12 Musculoskeletal And Connective Tissue - Usmle Step 1

Front 1

What layer of the epidermis is found just superficial to the stratum basalis?

Back 1

Stratum spinosum

2010-366

Front 2

What is the name of the most superficial layer of the epidermis?

Back 2

Stratum corneum

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Front 3

What layer is found directly below the epidermis?

Back 3

Dermis

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Front 4

How many layers are found in the epidermis?

Back 4

Five

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Front 5

What is the name of the deepest layer of the epidermis?

Back 5

Stratum basalis

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Front 6

What layer of the epidermis is found between the stratum spinosum and the stratum lucidum?

Back 6

Stratum granulosum

2010-366

Front 7

Name the layers of the epidermis from the surface to the base.

Back 7

Stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basalis (remember: Californians Like Girls in String Bikinis)

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Front 8

What layer of the epidermis is found just deep to the stratum corneum?

Back 8

Stratum lucidum

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Front 9

Which epithelial cell junctions allow adjacent cells to communicate for electric and metabolic functions?

Back 9

Gap junctions

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Front 10

What is another name for zona adherens?

Back 10

Intermediate junction

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Front 11

In the zona adherens, _____ molecules attach to _____ molecules in the cell to form a perimeter just below the zona occludens.

Back 11

Cadherins; actin

2010-366

Front 12

The zona occludens is composed of what two substances?

Back 12

Occludins and claudins

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Front 13

Which protein anchors macula adherens within the epithelial cell?

Back 13

Keratin

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Front 14

A hemidesmosome is formed from ______ in the cell binding to ______ in the basement membrane to keep cells connected to the underlying extracellular matrix.

Back 14

Integrin; lamin

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Front 15

Which epithelial cell junction surrounds the perimeter just below the zona occludens?

Back 15

Zona adherens

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Front 16

Which epithelial cell junctions are small, discrete sites of attachment?

Back 16

Macula adherens

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Front 17

Gap junctions are formed from ______ that have a central channel that allow adjacent cells to communicate for electric and metabolic functions.

Back 17

Connexons

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Front 18

The zona adherens contains which kind of filaments?

Back 18

Actin filaments

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Front 19

What is another name for the zona occludens?

Back 19

Tight junctions

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Front 20

Which epithelial cell junction connects cells with the underlying extracellular matrix?

Back 20

Hemidesmosome

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Front 21

Cadherins depend on what ion for their function?

Back 21

Calcium

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Front 22

What is another name for the macula adherens?

Back 22

Desmosome

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Front 23

Which epithelial cell junction prevents diffusion across the paracellular space?

Back 23

Zona occludens

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Front 24

What ligament attaches the lateral condyle of the femur to the lateral aspect of the tibia and fibula?

Back 24

Lateral collateral ligament

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Front 25

Name the cartilage that cushions the area between the medial condyle of the femur and the medial aspect of the tibia.

Back 25

Medial meniscus

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Front 26

The positive anterior drawer sign is an indication of the tearing of which knee ligament?

Back 26

Anterior cruciate ligament

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Front 27

Name the cartilage that cushions the area between the lateral condyle of the femur and the lateral aspect of the tibia.

Back 27

Lateral meniscus

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Front 28

The medial collateral, medial meniscus, and anterior cruciate ligaments are commonly injured when a person plays which sport?

Back 28

Football

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Front 29

What ligament attaches the lateral condyle of the femur to the anterior aspect of the tibia?

Back 29

Anterior cruciate ligament

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Front 30

What ligament attaches the medial condyle of the femur to the medial aspect of the tibia?

Back 30

Medial collateral ligament

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Front 31

The terms anterior and posterior with regard to the cruciate ligaments refer to the sites of ______ attachment.

Back 31

Tibial

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Front 32

Abnormal passive abduction of the knee indicates that what ligament is torn?

Back 32

Medial collateral ligament

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Front 33

What ligament attaches the medial condyle of the femur to the posterior aspect of the tibia?

Back 33

Posterior cruciate ligament

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Front 34

Pudendal nerve blocks are used to relieve pain in what clinical situation?

Back 34

Childbirth

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Front 35

What is located at McBurney's point?

Back 35

Pain due to appendicitis localizes to McBurney's point

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Front 36

Where is the needle inserted during a lumbar puncture?

Back 36

Between vertebrae at the level of the iliac crest

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Front 37

Sensation from which nerve can be blocked by injection of local anesthetic near the ischial spine?

Back 37

Pudendal nerve

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Front 38

Describe the location of McBurney's point.

Back 38

Two thirds of the way from the umbilicus to the anterior superior iliac spine

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Front 39

Which muscle of the rotator cuff is found on the anterior aspect of the humerus?

Back 39

Subscapularis

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Front 40

Which rotator cuff muscle adducts and laterally rotates the arm?

Back 40

Teres minor

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Front 41

Which rotator cuff muscle helps the deltoid abduct the arm?

Back 41

Supraspinatus

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Front 42

Which rotator cuff muscle laterally rotates the arm?

Back 42

Infraspinatus

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Front 43

Which rotator cuff muscle medially rotates and adducts the arm?

Back 43

Subscapularis

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Front 44

Which muscle of the rotator cuff is found on the superior aspect of the humerus?

Back 44

Supraspinatus

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Front 45

Name the muscles that make up the rotator cuff.

Back 45

Supraspinatus, infraspinatus, teres minor, subscapularis (remember: SItS; small t is for teres minor)

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Front 46

Which muscles insert on the posterior aspect of the humerus?

Back 46

Infraspinatus and teres minor

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Front 47

The interossei and adductor polliois muscles are innervated by what nerve?

Back 47

Branches of the deep ulnar nerve

2010-*

Front 48

The recurrent branch of the medial nerve can be damaged by a superficial laceration to what surface?

Back 48

The palm of the hand

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Front 49

The dermatome of the thumb is innervated by what nerve(s)?

Back 49

Radial and median nerves

2010-*

Front 50

C4 innervates what dermatome?

Back 50

Shoulder

2010-*

Front 51

Describe the dermatomal distribution of the ulnar nerve on the hand.

Back 51

Medial palmar and dorsal surfaces of the hand

2010-*

Front 52

Sublaxation of the radius causes trauma to which nerve?

Back 52

Deep branch of the radial nerve

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Front 53

The thenar muscles are innervated by what branch of the median nerve?

Back 53

The recurrent branch of the median nerve

2010-*

Front 54

Midshaft fracture of the humerus damages what nerve?

Back 54

Radial nerve

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Front 55

Improper use of crutches can compress what nerve?

Back 55

Radial nerve

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Front 56

Trauma to the heel of the hand can cause damage to which nerve?

Back 56

Ulnar nerve

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Front 57

The dermatome of the lateral aspect of the upper arm is innervated by what nerve root?

Back 57

C5

2010-*

Front 58

Fracture of what specific part of the humerus can cause ulnar nerve trauma?

Back 58

Medial epicondyle

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Front 59

A Pancoast's tumor can compress what trunk of the brachial plexus?

Back 59

Lower trunk

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Front 60

The C7 nerve root innervates which dermatome?

Back 60

The middle finger

2010-*

Front 61

How many tendons run through the carpal tunnel?

Back 61

Nine

2010-*

Front 62

The dermatome of the pinky is innervated by which nerve root?

Back 62

C8

2010-*

Front 63

The anterior interosseous nerve is at risk for compression where?

Back 63

The deep forearm

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Front 64

Name the nerve compressed in carpal tunnel syndrome.

Back 64

Median nerve

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Front 65

A dislocated lunate will affect which nerve?

Back 65

Median nerve

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Front 66

What nerve root is commonly compressed by a cervical disk lesion?

Back 66

C7

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Front 67

Fracture of the surgical neck or dislocation of the humerus can traumatize which nerve?

Back 67

Axillary nerve

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Front 68

Tendons from which two muscles anchor on the pisiform bone?

Back 68

Abductor digiti minimi and flexor carpi ulnaris

2010-*

Front 69

The flexor retinaculum is anchored between what three bones?

Back 69

Trapezium, hook of hamate, and scaphoid

2010-*

Front 70

Supracondylar fracture of humerus can compress what nerve causing what syndrome?

Back 70

Median nerve; pronator teres syndrome

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Front 71

Which dermatome covers the thumb?

Back 71

C6

2010-*

Front 72

The dermatome of the axilla is innervated by what nerve root?

Back 72

T2

2010-*

Front 73

The dermatome of the medial aspect of the forearm is innervated by what nerve root?

Back 73

T1

2010-*

Front 74

The palmar surface of the first three digits is innervated by what branch of the median nerve?

Back 74

Cutaneous branches of the median nerve

2010-*

Front 75

Fracture of hook of hamate can disrupt which nerve?

Back 75

Ulnar nerve

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Front 76

Compression of the lower trunk of the brachial plexus can lead to nerve injury known as what?

Back 76

Klumpke's palsy

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Front 77

A patient is unable to move his thumb. Physical exam reveals a "Pope's blessing" sign. If the cause is nerve damage, what is the principal nerve that is involved?

Back 77

Ulnar nerve

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Front 78

A "waiter's tip" results from lesions at what two nerve roots?

Back 78

C5 and C6

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Front 79

A patient presents with "Saturday night palsy," which consists of a wrist drop. What nerve was most likely injured?

Back 79

Radial nerve

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Front 80

A lesion at what cord of the brachial plexus would cause damage to the axillary and radial nerves?

Back 80

Posterior cord

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Front 81

A solitary lesion of what nerve within the brachial plexus might make it difficult to flex the elbow?

Back 81

Musculocutaneous nerve

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Front 82

Injury to the posterior cord of the brachial plexus would produce what sign on physical exam?

Back 82

Wrist drop

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Front 83

What muscle protects the brachial plexus during a clavicle fracture?

Back 83

Subclavius muscle

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Front 84

A patient presents with a "waiter's tip" deformity after being thrown from a motorcycle. What cervical roots have been injured?

Back 84

C5 and C6

2010-369

Front 85

Deltoid paralysis is caused by injury to what nerve?

Back 85

Axillary nerve

2010-369

Front 86

Name the order in which the brachial plexus divides.

Back 86

The order is Roots, Trunks, Divisions, Cords, and Branches (remember: Randy Travis Drinks Cold Beer)

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Front 87

A lesion of the lower trunk of the brachial plexus would cause what notable sign on physical exam?

