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Uworld Journal > Musculoskeletal + Skin > Flashcards

Musculoskeletal + Skin Flashcards

1
Q

Osteomyelitis in kids usually seeds where?

A

Metaphysis of long bones

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2
Q

Dystonia - definition and cause

A

Prolonged repetitive muscle contractions.

Occurs as a result of impaired basal ganglia function.

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3
Q

Safest location for a intragluteal injection?

A

Superolateral region - avoids the sciatic nerve and the superior gluteal nerve

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4
Q

Complications of ankylosing spondylitis (3)

A
  • Limited chest expansion
  • Ascending aortitis
  • Uveitis
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5
Q

Compliment deficiency in SLE

A

Decrease in C3, C4, CH50

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6
Q

Mechanism of C. perfringens necrosis

A

Lecithiniase/alpha-toxin/Phospholipase C

splits phospholipid molecules resulting in membrane destruction, cell death, hemolysis and necrosis

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7
Q

HLA-B27 is what class of HLA (I vs II)?

A

Class I serotype - present on all nucleated cells

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8
Q

DDx: back pain + elevated alkaline phosphatase = (2)

A
  • Osteoblast metastasis

- Paget’s disease of bone

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9
Q

anti-histidyl-tRNA transferase autoantibody =

A

Anti-Jo-1 antibody

polymyositis/dermatomyositis

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10
Q

bony deformities + hyperthyroidism + unilateral, large, irregular pigmented macules =

A

McClune Albright Syndrome

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11
Q

Definition - heteroplasmy

A

Coexistence of both mutated and wild type versions of mitochondrial genomes in one cell

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12
Q

Lactic acidosis + Histological ragged red fibers =

A

Mitochondrial myopathy

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13
Q

Bugs that cause necrotizing fascitis (3)

A
  • Strep pyogenes (Group A Strep)
  • Staph aureus
  • Clostridium perfringens
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14
Q

What is a “contracture” of a wound?

A

excessive metalloprotease (MMP) activity that results in excessive wound contraction

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15
Q

Muscle involved in the valsalva maneuver that develops the elevated intra-abdominal and intra-thoracic pressure =

A

Rectus muscle

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16
Q

Differences in stature in achondroplasia vs GH/IGF-1 deficiency

A

Achondroplasia = short, thick appendicular skeleton with a normal axial skeleton - disproportional short stature

GH/IGF-1 deficiency = proportional short stature

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17
Q

Tendons that line the anatomical snuff box (3)

A
  • Tendon of the extensor pollicis longus - medial border
  • Tendon of the abductor pollicis longus - lateral border
  • Tendon of the extensor pollicis brevis - lateral border
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18
Q

What kind of damage does UV light do to DNA?

A

pyrimidine dimers

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19
Q

What childhood exanthem has a maculopapular rash that begins on the face and quickly spreads down to extremities and trunk with co-presenting post-auricular and occipital lymphadenopathy

A

Rubella (part of the Togavirus family)

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20
Q

Intellectual disability + Gait/Posture disturbances + Eczema + Musty body odor =

A

Phenylketonuria (autosomal recessive)

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21
Q

What hormone is responsible for male pattern baldness?

A

DHT

“androgenic allopecia”

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22
Q

What causes the skin retraction seen in invasive breast cancer?

A

Infiltration of the suspensory Cooper ligament

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23
Q

What causes the peau d’orange appearance in invasive breast cancer?

A

Blockage of lymphatic drainage

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24
Q

Chronic glucocorticoid use to treat atopic dermatitis results in what (negative) side effect?

A

atrophy of the dermis caused by decreased ECM collagen and GAG production

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25
Q

First line treatment for someone having a gouty arthritis attack?

A

NSAIDs

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26
Q

Artery damaged during displacement of the femoral neck?

A

medial circumflex artery

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27
Q

How do you measure potency of an inhaled anesthetic?

A

MAC = minimal alveolar concentration

Inversely proportional to potency:

  • low MAC
  • increased potency
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28
Q

elderly patient + pulmonary TB + isoniazid treatment = peripheral neuropathy

Why?

A

Vitamin B6 deficiency caused by isoniazid use.

Requires pyridoxine supplementation.

