CT/MS Flashcards Preview

Random boards stuff > CT/MS > Flashcards

Flashcards in CT/MS Deck (299):
1

Crutches--damage which nerve

radial nerve

2

Weakness in forearm, wrist, and finger extensors caused by

radial nerve damage (wrist drop)

3

Cochicine tox

GI irritation, agranulocytosis
--inhibits microtubules, affects rapidly growing cells

4

contraindications to NSAIDs

renal failure
peptic ulcer dz
elderly peeps

5

Ankylosing spondylitis--RF elevated?

NO

6

Sx of ank spon

1. peripheral enthesitis (insertion of tendon to bone)
--esp at achilles
2. Enthesitis of castovertebral junctions--hypoventilation
--check chest expansion
3. aortic regurg
4. uveitis

7

First/2nd/3rd line acute therapy for gout

1. ibuprofen
2. colchicine (if cannot take NSAIDs)
3. glucocorticoids (if cannot take NSAIDs)

8

A band in sarcomere

same length

9

H band

Only mysoin

10

I band

only actin

11

How do you stain for muscle cells?

Actin, caldesmon, desmin

12

myasthenia gravis: which part of the NMJ is affected?

End motor plate potential decreased. Binding of antibody causes receptor internalization and fewer # of receptors

13

Perifascicular muscle inflammation

dermatomyositis

14

Anterior should dislocations will hurt which nerve?

axillary

15

What does axillary nerve innervate?

deltoid/teres minor with sensory innervation to the skin over the deltoid

16

Humeral midshaft fracture with swelling and ecchymoses of arm will damage which nerve

radial nerve

17

Describe pathophysiology of muscle repolarization/relaxation

1. L-type calcium channels.
2. activates (Ryanodine receptors) in junctional SR - Calcium-induced Calcium Release (CICR).
3.myofibrils to contract.
4. reuptake of calcium into SR stores
5. calcium efflux out of the cell via Sodium-Calcium Exchanger (NCX; ~20%) and via sarcolemmal calcium pump (Ca2+-ATPase).

18

Ryanodine receptors

When calcium enters cell through voltage gated Cachannels, ryanodine receptors allow release of calcium from the SR

19

Calmodulin

Activates Ca-ATPase which pumps Ca out of the cell. Also helps to repolarize muscle cell after contraction, although indirectly

20

typical presentation of reactive arthritis

urethritis, conjunctivitis, arthritis of knees, ankles, and feet of young men

21

achondroplasia

impaired cartilage proliferation in the growth plate. Short extremities with normal sized head and chest (dwarfts)
--Problem with endochonral, not membranous bone formation

22

mutation achondroplasia

activating mutation in FGFR3

23

Inheritance of achondroplasia

auto dom
most mutations are sporadic tho

24

osteogenesis imperfecta defect

collagen type I

25

osteogenesis imperfecta inheritance

autosomal dominant

26

OI presentation

fractures, blue sclera, and hearing loss. (bones of hearing fracture)

27

Why do OI pts have blue sclera?

exposure of the choroidal veins

28

osteopetrosis

abnormally thick heavy bone that fractures. Inherited defect of bone resorption

29

defect in osteopetrosis

carbonic anhydrase II. Creates acidic environment needed to leech Ca from bone

30

presentation of osteopetrosis

anemia, thrombocytopenia, leukopenia (replaces medulla of bone).
--hydrocephalus (bone builds up in skull) with hearing problems
--renal tubular acidosis (carbonic anhyrase deficiency)

31

Tx: osteopetrosis

bone marrow tranplant

32

pidgeon breast deformity, frontal bossing, rachitic rosary, and bowing of legs

Rickets

33

alkaline phosphatase

osteoblast activation. Need alkaline environment to add calcium to bone

34

Lab findings in osteomalacia

Low serum Ca, low phosphate, increased PTH and alkaline phosphatase

35

What protects against weight loss after age 30?

