Sports Injuries and Rheumatology Flashcards
colchicine used to treat _____
inhibits ____________, which disrupts chemotaxis, phagocytosis, degranulation, and also reduces formation of LTB4
gout
microtubular polymerization
young boy with fever and bone pain =
primarily affects the _______ of _____ bones
hematogenous osteomyelitis
metaphysis
long
normal infant at birth, progresses to lethargy, poor feeding, constipation, hypotonia, puffy face, umbilical hernia, protruding tongue, large anterior fontanelle, irreversible intellectual disability risk =
common cause
why delayed
congenital hypothyroidism
iodine deficiency
maternal T4 still active
osteocytes send signals and exchange nutrients and waste products within neighboring lamellae via _____
gap junctions
_________ is a benign childhood disorder marked by severe arthritis in adult life. This _____ disorder is caused by deficiency of ___________. Accumulated homogentisic acid causes pigment deposits in connective tissue through the body, notable blue black deposits in the sclerae and ear cartilage. Urine in these patients turns _____ when exposed to air
Alkaptonuria
AR
homogentistic acid dioxygenase
black
couple, similar pruritic papulopustural rash, back recently from vacation, most likely =
G negative rod, oxidase positive, produces green pigment, almost always culprit
bug also implicated in
hot tub folliculitis
P aeruginosa
burn victims
the _____ receptor initiate the extrinsic pathway of apoptosis. Mutations here or at the ____ligand can prevent apoptosis of autoreactive lymphocytes, thereby increasing the risk of AI disorders such as SLE
Fas
Fas
C tetani produces the ______ tetanospasmin that blocks the release of inhibitory NTs from inhibitory motor interneurons in the CNS. Tetanus is prevented by immunization with ______ that triggers the production of antitoxin antibodies.
exotoxin
toxoid
3 year old, pushes up from squat, enlarged calves =
due to a mutation affecting _________
inheritance =
truncated version of dystrophin =
Duchenne muscular dystrophy; Gower’s sign
dystrophin, sarcolemma cytoskeleton linker protein
X linked p21
Becker muscular dystrophy
sitting up from supine involves external abd. obliques, rectus abdominis, and
Iliopsoas
aortic dissection, mitral valve prolapse, spontaneous pneumothorax from apical blebs, ectopia lentis, joint hypermobility, marfan body type =
protein affected is ________ and is an extracellular glycoprotein that acts as a scaffold for _____
If affected protein was collagen =
Marfan syndrome
fibrillin-1
elastin
Ehlers-Danlos
headaches, visual and muscular symptoms, enlarged temporal artery, elevated ESR =
associated =
production of ______ correlates closely with severity of disease. Treatment with monoclonal antibody _____ is effective
Giant Cell Arteritis (temporal)
polymyalgia rheumatica
IL6
tocilizumab
Substance X causes an increase in serum calcium and URINE phosphate =
receptors found on ________
causes them increase production of ______ and MCSF
also decreases the release of _______, which will increase bone turnover
calcitonin effect is ______ of this
PTH
osteoblasts
RANK-L
OPG
opposite
Achondroplasia is due to a point mutation in ______ which causes exaggerated inhibition of ______
FGFR3
endochondral ossification
cafe-au-lait spots, precocious puberty, hyperthyroidis, mutliple osteolytic appearing lesion of hip and pelvis (fibrous dysplasia) =
Gene =
causes
McCune-Albright Syndrome
GNAS
Persistent activation of Gs/cAMP
during skeletal muscle contraction, calcium is released from the SR and binds _________, thereby allowing the binding of actin to myosin
Troponin C
postural skeletal muscles such as soleus and ______ contain predominantly __________ that derive ATP primarily from oxidative (aerobic) metabolism and have l myoglobin rich, glycogen poor fibers with many mitochondria
paraspinal muscles
Type I
bone mass in adulthood is determined by peak bone mass and the rate of bone loss. __________ women have higher bone density and a lower risk of fractures than other women
African American
acute joint pain, swelling, erythema, restricted ROM, fever =
best evaluated with ________ and should be sent for crystal analysis, cell count, gram stain, and culture
acute synovitis
arthrocentesis and synovial fluid analysis
recurrent skin and mucosal bacterial infections, no pus, poor wound healing, delayed umbilical cord separation, peripheral leukocytosis with neutrophilia =
due to absence of _____
inheritence
