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142 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Layers of skin from surface to base
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Corneum
Lucidum Granulosum Spinosum Basalis |
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Zona Adherens contains
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intermediate junction
below zona occludens cadherins connect to actin |
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Macula adherns contains:
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desmosome
cadherins connect to intermediate filaments (keratin and desmoplakin) |
site of pemphigus vulgaris
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What is the terrible triad?
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torn MCL, ACL and lateral meniscus
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What does a positive drawer sign indicate?
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ACL tear
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Where do the ACL and MCL insert on the tibia?
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ACL - anterior medial
PCL - posterior lateral |
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Where do you do a pudendal nerve block?
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ischial spine
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Where do you do a lumbar puncture?
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iliac crest
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What are the muscles that form the rotator cuff?
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SItS:
Supraspinatus Infraspinatus Teres minor Subscapularis |
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Nerve roots for Axillary nerve
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C5, C6
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What are the roots of the radial nerve?
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C5-C8
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What is the motor deficit in radial nerve injury?
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Brachioradialis
Extensors of wrist/fingers Supinators Triceps |
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What is the clinical sign in radial nerve injury?
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wrist drop
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What are the roots of median nerve?
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C6-C8, T1
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What is the sensory deficit in radial nerve injury?
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back of hand and arm
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What causes a proximal median nerve injury?
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fracture of supracondylar humerus
pronator teres syndrome |
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What is the motor deficit in proximal median nerve injury?
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lateral finger flexion
wrist flexion |
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What causes a distal median nerve injury?
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carpal tunnel syndrome
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What is the motor deficit in distal median nerve injury?
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opposition of thumb
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What is the clinical sign of proximal median nerve injury?
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"Ape hand"
thenar atrophy loss of opposability of thumb |
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What are the roots of the ulnar nerve?
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C8-T1
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What is the motor deficit in a proximal ulnar nerve lesion?
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lateral finger flexion
wrist flexion |
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What is the motor deficit in a distal ulnar nerve lesion?
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abduction and adduction of fingers (interossei)
Adduction of thumb Extension of 4th and 5th fingers (lumbricals) |
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What are the roots of the musculocutaneous nerve?
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C5-C7
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What is the motor deficit in musculocutaneous nerve lesion?
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biceps
brachialis coracobrachialis flexion of arm at elbow |
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What causes Erb-Duchenne palsy?
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traction or tear of the upper trunk of the brachial plexus (C5/C6 roots) following blow to shoulder or trauma during delivery
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What are the deficits/findings in Erb-Duchenne palsy?
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limb hangs by side (paralysis of abductors)
medially rotated (paralysis of lateral rotators) forearm is pronated (loss of biceps) |
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What causes Klumpke's palsy and thoracic outlet syndrome?
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embryologic or childbirth defect affecting inferior trunk of brachial plexus (C8-T1)
cervical rib can compress subclavian artery and inferior trunk. |
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What are the signs/findings in Klumpke's palsy and thoracic outlet syndrome?
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atrophy of thenar and hypothemar muscles
atrophy of interosseous muscles sensory deficits on the medial side of the forearm and hand disappearance of the radial pulse upon moving the head toward the ipsilateral side |
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What is ulnar claw?
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distal ulnar nerve lesion
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What are the signs/findings of ulnar claw?
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Pope's blessing: when you try to open the hand, the pinky and ring finger say clawed
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NOTE: this looks the same as trying to make a fist with a proximal median nerve injury
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What are the motor deficit in ulnar claw?
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loss of medial lumbrical function ==> can't extend 4th and 5th digits
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What is the injury in median claw?
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distal median nerve lesion (after branch containing C5-C7 branches off to feed forearm flexors)
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What are the signs/findings in median claw?
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when you try to open your hand the 2nd and 3rd digits stay clawed
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What is the motor deficit in median claw?
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loss of lateral lumbrical function ==> cannot extend 2nd and 3rd digit
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What is the nerve injury in Ape hand?
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proximal median nerve lesion
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What is the motor deficit in Ape hand?
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loss of opponens pollicis muscle ==> inability to abduct thumb
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What is the sign/finding in Ape hand?
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unopposable thumb
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What is the lesion in Klumpke's total claw?
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lower trunk (C8, T1)
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What is the motor deficit in Klumpke's total claw?
