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UWorld Musculoskeletal Flashcards

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USMLE® Step 1 flashcards
1
Q

Baby w/ poorly developed lumbar and sacrum. Due to?

A

Caudal regression syndrome - agenesis of sacrum/sometimes lumbar sine - resultant flaccid paralysis of legs, dorsiflexed contractures of feet, urinary incontenence. Can range from isolated anal atresia to sirenomelia. Frequently related to POORY CONTROLLED MATERNAL DIABETES. More commonly -transposition of the greate vessels.

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2
Q

Vit A overdose in mom cuases -> baby

A

Craniofacial abnormalitiesPosterior fossa CNS defectsAuditor defectsAbnormalities of Great Vessels.Defects ismilar to DiGeorge.

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3
Q

Osteoblasts trapped in bony matrix are called…How are these cells attached to each other?

A

Osteoblasts -> Osteocytes.Attached via gap junction All connected this way in order to exchange nutrients and waste products w osteocyte in neighboring lamellae - also can sense mechanical stress and send signals to module the activity of surace osteoblasts - regulate body remodeling.

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4
Q

Disproportionately short arms and legs - what is this? What is the defect? Is there inheritance?

A

Achondroplasia.Constitutively activating fibroblast growth factor recpetor 3 - which since always on is inhibitory. AD if inheirted.Majority of cases are sporadic utation though.Must be heterozygous, as homozygous achondroplasia -> death before/right after birthFully penetrant gnetic disorder.

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5
Q

Depression require what for diagnosis? What if its subacute?

A

MDD requires 5 or more out of 9 signs (SIGECAPS + Depressed mood) for at least 2 weeks. If less than this, and for 2 YEARS, then Dysthymic disorder(at least 2 of the following)Poor appetite or overeatingInsomnia, hypersomniaLow wnergy/fatigueLow self-esteemPoor conscentrating/difficlty making decisionsFeelins of hopelessness

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6
Q

Widening mediastium w/ medusa head colonies on standard media

A

Pulmonary anthraxAlso can see chest pain and hemoptysis

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7
Q

Major hip flexors?What assists in lateral flexion of the vertebral column?What does the obturator externus do?

A

Iliacus and psoasDefect can be seen w/ psoas abscess - fever, back/flank pain, inguinal mass, difficulty walking.Pain Exacerbated when psoas stretched (such as extension of the hip). Lateral flexion - quadratus lumborumObturator externus externally rotates the thigh (runs from obturator frramen of pelvis to trochanteric fossa of femur)

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8
Q

Mutation in Marfans? Ehlers Danlos?

A

Marfans - fibrillin/elastin (fibrillin is major component of microfibrils that form a sheath around elastin fibers) . FIbrillin common in lens, periosteum, aortic mediaEhlers Danlos - collagen (T3 - vasclar, T4 - classic stretchy skin

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9
Q

Best treatment for long term management of gout?Acute gout? What are special considerations?

A

Long Term - Gout - xanthine oxidase inhibitorsNSAIDS used for acute gout - be warry of chronic in elerdly due to GI bleeding, renal failure, Uricosuric drugs - avoid in pt w/ POOR RENAL FUNCTION - should be avoided to prevent uric acid neprholithiasis in pt who excrete LARGE amounts. Or who have impaired kidney function

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10
Q

Describe collagen formation.

A
  1. Hydroxylation of proline and lysine (Vit C dependent) on pro-a-chain2. Glycosylation o lysine residues on pro-a-chain. Prolyl hydorxylase, lysyl hydroxylase (vit C - within RER)3. Pro-a-chain assembly (INTRACELLULARL) into PROCALLAGEN TRIPLE HELIX.4. Procollagen is excreted.5. Extracellular Terminal propeptide (DISULFIDE BOND RICH) are cleaved by N and C PROCOLLAGEN PEPTIDASES.6. Collagen covalently cross linked by lysyl oxidase.
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11
Q

Hematogenous osteomyelitis - who does it usu affect? Where does it affect? WHy?

A

Usu young children. Esp boys.Usu affects METAPHYSISI of long bones - due to slow flowing vasculature that is conducive to microbial passage. Adults less likely to devo hematogenous osteomyelitis in long bones due to epiphysial closure.

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12
Q

Negative birefringent cryastals?Positive birefringent crystals?PT treated for negative birefrignent develos nausea vominting diarrhea - what was he given? Mech?

