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104 Cards in this Set

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What are the layers of the epidermis from surface to base?
Corneum, Lucidum, Granulosum, Spinosum, Basalis
What are the epithelial cell junctions?
1. Zona occludens (tight junctions)- prevents diffusion across paracellular space; composed of claudins and occludins
2. Zona adherins (intermediate junctions)- Surrounds perimeter just below zona occludens; cadherins connect to actin (Ca-dependent)
3. Macula adherens (desmosome)- Cadherins connect to intermediate filaments
3. Gap junction- Allows adjacent cells to communicate for electric and metabolic functions
What do hemidesmosomes do and what autoimmune disorder are they associated with?
Connect cells to underlying ECM; bullous pemphigoid produces autoantibodies
What does integrin do?
Maintains the integrity of the BM and binds to laminin in the BM, fibronectin, and collagen.
What do cadherins do?
Attach cells of the same type and do not attach to the BM (Ca-dependent). Remember these are down regulated in malignant neoplasms so that they can escape (E-cadherin)
What is the unhappy triad?
MCL =tibial collateral ligament, ACL, LATERAL meniscus
What does the ACL do and where is it attached?
The ACL prevents anterior displacement of the tibia relative to the femur when the knee is flexed (positive drawer sign indicates tearing). It attaches to the anterior part of the tibia and the posterior part of the medial surface of the lateral epicondyle.
What does the PCL do and where is it attached?
The PCL prevents posterior displacement of the tibia relative to the femur. It attaches to the posterior aspect of the tibia and the anterior part of the lateral surface of the medial epicondyle.
What indicates a torn MCL?
Abnormal passive abduction
What muscles make up the rotator cuff?
Supraspinatous- abducts initially (10 degrees). The tendon is vulnerable to injury because of impingement between the acromion and head of the humerus.
Infraspinatus- Laterally rotates arm; pitching injury
Teres minor- Adducts and laterally rotates arm
Subscapularis- Medially rotates and adducts arm
What structures are damaged in an anterior shoulder dislocation?
1. Axillary nerve and posterior circumflex artery
2. Supraspinatous tendon
3. Anterior glenohumeral ligaments and glenoid labrum separation from the articular surface of the anterior glenoid neck (Bankhart lesion)
4. Posterolateral humeral head defect (Hill-Sack lesion)
How is the axillary nerve injured?
Fracture of the surgical neck of the humerus, IM injections, dislocation of the humeral head (shoulder dislocation)
How is the radial nerve injured?
Midshaft fracture of the humerus, compressed in the axilla by incorrect use of a crutch, saturday night palsy
How is the deep branch of the radial nerve injured?
Subluxation of the radius
How is the median nerve injured?
Supracondylar fracture of the humerus, pronator teres syndrome, carpal tunnel syndrome, dislocated lunate
How is the lower trunk of the brachial plexus injured?
Compressed by a cervical rib or by a Pancoast tumor of the lung
How is the C7 root injured?
Cervical disk lesion, herniation
How is the upper trunk of the brachial plexus injured (includes MSC nerve)
Trauma, hyperextension of neck (MVA, birth trauma)
How is the ulnar nerve injured?
Repeated minor trauma, fracture of the medial epicondyle of the humerus, trauma to the heal of the hand, fracture of the hook of the hamate (falling onto an outstretched hand)
What motor lesions are seen with axillary nerve damage?
Deltoid (arm abduction at shoulder)
What sensory lesions are seen with axillary nerve damage?
Over deltoid muscle
What motor lesions are seen with radial nerve damage?
Problems with extension (brachioradialis, extensors of the wrist and fingers, supinators, triceps). WRIST DROP
What sensory lesions are seen with axillary nerve damage?
Over the deltoid muscle
What motor lesions are seen with median nerve damage?
Proximal- thumb opposition; See- APE HAND: Loss of thumb opposability. Ulnar deviation of wrist upon flexion
Distal- Lateral finger flexion, wrist flexion. See claw hand (like the distal ulnar nerve lesion except this time you're asking the patient to make a fist and they cant flex digits 1-3); If you ask them to extend their hand they cant extend digits 2, 3
What sensory lesions are seen with median nerve damage?