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loss of all lumbricals
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What do the lumbricles do?
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flex the MCP joints
extend the DIP/PIP joints |
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What is the nerve and muscle deficit in "winged scapula"?
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long thoracic nerve (C5-C7)
serratus anterior m. - connects the scapula to thoracic cage and abducts the arm above horizontal position |
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Dorsal interosseuous muscles function
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abduct the fingers
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DAB
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Palmar interosseous muscles function
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adduct the fingers
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PAD
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What are the functions of the thenar and hypothenar eminences?
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OAF
oppose abduct flex |
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Obdurator nerve spinal roots?
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L2-L4
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Obdurator nerve lesion motor deficit?
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thigh adduction
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Femoral nerve roots?
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L2-L4
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Sciatic nerve roots?
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L4-S2
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What is the motor deficit in common peroneal nerve injury?
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foot eversion
dorsiflexion toe extension |
PED
Peroneal Everts and Dorsiflexes |
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What are the signs/finding of common peroneal nerve injury?
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foot drop
foot slap steppage gait |
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Tibial nerve lesion motor deficit
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foot inversion
plantarflexion too flexion |
TIP
Tibial Inverts and Plantarflexes |
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Superior gluteal nerve roots
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L4-S1
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Superior gluteal nerve injury motor deficits
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thigh abduction (gluteus medius)
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What is the finding/sign in Superior gluteal nerve injury?
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positive trendelenburg sign - hip drops when standing on opposite foot
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What is the motor deficit in inferior gluteal nerve injury?
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loss of gluteus maximus
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What are the inferior gluteal nerve roots?
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L5-S2
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What are the signs/findings in inferior gluteal nerve injury?
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can't jump, climb stairs or rise from seated position
can't push inferiorly (downward) (gluteus maximus doesn't work) |
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Smooth muscle contraction steps
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membrane depolarization causes influx of Ca2+ ==> binds to calmodulin ==> activates MLCK ==> phosphorylation and activation of myosin + actin cross-bridge formation and contraction
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How does NO cause smooth muscle relaxation?
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NO ==> guanylate cyclase ==> inc. cGMP ==> inhibition of MLCK
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Osteopetrosis findings
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labs are normal
erlenmeyer flask on x-ray nerve palsies anemia/thrombocytopenia |
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What causes Osteopetrosis?
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genetic defect in carbonic anhydrase II
abnormal functioning of osteoclasts |
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What causes osteitis firbosa cystica?
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hyperparathyroidism
inc. PTH ==> inc. Ca2+ ==> inc. alkphos and dec. P04 |
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Findings in Paget's disease
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labs are normal except inc. Alkphos
mosaic bone pattern long bone chalk-stick fractures inc. blood flow from inc. arteriovenous shunts may cause high-output heart failure inc. hat size hearing loss may lead to osteosarcoma |
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What is polyostotic fibrous displasia?
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bone is replaced by fibroblasts, collagen, and irregular bony traneculae
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What is McCune-Albright Syndrome?
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a form of polyostotic firbours dysplasia characterized by multiple unilateral bone lesions associated with precocious puberty and cafe-au-lait spots
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Describe osteomas
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new piece of bone grows on another piece of bone, often in the skull
associated with Gardner's syndrome (FAP) |
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Describe osteoid osteomas
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Interlacing trabeculae of woven bone surrounded by osteoblasts
<2cm and found in proximal tibia and femur most common in men <25 years of age |
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Describe osteoblastoma
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same morphology as osteoid osteoma (Interlacing trabeculae of woven bone surrounded by osteoblasts) but >2cm and found in the spine
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Describe Giant Cell tumor (osteoclastoma)
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occurs most commonly at epiphyseal end of long bones (distal femur, proximal tibia)
peak incidence 20-40 years old x-ray: "double bubble, soap bubble" histo: spindle-shaped cells with multinucleated giant cells only one that is more common in women than men |
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Describe osteochondroma
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Most common benign bone tummor
mature bone wtih cartilagionous cap usually in men <25 commonly originates from long metaphysis malignant potential (but rare) |
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Describe enchondroma
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benign cartilaginous neoplasm found in intramedullary bone in the distal extremities (as opposed to chondrosarcoma)
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Which bone tumors are NOT the most common in young men?
