Msk System

Front 1

Indomethacin

Back 1

Gout treatment
Works FAST
Side-effects: GI & CNS

Front 2

NSAIDS for Gout

Back 2

Indomethacin
Ibuprofen

Front 3

Colchicine

Back 3

Gout
Prevents tubulin polymerization -> prevents leukocyte migration & phagocytosis
Side effects: **GI (diarrhea)**, hair loss, bone marrow depression
2nd line to NSAIDS

Front 4

Allopurinol

Back 4

Inhibits formation of uric acid by inhibiting xanthine oxidase (XO)
Its metabolite also inhibits XO

Front 5

Allopurinol Pharmacokinetics

Back 5

Cleared by kidneys (know GFR!)
Long 1/2-life
Converted to an active metabolite

Front 6

Allopurinol Side Effects

Back 6

Mainly allergic (especially with ampicillin)
Exacerbation of disease with initial treatment (give colchicine or NSAIDS before starting)

Front 7

Febuxostat

Back 7

Similar to allopurinol
Better for patients with renal insufficiency

Front 8

Uricosurics

Back 8

Work in renal tubules to a decrease in uric acid re absorption
Use high doses

Front 9

Probenecid

Back 9

Blocks Uric Acid reabsorption
Don't use if urine flow is low
Don't use if patients excrete large amounts of uric acid already

Front 10

Sulfinpyrazone

Back 10

Blocks uric acid reabsorption
Side effects: GI

Front 11

Choices for control of gout and prevent joint changes

Back 11

1st: Allopurinol
2nd: Probenecid
3rd: Sulfinpyrazone

Front 12

NSAIDS Properties

Back 12

Analgesia
Antipyresis
Anti-inflammatory
Anti-platelet

Front 13

NSAIDS MOA

Back 13

Inhibits COX enzymes -> inhibition of prostaglandin synthesis

Front 14

COX 1

Back 14

Present all of the time
Protective/Maintenance
Location: Stomach, Intestine, Kidney, Platelet

Front 15

COX 2

Back 15

Inducible
Pro-inflammatory function
Bring prostaglanins to inflammatory sites -> macrophages

Front 16

Aspirin

Back 16

Non-selective COX inhibitor (irreversible)
Relieves mild pain
Interferes with hypothalamus -> reduce fever

Front 17

Diflunisal

Back 17

Flourinated derivative or salicylate
Non-selective COX inhibitor
No anti-pyretic affect

Front 18

Median Nerve Motor

Back 18

Flexors of forearm
Thenar emminence
1st two lumbricals

Front 19

Median Never Sensory

Back 19

Anterior palm digits 1, 2, 3, & 1/2 of 4

Front 20

Thoracic Outlet compression (3 ways)

Back 20

Elevated 1st rib
Compression by clavicle
Pec minor pulling coracoid process inferiorly

Front 21

Ulnar Nerve Motor

Back 21

2 muscles of anterior forearm compartment -> Flexor carpi ulnaris & Flexor digitorum profundus (ulnar head)
Intrinsic muscles of hand

Front 22

Ulnar Nerve Sensory

Back 22

Anterior and posterior 1/2 of 4 and 5 digits

Front 23

Musculocutaneous Nerve Motor

Back 23

Flexors of elbow (anterior arm compartment)

Front 24

Musculocutaneous Nerve Sensory

Back 24

Lateral forearm

Front 25

Axillary Nerve Motor

Back 25

Deltoid
Teres Minor
Flexes, extends, & aBducts shoulder

Front 26

Radial Nerve Motor

Back 26

Posterior arm compartment
Posterior forearm compartment
Anconius & supinator

Front 27

Erb Duchenne Palsy

Back 27

Superior trunk damage
Proximal arm problems
Waiter's Tip Sign
Fall on head

Front 28

Klumpke Paralysis

Back 28

Inferior trunk damage
Stretch arm from above
Distal (hand) problems

Front 29

Superior Gluteal Never Motor & function

Back 29

Gluteus medius & minimus
Tensor Fascia Lata
ABducts lower limb
Resists pelvic tilt during normal gait

Front 30

Trendelenberg Sign

Back 30

Stand on 1 foot and hip drops on that side
=Superior Gluteal Nerve Palsy

Front 31

Inferior Gluteal Nerve Motor & function

Back 31

Gluteus maximus
Extend hip (climbing stairs and getting up from a chair)

Front 32

Femoral Nerve Motor & Function

Back 32

Anterior thigh
Psoas
Iliacus
Flex hip and extend knee

Front 33

Femoral Nerve Sensory

Back 33

Medial thigh, leg, and heel (via saphenous nerve)