Diet
exercise
estrogen

36

osteoporosis labs

`NORMAL LABS

37

What is contraindicated in osteoporosis?

Glucocorticoids--these increase bone loss

38

Paget disease of bone-pathophys

osteoclast goes rogue and starts eating up bone unregulated by blasts. Blast compensates by laying down bone improperly as fast as possible. then osteoclast burns out

Involves ONLY one or two bones!! not systemic

39

histology of paget's disease

mosaic pattern of lamellar bone. MOSAIC=bone not fused. Haphazard instead of concentric cement lines

40

bone pain, increased hat size, lion-like faces and hearing loss in age 60

paget's disease of the bone

41

lab finding in paget's disease of the bone

elevated alkaline phosphatase. EVERYTHING ELSE (including serum calcium) is normal

42

treatment for paget's

calcitonin and bisphosphonates

43

complications of paget's disease

high output cardiac failure
osteosarcoma

44

osteomyelitis in kids

metaphysis

45

osteomyelitis in adults

epiphysis

46

osteomyelitis in IV drug abuser

pseudomonas

47

osteomyelitis in dog/cat scratch

pasteurella

48

vertebral osteomyelitis

TB

49

osteoma

benign tumor in facial bone. associated with gardner's syndrome

50

osteoid osteoma

benign tumor of osteoblasts in cortex of long bones in young adults

51

bone pain that resolves with aspirin. X ray shows a bony mass with a radiolucent core

osteoid osteoma

52

osteoblastoma vs osteoid osteoma

over 2 cm
arises in vertebra
bone pane that does NOT respond to aspirin

53

most common benign tumor of bone

osteochondroma

sticks out from bone surface, continues from medullary

54

osteosarcoma

proliferation of osteoblasts

55

age of osteosarcoma pts

teenagers and elderly

56

High risk for osteosarcoma in teenagers

familial retinoblastoma

57

High risk for osteosarcoma in elderly

paget's disease of the bone. radiation

58

Where do you usually see osteosarcoma?

metaphysis of long bones, distal femur or proximal tibia

59

X ray finding in osteosarcoma

Codman's angle: raising of periosteum.

60

histology of osteosarcoma

pleomorphic cells producing osteoid

61

soap bubble appearance of bone on X-ray

giant cell tumor

62

epiphyseal tumor

giant cell tumor

63

ewing sarcoma derived from

neuroectoderm

64

ewing grows in

medullary cavity

65

Onion skin appearance on X-ray

ewing sarcoma

66

ewing histology

Small round blue cells with an 11,22 translocation

67

chondroma shows up in

medulla of small bones of hands and feet

68

chondrosarcoma shows up in

medulla of pelvis or central skeleton

69

osteolytic lesions

metastatic tumors. most common

70

prostatic carcinoma in bone

osteoblastic lesion (bone sclerosis)

71

RA associated with

HLA-DR4

72

pannus

granulation tissue in synovium. destroys cartilage and ankylosis (fusion) of joints.

73

complications of RA

anemia of chronic disease
secondary amyloidosis

74

complication of ank spon

aortitis-->aortic regurg

75

sausage finger/toe

psoriatic arthritis

76

Reiter's occurs after

chalmydia infection

77

infectious arthritis

S aureus
gonorrhea

78

Causes of secondary gout

Leukemia
Lesch-Nyhan
Renal insufficiency

79

negatively birefringent crystals

Yellow when parallel and under polarized light

80

psuedogout

rhomboid shaped crystals with weak positive birefringence

81

dermatomyositis associated with

underlying carcinoma, usually GI

82

malar rash seen in lupus and

dermatomyositis. Will also have gottron lesions and heliotrope rash

83

antibodies in dermatomyositis

Positive ANA and anti-Jo-1. Make sure you don't jump to Lupus! Get Anti-Jo-1 or Anti dsDNA

