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Flashcards in Anatomy Deck (397):
1

Order of neurovasculature in femoral triangle

vein, artery, nerve (medial to lateral)

2

location of cricothyroid membrane (for cricothyroidotomy if someone is choking)

superior to cricoid cartilage inferior to thyroid cartilage (vignettes 22)

3

paraesophageal hernia

Fundus protrudes into thoracic cavity. GEJ remains fixed below diagram unlike in sliding hiatal hernia.

4

Femoral nerve palsy: 1) common scenario 2) dysfunction

1) Pelvic fracture
2) weakness in right leg and lack of sensation in anterior area of thigh + weakness with extension of right knee + weak hip flexion

5

klumpke vs erb palsy

klumpke is an abduction injury; Erb palsy is an adduction injury

6

Jugular foramen (Vernet) syndrome

lesion to jugular foramen, thus CN 9, 10, 11 affected

7

Jugular foramen (Vernet) syndrome presentation

dysphagia + hoarseness + dysarthria + loss of gag reflex on ipsilateral side + deviation of uvula toward normal side + atrophy of sternocleidomastoid muscle and trapezius.

8

unhappy triad

ACL + MCL + medial meniscus

9

compartment syndrome presentation

Persistent leg pain + swollen, tense, and warm region + decreased anterior tibial pulse.

10

causes of compartment syndrome

crush injury + fracture + chronic vigorous exercise

11

FDS vs. FDP

- FDS wraps around PIP.
- FDP goes all the way to the end and flexes wrist + MCP + interphalangeal joints.

12

ACL location

lateral femoral condyle --> anterior tibia.

13

PCL location

medial femoral condyle --> posterior tibia.

14

Lachman test

Tests for ACL injury, at 30 degree angle

15

valgus/varus

lateral force/medial force

16

McMurray test

1) pain, "popping" on external rotation --> medial meniscal tear.
2) pain, "popping" on internal rotation --> lateral meniscal tear.

17

Baker cyst

Popliteal fluid collection in gastrocnemius-semimembranous bursa, commonly communicating with synovial space and related to chronic joint disease.

18

most common rotator cuff injury?

supraspinatus

19

test for supraspinatus tear?

"empty/full can" test.

20

infranspinatus innervation

suprascapular nerve

21

Most common pitching injury

infraspinatus

22

teres minor innervation

axillary

23

subscapularis innervation

upper and lower subscapular nerves

24

SITS muscle innervated by

C5-C6

25

bone palpated in anatomic snuff box

scaphoid

26

lunate dislocation

Can cause carpal tunnel syndrome

27

damage to hook of hamate

ulnar nerve injury (common with fall on outstretched hand).

28

axillary innervation

C5-C6

29

musculocutaneous innervation

C5-C7

30

loss of supination suggests...

musculocutaneous damage

31

decreased grip strength suggests

radial nerve injury (wrist extension necessary for maximal action of flexors)

32

Median innervation

C5-T1

33

supracondylar fracture of humerus damages

median

34

location of radial nerve deep branch

supinator canal, where it can be injured with repetitive pronation/supination (such as using a screwdriver).

35

ulnar innervation

C8-T1

36

radial deviation of wrist upon flexion indicates...

ulnar injury

37

Nerve responsible for abduction and adduction of fingers

Interossei muscle, innervated by ulnar.

38

recurrent branch of median nerve innervation

C5-T1

39

recurrent branch of median nerve 1) scenario 2) presentation

1) superficial laceration of palm
2) "ape hand", loss of thenar muscle group: oppostion, abduction, and flexion of thumb. *no loss of sensation

40

medial antebrachial cutaneous nerve distribution

FA 442

41

Damage to posterior cord causes...

Wrist drop

42

erb palsy muscle deficit

deltoid, supraspinatus, infraspinatus, biceps brachii

43

klumpke palsy nerve damage

C8-T1

44

lumbricals function

Flex MCP joints, extend DIP and PIP joints.

45

klumpke palsy muscle deficit

intrinsic hand muscles; lumbricals, interossei, thenar, hypothenar

46

TOS functional deficit

atrophy of instrinsic hand muscles; ischemia, pain, and edema due to vascular compression.

47

pope's blessing seen with

proximal median nerve injury

48

hand presentation for proximal ulnar nerve injury

"OK gesture" (digits 1-3 flexed)

49

dorsal vs. palmar interossei

Dorsal abduct fingers, palmars adduct (DAB PAD)

50

Obturator innervation

L2-L4

51

Pelvic surgery nerve at risk

obturator

52

femoral innervation

L2-L4

53

Nerve at risk with pelvic fracture

femoral

54

femoral injury presentation

decreased thigh flexion and leg extension

55

common peroneal roots

L4-S2

56

tibial roots

L4-S3

57

tarsal tunnel syndrome

distal lesion to tibial nerve

58

tibial nerve damage presentation

Inability to curl toes and loss of sensation on sole of foot.

59

tibial nerve proximal lesion

Foot everted at rest with loss of inversion and plantarflexion.

60

superior gluteal nerve roots

L4-S1

61

localizing trendelenburg

lesion is contralateral to side of hip that drops, ipsilateral to extremity on which patient stands

62

Inferior gluteal roots

L5-S2

63

nerve at risk with posterior hip dislocation

inferior gluteal

64

inferior gluteal lesion presentation

difficulty climbing stairs + rising from seated position + loss of hip extension

65

superior gluteal innervates..

gluteus medius, minimus + tensor fascia latae.

66

inferior gluteal nerve innervates...

gluteus maximus

67

sciatic nerve roots

L4-S3

68

sciatic path and innervation

innervates posterior thigh, splits into common peroneal and tibial nerves.

69

pudendal roots

S2-S4

70

Best location for IM gluteal injection

superolateral quadrant

71

Presentation of L3-L4 herniation

Weakness of knee extension, decreased patellar reflex.

72

Presentation of L4-L5 herniation

weakness of dorsiflexion, difficulty in heel-walking

73

Presentation of L5-S1 herniation

weakness of plantarflexion, difficulty in toe-walking + decreased achilles reflex

74

long thoracic nerve travels with...

lateral thoracic artery

75

axillary nerve travels with

posterior circumflex artery

76

radial nerve travels with

deep brachial artery

77

median nerve location

distal humerus/cubital fossa

78

median nerve travels with

brachial artery

79

tibial nerve travels with

popliteal artery

80

distal tibial nerve location

posterior to medial malleolus

81

tibial nerve travels with

posterior tibial artery

82

skeletal muscle triad

1 T-tubule + 2 terminal cisternae

83

cardiac muscle dyad

1 T-tubule + 1 terminal cisterna

84

release Ca effect in muscle cell physiology...