A

Negative - Gout (Monosodium urate)Positive - calcium pyrophyosphate crystals. Given colchicine - microtubule formation blocker. Impaired leukocyte chemotaxis and degranulation. Reduces inflam of gout. DIARRHEA IS VERY COMMON due to GI mucosa damage.

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13
Q

How to describe histo of:Rickets/OsteomalaciaOsteoporosisOsteopetrosis Hyperparathyroidism,Pagets

A

Osteomalacia - osteoid matrix accumulation aroudn trabeculaeOsteoporosis - trabecular thinning w/ few inreconnectionsOsteopetrosis - persistence of primary unmineralized spongiosa in medullary cannals. Thick dense bones. Hyperparthyroidism - periosteal resorption w/ cystic degeneration (osteitis fibrosa cystia)Pagets - Lamellera bone remambling a MOSAIC (of woven and lamellar bone) Haphazardous collagen laying down.

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14
Q

Brown teeth stains in baby -what was given to mom?

A

Tetracycline. Can be yellow, gray, bronw blue,

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15
Q

What does a train of 4 look like a depolarizing and nonpolarizing NMJ blocker? Give examples.

A

Depolarizing - Succinylcholine (ACh R agonist)(depol - phase 1) Appears blunted, flat across the top - (phase 2) - train of four response DEC as there is little ACh avialability that runs out.Nondepolarizing - turbocurarine - (ACh r antagonist) - has the same phase 2 DEC train of four response.

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16
Q

Prominent cement lines - mosaic pattern of lamellar bones think?INC risk for what?

A

Pagets.OsteosarcomaHigh output HFALSO YOU CAN SEE LARGE MULTINUCLEATED OSTEOCLASTS (UP TO 100! - normally have 2-5 nuclei) -

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17
Q

Penetrance vs Expressivity?

A

Penetrance - how many people show signs.Expressivity - What those signs are .

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18
Q

Different expressivitiy in pt w/ mitochondrial myopathy can be due to?

A

Heteroplasmy

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19
Q

SERM - selective estrogen receptor modulator.Name oneName what it INC estrogen activity in and DEc estrogen acitivity in

A

SERM - RaloxifeneEstrogen agonists in bone, cardiovascular, and blood/lipoproteinsDEC activity in breast and uterusAlendronate is a bisphosphonate analogue - dues NOT protect agaisnt CA.

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20
Q

What is Finasteride and its mech

A

Inhibitor of 5a reductase - prevents conversion of T to DHT. (antiandrogen)

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21
Q

Osteoclasts differentiate from what? What are 2 important factors for osteoclast differentiation? What produces these 2 factors?

A

Monocytes/macrophage lineage.2 factors are macrophage colony stim factor (M-CSF) - and RANKLBOTH OF TEHSE ARE PRODUCED BY OSTEOBLASTS.

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22
Q

Which musculoskeleton disease is CD8 mediated dmgCD4?

A

CD8 - polymyositis (endomysial)Dermatomyositis - CD4 (perimysial)Both have INC Ck, ANA, Anti-Jo, Anti-SRP, Anti-Mi2Tx both w/ steroids

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23
Q

How to treat Lyme?

A

Ceftriaxone, Doxycycline

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24
Q

Describe findings of Reiters (Reactive arthritis)What are the common 5 bugs? What are assoc side effects?

A

Conjunctivitis, urethritis, arthritisPost - GI effect!Shigella, Salmonella, Yersinia, CampylobacterPLUSSSSSSS CHLAMYDIAGonorrhea is called Infectious arthritis (S. aureus, Streptococcus, N. gonorhea)Sacroiliitis may occuer in 20% of Reactive Arthritis

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25
Q

B27 associations?

A

psoriasisankylosing spondylitisIBDReiters syndrome

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26
Q

Presentation of Avascular Necrosis of femoral head? What are 3 common things to trigger avascular necrosis? Es pof femoral head?

A

Groin pain that is excerbated w/ weight bear - painful/restricted passive/active moemvent - with NO SWELLING ERYTHEMA, TEMP CHANGES. MRI is most sensitive in diagnosis. SIckle cell - thrombotic occlusionsVasculitis/vessle injury - SLEHigh dose Steroid therapy. Also ALCOHOLISM - unknown mech.

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27
Q

What is LEMS assoiated w/?

