Usmle Step 1 Flashcards - Msk

Front 1

3 anti-TNF drugs and uses?

Back 1

Etanercept, Infliximab, Adalimumab

Used for RA, psoriasis, Crohn's, ankylosing spondylitis.

Front 2

Infliximab toxicity?

Back 2

Predispose to reinfections such as reactivation of latent TB.

Infliximab: anti-TNF antibody

Front 3

Relationship of salicylates and gout?

Back 3

Salicylates depress uric acid clearance. Do NOT give with gout.

Front 4

Drug interaction of probenecid?

Back 4

Inhibits secretion of penicillin.

Front 5

Drug interactions of allopurinol?

Back 5

Increases concentrations of azathioprine and 6-MP.
- all are metabolized by xanthine oxidase

Front 6

Bisphosphonate names?

Back 6

Etidronate, pamidronate, alendronate, risedronate, zoledronate (IV)

Front 7

Where is acetaminophen active?

Back 7

CNS. Inactivated peripherally

Front 8

Use and benefit of COX2 inhibitor (Celecoxib)?

Back 8

Use: rheumatoid and osteoarthritis

Benefit: spares COX1 --> less corrosive effects on GI lining, good for patients with gastritis or ulcers

Front 9

Effect of aspirin at different doses?

Back 9

Low dose (<300mg/day): decrease platelet aggregation
Intermediate (300-2400mg/d): antipyretic and analgesic
High dose (2400-4000mg/d): anti inflammatory

Front 10

Role of LTC4, D4, E4?

Back 10

Bronchoconstriction, vasoconstriction, contraction of smooth muscle, and increase vascular permeability

Front 11

SCC variant that grows rapidly and regresses spontaneously?

Back 11

Keratoacanthoma

Front 12

Chronic draining sinuses are associated with what cancer type?

Back 12

SCC

Front 13

What is seen within the blisters in bullous pemphigoid?

Back 13

Eosinophils

Front 14

Bullous pemphigoid vs pemphigus vulgaris?

Back 14

Bullous pemphigoid: IgG to hemidesmosomes, spares oral mucosa, linear immunofluorescence

Pemphigus vulgaris: IgG to desmosomes, involves oral mucosa, (+) Nikolsky's sign, reticular immunofluorescence

Front 15

Wickham's striae are seen in what skin condition?

Back 15

Lichen planus
- fine white lacy lesions of buccal mucosa

Front 16

Causes of erythema multiforme?

Back 16

Infections (Mycoplasma pneumoniae, HSV), drugs (sulfa, beta lactam, phenytoin), cancer, autoimmune disease

Front 17

Deposits in dermatitis herpetiformis?

Back 17

IgA deposits at tips of dermal papillae

Front 18

Exotoxin A and B of S. pyogenes?

Back 18

A - streptococcal toxic shock syndrome (STSS)

B - necrotizing fasciitis

Front 19

Site of damage in staphylococcal scalded skin syndrome (SSSS)?

Back 19

Exotoxin destroys keratinocyte attachments in the stratum granulosum only. Sloughing of upper layers of epidermis.

Front 20

More common type of mole in kids and adults?

Back 20

Kids: junctional
Adults: intradermal

Front 21

Skin layer changes in psoriasis?

Back 21

Acanthosis (increased stratum spinosum)
Parakeratosis
Decreased stratum granulosum

Front 22

Findings in verrucae?

Back 22

Epidermal hyperplasia
Hyperkeratosis
Koilocytosis

Front 23

Findings in a freckle (ephelis)?

Back 23

NORMAL # of melanocytes
Increased melanin pigment (melanosomes)

Front 24

"Mask of pregnancy" refers to?

Back 24

Melasma (chloasma)
- hyperpigmentation on forehead/cheeks

Front 25

Lesion with increased number of melanocytes?

Back 25

Solar lentigo ("liver spots")
- in sun exposed regions of elderly

Front 26

Findings in vitiligo?

Back 26

Irregular areas of complete depigmentation.

Decreased number of melanocytes.

Front 27

Causes of albinism?

Back 27

Decreased activity of tyrosinase (normal melanocyte # with decreased melanin production)
OR
Failure of NCC migration during development

Front 28

Histo findings in sarcoidosis?

Back 28

Epithelial granulomas containing microscopic Schaumann and asteroid bodies

Front 29

What can the edrophonium test distinguish in MG?

Back 29

Distinguish under and over-dosing of AChE inhibitors
- distinguishes myasthenic crisis from cholinergic crisis

Front 30

Abs in diffuse scleroderma and CREST syndrome?