Binds to TROPONIN C, causing conformational change that moves tropomyosin out of the myosin-binding groove on actin filaments.

85

Muscle cell physiology

tropomysin complex mooves out of myosin-binding groove ---> myosin releases bound ADP and Pi --> displacement of myosin on actin filament (power stroke) --> contraction results in shortening of H and I bands between Z lines but A band remains the same (A band Always same length).

86

Next step after contraction in muscle cell?

Binding of a new ATP molecule causes detachment of myosin head from actin filament. Hydrolysis of bound ATP --> ADP, myosin head adopts high-energy cocked position for the next contraction cycle.

87

Type 1 vs type II muscle fibers

codebook

88

NO synthase

activates L-arginine to nitric oxide

89

smooth muscle relaxation pathway

agonist binds to receptor --> calcium released --> calcium activates NO synthase --> NO diffuse through endothelial cell and into smooth muscle cell --> NO activates GTP to cGMP --> cGMP activates myosin-light-chain phosphatase (MLCP) --> MLCP dephosphorylates myosin II causing relaxation.

90

myosin-light-chain phosphatase (MLCP)

Enzyme that initiates smooth muscle cell relaxation

91

smooth muscle contraction pathway

Membrane depolarization --> Ca enters through L-type voltage gated channels --> forms calcium-calmodulin complex --> activates myosin-light-chain-kinase (MLCK) --> phosphorylates Myosin

92

endochondral ossification bones

codebook

93

defective process in achondrplasia

endochondral ossification

94

intramembranous ossification bones

codebook

95

endochondral ossification process

cartilaginous model --> woven bone --> lamellar bone

96

woven bone found in...

1) fractures
2) Paget disease

97

membranous ossification process

woven bone formed directly --> lamellar bone

98

origin of osteoblasts

differentiate from mesenchymal stem cells in periosteum

99

osteoclast mechanism

dissolves bone by secreting H+ and collagenases

100

osteoclast origin

Differentiates from a fusion of monocyte/macrophage lineage precursor.

101

PTH action

1) At low, intermittent levels, exerts anabolic effects (builds bone) through indirect mechanism.
2) chronic high PTH levels cause catabolic effects (osteitis fibrosa cystica)

102

osteitis fibrosa cystica

Presentation of primary hyperparathyroidism. Characteristic findings = subperiosteal erosions/thinning of phalanges + granular “salt-and-pepper” skull + osteolytic cysts in long bones.

103

estrogen mechanism in relation to bone.

Inhibits apoptosis in bone-forming osteoblasts and induces apoptosis in bone resorbing osteoclasts.

104

estrogen deficiency in relation to osteoporosis

Causes excess cycles of remodeling. Bone resoprtion leads to osteoporosis.

105

achondroplasia mechanism

Constitutive activation of fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation. So it's actually a gain of function mutation.

106

achondroplasia genetics

>85% occur sporadically; autosomal dominant with full penetrance (homozygosity is lethal).

107

trabeuclar bone

spongy bone

108

osteoporosis bone pathophys

There's normal mineralization and lab values but trabecular and cortical bone lose mass and interconnections.

109

levothyroxine SE

osteoporosis

110

osteoporosis diagnosis

Bone mineral density scan (dual energy x-ray absorptiometry) with a T-score of less than or equal to -2.5 OR fragility fracture of hip or vertebra.

111

osteoporosis treatment

Bisphosphonates + teriparatide + SERMS + rarely calcitonin + denosumab.

112

Colles fracture

Fracture of distal radius; classic sign of osteoporosis.

113

Osteopetrosis
1) etiology
2) presentation
3) treatment

o Coded character: walls made out of sponges/persistence of the primary spongiosa in the medullary cavity with no mature trabeculae. Dead zombies lining perimeter + page is weaving + woven bones all along back wall/caused by defective osteoclastic bone resorption, which results in accumulation of woven bone and diffuse skeletal thickening. /autosomal recessive and dominant forms. Skeleton with really thick bones on couch + covered in casts/causes thickened and dense bones that are prone to fracture. Skeletons bones look like below + big Erlenmeyer flasks on table/ends of long bones are misshapen and bulbous (“Erlenmeyer flask deformity”). Casts all over skeleton/although bone turnover is decreased, tissue becomes weak and predisposed to fractures. /cranial foramen decrease in size, leading to CN palsies. Huge spleen to the left of the couch + huge hippo on couch/hepatosplenomegaly. He has a pan on top of his head/bone fills marrow space pancytopenia + extramedullary hematopoiesis. /mutations (eg carbonic anhydrase II) impair ability of osteoclast to generate acidic environment necessary for bone resorption. Big pile of bones on top with Jo-Jo sitting on top/treatment = bone marrow transplant (osteoclasts derived from monocytes).

114

osteoid

unmineralized, organic portion of bone matrix that forms prior to maturation (mineralization) of bone.

115

lab profile in osteomalacia/rickets

lab profile = low levels of vitamin D and phosphate + low or normal level of calcium + elevated alkaline phosphatase

116

"looser zones"

pseudofractures, found in osteomalacia.

117

lab profile in paget's

normal Ca, phosphorus, PTH, + increased ALP.

118

fractures in paget's

long bone chalk-stick fractures

119

stages of paget's

lytic (osteoclasts) --> mixed (osteoclasts + osteoblasts) --> sclerotic (osteoblasts) --> queiescent (minimal osteoclast or blast activity)

120

causes of avascular necrosis

1) corticosteroids
2) alcoholism
3) sickle cell disease
4) trauma
5) the bends "caisson/decompression disease)
6) Legg-Calve-Perthes disease (idiopathic)
7) Gaucher disease
8) Slipped capital femoral epiphysis

121

Osteopetrosis lab values

everything normal except low/normal serum Calcium

122

Paget lab values

everything normal except increased ALP

123

"Brown tumors"

characteristic finding in osteitis fibrosa cystica due to fibrous replacement of bone, subperiosteal thinning.