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giant cell (20-40, females)
chondrosarcoma (men ages 30-60) |
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Where are osteosarcomas usually found?
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metaphysis of long bones often around distal femur and proximal tibial regions (knee)
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same region as osteoclastoma but different epi
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What does osteosarcoma look like on X-ray?
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sunburst pattern (from elevation of periosteum)
Codman's triangle |
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What are osteosarcomas associated with?
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paget's disease of bone
bone infacts radiation familial retinoblastoma |
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Where does Ewing's sarcoma typically appear?
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diaphysis of long bones
pelvis scapula ribs |
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What does Ewing's sarcoma look like histiologically?
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anaplastic small blue cell
"onion-skin" appearance in bone |
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What is the translocation in Ewing's sarcoma?
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t(11;22)
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What does chondrosarcoma look like?
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expansile glistening mass within the medullary cavity
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Where are chondrosarcomas usually located?
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(more central than distal like enchondroma)
pelvis spine scapula humerus tibia femur |
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What is the triad in Sjogren's syndrome?
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Xerophthalmia (dry eys, conjunctivitis)
Xerostomia (dry mouth, dysphagia) Arthrtis |
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What are the antibodies in Sjogren's?
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Anti-SS-A (Ro)
Anti-SS-B (La) |
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What is Sicca syndrome?
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dry eyes
dry mouth nasal and vaginal dryness chronic bronchitis reflux esophagitis NO arthritis |
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What is Sjogren's associated with?
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rheumatoid arthritis
inc. risk of B-cell lymphoma |
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What causes gout?
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hyperuricemia due to:
over-production: Lesch-Nyhan, PRPP excess, chemo, vonGierke's disease under-excretion: alcohol, thiazide diuretics |
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What are the crystals in gout and how do you identify them?
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monosodium urate
negatively birefringent = yellow crystals under parallel light (blue under perpendicular light) |
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What are the crystals in pseudogout and how do you identify them?
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calcium phyrophosphate
basophilic, rhomboid crystals that are weakly positively birefringent (blue under parallel like, yellow under perpendicular light) |
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Which joints does psuedogout usually affect?
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large joints, classically the knee
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Which organisms usually cause septic arthritis?
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S. aureus
Strep N. gonorrhoeae |
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How does gonorrhea septic arthritis present?
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monoarticular, migratory asymmetrical arthritis with associated dermatitis (pustules)
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What are the findings in akylosing spondilitis?
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ankylosis
uveitis aortic regurgitation |
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What is reactive arthritis (Reiter's syndrome)?
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conjunctivitis/uveitis
urethritis arthritis |
post-GI or chalymdia infection
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What is the histopathology of sarcoidosis?
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non-caseating granulomas containing microscopic Schaumann and asteroid bodies
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What are some common findings in sarcoidosis?
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restrictive lung disease (interstitial fibrosis)
inc. ACE hilar lymphadenopathy erythema nodosum epithelial granulomas hypercalcemia uveoparotitis Bell's palsy Gammaglobulinemia Rheumatoid arthritis |
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What are the symptoms/findings of polyarthritis rheumatica?
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pain and stiffness in shoulders and hips, often with fever. malaise and weight loss
NO muscular weakness |
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What other autoimmune disease is polyarthritis rheumatica associated with?
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Giant cell (temporal) arteritis
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Polymyositis symptoms/findings
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progressive symmetric poximal muscle weakness
most often involves shoulders perifascicular inflammation caused by CD8+ T-cells |
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Dermatomyositis symptoms/findings
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Polyomyositis plus:
malar rash heliotrope rash "shawl-and-face" rash Gottron's papules "mechanic's hands" |
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What are the diagnostic markers of polymyositis/dermatomyositis?
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inc. CK
inc. aldolase ANA+ anti-Jo-1+ |
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Describe diffuse scleroderma
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widespread, rapid, early visceral involvement
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CREST symptoms
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calcinosis
raynauds esophageal dysmotility sclerodactyly telangectasias limited skin involvement (hands and face) and more benign clinical course than diffuse scleroderma) |
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What are the auto-antibodies in scleroderma?
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anti-Scl-70
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Which layer is most hypertrophied in psoriasis?
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spinosum (granulosum is actually decreased)
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What is Auspitz sign?
