First Aid Musculoskeletal

Front 1

epidermal layers from top to bottom

Back 1

california likes girls in string bikinis:
corneum, lucidum, granulosum, spinosum, basalis

Front 2

found just below zona occludens; cadherins connect to actin and are Ca-dependent adhesion molecules

Back 2

zona adherens

Front 3

this epithelial cell junction prevents diffusion across paracellular space

Back 3

zona occludens (tight junction)

Front 4

cadherins in this epithelial cell junction connect to intermediate filaments

Back 4

desmosome (macula adherens)

Front 5

autoantibodies against this are associated with pemphigus vulgaris

Back 5

desmosome

Front 6

this epithelial cell junction connects cells to underlying ECM

Back 6

hemidesmosome

Front 7

autoantibodies against this are associated with bullous pemphigoid

Back 7

hemidesmosomes

Front 8

common football injury from force from the lateral side resulting in the unhappy triad

Back 8

1. medial collateral ligament
2. anterior cruciate ligament
3. lateral meniscus

Front 9

test that indicates torn MCL

Back 9

abnormal passive abduction

Front 10

clinical landmark for pudendal nerve block

Back 10

ischial spine

Front 11

McBurnye's point

Back 11

2/3 of the way from the umbilicus to the anterior superior iliac spine

Front 12

clinical landmark for lumbar puncture

Back 12

iliac crest

Front 13

shoulder muscles that form the rotator cuff

Back 13

SITS:
supraspinatus
infraspinatus
teres minor
subscapularis

Front 14

muscle involved in initially abducting the arm, most common rotator cuff injury

Back 14

supraspinatus

Front 15

Klumpke's palsy

Back 15

lesion of lower trunk of brachial plexus caused by cervical rib or pancoast tumor

Front 16

nerve involved in fracture of midshaft of humerus

Back 16

radial nerve in the spiral groove

Front 17

nerve involved in supracondylar fracture of humerus

Back 17

median nerve

Front 18

nerve that innervates thenar muscles via recurrent branch

Back 18

median nerve

Front 19

Erb's palsy (waiter's tip)

Back 19

lesion of upper trunk (C5,6)

Front 20

what protects the brachial plexus during clavicle fracture

Back 20

subclavius muscle

Front 21

nerve injury associated with fractured surgical neck of humerus or dislocation

Back 21

axillary nerve

Front 22

saturday night palsy

Back 22

extended compression of axilla by back of chair of crutches resulting in wrist drop

Front 23

differentiate where proximal vs. distal lesion of median nerve happens

Back 23

proximal - fracture of supracondylar humerus
distal - carpal tunnel syndrome

Front 24

nerve associated with lateral finger flexion, wrist flexion, and opposition of thumb

Back 24

median nerve
"ape hand" = thenar atrophy

Front 25

differentiate where proximal vs. distal lesion of ulnar nerve happens

Back 25

proximal - fracture of medial epicondyl of humerus
distal - fracture of hook of hamate (falling on outstretched hand)

Front 26

what two things can a cervical rib compress

Back 26

subclavian artery (thoracic outlet syndrome)
inferior trunk (Klumpke's palsy)

Front 27

signs of cervical rib compressing subclavian artery and inferior trunk

Back 27

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

Front 28

claw hand of 4th and 5th digits (Pope's blessing) is associated with what

Back 28

distal ulnar nerve lesion

Front 29

claw hand of 2nd and 3rd digits is associated with what

Back 29

distal median nerve lesion

Front 30

total claw hand (klumpke's)

Back 30

lower trunk lesion (C8, T1)

Front 31

ape hand is associated with what

Back 31

proximal median nerve lesion

Front 32

lesions of this nerve results in winged scapula

Back 32

long thoracic

Front 33

what muscles abduct and adduct the fingers

Back 33

abduct - dorsal interosseous (DAB)
adduct -palmar interosseous (PAD)

Front 34

muscles involved in flexing at the MCP join

Back 34

lumbrical muscles

Front 35

degenerative injury due to repeated use leading to tiny tears in tendons and muscles