Back 87

A total claw hand (Klumpke's palsy)

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Front 88

A patient presents with a winged scapula. What nerve has been injured?

Back 88

Long thoracic nerve

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Front 89

A patient with a fractured surgical neck of the humerus could demonstrate what sensory and motor deficits?

Back 89

Inability to abduct the arm at the shoulder, lack of sensation over the deltoid muscle

2010-370

Front 90

What is the cause of "Saturday night palsy"?

Back 90

Extended compression of the axilla by the back of a chair or crutches resulting in radial nerve injury

2010-370

Front 91

A patient has carpal tunnel syndrome involving swelling of the wrist that affects the flexors of the hand. What sensory deficit is expected?

Back 91

Decreased sensation in the palmar aspect of the thumb, index finger, middle finger, and half of the ring finger

2010-370

Front 92

A patient has a fracture at the medial condyle of the humerus that affects the flexors of the hand. What sensory deficit is expected on physical exam?

Back 92

Decreased sensation in palmar and dorsal sides of fifth digit and half of fourth digit

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Front 93

A patient presents with a loss of sensation over the lateral palm, the thumb, and the radial two and one half fingers. What fracture may have caused the deficit?

Back 93

Supracondylar fracture of the humerus

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Front 94

A patient has a supracondylar fracture of the humerus that affects the flexors of the hand. What sensory deficit is expected?

Back 94

Decreased sensation in the palmar aspect of the thumb, index finger, middle finger, and half of the ring finger

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Front 95

A patient suffers a midshaft humerus fracture damaging the extensor compartment. He has a wrist drop. What sensory deficit is expected?

Back 95

Deficit over the posterior arm and dorsal hand

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Front 96

A patient presents with "Pope's blessing/hand of benediction." What physical injury causes this finding?

Back 96

Fracture of the hook of hamate, likely from falling onto an outstretched hand, affecting the ulnar nerve

2010-370

Front 97

A patient presents with a flattened deltoid. Name the two injuries that could result in this finding.

Back 97

Fractured surgical neck of the humerus and dislocation of the humeral head resulting in axillary nerve injury

2010-370

Front 98

A patient has a fracture at the medial condyle of the humerus that affects the flexors of the hand. What motor deficits are expected on physical exam?

Back 98

Cannot abduct thumb or abduct or adduct fingers; claw hand

2010-370

Front 99

A patient presents with decreased sensation over the lateral forearm and an inability to flex the arm at the elbow. What nerve is damaged?

Back 99

Musculocutaneous nerve

2010-370

Front 100

A patient has carpal tunnel syndrome involving swelling of the wrist that affects the flexors of the hand. What motor deficit is expected on physical exam of the hand? Of the thumb?

Back 100

Cannot flex fingers; cannot abduct/oppose thumb

2010-370

Front 101

A patient presents with inability to extend his wrist, fingers (at the metacarpophalangeal joint), and thumb. What nerve is damaged?

Back 101

Radial nerve

2010-370

Front 102

Name the two muscle groups affected in a patient with ulnar claw hand.

Back 102

Interossei and lumbricals

2010-370

Front 103

Injury to the radial nerve may result in what sign on physical exam?

Back 103

Wrist drop

2010-370

Front 104

Name six causes of mononeuropathy.

Back 104

Compression, trauma, diabetes, vasculitis, radiation, and inflammation

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Front 105

A patient presents with his left arm hanging to the side, medially rotated, with pronation of the forearm. What type of palsy does he have?

Back 105

Erb-Duchenne palsy

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Front 106

The loss of innervation in what muscle causes pronation of the forearm in Erb palsy?

Back 106

Biceps

2010-371

Front 107

Erb-Duchenne palsy is caused by the traction/tear of what two nerve roots?

Back 107

C5 and C6

2010-371

Front 108

Thoracic outlet syndrome results from compression of the _____ artery and the _____ trunk of the brachial plexus by a cervical rib.

Back 108

Subclavian; inferior

2010-371

Front 109

Name the four components of thoracic outlet syndrome.

Back 109

1. Atrophy of the thenar and hypothenar eminences; 2. Atrophy of the interosseous muscles; 3. Sensory deficits on the medial side of the forearm and hand; 4. Disappearance of the radial pulse upon moving the head toward the opposite side

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Front 110

How does a proximal median nerve lesion affect the thumb?

Back 110

It causes an inability to abduct thumb, know as "ape hand"

2010-*

Front 111

A proximal median nerve lesion causes loss of what muscle function?

Back 111

It causes loss of opponens polliois muscle function

2010-*

Front 112

Median claw is caused by a lesion of the distal median nerve. Specify the exact location of the lesion.

Back 112

The lesion is located after the branch containing C5-C7 brances off to feed forearm flexors

2010-*

Front 113

Name the function of the lumbrical muscles of the hand.

Back 113

The lumbricals flex the metacarpophalangeal joints and extend both the distal interphalangeal and proximal interphalangeal joints

2010-*

Front 114

What digits are affected in a distal ulnar nerve lesion?

Back 114

Fourth and fifth digits

2010-*

Front 115

Ulnar claw or "Pope's blessing" is caused by a lesion of what nerve?

Back 115

A distal lesion of the ulnar nerve

2010-*

Front 116

Klumpke's total claw hand is caused by a lesion of what trunk of the brachial plexus affecting what nerve roots?

Back 116

Lower trunk and nerve roots C8, T1

2010-*

Front 117

What nerve of the upper extremity is known as the "great extensor nerve"?

Back 117

Radial nerve

2010-372

Front 118

Name the muscles innervated by the radial nerve.

Back 118

Brachioradialis, Extensors of the wrist and fingers, Supinator, and Triceps (remember: radial nerve innervates the BEST)

2010-372

Front 119

After supination, is the palm or dorsum of the hand facing up?

Back 119

Palm (remember: to supinate is to move as if carrying a bowl of soup)

2010-372

Front 120

What muscle group in the hand flexes the fingers at the metacarpophalangeal joint?

Back 120

Lumbrical muscles

2010-372

Front 121

What three muscles compose the hypothenar eminence?

Back 121

The opponens digiti minimi, the abductor digiti minimi, and the flexor digiti minimi (remember: Oppose, Abduct, and Flex (OAF))

2010-372

Front 122

What three muscles compose the thenar eminence?

Back 122

The opponens pollicis, the abductor pollicis, and the flexor pollicis brevis, remember: Oppose, Abduct, and Flex (OAF)

2010-372

Front 123

What muscle group in the hand abducts the fingers?

Back 123

Dorsal interosseous muscles (remember: DAB = Dorsals ABduct)

2010-372

Front 124

What muscle group in the hand adducts the fingers?

Back 124

Palmar interosseous muscles (remember: PAD = Palmars ADduct)

2010-372

Front 125

Name two specific injuries caused by repetitive elbow trauma.

Back 125

Lateral epicondylitis (tennis elbow), medial epicondylitis (golf elbow)

2010-372

Front 126

A patient has a posterior hip dislocation. She cannot jump, climb stairs, or rise from a seated position. What nerve has been damaged?

Back 126

Inferior gluteal nerve

2010-372

Front 127

If a patient has foot drop, his ______ nerve is damaged; but if a patient cannot stand on his tiptoes, then the _____ nerve is damaged.

Back 127

Common peroneal; tibial

2010-372

Front 128

A patient has a pelvic fracture. He can no longer flex his thigh or extend his leg. He has a sensory deficit along the anterior thigh and medial leg. What nerve has been damaged?

Back 128

Femoral nerve

2010-372

Front 129

A patient has had trauma to his knee and damaged his tibial nerve. What motor deficits would be expected on physical exam?

Back 129

Cannot invert foot, cannot plantar flex foot, and cannot flex toes (remember: TIP = Tibial Inverts and Plantarflexes; if injured, can't stand on TIPtoes)

2010-372

Front 130

A patient experiences trauma to his lateral leg and can no longer evert or dorsiflex his foot, nor can he extend his toes. What nerve has been injured?

Back 130

Common peroneal nerve, causing foot drop

2010-372

Front 131

Loss of foot eversion is due to damage of the _____ nerve, while loss of foot inversion is due to damage of the _____ nerve.

Back 131

Common peroneal; tibial

2010-372

Front 132

A patient has an anterior hip dislocation and can no longer adduct the thigh. She has a sensory deficit along the medial thigh. What nerve has been damaged?

Back 132

Obturator nerve

2010-372

Front 133

What two nerves may be damaged if a patient sustains a posterior hip dislocation?

Back 133

Inferior gluteal nerve and superior gluteal nerve

2010-372

Front 134

A patient has had trauma to his knee and can no longer invert or plantar flex his foot, nor can he flex his toes. He has decreased sensation in the sole of his foot. What nerve has been damaged?

Back 134

Tibial nerve

2010-372

Front 135

A patient has a posterior hip dislocation and cannot abduct his thigh (positive Trendelenburg sign). What nerve has been damaged?

Back 135

Superior gluteal nerve

2010-372

Front 136

Loss of dorsiflexion of the foot is due to damage of the _____ nerve, while loss of plantar flexion of the foot is due to damage of the _____ nerve.

Back 136

Common peroneal; tibial

2010-372

Front 137

A patient has a posterior hip dislocation. He has a positive Trendelenburg sign. What motor deficit is present?

Back 137

Inability to abduct thigh

2010-372

Front 138

A patient has a fibula neck fracture and can no longer evert or dorsiflex his foot, nor can he extend his toes. What nerve has been injured, and what sign is evident on physical exam?

Back 138

The common peroneal nerve; foot drop (remember: PED = Peroneal Everts and Dorsiflexes; if injured, foot dropPED)

2010-372

Front 139

During skeletal muscle signal conduction, postsynaptic ligand binding leads to the depolarization of which membrane?

Back 139

The motor end plate of the muscle cell

2010-373

Front 140

Name the specific receptors on the skeletal muscle cell membrane that are voltage sensitive.

Back 140

Dihydropyridine

2010-373

Front 141

During skeletal muscle signal conduction, the action potential travels down into invaginations in the membrane that are called what?

Back 141

T-tubules

2010-373

Front 142

During skeletal muscle contraction, which bands of the sarcomere shorten in length?

Back 142

H-band and I-band

2010-373

Front 143

In the sarcomere, does the I- band correspond to the area that is only actin or only myosin?

Back 143

Only actin

2010-373

Front 144

_____ receptors release calcium from the sarcoplasmic reticulum.

Back 144

Ryanodine

2010-373

Front 145

In the sarcomere, is the M line the site of actin or myosin attachment?

