Step 1 Musculoskeletal

Front 1

What are the order of epi cell junctions

Back 1

Apical --> baso late
Tight (occludens)
Zona adherens (cadherins - actin)
macula adherens- (desmosome) cadherin -- int filament *phemigus
Gapjunction (connexons)
Hemidesmosome cell to ECM *bullous pemphigoid
Integrin binds cell to laminin in BM

Front 2

whats the unhappy triad

Back 2

MCL, ACL, lateral meniscus

Front 3

where does the PCL attach

Back 3

Posterior intercondyl tibia to anterior lateral of medial epicondyl of the femur

Front 4

where is the anserine bursa

Back 4

Medial kneww

Front 5

Where does the ACL attach

Back 5

Anterior tibia --> lateral femoral condyle

Front 6

what is the landmark for a pudendal nerve block

Back 6

Ischial spine

Front 7

what does the supraspinatus do

Back 7

abducts the arm

Front 8

What does the infraspinatus do

Back 8

Laterally rotates arm (pitching injury)

Front 9

what does the teres minor do

Back 9

Laterally rotates and adducts

Front 10

Subscapularis

Back 10

MEdially rotes and adducts

Front 11

what is assoc with carpal tunnel syndrome

Back 11

preg, obesity, hypothy, ra, dm

Front 12

What innervates the extensors of the wrist and fingers

Back 12

Radial

Front 13

What innervates the brachoradialis

Back 13

Radial, flexion, supination, and pronation

Front 14

what innervates the interossi

Back 14

Ulnar

Front 15

what causes ape hand

Back 15

a proximal median nerve lesion - loss of opponens pollicis muscle function - unopposable thumb elbow or wrist lesion

Front 16

what 2 things does the serratus anterior connect to

Back 16

scapula and the thoracic cage, used for abduction above the horizaontal position

Front 17

What are the thenar muscles

Back 17

OAF - opponens policis, abductor pollicus brevis, Flexor pollicus brevis (median nerve)

Front 18

What will cause an obturator nerve lesion

Back 18

Anterior hip dislocation,

Front 19

what motor/sens does the obturator control

Back 19

Thigh adduction, sensory for medial thigh (the thigh adductors in the medial thigh - external obturator.[1], adductor longus, adductor brevis, adductor magnus, gracilis) and the pectineus (inconstant)

Front 20

What does the femoral control L2-L4

Back 20

Thigh flexion and leg extension (quads), sensory - ant thigh and medial leg.

Front 21

What causes a lesion in the femoral

Back 21

pelvic fracture

Front 22

What causes a lesion to the peroneal L4-S2

Back 22

lateral aspect of thigh trauma, or fibula neck fracture
** frosses the head of the fibula

Front 23

What does the peroneal control

Back 23

Motor - Eversion and dorsifelxion
Sens - anterolateral leg and dorsum of foot, toe extension

LESION = foot drop, foot slap, steppage gait

Front 24

What injury damages the tibial L4-S2

Back 24

Knee trauma

Front 25

What does the tibial control

Back 25

Motor - Inversion and plantar flexion and toe flexion
Sensory - sole of the foot

Front 26

What in jurse the superior gluteal (L4-S1)

Back 26

Posterior hip dislocation

Front 27

What does the sup glut control

Back 27

Thigh abduction (+ trendelenburg sign hip drops to contralateral side when standing on ipsilateral foot) controls the minimus

Front 28

What injury hurts the inferior gluteal L50S2

Back 28

Posterior hip dislocation

Front 29

What is a lesion to the inf gluteal like

Back 29

Glut max is out - can't climb stairs, rise from seated, cant push inferiorly downward

Front 30

What sarcomere band stays the same length

Back 30

A band, the H and I bands shorten

Front 31

Smooth muscle contraction - no troponin -- how does it work

Back 31

Ca increase --> inc ca in cyto, ca binds calmodulin --> activates myosin light chain kinase allows crossbridge I guess

Front 32

What bones come from endochobdral oss

Back 32

Longitundinal bone growht, cartilage model made first by chondrocytes, OCs and OBs later replace it with woven bone and remodel to lamellar

Front 33

What bones come from membranous ossification

Back 33

Flat bones, (skull, face, and axial skeleton), woven bone formed directly without caritlage. Later remodeled to lamellar

Front 34

What are the two types of lamellar bone

Back 34

1. Cortical (compact) oriented along lines of stress
2. Canellous (trabecular)

Front 35

What is woven bone

Back 35

immature non stress orriented see in embryo and fracture calluses

Front 36

what type of bone growth fails in achondroplasia

Back 36

Endochondrial ossification, membranous not affected
Defect is in FGFR3 constitutive activ
85% sporadiuc

Front 37

What type of bone is reduced in osteoporosis

Back 37

Trabecular (but senile can affect both)

Front 38

what the tx for osteoporosis

Back 38

Estrogen (SERM) and or cacitonin, Bisphopohates or pulsatile PTH for severe. GCCs are contraindicated.