Back 35

lateral and medial epicondylitis (tennis and golf elbow)

Front 36

positive Trendelenburg sign
nerve involved

Back 36

hip drops when standing on opposite foot
superior gluteal nerve

Front 37

injury to this nerve results in inability to jump, climb stair, or rise from seated position

Back 37

inferior gluteal

Front 38

sciatic nerve splits into what two nerves
what are their respective affects

Back 38

peroneal - everts and dorsiflexes foot
tibial - inervts and plantarflexes foot

Front 39

in the sarcomere, which band always remains the same length

Back 39

A band
H and I- bands shorten

Front 40

differentiate type 1 and muscle fibers

Back 40

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

Front 41

what allows actin/myosin cycling to initiate muscle contraction

Back 41

Calcium binding to troponin C causing conformational change and allowing tropomyosin to move out of the way

Front 42

what does ATP do during muscle contraction

Back 42

binds to myosin head and release actin filament allowing cross-bridge cycling and shortening to occur

Front 43

smooth muscle contraction

Back 43

increased calcium binds to calmodulin which activates myosin light-chain kinase (MLCK) to cause cross-bridge formation with contraction

Front 44

what does NO do to smooth muscle contraction

Back 44

increaes cGMP which inhibits MLCK leading to relaxation

Front 45

longitundinal bond growth via cartilagninous model of bone being made first by chondrocytes

Back 45

endochondral ossification

Front 46

flat bone growth of the skull, facial bones, and axial skeleton in which women bone formed directly without cartilage

Back 46

membranous ossification

Front 47

osteoblast source

Back 47

mesenchymal stem cells in periosteum

Front 48

failure of endochondral ossification but membranous ossification is unaffected, due to FGFR3a activation inhibits chondrycyte proliferation

Back 48

achondroplasia

Front 49

two fractures associated with osteoporosis

Back 49

vertebral crush fractures
femoral neck fracture

Front 50

prophylaxis for osteoporosis

Back 50

exercise and calcium ingestion before age 30

Front 51

bone defect due to abnormal function of osteoclasts, increased extremedullary hematopoiesis, associated with erlenmeyer flask bones that flare out

Back 51

osteopetrosis

Front 52

genetic deficiency in osteopetrosis

Back 52

carbonic anhydrase II deficiency resulting in abnormal function of osteoclasts

Front 53

calcium, PTH, and phosphate levels seen in vitamin D deficiency

Back 53

decreased calcium
increased PTH
decreased phosphate

Front 54

abnormal bone architecture caused by increased in both osteoblastic and osteoclastic activity, associated with paramyxovirus infection and increased ALP

Back 54

paget's disease (osteitis deformans)

Front 55

what other abnormalities is paget's disease associated with

Back 55

high-output cardiac failure
osteogenic sarcoma
hearing loss
increasing hat size

Front 56

serum calcium, phosphate, ALP, and PTH seen in osteitis fibrosa cystica (brown tumors)

Back 56

increased serum calcium
decreased phosphate
increased ALP
increased PTH

Front 57

form of polyostotic fibrous dysplasia (bone is replaced by fibroblasts, collagen, and irregular bony trabeculae) with precocious purbery and cafe-au-lait spots

Back 57

McCune-Albright syndrome

Front 58

interlacing trabeculae of women bone surrounded by osteoblasts, found in proximal tibia and femur, most common in men < 25 years

Back 58

osteoid osteoma

Front 59

locally aggressive benign tumor with characteristic "double bubble" appearance on x-ray, has spindle-shaped cells with multinucleated giant cells

Back 59

giant cell tumor (osteoclastoma)

Front 60

most common benign bone tumor with mature bone with cartilaginous cap, usually in younger men

Back 60

osteochondroma

Front 61

2nd most common primary malignant bone tumor (after MM) commonly found in metaphysis of long bone with sunburst pattern on x-ray

Back 61

osteosarcoma

Front 62

predisposing factors for osteosarcoma

Back 62

Paget's disease
radiation
familial retinoblastoma

Front 63

anaplastic small blue cell malignant tumor of bone with onion-skin appearance and t(11:22)

