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► Med Notes > Musculoskeletal - Skin - Connective Tissue_1 > Flashcards

Musculoskeletal - Skin - Connective Tissue_1 Flashcards

1
Q

What are the epidermis layers from surface to base?

A

Stratum Corneum (keratin • Stratum Lucidum • Stratum Granulosum • Stratum Spinosum • Stratum Basale

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2
Q

what are the spines in the stratum spinosum?

A

desmosomes

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3
Q

which epidermal layer is the stem cell site?

A

Stratum Basale

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4
Q

what are the 3 epidermal appendages?

A

Sebaceous gland • Eccrine gland • Apocrine gland

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5
Q

mechanism of sebaceous gland secretion?

A

holocrine secretion of sebum

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6
Q

sebaceous gland associated with what?

A

hair follicle

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7
Q

eccrine gland secretes what?

A

sweat

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8
Q

eccrine glands are found where?

A

throughout the body • Eccrine glands are every where

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9
Q

apocrine glands secrete what?

A

milky viscous fluid

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10
Q

apocrine glands are found where?

A

axillae, genitalia, areolae

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11
Q

when are apocrine glands functional?

A

do not become functional until puberty

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12
Q

why are apocrine glands malodorous?

A

because of bacterial action

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13
Q

functions of tight junctions?

A

zona occludens: • prevents paracellular movement of solutes

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14
Q

tight junctions are composed of what?

A

claudins and occludins

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15
Q

where are adherens junctions?

A

zonula adherins: below tight junctions

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16
Q

adherens junctions form what?

A

belt connecting actin cytoskeletons of adjacent cells with Cadherins

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17
Q

what are Cadherins?

A

Ca++ dependent adhesion proteins

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18
Q

loss of E-cadherin does what?

A

promotes metastasis

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19
Q

what is the function of desmosomes?

A

structural support via keratin interactions

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20
Q

atoantibodies to desmosomes cause what?

A

pemphigus vulgaris

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21
Q

components of desmosomes?

A

keratin • desmoplakin

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22
Q

what happens in gap junctions?

A

channel proteins called connexons permit electrical and chemical communication between cells

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23
Q

function of a hemidesmosome?

A

connects keratin in basal cells to underlying basement membrane

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24
Q

autoantibodies to hemidesmosomes cause what?

A

bullous pemphigoid

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25
Q

what are integrins?

A

membrane proteins that maintain integrity of basement membrane by binding to laminin in BM

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26
Q

how does unhappy triad happen?

A

common injury in contact sportsL lateral force applied to a planted leg

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27
Q

unhappy triad includes which injuries?

A

tear of ACL, MCL and meniscus (classically medial, but lateral more common)

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28
Q

treatment for unhappy triad?

A

often requires surgical reconstruction

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29
Q

A and P in ACL and PCL refer to what?

A

sites of tibial attachment

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30
Q

positive anterior drawer test means what?

A

ACL tear

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31
Q

abnormal passive abduction at the knee means what?

A

MCL tear

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32
Q

what is the important landmark for pudendal nerve block?

A

ischial spine

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33
Q

what is the important landmark in finding the appendix?

A

2/3 of the way from the umbilicus to the anterior superior iliac spine (McBurney’s point)

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34
Q

what is the important landmark in lumbar puncture?

A

iliac crest

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35
Q

what are the shoulder muscles that form the rotator cuff?

A

Supraspinatus • Infraspinatus • teres minor • Subscapularis • SItS (small t is for teres minor)

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36
Q

what is the most common rotator cuff injury?

A

Supraspinatus

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37
Q

action of supraspinatus?

A

abducts arm initially (before deltoid)

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38
Q

which rotator cuff muscle is a common pitching injury?

A

Infraspinatus

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39
Q

action of infraspinatus?

A

laterally rotates arm

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40
Q

action of teres minor?

A

adducts and laterally rotates arm

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41
Q

action of subscapularis?

A

medially rotates and adducts arm

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42
Q

rotator cuff muscles are innervated by what?

A

C5-C6

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43
Q

what are the bones of the wrist?

A

Scaphoid • Lunate • Triquetrum • Pisiform • Trapezium • Trapezoid • Capitate • Hamate • Some Lovers Try Positions That They Can’t Handle

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44
Q

what is the most commonly fractured carpal bone?

A

scaphoid

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45
Q

scaphoid is prone to which complication?

A

avascular necrosis owing to retrograde blood supply

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46
Q

dislocation of which wrist bone may cause acute carpal tunnel syndrome?

A

lunate

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47
Q

what is carpal tunnel syndrome?

A

entrapment of median nerve in carpal tunnel

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48
Q

what is the pathogenesis of carpal tunnel syndrome?

A

nerve compression → paresthesia, pain, and numbness in distribution of median nerve

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49
Q

cause of lesion in upper trunk of brachial plexus?

A

trauma

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50
Q

cause of lesion in C7 root of brachial plexus?

A

compressed by cervical disk lesion

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51
Q

cause of lesion in axillary nerve?

