First Aid Musculoskeletal And Connective Tissue

Front 1

What are the layers of the epidermis

Californians Like Girls in String Bikinis

Back 1

Corneum
Lucidum
Granulosum
Spinosum
Basalis

Front 2

what composes the unhappy triad of the knee?

Back 2

Medial collateral ligament
Anterior collateral ligament
Lateral meniscus

Front 3

What are the muscles of the rotator cuff and which is the most commonly injured?

Back 3

SItS

Supraspinatus
Infraspinatus
teres minor
Subscapularis

Supraspinatus most commonly torn

Front 4

where is the landmark for a pudendal nerve block? A lumbar puncture?

Back 4

ischial spine and iliac crest

Front 5

what motor deficit is seen with radial nerve damage and what usually causes it

Back 5

BEST extensors
Brachioradialis, Extensors of the wrist and fingers, Supinators, Triceps

Fracture at the mid shaft of the humerus

Front 6

what kind of fracture would cause a proximal lesion of the median nerve

Back 6

fracture of the supracondylar humerus

Front 7

which bands shrink during muscle contractions

Back 7

HIZ shrinkage

H and I bands

A remains the same

Front 8

what kind of mutation is involved with achondroplasia

Back 8

activating mutation of FGFR3

Front 9

what causes types 1 and 2 osteoporosis

Back 9

type 1: postmenopausal due to lack of estrogen

type 2: senile due to age

Front 10

what drug is contraindicated in osteoporosis

Back 10

glucocorticoids

Front 11

how are labs for osteopetrosis

Back 11

normal, especially with regards to ALP

Front 12

what is the isolated lab elevation with pagets disease?

Back 12

High ALP

Front 13

what are two sequelae that go along with pagets disease?

Back 13

high out-put cardiac failure

osteogenic sarcoma

Front 14

what is McCune-Albright syndrome

Back 14

a form of polyostotic fibrous dysplasia characterized by multiple UNILATERAL bone lesions associated with endocrine abnormalities and UNILATERAL pigmented skin lesions

Front 15

what syndrome is associated with osteomas

Back 15

gardners syndrome

Front 16

where are giant cell tumors found and how do they appear on xray

Back 16

on the epiphysis of bones, appear as "soap bubbles" or "double bubble" on xray

Front 17

what is the most common benign bone tumor?

Back 17

osteochondroma

Front 18

where are enchondromas usually found

Back 18

in the small bones of distal extremities, inside the bone (medulla, compare to chondrosarcoma for location)

ENchondromas....at the ENDs of your body (distal extremities)

Front 19

osteosarcoma: location, 3 risk factors and xray appearance

Back 19

metaphysis

radiation, familial retinoblastoma, pagets disease

Codman triangle, sunburst (elevation from periosteum) on xray

Front 20

ewings sarcoma: appearance on xray, gene translocation, derived from what tissue?

Back 20

appears as "onion-skin" on xray (going out for eWINGS and ONION rings)

gene translocation (11;22) 11+22 = 33 patrick ewings number

derived from neuroectoderm

Front 21

where does a chondrosarcoma arise?

Back 21

in the medulla of the pelvis or central skeleton

Front 22

where are the classic location for osteophytes to develop in osteoarthritis?

Back 22

at the DIP (heberdens nodes) and the PIP (Bouchards nodes)

Front 23

what HLA is associated with RA?

Back 23

HLA-DR4

Front 24

what joint is typically spared with RA

Back 24

the DIP, which is affected with osteoarthritis

Front 25

what is rheumatoid factor?

Back 25

IgM autoantibody against Fc portion of IgG (anti IgG ab) found in 80% of RA patients

Front 26

Classic triad of Sjogrens syndrom

Back 26

xerophthalmia, xerostoma, arthritis

Front 27

autoantibodies associated with sjogrens syndrome?

Back 27

SS-A (Ro) SS-B (La)

associated with RA

Front 28

what is sicca syndrome?

Back 28

similar to sjogrens (dry eyes, dry mouth) nasal and vaginal dryness, chronic bronchitis, reflux esophagitis and NO ARTHRITIS.

Front 29

what kind of crystals are seen with gout?

Back 29

needle shaped crystals that are NEGATIVELY birefringent, yeLLow under paraLLel light

Front 30

what kind of crystals are seen with pseudogout?

