1A: Dt 8 - 2

Front 1

What are the layers of the epidermis? (In order)

Back 1

Californians Like Girls in String Bikinis

Striatum Corneum
Lucidum
Granulosum
Spinosum
Basalis

Front 2

Where are blood vessels located in the skin?

Back 2

BVs in dermis, none in epidermis (gets nutrition by diffusion)

Front 3

Zona occludens:
Role

Back 3

tight junction--prevents diffusion across paracellular space (composed of claudins and occludins)

Front 4

Zona adherens:
Role

Back 4

Intermediate jn--surounds perimeter below zona occludens; cadherins connect to actin

Front 5

Macula adherens:
Role

Back 5

Desomosome; small, discrete sites of attachment; cadherins connect to intermediate filaments

Front 6

Pemphigus vulgaris:
Pathophys

Back 6

Autoantibodies to DESMOSOME (MACULA ADHERENS)

Front 7

Hemidesmosome:
Role

Back 7

COnnects cells to underlying ECM

Front 8

Bullous pemphigoid:
Pathophys

Back 8

Autoantibodies to HEMIDESMOSOME

Front 9

Describe the steps of leukocyte extravasation.

Include the adhesion molecules and cytokines needed.

Back 9

1. Rolling--E-selectin, P-selectin

2. Tight binding: ICAM-1

3. Diapedesis (leukocyte travels between endothelial cells and exits BV)--PECAM-1

4. Migration--leukocyte travels through interstitium to site of injury, guided by chemotactic signals--CILK: C5a, IL-8, LTB4, Kallikrein

Front 10

What are the acute phase cytokines?

Back 10

IL-1
IL-6
TNF-alpha

Front 11

Which of the following joins only cells of the same type and does not attach cells to the basement membrane?

Hemidesmosome
Cadherin
Integrin
ICAM-1

Back 11

Cadherin

Front 12

What is the unhappy triad?

Back 12

Force from lateral side injuring:
MCL
ACL
Lateral meniscus

Front 13

ACL vs PCL:
Attachment

Back 13

ACL: Anterior tibia
PCL: Posterior tibia

Front 14

Pudendal nerve:
Innervation

Back 14

Saddle region (block this area to relieve pain of delivery)

Front 15

Where are lumbar punctures performed?

Back 15

Between L3 and L4 (iliac crest)

Front 16

Rotator cuff:
Components and their actions
Which component is most commonly injuyed?

Back 16

SItS (small t for teres minor :))

Supraspinatus--abducts arm initial 10 degrees; most commonly injured

Infraspinatus--laterally rotates arm (pitching injury)

Teres minor--adducts and laterally rotates arm

Subscapularis: medially rotates and adducts arm

Front 17

Which muscles of rotator cuff:
Initial 15 degrees of arm abduction

Back 17

Supraspinatus

Front 18

Which muscles of rotator cuff:
Lateral rotation of the arm

Back 18

Infraspinatus
Teres minor

Front 19

Which muscles of rotator cuff:
Medial rotation of the arm

Back 19

Subscapularis

Front 20

Where does new bone formation take place in growing long bones?

Back 20

Epiphyseal plate

Front 21

A football plays who was kicked in the leg suffers from a damaged medial meniscus.

What else is likely to have been damaged?

Back 21

ACL
MCL
Lateral meniscus
(UNHAPPY TRIAD)

Front 22

What is the difference between a dislocated and separated shoulder?

Back 22

Dislocated--head of humerus rotates out of glenoid cavitiy

Separated--clavicle separates from acromion and coracoid process of scapula

Front 23

What structure can be damaged in anterior shoulder dislocation?
How would you test for this?

Back 23

Axillary nerve damage--test sensation over deltoid

Supraspinatus tendon

Front 24

Lateral vs Medial epicondylitis:
Pathophys

Back 24

Lateral epicondylitis: tennis elbow
Medial epicondylitis: golf elbow

Both are degenerative injuries due to repeated use; leads to tiny tears in tendons and muscles. May be inflammatory.

Front 25

Label

Back 25

Front 26

Type 1 vs Type 2 Muscle fibers

Back 26

One slow red ox!

Type 1: Slow twitch, red fibers due to inc'd mitochondria and myoglobin concentration (inc'd ox-phos)-->sustained contractions

Type 2:
Fast twitch, white fibers due to dec'd mitochondria and myoglobin concentrations (inc'd anerobic glycolysis); ex: weight training

Front 27

Endochondrial vs Membranous FR3Ossification

Back 27

Endochondral: Longitudinal bone growth, cartilaginous model of bone first made by chondrocytes

Membranous ossification: flat bone growth (skull, facial bones, axial skeleton); woven bone formed directly without cartilage.

Front 28

Achondroplasia:
What is it?
Mutation?
Risk of inheritance?