A

fracture of surgical neck of humerus • dislocation of humerus • intramuscular injections

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52
Q

cause of lesion to lower trunk of brachial plexus?

A

compressed by cervical rib or by pancoast tumor of lung

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53
Q

lesion of lower trunk of brachial plexus leads to what?

A

Klumpke’s palsy

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54
Q

cause of lesion to radial nerve in spiral groove?

A

lesioned by midshaft fracture of the humerus

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55
Q

cause of radial nerve compression in the axilla?

A

incorrect use of a crutch

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56
Q

cause of lesion in proximal median nerve?

A

compressed by supracondylar fracture of humerus • pronator teres syndrome

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57
Q

cause of lesion to deep branch of radial nerve?

A

stretched by subluxation of radius

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58
Q

cause of proximal ulnar nerve lesion?

A

lesioned by repeat minor trauma • fracture of medial epicondyle of humerus

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59
Q

caused of lesion to anterior interosseous nerve?

A

compressed in deep forearm

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60
Q

cause of lesion in distal median nerve?

A

compressed in carpal tunnel syndrome and by dislocated lunate

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61
Q

cause of distal ulnar nerve lesion?

A

lesioned by trauma to heel of the hand • fracture of hook of hamate

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62
Q

cause of lesion to recurrent branch of median nerve?

A

lesioned by superficial laceration

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63
Q

nerve root of top of shoulder dermatome?

A

C4

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64
Q

nerve root of lateral humerus dermatome?

A

C5

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65
Q

nerve root of medial arm → lateral forearm→ thumb and index finger dermatome?

A

C6

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66
Q

nerve root of middle finger and middle palm dermatome?

A

C7

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67
Q

Nerve root of ring/little finger and medial palm dermatome?

A

C8

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68
Q

Nerve root of medial forearm and distal medial arm dermatome?

A

T1

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69
Q

nerve root of medial proximal arm and inferior shoulder dermatome?

A

T2

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70
Q

cutaneous sensory nerve distribution on hand of the ulnar nerve?

A

little + 1/2 ring finger on palmar and dorsal surface of hand

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71
Q

cutaneous sensory nerve distribution on hand of median nerve?

A

thumb → half of ring finger on palmar surface • inner half of thumb, distal half of index to 1/2 ring finger on doral surface

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72
Q

cutaneous sensory nerve distribution on hand of radial nerve?

A

proximal edge of palmar thenar eminence on palmar and whole dorsum of thenar eminence

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73
Q

lesion to long thoracic nerve causes what?

A

winged scapula

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74
Q

lesion to upper trunk of the brachial plexus causes what?

A

Waiter’s tip (Erbs palsy)

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75
Q

lesion to lower trunk of brachial plexus causes what?

A

Claw hand (Klumpke palsy)

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76
Q

lesion to posterior cord of the brachial plexus causes what?

A

wrist drop

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77
Q

damage to the axillary branch of the brachial plexus causes what?

A

deltoid paralysis

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78
Q

damage to radial branch of the brachial plexus causes what?

A

Saturday night palsy (wrist drop)

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79
Q

damage to musculocutaneous branch of brachial plexus causes what?

A

Difficulty flexing elbow, variable sensory loss

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80
Q

damage to the median branch of the brachial plexus causes what?

A

decreased thumb function (pope’s blessing)

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81
Q

damage to the ulnar branch of the brachial plexus causes what?

A

intrinsic muscles of the hand, claw hand

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82
Q

roots that contribute to the long thoracic nerve?

A

C5, 6, 7

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83
Q

roots that contribute to upper trunk of the brachial plexus?

A

C5-6

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84
Q

roots that give rise to middle trunk of brachial plexus?

A

C7

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85
Q

roots that give rise to lower trunk of brachial plexus?

A

C8-T1

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86
Q

how many divisions in the brachial plexus?

A

6

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87
Q

trunks that contribute to the lateral cord of the brachial plexus?

A

upper • middle

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88
Q

trunks that give rise to posterior cord of the brachial plexus?

A

upper • middle • lower

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89
Q

trunks that give rise to medial cord of the brachial plexus?

A

lower

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90
Q

nerve roots that give rise to lateral cord of brachial plexus?

A

C5, 6, 7

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91
Q

nerve roots that give rise to posterior cord of brachial plexus?

A

C5, 6, 7, 8, T1,

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92
Q

nerve roots that give rise to medial cord of brachial plexus?

A

C8, T1

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93
Q

trunks that give rise to axillary branch of brachial plexus?

A

upper • middle • lower

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94
Q

trunks that give rise to radial branch of brachial plexus?

A

upper • middle • lower

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95
Q

trunks that give rise to musculocutaneous branch of brachial plexus?

A

upper • middle

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96
Q

trunks that give rise to median branch of brachial plexus?

A

upper • middle • lower

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97
Q

trunks that give rise to ulnar branch of brachial plexus?

A

lower

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98
Q

cords of brachial plexus that innervate flexors of forearm?

A

lateral • medial

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99
Q

cords of brachial plexus that innervates extensors of forearm?

