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140 Cards in this Set
- Front
- Back
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where is stratum lucidum
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under corneum, above granulosum and spinosum and basalis
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what is zona adherens? what is macula adherens and what do it acconect to?
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zona adherens - intermedate junction that connects actin filaments with E-cadherin 9has calcium). located just below zona occludens
macula adherens - desmosomes that are connected to intermediate filaments (keratin) via desmoplakins. |
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in hemidesmosomes, what are the proteins?
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integrins in the cell bind to laminin in BM
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what is the unhappy triad? what artery is injured?
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clipped form lateral side - medial collateral, ACL, and lateral meniscus
watch out for popliteal artery because it's rigidly fixed by adductor magnus and soleus muscles |
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where does the ACL attach on the femur and tibia? PCL?
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ACL attaches onposteromedial side of lateral epicondyl to anterior interosseuosu membrane of the tibia
PCL - anterior/lateral side of the medial femoral condyle with intercondylar area of the tibia (fibula not seen on MRI of the knee) |
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where should you palpate for a pudendal nerve block? what other nerves do you need to block for full relief of perineum? where do you need to palpate for LP?
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ischial spine (which separates greater and lesser sciatic notch) - also needed to block genitofemoral and ilioinguinal nerves for complete block
LP - palpate iliac crest |
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what are the lateral rorates of the rotator cuff? medial rotators? adducotrs? which is most commonly injured? which is most anterior?
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lateral = infraspintaus, teres minor
medial - subscapularis adductor - teres minor and subscapularis supraspinatus is most commonly injured cause impingement between acromion and head of humerus subscapularis is most anterior (along with coracoid process) |
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psoas - what vertebral bodies does it come from? what 2 actiosn does it have?
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originates from T12-L5
flexes hip, but may also laterally rotate and abduct thigh |
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how is the lower trunk injured? axilarry nerve? radial nerve (in 2 locations) median nerve?
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lower trunk - cerivcal rib or pancoast tumor
axillary - fracture of surgical neck, dislocation of the humerus, intramuscular injection radila nerve - proxiamlly it is compressed by crutches, more distally in spiral groove with midshaft lesion median - supracondular fracture of humerus, pronator teres syndrome |
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after elbow, what does radial nerve do? median nerve?
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radial - deep branch is just motor, and superficial branch ois sensory
median - anteiror interosseuous is motor to many muscles and median nerve continues along to carpal tunnel |
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in the arm, what nerve root innervates middle finger? medial 2 fingers? thumb? medial side of forearm? lateral side of forearm? lateral side of arm?
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middle finger = C7
medial 2 fingers = C8 thumb = C6 lateral forearm = C6 Medial forearm = T1 lateral arm = C5 upper shoulder = C4 |
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before going into carpal tunnel, waht does media nerve give off that goes on top of floexor retinaculum?
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palmar cutaneous nerve branch that innerves the palm, not fingers. recurrent branch comes off right after carpal tunel
each finger receives sensory nerve on each side |
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what nerve supplies back of pinky?
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ulnar nerve (supplies entire back of hand on the pink/half of ring digit)
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nerve roots of long thoracic?
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C5-7
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between what two muscles is the median nerve in the wrist?
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palmaris longus and flexor carpi radialis
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all of the cords of brachial plexus are enclosed where?
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in axillary sheath with axillary artery (implication for aneurysms and cord dysfunction)
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what does the ulnar nerve give off before entering guyon canal?
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cutnaoues branch to dorsum of hand
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what does a clavicle fracture not lead to brachial plexus damage?
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protected by subclavius
originates off first rib and lies in groove of clavicle |
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dislocaitn of shoulder - what nerve does it injure? in what way does shoulder dislocate?
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injures axillary nerve, causes dislocation anteriorly and inferiorly
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in LTN injury, what is the other funciton?
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to abduct past 90 degrees
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Pec major - what does it do at humerus? is it spared or not in modified radical mastectomy
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it is spared
adducts and internally rotates |
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femoral head receives blood supply from what artery?
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medial circumflex (altso a bit from lateral and gluteal arteries)
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a fracture of scaphoid causes pain where?
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anatomic snuff box
need to restore blood to avoid avascular necrosis |
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what is the job of C5
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flexion of the elbow
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axillary nerve root? what nerve does it run with
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C5-C6
runs with posterior circumflex humeral |
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radial nerve roots? runs with what artery? Name the BEST muscles?
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C5-C8
runs with deep brachial artery Brachioradialis, extensors of wrist and fingers, supinator, triceps |
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Median nerve roots? runs with what artery? runs in between what two muscles afer pronator teres?