84

perimysial inflammation and perifascicular atrophy of muscle

dermatomyositis

85

endomysial inflammation with CD8+ cells

polymyositis

86

biopsy of skeletal muscle shows a lot of fat

Duchenne's

87

inheritance of duchenne's

X linked

88

dystrophin

allows cell to links muscle cytoskeleton to ECM

89

calf pseudohypertrophy with proximal muscle weakness

duchennes

90

lab in duchenne's

creatinine kinase elevated

91

cause of death in duchenne's

cardiac respiratory failure

92

Becker

mutation (not deletion) of dystrophin

93

lipoblast

liposarcoma

94

most common malignant soft tissue tumor in children

rhabdomyosarcoma

95

desmin positive tumor

rhabdomyosarcoma

96

site of rhabdomyosarcoma

head and neck.

Vag in young girls

97

apocrine gland

milky fluid, axilla, genitalia and areolae

98

sebaceous glands found in

hari follicle. holocrine secretion.

99

tight junction made up of

claudins and occludins

100

adherens junction made of

cadherins.

101

loss of which cadherin causes metastasis?

E cadherin

102

desmosomes made up of

keratin and desmoplakin

103

gap jnction protein

connexons

104

antibodies to desmosomes

pemphigus vulgaris

105

antibodies to hemidesmosomes

bullous pemphigoid

106

integrins

strengthens BM, binds laminin

107

hemidesmosome binds

keratin in basal cell to BM.

108

autoantibodies to hemidesmosome

bullous pemphigoid

109

rotator cuff innervated by

C5/6

110

most common rotator cuff injury

supraspinatus

111

action infraspinatus

laterally rotates arm

112

action teres minor

adducts arm and laterally rotates

113

action subscap

medially rotates and adducts

114

dislocation of lunate

carpal tunnel

115

common wrist fracture

avascular necrosis

116

intramuscular injection

damage to axillary nerve

117

supracondylar fracture of humerus

median nerve damage. Pain with pronation

118

falling and hitting heel of the hand

ulnar nerve damage.

119

medial forearm skin supplied by

T1

120

lateral forearm skin supplied by

C6

121

which nerves travel above flexor retinaculum?

palmar cutaneous branch of median nerve
ulnar nerve

122

innervates thenar muscles

abductor pollicis brevis

123

axillary nerve roots

C5,6

124

Radial nerve roots

C5-T1

125

Muscles radial nerve

BEST extensors
Brachioradialis
Extensors of wrist and fingers
Supraspinator
Triceps

126

wrist drop

radial nerve

127

"ape hand" or pope blessing when asked to make a fist

median nerve damage

128

loss of opposition of thumb, lateral finger flexion and wrist flexion

median nerve

129

medial finger and wrist flexion deficit

ulnar

130

radial deviation of wrist with flexion

ulnar nerve damage

131

median nerve roots

C5-8, T1

132

ulnar nerve roots

C8, T1

133

MC nerve roots

C5-7

134

Upper trunk compression

MC damage

135

cannot flex arm at elbow

MC nerve

136

sensory deficit over lateral forearm

MC damage

137

muscles supplied by MC nerve

biceps, brachialis, coracobrachialis

138

presentation: erb-duchenne

infant with trauma during delivery

139

Erb duchenne damages

C5-C6, axillary and musculocutaneous affected

140

Klumpke's palsy

embryologic defect in C8, T1

141

atrophy of thenar/hypothenar, interosseous, with sensory deficit on medial forearm/hand

klumpke's palsy

142

disappearance of radial pulse when moving head to ipsilateral side

klumpke

143

long thoracic nerve roots

C5-C7

144

ulnar claw=damage to which muscles

medial lumbrical function. Cannot extend digits 4 and 5

145

Median claw

caused by carpal tunnel
-loss of lateral lumbricals. 2/3 digit claw when extension
-distal median nerve damage