A

posterior

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100
Q

nerve roots that contribute to axillary nerve?

A

C5-C6

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101
Q

nerve roots that contribute to radial nerve?

A

C5-T1

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102
Q

nerve roots that contribute to musculocutaneous nerve?

A

C5-C7

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103
Q

nerve roots that contribute to median nerve?

A

C5-T1

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104
Q

nerve roots that contribute to ulnar nerve?

A

C8-T1

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105
Q

brachial plexus is protected from clavicle fracture by what?

A

subclavius muscle

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106
Q

typically injury of axillary nerve?

A

fractured surgical neck of humerus • dislocation of humeral head

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107
Q

motor deficit in axillary nerve injury?

A

Deltoid- arm abduction at shoulder

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108
Q

sensory deficit in axillary nerve injury?

A

over deltoid muscle

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109
Q

sign associated with axillary nerve injury?

A

atrophied deltoid

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110
Q

what is the typical injury of the radial nerve?

A

fracture at midshaft of humerus • extended compression of axilla by back of chair or crutches

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111
Q

motor deficit seen in radial nerve injury?

A

BEST extensors • Brachioradialis • Extensors of wrist and fingers • Supinator • Triceps

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112
Q

sensory deficit seen in radial nerve injury?

A

posterior arm and dorsal hand and thumb

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113
Q

sign seen in radial nerve injury?

A

wrist drop

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114
Q

typical injury to the median nerve?

A

fracture of supracondylar humerus

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115
Q

motor deficit in proximal lesion to median nerve?

A

opposition of thumb • lateral finger flexion • wrist flexion

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116
Q

sensory deficit in proximal lesion to median nerve?

A

dorsal and palmar aspects of lateral 3 1/2 fingers • thenar eminence

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117
Q

sign seen in median nerve lesion?

A

ape hand • popes blessing

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118
Q

typical injury to ulnar nerve?

A

fracture of medial epicondyle of humerus • funny bone

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119
Q

motor deficit in proximal ulnar nerve injury?

A

medial finger flexion • wrist flexion

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120
Q

sensory deficit in proximal ulnar nerve lesion?

A

medial 1 1/2 fingers • hypothenar eminence

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121
Q

sign seen in proximal ulnar nerve lesion?

A

radial deviation of wrist upon wrist flexion

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122
Q

typical injury to musculocutaneous nerve?

A

upper trunk compression

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123
Q

motor deficit in musculocutaneous nerve injury?

A

biceps • brachialis • coracobrachialis • flexion of forearm at elbow

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124
Q

sensory deficit in musculocutaneous nerve injury?

A

lateral forearm

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125
Q

what causes erb-duchenne palsy ‘waiters tip’?

A

traction or tear of the upper trunk of the brachial plexus (C5-C6)

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126
Q

erb duchenne palsy ‘waiters tip’ seen in who?

A

infants following trauma during delivery

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127
Q

findings in erb-duchenne palsy ‘waiters tip’?

A

limb hangs by side (paralysis of abductors) • medially rotated (paralysis of lateral rotators) • forearm is pronated ( loss of biceps)

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128
Q

what are the causes of Klumpke palsy and thoracic outlet syndrome?

A

an embryologic or childbirth defect affecting inferior trunk of brachial plexus (C8-T1) • cervical rib can compress subclavian artery and inferior trunk, resulting in thoracic outlet syndrome

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129
Q

findings in klumpke palsy/thoracic outlet syndrome?

A

atrophy of thenar and hypothenar eminences • atrophy of interosseous muscles • sensory deficits on the medial side of the forearm and hand • disappearance of the radial pulse upon moving the head toward the ipsilateral side

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130
Q

clawing of the hand is conceptualized how?

A

as loss of the lumbricals, which flex the MCP joints and extend both the DIP and PIP joints

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131
Q

ulnar claw can be caused by what?

A

long-standing injury to ulnar nerve at hook of hamate (falling onto outstretched hand)

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132
Q

pathogenesis of ulnar claw?

A

distal ulnar nerve lesion → loss of medial lumbrical function→ inability to extend 4th and 5th digits when trying to open hand

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133
Q

median claw can be caused by what?

A

carpal tunnel syndrome or dislocated lunate

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134
Q

pathogenesis of median claw?

A

distal (after branches containing C5-C7 branches off to feed forearm flexors) median nerve lesion→ loss of lateral lumbrical function→ 2nd and 3rd digit are clawed upon attempted finger extension

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135
Q

what causes pope’s blessing?

A

proximal median nerve lesion causes loss of lateral finger extension and thumb opposition

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136
Q

finding in pope’s blessing?

A

when asked to make a fist, 2nd and 3rd digits remain extended and thumb remains unopposed, which looks like the hand of benediction

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137
Q

pathogenesis of ape hand?

A

proximal median nerve lesion → loss of opponens pollicus muscle function → unopposable thumb

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138
Q

pathogenesis of klumpke’s total claw?

