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126 Cards in this Set

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epidermal layers from top to bottom
california likes girls in string bikinis:
corneum, lucidum, granulosum, spinosum, basalis
found just below zona occludens; cadherins connect to actin and are Ca-dependent adhesion molecules
zona adherens
this epithelial cell junction prevents diffusion across paracellular space
zona occludens (tight junction)
cadherins in this epithelial cell junction connect to intermediate filaments
desmosome (macula adherens)
autoantibodies against this are associated with pemphigus vulgaris
desmosome
this epithelial cell junction connects cells to underlying ECM
hemidesmosome
autoantibodies against this are associated with bullous pemphigoid
hemidesmosomes
common football injury from force from the lateral side resulting in the unhappy triad
1. medial collateral ligament
2. anterior cruciate ligament
3. lateral meniscus
test that indicates torn MCL
abnormal passive abduction
clinical landmark for pudendal nerve block
ischial spine
McBurnye's point
2/3 of the way from the umbilicus to the anterior superior iliac spine
clinical landmark for lumbar puncture
iliac crest
shoulder muscles that form the rotator cuff
SITS:
supraspinatus
infraspinatus
teres minor
subscapularis
muscle involved in initially abducting the arm, most common rotator cuff injury
supraspinatus
Klumpke's palsy
lesion of lower trunk of brachial plexus caused by cervical rib or pancoast tumor
nerve involved in fracture of midshaft of humerus
radial nerve in the spiral groove
nerve involved in supracondylar fracture of humerus
median nerve
nerve that innervates thenar muscles via recurrent branch
median nerve
Erb's palsy (waiter's tip)
lesion of upper trunk (C5,6)
what protects the brachial plexus during clavicle fracture
subclavius muscle
nerve injury associated with fractured surgical neck of humerus or dislocation
axillary nerve
saturday night palsy
extended compression of axilla by back of chair of crutches resulting in wrist drop
differentiate where proximal vs. distal lesion of median nerve happens
proximal - fracture of supracondylar humerus
distal - carpal tunnel syndrome
nerve associated with lateral finger flexion, wrist flexion, and opposition of thumb
median nerve
"ape hand" = thenar atrophy
differentiate where proximal vs. distal lesion of ulnar nerve happens
proximal - fracture of medial epicondyl of humerus
distal - fracture of hook of hamate (falling on outstretched hand)
what two things can a cervical rib compress
subclavian artery (thoracic outlet syndrome)
inferior trunk (Klumpke's palsy)
signs of cervical rib compressing subclavian artery and inferior trunk
1. atrophy of the thenar and hypothenar enminences (median)
2. sensory defects on the medial side of the forearm and hand (ulnar)
3. disappearance of the radial pulse upon moving the head toward the ipsilateral side
claw hand of 4th and 5th digits (Pope's blessing) is associated with what
distal ulnar nerve lesion
claw hand of 2nd and 3rd digits is associated with what
distal median nerve lesion
total claw hand (klumpke's)
lower trunk lesion (C8, T1)
ape hand is associated with what
proximal median nerve lesion
lesions of this nerve results in winged scapula
long thoracic
what muscles abduct and adduct the fingers
abduct - dorsal interosseous (DAB)
adduct -palmar interosseous (PAD)
muscles involved in flexing at the MCP join
lumbrical muscles
degenerative injury due to repeated use leading to tiny tears in tendons and muscles
lateral and medial epicondylitis (tennis and golf elbow)
positive Trendelenburg sign
nerve involved
hip drops when standing on opposite foot
superior gluteal nerve
injury to this nerve results in inability to jump, climb stair, or rise from seated position
inferior gluteal
sciatic nerve splits into what two nerves
what are their respective affects
peroneal - everts and dorsiflexes foot
tibial - inervts and plantarflexes foot
in the sarcomere, which band always remains the same length
A band
H and I- bands shorten
differentiate type 1 and muscle fibers
type 1 (slow twitch) - red fibers with increased mitochondria and myoglobin concentration result in sustained contraction
type 2 (fast twitch) - white fibers with decreased mitochondria and myoglobin concentration
what allows actin/myosin cycling to initiate muscle contraction
Calcium binding to troponin C causing conformational change and allowing tropomyosin to move out of the way
what does ATP do during muscle contraction
binds to myosin head and release actin filament allowing cross-bridge cycling and shortening to occur
smooth muscle contraction
increased calcium binds to calmodulin which activates myosin light-chain kinase (MLCK) to cause cross-bridge formation with contraction
what does NO do to smooth muscle contraction