Back 145

Myosin

2010-373

Front 146

In the sarcomere, does the H-band correspond to the area that is only actin or only myosin?

Back 146

Only myosin

2010-373

Front 147

During skeletal muscle contraction, released calcium binds to troponin C, thereby causing a conformational change to move tropomyosin out of what area of the actin filament?

Back 147

The myosin-binding groove

2010-373

Front 148

In the sarcomere, does the A-band correspond to the length of actin or myosin?

Back 148

Myosin

2010-373

Front 149

In the sarcomere, is the Z line the site of actin or myosin attachment?

Back 149

Actin

2010-373

Front 150

During the conduction of an action potential to muscle, the action potential causes the opening of which voltage-gated channels in the nerve terminal?

Back 150

Voltage-gated calcium channels, causing release of neurotransmitter

2010-373

Front 151

A sarcomere is defined as the area between one ______ to the next ______.

Back 151

Z line; Z line

2010-373

Front 152

What term describes the process by which calcium entering a muscle cell through voltage-gated calcium channels on the cell membrane is able to increase the intracellular calcium content of the muscle cell by releasing more calcium from the sarcoplasmic reticulum?

Back 152

Calcium-induced calcium release

2010-373

Front 153

During skeletal muscle contraction, what band of the sarcomere remains the same length?

Back 153

A-band (remember: A band is Always the same length; HIZ shrinkage)

2010-373

Front 154

In type I muscle fibers, there is a(n) _____ (increase;decrease) in oxidative phosphorylation.

Back 154

Increase

2010-374

Front 155

Type II muscle fibers are _____ (fast/slow) twitch.

Back 155

Fast

2010-374

Front 156

Type I muscle fibers are _____ (fast/slow) twitch.

Back 156

Slow

2010-374

Front 157

True or False? Type I muscle fibers create a sustained contraction.

Back 157

True (remember: "one slow red ox")

2010-374

Front 158

In type II muscle fibers, there is a(n) _____ (increase; decrease) in anaerobic glycolysis.

Back 158

Increase

2010-374

Front 159

Weight training results in hypertrophy of what type of muscle fibers?

Back 159

Fast-twitch muscle fibers

2010-374

Front 160

Type II muscle fibers are white secondary to what?

Back 160

Decreased mitochondria and myoglobin concentration

2010-374

Front 161

Type I muscle fibers are red secondary to what?

Back 161

Increased mitochondria and myoglobin concentration

2010-374

Front 162

In skeletal muscle contraction, calcium binds to what substance, thereby causing a conformational change?

Back 162

Troponin C

2010-374

Front 163

The absence of ATP binding to the myosin head in skeletal muscle may cause what finding?

Back 163

Rigor mortis

2010-374

Front 164

What process causes cocking of the myosin head?

Back 164

Hydrolysis of ATP

2010-374

Front 165

The binding of ATP allows for what process in actin/myosin cross-bridging?

Back 165

Release

2010-374

Front 166

In skeletal muscle contraction, ATP binds to what molecule?

Back 166

Myosin head

2010-374

Front 167

In the process of smooth muscle cell contraction, calcium binds to what?

Back 167

Calmodulin

2010-374

Front 168

After a smooth muscle membrane is depolarized, voltage-gated _____ _____ will open.

Back 168

Calcium channels

2010-374

Front 169

In smooth muscle contraction, dephosphorylation of the myosin-actin complex is carried out by what enzyme?

Back 169

Myosin light-chain phosphatase

2010-374

Front 170

With the binding of calcium to calmodulin in smooth muscle contraction, the activation of _____ _____-_____ kinase takes place.

Back 170

Myosin light-chain

2010-374

Front 171

Dephosphorylation of the myosin-actin complex leads to what response by smooth muscle?

Back 171

Relaxation

2010-374

Front 172

Myosin light-chain kinase is an enzyme that adds a _____ group to the _____-_____ complex during _____ muscle contraction.

Back 172

Phosphate, actin-myosin; smooth

2010-374

Front 173

Osteoblasts are derived from _____ stem cells in the periosteum.

Back 173

Mesenchymal

2010-375

Front 174

In bone formation, _____ (endochondral/membranous) ossification is responsible for longitudinal bone growth, while _____ (endochondral/membranous) ossification is responsible for flat bone growth.

Back 174

Endochondral; membranous

2010-375

Front 175

_____ (Endochondral/Membranous) ossification involves the production a cartilaginous model that is remodeled into lamellar bone, while _____ (endochondral/membranous) ossification involves the direct production of woven bone that is remodeled into lamellar bone.

Back 175

Endochondral; membranous

2010-375

Front 176

In endochondral ossification, what two type of cells replace the cartilaginous model with woven and later lamellar bone?

Back 176

Osteoclasts and osteoblasts

2010-375

Front 177

The skull, facial bones, and axial skeleton are examples of bones formed as a result of what type of ossification pattern?

Back 177

Membranous ossification

2010-375

Front 178

Individuals with achondroplasia have _____ (normal/decreased) life span and fertility.

Back 178

Normal

2010-375

Front 179

In achondroplasia, the limbs are shorter than normal, but the _____ and _____ are normal.

Back 179

Head; trunk

2010-375

Front 180

In achondroplasia, the short limbs are a result of the failure of what type of bone growth?

Back 180

Longitudinal bone growth (this type of bone growth accounts for the growth of the long bones in the limbs)

2010-375

Front 181

In achondroplasia, _____ (endochondral/membranous) bone growth is not affected.

Back 181

Membranous (this type of bone growth accounts for the formation of the skull, the facial bones, and the axial skeleton)

2010-375

Front 182

True or False? Achondroplasia is associated with advanced paternal age.

Back 182

True

2010-375

Front 183

Achondroplasia is an autosomal _____ (dominant/recessive) genetic trait.

Back 183

Dominant

2010-375

Front 184

Achondroplasia represents a failure of cartilage maturation resulting from a mutation in what receptor?

Back 184

Fibroblast growth factor receptor

2010-375

Front 185

A reduction in bone mass despite normal bone mineralization is a description of what disease?

Back 185

Osteoporosis

2010-375

Front 186

Name four treatments for osteoporosis.

Back 186

Estrogen, calcitonin, bisphosphonates, and pulsatile parathyroid hormone

2010-375

Front 187

Which upper extremity fracture is commonly seen in patients with osteoporosis?

Back 187

Colles' fracture of the distal radius

2010-375

Front 188

What is type I osteoporosis?

Back 188

Increased bone resorption as a result of decreased estrogen levels

2010-375

Front 189

What is type II osteoporosis?

Back 189

Senile osteoporosis; affects men and women older than 70 years of age

2010-375

Front 190

A known osteoporotic patient presents with acute back pain, loss of height and kyphosis. From what is she suffering?

Back 190

Vertebral crush fractures

2010-375

Front 191

Which therapy for osteoporosis is considered controversial due to risk of serious side effects?

Back 191

Estrogen replacement therapy

2010-375

Front 192

Name two methods of osteoporosis prophylaxis.

Back 192

Exercise and calcium supplementation before age 30 years

2010-375

Front 193

In patients with osteopetrosis, is the serum phosphate level high, normal, or low?

Back 193

Normal

2010-375

Front 194

In patients with osteopetrosis, is the serum calcium level high, normal, or low?

Back 194

Normal

2010-375

Front 195

A failure of normal bone resorption that leads to thickened, dense bones is a description of which disorder?

Back 195

Osteopetrosis

2010-375

Front 196

What neurologic lesions may result from osteopetrosis?

Back 196

Cranial nerve palsies due to narrowed foramina in the skull

2010-375

Front 197

Osteopetrosis is a bone defect caused by the abnormal function of which cell type?

Back 197

Osteoclasts

2010-375

Front 198

In patients with osteopetrosis, is the alkaline phosphatase level high, normal, or low?

Back 198

Normal

2010-375

Front 199

A genetic deficiency in carbonic anhydrase II leads to what disease?

Back 199

Osteopetrosis

2010-375

Front 200

Name three complications of osteopetrosis due to decreased space for bone marrow.

Back 200

Anemia, thrombocytopenia, and infection

2010-375

Front 201

What is the classic x-ray finding in osteopetrosis?

Back 201

"Erlenmeyer flask" bones that flare out

2010-375

Front 202

Vitamin D deficiency in adults leads to decreased levels of what important element of bone formation?

Back 202

Calcium

2010-375

Front 203

A decreased level of calcium leads to increased levels of what hormone?

Back 203

Parathyroid hormone

2010-375

Front 204

In osteomalacia/rickets, phosphate levels are _____ (increased/decreased).

Back 204

Decreased (due to secondary hyperparathyroidism induced by low calcium levels)

2010-375

Front 205

Vitamin D deficiency in childhood causes what disorder?

Back 205

Rickets

2010-375

Front 206

What is the disorder in which the defective mineralization of osteoid leads to soft bones?

Back 206

Osteomalacia/rickets

2010-375

Front 207

In patients with osteitis fibrosa cystica, is the serum calcium level high, low, or normal?

Back 207

High

2010-376

Front 208

In patients with osteitis fibrosa cystica, is the serum phosphorus level high, low, or normal?

Back 208

Low

2010-376

Front 209

What condition causes osteitis fibrosa cystica?

Back 209

Hyperparathyroidism

2010-376

Front 210

In osteitis fibrosa cystica, what are brown tumors?

Back 210

Cystic spaces lined by osteoclasts that are filled with fibrous stroma or blood

2010-376

Front 211

In Paget's disease, is there abnormal activity of osteoblasts, osteoclasts, or both?

Back 211

There is abnormal activity of both osteoblasts and osteoclasts

2010-376

Front 212

In patients with Paget's disease, is the serum alkaline phosphatase level high, low, or normal?

Back 212

High

2010-376

Front 213

Patients with Paget's disease are at increased risk of what type of cancer?

Back 213

Osteogenic sarcoma

2010-376

Front 214

In patients with Paget's disease, is the parathyroid hormone level high, low, or normal?

Back 214

Normal

2010-376

Front 215

Which disease of the bone is described as abnormal architecture of the bone which is the result of increased osteoblastic and osteoclastic activity?

Back 215

Paget's disease

2010-376

Front 216

In patients with Paget's disease, is the serum phosphorus level high, low, or normal?

