PP Musculoskeletal, Skin, and Connective Tissue Flashcards
1
Q
What is Hairy leukoplakia?
A
White painless plaque on the tongue that can’t be scraped off
EBV mediated
Occurs in HIV + pt
2
Q
what aere 1st degree burns?
A
red (epidermnis)
3
Q
what are 2nd degree burns?
A
blisters (hipodermis)
4
Q
what are 3rd degree burns?
A
painless nueropathy (dermis)
5
Q
what diseases have palms and sole rashes?
A
“TRiCKSSS”
- Toxic Shock Syndrome
- Rocky mountain spotted fever
- Coxsackie A: Hand-Foot-Mouth disease
- Kawasaki
- Scarlet fever
- Stahp Scaled Skin}- Syphilis
6
Q
what is Erythema Multiforme?
A
target lesions (viral, drugs)
7
Q
what is Stevens Johnson síndrome?
A
Erythema Multiforme Mjor (mouth, eye, avgina)
8
Q
what is toxic epidermal necrolysis?
A
Steven Jonson w/skin sloughing
9
Q
what is Pemphigus Vulgaris?
A
Ab against desmosomes => circular immunofluoresence, in epidermis, oral lesions, + Nikolsky sign
10
Q
what is Bullous Pemphigoid?
A
Ab against hemidesmososmes => linear immunofluoresence, subepidermal, “floating” keratinocytes, eosinophils, (-) Nikolsky sing
11
Q
what is Atopic dermatitis (Eczema)?
A
dry flaky dermatitis in skin flexures “itch tha rashes”
12
Q
what is Nummular dermatitis?
A
circular eczemz
13
Q
what is Spongiotic eczema?
A
weeping eczema: scratching causes oozing “like a sponge”
14
Q
what is Lichenification?
A
scratching => thick leathery skin
15
Q
what is Pityriasis Rosea?
A
“herald patch” fallow days later by “Christmas tree” distribution
Self-resolving in 6-8weeks
16
Q
what is Lichen Planus?
A
pruritic, purple, polygonal planar papules and plaques
Sawtooth infiltrate of lymphocytes at dermal-epidermal junction
A/w hepatitis C
17
Q
what is Scabies?
A
linear excoriation “burrows” in webs of fingers, toes, belt line (Sarcoptes faces)
18
Q
what does UV-A causes?
A
aging
Dominant in tanning and photoaging
19
Q
what does UV-B causes?
A
Sunburns
Can lead to impetigo and skin cancer
20
Q
what ar teh ABCDE’s that indicate worse prognosis of sking cáncer?
A
- asimetric
- irregular borders
- color differences
- > 6mm diameter
- evolution over time
21
Q
what does the Clark level tell you?
A
invasión of melanoma
22
Q
what does Breslow´s classification tell you?
A
depth of melanoma
23
Q
where are Malignant Melanomas usually found?
A
Males: back
Females: leg
24
Q
what is the precursor of a Malignant Melanoma?
A
hutchison´s greckle
25
what are the types of Malignant Melanomas?
- Superficial spreading: most common, flat Brown
- Nodural: worst prognosis, black, dome-shape
- Lentigo malignant melanoma: elderly pts, fair-skin
- Acrolentigous: AIDS pts, dark skin
26
where are Squamous Cell carcinomas usually found?
Face, lower lip, ear and hands.
Locally invasive
Rarely metastasize
Histology: keratin pearls
27
what is the precursor of Squamous Cell carcinoma?
Actinic keratosis (red scaly plaque)
28
what are the types of Squamous Cell carcinoma?
Bowen´s disease: SCC in situ on uncircumcised penis dorsum
| Verrucous carcinoma: wart on foot
29
where are Basal Cell carcinomas usually found?
In sun exposed areas of the body
Locally invasive
Almost never metastasize
Pink, pearly nodules
30
what are the type of Basal Cell carcinoma?
Nodula: waxy nodule w/ central necrosis
Superficial: red scaly plaques, like eczema
Pigmented: looks like melanoma
Sclerosing: yellow waxy palques
31
what is Acne Rosaces?
blush all the time
| worse w/stress / alcohol
32
what is a Brown Recluse Spider Bite?
painful black necrotic lesion
33
what is cellulitis
Acute, painful, spreading infection of dermis and subcutaneous tissue
Usually from: * S. pyogenes, * S. aureus
34
what is Cutaneous Anthrax?
painless black necrotoc lession
35
what is Decubitus Ulce?
bedsore
36
what is a DVT?
blood clot in veins
| associated w/ hypercoagiulable state
37
what is Erysipelas?
shiny red
usually on face
associated w/ Step pyogenes
38
what is Miliaria?