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C6-T1
runs with brachial artery runs between flexor superficialis and profundus |
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what bone is dislocated most commonly in wrist and what nerve is injured? if injured at wrist, why don't you lose sensation of thenar eminence?
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lunate, dmages median nerve cause it is dislocated anteriorly
don't lose palmar sensation cause remember palmar cutaneous branch comes off prior |
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what is clincal sign of median nerve damage
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wrist = ulnar deviation upon flexing wrist, weak thumb abduction
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ulnar nerve roots? how is it damaged distally? what muscles odes it innervate? clinical sign upon wrist flxion?
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C8, T1
damaged distally by falling on outstrecthed hands or fracture of hook of hamate muscles = flexor carpi ulnaris, 1/2 of flex dig profundis, ab/adduction of interossei, adduction of thumb, medial lumbricals clinical sign - radial deviation with wrist flexion |
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nerve rootlets of musculocutaneous?
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C5-7 (like long thoracic nerve
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to anesthetize wrist median nerve, between what 2 muscles is it?
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between palmaris longus and flexor carpi radialis
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what is differential of mononeuropathy?
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compression, trauma, DM (usually involve CNIII, the somatic not parasympathetic division cause that has separate blood supply), vasculitis, radiation ,inflammation (VZV)
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Erb-duchene palsy, what trunk is injured (and roots? how is it injured? findings?
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upper trunk = C5,6
damaged by moving head away fromshoulder during delivery or trauma findings - paralyzed abductors (deltoid, supraspinatus), lateral rotators (teres minor, infraspinatus, deltoid), and lost of supination (cause loss of biceps) sensation likewise lost over lateral arm/forearm |
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klumpke's palsy injures what trunk? what are common ways it is injured? what signs does it cause?
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lower trunk = C8, T1
injured via sudden grabbing a tree, breech delivery signs - atrophy of thenar and hypothenar eminences (suppplies all intrinsic hand muscles), atrophy of interossei, sensory deficits on medial side of forearm (T1) annd hand (C8), disapperance of radial pullse when moving head toward opposite side |
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thoracic outlet syndrome is siilar to what palsy? what is treatment and what nerve do you have to watch out for
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siilar to klumpke's palsy
tx - cut anterior scalene (be careful of phrenic nerve) |
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in median claw, where does the lesion occur?
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after branch containing C5-7 splits off to feed forearm flexors
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lumbricals do what?
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flex MCP, extend DIP and PIP
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in klumpke's total claw, what has happened?
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lesion of lower trunk means loss of all intrinsic hand muscles. note forearm finger flexors with C5-7 are still intact
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does brachioradialis flex wrist?
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yes
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in superiomedial gluteal quadrant, what nerve? inferiomedial?
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superomedial = gluteal nerves
inferiomedial = sciatic |
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obturator nerve - how is it damaged?
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in pelvic surgery or anteiro hip dislocation
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what sensation does femoral nerve cover, and motor deficit?
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sensory - medial leg (like obturator) and anteiror hithg
motor - thihg flexio and leg extension |
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sensory and motor zones of superificla and deep peroneal
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superficial - motor to foot eversion, sensory to anterolateral leg and dorsal aspect of the foot
deep - dorsiflexion, toe extension. sensory to space in between 1-2 toes |
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tibial nerve sensation
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sole of foot
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how is superior gluteal nerve damaged?
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posterior hip dislocaiton or polio
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claw foot?
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loss of lumbrical/interossei (diabetics)
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saphenous nerve - cause of injury, sensory loss?
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damage at medial femoral condule
sensory loss over medial leg |
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what goes through greater sciatic foramen?
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mostly piriformis muscle. has superior gluteal nerve, arteyr vein above this muscle
has inferior gluteal, sciatic, pudendal nerves below |
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common interosseous artery - branch of what?
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ulnar, right below elbow
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what muscle can be avulsed from lesser trochanter of femur with sudden contraction?
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psoas
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what does the ryanodine receptor couple to?
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the dihydropyridine receptor so that AP coupling with calcium release is ensured
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What is the Z line? M line? H band, A band
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z line for actin (very dark)
M line for myosin A band for all of myson H band for just myosin |
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which fibers are red due to mitochondria and myoglobin? which fibers are white?
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red = type I (marathon fibers, sustained contraction, postural muscles)
type 2 - incrreased anaerobic glycolysis. These are weight training muscles that can hypertrophy |
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what is the relationship of active tension an dpassive tensio to length?
