Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
80 Cards in this Set
- Front
- Back
Zona occludens (tight jxns) - composed of?
|
claudins, occludins
|
|
Zona adherens (int jxn) - composed of?
|
actin, E-cadherin (Ca dependent adhesion molecule)
|
|
Macula adherens (desmosome) -composed of?
Autoab to these cause what disease? |
keratin, desmoplakin, cadherin (desmoglein)
Pemphigus Vulgaris |
|
Gap jxn - composed of?
|
connexon with central channel
|
|
Hemidesmosome - composed of? location
Autoab to these cause what disease? |
integrin, laminin in BM
Bullous pemphigoid - dermal, epidermal jxn |
|
What is the unhappy triad?
|
Force from lat side...
MCL ACL Lateral meniscus |
|
Where do you do a pudendal nerve block? LP?
|
Pudendal nerve block - ischial spine
LP - iliac crest |
|
Rotator cuff muscles, fxn, innervation?
|
SItS
supraspinatus - abducts before deltoid. suprascapular n. infraspinatus - lat rotation (pitching). suprascapular n. teres minor - adducts, lat rotation. axillary n. subscapularis - adducts, med rotation. subscapular n. |
|
What injury can lesion upper trunk brachial plexus, C7 root, lower trunk?
|
Upper trunk - trauma
C7 - cervical disk lesion compression Lower trunk - cervical rib compression, Pancoast tumor (Klumpke's palsy) |
|
What injury can lesion radial n. (upper, spiral groove, lower)
|
Upper - crutches, Sat night palsy
Spiral groove - midshaft humerus fx Lower - stretch by sublax of radius |
|
What injury can lesion medial n. in antecubital fossa, wrist, hand?
|
Antecubital fossa - supracondylar fx humerus
Wrist - carpal tunnel, dislocated lunate Hand - superficial lac |
|
What injury can lesion ulnar n. at elbow, hand?
|
Elbow - medial epicondyle humerus fx, repeated minor trauma
Hand - hook of hamate fx |
|
Cutaneous innervation of hand, where to test- median, radial, ulnar?
|
Radial - dorsum of hand by thumb
Medial - middle finger Ulnar - pinky |
|
What causes winged scapula?
|
"C5,6,7 wing your way to heaven" - long thoracic n. (serratus anterior - abducts above the horizontal), mastectomy
|
|
What protects the brachial plexus from clavicle fx?
|
Subclavius muscle
|
|
Axillary Nerve (C5-C6) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - Fx surgical neck humerus, dislocation humeral head
Motor - No arm abduction. Sensory - over deltoid Sign - flat deltoid |
|
Radial Nerve (C5-C8) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - midshaft humerus fx, Sat night palsy, crutches
Motor - No wrist/arm extension, or supination. Sensory - dorsum hand, back of arm. Sign - wrist drop. |
|
Median Nerve (C5-C8, T1) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - supracondylar humerus fx, carpal tunnel, dislocated lunate.
Motor - no wrist flexion, no MCP flexion or DIP/PIP extension lat lumbricals, no abductor pollicis. Sensory - middle finger. Sign - ape hand, thenar atrophy, ulnar dev, median claw hand. |
|
Ulnar Nerve (C8, T1) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - Funny bone, medial epicondyl fx, hook of hamate fx
Motor - no ulnar dev, abd/ad fingers, flexion MCP or extension DIP/PIP med lumbricals. Sensory - pinky. Sign - Ulnar claw hand (papal benediction) when asked to straighten fingers. |
|
Musculocutaneous Nerve (C5-C7) - cause of injury, motor deficit, sensory deficit.
|
Cause - upper trunk compression
Motor - no flex forearm. Sensory - lat forearm (lat cutaneous n.) |
|
Axillary Nerve (C5-C6) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - Fx surgical neck humerus, dislocation humeral head
Motor - No arm abduction. Sensory - over deltoid Sign - flat deltoid |
|
Radial Nerve (C5-C8) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - midshaft humerus fx, Sat night palsy, crutches
Motor - No wrist/arm extension, or supination. Sensory - dorsum hand, back of arm. Sign - wrist drop. |
|
Median Nerve (C5-C8, T1) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - supracondylar humerus fx, carpal tunnel, dislocated lunate.