A

Small cell Lung CA (50%)(presynaptic voltage gated Ca that participate in release of ACh) Dry mouthImpotenceDiffernet in LEMS and Myasthenia is thatLEMS has autonomic symptoms, HYPO/AREFLEXIA, and better response w/ repetitive stim.

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28
Q

How to differnetiaton polymyalgia rheumatic from Fibromyalgia?

A

Easiest way is AGE.PMR - assoc w/ Temporal artierits (older pt)PRM is seen in pt Older than 50INC ESR

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29
Q

Differnetiate PMR, Fibromyalgia, Polymyositis, Dermatomyositis

A

PMR, Fibromyalgia is pain without muscular weaknessPolymyositis and Dermtomyositis have muscle weakness. These 2 also have CD8, and CD4 response, respectively.

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30
Q

Most common cause of ostemyeltiits in a young kid?What are common findings?

A

Staph A - hematogenous seeding during episode of bacteremia Often see bone necrosis, periosteal disruption, swelling of surrounding soft tissue.

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31
Q

Absence of T tubule in some sarcolemma of muscles would lead to?

A

Uncordinated contractions.

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32
Q

Body distribution wise, where do you see t1 and wher do you see type 2?

A

Type 1 - slow - seen in postural musclesType 2 - seen in lats, pecs, biceps, deltoids, etc

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33
Q

Treatment for sporothrix schenckii?

A

Itraconazole, Potassium Iodide

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34
Q

Serum sicknes presntationHisto of vessels?Plasma content changes?

A

Fever, urticaria, arthrlagias, glomeruloneprhtiis, LNA activates complement -> low serum C3 levels. And thus may see vessel fibrinoid necrosis + N! infiltration into walls Can be triggered by sulfonamides, allopurinal, penicillins, fungal drugs, procainimide, quinidine, ibuprofen, rituximab - list goes on.

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35
Q

Gingival bleeding, echymoses, in person with tea and cracker diet? What other findings?3 Common populations to see this in?

A

Scurvy - common in alcoholics, poor, elderly.Also see periforllicular hemorrhages and coiled (corkscrew hairs)

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36
Q

Where does prolyl hydroxtlase and lysyl hydroxylase occur?

A

Both occur in the RER. Tricle helix made intracellualrly. Once procollagen (lots of disulfide bonds) is made, extracellular snipping of the ends (procollagen peptidase) - These colalgen fibrisl are then crosslinked by extracellular LYSYL OXIDASE)

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37
Q

Risk factors for osteoporosis?

A

SMOKINGALCOHOL USE. MenopauseCorticosteroid therapyPhysical inactivityWHITE (Blacks have LOWER RATES)Low body weight

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38
Q

Which pouch is the thymus derived from? What else is derived from tehre?Where is the thyroid derived from?

A

Thmuys and inferior parathyroid are both from 3rd pouch. (CN 9 - glossopharyngeal) Interestingly, superior parathyroid are from 4th pouch. Palatine tonsisl from 2nd pouch. Floor of foregut. Thyroid diverticulum migrates down the neck but remains attached to the floor of the mouth by the thyroglossal duct.

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39
Q

Before tx w/ Etanercept, Infliximab, adalimumab - must first?!

A

Screen for latent TB - PPD test.

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40
Q

What are associated concerns w/ ankylosing sponylitis specifically (dont give me the PAIR)

A

Enthesopathies - finalm at site of tendon insertiosn - involve costovertebral/costosternal junctions - limit chest movmenets - resutl in hypoventilation - be sure to monitor chest expansion.Cardiac - ascending aortitis - dilatation of aortic ring and aortic insufficiency.Eeye - anterior uveitis in 20-30$ of pt. blurred vision.

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41
Q

What is a secondary effect of Ca being rleased form the SR during muscle contraction

A

Primary - troponin C binding and shiftin gof tropomyosinSecondary - INC activity of phosphorylase kinase - which allows for faster glycogen pbreakdown. Initial glycogen -> glyocgen phosphorylase -> Phosphorylase Kinase. Phosphorylase Kinase is responsible for phosphorylation of glycogen phosphorylase.

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42
Q

High synovial fluid WBC 100,000/microL and absence of crystals is? What to do?

A

Suspect septic arthritis . Tx w/ cefriaxone .Gonococcal.