124

Primary hyperparathyroidism lab values

calcium, ALP, PTH up, phosphate down

125

secondary hyperparathyroidism lab values

decreased serum calcium, increased phosphate, ALP, PTH

126

Hyperphosphatemia in secondary hyperparathyroidism pathophys

pathophys = phosphate clearance declines due to fall in GFR increased phosphate binds free serum Ca2+, further exacerbating hypocalcemia.

127

lab profile in osteomalacia/ricktes

low serum ca + phosphate, high ALP, high PTH

128

Causes of hypervitaminosis D

1) Oversupplementation
2) Granulomatous disease (eg sarcoidosis)

129

lab profile in hypervitaminosis D

High serum calcium and phosphate, normal ALP, high PTH.

130

osteochondroma epidemiology

Most common benign bone tumor. Males

131

osteochondroma characteristics

Bony exostosis with cartilaginous (chondroid cap). rarely transforms to chondrosarcoma.

132

Giant cell tumor epidemiology, location, other name

20-40 years old, epiphyseal end of long bones, often around knee, "osteoclastoma." Locally aggressive benign tumor.

133

osteosarcoma --> epidemiology, RF's, location, management, characteristic findings

o Code: Evan Olmstead/Bimodal distribution: Peak incidence between 13 and 16, greater than 65 years old. Evil Dr. Hink in suit along wall + evil page/Rb + SIS oncogenes. Taryn with parrot on her shoulders slacklining above/teriparatide is a risk factor. Big devil behind Evan/malignant mesenchymal neoplasm of bone origin (osteoblasts). Aggressive. /second peak of incidence occurs in older adults + is associated with Paget + bone infarcts + ionizing radiation. Masses on his knees + femor/usually arise around knee + distal femur or proximal tibia. Bone stuck in ground with arrow through metaphyseal region/metaphyseal region. Tumors on shoulder + jaw/may also arise in shoulder + proximal femur + jaw. Evil anna petroveks attacking him/histology = anaplastic cells forming osteoid matrix. Below pattern as wallpaper/x-ray = “sunburst” pattern. Codman’s triangle in front of door/Codman’s triangle. /Other predisposing factor = bone infarcts. Surgeon cutting out evan’s back + he’s in a chemo chair/Treat with surgical en bloc resection (with limb salvage) + chemotherapy.

134

Fusion protein in Ewing's

EWS-FLI i

135

Giant cell tumor location

Epiphysis

136

osteoarthritis presentation/symmetry

- asymmetric
- knee cartilage loss begins medially ("bowlegged")

137

synovial fluid in osteoarthritis

non-inflammatory (WBC

138

joints involved in osteoarthritis

DIP, PIP, 1st CMC, NOT MCP.

139

osteoarthritis treatment

acetaminophen + NSAIDs + intra-articular glucocorticoids

140

pannus

proliferative granulation tissue seen in RA

141

RA RF's

smoking + silica exposure + female + HLA-DR4

142

DMARDS

methotrexate, sulfasalazine, hydroxychloroquine, leflunomide

143

Joint findings in RA

Bone and cartilage erosions + juxtaarticular osteopenia + joint space narrowing + soft tissue swelling + subchondral cysts + pannus formation + increased synovial fluid.

144

synovial fluid in RA

inflammatory (WBC>2000)

145

fibrinoid necrosis

necrosis arising from immune complex deposition.

146

fibrinoid necrosis occurs in..

polyarteritis nodosa, malignant hypertension, preeclampsia, hyperacute transplant rejection

147

rheumatoid nodule histology description

fibrinoid necrosis with palisading histiocytes. Occurs in subcutaneous tissue.

148

extraarticular manifestations of RA

ILD, pleuritis, pericarditis, anemia of chronic disease, neutropenia, splenomegaly, amyloidosis, Sjogren's, scleritis, carpal tunnel syndrome.

149

Felty syndrome

splenomegaly + RA

150

Joint findings in OA

thickened capsule + slight synovial hypertrophy + osteophytes + ulcerated cartilage + sclerotic bone + joint space narrowing + subchondral bone cyst

151

RA deformities

Deformities include subluxation, fingers with ulnar deviation, swan neck, boutonniere's.

152

what mediates degradation and inadequate repair in OA?

chondrocytes

153

Gouty nephropathy pathophys

Urate crystals are deposited in the renal medullary interstitium where they can form intratubular precipitates, inflammatory tophi, or uric acid renal stones. Tubular obstruction leads to cortical atrophy and scarring, so 20% of people with chronic gout eventually die of renal failure

154

Hyperuricemia in gout epidemiology and pathophys

1) 90% caused by underexcretion of uric acid--largely idiopathic; can be exacerbated by meds.
2) overproduction of uric acid (10% of patients)--Lesch-Nyhan, PRPP excess, increased cell turnover (tumor lysis syndrome), von Gierke's.

155

Tophi, etiology and location

Gout --> Accumulation of crystals in soft tissues), most commonly on external ears. Also olecranon bursa + achilles tendon.

156

What precipitates gout?

Alcohol consumption or large meal.

157

alcohol and gout pathophys

alcohol metabolites compete for same excretion sites in kidney as uric acid leading to decreased uric acid secretion.

158

Other name for pseudogout

calcium pyrophosphate deposition disease.

159

pseudogout associations

1) hemochromatosis
2) hyperparathyroidism
3) joint trauma

160

most commonly affected joint in calcium pyrophosphate deposition

knee

161

x-ray findings for calcium pyrophosphate deposition disease

chondrocalcinosis (cartilage calcification)

162

prophylaxis for calcium pyrophosphate deposition

colchicine

163

calcium pyrophosphate deposition acute treatment

same as gout: NSAIDs, colchicine, GC's

164

keratomalacia

eye disorder resulting from vitamin A deficiency

165

eye finding in sjogren's

keratoconjunctivitis sicca (decreased tear production and subsequent corneal damage)

166

xerostomia

decreased saliva production

167

sjogren's can be secondary to...