Back 30

rhomboid crystals that are weakly POSITIVELY birefringent, yellow when perpendicular

Front 31

whats a common cause of infectious arthritis and how does it present? another common cause seen in adults and older children?

Back 31

neisseria gonorrhoeae (an STD) presenting as Synovitis, Tenosynovitis and Dermatitis.

S. aureus

Front 32

what are the 4 spondyloarthropathies?

PAIR

Back 32

Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease (crohns and UC)
Reactive arthritis (Reiters syndrome)

Front 33

which HLA is associated with spondyloarthropathies?

Back 33

HLA-B27

Front 34

abs against the macula adherens results in what?

MAPv

Back 34

pemphigus vulgaris

Front 35

abs against hemidesmosomes results in what?

BPH

Back 35

bullous pemphigoid

Front 36

a fracture of the surgical neck of the humerus will likely damage what nerve? dislocation could also harm this nerve

Back 36

axillary nerve

Front 37

theres this nifty groove on the humerus and if you break it in a mid-shaft fracture you damage this nerve

Back 37

radial nerve

Front 38

what does the ulnar nerve pass through at the hand?

Back 38

guyons canal

Front 39

you fall asleep with your arm on the back of a chair, or you have been on crutches for like, ever....so what nerve are you beating up on and what will the manifestation be?

Back 39

likely hitting the posterior cord, specifically it could also be the radial nerve and you would see wrist drop

Front 40

axillary nerve is made up of what roots? damage results in deficit to what muscles?

Back 40

C 5 and 6, deltoid muscles

Front 41

radial nerve comes from what roots? damage leads to deficit of what muscles?

Back 41

C5-8, Brachioradialis, Extensors of wrist and fingers, Supinators, Triceps

BEST extensors

Front 42

median nerve is made up of what roots? what is the motor deficit from damage?

Back 42

C5-8, T1

if proximal lesion will lose opposition of thumb result in "ape hand"

if distal lesion will lose later finger flexion

Front 43

ulner nerve is made up of what roots? motor deficit?

Back 43

C8, T1

proximal lesion (fracture of the medial epicondyle--the funny bone) leads to wrist flexion deficit

distal lesion (falling on outstretched hand fx'ing the hook of hamate) leads to "popes blessing" hand

Front 44

what roots make up the musculocutaneous nerve? deficit if damaged?

Back 44

C5-7

flexion of arm deficit

Front 45

winged scapula is due to nerve damage of what nerve that innervates what muscle?

what kind of surgical history would go along with damage to this nerve?

Back 45

the long thoracic nerve innervating the serratus anterior

a mastectomy could damage this nerve

Front 46

three motions of the muscles of the hands?

OAF

Back 46

opponens, abductor, flexor

pollicis, pollicis breves for last two

digiti minimi for all three

Front 47

dorsal and palmar interosseous muscles do what?

Back 47

DAB---dorsal ABduct
PAD---palmar ADduct

Front 48

if you damage the lateral leg or fracture the neck of the fibula what nerve is at risk?

Back 48

the common peroneal

Front 49

if i stand on my left foot and my right hip drops, what is the name of this sign and what nerve is damaged and on which side?

Back 49

trendelenburg sign
superior gluteal nerve
left side damage

Front 50

what foot motion does the peroneal nerve control?

Back 50

eversion and dorsiflexion

so if damaged you get footdrop problems

foot dropPED----Peroneal, Evert, Dorsiflex

Front 51

what foot motion does the tibial nerve control?

Back 51

inversion and plantar flexion

if injured you can stand on your tiptoes

TIPtoes---Tibial, Inversion, Plantar flex

Front 52

your skull, face and axial skeleton have what kind of bone formation?

Back 52

membranous ossification

woven directly without cartilage model

Front 53

overexpression of FGFR3 does what and leads to what?

Back 53

inhibits chondrocyte proliferation and leads to achondroplasia (common cause of dwarfism)

Front 54

what are three clinical features of osteogenesis imperfecta?

Back 54

multiple fractures
blue sclera
hearing loss

Front 55

why the blue sclera in osteogenesis imperfecta?

