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My step 1 mnemonics > Musculoskeletal, Skin, and Connective Tissue > Flashcards

Musculoskeletal, Skin, and Connective Tissue Flashcards

1
Q

Rotator cuff muscles

A

S - Supraspinatus (suprascapular nerve)
I - infraspinatus (suprascapular nerve)
t - teres minor (axillary nerve)
S - Subscapularis (upper and lower subscapular nerves)

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2
Q

Rotator cuff muscles - adduction

A

Teres minor (+ external rotation)

Subscapularis (+ internal rotation)

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3
Q

Hand muscles

A

Thenar (median)-

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis - superficial head (deep head by ulnar nerve).

Hypothenar (ulnar)

Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis.

Both groups perform the same functions: Oppose, Abduct, and Flex (OAF).

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4
Q

C5-T1 Nerves

A

Radial
Median
Recurrent branch of Median

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5
Q

Ulnar nerve roots

A

C8-T1

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6
Q

Recurrent branch of Median lesion

A

“Ape hand” (+ “Pope’s blessing” in lesion of median nerve) -> Loss of thenar muscle group: opposition, abduction, and flexion of the thumb
No loss of sensation (Loss of sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2 fingers with proximal lesion of median)

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7
Q

Axillary nerve roots

A

(C5-C6)

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8
Q

Musculocutaneous

nerve roots

A

Upper trunk compression

C5-C7

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9
Q

Erb palsy

INJURY

MUSCLE DEFICIT

A

upper trunk:
C5-C6 roots

Deltoid, supraspinatus
lnfraspinatus
Biceps brachii

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10
Q

Klumpke palsy

INJURY

MUSCLE DEFICIT

A

lower trunk:
C5-T1 roots

Intrinsic hand muscles:
lumbricals,
interossei,
thenar,
hypothenar
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11
Q

Thoracic outlet
syndrome
INJURY

MUSCLE DEFICIT

A

Compression of lower trunk AND subclavian vessels, most commonly within the scalene triangle

Atrophy of intrinsic palsy hand muscles; ischemia, pain, and edema due to vascular compression.

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12
Q

Winged scapula

A

Lesion of long thoracic nerve, roots C5-C7 (“wings of heaven”)

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13
Q

“Clawing” - seen best with _____ lesions of median or ulnar nerves.

A

distal

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14
Q

Knee exam

A

Lateral femora l condyle to anterior tibia: ACL.
Medial femoral condyle to posterior tibia: PCL.
LAMP.

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15
Q

McMurray test

A

During flexion and extension of knee with rotation of tibia/foot (LIME):
• Pain, “popping” on internal rotation - Lateral meniscal tear (Internal rotation stresses lateral meniscus)
• Pain, “popping” on external rotation - Medial meniscal tear (External rotation stresses medial meniscus)

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16
Q

iliohypogastric - Nerve roots

Genitofemoral nerve - Nerve roots

Lateral femoral cutaneous - Nerve roots

A

iliohypogastric - (T12- L1)

Genitofemoral nerve - (L1-L2)

Lateral femoral cutaneous - (L2-L3)

Series

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17
Q

Obturator - Nerve roots

Femoral - Nerve roots

A

Obturator (L2-L4)
Femoral (L2-L4)

Same

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18
Q

Sciatic - Nerve roots
Common peroneal - Nerve roots
Tibial - Nerve roots

A

Sciatic (L4-S3)

Common peroneal (L4-S2)

Tibial {L4-S3)

One in the middle

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19
Q

lliohypogastric

Sensory-?

Motor-?

A

Sensory- suprapubic region

Motor- transversus abdominis and internal oblique

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20
Q

Genitofemoral nerve

Sensory-?

Motor-?

A

Sensory- scrotum/labia majora, medial thigh

Motor- cremaster

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21
Q

Lateral femoral cutaneous

Sensory-?

A

Sensory- anterior and lateral thigh

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22
Q

Obturator

Sensory-?

Motor-?

A

Sensory- medial thigh

Obturator externus
G - gracilis
A - adductor brevis
A - adductor longus
A - adductor magnus
P - pectineus, adductor
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23
Q

Femoral

Sensory-?

Motor-?

A

Sensory- anterior thigh, medial leg

Motor- 
Q - quadriceps
I - iliacus,
P - pectineus
Sr - sartorius
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24
Q

Sciatic

Motor-?

A

B - biceps femoris
A - adductor Magnus
S - semimembranosus
S - semitendinosus,

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25
Q

Common peroneal

Sensory-?

Motor-?