Motor - no wrist flexion, no MCP flexion or DIP/PIP extension lat lumbricals, no abductor pollicis. Sensory - middle finger. Sign - ape hand, thenar atrophy, ulnar dev, median claw hand. |
|
Ulnar Nerve (C8, T1) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause - Funny bone, medial epicondyl fx, hook of hamate fx
Motor - no ulnar dev, abd/ad fingers, flexion MCP or extension DIP/PIP med lumbricals. Sensory - pinky. Sign - Ulnar claw hand (papal benediction) when asked to straighten fingers. |
|
Musculocutaneous Nerve (C5-C7) - cause of injury, motor deficit, sensory deficit.
|
Cause - upper trunk compression
Motor - no flex arm. Sensory - lat forearm |
|
Explain Erb's Palsy.
|
C5-C6 trunk compression.
No axillary n - arm adducted, medially rotated (deltoid, teres minor). Waiter's Tip. No musculocutaneous n - no bicep flexion. |
|
Explain Klumpke's Palsy.
|
C8-T1 trunk compression.
No ulnar or median n. - thenar/hypothenar atrophy, loss of all lumbricals and interossei, loss of wrist/finger flexion. Not the same as Klumpke's total claw. |
|
What causes Ape Hand vs Median Claw?
|
Ape Hand- prox, lose opponens pollicis
Median Claw-distal, lose lat 2 lumbricals |
|
Obturator nerve (L2-L4) - cause of injury, motor deficit, sensory deficit.
|
Cause: Ant dislocation hip
Motor: no thigh adduction. Sensory: med thigh. |
|
Femoral nerve (L2-L4) - cause of injury, motor deficit, sensory deficit.
|
Cause: pelvic fx.
Motor: no thigh flexion, knee extension. Sensory: ant, med thigh. |
|
Common peroneal nerve (L4-S2) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause: trauma to lat leg, fibula neck fx.
Motor: no eversion, dorsiflex foot. Sensory: lat leg, dorsum foot. FOOT DROP |
|
Tibial nerve (L4-S2) - cause of injury, motor deficit, sensory deficit, sign.
|
Cause: knee trauma
Motor: no inversion, plantarflexion. Sensory: sole of foot. NO TIPTOES |
|
Sup gluteal nerve (L4-S1) - cause of injury, motor deficit, sign.
|
Cause: post hip dislocation, polio, injection in superomed portion of butt
Motor: no thigh abduction. Trendelenburg - hip drops on contralat side. (gluteus medius, minimus, tensor fascia latae) |
|
Inf gluteal nerve (L5-S2) - cause of injury, motor deficit, sensory deficit.
|
Cause: post hip dislocation
Motor: can't stand up, jump. (gluteus maximus) |
|
What gives rise to the common peroneal and tibial n? Where do they go?
|
Sciatic n (L4-S2) - tibial n down popliteal fossa, common peroneal wraps around lat fibula and then splits into deep peroneal and superficial peroneal.
|
|
How does action potential generate contraction in skeletal muscle?
|
AP opens volt-gated Ca channel in neuron causing Ach release. Ach binds to nicotinic receptor, depol transmitted down T-tubule. Dihydropiridine receptor depol, coupled to ryanodine receptor, opens SR to release Ca. Ca binds troponin C, conf change, moves tropomyosin out of myosin-binding groove. Myosin releases bound ADP and displaced on actin filament.
|
|
Which parts of sarcomere shorten during contraction? Which stays same?
|
A- always same
H band, I band - shorten |
|
What is Type 1 muscle vs Type 2? Which type does wt training increase?
|
"one slow red ox"
Type 1 - slow, red fibers, lots mitos for increased ox phos, endurance. Type 2 - fast, white, anaerobic glycolysis, wt training causes hypertrophy. |
|
How does action potential generate contraction in smooth muscle? How does NO relax?
|
AP, smc depol, volt-gated Ca channel open, Ca binds calmodulin, activates myosin light chain kinase, phosphorylate myosin, actin-myosin cycling.
