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Quick Notes for Step 1 > Musculoskeletal/Skin > Flashcards

Musculoskeletal/Skin Flashcards

1
Q

Superior Laryngeal Nerve

A

Nerve runs by the piriform recess in the larynx

  • Mediates cough reflex
  • Branch of the vagus nerve
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2
Q

Jugular Foramen

A

Jugular vein, CN 9, 10, 11

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3
Q

Foramen Spinosum

A

Middle menengial artery and vein

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4
Q

Foramen Ovale

A

CN V3

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5
Q

Foramen Rotundum

A

CN V2

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6
Q

Superior Orbital Fissure

A

CN 3, 4, V1, and 6, ophthalmic vein, sympathetic fibers

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7
Q

Radial Nerve Sensory Branch

A

Sensory branch comes off near mid-humerus, after that its all motor

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8
Q

Path of the Saphenous Vein

A

Medial leg, anterior over thigh, posterior to knee, then anterior again

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9
Q

Osteosarcoma aw/:

A

Pagets

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10
Q

Red Safranin O

A

Stains cartilage, mast cell granules, and mucin red

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11
Q

Femoral Hernias

A

More common in women (right sided), medial to the femoral vein

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12
Q

Indirect Hernia

A

Lateral to epigastric arteries and through the inguinal canal

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13
Q

Direct Hernia

A

Medial and through transversalis fascia (Hesselbech’s triangle)

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14
Q

Femoral Hernia

A

Through femoral ring

- MC in women

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15
Q

Median Nerve Runs Between

A

Flexor digitorum profundus and Flexor digitorum superficialis

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16
Q

Gag Reflex

A

afferent CN IX (glossopharyngeal) and efferent bilateral CN X (vagus)

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17
Q

______ aw/ more Stress Fractures

A

Anorexia

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18
Q

Superior Orbital Fissure

A

V1

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19
Q

Foramen Rotundum

A

V2

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20
Q

Foramen Ovale

A

V3

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21
Q

Foramen Spinosum

A

Middle meningeal artery and vein

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22
Q

Myasthenia Gravis

A
  • aw/ thymoma; Abs to Ach receptors
  • Test with edrophonium (AchE inhibitor)
  • Decreased motor end plate potential
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23
Q

Lambert- Eaton Syndrome

A
  • aw/ small cell carcinoma (paraneoplastic)

- Abs to Ca2+ channels

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24
Q

Median Nerve Function: : Thumb

A

flexion, opposition, and ABduction of the thumb

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25
Q

Ulnar Nerve: Thumb

A

Adduction

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26
Q

Radial Nerve: Thumb

A

Extension (longus and brevis)

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27
Q

anti-centromere Ab

A

CREST

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28
Q

Cleft Lip

A

failure for the lateral maxillary prominence to fuse with the medial nasal prominence

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29
Q

Reflexes: tendon tap sensed by _____

A

spindle afferents

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30
Q

Empty Can Test for _____

A

Supraspinatus

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31
Q

Lipsarcoma MC located in:

A

thigh and retroperitoneum

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32
Q

Malignant Hyperthermia

A
  • Muscle rigidity due to intracellular release of and hypersensitivity to Ca2+ in skeletal muscle and generation of heat
  • Soon after surgery w/ general anesthesia (especially inhaled anesthetics like halothane)
  • AD inherited susceptibility
  • Tx. Dantrolene: blocks ryanodine receptors preventing released of Ca into cytoplasm of muscle cells
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33
Q

Injection in superomedial quadrant of buttock may injure ______

A

Superior gluteal nerve (to gluteus medius and minimus)

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34
Q

Septic monoarthritis

A

caused by gonococcus usually (if not septic, most likely gout or pseudogout)

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35
Q

Middle meningial artery is a branch of:

A

maxillary artery

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36
Q

Osteomyelitis Causes:

A
  • Hematogenous spread typically to Metaphysis
  • In sickle cell disease → caused by salmonella
  • In vertebral body (Pott’s disease) → caused by TB
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37
Q