"Heat rash": burning, itching papules on trunk
39
what is Molluscum Contagiosum?
```
Umbilicated, flesh-color papules w/ central dimple
pox virus (STD) parvovirus
```
*pathology: eosinophilia cytoplasmic inclusions bodies
40
what is Psoriasis?
Papule and plaques with silver scale on knees and elbows
Increase stratum spinosum and decrease stratum granulosum
- Auspitz sing: remove scale => pinpoint bleeding
A/w nail pitting and psoriatic arthritis
41
What is a Pyogenic Granuloma?
vascular nodule at site of previous injury
42
what is Seborrheic Dermatitis?
Greasy areas, dandruff in eyebrowns, nose, behind ears
43
what is Seborrheic Keratosis?
Flat, greasy, pigmented squamous epithelial priliferation with keratin-filled cyst ( horn cyst)
Looks "stuck on"
Common bening neoplasm in older person (GI)
Leser-Trelat sing-> sudden appearance of multiple seborrheic keratoses, indicate an underlying malignancy
44
what is Trombophebitis?
veins inflamation w/ thrombus
45
what is Vitíligo?
White patches
| Cause by a decrease of Melanocytes
46
what is Xeroderma Pigmentosa?
bad DNA repair
47
what is Erythemna Chronicum Migrans?
Lyme disease (solitary lesión that spreads)
48
what is Erythema Infectiosum?
fifth disease "slapped cheeks" do to Parvovirus B19
49
what is Erythema Marginatum?
reumatic fever (red margins)
50
what is Erythema Multiforme?
```
Iris-like target lesión do to:
HSV
Phenytoin
Barbs
Sulfas
```
51
what is Erythema Multiforme Mjor?
Steven Johnson síndrome ( >1 mucosal surface)
52
what is Erythema Nodosum? What diseases are a/w?
Subcutaneous fat inflammation ( painfull red nodules on anterior shins)
A/w sarcoidosis, coccidioidomycosis, histoplasmosis, TB, strep infection, IBD, Behcet disease
53
what is Erythema Toxicum?
Newborn beninh rash ( looks like flea bites w/ eosinophils)
54
where is CK-MM found?
muscle
55
where is CK-BB found?
brain
56
how does a neurogenic mucle disease presents?
distal weakness + fasciculations
57
how does a myophatic muscle diseae presents?
proximal weakness + pain
58
what is Duchenne´s MD?
dystrophin framershift
Gower sing
Clsf pseudohypertrophy
59
what is Becker´s MD?
Dystriphin missense
| sx > 5 y/o
60
what is Myotonic Dystrophy?
Bird´s beak face
| cant let go when shake hands
61
what is Myasthenic syndrome = Lambert-Eaton?
gets stronger as day goes by
stronger w / EMG
not small cell CA
62
what is Myasthenia gravis?
gets weak as the day goes by
stronger w/ Edrophonium}weaker w / EMG
rule out Thymoma
63
what is multiple sclerosis?
Anti-myelin Ab
Young woman w /visión problems
xs comes and go
64
what is Metachromatic Leukodystrophy?
Arylsulfatase deficiency
| kids with MS presentation
65
what is Ataxia Telangectacia?
spider veins
| IgA deficiency
66
what is Friedreich ataxia?
rinitis pigmentosa
| scoliosis
67
what is Adrenal Leukodystrophy?
carnitine shuttle problema
| adrenal failure
68
what is Guillain-Barre?
Ascending paralysis
| 2 weaks after URI
69
what is ALS?
middle age male w/ fasciculations, descending paralysis,
| no sensory problems
70
what is Werdnig-Hoffman?
fasciculations in a newborn
| no anterior horn
71
what is Polio?
asymetric dasciculation in child
| 2 wks after gastroenteritis
72
what is Choreoathetosis?
dance-like movements
wringing of hands
quivering voice
73
what is Atonic cerebral plasy?
no muscle tone
| floppy
74
what is Slipped Capital Femoral Epiphysis?
obese boys w/ dull achy pain
75
what is Legg-Calves-Perthes?
limp ( femur head avascular necrosis)
76
what is Osgood-Schlatter?
A traction apophysitis of the tibial tubercle
* growing pains
* knee pain ( tibial tubercle avascular necrosis) common in adolescent
77
what is Septic Arthritis?
joint pain (staph aereus)
78
what is Ankylosing Spondylitis?
ligament ossification => vertebral body fusión, decrease lumbar curve, stiffer in morning, kyphosis, uveítis, HLAB-27
79
what is Cauda Equina Syndrome?