often infected with _____ or g(-) rods
Leukocyte adhesion deficiency
CD18
AR
S aureus
knee pain with repetitive or prolonged kneeling =
obesity or overuse knee pain along medial knee =
pain between distal femur and quads, caused by a direct blow or repetitive quadriceps activity like running =
prepatellar bursitis
anserine bursitis
suprapatellar bursitis
episodes of gouty arthritis with increased serum uric acid levels, prophylactic therapy is _________ such as allopurinol or febuxostat
first line therapy during attack =
XO inhibitors
NSAIDs
childhood osteomyelitis =
sickle cell osteomyelitis =
pott disease osteomyelitis
DM, impaired mobility, or recent trauma or surgery osteomyelitis -
S aureus
salmonella
TB
polymicrobial
early muscular dystrophy in distal muscle biopsy
late
true hypertrophy
fibrofatty muscle replacement
polyarthritis, morning stiffness, systemic symptoms, progressive joint pain in the hands that gets better as day goes on =
first line DMAR
can cause oral ulcers, alopecia, pancytopenia, hepatoxicity, and pulmonary fibrosis
RA
methotrexate
_________ such as alendronate and risedronate are the preferred initial treatment of osteoporosis and chemically resemble
bisphosphates
pyrophosphate
gaseous gangrene at a penetrating injury =
usually associated with late onset _______ and transient watery diarrhea with abdominal discomfort
clostridium perfringens
food poisoning
the ______ is anatomic space in teh wrist defined by the carpal bones on the dorsal aspect and the _________ (flexor retinaculum) and can compress the _____ nerve causing carpal tunnel syndrome (1st 3 digits and radial half of 4th)
carpal tunnel
transverse carpal ligament
median
first line treatment for GCA =
glucocorticoids
MG is associated with abnormalities of the _____, which, along with the _______ glands arises from the 3rd pharyngeal pouch
thymus
inferior parathyroid
________ is characterized by stiffness and fusion of axial joints and inflammation at the site on insertion of tendons into bone. Involvement of the ____ and ribs can limit __________, leading to hypoventilation, thus __________ should be monitored closely
Ankylosing spondylitis
thoracic spine
chest wall expansion
chest wall expansion
during wound healing, excessive MMP activity and myofibroblast accumulation in the wound margins can result in _______, most often in the palms, soles, anterior thorax, and at serious burn sites
contracture
inability to exten right wrist and several fingers, history of asthma, high Eosinophils, serum ANA/anti myeloperoxidase + =
mononeuritis multiplex due to
eosinophilic granulomatosis with polyangitis (CHurg Strauss)
involvment of epineural vessels
the ________ originates from the anterior surface of the transverse processes and lateral surface of the vertebral bodies at ________. IV drug users can develop _______ abscess at this muscle and it can seed the L spine
Psoas major
T12-L5
S aureus
foot is everted and dorsiflexed after injury
injury to =
sensory loss on =
tibial nerve, puncture at popliteal fossa
plantar surface of foot
_______ of the hands is characterized by osteophyte formation leading to hard bony enlargement of the ______ (heberden nodes) and __________ (Bouchard nodes) brief morning stiffness may be present and patients are usually older, compared to RA patients who have prolonged morning stiffness, proximal joint involvement, and are younger
Osteoarthritis
DIP
DIP
first line for gout attack =
if patient has PUD =
NSAID
Colchicine
abrupt onset fever, arthralgias, rash, ANA+, after TB therapy =
due to
Drug induced lupus erthematosus
slow liver acetylators
rhomboid shaped crystals, symptoms of gout but in the knee, synovial fluid analysis reveals elevated WBC with neutrophilic predominance =
crystals contain
pseudogout
calcium pyrophosphate
SLE: malar or discoid butterfly rash, gradual symtom onset, joint renal, serosal or neuronal involvement
Labs: anemia, leukopenia, thrombocytopenia
+______, +______ and +_________, increased immune complexes and ____ C3 and C4
Anti CCp+ =
Anti-mitochondrial antibodies + =
HLA B27 + =
ANA
AntidsDNA
Anti Smith
low
RA
primary biliary cirrhosis
seronegative spondyloarthropathies
bisphosphates attach to _______ binding sites on bony surfaces to inhibit __________ by mature ________
hydroxyapatite
bone resportion
osteoclasts
_____ occurs with increased frequency in patients with activating mutations involving phosphoribosyl pyrophosphate synthetase due to increased production and degradation of purines
gout