Back 30

Diffuse: anti-Scl-70 (anti-DNA topoisomerase I)

CREST: anti-centromere

Front 31

Hyperkeratosis vs acanthosis?

Back 31

Hyperkeratosis: increased thickness of stratum corneum

Acanthosis: epidermal hyperplasia (increased stratum spinosum)

Front 32

Most common area involved in polymyositis?

Back 32

Shoulders.
- progressive symmetric proximal muscle weakness

Front 33

Derm and lab findings in dermatomyositis?

Back 33

Malar rash, heliotrope rash, "shawl and face" rash, Gottron's papules, "mechanic's hands"

Lab: increased CK and aldolase, (+) ANA, anti Jo-1

Front 34

Common sites for tophus formation?

Back 34

External ear
Olecranon bursa
Achilles tendon

Front 35

Crystal type in pseudogout?

Back 35

Basophilic, rhomboid crystals, weakly positively birefringent

Front 36

Most common causes of chronic infectious arthritis?

Back 36

TB (from mycobacterial dissemination) and Lyme disease (Borrelia burgdorferi)

Front 37

Findings in ankylosing spondylitis?

Back 37

Ankylosis
Anterior uveitis
Aortic regurgitation

Front 38

Complication of "bamboo spine"?

Back 38

Can lead to kyphosis which can lead to restrictive lung disease

Evaluate with Schober test

Front 39

Causes of gout?

Back 39

Lesch-Nyhan syndrome
PRPP excess
Decreased excretion (thiazide, etc)
Increased cell turnover
Von-Gierke's disease

Front 40

Risks with Sjogren's syndrome?

Back 40

B-cell lymphoma, dental caries

Front 41

Most common sites of osteoarthritis?

Back 41

Femoral head, knee, cervical/lumbar vertebrae, hands

Front 42

Findings in OA?

Back 42

Destruction of articular cartilage, subchondral cysts, sclerosis, osteophytes (bone spurs), eburnation (polished, ivory-like appearance), Heberden's nodes (DIP), Bouchard's nodes (PIP)

Front 43

Baker's cyst is seen in what?

Back 43

Rheumatoid arthritis
- synovial cyst behind the knee

Front 44

Abs and HLA association of RA?

Back 44

RF (anti-IgG Ab), anti-CCP
HLA-DR4 association

Front 45

Histology of subcutaneous rheumatoid nodule?

Back 45

Fibrinoid necrosis surrounded by palisading histiocytes
- often found in forearm and lungs

Front 46

3 finger "deformities" in RA?

Back 46

Boutonniere and swan neck deformity (PIP) and Z-thumb (IP)

Front 47

Felty's syndrome?

Back 47

1. Rheumatoid arthritis
2. Neutropenia
3. Splenomegaly

Front 48

Zona adherens vs macula adherens?

Back 48

Zona (intermediate junction): cadherins connect to actin just below zona occludens

Macula (desmosome): cadherins connect to intermediate filaments
- auto Abs --> pemphigus vulgaris

Front 49

Rotator cuff muscles that laterally rotate arm?

Back 49

Infraspinatus and teres minor

Front 50

Rotator cuff muscles that adduct arm?

Back 50

Subscapularis and teres minor

Front 51

Papillary vs reticular dermis?

Back 51

Papillary: loose
Reticular: dense

Front 52

Dermatomes of forearm?

Back 52

C5, C6, T1

(C7 and C8 are on ventral hand/wrist)

Front 53

Nerve compressed in axilla from using crutch?

Back 53

Radial

Front 54

Nerve damaged with midshaft fracture of humerus?

Back 54

Radial

Front 55

Nerve damaged at surgical neck of humerus, dislocation of humerus, or IM injections?

Back 55

Axillary

Front 56

Fracture of the hook of the hammate damages what nerve?

Back 56

Ulnar

Front 57

Dislocated lunate damages what nerve?

Back 57

Median

Front 58

Supracondylar fracture of humerus damages what nerve?

Back 58

Median

Front 59

Waiter's tip (Erb-Duchenne palsy) cause and findings?

Back 59

Cause: C5/C6 damage (blow to shoulder, trauma during delivery)

Findings: limb hangs by side, medially rotated, forearm is pronated

Front 60

Klumpke's palsy results from what? What can accompany it?

Back 60

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

Front 61

Ape hand results from what?

Back 61

Proximal median nerve injury

Front 62

Bands that shrink with muscle contraction?

Back 62

H, I, Z

("A" band: "Always" the same)

Front 63

Damage to what nerve causes winged scapula?

Back 63

Long thoracic nerve (C5-C7)

Front 64

Tennis vs golf elbow?

