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Step 1 First Aid: Musculoskeletal

Step 1 First Aid: Musculoskeletal

by bhs10289, May 2013

Subjects: Musculoskeletal

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235 Cards in this Set

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	5 layers of epidermis from outside -> in	stratum Corneum s. Lucidum s. Granulosum s. Spinosum s. Basalis (Californians Like Girls in String Bikinis)
	3 kinds of epithelial cell junctions	tight anchoring gap
	tight junctions are aka ___ they connect a cell to ___ they are located at ___ and do ___ (2)	zona occludens another cell apical end of cell maintain epithelial polarization prevent paracellular leakage
	2 proteins which make up tight junction	claudin occludin
	4 kinds of anchoring junctions	adherens junction desmosomes focal adhesions hemidesmosomes
	adherens junctions are aka ___ (2) they connect a cell to ___ they are located at ___	zona adherens intermediate junctions another cell apex beneath tight junction
	adherens junctions use ___ to connect to ___	cadherins actin cytoskeleton
	cadherins require ___ to work	Ca2+
	desmosomes are aka ___ they connect a cell to ___ they are located ___	macula adherens another cell sporadically
	desmosomes use ___ to connect to ___	cadherins intermediate filament cytoskeleton (e.g. keratin)
	focal adhesions connect a cell to ___ they connect the membrane to ___	ECM actin cytoskeleton
	hemidesmosomes connect a cell to ___ they connect the membrane to ___	ECM intermediate filament cytoskeleton
	in desmosomes, ____ is an intracellular protein which binds ___, which does extracellular adhesion, and ___	desmoplakin cadherin intermediate filaments
	unhappy knee triad	medial collateral ligament anterior cruciate l. lateral meniscus
	unhappy triad is caused by blow from the ___ side	lateral
	___ indicates torn ACL	anterior drawer sign (tibia moves too far forward)
	___ indicates torn PCL	posterior drawer sign (tibia moves too far backward)
	___ indicates torn MCL	abnormal passive abduction
	rotator cuff muscles (in CW order of insertions on R humerus when viewed laterally, starting at 12)	supraspinatus subscapularis teres minor infraspinatus
	supraspinatus does ___ to humerus	abduction
	subscapularis does ___ to humerus (2)	internal rotation adduction
	teres minor does ___ to humerus (2)	external rotation adduction
	infraspinatus does ___ to humerus	external rotation
	3 dermatomes of medial arm/forearm/hand, from proximal to distal	T2 T1 C8
	4 dermatomes of lateral arm/forearm/hand, from proximal to distal	C4 (shoulder) C5 (upper arm) C6 (forearm + lateral 2 digits) C7 (middle wrist + 3rd digit)
	C6 has finger(s)	1 2
	C7 has finger(s)	3
	C8 has finger(s)	4 5
	Erb's palsy is from ___ lesion 2 causes are ___ it pw ___	superior brachial plexus trunk (C5 + C6 roots) shoulder dystocia trauma waiter's tip
	waiter's tip posture includes ___ (3)	adduction of humerus medial rotation of humerus elbow pronation
	Klumpke's palsy is from ___ lesion 4 causes are ___ it pw ___	inferior brachial plexus trunk (C8 + T1 roots) congenital defect shoulder dystocia traction from hanging by one arm compression by cervical rib thoracic outlet syndrome Pancoast tumor
	thoracic outlet syndrome includes ___ (5)	thenar + hypothenar atrophy lumbricals + interossei atrophy medial hand + forearm sensory deficit radial pulse absent on rotating head ipsilateral to lesion Horner's syndrome
	loss of lumbricals + interossei in Klumpke's palsy causes ___	total claw hand
	lumbricals are innervated by ___ fibers of ___ (2) n.s they do ___ (3)	C8 + T1 median (1st + 2nd) ulnar (3rd + 4th) MCP flexion PIP extension DIP extension