"Saddle anesthesia": can¨t feel butt, thighs, perineum
80
where does bone cáncer metástasis occur from?
breast
prostate
lung
kidney
81
what is Costochondritis?
Painful s2welling of chest joint-bone attachments
| worse w/ deep breath
82
what is Disk Herniation?
Straight leg raise => shooting pain
83
what is Lumbar Stenosis?
MRI "bourglass"
| low back pain
84
what is Ochronosis = Alkaptonuria?
kids with OA
black urine
homogentisic acid oxidase deficiency
85
what is Osteítis Fisbrosis cística?
inflammation of bone w/ holes
86
what is Osteogenesis Imperfecta?
blue sclera
| multiple broken bone
87
what is Osteomalacia/ Rickets?
```
soft bones (waddling gait)
craniotabes ( soft skull)
Rachitic rosary ( costochondral thickening)
Harrison´s Groove
Pigeon breast ( sternum protrusión)
```
88
what is Osteomyelitis?
infected bones
89
what is Osteonecerosis= Legg-Calve-Perthes?
Wedge-shape necrosis of femur head
90
what is Osteopetrosis?
decrease osteoclas activity => marble bones (obliterate own bone marrow)
91
what is Osteoporosis?
loss of bone matrix ( not calcification) => compression fractures
92
what is Osteosclerosis?
thick bones
93
what is Paget´s Disease?
```
"My hat dosen´t fi"
paramyxovirus
increase osteoclast/blast
fluffy bone
osteosarcoma
increase CO
heart failure
deafness
increase alkaline phosphatase alone
```
94
what is Rheumatoid Factor?
An IgM against IgG Fc
95
what are Tophi?
Gout crystals
| + Giant cells
96
what is Podagra?
Big toe inflammation
97
what ie CREST síndrome?
```
Calcinosis
Raynaud´s
esophageal dysmotility
Sclerodactyly
telangiectasia
```
98
what Ab is associated with CREST
Anti-centromere Ab
99
What diseases have Raynaud's syndrome?
Scleroderma
Takayasu's
RA
SLE
100
Which vasculitis has a high platelet count?
Kawasaki disease
101
Which vasculitis has a normal platelet count?
Henoch-Scjonlein purpura
102
What is Osteoarthritis?
Pain worse w/ activity, relieved by rest
PIP/DIP joints
* the joint is NOT tender & systemic symptoms are absent
103
What is Rheumatoid Arthritis?
Morning stiffness lasting more than 30min and improving with use
MCP / PIP joint
104
What is STill's disease?
Juvenile RA
105
What is Pseudogout?
Deposition of Ca Pyrophosphate crystals
106
What is Gout?
Urea te crystals in big toe
| - birefringence
107
What is Myositis?
muscle inflammation it hurts
108
What is Dermatomyositis?
Myositis + rash
109
What is Fibromyalgia?
Widespread musculoskeletal pain (11 points)
MC in woman
A/w depression
110
What is Polymyalgia Rheumatica?
Weak shoulders
| Temporar arteritis
111
What is SLE=Lupus?
Meet 4 criteria: "DOPAMIN RASH"
- Discioid rash
- Oral ulcer
- Photosensitivity
- Arthritis
- Malar rash
- Immunologic disorder: Anti-ds DNA, Sm, Cardiolipin Ab
- Neurologic disorder: seizures or psychosis
- Renal failure: DIE OF THIS
- ANA
- Serositis: pleuritis/ pericarditis ( Libman- Sacks endocarditis )
- Hemolytic anemia
112
What is Scleroderma?
Tight skin
| Fibrosis
113
What is Takayasu's arteritis?
Pulseless Asian women
| Aorta inflammation
114
What is Polyarteritis Nodosa?
p-ANCA Ab
Attacks gut/ kidney
Hep B
115
What is Wegener's Granulomatosis?
c-ANCA Ab
Attacks ENT
Lungs
Kidney
116
What is Goodpasture's?
Anti-GBM Ab
Attacks lung/ kidney
RPGN
117
What is Reiter's syndrome?
Males that can't see, can't pee or climb a tree
118
What is Sjögren's syndrome?
Female that have
- dry eye
- dry mouth
- RA
119
What is Behcets syndrome?
Oral and genital ulcer
| Uveitis
120
What is Churg-Strauss?
Asthma
Eosinophils
Multiple-organ involved
121
What is Felty's syndrome?
RA
Leukopenia
Splenomegaly
122
What is Kawasaki's disease?
"CRASH"
- conjunctivitis
- rash ( Palm/ sole)
- aneurysm ( coronary artery) -> MI in kids
- strawberry tongue
- hot ( fever > 102 for at least 3 days + cervical lymphadenopathy)
123
Which are the 3 type of skin cancer?
