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129 Cards in this Set
- Front
- Back
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What abducts/adducts the fingers and what is it innervated by?
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Interossei muscles
(ulnar nerve (C8-T1) |
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Blow to shoulder/trauma in delivery lead to what nerve loss?
What does it cause? |
loss of C5 and C6 roots
limb hangs by side (paralysis of abductors) medially rotated Forearm is pronated WAITER'S TIP |
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Male age 15 gets a malignant bone cancer. What is it and what are some predisposing factors.
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Osteosarcoma.
Paget's disease of bone bone infarcts radiation familial retinoblastoma |
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Male age 45 gets a cartilaginous tumor. What is it and what might be it's primary origin?
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CHONDROSARCOMA
glistening mass within medullary cavity - May ome from a OSTEOCHONDROMA |
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Anasplastic small blue cells in a malignant bone tumor. Seen in a young boy. What is the chromosomal abnormality associated with it and what does it look like in bone?
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Ewing sarcoma - looks like "onion-skin" in bone; 11;22. commonly appears in diaphysis of long bones, pelvis, scapula, and ribs.
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What are osteoma's associated with?
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FAP Gardner's syndrome. New piece of bone grows on another piece of bone (skull)
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Osteoid osteoma
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interlacing trabeculae of woven bone surrounded by osteoblasts < 2cm and found in proximal tibia and femur.
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Larger osteoid osteoma, where is it found?
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Osteoblastoma
seen in Vertebral column |
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Male age 30 with break in distal femur. "double bubble" appearance on x-ray. What does it look like histologically?
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spindle shape with multinucleated cells
(Giant cell tumor - osteoclastoma) |
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mature bone with a cartilaginous cap. What can it transform to (rare)?
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chondrosarcoma
this is a osteochondroma (exostosis) -#1 benign tumor |
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Benign cartilaginous neoplasm (Enchondroma). Where is it found?
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intramedullary bone, usually in distal extremities
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What layer of skin has activity dividing stem cells?
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Stratum basalis
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What layer of skin contains desmosome attachments?
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spinosum
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What layer of skin has keratohyaline granules?
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granulosum
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What layer of skin holds melanocytes?
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Basalis
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What are some common things that can compress the lower trunk of the brachial plexus?
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Pancoast Tumor (lung tumor)
Cervical rib |
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What happens with a fracture at the surgical neck of the humerus?
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An axillary nerve lesions
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What happens if there is a midshaft lesion of the humerus?
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Radial nerve passes on posterior side of the humerus
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What does subluxation of the radius cause?
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stretching of the deep branch of the radial nerve
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What is compressed in carpal tunnel?
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median nerve
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what nerve is lesions by trauma to the heel of the hand or a fracture of the Hook of Hamate?
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ulnar nerve
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What dermatome innervates the medial aspect of the forearm?
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T1
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A deep forearm compression can affect which nerve?
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Anterior interosseous nerve (off of median nerve)
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A superficial lesion in the palm of the hand causes what?
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gash at recurrent branch of the median nerve
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What nerve does the cutaneous innervation of the giners?
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median nerve
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what innervates the adductor pollicis?
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Ulnar Nerve (also innervates interossei and 3/4 lumbricals)
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What nerve runs in Guyon's canal?
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Ulnar nerve
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What nerve does the innervation for the 5th and part of the 4th digits?
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ulnar nerve
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what protects the brachial plexus in a clavicle fracture?
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the subclavius muscle
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What is lesioned in Klumpke's total claw?
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C8-T1, cause loss of lumbricals and some other stuff
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What is lost in Ape hand?
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proximal median nerve lesion, loss of opponens pollicis (thenar muscle)
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What muscles does the Radial nerve innervate?
its rad to be the Best |
Brachioradialis, Exensors of the wrist and finger, supinator, and triceps (BEST)
it's rad to be the BEST! |
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Name the thenar muscles
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opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
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Doral vs palmer interosseus muscles
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Doral - ABduct
Palmar- ADduct |
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What is the sensory deficit seen with an anterior hip dislocation?
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Anterior hip dislocates and gets obturator nerve (loss of thigh adduction and medial thigh sensation)
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What deficit does a pelvic fracture cause?
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Femoral nerve lesion
loss of thigh flexion and leg extension loss of sensation on anterior thigh and medial leg |
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What does trauma to the lateral leg/ fibula neck cause?
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Loss of common peroeal nerve
loss of foot eversion and dorsiflexion; toe extension sensory loss to anterolateral leg and doral foot |
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Wha does knee trauma cause?
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loss of tibial nerve
loss of foot inversion and plantarflexion, toe flexion sensory deficit on sole of foot |
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What does a posterior hip disolocation/polio cause?
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Superior gluteal nerve lesion
loss of thigh abduction + Trendelenburg sign (loss of control of pelvis) |
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What does a posterior hip dislocation disrupt?