Myosin light chain kinase and calmodulin

A

only in smooth muscle

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38
Q

Acute Gouty Arthritis Tx:

A

NSAID first (unless contraindicated), colchicine next (2nd line)

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39
Q

Bursitis: Prepateller and Anserine

A
  • Prepatellar bursitis from kneeling

- Anserine bursa is medial

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40
Q

Bone Alkaline Phosphatase is Specific to:

A

Osteoblast activity

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41
Q

Osteocytes exchange nutrients and waste via:

A

gap junctions

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42
Q

PTH effect on Osteoblast vs Osteoclasts

A

acts on osteoclasts indirectly; acts directly on osteoblasts which will produce RANKL to stimulate osteoclasts

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43
Q

Golgi tendon Organ

A
  • monitors and maintains a muscle force

- Sudden muscle relaxation if there is too much force

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44
Q

Muscle Spindle System

A
  • feedback that monitors and maintains muscle length

- Reflexes (detects hyperextension)

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45
Q

Cori Disease

A

debranching enzyme deficiency; will see small dextrin like material

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46
Q

Guyton’s Canal

A

ulnar nerve runs between hook of hamate and the pisiform bone → injury will cause weakness on ulnar side of hand and intrinsic hand muscles

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47
Q

Injury to Ulnar Nerve near Medial epicondyle

A

Claw hand deformity

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48
Q

• Median (thumb) and Ulnar (pinky) Nerve problems: Proximal Lesion

A

can’t flex affected side

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49
Q

Median (thumb) and Ulnar (pinky) Nerve problems: Distal Lesion

A

can’t extend affected side

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50
Q

Phases of Pagets

A
  1. Osteoclast
  2. Mixed Clast and Blast
  3. Osteoblast
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51
Q

Slow Twitch Muscle Fibers

A
  • Type I Fibers
  • Red, lots of myoglobin and mitochondria
  • in postural muscles (paraspinal) or soleus muscle
    (Type IIa are intermediate, Type IIb are fast)
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52
Q

Artery that Runs w/ Radius Behind Humeral Shaft

A

Deep Brachial Artery

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53
Q

Myasthenic Crisis

A

When a patient is being undertreated for their condition

  • edrophonium temporarily fixes improves their condition
  • patient should be given a higher dose of their ACHE inhibitor
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54
Q

Femoral Nerve

A

IPSQuad
Flexion of Hip
Extension of Knee
Sensory on anterior thigh and anterior/medial leg

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55
Q

Decreased Risk of Osteoporosis in:

A

African American Women

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56
Q

Ankle Reflex

A

S1

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57
Q

Patellar/Knee Reflex

A

L4

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58
Q

Posterior and lateral thigh and leg pain shooting to inner foot

A

L5 root compression (of sciatic nerve)

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59
Q

Strictly posterior thigh and leg pain shooting to foor

A

S1 root compression (of sciatic nerve)

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60
Q

Uricosuric agents should be avoided in:

A
  • Acute gouty arthritis

- Patients who excrete large amounts of uric acid (to prevent uric acid nephrolithiasis)

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61
Q

Teres Minor

A

Lateral rotation and adduction

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62
Q

Infraspinatus

A

Lateral rotation

pitching injury

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63
Q

Subscapularis

A

Medial rotation and adduction

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64
Q

Supraspinatus vs Deltoid

A

Supraspinatus: initiates abduction
Deltoid: continues abduction

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65
Q

+ Tinel or Phalen Test

A

Carpal Tunnel Syndrome

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66
Q

5 causes of Carpal Tunnel due to decreased space:

A 
Dialysis (B2 microglobulin)
Pregnancy (fluid buildup)
Hypothyroid (gag buildup)
Diabetes (CT thickening)
RA (tendon inflammation)
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67
Q

Median Nerve Innervates

A

LOAF + all flexors (except flexor carpi ulnaris and 1/2 of flexor digitorum profundus)

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68
Q

Ulnar Nerve Innervates

A

All intrinsic hand muscles (except LOAF) and Flexor carpi ulnaris and 1/2 of flexor digitorum profundus