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29
Q

Older patient + new back pain + recent/treated Staph bacteremia infection + fever + fatigue + malaise =

How to dx?

A

Vertebral osteomyelitis - probably from the Staph infection

to dx = MRI of the spine

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30
Q

Child with sickle cell disease + fever + pain in foot + leukocytosis =

A

Osteomyelitis (Salmonella typhi)

Avascular necrosis would present as bone pain only

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31
Q

40 year old African American woman, fever, malaise, bilateral hilar adenopathy, erythema nodosum, elevated serum Ca =

A

Sarcoidosis (African american woman + hilar adenopathy)

Elevated level of 1,25 dihydroxycholecalciferol (active vitamin D due to the presence of alpha1 hydroxylase in the epithelioid macrophages)

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32
Q

7 causes of erythema nodosum

A
  • Sarcoidosis
  • Coccidiomycoses
  • Histoplasmosis
  • TB
  • Leprosy
  • Strep infections
  • Inflammatory Bowel Disease
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33
Q

Male newborn with macrocephaly + poor skull mineralization + misshapen long bones + fractures that occurred during birth =

A

Osteogenesis imperfecta - decreased collagen type I production

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34
Q

Hyperreflexia is seen in a lesion of the UMN or LMN?

A

UMN lesion leads to hyperreflexia

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35
Q

What childhood exanthem has a rash that begins at the head and travels downward but is preceded by cough + conjunctivitis + spots in the mouth?

A

Measles (part of the Paramyxovirus family)

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36
Q

“trabecular thinning of bone”

A

Osteoporosis

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37
Q

“persistence of primary unmineralized spongiosa in the medullary canals”

A

Osteopetrosis

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38
Q

6 P’s of lichen planus =

A 
Purple
Puritic
Polygonal
Planar
Papules 
Pustules
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39
Q

3 arm nerves that are flexors =

A

Musculocutaneous (C5-C7)
Median (C5-T1)
Ulnar (C8-T1)

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40
Q

2 arm nerves that are extensors =

A

Axillary (C5-C6)

Radial (C5-T1)

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41
Q

Lab values (serum Ca, PTH, PO4)

Osteoporosis =
Paget’s disease of the bone =
Osteopetrosis =

A

All normal!

Paget’s disease will have increased ALP due to last stage being osteoblast-heavy

42
Q

Weakness in hands and heaviness in eyelids by the end of the day + anterior mediastinal mass

A

Myasthania gravis + associated thymoma or thymic hyperplasia

43
Q

Diseases caused by defective DNA break repair mechanisms (6)

A
  • Xeroderma pigmentosum
  • Carcinogenesis
  • Hereditary nonpolyposis colorectal cancer (HNPCC)
  • Ataxia telagiectasia
  • Fanconi anemia (-> aplastic anemia)
  • Bloom syndrome
44
Q

Recurrent sinopulmonary infections + superficial blanching nests of distended capillaries + atrophied cerebellum + child =

A

Ataxia telagiectasias

superficial blanching nests of distended capillaries = telagiectasias

45
Q

Rash on palms and soles and body = (4)

A
  • N. meningitidis
  • Coxsackie A
  • Rocky mountain spotted fever
  • Syphilis (secondary)

You drive Nice CARS with your hands and feet.

46
Q

Man with an inflamed, red knee. Aspirate has crystals and increased WBC with neutrophilic predominance.

A

Pseudogout with Calcium pyrophosphate crystals

47
Q

Cytokines important in granuloma formation = (3)

A
  • IL-12
  • IFN-gamma
  • TNF-alpha
48
Q

Sensory innervation of the musculocutaneous nerve

A

Musculocutaneous nerve (C5-C7) -> lateral cutaneous nerve of the forearm -> lateral forearm sensation

49
Q

Posterior arm + Posterior forearm + Dorsal hand sensory

A

Posterior cutaneous branches of the radial nerve

50
Q

Anterior forearm, medial forearm, and anterior arm sensation

A

Medial antebrachial cutaneous nerve - branch off the median cord of the brachial plexus

51
Q

Trendelenburg gait - damage to inferior or superior gluteal n?

A

Superior gluteal nerve - gluteus minimus, medius and tensor fascia latae muscle

52
Q

Difficulty rising from seated and difficulty climbing stairs - damage to inferior or superior gluteal n?

