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USMLE Step 1 > MSK > Flashcards

MSK Flashcards

1
Q

what are symptoms of axillary nerve injury?

A

(C5-6) flat deltoid, failure with abduction of arm >15 degrees, usually with neck fracture of humerus or anterior dislocation

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2
Q

Radial nerve injury?

A

C5-T1, wrist drop, loss of extension of wrist, elbow, finger , dec grip strength, , loss sensation posterior forearm and dorsal hand

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3
Q

Median nerve injury?

A

supracondylar fracture, carpel tunnel, loss of wrist flex and fingers, thumb opposition. Loss of sensation over thenar eminence and palmar aspect of 3.5 fingers

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4
Q

Ulnar injury?

A

fracture median epicondyle- hamate- loss wrist flexion, flexion medial fingers, adduction of the fingers

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5
Q

what is erbs palsy?

A

(C5/6)lateral traction neck during delivery, arm is adducted, medially rotated, pronated and extended

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6
Q

what is klumpke palsy?

A

lower trunk C8-T1, you get claw hand, upward force of the arm at delivery or adults, grabbing tree branch during fall, lumbricals, interossei, thenar and hypothenar

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7
Q

what does the McMurray test for?

A

Meniscal tears- popping or pain with external rotation is a medial menicus tear, while popping or pai with internal rotation is a lateral menicus tear

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8
Q

what is a baker’s cyst?

A

fluid collection (secondary to inflam-osteoarthritis or rheumatoid) in gastrocnemius and semimembranous bursa- popliteal fluid collection

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9
Q

What is the most common lower ankle sprain? What is the most common high ankle sprain?

A

low- anterior talofibular ligament

high- anterior inferior tibiofibular ligament

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10
Q

what nerve injury is associated with pelvic fracture?

A

femoral nerve (L2-4), anterior thigh and medial thigh sensation, , dec thigh flexion and leg extension

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11
Q

what does the sciatic nerve split into?

A

common peroneal and tibular nerves (injury from herniated disc)

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12
Q

what causes trendelenburg gait?

A

superior gluteal nerve injury (L4-S1), the hip that drops- the injury is on the other side

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13
Q

what does the pudenal nerve supply?

A

(S2-4) perineum-urethral and anal sphincters

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14
Q

what is De Quervain tenosynovitis

A

non inflam thickening of abductor pollicis brevis and extensor pollicis brevis, pain on Finkelsteins , radial styloid with active or passive stretch of thumb

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15
Q

What is Legg-Calve Perthes?

A

usually 5-7 year olds necrosis of femoral head, x-ray often normal, hip pain with limp

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16
Q

What is slipped capital femoral epiphysis?

A

epiphyses slips relative to femoral head, usually obese 12 year old due to axial forces, hip/knee pain and surgery needed

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17
Q

which direction to lumbosacral discs usually herniate?

A

posterolateral into the central canal so affect nerve underneath (ie L3/4 affects L4)

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18
Q

what are the common lumbosacral radiculopathies?

A
  1. L3/L4- difficulty with knee extension, dec patellar reflex
  2. L4/5- difficulty with heel walking and dorsiflexion
  3. L5/S1- difficulty with toe walking and plantar flexio, dec achilles reflex
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19
Q

What are type 1 and type 2 muscle fibers?

A

Type 1: red, high mitochondria and myoglobin, red, for endurance, oxidative phosphorylation
Type 2: white: low mitochondria, low myoglobin, weight training, sprinting, white fibers, anaerobic glycolysis

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20
Q

How does estrogen work in bone metabolism?

A

-inhibits osteoclasts and increases osteoblasts. Fusion of epiphyseal plate in puberty

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21
Q

What is achondroplasia?

A

failure of endochondral and membranous ossification- failure of long bones and big head relative to rest of body (membranous), constitutive activation of FGFR inhibits chondrocytes. Most sporadic, can be AD, homozyg lethal

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22
Q

What is osteomalacia/Ricketts?

A

failure of bone mineralization, vitamin D deficiency

-widening epiphyses, metaphyseal cupping, rachitic rosary (bead-like costo-chondral junctions)

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23
Q

What is Pagets disease?

A

increased osteoclast then osteoblast formation, , poor quality bone

  • Ca, PTH and phosphorus all normal
  • hearing loss is common secondary to auditory foramen narrowing
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24
Q

Why do you get osteonecrosis (avascular necrosis) of the femoral head?

A

medial circumflex femoral artery

-legg calve perthes, slipped capital femoral epiphyses, alcohol, corticosteroids,sickle cell, gaucher disease

25
Q

What are the antibodies for rheumatoid arthritis?

A

IgM against IgG Fc portion, anti-CCP

26
Q

whats the difference between Rheumatoid joint involvement and OA?

A

OA- DIP, PIP, 1CMC, osteophytes, heberdej nodes on DIP, bouchard on PIP
Rheumatoid- 1st CMC, PIP, erosions, subluxations, swan neck and boutinerres

27
Q

What are the most common bugs for septic arthritis?

