First Aid: Msk

Front 1

Epidermis layers

Back 1

stratum:

Corneum
Granulosum
Lucidum
Basalis

"Californians Like Girls in String Bikini's"

Front 2

Zona occludens

Back 2

cell-to-cell tight junctions, composed of occludins and claudins

close to apical side

Front 3

Zona adherens

Back 3

cell-to-cell intermediate junctions, just below zona occludens

cadherins attach to actin

Front 4

Cadherins

Back 4

Ca dependant adhesion molecules involved in cell-to-cell adhesion

Front 5

Macula adherens

Back 5

Desmosomes, cell-to-cell adhesion, small to discrete sites of attachment

Cadherins attach to intermediate filaments
Require desmoplakins (attachment proteins)

Front 6

Hemidesmosome

Back 6

connects cell to underlying ECM (on basolateral side of cell)

Front 7

Integrins

Back 7

Maintain integrity of BM
Binds to laminin in BM

Front 8

Abnormal passive abduction suggests:

Back 8

Torn MCL

Front 9

Landmark in pudendal nerve block:

Back 9

Ischial spine

Relieve pain of pregnancy

Front 10

Upper trunk injuries

Back 10

Lesioned by trauma

Front 11

Axillary n. injuries

Back 11

Fracture of the surgical neck of the humerus

Dislocation of the humerus

IM injection

Front 12

Radial n. in the spiral groove injuries

Back 12

Fracture midshaft of the radius

Front 13

Radial n. (deep branch) injury

Back 13

Stretched by subluxation of radius

Front 14

Recurrent branch of the median n. injury

Back 14

Superficial laceration of the palm

Front 15

C7 root injury

Back 15

compression by cervical disk lesion

Front 16

Lower trunk of the brachial plexus injuries

Back 16

Compression by cervical rib (Thoracic Outlet Syndrome)

Pancoast's tumor

*Leads to Klumpke's Palsy

Front 17

Radial n. injury

Back 17

Compression by incorrect use of a crutch

Front 18

Median n. at cubital fossa injuries

Back 18

Supracondylar fracture of the humerus

Pronator teres syndrome

Front 19

Ulnar n. at the cubital fossa injury

Back 19

Fracture of the medial epicondyle of the humerus

Front 20

Ant. interosseous n. injury (branch of median n.)

Back 20

compressed in deep forearm

Front 21

Median n. injury at the wrist

Back 21

Carpal Tunnel Syndrome

Dislocated luneate

Front 22

Distal ulnar n. injury

Back 22

Trauma to heel of the hand

Fracture of the hook of the hamate

Front 23

How is the brachial plexus protected during a clavicle fracture?

Back 23

By the subclavius muscle

Front 24

Obturator n.

1. Cause of injury
2. Motor deficit
3. Sensory deficity

Back 24

1. Anterior hip dislocation

2. Thigh adduction

3. Medial thigh

Front 25

Common peroneal n.

1. Cause of injury
2. Motor deficit
3. Sensory deficity

Back 25

1. Trauma to lateral aspect of leg or fibular neck fracture

2. Foot dorsiflexion, Toe extension, Foot eversion

3. Anterolateral side of leg, dorsum of the foot

Front 26

Inferior gluteal

1. Cause of injury
2. Motor deficit
3. Sensory deficity

Back 26

1. Posterior hip dislocation

2. Can't jump, climb or rise from seated position

3. --

Front 27

Femoral n.

1. Cause of injury
2. Motor deficit
3. Sensory deficity

Back 27

1. Pelvic fracture

2. Flex thigh, extend leg

3. Anterior aspect of thigh, medial aspect of the leg

Front 28

Tibial n.

1. Cause of injury
2. Motor deficit
3. Sensory deficity

Back 28

1. Patellar fracture

2. Foot inversion, Toe flexion, Foot plantar flexion

3. Sole of foot

Front 29

Superior gluteal n.