```
BCC
SCC
Melanoma
Most common: BCC > SCC > Melnoma
Risk of metastasize: Melanoma > SCC > BCC
```
124
What is Dermatitis Herpetiforme?
Pruritic papules, vesicles and bullae
Deposits of IgA at the tip of dermal papillae
A/w celiac disease
125
What is Acanthosis Nigrians?
Epidermal hyperplasia causing symmetrical hyperpigmented skin ( neck and axilla)
A/w hyperinsulinemia and visceral malignancy
126
What is Actinic keratosis?
Premalingnat lesion caused by sun exposure
Precursor of SCC ( depend of degree of epithelial dysplasia)
Sand paper-like texture
127
What is Impetigo?
Very superficial skin infection
Usually from: S. aureus or S. pyogenes
Contagious
Honey colored crusting
128
What is Bullous impetigo?
Has bullae
| Usually cause by S. aureus
129
What is Necrotizing fasciitis?
Deeper tissue injury
From: anaerobic bacteria or S. pyogenes
Result in crepitus from methane and CO2 production
Causes bullae and a purple color to the skin
130
What is Staphylococcal scaled skin syndrome (SSS)?
Exotoxin destroys keratinocytes attachments in the stratum granulosum only
Fever and erythematous rash with sloughing of upper layer of epidermis
Seen in newborn and children
131
Which are the Rotator cuff muscles?
Supraspinatus (mc rotator cuff injury)
Infraespinatus ( pitching injury)
Teres minor
Subscapluris
132
Unhappy triad/ knee injury?
MCL
ACL
Lateral meniscus
133
Supraespinatus muscle?
Abduct arm initially
134
Infraespinatus muscle?
Laterally rotates the arm
135
Teres minor muscle?
Adducts and laterally rotates arm
136
Subscapularis muscle?
Medially rotates and adducts arme
137
Which are the wrist bone?
"Some Lovers Try Positions That They Can't Handle"
- scaphoid ( MC fracture carpal and is prone to vascular necrosis)
- lunate ( dislocation may cause acute carpal tunnel syndrome)
- trinquetum
- pisiform
- hemate
- capitate
- trapezoid
- trapezium
138
What is Carpal tunnel Syndrome?
Entrapment of median nerve in carpal tunnel -> nerve compression
139
Which are the ligament involve in an Ankle sprain?
```
Lateral ( MC)
1. Anterior Talofibular
2. Calcaneofibular
3. Posterior Talofibular
Medial
1. Deltoid lig
```
140
Axillary nerve?
(C5,C6)
Injury: fracture of the surgical neck of humerus, dislocation of humeral head
Motor defi: Deltoid - arm abduct at shoulder
Sign: Atrophied deltoid
141
Radial nerve?
(C5-T1)
Injury: fracture midshaft of humerus
Motor defi: "BEST extensor" brachioradialis, extensors of wrist and finger, supinator, triceps
Sign: wrist drop
142
Median nerve?
(C5-C8, T1)
Injury: fracture of the supracondilar humerus
Motor defi: opposition of thumb, lateral finger flexion, wrist flexion
Sign: "Ape hand"; "Pope's blessing"
143
Ulnar nerve?
(C8, T1)
Injury: fracture of medial epicondyle of humerus
Motor defi: medial finger flexion, wrist flexion
Sign: radial deviation of wrist upon wrist flexion
144
Muculocutaneous nerve?
(C5-C7)
Injury: upper trunk compression
Motor defi: biceps, brachialis, coracobrachialis ( flexion of the arm at elbow)
145
What is ER -Duchenne palsy "Waiter's tip"?
Due to traction or tear of the upper trunk of the brachial plexus
C5 and C6 roots
Seen in infant following trauma during delivery
Findings: limb hang by side, medially rotates, forearm is pronated
146
Winged scapula?
Lesion to the serratus anterior
| A/w long thoracic nerve
147
Which are the hand muscle?
```
Thenar eminence (median)
Hypothenar eminence (ulnar)
Dorsal interosserous muscle - abduct finger
Palmar interosserous muscle - adduct finger
Lumbrical muscles flex at the MCP joint, extend PIP and DIP joint
```
148
Which are the muscles of the Thenar eminence?
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
149
Which are the muscles of the Hypothenar eminence?
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi
150
Obturator nerve?
(L2-L4)
Injury: Anterior hip dislocation
Motor defi.: thigh adduction
151
Familiar nerve?