	interossei are innervated by ___ fibers of ___ n. they do ___ (2)	C8 + T1 ulnar abduction (dorsal interossei) adduction (volar interossei)
	thumb opposition is done by ___ branch of ___ n. it can be injured by ___ muscle is ___	recurrent median superficial laceration opponens pollicis
	saturday night palsy is injury of ___ it causes ___ (4) motor deficits and ___ (3) sensory deficits	radial n. wrist drop (wrist extensor palsy) finger extensor palsy thumb abduction palsy supinator palsy posterior arm posterior hand dorsal thumb
	proximal median n. lesion is caused by ___ it causes ___ motor deficit and ___ (2) sensory deficits	supracondylar humerus fx thumb opposition ("ape hand") lateral 3.5 fingers (dorsal and volar) thenar eminence
	distal median n. lesion is caused by ___ (2) it causes ___ motor deficit and ___ sensory deficit	carpal tunnel syndrome lunate dislocation lateral finger flexion palsy (lumbricals) lateral 3.5 fingers (dorsal and volar)
	sign of distal median n. lesion	ulnar deviation with wrist flexion
	proximal ulnar n. lesion is caused by ___ it causes ___ (2) motor deficits and ___ (2) sensory deficits	medial epicondylar humerus fx medial finger flexion palsy wrist flexion palsy medial 1.5 fingers hypothenar eminence
	sign of proximal ulnar n. leison	radial deviation with wrist flexion
	distal ulnar n. lesion is caused by ___ it causes ___ (3) motor deficits and ___ (2) sensory deficit	hook of hamate fx interossei palsy adductor pollicis palsy medial lumbricals palsy medial 1.5 fingers hypothenar eminence
	sign of distal ulnar n. lesion	ulnar claw hand
	ulnar claw hand means ___	pope's benediction sign when asked to extend all fingers
	the posterior interosseus is a branch of ___ n. it may be injured by ___ it is a continuation of ___ after the latter does ___ it innervates ___	radial radial subluxation deep branch of radial gives branches to supinator and ECRB hand extensors
	midshaft fx of humerus injures ___ n. in ___	radial spiral groove
	tennis elbow is ___ golf elbow is ___	lateral epicondylitis medial epicondylitis
	anterior interosseus n. is a branch of ___ n. it innervates ___ (3)	median flexor pollicis longus pronator quadratus flexor digitorum profundus (lateral 2 digits)
	4 muscles innervated by radial n.	Brachioradialis Extensors of wrist + fingers Supinator Triceps
	obturator n. lesions are caused by ___ they cause motor deficit for ___ and sensory deficit for ___	anterior hip dislocation thigh adduction medial thigh
	femoral n. lesions are caused by ___ they cause motor deficit for ___ (2) and sensory deficit for ___ (2)	pelvic fx hip flexion knee extension anterior thigh medial leg
	common peroneal n. lesions are caused by ___ (2) they cause motor deficit for ___ (3) and sensory deficit for ___ (2)	fibular neck fx lateral leg trauma foot eversion foot dorsiflexion toe extension anterolateral leg dorsal foot
	tibial n. lesions are caused by ___ they cause motor deficit for ___ (3) and sensory deficit for ___	knee trauma foot inversion foot plantarflexion toe flexion sole of foot
	superior gluteal n. lesions are caused by ___ (2) they cause motor deficit for ___ and sensory deficit for ___	posterior hip dislocation polio thigh abduction none
	thigh abduction deficit in sup. gluteal n. palsy is called ___	Trendelenburg sign
	inferior gluteal n. lesions are caused by ___ they cause motor deficit for ___ and sensory deficit for ___	posterior hip dislocation hip extension (jumping, stair climbing, getting up from chair) none
	in sarcomere, 2 thick bands and intervening white space define ___	A band
	___ is the white zone in the middle of the A band ___ is the line in the middle of that zone	H band M line
	___s extend from M line	myosin fibers
	adjacent A bands are separated by ___	I bands
