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166 Cards in this Set
- Front
- Back
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layers of the epidermis
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surface to base: corneum, lucidum, granulosum, spinosum, basalis (californians like girls in string bikinis)
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components of tight junction
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claudins and occludins
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components of intermed junction
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cadherins (Ca+ dependent), connect to actin
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components of desmosome
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cadherins (Ca++ dependent), connect to desmoplakin (IF's)
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components of hemidesmosomes
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integrins (maintain integrity of BM), bind to laminin in the BM
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unhappy triad
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caused by clipping from the lateral side; damage to MCL, ACL and medial meniscus
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ACL and PCL attachement
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anterior and posterior refer to their sites of tibial attachment; PCL: superior medially, inferior laterally; ACL: superior laterally, inferior medially
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most commonly injured muscle of the rotator cuff
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supreaspinatus
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muscles of rotator cuff
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supraspinatus (abducts the arm), infraspinatus (lateral rotator), teres minor (adducts, lateral rotator), subscapularis (medial rotator, adducts)
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fracture of the surgical neck of the humerus, dislocation of humeral head
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damages the axillary nerve; can't aduct the arm at the sholder (deltoid), sensory loss over delt
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incorrect use of crutch
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damages radial nerve, causes defects in tricep extension, wrist extension, finger extension at MCP, supination and thumb extension/abduction
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sublaxation of the radius
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damages radial nerve, causes defects in wrist extension, finger extension at MCP, supination and thumb extension/abduction
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midshaft fracture of the humerus
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damages radial nerve, causes defects in tricep extension, wrist extension, finger extension at MCP, supination and thumb extension/abduction; can also hit the deep brachial artery
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supracondylar fracture of humerus
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(fracture of humerus just superior to elbow) damages brachial artery and median nerve, loss of thumb opposition, lateral finger flexion, wrist flexion
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compression by carpal tunnel
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damages median nerve, loss of lateral finger flexion, wrist flexion
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dislocated lunate
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damages median nerve, loss of lateral finger flexion, wrist flexion
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fracture of medial epicondyle of the humerus
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damages ulnar nerve; causes defects in: medial finger flexion, wrist flexion, abd/add of fingers, add of thumb
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fracture of the hook of the hamate
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damages ulnar nerve; causes defects in: medial finger flexion, abd/add of fingers, add of thumb
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axillary nerve
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C5-6, deltoids and teres minor, abducts arm at shoulder
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radial nerve
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C5-8, "great extensor", innervates posterior muscles of the arm, some posterior forearm compartment; actions inclue extension of arm and wrist, supination, finger extension at MCP, thumb extension and abduction
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median nerve
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C6-8, T1; innervates the flexors of the forearm, pronators, thenar eminanece, 2nd and 3rd lumbricals; actions are opposition of thumb, wrist flexion, lateral finger flexion
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lumbricals
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flex at MCP but maintain extension at IP; 2 and 3 innervated by median, 4 and 5 by ulnar nerve
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interossei muscles
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innervated by ulnar nerve; dorsal abduct, palmar adduct
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ulnar nerve
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C8-T1; innervates some muscles of the anterior compartment of the forearm and many in the hand, crosses superficial to the retinaculum so not in carpel tunnel, also hypothenar eminence, all interossei, 4th and 5th lumricals; causes wrist flexion, medial finger flexion, ab/adduction of fingers, adduction of thumb
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MC nerve
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C5-7, flexion of arm at elbow and supination
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Erbs palsy
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occurs with damage to upper trunk (C5/6 roots), follows blow to shoulder or can occur during delivery; limb hangs by side (axillary nerve), medially rotated, forearm is pronated (MC nerve, biceps); sensory loss on lateral arm
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Klumke's palsy
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an embyrologic defect affecting the inferior trunk of brachial plexus (C8,T1), cervical rib can also compress subclavian artery; causes atrophy of thenar and hypothenar, atrophy of interossei, sensory def on medial side of hand, dissapearence of radial pulse when moving head to opp side; loss of function of all lumbricals causes total claw