Back 63

Ewing's sarcoma
11 + 22 = 33, Ewing's number

Front 64

where are osteoclastoma (giant cell tumors) most commonly found in the bone

Back 64

epiphyseal end of long bones

Front 65

mechanical wear and tear of joints leads to destruction of articular cartilage

Back 65

osteoarthritis

Front 66

differentiate finger joints involved with osteoarthritis vs. RA

Back 66

OA - DIP and PIP
RA - MCP and PIP

Front 67

autoimmune inflammatory disorder affecting synovial joints with pannus formation in joints

Back 67

RA

Front 68

rheumatoid factor

Back 68

anti-IgG antibody

Front 69

what type of hypersensitivity is RA

Back 69

type III hypersensitivity
*anti-IgG antibodies and anti-CCP antibodies

Front 70

patient presents with morning stiffness lasting > 30 minutes and improving with use, symmetric joint involvement with fever and fatigue

Back 70

RA

Front 71

other abnormalities that can be associated with RA

Back 71

pleuritis
pericarditis

Front 72

does OA have inflammation of systemic symptoms

Back 72

No, this occurs in RA

Front 73

classic triad of sjogren's syndrome

Back 73

1. xerophthalmia
2. xerostomia
3. arthritis

Front 74

disease with autoantibodies to ribonucleoprotein antigens, SS-A (Ro) and SS-B (La)

Back 74

Sjogren's syndrome

Front 75

which other autoimmune disease is associated with RA

Back 75

sjogren's syndrome

Front 76

precipitation of monosodium urate crystals into joints due to hyperuricemia

Back 76

gout

Front 77

causes of gout (monosodium urate crystals)

Back 77

Lesch-Nyhan syndrome
PRPP excess
decreased excretion of uric acid
increased cell turnover
von Gierke's disease

Front 78

are most cases of gout caused by underexcretion of overproduction of urate crystals

Back 78

underexcretion

Front 79

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

Back 79

gout
alcohol metabolites compete for same excretion sites in kidney as uric acid causing buildup

Front 80

differentiate the crystals found in gout vs. pseudogout

Back 80

gout - needle shaped negatively birefringent (yellow when parallel)
pseudogout - rhomboid crystals that are weakly positively birefringent (blue when parallel)

Front 81

caused by deposition of calcium pyrophosphate crystals within the joint space

Back 81

pseudogout

Front 82

3 common organisms associated with septic arthritis

Back 82

S. aureus
Streptococcus
Neisseria gonorrhea

Front 83

two organisms associated with chronic infectious arthritis

Back 83

TB
Lyme disease

Front 84

STD that presents with monoarticular, migratory arthritis with asymmetrical pattern

Back 84

gonococcal arthritis

Front 85

4 seronegative spondyloarthropathies

Back 85

PAIR:
psoriatic arthritis
ankylosing spondylitis
inflammatory bowel disease
reaction arthritis (Reiter's syndrome)

Front 86

type of arthritis without rheumatoid factor and has strong associated with HLA-B27

Back 86

seronegative spondyloarthropathies

Front 87

classic triad seen in Reiter's syndrome

Back 87

1. conjunctivitis and anterior uveitis
2. urethritis
3. arthritis

Front 88

arthritis associated with post-GI or chlamydia infections

Back 88

Reter's syndrome

Front 89

antibodies associated with drug-induced lupus

Back 89

antihistone antibodies

Front 90

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

Back 90

SLE

Front 91

screening test for SLE

Back 91

antinuclear antibodies (ANA)

Front 92

these antibodies are associated with poor prognosis in SLE

Back 92

anti-ds DNA antibodies

Front 93

characterized by immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels seen in black people

Back 93

Sarcoidosis

Front 94

increased ESR with normal CK associated with pain in stiffness in shoulders and hips, often with fever, malaise, and weight loss

Back 94

polymyalgia rheumatica

Front 95

progressive symmetric proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers. perifascicular inflammation is diagnostic