	___ is the line in the middle of the I band	Z line
	___s extend from Z line	actin fibers
	on contraction, ____ bands shrink	H I
	in skeletal muscle, depolarization of ___ (2) in muscle causes ___ current through ___ receptors this causes ___ current through ___ receptors in ___	plasma membrane t-tubules Ca2+ DHP Ca2+ ryanodine sarcoplasmic reticulum
	DHP channels are aka ___	L type
	type ___ fibers are slow twitch they are ___ colored they have ___ metabolism	I red aerobic
	4 steps in myosin power stroke	ATP binding/ADP release cocking cross-bridging power stroke
	reaction in cocking step of power stroke	ATP hydrolysis
	reaction in cross-bridging step of power stroke	Ca2+ binding TnC
	reaction in power stroke step of power stroke	P_i release
	2 kinds of bone formation	endochondral membranous
	endochondral bone growth is for ___ bones membranous is for ___	longitudinal flat
	___ bone growth happens in 3 steps the first is ___ the second is ___ the third is ___	endochondral cartilaginous model replacement of model with woven bone lamellar bone
	cartilaginous model for endochondral ossification is made by ___ woven bone replacement is made by ___ (2)	chondrocytes osteoblasts osteoclasts
	osteoblast stem cells live in ___ they are from ___ lineage	periosteum mesenchyme
	membranous ossification happens in ___ steps these are ___	2 woven bone lamellar bone
	achondroplasia is a defect in ___ ossification	endochondral
	T/F: achondroplasia is usually inherited	false (85% sporadic)
	2 kinds of osteoporosis	post-menopausal senile (after 70 y.o.)
	Ca2+ prophylaxis for osteoporosis begins before age ___	30
	osteopetrosis is deficiency of ___	bone resorption
	bone resorption defect in osteopetrosis is due to ___ defective enzyme is ___	defective osteoclasts carbonic anhydrase II
	blood chemistry in osteopetrosis is normal/abnormal	normal
	CBC in osteopetrosis is normal/abnormal	abnormal
	3 CBC abnormalities in osteopetrosis	anemia leukopenia thrombocytopenia (reduced bone marrow space)
	X-ray finding in osteopetrosis	erlenmeyer flask bones
	neurological problem in osteopetrosis this is caused by ___	CN impingement narrowing foramina
	3 abormal blood levels in osteomalacia	high PTH low Ca2+ low phosphate
	___ is bone defect caused by hyper PTH	osteitis fibrosa cystica
	osteitis fibrosa cystica has normal/abnormal blood chemistry	abnormal
	gross histopath in osteitis fibrosa cystica	brown tumor
	brown tumor of osteitis fibrosa cystica is lined by ___	osteoclasts
	3 lab findings in osteitis fibrosa cystica	high Ca2+ low phosphate high ALP
	Paget's disease of bone is aka ___ it is caused by ___	osteitis deformans increased osteoblast + osteoclast activity
	lab finding in Paget's disease of bone	high ALP
	in ___ bone is replaced by fibroblasts and ___ (2) ___ is one subtype with unilateral lesions and endocrine abnormalities	polyostotic fibrous dysplasia collagen irregular trabeculae McCune Albright
	main endocrine abnormality in McCune Albright	precocious puberty
	skin finding in McCune Albright	cafe au lait spots
	___ aka ___ is most common benign bone tumor	osteochondroma exostosis
	osteochondroma has ___ bone with ___ typically occurs in ___ population typically occurs in ___ in body	mature cartilaginous cap men<25 y.o. long bone metaphysis
	osteochondroma ___ly transforms to osteosarcoma	infrequently
	enchondroma is located in ___ of bone and ___ of body	intramedullary distal extremity
	giant cell tumor aka ___ has peak incidence at ___ y.o. sign on X-ray is ___ or ___ typically occurs in ___ or ___	osteoclastoma 20--40 double bubble soap bubble distal femur proximal tibia
	osteoma is associated with ___ syndrome commonly occurs in ___	Gardner's skull
