Musculoskeletal

Front 1

soccer player who was kicked in the leg suffered a medial meniscus. What else is likely to have been damaged.

Back 1

Anterior cruciate ligament (remember the "unhappy triad"

Front 2

Gymnast dislocates her shoulder anteriorly. What nn is most likely to have been damaged

Back 2

Axillary nn (C5,C6)

Front 3

X-ray shows bilateral hilar lymphadenopathy. What is the dx?

Back 3

Sarcoidosis

Front 4

Child exhibits weakness & enlarged calves. What is the dz & how is it inherited?

Back 4

Duchenne's muscular dystrophy. X-linked recessive

Front 5

25 y/o woman presents with a low grade fever, a rash across her nose that gets worse when she is out in the sun and widespread edema. What are you concerned about?

Back 5

SLE

Front 6

85 y/o man presents with acute knee pain and swelling X-ray shows joint space w/o erosion. What is the dx & what would you find on aspiration

Back 6

pseudogout; rhomboid calcium pyrophosphate crystals

Front 7

epidermis layer from surface to base [image p. 313]

Back 7

stratum Cornium
stratum Lucidum
stratum Granulosum
stratum Spinosum
stratum Basalis

mneu: CA Likes Girls w/ String Bikinis

Front 8

Epithelial cell junctions:
This jx prevents diffusion across intracellular spaces

Back 8

Zona occludens (tight jx)

Front 9

Epithelial cell junctions:
This jx uses actin filaments and E-cadherins to surround the perimeter just below the zona occludens.

Back 9

Zona adherens (intermediate jx)

Front 10

Epithelial cell junctions:
This jx uses keratin & desmoplakin as small, discrete sites of attachemet

Back 10

Macula adherens (desmosone)

Front 11

Epithelial cell junctions:
This jx allows adjacent cells to communicate for electrical and metabolic functions and provides a connection with the central channel

Back 11

gap jx

Front 12

Epithelial cell junctions:
This jx connects cells to underlying extracellular matrix

Back 12

hemidesmosome

Front 13

Epithelial cell junctions:
This jx maintains the integrity of the basement membrane

Back 13

integrin

Front 14

image Epithelial cell junctions [p.313]

Back 14

--

Front 15

this type of bone formation is spontaneous bone formation w/out preexisting cartilage (endochodral or intramembranous)

Back 15

intramembranous

Front 16

this type of bone formation is ossification of cartilaginous molds. Long bones form by this type of ossification at primary and secondary centers(endochodral or intramembranous)

Back 16

endochodral

Front 17

this common football injury caused by clipping from the lateral sides is called the unhappy triad and consists of injury to these three things

Back 17

medial meniscus
medial collateral ligament (MCL)
anterior crutiact ligament

Front 18

what test would you do to check for tearing of the ACL

Back 18

anterior drawer sign (+ indicates tear)

Front 19

abnormal passive abduction indicates a torn this

Back 19

MCL

Front 20

PCL stands for

Back 20

posterior cruciate ligament

Front 21

LCL stands for

Back 21

lateral collateral ligament

Front 22

"anterior" and "posterior" in ACL and PCL refer to the sites of _______ attachment

Back 22

tibial

Front 23

imate knee [p313]

Back 23

--

Front 24

Shoulder muscles that form the rotator cuff

Back 24

SItS

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

counterclockwise from the top

Front 25

skeletal mm contraction [image & text p. 315]

Back 25

--

Front 26

conduction to contraction [image & text p. 316]

Back 26

--

Front 27

smooth mm contraction[flow chart p. 317]

Back 27

--

Front 28

In this autosomal-dominant trait failure of longitudinal bone growth results in short limbs. Membranous ossification is not affected (skull, facial bones, and axial skeleton are all normal. Therefore pt presents with a head and trunk of normal size, but limbs much shorter than normal.

