Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
92 Cards in this Set
- Front
- Back
What are the order of epi cell junctions
|
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 |
|
whats the unhappy triad
|
MCL, ACL, lateral meniscus
|
|
where does the PCL attach
|
Posterior intercondyl tibia to anterior lateral of medial epicondyl of the femur
|
|
where is the anserine bursa
|
Medial kneww
|
|
Where does the ACL attach
|
Anterior tibia --> lateral femoral condyle
|
|
what is the landmark for a pudendal nerve block
|
Ischial spine
|
|
what does the supraspinatus do
|
abducts the arm
|
|
What does the infraspinatus do
|
Laterally rotates arm (pitching injury)
|
|
what does the teres minor do
|
Laterally rotates and adducts
|
|
Subscapularis
|
MEdially rotes and adducts
|
|
what is assoc with carpal tunnel syndrome
|
preg, obesity, hypothy, ra, dm
|
|
What innervates the extensors of the wrist and fingers
|
Radial
|
|
What innervates the brachoradialis
|
Radial, flexion, supination, and pronation
|
|
what innervates the interossi
|
Ulnar
|
|
what causes ape hand
|
a proximal median nerve lesion - loss of opponens pollicis muscle function - unopposable thumb elbow or wrist lesion
|
|
what 2 things does the serratus anterior connect to
|
scapula and the thoracic cage, used for abduction above the horizaontal position
|
|
What are the thenar muscles
|
OAF - opponens policis, abductor pollicus brevis, Flexor pollicus brevis (median nerve)
|
|
What will cause an obturator nerve lesion
|
Anterior hip dislocation,
|
|
what motor/sens does the obturator control
|
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)
|
|
What does the femoral control L2-L4
|
Thigh flexion and leg extension (quads), sensory - ant thigh and medial leg.
|
|
What causes a lesion in the femoral
|
pelvic fracture
|
|
What causes a lesion to the peroneal L4-S2
|
lateral aspect of thigh trauma, or fibula neck fracture
** frosses the head of the fibula |
|
What does the peroneal control
|
Motor - Eversion and dorsifelxion
Sens - anterolateral leg and dorsum of foot, toe extension LESION = foot drop, foot slap, steppage gait |
|
What injury damages the tibial L4-S2
|
Knee trauma
|
|
What does the tibial control
|
Motor - Inversion and plantar flexion and toe flexion
Sensory - sole of the foot |
|
What in jurse the superior gluteal (L4-S1)
|
Posterior hip dislocation
|
|
What does the sup glut control
|
Thigh abduction (+ trendelenburg sign hip drops to contralateral side when standing on ipsilateral foot) controls the minimus
|
|
What injury hurts the inferior gluteal L50S2
|
Posterior hip dislocation
|
|
What is a lesion to the inf gluteal like
|
Glut max is out - can't climb stairs, rise from seated, cant push inferiorly downward
|
|
What sarcomere band stays the same length
|
A band, the H and I bands shorten
|
|
Smooth muscle contraction - no troponin -- how does it work
|
Ca increase --> inc ca in cyto, ca binds calmodulin --> activates myosin light chain kinase allows crossbridge I guess
|
|
What bones come from endochobdral oss
|
Longitundinal bone growht, cartilage model made first by chondrocytes, OCs and OBs later replace it with woven bone and remodel to lamellar
|
|
What bones come from membranous ossification
|
Flat bones, (skull, face, and axial skeleton), woven bone formed directly without caritlage. Later remodeled to lamellar
|
|
What are the two types of lamellar bone
|
1. Cortical (compact) oriented along lines of stress
2. Canellous (trabecular) |
|
What is woven bone
|
immature non stress orriented see in embryo and fracture calluses
|
|
what type of bone growth fails in achondroplasia
|
Endochondrial ossification, membranous not affected
Defect is in FGFR3 constitutive activ 85% sporadiuc |
|
What type of bone is reduced in osteoporosis
|
Trabecular (but senile can affect both)
|
|
what the tx for osteoporosis
|
Estrogen (SERM) and or cacitonin, Bisphopohates or pulsatile PTH for severe. GCCs are contraindicated.
|
|
what are causes of secondary osteoporosis
|
drugs (heparin), hypogonadism, hypercortisolism, hyperthyroidism, space, renalfailure, chronic acidosis
|
|
What is osteopetrosis? what are the labs?
|
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
|
|
Whats the issule in osetomalacia
|
Defective mineralization/calcification of osteoid --> soft bones
Labs = Low D --> low ca --> inc PTH --> low PO4 ** ALP is normal |
|
What are the 3 phases of pagets
|
1. Hypervascular osteolytic..massive turnover
2. Intermed OB activity dominates 3. quiescent - OB activity decreases |
|
What is the possible origin of pagets
|
possibly viral (paramyxovirus
|
|
What are the labs in pagets
|
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
|
|
What is pagets assoc with
|
Osteogenic sarcoma, Inc hhat size, can have hearing loss due to auditory foramen narrowing
|
|
In osteitis fibrosa cystica - what are the labs
|
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
|
|
in polyostotic fibrous dysplasia what is happening? whats the association?
