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251 Cards in this Set
- Front
- Back
|
5 layers of the epidermis
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stratum corneum (outer)
stratum lucidum stratum granulosum stratum spinosum stratum basalis (inner) |
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layer of the epidermis present only in the hands and feet
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startum lucidum
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which epithelial cell junction forms tight junctions
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zona occludens
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in which epithelial cell junction do cadherins bind to actin
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zona adherens
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which epithelial cell junctions form desmosomes
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macula adherens
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autoantibodies against desmosomes suggest what disease
|
pemphigus vulgaris
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what protein is mutated in pemphigus vulgaris
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desmoglein
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autoantibodies against hemidesmosomes suggest what disease
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bullous pemphigoid
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which immunoglobulins are increased in bullous pemphigoid
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IgG
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3 things damaged in the unhappy triad (aka O'Donohue's triad)
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MCL, ACL, and meniscus (lateral more common)
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positive anterior drawer sign indicated what injury
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torn ACL
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which ligament attaches the posterior femur to the anterior tibia
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ACL
**named for tibial attachment** |
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which ligament attaches the anterior femur to the posterior tibia
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PCL
**named for tibial attachment** |
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positive patellar grind test suggests what injury
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chondromalacia or patellofemoral syndrome
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abnormal passive abduction of the knee suggest what injury
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torn MCL
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site of pudendal nerve block
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ischial spine
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where is McBurney's point and what condition is it associated with
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McBurney's point: located 2/3 of the way from the umbilicus to the ASIS; associated with appendicitis
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anatomical bony landmark for a lumbar puncture
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parallel to iliac crest (L4)
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what are the rotator cuff muscles
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supraspinatus, infraspinatus, teres minor, and subscapularis
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MOST commonly injured rotator cuff muscle
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supraspinatus
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function of supraspinatus
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abduction
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function of infraspinatus and teres minor
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external rotation
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function of subscapularis
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internal rotation
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brachial plexus levels
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C5-T1
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fracture to the surgical neck of the humerus or humeral dislocation affects what nerve
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axillary nerve
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midshaft fracture of humerus affects what nerve
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radial nerve
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damage to medial epicondyle affects what nerve
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ulnar nerve
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the "funny bone" refers to what nerve
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ulnar nerve
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incorrect use of crutches usually affects what nerve
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radial nerve
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damage to upper trunk of brachial plexus causes what dysfunction
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Erb's palsy
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MOST common musculoskeletal injury caused during natural childbirth
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Erb's palsy
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Saturday Night syndrome corresponds with what nerve
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radial nerve
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damage to the lower trunk of the brachial plexus causes what dysfunction
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klumpke's palsy
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nerve damaged with supracondylar fracture of the distal humerus
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median nerve
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nerve damaged in pronator teres syndrome
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median nerve
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subluxation of the radius affects which nerve
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radial nerve (deep branch)
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superficial laceration over the thenar eminence damages which nerve
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recurrent branch of the median nerve
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nerve compressed in carpal tunnel
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median nerve
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fracture of the hook of the hamate damages which nerve
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ulnar nerve
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dermatome of the shoulder
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C4
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dermatome of thumb and index finger
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C6
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dermatome of middle finger
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C7
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dermatome of 4th and 5th digits
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C8
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innervation to thenar eminence and 1st 3 digits (palmar side)
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median nerve
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innervation to nail beds of the 2nd and 3rd digits
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median nerve
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innervation to nail bed of thumb
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radial nerve
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innervation to nail bed of 4th/5th digits, dorsal side of palm over 4th/5th metatarsals, and hypothenar eminence
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ulnar nerve
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innervation to dorsal side of palm over the 1st 3 metatarsals
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radial nerve
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3 muscles of the thenar eminence and the innervation
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opponens pollicis
abductor pollicis brevis flexor pollicis brevis *innervated by median n. |
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3 muscles of the hypothenar eminence and the innervation
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opponens digiti minimi
abductor digiti minimi flexor digiti minimi *innervated by ulnar n. |
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what muscle protects the brachial plexus from injury during when the clavicle is fractured
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subclavius
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innervation of deltoid
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axillary n.