43
Q

What do the following treat?CIprofloxacinCeftriaxoneAzithromycinVancomysinPip Tazo

A

Ciprofloxin - first gen fluoroquinolone - active agasint GN rods and bacilli including Legionella and Pseudomonas. POOR AGAINST ANAEROBESCeftriaxone - 3rd gene cephalosporin - GN bacilli and most enteric organisms: Neisseria, Klebsiella, H flu. POOR AGAINST ANAEROBES.Azithromycin - Macrolide - Chlamydia, Mycoplasm, H flu, MroaxellaVANC - inhibits peptidoglycna synth - big, cant do GN. Used for MRSA, MRSE (epidermitis), C DiffPip Tazo - GP and GN and ANAEROBIC BACTERIA! Esp against B lactamase ones. Tazo is B lactamase inhibitor.

44
Q

Hypotonia, Jaundice, Hoarse Cry, Poor Feeding, Macroglossia, Coarse facial features, Umbilical hernia? What else are they at risk for?Who else may have macroglossia?

A

Hypothyroidism.ASD, VSD, irreversible mental retardation (T4 needded for brain devo) if too late. If you SCREEN EARLY, can prevent MR. BY LAW - babies screened for hypothyroidism, PKU, galactosemiaDOwns may also have macroglossia.

45
Q

First line for severe rheumatoid arthritis?Mech?Side effects?

A

Methotrexate. DHF inhibitor, cytotoxic to lymphocytes. Sid eeffects - painful mouth ulcerse, hepatotoxic, Supplement w/ folic acid

46
Q

Seronegative spondylarthropathies - what do you see on joint aspiration?

A

Joint aspirations are sterile!Hence called REACTIVE arthritis, Not INFECTIOUS (S aureus, Streptococcus, Neisseria gonorrhea)HLA B27+ - MHC class 1!

47
Q

How do osteoclasts become osteoclasts?

A

OSTEOBLASTS produce RANK ligand AND M-CSF. Both of these stim monocytes to become multinucleated OSTEOCLASTS. Therefore, Osteoclasts have RANK RECEPTORS. Osteoblasts also secrete aa protein called OSTEOPROTEGERIN (OPG), which is a decoy receptor for RANK-L. In essense, osteoblasts INDUCE osteoclasts (RANKL) and can DEC osteoclast formation (OPG) RANK-L and OPG are competitiors. Osteoclasts DO NOT HAVE PTH receptors. PTH stimulates Osteoblasts to secrete RANK-L and M-CSF. IN ESSENSE IT ALWAYS STARTS W/ OSTEOBLASTS!!!!

48
Q

Bilateral retinal hemorrhages and subdural hematoma in infant. think?

A

Shaken baby syndrome

49
Q

Radial head subluxation (nursemaids elbow). What ligament is displaced?Tx?

A

Annular ligament displacement. A ligament connecting the radius to the ulna. transverse of long bones. Tx - fully supinate, then flex at elbow.

50
Q

Reflexs?BcepsTricepsPatellaAchilles

A

S1,2, - buckle my shoe (achilles)L3,4, - kick the door (patellar)C5,6, pick up sticks - biceps)C7,8 lay em straight (Tricepts)L1,2, - Testicles moveS3,4, winks galoreBiceps C5Triceps C7Patella L4Achilles S1

51
Q

Damage w/ impaired biceps, weak forearm flexion. Lateral forearm sensation loss. What is this?

A

C5-7. - MUSCULOCUTANEOUS.Muscles + sensation!

52
Q

When do you get ecthyma gangrenosum?

A

Neutropenic/immunosuppressed pt w/ bacteiral Pseudomonas sepsis.

53
Q

What drugs undergo liver..Acetylation?Sulfate ConjugationHydroxylationHydrolysis?

A

Acetylation - phase 2- hydralazine, procainamide (SLE)Sulfate conjugation phase 2 - (chloramphenical + phenolHydroxlation (P450) - phenobarbitalHydrolysis - phase 1 - Aspirin, Prociane, lidocaine

54
Q

Arthrlagia, brown spots on sclerae and darkening ears?

A

Homogentisic acid oxidase def - Alkaptouria - urine turns black!

55
Q

Foot drop. Think?

A

Common peroneal nerve injury - often can be due to compression or bondy fracture. As it traces the lateral aspect of fibular neck.

56
Q

What i a positive Trendelenburg test?