|
Bone is replaced by fibroblasts, collagen and irregular bony trabeculae, this affects many bones. assoc w/ mccune albright syndrome
|
|
What do you see in mccune albringt
|
Multiple unilateral bone lesions assoc with endocrine abns (precocious pub) unilateral ash leaf spots this is a gain of function mosaicism mutation
|
|
Where do osteomas occur often
|
the skull (assoc with Gardners bone on top of bone)
|
|
What are osteoid osteomas
|
Interlacing trabeculae of wven bone surrounded by osteoblasts <2cm and food in the prox tibia and femur
|
|
WHat is an osteoblastoma
|
same as an osteoid osteoma but >2cm and found in the vert column
|
|
What is a giant cell tumor
|
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
|
|
Osteochondroma
|
Most common benign bone tumore, mature bone with cart cap, usually in med <25, originates from long metaphysis. Malig
|
|
Where are endochondromas found?
|
Intramedullary bone, usually the distal extremities (unlike chondrosarcoma which is in the pelvis spine, scapula, humerus, tibia, or femur
|
|
Osteosarcoma - where is it found, age, Rfs
|
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 |
|
What are the histo characteristic of Ewings
|
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
|
|
Whats the transloc for ewings
|
11,22
|
|
What is a chondrosarcoma
|
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.
|
|
Where do you see heberdens nodes, and bouchards?
|
Heb - DIP
Bouchard PIP Both assoc w/ OA |
|
What are some secondary causes of OA -
|
obestiy
|
|
Where does RA affect
|
MCP and PIP, AI disease against synovial joints with pannus formation
|
|
what joint is not involved
|
DIP
|
|
Whats the HLA assoc
|
HLA DR4
|
|
What type of HSN is RA
|
Type III
|
|
What is RF
|
and Annti IgG antibody, another one is anti ccp it is less sensitive but more specific
|
|
What do rheum nodules look like histologically
|
Pallisading histos with fibrinoid necrosis
|
|
Whats classic RA presentation
|
Morning stiffness >30 min, improves with use (unlike OA) symmetric joint involement, systemic sx (fever, pleuritis, pericarditis)
|
|
What joints does RA not affect
|
any joint that is not synovial (like Intravertebral)
|
|
What are some extraarticular manifestations of RA
|
anemia of CD, feltys syndrome (RA, splenomeg, leukopenia), pleuritis, effusion, fibrosis, caritis, vasculitis, carpal tunnel
|
|
Whats the classic triad of sjogrens
|
1. Xeropthalmia
2. Xerostomia 3. Arthritis Partoid enlargement and risk of B cell lympohoma assoc with RA |
|
Whats sicca syndrome?
|
Dry eyes, dry mouth, nasal and vag dryness, chronic bronchitis, reflux esophagitis. NO ARTHRITIS.
|
|
how do you treat RA
|
acute/rapid - steroids
MX - takes weeks but is preferred for mod-severe RA DMARDS 0 mild early seroneg |
|
What can excess PRPP cause
|
Gout
|
|
what can precipitate a gout attack
|
alcohol, big meal (red meat) [Alco metabolites compete for the same binding sites as uric acid causing dec secretion) thiazides can cause gout
|
|
Acute tx of gout
|
NSAIDs, cochicine (MT inhibits neutrophil migration)
|
|
CHronic gout tx
|
Allopurinol, or uricourics like probenacid (for under excreters)
|
|
What are the crystals and birefringence of pseudogout
|
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 |
|
what things can gonorrhea cause in the musculoskel sys
|
Synovitis (eg knee), tenosynovitis (hand) and dermatitis (pustules)
|
|
What infections can cause chronic arthritis
|
TB, Lyme
|
|
Seronegative spodyloarthropathies = what are they negative for
|
Rheumatoid factor!
|
|
What are the joint findings in psoriasis
|
asymm, patchy involvement, dactylitis, pencil in a cup deformity on xray..seen in fewer than a 1/3 of pts
|
|
What heart condition can you see in ankylosing spondylitis
|
aortic regurgitation, remember the kyphosis can cause a restrictive lung picture so monitor PFTs
|
|
what is seen in Sarcoidosis
|
Widespread noncaseating granulomas, elevated serum ace.
|
|
What is sarcoid assoc with
|
Restrictive lung dz, bilateral hilar lymphadenopathy, erythema nodosum, bells palsyepi granules with schaumann and asteoroid bodies, uveoparotitis, hypercalcemia.
|
|
How do you treat sarcoid
|
steroids
|
|
What does the GRAIN acronym stand for in sarcoid
|
Gammaglobinemia, RA, ACE increase, interstitial fibrosis, non caseating granulomas
|
|
What are the sx of polymyalgia rheumatica
|
Pain and stiffness in shoulders and hips, often wtih feer, malaise, and weight loss. NO WEAKNESS
|
|
What are the labs and tx w/ polymyalgia neurmatics
|
Inc ESR and normal CK, tx w/ prednisone
|
|
What is the presentation of polymyositis
|
Progressive symmetric proximal muscles weakness caused by CD8+ Tcell induced injury to myofibers. Most often inolves the SHOULDERS
|
|
What are the additional findings in dermatomyositis
|
Malar rash (similar to SLE), heliotrope rash, shawl and face rash, gottrons papules, inc rsik of malgnancy
|
|
What are the lab findings in polymyo/dermatomyo
|
Inc CK, Inc aldolates,positive ANA and anti Jo 1 antibody
|
|
What is the antibody assoc in diffuse scleroderma
|
Anti scl 70 (anti dna topo I) Worse prognosis rapid progression early visceral involvement
|