Musculoskeletal And Connective Tissue

Front 1

Upper limb Nerve Routes and Common Lesions
1. C7 root
2. Axillary n.
3. radial n.
4. median n.
5. ulnar n.
6. recurrent branch of median n.

Back 1

1. cervical disk lesion
2. surgical neck fracture, IM injections
3. incorrect use of crutch, midshaft humerus fracture
4. suracondylar fracture of humerus, pronator teres syndrome, carpal tunnel
5. reeated trauma, fracture of hook of hamate
6. superficial hand laceration

Front 2

Brachial plexus lesions
1. long thoracic nerve (C5, C6, C7)
2. lower trunk (C8, T1)
3. upper trunk (C5, C6)
4. posterior cord
5. radial nerve
6. median nerve

Back 2

1. winged scapula
2. klumpke's palsy (total claw hand)
3. Erb's palsy (waiter's tip)
4. wrist drop
5. saturday night palsy (wrist drop)
6. dec thumb function (ape hand)

Front 3

Distortions of the Hand: nerve lesion, lost lumbricals, clawed digits
1. ulnar claw
2. median claw
3. ape hand
4. Klumpke's

Back 3

1. distal ulnar n. lesion; medial lumbricals; 4th and 5th digits
2. distal median n. lesion; lateral lumbricals; 2nd and 3rd digits
3. proximal median n. lesion, loss of opponens pollicis,; can't abduct thumb
4. lower trunk lesion; all lumbricals; all digits

Front 4

Lower Extremity Nerves: Motor/Sensory action
1. obturator n.
2. femoral n.
3. common peroneal n.
4. tibial n.
5. superior gluteal
6. inferior gluteal

Back 4

1. adducts thigh/medial thigh
2. flexes thigh, extends leg/anterior thigh, medial leg
3. foot eversion, dorsiflexion/lateral leg and dorsal foot
4. foot inversion, plantarflexion/sole of foot
5. abducts thigh (lost with polio = Trendelberg sign)
6. helps rise from seated position

Front 5

Muscle contraction

Back 5

1. action potential opens voltage gated calcium channels
2. depolarization travels along muscle fiber into T tubules
3. depolarization of dihydropyridine recepter, coupled to ryanodine receptor on SR, causes calcium release from SR
4. released calcium binds troponin C causing conf change that moves tropomyosin out of myosin-binding grooves on actin filaments
5. myosin release bound ADP and is displaced actin filament causing power stroke (shortened H and I band)

Front 6

Muscle fibers
1. type 1
2. type 2

Back 6

1. slow twitch, red fibers, inc myoglobin/mito, oxidative phosphorylation (one slow red ox)
2. fast twitch, white fibers, dec myoglobin/mito, anaerobic glycolysis

Front 7

Achondroplasia
1. cause
2. inheritance
3. associated with...
4. presentation

Back 7

1. mutation in FGFR3 causing impaired cartilage maturation in growth plate
2. AD
3. advanced paternal age
4. short limbs, normal head (dwarfism)

Front 8

Osteopetrosis
1. cause
2. XRay findings
3. lab values

Back 8

1. deficiency of carbonic anhydrase II causing abnormal function of osteoclasts (dec bone resorption = marble bone disease)
2. erlenmeyer flask bones that flare out
3. calcium, phosphate, and ALP are normal

Front 9

Osteitis fibrosa cystica
1. cause
2. histology
3. lab values

Back 9

1. hyperparathyroidism
2. brown tumors: cystic spaces lined by osteoclasts and filled with fibrous stroma/blood
3. high calcium, low phosphorous, high ALP

Front 10

Paget's disease (Osteitis deformans)
1. cause
2. histology
3. labs
4. presentation
5. can lead to...

Back 10

1. inc osteoblast and osteoclast activity; most likely due to paramyxovirus
2. mosaic bone pattern
3. normal calcium, phosphorus and PTH; high ALP
4. inc hat size, hearing loss
5. osteogenic sarcoma

Front 11

Lab values in bone disorders: Ca, Ph, ALP, PTH, comments
1. osteoporosis
2. osteopetrosis
3. osteomalacia/rickets
4. osteitis fibrosa cystica
5. Paget's disease

Back 11

1. labs normal, dec bone mass
2. labs normal, thickened, dense bones
3. dec Ca, dec Ph, normal ALP, inc PTH, soft bones
4. inc Ca, dec Ph, inc ALP, inc PTH, brown tumors
5. normal Ca, normal Ph, inc ALP, normal PTH, abnormal architecture

Front 12

McCune-Albright syndrome
1. form of...
2. pathogenesis
3. presentation

Back 12

1. polyostotic fibrous dysplasia
2. bone is replaced by fibroblasts, collagen, and inrregular bony trabeculae
3. multiple unilateral bone lesions, endocrine abnormalities (precocious puberty), unilateral pigmented skin lesions (cafe au lait)

