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251 Cards in this Set

  • Front
  • Back
5 layers of the epidermis
stratum corneum (outer)
stratum lucidum
stratum granulosum
stratum spinosum
stratum basalis (inner)
layer of the epidermis present only in the hands and feet
startum lucidum
which epithelial cell junction forms tight junctions
zona occludens
in which epithelial cell junction do cadherins bind to actin
zona adherens
which epithelial cell junctions form desmosomes
macula adherens
autoantibodies against desmosomes suggest what disease
pemphigus vulgaris
what protein is mutated in pemphigus vulgaris
desmoglein
autoantibodies against hemidesmosomes suggest what disease
bullous pemphigoid
which immunoglobulins are increased in bullous pemphigoid
IgG
3 things damaged in the unhappy triad (aka O'Donohue's triad)
MCL, ACL, and meniscus (lateral more common)
positive anterior drawer sign indicated what injury
torn ACL
which ligament attaches the posterior femur to the anterior tibia
ACL

**named for tibial attachment**
which ligament attaches the anterior femur to the posterior tibia
PCL

**named for tibial attachment**
positive patellar grind test suggests what injury
chondromalacia or patellofemoral syndrome
abnormal passive abduction of the knee suggest what injury
torn MCL
site of pudendal nerve block
ischial spine
where is McBurney's point and what condition is it associated with
McBurney's point: located 2/3 of the way from the umbilicus to the ASIS; associated with appendicitis
anatomical bony landmark for a lumbar puncture
parallel to iliac crest (L4)
what are the rotator cuff muscles
supraspinatus, infraspinatus, teres minor, and subscapularis
MOST commonly injured rotator cuff muscle
supraspinatus
function of supraspinatus
abduction
function of infraspinatus and teres minor
external rotation
function of subscapularis
internal rotation
brachial plexus levels
C5-T1
fracture to the surgical neck of the humerus or humeral dislocation affects what nerve
axillary nerve
midshaft fracture of humerus affects what nerve
radial nerve
damage to medial epicondyle affects what nerve
ulnar nerve
the "funny bone" refers to what nerve
ulnar nerve
incorrect use of crutches usually affects what nerve
radial nerve
damage to upper trunk of brachial plexus causes what dysfunction
Erb's palsy
MOST common musculoskeletal injury caused during natural childbirth
Erb's palsy
Saturday Night syndrome corresponds with what nerve
radial nerve
damage to the lower trunk of the brachial plexus causes what dysfunction
klumpke's palsy
nerve damaged with supracondylar fracture of the distal humerus
median nerve
nerve damaged in pronator teres syndrome
median nerve
subluxation of the radius affects which nerve
radial nerve (deep branch)
superficial laceration over the thenar eminence damages which nerve
recurrent branch of the median nerve
nerve compressed in carpal tunnel
median nerve
fracture of the hook of the hamate damages which nerve
ulnar nerve
dermatome of the shoulder
C4
dermatome of thumb and index finger
C6
dermatome of middle finger
C7
dermatome of 4th and 5th digits
C8
innervation to thenar eminence and 1st 3 digits (palmar side)
median nerve
innervation to nail beds of the 2nd and 3rd digits
median nerve
innervation to nail bed of thumb
radial nerve
innervation to nail bed of 4th/5th digits, dorsal side of palm over 4th/5th metatarsals, and hypothenar eminence
ulnar nerve
innervation to dorsal side of palm over the 1st 3 metatarsals
radial nerve
3 muscles of the thenar eminence and the innervation
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

*innervated by median n.
3 muscles of the hypothenar eminence and the innervation
opponens digiti minimi
abductor digiti minimi
flexor digiti minimi

*innervated by ulnar n.
what muscle protects the brachial plexus from injury during when the clavicle is fractured
subclavius
innervation of deltoid
axillary n.
what are the extensor muscles of the arm and what is the innervation
extensor muscles include bracioradialis, supinators, and triceps

innervated by radial n.
nerve damaged in wrist drop
radial nerve
nerve damaged in ape hand
median nerve
this condition is aka "waiter's tip" position
Erb's palsy
innervation of lumbricals
1st and 2nd lumbricals innervated by median nerve