Back 216

Normal

2010-376

Front 217

An individual experiencing hearing loss and increased hat size may suffer from what disorder?

Back 217

Paget's disease (hearing loss is a result of auditory foramen narrowing)

2010-376

Front 218

Patients with Paget's disease are at increased risk of what type of fractures?

Back 218

"Chalk stick" fractures of long bones

2010-376

Front 219

Patients with Paget's disease are at increased risk of what type of cardiac disease?

Back 219

High-output congestive heart failure (due to increased atrioventricular shunting)

2010-376

Front 220

In patients with Paget's disease, is the serum calcium level high, low, or normal?

Back 220

Normal

2010-376

Front 221

True or False? Osteopetrosis is characterized by elevated calcium.

Back 221

False; lab values are normal

2010-376

Front 222

In osteitis fibrosa cystica, serum calcium levels are _____ (increased/decreased); phosphate levels are _____ (increased/decreased); ALP levels are ____ (increased/decreased) and PTH levels are _____ (increased/decreased).

Back 222

Increased; decreased; increased; increased

2010-376

Front 223

In osteomalacia/rickets, serum calcium levels are _____ (increased/decreased), phosphate levels are _____ (increased/decreased) and PTH levels are _____ (increased/decreased).

Back 223

Decreased; decreased; increased

2010-376

Front 224

Describe the effect osteopetrosis has on bones.

Back 224

Bones are thickened and dense

2010-376

Front 225

What lab value is elevated in Paget's disease?

Back 225

Alkaline phosphatase

2010-376

Front 226

What are the dermatologic findings in McCune Albright syndrome?

Back 226

Café-au-lait spots and "coast of Maine" spots

2010-376

Front 227

In polyostotic fibrous dysplasia, bone is replaced by what three substances?

Back 227

Fibroblasts, collagen, and irregular bony trabeculae

2010-376

Front 228

What is the endocrine abnormality found in patients with McCune-Albright syndrome?

Back 228

Precocious puberty

2010-376

Front 229

Which syndrome is a form of polyostotic fibrous dysplasia characterized by unilateral bone involvement, unilateral "coast of Maine" spots, and precocious puberty?

Back 229

McCune-Albright syndrome

2010-376

Front 230

Describe the histology of osteoid osteomas.

Back 230

An osteoid osteoma is composed of interlacing trabeculae of woven bone surrounded by osteoblasts

2010-377

Front 231

Where are chondrosarcomas usually located?

Back 231

In the pelvis, spine, scapula, humerus, tibia, and femur

2010-377

Front 232

What is another name for giant cell tumor?

Back 232

Osteoclastoma (not to be confused with osteoblastoma)

2010-377

Front 233

Giant cell tumors have a peak incidence in patients in what age range?

Back 233

20 to 40 years of age

2010-377

Front 234

Chondrosarcomas are most common among men who are between what ages?

Back 234

30 to 60 years of age

2010-377

Front 235

What is the name of a malignant cartilaginous tumor?

Back 235

Chondrosarcoma

2010-377

Front 236

Where are the four most common sites of Ewing's sarcoma?

Back 236

The diaphysis of the long bones, the pelvis, the scapula, and the ribs

2010-377

Front 237

Which primary bone tumor has a characteristic "double bubble" or "soap bubble" appearance on x-ray?

Back 237

Giant cell tumor

2010-377

Front 238

Histologically, what benign bone tumor can be described as mature bone with a cartilaginous cap?

Back 238

Osteochondroma (exostosis)

2010-377

Front 239

What is a benign cartilaginous neoplasm that is found in the intramedullary bone?

Back 239

Enchondroma

2010-377

Front 240

_____ _____ is a benign bone tumor most common in men <25 years old and most commonly found in the proximal tibia and femur.

Back 240

Osteoid osteoma

2010-377

Front 241

Where are osteosarcomas most commonly found?

Back 241

In the metaphysis of the long bones, especially around the knee

2010-377

Front 242

What is the most common primary benign bone tumor?

Back 242

Osteochondroma

2010-377

Front 243

How does a chondrosarcoma look on gross exam?

Back 243

As an expansile glistening mass within the medullary cavity

2010-377

Front 244

Which malignant primary bone tumor is described as having anaplastic small blue cells?

Back 244

Ewing's sarcoma

2010-377

Front 245

What is the second most common primary malignant bone tumor after multiple myeloma?

Back 245

Osteosarcoma

2010-377

Front 246

At what age do men usually develop osteochondromas?

Back 246

When they are < 25 years of age

2010-377

Front 247

Ewing's sarcoma is very aggressive with early _____, but it is responsive to chemotherapy.

Back 247

Metastases

2010-377

Front 248

Which bone tumor is described as a locally aggressive benign tumor that is often seen in the distal femur or the proximal tibia?

Back 248

Giant cell tumor

2010-377

Front 249

What is another name for osteochondroma?

Back 249

Exostosis

2010-377

Front 250

Osteochondromas rarely transform into which type of malignancy?

Back 250

Chondrosarcoma

2010-377

Front 251

What is Codman's triangle?

Back 251

X-ray findings of elevation of the periosteum, which is classic for osteosarcoma

2010-377

Front 252

From where do osteochondromas most commonly originate?

Back 252

Metaphysis of long bones

2010-377

Front 253

What four factors predispose to osteosarcoma?

Back 253

Paget's disease of bone, bone infarcts, radiation, and familial retinoblastomas

2010-377

Front 254

What is the histopathologic appearance of giant cell tumors?

Back 254

Spindle-shaped cells and multinucleated giant cells

2010-377

Front 255

A chondrosarcoma may be of primary origin or may occur as a result of what?

Back 255

An osteochondroma with malignant transformation

2010-377

Front 256

The incidence of osteosarcoma peaks in males in what age range?

Back 256

10 to 20 years of age

2010-377

Front 257

What genetic change is associated with Ewing's sarcoma?

Back 257

11;22 Translocation

2010-377

Front 258

Which benign bone tumor is associated with Gardner's syndrome?

Back 258

Osteoma

2010-377

Front 259

What is the classic radiographic appearance of bone in Ewing's sarcoma?

Back 259

It has an "onion-skin" appearance

2010-377

Front 260

How do osteoblastomas differ from osteoid osteomas?

Back 260

Although the two have the same morphology, osteoid osteomas are < 2 cm and found in the proximal tibia and femur, whereas osteoblastomas are larger and found in the vertebral column

2010-377

Front 261

Where are enchondromas generally found?

Back 261

Distal extremities

2010-377

Front 262

Patients of what sex and age are predisposed to Ewing's sarcoma?

Back 262

Males younger than 15 years of age

2010-377

Front 263

Which type of tumor causes the formation of Codman's triangle?

Back 263

Osteosarcoma

2010-378

Front 264

Benign _____ and malignant _____ are found in the metaphysis of bone.

Back 264

Osteochondromas; osteosarcomas

2010-378

Front 265

Benign _____ _____ and malignant _____ _____ are found in the diaphysis of bone.

Back 265

Osteoid osteomas; Ewing's sarcoma

2010-378

Front 266

Benign _____ and malignant _____ are found in the intramedullary part of bone.

Back 266

Enchondromas; chondrosarcomas

2010-378

Front 267

Osteoclastomas (giant cell tumors) are found in the _____ (epiphysis/metaphysis/diaphysis/intramedullary) part of long bones.

Back 267

Epiphysis

2010-378

Front 268

"Soap bubble" tumors are also known as?

Back 268

Giant cell tumor

2010-378

Front 269

What are Heberden's nodes?

Back 269

Calcific spurs of the articular cartilage at the distal interphalangeal joint characteristic of osteoarthritis

2010-378

Front 270

Pain in weight-bearing joints after use that improves with rest is a classic presentation of which type of arthritis?

Back 270

Osteoarthritis

2010-378

Front 271

Name three risk factors for the development of osteoarthritis.

Back 271

Age, obesity, and joint deformity

2010-378

Front 272

In osteoarthritis of the knees, cartilage loss begins where, leading to what finding?

Back 272

Medial aspect of the knee, leading to a "bowlegged" appearance

2010-378

Front 273

What pathologic changes of bone are found in osteoarthritis?

Back 273

Histologically, subchondral cysts, sclerosis, thickened capsule, and slight synovial hypertrophy are found in osteoarthritis

2010-378

Front 274

Systemic symptoms such as fever and malaise are _____ (present/absent) in osteoarthritis.

Back 274

Absent; osteoarthritis is not associated with systemic symptoms

2010-378

Front 275

In osteoarthritis, the wear and tear of joints leads to the destruction of what?

Back 275

Articular cartilage

2010-378

Front 276

What are Bouchard's nodes?

Back 276

Calcific spurs of the articular cartilage at the proximal interphalangeal joint

2010-378

Front 277

What joint finding is pathognomonic in rheumatoid arthritis?

Back 277

Pannus formation in the joints

2010-379

Front 278

Rheumatoid arthritis has a strong association with which human leukocyte antigen complex?

Back 278

Human leukocyte antigen DR4

2010-379

Front 279

Is rheumatoid arthritis more prevalent in males or females?

Back 279

Females

2010-379

Front 280

Rheumatoid arthritis is characterized by what symptoms other than arthritis?

Back 280

Morning stiffness improving with use, symmetric joint involvement, and systemic symptoms (fever, fatigue, pleuritis, pericarditis)

2010-379

Front 281

What dermatologic finding is seen in rheumatoid arthritis?

Back 281

Subcutaneous nodules

2010-379

Front 282

_____ cysts are associated with rheumatoid arthritis.

Back 282

Baker's cysts, which are located behind the knee

2010-379

Front 283

Is the joint involvement in rheumatoid arthritis unilateral or symmetric?

Back 283

Symmetric

2010-379

Front 284

What are the histologic findings in rheumatoid arthritis?

Back 284

Bone and cartilage erosion, increased synovial fluid, and pannus formation

2010-379

Front 285

Which type of joint is affected by rheumatoid arthritis?

Back 285

Synovial joints

2010-379

Front 286

In the hand, which two joints are most affected in rheumatoid arthritis?

Back 286

Metacarpophalangeal and proximal interphalangeal joints

2010-379

Front 287

What kind of problem is rheumatoid arthritis: mechanical or autoimmune?

Back 287

Autoimmune

2010-379

Front 288

Name the finger joint spared in rheumatoid arthritis.

Back 288

Distal interphalangeal joints

2010-379

Front 289

What serologic test is less sensitive but more specific for rheumatoid arthritis than rheumatoid factor?