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Inferior gluteal nerve lesion
can't jump, climb stairs, get up from seated position |
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describe type I muscle fibers.
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Slow twitch
Increase MT Increaes myoglobin Increase oxidative phosphorylation |
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Which type of muscle fibers increaes with weight training?
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Type II (fast twitch) hypertrophy during weight training
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In smooth muscle contraction, what does Ca bind to?
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Calmodulin
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In smooth muscle, what happens after Ca binds to calmodulin?
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Activation of myosin light chain kinase
Phosphorylation of Myosin and cotnraction |
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how does membranous ossification differ from endochondral ossification?
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membranous ossification does not have a cartilaginous model for osteoclasts and osteoblasts to work from;
instead, woven bone is directly formed in membranous ossification and is later remodeled to lamellar bone |
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What is the source of osteoblasts
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mesenchymal stem cells in periosteum
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A child born with a father with ADVANCED PATERNAL AGE has SHORT LIMBS and a normal size head (MEMBRANOUS OSSICATION UNAFFECTED). What's going on?
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Achondroplasia
AD due to IMPAIRED CARTILAGE MATURATION due to MUTATED FIBROBLAST GROWTH FACTOR 3 (FGFR3) causes Drawfism |
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What is the diference between osteoporosis type I and type II
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Type I - postmenopausal (Increase bone resorption due to decreasing E)
Type II - senile osteoporosis - affects men and women> 70 |
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What fractures are common in the arm of a person with osteoporosis?
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Colle fracture of distal radius
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See a patient with DECREASE MARROW SPACE (anemia, thrombocytopenia, infection) and bones that flare out on exam ("erlenmeyer flask"
also has cranial nerve impingement and palsies. What is it? |
Osteopetrosis due to abnormal osteoclasts
-genetic defect in carbonic anyhrase II normal serum Ca, phosphate, Alk phosp |
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An automosomal dominant disease with pathological fractures at birth, blue sclera, and deafness.
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Osteogenesis imperfecta due to defective synthesis of type I collagen
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A patient with "brown tumors" (cystic spaces lined by osteoclasts filled with a fibrous stroma and sometimes blood). What caused this?
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Hyperparathyroidism causing Osteitis fibroa cystica
see Increase serum Ca, Decrease P, Increase ALP |
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Viral infection predisposing to long bone chalk-stick fractures, AV Malformations causing high output CHF, and an enlarging hat size.
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Paget's disease (osteitis deformans)
due to increase osteoclastic activity (early) and increased osteoblastic activity (late)- causes increase Alk Phosp, thick, weak bones causes fractures, risk of osteogenic sarcoma, and CHF |
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Bone replaced by fibroblasts, collagen, and irregular bony trabeculae.
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Polyostotic fibrous dysplasia
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unilateral bone lesions, precocious pubert, and pigmented skin lesions
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McCune-Albright syndrome (polyostotic fibrous dysplasia) with bone lesions, endocrine abnormalities, and unilateral pigmented lesions "cafe-au-lait" spots
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bone deformity where one piece of bones grows on another piece of bone., often in skull. What is it and what is it associated with?
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Osteoma
associated with Gardner Syndrome of FAP |
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MAN, age 25, with a osteoid osteoma. What do you see microscopically (woven bone surrounded by what?)
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woven bone surrounded by osteoblasts (seen in proximal tibia/ femur)
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Osteoid osteoma seen in vertebral column.
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osteoblastoma
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30 year old with locally aggressive tumor of distal femur. "double bubble" on x-ray
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Giant cell tumor (osteoclastoma)
spindle-shaped cells with multinucleated giant cells |
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Most common benign bone tumor. What do you see?
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Osteochondroma
see mature bone with a cartilaginous cap in long metaphysis. |
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Enchondroma. What does it do to intremedullary bone?
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its a cartilaginous neoplasm, usually seen in the distal extremities
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2nd most common malignant tumor of bone= Osteosarcoma. Where do you see it?
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femur, tibial region
predisposing factors = pagets disease, bone infarcts, radiation, familial retinoblastoma see codman's triange/sunburst pattern on x-ray (elevated periosteum) |
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Small blue cell tumor in a young oy, with characteristic Onion skin appearance in bone. What is it?
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Ewing sarcoma (22 points 11 rebounds)
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A malignant cartilaginous tumor (chndrosarcoma). What do you see?
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Expansile glistening mass within medullary cavity
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What benign tumor is most likely to effect the epiphysis?
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Giant cell tumor "double bubble sign"
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What benign and malignant tumors are most likely to effect the metaphysis?
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osteochondroma (benign)
osteosarcoma (malignant) |
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What benign/malig tumors are most likely to effect the diaphysis?
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osteoid ostoma
Ewing Sarcoma |
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What benign and malignant tumor is most likely to effect the intremedullary area?