1. Cause of injury
2. Motor deficit
3. Sensory deficity

Back 29

1. Posterior hip dislocation, polio

2. Thigh abduction (+ Trendelenberg sign)

3. --

Front 30

Which bands in the skeletal muscle sarcomere shrink during contraction?

Back 30

"HIZ shrink, A is Always the same"

H, I bands shrink (Z lines move closer together)

Front 31

Steps in skeletal muscle contraction

Back 31

1. Action potential at post-synaptic NMJ causes opening of voltage-gated Ca channels

2. Ca causes vesicle release of ACh

3. ACh binds post-synaptic nicotinic receptors, causing depol

4. Depol travels along muscle cell and down T-tubules

5. Depolarization of voltage-gated Ca channels (dihydropyridine receptors) on sarcolemmal membrane

6. Dihydropyridine receptors are coupled to ryanodine Ca receptors on sarcoplasmic reticulum --> CICR

7. Ca can bind troponin C, causing conformational change in tropomyosin, exposing myosin binding site on actin

8. Myosin-ADP binds actin and is displaced, releasing ADP (power stroke)

9. Contraction occurs (H, I bands shorten)

Front 32

Type 1 muscle fibers

Back 32

"One slow red ox"

Slow twitch
Red fibers due to increased mitochondria and myoglobin
Oxidative phos (increased)

For sustained contraction

Front 33

Type 2 muscle fibers

Back 33

Fast twitch
White fibers --> low mitochondria and myoglobin
Mostly anaerobic glycolysis

weight training

Front 34

Endochondral ossification is what type of bone growth?

Back 34

Longitudinal bone growth

Cartilagenous model made first by chondrocytes later remodelled to woven then lamellar bone by osteoblasts/clasts.

Front 35

Membranous ossification

Back 35

Flat bone growth (skull, facial bones, axial skeleton)

No cartilagenous model. Later remodelled to woven and lamellar bone.

Front 36

Source of osteoblasts

Back 36

Mesenchymal stem cells in the periosteum.

Front 37

Benign bone tumors

Back 37

Osteoma
Osteoid osteoma
Osteoblastoma
Giant cell tumor (osteoclastoma)
Osteochondroma
Enchondroma

Front 38

Malignant bone tumors

Back 38

Osteosarcoma (osteogenic sarcoma)
Ewing's sarcoma
Chondrosarcoma

Front 39

Osteoma

Back 39

Benign bone tumor

Gardner's syndrome (FAP)
Skull

Front 40

Osteoid osteoma

Back 40

Benign bone tumor

Osteoblastoma < 2cm
Tibia and Femur
Men < 25yrs
Bone pain at night, relieved by NSAIDs

Front 41

Osteoblastoma

Back 41

Benign bone tumor

>2cm
verterbral column

Front 42

Giant cell tumor (Osteoclastoma)

Back 42

Benign bone tumor

Epiphyses
20-40yrs
Locally aggressive
"Double bubble", "Soap bubble" on X-ray
Multinucleated giant cells

Front 43

Osteochondroma

Back 43

Most common benign bone tumor

long metaphyses
mature bone with cartilage cap
men < 25yrs

Front 44

Endochondroma

Back 44

Benign cartilage neoplasm

Distal extremities

Front 45

Osteosarcoma/Osteogenic sarcoma

Back 45

2nd most common malignant bone tumor

Men 10-20yrs
Metaphysis
Predisposing factors: Paget's disease, bone infarcts, radiation, familial retinoblastoma
Codman's triangle, sunburst pattern on X-ray

Front 46

Ewing's sarcoma

Back 46

Malignant bone tumor

small blue cells
boys <15
aggressive with mets
responds to chemo
"onion skin" appearance
diaphysis
11;22 translocation

Front 47

Chondrosarcoma

Back 47

Malignant cartilagenous tumor

men 30-60
primary origin or develop from osteochondroma
glistening mass in medullary cavity

Front 48

Primary bone tumor in epiphysis (benign and malignant)

Back 48

Benign: Giant cell tumor (Osteoclastoma)