Back 55

scleral collagen thinning reveals underlying choroidal veins

Front 56

what type of bone is affected with osTeoporosis?

Back 56

trabecular (spongy) bone

Front 57

abnormal function of what leads to osteopetrosis?

Back 57

osteoclasts

Front 58

bone resorption requires an acidic environment...what mutation disrupts this? what disease is this associated with?

Back 58

carbonic anhydrase II

osteopetrosis

Front 59

"erlenmeyer flask" on xray is characteristic of what disease?

Back 59

osteopetrosis

Front 60

what is the Rx for osteopetrosis?

Back 60

bone marrow transplant since osteoclasts are derived from monocytes in the marrow

Front 61

vit D deficiency leads to what levels of these things

calcium
PTH
phosphate

Back 61

LOW calcium
HIGH PTH
LOW phosphate

Front 62

"rosary" chest is associated with what disease and why?

Back 62

rickets

due to osteoid deposition at the costochondral junctions

Front 63

frontal bossing is seen in what disease of the bones? due to what?

Back 63

rickets

due to osteoid deposition in the skull

Front 64

defective mineralization of the osteoid causes what?

Back 64

rickets/osteomalacia

Front 65

all labs are normal but this lady has bone problems...whats up?

Back 65

osteoporosis

Front 66

2 complication of pagets disease

Back 66

high-output cardiac failure d/t formation of AV shunts in bone

osteosarcoma

Front 67

what causes pagets disease? 3 stages?

Back 67

imbalance between osteoclasts and osteoblasts

1) high osteoclast activity
2) mixed osteoclast/osteoblast activity
3) high osteoblast activity

Front 68

this dude comes in saying, "hey doc...my hat size has increased like, big time in the last few months" what could be going on?

Back 68

pagets disease

Front 69

osteoma commonly appears where?

Back 69

on the face bones

Front 70

this man less than 25 years old comes in complaining of bone pain relieved by aspirin...whats he got? where is it located? size?

Back 70

hes got an osteoid osteoma
located in the region of the diaphysis
less than 2cm

Front 71

where does the most common benign bone tumor appear (region of bone)

what else can you tell me about it?

is malignant transformation rare?

Back 71

the metaphysis

it is a lateral projection of this region and is continuous with bone marrow

YES

Front 72

what are the two bone tumors on the metaphysis?

Back 72

osteochondroma
osteosarcoma

Front 73

codman triangle...whats it all about?

Back 73

seen on xray with an osteosarcoma

Front 74

is gout more commonly an underexcretion or overproduction problem?

Back 74

90% UNDEREXCRETION

Front 75

this dude cant see, cant pee, or cant climb a tree....and he also had a GI infection a short while ago (or was it a chlamydia trachomatis infection??)

whats he got

Back 75

hes got reactive arthritis (reiters syndrome)

Front 76

what are antihistone abs seen in?

Back 76

drug-induced lupus

Front 77

why is calcium high with sarcoidosis?

Rx?

Back 77

1-alpha-hydroxylase mediated vitamin D activation in epithelioid macrophages lead to high Ca levels

treat with steroid

Front 78

pt presents not being able to comb their hair (proximal muscle weakness), they also have malar rash and gattrons papules...what do they have?

Back 78

dermatomyositis

Front 79

perifascicular atrophy and perimysial inflammation are seen in what?

Back 79

dermatomyositis

Front 80

positive ANA and anti-Jo-1 abs are seen in what?

Back 80

dermatomyositis and polymyositis

Front 81

endomysial inflammation is seen in what disease? one more thing about it that differentiates it.

Back 81

polymyositis

NO skin involvement (unlike dermatomyositis)

Front 82

what is myasthenia gravis associated with?

hint: its a tumor-of sorts

Back 82

thymoma

Front 83

what drug is used to Dx myasthenia gravis?

Back 83

edrophonium

Front 84

person presents with proximal muscle weakness that gets BETTER with repeated use...what do they have what is it often associated with?

Back 84

lambert-eaton syndrome

associated with paraneoplastic diseases (small cell lung cancer)

Front 85

what is CREST syndrome?

Back 85

Calcinosis
Raynauds phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Front 86

what is antiCentromere ab associated with?

Back 86

Crest syndrome

Front 87

where is CREST syndrome often restricted to?

