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95 Cards in this Set
- Front
- Back
3 anti-TNF drugs and uses?
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Etanercept, Infliximab, Adalimumab
Used for RA, psoriasis, Crohn's, ankylosing spondylitis. |
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Infliximab toxicity?
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Predispose to reinfections such as reactivation of latent TB.
Infliximab: anti-TNF antibody |
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Relationship of salicylates and gout?
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Salicylates depress uric acid clearance. Do NOT give with gout.
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Drug interaction of probenecid?
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Inhibits secretion of penicillin.
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Drug interactions of allopurinol?
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Increases concentrations of azathioprine and 6-MP.
- all are metabolized by xanthine oxidase |
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Bisphosphonate names?
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Etidronate, pamidronate, alendronate, risedronate, zoledronate (IV)
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Where is acetaminophen active?
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CNS. Inactivated peripherally
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Use and benefit of COX2 inhibitor (Celecoxib)?
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Use: rheumatoid and osteoarthritis
Benefit: spares COX1 --> less corrosive effects on GI lining, good for patients with gastritis or ulcers |
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Effect of aspirin at different doses?
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Low dose (<300mg/day): decrease platelet aggregation
Intermediate (300-2400mg/d): antipyretic and analgesic High dose (2400-4000mg/d): anti inflammatory |
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Role of LTC4, D4, E4?
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Bronchoconstriction, vasoconstriction, contraction of smooth muscle, and increase vascular permeability
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SCC variant that grows rapidly and regresses spontaneously?
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Keratoacanthoma
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Chronic draining sinuses are associated with what cancer type?
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SCC
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What is seen within the blisters in bullous pemphigoid?
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Eosinophils
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Bullous pemphigoid vs pemphigus vulgaris?
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Bullous pemphigoid: IgG to hemidesmosomes, spares oral mucosa, linear immunofluorescence
Pemphigus vulgaris: IgG to desmosomes, involves oral mucosa, (+) Nikolsky's sign, reticular immunofluorescence |
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Wickham's striae are seen in what skin condition?
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Lichen planus
- fine white lacy lesions of buccal mucosa |
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Causes of erythema multiforme?
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Infections (Mycoplasma pneumoniae, HSV), drugs (sulfa, beta lactam, phenytoin), cancer, autoimmune disease
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Deposits in dermatitis herpetiformis?
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IgA deposits at tips of dermal papillae
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Exotoxin A and B of S. pyogenes?
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A - streptococcal toxic shock syndrome (STSS)
B - necrotizing fasciitis |
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Site of damage in staphylococcal scalded skin syndrome (SSSS)?
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Exotoxin destroys keratinocyte attachments in the stratum granulosum only. Sloughing of upper layers of epidermis.
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More common type of mole in kids and adults?
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Kids: junctional
Adults: intradermal |
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Skin layer changes in psoriasis?
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Acanthosis (increased stratum spinosum)
Parakeratosis Decreased stratum granulosum |
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Findings in verrucae?
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Epidermal hyperplasia
Hyperkeratosis Koilocytosis |
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Findings in a freckle (ephelis)?
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NORMAL # of melanocytes
Increased melanin pigment (melanosomes) |
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"Mask of pregnancy" refers to?
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Melasma (chloasma)
- hyperpigmentation on forehead/cheeks |
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Lesion with increased number of melanocytes?
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Solar lentigo ("liver spots")
- in sun exposed regions of elderly |
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Findings in vitiligo?
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Irregular areas of complete depigmentation.
Decreased number of melanocytes. |
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Causes of albinism?
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Decreased activity of tyrosinase (normal melanocyte # with decreased melanin production)
OR Failure of NCC migration during development |
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Histo findings in sarcoidosis?
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Epithelial granulomas containing microscopic Schaumann and asteroid bodies
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What can the edrophonium test distinguish in MG?
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Distinguish under and over-dosing of AChE inhibitors
- distinguishes myasthenic crisis from cholinergic crisis |
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Abs in diffuse scleroderma and CREST syndrome?