Back 28

Achrondoplasia

Front 29

this disorder commonly presents in older pts who complain of pain in weight-bearing joints after use (e.g., at the end of the day improving with rest.) There are no systemic symptoms. This disorder results from the mechanical wear and tear of joints and leads to destruction of articular cartilage, subchondral bone formation, sclerosis, ostephytes and eburnation, Heberden's nodes (DIP) and Bouchard's nodes (PIP)

Back 29

Osteoarthritis [image p. 318]

Front 30

this autoimmune dz affects females more than men. Pts usually complain of morning stiffness improving with use, symmetric joint involvement, and systemic symptoms (fever, fatigue, pleuritis, pericarditis). This dz is an inflammatory d/o affecting synovial joints with pannus formation in the MCP, PIP joints. SubQ nodule, ulnar deviation, and subluxation may be preesent.

Back 30

rheumatoid arthritis

[image p. 318 RA]

Front 31

80% of pts w/ RA are positive for this IgG Ab

Back 31

rhematoid factor

Front 32

[image p. 318 RA-Boutonniere Deformity]

Back 32

--

Front 33

[image p. 318 RA-Swan neck Deformity/Z thumb deformity]

Back 33

--

Front 34

this d/o describes a reduction of bone mass in spite of normal bone mineralization

Back 34

osteoporosis

Front 35

osteoporosis most commonly affects this racial group

Back 35

whites>blacks>asians

Front 36

this type of osteoporosis strikes women and is due to increased bone resorption due to decreased estrogen llevels. Estrogen replacement is controversial as prophylaxis due to side effects

Back 36

type I-postmenopausal

Front 37

this type of osteoporosis affects both men and women >70 7/o

Back 37

type II-senile osteoperosis

Front 38

tx for osteoperosis/tx for severe cases

Back 38

biphosphonates
pulsatile PTH

Front 39

this desease results when there is a failure of normal bone resorption leading to thickened, dense bones. The bone defect is due to abnormal fx of osteoclasts. Serum Ca++, phosphate, and alkaline phosphatase are normal

Back 39

Osteopetrosis (marble bone dz)

Front 40

this dz results form defective mineralization of osteoid resulting in soft bones. Vit D deficiency leads to decreased Ca++ levels, increased secreation of PTH, increased serum phosphate. This d/o is reversible when vit D is replaced.

Back 40

Osteomalacia (adults)/rickets (children)

Front 41

This dz is caused by hyperparathyroidism. It is characterized by "brown tumors" (cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood). Pt presents with high serum Ca++, low serum phosphorus, and high alk phos.

Back 41

Osteitis fibrosa cystica

Front 42

this dz results in abnormal bone archhitecture caused by increase in both osteoplastic and osteoclastic activity. Serum Ca++, Phos, and PTH levels are normal. Serum ALK PHOS is ELEVATED.

Back 42

Paget's dz (osteitis dformans.

Front 43

In this d/o bone is replaced by fibroblasts, collagen, and irregular bony trabecula. It affects many bones.

Back 43

Polyostotic fibrous dysplasia.

Front 44

This is a form of polyostotic fibrous dysplasia in which there are multiple unilateral bone lesions associated with endocrine abnromalities (precocious puberty) and unilateral pigmented skin lesions

Back 44

Albrights syndrome

Front 45

This dz occurs in pts > 50 y/o presents with pain and stiffness in the shoulders and hips, often with fever, malaise, and weight loss. There is no muscular weakness. ESR is increased and it is associated with temporal (giant cell) arteritis. Tx with prednisone

Back 45

Polymyalgia Rheumatica

Front 46

This is progressive proximal mm weakness caused by CD8+ T cell induced injury to myofibers. Muscle bx with evidence of inflammation is diagnostic.
Labs show increased CK, aldolase, and positive ANA & anti-Jo-1.

Back 46

Polymyositis

Front 47

This dz is similar to polymyositis but it also involves a skin rash and inceased risk of malignany. Labs show increased CK, aldolase, and positive ANA & anti-Jo-1.

