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MSK Flashcards

1
Q

Osteosarcoma

A

Primary vs. secondary forms (Paget radiation). Most common primary tumor of bone (B-cell lymphoma is most common overall). Found around knee. Bimodal (10-20 and >65). Codman’s triangle = raised periosteum. Secretes osteoid. Rarely invades epiphysis.

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2
Q

Osteoclast mechanism?

A

Pump out H+ produce by carbonic anhydrase against gradient into Howship lacunae to release calcium, phosphoric acid, and carbonic acid.

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3
Q

Lumbar lordosis etio?

A

Imbalance of hip flexion > extension. Obesity, pregnancy, osteoporosis, discitis, kyphosis, spondylithesis, achondroplasia

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4
Q

Reiter syndrome

A

Triad of reactive arthritis, urethritis, and conjunctivitis 2/2 to urogenital infection (Chlamydia) or GI inf (Salmonella, Shigella, Campy, Yersinia). HLA-B27 associated.

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5
Q

Superficial inguinal LN’s drain what structures?

A

Cutaneous lymph from umbilicus to feed except posterior calf (popliteal LN’s). Includes external genitalia (e.g. scrotum) and anus up to dentate line.

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6
Q

Most common congenital anomaly

A

Accessory nipple = polythelia. Failure to involute. Usu. asymptomatic, although may become so during pregnancy or lactation.

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7
Q

Deep inguinal LN’s drain what structures?

A

Glans/clitoris + superficial inguinal LN’s

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8
Q

Layers of the epidermis?

A

Californians Like Girls in String Bikinis. Stratum Corneum, Lucidum, Granulosum, Spinosum, Basale.

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9
Q

At what epidermal layer are the cells starting to die?

A

Granulosum -> Lucidum

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10
Q

Zonula adherens vs. Macula adherens?

A

Zonula adherens is the adherent junction. Belt below the tight junction connecting actin cytoskeletons of cells with CADherins. Loss of E-cadherin promotes metastasis. Macula adherents are desmosomes (Desmoplakin; site of pemphigus vulgarism auto ab’s)

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11
Q

Tight junction make-up?

A

Claudins and occludins

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12
Q

Gap junction make-up?

A

Connexon with central channel

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13
Q

Integrins vs. cadherins?

A

Integrins on basolateral membrane with the hemidesmosomes. Cadherins with the adherents junction (belt).

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14
Q

Valgus vs. varus?

A

Varys is wide. Valgus is knock-kneed.

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15
Q

McMurray test?

A

External rotation of knee (varus stress)–> pain from MEDIAL meniscus. Pain on internal rotation (valgus stress) is LATERAL meniscus.

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16
Q

Where do you do a pudendal nerve block?

A

Ischial spine

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17
Q

Where is McBurneys point?

A

2/3 of distance from umbilicus to ASIS (right)

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18
Q

F(x) of supraspinatus and nerve?

A

Abduct arm before deltoid. Suprascapular nerve.

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19
Q

F(x) of infraspinatus and nerve?

A

Lateral rotation of arm. Suprascapular nerve.

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20
Q

F(x) of teres minor and nerve?

A

Adduction and lateral rotation of arm. Axillary nerve.

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21
Q

F(x) of subscapularis and nerve?

A

Medial rotation and adduction. Subscapular nerve.

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22
Q

Most common rotator cuff tear?

A

Supraspinatus

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23
Q

Ulnar nerve injury that localizes to wrist?

A

Probably outstretched hand. Hook of hamate.

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24
Q

Wrist bone most commonly fractured?

A

Scaphoid

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25
Q

Acronym for wrist bones.

A

So Long to Pinky, Here Comes The Thumb. Scaphoid, Lunate, Triquetrum, Pisiform. Hamate, Capitate, Trapezoid, Trapezium.

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26
Q

Guyon canal syndrome?

A

Ulnar nerve compression at wrist or hand. Classically for cyclist and handlebar pressure.

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27
Q

Klumpke’s palsy

A

Lower trunk (C8-T1) -> CLAW hand. Often 2/2 to upward traction during delivery or breaking fall with arm.

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28
Q

Erb palsy

A

Upper trunk (C5-C6) -> waiter’s tip. Unable to abduct arm (deltoid, supraspinatus), laterally rotate (infraspinatus), flex or supinate (biceps brachii)

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29
Q

General differences between distal and proximal median/ulnar nerve “clawing?”

A

Distal lesions are worse and seen with extension of the fingers/at rest (cannot extend). Proximal lesions are less pronounced and tend to be seen during voluntary flexion (cannot flex).

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30
Q

Distal ulnar n. vs proximal ulnar n.?

A

Distal ulnar nerve -> inability to extend lateral fingers = “Ulnar claw.” Proximal ulnar nerve -> inability to flex lateral fingers = OK gesture while making fist.