3rd and 4th lumbricals iunnervated by ulnar nerve
innervation of the interosseous muscles of the hand
ulnar nerve
innervation of the biceps, brachialis, and coracobrachialis
musculocutaneous n.
patient loses sensations in the lateral forearm; what nerve is most likely damaged
musculocutaneous n.
what vessels are most commonly compressed in thoracic outlet syndrome
brachial plexus, phrenic nerve, subclavian vein
functions of the dorsal vs. palmar interosseous muscles
dorsal interossei: abduct fingers (DAB)
palmar interossei: adduct fingers (PAD)
functions of the lumbricals
flex at the MCP joints
extend at the DIP and PIP joints
muscle and nerve damaged in winging of the scapula
serratus anterior and the long thoracic nerve
tennis elbow
lateral epicondylitis
golfers elbow
medial epicondylitis
nerve damaged in anterior hip dislocation
obturator n.
nerve most commonly damaged in pelvic fracture
femoral n.
most commonly damaged nerve from knee trauma
tibial n.
nerve damaged in posterior hip dislocation and polio
superior/inferior gluteal nerves (superior only in polio)
innervation to gluteus medius/minimus
superior gluteal n.
innervation to gluteus maximus
inferior gluteal n.
patient is restricted in adduction of the thigh and has decreased sensation along the medial thigh; which nerve is damaged
obturator
patient has decreased muscle strength in flexion of the thigh and extension of the leg; also has decreased sensation over anterior thigh and medial leg; which nerve is damaged
femoral n.
patient is restricted in foot inversion and plantarflexion; also has decreased sensation over the sole of the foot; which nerve is damaged
tibial n.
patient is restricted in foot eversion and dorsiflexion; also has decreased sensation over anterolateral leg and dorsal foot; which nerve is damaged
common peroneal n.
nerve damaged in foot drop/slap (steppage gait)
common peroneal n.
what does the sciatic nerve become
splits into tibial and common peroneal nerves
what makes up the I band in a muscle fiber
only actin
what makes up the H zone in a muscle fiber
only myosin
what makes up the A band in a muscle fiber
BOTH actin and myosin
calcium binds to which troponin
troponin C
what is the power stroke in a muscle contraction
when myosin releases ADP and is displaced from the actin filament
only portion of the muscle fiber to remain constant in length during contraction
A band
differences between type I vs. type II muscle fibers
type 1 muscle fibers: slow twitch, fibers are red due to increased mitochondria and myoglobin; undergoes oxidative phosphorylation

type II muscle fibers: fast twitch, fibers are white due to decreased mitochondria and myoglobin; these fibers hypertrophy during weight lifting; undergo anaerobic glycolysis
which troponin binds to actin
troponin I
which troponin binds to tropomyosin
troponin T
effect when calcium binds to calmodulin
activates myosin light chain kinase
which type of ossification is responsible for longitudinal bone growth
endochondral ossification
which type of ossification is responsible for flat bone growth
membranous ossification
upregulation of FGFR3 receptors causes what disease
achondroplasia
mode of inheritance of achondroplasia
autosomal dominant
characterized by a reduction is trabecular (spongy) bone despite normal mineralization levels
osteoporosis
vitamin D deficiency in adults vs children
osteomalacia in adults
rickets in children
skeletal disorder caused by a deficiency of carbonic anhydrase II; characterized by a "Erlenmeyer flask" bones that flare out
osteopetrosis ("marble bone disease")
virus family linked to Paget's disease of the bone
paramyxoviruses (parainfluenza, RSV, rubeola, mumps)
skeletal condition characterized by abnormal bone architecture secondary to an increase in BOTH osteoclasts and osteoblasts; alkaline phosphatase is increased; associated with hearing loss
Paget's disease of the bone
form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and pigmented skin lesions (cafe au lait spots)
McCune-Albright syndrome
where are osteoblastomas found
vertebral column
bone tumor characterized by a "double-bubble" or "soap-bubble" appearance on xray; cells are spindle shaped with giant cells; usually found at the epiphyseal end of long bones (femur and tibia)
osteoclastoma (giant cell tumor)
bone tumor originating from metaphysis; MOST common benign bone tumor
osteochondroma (exostosis)
peak age for osteosarcoma
teenagers
MOST common area of the body for osteosarcomas
around the knee
gene mutation associated with osteosarcoma
Rb gene (retinoblastoma, pineoblastoma, osteosarcoma)
characteristic features of osteosarcoma when seen on xray
Codmans triangle and sunburst pattern
this bone tumor has a characterstic "onion-skin" appearance and is comprised of anaplastic blue cells
Ewings sarcoma
translocation associated with Ewings sarcoma
11;22
characteristic formation in the DIP and PIP joints in someone with osteoarthritis
Heberdens nodes in the DIPs
Bouchards nodes in the PIPs
characteristic features that form in the joints in someone with rheumatoid arthritis
pannus
characteristic formations behind the knee in someone with rheumatoid arthritis
Bakers cysts
rheumatoid arthritis usually spares which phalangeal joints
spares the DIPs
what type hypersensitivity is RA
type III hypersensitivity
which HLA allele is associated with RA
HLA-DR4
antibodies found in most cases of RA
anti-IgG (Fc portion) antibodies
anti-CCP antibodies (less sensitivie but more specific)
2 common extra-musculoskeletal complications of RA
pleuritis and pericarditis
classic triad of Sjogrens
xerophthalmia (dry eyes)
xerostomia (dry mouth)
arthritis