Back 47

Dermatomysitis

Front 48

female between 40-60 y/o presents with xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia, and arthritis & parotid involvement. What do you suspect

Back 48

Sjorgrens syndrome

Front 49

What autoantibodies to ribonucleoprotein Ag would you seen in Sjorgrens syndrome

Back 49

Anti SS-A (Ro)
Anti SS-B (La)

Front 50

Sjorgrens syndrome increases risk of what CA

Back 50

B-cell lymphoma

Front 51

what autoimmune dz is Sjorgrens syndrome associated with

Back 51

rheumatoid arthritis

Front 52

Sjorgrens syndrome often presents with this syndrome which consists of dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, and reflux esophagitis

Back 52

Sicca syndrome

Front 53

30 y/o black female presents with malar rash, fever, fatigue, weight loss, nonbacterial verucous endocarditis, hilar adenopathy, and Raynaud's phenominon. WIRE LOOP lesions are found in the kidney with immune complex deposition (with nephrotic syndrome. Eventially pt dies from renal failure and infections.

Back 53

Systemic lupus erythematosis

Front 54

SLE pts may be false positive on this STD test. why

Back 54

RPR/VDRL for syphilis due to presence of antiphospholipid Ab

Front 55

given the lab test for SLE describe its usefulness:
Antinuclear Ab (ANA)

Back 55

sensitive but not specific for SLE

Front 56

given the lab test for SLE describe its usefulness:
Antibodies to double stranded DNA (anti-dsDNA

Back 56

very specific, indicates a poor prognosis

Front 57

given the lab test for SLE describe its usefulness:
Anti-smith Ab (anti-sm)

Back 57

very specific but not prognostic

Front 58

given the lab test for SLE describe its usefulness:
Antihistone Ab

Back 58

indicates drug induced lupus

Front 59

this is an autoimmune-mediated intolerance of gliadin (wheat) which leads to steatorrhea. It is associated with people of northern european descent. Findings inlude blunting of villi, lyphocytes in the lamina propria, and abnormal D-xylose test. It tends to affect the jejunum.

Back 59

Celiac Sprue

Front 60

What immune dz is celiac sprue associated with

Back 60

dermatitis herpetiformis

Front 61

10-15% of Celiac sprue cases lead to malignancy what is the most common CA

Back 61

T-cell lymphoma

Front 62

Man presents with enlarged painful MTP joint in the big toe (podagra). He describes nodules on his external ear and achilies tendon. He describes the pain getting worse after alcohol or eating a big meal. He has a dz that manifests itself in the precipitation of monosodium urate crystals into joints due to hyperuricemia.

Back 62

Gout

Front 63

what inherited enzyme deficiencies can result in gout (give 2)

Back 63

lesch-nyhan syndrome
PRPP excess
glucose 6 phosphate deficiency

Front 64

give an iatrogenic cause of gout

Back 64

thiazide diuretics

Front 65

describe the crystals in gout

Back 65

needle shaped and NEGATIVELY BIREFRINGENT

Front 66

give 2 tx medications for gout

Back 66

allopurinol, probenecid, colchicine, and NSAIDS

Front 67

this dz effects men and women over the age of 50 equally. It is caused by deposition of calcium pyrophosphate crystals within the joint space. It usually affects large joints like the knee.

Back 67

pseudogout

Front 68

describe the crystals in pseudogout.

Back 68

basophilic, rhomboid crystals that are weakly positively birefringant.

Front 69

what are the crystals made of in pseudogout? gout?

Back 69

calcium pyrophosphate
uric acid

Front 70

IM DAMN SHARP mneumonic for lupus stands for

Back 70

Immunoglobins (anti-dsDNA, anti-sm, antiphospholiid)
Malar rash
Discoid rash
Antinuclear Ab
Mucositis (oropharyngeal ulcers
Neurologic d/o
Serositis (pleuritis, pericardiitis)
Hematologic d/o
Arthritis
Renal d/o
Photosensitivity

Front 71

Man 20-40 y/o presents with hemoptysis from pulmonary hemorrhages, hematuria, anemia, and crescentric glomarulonephritis due to renal lesions. Anti-glomerular basement membrane Ab produce linear staining on immunoflurescence.

Back 71

Goodpasture's syndrome

mneu: There are 2 Good Pastures for this dz: Glomerulus & Pulmonary.

Front 72

Goodpasture's syndrome is this type of hypersensitivity dz

Back 72

type II

Front 73

this dz common in black females is characterized by immune-mediated, widespread noncaseating granulomas.