Back 64

Tennis: lateral epicondylitis (extensors)
Golf: medial epicondylitis (flexors)

Front 65

The sciatic nerve splits into what 2 nerves?

Back 65

Tibial and common peroneal

Front 66

Anterior hip dislocation causes injury to what nerve?

Back 66

Obturator (L2-L4)

Front 67

Pelvic fracture causes injury to what nerve?

Back 67

Femoral (L2-L4)

Front 68

Fibula neck fracture causes injury to what nerve?

Back 68

Common peroneal (L4-S2)
- defective foot eversion and dorsiflexion

Front 69

Knee trauma causes injury to what nerve?

Back 69

Tibial (L4-S2)
- defective foot inversion and plantarflexion and toe flexion

Front 70

What causes Trendelenburg sign?

Back 70

Damage to the superior gluteal nerve (L4-S1)
- can be a result of posterior hip dislocation or polio

Front 71

What happens with damage of the inferior gluteal (L5-S2) nerve?

Back 71

Can't jump, climb stairs, or rise from seated position, can't push inferiorly (downward)

Front 72

Muscle fibers with high mitochondria and myoglobin concentration?

Back 72

Type 1 (slow twitch, sustained contraction)

Front 73

Genetics of achondroplasia?

Back 73

FGFR3 is constitutively active --> inhibits chondrocyte proliferation

>85% are spontaneous mutations
Associated with advanced paternal age
Can demonstrate autosomal dominant inheritance

Front 74

Common fractures in osteoporosis?

Back 74

Vertebral crush fractures, femoral neck, distal radius (Colles')

Front 75

Change in bone in osteoporosis?

Back 75

Primarily reduction of trabecular (spongy) bone mass despite normal bone mineralization

Front 76

Lab values in osteopetrosis?

Back 76

Normal Ca, phosphate, ALP
Anemia, thrombocytopenia (decreased marrow space)

Front 77

"Erlenmeyer flask" bones are found in?

Back 77

Osteopetrosis (marble bone disease)

Front 78

Complications in osteopetrosis?

Back 78

Fractures (thick, dense bones)
Cranial nerve impingment and palsies (narrowed foramina)
- also complications of Paget's disease

Front 79

Mosaic bone pattern seen in?

Back 79

Paget's disease

Front 80

How does Paget's disease cause high output heart failure?

Back 80

Increased blood flow from AV shunts

Front 81

McCune-Albright syndrome?

Back 81

Form of polyostotic fibrous dysplasia
- multiple unilateral bone lesions
- endocrine abnl (precocious puberty)
- unilateral pigmented skin lesions (cafe au lait spots)

Front 82

Osteoma and location?

Back 82

New piece of bone on another bone
- often in skull
- associated with Gardner's (FAP)

Front 83

Osteoid osteoma location?

Back 83

Interlacing trabeculae of woven bone surrounded by osteoblasts
- in proximal tibia and femur

Front 84

Osteoblastoma vs osteoid osteoma?

Back 84

Osteoblastoma: bigger, found in vertebral column (instead of proximal tibia/femur)

Front 85

Epiphyseal tumor in distal femur with "double bubble" appearance on x-ray?

Back 85

Giant cell tumor (osteoclastoma)

Front 86

Mature bone tumor with cartilagenous cap in metaphysis?

Back 86

Osteochondroma (exostosis)
- most common benign bone tumor
- men < 25 yo

Front 87

Benign cartilaginous neoplasm found in intramedullary bone of distal extremities?

Back 87

Enchondroma

Front 88

Location of osteosarcoma?

Back 88

Metaphysis of distal femur/proximal tibia

Front 89

Risk factors for osteosarcoma?

Back 89

Paget's disease, bone infarcts, radiation, familial retinoblastoma, fibrous dysplasia

Front 90

Ewing sarcoma histo appearance?

Back 90

Small blue cell malignant tumor, anaplastic

Front 91

Ewing sarcoma location and genetics?

Back 91

Found in diaphysis of long bones, pelvis, scapula, and ribs
11;22 translocation

Front 92

Location of chondrosarcoma?

Back 92

Pelvis, spine, scapula, humerus, tibia, femur
- expansile glistening mass within the medullary cavity

Front 93

Lab values in osteitis fibrosa cystica?

Back 93

High Ca, low phosphate, High ALP, high PTH
- see "brown tumors"

Front 94

3 muscles affected with musculocutaneous nerve injury?

Back 94

Biceps
Brachialis
Coracobrachialis

Front 95

Motor deficit with radial nerve injury (C5-C8)?

Back 95

"BEST" extensors:
Brachioradialis
Extensors of wrist and fingers
Supinators
Triceps