MusculoSkeletal, Skin, and Neuro Flashcards
Signs of HyperPTH
“Stones, bones, groans, and psychiatric moans”
Renal Stones, osteoporosis, GI constipation/peptic ulcer dt hypergastric acid secretion, and lethargy/fatigue/psych issues
Drug known to cause hyperuricemia
Thiazide Diuretics (don’t forget this mofo)
ACL vs PCL Mneumonic?
“AIM for ACL” ACL’s path is anterior, inferior, and medial.
“PIL for PCL” Posterior Inferior and Lateral
Layers of skin
Out to in:
Stratum 1) Corneum, Lucidum, Granulosum, Spinosum, Basalis
Autoimmune sx associated with small cell lung cancer?
Lambert-Eaton Myasthenic Syndrome (antibodies to Pre-synaptic voltage gated Ca2+ channels). Associated with Small Cell Lung Carcinoma
Branchial Apparatus: Arches, Clefts Pouches what type of endo/ect/mesoderm?
What cranial nerves correspond to each structure?
“CAP: Cleft (ecto), Arches (meso), Pouches (endo)”
FOR THE BRANCHIAL STUFF LINK CRANIAL NERVES TO STRUCTURES THEY WILL GIVE YOU A HINT OF WHAT ITS FROM: CN5 (1st), CN7 (2nd), CN9 (3rd), CN10 (4/6th)
Branchial Arch Derivatives?
At the golden ARCHES: first you chew (1), smile (2) , swallow STYlyishly (3), then simple swallow (4) and speak (6).
NB: the ductus arteriosus is part of the 6th arch
Branchial pouch derivatives?
1) Ears, 2) Tonsils, 3) Bottom [thymus, inferior PT]-to 4) Top [sup PT]
(inferior parathryroids start w/ thymus above superior thyroids and migrate down)
Swollen painful toe after a weekend of vacation. Initial Tx? What don’t you use?
Gout (brought on from drinking and red meat consumption). Joint aspiration shows neutrophils with negatively birefringent (yellow in parallel light) needle shaped crystals.
NSAIDS or Colchicine (microtubule inhibitor) for ACUTE tx (steroids if non-responding).
NO ASPIRIN competes for channels in renals.
Swollen painful toe after a weekend of vacation. Secondary Tx? Why don’t you use initially? Mechanism?
Gout. Use Allopurinol or Febuxostat (Xanthine Oxidase inhibitors producing less Uric acid). Don’t use initially as they can increase chance for a gout precipitation (occurs when levels fluctuate up or DOWN).
Colchicine SEs?
Use until patient gets diarrhea. Risk for aplastic anemia and neuromyopathy.
Allopurinol SEs?
Highly Allergenic, Rash (**steven Johnson syndreome*), Eosinophilia, and interstitial nephritis. Risk for Aplastic Anemia
Uricosuric Agent?
Probenecid. Used to increase penicillin half life in WWII
Probenecid?
Uriocosuric Agent
Fexbuxostat
Xanthine Oxidase Inhibitor; safer side effect profile than Allopurinol. Raises LFTs and can produce Rash/Diarrhea
Patient has jerky movements and has been unusually agressive? Condition? Chromosome? Defect?
Huntington’s Disease, Autodominant, CAG (“hAuntington’s”), Chromosome 4 (“hunt for food”), Deficiency of GABA in the degenerating Striatum (caudate and putamen)
Gomori Trichrome Stain showing red blotchy appearance
Mitochondrial Myopathies. Mitochondrial Inheritance pattern. “Ragged Red Fibers”
Allopurinol MAO
Sucidine Inhibitor Purine Analog for Xanthine Oxidase.
Contraindicated in Acute Gout?
Indicated in Acute Gout?
ASPIRIN, XO inhibs, Urocosic agents, and Fructose Drinks. (Aspirin antagonizes same urate transporter used to secrete in prox tubule)
NSAIDS, colchicine, Caffeine and Diary.
Infectious/Septic Arthritis:
2 most common, Age 16-50, IVDA?
1) Staph > Strep
2) Gonorrhea in 16-50
3) Psuedomonas in IVDA
Rheumatoid Arthritis HLA? What chromo? What other thing associated with that HLA?
HLA DR4
ALL HLA’s on Chromo 6
DM1 (also on HLA DR3)
Rheumatoid Arth spares what joints?
Spares Hips, and DIPs (affects PIPs). Thus with DIP think osteoarthritis more.
Rheumatoid Factor? Causing release of?
IgM against Fc of IgG; causing macrophage release of TNF-alpha
What is a Pannus? What does is cause the release of?
Abrnomal joint granulation tissue of mesenchymal and bone marrow derived cells. Causes release of IL-1 inflamation and bone destruction (osteoclast activation)
Osteomyelitis bugs? (Top 3): Adult/Kid location: IVDA Dental Extraction Sickle Cell DM
1) Staph Aur 2) Pseudomonas 3) Enterobacteria Adult location: Vertebrate Kids: Long bones IVDA: Pseudomonas Dental Extraction: Strep Viridans Sickle Cell: Salmonella*** DM: Polymicrobial
Causes of Cellulitis:
Most common (2)
Animal Bites
Salt Water
1) Staph 2) Strep
Animal: Pasturella
Salt Water: Vibrio vulnificus (also associated with undercooked oysters)
Necrotizing Infection:
Type 1
2
3
1: Polymicrobial: DM or Immunocomp
2: Strep Pyogenes (healthy person); MRSA
3: Vibro Vulnificus: Risk factor is liver disease and marine life contact/salt water
Positive Nikolsky Sign
Pemphis Vulgaris, Staph Scaled Skin Syndrome. Negative in Bullous Pemphigus
Disseminated psuedomonas infection?