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enchondroma (hands/feet)
chondrosarcoma |
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What do the presence of Hebergen's nodes and Bouchard's nodes indicate?
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Osteoarthritis
Hebergen's nodes - DIP Bouchard's nodes - PIP |
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subchondral cysts, with pain in weight bearing joints and bowlegged appearance. What is it?
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osteoarthritis
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what are the cysts found behind the knee in Rheumatoid arthritis called?
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Baker's cyst
RA - positive rheumatoid factor (IgM antibody to IgG antibody) |
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What is the primary mechaism of Pannus formation n RA?
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chronic inflammatory synovial tissue
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what are the hematological and pulmonary consequences of RA?
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Heme- Anemia of chronic dz.
Felty syndrome (autoimmune destruction of PMN and platelets) Pulmonary: Pleuritis, interstitial fibrosis |
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What HLA type is associated with RA?
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HLA-DR4
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Dry eyes, dry mouth, and arthritis. What are the autoantibodies in this disease?
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Sjogren syndrome
autoantibodies to ribonucleoprotein (SS-A (Ro) and SS-B (La) |
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What is sicca syndrome?
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seen with Sjogren syndrome
-dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis. No arthritis |
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What is the confirmatory test for Sjogren syndrome?
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Lip bx showing lymphoid destruction of minor salivary glands
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Where are the tophi of gout located?
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external ear/ achilles tendon
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What type of crystals are seen in gout?
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monosodium urate
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What diseases also cause monosodium urate crystals?
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hyperuricemia diseases
- Lesch-Nyhan syndrome, PRPP excess, decrease exretion of uric acid (thiazid diuretics), Increase cell turnover, or Von Gierke's disease |
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what type of crystals are found in pseuodogout?
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calcium pyrophosphate crystals (weak + birefringent (blue when parallel)
-rhomboid crystals |
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what two organisms can cause a chronic infectious arthritis?
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TB (mycobacterial dissemiination) and lyme disease
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What is the classic triad of Reiter's syndrome and when you do you get it?
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Conjunctivitis and ant. uveitis
Urethritis Arthritis "Can't see, Can't pee, can't climb a tree" seen with HLA-B27 Post GI / Chlamydia infection |
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asymmetric and patchy involvement causing sausage fingers and pencil in cup deformities.
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Psoriatic arthritis
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What are some common diseases that arthritis is associated with?
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arthritis associated with Ulcerative colitis, shigellosis, psoriasis
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What are some cardiac and respiratory complications of SLE?
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Cardiac - nonbacterial verrucous endocarditis
Respiratory - hilar adenopathy also se Raynaud's phenomenon |
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What is the renal finding in SLE?
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wire-loop lesions in kidney with immune complex deposition
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What antibodies are elevated in SLE and drug induced SLE?
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ANA - sensitive, not specific for SLE
anti-dsDNA - very specific, poor px Anti-Smth antibodies (specific, not bad px) Drug induced - anti-histone antibodies |
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Name some diseases where you see positive ANA
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SLE
Sjogren Sicca Scleroderma Polymyositis Dermatomyositis RA Juvenile arthritis Mixed connective tissue disease |
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What is seen in Sarcoidosis.
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Noncaseating granulomas
Elevated serum ACE levels associated with HILAR LYMPHADENOPATHY, BELLS PALSY, EPITHELIAL GRANULOMAS schaumann and asteroid bodies HYPERCALCEMIA (increase Vit D) |
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Pain in shoulders and hips with NO WEAKNESS. What is it associated with and what is the ESR?
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Polymyalgia rheumatica, associated with temporal cell arteritis
Increase in ESR, normal CK tx prednisone |
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What causes polymyositis?
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CD8+ T-cells attacking myofibers, most often seen in shoulders
Dx by muscle biopsy |
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What is characteristic of dermatomyositis?
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Rash, similar to SLEs rash
heliotrope rash "shawl and face" rash Gottron's papules- painful on finger tips) Increase risk of malignancy |
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What are the lab findings in polymyositis and dermatomyositis?
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Icnrease CK, Increase Aldolase
POSITIVE ANA-Jo-1 |
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droopy eyelid, double vision and general weakness. What is it and was is it associated with?
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Myasthenia Gravis
associated with Thymomas can occur with AChE inhibitors. |
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In mixed connective tissue disease, what do you see?
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Raynaud's phenomenon
arthralgias myalgias fatigue esophageal hypomotility antibodies to U1RNP and +ANA |
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Excessive fibrosis and collagen deposition throughout the body. What AB are associated?
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Scleroderma (with Anti-Scl-70 Ab (anti-DNA Topoisomerase I antibody)
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What are the two types of progressive systemic sclerosis (Pss)?