146

pope's blessing

proximal median nerve lesion
-loss of opponens pollicis

147

situation causing long thoracic nerve damage

mastectomy

148

Thenar muscles

opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

149

Hypothenar muscles

opponens digiti minimi
abductor digiti minimi
flexor digiti minimi

150

Dorsal interosseous muscles

abduct fingers (DAB)

151

palmar interosseous muscles

adduct fingers (PAD)

152

Peroneal nerve

everts and dorsiflexes

153

tibial nerve

inverts and plantarflexes

154

oBTURATOR INJURY

ANTERIOR HIP DISLOCATION

155

obturator motor deficit

thigh adduction

156

obturator sensory

medial thigh

157

femoral injury

pelvic fracture

158

femoral motor

thigh flexion and leg extension

159

femoral sensory

anterior thigh and medial leg

160

common peroneal injury

fibula neck fracture

161

common peroneal motor

foot eversion and dorsiflexion with foot drop/slap

162

sensory loss in anterolateral leg and dorsal foot

peroneal

163

knee trauma

tibial nerve

164

loss of sense on sole of foot

tibial

165

posterior hip dislocation

superior gluteal nerve or inferior gluteal nerve

166

positive trendelenburg

superior gluteal

167

can't climb stairs, jump, rise from seated position or push downward

inferior gluteal

168

L2-L4

femoral obturator

169

L4-S2

common peroneal

170

L4-S3

tibial

171

L4-S1

superior gluteal

172

L5-S2

Inferior gluteal

173

slow twitch muscle with red fibers

type 1

174

fast twitch muscles with white fibers

type 2 muscle

175

Parathyroid hormone effect low dose vs high dose

low dose: builds bone
high dose: breaks down bone --> osteitis fibrosa cystica

176

How does estrogen affect bone

inhibits apoptosis in blasts
increases apoptosis in clasts

177

Type I osteoperosis

postmenopausal.

178

Fractures in type I osteoporosis

femoral neck fracture
distal radius (colles' fracture)

179

treatment for osteoperosis

pulsatile PTH
SERMS
calcitonin
bisphosphon

180

osteopetrosis labs

low calcium, high ALP

181

osteitis fibrosa cystica labs

high calcium low phosphate high ALP high PTH

182

Osteomalacia labs

low calcium, phosphate
high ALP, PTH

183

Bone replaced by fibroblasts, collagen, and irregular bony trabeculae

polyostotic fibrous dysplasia

184

McCune albright

cafe au lait
precocious puberty
polyostotic fibrous dysplasia

185

Histol: giant cell tumor

spindle shaped cells with multinucleated giant cells

186

benign tumors of the bone

giant cell tumor and osteochondroma

187

Expansile glistening mass within medullary cavity

chondrosarcoma

188

Codman's triangle (periosteum elevation) and sunburst pattern on x-ray

osteosarcoma

189

Treatment osteosarcoma

surgical resection and chemo

190

disease modifying agents in RA

methotrexate, sulfasalazine, TNF-alpha inhibitors

191

biopsy of sjogren's glands

lymphocytic infiltration

192

sjogren's assoc'd with

RA

193

Sjogren's at risk for

B cell lymphoma

194

Diseases causing gout

Lesch NyHan and von Gierke's disease

195

Why do you get gout after alcohol?

metabolites compete for same excretion sites as kidney

196

pseudogout--men or women?

same. gout affects more men

197

Tx for pseudogout

steroids, NSAIDs, colchicine

198

Causes of avascular necrosis

High dose steroids, alcoholism, sickle cell

199

pencil in cup deformity

psoriatic arthritis

200

Most common cause of death in SLE

nephritis

201

dsDNA

Lupus: specific, poor prognosis

202

anti-smith

Lupus: specific

203

false positive on syphilis tests

SLE--b/c of antiphospholipid antibodies

204

antihistone antibodies

SLE--drug induced

205

Lupus nephritis

diffuse proliferative

206

Lupus nephrotic syndrome

membranous glomerulonephritis

207

levels of what enzyme is high in sarcoidosis

ACE

208

Findings in sarcoidosis

1. bilateral hilar adenopathy
2. restrictive lung disease
3. erythema nodosum
4. bell's palsy
5. granulomas with schaumann and asteroid bodies
6. hypercalcemia