(may also have parotid enlargement and dental carries)
antibodies found in Sjogrens
SS-A (Ro) and SS-B (La) antibodies
Sjogrens increases risk for what cancer
B-cell lymphoma
young female patient presents complaining of dry eyes, dry mouth, and decreased vaginal lubrication; PMH is remarkable for chronic bronchitis and GERD; serology for SS-A and SS-B are NEGATIVE; she has no history of arthritis; what's the diagnosis
Sicca syndrome
gout is caused by accumulation of what
monosodium urate crystals secondary to hyperuricemia
genetic conditions (2) associated with gout
Lesch-Nyhan syndrome and Von Gierkes
enzyme deficiency in Lesch-Nyhan syndrome
HGPRT deficiency
antihypertensive drug that cause gout
thiazide diuretics
how will gout appear vs pseudogout in imaging of fluid aspiration
gout: crystals appear yellow in parallel light and blue in perpindicular light

pseudogout: crystals appear yellow when perpindicular to the light and blue in parallel light
Is gout positively or negatively birefringent? what about pseudogout?
gout is negatively birefringent
pseudogout is weakly positive birefringent
MOST common location for gout to manifest
MTP joint of the big toe (podagra)
what are tophi
chalky white deposits under the skin associated with gout
3 common locations to find tophi
external ear, olecranon bursa, and achilles tendon
why does alcohol increase risk of gout
metabolites of alcohol compete for the same excretion site in the kidney as uric acid does causing decreased overall secretion of uric acid thus leading to hyperuricemia (DOC in this scenario would be probenecid)
treatment of acute gout
indomethacin (NSAIDs) or colchicine
pathogenesis of pseudogout
deposition of calcium pyrophosphate crystals
treatment of pseudogout
there is no treatment
3 MOST common bacterial causes of septic arthritis; what about chronic infectious arthritis?
septic arthritis: S. aureus, Streptococcus, N. gonorrhea

chronic infectious arthritis: TB, Lyme disease
the seronegative spondyloarthropathies are associated with what HLA allele
HLA-B27

("PAIR" -> psoriatic arthritis, ankylosing spondylitis, IBS, Reiters syndrome)
patient presents with recent onset of joint pain and stiffness; PE reveals "sausage fingers" and xray reveals "pencil-in-cup" deformity; numerous plaques are also noted particularly on the knee and elbows--this finding is expected based on his PMH; whats the current presentation?
psoriatic arthritis secondary to psoriasis
patient presents with pain in his lower back and hip; PE reveals inflammation of the SI joints and a bamboo spine; a blowing diastolic murmur is noted on auscultation in the 2nd ICS on the L; PMH is remarkable for recurrent uveitis; whats the current diagnosis
ankylosing spondylitis
classic triad of Reiter's syndrome
conjunctivitis/uveitis
urethritis
arthritis