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Diffuse: anti-Scl-70 (anti-DNA topoisomerase I)
CREST: anti-centromere |
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Hyperkeratosis vs acanthosis?
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Hyperkeratosis: increased thickness of stratum corneum
Acanthosis: epidermal hyperplasia (increased stratum spinosum) |
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Most common area involved in polymyositis?
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Shoulders.
- progressive symmetric proximal muscle weakness |
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Derm and lab findings in dermatomyositis?
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Malar rash, heliotrope rash, "shawl and face" rash, Gottron's papules, "mechanic's hands"
Lab: increased CK and aldolase, (+) ANA, anti Jo-1 |
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Common sites for tophus formation?
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External ear
Olecranon bursa Achilles tendon |
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Crystal type in pseudogout?
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Basophilic, rhomboid crystals, weakly positively birefringent
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Most common causes of chronic infectious arthritis?
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TB (from mycobacterial dissemination) and Lyme disease (Borrelia burgdorferi)
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Findings in ankylosing spondylitis?
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Ankylosis
Anterior uveitis Aortic regurgitation |
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Complication of "bamboo spine"?
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Can lead to kyphosis which can lead to restrictive lung disease
Evaluate with Schober test |
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Causes of gout?
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Lesch-Nyhan syndrome
PRPP excess Decreased excretion (thiazide, etc) Increased cell turnover Von-Gierke's disease |
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Risks with Sjogren's syndrome?
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B-cell lymphoma, dental caries
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Most common sites of osteoarthritis?
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Femoral head, knee, cervical/lumbar vertebrae, hands
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Findings in OA?
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Destruction of articular cartilage, subchondral cysts, sclerosis, osteophytes (bone spurs), eburnation (polished, ivory-like appearance), Heberden's nodes (DIP), Bouchard's nodes (PIP)
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Baker's cyst is seen in what?
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Rheumatoid arthritis
- synovial cyst behind the knee |
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Abs and HLA association of RA?
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RF (anti-IgG Ab), anti-CCP
HLA-DR4 association |
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Histology of subcutaneous rheumatoid nodule?
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Fibrinoid necrosis surrounded by palisading histiocytes
- often found in forearm and lungs |
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3 finger "deformities" in RA?
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Boutonniere and swan neck deformity (PIP) and Z-thumb (IP)
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Felty's syndrome?
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1. Rheumatoid arthritis
2. Neutropenia 3. Splenomegaly |
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Zona adherens vs macula adherens?
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Zona (intermediate junction): cadherins connect to actin just below zona occludens
Macula (desmosome): cadherins connect to intermediate filaments - auto Abs --> pemphigus vulgaris |
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Rotator cuff muscles that laterally rotate arm?
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Infraspinatus and teres minor
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Rotator cuff muscles that adduct arm?
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Subscapularis and teres minor
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Papillary vs reticular dermis?
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Papillary: loose
Reticular: dense |
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Dermatomes of forearm?
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C5, C6, T1
(C7 and C8 are on ventral hand/wrist) |
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Nerve compressed in axilla from using crutch?
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Radial
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Nerve damaged with midshaft fracture of humerus?
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Radial
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Nerve damaged at surgical neck of humerus, dislocation of humerus, or IM injections?
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Axillary
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Fracture of the hook of the hammate damages what nerve?
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Ulnar
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Dislocated lunate damages what nerve?
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Median
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Supracondylar fracture of humerus damages what nerve?
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Median
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Waiter's tip (Erb-Duchenne palsy) cause and findings?
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Cause: C5/C6 damage (blow to shoulder, trauma during delivery)
Findings: limb hangs by side, medially rotated, forearm is pronated |
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Klumpke's palsy results from what? What can accompany it?
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Inferior trunk of brachial plexus (C8, T1) damage
Can be caused by birth defect or cervical rib that can also compress subclavian artery and result in thoracic outlet syndrome |
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Ape hand results from what?
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Proximal median nerve injury
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Bands that shrink with muscle contraction?
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H, I, Z
("A" band: "Always" the same) |
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Damage to what nerve causes winged scapula?
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Long thoracic nerve (C5-C7)
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Tennis vs golf elbow?