Ecthyma Gangrenosum; associated with neutropenia. Uses ADP ribosylation to inhibit E2F
Parakeratosis? Associated with? Induced by? Risk for?
Thickening of epidermis with nuclei in the stratum corneum. Psoriasis, will also get undulating of the dermal epidermal junction (papilomatosis). Can be induced by lithium. Psoriasis associated with risk of cardiovascular disease.
Erythema Multiforme cause?
Herpes Simplex
Steven Johnson cause?
Mycoplasma pneumonia, sulfas, anticonvulsants, NSAIDS
Patient with short bones but normal torso and head? Defect?
Achondroplasia, broken FGF3 receptor, autodominant associated with advanced paternal age
Progressive symmetric proximal muscle weakness. Cause? Characterized by?
Polymyositis=Endomyseal inflammation of CD8+ Cells (dermatomyositis is CD4+ cells); most often involves shoulders.
Malar rash with proximal muscle weakness. Cause Characterized by?
Dermatomyositis=Permyseal inflammation. Characterized by CD4+ T Cells*** (Polymyositis = CD 8+ T cells)
Bilateral stiffness of shoulders and pelvic girdle, fever and weight loss: cause? Associated with?
Polymyaglia rheumatica. Elevated ESR and with Temporal Giant Cell Arteritis
Innervation of thyroid?
Superior Laryngeal nerve: Cricothryroid muscle (external), and sensory above vocal cords (Internal).
Reccurent Laryngeal Nerve: All laryngeal muscles except Cricothyroid; also does all sensory below vocal cords
Both at risk to injury during thryoidectomy (usually recurrent)
Muscles of mastication?
Muscle that opens/protrudes jaw?
3 M’s of mastication: Masseter, teMporalis, Medial ptergoid
Lateral ptergoid opens
Patient walks and right hip drops down as they walk?
Nerve?
Muscles?
Trendelenberg Sign: injury to the superior gluteal nerve causing weakened gluteus medius and minimus (they normally are used for ABDUCTION of thigh).
Glut max injury: difficulty walking up stairs/rising from chair
Damage to what results in:
- Can’t wipe bottom
- Weak lateral rotation of arm
- Initial arm abduction
- Midshaft break of humerus (and what A?)
- Anterior dislocation of shoulder
- Thoracodorsal nerve (no lats dorsi)
- Suprascapular N
- Suprascapular N
- Radial and Deep brachial A
- Axillary and Posterior circumflex
Spongiosus
Part of eczymatous dermatisis: Fluid inTERcellularly separating the intracellular bridges making it look like a sponge
Acanthosis
Increased thickness of stratum spinosum. Occurs in psoriasis
Dyskeratosis
Abnormal Premature keratinization of keratinocytes (squamous cell carcinoma)
Hyperparakeratosis
Retention of nuclei in the stratum corneum (incomplete keratinziation seen in actinic keratosis (precursor to squamous CC (?)))
Hypergranulosus
Extra granulation in stratum granulosum asssociated with lichen planus
Blood supply to esophagus?
Upper 1/3: Inferior thyroid artery;
Middle 1/3: Thoracic Portion of Aorta;
Lower 1/3: Esophageal branches of left gastric artery
Where do adductors of the leg attach to?
Ischium
Mechanism of Skin aging?
Decreased collagen fibril production (net loss of dermal collagen and elastin)
Melanoma Mutation?
BRAF mutation from V600Ex
“Cuz dermatologists want to B-e R-ich A-s F-uck”
Medical names for bruises and their sizes?
Petechia 0-5mm
Purpurae 5mm-1cm
Ecchymoses 1cm+
Damage to Pterion results in damage to what artery and what does that come from?
Middle Meningeal Artery which is a branch of the maxillary artery
Innervation of Tensor Tympani? Stapedius Muscle?
CN5 (Tensor by Trigem), CN 7 (Stapedius by FaSial)
LP for anesthesia–where is anesthesia dosed? Where is CSF?
Anesthesia given at L3-L5 in EPIDURAL SPACE.
CSF in Subarachnoid space
Soap Bubble Appearance on XRAY?
Giant Cell tumor of bone. “Giant Soap Bubbles”
Scleroderma esophageal dysmotility vs Myasthenia gravis dysmotility?
CREST: issue of smooth muscle thus lower 1/3
Myasthenia: Issue of skeletal muscle thus upper 1/3 of esophagus
Nerve deficit after a mastectomy?
Lesion of long thoracic nerve (loss of serratus anterior muscle)
Neurovascular pairings associated with the following locations: Axilla/lateral thorax Surgical Neck of Humerus Midshaft of humerus Distal humerus/cubital fossa Popliteal fossa Posterior to medial malleous
Axilla/lateral thorax: Long Thoracic N + Lateral Thoracic A
Surgical Neck of humerus: Axiallary and Post Circumflex
Midshaft of humerus: Radial N with Deep Brachial
Distal humerus/cubital fossa: Median N with Brachial A
Popliteal fossa: Tibial N with Popliteal A
Posterior to medial malleous: Tibial N with Posterior Tibial A
Muscle Fiber types?
Type 1 Red Slow Muscles=increased Mito and myoglobin concentration allowing for more ox phos
Type 2 White Fast Twitch Muscle fibers=dec mito and myoglobin, increased anaerobic glycolysis
Paget’s Disease of bone put person at risk for what 2 things?
Hyperbone remodeling—risk for 1) Osteosarcoma 2) High output heart failure from increased AV shunts in bone
Pruritic purple planar papules. Condition and associated with?
Lichen Planus; Hep C
What not to use in chronic gout?
Salicylates: they inhibit uric acid secretion except at megahigh doses
What cell type are osteoclasts most like?
Derived from monocyte/macrophage lineage
Most common bone tumor?
Multiple Myeloma not osteosarcoma
