Msk/rheum/derm Final

Front 1

Most common benign tumor of bone

Back 1

osteochondroma (young males < 25)

Front 2

"Soap bubble" appearance of bone with this tumor

Back 2

osteoclastoma - tumor of osteoclasts

Front 3

Prevention of osteoperosis

Back 3

Stop smoking/alcohol. Stop steroids if able, avoid PPI/H2 blockers if possible. Take bisphosphonates, exercise

Front 4

Alendronate, Risendronate, Etidronate - what are these drugs and hwo do they work?

Back 4

Bisphosphonates. Inhibit osteoclasts to allow the osteoblasts to "catch up" and build more bone

Front 5

Side effects of bisphosphonates

Back 5

Erosive esophagitis, osteonecrosis of Jaw (very rare)

Front 6

Bisphosphonates are structural analogues of ____

Back 6

Pyrophosphate - a component of hydroxyapatite. Bisphosphanates make hydroxyapatite more soluble

Front 7

What is teriparatide? How is this used to treat osteoperosis?

Back 7

PTH analogue - reduces rate of fractures

Front 8

PTH, calcium and phosphorus levels in primary osteoperosis?

Back 8

Normal

Front 9

What is the pathogenesis of osteopetrosis?

Back 9

Osteoclasts deficient in carbonic anhydrase II - can't break down bony matrix, so you get rock-like, dense/thick bones

Front 10

X ray showing bones "flaring out" at the ends because they're widened here. Patients can also have anemia/thrombocytopenia/low WBCs because of growth into marrow matrix

Back 10

osteopetrosis

Front 11

Bone specific alk phos reflects Osteoblastic or osteoclastic activity? What about urinary deoxypyridinoline?

Back 11

Osteoblast, osteoclast

Front 12

Increased hat size or hats getting too tight. Possibly some hearing loss due to narrowing of auditory foramen

Back 12

Paget disease of bone

Front 13

Increased risk of osteosarcoma in this disease of bone

Back 13

Paget disease of bone

Front 14

Bone replaced by collagen and fibroblasts

Back 14

Polyostotic fibrous dysplasia

Front 15

Fibrous dysplasia of bone (aka polyostotic fibrous dysplasia) is one part of triad in McCune Albright syndrome - what are the other two symptoms? How does this differ from albright hereditary osteodystrophy?

Back 15

Percocious puberty, cafe au lait spots, and fibrous dysplasia

Albright hereditary osteodystrophy - lack of responsiveness to PTH (so this is part of pseudohypoparathyroidism type 1). They have short stature, mental retardation, and short 4th/5th metacarpals with round faces.

Front 16

Elevated alk phos, but normal calcium, phosphate, PTH

Back 16

Paget disease of bone

Front 17

What vessels and nerves are damaged with posterior hip dislocations?

Back 17

Medial/lateral circumflex arteries (which surround femoral head), femoral vein, and femoral nerve

Front 18

MCL, ACL, and either lateral or medial meniscus damaged in this injury

Back 18

Unhappy triad - lateral force on knee with platned foot

Front 19

Most common ligament tear in ankle sprains

Back 19

anterior talofibular ligament (ATFL - Always tears first ligament)

Front 20

Pain in the medial arch of your foot or around your heal happening with first steps in the morning or after weight bearing

Back 20

Plantar fasciitis

Front 21

What are the 4 muscles of the rotator cuff?

Back 21

Supraspinatus - abduction, infraspinatus - medial rotation, teres minor - medial rotation, subscapularis - medial rotation

Front 22

Which structures can be damaged in anterior shoulder dislocation?

Back 22

Axillary nerve and posterior circumflex artery, supraspinatus tendon

Front 23

Achilles tendon rupture with these antibiotics

Back 23

Fluoroquinolones

Front 24

Tenderness in anatomic snuffbox - which bone is likely fractured? Risk following fracture?

Back 24

Scaphoid. risk of nonunion and avascular necrosis due to it's poor blood supply

Front 25

Pathogenesis of acetaminophen toxicity + antidote for toxicity

Back 25

NAPQI is a metabolite of the drug that depletes glutathoine - reacts with hepatocytes and can cause hepatic necrosis/liver failure. Antitode is N acetylcysteine, helps you regenerate glutathione

Front 26

NSAIDs reversibly inhibit COX 1 and 2, but aspirin IRREVERSIBLEY binds Cox 1

Back 26

remember that

Front 27

Pannus formation in MCP and PIP but NOT in the DIPs

Back 27

Rheumatoid arthritis - Osteoarthritis affects the DIPs

Front 28

Prefered DMARD for patients with moderate/severe rheumatoid arthritis? What drug is this and what side effects does it have?