first line of therapy for gout
they inhibit COX and exert a broad anti-inflammatory effect that includes inhibition of _____
NSAIDs
neutrophils
the quadriceps muscle group is connected to the patella, which is in turn attached to the ________ by the patellar ligament. Repetitive quardriceps contraction can lead to ________ which is characterized by focal pain and swelling at this location
Tibial tuberosity
Osgood schlatter
____ is produced by Th2 cells, it facilitates growth and of cells and Th2 lymphocytes and stimulates the anti body isotype switch to IgE
IL4
________ is a virulence factor found in the peptidoglycan wall of S aureus that binds the Fc portion of IgG, leading to impaired complement activation, opsonization, and phagocytosis
man with pain swelling erythemia in leg after suffering minor cut
Protein A
cellulitis
polycythemia vera plus episodic knee pain, redness, swelling, non compliant with treatments =
synovial fluid contains
due to
gout
needle shaped, (-) birefringent crystals
increased uric acid production from cell turnover
preceding genitourinary infection or enteritis, followed by arthritis
extraarticular symptoms
lab?
reactive arthritis (sterile)
conjunctivitis, urethritis
HLA-B27
older man, bone pain, elevated alkphos is either ______ or _______.
biopsy showing a _____ pattern of lamellar bone is diagnostic for ________. The initial phase of this disorder is characterized by an increase in ______ activity
the second phase is mixed _______-_______ activity
the 3rd phase is the osteosclerotic phase which is _________ and presents with the mosaic pattern and prominent _______
osteoblast metastases or Paget disease of Bone
Mosaic
PDB
Osteoclast
osteoclastic-osteoblastic
Osteoblast dominant
cement lines
subcutaneous mycosis with no relevant history
fungus =
from =
sporotrichosis
Sprothrix Schenckii
thorn prick
use of a monoclonal antibody (infliximab) or venom antitoxins followed by joint pain and pruritic skin rash with fibrinoid necrosis and neutrophil infiltration =
type of reaction
other lab
serum sickness
Type III HS
low C3/C4 due to deposition of circulating immune complexes
bone specific alkphos reflects
tartrate resistent acid phosphatase, urinary hydroxyproline, and urinary doxypyridinoline reflect
osteblastic activity
osteoclastic activity
Na+ and Cl- are located
K+ is located
Calcium is located
extracellular
intracellular
extracellular
nausea, abdominal pain, and diarrhea, being treated for gout, side effects of =
affects =
colchicine
cytoskeleton
flat topped, violaceous papules over the joints of teh fingers, heliotrope rash characteristic for______ especially in the presence of proximal muscle weakness and elevated muscle enzymes
Antibody
papules called
dermatomyositis
Anti-Jo-1
Gottron papules
________ muscle assists in abduction of the arm and stabilization of the GH joint. The tendon is vulnerable to injury due to impingement between the acromion and the head of the humerus. Most common cause of rotator cuff syndrome
Supraspinatus
intubated, skeletal muscle relaxant given, arrhythmia develops and serum potassium is really high, drug used =
hyperkalemia most likely in
can also cause
succinylcholine
burns, myopathies, crush injuries, denervating injuries/disease
malignant hyperthermia
variable clinical expressions in affected family members can occur due to _______, which is the coexistence of distinct versions of mitochondrial genomes in an individual cell
lactic acidosis and ragged skeletal muscle fibers indicate
________ inherited
hereoplasmy
mitochondrial myopathy
maternally
SERMs used for decreasing the risk of bone fractures and breast cancer =
Raloxifene
+ Lachman or anterior drawer
Anterior cruciate ligament
GCA is characterized by ______ of the media
granulomatous inflammation
anticonvulsants, aromatase inhibitors, medroxyprogesterone, GnRH agonists, proton pump inhibitors, glucocorticoids, unfractionated heparin, thiazolidinediones all increase risk of
osteoporotic fractures
sickle cell disease, young, left hip and pelvic pain, no fever, decreased rotation, extension, abduction =
due to
also caused by
avascular necrosis
thrombotic/embolic occlusion from sickle cell or decompression sickness
glucocorticoids
XO catalyzes 1 of 2 major ___________inactivating pathways. Allopurinol competitvely inhibits _____, which results in increased conversion of this substance to its active metabolite
azathioprine
XO
minor trauma, erythema overlying skin, swelling and edema pain out of proportion to examination findings =