A

Hip drops to the contralateral side of injury.Dmg to SUperior gluteal nerve, which innervate mediis and minimous. These muscels are not ablet o constrist the hit down, so the icontralateral side overpowers and dips down.

57
Q

Prominence of Inferior scapular angle. Unable to abduct arm past horizontal. What is this? Common cause?

A

This is winging of scapula. Often due to mastectomy. Damge to the long thorac nerve which innervates the serratus anterior.

58
Q

What are the role of snRNPs?

A

Removal of inrons from RNA transcrips - small nuclear ribosomal proteins. Formsplicesome.

59
Q

Clostridium perfringens - what is severe and less severe presentation?

A

Severe - gas gangreneLess severe - transient watery diarrhea - gastroenteritis from toxin w/ spore ingestion. Dleayed onset due to the spores have to create the toxin.Opposite of preformed S aureus and B cereus toxins. AKAK C. PERFRINGENS - LATE ONSET FOOD POISONING AND CLOSTRIDIAL MYONECROSIS (GAS GANGRENE)

60
Q

Diffuse pruritic papulopusutlar rash? Produces Pigment. Bacteria and source?

A

Hot tub folliculitis. Pseudomonas. Source is water. Pseudomonas is water. “produce PIGMENT

61
Q

What is damaged in anterior motion of tibia? Posterior?

A

ACL dmged in anterior motionPCL damaged in posterior motion. AKA ACL testsed in anterior drawer. PCL tested in posterior drawer.

62
Q

Bisphosphontes are strucutrla analgoues to?

A

Pyrophosphate - a compoenent of hydroxapatite.BIsphosphonates DEC bone resorption by inerrfering w/ osteoclasts.

63
Q

What is an easy way to abolish paroxysmal supraventricular tachycardia?

A

Valsalva - INC ab pressure - INC vagal tone and INC refractory period of AV node. If this fails, IV Adenosine

64
Q

TOp 3 cuase of osteomyelitis in sickle cell pt?

A

Salmonella, Ecoli, Stap h A(Staph A is number 1 cuase in healthy audlts and kids)

65
Q

What are beta hemolytic? What does this mean?Alpha hemolytic?

A

B hemolytic - total clearingStaph A, Strep pyogenens, agalactiae (GBS), ListeriaAlpha - green partial clearingStrep pneumo, VIridans

66
Q

3 most common causes of Nec Fasc?

A

Strep pyogenses, Staph A, Clostridium PerfringensOnlyStpre pyogenes (GAS) is Pyrrolidonyl arylamidase (PYR) positive. Alos bacitracin sensitive (which has PYR test)

67
Q

What are the basic receptor pathways? HAV1MM3B1B2,D1,H2,VsM2,A2,D2

A

Phospholipase c -> PIP2, IP3 (Ca) + DAG (Protein inase CGs.Gi -> Adenylyl cyclase, ATP->CAMP Protein A -> CaKnow that C is on top of A!

68
Q

What ist he most specific test for Rheumatoid arthritis?

A

Anti-cyclic citrullinated peptide Ab (CCP)

69
Q

Repeated kneeling (housemaids knee) - dmgs what?

A

Prepatellear bursa.Prolonged kneeling not assoc w/ suprapatellar, poplitieal, or gastrocneumius burasae.Bakers cyst -> popliteal, gastrocnemiusAnserine burisits (pes anserinus bursitis) - pain along medial knee - usu heavy athletes.

70
Q

1 year old black kid with swelling in hands and feet

A

SIcke cell - dactylitis - because they still have hematopoeitic stem cell in bones etc. Vasoocclusive! - Get hemolysisi, DEC haptoglobin levels during intravascular hemolysis - complex is hepatically cleared (biriubin etc) Haptoglobin binds free Hb to preven its renal excretion.

71
Q

Adult pt w/ arthritis of hands and major joints. THeir kid has fever + rash on face a few days later. What is this?

A

Parvovirus.

72
Q

Transmissino of osteogenesis imperfecta?

A

AD inheritance. Also Marfans is AD.EHlers can be either AD or AR. Usu AD.

73
Q

“knee buckling” difficulty climbing stairs , hyporeflexic at knee. What ther deificit?

A

Femoral nerve injury - loss of sensation to anterior aspect of right thigh

74
Q

V/Q scan during MI? During PE?

A

MI - Matched defect of V/QPE - mismatched V/Q defect (w/ perfusion effected more)

75
Q

Most common carpal bone fraction? Location on wrist?