Front 39

what are causes of secondary osteoporosis

Back 39

drugs (heparin), hypogonadism, hypercortisolism, hyperthyroidism, space, renalfailure, chronic acidosis

Front 40

What is osteopetrosis? what are the labs?

Back 40

Failure of normal bone resportion, thickened, dense bones that are prone to fracture. Due to abn OC function. Labs are all normal. Dec marrow space leads to anemia, thrombocytopenia. COuld be due to genetic def in CAII. Can get CN palsies

Front 41

Whats the issule in osetomalacia

Back 41

Defective mineralization/calcification of osteoid --> soft bones
Labs = Low D --> low ca --> inc PTH --> low PO4 ** ALP is normal

Front 42

What are the 3 phases of pagets

Back 42

1. Hypervascular osteolytic..massive turnover
2. Intermed OB activity dominates
3. quiescent - OB activity decreases

Front 43

What is the possible origin of pagets

Back 43

possibly viral (paramyxovirus

Front 44

What are the labs in pagets

Back 44

Ca, phos, and PTH are normal ALP is inc see a mosaic bone patter, long bone chalk stick fractures. AV shuts may cause high output heart failure

Front 45

What is pagets assoc with

Back 45

Osteogenic sarcoma, Inc hhat size, can have hearing loss due to auditory foramen narrowing

Front 46

In osteitis fibrosa cystica - what are the labs

Back 46

its chronic PTH so you finally break down a bunch of bone and Ca goes up also see inc in ALP, PTH is elevated and phosphate is low

Front 47

in polyostotic fibrous dysplasia what is happening? whats the association?

Back 47

Bone is replaced by fibroblasts, collagen and irregular bony trabeculae, this affects many bones. assoc w/ mccune albright syndrome

Front 48

What do you see in mccune albringt

Back 48

Multiple unilateral bone lesions assoc with endocrine abns (precocious pub) unilateral ash leaf spots this is a gain of function mosaicism mutation

Front 49

Where do osteomas occur often

Back 49

the skull (assoc with Gardners bone on top of bone)

Front 50

What are osteoid osteomas

Back 50

Interlacing trabeculae of wven bone surrounded by osteoblasts <2cm and food in the prox tibia and femur

Front 51

WHat is an osteoblastoma

Back 51

same as an osteoid osteoma but >2cm and found in the vert column

Front 52

What is a giant cell tumor

Back 52

Epiphyseal end of long bones, peak 20-40 years, locally aggressive benign tumor often around the distal femur pox tib. Double bubble on xray, spindle cells with multinucleated giantcells

Front 53

Osteochondroma

Back 53

Most common benign bone tumore, mature bone with cart cap, usually in med <25, originates from long metaphysis. Malig

Front 54

Where are endochondromas found?

Back 54

Intramedullary bone, usually the distal extremities (unlike chondrosarcoma which is in the pelvis spine, scapula, humerus, tibia, or femur

Front 55

Osteosarcoma - where is it found, age, Rfs

Back 55

2nd most common primary malignant tumor of bone (after multiple myeloma) Peak incidence is in men 10-20 yo. Commonly found in the metaphysis of long bones, often around distal femur, prox tibia.
RF - pagets, bone infarct, radiation and familial RB
See - codmans triabgle or a sunburst pattern (from elevation of the periosteum on xray. Porr prog

Front 56

What are the histo characteristic of Ewings

Back 56

Anaplastic small blue cell, malignant. Most common in boys <15 extremely aggressive with early mets but responsive to chemo. Characteristic onion skin appearance in bone. Appears in diaphysis

Front 57

Whats the transloc for ewings

Back 57

11,22

Front 58

What is a chondrosarcoma

Back 58

Malignant cartilaginous tumor. Most common in men 30-60 usually in the pelvis, spine, scapula, humerus, tibia, or femur or from osteochondroma. Expansile glisening mass within the medullary cavity.

Front 59

Where do you see heberdens nodes, and bouchards?

