Musculoskeletal First Aid 2007

Front 1

tight junction

Back 1

zona occludens

Front 2

intermediate junction

Back 2

zona adherens
actin and e-cadherens

Front 3

desmosome

Back 3

macula adherens
keratin and desmoplakin

Front 4

phospholambin does what?

Back 4

inhibits the ATPase when the skeletal mm contraction is done

Front 5

smooth muscle contraction- after calsium is released what happens?

Back 5

Ca binds to calmodulin and activates myosin light chain kinase and this causes myosin and actin to go from contraction to myosin-P and actin (cross bridge formation)

Front 6

how do you get the P off myosin during SM contraction?

Back 6

myosin light chain phosphatase

Front 7

Achondroplasia- what is effected membranous ossification or cartilage maturation?

Back 7

cartilage maturation effected due to mutation due to FGF-R3 in growth plate

Front 8

where does membranous ossification take place?

Back 8

skull, facial boneas and axial skeleton

Front 9

osteoarthritis

Back 9

wear and tear of joints
destruction of articular cartilage
subchondral cysts, sclerosis, osteophytes, eburnation

Heberden's nodes (DIP)
Bouchard's nodes (PIP)

Front 10

what will you see in the joint with oseoarthritis?

Back 10

thickened capsule
synovial hypertrophy
osteophytes

Front 11

Rheumatoid arthritis

Back 11

anti-IgG antibody with morning stiffness improving with use
synovial joints with pannus formation in MCP and PIP, subcutaneous nodules, subluxation and ulnar devation

Front 12

what are the systemic signs of RA?

Back 12

fever fatigue pleuritis and pericarditis

Front 13

osteoporsis- reduced ___ in spite of _______

Back 13

bone mass: mineralization

sparse trabeculae

whites> blacks > asians

Front 14

Type I and II osteoporosis and the fractures associated with each?

Back 14

type I- postmenopausal bone resorption due to decreased estrogen

type II- senile osteoporosis; men and women >70yrs

type I- vertebral crush fractures- kyphosis (& loss of height)
Type II-distal radius Colle's fracture, vertebral wedge fractures

Front 15

what is the TX for RA?

Back 15

bisphosphonates or pulsatile PTH for severe cases

Front 16

osteopetrosis
(marble bone disease)

Back 16

failure of normal bone resorption- thick dense bone
-due to osteoclast malfxn
-decreased marrow space can lead to anemia, thrombocytopenia and infection
-normal Ca P and alkphos

Front 17

osteomalacia (Rickets)

Back 17

defective mineralization of osteoid- soft bones
-vit D defic causes dec Ca adn increased PTH and thus dec serum phos
-reversed with vit D administration

Front 18

osteitis fibrosa cystica

Back 18

caused by hyperPTHism
-"brown tumors" cystic spaces lined by clasts and fibrous stroma and (blood)
-high ca, low phos and high alk phos

Front 19

Boutonniere deformity and swan-neck deformity and Z thumb deformity
-assoc with RA

Back 19

PIP, DIP and thumb joint
-assoc with RA

Front 20

Pagets disease

Back 20

abnormal bone architec caused by increased in clasts and then blasts
-only alk phos is elevated
-chalkstick fractures
- fibroblasts endothel cells and vascularity are increased
-high output cardiac failure

Front 21

Polyostotic fibrous dysplasia

Back 21

bone replaced by fibroblasts, collagen and irrerg trabecula
-Albrights syndrome- mult unilat bone lesions assoc with endo abnormalities (precoc puberty) and unilat skin pigmentation

Front 22

Polymyalgia rheumatica

Back 22

pain in shoulders and hips
- not assoc with mm weakness
- temp arteritis assoc
->50yrs
-tx: prednisone

Front 23

polymyositis/ dermatomyositis

Back 23

POLYMYOSITIS-progressive symmetric prox mm weakness
-CD8 T cell induced injury to myofibrils

DERMATOMYOSITIS: similar to poly but has shawl and face skin rash and increased risk for malig

labs: inc CK aldolase and ANA and anti-jo1

Front 24

MCTD

Back 24

Reynauds phenomenon, arthralgia, myalgia and esoph hypomotility

-U1RNP Ig's and responds to steroids

Front 25

Sjogrens syndrome

Back 25

xerothalmia xerostomia (dry mouth, dysphagia) arthritis
-parotid enlargement and incr risk of B cell lymphoma
-dental caries
-anti SS-A (ro) SS-B (la)
-female 40-60yrs