RA, SLE, systemic sclerosis

168

MALT presentation

parotid enlargement, can be complication of sjogren's

169

common causes of septic arthritis

S. aureus + streptococcus + neisseria gonorrhea

170

synovial fluid in septic arthritis

purulent (WBC>50,000/mm3)

171

gonococcal arthritis

STI presenting either as purulent arthritis or triad of polyarthralgias + tenosynotivis (eg, hand) + dermatitis

172

commonalities among seronegative spondylarthritis

inflammatory back pain (morning stiffness improving with exercise) + periphral arthritis + enthesitis + dactylitis + uveitis

173

enthesitis

Inflamed insertion sites of tendons (eg achilles)

174

reactive arthritis post...

shigella + salmonella + yersinia + campylobacter + chlamydia

175

anti-smith antibodies

antibodies to spliceosomal snRNPs

176

lupus antibodies

anti-nuclear antibody (ANA) + anti-DNA antibodies + anti-phospholipid + **anti-smith (anti-SM) antibodies (specific) + anticardiolipin

177

lupus HLA associations

DR2 and DR3

178

libman sacks vegetation locations

usually on mitral or aortic valves

179

lupus nephritis

glomerular deposition of anti-DNA immune complexes

180

Most common and severe type of lupus nephritis

Diffuse proliferative

181

other finding in lupus I don't often think of...

serositis (inflammation of serous tissue)

182

Antinuclear antibodies in lupus sensitivity/specifity

sensitive, not specific

183

Anti-dsDNA antibodies in lupus sensitivity/specifity

specific, poor prognosis (renal disease)

184

Anti-Smith antibodies in lupus sensitivity/specifity

Specific, not prognostic (directed against snRNPs)

185

Antihistone antibodies in lupus sensitivity/specifity

sensitive for drug-indcued lupus (eg, hydralazine, procainamide).

186

complement deficiency in lupus

C3, C4, CH50

187

lupus treatment

NSAIDS, steroids, immunosuppressants, hydroxychloroquine

188

Lab findings in APA syndrome

lupus anticoagulant + anticardiolipin + antiB2 glycoprotein antibodies

189

treatment for APA syndrome

systemic anticoagulation

190

false positives on VDRL

viral infection (mono, hepatitis) + drugs (chlorpromazine; procainamide) + rheumatic fever + lupus + leprosy + anticardiolipin antibodies (APA syndrome).

191

speckled ANA

anti-U1 RNP antibodies

192

hypercalcemia in sarcoidosis pathophys

expression of 1-alpha-hydroxylase by activated macrophages.

193

fibrosis affect on lung function

INCREASED elasticity + decreased compliance

194

sarcoidosis on ECG

shortened QT interval (hypercalcemic)

195

sarcoidosis pathophys

pathophys = interactions between macrophages and Th1 CD4+ cells via MHC class II result in production of cytokines that favor the production of granulomas. Th1 cells secrete IL-2 + interferon-gamma (IFN-gamma).

196

lavage fluid findings in sarcoidosis

elevated ACE + elevated CD4/CD8 ratio.

197

common presentation of sarcoidosis

asymptomatic except for enlarged lymph nodes. No need to treat if not symptomatic!

198

lupus pernio

skin lesions of face resembling lupus (characteristic of sarcoidosis)

199

granulomas in sarcoidosis

epithelioid granulomas containing microscopic schaumann and asteroid bodies

200

lab findings in polymyalgia rheumatica

elevated ESR + elevated CRP + normal CK

201

fibromyalgia treatment

gradual, incremental aerobic exercise. Antidepressants (TCA’s + SNRI’s) + anticonvulsants in more severe cases.

202

proposed mechanism for fibromyalgia

abnormal central processing of painful stimuli

203

Lab findings in polymyositis/dermatomysitis

Increased CK + positive ANA + positive anti-Jo-1 + positive anti-SRP + anti-MI-2 antibodies

204

treatment for polymyositis/dermatomysitis

steroids followed by long-term immunosuppressant therapy (methotrexate)

205

most common site of involvement of polymyositis

shoulders

206

other findings in dermatomyositis

malar rash (like SLE) + gottron papules + heliotrope (erythematous periorbital rash) + shawl and face rash + mechanic's hands.

207

Inflammatory differences between poly and dermatomyositis

polymyositis --> endomysial inflammation w/ CD8+ T cells.
Dermatomyositis --> perimysial inflammation and atrophy with CD4+ T cells.

208

potential sequela of dermatomyositis

risk of occult malignancy

209

MG diagnosis

edrophonium

210

MG treatment

pyridostigmine

211

which improves and which worsens with muscle use

MG worsens with muscle use, LEMS improves.

212

Frequency of MG vs LEMS

MG common, LEMS rare.

213

LEMs etiology

autoantibodies to presynaptic Ca2+ channel, leads to decrease ACh release.

214

Treatment for LEMS

can't do much, not in FA at least

215

LEMS presentation

proximal muscle weakness + autonomic symptoms (dry mouth, impotence)

216

suspicious mass at site of previous trauma suggests...

myositis ossificans

217

scleroderma (systemic sclerosis)

Triad of autoimmunity + noninflammatory vasculopathy + collagen deposition with fibrosis. Includes both diffuse scleroderma and limited scleroderma.

218

Limited scleroderma

Limited skin involvement confined to fingers and face. This is the type that occurs with CREST syndrome

219

derm findings in scleroderma

puffy, taut skin WITHOUT wrinkles + fingertip pitting.

220

scleroderma epidemiology

75% female

221

CREST acronym

calcinosis, Raynauds, esophageal dysmotility, sclerodactyly, telangiectasia

222

Color transition in raynaud's

white (ischemia) --> blue (hypoxia) --> red (reperfusion)

223

Raynaud's pathophys

decreased blood flow to skin due to arteriolar vasospasm in response to cold or stress.

224

Raynaud disease vs. raynaud syndrome

disease = primary (idiopathic)
syndrome = secondary

225

digital ulceration

critical ischemia seen in secondary raynaud's (raynaud syndrome)

226

Other names for subcutaneous fat

hypodermis, subcutis

227

Epidermis layers from surface to base

Corneum --> Lucidum --> Granulosum --> spinosum --> basale (californians like girls in string bikinis)

228

where is keratin found?

stratum corneum (uppermost layer)

229

where are desmosomes found?

stratum spinosum

230

stem cell site

stratum basale

231

zonula occludens

area of tight junction

232

composition of tight junctions

claudins + occludins

233

function of tight junctions

prevent paracellular movement of solutes

234

adherens junction
1) location
2) function

1) below tight junction
2) forms belt connecting actin cytoskeletons of adjacent cells with cadherins

235

CADherins

Ca2+-dependent adhesion proteins.