Back 28

Failure of longitudinal bone growth (endochondral)

Due to mutation in FGFR3

AUTOSOMAL DOMINANT: 50% risk of inheritance if one normal parent, one dwarfed parent

Front 29

Osteoporosis:
Risk factors
Presentation
Prophylaxis

Back 29

Note: normal bone mineralization and lab values!!

Risks:
older age
smoking
steroids
white
thin
No weight-bearing exercise
Poor ca2+, vit D
hypogonadism (menopause included)
heparin

Presents with vertebral crush fractures (acute back pain, kyphosis, loss of height)
Femoral neck fracture

Prophylaxis: exercise, calcium ingestion before age 30

Tx: SERMs, calcitonin, bisphosphonates!

Front 30

Bisphosphonates:
Suffix
MOA
AE

Back 30

-dronates

MOA: inhibit osteoclasts

AE: corrosive esophagitis; must remain upright for a few hours after ingesting drug

Front 31

Osteopetrosis:
Pathophys
Lab values

Back 31

Failure of normal bone resorption-->thik, dense bones prone to fracture

Due to abnl fn of osteoclasts

Labs: Normal ALP, normal Ca2+, normal phosphate
Dec'd marrow space-->anemia, low PLT, infection (PANCYTOPENIA), inc'd extramedullary hematopoiesis

Front 32

Osteomalacia/Rickets:
Pathophys
Lab values

Back 32

Vitamin D deficiency, low calcium levels, inc'd PTH, low serum phosphate

Front 33

Paget's Disease of Bone:
Pathophys
Lab values
Treatment

Back 33

Abnl bone architecture caused by inc in both oblast and oclast activity

Hat size can be inc'd, hearing loss common due to auditory foramen narrowing

Labs: inc'd ALP with anl bone architecture

Tx: bisphosphonates

Front 34

Vitamin D intoxication:
Effects
What disease can mimic this?

Back 34

Inc'd absorption of Ca2+ and PO4
Dec'd PTH
ALP normal
Granulomatous dz ~sarcoidosis can cause elevated vitamin D

Front 35

Effect of renal insufficiency on:
Calcium
Phosphate
PTH

Back 35

Dec'd serum Ca2+ (can't activate Vit D as well)
Elevated PTH
Elevated Phosphate (can't excrete)

Front 36

Polyostotic fibrous dysplasia:
Pathophys
Presentation

Back 36

Bone replaced by fibroblasts, collagen, irregular boney trabeculae

A form of this is McCune-Albright Syndrome--precocious puberty, unilateral pigmented lesions (cafe-au-lait spots)

Front 37

Which bony disease:
Reversible when Vitamin D replaced

Back 37

Osteomalacia/Rickets

Front 38

Which bony disease:
Excess osteoclastic activity results in disorganized bony architecture

Back 38

Paget's

Front 39

Which bony disease:
Bone replaced by fibroblasts, collagen, irregular bony trabeculae

Back 39

Polyostotic fibrous dysplasia

Front 40

Which bony disease:
Soft bones due to defective mineralization of osteoid

Back 40

Osteomalacia/Rickets

Front 41

Which bony disease:
Failure of bone resorption-->thickened and dense bones

Back 41

Osteopetrosis

Front 42

Which bony disease:
Genetic deficiency of carbonic anhydrase II

Back 42

Osteopetrosis

Front 43

What are the following lab values like in Paget's disease?

Serum Ca
Serum Phos
Alk Phos
PTH

Back 43

Elevated Alk Phos

Front 44

What are the following lab values like in osteomalacia/Rickets?

Serum Ca
Serum Phos
Alk Phos
PTH

Back 44

Low vit D-->Low serum Ca
Elevate PTH (phosphorus trashing hormone!)
Low serum phos

Front 45

What are the following lab values like in osteitis fibrosa cystica?

Serum Ca
Serum Phos
Alk Phos
PTH

Back 45

PTH high
High serum Ca
Inc'd Alk Phos
Low serum phos

Front 46

What are the following lab values like in osteoporosis?

Serum Ca
Serum Phos
Alk Phos
PTH

Back 46

ALL NORMAL :)

Front 47

What are the following lab values like in osteopetrosis?