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ulnar claw
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distal ulnar lesion (fracture hook of hamate), loss of medial lumbricals, 4th and 5th fingers are clawed
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median claw
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distal median lesion, loss of lateral lumbrical function, 2nd and 3rd digits are clawed
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ape hand
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proximal median nerve lesion, loss of opponens
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muslces of the thenar and hypothenar eminences
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FAO schwartz; thenar: opponens pollicic, abductor pollicis brevis, flexor pollicis brevis; hypo: opponens digiti minimi, abductor digiti minimi, flexor digiti minimi
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obturator nerve
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medial thigh; injured by anterior hip dislocation; results in defects in thigh adduction, sensory deficit in medial thigh
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femoral nerve
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anterior thigh (quad), damaged by pelvic fracture; damage leads to difficulty with thigh flexion and leg extension; sensory deficit over ant thigh and med leg
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common peroneal
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also called fibular nerve, damaged by trauma to the lateral aspect of the leg or fibula neck fracture, also anterior compartment syndrome; foot eversion and dorsiflexion, toe extension
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tibial nerve
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posterior lower leg, runs in the middle of the popliteal fossa; damaged by knee trauma, just below middle maleolus; foot inversion, plantarflexion, toe flexion
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superior gluteal nerve
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glut med and min, important stabalizers; damaged by posterior hip dislocation, injection to superior medial quad; difficulty with thigh abduction (+Trendelenburg)
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inferior gluteal nerve
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glut max, posterior hip dislocation; can't jump or climb stairs
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dihydropyridine receptor
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voltage gated receptors located on T-tubules, when T-tubules are depolarized, these also depolarize and induce a conformational change; are coupled to ryanodine receptors which allow Ca++ release from SR
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A-band
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corresponds to length of myosin bands extending from M-line; always same length
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I-band
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is where there is only actin; since contraction causes incr in overlap between A and M, I-band shortens with contraction
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type I muscle fibers
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slow twitch, red due to incr mito and myoglobin concentration; have incr oxid phosphorylation so they can sustain contraction; incr in endurance runners, exist in muscles like paraspinal muscles (one slow red ox)
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type II fibers
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fast twitch, white due to decr mito and myoglobin; incr anaerobic glycolysis; incr in sprinters and weight trainers
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Ca++ binding effect on contraction
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Ca binds to toponin, causes conformation change, moves tropomyosin out of way, A/M crossbridging; release of P causes power stoke and sliding; binding of new ATP releases ADP and releases the actin
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SM contraction
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AP → membrane depol → volatage gated Ca channels open → incr Ca in cytoplasm which binds to calmodulin → activates myosin-light chain kinase (MLCK) → phosphrylates myosin which allows it to form a cross bridge with actin; myosin light chain phosphorlase reverses this
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articular cartilage
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found on bone in joint spaces, made of hyaline cartilage, can be stained with Red Safrin O; type II collagen
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pyrophosphate
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important component of hydroxyappetite; bisphosphanates are structural analogs
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how are adjacent osteocytes connected to each other
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gap junctions in cannaliculi
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OPG
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RANK ligand decoy, prevents osteoclast differentiation
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endochondral ossification
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longitudinal bone growth, cartilaginous model of bone is made by chondrocytes, osteoblasts/clasts later replace with woven bone and remodel to lamellar bone
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membranous ossification
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flat bone growth (skull, facial bones, axial skeleton); woven bone formed directly without cartilage, later reformed to lamellar bone
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source of osteoblast cells
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mesenchymal stem cells in periosteum, important in fracture healing
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heterotropic ossification
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bone formed outside regular bone, can off as complication of fracture if osteoblast cells are misdirected
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achondroplasia
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AD, associated with advanced paternal age; failure of longitudinal bone growth leads to short limbs but normal torso/head size; impaired cartilage maturation due to FGF receptor mutation; common cause of dwarfism
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osteoporosis general findings