	osteoid osteoma and ____ have interlacing trabeculae of ___ surrounded by ___	osteoblastoma woven bone osteoblasts
	osteoid ostseoma size is ___ it is located in ___ and ___	<2 cm proximal femur proximal tibia
	osteoblastoma size is ___ it is located in ___	>2 cm vertebral column
	most common 1' malignancy of bone	multiple myeloma
	___ aka ___ is 2nd most common 1' malignancy of bone	osteosarcoma osteogenic sarcoma
	osteosarcoma has peak incidence in ___	men 10--20 y.o
	osteosarcoma occurs in ___ of ___ bones usually in ___ or ___ in body 2 signs on X-ray are ___	metaphysis long distal femur proximal tibia Codman's triangle sunburst pattern
	Codman's triangle indicates ___	periosteal elevation
	4 osteosarcoma RFs	Paget's disease of bone bone infarct radiation familial retinoblastoma
	Ewing sarcoma occurs in ___ of ___ (4) bones	diaphysis long bones pelvis scapula ribs
	microscopic histopath of Ewing's sa has ___ (2)	small blue cells onion skin appearance
	translocation in Ewing's sa	11;22
	peak incidence for Ewing's sa	boys <15 y.o.
	chondrosarcoma is most commonly in ___ (6) bones	humerus scapula spine pelvis femur tibia
	peak incidence for chondrosarcoma	men 30--60
	gross histopath for chondrosa	glistening mass in medullary cavity
	2 knuckle deformities in osteoarthritis	Bouchard's nodes Heberden's nodes
	Bouchard's nodes occur at ___ joint	PIP
	osteoarthritis is worse at ___ time of day	end of day (after use)
	knee osteoarthritis starts in ___ aspect	medial
	RA is a type ___ hypersensitivity it affects men/women more it is linked to gene ___	3 women HLA-DR4
	2 serum abnormalities for RA ___ is more sensitive ___ is more specific	rheumatoid factor anti-CCP rheumatoid factor anti-CCP
	anti-CCP Abs attack ___ (3)	filaggrin vimentin keratin
	2 findings in Sjögren syndrome	enlarged parotid dental caries
	Sjögren syndrome has increased risk of ___ (2)	B cell Ly dental caries
	2 serum findings in Sjögren syndrome ___ is more specific	anti SS-A (Ro) anti SS-B (La) anti SS-B (La)
	Sjögren syndrome has peak incidence in ___	women 40--60 y.o.
	gouty tophus is made from ___ located in ___	uric acid fibrous tissue
	gout attacks follow ___ (2)	large meal alcohol consumption
	alcohol intake causes gout attack because	metabolites compete in kidney with uric acid for excretion
	glycogen storage disease associated with gout	Von Gierke
	___% of gout is due to urate overproduction the rest is due to ___	10 underexcretion
	diuretics which cause underexcretion	thiazides
	urate crystals are ___ shaped they are ___ly birefringent this means they are ___ colored when aligned ___ to light	needle negatively yellow parallel
	gout is more common in men/women	men
	4 drugs for gout ___ (2) can be used for acute attack	NSAIDs colchicine allopurinol probenecid NSAIDs colchicine
	preferred NSAID for gout	indomethacin
	avoid ___ drugs in gout, because ___	salicylate they depress urate excretion (in low doses)
	colchicine prevents ___ (2) by ___ing, which does ___	leukocyte degranulation leukocyte chemotaxis binding tubulin monomers prevents microtubule polymerization
	probenecid does ___	increases urate excretion in PCT
	probenecid interacts with other drugs by ___ing	preventing their excretion
	allopurinol works by ___ing	inhibiting xanthine oxidase
	xanthine oxidase does ___ (2)	hypoxanthine -> xanthine xanthine -> uric acid
	allopurinol interacts with ___ (2) drugs by ___ing	azathioprine 6-MP preventing their breakdown by xanthine oxidase
	pseudogout crystals are made of ___ they are ___ shaped they are ___ly birefringent	Ca2+ pyrophosphate rhomboid positively
	pseudogout mainly affects men/women	both equally
	joint most commonly affected in pseudogout	knee
	tx for pseudogout	none!