A

Inferior gluteal nerve - gluteus maximus muscle

53
Q

Asteroid body is found in

A

Sarcoidosis

54
Q

Main cell type in the pathology of polymyositis.

Where is the inflammation located?

A

CD4 T cells -> endomyseal inflammation

55
Q

Main cell type in the pathology of dermatomyositis.

Where is the inflammation located?

A

CD8 T cells -> perimyseal inflammation

56
Q

2 mechanisms of albinism:

A
  • Decreased tyrosinase activity
  • Defective tyrosine transport

Overall, decreased melanin synthesis

57
Q

Autoimmune destruction of melanocytes

A

Vitligo

58
Q 
Type of gland:
Salivary =
Sweat glands = 
Mammary gland = 
Sebaceous gland = 
Meibomian gland (eyelid) =
A
  • Salivary = merocrine
  • Sweat glands = merocrine
  • Mammary gland = apocrine
  • Sebaceous gland = holocrine
  • Meibomian gland (eyelid) = holocrine
59
Q

Mutation in xeroderma pigmentosum

A

Defective UV-specific endonuclease

60
Q

Twisted ankle inwards + pain and ecchymoses on anterolateral ankle + can still walk unassisted =

A

Tear of the anterior talofibular ligament

61
Q

two locations of collagen synthesis

A
  • RER of fibroblasts

- ECM

62
Q

Serum _ measures osteoblast activity

A

ALP

63
Q

Urinary _ measures osteoclast activity

A

Deoxypyridinoline

64
Q

Family history of hypermobile joints + susceptible to easy bruising + hyperelastic skin

A

Ehlers-Danlos Syndrome

65
Q

Cytokine responsible for keloid production/growth

A

TGF-beta

66
Q

Hartnup disease treatment

A

Niacin

Most of the symptoms are due to tryptophan deficiency (-> niacin deficiency)

67
Q

Positive lepromin skin test indicates a cell response with b (3) cytokines and a c bacterial load.

A

a=Th1
b=IL-2, IFN-gamma, IL-12
c=low

68
Q

Negative lepromin skin test indicates a cell response with b (3) cytokines and a c bacterial load.

A

a=Th2
b=IL-4, IL-5, IL-10
c=high

69
Q

Latissimus dorsi does medial/lateral rotation of the humerus. Innervated by _.

A

Medial rotation of the humerus

Innervated by thoracodorsal nerve (T7-T12)

70
Q

Metastases to bone - osteoblastic/sclerotic (3)

A
  • Prostate
  • Small cell lung
  • Hodgkin lymphoma
71
Q

Metastases to bone - osteolytic (5)

A
  • Multiple myeloma
  • Non-small cell lung
  • Non-hodgkin lymphoma
  • Melanoma
  • Renal cell carcinoma
72
Q

Metastases to bone - both osteoblastic and osteolytic (2)

A
  • GI

- Breast

73
Q

What bone tumor:

  • elevation of the periosteium
  • may be associated with other familial cancers
  • bimodal age distribution
A

Osteosarcoma

  • Codman’s triangle - elevation of the periosteium due to the tumor being located on the edge
  • Sunburst pattern on xray
  • Associated with Rb/Li Fraumeni
  • Occurs in young and elderly
74
Q

What bone tumor is associated with t(11;22)

A

Ewing Sarcoma

  • occurs in boys less than 15 yo
  • diaphysis of bone
  • onion skin periosteal reaction
  • small blue cell malignant tumor
75
Q

What bone tumor has bone pain that resolves with aspirin use and is found on the diaphysis?

A

Osteoid osteoma

76
Q

What bone tumor has pain that does not resolve with aspirin use and is found in the vertebrae.

A

Osteoblastoma

77
Q

Young boy with frequent fractures from minimal trauma + anemia + target RBCs

A

Osteopetrosis - defective osteoclasts

Mutation may be in carbonic anhydrase II therefore impairing the ability of osteoclasts to generate the acidic environment needed

78
Q

Sawtooth infiltrate of lymphocytes at the dermal-epidermal junction

A

Lichen planus

Associated with HepC

79
Q

54 year old woman with a past history of radical mastectomy and chronic lymphedema. Presents with multiple violaceous nodules on her arm.