Back 289

Anticyclic citrullinated peptide

2010-379

Front 290

Do the symptoms of rheumatoid arthritis improve or worsen with use?

Back 290

Morning stiffness is associated with rheumatoid arthritis and improves with use

2010-379

Front 291

What physical exam finding is characterized by flexed distal interphalangeal joints and overextended proximal interphalangeal joints?

Back 291

Swan-neck deformity

2010-379

Front 292

_____ deviation of the fingers is associated with rheumatoid arthritis.

Back 292

Ulnar

2010-379

Front 293

Eighty percent of patients with rheumatoid arthritis have what serologic finding?

Back 293

Rheumatoid factor (anti-immunoglobulin G antibodies)

2010-379

Front 294

What physical exam finding is characterized by overextended distal interphalangeal joints and flexed proximal interphalangeal joints?

Back 294

Boutonniere deformity

2010-379

Front 295

Rheumatoid factor is an antibody against what type of molecule?

Back 295

Immunoglobulin G

2010-379

Front 296

Sjögren's syndrome is characterized by which triad of signs and symptoms?

Back 296

Xerophthalmia (dry eyes and conjunctivitis), xerostomia (dry mouth and dysphagia), and arthritis

2010-379

Front 297

A 55-year-old woman complains of a myriad of symptoms including dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, and reflux esophagitis. She denies any arthritic symptoms. What diagnosis can explain this constellation of symptoms?

Back 297

Sicca syndrome

2010-379

Front 298

Individuals with Sjögren's syndrome have an increased risk of what type of cancer?

Back 298

B-cell lymphoma

2010-379

Front 299

Which serologic findings are characteristic of Sjögren's syndrome?

Back 299

Antiribonucleoprotein antibodies; also known as anti-Ro and anti-La or SS-A and SS-B

2010-379

Front 300

Sjögren's syndrome typically affects which demographic?

Back 300

Females 40 to 60 years of age

2010-379

Front 301

Individuals with Sjögren's syndrome are at increased risk for which dental condition?

Back 301

Caries, due to decreased production of saliva

2010-379

Front 302

What is the name of the painful metatarsophalangeal joint found in the big toe of a patient with gout?

Back 302

Podagra

2010-380

Front 303

Is gout more common in men or women?

Back 303

Men

2010-380

Front 304

Gout occurs from the precipitation of _____ _____ crystals into the joints as a result of hyperuricemia.

Back 304

Monosodium urate

2010-380

Front 305

Are joints affected by gout in a symmetric or asymmetric pattern?

Back 305

Asymmetric

2010-380

Front 306

Which inborn errors of metabolism can predispose to gout?

Back 306

Lesch Nyhan and Von Gierke's disease

2010-380

Front 307

Thiazide diuretics inhibit the excretion of _____ _____, leading to increased risk of gout.

Back 307

Uric acid

2010-380

Front 308

What are two common triggers of acute gout?

Back 308

Consumption of alcohol (alcohol metabolites compete with uric acid for excretion sites in kidney, causing reduced uric acid secretion and buildup in blood) or a large meal

2010-380

Front 309

In patients with gout, tophi often form on which areas of the body?

Back 309

External ear, olecranon bursa, Achilles tendon

2010-380

Front 310

The crystals in gout are _____ (positively/negatively) birefringent and _____ (needle/rhomboid)-shaped.

Back 310

Negatively; needle

2010-380

Front 311

Name four treatments for gout.

Back 311

Allopurinol, probenecid, colchicine, and nonsteroidal antiinflammatory drugs

2010-380

Front 312

In pseudogout, are the crystals positively or negatively birefringent?

Back 312

Weakly positively birefringent

2010-380

Front 313

Pseudogout tends to affect predominantly the _____ (large/small) joints.

Back 313

Pseudogout affects large joints (classically the knee)

2010-380

Front 314

Are men or women more affected by pseudogout?

Back 314

Both are equally affected

2010-380

Front 315

While in gout crystals are yellow when _____ (perpendicular/parallel) to the light of the microscope, in pseudogout crystals are yellow when _____ (perpendicular/parallel) to the light of the microscope.

Back 315

Parallel; perpendicular

2010-380

Front 316

Pseudogout is caused by the deposition of _____ _____ crystals within the joint space.

Back 316

Calcium pyrophosphate

2010-380

Front 317

Pseudogout tends to affect people who are more than ____ years old.

Back 317

50

2010-380

Front 318

Name two diseases that can cause chronic infectious arthritis.

Back 318

Tuberculosis and Lyme disease

2010-380

Front 319

Name three organisms that commonly cause septic arthritis.

Back 319

Staphylococcus aureus, Streptococcus, and Neisseria gonorrhoeae

2010-380

Front 320

Which organism is a common cause of septic arthritis leading to red and painful joints presenting in a monoarticular, migratory, asymmetric pattern?

Back 320

Neisseria gonorrhoeae (remember: STD = Synovitis (eg, knee), Tenosynovitis (eg, hand), and Dermatitis (eg, pustules)

2010-380

Front 321

Seronegative spondyloarthropathies are a form of autoimmune arthritis that occurs without a positive _____ _____ in the blood.

Back 321

Rheumatoid factor

2010-381

Front 322

True or False? Most individuals with psoriasis are affected with psoriatic arthritis as well.

Back 322

False; fewer than one third of patients with psoriasis are affected by psoriatic arthritis

2010-381

Front 323

What is the classic triad of clinical signs and symptoms in Reiter's syndrome?

Back 323

Urethritis, ophthalmologic findings (conjunctivitis and anterior uveitis), and arthritis (remember: "Can't see, can't pee, can't climb a tree")

2010-381

Front 324

What are two triggers for Reiter's syndrome?

Back 324

Gastrointestinal infection and chlamydial infection

2010-381

Front 325

Do seronegative spondyloarthropathies affect more men or more women?

Back 325

Men

2010-381

Front 326

Psoriatic arthritis commonly presents in a(n) _____ (symmetric/asymmetric) pattern.

Back 326

Asymmetric and patchy involvement

2010-381

Front 327

In seronegative spondyloarthropathies, there is a strong association with which human leukocyte antigen?

Back 327

Human leukocyte antigen B27

2010-381

Front 328

What is the classic triad of clinical signs and symptoms in ankylosing spondylitis?

Back 328

Ankylosis (stiff spine), uveitis, and aortic regurgitation

2010-381

Front 329

The physical exam finding of dactylitis ("sausage fingers") and radiologic finding of "pencil-in-cup" deformity are associated with which type of arthritis?

Back 329

Psoriatic arthritis

2010-381

Front 330

Patients with systemic lupus erythematosus may be falsely diagnosed with which disease based on serologic testing?

Back 330

False-positive rapid plasma reagin or venereal disease research laboratory tests for syphilis occur as a result of the presence of antiphospholipid antibodies

2010-381

Front 331

Which antibody is specific for lupus and predicts a poor prognosis?

Back 331

Anti-double-stranded DNA

2010-381

Front 332

Which antibody is specific for lupus but is not prognostic?

Back 332

Anti-Smith antibodies

2010-381

Front 333

True or False? Raynaud's phenomenon is associated with systemic lupus erythematosus.

Back 333

True

2010-381

Front 334

Which form of endocarditis is associated with systemic lupus erythematosus?

Back 334

Nonbacterial verrucous endocarditis

2010-381

Front 335

Systemic lupus erythematosus is most common and severe in which ethnic group: whites, African-Americans, or Asians?

Back 335

African-Americans

2010-381

Front 336

In false-positive rapid plasma reagin or venereal disease research laboratory syphilis tests, the antiphospholipid antibody cross-reacts with what substance?

Back 336

Cardiolipin

2010-381

Front 337

What are the eleven findings used to make a clinical diagnosis of systemic lupus erythematosus?

Back 337

For the characteristics of systemic lupus erythematosus, remember I'M DAMN SHARP: Immunoglobulins (anti-double-stranded DNA, anti-Smith, antiphospholipid), Malar rash, Discoid rash, Antinuclear antibody, Mucositis (oropharyngeal ulcers), Neurologic disorders, Serositis (pleuritis, pericarditis), Hematologic disorders, Arthritis, Renal disorders, Photosensitivity

2010-381

Front 338

A woman has a rash on her cheeks that involves the bridge of the nose but spares the area below the nasolabial sulcus. What is the name of this rash, and what disease is it most commonly associated with?

Back 338

Malar rash; systemic lupus erythematosus

2010-381

Front 339

Which demographic is most commonly affected by lupus?

Back 339

Females 14 to 45 years of age

2010-381

Front 340

What abnormal finding could a patient with systemic lupus erythematosus have on chest x-ray?

Back 340

Hilar adenopathy

2010-381

Front 341

What are two common causes of death in patients with systemic lupus erythematosus?

Back 341

Renal failure and infection

2010-381

Front 342

Which antibody is sensitive for lupus but is not specific?

Back 342

Antinuclear antibodies

2010-381

Front 343

In patients with drug-induced lupus, which antibodies are detected?

Back 343

Antihistone antibodies

2010-381

Front 344

What is the histopathologic appearance of renal disease in systemic lupus erythematosus?

Back 344

Wire loop lesions, due to immune complex deposition in the glomeruli

2010-381

Front 345

Which serologic findings (antibodies) can be positive in patients with lupus?

Back 345

Antinuclear antibodies, anti-double-stranded DNA, anti-Smith antibodies, and antihistone antibodies

2010-381

Front 346

Serositis in systemic lupus erythematosus refers to inflammation of which membranes?

Back 346

Pleuritis and pericarditis

2010-381

Front 347

In which diseases can a positive antinuclear antibody result be found on serologic testing?

Back 347

Systemic lupus erythematosus, Sjögren's syndrome (and sicca), and scleroderma

2010-381

Front 348

What type of lymphadenopathy is associated with sarcoidosis?

Back 348

Bilateral hilar lymphadenopathy

2010-382

Front 349

What is the underlying pathology in sarcoidosis?

Back 349

Widespread noncaseating granulomas

2010-382

Front 350

What two histopathologic findings are seen in the epithelial granulomas of sarcoidosis?

Back 350

Schaumann bodies and asteroid bodies

2010-382

Front 351

What type of lung disease is associated with sarcoidosis: obstructive or restrictive?

Back 351

Restrictive

2010-382

Front 352

What is a common finding on the chest x-ray of a patient with sarcoid?

