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104 Cards in this Set
- Front
- Back
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What are the layers of the epidermis from surface to base?
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Corneum, Lucidum, Granulosum, Spinosum, Basalis
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What are the epithelial cell junctions?
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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 |
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What do hemidesmosomes do and what autoimmune disorder are they associated with?
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Connect cells to underlying ECM; bullous pemphigoid produces autoantibodies
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What does integrin do?
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Maintains the integrity of the BM and binds to laminin in the BM, fibronectin, and collagen.
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What do cadherins do?
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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)
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What is the unhappy triad?
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MCL =tibial collateral ligament, ACL, LATERAL meniscus
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What does the ACL do and where is it attached?
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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.
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What does the PCL do and where is it attached?
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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.
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What indicates a torn MCL?
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Abnormal passive abduction
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What muscles make up the rotator cuff?
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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 |
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What structures are damaged in an anterior shoulder dislocation?
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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) |
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How is the axillary nerve injured?
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Fracture of the surgical neck of the humerus, IM injections, dislocation of the humeral head (shoulder dislocation)
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How is the radial nerve injured?
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Midshaft fracture of the humerus, compressed in the axilla by incorrect use of a crutch, saturday night palsy
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How is the deep branch of the radial nerve injured?
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Subluxation of the radius
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How is the median nerve injured?
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Supracondylar fracture of the humerus, pronator teres syndrome, carpal tunnel syndrome, dislocated lunate
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How is the lower trunk of the brachial plexus injured?
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Compressed by a cervical rib or by a Pancoast tumor of the lung
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How is the C7 root injured?
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Cervical disk lesion, herniation
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How is the upper trunk of the brachial plexus injured (includes MSC nerve)
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Trauma, hyperextension of neck (MVA, birth trauma)
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How is the ulnar nerve injured?
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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)
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What motor lesions are seen with axillary nerve damage?
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Deltoid (arm abduction at shoulder)
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What sensory lesions are seen with axillary nerve damage?
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Over deltoid muscle
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What motor lesions are seen with radial nerve damage?
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Problems with extension (brachioradialis, extensors of the wrist and fingers, supinators, triceps). WRIST DROP
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What sensory lesions are seen with axillary nerve damage?
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Over the deltoid muscle
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What motor lesions are seen with median nerve damage?
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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 |
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What sensory lesions are seen with median nerve damage?
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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 |
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What motor deficits are seen with ulnar nerve damage?
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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) |
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What is Klumpke's total claw?
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Lesion of the lower trunk (C8-T1); loss of function of lumbricals, forearm finger flexors (median), and finger extensors (radial). Clawing of all digits
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How is the LTN injured?
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Radical mastectemy!!!!! Winged scapula and lymphedema
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What do the dorsal interosseus muscles do?
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Abduct the fingers (ulnar)
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What do the palmar interosseus muscles do?
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Adduct the fingers (ulnar)
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What is tennis elbow?
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Lateral epicondylitis
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What is golf elbow?
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Medial epicondylitis
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Obturator nerve
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Nerve: L2-L4
Injury:Anterior hip dislocation Motor:Thigh adduction Sensory:Medial thigh |
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Femoral nerve
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Nerve:L2-L4
Injury:Pelvic fracture Motor:Thigh flexion and leg extension Sensory:Anterior thigh and medial thigh |
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Common peroneal nerve
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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 |
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Tibial nerve
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Nerve:L2-L4
Injury:Knee trauma Motor:Foot inversion and plantar flexion, toe flexion Sensory:Sole of foot |
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Superior gluteal nerve
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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) |
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Inferior gluteal nerve
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Nerve: L5-S2
Injury: Posterior hip dislocation Motor: Can't jump, climb stairs, or rise from a seated position, can't push down |
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Sciatic nerve
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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
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What part of the sarcomere only contains actin?
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I band (actin is attached to Z line)
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What part of the sarcomere only contains myosin?
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H zone (myosin attaches to M line in the middle)
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What part of the sarcomere contains both actin and myosin?
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A band
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What shortens during contraction?
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H- and I-bands; A remains the same!!!!!!
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What arteries are at the femoral head?
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Superior and inferior gluteal arteries
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What arteries are at the femoral neck?
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Medial and lateral circumflex arteries
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How does the muscle relax?
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Ca efflux from the cytoplasm- via Ca-ATPase and Na/Ca exchange
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What are the steps of skeletal muscle contraction
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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 |
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How does smooth muscle contraction occur?
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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)
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What abnormalities are seen in osteoporosis?
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Loss of trabecullar (spongy bone) with normal lab values and bone mineralization
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What abnormalities are seen in osteopetrosis?
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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 |
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What abnormalities are seen in Paget's disease (osteitis deformans)?
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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 |
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What is polyostotic fibrous dysplasia?
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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) |
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Osteoma- benign
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Associated with Gardner's syndrome (FAP). Often in skull (sinuses, facial)- new piece of bone grows on an existing bone. Benign
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Osteoid osteoma- benign
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Woven bone surrounded by osteoblasts < 2cm on proximal tibia and femur. Most common in men < 25 years. Nocturnal pain is relieved with ASA
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Osteoblastoma- benign
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Looks the same as osteoid osteoma but larger and in vertebral column. Pain NOT relieved by ASA
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Osteochondroma- benign
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MC benign bone tumor; Mature bone with cartilagenous cap. Men < 25 years in long bone metaphysis. Rare malignant transformation
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Enchondroma- benign
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Found in intramedullary bone on distal extremities (hands, feet). Diaphysis
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Giant cell tumor (osteoclastoma)- Benign
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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
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Osteosarcoma (malignant)
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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 |
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Ewing's sarcoma
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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
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Chondrosarcoma- malignant
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Men 30-60 in PELVIS, spine, scapula, long bones. Seen in diaphysis as a glistening mass
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Increasing order of age for bone tumors
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Ewing < osteosarcoma < chondrosarcoma < multiple myeloma
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Decreasing frequency of bone tumors
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Multiple myeloma, osteosarcoma, chondrosarcoma, Ewing sarcoma, Giant cell tumor
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What are rhematoid nodules?