NO, GC, increase cGMP, inhibit MLCK. |
|
What is endochondral ossification vs membranous ossification?
|
Endochondral - long bones. Cartilage replaced by woven, then lamellar bone. **This is defective in achondroplasia.
Membranous - flat bones. Directly to woven, then lamellar bone. |
|
Type 1 vs Type 2 osteoporosis?
|
Type 1 - Postmenopausal, increased bone resorption due to low E.
Type 2 - Senile osteo, men and women >70. |
|
Osteopetrosis
-Defect -Sx -Labs |
-Def carbonic anhydrase II prevents bone resorption by osteoclasts. Thick bones prone to fx.
-CN palsies, pancytopenia due to decreased marrow space, extramed hematopoiesis, fx. -NORMAL Ca, P, alkP! Ehrlenmeyer flask bones. |
|
Paget's Disease of Bone
-Defect -Sx -Labs |
-Defect of osteoclast and osteoblasts, abnl bone architecture.
-Increased hat size, hearing loss, fx. -high alkP, cottonball bones |
|
How can Paget's Disease cause high-output heart failure?
|
Increased blood flow from AV shunts in vascular bone.
|
|
Polyostotic Fibrous Dysplasia
-Defect -Assoc disease |
-Bone replaced by fibroblasts, collagen, irreg bony trabeculae.
McCune Albright - polyostotic fibrous dysplasia, Coast of Maine spots, precocious puberty. |
|
Osteoma
|
Benign, new piece of bone grows on old piece (skull). Think Gardner's Syndrome (FAP).
|
|
Osteoid Osteoma
|
Benign, interlacing trabeculae of woven bone surrounded by osteoblasts, prox tibia/femur, boys<25.
|
|
Osteoblastoma
|
Benign, same as osteoid osteoma, vertebra
|
|
Osteoclastoma (giant cell tumor)
|
Benign, spindle-shaped cells with multinuc giant cells, epiphysis, knee, age 20-40, soap bubble xray.
|
|
Osteochondroma (exostosis)
|
MOST COMMON benign, mature bone with cartilaginous cap, long metaphysis, boys<25.
|
|
Endochondroma
|
Benign, cartilage neoplasm intramed bone, in hands and feet.
|
|
Osteosarcoma
|
Adolescent boys, metaphysis (knee), Codman's triangle/sunburst pattern.
Rb tumor sup mutation, Paget's can predispose. |
|
Ewing's Sarcoma
|
Young boys, anaplastic small blue cell, diaphysis, t(11;22), onion skinning, responsive to chemo
|
|
Chondrosarcoma
|
Men 30-60, malig cartilage tumor intramed, glistening mass.
|
|
Where does cartilage loss in OA begin in the knee?
|
Medial side. Bone spurs, eburnation, subchondral sclerosis and cysts, jt space narrowing.
|
|
What is histo of rheumatoid nodule? Which ab test are sen vs spec?
|
Fibrinoid necrosis surrounded by palisading histiocytes.