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69
Q

Radial Nerve Innervates

A

All extensors, brachioradialis, supinator, and anconeus

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70
Q

Erb palsy

A

Upper trunk problem (waiter’s tip)

- lateral traction during delivery of infant or trauma

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71
Q

Klumpke’s Palsy

A

Lower trunk problem
(total claw hand)
- upward force or grabbing a tree branch

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72
Q

Sensory Part of Musculoculateneous Innervates

A

Lateral forearm

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73
Q

Sensory part of Radial Innervates

A

Posterior arm/forearm and dorsal hand (thumb side)

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74
Q

Actions of Tibial Nerve

A

Plantar flexion and inversion

common peroneal does dorsiflexion and eversion

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75
Q

Sensory Part of Tibial Nerve Innervates

A

Bottom of foot

common peroneal does dorsum of foot

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76
Q

Artery that the Median nerve runs with

A

Brachial Artery (distal humerus)

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77
Q

Artery that Axillary nerve runs with

A

Posterior Circumflex artery (surgical neck of humerus)

78
Q

Most of blood supply to femoral neck

A

Medial Circumflex artery

79
Q

Power Stroke

A

Release of ADP

new ATP binding causes myosin head to detach from actin

80
Q

Smooth Muscle Contraction

A
  • Action potention depolarization opens up L-type Ca2+ channels
  • Ca2+- calmodulin complexes –> myosin light chain kinase
  • Myosin gets phosphorylated –> contraction via cross bridging
81
Q

Membranous Ossification

A

Calvarium and facial bones (woven bone formed directly without cartilage and is later remodeled to lamellar bone)

82
Q

Endochondral Ossification

A

Axial and appendicular skeleton

woven bone made over a cartilaginous model which is lated remodeled to lamellar bone

83
Q

Osteoclast Differentiate from:

A

monocytes/macrophages

84
Q

Osteitis Fibrosa Cystica aw/

A

Primary hyperparathyroidism

85
Q

Spike of PTH vs Constant PTH

A

Spike: blast & clast stimulation –> build
Constant: clast stimulation –> breakdown

86
Q

Osteoprotegerin (OPG)

A

Antagonist of RANK-L receptor –> inhibits clasts

87
Q

Denosumab

A

Antibody to RANK-L to inhibit clasts

88
Q

Thick, dense, weak bone w/ unmineralized spongiosa in medullary canals

A

Osteopetrosis

- bone fills marrow space causing pancytopenia

89
Q

Osteoid (unmineralized) –> soft bones and rosary chest

A

Osteomalacia/Ricketts

  • Vit D deficiency
  • too much blast activity
90
Q

Increased risk of Osteogenic Sarcoma or High output heart failure w/:

A

Pagets Disease of bone

- heart failure due to increased AV shunt

91
Q

Mosiac or woven bone w/ increased hat size and hearing loss

A

Pagets Disease

92
Q

Lab Values w/ Osteoporosis

A

All normal but have decreased bone mass (trabecular thinning)

93
Q

Epiphyseal Bone Tumor

A

Giant Cell tumor (usually near knee)

94
Q

Diaphysis Bone Tumors

A
  • Ewings

- Chondrosarcoma

95
Q

Metaphysis Bone Tumors

A
  • Osteosarcoma

- Osteochondroma

96
Q

Young adult female w/ benign aggressive bone tumor in epiphysis

A

Giant Cell Tumor (soap bubble appearance)

97
Q

Young male w/ the most common benign tumor

A

Osteochondroma (in metaphysis)

- has cartilaginous cap

98
Q

Maligant tumor showing Codman’s triangle/sunburst on metaphysis

A

Osteosarcoma

99
Q

Young boy w/ a malignant tumor w/ small round blue cells w/ onion skin appearance

A

Ewing Sarcoma (in diaphysis)

100
Q

Ewing sarcoma translocation

A

t(11;22)

101
Q

Older male w/ a malignant bone tumor that looks like a glistening mass

A

Chondrosarcoma (in diaphysis)