Back 352

Bell's palsy

2010-382

Front 353

What type of skin pathology is associated with sarcoidosis?

Back 353

Erythema nodosum

2010-382

Front 354

Inflammation of which structures of the head is seen in sarcoidosis?

Back 354

Ocular and parotid gland inflammation

2010-382

Front 355

What enzyme levels are elevated in the serum in patients with sarcoidosis?

Back 355

Serum angiotensin-converting enzyme levels

2010-382

Front 356

What type of arthritis is associated with sarcoidosis?

Back 356

Rheumatoid arthritis (remember: GRAIN (Gammaglobulinemia, Rheumatoid arthritis, ACE increase, Interstitial fibrosis, Noncaseating granulomas)

2010-382

Front 357

What is the treatment for sarcoidosis?

Back 357

Steroids

2010-382

Front 358

What specific population is most affected by sarcoidosis?

Back 358

African-American females

2010-382

Front 359

Hypercalcemia associated with sarcoidosis occurs because of the increased conversion of what substance into its active form in epithelioid macrophages?

Back 359

Vitamin D

2010-382

Front 360

What is the diagnostic procedure for dermatomyositis and polymyositis?

Back 360

Muscle biopsy

2010-382

Front 361

Which part of the immune system causes damage in polymyositis?

Back 361

CD8+ T-cell-induced injury to myofibers

2010-382

Front 362

Polymyositis most often involves what body part?

Back 362

Shoulders

2010-382

Front 363

Dermatomyositis is similar to polymyositis but also involves what skin symptom?

Back 363

Rash (heliotrope, malar and "shawl and face")

2010-382

Front 364

Polymyositis involves progressive _____ (proximal/distal) muscle weakness.

Back 364

Proximal

2010-382

Front 365

Gottron's papules are symptoms of what disease?

Back 365

Dermatomyositis

2010-382

Front 366

Which lab results are abnormal in polymyositis/dermatomyositis?

Back 366

Elevated creatine kinase, elevated aldolase, positive antinuclear antibody, and anti-Jo-1

2010-382

Front 367

What is the treatment for polymyositis and dermatomyositis?

Back 367

Steroids are used to treat both disorders

2010-382

Front 368

While myasthenia gravis involves autoantibodies against the _____ (presynaptic/postsynaptic) acetylcholine receptors, Lambert-Eaton syndrome involves autoantibodies against the _____ (presynaptic/postsynaptic) calcium channels.

Back 368

Postsynaptic; presynaptic

2010-382

Front 369

Lambert-Eaton syndrome leads to _____ (proximal/distal) muscle weakness.

Back 369

Proximal

2010-382

Front 370

Name two ophthalmic manifestations of myasthenia gravis.

Back 370

Ptosis and diplopia

2010-382

Front 371

True or False? Both myasthenia gravis and Lambert-Eaton syndrome improve with acetylcholinesterase inhibitor use.

Back 371

False; although myasthenia gravis symptoms reverse with the use of acetylcholinesterase inhibitors, there is no reversal in Lambert-Eaton syndrome with acetylcholinesterase inhibitors alone such as edrophonium

2010-382

Front 372

Myasthenia gravis is caused by autoantibodies to which receptor?

Back 372

Acetylcholine receptors

2010-382

Front 373

While the symptoms of myasthenia gravis _____ (improve/worsen) with muscle use, symptoms of Lambert-Eaton syndrome _____ (improve/worsen) with muscle use.

Back 373

Worsen; improve

2010-382

Front 374

In contrast to myasthenia gravis, Lambert-Eaton syndrome spares what muscle group?

Back 374

Extraocular muscles

2010-382

Front 375

Myasthenia gravis is associated with which type of tumor?

Back 375

Thymoma

2010-382

Front 376

Which malignancy is most closely associated with Lambert-Eaton syndrome?

Back 376

Small-cell lung cancer

2010-382

Front 377

Individuals with myasthenia gravis complain of generalized weakness that is worse in the _____ (morning/evening).

Back 377

In myasthenia gravis, weakness tends to be worse toward the end of the day

2010-382

Front 378

Lambert-Eaton syndrome is caused by autoantibodies to which types of ionic channels, leading to a decrease in acetylcholine release?

Back 378

Calcium channels

2010-382

Front 379

Patients with mixed connective tissue disease are positive for _____ autoantibodies.

Back 379

U1 ribonucleoprotein

2010-382

Front 380

What is the treatment for mixed connective tissue disease?

Back 380

Steroids

2010-382

Front 381

What five characteristics are associated with mixed connective tissues diseases?

Back 381

Raynaud's phenomenon, Fatigue, Arthralgias, Myalgias, and Esophageal hypomotility (remember: Raynaud's FAME)

2010-382

Front 382

Does scleroderma affect more men or women?

Back 382

Women

2010-383

Front 383

What condition involves excessive fibrosis and collagen deposition throughout the body but most commonly under the skin?

Back 383

Scleroderma

2010-383

Front 384

What are the two types of scleroderma?

Back 384

Diffuse scleroderma and CREST syndrome

2010-383

Front 385

Describe the progression of diffuse scleroderma.

Back 385

Widespread skin involvement, rapid progression, and early visceral involvement

2010-383

Front 386

A patient presents for examination. Although middle-aged, she has no wrinkles (denies plastic surgery) and her skin is puffy and taut. She also complains of difficulty swallowing. From what disease is she suffering?

Back 386

Scleroderma

2010-383

Front 387

Skin involvement in CREST syndrome is often confined to which two areas of the body?

Back 387

Fingers and face

2010-383

Front 388

Diffuse scleroderma is associated with which antibody?

Back 388

Anti-Scl-70 antibody (anti-DNA topoisomerase I antibody)

2010-383

Front 389

Which has a more benign course: diffuse scleroderma or CREST syndrome?

Back 389

CREST syndrome

2010-383

Front 390

Although scleroderma most commonly affects the skin, what four other organ systems can it affect?

Back 390

Cardiovascular, pulmonary, gastrointestinal, and renal

2010-383

Front 391

What does CREST stand for?

Back 391

Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia

2010-383

Front 392

Which antibody is associated with CREST syndrome?

Back 392

Anticentromere antibody (remember: C for CREST)

2010-383

Front 393

Rhabdomyosarcomas often arise from skeletal muscle from what two locations in the body?

Back 393

Head and neck

2010-383

Front 394

Rhabdomyoma of the heart is associated with which genetic disease?

Back 394

Tuberous sclerosis

2010-383

Front 395

Rhabdomyoma is a benign tumor derived from what kind of muscle?

Back 395

Striated (skeletal or cardiac) muscle

2010-383

Front 396

What is the most common malignant soft tissue tumor of childhood?

Back 396

Rhabdomyosarcoma

2010-383

Front 397

While lipomas are _____ (benign/malignant) in nature, liposarcomas are _____ (benign/malignant).

Back 397

Benign; malignant

2010-383

Front 398

What is a lipoma?

Back 398

A soft, well-encapsulated tumor derived from fat

2010-383

Front 399

True or False? Lipoma recurrences are common even after excision.

Back 399

False; simple excision of lipomas is usually curative

2010-383

Front 400

An increased thickness of the stratum corneum is known as _____.

Back 400

Hyperkeratosis

2010-383

Front 401

_____ (Macules/Patches) are flat discolorations of the skin <1 cm in size, while _____ (macules/patches) represent a similar lesion except they are > 1 cm in size.

Back 401

Macules; patches

2010-383

Front 402

Hives are an example of what type of dermatologic lesion?

Back 402

Wheal

2010-383

Front 403

Tinea versicolor is an example of what type of dermatologic lesion?

Back 403

Macule

2010-383

Front 404

Chickenpox is an example of what type of dermatologic lesion?

Back 404

Vesicle

2010-383

Front 405

Pemphigus vulgaris causes which pathologic change of the epidermis?

Back 405

Acantholysis

2010-383

Front 406

Psoriasis causes what gross and microscopic dermatologic lesions?

Back 406

Plaques, parakeratosis and hyperkeratosis

2010-383

Front 407

Dried exudate from a vesicle, bulla, or pustule is called a _____.

Back 407

Crust

2010-383

Front 408

_____ (Papules/Plaques) are elevated skin lesions < 1 cm in size, while _____ (papules/plaques) represent a similar lesion but are > 1 cm in size.

Back 408

Papules; plaques

2010-383

Front 409

Which phenomenon describes hyperkeratosis with retention of nuclei in stratum corneum, as seen in psoriasis?

Back 409

Parakeratosis

2010-383

Front 410

Acne vulgaris is an example of what type of dermatologic lesion?

Back 410

Papule

2010-383

Front 411

What is the medical term for a blister containing pus?

Back 411

Pustule

2010-383

Front 412

What irregular, raised lesion results from scar tissue hypertrophy following trauma to skin, especially in African-Americans?

Back 412

Keloid

2010-383

Front 413

While acantholysis is the _____ (hyperplasia/separation) of epidermal cells, acanthosis represents epidermal _____ (hyperplasia/separation).

Back 413

Separation; hyperplasia

2010-383

Front 414

Which dermatologic term describes a transient vesicle?

Back 414

Wheal

2010-383

Front 415

_____ (Bullae/Vesicles) are small fluid-containing blisters, while _____ (bullae/vesicles) are large fluid-containing blisters.

Back 415

Vesicles; bullae

2010-383

Front 416

A parents calls the pediatrician because her newborn has a fever and rash. Every time she picks the baby up, it seems like her skin peels off. From what is the baby suffering?

Back 416

Staphylococcal scalded skin syndrome

2010-384

Front 417

Hairy leukoplakia is associated with which underlying medical condition?

Back 417

HIV infection

2010-384

Front 418

Allergic contact dermatitis is a type _____ hypersensitivity reaction that follows exposure to an allergen.

Back 418

IV

2010-384

Front 419

What developmental failure can result in albinism?

Back 419

Failure of neural crest cell migration during development

2010-384

Front 420

Acanthosis with parakeratotic scaling that is particularly found on knees and elbows is called what?

Back 420

Psoriasis

2010-384

Front 421

A patient presents with large bullae. On exam, there is epidermal separation on stroking of the lesion. What is this sign called and from what disorder is this patient suffering?

Back 421

Positive Nikolsky's sign; the patient has pemphigus vulgaris

2010-384

Front 422

Which autoimmune blistering skin disorder affects the skin but not the oral mucosa?