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reduction of bone mass but normal mineralization, sparse trabeulae
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type I osteoporosis
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post menopausal; bone break down > new bone (incr bone resorption) due to decr estrogen levels; normal Ca, PO4, ALP and PTH levels
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Colles fracture
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fracure of the distal radius, seen in osteoporosis
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osteopetrosis
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failure of normal bone resorption leads to thickened dense bones (defective osteoclasts) which are often brittle; normal Ca, PO4, ALP; decr marrow space leads to decr WBC/RBC/platelets; genetic def of carbonic anhydrase II; can lead to nerve palsies
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osteomalacia/rickets
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generalized decr in bone mass due to defective mineralization of osteoid leads to soft bones; normal # of trabeulae; may have incr osteoblast activity which tries to compensate for the soft bones by incr osteoid (which then can't be mineralized); due to decr Vit D; low Ca, low PO4, incr PTH, normal ALP
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cupping and fraying of metaphysis
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think osetomalacia/rickets
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osteitis fibrosa cystica
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caused by hyper-PTH; characterized by "brown tumors" (cystic spaces lined by osteoclasts, filled with fibrous stroma); high serum Ca, low PO4, high ALP
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Paget's dz
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abnormal bone architecture due to incr in both osteoblast and clast activity; possibly viral in origin (paramyxovirus); normal Ca/PO4/PTH levels, incr ALP; mosaic pattern of lamellar bone (like a jgsaw puzzle) with prominent cement lines that haphazerdly connect units (thick and weak); can lead to high output CHF (incr AV shunts in bone); also incr risk of osteogenic sarcomas
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polyostotic fibrous dysplasia
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bone is replaced by fibroblasts, collagen and irregular trabeculae; ex is McCune Albright; lesions (skin and bone) are on the same side of the body
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myositis ossificans
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usually in young atheletes following trauma; is essentially bone growth within a muscle; fibroblasts proliferate and this is then ossified; simple excision
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osteoma
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associated with Gardners; new piece of bone grows on another peice of bone, often in skull; benign
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osteoid osteoma
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interlacing trabeculae of woven bone surrounded by osteoblasts; < 2cm, found in prox tibia and femur in men <25 years old
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osteoblastoma
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interlacing trabeculae of woven bone surrounded by osteoblasts; larger than osteoid osteoma, found in vertberal column
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giant cell tumor
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osteoclastoma; most commonly at epiphyseal end of long bones, 20-40 years old; locally agressive benign tumor often around distal femur/proximal tibia; double bubble appearence on x-ray; spindle shaped cells with multinucleated giant cells
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osteochondroma
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most common benign bone tumor; mature bone with cartilagenous cap (exostosis, polyp like), usually men <25 years old, commonly in metaphysis, malignant transformation rare
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enchondroma
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benign cartilagenous neoplasm found in intramedullary bone; usually distal extremeties (ex: hands and feet)
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osteosarcoma
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2nd most common malignant tumor of bone; men 10-20 years old, commonly in metaphysis of long bones (distal femur/prox tibia); incr incidence in Pagets, bone infarcts, radiation and fam retinoblastoma; Codman's triangle or sunburst appearence (from lifting of periosteum); forms an osteoid matrix; presents with pain or pathologic fractures
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Ewings sarcoma
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anaplastic blue cell malignant tumor, boys <15, agressive with early mets but responsive to chemo; "onion skinning" appearence of bone; commonly in the diaphysis of long bones, pelvis, scapula and ribs; t(11;22)
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chondrosarcoma
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malignant cartilagenous tumor; men 30-60; pelvis, spine, scapula, humerus, tibia, femur; expansile glistening mass within the medullary cavity
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epiphysis plus tumors found there
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very end of a long bone, contains the caritlage; giant cell tumors grow here
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metaphysis plus tumors found there
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located medially to the epiphysis of bone but lateral to diaphysis; osteochondromas and osteosarcomas form here
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diaphysis plus tumors found there
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the middle most part of a bone, longest part; osteoid osteomas and Ewing's sarcomas occur here
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which tumors are found with in the intramedullary space
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endochrondromas and chondrosarcomas
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osteoarthritis
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mechanical wear and tear of joints leads to detruction of articular cartilage and joint space narrowin, subchondral cysts, sclerosis of bone, osteophytes, Heberden's nodes (DIP) and Bouchards (PIP); may have eburnation (polished, ivory like appearence); pain in weight bearing joints after use, improves with rest; noninflammatory, no systemic symptoms