102
Q

Baker’s Cyst aw/

A

Rheumatoid Arthritis

103
Q

anti-CCP highly specific for:

A

Rheumatoid Arthritis

104
Q

Rheumatoid Factor

A

Anti-IgG antibody

105
Q

Activating mutation of PRPP synthetase –> __________

A

Increased frequency of gout due to increased production and degradation of purines

106
Q

Drugs that decrease uric acid excretion

A

Aspirin and Thiazide Diuretics

107
Q

Drugs that may exacerbate Gout

A

Azathioprine and 6-MP due to metabolization by xanthine oxidase

108
Q

Febuxostat

A

Non-purine xanthine oxidase inhibitor (more potent than allopurinol)

109
Q

Probenecid

A

Increases uric acid excretion by competing w/ OAR/URATI transporter

110
Q

Pegloticase

A

Uricase enzyme that converts uric acid into allantoin (water soluble metabolite)

111
Q

Cells responsible for the inflammation seen w/ gout

A

Neutrophils

112
Q

Overproduction of Uric Acid seen w/: (4)

A

Lesch Nyhan, Von Gierke, Tumor lysis syndrome, and PRPP excess

113
Q

Enthesopathy

A

Limited chest expansion due to costosternal and vertebral pain (due to inflammation of tendon insertion sites)
- aw/ ankylosing spondylitis

114
Q

Complication of Sjogren’s

A

Dental caries and MALT lymphoma

115
Q

Causes of Reactive Arthritis (5)

A

Chlamydia, Campylobacter, shigella, salmonella, yersinia

- conjunctivitis, urethritis, arthritis

116
Q

Nephritic syndrome in SLE:

A

Diffuse proliferative glomerulonephritis (DPGN)

117
Q

Nephrotic syndrome in SLE:

A

Membranous glomerulonephritis

118
Q

False Positive VDRL:

A

virus, drugs, rheumatic fever, lupus, leprosy

119
Q

Drug Induced Lupus:

A

Anti-histone antibodies
Procainamide, hydralazine, isoniazid
(drugs metabolized by N-acetylation in liver)

120
Q

Antiphospholipid Antibody Syndrome:

A

False + syphilis test
Thromboembolisms
Recurrent pregnancy loss

121
Q

Polymyositis vs Dermatomyositis

A

Poly: endomysial CD8+ w/ proximal muscle weakness
Dermatomyositis:
- perimysial CD4+
- muscle weakness w/ malar rash, gottron’s papules, shawl and face rash, increased risk of occult malignancy

122
Q

ANA, anti-Jo, anti-SRP, anti-Mi2

A

Polymyositis and Dermatomyositis

123
Q

Myositis Ossificans

A

Skeletal muscle metaplasia to bone following trauma

124
Q

Melasma

A

Hyperpigmentation aw/ pregnancy and OCPs (mask of pregnancy)

125
Q

Junctional Nevi

A

Flat macules

126
Q

Intradermal Nevi

A

Papular

127
Q

Seborrheic Keratosis

A

Stuck On appearance

128
Q

Leser Trelat Sign

A

Sudden appearance of multiple seborrheic keratosis indicates an underlying malignancy

129
Q

Necrotizing Fasciitis

A

Deeper tissue injury form anaerobic bacteria or S. pyogenes

  • crepitus from gad
  • bullae and purple skin color
130
Q

Difference between Staph Scalded Skin Syndrome and TEN syndrome

A

SSS destroys attachments in stratum granulosum only

- toxic epidermal necrolysis destroys epidermal-dermal junction

131
Q

IgG to desmoglein of desmosomes (reticular/net-like on IF)

A

Pemphigus Vulgaris
(Nikolsky +, does not spare oral mucosa)
- acantholysis

132
Q

IgG to hemidesmosomes

A

Bullous Pemphigoid

spares oral mucosa

133
Q

Erythema Multiforme

A

-Target like lesions

aw/ mycoplasma, HSV (usually), and drugs (sulfa, beta lactams, and phenytoin)