(L2-L4)
Injury: pelvic fracture
Motor defi.: thigh flexion and leg extension
152
Common peroneal nerve?
(L4- S2)
Injury: Trauma or compression of lateral aspect of leg or Fibula neck fracture
Motor defi.:Foot eversion and dorsiflexion; Toe extension; Foot drop; Foot slap; Steppage gait
153
Tibial nerve?
(L4- S3)
Injury: knee trauma
Motor defi.: Foot inversion and plantarflexion; Toe flexion
154
Superior gluteal nerve?
(L4- S1)
Injury: Posterior dislocation or Polio
Motor defi.: thigh abduction
155
Inferior gluteal nerve?
(L5- S2)
Injury: posterior hip dislocation
Motor defi.: can't jump, climb stairs or rise from seated position
156
Xeroderma pigmentosum
Defective nucleotide excision repair
157
Basal cell carecinoma histology?
Basaltic cells with hyperchromatic nuclei.
158
Honey- colored crusting
Impetigo
| Tx:topical abx Mupirocin (Bactroban)
159
Velvety, hyperpigmented plaques on the skin of neck and axillae
Acanthosis nigricans
- in flexure regions
- A/ w insulin resistance or obesity
- A/w GI and lung malignancy
160
Immmunofluorecens reveals linear patter (IgG C3) at epidermal ( basement mm.)- dermal junction
Bellos penhigoid
* spares oral mucosa
* biopsy: subepidermal cleavage
Tx:High potency topical glucocorticoid (Colbetasol)
161
Acantholysis
Separation of epidermal cell
| + in pemphigus vulgaris
162
Flaccid intraepidermal bullae?
Pemphigus vulgaris
- causes acantholysis
- IF: Ab around epidermal cells
163
Kaposi sarcoma
Endothelial malignancy
A/w HHV-8 and HIV
Has lymphocytic infiltrates
164
MC type of skin cancer; the lesión is a pearly-colored papeles with a translucent surface and telangectasis
BCC
165
Flat-topped papules
Lichen planus
166
Pinkish, scaling, flat lesions on the chest and back?
Tinea (pityriasis) vesicolor
| *Maleasar furfur
167
Dewdrops on a rose petal
Lesions of primary varicella
168
"Crearle cap"
Seborrheic dermatitis
* adherent greasy scales with a mildly erythematous base seen on scalp
* predilection for areas with oily skin
169
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women
Lichen sclerosis
170
Exophytic nodules on the skin with varying degrees of scaling or ulceration
SCC
| *2nd MC type of skin cancer
171
Espongiosis
Epidermal accumulation of edematous fluid in intracellular space
* eczematous dermatitis
172
Nikolsy sign
+ pemphigus vulgaris ( separation of epidermis upon manual stroking of skin)
- bullous pemphigoid
173
Cytoplasmic vacuolization (koilicytosis) forming perinuclear halos
```
Verruca vulgaris ( common warts)
Due to HP
```
* non-umbilicated, skiing-colored papules or growth
* ITCHIng
174
Auspitz sign
Psoriasis
175
Radial head subluxation
Nursemaid elbow
- common in preschool
- axial traction of forearm with elbow extended ( child pulled, lifted, swung by)
- presents: arm held extended & probated. No swelling, deformities or focal tenderness.
- Tx: Hyperpronation of forearm or supination of forearm & flexión of elbow
176
Patellofemoral stress syndrome
Overuse injury commonly seen in runners
* Anterior knee pain that worsens upon descending steps or hills.
177
Inflammatory causes of low back pain
Ankylosis spondylitis, Reactive arthritis, Psoriatic arthritis, IBD
- better with activity or exercise
- no improvement with rest
- gradual unset
- HLA-B27 present
178
An X-ray finding of an expansive & eccentric lytic area suggestive of?
"Soap - bubble " appearance of Giant cell tumor of bone ( Osteoclastomas)
179
Enthesitis
Characterized by information and pain at site of tendon and ligament attachment to bone.
* Seen in Ankylosis spondylitis ( inflammatory cause of lower back pain)
180
Spondylolisthesis
A developmental disorder characterized by a forward slip of vertebra ( L5 over S1)
*a palpable "step-off" is detected on examination if the problem is severe
181
Polyarticular Juvenile idiopathic arthritis
Autoimmune disorder of childhood make by symmetric arthritis of the upper and lower extremity.
- Labs: systemic inflammation including increase in inflammatory markers (ESR, CRP), Hyperferritinemia, Hypergammaglobulinemia & Thrombocytosis.
* Anemia is commonly seen due to the chronic inflammation &a decrease in Fe.
182
Trendelenburg sign
A drooping of the contralateral pelvis that occurs when the pt stands on one foot.