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pannus formation in RA
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pannus is overgrowth of synovial tissue, grows over and destorys articular cartilage, eventually produces fibrosis and joints can become fixed and immovable; occurs in the MCP and PIP joints
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Baker's cyst
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cyst behind the knee, can be associated with RA
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HLA associated with RA
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HLA-DR4
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type of inflammatory cells present in RA joints
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lymphs, macrophages and plasma cells
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Caplan syndrome
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RA nodules in the lung plus pneumoconeosis
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RA factor
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IgM against IgG
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treatment of RA
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start with NSAIDs, steroids for immediate relief; if severe, consider methotrexate
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Sjogrens
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xeropthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis; parotid enlargement, incr risk of B-cell lymph, females 40-60; assoc with RA
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sicca syndrome
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similar to Sjogrens, dry eyes, nose, mouth, vagina; chronic bronchitis, reflux esophagitis; no arthritis
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why does alcohol often precipitate gout
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alcohol and uric acid compete for same excretion sites in the kidney, decr uric acid secretion and it builds up in the blood
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composition and detection of gout crystals
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monosodium urate; needle shaped and negatively birefringent (yellow under parrallel light)
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conditions that may incr risk of gout
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Lesch-Nyhan, PRPP excess, decr excretion of uric acid (thiazides), incr cell turnover, Von Gierkes
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pseudogout
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calcium pyrophosphate crystals, rhomboid, weakly positively birefringent (yellow with perpindicular)
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3 most common causes of septic arthritis
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N. gonorrhoeae, s. aureus, strep
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common complications of ankylosing spondilitis
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restriction of ability to breath, aortic regurg
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psoriatic arthritis
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joint pain associated with psorisasis; assymetric and patchy involvement; dactylitis (sausage fingers), pencil in cup deformities in fingers
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antiphospholipid Ab's in SLE
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cross react with cardiolipin which is used in RPR syphyllis test; also produce vessel thrombosis, miscarriages and incr PTT;
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consequence of presence of anti-Ro Ab's in SLE
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can cross the placenta in pregnant women and attack babys circulation system leading to complete heart block
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anti-dsDNA and anti-Smith
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anti-dsDNA: very specific to SLE, poor prognosis (incl development of nephritis); anti-smith: very specific for SLE but not prognostic
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4 commom causes of drug induced lupus
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phenytoin, INH, procainamide, hydralazine (HIPP); low incidence of renal and CNS involvement; have anti-histone Ab's
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definining features of sarcoidosis
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widespread noncaseating granulomas and elevated ACE levels, often also have hyper-Ig's and incr cytokines
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cause of cutaneous anergy in sarcoidosis
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may have cutaneous anergy to common skin Ag's because all the CD4 cells are in granulomas
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organs affected in Sarcoidosis
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always hits the lungs (restrictive fibrosis); next most common is face (uveitis and salivary glands, Bell's palsy), skin (erythema nodosum)
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erythema nodusum
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inflammation of the fat under the skin, causes tender skin nodules often on the skin; can be seen in sarcoidosis, Crohns, TB
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polymyalgia rheumatica
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pain and stifness in shoulders and hips; often associated with fever, malaise, weight loss; no muscular weakness; associated with temporal arteritis, often >50 years old
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polymyositis
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progressive symmetric prox muscle weakness due to CD8 mediated injury to muscle (biopsy shows muscle inflammation, muscle cells have incr MHC expression), often involves shoulders; no skin involvement; incr CK; +ANA, anti-Jo1
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dermatomyositis
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similar to polymyositis (muscle inflammation) but also a malar rash, heliotrope rash (racoon eyes), Gottron's papules (similar to psoriasis); incr risk of CA (esp lung)
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myotonic dystrophy
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AD, most common adult muscular dystrophy, trinucleotide repeat; selective atrophy of type I fibers; often starts with weakness of facial muscles, failure to relax muscles; CV problems and DM, frontal balding, cataracts
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mixed CT dz