	2 non-spinal sx of ankylosing spondylitis	uveitis aortic regurg
	psoriatic arthritis happens in ___% of psoriasis it pw ___ and ___ on X-ray	33 dactylitis (sausage finger) pencil-in-cup deformity
	3 serum findings in SLE 1 serum finding in drug-induced SLE	ANA anti-dsDNA anti-Smith anti-histone
	SLE marker ___ is specific but not prognostic SLE marker ___ is specific with poor prognosis	anti-Smith anti-dsDNA
	SLE marker ___ is sensitive but not specific	ANA
	3 abnormal lab values in sarcoidosis	vitamin D Ca2+ ACE
	inflammation associated with sarcoidosis	uveoparotitis
	3 micro histopath findings in sarcoidosis	noncaseating granulomas Schaumann bodies asteroid bodies
	Schaumann bodies are ___	calcifications inside giant cell
	polymyalgia rheumatica causes pain in ___ (2) it is associated with ___	shoulders hips GCA
	polymylagia rheumatica has high ___ and normal ___	ESR CPK
	tx for polymyalgia rheumatica	CS
	polymyositis is caused by ___ it usually affects ___ in body dx is via ___	CD8 attack on muscle fibers shoulders bx
	dermatomyositis has features of ___ plus ___ (3)	polymyositis heliotrope rash Gottron's papules increased risk of malignancy
	Gottron's papules are ___	pink patches on extensor surfaces + knuckles
	4 lab findings in polymyositis/dermatomyositis	CPK aldolase ANA anti-Jo-1
	tx for polymyositis/dermatomyositis	CS
	mixed connective tissue disease pw ___ (5)	Raynaud's phenomenon Fatigue Arthralgia Myalgia Esophageal dysmotility
	serum finding in mixed connective tissue disease	anti-U1RNP
	2 kinds of scleroderma ___ is worse	diffuse scleroderma CREST syndrome diffuse scleroderma
	serum finding in diffuse scleroderma	anti-Scl-70
	Scl-70 is aka ___	topoisomerase I
	serum finding in CREST syndrome	anti-centromere
	rhabdomyoma of ___ is associated with the phakomatosis ___	heart tuberous sclerosis
	2 histopath changes in psoriasis	hyperkeratosis parakeratosis
	hyperkeratosis means ___	thickened stratum corneum
	parakeratosis means ___	nuclei retained in stratum corneum
	in psoriasis, s. granulosum is ___ s. spinosum is ___	thin thick
	finding on fingers in psoriasis	nail pitting
	suborrheic keratosis has ___-filled cysts sudden appearance of multiple keratoses can mean ___	keratin cancer (GI, Ly)
	cellulitis is usually caused by ___ (2)	SA S. pyogenes
	necrotizing fasciitis is caused by ___ (2)	S. pyogenes anaerobes
	Staph scalded skin syndrome toxin affects ___ of skin	s. granulosum
	hairy leukoplakia in HIV is caused by ___	EBV
	pemphigus/pemphigoid is worse	pemphigus
	histopath finding in pemphigus vulgaris	acantholysis (intraepidermal bullae) of skin + oral mucosa
	IF finding in pemphigus vulgaris	netlike IgG pattern in epidemis
	clinical sign in pemphigus vulgaris	separation of epidermis with stroking (Nikolsky's sign)
	Abs in pemphigus vulgaris are against	desmosomes
	bullous pemphigoid is similar to ___ but doesn't affect ___ Nikolsky's sign is ___	pemphigus vulgaris oral mucosa negative
	IF pattern in bullous pemphigoid	linear IgG below epidermis
	Abs in bullous pemphigoid are against ___	hemidesmosomes
	bullous pemphigoid has ___ inside blisters	eosinophils