Back 73

sarcoidosis

Front 74

what lab test will show elevated levels in sarcoidosis

Back 74

elevated ACE levels

Front 75

Give 5 dz or findings associated with sarcoidosis

Back 75

restrictive lung dz, bilateral hilar lympadenopathy, erythema nodosum, Bell's palsy, epothelial granulomas containing microscopic Schaumann & asteroid bodies, uveoparotitis,, and hypercalcemia (due to its active form in the epithelioid macrophage)

Front 76

What does the mneumonic for Sarcoidosis GRAIN stand for

Back 76

Gammaglobinemia
Rheumatoid arthritis
ACE increase
Interstitial fibrosis
Noncaseating granulomas

Front 77

Name 2 Seronegative spondyloarthropathies (arthritis with no rheumatoid factor [no anti-IgG Ab)

Back 77

Ankylosing spondylitis
Reiter's syndrome

Front 78

Seronegative spondyloarthropathies have a strong association for this gene that codes for HLA MHC I

Back 78

HLA B27

Front 79

Seronegative spondyloarthropathies occur more often in males or females

Back 79

males

Front 80

this is a chronic inflammatory dz of the spine and sacroiliac joints which leads to ankylosis (stiff spine), uveitis, and aortic regurgitation

Back 80

ankylosing spondylitis

Front 81

pt with the dz often presents post GI or chlamydia infectins with the classic triad of urethritis, conjunctivitis, and anterior uveitis, and arthritis

Back 81

Reiter's syndrome

mneu: can't see (anterior uveitis/conjunctivitis), can't pee (urethritis), can't climb a tree (arthritis)

Front 82

this dz is excessive fibrosis and collagen deposition throughout the body. It commonly effects females and is most often seen in the skin but also effects the CV, GI and renal systems

Back 82

Scleroderma (progressive systemic sclerosis-PSS)

Front 83

give the 2 types of Scleroderma

Back 83

1)diffuse
2)crest

Front 84

this type of Scleroderma has widespread skin involvement, rapid progression, and early visceral involvement

Back 84

diffuse scleroderma

Front 85

what Ab is diffuse scleroderma associated w/

Back 85

Scl-70

Front 86

this type of Scleroderma includes Calcinosis, Raynaud's phenominon, Esophageal dysmotility, Sclerodactyly, and Telagiectasia. There is limited skin involvement (often confined to fingers and face) and a more benign clinical course.

Back 86

CREST Syndrome

Front 87

What Ab is CREST Syndrome associated with

Back 87

anticentromere Ab

Front 88

Skin disorders:
This describes a group of inflammatory pruritic skin d/o. The etiology involvves allergy (usually type IV hypersensitivity), chemical injury, or infection.

Back 88

dermatitis

Front 89

Skin disorders:
this describes a pruritic eruption, commonly on the flexor surfaces. It is often associated with other atopic dz like asthma, or allergic rhinitis

Back 89

Atopic dermatitis (eczema)

Front 90

Skin disorders:
this describes a type IV hypersensitivity reaction that follows exposure to an allergen (e.g., poison ivy, poison oak, nickel, rubber, chemicals) lesions occur at the site of contact

Back 90

allergic contact dermatitis

Front 91

Skin disorders:
this descrribes epidermal hyperlasia (acanthosis with parakeratoic scaling (nucleii still in stratum corneum) especially on knees and elbows. There is an increase in stratum spinosum BUT A DECREASE IN STRATUM GRANULOSUM. You may see the Auspitz sign

Back 91

psoriasis

Front 92

Skin disorders:
this presents with pruritic papules and vesicles. It is associated with celiac dz

Back 92

dermatitis herpetiformus.

Front 93

Skin disorders:
This describes pruretic, purple, polygonal papules with infiltrates of lymphocytes at dermoepidermal jx

Back 93

lichen planus

Front 94

Skin disorders:
This is associated with infections, drugs, cancers, and autoimmune dz. Pt presents with multiple types of lesions, including macules, papules, vesicles, and TARGET LESIONS (red papules with pale central area

Back 94

erythema multiforme

Front 95

this is the major form of erythema multiform. It is characterized by high fever, bulla formation and necrosis, ulceration of skin, and a high mortality rate

Back 95

Stevens-Johnson syndrome

Front 96

Skin disorders:
this describes flat, pigmented squamous epithelial proliferation with keratin-filled cysts (HORN CYSTS)
this is a BENIGN d/o