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31
Q

Distal ulnar n. vs distal median n.?

A

Distal ulnar n = ulnar claw when at rest. Distal median nerve = median claw when at rest (can’t extend medial fingers)

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32
Q

Proximal median n. vs. distal median n.?

A

Proximal median n. = pope’s blessing when closing the hand (medial fingers cannot flex). Distal median n. = median claw (medial fingers cannot extend)

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33
Q

Lumbrical muscle function?

A

Flex MCP, extend PIP and DIP.

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34
Q

Fractured surgical neck of humerus?

A

Axillary n. (C5-C6) injury. Posterior circumflex a.

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35
Q

Midshaft fracture of humerus?

A

Radial n. injury (C5-T1). Deep branchial artery.

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36
Q

Supracondylar fracture of humerus?

A

Median n. injury

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37
Q

Medial epicondyle fracture of humerus?

A

Ulnar n. injury

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38
Q

Compression of axilla injury?

A

Radial n. injury.

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39
Q

Fractured hook of hamate injury?

A

Ulnar n. (distal) injury.

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40
Q

Anterior dislocation of humerus injury?

A

Axillary n. injury

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41
Q

Axillary n. injury presentation?

A

Flattened deltoid, inability to abduct > 15 deg. Loss of sensation over deltoid and lateral arm.

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42
Q

Median n. injury presentation?

A

Ape hand, pope’s blessing. Loss of wrist flexion, thumb opposition. Median n. sensory loss

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43
Q

Ulnar n. injury presentation?

A

Ulnar claw

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44
Q

Recurrent branch of median n. presentation?

A

Superficial laceration of palm. Ape hand. Loss of thenar muscle group = opposition, abduction, and flexion of the thumb. NO loss of sensation.

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45
Q

Radial n. injury prsentation?

A

Rist drop. Inability to extend elbow, wrist, finger. Decreased grip strength. Radial n. distribution.

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46
Q

Thenar muscles and nerve?

A

Median n. Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis. OAF.

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47
Q

Hypothenar muscles and n.?

A

Ulnar n. Opponens digiti minimi, Abductor digit minimi, flexor digiti minimi brevis. OAF.

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48
Q

Dorsal vs. palmar interosseous muscles function?

A

Dorsals ABduct. Palmar ADDUCT. Palms add together to pray.

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49
Q

Common peroneal nerve injury presentation?

A

Foot drop. Loss of sensation on dorsum of foot.

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50
Q

Tibial nerve injury presentation?

A

Can’t curl toes (can’t stand on toes either). Loss of sole sensation. Proximal lesions -> foot eversion (Baker cyst).

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51
Q

Superior gluteal n. injury presentation?

A

Trendelenburg sign/gait. Lesion is OPPOSITE of side that drops b/c the contralateral gluteus medius and minims is supposed to hip ABduct.

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52
Q

Inferior gluteal n. presentation?

A

Difficulty climbing stairs, rising from seat. Loss of hip extension (maximus)

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53
Q

Obturator vs. femoral n. presentations?

A

Femoral n. is decreased thigh FLEXION and leg extension (Femoral n. is the kick!). Obturator n. is decreased medial thigh sensation and decreased adduction. Obturator is crossing the legs.

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54
Q

Popliteal fossa injury?

A

Tibial n. and popliteal artery.

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55
Q

Distal humerus/cubital fossa injury?

A

Median n. and branchial a.

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56
Q

What band of the sarcomere never changes length?

A

A band = myosin-only length.

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57
Q

Two main muscle fiber types?

A

Slow = type 1. Fast = type 2. (Cuz slow and steady wins the race, myoglobin, AND mitochondria). Type I requires aerobic metabolism (high myoglobin for o2 and mitochondria).

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58
Q

T-tubule depolarization is linked to what Ca2+-channel receptors?

A

Dihydropyridine receptor (T-tubule) and ryanodine receptor.

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59
Q

How does smooth muscle contract generally speaking?

A

NOT with troponin and T-tubules. A depolarization causes L-type voltage-gated Ca+ channels to open leading to increased Ca -> Ca-calmodulin binding -> activates myosin light chain kinase -> phosphorylates myosin and makes it HIGH ATPase activity -> cross-bridge cycling.

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60
Q

How does NO relax smooth muscle cells?

A

NO activates guanylate cyclase to make cGMP, which activates myosin-light-chain phosphoatase -> remove phosphate from myosin and dec. cross-bridge cycling.

61
Q

Woven bone vs. lamellar bone?

A

Histological types. Woven bone is NOT organized and stress-oriented whereas lamellar bone. Lamellar bone is made from remodeling woven bone.

62
Q

Endochondral vs. membranous ossification?