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Fibrinoid necrosis surrounded by palisaiding histiocytes that are subcutaneous in the elbows or lumbosacral areas usually
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What autoantibodies are found in RA?
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anti-IgG antibody (rheumatoid factor), anti-CCP (less sensitive, but more specific)
Associated with HLA-DR4 |
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What type of hypersensitivity is RA?
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Type III
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What joint is NOT involved in RA?
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DIP
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What is the triad seen in Sjogrens?
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Xerophthalmia (dry eyes, conjunctivitis)
Xerostomia (dry mouth, dysphagia), but parotid enlargement (increased risk of B-cell lymphoma) and dental caries Arthritis |
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How is sicca syndrome from Sjogrens?
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No arthritis
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What autoantigens are seen in Sjogrens?
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SS-A (Ro), SS-B (La)
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What causes gout?
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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.
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Why do bouts of gout happen after alcohol consumption?
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Alcohol metabolites compete for the same excretion sites in the kidney as uric acid.
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What is the treatment for acute gout? chronic gout?
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Acute- NSAIDs, Colchicine
Chronic- Allopurinol, probenecid |
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Where does pseudogout tend to occur and what are the crystals made of?
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At the knee, calcium pyrophosphate
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What is associated with gonococcal arthritis?
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Synovitis at the knee, tenosynovitis at the hand, dermatitis (usually wrists and feet)
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What is seen in ankylosing spondylitis?
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Affects sacroiliac joints, ankylosis (fusion of joints causing it to be stiff; improves by exercise), bamboo spine with Ca at edges, uveitis, aortic regurgitation
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What is the triad seen in reactive arthritis?
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Arthritis (achilles tendon), urethritis, conjunctivitis and uveitis
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What organisms can cause reactive arthritis?
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Shigella, salmonella, campylobacter, yersinia, bartonella, chlamydia. REMEMBER THIS IS AUTOIMMUNE MEDIATED SO NO BACTERIA IN SYNOVIAL FLUID. This occurs POST-infection!!!!
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What is anti-smith antibody
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Specific for lupus, but not prognostic
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What features are seen in SLE?
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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)
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What features are seen in sarcoidosis?
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Restrictive lung disease (interstitial fibrosis), bilateral hilar LAD, erythema nodosum (on shins), Bell's palsy, uveoparotitis, hypercalcemia, elevated serum ACE levels, UVEITIS
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What is polymyalgia rheumatica?
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Pain and stiffness in shoulders and hips associated with temporal arteritis. Elevated ESR but normal CK (DOES NOT AFFECT MUSCLES- affects JOINTS)
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What muscles are affected by polymyositis?
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Shoulders and proximal weakness. Has perifascicular inflammation
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What is seen in MG?
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Muscle weakness worsens with use (see on compound muscle AP test), ptosis, diplopia, general weakness
Antibodies to POSTSYNAPTIC AChR |
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What is seen in Lambert-Eaton syndrome?
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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!!!! |
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What is seen in CREST?
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Calcinosis- subepithelial Ca deposits
Raynaud's Esophageal dysmotility (GERD, achalasia) Sclerodactyly Telangectasia (fingers, face) |
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What does hyperkeratosis mean?
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Increased thickness of the stratum corneum.
Psoriasis |
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What is parakeratosis?
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Hyperkeratosis with retention of nuclei in stratum corneum.
Psoriasis |
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What is acantholysis?
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Separation of epidermal cells
Pemphigus vulgaris |
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What is acanthosis?
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Epidermal hyperplasia (increased spinosum)
Psoriasis |
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What is dyskeratosis?
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Abnormal, premature keratinization of individual keratinocytes, eosinophilis
SCC |
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What is spongiosis?
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Edematous fluid in the intracellular space
Allergic dermatitis |
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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 (GI, lymphoid)
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What is vitiligo commonly seen with?
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Hypothyroidism
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Where does SSSS commonly occur in newborns?
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Umbilical stump- binds GM4
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What is lichen planus associated with?
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HCV
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When do you see erythema nodosum?
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Coccidioidomycosis, histoplasmosis, TB, leprosy, strep, sarcoidosis
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Urticaria
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Dermal edema; NO epidermal changes
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What is Acanthosis Nigricans?
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Hyperplasia of stratum spinosum associated with hyperinsulinemia and visceral malignancy
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What is seborrheic keratosis?
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Keratin-filled cysts that look pasted on
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What is actinic keratosis?
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Sand-papery, predisposition to SCC
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What is Klumpke's palsy and thoracic outlet syndrome?
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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. |
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What can cause Klumpe's palsy and thoracic outlet syndrome?
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Cervical rib compression, hypertrophy of anterior scalene, pancoast tumor, clavicle fracture
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What are people with lupus anticoagulant at risk for? (false positive VRDL)
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Antiphospholipid syndrome- venous and arterial thromboembolism, repeated miscarriages. They have a prolonged PTT
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