"can't see, can't pee, can't climb a tree"
2 MOST common causes of Reiter syndrome
C. jejuni and chlamydia
treatment of chronic gout
allopurinol (for over-producers)
probenecid (for under-secreters)
MOST common people affected by SLE
black women (ages 15-45)
endocarditis linked to SLE
Libman-Sacks endocarditis
MOST common cause of death in SLE
kidney failure
pathogenesis of kidney damage in SLE
immune complex deposition (wire-looping of the capillaries) most commonly causing diffuse proliferative glomerulonephritis (*nephritic)
why do people with SLE have false positives in syphylis testing
people with SLE have anti-phospholipid antibodies which cross-react with cardiolipin
antibodies linked to SLE
ANA (sensitive but not specific)
anti-dsDNA (specific)
anti-Sm (specific)
antiphospholipid
antibodes linked to drug-induced lupus
anti-histone antibodies
symptoms of SLE
malar rash
discoid rash
mucositis
neurologic disorders
pleuritis
pericarditis
hematologic disorders
arthritis
renal dysfunction
photosensitivity
autoimmune lung disease associated with RA
sarcoidosis
musculoskeletal autoimmune disorder associated with temporal arteritis
polymyalgia rheumatica
DOC for polymyalgia rheumatica
prednisone
progressive symmetric proximal muscle weakness caused by CD8 induced injury in the absence of skin involvement
polymyositis
patient presents with symmetric proximal muscle weakness and a rash across the face; PE confirms the presence of a heliotrope rash around the eyes and Gottrons papules on the hands
dermatomyositis
antibodies suggestive of polymyositis/dermatomyositis
ANA (sensitive but not specific)
anti-Jo (specific)
tumor linked to myasthenia gravis
thymoma
pathogenesis of myasthenia gravis
autoantibodies against postsynaptic ACh receptors
symptoms of myasthenia gravis
muscle weakness (especially trouble holding the head up due to weak neck muscles), diplopia, and ptosis
DOC to TEST for myasthenia gravis
edrophonium
DOC to TREAT myasthenia gravis
pyridostigmine (alternative is neostigmine)
pathogenesis of Lambert-Eaton syndrome
autoantibodies against presynaptic calcium channels causing decreased release of ACh leading to proximal muscle weakness only
Lambert-Eaton syndrome is linked to what cancer
small cell carcinoma of the lung
do symptoms improve throughout the day in myasthenia gravis? what about Lambert-Eaton?
symptoms improve with muscle use in Lambert-Eaton

symptoms worsen with muscle use in myasthenia gravis
antibodies associated with diffuse scleroderma
anti-Scl-70 antibodies
antibodies associated with CREST syndrome of scleroderma
anti-centromere antibodies
symptoms of CREST syndrome
Calcinosis
Raynaud's
Esophageal dysmobility
Sclerodactyly
Telangiectasia
intense pruritic wheals that form after mast cell degranulation
urticaria
dermatitis linked to nickel and poison ivy
contact dermatitis (type IV hypersensitivity)
bleeding spots from scraping off plaques from the skin as seen in psoriasis
Auspitz sign
sudden appearance of multiple seborrheic keratoses are suggestive of what
underlying malignancy (Leser-Trelat sign)
enzyme deficiency in albinism
tyrosinase
patchy areas of complete depigmentation vs. areas of normal pigmentation; caused by decrease in melanocytes
vitiligo
what is the only layer destroyed in Staphylococcal Scalded Skin syndrome
stratum granulosum
hairy leukoplakia is linked to what illness
HIV
can hairy leukoplakia be scraped off
No
patient presents with painful bullae forming on the skin and in the oral mucosa; on PE its noted that there is separation of the epidermis during stroking of the skin; serology is positive for antibodies that correspond to the suspected disease
pemphigus vulgaris
patient presents with blister formation on his skin, but sparing the mouth; stroking the skin causes no effect to the epidermis; immunofluorescence shows linear lesions; serology is positive for IgG antibodies
Bullous pemphigoid
dermatitis herpetiformis is linked to what disease
celiac disease
dermatitis herpetiformis is characterized by what immunoglobulins at the tips of the dermal papillae
IgA
Lichen planus is linked to what disease
hepatitis C
actinic keratosis increases risk for what cancer
squamous cell carcinoma
Acanthosis nigricans is characterized by hyperplasia of what layer of the epidermis
stratum spinosum
skin cancer linked to arsenic exposure
squamous cell carcinoma
morphologic feature of squamous cell carcinoma
keratin pearls
skin cancer characterized by rolled edges with central ulceration and usually telangiectasias
basal cell carcinoma
morphologic feature of basal cell carcinoma
palisading nuclei
tumor marker for melanoma
S100
people at highest risk for melanoma
light skinned, blue eyes
precursor lesion to melanoma
dysplastic nevus
MOA of Zileuton
inhibits lipoxygenase
MOA of Montelukast / Zafirlukast
blocks leukotrienes
MOA of NSAIDs
inhibits cyclooxygenase
corticosteroids inhibit what enzyme
phospholipase A2
MAJOR effect of low-dose aspirin
decreased platelet aggregation (anti-coagulant)
MAJOR effect of regular-dose aspirin
antipyretic and analgesic
MAJOR effect of high-dose aspirin
anti-inflammatory
Reye's syndrome is a SE of what medication
aspirin
NSAID that closes a PDA
indomethacin
MOA of celecoxib
reversibly inhibits only COX2 (spares COX1)
benefit of using celecoxib over other NSAIDs
No GI side effects
DOC for acetaminophen overdose
N-acetylcysteine
MOA of bisphosphonates
inhibits osteoclast activity
SE of bisphosphonates
corrosive esophagitis and osteonecrosis of the jaw
MOA of colchicine
binds and stabilizes tubulin to inhibit polymerization which impairs leukocyte chemotaxis and degranulation
SE of colchicine
severe GI disturbances
MOA of probenecid
inhibits reabsorption of uric acid in the PCT
MOA of allopurinol
inhibits xanthine oxidase
people taking allopurinol need dose reducing of what other 2 drugs
azathioprine and 6MP
MOA of etanercept, infliximab, adalimumab
TNF-a inhibitors
this drug can be used to treat Crohns disease, RA, and ankylosing spondylitis
infliximab
pluripotent mesenchymal stem cells of the bone
osteoprogenitor cells
main collagen found in bones
type 1
main collagen found in cartilage
type II
which form of ossification uses cartilage formation as an intermediate step on the way to forming the bone
endochondral ossification
mutated type I collagen
osteogenesis imperfecta
patient presents with recent hearing loss; during PE it's noted that his dentition is in poor health; his PMH reveals multiple bone fractures and a noodle-like appearance of the femur and tibia; based on the presumptive diagnosis, what other unique symptom does he likely have
blue sclera