A

lesion of lower trunk (C8-T1) of brachial plexus → loss of function of all lumbricals; • forearm finger flexors (fed by part of median nerve with C5-C7) and finger extensors (fed by radial nerve) are unopposed→ clawing of all digits

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139
Q

muscle innervated by LTN?

A

serratus anterior

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140
Q

action of serratus anterior?

A

anchors scapula to thoracic cage • used for abduction above horizontal position

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141
Q

LTN can be injured how?

A

mastectomy

142
Q

what happens when LTN is injured in mastectomy?

A

winged scapula and ipsilateral lymphedema

143
Q

what innervates the muscles of the thenar eminence?

A

median

144
Q

what innervates the muscles of the hypothenar eminence?

A

ulnar

145
Q

what are the muscles in the thenar eminence?

A

Opponens pollicus • Abductor pollicus brevis • Flexor pollicus brevis

146
Q

what are the muscles in the hypothenar eminence?

A

opponens digiti minimi • abductor digiti minimi • flexor digiti minimi

147
Q

function of the dorsal interosseous muscles?

A

abduct the fingers

148
Q

action of the palmar interosseous muscles?

A

adduct the fingers

149
Q

action of the lumbrical muscles?

A

flex at the MCP joint • extend PIP and DIP joints

150
Q

roots of obturator nerve?

A

L2-L4

151
Q

roots of femoral nerve?

A

L2-L4

152
Q

roots of common peroneal nerve?

A

L4-S2

153
Q

roots of tibial nerve?

A

L4-S3

154
Q

roots of superior gluteal nerve?

A

L4-S1

155
Q

roots of inferior gluteal nerve?

A

L5-S2

156
Q

cause of injury to obturator nerve?

A

anterior hip dislocation

157
Q

motor defect in obturator nerve injury?

A

thigh adduction

158
Q

sensory deficit in obturator nerve injury?

A

medial thigh

159
Q

cause of injury to femoral nerve?

A

pelvic fracture

160
Q

motor deficit in femoral nerve injury?

A

thigh flexion and leg extension

161
Q

sensory deficit in femoral nerve injury?

A

anterior thigh and medial leg

162
Q

cause of injury to common peroneal nerve?

A

trauma or • compression of lateral aspect of leg or • fibula neck fracture

163
Q

motor deficit in common peroneal nerve injury?

A

foot eversion and dorsiflexion; • toe extension; • foot drop, foot slap, steppage gait

164
Q

sensory deficit in common peroneal nerve injury?

A

anterolateral leg and dorsal aspect of foot

165
Q

what is the cause of injury to tibial nerve?

A

knee trauma

166
Q

what is the motor deficit in tibial nerve injury?

A

foot inversion and plantarflexion; • toe flexion

167
Q

what is the sensory deficit in tibial nerve injury?

A

sole of foot

168
Q

cause of injury to superior gluteal nerve?

A

posterior hip dislocation or polio

169
Q

motor deficit in superior gluteal nerve lesion?

A

thigh abduction (positive trendelenberg sign)

170
Q

cause of injury to inferior gluteal nerve?

A

posterior hip dislocation

171
Q

motor deficit in inferior gluteal nerve injury?

A

cant jump, climb stairs, or rise from seated position • can’t push inferiorly

172
Q

mnemonic for common peroneal nerve?

A

PED= Peroneal Everts and Dorsiflexes; if injured, foot dropPED

173
Q

mnemonic for Tibial Nerve?

A

TIP= Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes

174
Q

root of sciatic nerve?

A

L4-S3

175
Q

course of sciatic nerve?

A

posterior thigh,splits into common peroneal and tibial nerve

176
Q

6 steps in muscle excitation/ contraction?

A
  1. AP depolarization opens presynaptic VG-Ca channels→ NT release • 2. postsynaptic ligand binding → muscle cell depolarization in motor end plate • 3. depolarization travels along muscle cell + down T tubule • 4. depolarization of VS-DHPR, mechanically coupled to ryanodine receptor on SR→ conformational change → Ca release from SR • 5. released Ca binds to troponin C → conformational change that moves tropomyosin out of myosin binding groove on actin filaments • 6. myosin releases bound ADP and is displaced on the actin filament (powerstroke). contraction → shortening of H and I bands and between Z lines (HIZ shrinkage), but the A band remains the same length
177
Q

which band of sarcomere is always same length in contraction?

A

A band

178
Q

which bands shrink during muscle contraction?

A

HIZ

179
Q

what are the types of muscle fibers?

A

Type 1 muscle • Type 2 muscle

180
Q

action of type 1 muscle?

A

slow twitch

181
Q

;how do the morphologic features of type 1 muscle correspond to its action?

A

red fibers resulting from ↑ mitochondria and myoglobin concentration (↑OxPhos)→sustained contraction

182
Q

action of Type 2 muscle?

A

fast twitch

183
Q

morphology of type 2 muscle?

A

white fibers resulting from ↓ mitochondria (↑ anaerobic glycolysis)

184
Q

weight training results in hypertrophy of which type of muscle?