134
Q

Erythema Nodosum

A

Painful inflamed subcutaneous fat on shins

  • can be aw/ sarcoidosis, coccidioides, histoplasma, TB, strep, leprosy, and Crohn’s
  • usually idiopathic
135
Q

Lichen Planus

A

Pruritis, purple, polygonal, planar papules and plaques

  • Mucosal involvement (Wickham striae/reticular white lines)
  • aw/ Hep C
136
Q

Acanthosis

A

Aw/ psoriasis

137
Q

Dyskeratosis

A

Aw/ Squamous cell carcinoma

138
Q

Hyperkeratosis

A

aw/ Actinic Keratosis (can become squamous cell carcinoma)

139
Q

Hypergranuloses

A

aw/ lichen planus

140
Q

Spongiosis

A

aw/ eczematous or contact dermatitis

141
Q

Vitiligo

A

due to loss of epidermal melanocytes

- Autoimmune

142
Q

Cafe Au Lait

A

Increased melanosome aggregation

143
Q

Albinism

A

Decreased melanin production due to defective tyrosinase

144
Q

Stasis Dermatitis

A

From incompetent venous valves

  • Erythema and scaling/ progressive dermal fibrosis and hyperpigmentation near feet
  • Varicose veins
145
Q

Tx for Skin/Soft Tissue Infections w/ Staph Aureus:

A

Nafcillin

146
Q

Calcipotriene

A

VitD analog that can be used to treat Psoriasis by inhibiting keratinocyte

147
Q

Osler-Weber-Rendu Syndrome

A

Hereditary hemorrhagic telengectasias

- Skin and mucosal telengectasias and recurrent nosebleeds

148
Q

Sturge-Weber

A

Port wine stain w/ seizures, mental retardation, tram track calcifications on skull radiographs

149
Q

Waardenburg

A

Piebaldism w/ deafness

150
Q

Layers of Skin

A 
Corneum
Lucidum (in acral regions)
Granulosum
Spinosum
Basale
151
Q

Pityriasis Rosea

A

Herald Patch followed by Christmas tree distribution

152
Q

Lichen Planus is aw/

A

Hepatitis C

153
Q

Pearly nodule w/ telangectasia, rolled borders, central ulceration, & pseudopalisading nuclei

A

Basal Cell Carcinoma
(MC skin cancer)
- rarely metastasizes

154
Q

Ulcerative red lesion w/ frequent scale & keratin pearls

A

Squamous Cell Carcinoma

2nd MC skin cancer

155
Q

Actinic Keratosis

A

Small brownish yellow, sandpaperlike (rough)

  • Premalignant lesion due to sun exposure
  • can progress to squamous cell carcinoma
156
Q

Keratoacanthoma

A

Variant of squamous cell carcinoma that grows rapidly (4-6 weeks) then may spontaneously regress
- Solitary flesh colored nodule w/ central keratin plug

157
Q

Melanoma Metastatic Potential

A

Depends on vertical growth

Breslow and Clark level

158
Q

Vemurafenib

A

BRAF kinase inhibitor used for metastatic or unresectable melanoma in BRAF V600E mutation patients

159
Q

Chronic draining sinuses aw/

A

Squamous cell carcinoma

160
Q

COX-2

A

Inducible enzyme that is normally not detectable except in tissues w/ inflammation

161
Q

Low-Dose Aspirin

A

Anticoagulation

-decreased thromboxane and prostaglandin synthesis

162
Q

High-Dose Aspirin

A

Anti-inflammatory

163
Q

Intermediate Dose Aspirin

A

Analgesic and anti-pyretic

164
Q

Aspirin vs NSAIDs

A

Both inhibit COX 1 and 2
Aspirin is irreversible (covalent acetylation)
NSAIDs are reversible

165
Q

COX2 inhibitors (celecoxib)

A
  • Spares COX1 so: platelets unaffected (don’t have an effect on TXA2 which depends on COX1) and gastric mucosa unaffected
  • sulfa allergy and increased risk of thrombosis
  • used in patients w/ gastric ulcers
166
Q