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bleeding spots when scales are scraped off in psoriasis
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Describe the lesion in seborrheic keratosis
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flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts).
look pasted on common benign neoplasm in ederly |
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What is the sign of Leser-Trelat?
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sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (esp. GI or lymphoid)
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What layer of the skin is effected by the toxin in SSS?
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granulosum only so slough off the upper layers of the epidermis
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pemphigus vulgaris pathophys
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IgG antibody against desmosomes - intraepithelial separation only (ancantholysis)
effects oral mucosa |
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Bullous pemphigoid
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IgG antibody again hemidesmosomes so separation of layers at the level of the basement membrane
spares oral mucosa |
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What is the difference between bullous and vulgarus pemphigoid on immunofluorescence?
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vulgaris - reticular/net-like
bullous - linear pattern |
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What is dermatitis herpetiformis
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pruritic papules and vesicles on extensor surfaces of skin
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What causes dermatitis herpetiformis and what is it associated with?
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deposition of IgA at dermal papillae
assoc. with celiac disease |
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What causes/is associated with erythema multiforme?
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M. pneumo
HSV sulfa phenytoin Beta-lactams cancers auto-immune disease |
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How does erythema multiforme present?
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multiple types of lesions simultaneously - macules, papules, vesicles and target lesions
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How does Steven-Johnson syndrome present?
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fever
bulla formation and necrosis sloughing of skin high mortality rate |
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Lichen planus
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pruritic, purple, polygonal papuls
sawtooth infiltrates of lymphocytes and dermal-epidermal junction assoc. with Hep C |
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Actinic keratosis
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small, rough, erythematous or brownish papules
"cutaneous horn" pre-malignant (squamous cell carcinoma) assoc. with sun exposure |
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describe Erythema nodosum
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inflammatory lesions of subcutaneous fat, usually on anterior shins
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What diseases is erythema nodosum associated with?
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coccidio
histo TB leprosy strep sarcoidosis |
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Describe Pityriasis rosea
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"heral patch" followed days later by "christmas tree" distribution
multiple papular eruptions remits spontaneously |
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What is classically seen on histology of squamous cell carcinoma?
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keratin "pearls"
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What is a keratoacanthoma?
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a variant of squamous cell carcinoma that grows rapidly (4-6 wks) and then regresses spontaneously (4-8 wks)
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What is the gross morphology of basal cell carcinoma?
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rolled edges with cetnral ulceration
pearly papules, commonly with telangiectasias |
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What is the histopathology of basal cell carcinoma?
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peripherally palisading nuclei
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What is the function of LTB4?
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neutrophil chemotactic agent
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What do LTC4, D4, E4 do?
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bronchoconstriction, vasoconstriction, contraction of smooth muscle
inc. vascular permeability |
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What does PGI2 do?
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inhibits platelet aggregation and promotes vasodilation
dec. uterine tone |
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What does PGE2 do?
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dec. vascular tone
inc. uterine tone pain fever |
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What does TXA2 do?
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promotes platelet aggregation
vasoconstriction |
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Celecoxib toxicity
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inc. risk of thrombosis
sulf allergy |
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What is acetaminophen toxicity, how does it happen and how do you reverse it?
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hepatic necrosis due to metabolites depleting glutathione and forming toxic tissue adducts in liver.
You can give N-acetylcysteine as an antidote to regenerate glutathione |
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Bisphosphonates MOA
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inhibit osteoclastic activity
reduce both formation and resoption of hydroxyapatite |
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Bisphosphonates clinical use
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postmenopausal osteoporosis
malignancy-associated hypercalcemia Paget's disesase of bone |
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Bisphosphonates toxicity
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corrosive esophagitis
nausea diarrhea osteonecrosis of the jaw |
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What drug should you NOT give to gout patients?
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salicylates because they depress renal uric acid clearance
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Entanercept MOA
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recombinant form of human TNF receptor that binds TNF so that it can't bind to the real (endogenous) receptors as much
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Entanercept clinical use
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RA
psoriasis ankylosing spondylitis |
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Infliximab MOA
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anti-TNF antibody
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Infliximab clinical uses
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crohn's
RA ankylosing spondylitis |
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Adalimumab MOA
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anti-TNF antibody
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Adalimumab clinical use
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RA
psoriasis ankylosing spondylitis |
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