A

staph, strep and neisseria

28
Q

What are the seronegative spondyloarthropathies?

A

RF negative (usually HLA B27- no IgG antibodies)

  1. Psoriatic
  2. IBD
  3. Ankylosing spondylitis
  4. Reactive
29
Q

What is the classic triad for reactive arthritis and what bugs cause it?

A

urethritis, arthritis and conjunctivitis

-shigella, yersinia, campylobacter, chlamydia, salmonella

30
Q

What are the manifestations of lupus?

A

SOAP BRAIN MD
-serositis, oral ulcers (painless), arthritis, photosensitivity, blood disorder (cytopenias), renal disease, ANA positive, immune (type 3 hypersensitivity-lack of early complement C1q, C4, C2, dec clearance immune complexes), neurological, malar, discoid rashes

31
Q

What is the difference between polymyalgia rheumatica and polymyositis?

A

polymyositis/dermatomyositis has elevated CK

32
Q

what are the antibiotdies for polymyositis and dermatomyositis?

A

anti-Jo, anti-SRP, anti-M2, elevated CK

33
Q

polymyositis is associated with what on biopsy?

A

endomysial inflammation with CD8 T cells

34
Q

what are the common derm features of dermatomyositis?

A

gottrons papules, heliotrope rash, malar rash that affects nasiolabial folds, shawl rash

35
Q

what are the path findings for dermatomyositis?

A

permysial inflam with CD4 T cells

36
Q

What antibodies are diffuse scleroderma related to?

A

anti-Scl70 and anti-topoisomerase I antibody

37
Q

What is CREST?

A 
calcinosis cutis
-anti-centromere antibody
raynauds
esophageal dysmotility
sclerdactyly
telangiectasia
38
Q

what is acantholysis?

A

separation of the epidermal layers

39
Q

what is acanthosis?

A

epidermal hyperplasia

40
Q

what is auspitz sign?

A

psorasis- pinpoint bleeding when scale removed

41
Q

what is erysipelas?

A

upper dermis infection, usually S pyogenes, well demarcated area

42
Q

what layer does cellulitis often affect?

A

the deeper dermis, S aureus or S pyogenes

43
Q

what is necrotizing fasciitis?

A

deeper layers of skin, walled off, anaerobic or S pyogenes, produces methane and Co2 so you get crepitus

44
Q

what is staph scalded skin?

A

the exotoxin destroys the keratin, separates the epidermal layer and destroys attachment to granulosum, fever and generalized rash, heals completely but can cause renal insufficiency
-+Nikolsky sign

45
Q

what is pemphigus vulgaris?

A

autoimmune- IgG against desmoglein that connects keratinocytes to the stratum spinosum- get intraepidermal bullae, acanthlolysis (separation of keratinocytes) tombstone pattern

  • type 2 hypersensitivity reaction
  • nikolsky sign
46
Q

what is the difference between pemphigus vulgaris and bullous pemphigoid?

A

BP is IgG to hemidesmosomes

  • tense blisters with eosinophils
  • type 2 hypersensitivity
  • no nikolsky sign
  • linear pattern on immunofluroscence as opposed to reticular like BP
47
Q

what is dermatitis herpetiformis?

A

pruritic papules, vesicles, bullae

  • igA in tip of dermis
  • celiac disease
  • dapsone
48
Q

what is steven johnson syndrome?

A

fever, bullae, sloughing of skin at epidermal-dermal junction, usually in reaction to drug

  • > 30% involved and its toxic epidermal necrolysis (TEN)
  • life threatening
49
Q

what layer of the skin does erythema nodosum disrupt?

A 
subcutaneous fat (panniculitis)
-sacoidosis, coccidiodomycosis, histoplasmosis, streptococcal infection, leprosy, IBD
50
Q

What is lichen planus?

A

6 Ps- purple, pruritic, polygonal, planar, papules, plaques

  • can be associated hep C
  • reticular involvement of mucosa- Wickham striae, sawtooth infiltrates of lymphocytes
51
Q

what is a herald patch associated with?

A

pityrasis rosea

52
Q

what type of UV is with sunbruns and which is aging and tanning?

A

UVB is burn and UVA is tAnning and Aging

53
Q

what are the burn depths?

A
  1. epidermis
  2. partial thickness through epidermis and dermis
  3. full thickness through epidermis, dermis and hypodermis (scarring), waxy, leathery, nonblanching
54
Q

what correlates with risk of mets in melanoma?

A

depth of the lesion (breslow)

55
Q

what is the mutation associated with melanoma?

A

BRAF kinase

56
Q

how does tylenol work?

A

reversibly inhibits cyclooxygenase in CNS, inactive peripherally

57
Q

how does celecoxib work?

A

selective cox2 inhibitor, helps maintain gastric mucosa, spares plt as well

58
Q

what are some important functions of prostaglandins that cox inhibitors interfer with?

A

protect the gastric mucosa and cause vasodilation of afferent arteriole in the kidney

USMLE Step 1 (20 decks)

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