A

Cutaneous angiosarcoma

  • CD31+
  • infiltration of the dermis with slit-like abnormal vascular spaces
  • vascular tumor that commonly arises post-chronic lymphedema
80
Q

Procollagen peptidase action in collagen synthesis

A

Cleavage of disulfide-rich terminal regions of procollagen
Occurs in the ECM

This is inhibited in EDS

81
Q

Irritant found in poison ivy, poison oak, poison sumac

A

Urushiol

82
Q

Cell type responsible for linear growth

A

Chondrocytes - produces the cartilaginous matrix in the physis/growth plate

“Endochondrial ossification”
-controlled by FGF3

83
Q

Urticaria on light microscopy

A

Dermal edema caused by increased vascular permeability

84
Q

RA can involve what part of the vertebral column?

A

Cervical spine

85
Q

Reactive arthritis follows what 2 types of infections?

A
  • Genitourinary or Enteritis (GI)
  • Clinical manifestations are due to immune complexes that form involving bacterial antigens (even though the joint aspirates are sterile)
86
Q

Genetics of achondroplasia

A

AD
Gain of function mutation in FGF Receptor 3
Associated with advanced paternal age

87
Q

What substance is responsible for increasing the reaction rate in skeletal muscle contraction?

A

Calcium

Stimulates phosphorylase kinase -> activates glycogen phosphorylase-a by phosphorylating it -> turns glycogen into G1P -> ATP!

88
Q

Causes of bilateral carpal tunnel syndrome (5)

A
  • Pregnancy - fluid accumulation
  • Hypothyroidism - glycosaminoglycan build up
  • Diabetes Mellitus - connective tissue thickening
  • Rheumatoid Arthritis - tendon inflammation
  • Chronic hemodialysis - beta-2 microglobulin deposition
89
Q

These are types of _

  • superficial spreading
  • nodular
  • lentigo maligna
  • acral lentiginous
A

melanoma

90
Q

Rheumatoid factor is _

A

IgM autoantibody that targets the Fc portion of IgG

91
Q

what effect does osteoporosis have on osteoclast activity, RANK L concentration and osteoblast concentration?

A

Low estrogen -> osteoporosis

low estrogen ->

  • increases osteoclast activity
  • increases RANK-L concentration
  • decreases osteoblast concentration due to increasing turn over
92
Q

Osteomalacia cause?

A

Caused by decreased vitamin D

93
Q

diabetic neuropathy pain?

A

burning pain

94
Q

What tumor is often associated with Paget’s disease of the bone?

A

Osteosarcoma

95
Q

Globus sensation/hystericus/pharyngeus

A

Abnormal sensation of a foreign body/tightness in the throat

Worse when swallowing saliva, alleviated when swallowing food or liquid

Functional disorder

96
Q

Removing _ from ECF will cause cadherins to dissociate

A

Calcium

Cadherins are calcium-dependent

(cell)-cadherin-cadherin-(transmembrane protein-filament)

97
Q

Posteriorly dislocated tibia most commonly injures the _

A

Popliteal artery
-It is located deep within the popliteal fossa and is susceptible to tearing by traction (anterior or posterior dislocation)

(anterior)-bones-popliteal artery-popliteal vein-tibial nerve-(posterior)

98
Q

Patient had a chest tube put in and now she cannot raise her R arm above her head and when pushing against a wall, the R scapula protrudes. What nerve and muscle?

A

Long thoracic nerve is damaged resulting in damage to serratus anterior

99
Q

Articular cartilage is made of

A

Type II collagen

Also made of type II collagen = all other cartilage, vitreous body, nucleus pulposus

100
Q

Red safranin O stain, stains what 3 things red

A
  • Cartilage
  • Mast cell granules
  • Mucin
101
Q

What is the lens made out of?

A

Type IV collagen

Also made of type IV collagen = basement membrane, basal lamina

102
Q

What is the only unmyelinated efferent nerve?

A

Autonomic postganglionic nerve

Other group C nerves:

  • Afferent neurons that conduct heat, slow onset dull burning/visceral pain
  • Primary bipolar sensory neurons

Uworld Journal (12 decks)

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