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raynauds, arthralgias, myalgias, fatigue, esophageal hypomotility; anti-U1RNP
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myasthenia gravis
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type II HS with IgG's to postsynaptic N-AChR causing a decr end plate potential; causes ptosis, diplopia, general weakness; associated with thymoma (thymus tissue, contains germinal centers); symptoms worsen with use
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Lambert-Eaton
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auto-Ab's to presynaptic Ca++ channels, causes prox muscle weakness; associated with paraneoplastic (small cell), symptoms improve with use
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Scleroderma (general)
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excessive fibrosis and collagen deposition throughout body, puffy taught skin with no wrinkles; also affects renal, CV (HTN), pulmonary (fibrosis) and GI systems (dysphagia, malabsorption); mostly female; diffuse and CREST; Raynoud most common presenting symptom
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diffuse scleroderma
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widespread skin involvement, rapid progression, early visceral involvement; anti-Scl70
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CREST
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calcinosis, Raynouds (often first presenting sign), Esophageal dysmotility (no peristalsis in lower esophagus, decr LES presure can lead to GERD), Sclerodactly, Telangiectasia; limited skin involvement, anti-centromere
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hyperkeratosis
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incr thickness of stratum corneum (seen in psoriasis)
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parakeratosis
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hyperkeratosis with rentention of nuclei in stratum corneum (seen in psoriasis)
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acntholysis
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separation of epidermal cells, seen in pemphigus vulgaris
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acanthosis
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epiderma hyperplasia
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nevocellular nevis
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common mole, benign
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ephelis
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freckle, normal # of melanocytes but incr melanin pigment
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atopic dermatitis
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type I HS, eczema, common in skin flexures, often assocaited with other atopic dzs (asthma, allergic rhinitis)
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psoriasis
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silver scaling, esp on knees and elbows; acanthosis with parakeratotic scaling; incr stratum spinosum, decr granulosum, can be associated with nail pitting and psoriatic arthritis
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Auspitz sign
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seen in psoriasis, bleeding spots when scales are scraped off
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seborrheic keratosis
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flat, greasy pigmented epithelial proliferation with keratin filled cysts (horn cysts); lesions on head, trunk, extremities; common in older people, benign
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vitiligo
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irregular areas of complete depigmentation, caused by decr # of melanocytes
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melasma
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hyperpigmentation associated with pregnancy, OCPs
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which levels of the skin/tissue does cellulitis affect
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dermis and sub-q tissues
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necrotizing fasciitis
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deep tissue injury, usually anerobic bacteria and S. pyogens; results in crepitus from methane and CO2 production
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scaled skin syndrome
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toxin destroys keratinocyte attachements in granulosum layer only; fever and generalized erythematous rash with sloughing of supper layers of epidermis
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hairly leukoplakia
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white, painless plaques on tongue, cannot be scraped off, EBV mediated, assoc with HIV, treat with acyclovir
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pemphigus vulgaris
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IgG and C3B against desmosomes (cadherin, desmoplankin), linear immunofluresence throughout epidermis; acantholysis: intraepidermal bullae involving skin and oral mucosa (usually first); + Nikolskys (stroking skin causes separation of epidermis), incr in Jewish and Med
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bullous pemphigoid
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IgG against hemidesmisomes, subepidermal linear immunofluresence; can have eosiniphils in blisters; spares oral mucosa; neg Nikolskis; blisters are more firm and don't rupture as easily
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dermatitis herpetiformis
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assoc with celiac, on extensors of extremities and buttocks, deposits of IgA on tips of dermal papillae
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Steven's Johnson
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fever, bullae formation and necrosis, sloughing of skin and high mortality rate, usually drug reaction
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toxic epidermal lysis
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similar to Stevens Johnson but more severe with greater epidermal invovlement
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lichen planus
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pruritic, purple, polygonal papules; sawtooth infiltrate of lymphs at D-E junction; assoc with hep C
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actinic keratosis
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premalignant lesions (risk related to degree of epithelial dysplasia), small rough erythemetous/brownish papules, "cutaneous horn", nuclear atypia in basal layer, hyperkeratosis, parakeratosis; chelitis refers to presence on lip