236

clinical significance of loss of E-cadherin expression

promotes metastasis

237

zonula adherens

adherens junction

238

macula adherens

desmosome

239

desmosome
1) function
2) protein composition

1) structural support via intermediate filament interactions.
2) cytokeratin + desmoplakin

240

gap junction

composed of channel proteins called connexons that permit electrical and chemical communication between cells

241

hemidesome function

connects keratin in basal cells to underlying basement membrane

242

Integrins

Membrane proteins that maintain integrity of basolateral membrane by binding to collagen and laminin in basement membrane.

243

macule

flat lesion with well-circumscribed change in skin color

244

patch

macule > 1 cm (eg congenital nevus/birthmark)

245

papule

elevated solid skin lesion

246

plaque

papule > 1 cm (psoriasis)

247

vesicle

small fluid-containing blister

248

bulla

large fluid-containing blister >1 cm (bullous pemphigoid)

249

pustule

vesicle containing pus (pustular psoriasis)

250

wheal

transient smooth papule or plaque (Hives)

251

scale

flaking off of stratum corneum (eczema, psoriasis, SCC)

252

crust

dry exudate (impetigo)

253

psoriasis can be pustular

ok

254

hyperkeratosis
1) characteristics
2) examples

1) increased thickness of stratum corneum
2) psoriasis, calluses

255

parakeratosis
1) characteristics
2) examples

1) hyperkeratosis with retention of nuclei in stratum corneum
2) psoriasis

256

Hypergranulosis
1) characteristics
2) examples

1) increased thickness of stratum granulosum
2) lichen planus

257

spongiosis
1) characteristics
2) examples

1) epidermal accumulation of edematous fluid in intercellular spaces
2) eczematous dermatitis

258

acantholysis
1) characteristics
2) examples

1) separation of epidermal cells
2) pemphigus vulgaris

259

acanthosis
1) characteristics
2) examples

1) epidermal hyperplasia (increased thickness of spinosum)
2) acanthosis nigricans

260

albinism etiology

normal melanocyte number, decreased melanin production

261

chloasma

melasma

262

vitiligo etiology

autoimmune destruction of melanocytes. Complete absence of melanocytes.

263

acne description

pilosebaceous follicles with increased sebum, eratin.

264

acne treatment

retinoids + benzoyl peroxide + antibiotics

265

location of atopic dermatitis

flexural surface

266

lab findings in atopic dermatitis

increased IgE

267

presentation of atopic dermatitis in infancy

appears on face and then antecubital fossa

268

common triggers of ACD

nickel, poison ivy, neomycin

269

medical term for common mole

melanocytic nevus

270

difference between intradermal nevi and junctional nevi

intradermal = papular
junctional = flat

271

derm findings in psoriasis

1) acanthosis with parakeratotic scaling (nuclei still in stratum corneum)
2) Munro microabscesses
3) increased stratum spinosum
4) decreased stratum graunlosum
5) Auspitz sign -- pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off.
6) can be associated with nail pitting

272

rhinophyma ssociated with..

phymatous rosacea

273

rosacea description

erythematous papules and pustules

274

horn cysts

keratin-filled cysts, found in seborrheic keratosis

275

leser-trelat associated with

GI + lymphoid malignancy

276

characteristics of verrucae

epidermal hyperplasia + hyperkeratosis + koilocytosis

277

condylomata acuminata

verrucae on genitals

278

feature differentiating bacillary angiomatosis from kaposi's

neutrophilic infiltrate in bacillary

279

glomus tumor

Mom: big globe hanging from ceiling above her/glomus tumor. she has super long nails and a red-blue tumor under them/benign, painful, red-blue tumor under fingernails. Globe is a thermostat + wrapped in smooth muscle/arises from modified smooth muscle cells of the thermoregulatory glomus body.

280

infiltrate in kaposi sarcoma

lymphocytic

281

pyogenic granuloma

Big hole in ground with a massive pie in it/pyogenic granuloma. Page’s finger looks like below/polypoid capillary hemangioma that can ulcerate and bleed. Page on the couch, pregnant + being hit by Toby with a bat/associated with trauma + pregnancy.

282

pyogenic granuloma description

polypoid lobulated capillary hemangioma.

283

kaposi's

Neoplastic growth associated with HIV. Can also be caused by HHV-8.

284

strawberry hemangioma epidemiology

1/200

285

strawberry hemangioma timeline

Initial rapid growth then regress spontaneously by 5-8 yo

286

cystic hygroma

cavernous lymphangioma

287

bullous impetigo causative organism

s aureus

288

erysipelas
1) area of location
2) organism
3) presentation

1) upper dermis and superficial lymphatics
2) s pyogenes
3) well-defined demarcation between infected and normal skin

289

cellulitis causative organisms

s pyogenes + s aureus

290

cellulitis area of involvement

deeper dermis + subcutaneous tissues

291

staphylococcal scalded skin syndrome pathophys

exotoxin destroys keratinocyte attachments in stratum granulosm only (vs. toxic epidermal necrolysis, which destroys epidermal-dermal junction).

292

staphylococcal scalded skin syndrome
1) presentation
2) prognosis
3) epidemiology

1) fever + generalized erythematous rash with sloughing of upper layers of epidermis.
2) heals completely
3) newborns and childrens + adults with renal insufficiency

293

hairy leukoplakia vs. leukoplakia

leukoplakia is cancerous.

294

zinc derm presentation

acrodermatitis enteropathica

295

acanthosis nigricans etiology

epidermal hyperplasia causing symmetric hyperpigmentation

296

acanthosis nigricans associations

diabetes, obesity, Cushing syndrome, gastric adenocarcinoma

297

erythema nodosum

painful inflammatory lesions of subcutaneous fat, usually on shins

298

erythema nodosum associations

sarcoidosis, coccidioidomycosis, histoplasmosis, TB, streptococcal infections, leprosy, IBD

299

wickham striae

reticular white lines. manifestation of lichen planus

300

underlying condition in lichen planus

sawtooth infiltrate of lymphocytes at dermal epidermal junction

301

lichen planus association

hep c

302

pityriasis rosea prognosis

self resolves in about 6 weeks

303

UVA

tanning and photoaging

304

UVB

sunburn

305

sunburn pathophys

causes DNA mutations, inducing apoptosis of keratinocytes

306

BCC characteristic behavior

locally invasive, but rarely metastasizes.