Front 34

Obturator Nerve Motor

Back 34

ADductors in medial compartment of thigh

Front 35

Obturator Nerve Sensory

Back 35

Medial thigh

Front 36

Sciatic Nerve Branches

Back 36

Tibial
Common Fibular

Front 37

Tibial Nerve Motor in the thigh

Back 37

Hamstrings

Front 38

Common Fibular Nerve Motor in the thigh

Back 38

Short head biceps femoris

Front 39

Tibial Nerve Motor (lower leg) & Function

Back 39

Deep and superficial posterior compartments of leg
Plantar flexion
Inversion
Toe flexion

Front 40

Common Fibular Branches

Back 40

Superficial Fibular
Deep Fibular

Front 41

Superficial Fibular Nerve Motor & Function

Back 41

Lateral lower leg
Eversion

Front 42

Deep Fibular Nerve Motor & Function

Back 42

Dorsiflexion
Toe extension

Front 43

Muscle Spindle Fibers

Back 43

Provide info on tension
Adjust tone to prevent injury
Relaxes antagonist muscle

Front 44

Golgi Tendon Organs

Back 44

Cause stretched muscle to relax
Contract antagonist
Prevents a muscle tear

Front 45

UMN Lesion

Back 45

Weakness
Increased tone
Increased reflex

Front 46

LMN Lesion

Back 46

Weakness
Atrophy
Fasiculations
Decreased reflex
Decreased tone

Front 47

Most common manifestation of SLE

Back 47

Polyarthralagia or arthritis

Front 48

Rheumatoid Factor

Back 48

Produced by B-cells of synovium
IgG or IgM Ab against Fc region of IgG

Front 49

Citrullinated Peptides

Back 49

Key in the diagnosis of rheumatoid arthritis

Front 50

Where does Rheumatoid Arthritis typically begin?

Back 50

Small joints of hands, wrists, ankles, knees, elbows, and shoulders

Front 51

Joints in fingers affected by Rheumatoid Arthritis

Back 51

PIP
MCP
NOT DIP

Front 52

Subcutaneous Nodules on extensors surface of forearm?

Back 52

Rheumatoid Arthritis

Front 53

Diagnostic Criteria of Rheumatoid Arthritis

Back 53

Morning stiffness
Arthritis in 3 or more joints
Arthritis of hand joints
Symmetric
Rheumatoid nodules
Serum Rheumatoid Factor (RF)
Radiologic changes

Front 54

Felty's syndrome

Back 54

Association of rheumatoid arthritis, splenomegaly, & neutropenia
Develops in patients with high titer rheumatoid factor, nodules, and HLA-DR4

Front 55

TNF Alpha (in Rheumatoid Arthritis)

Back 55

Activates inflammatory mechanisms
Stimulates endothelial cells
Cells breakdown surrounding matrix

Front 56

Juvenille Rheumatoid (Idiopathic) Arthritis

Back 56

<16 years old
1 or more joint
Both cellular and humoral immune abnormalities

Front 57

Ankylosing Spondylitis

Back 57

Chronic inflammation of sacroiliac joints, vertebrae, entheses
HLA-B27+
No RF
X-Linked (usually younger men)
Always stiff in morning
**Inflammation in eye**

Front 58

Reactive Arthritis (Reiter's)

Back 58

Arthritis, urethritis, & conjunctivitis
Usually affects males
Asymmetric
Usually lower extremity joints
Thought to be an immune response to an infection somewhere else in the body
HLA-B27 + (80%)

Front 59

Myasthenia Gravis

Back 59

Ab's against post-synaptic acetylcholine receptors at NMJ
Muscle Weakness

Front 60

Myastenia Gravis is often associated with?

Back 60

Thymomas
Thymic hyperplasia

Front 61

What do all types of polymyositis & dermatomyositis have in common?

Back 61

Skeletal muscle that is damaged by lymphocytic inflammation

Front 62

polymyositis & dermatomyositis immunologic features

Back 62

ANA +
Ab against cytoplasmic antigens
CD8+ T-cells and macrophage infiltration of involved muscle
Pro-inflammatory and cytotoxic cytokine production

Front 63

Proximal muscle weakness

Back 63

Think polymyositis & dermatomyositis

Front 64

Heliotrope rash

Back 64

dermatomyositis
Eyelids

Front 65

Gottron's sign

Back 65

dermatomyositis
Knuckles

Front 66

Diagnostic criteria of polymyositis & dermatomyositis

Back 66

Proximal muscle weakness
Biopsy evidence
Elevated muscle enzymes (CCK)