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acnthosis nigricans
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hyperplasia of stratum spinosum; associated with hyperinsulinema (DM) and visceral malignancy
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pityriasis rosea
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herald patch followed days later by christmas tree distribution; papular eruptions, remits spontaneously
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basal cell CA
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rolled edges with central ulceration; pearly papules and palasading nuclei; locally invasive, rarely met
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melanoma
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S-100+, depth of tumor correlates with risk of mets; dysplastic nevus is precursor; dark with irregular borders
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phospholipase A2
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breaks down membrane lipids to arachadonic acid
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lipoxygenase pathway
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produces leukotrienes which genreally cause bronchoconstriction, vasoconstriction, incr permeability
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LTB4
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leukotriene, involved in PMN chemotaxis
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prostacyclin
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also PGI2, decr platelet aggregation, vasodilation, decr uterine tone; released from endothelium
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PGE2
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decr vascular tone, incr pain, incr uterine tone, incr temp, stomach protection
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thromboxane A2
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causes platelet aggregation and vasoconstriction (slows blood flow and allows platelets to aggregate), bronchoconstriction; made in platelets
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bone histo in primary hyperparathyroidism
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subperiosteal thinning
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M line
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where the myosin attach to
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H zone
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just lateral to the M line, where there is no actin, just myosin, gets smaller with contraction
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RANK ligand
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under stimulation, osteoblasts display the RANK ligand and this leads to osteoclast differentiation
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carbonic anhydrase role in bone
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important role in osteoclasts, allows them to generate acid to demineralize bone
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cortical vs. trabecullar bone
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cortical: long bones, mechanical support, sites of mucle attachement; trabecular (spongy, cancellous): 15% of total skeleton, more metabolically active, ex: vertebrae, more commonly affected in osetoporosis
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clinical presenation of RA
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morning stiffness improving with use, symmetric joint involvement, systemic symptoms (fever, fatigue, pleuritis, pericarditis, interstitial lung fibrosis)
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common locations for tophi
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external ear, achilles tendon
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Asteroid bodies and Schaumann bodies
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seen in Sarcoidosis; asteroid: stellate inclusions within giant cells; schaumann: laminated concretions of Ca and protein
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erythema multiforme
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associated with infetions (ex: myco pneumo, HSV, fungi), drugs, CA and autoimmune disorders, present with a variety of lesions (macules, papules, target lesions); due to cytotoxic T-cells primed against a specific Ag seem to cross react with Ag of the skin
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location of melanocytes in the epidermis
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in the basal layer
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enteroperoxides
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formed from COX pathway, precursors to PC's, PG's and TX
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VEGF
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secreted by cells in hypoxic conditions (ex: muscle cells in exercise)
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scabies
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ectoparasite transmitted by mite, severe itching, papules on wrists, elbows, buttocks, groin; permethrian cream
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crush injury
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causes rhabdomyolysis, myoglobinuria; damaged cells release K+, PO4, uric acid;
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muscles with tensor in name innervated by who
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V3
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muscles of palate, pharynx and larynx
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all are innervated by 10 except stylopharyngeas
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lordosis
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concave back, could be do to extensive contraction of hip flexors
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size of petichiae, purpura and echymosis
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petichie (<5mm), purpura (5mm-1cm), echymosis (>1cm); RBC extravasation, don't blanch, not palpable
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skeletal muscle (2)
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striated, peripheral nuclei
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cardiac muscle (3)
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striated, branched fibers, central nuclei
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SM (2)
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nonstriated, elongated nuclei
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