*due to muscle weakness of Gluteous medius & Gluteus minimus as result of Superior gluteal nerve damage
183
Valgus vs. Varus laxity
Valgus-> MCL tear
* laxity when leg is forced to abduction
Varus-> LCL tear
184
Malignancy causes of low back pain?
Metastatic cancer to bone:
- H/O Malignancy
- age > 50
- Worse at night
- cauda equina syn
185
Most beneficial Tx option in preventing long term morbidity in pt with septic joints?
Surgical drainage & debridement
186
Myasthenia graves Vs. Lambert Eatin syndrome
MG: auto-ab against post-synaptic acetylcholine receptors in NMJ.
* presents: ocular fatigue ( ptosis, diplopia) & muscular weakness
with preserved reflexes
LEMS: auto-ab against the voltage gated Ca channel in presynaptic motor nerve terminal.
* presents: proximal muscle weakness with decrease/absent tendon-
Reflexes
187
Pseudogout
A form of acute arthritis induce by the release of Calcium pyrophosphate dehydrate crystals from sites of chondrocalcinosis into the joint space.
* often occurs in the setting of recent surgery or medical illness.
188
Myotonia
Delayed muscle relaxation
189
Infectious causes of low back pain
```
Osteomyelitis,Discitis, Abscess
- due to: recent infection
IV drug user
Diabetes
* fever, exquisite point tenderness
*MRI is the Dx image
```
190
Rafionuclide bone scan are used to evaluate?
Malignancy
Infections
Inflammatory diseases of bone
191
Neurogenic Arthropathy
Charcot joint
- complication of neuropathy & repited joint trauma
- affects weight bearing joints
- manifest with: functional limitation deformity, degenerative joint
- X-ray: loss of cartilage, osteophyte development, lose bodies
192
Sharp, localized pain & tenderness over the anterior-medial part of the tibial plateau just below the joint line of the knee.
Pes anserius syn
- valgus stress test will not agraviate the pain
- normal x-ray
193
In case of amputation injury, what is the best next step with the amputated limb?
Amputated part should be wrapped in saline-moistened gauze, sealed in a plastic bag, place on ice
194
A dashboard knee injury results in?
Disruption of the posterior cruciales ligament PCL
195
Chondrocalcinosis
Calcification of articular cartilage
| * seen in Hemochromatosis
196
Posas sign
Abd pain with hip EXTENSION
| -clinical presentation in a Psoas abscess
197
Legg-Calve-Perthes disease Vs. Slipped Capital Femoral Epiphysis
LCP-> idiopathic AVN(osteonecrosis) of the femoral head.
-> boys 4-10y/o peak at 7y
SCFE-> separation of the proximal femoral epiphysis.
-> boy 11-13y/o in Obese adolescent
* bouth present with limited abduction & internal rotation of the hip
198
What time of exam should accompany all clavicle fx & why?
A neuronascular exam.
| * due to the proximity to the subclaviar art. & brachial plexus
199
Clinical manifestations of SLE?
- symmetric migratory arthritis (hand, knee)
- serositis: pleurisis, pericarditis, peritonitis
- thromboembolic event
- fever, fatigue, weight loss
- butterfly rash and photosensitivity
*Labs: hemolytic anemia, thrombocytopenia, leukopenia
Hypocomplemenmia (C3 &C4) decreases
Antibodies: ANA & anti-dsDNA, anti-Sm
Renal: proteinuria, increase Cr
200
Triad of clinical findings of Fety syndrome?
Inflammatory arthritis
- > erosive joint disease & deformi
- > rheumatoid nodules
- > vasculitis( mononeuritis, necrotizing skin lesions)
Neutropenia
Splenomegaly
201
Indication for imaging in low back pain?
X-ray: osteoporosis, compression fx, malignancy, ankylosis spondylitis
MRI: sensory/motor deficit, cauda equina syn, epidural abscess/ infection
202
Musculoskeletal causes of low back pain
1. Mechanical ( muscle strain, spasm, degenerative arthritis)
2. Herniated disk
3. Spinal stenosis: better with spine flexión
4. Compression fx
203
Symptoms of meniscal tear?
Acute "popping" sensation from twisting injury of the knee
Slow onset joint effusion
Impaired knee extension
Pain exacerbated with squatting
* presents: "catching" sensation, "locking", reduce range of motion
204
Pt with pseudogaut should be evaluated for secondary causes like?