307

BCC presentations

1) pink, pearly nodules with telangiectasias, rolled borders, central ulcerations or cursting
2) nonhealing ulcers with infiltrating growth
3) scaling plaque

308

SCC RF's

aresnic, immunosuppression, sunlight

309

SCC locations

face, lower lip, ears, hands

310

SCC characteristic behavior

locally invasive, may spread to lymph nodes. Rarely metastasize.

311

SCC presentation

ulcerative red lesions with frequent scale.

312

SCC presentation

chronic draining sinuses.

313

keratoacanthoma

variant of SCC that grows rapidly (4-6 weeks) and may regress spontaneously over months.

314

diameter cutoff for melanoma

6 mm

315

different types of melanoma

1) Superficial spreading
2) nodular
3) lentigo maligna
4) acral lentiginous

316

melanoma treatment

resection with appropriately wide margins

317

vemurafenib used in..

metastatic or unresectable melanoma in patients with BRAF V600E mutation

318

LTB4, leukotriene B4

neutrophil chemotactic agent

319

PGI2

Platelet-gathering Inhibitor. Inhibits platelet aggregation and promotes vasodilation

320

acetaminophen MOA

reversibly inhibits cyclooxygenase, mostly in CNS, inactivated peripherally

321

aspirins effect on coagulation

increased bleeding time. Effect lasts until new platelets are produced.

322

aspirin clinical use

low dose (less than 300 mg/day): decreases platelet aggregation.
Intermediate dose (300-2400 mg/day): antipyretic and analgesic
High dose (2400-4000 mg/day): anti-inflammatory.

323

aspirin AE's

gastric ulceration + tinnitus. chronic use can lead to ARF, interstitial nephritis, GI bleeding.

324

good things about celecoxib

spares gastric mucosa + spares platelet function (TXA2 production depends on Cox-1

325

meloxicam

NSAID

326

piroxicam

NSAID

327

NSAID clinical use

antipyretic, analgesic, anti-inflammatory

328

NSAIDs AEs

interstitial nephritis + gastric ulcer + renal ischemia

329

leflunomide MOA

reversibly inhibits dihydroorotate dehydrogenase, preventing pyrimidine synthesis. Suppresses T-cell proliferation

330

leflunomide AE's

diarrhea + HTN + hepatotoxic + teratogenicity

331

bisphosphonates MOA

pyrophosphate analogs, bind hydroxyapatite in bone, inhibiting osteoclast activity

332

bisphosphonates clinical use

osteoporosis, hypercalcemia, paget's, metastatic bone disease, OI

333

bisphosphonates AE's

esophagitis + osteonecrosis of jaw + atypical stress fractures

334

guidelines for oral bisphosphonates

take with water + remain upright for 30 minutes

335

teriparatide MOA

recombinant PTH analog that increases osteoblastic activity

336

teriparatide route

given subcutaneously daily

337

teriparatide clinical use

osteoporosis, unlike antiresorptive therapies, it causes increased bone growth.

338

allopurinol MOA

competitive inhibitor of xanthine oxidase, decreases covnersion of hypoxanthine and xanthine to urate. Increases concentrations of azathioprine and 6-MP (both normally metabolized by xanthine oxidase).

339

pegloticase MOA

recombinant uricase that catalyzes metabolism of uric acid to allantoin (more water-solube product)

340

probenecid MOA

inhibits reabsorption of uric acid in PCT.

341

probenecid caveats

1) Inhibits secretion of penicillin.
2) can precipitate uric acid calculi

342

NSAIDs to give for gout and caveat

naproxen + indomethacin. Don't give salicylates.

343

gout prophylaxis

colchicine

344

colchicine MOA

binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrohil chemotaxis and degranulation.

345

Problem with TNF-alpha inhibitors and pathophys

Predispose to infection, including reactivation of latent TB, since TNF is important in granuloma formation and stabilization.

346

etanercept mechanism

fusion protein (receptor for TNF-alpha + IgG1 Fc) produced by recombinant DNA. Decoy receptor.

347

etanercept clinical uses

RA, psoriasis, ankylosing spondylitis

348

adalimumab

anti-TNF-alpha monoclonal antibody

349

infliximab, adalimumab clinical uses

IBD, RA, ankylosing spondylitis, psoriasis

350

rasburicase MOA

recombinant uricase that catalyzes metabolism of uric acid to allantoin.

351

Xanthine oxidase

catalyze hypoxanthine to xanthine, and then xanthine to plasma uric acid

352

Purine metabolism pathway

purine --> hypoxanthine --> xanthine --> plasma uric acid

353

drainage area of superficial lymph nodes

tumors of penis + skin of vagina + anal canal BELOW the dentate line drain to the superficial inguinal lymph nodes. /superficial inguinal lymph nodes also drain the lower extremity + gluteal region + skin below the umbilicus.

354

lymphatic drainage of legs

• /generally follows the course of the superficial veins (see below). /most venous drainage is to great saphenous vein. Accompanying lymphatics drain into the superficial group of the inguinal lymph nodes. Paint the lateral foot and back of leg green/however, skin drained by small saphenous vein, including lateral aspect of dorsum of foot is an exception to this rule. Lymphatic fluid from this area drains into lymphatics accompanying the small saphenous vein, then drains into lymph nodes behind the knee in the popliteal fossa.

355

pouch of douglas

rectouterin pouch

356

leg compartments

Lateral -- superficial peroneal nerve
Anterior -- anterior tibial
Deep posterior -- Posterior tibial nerve + posterior tibial artery

357

Jaw muscle anatomy

lateral pterygoid function = pulls mandible forward in the process of opening the jaw against resistance + protracts mandible + pulls mandible side to side. /unilateral action of the lateral pterygoid results in deviation of the mandible to the opposite side. /all other jaw muscles (masseter + medial pterygoid + temporalis) act to CLOSE THE JAW.

358

gastrocolic ligament and what it contains

portion of the greater omentum between the greater curvature of the stomach and the transverse colon. Contains the gastroepiploic vessels.

359

gastrohepatic ligament and what it contains

portion of the lesser omentum between the liver and lesser curvature of the stomach. Contains the right and left gastric vessels.