A

Scaphoid - from falling onto outstretche dhands - its lcoated in snuffbox - avascular necorsis.. Right at radial aspect of hand. Blood supply to the proximal pole proceeds in retrograde manner - may be easily interrupted by fracture. At risk for avascular necorsis and NONUNION.

76
Q

muscle relaxant -> cardiac arrest, v fib, hyperkalemia. Wht is this what is it caused by?

A

Succinylcholine - HALIGNANT HYPERTHERMIA DONT NECESSARILY NEED TO SAY MYOCLONUS ETC. Also happens w/ halothane and other volaties. Not NO)ARRHYTHMIAS AND HYPERKALEMIA IS COMMON W/ CRUSH, BURN, MALIGNANT HYPERTHERMIA. dEiNERVATING (guillain barre, quadriplegia), myOPTHIES. dUE TO RHABDO.

77
Q

Whta is baclofen?

A

Muscle relaxant -a ffects GABAb at level of spinal cord.

78
Q

What medicaltion would inhibit platelet aggregation and directly dilate arteires?

A

CIlostazol, dipyridamole - Block PDE - INC cAMP -> vasodilation.

79
Q

Polymyositis presentation? Possibly mech of polymyositis?

A

Get weakness in Polymyositis and Dermatomyositis. No weakness in PMR and FM. Mech - immune mediate inflam possible triggered by viral antigens - Myocites INC expresion of MHC protein -> recognized by CD8 cells that initate muscle dsruction. THus see inflam, necrosis, regen and fibrosis on muscle biopsy. Also endomysium infiltration by macrophages.Dermatomyositis is CD4, and perimysial - it;s more hands off. See INC CK and anti-Jo1 for both. Plymyositis INc risk fo malignancy in general.

80
Q

What does gluteus medius gate look like?Where should you inject to block this muscle/nerve?Where would injection cause damage to this muscle nerve?

A

Hip dips downwards when ipsilateral foot lifted. (also contralateral hip dips down. DUe to dmg to superior glutean nerve/gluteusm edius iteslf. Nerves (superior gluteal and sciatic) are on the MEDIAL side - duh comes off of backbone.One should inject to the Superolateral quadrant for safetly.Injection to superior medial can cuase damage to nerves. Inferolateral does not have nerves but is the site of many tendinous insertions.

81
Q

Describe reaction formation? Displacement?

A

Rx formation - Immature defense where unacceptable feels are ignored and OPPOSITE sentiment is adopted.Man who is angry of wife but compliments her dress - REACTION FORMATION. Displacement - also immature - redicrects netagive emotiosn to a more acceptable, but still inappropriate person/object.

82
Q

First line for acute gouty arhtritis?

A

NSAIDS> Avoid in renal and hepatic dysfunction. Generaly avoided in elderly pt. COlchicine is scond line due to side effect sof nausea nad diarrhea. Steroids if pt is conraiindicative to BOTh nsaids and colchicine. Maintenance/prophylaxis w/ allopurinol and uricosuric (renal OK)

83
Q

Most important factor of peak bone mass?

A

Genetic factors.

84
Q

What does calcium pyrophosphate appear like?

A

Pseudogout - positively birefrigenetn - rhomboid crystals. Neutrophilic predominence.

85
Q

What would a PRPP INC Vmax enzyme mutation lead to?

A

Excess purines -> uric acid production gout can occur in pt w/ activating mutations of PRPP.

86
Q

What are the main inflam cells of gout and pseudogout?

A

N! due to phagoytosing monosdium urate etc. crystals. Colchicine is effective in interfering w/ adhesion molecules of N! chemotaxis.

87
Q

What is presbyopia?

A

Hardening of lens - unable to thicken upon ciliary conractino (accommodation is ciliary contraction lead to thickening of lens)Age related. 40-50s. Age related difficulty to see close objects.

88
Q

What does Protein A do? Where is it found?What does IgA protease do? WHere is it found?

A

Protein A - prevent binding of Fc portion of IgG. Staph AIgA protease - cleaves IgA - Strep pneumo, H flu type B, Neisseria

89
Q

Where do you see Heberdens and Bouchards nodes? Whatare they due to?

A

see it in Osteoarthritis - due to osteophyte formation.

90
Q

What is tetanus due to? What does the tetanus vaccination due?