Malignant: none

Front 49

Primary bone tumor in metaphysis (benign and malignant)

Back 49

Benign: Osteochondroma

Malignant: Osteosarcoma

Front 50

Primary bone tumor in diaphysis (benign and malignant)

Back 50

Benign: Osteoid osteoma

Malignant: Ewing's sarcoma

Front 51

Primary bone tumor in intramedullary (benign and malignant)

Back 51

Benign: Enchondroma

Malignant: Chondrosarcoma

Front 52

Osteitis fibrosa cystica

Back 52

Caused secondarily by hyperparathyroidism (adenoma, carcinoma, renal osteodystrophy)

brown tumors in bone

high serum Ca, high PTH, low P, high ALP

Front 53

Polyostotic fibrous dysplasia

Back 53

bone replaced by fibroblasts, collagen, irregular bone trabecula.

McCune-Albright Syndrome is an example.

Front 54

McCune Albright Syndrome

Back 54

Polyosotic fibrous dysplasia

multiple bone lesions
precocious puberty
cafe-au-lait spots

Front 55

Septic arthritis

3 organisms

Back 55

Staph aureus
Streptococcus
N. gonorrhea

Front 56

Gonococcal arthritis: Sx's

Back 56

monoarticular, asymmetric migratory arthritis

STD
Synovitis (knee)
Tenosynovitis (hand)
Dermatitis

Front 57

Mixed CT disease

Back 57

"Raynaud's FAME"

Raynaud's
Fatigue
Arthalgias
Myalgias
Esophageal Dysmotility

Abs to U1RNP

Front 58

flat dermatologic lesions (2 terms)

Back 58

macule/patch

Front 59

raised dermatologic lesions (2 terms)

Back 59

papule/plaque

Front 60

fluid-filled dermatologic lesions (3 terms)

Back 60

vesicle/wheal/bullous

Front 61

Bullous pemphigoid

Back 61

autoimmune disease causing blisters between the dermis and epidermis

Front 62

Impetigo

Back 62

Type of crust

highly contagious bacterial skin infxn, usually people who play contact sports or school age kids

Front 63

Crust

Back 63

dried exudate from a vesicle, bulla or pustule

Front 64

Hyperkeratosis

Back 64

increased thickness of stratum corneum

Front 65

Parakeratosis

Back 65

Hyperkeratosis with retention of nuclei in stratum corneum

Front 66

Acantholysis

Back 66

Separation of epidermal cells

ex: pemphigus vulgaris

Front 67

Pemphigus vulgaris

Back 67

type of acantholysis

blistering skin disease producing painful skin lesions

Front 68

Verrucae

Back 68

Warts.

Epidermal hyperplasia, hyperkeratosis, koilocytosis.

Front 69

Verruca vulgaris

Back 69

Warts on the hands

Front 70

Condyloma acuminatum

Back 70

Warts on genitals. Caused by HPV

Front 71

Ephelis

Back 71

Freckle.

Normal number of melanocytes, increased melanin pigment.

Front 72

Atopic dermatitis

Back 72

Pruritic eruption on skin flexures.

Often associated with other atopic diseases (asthma, allergic rhinitis)

Front 73

Allergic contact dermatitis

Back 73

Type IV Hypersensitivity Rxn

Front 74

Psoriasis

Back 74

Papules and plaques with silvery scaling. Knees and Elbows.

Acanthosis with parakeratotic scaling.

Can be assoc with nail pitting and psoriatic arthritis.

Auspitz sign: bleeding when scales are scraped off.

Front 75

Auspitz sign

Back 75

Psoriasis.

Bleeding when scales are scraped off.

Front 76

Seborrheic keratosis

Back 76

Flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts.

Benign neoplasm of elderly.

Front 77

Sign of Leser-Trelat

Back 77

sudden appearance of multiple seborrheic keratosis indicating underlying malignancy.

Front 78

Albinism

Back 78

Autoimmune.

Normal melanocyte number, decreased melanin pigment.

Decreased activity of tyrosinase.