(*this is osteogenesis imperfecta)
mutated FGFR2 receptor
Crouzon syndrome
common complication seen in osteopetrosis (marble bone disease)
cranial nerve impingement
fracture of the distal radius
Colles fracture
what organ system other than musculoskeletal does Paget's disease of the bone commonly affect
cardiac (leads to CHF)
primitive matrix formed in the area of a bone fracture
callus
the formation of periosteal abscesses is linked to what disease of the bone
osteomyelitis
MOST common cause of osteomyelitis overall
S. aureus
MOST common cause of osteomyelitis in sexually active people
N. gonorrhea
MOST common cause of osteomyelitis in diabetics and drug addicts
pseudomonas
MOST common cause of osteomyelitis in sickle cell
salmonella
MOST common cause of osteomyelitis in prosthetic replacements
S. aureus and S. epidermidis
MOST common cause of osteomyelitis in the spine
mycobacteria tuberculosis (aka Pott's disease)
MOST common cause of osteomyelitis after a cat/dog bite
pasteurella multicida
manifestation of osteomyelitis in newborns with congenital syphilis is commonly known as what
saber shins
MOST common locations for enchondromas
distal extremities
this malignant bone tumor presents as a glistening mass within the medullary cavity
chondrosarcoma
4 MOST common cancers that metastasize to the bone
prostate, breast, kidney, and lung
bone undergoes eburnation and appears as polished white ivory in this condition
osteoarthritis
which subtype of rheumatoid arthritis are large joints affected more commonly than small joints
juvenile idiopathic rheumatoid arthritis
patient presents with pain in his knees and discharge coming out of his eyes; 1 week ago he had an undiagnosed GI infection that caused vomiting and diarrhea; what other symptom does he most likely have
painful and difficulty urinating due to urethritis

(*this is Reiter's syndrome happening after a C. jejuni infection)
MOST common cause of infectious arthritis in children
H. influenzae
pseudoarthrosis is a consequence of what
improper bone healing after a fracture
lytic lesions in various bones throughout the body WITH keratin-positive cells
metastatic cancer

(*note that multiple myeloma will cause lytic lesions but will NOT have keratin-positive cells)
dangerous complication seen in Legg-Calve-Perthes disease
avascular osteonecrosis
osteomyelitis most commonly affects which part of the bone
metaphysis
MOST common soft-tissue tumor
lipoma
soft-tissue tumor made of macrophages that forms most commonly after radiation
malignant fibrous histiocytoma
highly malignant soft-tissue tumor that forms in a joint
synovial sarcoma
bone condition linked to steroid use
osteoporosis
precursor to osteoporosis
osteopenia
pediatric musculoskeletal condition characterized by the inability to calcify osteoid
rickets
bone deformity characterized by a mosaic pattern of lamellar bone, and it carries and increased risk for osteogenic sarcomas
Paget's disease of the bone
finger deformities associated with RA
boutonniere and swan-neck deformities
what age group is Paget's disease of the bone seen in
elderly
ulnar deviation and subluxation is seen in what autoimmune disorder
rheumatoid arthritis
MOST common cause of osteomyelitis in newborns
group B strep
life-threatening SE of succinylcholine
hyperkalemia