Proximal- Dorsal and palmar aspects of the lateral 3 1/2 fingers, thenar eminance

Distal- Dorsal and palmar aspects of the lateral 3 1/2 fingers
What motor deficits are seen with ulnar nerve damage?
Proximal- Medial finger flexion (cant make a fist with digits 4 and 5), wrist flexion. WIll see radial deviation of the wrist upon flexion..

Distal- Abduction and adduction of fingers (interossei); adduction of thumb, extension of 4th and 5th digits. Will see claw hand (patient tries to extend fingers but can't extend 4 and 5)
What is Klumpke's total claw?
Lesion of the lower trunk (C8-T1); loss of function of lumbricals, forearm finger flexors (median), and finger extensors (radial). Clawing of all digits
How is the LTN injured?
Radical mastectemy!!!!! Winged scapula and lymphedema
What do the dorsal interosseus muscles do?
Abduct the fingers (ulnar)
What do the palmar interosseus muscles do?
Adduct the fingers (ulnar)
What is tennis elbow?
Lateral epicondylitis
What is golf elbow?
Medial epicondylitis
Obturator nerve
Nerve: L2-L4
Injury:Anterior hip dislocation
Motor:Thigh adduction
Sensory:Medial thigh
Femoral nerve
Nerve:L2-L4
Injury:Pelvic fracture
Motor:Thigh flexion and leg extension
Sensory:Anterior thigh and medial thigh
Common peroneal nerve
Nerve:L4-S2
Injury:Trauma to lateral aspect of leg or fibula neck fracture
Motor:Foot eversion, dorsiflextion, toe extension. FOOT DROP, FOOT SLAP, STEPPAGE GAIT
Sensory:Anterolateral leg and dorsal aspect of foot
Tibial nerve
Nerve:L2-L4
Injury:Knee trauma
Motor:Foot inversion and plantar flexion, toe flexion
Sensory:Sole of foot
Superior gluteal nerve
Nerve: L4-S1
Injury:Posterior hip dislocation, polio, injection to the superiomedial buttock
Motor:Thigh abduction; TRENDELENBURG SIGN- Hip drops when standing on the oppostie side)
Inferior gluteal nerve
Nerve: L5-S2
Injury: Posterior hip dislocation
Motor: Can't jump, climb stairs, or rise from a seated position, can't push down
Sciatic nerve
Nerve: L4-S2; splits into common peroneal and tibial nerve. Posterior thigh. The S1 root is commonly injured and there is pain in the posterior thigh that shoots to the foot and decreased ankle jerk reflex. Irritation by bone spurs, piriformis, or herniated disc
What part of the sarcomere only contains actin?
I band (actin is attached to Z line)
What part of the sarcomere only contains myosin?
H zone (myosin attaches to M line in the middle)
What part of the sarcomere contains both actin and myosin?
A band
What shortens during contraction?
H- and I-bands; A remains the same!!!!!!
What arteries are at the femoral head?
Superior and inferior gluteal arteries
What arteries are at the femoral neck?
Medial and lateral circumflex arteries
How does the muscle relax?
Ca efflux from the cytoplasm- via Ca-ATPase and Na/Ca exchange
What are the steps of skeletal muscle contraction
1. Ca binds Troponin C so that tropomyosin moves out of the way. In a cocked state
2. Myosin (attached to ADP and Pi) binds to actin to form the cross-bridge
3. ADP and Pi are released (power stroke)
4. ATP binds myosin and releases actin filment and shortening occurs. Without ATP- rigor mortis
How does smooth muscle contraction occur?
Depolarization causes opening of VG Ca Channels, increased Ca in cytoplasm, Ca binding calmodulin, and activation of MLCK, which allows cross-bridge formation. (NO inhibits MLCK and activates MLCP to relax)
What abnormalities are seen in osteoporosis?
Loss of trabecullar (spongy bone) with normal lab values and bone mineralization
What abnormalities are seen in osteopetrosis?
Normal Ca, PO4, ALP
Abnormal osteoclasts- not enough bone resorption, thick bones. Decreased marrow space leads to anemia, thrombocytopenia, infection
Erlenmeyer flask bones, CN impingement
What abnormalities are seen in Paget's disease (osteitis deformans)?