Back 422

Bullous pemphigoid

2010-384

Front 423

A freckle, a lesion that results from increased melanin pigment, is also known as _____.

Back 423

Ephelis

2010-384

Front 424

In albinism, melanocyte number is _____ (increased/decreased/unchanged), while in vitiligo melanocyte number is _____ (increased/decreased/unchanged).

Back 424

Unchanged (ie normal); decreased

2010-384

Front 425

Hives, also known as _____, are pruritic wheals that form secondary to degranulation of what type of cell?

Back 425

Urticaria; mast cells

2010-384

Front 426

Which virus causes hairy leukoplakia?

Back 426

Epstein-Barr virus

2010-384

Front 427

True or False? A positive Nikolsky's sign is common in both pemphigus vulgaris and bullous pemphigoid.

Back 427

False; patients with bullous pemphigoid have a negative Nikolsky's sign

2010-384

Front 428

A patient presents with bullae sparing the oral mucosa. From what disease is she suffering?

Back 428

Bullous pemphigoid

2010-384

Front 429

Which infectious superficial skin infection is commonly characterized by "honey-colored" crusting?

Back 429

Impetigo

2010-384

Front 430

Cellulitis, an acute painful spreading infection of the dermis and subcutaneous tissues, is most commonly caused by which two organisms?

Back 430

Staphylococcus aureus and Streptococcus pyogenes

2010-384

Front 431

An increased stratum spinosum and a decreased stratum granulosum is seen with which skin disorder?

Back 431

Psoriasis

2010-384

Front 432

A woman develops plaques and papules with silvery scaling on her elbows and knees. Pinpoint bleeding occurs when a scale is removed. What is the name of the sign describing the latter phenomenon? What is the most likely diagnosis?

Back 432

Auspitz sign; psoriasis

2010-384

Front 433

Which bacteria cause necrotizing fasciitis?

Back 433

Anaerobic bacteria and Streptococcus pyogenes

2010-384

Front 434

Staphylococcal scalded skin syndrome is caused by a bacterial product called an _____ that destroys the keratinocyte attachments in the stratum _____ only.

Back 434

Exotoxin; granulosum

2010-384

Front 435

True or False? Hairy leukoplakia is described as white painless plaques on the tongue that can be easily scraped off.

Back 435

False; hairy leukoplakia is characterized by white plaques on the tongue that cannot be scraped off

2010-384

Front 436

In albinism, decreased melanin production is due to what?

Back 436

Decreased activity of tyrosinase

2010-384

Front 437

Which blistering autoimmune skin disorder is most severe?

Back 437

Pemphigus vulgaris

2010-384

Front 438

Name the deep tissue infection caused by "flesh-eating" bacteria that results in crepitus due to bacterial production of carbon dioxide and methane.

Back 438

Necrotizing fasciitis

2010-384

Front 439

Atopic dermatitis is often associated with which two other atopic diseases?

Back 439

Asthma and allergic rhinitis

2010-384

Front 440

Condyloma acuminatum, or genital warts, are caused by what virus?

Back 440

Human papillomavirus

2010-384

Front 441

In the case of atopic dermatitis (eczema), pruritic eruption takes place on which surfaces of the body?

Back 441

Flexor surfaces

2010-384

Front 442

What is the difference in the appearance of bullous pemphigoid and pemphigus vulgaris on immunofluorescence?

Back 442

Bullous pemphigoid demonstrates linear immunofluorescence whereas pemphigus vulgaris reveals antibodies around cells of the epidermis in a reticular or netlike pattern

2010-384

Front 443

Which skin disorder is described as flat, pigmented, squamous epithelial proliferation with keratin-filled cysts?

Back 443

Seborrheic keratosis

2010-384

Front 444

How does vitiligo appear clinically?

Back 444

As irregular areas of complete skin depigmentation

2010-384

Front 445

While in bullous pemphigoid immunoglobulin G antibody is directed against the _____, in pemphigus vulgaris immunoglobulin G antibody is directed against the _____.

Back 445

Hemidesmosomes (epidermal basement membrane); desmosomes

2010-384

Front 446

Warts found on the hands are referred to as _____ _____, while warts found on the genitals are called _____ _____.

Back 446

Verruca vulgaris; condyloma acuminatum

2010-384

Front 447

Another name for warts, _____ are soft, tan-colored, cauliflower-like lesions of the skin.

Back 447

Verrucae

2010-384

Front 448

What is the Sign of Leser-Trélat?

Back 448

The sudden appearance of multiple seborrheic keratoses indicating underlying malignancy

2010-384

Front 449

Name three histopathologic findings in verrucae.

Back 449

Epidermal hyperplasia, hyperkeratosis, and koilocytosis

2010-384

Front 450

Melasma, or skin hyperpigmentation, is associated with what two situations?

Back 450

Pregnancy and oral contraceptive use

2010-384

Front 451

Patients with bullous pemphigoid have what cell type within blisters?

Back 451

Eosinophils

2010-384

Front 452

Name two organisms that commonly cause impetigo.

Back 452

Staphylococcus aureus and Streptococcus pyogenes

2010-384

Front 453

What is the lay term for a nevocellular nevus, a benign lesion?

Back 453

Mole

2010-384

Front 454

Which skin disorder presents with multiple types of lesions, including macules, papules, vesicles, and target lesions?

Back 454

Erythema multiforme

2010-385

Front 455

At what age does strawberry hemangioma typically regress?

Back 455

5 to 8 years of age

2010-385

Front 456

Which skin disorder involves pruritic, purple, and polygonal papules?

Back 456

Lichen planus

2010-385

Front 457

Which syndrome is characterized by high fever, bulla formation, necrosis, ulceration of the skin, and a high mortality rate?

Back 457

Stevens-Johnson syndrome

2010-385

Front 458

List four causes of erythema multiforme.

Back 458

Infection (Mycoplasma pneumoniae, HSV), drugs, cancers, and autoimmune disease

2010-385

Front 459

Dermatitis herpetiformis is associated with pruritic papules and vesicles and deposits of what at the tips of dermal papillae?

Back 459

Immunoglobulin A

2010-385

Front 460

Stevens-Johnson syndrome usually has what etiology?

Back 460

Drug reaction

2010-385

Front 461

Name two clinical conditions that are associated with acanthosis nigricans.

Back 461

Hyperlipidemia (ie., from Cushing's disease, diabetes) and hyperinsulinemia

2010-385

Front 462

Cherry hemangiomas _____ (do/do not) regress spontaneously.

Back 462

Do not

2010-385

Front 463

With what disease processes is erythema nodosum associated?

Back 463

Coccidioidomycosis, histoplasmosis, tuberculosis, leprosy, streptococcal infections, sarcoidosis

2010-385

Front 464

What skin condition is associated with celiac disease?

Back 464

Dermatitis herpetiformis

2010-385

Front 465

A more severe form of Steven-Johnson syndrome is known as what?

Back 465

Toxic epidermal necrolysis

2010-385

Front 466

In what stage of life is strawberry hemangioma seen?

Back 466

During the first few weeks of life

2010-385

Front 467

Erythema nodosum is characterized by inflammatory lesions of subcutaneous fat located on which part of the body?

Back 467

Anterior shins

2010-385

Front 468

At what age do cherry hemangiomas appear?

Back 468

30 to 49 years of age

2010-385

Front 469

What infectious disease is associated with lichen planus?

Back 469

Hepatitis C

2010-385

Front 470

What kind of lesion is actinic keratosis: malignant, benign, or premalignant?

Back 470

Premalignant

2010-385

Front 471

Which skin disorder is described as small, rough, erythematous, or brownish papules?

Back 471

Actinic keratosis

2010-385

Front 472

What skin disorder is characterized by a "herald patch" followed by a "Christmas tree" distribution of lesions?

Back 472

Pityriasis rosea

2010-385

Front 473

Describe the appearance and course of pityriasis rosea.

Back 473

Multiple papular eruptions with spontaneous remissions

2010-385

Front 474

Where are basal cell carcinomas most commonly found?

Back 474

On sun-exposed areas of the body

2010-386

Front 475

Squamous cell carcinoma is associated with what environmental exposures?

Back 475

Sunlight and arsenic

2010-386

Front 476

Does squamous cell carcinoma metastasize rarely or commonly?

Back 476

Rarely

2010-386

Front 477

What aspect of a melanoma correlates best with the risk of metastases?

Back 477

Depth of invasion

2010-386

Front 478

Describe the physical appearance of melanoma on exam.

Back 478

Dark with irregular borders

2010-386

Front 479

Basal cell carcinomas are locally invasive but almost never _____.

Back 479

Metastasize

2010-386

Front 480

Where does squamous cell carcinoma most commonly occur?

Back 480

Hands and face

2010-386

Front 481

What tumor marker is associated with melanoma?

Back 481

S-100

2010-386

Front 482

What is the histopathologic finding in squamous cell carcinoma?

Back 482

Keratin "pearls"

2010-386

Front 483

Squamous cell carcinoma is associated with what chronic condition?

Back 483

Associated with chronic draining sinuses in the skin

2010-386

Front 484

Basal cell tumors have "_____" nuclei seen on histology.

Back 484

Palisading

2010-386

Front 485

What is the gross appearance of basal cell carcinomas?

Back 485

Pearly papules

2010-386

Front 486

What lesion is a precursor of melanoma?

Back 486

Dysplastic nevus (atypical mole)

2010-386

Front 487

A bald male patient presents with a lesion on the crown of his head. It has rolled edges with central ulceration. What type of cancer does he have?

Back 487

Basal cell tumor

2010-386

Front 488

What is the gross appearance of squamous cell carcinoma?

Back 488

Ulcerative red lesion

2010-386

Front 489

Keratoacanthoma is a variant of squamous cell carcinoma with what growth pattern?

Back 489

Rapid growth (4-6 weeks) and spontaneous regression (4-8 weeks)

2010-386

Front 490

What is a common precursor lesion to squamous cell carcinoma?

Back 490

Actinic keratosis

2010-386

Front 491

What drug inhibits the enzyme lipoxygenase?

Back 491

Zileuton

2010-387

Front 492

Within the arachidonic acid cascade, what two enzymes use arachidonic acid as their substrate?

Back 492

Lipoxygenase and cyclooxygenase

2010-387

Front 493

Name four effects of prostaglandins on the body.

Back 493

Prostaglandins cause a decrease in vascular tone, increase in pain, increase in uterine tone, increase in temperature

2010-387

Front 494

What is the first step of the arachidonic acid pathway?