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Tennis: lateral epicondylitis (extensors)
Golf: medial epicondylitis (flexors) |
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The sciatic nerve splits into what 2 nerves?
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Tibial and common peroneal
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Anterior hip dislocation causes injury to what nerve?
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Obturator (L2-L4)
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Pelvic fracture causes injury to what nerve?
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Femoral (L2-L4)
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Fibula neck fracture causes injury to what nerve?
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Common peroneal (L4-S2)
- defective foot eversion and dorsiflexion |
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Knee trauma causes injury to what nerve?
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Tibial (L4-S2)
- defective foot inversion and plantarflexion and toe flexion |
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What causes Trendelenburg sign?
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Damage to the superior gluteal nerve (L4-S1)
- can be a result of posterior hip dislocation or polio |
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What happens with damage of the inferior gluteal (L5-S2) nerve?
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Can't jump, climb stairs, or rise from seated position, can't push inferiorly (downward)
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Muscle fibers with high mitochondria and myoglobin concentration?
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Type 1 (slow twitch, sustained contraction)
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Genetics of achondroplasia?
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FGFR3 is constitutively active --> inhibits chondrocyte proliferation
>85% are spontaneous mutations Associated with advanced paternal age Can demonstrate autosomal dominant inheritance |
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Common fractures in osteoporosis?
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Vertebral crush fractures, femoral neck, distal radius (Colles')
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Change in bone in osteoporosis?
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Primarily reduction of trabecular (spongy) bone mass despite normal bone mineralization
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Lab values in osteopetrosis?
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Normal Ca, phosphate, ALP
Anemia, thrombocytopenia (decreased marrow space) |
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"Erlenmeyer flask" bones are found in?
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Osteopetrosis (marble bone disease)
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Complications in osteopetrosis?
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Fractures (thick, dense bones)
Cranial nerve impingment and palsies (narrowed foramina) - also complications of Paget's disease |
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Mosaic bone pattern seen in?
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Paget's disease
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How does Paget's disease cause high output heart failure?
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Increased blood flow from AV shunts
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McCune-Albright syndrome?
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Form of polyostotic fibrous dysplasia
- multiple unilateral bone lesions - endocrine abnl (precocious puberty) - unilateral pigmented skin lesions (cafe au lait spots) |
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Osteoma and location?
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New piece of bone on another bone
- often in skull - associated with Gardner's (FAP) |
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Osteoid osteoma location?
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Interlacing trabeculae of woven bone surrounded by osteoblasts
- in proximal tibia and femur |
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Osteoblastoma vs osteoid osteoma?
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Osteoblastoma: bigger, found in vertebral column (instead of proximal tibia/femur)
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Epiphyseal tumor in distal femur with "double bubble" appearance on x-ray?
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Giant cell tumor (osteoclastoma)
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Mature bone tumor with cartilagenous cap in metaphysis?
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Osteochondroma (exostosis)
- most common benign bone tumor - men < 25 yo |
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Benign cartilaginous neoplasm found in intramedullary bone of distal extremities?
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Enchondroma
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Location of osteosarcoma?
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Metaphysis of distal femur/proximal tibia
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Risk factors for osteosarcoma?
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Paget's disease, bone infarcts, radiation, familial retinoblastoma, fibrous dysplasia
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Ewing sarcoma histo appearance?
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Small blue cell malignant tumor, anaplastic
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Ewing sarcoma location and genetics?
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Found in diaphysis of long bones, pelvis, scapula, and ribs
11;22 translocation |
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Location of chondrosarcoma?
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Pelvis, spine, scapula, humerus, tibia, femur
- expansile glistening mass within the medullary cavity |
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Lab values in osteitis fibrosa cystica?
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High Ca, low phosphate, High ALP, high PTH
- see "brown tumors" |
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3 muscles affected with musculocutaneous nerve injury?
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Biceps
Brachialis Coracobrachialis |
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Motor deficit with radial nerve injury (C5-C8)?
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"BEST" extensors:
Brachioradialis Extensors of wrist and fingers Supinators Triceps |