209

Polymyalgia rheumatica associated with

temporal cell arteritis

210

lab findings in PMR

high ESR, normal CK

211

myositis ossificans

metaplasia of muscle to bone after trauma

212

Most likely cause of death in scleroderma

pulmonary fibrosis

213

Scl-70

scleroderma (anti-DNA topoisomerase)

214

anti-centromere antibody

CREST

215

Parakeratosis

hyperkeratosis with retained nuclei in stratum corneum

216

Acanthosis

epidermal hyperplasia

217

acantholysis

separation of epidermal cells (tombstoning in pemphigus vulgaris)

218

Causes of albinism

decreased melanin production from reduced tyrosinase activity
OR
neural crest cell migration problem

219

melasma

hyperpigmentation with pregnancy

220

melanocyte # in albinism vs vitiligo

albinism: normal melanocyte count
vitiligo: decrease in melanocytes

221

papular nevi

intradermal

222

flat nevi

junctional--btw dermis and epidermis

223

Ephelis

freckle. Has normal # melanocytes, more pigment

224

Which layers of skin are abnormal in psoriasis?

Increased stratum spinosum
Decreased stratum granulosum

225

auspitz sign

pinpoint bleeding spots from exposure of dermal papillae when scales are pulled

226

Leser-trelat sign

sudden appearance of multiple seborrheic keratoses which indicate an underlying malignancy

227

positive nikolsky sign

pemphigus vulgaris

228

reticular immunofluorescence

pemphigus vulg

229

IgG to desmoglein 1/3

pemphigus vulg

230

IgG against hemidesmosomes

bullous pemphigoid

231

linear immunofluorescence

bullous pemphigoid

232

eosinophils with tense blisters

bullous pemphigoid

233

pruritic papules, vesicles, and bullae with deposits of IgA at the tips of dermal papillae

dermatitis herpetiformis

234

Dermatitis herpetiformis is associated with

celiac disease

235

fever, bullae, necrosis, sloughing of skin and high mortality rate after giving a drug

Stevens Johnson

236

What causes erythema multiforme?

Infections
Drugs
Cancers
Autoimmune

237

Cause of acanthosis nigracans

visceral malignancy (and hyperinsulinemia)

238

erythema nodosum is caused by

TB
Leprosy
Crohn's

Histoplasmosis
Coccidioides

Strep
Sarcoid

239

collarette scale

pityriasis rosea

240

sawtooth infiltrate of lymphocytes at dermal/epidermal junction

Lichen planus

241

Lichen planus associated with:

hepatitis C

242

UVA vs UVB

UVB=sunburn
UVA=tanning/photoaging

243

Staph scalded skin histology:

Exotoxin destroys kertinocyte attachment in the stratum granulosum

244

Toxic epidermal necrolysis histology

Destroys epidermal-dermal junction cells

245

Gas produced in necrotizing fasciitis

CO2 and methane

246

pink, pearly tumor with telangiectasias and rolled borders

BCC

247

palisading nuclei histology

BCC

248

SCC associated with

arsenic exposure
chronic draining sinuses

These cancers rarely metastasize

249

keratin pearls

SCC

250

keratoacanthoma

SCC variant that grows rapidly then spontaneously regress

251

Melanoma tumor marker

S-100

252

Treatment for melanoma

excision with appropriately wide margins

253

Risk of metastasis with melanoma

Breslow Depth!

254

Which factors tell you if a nevus could be melanoma?

asymmetry
border
color
diameter > 6
Evolution

255

how to tx melanoma metastatic in pts with BRAF V600E mutation?