A

type 2

185
Q

4 biochemical changes that drive mechanical skeletal and cardiac muscle contraction?

A
  1. Ca binds troponin C→ conformational change→displacement of tropomyosin and actin/myosin cycling • 2. Pi is released, changing myosin head conformation, causing power stroke • 3. ATP binds myosin head→ release from actin filament • 4. ATP hydrolysis cocks myosin head
186
Q

4 states in mechanical skeletal muscle contraction?

A
  1. cocked state • 2. cross bridged state • 3. power-stroke state • 4. released state
187
Q

what does lack of ATP do to muscle contraction?

A

causes rigor mortis

188
Q

what are the 2 types of bone formation?

A

endochondrial ossification • membranous ossification

189
Q

where does endochondrial ossification take place?

A

bones of axial and appendicular skeleton • base of the skull

190
Q

what happens in endochondrial ossification?

A

cartilaginous model of bone is first made by chondrocytes • osteoclasts and osteoblasts later replace with woven bone and then remodel to lamellar bone

191
Q

in adults, woven bone occurs when?

A

after fractures • Paget’s disease

192
Q

where does membranous ossification take place?

A

bones of calvarium and facial bones

193
Q

what happens in membranous ossification?

A

woven bone formed directly without cartilage • later remodelled to lamellar bone

194
Q

action of osteoblasts?

A

build bone by secreting collagen and catalyzing mineralization

195
Q

origin of osteoblasts?

A

differentiate from mesenchymal stem cells in periosteum

196
Q

what are osteoclasts?

A

multinucleated cells that dissolve bone by secreting acid and collagenases

197
Q

osteoclasts differentiate from what?

A

monocytes/macrophages

198
Q

effects of PTH on bone at low, intermittent levels?

A

exerts anabolic effects (building bone) on osteoblasts and osteoclasts (indirect)

199
Q

effects of chronic high PTH on bone?

A

catabolic effects (osteitis fibrosa cystica)

200
Q

effect of estrogen on bones?

A

inhibits apoptosis in bone forming osteoblasts and induces apoptosis in bone resorbing osteoclasts

201
Q

what happens to bone in estrogen deficiency (surgical or postmenopausal)?

A

excess remodeling cycles and bone resorption lead to osteoporosis

202
Q

pathogenesis of achondroplasia?

A

failure of longitudinal bone growth (endochondral ossification)→ short limbs • membranous ossification is not affected → large head relative to limbs

203
Q

molecular cause of achondroplasia?

A

constitutive activation of FGFR3 actually inhibits chondrocyte proliferation

204
Q

inheritance of achondroplasia?

A

> 85% of mutations occur sporadically and are associated with ↑ paternal age • also demonstrates AD inheritance

205
Q

achondroplasia is a common cause of what?

A

dwarfism

206
Q

prognosis of achondroplasia?

A

normal life span and fertility

207
Q

what happens in osteroporosis?

A

trabecular (spongy) bone loses mass and interconnections despite normal bone mineralization and lab values (Ca and PO4)

208
Q

osteoporosis can lead to what?

A

vertebral crush fractures- acute back pain, loss of height, kyphosis

209
Q

what is type I osteoporosis?

A

post menopausal- ↑ bone resorption due to ↓ estrogen

210
Q

injuries common to type I osteoporosis?

A

femoral neck fracture • distal radius (colles fracture)

211
Q

what is type II osteoporosis?

A

senile osteoporosis- men and women >70yo

212
Q

prophylaxis for type II osteoporosis?

A

regular weight bearing exercise and adequate calcium and VitD intake throughout adulthood

213
Q

treatment for osteoporosis?

A

estrogen (SERMs) +/- calcitonin • bisphosphonates or pulsatile PTH for severe cases

214
Q

what meds are CI in osteoporosis?

A

glucocorticoids

215
Q

osteopetrosis AKA?

A

marble bone disease

216
Q

pathogenesis of osteopetrosis?

A

failure of normal bone resorption due to defective osteoclasts → thickened, dense bones that are prone to fracture

217
Q

hematologic complications of osteopetrosis?

A

bone fills marrow space → pancytopenia, extramedullary hematopoiesis

218
Q

molecular cause of osteopetrosis?

A

mutations (carbonic anhydrase II) ↓ ability of osteoclast to generate acidic environment necessary for bone resorption

219
Q

Xray findings in osteopetrosis?

A

bone in bone appearance

220
Q

osteopetrosis can result in what?

A

cranial nerve impingement and palsies as a result of narrowed foramina

221
Q

tx for osteopetrosis?

A

BM transplant is potentially curative since osteoclasts are derived from monocytes

222
Q

what causes osteomalacia/rickets?

A

vitamin D deficiency

223
Q

pathogenesis of osteomalacia/rickets?

A

defective mineralization/calcification of osteoid→ soft bones that bow out

224
Q

hormonal changes in osteomalacia/rickets?

A

↓ VitD→ ↓ serum Ca → ↑ PTH secretion → ↓ serum PO4

225
Q

result of hyperactive osteoblasts in osteomalacia/rickets?