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what are the extensor muscles of the arm and what is the innervation
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extensor muscles include bracioradialis, supinators, and triceps
innervated by radial n. |
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nerve damaged in wrist drop
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radial nerve
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nerve damaged in ape hand
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median nerve
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this condition is aka "waiter's tip" position
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Erb's palsy
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innervation of lumbricals
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1st and 2nd lumbricals innervated by median nerve
3rd and 4th lumbricals iunnervated by ulnar nerve |
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innervation of the interosseous muscles of the hand
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ulnar nerve
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innervation of the biceps, brachialis, and coracobrachialis
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musculocutaneous n.
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patient loses sensations in the lateral forearm; what nerve is most likely damaged
|
musculocutaneous n.
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what vessels are most commonly compressed in thoracic outlet syndrome
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brachial plexus, phrenic nerve, subclavian vein
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functions of the dorsal vs. palmar interosseous muscles
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dorsal interossei: abduct fingers (DAB)
palmar interossei: adduct fingers (PAD) |
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functions of the lumbricals
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flex at the MCP joints
extend at the DIP and PIP joints |
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muscle and nerve damaged in winging of the scapula
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serratus anterior and the long thoracic nerve
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tennis elbow
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lateral epicondylitis
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golfers elbow
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medial epicondylitis
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nerve damaged in anterior hip dislocation
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obturator n.
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nerve most commonly damaged in pelvic fracture
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femoral n.
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most commonly damaged nerve from knee trauma
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tibial n.
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nerve damaged in posterior hip dislocation and polio
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superior/inferior gluteal nerves (superior only in polio)
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innervation to gluteus medius/minimus
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superior gluteal n.
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innervation to gluteus maximus
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inferior gluteal n.
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patient is restricted in adduction of the thigh and has decreased sensation along the medial thigh; which nerve is damaged
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obturator
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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
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femoral n.
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patient is restricted in foot inversion and plantarflexion; also has decreased sensation over the sole of the foot; which nerve is damaged
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tibial n.
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patient is restricted in foot eversion and dorsiflexion; also has decreased sensation over anterolateral leg and dorsal foot; which nerve is damaged
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common peroneal n.
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nerve damaged in foot drop/slap (steppage gait)
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common peroneal n.
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what does the sciatic nerve become
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splits into tibial and common peroneal nerves
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what makes up the I band in a muscle fiber
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only actin
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what makes up the H zone in a muscle fiber
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only myosin
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what makes up the A band in a muscle fiber
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BOTH actin and myosin
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calcium binds to which troponin
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troponin C
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what is the power stroke in a muscle contraction
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when myosin releases ADP and is displaced from the actin filament
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only portion of the muscle fiber to remain constant in length during contraction
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A band
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differences between type I vs. type II muscle fibers
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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 |
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which troponin binds to actin
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troponin I
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which troponin binds to tropomyosin
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troponin T
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effect when calcium binds to calmodulin
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activates myosin light chain kinase
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which type of ossification is responsible for longitudinal bone growth
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endochondral ossification
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which type of ossification is responsible for flat bone growth
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membranous ossification
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upregulation of FGFR3 receptors causes what disease
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achondroplasia
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mode of inheritance of achondroplasia
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autosomal dominant
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characterized by a reduction is trabecular (spongy) bone despite normal mineralization levels
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osteoporosis
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vitamin D deficiency in adults vs children
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osteomalacia in adults
rickets in children |
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skeletal disorder caused by a deficiency of carbonic anhydrase II; characterized by a "Erlenmeyer flask" bones that flare out
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osteopetrosis ("marble bone disease")
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virus family linked to Paget's disease of the bone
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paramyxoviruses (parainfluenza, RSV, rubeola, mumps)
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skeletal condition characterized by abnormal bone architecture secondary to an increase in BOTH osteoclasts and osteoblasts; alkaline phosphatase is increased; associated with hearing loss