increaes cGMP which inhibits MLCK leading to relaxation
longitundinal bond growth via cartilagninous model of bone being made first by chondrocytes
endochondral ossification
flat bone growth of the skull, facial bones, and axial skeleton in which women bone formed directly without cartilage
membranous ossification
osteoblast source
mesenchymal stem cells in periosteum
failure of endochondral ossification but membranous ossification is unaffected, due to FGFR3a activation inhibits chondrycyte proliferation
achondroplasia
two fractures associated with osteoporosis
vertebral crush fractures
femoral neck fracture
prophylaxis for osteoporosis
exercise and calcium ingestion before age 30
bone defect due to abnormal function of osteoclasts, increased extremedullary hematopoiesis, associated with erlenmeyer flask bones that flare out
osteopetrosis
genetic deficiency in osteopetrosis
carbonic anhydrase II deficiency resulting in abnormal function of osteoclasts
calcium, PTH, and phosphate levels seen in vitamin D deficiency
decreased calcium
increased PTH
decreased phosphate
abnormal bone architecture caused by increased in both osteoblastic and osteoclastic activity, associated with paramyxovirus infection and increased ALP
paget's disease (osteitis deformans)
what other abnormalities is paget's disease associated with
high-output cardiac failure
osteogenic sarcoma
hearing loss
increasing hat size
serum calcium, phosphate, ALP, and PTH seen in osteitis fibrosa cystica (brown tumors)
increased serum calcium
decreased phosphate
increased ALP
increased PTH
form of polyostotic fibrous dysplasia (bone is replaced by fibroblasts, collagen, and irregular bony trabeculae) with precocious purbery and cafe-au-lait spots
McCune-Albright syndrome
interlacing trabeculae of women bone surrounded by osteoblasts, found in proximal tibia and femur, most common in men < 25 years
osteoid osteoma
locally aggressive benign tumor with characteristic "double bubble" appearance on x-ray, has spindle-shaped cells with multinucleated giant cells
giant cell tumor (osteoclastoma)
most common benign bone tumor with mature bone with cartilaginous cap, usually in younger men
osteochondroma
2nd most common primary malignant bone tumor (after MM) commonly found in metaphysis of long bone with sunburst pattern on x-ray
osteosarcoma
predisposing factors for osteosarcoma
Paget's disease
radiation
familial retinoblastoma
anaplastic small blue cell malignant tumor of bone with onion-skin appearance and t(11:22)
Ewing's sarcoma
11 + 22 = 33, Ewing's number
where are osteoclastoma (giant cell tumors) most commonly found in the bone
epiphyseal end of long bones
mechanical wear and tear of joints leads to destruction of articular cartilage
osteoarthritis
differentiate finger joints involved with osteoarthritis vs. RA
OA - DIP and PIP
RA - MCP and PIP
autoimmune inflammatory disorder affecting synovial joints with pannus formation in joints
RA
rheumatoid factor
anti-IgG antibody
what type of hypersensitivity is RA
type III hypersensitivity
*anti-IgG antibodies and anti-CCP antibodies
patient presents with morning stiffness lasting > 30 minutes and improving with use, symmetric joint involvement with fever and fatigue
RA
other abnormalities that can be associated with RA
pleuritis
pericarditis
does OA have inflammation of systemic symptoms
No, this occurs in RA
classic triad of sjogren's syndrome
1. xerophthalmia
2. xerostomia
3. arthritis
disease with autoantibodies to ribonucleoprotein antigens, SS-A (Ro) and SS-B (La)
Sjogren's syndrome
which other autoimmune disease is associated with RA
sjogren's syndrome
precipitation of monosodium urate crystals into joints due to hyperuricemia
gout
causes of gout (monosodium urate crystals)
Lesch-Nyhan syndrome
PRPP excess
decreased excretion of uric acid
increased cell turnover
von Gierke's disease
are most cases of gout caused by underexcretion of overproduction of urate crystals
underexcretion
patients presents with painful MTP joint of big toe and tophus formation on achilles tendon. He says attacks are precipitated after alcohol consumption, what disease does he have and what is the mechanism
gout
alcohol metabolites compete for same excretion sites in kidney as uric acid causing buildup
differentiate the crystals found in gout vs. pseudogout
gout - needle shaped negatively birefringent (yellow when parallel)
pseudogout - rhomboid crystals that are weakly positively birefringent (blue when parallel)
caused by deposition of calcium pyrophosphate crystals within the joint space
pseudogout
3 common organisms associated with septic arthritis
S. aureus
Streptococcus
Neisseria gonorrhea
two organisms associated with chronic infectious arthritis
TB
Lyme disease
STD that presents with monoarticular, migratory arthritis with asymmetrical pattern
gonococcal arthritis