Back 96

Seborrheic keratosis

Front 97

Skin disorders:
This is caused by sun exposure. It is a small, rough erythematous or brownish papule. It is a premalignant lesion. The risk of carcinoma is proportional to epithelial dysplasia

Back 97

Actinic keratosis

Front 98

Skin disorders:
This is a tumor of connective tissue elements of dermis that causes raised, thickened scars. It follwos trauma to the skin, especially in African Americans

Back 98

Keloid

Front 99

Skin disorders:
This is an autoimmune d/o with IgG Ab against epidermal basement membrane (linear immunofluorescence). It is similar to but less severe than pemphigus vulgaris in that it affects the skin but spares the oral mucosa.

Back 99

Bullous Pemphigoid

Front 100

Skin disorders:
This is a potentially fatal autoimmune skin d/o. It causes intradermal bullae involveing the oral mucosa and skin. Findings include acantolysis (breakdown of epithelial cell-to cell jxns) and IgG Ab against epidermal cell surface (immunofluorescence throughout epidermis)

Back 100

pemphigus vulgaris

Front 101

This very common skin cancer is associated with excessive exposure to sunlight and to arsenic exposure. Lesions commonly appear on hands and face. It is locally invasive but rarely metastasizes.

Back 101

squamous cell carcinoma

Front 102

what is the precursor to squamous cell carcinoma

Back 102

actinic keratosis

Front 103

what is the key histopathologic finding of squamous cell carcinoma

Back 103

keratin "pearls"

Front 104

This skin cancer is most common in sun exposed areas of the body. It is locally invasive but almost never metastasizes. Gross pathology shows pearly papules

Back 104

Basal cell carcinoma

Front 105

Basal cell tumors have this type of nucleii

Back 105

palasading

Front 106

This skin cancer is a common tumor with significant risk of metastisis. It is associated with sinlight exposure and light skined persons are at increased risk. Incidence is rapidly increasing.

Back 106

melanoma

Front 107

what factor of a melanoma primary coorelates with increased risk of metastasis

Back 107

depth

Front 108

this is a precursor to melanoma

Back 108

dysplastic nevus

Front 109

This tumor occurs most commonly at the epiphyseal end of long bones. Peak incidence is 20-40 y/o. It is a locally agressive benign tumor often found around the distal femur or proximal tibial region. It has a characteristic "double bubble" or "soap bubble" appearance on ex-ray. Microscopically you sse spindle shaped cells with multinucleated giant cells

Back 109

giant cell tumor

Front 110

this is the most common benign bone tumor it usually occurs in men < 25 y/o. It commonly originates from the metaphysis. Maliggnant transformation to chondrosarcoma is rare.

Back 110

Osteochondroma

Front 111

this is a benign cartilaginous neoplasm found in the intramedullary bone. It usually occurs in the distal extremities

Back 111

Enchondroma

Front 112

This is the most common primary malignant tumor of the bone. Peak incindence is in men 10-20 y/0 it is commonly found in the metaphysis of long bones. Predisposing factors include Paget's dz of the bone, bone infarcts, radiation, and familial retinoblastoma. You often see Codman's triange (from elevation of the periosteum) on x-ray.

Back 112

Osteosarcoma (osteogenic carcinoma)

Front 113

This is an anaplastic small blue cell malignant tumor. It is most common in boys <15 y/o. It is extremely aggressive with early mets but responsive to chemotherapy. There is characteristic "ONION-SKIN" appearance in bone. It commonly appears in the diaphysis of long bones, teh pelvis, scapula and ribs. It is associated with a 11;22 translocation

Back 113

Ewing's sarcoma

mneu:going out for eWINGS & ONION rings

Front 114

this is a malignant cartilaginous tumor. It is most common in men aged 30-60 y/o. It is usually located in the pelvis, spine, scapula, humerus, tibia or femur. It may be of primary origin or from a osteochondroma.