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passive tension increases with length
active tension increases then decreases when passive tension starts to rise total tension = active+passive |
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how is smooht muscle contraction handled?
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AP-->depolarized membrane, opening up calcium in cytoplasm (which is lwoered by nitrates through cGMP) and binds calmodulin, which activates MLCK to phosphorylate myosin, which bridges with actin
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where do you aneshetize for a rib fracture?
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below rib (where nerve is) and lateral to the angle of the rib (most common fracture site)
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how does endochondral ossification form?
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longitudinla bone growth where chondrocytes are replaced by woven bone and remodel to lamellar bone.. osteoblasts from stem cells in periosteum
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membranous ossification - what kind of bones?
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flat bone growth of skull, facial bones, and axial skeleton and clavicle. woven bone made first then lamellar
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how is achrondoplasia inherited? chrom? is the receptor inhibited or activated? is it inherited or sporadic?
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AD, chrom 4. 85% actually sporadic. normal life span. small appendicular skeleton compared to axial skeleton
constituve activate of FGF actually inhibits chondrocyte prolfieration |
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which bone in osteoporisis is affected most. Is this a genetic disease? risk factors?
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trabecular (spongy) bone affe cted most cause of large surface area.
75% genetic risks - smoking, low exercise, caucasian, low BMI, alcohol. can see Colles' fractures |
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in osteopetrosis, what are calciu, phosphate, alk phos? why ist here anemia? what is one genetic cause? what does xray show?
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all levels are normal
anemia due to decrease marrow space genetic deficiency in carbnoic anhydrase II xray show erlenmeyer flask bones that flare out |
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in osteomalacia/rickets, what is teh soft skull called what does the osteoid look like?
what happens to ribs |
craniotabes
widened osteoid seams harrisons sulci (indents in ribs - thus the diaphragm, which is always in tension, pulls the softened bone inward) +rachitic rosary |
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what is osteoprotegerin?
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a decoy receptor for RANK-L, secreted by osteobalsts
osteoclasts use RNAK-L and M-CSF to differentiated, not PTH |
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what are in the cysts of osteitis fibrosa cystica? what lines it
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the cyst has fibrous stroma and sometimes blood. teh cyst is lined by osteoclasts
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what is osteitis deformans also known as? what is the bone pattern? what kind of fractures? what happens ot the heart?
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paget's disase
mosaic bone pattern chalk stick fracture of the long bone high output cardiac failure due to AV shunting |
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is alk phos elevate in rickets? what about osteoporosis?
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nope in either
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what is polyostotic dysplasia, what syndrome is associated?
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bone is replaced by fibroblasts, colagen, and irregular trabeculae
McCune Albright syndrome - polyostotic dysplasia with endocrine abnormalities (precocious puberty) and unilateral pigmented skin lesions (coast of Maine spots, cafe au lait) |
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what is a kids alk phos compared to an adult
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5x
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osteoma is associated with what syndrome? where is it located?
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associated with gardner's syndrome
often in skull (bone grows on existing bone) |
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osteioid osteoma - how big, where is it found, who is affected?
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<2 cm, in proximal tibia/femur. men<25
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osteoblastoma - similar to what? where is it found?
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similar to osteoid osteoma, but larger and foundin vertebral column
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giant cell tumor - where is it located? peak incidence? is it benign?x-ray appearance?
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at epiphysis
20-40 years around knee locally aggressive but benign "double bubble' or "soap bubble" apperance |
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what is an exostosis? what does it have on top? how old? where is it located?
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osteochondroma
capped with cartilage men<25 metaphysis |
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what is a benign cartilaginous neoplasm in intramedullary bone, usually distal extremities?
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enchondroma
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where are osteosarcomas found? what are 4 predisposing factors?
how are the cells described? |
found in metaphsys
paget's disease, bone infarcts, radiation, and familial retinoblastoma predipose "anaplastic cells making osteoid matrix) |
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ewing's sarcoma - what does the bone look like? what part of bone does it affect?
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onion skin apperance
affects diaphysis |
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chondrosarcoma - who is affected? how is it described?
where is it located |
men 30-60
expansile glistening mass in medullary cavity |
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what is myositis ossificans?
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ossifcation of fibrotic area after injury. radiodensities around radiolucent center
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what tumor is in epiphyss? metaphysis? diaphysis? intramedullary?
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epiphysis = giant cell tumor
metaphysis - osteochondroma, osteosarcoma (the 2 most common) diaphysis - osteoid osteoma, ewing's intramedullary - enchondroma, chondrosarcoma |
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in OA - what are xray findings? where does cartilage loss begin with knee?