Back 87

the fingers and face

Front 88

lambert-eaton or myasthenia gravis...which usually spares the eyes?

Back 88

lamber-eaton

Front 89

what is a gattrons papule?

Back 89

red, flat-topped papule with a light scale that appears over the body prominences. commonly the MCP, DIP and PIP in hands

Front 90

describe appearance of psoriasis on the skin

Back 90

papules and SALMON COLORED plaques with SILVERY SCALING, especially on the knees and elbows

Front 91

what is the auspitz sign?

Back 91

bleeding when picking off a psoriatic scale

Front 92

you see pruritic, purple, polygonal papules with a sawtooth formation on microscope...what is it?

Back 92

lichen Planus

Front 93

what hepatitis is lichen planus associated with?

Back 93

hep. C

Front 94

this superficial skin infection usually comes from staph aureus or strep pyogenes and its SUPER contagious. how does it look as well?

Back 94

impetigo

looks like honey-colored crusting

Front 95

what is the nikolsky sign and what disease is it seen in?

Back 95

epidermis separates upon manual stroking

seen in pemphigus vulgaris

Front 96

pemphigus vulgaris and bullous pemphigoid...which hits the oral mucosa as well as the skin?

Back 96

vulgaris

you are VULGAR with you mouth

Front 97

what is dermatitis herpetiformis and what disease is it associated with?

Back 97

deposits of IgA at the tips of the dermal papillae

associated with celiac disease

Front 98

what skin abnormality is seen with hyperinsulinemia?

Back 98

acanthosis nigricans

Front 99

what causes vitiligo?

Back 99

DECREASE in melanocytes due to autoimmune destruction

Front 100

what causes albinism

Back 100

enzyme defect (usually tyrosinase) that impairs melanin production

Front 101

what is the MOST important prognostic factor for predicting metastasis in melanoma?

Back 101

the Breslow thickness (depth of extension)

Front 102

what is the leser-trelat sign?

Back 102

sudden onset of multiple seborrheic keratoses that suggest underlying GI tract carcinoma

Front 103

what is the precursor lesion to squamous cell carcinoma?

Back 103

actinic keratosis

Front 104

which UV ray is bad for you?

Back 104

UVB

Front 105

basal cell and squamous cell carcinomas...which is classically associated with upper lip?

Back 105

basal cell

this is a bunch of
B
S

(B on the top (upper))

Front 106

what does aspirin inhibit the formation of? what are the different doses for?

Back 106

it inhibits cyclooxygenase thus inhibiting the formation of thromboxane and prostaglandins

low dose: decrease platelet aggregation
medium dose: antipyretic and analgesic
high dose: anti-inflammatory

Front 107

ibuprofen, naproxen, indomethacin, ketorolac

class, MOA, use and tox

Back 107

NSAIDS
reversibly inhibit COX-1 and 2

Front 108

celecoxib

class, use, tox

Back 108

COX-2 inhibitor

use in RA and osteoarthritis

increase risk of thrombosis, sulfa allergy

Front 109

acetaminophen

moa, use, tox (OD antidote)

Back 109

inhibits COX, but LACKS anti-inflammatory properties

use instead of aspirin in kids to prevent reyes syndrome

OD kills liver by depelting glutathione
antidote is N-acetylcysteine to regenerate glutathione

Front 110

the -dronates

class, use, tox

Back 110

bisphosphonates

used to inhibit osteoclast activity
use with pagets, post-menopause osteoporosis
can cause corrosive esophagitis and OSTEONECROSIS of the jaw

Front 111

colchicine

moa, use, tox

Back 111

binds and stabilizes tubulin to inhibit polymerization and thus impairs leukocyte chemotaxis and degranulation

used for acute gout

NVD (from inhibition of tubulin), especially if given orally

Front 112

probenecid

moa, use and tox

Back 112

inhibits reabsorption of uric acid it PCT

using in chronic gout

should be avoided in pts that excrete large amounts of uric acid as this could lead to uric acid stones

Front 113

allopurinol

moa, use

increase concentration of what two drugs

Back 113

inhibits xanthine oxidase to decrease formation of uric acid from xanthine

used in chronic gout

increase azathioprine and 6-MP

Front 114

what drug to avoid for gout?

Back 114

salicylates