Back 28

Methotrexate - PAINFUL MOUTH ULCERS and hepatoxicity, as well as increased susceptibility to infection b/c of bone marrow supression

Front 29

DMARDs - disease modifing antirheumatic drugs

Back 29

used to treat rheumatoid arthritis - methotrexate, hydroxychloroquine, sulfasalazine, TNF alpha inhibitors (etancercept/infliximab/adalimumab)

Front 30

This infection causes erythema infectiousum in children (facial rash/fever) and arthritis in adults. It can mimic rheumatoid arthritis but it is SELF RESOLVING usually

Back 30

Parvovirus B19

Front 31

How does drinking alcohol cause gout flare ups?

Back 31

Alcohol metabolites use the same excretion sites as uric acid in kidney. Because the kidney has to choose between excreting alcohol/uric acid, so uric acid builds up and you get gout

Front 32

How do you reat acute gout? Chronic gout?

Back 32

(1) Acute - NSAIDs mostly, or colchicine (stabalizes tubulin and inhibits polymerization of tubules to impair leukocyte chemotaxis --> Less inflammation) (2) Chronic - A) Allopurinol - inhibit xanthine oxidase to decrease uric acid synthesis. B) probenecid. inhibits uric acid reabsorption in PCT so it stays in urine and is excreted

Front 33

Sausage fingers (dactylitis) with psoriasis and arthritis and "pencil in cup" deformity on x ray

Back 33

Psoriatic arthritis

Front 34

Describe the respiratory, cardiovascular, and eye findings in ankylosing spondylitis

Back 34

Respiratory - ethesopathies (inflammation at tendon insertion site) is common with this disease, especially costovertebral/costosternal junction. This causes limited chest movement and results in hypoventilation. Cardiovascular - ascending aortitis leading to dilation and aortic insufficiency. Eye - uveitis

Front 35

Can't pee, can't see, can't climb a tree

Back 35

Reiter syndrome (aka reactive arthritis) - common after chlamydia or GI infections too - uveitis/conjunctivitis, urethritis, arthritis

Front 36

DMARDs can be used to treat seronegative spondyloarthropathies. One of these drug classes are TNF alpha inhibitors - what are these drugs?

Back 36

Entanercept, Infliximab, adalimumab, golimumab, certolizumab

Front 37

What are the three types of Juvenile idopathic arthritis (JIA)

Back 37

Polyarticular - severe symmetrical arthritis, Pauciarticular - few large joints, Systemic onset - systemic systems THEN arthritis later

Front 38

Septic arthritis most commonly caused by these 3 organisms

Back 38

staph aureus, streptococcus, neisseria gonorrhoeae

Front 39

11 diagnostic criteria for lupus, need to have 4 of these at some point during course of disease to have lupus

Back 39

DOPhAMINE RASH

Discoid lupus, Oral lesions, Photosensitivity, ANA+, Malar rash, Immuno (ANA+, Anti Smith, Anti dsDNA, Neuro, ESR, Renal, Arthritis, Serositis (pleuritis/pericarditis), Heme (thrombocytopenia, leukopenia, hemolytic anemia)

Front 40

Antiphosphlipid antibody (aka anticardiolipin) anti dsDNA, anti Smith, false positive VDRL

Back 40

possible lab manifestations of lupus

Front 41

Anti histone antibodies associated with

Back 41

drug induced lupus

Front 42

Which drugs can cause lupus? What lab test would confirm drug induced lupus?

Back 42

SHIPP - Sulfanoamides, hydralazine, isoniazid, phenytoin, procainamide. Anti histone antibody. Associated with N-acetylation in the liver

Front 43

Diffuse, widespread sclerosis that progresses rapidly and is associated with Anti DNA topoisomerase I (Anti SCL 70)

Back 43

Diffuse scleroderma

Front 44

What is CREST syndrome?

Back 44

Other type of scleroderma. C-calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangectasia

Front 45

Antibodies implicated with diffuse scleroderma vs CREST syndrome

Back 45

Anti topoisomerase I (Anti SCL 70) in diffuse, anti centromere antibodies with CREST syndrome

Front 46

Anti SSA (Anti Ro) and Anti SSB (anti La)

Back 46

Sjogren's syndrome - dry eyes, dry mouth, arthritis

Front 47

X linked frameshift mutation causing dystrophin gene deletion? Mutation?