A

↑ ALP (osteoblasts require alkaline environment)

226
Q

Paget’s disease of bone AKA?

A

osteitis deformans

227
Q

what is Paget’s disease of bone?

A

common, localized disorder of bone remodeling caused by ↑ in both osteoblastic and osteoclastic activity

228
Q

lab values in pagets disease of bone?

A

serum Ca, PO4, PTH= NL • ↑ ALP

229
Q

findings in pagets disease of bone?

A

mosaic woven bone pattern • long bone chalk stick fractures • hat size ↑ • hearing loss due to auditory foramen narrowing

230
Q

CV complication of pagets disease of bone?

A

↑ blood flow from ↑ arteriovenous shunts may cause high output cardiac failure

231
Q

pagets disease of bone carries ↑ risk of what?

A

osteogenic sarcoma

232
Q

lab values in osteoporosis?

A

↓ bone mass with normal Ca, PO4, ALP, PTH

233
Q

lab values in osteopetrosis?

A

thickened dense bones with • ↓ Ca • ↑ ALP • normal PO4 and PTH

234
Q

lab values in osteomalacia/rickets?

A

soft bones with • ↓ Ca and PO4 • ↑ ALP and PTH

235
Q

lab values in osteitis fibrosa cystica?

A

brown tumors of hyperparathyroidism • ↓ PO4 • ↑ Ca, ALP, PTH

236
Q

lab findings in paget’s disease of bone?

A

abnormal bone architecture with • ↑ ALP • normal Ca, PO4, PTH

237
Q

what happens in polyostotic fibrous dysplasia?

A

bone is replaced by fibroblasts, collagen, and irregular bony trabeculae

238
Q

what is McCune-Albright syndrome?

A

form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and cafe au lait spots

239
Q

what are the benign primary bone tumors?

A
  1. giant cell tumor (osteoclastoma) • 2. osteochondroma (exostosis)
240
Q

epidemiology/location of Giant cell tumor/osteoclastoma?

A

20-40yo • epiphyseal end of long bones

241
Q

presentation of giant cell tumor/osteoclastoma?

A

locally aggressive benign tumor often around the distal femur, proximal tibial region

242
Q

Xray appearance of giant cell tumor/osteoclastoma?

A

double bubble or soap bubble appearance

243
Q

histopathology in giant cell tumor/osteoclastoma?

A

spindle shaped cells with multinucleated giant cells

244
Q

what is the most common benign primary bone tumor?

A

osteochondroma (exostosis)

245
Q

epidemiology of osteochondroma?

A

males <25yo

246
Q

characteristics of osteochondroma?

A
  1. mature bone with cartilaginous cap • 2. commonly originates from long metaphysis • 3. malignant transformation to chondrosarcoma is rare
247
Q

what are the malignant primary bone tumors?

A

osteosarcoma • ewings sarcoma • chondrosarcoma

248
Q

what is the 2nd most common primary malignant bone tumor?

A

osteosarcoma (1st is multiple myeloma)

249
Q

epidemiology of osteosarcoma?

A

M>F • 10-20yo 1°

250
Q

what are the predisposing factors for osteosarcoma?

A

pagets disease of bone • bone infarcts • radiation • familial retinoblastoma

251
Q

location of osteosarcoma?

A

metaphysis of long bones, often around distal femur, proximal tibial region

252
Q

xray findings in osteosarcoma?

A

codman’s triangle (from elevation of periosteum) or sunburst patten

253
Q

prognosis of osteosarcoma?

A

aggressive

254
Q

tx for osteosarcoma?

A

surgical en bloc resection (with limb salvage) and chemotherapy

255
Q

epidemiology of ewings sarcoma?

A

boys <15yo

256
Q

ewings sarcoma commonly appears where?

A

in diaphysis of long bones, pelvis, scapula, ribs

257
Q

severity of ewings sarcoma?

A

extremely aggressive with early metastases, but responsive to chemotherapy

258
Q

histopathology of ewings sarcoma?

A

anaplastic small blue cell malignant tumor • onion skin appearance in bone • ‘going out for ewings and onion rings’

259
Q

genetic cause of ewings sarcoma?

A

t(11;22) • 11+22=33 patrick ewings jersey number

260
Q

epidemiology of chondrosarcoma?

A

men 30-60yo

261
Q

location of chondrosarcoma?

A

usually located in pelvis, spine, scapula, humerus, tibia, or femur

262
Q

what type of cancer is chondrosarcoma?

A

malignant cartilaginous tumor

263
Q

where does chondrosarcoma come from?

A

may be of primary origin or from osteochondroma

264
Q

histopathology of chondrosarcoma?

A

expansile glistening mass within the medullary cavity

265
Q

epihphyseal bone tumor?

A

giant cell tumor (soap bubble)

266
Q

metaphyseal bone tumor?

A

benign= osteochondroma -exostosis • malignant= osteosarcoma- codmans triangle

267
Q

diaphyseal bone tumor?