Back 59

Heb - DIP
Bouchard PIP

Both assoc w/ OA

Front 60

What are some secondary causes of OA -

Back 60

obestiy

Front 61

Where does RA affect

Back 61

MCP and PIP, AI disease against synovial joints with pannus formation

Front 62

what joint is not involved

Back 62

DIP

Front 63

Whats the HLA assoc

Back 63

HLA DR4

Front 64

What type of HSN is RA

Back 64

Type III

Front 65

What is RF

Back 65

and Annti IgG antibody, another one is anti ccp it is less sensitive but more specific

Front 66

What do rheum nodules look like histologically

Back 66

Pallisading histos with fibrinoid necrosis

Front 67

Whats classic RA presentation

Back 67

Morning stiffness >30 min, improves with use (unlike OA) symmetric joint involement, systemic sx (fever, pleuritis, pericarditis)

Front 68

What joints does RA not affect

Back 68

any joint that is not synovial (like Intravertebral)

Front 69

What are some extraarticular manifestations of RA

Back 69

anemia of CD, feltys syndrome (RA, splenomeg, leukopenia), pleuritis, effusion, fibrosis, caritis, vasculitis, carpal tunnel

Front 70

Whats the classic triad of sjogrens

Back 70

1. Xeropthalmia
2. Xerostomia
3. Arthritis
Partoid enlargement and risk of B cell lympohoma
assoc with RA

Front 71

Whats sicca syndrome?

Back 71

Dry eyes, dry mouth, nasal and vag dryness, chronic bronchitis, reflux esophagitis. NO ARTHRITIS.

Front 72

how do you treat RA

Back 72

acute/rapid - steroids
MX - takes weeks but is preferred for mod-severe RA
DMARDS 0 mild early seroneg

Front 73

What can excess PRPP cause

Back 73

Gout

Front 74

what can precipitate a gout attack

Back 74

alcohol, big meal (red meat) [Alco metabolites compete for the same binding sites as uric acid causing dec secretion) thiazides can cause gout

Front 75

Acute tx of gout

Back 75

NSAIDs, cochicine (MT inhibits neutrophil migration)

Front 76

CHronic gout tx

Back 76

Allopurinol, or uricourics like probenacid (for under excreters)

Front 77

What are the crystals and birefringence of pseudogout

Back 77

Calcium pyrophosphate crystals within the joint space, forms basophilic rhomboid crystals that are weakly postively birefringent. Usually affects large joints (esp knee)
Both sexes equally

Front 78

what things can gonorrhea cause in the musculoskel sys

Back 78

Synovitis (eg knee), tenosynovitis (hand) and dermatitis (pustules)

Front 79

What infections can cause chronic arthritis

Back 79

TB, Lyme

Front 80

Seronegative spodyloarthropathies = what are they negative for

Back 80

Rheumatoid factor!

Front 81

What are the joint findings in psoriasis

Back 81

asymm, patchy involvement, dactylitis, pencil in a cup deformity on xray..seen in fewer than a 1/3 of pts

Front 82

What heart condition can you see in ankylosing spondylitis

Back 82

aortic regurgitation, remember the kyphosis can cause a restrictive lung picture so monitor PFTs

Front 83

what is seen in Sarcoidosis

Back 83

Widespread noncaseating granulomas, elevated serum ace.

Front 84

What is sarcoid assoc with

Back 84

Restrictive lung dz, bilateral hilar lymphadenopathy, erythema nodosum, bells palsyepi granules with schaumann and asteoroid bodies, uveoparotitis, hypercalcemia.

Front 85

How do you treat sarcoid

Back 85

steroids

Front 86

What does the GRAIN acronym stand for in sarcoid

Back 86

Gammaglobinemia, RA, ACE increase, interstitial fibrosis, non caseating granulomas

Front 87

What are the sx of polymyalgia rheumatica

Back 87

Pain and stiffness in shoulders and hips, often wtih feer, malaise, and weight loss. NO WEAKNESS

Front 88

What are the labs and tx w/ polymyalgia neurmatics

Back 88

Inc ESR and normal CK, tx w/ prednisone

Front 89

What is the presentation of polymyositis

Back 89

Progressive symmetric proximal muscles weakness caused by CD8+ Tcell induced injury to myofibers. Most often inolves the SHOULDERS

Front 90

What are the additional findings in dermatomyositis

Back 90

Malar rash (similar to SLE), heliotrope rash, shawl and face rash, gottrons papules, inc rsik of malgnancy

Front 91

What are the lab findings in polymyo/dermatomyo

Back 91

Inc CK, Inc aldolates,positive ANA and anti Jo 1 antibody

Front 92

What is the antibody assoc in diffuse scleroderma

Back 92

Anti scl 70 (anti dna topo I) Worse prognosis rapid progression early visceral involvement