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1. Diffuse scleroderma - widespread skin involvement, rapid progression, early visceral involvement (renal, pulmonary, Cardiovascular, GI systems)
2. CREST syndrome -Calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly, Telangiectasia |
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What happens if you don't adequately excise a liposarcoma?
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it will recurr
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Where are rhabdomyosarcomas most often seen?
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soft tissue (seen in children)
arises from skeletal muscle, mostly seen in head/neck |
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What is acantholysis?
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separation of epidermal cells
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What is hyperkeratosis
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Increase thickness of stratum corneum (scaly skin)
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What is acanthosis?
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epidermal hyerplasia
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Ephelis. what is it?
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a freckle due to increase melanin pigments
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Papules and plaques with silver scaling (psoriasis). What is an Auspitz sign and what do you see histologically?
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Auspitz- bleeding spots when scales are scraped off
see an increase in stratum granulosum ACANTHOSIS with parakeratotic scaling (nuclei still present in stratum corneum) |
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A pasted on looking, flat, greasy pig. squamos cell epithelial proliferation. What is it and what can it be a marker for?
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Seborrheic keratosis
maybe a marker for stomach cancer |
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What enzyme is decreased in activity in albinism?
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decrease tyrosinase activity causes decrease melanin production
-normal melanocyte number note: could also be caused by failure of neural crest cell migration during development |
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Caused by a decrease in melanocytes, what is this skin disorder?
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Vitiligo (irregular areas of complete depigmentation)
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what is melasma associated with?
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hyperpigmentation associated with pregnancy / OCP use
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What causes necrotizing fasciitis?
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anaerobic bacteria and S. Pyogenes
see crepitus (methane and CO2 production) |
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Staphylococcal scalded skin syndrome. what is it caused by?
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EXOTOXIN destroys keratinocyte attachments in the sratum granulosum.
see fever, erythematous rash with sloughing of the upper layers of the epidermis (seen in newborns/children) |
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What virus causes Hairy Leukoplakia?
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EBV
white tongue lesions that cannot be scrapped off |
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skin disorder against desmosomes showing immunofluorescene throughout epidermis. CLEAVAGE ABOVE THE BASAL LAYER and seen in ORAL MUCOSA. What is it and what antibody is associated?
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PEMPHIGUS VULGARIS
IgG antibody to desmoglein 1 (anti-epithelial cell Ab) see + Nikolksky sign - separation of epidermis upon stroking |
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IgG antibody to hemidesmosomes (epidermal BM) with linear staining. What type of cells are seen in blisters?
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Eosinophils are seen
spares oral mucosa Ab to BpAg1, BpAg2, alpha-6 integrin, laminin 5 CLEAVAGE BELLOW BM |
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Dermatitis herpetiformis. what type of Ab seen and where?
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seen on extensor surface of extremities
IgA Ab PMN abscesses |
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What infectious bugs can give you erythema multiforme?
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Mycoplasma pneumoniae
Herpes Simplex Vir |
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Sulfonamide, penicillin, barbiturates, phenytoin all cause what type of skin manifestation?
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erythema multiforme (macules, papules, vesicles, target lesions)
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Steven Johnson syndrome is a worse type of what?
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Erythema multiforme
characterized by bulla, necrosis, sloughing of skin and high mortality usually seen with an adverse drug rxn |
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What is a worse form of Stevens-Johnson syndrome?
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toxic epidermal necrolysis
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Pruritic, purple, polygonal papules.
where is the infiltrate and what disease is it associated with? |
Lichen Plan
sawtooth infiltrate at dermal-epidermal junction. ASSOCIATED WITH HEP. C |
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a premalignant lesion caused by sun exposure, with small rough, erythematous/brown papules.
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Actinic Keratosis
will recurr if scrapped off |
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Hyperlipidemia (Cushing's disease, DM) causes this skin finding.
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Acanthosis nigricans (hyerplasia of stratum spinosum)
also seen with visceral malignancy (stomach adenoCA) |
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What bugs cause erythema nodosum?
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Cocci, histo, TB, Leprosy, streptococcal infections, sarcoidosis
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what is a "herald patch" followed by "christmas tree" distribution and what is it characteristic?
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Pityriasis rosea
herald patch- oval scales on trunk christmas tree- along lines of cleave remits in 2-10 weeks |
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What is SCC of the skin associated with?
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Chronically draining sinuses
Actinic keratoses is a precursor keratin pearls |
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skin cancer that arises from basal cells of epidermis. What is seen microscopically?
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basal cell CA shows palisading nuclei
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What are positive tumor markers for melanoma?
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S-100 tumor marker
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What is wrong in Ichthosis Vulgaris?
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common AD skin disorder due to defect in keratinization --> increase thickness of stratum corneum and absent stratum granulosum
see hyperkeratotic, dry skin |
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What does Xerosis cause
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dry skin/pruritis in elderly due to decrease in FA
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