A

malignant: • ewings sarcoma • chondrosarcoms

268
Q

etiology of osteoarthritis?

A

mechanical- joint wear and tear destroys articular cartilage

269
Q

etiology of RA?

A

autoimmune- inflammatory destruction of synovial joints • type III HSR

270
Q

joint findings in osteoarthritis?

A

subchondral cysts • sclerosis • osteophytes (bone spurs) • eburnation (polished, ivory like appearance of bone) • Heberden’s nodes (DIP) • Bouchard’s nodes (PIP) • no MCP involvement

271
Q

joint findings in RA?

A

pannus formation in joints (MCP, PIP) • subcutaneous rheumatoid nodules • ulnar deviation of fingers • subluxation • Baker’s cysts • no DIP involvement

272
Q

pathology in subcutaneous rheumatoid nodules in RA?

A

fibrinoid necrosis

273
Q

location of Baker’s cysts in RA?

A

popliteal fossa

274
Q

predisposing factors for OA?

A

age • obesity • joint deformity

275
Q

predisposing factors for RA?

A

F>M • 80% RF (+) • anti-cyclic citrullinated peptide antibody is more specific • strong association with HLA-DR4

276
Q

classic presentation of OA?

A

pain in weight bearing joints after use (EOD) improving with rest • knee cartilage loss medially (bowlegged) • noninflammatory • no systemic symptoms

277
Q

classic presentation of RA?

A

morning stiffness > 30min improving with use • symmetric joint involvement • systemic symptoms

278
Q

systemic symptoms of RA?

A

fever • fatigue • pleuritis • pericarditis

279
Q

Tx for OA?

A

NSAIDs • intra-articular glucocorticoids

280
Q

Tx for RA?

A

NSAIDs • glucocorticoids • disease modifying agents (MTX, sulfasalazine, TNF-α inhibitors)

281
Q

what happens in Sjogrens syndrome?

A

lymphocytic infiltration of exocrine glands, especially lacrimal and salivary

282
Q

classic triad of sjogrens syndrome?

A

xerophthalmia (dry eyes, conjunctivitis) • xerostomia (dry mouth, dysphagia) • arthritis

283
Q

sjogrens causes what complications?

A

parotid enlargement • ↑ risk of B cell lymphoma • dental caries

284
Q

markers present in sjogrens syndrome?

A

autoantibodies to ribonucleoprotein antigens: SS-A (Ro), SS-B (La)

285
Q

sjogrens predominantly affects who?

A

females 40-60yo

286
Q

sjogrens associarted with what?

A

RA

287
Q

what are the findings in gout?

A

precipitation of monosodium urate crystals into joints due to hyperuricemia

288
Q

hyperuricemia that causes gout can be caused by what?

A

lesch-nyhan syndrome • PRPP excess • ↓ excretion of uric acid (thiazides) • ↑ cell turnover • von gierkes disease

289
Q

percentage of gout due to underexcretion?

A

90%

290
Q

percentage of gout due to overproduction?

A

10%

291
Q

features of crystals in gout?

A

needle shaped and negatively birefringent = yellow crystals under parallel light

292
Q

gout is more common in who?

A

men

293
Q

symptoms of gout?

A

asymmetric joint distribution • joint is swollen, red and painful • painful MTP joint of the big toe (podagra) • tophus formation

294
Q

common location of tophus formation in gout?

A

external ear • olecranon bursa • Achilles tendon

295
Q

acute attack of gout tends to occur when?

A

after large meal or alcohol consumption

296
Q

why does alcohol precipitate a gout attack?

A

alcohol metabolites compete for same excretion sites in kidney as uric acid, causing ↓ uric acid secretion and subsequent build up in blood

297
Q

treatment for acute gout?

A

NSAIDs (indomethacin) • glucocorticoids

298
Q

treatment for chronic gout?

A

xanthine oxidase inhibitors (allopurinol, febuxostat)

299
Q

pseudogout is caused by what?

A

deposition of calcium pyrophosphate crystals within the joint space

300
Q

pseudogout forms crystals with which features?

A

basophilic, rhomboid crystals that are weakly positively birefringent

301
Q

typical location of pseudogout?

A

usually affects large joints (classically the knee)

302
Q

pseudogout affects who?

A

> 50yo, M=F

303
Q

treatment for pseudogout?

A

NSAIDs for sudden severe attacks • steroids • colchicine

304
Q

difference between gout and pseudogout crystals under parallel light?

A

gout= yellow • pseudogout=blue

305
Q

what are the common causes of infectious arthritis?

A

S aureus • Streptococcus • Neisseria gonorrhea

306
Q

what is gonococcal arthritis?

A

STD that presents with migratory arthritis with asymmetric pattern

307
Q

presentation of gonococcal arthritis?

A

affected joint is swollen, red and painful • STD= Synovitis (knee), Tenosynovitis (hand), Dermatitis (pustules)

308
Q

cause of osteonecrosis (avascular necrosis)?

A

infarction of bone and marrow

309
Q

symptoms of osteonecrosis?