Serum Ca
Serum Phos
Alk Phos
PTH

Back 47

ALL NORMAL :)

Front 48

Osteosarcoma:
Incidence
Risk factors
Presentation on x-ray

Back 48

Peak incidence in men 10-20 years of age

Risk factors: Paget's dz, bone infarcts, XRT, familial retinoblastoma (Rb gene)

Poor prognosis

Codman's triangle or sunburst pattern (form elevation of periosteum) on x-ray

Front 49

Ewing's sarcoma:
Presentation
Hallmark feature

Back 49

Anaplastic small blue cell tumor (malignant) in boys <15
Extremely aggressive with early mets, but responsive to chemo

Hallmark = onion-skin appearance in bone (going out for eWINGS and ONION rings)
Pseudorosettes

Front 50

Which bone tumor:
Most common malignant primary bone tumor of children

Back 50

Osteosarcoma

Front 51

Which bone tumor:
Most common malignant primary bone tumor in adults

Back 51

Multiple myeloma

Front 52

Which bone tumor:
Most common benign bone tumor

Back 52

Osteochondroma

Front 53

Which bone tumor:
11;22 translocation

Back 53

Ewing Sarcoma

Front 54

Which bone tumor:
Soap-bubble appearance on x-ray

Back 54

Giant Cell Tumor

Front 55

Which bone tumor:
Onion-skin appearance of bone

Back 55

Ewing Sarcoma

Front 56

Which bone tumor:
May actually be a hamartoma

Back 56

Osteochondroma

Front 57

Which bone tumor:
Codman's triangle on x-ray

Back 57

Osteosarcoma

Front 58

Which bone tumor:
Associated with Gardner's syndrome

Back 58

Osteoma; note Gardner's syndrome = familial adenomatous polyposis!!!!!!

Front 59

Osteoarthritis:
Pathophys
Risk Factors
Presentation
Treatment

Back 59

Pathophys: Wear and tear dz; wear away cartilage

Risk factors: age, obesity, joint deformity

Presentation: pain in weight-bearing joints after use (at end of day for example)
NON INFLAMMATORY

Tx: acetaminophen, NSAIDS, COX-2 inhibitors, injected steroids into joint

Front 60

Rheumatoid Arthritis:
Pathophys
Diagnosis
Presentation
Treatment

Back 60

SYSTEMIC autoimmune dz--affects MCP, PIP (not DIP)

This is a TYPE III HYPERSENS RXN; 80% of pts have RF (+)

Presentation: Morning stiffness > 30 minutes and improving with use, symmetric joint involvement, systemic syx (fever, fatigue, pleuritis, pericarditis)

Treatment: NSAIDs, TNF-alpha inhibitors (Etanercept, infliximab, adalimumab)

Front 61

Sjogren's Syndrome:
Presentation
Diagnosis

Back 61

Can't see, can't spit, can't climb up shit:
Dry eyes, dry mouth, arthritis

Dx: SS-A (Ro), SS-B (La) antibodies; parotid enlargement (inc'd risk B cell lymphoma)

Front 62

Back 62

Swan neck deformity-->RA

Front 63

Gout:
Presentation
Diagnosis
Treatment

Back 63

Asymmetric joint distribution. Joint is swollen, red, painful.
Classic at MTP joint of BIG TOE (podagra).
Tophus formation often of external ear, olecranon bursa, or Achilles tendon.

Acute attack after large meal or alcohol consumption

ELEVATED URIC ACID LEVELS ≠ GOUT DIAGNOSIS

Dx: Negatively birefrignent uric acid crystals!

Tx:
Acute: Indomethacin (NSAID), colchicine
Chronic: Allopurinol, probenecid (uricosuric)

Front 64

Colchicine:
MOA

Back 64

Bind and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulatoin (it's an NSAID)

Front 65

Probenecid:
MOA

Back 65

Inhibits reabsorption of uric acid in PCT

Front 66

Allopurinol:
MOA

Back 66

Inhibits xanthine oxidase; dec'd conversion of xanthine to uric acid

Front 67

NSAIDs:
MOA

Back 67

-Inhibit both COX-1 and COX-2
-Block PG synth

Front 68

This drug can close PDAs.

Back 68

Indomethacin--an NSAID

Front 69

Celecoxib:
Drug Class

Back 69

Irreversible COX-2 inhibitor

Front 70

What is the treatment of acute out exacerbation?

Back 70

Colchicine
NSAIDs--DRUG OF CHOICE
Steroids

Front 71

What is the treatment of chronic gout?

Back 71

Probenecid
Allopurinol
Colchicine
NSAIDs

Front 72

Pseudogout:
How does it differ from gout?
Diagnosis?

Back 72

Calcium pyrophosphate crystals (Rhomboid)
Weakly positive birefringent

Dx: Chondrocalcinosis; cartilage has calcium deposits (in knee for ex bc pseudogout affects large joints)
Gold standard = joint aspirate

Front 73

Young, sexually active person with a swollen knee.

Cause?

Back 73

Infectious arthritis--Neisseria gonorrhoeae

Front 74

Man presents with pain and swelling of knees, subcutaneous nodules around joints and Achilles tendon, and exquisite pain in the metatarsophalangeal joint of his right big toe.

Biopsy reveals needle-like crystals.

Diagnosis?

Back 74

Gout