A

Superficial peroneal nerve:
• Sensory-dorsum of the foot (except web space between the hallux and 2nd digit)
• Motor-peroneus longus and brevis

Deep peroneal nerve:
• Sensory- web space between the hallux and 2nd digit
• Motor-tibialis anterior

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26
Q

Tibial

Sensory-?

Motor-?

A

Sensory- sole of foot

T -  triceps surae
I - 2-  biceps femoris (long head)
B
I - 2-  biceps femoris (long head)
a
l

Pope plants and flex - popliteus, plantaris, flexor muscles of the foot

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27
Q

Superior gluteal - Nerve roots

Inferior gluteal- Nerve roots

Pudendal - Nerve roots

A

Superior gluteal (L4-S1)

Inferior gluteal (L5-S2)

Pudendal (S2-S4)

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28
Q

Superior gluteal

Motor-?

A

Motor-
gluteus medius,
gluteus minimus
tensor fascia latae

Trendelenburg sign

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29
Q

Inferior gluteal

Motor-?

A

Motor- gluteus maximus

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30
Q

Pudendal

Sensory-?

Motor-?

A

Sensory- perineum

Motor- external urethral and anal sphincters

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31
Q

Abductors

A

Gluteus medius, gluteus minimus

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32
Q

Adductors

A

Adductor magnus, adductor longus, adductor brevis

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33
Q

Extensors

A

Gluteus maxi mus, semitend inosus, semimembranosus

MAX + SEMI

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34
Q

Flexors

A 
S - sartorius
T -  tensor fascia lata
R - rectus femoris
I - Iliopsoas
P - pectineus
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35
Q

Internal rotation

A

Gluteus medius, gluteus minimus, tensor fascia latae

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36
Q

External rotation

A

O - obturator

P - piriformis
I - Iliopsoas
G - gluteus maximus

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37
Q

Endochondral

ossification

A

Bones of axial skeleton, appendicular skeleton, and base of skull.

Cartilaginous model-> woven - > lamellar

38
Q

Membranous

ossification

A

Bones of calvarium, facial bones, and clavicle.

woven - > lamellar

39
Q

Osteoblast activity measured by

A

Osteoblastic activity measured by:

bone ALP

osteocalcin (mineralisaion)

propeptides of type I procollagen

40
Q

Osteoclast

A

Dissolves (“crushes”) bone by secreting H+ and collagenases

RANK receptors

41
Q

Carpal tunnel syndrome caused by:

A

D - diabetes
U - use (repetitive)
A - amyloidosis ( dialysis-related)
L - Lunate bone disslocation (acute)

T - thyroidism (hypo)
R - rheumatoid arthritis
A - acromegaly
P - pregnancy (due to edema)

42
Q

Trochanteric bursitis

A

Inflammation of the gluteal tendon and bursa lateral to greater trochanter of femur.

43
Q

“Unhappy triad”

A

damage to the ACL MCL, and medial meniscus (attached to MCL).

however, lateral meniscus involvement is more common

44
Q

Prepatellar bursitis cause

A

pressure from excessive kneeling (a lso called “housemaid’s knee”).

45
Q

Baker cyst

A

in gastrocnemius-semimembranosus bursa commonly communicating with synovial space and related to chronic joint disease (OA/RA)

46
Q

DeQuervain tenosynovitis

A

Noninflaammatory thickening of abductor pollicis longus and extensor pollicis brevis tendons

Finkelstein test

risk in new mothers, golfers, racquet sport players.

47
Q

Ganglion cyst

A

Fluid-filled swelling overlying joint or tendon sheath, most commonly at the dorsal side of wrist. Arises from herniation of dense connective tissue.

48
Q

iliotibial band syndrome

A

friction of iliotibial band against lateral femo ral epicondyle.

49
Q

Osteoporosis causes:

A

Most common: estrogen levels and old age.

other causes:
C - coagulants (anti)
A - alcohol
M - malabsorption
P - parathyroidism (hyper)
S - steroids
T - thyroid replacement therapy
e
C -convulsants (anti)
T - thyroidism (hyper)
u 
M - multiple myeloma
50
Q

Osteopetrosis

A

Failure of normal bone resorption due to defective osteoclasts - thickened, dense bones that are
prone to fracture.

pancytopenia, extramedullary hematopoiesis. It can result in cranial nerve impingement and palsies due to narrowed foramina.

Bone marrow transplant is potentially curative as osteoclasts are derived from monocytes.

51
Q

Osteitis deformans

A

inc osteclastic activity followed by inc osteoblastic activity that forms poor-quality bone.