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narrowed space on xray with subchondral cysts, osteophytes, sclerosis, eburnation (polished ivory apperance of bone)
begins on medial aspect of knee (bowlegged) |
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what are 3 markers of osteoclasts?
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tartrate resistant acid phosphatase, urinary hydroxyproline
urinary deoxypyridinoline (most reliable) |
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heberdon's node? bouchard's node?
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DIP for heberdons
bouchards is PIP |
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what is pannus? what are in subQ nodules? what is the cyst behind the knee called? which antibody is more specific? Rh-factor is what ytpe of antibody?
what are the heart and lung findings? |
pannus = granulation tissue in synovium extending into cartilage and bone
bakers cyst anti-CCP is more specifc Rf = IgM against IgG Fc portion nodules = fibrinoid necrosis surrounded by palsaidng histiocytes pericarditis, pleuritis |
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what is the boutonnier deformity? swan neck?
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boutonier is flexing on the PIP
swank neck = DIP can also have a "z" thumb where PIP goes inward |
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SS is associated with what cancer risk? which antibody is more specific to use in diagnosis? what is sicca syndrome?
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associated with B-cell lymphoma with parotid enlargement
SS-B is more specific sicca = dry eyes, mouth, nose, vagina, bronchitis, GERD but NO ARTHRITIS |
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where are tophi typically? what glyocgen storage disease is associated with gout? crystals are what color under parallel light? what is first line treatment?
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tophi in olecranon bursa, external ear, achilles tendon
associated with von gierke's crystals are yellow first line = NSADIS, then colchicine (risk of bone marrow suppression) |
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what do pseudogout crystals look like? can you see on xray?what joint does it effect? treatment?
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rhomboid, basophilic crystals
seen on xray associated with hemochromatosis and hyperPTH 50% knee no treatment |
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in gonococal arthritis - what is the triad? what causes chronic septic arhtritis?
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synovitis (knee), tenosynovitis (hand), dermatitis (pustules)
chronic = TB, lyme disease |
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what are some risk factors for SCC?
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actinic solar keraotis, arsenic, scar tissue in 3rd degree burn, immunosuppressive therapy. favors lower lips
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ankylosin gpsondylitis - what happens to artoa? eye?what should you monitor
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aortitis and regurgitation
uveitis monitor chest expansion (may hypoventilate due to enthesopathy of costovertebral jucntions |
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psoriatic arthritis - symmetric or not? what deformity on xray? what % of psoraiss patients?
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not symmetric
pencil in cup defomity less than 1/3 of psoriasis patients |
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in reiter's - what is the aspiration show? is it symmetric?
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sterile aspiraiton
iasymmetric |
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in lupus, what causes positive RPR? anti-dsDNA? anti-smith?
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antiphospholipid antibodies (aka anticoagulant),
anti-dsDNA is specific and poor prognosis for nephritis. smith is not prognosis can see hematologic disorder, neurologic |
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ANA positive in what diseases?
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rheumatoid arthritis, juvenile arthritis, etc.
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ssarcoidosis associated?
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bell's palsy
erythema nodsoum granulomas have schaumann and asteroid bodies (both are junk in macorphages) uveoparotitis arthralgias |
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does polymyalgia rheumatic has pain? weakness?
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pain, but no weakness
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which myositis is CD8 regulated? what does polymyosiits most often involve? does dermatomyosistis have a malar rash? which has increased risk of malignancy?
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polyomyositis is CD8 attack, involves shoulder most
yes to malar rash dermato has higher risk of malignancy check aldolase, ck, jo-1 |
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what muscles are affected in LES?
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not extraocular
proximal. incremental response |
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what does d geiffuse scleroderma often die from? what 2 antibodies?
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pulmonary death
anti-scl-70 and anti-polI |
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what does crust come from?
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dried exudate from vesicle, bulla, or pustule (fluid filled things)
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what is acanthosis?
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epidermal hyperplasia of spinosum
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apocrine glands are regulate by what system?
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adrenergic
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disstinction of petechiae, purpura, ecchymoses
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nonblanching
<5 mm 5-10 mm >10 mm |
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ephelis?
how many melanocytes? |
frckle. normal number of melanocytes, but increase melanin
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what is the histo finding of allergic dermatitis? atopic dermatitis? urticaria?
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allergic derm - spongiosis
atopic derm - acanthosis, intrapeidermal vesicles urticaria - dermal edema with lymph dilation |
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what disease has munro microabscess with rete ridge elongation, acanthosis? whay layer is increased, what is decreased
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psoriasis
granulosum is decreased, spinosum is increased |
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what disease has horn cysts?