Back 47

Duchenne, Becker

Front 48

Accelerated muscle breakdown leading to elevated CK

Back 48

Duchenne

Front 49

Pain/stiffness in proximal joints (eg shoulder/hips) with malaise, weight loss, fever, associated with temporal arteritis

Back 49

PMR - polymyalgia rheumatica

Front 50

CD8 T cell induced injury to muscle fibers in shoulders/pelvis leading to proximal muscle weakness

Back 50

Polymyositis

Front 51

Anti Jo 1 and ANA

Back 51

Polymyositis

Front 52

Excess muscle tenderness at particular sites, associated with stiffness, paresthesia, poor sleep, emotional disturbances

Back 52

Fibromyalgia

Front 53

Layers of epidermidis

Back 53

Californians like girls in string bikinis - Stratum corneum, lucidum, granulosum, spinosoum, basale

Granulosum - psoriasis

Melanin is in the basal layer

Front 54

E cadherin, actin associated with zonula adherens, these make ___ junction

Back 54

intermediate

Front 55

Macula adherens aka

Back 55

Desmosome - keratin involved here

Front 56

This connects the epithelial cell to basement membrane

Back 56

Hemidesmosome

Front 57

Antibodies to hemidesmisome cause ____. Antibodies to desmosomes cause ____

Back 57

bullous pemphigoid, pemphigus vulgaris

Front 58

Atopic dermatitis aka eczema commonly found on ___ surfaces

Back 58

flexor

Front 59

Treatment for acne address the hyperkeratosis, sbum overproduction, propionibacterium acnes proliferation, and inflammation

Back 59

(1) Retinoids (vitamin A analogs) eg tretinoin (2) Isotretinoin or spironolactone/estrogen (3) Erythromycin/clindamycin or benzoyl peroxide (4) Steroids if need really really quick reduction of inflammation

Front 60

Silvery scale rash, can also be associated with pitting of nails

Back 60

Psoriasis

Front 61

"parakeratotic scaling"

Back 61

Psoriasis

Front 62

Albinism vs vitiligo

Back 62

Albinism has normal melanocytes but less melanin (because of tyrosine enzyme deficiency), Vitiligo has DECREASED melanocytes

Front 63

Hairy leukoplakia on side of tongue caused by

Back 63

EBV in immunocompromised people

Front 64

Nikolsky's sign used to differentiate between

Back 64

Bullous pemphigoid and pemphigus vulgaris - in pemphigus vulgarius, you'll just rub someone's little mole thing and it'll fall off and that's positive. Negative in bullous pemphigoid

Front 65

Erythema multiforme often caused by

Back 65

drugs (kinda mild steven johnson syndrome)

Front 66

Which drugs can cause steven johnson syndrome?

Back 66

SAPS -

Seizure meds, Allopurionol, Penicillins, Sulfa meds

Front 67

Purple, plaques associated with hepatitis C

Back 67

Lichen Planus

Front 68

Pityriasis Rosea

Back 68

christmas tree rash

Front 69

Sandpaper like, red premalignant lesions on bald men commonly. Treat with 5 fluorouracil

Back 69

Actinic keratosis

Front 70

Keratin pearls, ulcerative red lesion on sun exposed areas, especially hands/face

Back 70

Squamous cell carcinoma

Front 71

Rolled edge appearance with telangectasias

Back 71

Basal cell carcinoma

Front 72

S100 is a marker of this

Back 72

Melanoma

Front 73

Use this SERM to treat osteoporosis and breast cancer

Back 73

Ralosifene - estrogen agonist in bone, estrogen antagonist in breast

Front 74

Osteomyelitis most commonly affects children - which part of bone does it affect mainly?

Back 74

metaphysis of long bones

Front 75

Treatment of myasthenia gravis?

Back 75

Pyridostigmine or neostigmine - cholinesterase inhibitors. Give scopolamine if you get muscaranic overstimulation (this is an antimuscarinic agent)

Front 76

Sunlight exposure catalyzes first reaction of active vitamin D synthesis

Back 76

7 dehydrocholesterol ---> cholecalciferol (aka Vitamin D3)

Front 77

What is caudal regression syndrome?