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Paget's disease of the bone
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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)
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McCune-Albright syndrome
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where are osteoblastomas found
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vertebral column
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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)
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osteoclastoma (giant cell tumor)
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bone tumor originating from metaphysis; MOST common benign bone tumor
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osteochondroma (exostosis)
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peak age for osteosarcoma
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teenagers
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MOST common area of the body for osteosarcomas
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around the knee
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gene mutation associated with osteosarcoma
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Rb gene (retinoblastoma, pineoblastoma, osteosarcoma)
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characteristic features of osteosarcoma when seen on xray
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Codmans triangle and sunburst pattern
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this bone tumor has a characterstic "onion-skin" appearance and is comprised of anaplastic blue cells
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Ewings sarcoma
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translocation associated with Ewings sarcoma
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11;22
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characteristic formation in the DIP and PIP joints in someone with osteoarthritis
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Heberdens nodes in the DIPs
Bouchards nodes in the PIPs |
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characteristic features that form in the joints in someone with rheumatoid arthritis
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pannus
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characteristic formations behind the knee in someone with rheumatoid arthritis
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Bakers cysts
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rheumatoid arthritis usually spares which phalangeal joints
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spares the DIPs
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what type hypersensitivity is RA
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type III hypersensitivity
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which HLA allele is associated with RA
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HLA-DR4
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antibodies found in most cases of RA
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anti-IgG (Fc portion) antibodies
anti-CCP antibodies (less sensitivie but more specific) |
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2 common extra-musculoskeletal complications of RA
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pleuritis and pericarditis
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classic triad of Sjogrens
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xerophthalmia (dry eyes)
xerostomia (dry mouth) arthritis (may also have parotid enlargement and dental carries) |
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antibodies found in Sjogrens
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SS-A (Ro) and SS-B (La) antibodies
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Sjogrens increases risk for what cancer
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B-cell lymphoma
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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
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gout is caused by accumulation of what
|
monosodium urate crystals secondary to hyperuricemia
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|
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genetic conditions (2) associated with gout
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Lesch-Nyhan syndrome and Von Gierkes
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enzyme deficiency in Lesch-Nyhan syndrome
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HGPRT deficiency
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antihypertensive drug that cause gout
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thiazide diuretics
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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 |
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Is gout positively or negatively birefringent? what about pseudogout?
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gout is negatively birefringent
pseudogout is weakly positive birefringent |
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MOST common location for gout to manifest
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MTP joint of the big toe (podagra)
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what are tophi
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chalky white deposits under the skin associated with gout
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3 common locations to find tophi
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external ear, olecranon bursa, and achilles tendon
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why does alcohol increase risk of gout
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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)
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treatment of acute gout
|
indomethacin (NSAIDs) or colchicine
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pathogenesis of pseudogout
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deposition of calcium pyrophosphate crystals
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treatment of pseudogout
|
there is no treatment
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3 MOST common bacterial causes of septic arthritis; what about chronic infectious arthritis?
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septic arthritis: S. aureus, Streptococcus, N. gonorrhea
chronic infectious arthritis: TB, Lyme disease |
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the seronegative spondyloarthropathies are associated with what HLA allele
|
HLA-B27
("PAIR" -> psoriatic arthritis, ankylosing spondylitis, IBS, Reiters syndrome) |
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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
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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
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classic triad of Reiter's syndrome
|
conjunctivitis/uveitis
urethritis arthritis "can't see, can't pee, can't climb a tree" |
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2 MOST common causes of Reiter syndrome
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C. jejuni and chlamydia
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treatment of chronic gout
|
allopurinol (for over-producers)
probenecid (for under-secreters) |
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MOST common people affected by SLE
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black women (ages 15-45)
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endocarditis linked to SLE
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Libman-Sacks endocarditis
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MOST common cause of death in SLE
|
kidney failure
|
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pathogenesis of kidney damage in SLE
|
immune complex deposition (wire-looping of the capillaries) most commonly causing diffuse proliferative glomerulonephritis (*nephritic)
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why do people with SLE have false positives in syphylis testing
|
people with SLE have anti-phospholipid antibodies which cross-react with cardiolipin
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antibodies linked to SLE
|
ANA (sensitive but not specific)
anti-dsDNA (specific) anti-Sm (specific) antiphospholipid |