Vemurafenib, a BRAF kinase inhibitor

256

LTC/D/E4

bronchoconstriction
vasoconstriction
contraction of smooth muscle
increased vascular permeability

257

PGI2

inhibits platelet aggregation and promotes vasodilation

258

Prostacyclin effect

decreased:
platelet aggregation
vascular tone
bronchial tone
uterine tone

259

Prostaglandin effects

Increased uterine tone
decreased vascular tone
Decreased bonchial tone

260

aspirin mechanism

Irreversibly inhibits COX through acetylation, decreasing thromboxane A2 and prostaglandins

261

aspirin overdose

respiratory alkalosis with metabolic acidosis

262

aspirin tox

tinnitus, acute renal failure

263

NSAID tox

interstitial nephritis and renal ischemia (PGs dilate afferent arteriole)

264

COX-1

maintains gastric mucosa
Produces TXA2

265

Indications for bisphosphonates

hypercalcemia
paget's disease of bone

266

tox: bisphosphonates

corrosive esophagitis
osteonecrosis of the jaw

267

Contraindications in gout

salicylates (probenicid). These depress uric acid clearance.

268

other allopurinol uses

extends life of Azathioprine and 6-MP which are metabolized by xanthine oxidase

269

febuxostate

inhibits xanthine oxidase

270

probenicid

Inhibits reabsorption of uric acid in PCT

271

colchicine

binds and stabilizes tubulin to inhibit polymerization and inhibit leukocyte chemotaxis

272

colchicine tox

massive diarrhea

273

Drugs for acute gout

NSAIDs and glucocorticoids

274

Entanercept

Fusion of TNF-alpha receptor and IgG1Fc
--binds up TNA alpha which is then phagocytosed

275

Infliximab/adalimumab

anti-TNF alpha monoclonal antibody

276

TNF-a indications

Crohn's, rheumatoid arthritis, ankylosing spondylitis, psoriasis

277

A young child has his arm pulled and injures:

C8-T1 roots of the brachial plexus
--Damages median and ulnar nerves
--Total hand weakness

278

Sciatic nerve branches

common fibular
tibial

279

superficial fibular nerve

innervates lateral leg, foot eversion

280

deep fibular nerve innervates

anterior compartment of leg: dorsiflexors

281

deep fibular provides sensory to

between first and second toes

282

presentation of damage to common peroneal

foot drop

283

tibial nerve actions

plantar flexion and inversion

284

anterior to medial malleolus

saphenous and great saphenous vein

285

posterior to the medial malleolus

posterior tibial artery
tibial nerve
tendons of the flexor digitorum longus, flexor hallucis longus, tibialis posterior

286

matrix metalloproteases role in healing

Scar contractures

287

Postitive trendelenberg sign indicates

Weakness of gluteus medius/minimus on the leg which they are standing on.
---these are innervated by superior gluteal nerve

288

Inferior gluteal muscle innervates the

gluteus maximus muscle. Difficulty climbing stairs and rising from seated position

289

inheritance of duchenne's

X linked.

290

calf pseudohypertrophy, replaced by fat

DUCHENNE. Begins with muscle hypertrophy, then changes to fat later on.

291

Acanthosis

Thickening of the stratum spinosum. Think psoriasis

292

dyskeratosis

abnormal permature keratinization. Think squamous cell cancer.

293

hyperparakeratosis

Retention of nuclei in stratum corneum
--actinic keratosis
--normal on mucous membranes

294

Hypergranulosis

lichen planus

295

Synovial fluid of gout vs septic arthritis

WBC<20,000 in gout, over 100K in septic arthritis

296

What gives elastin is elasticity?

cross linking of desmosine.
--Elastin is not hydroxylated and does not form a triple helix like collagen

297

Osteoma arises on

surface of facial bone

298

Osteoma associated with

gardner syndrome

299

osteoid osteoma shows up in what part of the bone

arises in cortex of diaphysis