52
Q

Avascular necrosis of bone

A 
C - Corticosteroids
A - Alcoholism
S - Sickle cell disease
T - Trauma
S - SLE

Bend - “ the Bends” (caisson/decompress ion disease)

LE - LEgg-CalvePerthes
G - Gaucher disease
S - Slipped capital femoral epiphysis

53
Q

Osteoarthritis
JOINT FINDINGS
TREATMENT

A 
Osteophytes (bone spurs), joint space narrowing, subchondral sclerosis, and cysts. Synovial
fluid noninflammatory (WBC < 2000/mm'}.

DIP
PIP
CMC
NOT MCP!

Heberden nodes,Bouchard nodes

Activity modification, acetaminophen, NSAIDs, intra-articular glucocorticoids.

54
Q

Rheumatoid arthritis

JOINT FINDINGS

A

Erosions, juxta-articular osteopenia, soft tissue swelling, subchondral cysts, joint space narrowing. Deformities: cervical subluxation, ulnar finger deviation, swan neck, boutonniere.

MCP
PIP
wrist;
not DIP.

Synovial fluid inflammatory.

55
Q

Rheumatoid arthritis TREATMENT

A

N - NSAIDs
o

G - glucocorticoids
oo
D - disease-modifying

H - hydroxychloroquine
e
L -  leflunomide
M - methotrexate
e
T - TNF-a inhibitors
S - sulfasalazine
56
Q

rheumatoid nodules

A

fibrinoid necrosis with palisading histiocytes - in subcutaneous tissue and lung

57
Q

Caplan syndrome

A

pneumoconiosis + RA

58
Q

Felty syndrome

A

interstitial lung disease, pleuritis, pericarditis, anemia of chronic disease, neutropenia + splenomegaly

59
Q

Gout/Pseudogout Tx

A

Gout Tx
Acute: NSAIDs (eg, indomethacin), glucocorticoids, colchicine.
Chronic (preventive): xanthine oxidase inhibitors (eg, allopurinol, febuxostat).

Pseudogout Tx
Acute treatment: NSAIDs, colchicine, glucocorticoids.
Prophylaxis: colchicine.

60
Q

Calcium pyrophosphate deposition disease associated with:

A

Usually idiopathic, sometimes associated with hemochromatosis, hyperparathyroidism, joint trauma.

61
Q

Gout causes:

A
  • Underexcretion of uric acid (90% of patients)- largely idiopathic, potentiated by renal failure; can be exacerbated by certain medications (eg, thiazide diuretics).
  • Overproduction of uric acid (10% of patients)- Lesch-Nyhan syndrome, PRPP excess, t cell turnover (eg, tumor lysis syndrome), von Gierke disease.
62
Q

Systemic juvenile idiopathic arthritis

A

Systemic arthritis seen in < 12 year olds. Usually presents with daily spiking fevers, salmon pink
macular rash, arthritis (commonly 2+ joints). Frequently presents with leukocytosis,
thrombocytosis, anemia, ESR, CRP.

give:

S - steroids
o
M -  methotrexate
T - TNF inhibitors
h
i
N - NSAIDs
63
Q

Systemic lupus
erythematosus
presents with:

A 
RASH OR PAIN
Rash (malar or discoid )
Arthritis (nonerosive)
Serositis (eg, pleuritis, pericarditis)
Hematologic disorders (eg, cytopenias)

Oral/nasopharyngeal ulcers (usually painless)
Renal disease

Photosensitivity
Antinuclear antibodies
Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
Neurologic disorders (eg, seizures, psychosis)

64
Q

Polymyositis/
dermatomyositis
labs

A

Nonspecific: ANA, inc. CK.
Specific: anti-Jo-I (histidyl-tRNA synthetase), anti-SRP (signal recognition particle), anti-Mi-2 (helicase).

65
Q

Polymyositis

A

Progressive symmetric proximal muscle weakness, characterized by endomysial inflammation with CD8+ T cells. Most often involves shoulders.

66
Q

Dermatomyositis

A

Clinically similar to polymyositis, but also involves:
Gottrnn papules
photo-distributed facial erythema (eg, heliotrope (violaceous] edema of the eyelids)
“shawl and face” rash.
darkening and thickening of fingertips and sides.
risk of occult malignancy.

Perimysial inflammation and atrophy with CD4+ T cells.

67
Q

Diffuse scleroderma Associated with

A

anti-Scl-70 antibody (anti-DNA topoisomerase-1 antibody)

anti-RNA polymerase III

68
Q

Epithelial cell junctions

A

TAD gap hemi
T - Tight junctions (zonula occludens) - claudins and occludins.