Sen - RF (anti-IgG) Spec - anti-CCP (anti-cyclic citrullinated protein) |
|
What is Sicca syndrome?
|
Dry eyes, dry mouth, dry vagina
Chronic bronchitis Reflux esophagitis (No arthritis as in Sjogren's) |
|
Why does EtOH precipitate gout attacks?
|
EtOH and uric acid compete for same excretion sites in the kidney.
|
|
What deformities do you see with psoriatic arthritis?
|
Dactylitis (sausage fingers)
pencil-in-cup deformitiy on xray |
|
What are Schaumann and asteroid bodies? Where are they found?
|
Granulomas in sarcoidosis
Schaumann bodies - micro Ca/protein inclusions in giant cells Asteroid bodies - fireworks |
|
Why do you get hyperCa in sarcoid?
|
Elevated 1alpha-hydroxylase in epithelioid macs.
|
|
Polymyositis - pathophys?
|
CD8 killer cells attack muscle.
|
|
Define hyperkeratosis, parakeratosis, and acanthosis?
|
Hyperkeratosis - increased thickness stratum corneum
Parakeratosis - hyperkeratosis with retention of nuclei because cells turning over too fast Acanthosis - hyperplasia of stratum spinosum (acanthocytes are spiny) |
|
Define ephelis.
|
Ephelis - freckle, increase melanin pigment.
|
|
What is the Sign of Leser-Trelat?
|
sudden appearance of mult seborrheic keratoses (barnacles of old age) signifying underlying malig (GI, lymphoma)
|
|
What layer of epidermis does Staph Scalded Skin Syndrome attack?
|
exfoliatin toxin attacks statrum granulosum only
|
|
Dermatitis herpetiformis - histo?
|
IgA deposits at tips of dermal papillae.
|
|
Lichen planus - appearance, histo, assoc?
|
Pruritic, polygonal, purple, papules. Sawtooth infiltrate of lymphs at dermal-epidermal jxn. Assoc with HepC.
|
|
Acanthosis nigricans - histo?
|
Hyperplasia of stratum spinosum - duh, it's called acanthosis!
|
|
What is keratoacanthoma?
|
Rapidly growing variant of squamous cell carcinoma that regresses spontaneous (4-8wk)
|
|
Squamous cell carcinoma - histo?
BCC - histo? |
SCC - keratin pearls
BCC - palisading nuclei |
|
Zileuton - MOA?
Montelukast, zafirlukast - MOA? |
Zileuton - inhibits lipoxyoxygenase, decreasing syn of ALL leukotrienes.
lukasts - inhibits LTC4, LTD4, LTE4 (bronchocon) |
|
ASA - MOA, use, tox?
|
Irrev inhibits COX1/2 by acetylation (covalent binding) to decreases TXA2, PGI2, PGE2.
Low dose - plt Med dose - fever, pain High dose - inflam Tox - ulcers, bleeding, Reye's syndrome, nephrotox |
|
NSAID's - MOA, use, tox?
|
Rev inhibit COX1/2. Block PG syn.
Tox - ulcers, nephrotox, fluid retention, aplastic anemia. |
|
Celecoxib - MOA, use, tox?
|
Rev inhibits COX2 only.
RA, OA, pt with ulcers. Tox - increase risk thrombosis, sulfa drug. |
|
Acetaminophen - why only an antipyretic, tox?
|
Rev inhibits COX1/2 in CNS only, inactivated periph!
Tox - hepatic necrosis |
|
Bisphosphonates - tox?
|
corrosive esophagitis (except zolendronate)
osteonecrosis of jaw nausea diarrhea |
|
Colchicine - MOA, tox?
|
Inhibits microtubule polym to prevent leukocyte chemotaxis.
Diarrhea Nephrotox - give steroids to these pt instead Agranulocytosis |
|
Probenecid - MOA?
Allopurinol - MOA, tox? |
Probenecid - Inhibits reabsorption of uric acid in PCT. Increases con of PCN.
Allopurinol - xanthine oxidase inhibitor. Increases con of azathioprine, 6-MP. Drug-induced lupus, Stevens-Johnson. |
|
Etanercept - MOA?
Infliximab, adalimumab - MOA? |
Etanercept - Decoy TNFalpha receptor that soaks up all the TNF.
Infliximab - anti-TNF ab |