A

TOXIN. Not bacteira itself.Vaccination is against tetanus toxin (formaldehyde inactivated) - elicits HUMORAL immunity. Tetanus immunoglobulin can also be adminsitered in acute tx or tetanus prophylaxis.It is against the protein toxin, not the bacteira.

91
Q

If channels open, what way does?Na +65K -80Cl -90FLow

A

Na flows in.K flows outThese 2 establish potentnailCl does not flow out because there is so much more Cl ouside.

92
Q

Fracture to humeral shaft would damage which arteries?

A

Deep brachial artery. Deep brachial artery runs w/ radial nerve posteriorl.y

93
Q

STATINS ARE FOR WHAT?!

A

Lipid problems.NOT HTN.

94
Q

What is the most frequently damaged rotator cuff? Why?

A

Supraspinatus.It can be repeatedly impingened agaisnt humeral head and acromiun.

95
Q

What does the tibial nerv einnervate?

A

Sensory on the skin of the sole of the fut - gastrocnemius, soleus ((plantar flexion), and inversion (tibial posterior muscle)

96
Q

Where does the sternocleidomastoid originate and insert?

A

Originates - medial clavicle/sterum. Inserts on mastoid of skull.Results in clavicle being pulled upwards during medial fracture of clavicle.

97
Q

Where does the musculocutaneous course?Median nerve?Ulnar nerve? Raidal

A

MC - between bieps brachii and coracobrachialis. Leasd to paralysis of biceps and brachialis. Inability to flex forearm.Median - courses within brachial artery in the groove between biceps brachii and brachialis. Gains access to forearm via medial aspect of antecubital fossa = courses between humeral and ulnar heads of the pronator teres. THEN between flexdor digitorum superifcialis and digitorum profundus! before entering flexor retinaculum. Unar - First between olecranon and medial epicondyle of humerus - “funny bone” between flexor carpi ulnaris and flexor digitorum profundus - IN THE WRIST - ulnar asses between hook of hamate and pisiform bone in a tunnel known as Guyons canal. - leads to claw hand injury. Radial - through supinator muscle near head of radius - Injury causes wirst drop as it inenrvates extensors of hand and forearm.

98
Q

What is achondroplasia due to? 2 bone types?

A

Achondroplasia is constitutive activation of Fibroblast growth factor RECEPTOR! at epiphyseal growth flate - inbhits growth at epiphyseal growth plate. FBFR gain of function leads to FIALURE OF CHONDROYTES (achondro!plasia)Spine length is normal.ENchondral - axial and appendicular skeleton, base of skull. Cartialge made of chondrocytes! Replaces w/ woven bone and then lamellar bone. Interosseous (nonchondral) - Calvarian and FACIAL. Women bone formed directly w/o cartilage. BONES OF THE HEAD NEED TO COME OUT STRONG! Arms can be squishy to get out of womb!

99
Q

Femoral neck fracture most likel to compormise?

A

Medial femoral circumflex - which supplies the majort yof the blood supply to femoral head and neck - can lead to avascular necorsis of emoral head.

100
Q

Anterior shoulder silocation - assoc w/ ?

A

Most common dislocation of shoulder - Most comply from forecful external rotation and adbduction. AXILLARY NERVE INJURy - leads to deltoid paralysis and flattening, as well as loss of sensatin over the lateral arm

101
Q

Inability to dorsiflex, numbness on dorusm of foot. What nerve and where was it damaged?

A

Common peroneal.ost likley nerve compression at fibular head - due to superficial location as it courses laterally to neck of fibula. Superficial peroneal innervates muscles of lateral compartmentDeep peroneal innervates anerior part of lug - dorsiflexSo you get both dorsiflex and eversion knockouts.

102
Q

Difference between roseola infantum and erythema infectiosum?

A

Roseola - HIGH FEVER resolves in 3 days - folllowed by apperance of maculpapular rash that starts on trunk and spreads peripherally - Herpes virus 6. Rash from immune rxErythema infectiosum (5th diseasE) - parvovirus - transmitted via respiratory - bright red rash on cheeks. lacelike rash on trunk and extremities. fever etc.

103
Q

Sudden upward stretch of the arm - aka fall from tree and grab something - dmg what?

A

can damage lower trunk of branchial plexus - C8,T1 - median/ulnar. ALL INTRINSIC MUSCLES OF THE HAND

USMLE (16 decks)

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