Back 95

polymyositis

Front 96

associated with increased CK, and positive ANA, anti-Jo-1

Back 96

polymyositis/dermatomyositis

Front 97

autoantibodies to postynaptic AChR cause ptosis, diplopia, and general weakness; associated with thymoma

Back 97

myasthenia gravis

Front 98

autoantibodies to presynaptic Ca channel results in decreased ACh release leading to proximal muscle weakness

Back 98

Lambert-Eaton syndrome

Front 99

neuromusclar junction disease associated with small cell lung cancer (paraneoplastic disease)

Back 99

Lambert-Eaton syndrome

Front 100

excessive fibrosis and collagen deposition throughout the body; commonly in the skin, renal, pulmonary, CV, and GI sysytems

Back 100

scleroderma

Front 101

two types of scleroderma

Back 101

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

Front 102

differentiate antibodies seen in the two types of scleroderma

Back 102

diffuse scleroderma - anti-Scl-70 antibody (topoisomerase I)
CREST - anti-Centromere

Front 103

differentiate name for warts on hands vs. genitals (HPV infection)

Back 103

hands - verruca vulgaris
genitals - condyloma acuminatum

Front 104

pruritic eruption common on skin flexures, often associated with asthma and allergic rhinitis

Back 104

atopic dermatitis (eczema)

Front 105

type IV hypersensitivity reaction that follows exposure to allergen, lesion occurs at site of contact

Back 105

allergic contact dermatitis

Front 106

papules and plaques with silvery scaling, especially on knees, elbows, and scalp. Associated with increased statum spinosum, nail pitting, and arthritis

Back 106

psoriasis

Front 107

sudden appearance of multiple seborrheic keratoses

Back 107

indicates underlying malignant - GI or lymphoid

Front 108

pigmented squamous epithelial poliferation with horn cysts that look pasted on

Back 108

seborrheic keratosis

Front 109

normal melanocyte number with decreased melanin due to decreased activity of tyrosinase

Back 109

albinism

Front 110

irregular areas of complete depigmentation caused by decreased in melanocytes

Back 110

vitiligo

Front 111

superficial skin infection associated with honey-colored crusting

Back 111

impetigo - S. aureus or S. pyogenes

Front 112

exotoxin destroys keratinocyte attachments in the stratum granulosum only, associated with generalized erythema and sloughing of upper layer of epidermis

Back 112

staphylococcal scalded skin syndrome

Front 113

white, painless plaques on the tongue that cannot be scraped off, EBV-mediated

Back 113

HIV-positive patient - hairy leukoplakia

Front 114

IgG antibodies against desmosomes associated with separation of epidermis upon manual stroking of skin

Back 114

pemphigus vulgaris

Front 115

IgG antibodies against hemidesmosomes associated with blisters with eosinphils

Back 115

bullous pemphigoid

Front 116

deposits of IgA at the tips of dermal papillae associated with celiac disease

Back 116

dermatitis herpetiformis

Front 117

fever, bulla formation and necrosis, with sloughing of skin associated with adverse drug reactions

Back 117

stevens-johnson syndrome

Front 118

sawtooth infiltrate of lymphocytes at dermal-epidermal junction associated with hepatitis C

Back 118

lichen planus

Front 119

premalignant lesions caused by sun exposure with cutaneous horns

Back 119

actinic keratosis

Front 120

differentiate strawberry and cherry hemangioma

Back 120

strawberry - first few weeks of life, regresses spontaneously at 5-8 years
cherry - appears in 30's-40's, does not regress

Front 121

what is a precursor to SCC of the skin

Back 121

actinic keratosis

Front 122

skin cancer associated with chronic draining sinuses and keratin pearls

Back 122

SCC

Front 123

skin cancer with pearly papules that almost never metastsizes, has palisading nuclei

Back 123

basal cell carcinoma

Front 124

what is a precursor to melanoma

Back 124

dysplastic nevus

Front 125

skin cancer with significant risk of metastasis, S-100 tumor marker associated with sunlight exposure

Back 125

melanoma

Front 126

what correlates with risk of metastasis and prognosis in a melanoma

Back 126

depth