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seborreic keratoses
these are keratin filled cysts |
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what is melasma and associated with?
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hyperpigmentaiton, associated with pregnancy or OCP
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cellulitis is infection of what layers?
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dermis and subQ tissues
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necrotizing fasciits affect what? why crepitus?
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deeper tissue
S. pyogenes or anaerobes crepitus form methane and cO2 |
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what layer does SSSS destroy?
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granulosum
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in pemphigus, what does IF show?
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antibodies around cells of epidermis in a reticular o rnetlike pattern
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in erythema mulitforma, what drugs, infections are associated along wiht cancer san duatoimmune diseases?
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myocplasma, HSV, sulfa drugs, beta lactam, phenytoin
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what is a more severe form of S-J syndromes?
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toxic epidermal necrolysis
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lichen planus associated with? malignant? 4 P's?
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hepatitis C
not malignant rpuritic, purple, polygonal papules. sawtooth infiltrate of lymphocytes at dermal-epidermal unction |
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erythema nodosum is an inflammaiton of what? seen in what diseases?
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inflammatin of subQ fat.
cocci, histoplasmosis, TB, leprosy, strepococcal infections, sarcoidosis |
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how is androgenetic alopecia inherited?
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AD in males and females
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what is SCC associated with? what is a variant?
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associated with chronic draining sinuses (osteomyelitis) and arsenic
keratoacanthoma is a variant that grows within 1 month and regresses within 1-2 months. |
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what do LTC4-E4 do?
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bronchoconstrict, vasoconstrict, increase vascular permeability
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what is the immediate product of lipoxygenase?
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HPETES
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PIGI2 unlike E2 has what effect on uterine tone?
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decrease uterine tone
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what does PGE2 do?
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decrase ascular tone
increase pain increase uterine tone increase temp |
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what is low dose aspirin? medium? high?
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low = <300 mg/day to decrease aggreagtion
intermeidate - 300-2400, antipyretic and analgesic high dose 2400-4000, antiinflammatory |
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what are the side effects of NSAIDS?
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renal damage, fluid retention, asplastic anemia, GI distress, ulcers
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cox-2 have a special indication for what cancer? what allergy?
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use for FAP
sulfa allergy |
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mech of tylenol? is it anti-inflammatory?
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inhibits COX in CNS, inactivated peripherally
not anti-inflammatory (not an NSAID) |
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names of bisphosphonates? analogue of what? big toxicity? administer fasting or eating?
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etidronate, pamidronate, alendronate, risedornate
analogue of pyrophase in hydrxyapatite, which inhibits osteoclastic activity, reducing formation and resorption of hydroxyapatite. use in hypercalcemia (malignancy associated), paget's disease, osteoporsis corrosive esophagitis - administer in fasting state wiht water |
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probeneic inhibits abosrpiton of what and secretion of what?
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inhibits absorption of uric acid
decreases secretion of penicillin |
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saliculates inhibit uric acid clearance excpet when?
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high doses 5-6 grams/day
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different of zinc oxide v. PABA ester sunscreens?
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PABA doesn't protect aginst UVA, just UVB
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MOA of etanercept, infliximab, adalimumab?
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etanercept - recomibnant human TNF receptor
infliximab - anti-TNF antibody adalimumab - blocks TNF receptor |
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what is superior laryngeal external and internal branch? which do you damage by ligating superior laryngeal artery? what about suprior thyroid artery
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external = cricothyroid. internal = innervates mucosa above vocal folds
ligate superior laryngeal artery = internal branch ligated superior thyroid artery (from external carotid) = external branch remember - superior thyroid artery runs with run that innervates cricothyroid |
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which artery travels close to recurrent laryngeal?
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inferior thyroid from thyrocervical trunk
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where is the brachial artery in relation to biceps tendon at elbow?
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medial
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what artery supplies nose?
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sphenopalatine ,branch off maxillary artery
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ear innervation
anterior external ear canal? posterior ahlf? lower auricle? |
anterior - auriculotempoeral
psoterior = vagus lower auricle = greater auricular |
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from superior to inferior, list the neurovascular bundle of rib and which is most likely to be injured?
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vein artery nerve (most likely to be injured, so insert chest tube a bit above superior aspect of ribs to avoid collaterals
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what is the fossa ovalis of the leg?
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where teh saphenous vein meets the femoral
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suboccipital artery contains what artery?
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vertebral artery (sublcavian--> cervical transverse foraminea--> foramen magnnum
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