due to =
if coagulase positive and catalase positive
other bacteria involved
treatment
necrotizing fasciitis
strep pyogenes (group A), PYR positive
S aureus
clostridium perfringens
surgical debridement
frontal bossing, femoral and tibial bowing, softened skull bones, immigrants from heavily sun exposed area to less sun exposed, infant =
due to =
Rickets
insufficient Vitamin D and excess unmineralized osteoid matrix
fever and facial rash in child, acute symmetric arthropathy in parent looks like RA but negative labs =
characteristics
parvovirus B19
ssDNA virus
_____________ is a leukocytoclastic vasculitis following ______, cephalosporin, sulfonamides, phenytoin, and allopurinol use. The rash is nonblanching, palpable purpura on the lower extremities and consists primarily of
Cutaneous small vessel vasculitis
penicillins
neutrophils
the _____ band is the region of the sarcomere that contains only thick myosin filaments, while the _____ band contains only thin actin filaments. The ___ band contains an area where they overlap
H band
I band
A band
inability to externally rotate the shoulder after traumatic injury to it from behind
infraspinatus injury
peroneal nerve damage due to fracture of the neck of the fibula results in loss of ______ sensation and _______
dorsal foot
foot drop
trendelenburg indicates weakness in glute med on _____ side of hip drop. Can be due to injection in the _____ part of the buttock, risking injury to the _____ nerve. If injections are given in the ______ or _______ regions, the sciatic nerve is at risk
opposite
supermedial
superior gluteal
inferolateral
inferomedial
symmetrical proximal muscle weakness, increased difficulty climbing stairs, getting up from chair, carrying heavy objects =
elevated ______ enzmes, antibody
_______mononuclear infiltrate of ________ with patchy necrosis and increased expression of MHC I
polymyositis
muscle enzymes, Anti Jo-1
endomysial, CD8+
patellar fracture due to direct impact on the anterior aspect of the, patients will have inability to _______
extend knee against gravity
clubbing of the digits due to lung diseases like _______
bronchiectasis
thin acting filaments are bound to structural proteins at the _______, whereas thick myosin filaments are bound to structural proteins at the
Z line
M line
anterior lateral displacement of the humerus in a supracondylar humeral fracture, most likely to be injured
superficial supracondylar fracture
posterior displacement of proximal humerus (falling on flexed elbow)
anterior medial displacement =
Radial nerve
basilic vein
ulnar nerve
median nerve
the most common elbow injury in children, sudden traction on the outstretched and pronated arm of a child, distressing to try to move the elbow =
also called =
ligament damaged
radial head subluxation
nursemaids elbow
annular ligament
patients with SLE can have autoantibodies directed against _______, which remove introns from RNA transcripts
snRNPs (anti-Smith)
Low estrogen states cause osteoporosis by decreasing osteoprotegerin production, increasing ______ production, and increasing RANK expression in osteoclast precursors, leading to increased __________
RANK-L
bone resorption
young adult african american with cough, dyspnea, bilateral hilar adenopathy with noncaseating granulomas =
present with _________ that is caused by parathyroid hormone independent formation of 1,25dihydroxyvitamin D by _________, which leads to increased intestinal absorption of calcium
sarcoidosis
hypercalcemia
activated macrophages
T tubules are extension of the ______ and ensure coordinated ________ of all myofibrils. No T tubules leads to ________
sarcolemma
contraction
uncoordinated contraction
the resting membrane potential is due to a high ______ efflux and some _________ influx
Potassium
sodium
blue sclera, history of severall fractures after minimal trauma, suggests :
due to a deficiency in
inheritence
primary impariment
osteogenesis imperfecta
collage type I
AD
bone matrix formation
proximal muscle weakness, cranial nerve involvement, autonomic symptoms, mass in the upper lung lobes
Lambert Eaton Myasthenic Syndrome
older, LE pain, numbness, paresthesia, weakness, worse standing or walking upright, relieved by walking uphill, leaning on a stroller/shopping cart (lumbar flexion) =
due to hypertrophy of
lumbar spinal stenosis
ligamentum flavum
radial nerve injury on the lateral side of the arm, cant extend wrist, artery also injured that runs with it?