Front 26

sjogrens is assoc with ____ and ___ syndrome

Back 26

-RA
- SICCA SYNDROME: dry eyes and dry mouth, nasal and vag dryness and chronic bronchitis and reflux esophagitis

Front 27

sarcoidosis

Back 27

non caseating granulomas and inc ACE
-black females
-restric lung disease, bilateral hilar lymphadeno, erythema nodosum, bells palsy
-epith granulomas containing Schaumann and asteroid bodies
-uveoparotitis and hypercalcemia
-BC VIT D is conv to its active form

Front 28

erythema nodosum

Back 28

-assoc with sarcoidosis
-inflamm of fat cells under the skin on both shins due to exudation of blood and serum

Front 29

pseudogout

Back 29

calcium pyrophos crystals that are weakly pos bifringent
-in lg joints (knee)
->50 yrs old and men = women

Front 30

gout

Back 30

monosodium urate crystals
-lesh-nyhan ,PRPP excess, G6PD defic
-assoc with thiazides that competit inhibit secretion of uric acid
-assym joint distib
-podagra in big toe
-tophus formation on ear or achilles tendon
-neg bifring crystals

Front 31

lupus

Back 31

-black females
-non bacterial verrucous endocarditis
-wire loop lesions in kidney
-death from renal failure and infx
-false pos on syphillis test (anti phoslipid Ig)
-sensit but not spec for SLE ana
-anti-dsDNA, spec, poor prog
-anti-sm Ig, spec but not prognostic
-anti-histone Ig- drug induced lupus
(photosensit and discoid rash)

Front 32

ankylosing spondylitis

Back 32

-sacroileac joints and spine, uveitis and aortic regurg
-arthritis, conjunc, and urethritis
-post GI or chlamydial infxn

Front 33

scleroderma
-progressive systemic sclerosis-PSS

Back 33

excessive fibrosis and collagen throughout body- 75% female
-commonly skin but also GI kidney and cardiovascular

Front 34

what are the 2 types of scleroderma?

Back 34

diffuse- widespread skin involvement, rapidly progressing with early visceral involvement.
-anti -Scl-70 Ig

CREST syndrome- Calcinosis, Raynauds phenom, Esoph dysmotility, Sclerodactyly and Telangiectasia
-limited skin involvement (fingers and face) more benign course
-anti-centromere Ig

Front 35

impetigo

Back 35

honey crusting lesions highly contagious

Front 36

dermatitis

Back 36

inflamm pruritic skin disorders (chemical injury of infxn)
HypSen rxns usually type IV

Front 37

Atopic dermatitis
Eczema

Back 37

pruritic eruption usu on flexor surface
often assoc with other atopic diseases (asthma, allergic rhinitis)

Front 38

allergic contact dermatitis

Back 38

Type IV hypsen rxn that follows exposure to allergen (poison ivy)

Front 39

Psoriasis

Back 39

epidermal hyperplasia (acanthosis) with parakeratotic scaling (nucleii still in strat corneum)
-esp on knees and elbows
-increased stratum spinosum and decreased granulosum
-Auspitz sign

Front 40

Dermatitis herpetiformis

Back 40

assoc with celiac disease
-IgA at the tips of dermal papillae

Front 41

Lichen planus

Back 41

pruritic purple polygonal papules with lymphocytes at the dermalepidermal junction (localized baldness)

Front 42

erythema multiforme

Back 42

assoc with infections drugs cancer and autoimmune dis.
- multiple types of lesion and "target lesions"

Front 43

Stevens-johnson syndrome

Back 43

sulfa and anticonvulsant drugs (major form of erythema multiforme
high fever bullae formation and ulceration of the skin and high mortality rate
-multiple mucous membrane involvement

Front 44

Seborrheic keratosis

Back 44

flat pgmented sq epith proliferation with keratin filled cysts (horn cysts)
BENIGN

Front 45

Actinic Keratosis

Back 45

caused by sun exposure
-small rough erythematous brown papules
-PREMALIGNANT risk of carcinoma is proportional to epith dysplasia

Front 46

keloid

Back 46

african americans with a tumor of connective tissue elements that causes raised thickened scars

Front 47

Bullous pemphigoid

Back 47

autoimmune IgG against epidermal BM hemidesmosomes (linear immuno flourescence)
-similar to but less severe than pemphis vulgaris
-not in the mouth!

