes?

A

Decreased melanin - albinism (tyrosinase deficiency)

Decreased melanocytes - vitiligo (autoimmune destruction of melanocytes)

71
Q

What is the first step in management of a patient with necrotizing fasciitis?

A

Surgical wond debridement

72
Q

anti-desmoglein Abs

A

Pemphigus vulgaris

“DAMN is a vulgar word” Desmosomes, Acantholysis, Mouth, Nikolskys sign

73
Q

anti-hemidesmosome Abs

A

Bullous pemphigoid

“BPH” Bullous Pemphigoid Hemidesmosomes

74
Q

What does Erythema multiforme look like?

What can trigger it?

A

Many things, including targetoid rash with central necrosis

Drug reaction, HSV

75
Q

What drugs are known for causing SJS?

A

Seizure drugs, Sulfa drugs, penicillins, allopurinol

76
Q

Saw-tooth lymphocytic infiltrate at the dermal-epidermal junction

A

Lichen planus

77
Q

What infection is associated with Lichen planus?

A

Hepatitis C

78
Q

Papule’s that feel like sand paper

A

Actinic keratosis

79
Q

What anti-cancer drug is used to treat actinic keratosis?

A

5-flurouracil

80
Q

What pathology is most strongly associated with Erythema nodosum?

A

Sarcoidosis

81
Q

Herald patch followed by christmas tree distribution of plaques

A

Pityriasis rosea (HHV6/7 Roseola reactivation)

82
Q

Keratin pearls

A

Squamous cell CA

83
Q

What skin cancer presents as an ulcer?

A

Squamous cell CA

84
Q

Waiter’s tip

A

Erb-Duchenne palsy (C5/C6 root)

  1. Arm hangs to side (axillary - deltoid, suprascap n - suprascap m)
  2. Internal rotation (acillary - teres minor)
  3. Pronation (musculocutaneous - biceps)
85
Q

Claw hand

A

Klumpke’s palsy (inferior trunk)

  1. PIP extension + DIP flexion (lumbricles)
  2. Intrinsic muscle atrophy (ulnar - interosseous)
  3. Thenar/hypothenar atrophy (median, ulnar)
86
Q

What is the difference between the ulnar claw and pope’s blessing hand?

A

Ulnar claw = at rest (ulnar nerve damage - lumbricles 4/5)

Pope’s blessing = only when making a fist (median nerve damage - lumbricles 2/3)

87
Q

What is the difference between median claw and OK gesture?

A

Median claw = at rest (medicine nerve damage - lumbricles 2/3)
OK gesture = only when making a fist (ulnar nerve damage - lumbricles 4/5)

88
Q

What nerve is damaged with fracture of the humerus at the surgical neck?
At the shaft?

A

Axillary nerve

Radial nerve

89
Q

What nerve is damaged in a pelvic fracture?

What would you find?

A

Femoral nerve

Loss of hip flexion/knee extension (can’t kick a ball), sensation loss over anterior thigh and medial leg

90
Q

What nerve is damaged in anterior thigh dislocation?

A

Obturator nerve

91
Q

What nerve is damaged in a posterior thigh dislocation?
What clinical finding would be seen?
What infection can cause damage to the same nerve?

A

Superior gluteal nerve
Trendelenberg gait
Polio

92
Q

Loss of sensation on the sole of the foot

A

Tibial nerve injury

93
Q

Foot drop

A

Common fibular nerve injury

94
Q

Wrist drop

A

Radial nerver injury

USMLE (12 decks)

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