Front 13

Primary Bone Tumors
**Benign
1. giant cell tumor (osteoclastoma)
2. osteochondroma
3. osteoid osteoma
4. enchondroma
**Malignant
5. osteosarcoma
6. ewing's sarcoma
7. chondrosarcoma

Back 13

1. epiphyses, knee, soap bubble appearance on xray, spindle cells with multinucleated giant cells
2. metaphysis, most common, mature bone with cartilaginous cap
3. diaphysis, interlacing trabeculae surrounded by osteoblasts, prox tibia and femur
4. intramedullary, cartilaginous neoplasm
5. metaphysis, knee, Codman's triangle/sunburst pattern on xray
6. diaphysis, small blue cell tumor, "onion-skin" on bone, 11;22
7. intramedullary, expansile glistening mass

Front 14

Rheumatoid Arthritis
1. pathogenesis
2. labs
3. genetics
4. presentation

Back 14

1. autoimmune-inflammatory disorder with pannus formation in MCP/PIP joints
2. positive RF
3. HLA-DR4
4. morning stiffness improving with use, systemic symptoms, boutnniere/swan-neck/Z-thumb deformities, ulnar deviation

Front 15

Sjogren's syndrome
1. classic triad
2. labs
3. vs. Sicca syndrome

Back 15

1. dry eyes, dry mouth, arthritis
2. anti-ribonucleoprotein antibodies: SS-A (Ro), SS-B (La)
3. sicc has dry eyes and dry mouth without arthritis

Front 16

Gout
1. presentation
2. findings
3. treatmetn

Back 16

1. red, swollen, painful joint (1st toe MTP = podagra), tophi
2. monosodium urate crystals that are needle shaped and negatively birefringent (yellow with parallel light)
3. colchicine, NSAIDs (indomethacin), probenecid, allopurinol

Front 17

Pseudogout

Back 17

calcium pyrophosphate crytals in joint space, rhomboid, positively birefringent (yellow when perpendicular light), large joints (knee)

Front 18

Infectious arthritis
1. septic: common causes, presentation
2. chronic

Back 18

1. S. aureus, strep, Neisseria gonorrhoeae; monoarticular, asymmetrical, migratory arthritis (gonococcal)
2. TB, lyme disease

Front 19

Spondyloarthropathies
**genetics
1. ankylosing spondylitis
2. Reiter's syndrome
3. Psoriatic arthritis

Back 19

**HLA-B27
1. disease of spine and sacroiliac joints, bamboo spine
2. classic triad: conjunctivitis, urethritis, arthritis; post-GI or post-chlamydia infections
3. sausage fingers, pencil in cup deformity of DIP joints

Front 20

SLE
1. lab tests
2. I'M DAMN SHARP

Back 20

1. ANA, anti-dsDNA antibodies, anti-smith antibodies, antihistone antibodies; will see false positive syphilis test
2. immunoglobulines, malar rash, discoid rash, ANA, mucositis, neurological disorders, serositis, hematologic disorders, arthritis, renal disorders/raynauds, photosensitivity

Front 21

Sarcoidosis
1. GRAIN
2. histology
3. treatment

Back 21

1. gammaglobulinemia, rheumatoid arthritis, ACE increase, intersitial fibrosis, noncaseating granulomas
2. eipthelial granulomas containing Schaumann and asteroid bodies
3. steroids

Front 22

Polymyalgia rheumatica
1. symptoms
2. associated with..
3. lab findings
4. treatment

Back 22

1. pain and stiffness in shoulders and hips, systemic symptoms, not muscular weakness
2. temporal (giant cell) arteritis
3. inc ESR, normal CK
4. prednisone

Front 23

Polymyositis/Dermatomyositis
1. PM symptoms
2. DM symptoms
3. lab findings
4. treatment

Back 23

1. symmetric proximal weakness caused by CD8 T cell injury to myofibers, evidence of inflammation
2. also involves malar, heliotrope, and shawl and face rash, Gottron's papules, inc risk of malignancy
3. inc CK, inc aldolase, positive for ANA and anti-Jo-1
4. steroids

Front 24

NMJ disease
1. Myasthenia gravis
2. Lambert Eaton

Back 24

1. postsynaptic AChR antibodies, ptosis, diplopia, weakness, assoc with thymoma, symptoms worsen with muscle use and reverse with AChE inhibitors
2. presynaptic Ca channel antibodies, paraneoplastic disease (small cell), symptoms improve with muscle use

Front 25

Scleroderma
1. what is it?
2. Diffuse scleroderma: symptoms, antibody
3. CREST syndrome: symptoms, antibody