A

pain associated with activity

310
Q

osteonecrosis is caused by what?

A

trauma • high dose corticosteroids • alcoholism • SCD

311
Q

most common site of osteonecrosis?

A

femoral head

312
Q

what are the seronegative spondyloarthropathies?

A

PAIR • Psoriatic arthritis • Ankylosing spondylitis • Inflammatory bowel disease • Reactive arthritis

313
Q

what are seronegative spondyloarthropathies?

A

arthritis without rheumatoid factor ( no anti-IgG antibody)

314
Q

seronegative spondyloarthropathies have strong association with what?

A

HLA-B27 (gene that codes for HLA MHC class II)

315
Q

sernegative spondyloarthropathies occur more often in who?

A

males

316
Q

what is psoriatic arthritis?

A

joint pain and stiffness associated with psoriasis

317
Q

how does psoriatic arthritis present?

A

asymmetric and patchy involvement • dactylitis (sausage fingers) • pencil in cup deformity on xray

318
Q

frequency of psoriatic arthritis?

A

seen in fewer than 1/3 of patients with psoriasis

319
Q

pathogenesis of ankylosing spondylitis?

A

chronic inflammatory disease of spine and sacroiliac joints→ ankylosis (stiff spine due to fusion of joints), uveitis, and aortic regurgitation

320
Q

common presentation of ankylosing spondylitis?

A

bamboo spine (vertebral fusion)

321
Q

why is IBS considered a seronegative spondyloarthropathy?

A

Crohns and UC are often accompanied by ankylosing spondylitis or peripheral arthritis

322
Q

classic triad in reactive arthritis (reiters syndrome)?

A

conjunctivitis and anterior uveitis • urethritis • arthritis • can’t see can’t pee can’t climb a tree

323
Q

when does reiters syndrome occur?

A

post GI or chlamydia infection

324
Q

epidemiology of SLE?

A

90% are female 14-45yo

325
Q

SLE most common and most severe in who?

A

black females

326
Q

presentation of SLE can include what?

A

fever • fatigue • weight loss • Libmann-Sacks endocarditis • hilar adenopathy • Raynauds phenomenon

327
Q

what is libmann sacks endocarditis?

A

verrucous, wart like, sterile vegetations on both sides of valve

328
Q

what is the common cause of death in SLE?

A

nephritis

329
Q

what type of nephritis causes death in SLE?

A

DPGN if nephritic • MGN if nephrotic

330
Q

SLE pts test false positive for what?

A

syphilis RPR/VDRL due to antiphospholipid antibodies, which cross react with cardiolipin used in tests

331
Q

Lab tests for SLE detect the presence of what?

A

ANA • Anti-dsDNA • anti-Sm • antihistone Ab

332
Q

use of ANA test for SLE?

A

sensitive (primary screening) but not specific for SLE

333
Q

use of anti-dsDNA test for SLE?

A

very specific, poor prognosis

334
Q

use of anti-Sm test for SLE?

A

very specific, but not prognostic

335
Q

use of antihistone test for SLE?

A

more sensitive for drug induced lupus

336
Q

mnemonic for SLE?

A

I’M DAMN SHARP • Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid) • Malar rash • Discoid rash • Antinuclear antibody • Mucositis • Neurologic disorders • Serositis • Hematologic disorders • Arthritis • Renal disorders • Photosensitivity

337
Q

sarcoidosis is characterized by what?

A

immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels

338
Q

sarcoidosis is common in who?

A

black females

339
Q

typical presentation of sarcoidosis?

A

often asymptomatic except for enlarged lymph node. incidental findings on CXR of bilateral hilar adenopathy or reticular opacities

340
Q

sarcoidosis is associated with what?

A

restrictive lung disease (interstitial fibrosis) • erythema nodosum • bells palsy • epithelial granulomas containing microscopic Schaumann and asteroid bodies • uveitis • hypercalcemia

341
Q

what causes hypercalcemia in sarcoidosis?

A

elevated 1α-hydroxylase-mediated vitD activation in epitheloid macrophages

342
Q

what is the treatment for sarcoidosis?

A

steroids

343
Q

what are the symptoms of polymyalgia rheumatica?

A

pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss • does not cause muscular weakness

344
Q

polymyalgia rheumatica is more common in who?

A

women >50yo

345
Q

polymyalgia rheumatica is associated with what?

A

temporal (giant cell) arteritis

346
Q

findings in polymyalgia rheumatica?

A

↑ ESR • normal CK

347
Q

treatment for polymyalgia rheumatica?

A

rapid response to low dose corticosteroids

348
Q

fibromyalgia is most commonly seen in who?

A

women 20-50yo

349
Q

presentation of fibromyalgia?

A

chronic widespread musculoskeletal pain associated with stiffness, paresthesia, poor sleep, and fatigue

350
Q

what is polymyositis?

A

progressive symmetrical proximal muscle weakness, characterized by endomysial inflammation with CD8+ T cells

351
Q

polymyositis most often involves which location?

A

shoulders

► Med Notes (62 decks)

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