deep brachial (profunda brachii)
small joints, cervical spine subluxation, prolonged morning stiffness and assoicated fatigue =
antibodies
RA
Anti-CCP (cyclic, citrullinated peptide)
pathologic _____ can be caused by decreased physical workload, loss of innervation, decreased blood supply, inadequate nutrition, absent endocrine stimulation, aging, or mechanical pressure
atrophy
selective COX2 inhibitors such as _______ relieve pain with a lower risk of bleeding and ______ than NSAIDs
celecoxib
gastric ulceration
__________ of the humerus classically follow a blow to an externally rotated and abducted arm. There is typically a flattening of the deltoid muscle and insensitivity to overlying skin to pinprick. This is due to damage to the -________ nerve, which innervates the deltoid and tere minor muscles along with skin over the lateral shoulder
Anterior dislocation
axillary
vertebral fracture from sitting down in hard chair in a patient with RA, due to
chronic glucocorticoid use promoting osteoporosis
young man dull back pain, limited anterior spinal flexion, no swelling, narrowing of SI joints, bamboo spine =
strongly associated with
ankylosing spondylitis
CLASS I HLA B27
aspiring professional athlete with nodular and comedonal acne in 20s =
anabolic steroid abuse
the Valsalva maneuver increased _____ tone and can be used to abolish _______. The most important muscle in achieving the increased intraabdominal and intrathoracic pressure is the _______
vagal
PSVT
rectus abdominis
fall on outstretched hand, fracture in the anatomical snuffbox, highest risk for __________ of the ________ bone
avascular necrosis
scaphoid
during skeletal muscle contraction cycle, ATP binding to myosin causes the __________________
without ATP, a muscle will be fixed in a _________ state called ________
release of myosin head from its binding site on actin filament
contracted
rigor mortis
patients with GCA require immediate glucocorticoid therapy to prevent
ischemic optic neuropathy
patient presents with monoarticular arthritis with effusion, decreased ROM, synovial fluid Leukocyte count of >100,000 =
if no trauma, most likely due to
requires
septic arthritis
gonococcus infection
antibiotic treatment
______, also known as alpha toxin, is the main toin produced by ___________. It function to degrade lecithin, a component of phospholipid memebranes
gas gangrene
lecithinase
Clostridium perfringens
lateral ankle sprain due to inversion of a plantar flexed foot most commonly involves ______
anterior talofibular ligament
ligament at the anterior part of the lateral aspect of the medial femoral epicondyle
PCL
dorsal aspect of hand, carpals from thumb to pinky
top row
bottom row
more medial bone that articulates with the radius
more lateral
trapezium, trapezoid, capitate, hamate
scaphoid, lunate, triquetrum
lunate
scaphoid
Osteoporosis due to trabecular _______ with _____ interconnections
thinning
fewer
UE numbness, weakness, tingling in a young pitcher, symptoms worsen with overhead actvities
due to copmression at
Thoracic outlet syndrome
scalene muscles
young adult with episodic renal, nervous,bloody GI, and myositis/arthritis, transmural inflammation with fibrinoid necrosis, ANA negative =
associated with
Polyarteritis nodosa
Hep B
______ passes through the greater sciatic foramen and is involved with external hip rotation. Patients with _______ due to muscle injury or hypertrophy compressing the sciatic nerve present with persistent pain in the right buttock and posterior thigh
piriformis
piriformis syndrome
a _______ abscess can occur as a result of seeding from a distant or adjacent site. Patients can present with fever, back or flank pain, inguinal mass, difficulty walking. Inflammation of the muscle causes pain when the _____ is extended
psoas
hip
MG is due to _____________ against skeletal myocyte surface ______. ________ similarly involves autoantibodies against ________ in the renal glomeruli and lung alveoli
IgG autoantibodies
acetylcholine receptors
Goodpasture Syndrome
BM collagen
vertebral osteomyelitis should be suspected in patients with worsening back pain, fever, recent endocarditis or bacteremia (especially S aureus). Also suspected if new neuro findings and fever without back pain. ______ of the spine is the preferred diagnosis
MRI
in patients with primary osteoporosis not caused by a medical disorder, serum calcium, phosphorus, and PTH are all