Hyperparathyroidism
Hypothyroidism
Hemochromatosis
205
Shoulder dislocation
1. Anterior
2. Posterior
Anterior: -MC - Axillary nerve damage
- pt holding arm in Abd & external rotation
Posterior: - in seizure ( eclampsia) pt
- pt holding arm in Add & internal rotation
206
Early physical sings of Compartment syn?
Extremity tightness
Weakness
Pain with passive motion
Pain out of proportion to injury
* untreated: paralysis , muscle contracture, sensory deficit, infection, skin ulceration & necrosis
* Tx: fasciotomy if pressure is > 20-30mmhg
207
Diagnosis of Myopathy with normal ESR & increase CK
1. Station-induce myopathy: muscle pain/tenderness with or without weakness
2. Hypothyroid myopathy: features of hypothyroid +
- > pain, cramps & weakness involving proximal muscle
- > delayed tendon reflexes & myoedema
208
Diagnosis of Myopathy with normal ESR and CK
Glucocorticoid- induced myopathy
- > progressive proximal muscle weakness & atrophy without pain or tenderness
- > Lower extremity muscles are more involved
209
Diagnosis of Myopathy with increase ESR and normal CK
Polymyalgia rheumatica
- > muscle pain & stiffness in the shoulder & pelvic girdle
- > tenderness with decreased ROM at shoulder, neck and hip
- > responds rapidly to Glucocorticoid
210
Diagnosis of Myopathy with increase ESR and CK
Inflammatory myopathys
- > muscle pain, tenderness and proximal muscle weakness
- > skin rash and inflammatory arthritis my be present.
211
Acute monoarthritis with fever?
Septic arthritis
* A/w restricted ROM
* common in pt with underlying joint disease
212
Reactive arthritis
Reiter syndrome
-Triad: conjunctivitis, uveitis, arthritis (can't see, pee or climb a tree)
*2 subtypes: post- enteric(GI bugs) and post-venereal (chlamydio)
213
Golfer's elbow
Medial epicondolitis
Repetitive flexión
C5,6
214
Bone pain, bone enlargement, arthritis
Paget disease of bone
* increase osteoblasts and osteoclasts activity
- normal Ca and phosphate, increase ALP
215
Patella fx
Inability to EXTEND the knee
216
Achondroplasia
Failure of longitudinal bone growth
- endochondral ossification ( short limbs)
FGFR3
AD
217
Triad of:
1. Autoimmunity
2. Non inflammatory vasculopathy
3. Collagen deposition with fibrosis
Scleroderma (systemic sclerosis)
218
Primary malignant bone tumors
Osteosarcoma ( codman triangle, sunburst)
| Edwing sarcoma "onion"
219
Polymyositis/ Dermatomyositis
Progressive symmetric proximal muscle weakness
- increase CK
- (+ )ANA, anti-Jo-1, anti-SRP and anti-Mi-2
* Polymyositis: increase CD8
* Dermatomyositis: increase CD4, malignancy, malar rash, gottron papules and heliotropic rash
220
Anti- U1 RNP antibody
A/w Mixed connective tissue disease
221
Polymyalgia rheumatica
Pain and stiffness in shoulder and hip
* increase ESR, increase CRP and normal CK
* A/w TGCA
222
Pseudogout
Rhomboid crystals that are weakly brirefringent under polarized light
223
Musculocutaneous nerve
1. Inervates
2. Provides
3. Drive from
1. Foramen flexors ( biceps) & choracobrachialis ( flexes and adduct the arm)
2. Sensory innervation to the lateral forearm
3. Upper truck (C5-C7)
224
Long thoracic nerve injury
- during axillary lymph node dissertation
- paralysis of Serratus Anterior M.
- wining of the scapula
* C5-C7
225
L4
| - sensory loss: lower anterolateral thigh, knee and medial calf & foot
Patellar reflex
226
3 MC carpal bone injury
1. Scaphoid Fx: MC, a vascular necrosis
2. Lacunate dislocation: acute CTS
3. Hook of the Hemate: fall on outstretched hand, ulnar nerve injury
227
Type IV collagen
Basement mm
Lens
Defective in Alport syndrome ( can’t see, pee, hear a thing)
228
Prescription of monosodium ureate crystals
Gout
229
Antinuclear antibodies
SEL, non specific
230
Anti- body highly specific for SEL
Anti-Smith antibodies
231
Piriformis syndrome
Compression of the Sciatic nerve in the Foramen
*Due to Piriformis muscle injury or hypertrophic
232
Tennis elbow
Lateral epicondylitis
Repetitive EXTENSION
C6-8
233
Osteopetrosis
Failure of normal bone resorption due to defective osteoclasts.