Back 25

1. excessive fibrosis and collagen deopsition throughout the body (esp skin, renal, pulm, CV, GI)
2. widespread skin involvement, anti-Scl-70 antibody (anti-DNA topoisomerase I)
3. calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangectasia; skin involvement often confined to fingers and face, anti-centromere antibody

Front 26

Common skin disorders
1. verrucae
2. psoriasis
3. seborrheic keratosis

Back 26

1. warts, koilocytosis, verruca vulgaris on hands, condyloma acuminatum on genitals (HPV)
2. silver scaling plaques on knees and elboes, paraketotic scaling, auspitz sign, nail pitting
3. keratin filled cysts (horn cysts), look pasted on

Front 27

Pigmentation disorders
1. albinism
2. vitiligo
3. melasma

Back 27

1. dec tyrosinase or failure of neural crest migration results in decreased melanin production (normal # of melanocytes)
2. decrease in melanocytes
3. hyperpigmentation with pregnancy or OCP use

Front 28

Infectious skin disorders
1. impetigo
2. SSSS
3. hairy leukoplakia

Back 28

1. honey colored crusting, S aureus or S. pyogenes
2. S. aureus exotoxin destroys keratinocyte attachments in stratum granulosum, sloughing of upper layer of epidermis
3. white plaques on tongue, EBV mediated, specific for HIV

Front 29

Blistering disorders
1. pemphigus vulgaris
2. bullous pemphigoid
3. dermatitis herpetiformis
4. erythema multiforme

Back 29

1. IgG aginst desmosomes, IF throughout epidermis, bullae in skin and oral mucosa, positive Nikolsky's sign
2. IgG antibody against hemidesmosomes, linear IF, eosinophils in blisters, spares oral mucosa
3. IgA at tips of dermal papillae, assoc with celiac disease
4. pneumoniae, HSV, target lesions (red papules with a pale central area)

Front 30

Miscellaneous skin disorders
1. lichen planus
2. actinic keratosis
3. acanthosis nigricans
4. erythema nodosum
5. pityriasis rosea

Back 30

1. pruritic, purple, polygonal plaques, assoc with hepatitis C, sawtooth lymphocyte infiltrates at epi-derm junction
2. premalignant squamous cell, cutaneous horn, sun exposure
3. hyperplasia of stratum spinosum, assoc with hyperlipidemia and visceral malignancys
4. fat on anterior shins, assoc with cocci, histo, TB, leprosy, strep, sarcoidosis
5. herald patch followed by christmas tree distribution

Front 31

Skin Cancer
1. squamous cell
2. basal cell
3. melanoma

Back 31

1. actinic keratosis is precursor, ulcerative red leasion, chronic draining sinuses, keratin pearls
2. rolled edges with central ulceration, pearly papules, palisading nuclei
3. risk of mets (assoc with depth), S-100 tumor marker, dysplastic nevus is precursor

Front 32

Aspirin
1. MOA
2. clinical use
3. toxicity

Back 32

1. irreversibly inhibits COX by covalent bindings > dec TAX and PG
2. depends on dose: dec platelet aggregation (low), antipyretic/analgesic (intermediate), anti-inf (high)
3. gastric upset, Reye's syndrome (kids with viral inf)

Front 33

NSAIDS
1. examples
2. MOA
3. clinical use
4. toxicity

Back 33

1. ibuprofen, naproxen, indomethcin, ketorolac
2. reversible inhibition of COX > dec PG
3. antipyretic, analgesic, anti-inf, close PDA (indomethacin)
4. nephrotoxic, GI ulcers

Front 34

Acetominophen
1. MOA
2. clinical use
3. toxicity

Back 34

1. reversibly inhibits COX, mostly in CNS
2. antipyretic, analgesic (not anti-in f)
3. hepatic necrosis, give N-acetylcysteine as antidote

Front 35

Bisphosphonates
1. examples
2. MOA
3. clinical use
4. toxicity

Back 35

1. etidronate, pamidronate, alendronate, risedronate
2. inhibit osteoclast activity
3. paget's, post-menopausal osteoporosis
4. corrosive esophagitis

Front 36

Gout drugs
1. indomethacin
2. colchicine
3. probenecid
4. allopurinol

Back 36

1. NSAID, acute gout, also for closing PDA
2. depolymerizes microtubues
3. inhibits resorption of urate in PCT, don't use for acute
4. inhbiits xanthine oxidase, inc concentrations of azathioprine and 6-MP, not for acute

Front 37

TNF-medated drugs
1. etanercept
2. infliximab

Back 37

1. recombinant form of human tnf receptor
2. anti-tnf antibody, can reactivate TB