Front 67

Anaerobes Usually Lack

Back 67

Superoxide dismutase
Coverts O2- to O2 + H2O2

Front 68

Clinical findings suggestive of anaerobes

Back 68

Foul smell
Necrotic tissue with gas
Black discoloration

Front 69

Predominate anatomical sites for anaerobic infection

Back 69

Mouth
GI

Front 70

Bacteroides fragilis

Back 70

Gram - rod
Growth stimulated by bile
Think abdominal -> GI abscess
Pelvic inflammatory disease
Think below waste

Front 71

Prevotella (Bacteriodes) melaninogenicus

Back 71

Gram - coccobacilli
Oral and brain abscesses
Think above waist

Front 72

Above waist infection think

Back 72

Prevotella (Bacteriodes) melaninogenicus

Front 73

Below waist infection think

Back 73

Bacteroides fragilis

Front 74

Tx of anaerobic infection

Back 74

Debridement and drainage
Metronidazole or clindamycin

Front 75

Fusobacterium nucleatum

Back 75

Thin gram - rods
Fusiform shaped
Head, neck, & chest infections

Front 76

Vincent's angina aka trench mouth

Back 76

Fusobacterium nucleatum

Front 77

Gram + spore formers

Back 77

Most pathology due to toxins
Unable to infect healthy tissue
Will not produce toxin at high Eh

Front 78

Clostridium perfringens

Back 78

Normal habitat is GI and soil
Causes cellulitis & gas gangrene
Alpha toxin -> degrades mammalian cell membranes

Front 79

Alpha toxin

Back 79

Think Colstridium perfringens

Front 80

Myonecrosis

Back 80

Gas gangrene
Clostridium perfringens
Follows trauma/lack of circulation

Front 81

Gram + box car-like rods
Zonal hemolysis

Back 81

Clostridium perfingens -> gas gangrene

Front 82

Clostridium tetani

Back 82

Virulence factor -> tetanospasmin
Gram + rod
Terminal spores

Front 83

Tetanospasmin

Back 83

Clostridium tetani
Suppresses release of inhibitory NT's -> signals are unopposed and muscles are constantly stimulated

Front 84

Clostridium botulinum

Back 84

Toxin produces release of acetylcholine from alpha-motor neuron
No signals to muscle = flaccid paralysis

Front 85

Clostridium difficile

Back 85

Causes pseduomembraneous colitis
Enterotoxin (Toxin A) -> fluid production and mucosal damage
Cytotoxin(Toxin B) -> Kills mucosal cells

Front 86

pseduomembraneous colitis

Back 86

Clostridium difficile
Usually caused by selection via antibiotic treatment

Front 87

Necrotizing Fasciitis Features

Back 87

Extensive tissue destruction
Thrombosis of vessels
Bacteria spread through fascial planes

Front 88

Differentiating necrotizing fasciitis vs cellulitis

Back 88

**PAIN**
High fever
Toxic appearance

Front 89

Type 1 Necrotizing Fasciitis

Back 89

Mixed infections
Diabetes, ab surgery, perineal infection
Resembles gas gangrene
Unpleasant odor
Involved muscle still reacts to stimulation

Front 90

Type 2 Necrotizing Fasciitis

Back 90

Group A Strept
Rapid progression

Front 91

Type 1 Necrotizing Fasciitis Diagnostic aids

Back 91

Culture usually mixed
Anaerobic strept, group A strept, S. aureus
Increased leukocytes (left shift)
Increased ESR
Increased CCK

Front 92

Gangrene with/without gas

Back 92

With -> Clostridium
Without -> Strept pyogenes

Front 93

Aeromonas hydrophilia myonecrosis

Back 93

Motile Gram - rods
Live in fresh water
Oxidase positive
Rapid progression following penetrating trauma in freshwater environment
Tx -> Fluoroquinolone

Front 94

Clinical Findings with Necrotizing Fasciitis

Back 94

Lots of pain
Pt appears ill with rapid pulse and falling BP
Shock and renal failure may follow shortly
Rapid process and often fatal

Front 95

Spontaneous, non-traumatic gas gangrene

Back 95

Clostridium septicum
Usually associated with colon cancer, diverticulitis, or GI surgery

Front 96

Neisseria Characteristics

Back 96

Gram -
Diplicocci (coffee bean shape)
Oxidase positive

Front 97

Clinical features of infectious arthritis

Back 97

90% are mono-articular
Knee is most common, followed by hip
Swollen hot painful joint

Front 98

Joints most susceptible to infection?

Back 98

Previously damaged -> Increase adhesion factors