4 seronegative spondyloarthropathies
PAIR:
psoriatic arthritis
ankylosing spondylitis
inflammatory bowel disease
reaction arthritis (Reiter's syndrome)
type of arthritis without rheumatoid factor and has strong associated with HLA-B27
seronegative spondyloarthropathies
classic triad seen in Reiter's syndrome
1. conjunctivitis and anterior uveitis
2. urethritis
3. arthritis
arthritis associated with post-GI or chlamydia infections
Reter's syndrome
antibodies associated with drug-induced lupus
antihistone antibodies
disease associated with nonbacterial verrucous endocarditis, wire-loop lesions in kidney with immune complex deposition, false positive on syphilis test due to antiphospholipid antibodies that cross-react with cardiolipin
SLE
screening test for SLE
antinuclear antibodies (ANA)
these antibodies are associated with poor prognosis in SLE
anti-ds DNA antibodies
characterized by immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels seen in black people
Sarcoidosis
increased ESR with normal CK associated with pain in stiffness in shoulders and hips, often with fever, malaise, and weight loss
polymyalgia rheumatica
progressive symmetric proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers. perifascicular inflammation is diagnostic
polymyositis
associated with increased CK, and positive ANA, anti-Jo-1
polymyositis/dermatomyositis
autoantibodies to postynaptic AChR cause ptosis, diplopia, and general weakness; associated with thymoma
myasthenia gravis
autoantibodies to presynaptic Ca channel results in decreased ACh release leading to proximal muscle weakness
Lambert-Eaton syndrome
neuromusclar junction disease associated with small cell lung cancer (paraneoplastic disease)
Lambert-Eaton syndrome
excessive fibrosis and collagen deposition throughout the body; commonly in the skin, renal, pulmonary, CV, and GI sysytems
scleroderma
two types of scleroderma
1. diffuse scleroderma - widespread skin involvement with early visceral involvement
2. CREST - limited skin involvement, often confined to fingers and face, more benign clinical course
differentiate antibodies seen in the two types of scleroderma
diffuse scleroderma - anti-Scl-70 antibody (topoisomerase I)
CREST - anti-Centromere
differentiate name for warts on hands vs. genitals (HPV infection)
hands - verruca vulgaris
genitals - condyloma acuminatum
pruritic eruption common on skin flexures, often associated with asthma and allergic rhinitis
atopic dermatitis (eczema)
type IV hypersensitivity reaction that follows exposure to allergen, lesion occurs at site of contact
allergic contact dermatitis
papules and plaques with silvery scaling, especially on knees, elbows, and scalp. Associated with increased statum spinosum, nail pitting, and arthritis
psoriasis
sudden appearance of multiple seborrheic keratoses
indicates underlying malignant - GI or lymphoid
pigmented squamous epithelial poliferation with horn cysts that look pasted on
seborrheic keratosis
normal melanocyte number with decreased melanin due to decreased activity of tyrosinase
albinism
irregular areas of complete depigmentation caused by decreased in melanocytes
vitiligo
superficial skin infection associated with honey-colored crusting
impetigo - S. aureus or S. pyogenes
exotoxin destroys keratinocyte attachments in the stratum granulosum only, associated with generalized erythema and sloughing of upper layer of epidermis
staphylococcal scalded skin syndrome
white, painless plaques on the tongue that cannot be scraped off, EBV-mediated
HIV-positive patient - hairy leukoplakia
IgG antibodies against desmosomes associated with separation of epidermis upon manual stroking of skin
pemphigus vulgaris
IgG antibodies against hemidesmosomes associated with blisters with eosinphils
bullous pemphigoid
deposits of IgA at the tips of dermal papillae associated with celiac disease
dermatitis herpetiformis
fever, bulla formation and necrosis, with sloughing of skin associated with adverse drug reactions
stevens-johnson syndrome
sawtooth infiltrate of lymphocytes at dermal-epidermal junction associated with hepatitis C
lichen planus
premalignant lesions caused by sun exposure with cutaneous horns
actinic keratosis
differentiate strawberry and cherry hemangioma
strawberry - first few weeks of life, regresses spontaneously at 5-8 years
cherry - appears in 30's-40's, does not regress
what is a precursor to SCC of the skin
actinic keratosis
skin cancer associated with chronic draining sinuses and keratin pearls
SCC
skin cancer with pearly papules that almost never metastsizes, has palisading nuclei
basal cell carcinoma
what is a precursor to melanoma
dysplastic nevus
skin cancer with significant risk of metastasis, S-100 tumor marker associated with sunlight exposure
melanoma
what correlates with risk of metastasis and prognosis in a melanoma
depth