Acetaminophen

A

Reversible inhibition of COX (mostly in CNS)

Antipyretic and analgesic but NOT anti-inflammatory

167
Q

Side Effects of Bisphosphonates

A

Corrosive esophagitis and Osteonecrosis of Jaw

168
Q

Avascular necrosis of femoral head aw/

A

Sickle cell disease, SLE, high-dose steroid therapy, and alcoholism
- no swelling, erythema, or warmth; only pain

169
Q

Procollagen Peptidase Deficiency

A

Form of Ehlers Danlos

  • joint laxity, loose skin, and easy bruising
  • impaired cleavage of procollagen N and C termini results in a more soluble form of collagen that cannot properly crosslink
170
Q

Succinylcholine

A
  • Can cause Malignant Hyperthermia (esp w/ halothane)
  • severe hyperkalemia in burn patients
  • augmented by neostigmine in Phase I
  • blocked by neostigmine in Phase II
171
Q

Stewart Treves Syndrome: Chronic lymphedema is a risk factor for:

A

Cutaneous angiosarcoma

172
Q

Injections in the Gluteal Region

A

Should be given in the Superolateral quadrant of the buttock (safest site)

173
Q

Cardiac abnormality aw/ Ankylosing Spondylitis:

A

Aortic regurgitation from ascending aortitis and aortic ring dilation

174
Q

Cricothyroid is innervated by:

A

Superior Laryngeal Nerve

- Everything else is the Recurrent Laryngeal Nerve

175
Q

Osteogenesis Imperfecta

A

AD abnormality or deficiency in Type I collagen

  • blue sclera, brittle bones
  • primary defect is in bone matrix production
176
Q

Recurrent Laryngeal Nerve Runs With:

A

Inferior Thyroid Artery

177
Q

Superior Laryngeal Nerve Runs with:

A

Superior Thyroid Artery

178
Q

CREST: pulmonary symptoms

A

Pulmonary Hypertension due to intimal thickenings of pulmonary arteries

179
Q

Deep Fibular Nerve

A

Dorsiflexion and sensation between the big toe and 2nd toe

180
Q

Superficial Fibular Nerve

A

Eversion and sensation on the majority of the dorsum of the foot

181
Q

Elasticity

A

4 Lysine crosslinking

182
Q

PABA protects from:

A

UVB radiation only

183
Q

Osteoclasts require _______

A

Carbonic anhydrase to produce H+ ions that are pumped into the resorptive pit to create an acidic environment for bone demineralization

184
Q

Muscles on Lateral End of Clavicle

A

Deltoid (pulls clavicle inferolaterally) and Trapezius (pulls clavicle superomedially)

185
Q

Abscess in Psoas Muscle

A

May lead to formation of an abscess in the groin and pain referred to that region

186
Q

Dysplastic Nevus Syndrome

A

Number dysplastic nevi in a young person with a family history of melanoma
- mutation in CDKN2A gene on chromosome 9p21

187
Q

+ Psoas Sign on iliopsoas Test

A

Patient flexes hip against resistance

- pain suggests psoas inflammation possibly due to appendicitis, psoas abscess, or peritoneal inflammation

188
Q

Structures through the Diaphragm

A

IVC at T8
Esophagus and Vagal trunks at T10
Aorta, Thoracic Duct, Azygos Vein at T12

189
Q

Hyperemia

A
  • Overcompensation of reperfusion after occlusion
  • Blood flow increases during exercise
  • The more anaerobic metabolism you use and lactate build-up you have, the more hyperemia you need to clear out the waste products
190
Q

Osgood-Schlatter

A
  • also known as apophysitis of the tibial tubercle
  • due to chronic stress/irritation at the insertion of the patellar ligament on the tibial tubercle
  • classically seen in the teenagers doing repetitive vigorous activity (running, jumping)
191
Q

Sweat Gland Secretion

A

Apocrine

initially odorless but can become malodorous secondary to bacterial decomposition on skin surface

Quick Notes for Step 1 (18 decks)

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