A - Adherens junction (belt desmosome, zonula adherens) - CADherins (Ca2+ dependent adhesion proteins). Loss of E-cadherin promotes metastasis.

D - Desmosome (spot desmosome, macula adherens) - structural support via intermediate filament
interactions

Gap - Gap junction - connexons

Hemidesmosmes - connects keratin in basal cells to the underlying basement membrane.

69
Q

Hyperkeratosis

A

thickness of stratum corneum

Psoriasis, calluses

70
Q

Parakeratosis

A

Retention of nuclei in stratum corneum

Psoriasis, actinic keratosis

71
Q

Hypergranulosis

A

thickness of stratum granulosum

Lichen planus

72
Q

Spongiosis

A

Epidermal accumulation of edematous fluid in intercellular spaces

Eczematous dermatitis

73
Q

Acantholysis

A

Separation of epidermal cells

Pemphigus Vulgaris

74
Q

Acanthosis

A

Epidermal hyperplasia (inc spinosum)

Acanthosis nigricans

75
Q

Acne

A

sebum/androgen production

abnormal keratinocyte desquamation

Cutibacterium acnes colonization of the pilosebaceous unit (comedones), and inflammation.

Treatment: retinoids, benzoyl peroxide, and antibiotics.

76
Q

Atopic dermatitis

eczema

A

Pruritic eruption, commonly on skin flexures.

Mutations in filaggrin gene predispose

77
Q

Allergic contact dermatitis

A

Type IV hypersensitivity reaction secondary to contact allergen

78
Q

Psoriasis

A

Acanthosis with parakeratotic scaling

Munro microabscesses.

Inc. stratum spinosum

Dec. stratum granulosum.

Auspitz sign - pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off.

Associated with nail pitting and psoriatic arthritis.

79
Q

Rosacea

A

An inflammatory facial skin disorder characterized by erythematous papules and pustules, but NO comedones.

Phymatous rosacea can cause rhinophyma.

80
Q

Seborrheic keratosis

A

Flat, greasy, pigmented squamous epithelial proliferation of immature keratinocytes with keratin filled cysts (horn cysts)

Looks “stuck on.”

Leser-Trelat sign - indicates possible malignancy

81
Q

Urticaria

A

Hives. Pruritic wheals that form after mast cell degranulation. Characterized by superficial dermal edema and lymphatic channel dilation.

82
Q

Dermatitis herpetiformis Tx:

A

dapsone, gluten-free diet.

83
Q

Erythema multiforme associated with infections:

A 
P - phenytoin
H - HSV
o
B - Beta lactams
i
S - sulfa drugs
M - Mycoplasma pneumoniae
84
Q

Nikolsky sign is present in:

A

Staphylococcal scalded skin syndrome - stratum granulosum
Pemphigus Vulgaris - stratum spinosum
Stevens-Johnson syndrome - dermal-epidermal junction

85
Q

Acanthosis nigricans Associated with

A

insulin resistance (eg, diabetes, obesity Cushing syndrome, PCOS)

visceral malignancy (eg, gastric adenocarcinoma).

86
Q

Erythema nodosum

A

Painful, raised inflammatory lesions of subcutaneous fat, associated with:

S - sarcoidosis
H - histoplasmosis
I - inflammatory bowel disease
T - TB

C - coccidioidomycosis
L - leprosy
S - streptococcal infections

87
Q

Lichen Planus

A

Pruritic, Purple, Polygonal Planar Papules and Plaques are the 6 P’s
MucosaI involvement manifests as Wickham striae
Sawtooth infiltrate of lymphocytes at the dermal-epidermal junction.

88
Q

Pityriasis rosea

A

“Herald patch”, followed days later by other scaly erythematous plaques, often in a “Christmas
tree” distribution on the trunk.

Multiple pink plaques with a collarette scale.

Self-resolving in 6-8 weeks.

89
Q

Lichen Planus associated with_____

A

hepatitis C.

90
Q

Keratoacanthoma

A

Seen in middle-aged and elderly individuals.

Rapidly growing, resembles squamous cell carcinoma. Presents as a dome-shaped nodule with a keratin-filled center.

Grows rapidly (4-6 weeks) and may spontaneously regress

91
Q

Melanoma evaluation

A

Depth of tumor (Breslow thickness) correlates with the risk of metastasis.

Look for the ABCDEs: 
Asymmetry
Border irregularity
Color variation
Diameter > 6 mm,
Evolution over time.
92
Q

Melanoma types

A

At least 4 different types of melanoma, including:

S - superficial spreading
L - lentigo maligna
A - acral lentiginous (highest prevalence in African-Americans and Asians)
N - nodular

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