Back 114

Chondrosarcoma

Front 115

image p.323 -Primary bone tumors

Back 115

--

Front 116

this dz is seen in heavy smokesr. It is ideopathic and presents with thrombosing vasculitis of intermediate and small peripheral arteries and beins. On exam you may see intermittent claudication, superficial nodular phlebitis, cold sensitivity (raynaud's phenomenon) and severe pain in the effected part. It may lead to gangrene. The tx is to stop smoking

Back 116

Buerger's dz (AKA thromboangiitis obliterans)

Front 117

this dz primarily affects Aisian females <40 y/o. It is is known as "pulseless dz." They may show symptoms of Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, Weak pulses in upper extremities. It is a granulomatous thickening of the aortic arch and/or proximal great vessels it is associated with an elevated ESR.

Back 117

Takayasu's arteritis

mneu: Symptoms: FAN MY SKIN On Wednesday

Front 118

Takayasu's arteritis affects these sized arteries

Back 118

medium and large

Front 119

This dz usually affects elderly females. It is the most common vasculitis that affects medium and small arteries-- usually branches of the carotid arteries. It is focal and granulomatous. Findings include unilateral headache, jaw claudication, impared vision (occlusion of opthalmic artery, which can lead to blindness. Half of pts have systemic involvement and polymalgia rheumatica (proximal mm pain and periarticular pain

Back 119

Temporal arteritis (giant cell arteritis)

Front 120

What lab value is elevated in Temporal arteritis (giant cell arteritis)

Back 120

ESR

Front 121

How do you tx Temporal arteritis (giant cell arteritis)

Back 121

steroids

Front 122

this dz is characterized by necrotizing immune complex inflammation of medium sized muscular arteries typically involving renal and visceral vessels. Symptoms include fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, hypertension, neurologic dysfunction and cutaneous eruptions. Multiple aneurisms and constrictions on arteriogram.

Back 122

Polyarteritis nodosa

Front 123

30% of Polyarteritis nodosa pts are seropositive for this.

Associated with ANCA?

Back 123

Hep B

No

Front 124

Tx of Polyarteritis nodosa

Back 124

corticosteroids, cyclophosphamide

Front 125

this dz is characterized by a triad of focal necrotizing vasculitis, necrotizing granulomas in the lung and uppeer airway, and necrotizing glomerulonephritis. Symptoms include perforation of the nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, hematuria, and red cell casts. Chest X-ray may reveal large nodular densities

Back 125

Wegener's granulomatosis

Front 126

This is a strong antibody marker for Wegener's granulomatosis

Back 126

C-ANCA

Front 127

tx for Wegenner's granulomatosis

Back 127

cyclophosphamide and corticosteroids

Front 128

This P or C-ANCA positive vasculitis is like Wegners but lacks granulomas

Back 128

microscopic polyangitis

Front 129

This ANCA positive vasculitis is limited to the kidney

Back 129

primary pausi-immune crescentic glomerulonephrits

Front 130

This ANCA positive vasculitis is granulomatous vasculitis with eosinophilia. It involves the lung, heart, skin, kidneys, enrves. It is often seen in atopic pts.

Back 130

Churg-Strauss syndrome

Front 131

this is an acute self-limiting dz of infants/kids. It is an acute necrotizing vasculitis of small/medium sized vessels. It presents with fever, congested conjunctiva, changes in lips/oral mucosa, and lymphadenitis. Child may develop coronary aneuriysms.

Back 131

Kawasaki dz

Front 132

This is the most common form of childhood systemic vasculitis. It presents with skin rash, arthralgia, intestinal hemorrhag,e abdominal pain, and melana

Back 132

Henoch-Schonlein purpura

Front 133

This tumor occurs most commonly at the epiphyseal end of long bones. Peak incidence is 20-40 y/o. It is a locally agressive benign tumor often found around the distal femur or proximal tibial region. It has a characteristic "double bubble" or "soap bubble" appearance on ex-ray. Microscopically you sse spindle shaped cells with multinucleated giant cells

Back 133

giant cell tumor

Front 134

this is the most common benign bone tumor it usually occurs in men < 25 y/o. It commonly originates from the metaphysis. Maliggnant transformation to chondrosarcoma is rare.

Back 134

Osteochondroma

Front 135

this is a benign cartilaginous neoplasm found in the intramedullary bone. It usually occurs in the distal extremities

Back 135

Enchondroma