Initially increased osteoclast activity, followed by increased osteoblast activity, mosaic bone pattern, chalk-stick fractures, may cause high-output heart failure due to AV shunts, hearing loss due to auditory foramen narrowing, increased hat size, can lead to osteogenic sarcoma, mosaic pattern
-Normal Ca, PO4, PTH, VERY HIGH ALP
What is polyostotic fibrous dysplasia?
Bone is replaced by fibroblasts, collagen, and irregular bone trabeculae.
McCune-Albright syndrome- multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and unilateral pigment spots (Cafe-au-lait/coast of maine)
Osteoma- benign
Associated with Gardner's syndrome (FAP). Often in skull (sinuses, facial)- new piece of bone grows on an existing bone. Benign
Osteoid osteoma- benign
Woven bone surrounded by osteoblasts < 2cm on proximal tibia and femur. Most common in men < 25 years. Nocturnal pain is relieved with ASA
Osteoblastoma- benign
Looks the same as osteoid osteoma but larger and in vertebral column. Pain NOT relieved by ASA
Osteochondroma- benign
MC benign bone tumor; Mature bone with cartilagenous cap. Men < 25 years in long bone metaphysis. Rare malignant transformation
Enchondroma- benign
Found in intramedullary bone on distal extremities (hands, feet). Diaphysis
Giant cell tumor (osteoclastoma)- Benign
Epiphyseal end of long bones, peak incidence 20-40 years, locally aggressive around the knee; double bubble or soap bubble appearance on x-ray; spindle shaped with multinucleated giant cells
Osteosarcoma (malignant)
Peaks 10-20 years, 2nd MC malignant (after multiple myeloma). Found at metaphysis of long bones (knee).
Predisposing factors- Paget's, bone infarct, radiation, familial Rb.
See Codman's triangle or sunburst pattern due to elevation of periosteum. Poor prognosis
Ewing's sarcoma
Anaplastic small blue cell tumor. Boys < 15, onion skin appearance in bone, aggressive but responsive to chemo, See in diaphysis of long bones, pelvis, scapula, and ribs. 11;22
Chondrosarcoma- malignant
Men 30-60 in PELVIS, spine, scapula, long bones. Seen in diaphysis as a glistening mass
Increasing order of age for bone tumors
Ewing < osteosarcoma < chondrosarcoma < multiple myeloma
Decreasing frequency of bone tumors
Multiple myeloma, osteosarcoma, chondrosarcoma, Ewing sarcoma, Giant cell tumor
What are rhematoid nodules?
Fibrinoid necrosis surrounded by palisaiding histiocytes that are subcutaneous in the elbows or lumbosacral areas usually
What autoantibodies are found in RA?
anti-IgG antibody (rheumatoid factor), anti-CCP (less sensitive, but more specific)
Associated with HLA-DR4
What type of hypersensitivity is RA?
Type III
What joint is NOT involved in RA?
DIP
What is the triad seen in Sjogrens?
Xerophthalmia (dry eyes, conjunctivitis)
Xerostomia (dry mouth, dysphagia), but parotid enlargement (increased risk of B-cell lymphoma) and dental caries
Arthritis
How is sicca syndrome from Sjogrens?
No arthritis
What autoantigens are seen in Sjogrens?
SS-A (Ro), SS-B (La)
What causes gout?
Lesch-Nyhan syndrome, PRPP excess, decreased excretion of uric acid (thiazides), increased cell turnover (tumor lysis syndrome), von Gierke's disease. Mostly due to underexcretion (90%) of uric acid as opposed to overproduction.
Why do bouts of gout happen after alcohol consumption?
Alcohol metabolites compete for the same excretion sites in the kidney as uric acid.
What is the treatment for acute gout? chronic gout?
Acute- NSAIDs, Colchicine
Chronic- Allopurinol, probenecid
Where does pseudogout tend to occur and what are the crystals made of?
At the knee, calcium pyrophosphate
What is associated with gonococcal arthritis?
Synovitis at the knee, tenosynovitis at the hand, dermatitis (usually wrists and feet)
What is seen in ankylosing spondylitis?
Affects sacroiliac joints, ankylosis (fusion of joints causing it to be stiff; improves by exercise), bamboo spine with Ca at edges, uveitis, aortic regurgitation
What is the triad seen in reactive arthritis?