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antibodes linked to drug-induced lupus
|
anti-histone antibodies
|
|
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symptoms of SLE
|
malar rash
discoid rash mucositis neurologic disorders pleuritis pericarditis hematologic disorders arthritis renal dysfunction photosensitivity |
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autoimmune lung disease associated with RA
|
sarcoidosis
|
|
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musculoskeletal autoimmune disorder associated with temporal arteritis
|
polymyalgia rheumatica
|
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DOC for polymyalgia rheumatica
|
prednisone
|
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|
progressive symmetric proximal muscle weakness caused by CD8 induced injury in the absence of skin involvement
|
polymyositis
|
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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
|
|
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antibodies suggestive of polymyositis/dermatomyositis
|
ANA (sensitive but not specific)
anti-Jo (specific) |
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tumor linked to myasthenia gravis
|
thymoma
|
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pathogenesis of myasthenia gravis
|
autoantibodies against postsynaptic ACh receptors
|
|
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symptoms of myasthenia gravis
|
muscle weakness (especially trouble holding the head up due to weak neck muscles), diplopia, and ptosis
|
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DOC to TEST for myasthenia gravis
|
edrophonium
|
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DOC to TREAT myasthenia gravis
|
pyridostigmine (alternative is neostigmine)
|
|
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pathogenesis of Lambert-Eaton syndrome
|
autoantibodies against presynaptic calcium channels causing decreased release of ACh leading to proximal muscle weakness only
|
|
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Lambert-Eaton syndrome is linked to what cancer
|
small cell carcinoma of the lung
|
|
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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
|
|
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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
|
|
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dermatitis linked to nickel and poison ivy
|
contact dermatitis (type IV hypersensitivity)
|
|
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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
|
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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
|
|
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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
|
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MOST common cause of osteomyelitis in diabetics and drug addicts
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pseudomonas
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MOST common cause of osteomyelitis in sickle cell
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salmonella
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MOST common cause of osteomyelitis in prosthetic replacements
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S. aureus and S. epidermidis
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MOST common cause of osteomyelitis in the spine
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mycobacteria tuberculosis (aka Pott's disease)
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MOST common cause of osteomyelitis after a cat/dog bite
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pasteurella multicida
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manifestation of osteomyelitis in newborns with congenital syphilis is commonly known as what
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saber shins
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MOST common locations for enchondromas
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distal extremities
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this malignant bone tumor presents as a glistening mass within the medullary cavity
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chondrosarcoma
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4 MOST common cancers that metastasize to the bone
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prostate, breast, kidney, and lung
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bone undergoes eburnation and appears as polished white ivory in this condition
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osteoarthritis
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which subtype of rheumatoid arthritis are large joints affected more commonly than small joints
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juvenile idiopathic rheumatoid arthritis
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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
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painful and difficulty urinating due to urethritis
(*this is Reiter's syndrome happening after a C. jejuni infection) |
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MOST common cause of infectious arthritis in children
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H. influenzae
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pseudoarthrosis is a consequence of what
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improper bone healing after a fracture
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lytic lesions in various bones throughout the body WITH keratin-positive cells
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metastatic cancer
(*note that multiple myeloma will cause lytic lesions but will NOT have keratin-positive cells) |
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dangerous complication seen in Legg-Calve-Perthes disease
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avascular osteonecrosis
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osteomyelitis most commonly affects which part of the bone
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metaphysis
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MOST common soft-tissue tumor
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lipoma
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soft-tissue tumor made of macrophages that forms most commonly after radiation
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malignant fibrous histiocytoma
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highly malignant soft-tissue tumor that forms in a joint
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synovial sarcoma
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bone condition linked to steroid use
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osteoporosis
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precursor to osteoporosis
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osteopenia
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pediatric musculoskeletal condition characterized by the inability to calcify osteoid
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rickets
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bone deformity characterized by a mosaic pattern of lamellar bone, and it carries and increased risk for osteogenic sarcomas
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Paget's disease of the bone
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finger deformities associated with RA
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boutonniere and swan-neck deformities
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what age group is Paget's disease of the bone seen in
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elderly
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ulnar deviation and subluxation is seen in what autoimmune disorder
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rheumatoid arthritis
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MOST common cause of osteomyelitis in newborns
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group B strep
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life-threatening SE of succinylcholine
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hyperkalemia
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