	dermatitis herpetiformis is associated with ___ it pw ___	celiac pruritic papules + vesicles
	immunohistopath finding in dermatitis herpetiformis	IgA at tips of dermal papillae
	lichen planus pw ___ it is associated with ___	purple polygonal pruritic papules HCV
	micro histopath of lichen planus has ___ infiltrate at ___	sawtooth lymphocytic dermal-epidermal junction
	histopath of acanthosis nigricans	s. spinosum hyperplasia
	erythema nodosum is associated with ___ (3)	granulomatous disease streptococcal infection coccidioidomycosis
	5 granulomatous diseases associated with erythema nodosum	TB leprosy sarcoidosis histoplasmosis Crohn's
	pityriasis rosea has ___ followed by ___ rash it is not ___	herald patch christmas tree (along rib line) infectious
	cherry hemangiomas appear at age ___	30--40
	palisading nuclei occur in ___ skin cancer	BCC
	arachidonic is released from ___ by ___	membrane lipids PLA2
	PLA2 is inhibited by ___	CS
	2 kinds of enzyme which metabolize arachidonic acid	COX lipooxygenase
	COX makes ___s lipooxygenase makes ___s	endoperoxides hydroperoxides
	endoperoxides become ___ (3) hydroperoxides become ___	PGs PGI2 (prostacyclin) TX LTs
	LTB4 does ___	neutrophil chemotaxis
	LTC4/D4/E4 does ___	bronchoconstriction
	PGI2 does ___ (3)	reduced platelet aggregation vasodilation reduced uterine tone
	PGE2 does ___ (4)	reduced vascular tone pain increased uterine tone increased temperature
	TXA2 does ___ (2)	increased platelet aggregation vasoconstriction
	zafirlukast does ___	LT R block
	zileuton does ___	lipoxygenase inhibition
	montelukast does ___	LT R block
	low dose ASA is ___ and does ___ intermediate dose ASA is ___ and does ___ high dose ASA is ___ and does ___	<300 mg/d platelet antiaggregant 300--2400 mg/d antipyretic + analgesic 2400--4000 mg/d anti-inflammatory
	3 SEs from chronic ASA	upper GI bleed ARF interstitial nephritis
	COX1 is expressed in ___ cells COX2 is expressed in ___ (2) cells	most inflammatory vascular endothelium
	platelets express COX___	1
	___ is a COX2 selective inhibitor	celecoxib
	2 SEs from celecoxib	thrombosis risk sulfa allergy
	COX1 is important for ___ protection because ___	gastric PGE1 inhibits H+ secretion
	acetaminophen is ___ (2) but isn't ___	antipyretic analgesic anti-inflammatory
	bisphosphonates end in ___ they work by ___ing	dronate inducing osteoclast apoptosis
	bisphosphonates ___ hydroxyapatite formation and ___ hydroxyapatite resorption	reduce reduce
	3 bisphosphonate indications	type I osteoporosis hypercalcemia of malignancy Paget's disease of bone
	3 bisphosphonate SEs	corrosive esophagitis nausea diarrhea
	3 kinds of biological anti-TNF drugs ___ is associated with TB reactivation	etanercept adalimumab infliximab infliximab
	etanercept is ___ it is indicated for ___ (3)	soluble TNFR RA psoriasis ankylosing spondylitis
	adalimumab is ___ it is indicated for ___ (3)	anti TNFR mAb RA psoriasis ankylosing spondylitis
	infliximab is ___ it is indicated for ___ (3)	anti-TNF mAb Crohn's RA ankylosing spondylitis

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