Front 48

Pemphigus vulgaris

Back 48

-potentially fatal autoimmune disorder
-intraepidermal bullae involving ORAL mucosa and skin
-acantholysis- breaking epith cell to cell jxn
-IgG against epidermal cell surface desmosomes
-immunoflour throughout epidermis

(MD- Macula adherens Desmosome (keratin and desmoplakin)

Front 49

Verucae

Back 49

soft tan colored cauliflower lesions
epidermal hyperplasia, hyperkeratosis, koilocytosis
VERRUCA VULGARIS on HANDS
CONDYLOMA ACUMINATUM on GENITALS
- HPV infects stratum basale

Front 50

squamous cell carcinoma

Back 50

very common!-excess sunlight, arsenic exposure
-hands and face and locally invasive
-rarely mets
-keratin pearls
-actinic keratosis precursor

Front 51

basal cell carcinoma

Back 51

most common in sun exposed areas
locally invasive- usu never mets
pearly papules on gross path
-PALISADING NUCLEII

Front 52

melanoma

Back 52

common tumor with risk of mets
sunlight exposure- depth correl with risk of mets
-DYSPLASTIC NEVUS is a precursor

Front 53

giant cell tumor

Back 53

epiphyseal end of long bones
double bubble and MNC giant cells
-men 20-40 yrs

Front 54

osteochondroma

Back 54

MC benign bone tumor
bone with cartilage cap found at long metaphysis <25yrs male
-transformation to chondrosarcoma is rare

Front 55

enchondroma

Back 55

cartilage neoplasm of intramedullary bone usually distal extremities (unlike chondrosarcoma)

Front 56

osteosarcoma

Back 56

MC malig tumor of bone
10-20 male
-at metaphysis of long bone
-RF: pagets disease, bone infarcts, radiation, familial retinoblastoma and Codman's triangle (elevation of periosteum on Xray)

Front 57

Ewings sarcoma

Back 57

(11:22) <15yrs boys
aggressive with early mets responsive to chemo
- onion skinning
-diaphysis of long bones, pelvis, scapula and ribs

Front 58

chondrosarcoma

Back 58

men 30-60yrs
-pelvis spine humerus scapula tibia femur
-can be 1ary or from osteochondroma
-expansile glistening mass in medullary cavity

Front 59

Takayasu's arteritis

Back 59

elevated ESR like temporal arter.
-Fever arthritis night sweats myaligia skin nodules ocular disturbances weak pulse in upper extrem

Front 60

temporal arteritis

Back 60

responds to steroids
half of patients have polymyalgia rheumatica (proximal mm pain and periarticular pain)

Front 61

polyarteritis nodosa

Back 61

necrotizing immune complex inflamm in muscular and renal and visceral aa
- neurological dysfunction and cutaneous eruptions
-Hep B seroposit in 30% pts
- multiple anyeurysms and constricts on angiogram (lesions of diff ages)
-TX corticosteroids and cyclophosphamide

Front 62

Wegener's

Back 62

C-ANCA hematuria and red cells casts
TX cyclophos. and corticosteroids

Front 63

microscopic polyangiitis

Back 63

like wegners but P-ANCA

Front 64

Churg- Strauss

Back 64

granulomatous vasculitis with eosinophilia. heart lung skin kidneys and nerves. seen in atopic pts
-P-ANCA

Front 65

Kawasaki disease

Back 65

self limiting disease of kids
-fever, congested conjunctiva, changes in LIPS and ORAL mucosa and lyphadenitis
-may devp coronary anyeurysms
-transmural inflamm

Front 66

Heoch-Schonlein purpura

Back 66

most common childhood systemic vasculitis
-palpable purpura, arthralgia, intestinal hemorr, abdominal pain and melena
-multiple lesions of the same age

Front 67

Telangiestasia

Back 67

AV malformation in small vessells
-looks like dilated capilary
-heridatary hemorragic telan. AD and presents with nose bleeds and skin discolorations