360

splenorenal ligament and what it contains

mesentery that connects the spleen to the posterior abdominal wall. Contains the splenic artery and splenic vein + tail of the pancreas.

361

Salivary gland anatomy

sublingual gland full of mucous/as you move from the midline laterally, acini in sublingual gland are almost pure mucous cells serous blacks cut in half/acini in submandibular gland contain a mixture of serous and mucous cells. Serous blacks in all acini of parotid gland/acini in parotid gland are mostly pure serous cells.

362

Sensory supply of ear

Massive ear on back wall of anatomy lab. /vestibulocochlear = hearing and motion sense. Small oxe nailed to top of auricle/lesser occipital = upper part of the auricle. Giant orating at base/greater auricular = lower part of the auricle. Ears stuck to clocks on anterior half of canal/auriculotemporal = anterior half of external ear canal. Vagus signs lighting up posterior half of canal/auricular branch of vagus nerve = posterior half of the external ear canal.

363

esophageal histology

Indians in chains lining esophagus/nonkeratinized stratified squamous epithelium. /striated muscle in upper 1/3, smooth muscle in bottom 2/3.

364

Epithelia of rectum

columns above dentate line/mucosa above dentate (pectinate) line = simple columnar epithelium. Indians covered in poop below dentate line/below dentate line = squamous.

365

Epithelia of respiratory tract

o nose and nasopharynx lined with columns/nose, paranasal sinuses, nasopharnyx, most of larynx, and tracheobronchial tree = pseudostratified columnar, mucus-secreting. Oropharynx and below lined with Indians + Indians in chains singing and standing around vocal folds + lining anterior and posterior epiglottis/oropharynx + laryngopharynx + anterior epiglottis + upper half of posterior epiglottis + vocal folds (true vocal cords) = stratified squamous epithelium. This is to protect it from abrasive swallowing of food. /So it’s pretty much all pseudostratifeid columnar except oropharynx/laryngopharynx area. Imagine alveoli and respiratory bronchioles lined with cubes/past the terminal bronchioles, in respiratory bronchioles and alveolar duct, epithelia transitions to cuboidal cells. Imagine Indians lining alveolar sacs/alveoli = simple squamous.

366

Epithelia of the female reproductive tract

imagine ovary lined with cubes/ovary = simple cuboidal (rapidly proliferate to repair ovulatory surface defects). Imagine fallopian tube lined with columns/fallopian tube = simple columnar. Imagine uterus lined with columns/uterus = simple columnar. ectocervix lined with a circle of native americans + circle of columns behind them/cervix = ectocervix = stratified, squamous non-keratinized, endocervix = simple columnar. Indians in chains lining vagina/vagina = stratified squamous non-keratinized. Imagine Hannah Mcdermotts in transformation zone/transformation zone = squamocolumnar junction (most common area for cervical cancer)

367

recurrent laryngeal supplies...

recurrent laryngeal nerves are branches of the vagus (X) and supply all intrinsic muscles of the larynx except the cricothyroid. /damage (such as in thyroid surgery) can cause hoarseness.

368

Musculocutaneous

jacked due from brachial plexus memory palace: he has super biceps + his lateral forearms are on fire/innervates major forearm flexors (biceps, brachialis) and coracobrachialis + provides sensory innervation to the lateral forearm. He’s a baseball player/often injured by trauma or strenuous upper extremity exercise (baseball).

369

Distal location of median nerve

before the median nerve enters the carpal tunnel, it lies between the tendons of the palmaris longus + flexor carpi radialis. Local anesthetic may be injected at this point to achieve anesthesia in the cutaneous region supplied by the median nerve.

370

phrenic nerve innervation and damage

panicky method with a ham bone + it’s hailing/arises from C3-C5 segments of the spinal cord and innervates the Ipsilateral hemidiaphragm. He has wings on + is hiccupping intensely/damage causes hiccups + diaphragmatic paralysis with dyspnea + referred pain to the shoulder. /affected hemidiaphragm will be elevated on CXR.

371

recurrent laryngeal location

left recurrent laryngeal arises from the vagus as the vagus crosses in front of the arch of the aorta. /right recurrent laryngeal nerve arises from right vagus nerve as it crosses anterior to the right subclavian artery.

372

Layers of anterior abdominal wall

1) skin. Bunch of people camping in front with fat everywhere/2) superficial fascia of Camper (fatty layer). Climbers climbing up tunnel after them/3) superficial fasca of Scarpa (membranous layer). External oblique muscle (angled up and down)/4) external oblique muscle/aponeurosis. Internal oblique muscle (angle up and down but opposite to external)/5) internal oblique muscle/aponeurosis. Tranny stretched out across tunnel with a jacked 6 pack (it’s transverse/horizontal stretching out across tunnel)/6) transversus abdominis muscle/aponeurosis. Then a thick layer of fascia/7) fascia transversalis. Then a thick layer of fat/8) extraperitoneal fatty tissue. Into the north/9) peritoneum.

373

Temporomandibular disorder (TMD):

o /arises from problems involving the temporomandibular joint, the muscles of mastication, and the nerves that supply the jaw. He has a trident stuck into his jaw/affected nerve = mandibular division of the trigeminal nerve. Wearing headphones + axe in his jaw + screw through his head/presentation = otologic symptoms (ear discomfort) + jaw pain + unilateral facial pain worsening with jaw movement + headache.

374

Vagus nerve respiratory action

main efferent action is bronchoconstriction and increased bronchial mucus secretion.

375

Cranial nerves and locations of exit through the skull.

o big hole in ceiling and gram taking a duce through it + playing crocae + Dr. Soohoo peaking his head over + huge eye with motor dangling from it/oculomotor (CN III) + ophthalmic nerve (CNV1) + trochlear (CN IV) + abducens (CN VI) enter the orbit via the superior orbital fissure. Blue blood vessel attached to hanging eye/superior ophthalmic vein also passes through the superior orbital fissure to enter the orbit. Really fat Max in far right corner/foramen rotundum transmits the maxillary division of the trigeminal nerve (CN V2). Big oval hole in back wall with mandible hanging in it and trident stuck into it/foramen ovale transmits mandibular branch of the trigeminal nerve (V3). Huge nose stuck on wall to right with plate through it midway/CN 1 olfactory bundles traverse cribriform plate. /foramen spinosum = middle meningeal artery + vein. Huge jacked magnus bench pressing in middle covered in shiny accessories/foramen magnum = spinal roots of CN XI (enter brain through foramen magnum) + brain stem + vertebral arteries. Big jug of milk in far left corner + vegas sign above it + Kelsey fitzgibbons sucking dick + milk jug covered in shiny accessories/jugular foramen = CN IX + X + XI (leaves through jugular foramen) + jugular vein. Ears on face with chunks meat stuck to them/internal auditory meatus = CN VII + VIII.