Back 494

Membrane lipids are converted to arachidonic acid by phospholipase A2

2010-387

Front 495

Cyclooxygenase directly converts arachidonic acid into what category of compounds resulting in what two products?

Back 495

Endoperoxides; prostaglandins G and H

2010-387

Front 496

What effect does prostacyclin (PGI2) have on the vasculature?

Back 496

Promotes vasodilation

2010-387

Front 497

Hydroperoxides are the precursors of what class of arachidonic acid products?

Back 497

Leukotrienes

2010-387

Front 498

Zileuton inhibits the conversion of _____ to _____.

Back 498

arachidonic acid to hydroperoxides

2010-387

Front 499

List two drugs that inhibit leukotrienes from producing an increase in bronchial tone.

Back 499

Zafirlukast and montelukast

2010-387

Front 500

What effect do leukotrienes C4, D4, and E4 have on the bronchi and the bronchioles?

Back 500

Bronchoconstriction

2010-387

Front 501

Which arachidonic acid product is a neutrophil chemotactic agent?

Back 501

Leukotriene B4 (remember: Neutrophils arrive "B4" others)

2010-387

Front 502

What effect do leukotrienes C4, D4, and E4 have on the vasculature?

Back 502

Vasoconstriction and increase vascular permeability

2010-387

Front 503

Name three effects of prostacyclin.

Back 503

Prostacyclin decreases platelet aggregation, causes vasodilation and decreases uterine tone

2010-387

Front 504

What does the lipoxygenase pathway of the arachidonic acid pathway yield?

Back 504

Leukotrienes (remember: L for Lipoxygenase and Leukotrienes)

2010-387

Front 505

What effect does prostacyclin (PGI2) have on platelets?

Back 505

Inhibits platelet aggregation (remember Platelet-Gathering Inhibitor)

2010-387

Front 506

Endoperoxides are the precursors of what three arachidonic acid products?

Back 506

Prostacyclin, prostaglandins, and thromboxane

2010-387

Front 507

What are the two mechanisms of action of steroids on the arachidonic acid pathway?

Back 507

Steroids inhibit the action of phospholipase and inhibit the synthesis of cyclooxygenases

2010-387

Front 508

Aspirin _____ (reversibly/irreversibly) inhibits cyclooxygenase.

Back 508

Irreversibly

2010-387

Front 509

At what dose does aspirin have antiinflammatory properties?

Back 509

High dose; 2400-4000 mg/day

2010-387

Front 510

What syndrome can develop in children with viral illnesses who are given aspirin?

Back 510

Reye's syndrome

2010-387

Front 511

Chronic use of aspirin can cause what three problems?

Back 511

Acute renal failure, interstitial nephritis, and upper gastrointestinal bleeding

2010-387

Front 512

What is a common toxicity of aspirin use?

Back 512

Gastric upset

2010-387

Front 513

Aspirin causes a decrease in synthesis of what two products?

Back 513

Thromboxane and prostaglandins

2010-387

Front 514

At what dose does aspirin have antipyretic and analgesic properties?

Back 514

Intermediate dose; 300-2400 mg/day

2010-387

Front 515

At what dose does aspirin cause decreased platelet aggregation?

Back 515

Low-dose; < 300 mg/day

2010-387

Front 516

What four toxicities are associated with nonsteroidal antiinflammatory drugs?

Back 516

Renal damage, aplastic anemia, gastrointestinal distress, and ulcers

2010-387

Front 517

Nonsteroidal antiinflammatory drugs work by reversibly inhibiting what substance?

Back 517

Cyclooxygenase

2010-387

Front 518

Name four examples of nonsteroidal antiinflammatory drugs.

Back 518

Ibuprofen, naproxen, indomethacin, and ketorolac

2010-387

Front 519

Do ibuprofen, naproxen, indomethacin, and ketorolac inhibit cyclooxygenase-1, cyclooxygenase-2, or both?

Back 519

Both

2010-387

Front 520

Which nonsteroidal antiinflammatory drug is used to close a patent ductus arteriosus?

Back 520

Indomethacin

2010-387

Front 521

What are the three effects of administration of nonsteroidal antiinflammatory drugs?

Back 521

They are antipyretics, analgesics, and antiinflammatory agents

2010-387

Front 522

Nonsteroidal antiinflammatory drugs block the synthesis of what substance?

Back 522

Prostaglandins

2010-387

Front 523

There is an increased risk of _____ when taking cyclooxygenase-2 inhibitors.

Back 523

Thrombosis

2010-388

Front 524

How do cyclooxygenase-2 inhibitors differ from other nonsteroidal antiinflammatory drugs?

Back 524

Reversibly inhibit cyclooxygenase-2, found in inflammatory cells and vascular endothelium, mediates inflammation and pain; unlike nonsteroidal antiinflammatory drugs, it spares cyclooxygenase-1

2010-388

Front 525

Individuals with an allergy to _____ should avoid taking cyclooxygenase-2 inhibitors.

Back 525

Sulfa

2010-388

Front 526

What are the two clinical indications for using cyclooxygenase-2 inhibitors?

Back 526

To treat rheumatoid arthritis and osteoarthritis

2010-388

Front 527

Explain the mechanism by which cyclooxygenase-2 inhibitors help maintain the gastric mucosa.

Back 527

Cyclooxygenase-2 inhibitors do not affect the cyclooxygenase-1 enzymes that produce the prostaglandins that protect the gastric mucosa

2010-388

Front 528

Acetaminophen has antipyretic and analgesic activities but lacks what other property that is common to nonsteroidal antiinflammatory drugs?

Back 528

Antiinflammatory properties

2010-388

Front 529

What are the physiologic effects of an acetaminophen overdose?

Back 529

Hepatic necrosis

2010-388

Front 530

What is the antidote to acetaminophen toxicity?

Back 530

N-acetylcysteine; regenerates glutathione depleted by acetaminophen overdose

2010-388

Front 531

Acetaminophen's metabolite depletes what reducing substance in hepatic cells?

Back 531

Glutathione

2010-388

Front 532

Acetaminophen reversibly inhibits what substance in the central nervous system?

Back 532

Cyclooxygenase

2010-388

Front 533

True or False? Acetaminophen has antiinflammatory activity.

Back 533

False; acetaminophen is an nonsteroidal antiinflammatory drug without antiinflammatory activity

2010-388

Front 534

Aspirin is a Nonsteroidal Antiinflammatory Drug with what additional activity?

Back 534

Antiplatelet activity

2010-388

Front 535

Name three clinical indications for use of bisphosphonates.

Back 535

Malignancy-associated hypercalcemia, Paget's disease of bone, postmenopausal osteoporosis

2010-388

Front 536

Name four bisphosphonates.

Back 536

Etidronate, pamidronate, alendronate, and risedronate

2010-388

Front 537

What is the mechanism of action of bisphosphonates?

Back 537

Inhibit osteoclastic activity

2010-388

Front 538

Name the three major toxicities of bisphosphonates.

Back 538

Corrosive esophagitis, nausea, and diarrhea

2010-388

Front 539

Which treatment for gout inhibits xanthine oxidase, which decreases the conversion of xanthine oxidase into uric acid?

Back 539

Allopurinol

2010-388

Front 540

Which two reactions are inhibited by allopurinol and catalyzed by xanthine oxidase?

Back 540

Conversion of hypoxanthine to xanthine and conversion of xanthine to uric acid

2010-388

Front 541

Which treatment for gout inhibits xanthine oxidase and is used to prevent tumor-lysis-associated urate nephropathy in individuals with lymphomas and leukemias?

Back 541

Allopurinol

2010-388

Front 542

Which two drugs inhibit the tubular reabsorption of uric acid?

Back 542

Probenecid and high-dose salicylates

2010-388

Front 543

Which medication is used more often to treat acute gout because it causes less toxicity than colchicine?

Back 543

Indomethacin

2010-388

Front 544

Which two drugs inhibit the tubular secretion of uric acid?

Back 544

Diuretics and low-dose salicylates

2010-388

Front 545

Is colchicine used to treat chronic gout or acute gout?

Back 545

Acute gout

2010-388

Front 546

Is probenecid used to treat chronic gout or acute gout?

Back 546

Chronic gout

2010-388

Front 547

Which medication for gout inhibits the reabsorption of uric acid and the secretion of penicillin?

Back 547

Probenecid

2010-388

Front 548

Colchicine has adverse effects related to which organ system, especially when taken orally?

Back 548

The gastrointestinal system

2010-388

Front 549

Is allopurinol used to treat chronic gout or acute gout?

Back 549

Chronic gout

2010-388

Front 550

What substance is converted to uric acid for excretion from the body? What are the intermediates?

Back 550

Purines; hypoxanthine and xanthine

2010-388

Front 551

Allopurinol causes increased serum levels of which drugs if taken concurrently?

Back 551

Azathioprine and 6-MP; both normally metabolized by xanthine oxidase, which is inhibited by allopurinol

2010-388

Front 552

What drug should not be used to treat gout?

Back 552

Salicylates, which depress uric acid clearance

2010-388

Front 553

Which medication used for gout depolymerizes microtubules, thereby impairing leukocyte chemotaxis and degranulation?

Back 553

Colchicine

2010-388

Front 554

What is the mechanism of action of infliximab?

Back 554

Anti-tumor necrosis factor antibody (remember: INFLIXimab INFLIX pain on TNF)

2010-*

Front 555

A patient with Crohn's disease presents for treatment with infliximab. What infection does the physician worry about reactivating?

Back 555

Latent tuberculosis

2010-*

Front 556

Name the drug with the following mechanism: recombinant form of human tumor necrosis factor receptor that binds tumor necrosis factor.

Back 556

Etanercept (remember: EtanerCEPT is a TNF decoy reCEPTor)

2010-*

Front 557

List three clinical uses for adalimumab.

Back 557

Rheumatoid arthritis, psoriasis, and ankylosing spondylitis

2010-*

Front 558

List three clinical uses for infliximab.

Back 558

Crohn's disease, rheumatoid arthritis, and ankylosing spondylitis

2010-*

Front 559

Name the drug with the following mechanism: directly binds tumor necrosis factor receptor sites.

Back 559

Adalimumab

2010-*

Front 560

List three clinical uses for etanercept.

Back 560

Rheumatoid arthritis, psoriasis, and ankylosing spondylitis

2010-*