Arthritis (achilles tendon), urethritis, conjunctivitis and uveitis
What organisms can cause reactive arthritis?
Shigella, salmonella, campylobacter, yersinia, bartonella, chlamydia. REMEMBER THIS IS AUTOIMMUNE MEDIATED SO NO BACTERIA IN SYNOVIAL FLUID. This occurs POST-infection!!!!
What is anti-smith antibody
Specific for lupus, but not prognostic
What features are seen in SLE?
Immunoglobulins, Malar rash, discoid rash, ANA, Mucositis (oropharyngeal ulcers), Neurologic disorders (headaches, foot drop), Serositis (pleuritis, fibrinous pericarditis), hematologic disorders (microangiopathic hemolytic anemia), arthritis, renal disorders, photosensitivity (IM DAMN SHARP)
What features are seen in sarcoidosis?
Restrictive lung disease (interstitial fibrosis), bilateral hilar LAD, erythema nodosum (on shins), Bell's palsy, uveoparotitis, hypercalcemia, elevated serum ACE levels, UVEITIS
What is polymyalgia rheumatica?
Pain and stiffness in shoulders and hips associated with temporal arteritis. Elevated ESR but normal CK (DOES NOT AFFECT MUSCLES- affects JOINTS)
What muscles are affected by polymyositis?
Shoulders and proximal weakness. Has perifascicular inflammation
What is seen in MG?
Muscle weakness worsens with use (see on compound muscle AP test), ptosis, diplopia, general weakness
Antibodies to POSTSYNAPTIC AChR
What is seen in Lambert-Eaton syndrome?
Antibodies to PRESYNAPTIC Ca-channels (results in decreased ACh release) and proximal muscle weakness. Eye muscle involvement is uncommon (but can occur). Cranial nerve involvement is present (usually oculobulbar) and autonomic (dry mouth, impotence), HYPOreflexia
Improves with use!!!!
What is seen in CREST?
Calcinosis- subepithelial Ca deposits
Raynaud's
Esophageal dysmotility (GERD, achalasia)
Sclerodactyly
Telangectasia (fingers, face)
What does hyperkeratosis mean?
Increased thickness of the stratum corneum.
Psoriasis
What is parakeratosis?
Hyperkeratosis with retention of nuclei in stratum corneum.
Psoriasis
What is acantholysis?
Separation of epidermal cells
Pemphigus vulgaris
What is acanthosis?
Epidermal hyperplasia (increased spinosum)
Psoriasis
What is dyskeratosis?
Abnormal, premature keratinization of individual keratinocytes, eosinophilis
SCC
What is spongiosis?
Edematous fluid in the intracellular space
Allergic dermatitis
What is the sign of Leser-Trelat?
Sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (GI, lymphoid)
What is vitiligo commonly seen with?
Hypothyroidism
Where does SSSS commonly occur in newborns?
Umbilical stump- binds GM4
What is lichen planus associated with?
HCV
When do you see erythema nodosum?
Coccidioidomycosis, histoplasmosis, TB, leprosy, strep, sarcoidosis
Urticaria
Dermal edema; NO epidermal changes
What is Acanthosis Nigricans?
Hyperplasia of stratum spinosum associated with hyperinsulinemia and visceral malignancy
What is seborrheic keratosis?
Keratin-filled cysts that look pasted on
What is actinic keratosis?
Sand-papery, predisposition to SCC
What is Klumpke's palsy and thoracic outlet syndrome?
Compression of the subclavian artery and inferior trunk of the brachial plexus:
1. Atrophy of the thenar and hyothenar eminences.
2. Atrophy of the interosseus muscles.
3. Sensory deficits on the medial side of the forearm and hand.
4. Disappearance of the radial pulse upon moving head to the ipsilateral side.
What can cause Klumpe's palsy and thoracic outlet syndrome?
Cervical rib compression, hypertrophy of anterior scalene, pancoast tumor, clavicle fracture
What are people with lupus anticoagulant at risk for? (false positive VRDL)
Antiphospholipid syndrome- venous and arterial thromboembolism, repeated miscarriages. They have a prolonged PTT