Back 77

This is in BABIES - Sacral agenesis causing lower extremity paralysis and urinary incontinence - associated with poorly controled maternal diabetes

Front 78

Common peroneal (aka fibular) nerve injury occurs with compression or trauma to lateral knee because it's superficially location. What motor/sensory dysfunction do you get with damage to this nerve?

Back 78

Superficial branch of the peroneal everts the foot and provides sensation to the majority of the dorsum of the foot. Deep peroneal nerve dorsiflexes the foot and provides sensation to the space between two first toes. Common peroneal nerve injury would cause foot drop and numbness to top of foot. It innervates the

Front 79

Upon release from sarcoplasmic reticulum, what does calcium bind to?

Back 79

Troponin C on thin filmenets. This shifts position of tropomyosin and exposes the myosin binding sites on the actin filaments.

Front 80

Where are the two common locations of ulnar nerve damage causing "claw hand" deformity?

Back 80

Either medial epicondyle of the humerus, or Guyon's canal near the hook of hamate and pisiform bone in the wrist

Front 81

Part of sarcomere with only thin actin filments? part of sarcomere that only has thick mysoin filaments

Back 81

I band (on either side of Z line). H band is the middle part of the A band (on either side of M line) that has only thick myosin filaments

Front 82

Which wrist bone is commonly dislocated with falls? Which one is broken?

Back 82

Lunate. It's smaller than the scaphoid on X ray. But these are the two bones that articulate with the radius

Scaphoid often broken

Front 83

The sciatic nerve splits into these two nerves - name them and their function

Back 83

Tibial - goes in the popliteal fossa behind the knee. Involved with plantar flexion, toe flexion, and inversion of the foot (so damage means you'll be dorsiflexed and everted). Also provides sensation to PLANTAR foot Common peroneal lets you dorsiflex and sensation to the dorsum of the foot

Front 84

Psoas sign

Back 84

inflammation of psoas muscle causes pain when hip is extended.

Front 85

Which two muscles are major flexors of the hip?

Back 85

iliacus and psoas muscles

Front 86

Which nerve exits the plevis through the obturator foramen? This nerve supplies adductor muscles of the thigh and can be damaged during pelvic surgery

Back 86

Obturator

Front 87

Brachial plexus branching nerves from th lateral to medial cord?

Back 87

MARMU - Musculocutaneous, Axillary, Radial, Median, Ulnar

Front 88

The median nerve courses between the humeral and ulnar heads of the pronator teres muscle then runs between flexor digitorum superficialis/profundus muscles before entering wrist and hand within carpal tunnel

Back 88

just know that

Front 89

"mosaic pattern of lamellar bone" with cement lines linking irregular sections of lamellar bone

Back 89

Paget's disease of the bone

Front 90

Muscles are made of two main fiber types - slow twitch (Type 1) and fast twitch (Type II) - what's the function of each? How do they differ in content of myoglobin and glycogen?

Back 90

Type I is low level, sustained force (like maintaining posture). They have high myoglobin concentration (example - paraspinal muscles). Type II are made for rapid forceful pulses of movement. They have very high glycogen content

Front 91

Injections in superomedial part of butt risk injury of ____. Injections in superromedial, inferomedial, and inferolateral regions risk injury to ____ nerve. The superolateral quadrant is relatively safe

Back 91

Superior gluteal nerve. Sciatic nerve

Front 92

Fracture of right humeral shaft can damage which artery?

Back 92

Deep brachial artery

Front 93

Osteoid matrix accumulation around trabeculae and bowing of legs

Back 93

Vitamin D deficiency - rickets or osteomalacia

Front 94

Fetal bone growth retardation and discoloration of teeth if mom uses

Back 94

Tetracyclines -

Front 95

Femoral neck fractures can damage blood supply to femoral head and neck - which artery is damaged? This can cause avascular necrosis of femoral head

Back 95

Medial femoral circumflex

Front 96

Pathogenesis of lambert eaton myasthenic syndrome

Back 96

Antibodies against voltage gated calcium channels participating in acetylcholine release

Front 97

Proximal muscle weakness, cranial nerve involvement (diplopia, ptosis, dysarthria/dysphagia), and autonomic signs with possible small cell lung cancer

Back 97

Lambert Eaton

Front 98

Sudden traction on outstretched/pronated arm of a child (eg, kid falls while holding hands with someone) can cause this injury

Back 98

Annular ligament tear and displaced. Radial head is subluxed. Pain when moving elbow