normal
the most commonly fractured bone in young children is
the _____ muscle causes superior displacement of teh medial fragment, while the weight of the arm and pec mjaor cause inferior displacement of the lateral fragment
clavicle
SCM
mab =
cept =
nib =
monoclonal antibody
receptor molecule decoy
kinase inhibitor
Rheumatoid factor is an IgM antibody specific for
anticentromere antibodies =
antiphospholipid antibodies =
Fc component of IgG
CREST syndrome
SLE, antiphospholipid antibody syndrome (hypercoaguable state with paradoxical PTT prolong)
________ edema factor is adenylate cyclase that causes massive increases in intracellular cAMP, leading to neutrophil and macrophage dysfxn. The mechanism of action is similar to that of adenylate cyclase toxin produced by
bacillus anthracis
bordetella perstussis
the ______ system monitors and maintains muscle length, while the ________ is a system that monitors and maintains muscle force and is exquisitely sensitive to increases in muscle tension
muscle spindle
Golgi Tendon Organ
the __________ is innervated by the thoracodorsal nerve and functions to extend, adduct, and medially (internally) rotate the humerus
Latissimus dorsi
widespread MSK pain, fatigue, impaired attention/concentration, psychiatric disturbances, symptoms for >3months, no joint or muscle inflammation, normal ESR and CRP, multiple tenderpoints
fibromyalgia
joint pain and swelling, facial palsy history, hiking trip to northeast US, early flu like symptoms, erythema chornicum migrans =
vector
treatment
Borrelia burgdorferi: lyme disease
ixodes tick
doxycycline or penicillin type abx (ceftriaxone)
calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasias
female, nonpitting edema of hands, fingers turn blue in cold, retrosternal burning and regurg when supine
antibody
CREST
Anti centromere
lateral epicondylitis (____elbow) is caused by oversuse of the extensor carpi radialis brevis and is characterized by angifibroblastic tendinosis at is origin on the lateral epicondyle
involves
tennis
wrist extension
________ can be injured at the medial epicondyle of the humerus (funny bone) or in Guyons canal near the ________. Patients often have sensory loss over the 5th digit and hypothenar eminence and weakness with wrist flexion adduction, finger abd/add, and flexion of the 4th/5th digits. The _______ may flatten due to muscle atrophy
ulnar nerve
hook of the hamate and pisiform bone in the wrist
hypothenar eminence
migratory arthritis, high fever, new holosystolic murmur, ASO titer positive in a 12 yr old girl =
great risk of dying from
years or decades later =
Acute rheumatic fever
severe pancarditis
mitral stenosis
anti jo antibodies in polymyositis are direct against
anti-histidyl tRNA synthetase
impaired abduction of the shoulder past horizontal, right upper limb weakness and fatigue, winging of scapula on resisted abduction =
woman, most likely hospitalized for
long thoracic nerve injury
mastectomy with axillary lymph node removal
sustained in repetitive muscle contractions =
due to impaired function of the
most common types are _____, blepharospasm, and writers cramp
dystonia
basal ganglia
cervical spasmodic torticollis
older man, right tibial pain with increasing intensity, progressive hearing impairment, numerous multinucleated cells on biopsy =
essential for differention of these cells =
Paget disease of bone
RANKL
_______ inhibitors like Etanercept impair cell mediated immunity. All patients beginning treatment with these drugs should be evaluated for latent
TNF-a
TB
the _________ and its branches provide the majority of the blood supply to the femoral head. Injury to these vessels due to a displaced femoral neck fracture can cause __________ of the femoral head
medial femoral circumflex artery
osteonecrosis
the _____ resists force that pushes the knee medially. increased laxity of the knee with valgus stress test indicates injury to this
Medial collateral ligament
lesions of the femoral nerve can occur due to trauma, compression via hematoma, stretch injury or ischemia. Patients develop weakness of the quadriceps muscles, loss of patellar refelex, and loss of sensation over
anterior and medial thigh and medial leg
response to DMARDs may take several weeks, while NSAIDs and _________ can provide rapid symptom relief in the interim
glucocorticoids