* carbonic anydrase II mutation
* thickened bone prone to fx
234
Landmarks Dermatomes
| T4,T7,T10,L1,L4,S2-4
```
T4- nipple
T7- xiphoid process
T10- umbilical
L1- inguinal ligament
L4-knee
S2,3,4- erectior &sensation of penil and anal zone
```
235
Osteonecrosis
Infarction of bone
| * MC site is the Femoral head
236
“Foot drop”
Injury of Common peroneal nerve
237
Mosaic pattern of woven & lamellar bone
Paget disease ( osteitis deformans)
238
Loss of dorsal foot sensation
Impaired dorsiflexion &
Eversion resulting in “foot drop”
Common peroneal nerve injury
239
Type III collagen
Ehlers-Danlos syndrome ( vascular defect)
240
Extension of the thigh
Gluteus Maximus
* supplie by Inferior gluteal nerve
241
Erbs palsy
Waiters tip
| Traction or tear of Upper trunk C5-6
242
Bone pain, worse at night and relieve by Aspirin
Osteoid osteoma
| * Diaphisis ( tibia, femur)
243
Mid shaft fx of the Humerus can result in injury of?
Deep brachial artery
Radial nerve
* bought run together along the posterior aspect of the humerus
244
Thoracic outlet syndrome
Compression of lower trunk and subclavian vessels
245
External hip rotation
Piriformis muscle
246
Antibodies to ............ peptides/ proteins have a high specific for RA
Citrulinate
247
“ Onion skin”, periosteal reaction in bone
Edging sarcoma
| A/w t(11:22)
248
Codman triangle or sunburst pattern on X-ray
Osteosarcoma
249
Seronegative Spondyloarthropathies
```
Arthritis without Reumatoid factor
A/w HLA-B27 (MCH class I)
- PAIR: psoriasis arthritic, ankylosis spondolitis, IBS, reactive arthritis
```
250
“Soap bubble” appearance on r-ray
Giant cell tumor “Osteoclastoma”
251
Primary bening bone tumor
```
Osteoclastoma
Osteochondroma
Osteoma
Osteoid osteoma
Osteoblastoma
```
252
“Empty-can” test
Isolates the action of the Supraspinatus muscle
253
Osteomalacia
Decrease mineralization of osteoid
MCC is vit. D defi
* presents: bone pain, muscle weakness and increase fx
*labs: increase ALP and PTH, decrease Ca, phosphorus and 25OH-D
254
Sistic nerve
L4-S3
Innervates posterior thigh
*splits into: common peroneal n. & tibial n.
255
Defective protein in Marián syndrome
Fibrillin 1
256
Rotator cuff muscles
Supraspinatus- Ab
Infraspinatus- lat rotation
Teres minor- Ad, lat rotation
Subscapularis- Ad, internal rotation
257
Pudendal nerve
Innervation to the perineal region
258
Tubercular (spongy) bone losses mass & interconnections
Osteoporosis
259
- Hilar & mediastinal Adenopathy
- Hypercalcemia
- Uveitis
- RLD ( interstitial fibrosis)
Sarcoidosis
| * common autoimmune disease in young african American women
260
Unhappy triad
ACL
MCL
Medial meniscus
261
The superior gluteal nerve innervates?
Gluteus medius, minimus and tensor fascia latae m.
* they abduct the thigh
262
Antinuclear antibodies SS-A (anti-Ro)
| SS-B (anti-La)
Sjogres syndrome
263
The femoral N.
1. Innervates
2 provides sensation
1. Muscle of the anterior compartment of the thigh
- quadriceps
- sartorius
- pectineus
* responsible for knee extension and hip flexion
2. Anterior thigh & medial leg
264
Goodpasture syndrome
Autoantibodies against
- glimerular bm ( RPGN)
- alveolar bm ( hemorrhage)
* Anti-GBM
265
Obturator nerve
Addiction of the thigh
266
Sudden upward on the arm at the shoulder can damage?
Lower trunk C8-T1
* klumpke palsy
* finger clumsiness
* claw hand deformities
* absent grant reflex
267
Tibial nerve
1. Innervates
2. Provides sensation to
1. Posterior compartment of leg and plantar aspect of foot.
- flexion of the knee & digits
- plantar flexion
2. Leg ( except medial side and plantar foot)
268
Weakened plantar flexion
Decrease inversion of foot
Decrease sensation at the sole of the foot
Tibial nerve injury
269
Medication to DX Myasthenia gravís
Edrophonium
270
Back pain that is exacerbated by standing & walking, but relieved with sitting and hyperflexion of the hip
Spinal stenosis
271
Immune mediated, widespread non caseating granulomas, increase ACE levels and CD4/CD8 ratio
Sarcoidosis