Could be caused by decreased neural crest cell migration during development.

Front 79

Vitiligo

Back 79

Autoimmune.

Irregular areas of complete depigmentation. Decrease in number of melanocytes.

Front 80

Melasma

Back 80

Autoimmune

Hyperpigmentation assoc with pregnancy or OCP use.

Front 81

Impetigo

Back 81

Very superficial, highly contagious bacterial skin infection.

S.aureus or S.pyogenes.

Honey-colored crusting.

Front 82

Cellulitis - organisms

Back 82

S. pyogenes or S. aureus

Front 83

Necrotizing faciiitis

Back 83

Deeper tissue injury, usually from anaerobic bacteria or S. pyogenes.

Crepitus from methane and CO2 production.

Front 84

SSSS

Staphylococcal scalded skin syndrome

Back 84

Exotoxin destroyce keratinocyte attachment in stratum granulosum only.

Fever, erythematous rash, sloughing of upper layers of the epidermis.

Newborns and kids.

Front 85

Hairy leukoplakia

Back 85

EBV mediated, white painless plaques on tongue.

HIV patients.

Front 86

Pemphigus vulgaris

Back 86

Bullous/Autoimmune disorder.

Potentially fatal, IgG Ab against desomosomes (anti-epithelial Ab)

Immunofluorescence reveals Ab against epidermis.

Acantholysis - bullae involving skin and oral mucosa.

Positive Nikolsky's sign (separation of epidermis upon stroking of the skin)

Front 87

Nikolsky's sign

Back 87

Separation of epidermis following stroking of the skin.

Positive in pemphigus vulgaris.
Negative in bullous pemphigoid.

Front 88

Bullous pemphigoid

Back 88

Autoimmune disorder.

IgG Abs agains hemidesmosomes (epidermal BM)

Linear immunofluorescence.
Eosinophils in blister.
Less severe than pemphigus vulgaris.
Skin, but spare oral mucosa.
Negative Nikolsky's sign.

Front 89

Dermatitis herpetiformis

Back 89

Pruritic papules and vesicles.
Celiac's.

Front 90

Erythema multiforme

Back 90

Assoc. with infxns, drugs, cancers and AI diseases.

Multiple types of lesions -- macules, papule, vesicles, target lesions.

Front 91

Stevens-Johnson syndrome

Back 91

fever, bullae formation and necrosis, sloughing of skin.

high mortality rate.

adverse drug rxn.

more severe form: toxic epidermal necrolysis

Front 92

Lichen planus

Back 92

Pruritic, Purple, Polygonal Papules.

Infiltrate of lymphocytes at dermal-epidermal junction.

Assoc. with Hepatitis C.

Front 93

Actinic keratosis.

Back 93

Pre-malignant lesions caused by sun exposure.

Front 94

Acanthosis nigrans

Back 94

Hyperplasia of stratum spinosum.

Result of hyperinsulinemia and visceral malignancy.

Front 95

Erythema nodosum

Back 95

Inflammatory lesions of subq fat, usually on anterior shins.

Coccidiomycosis, histoplasmosis, TB, leprosy, strep infxns, sarcoidosis.

Front 96

Pityriasis rosea

Back 96

"herald patch"
"Christmas tree" distribution.

Multiple papular eruptions--remit spontaneously.

Front 97

Strawberry hemangioma

Back 97

first few weeks of life.
grow rapidly, regress spontaneously.
young kids.

Front 98

cherry hemangioma

Back 98

30-40yrs

Do not regress.

Front 99

What lesion is a precursor to squamous cell cancer?

Back 99

Actinic keratosis

Front 100

Ulcerative red lesions
Chronic draining sinus
Keratin pearls

Back 100

Squamous cell carcinoma

Front 101

Central ulceration
Pearly papules
Telangiectasia

Back 101

Basal cell carcinoma

Front 102

S-100 tumor marker

Back 102

Melanoma

Front 103

In melanoma, what correlates with risk of metastasis?

Back 103

Depth of tumor.