376

eye muscles + innervation

/remember that oculomotor also innervates skeletal muscle found in the levator palpebrae superioris.
/from the abducted position, the superior rectus is the only muscle that can elevate the eye.
/inferior oblique is only muscle that can elevate the eye in the adducted position.

377

location of IVC

L4/L5

378

Lungs anatomic location

Picture nasty hair filling horizontal fissure/Horizontal fissure of right lung lies at the level of the 4th rib. Ivy on midaxial/lower border at midaxillary line located at rib 8. Hash block stuck into bottom/lower border along midclavicular located at rib 6. Tie hanging off backside at paravertebral line/lower border at 10th rib on paravertebral line.

379

functions that occur in the cytoplasm

Big pool in entryway: machine spitting out bacon + cholesterol eggs + steak/glycolysis + fatty acid synthesis + protein synthesis (RER) + steroid synthesis (SER) + cholesterol synthesis.

380

Vesicular trafficking proteins

COP with a sombrero forcing traffic backwards/COPI: Golgi golgi (retrograde) + cis-golgi ER. Cop in chicken suit forcing traffic forward/COPII: ER cis-Golgi (anterograde). Kate throws steak intos into the lysosome hottub + circle of trannies around her/Clathrin: trans-Golgi lysosomes.

381

cerebellar anatomy and lesions

/neocerebellum/cerebrocerebellum rests is responsible for fine movements of the hand and face. Lesions would cause dysdiadochokinesis (impairment in rapidly alternating hand movements) and intention tremor. /acute lesion to the cerebellar vermis causes truncal + gait ataxia. Put horns on flocculonodular lobe/involvement of the flocculonodular lobe causes vertigo/nystagmus due to dysregulation of the vestibular nuclear complex.

382

sertoli cell functions

White guys from star wars shooting up a fish/produce Inhibin B, which downregualtes FSH synthesis and inhibits FSH secretion. they’re shooting up a uterus hanging from the ceiling/secrete Mullerian inhibiting factor. They’re covered in roses/testosterone is aromatized in sertoli cells to produce estrogen. /secrete androgen binding protein. /nurture developing sperm.

383

2 cell hypothesis

/theca cells are stimulated by LH to secrete androgens androstenedione and testosterone these diffuse into the granulosa cells where they are aromatized to estrogens. This conversion is stimulated by FSH action on granulosa cells.

384

granulosa cell functions

pile of grains on either side of entrance to Ben’s house/female equivalent of sertoli cells. Anna covered in floors on top/produce estrogen. /FSH stimulates aromatase in granulosa cells to synthesize estrogen. Big egg on top of the area with chicken bursting out/as the follicle approaches ovulation, LH receptors begin to be expressed by granulosa cells. Response of granulosa cells to LH, which favors progesterone production is required for maturation of the dominant follicle, ovulation, and then luteinization.

385

estrogen types

o Estradiol: huge pile of grains by window/synthesized by granulosa cells. Arnold Schwarzenegger standing in middle of the room/precursor = testosterone.
o Estrone (aka estradione): tons of really fat people walking around and big stones everywhere/synthesized by adipocytes. Andrew black standing in middle/precursor = androstenedione. Old granny at counter/only estrogen still detectable in menopausal women since it’s synthesized in peripheral adipocytes.
o Estriol (E3): huge placenta on floor/synthesized by placenta. Tosh.0 dressed as a military commander screaming and yelling at the class/precursor = 16-alpha-OH-DHEAS.

386

androgen synthesis in females

o Picture the follicle and then islands of flowers within huge granular mounds of sands/LH stimulates the theca interna cells of the ovarian follicle to produce androgens. aromatase within the follicle’s granulosa cells subsequently converts these androgens to estradiol under FSH stimulation.

387

Marker for osteoclast activity

Hydroxyproline

388

osteitis deformans

Paget's

389

Juvenile Idiopathic Arthritis (JIA) AKA Juvenile Rheumatoid Arthritis (JRA)

o Coded character: Kiya (Sarah’s daughter)/more common in females and usually in kids under 16. She’s in a wheelchair + 1920s wagon full of kids covered in a rash/presentation = joint pain + joint swelling + migratory rash. Newts crawling around everywhere and walls made of sand/labs = elevated ESR + neutrophils. she has motorcycle goggles on/uveitis that may lead to blindness can be a serious complication.
o Location: Grassy area at AZ hotel

390

Vertebral subluxation:

o Code: Two EMT’s holding Cam + he has a c spine collar on/severe chronic RA can involve the cervical spine and cause joint destruction with vertebral malalignment (subluxation). Huge globe on a car axis/the atlantoaxial joint is often involved and more prone to subluxation because the atlas (C1) has a high degree of mobility relative to the axis. IV pole next to him + he’s paralyzed + axe in his neck/anterior movement of the atlas can cause spinal cord compression, presenting with neck pain + stiffness + radicular pain + paralysis with decreased or absent reflexes beleververtow the level of the compression (areflexic paralysis) + hypotension (due to loss of sympathetic tone) + and/or sudden death.
o Location: Entrence of Res dinner

391

osteoporosis risk factors

1) Age
2) Gender. **NBME answer for greatest RF. Women are at much higher risk of osteoporosis than men.
3) Smoking
4) ethnicity

392

Genitofemoral supplie

sensation to upper anterior thigh + skin of anterior scrotum + mons pubis

393

pudendal nerve

Carries sensation from the external genitalia of both sexes + skin around anus and perineum.

394

Name the spinal ligaments.

...

395

p53 actions

1) Inhibits apoptosis
2) Inhibits progression from G1-->S
3) Stimulates cell-cycle repair

396

Proteinase 3

epitope of anti-neutrophil cytoplasmic antibodies of c-ANA so relevance = Wegener's granulomatosis

397

Prader willi other mechanism of inheritance

MATERNAL uniparental disomy