A

Endochondral ossification relies on a cartilaginous model of bone made by chondrocytes - axial and appendicular skeleton. Membranous ossification is woven bone made directly - calvarium and facial bones.

63
Q

How does estrogen affect bone formation?

A

Estrogen INHIBITS osteoblast apoptosis and induces osteoclast apoptosis.

64
Q

Osteoblasts and osteoclasts differentiate from what cells?

A

Osteoclasts (Eaters) differentiate from monocytes/macrophages. Osteoblasts (builders) differentiate from mesenchymal stem cells of periosteum.

65
Q

Achondroplasia

A

Activation of FGFR3 inhibits chondrocyte proliferation leading to failure of long-bone growth (endochondral oss) -> short limbs. Mostly sporadic and associ. with adv. paternal age.

66
Q

Two types of osteoporosis?

A

Type I is post-menopausal. Type II is senile > 70.

67
Q

Ppx for osteoporosis?

A

Regular wt-bearing exercise, Ca, Vitamin D.

68
Q

Treatment for osteoporosis?

A

Bisphosphonates, PTH, SERMs. Denosumab (monoclonal antibody AGAINST RANKL). Calcitonin rarely.

69
Q

Osteopetrosis

A

Osteoclast failure (e.g. CA II mutation) -> dense, thick bones prone to fracture + no bone marrow -> pancytopenia and extramedullary hematopoiesis. Nerve impingement, CN. Tx = bone marrow transplant to make new osteoclasts (From monocytes)

70
Q

Osteomalacia and lab values?

A

Vitamin D deficiency in adults -> defective mineralization of osteoid. Lab finds = dec. Ca, inc. PTH, dec. phosphate

71
Q

Paget disease of bone mech and labs

A

Bone remodeling disorder characterized by increased osteoblastic and clastic activity. Normal lab values BUT increased alkaline phophatase. Mosaic pattern of bone.

72
Q

Paget disease of bone presentation

A

Long bone chalk-stick fractures. High-output HF 2/2 AV shunts. Risk of osteogenic sarcoma.

73
Q

4 stages of Paget disease

A

Lytic (clast), Mixed, Sclerotic (blast), Quiescent (minimal activity)

74
Q

Etios of osteonecrosis (avascular necrosis)?

A

Trauma, high-dose corticosteroids, alcoholism, sickle cell. Most common site is femoral head 2/2 medial circumflex artery

75
Q

Osteitis fibrosa cystica?

A

As a consequence of hyperparathyroidism (primary OR secondary), bone resorption + blastic activity -> fibrous replacement of bone often with hemorrhagic debris (“brown tumors”)

76
Q

Names of benign primary bone tumors?

A

Giant cell tumor and osteochondroma

77
Q

Treatment for osteosarcoma?

A

Surgical en bloc resection and chemo.

78
Q

Pathology of Ewing’s sarcoma?

A

Anaplastic small blue cell malignant tumor. Onion skin in bone.

79
Q

Ewing’s sarcoma presentation?

A

Boys < 15. Often in diaphysis of long bones, pelvis, scapula, ribs. Associated with t(11;22) translocation.

80
Q

Predisposing factors for osteosarcoma?

A

Paget disease of bone, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni

81
Q

Giant cell tumor presentation?

A

Soap bubble appearance. Typically around knee (epiphyseal ends of long bones). 20-40 yrs old.

82
Q

Chondrosarcoma path?

A

Expansile glistening mass within MEDULLA.

83
Q

Chondrosarcoma presentation?

A

Men 30-60. Pelvis, spine, scapula, humerus, tibia, femur.

84
Q

Osteochondroma?

A

An exotosis of mature bone with cartilaginous cap. Most common benign tumor. Males < 25 y/o. Rarely transforms into chondrosarcoma.

85
Q

RA etiology?

A

Autoimmmune inflammatory destruction of joints mediated by cytokines and type III (IC) and type IV (delayed T-cell) HS reactions.

86
Q

Joint findings in OA?

A

Subchondral cysts, osteophytes (bone spurs), eburnation (polished appearance of bone). Heberden (DIP) and Bouchard (PIP) nodes. NO MCP.

87
Q

Joint findings in RA?

A

Pannus formation in joints (MCP, PIP), SQ rheumatoid nodules (fibrinoid necrosis), ulnar deviation of fingers, subluxation. Baker cyst. NO DIP.

88
Q

Predisposing factors for RA?

A

F>M. Rheumatoid factor (which is an anti-IgG antibody). Anti-cyclic citrullinated peptide is specific. DR4.

89
Q

Tx for OA vs. RA?

A

Both use NSAIDS. OA use intra-articular glucocorticoids. RA use systemic glucocorticoids and DMARDS (methotrexate, sulfasalazine, TNF-alpha inhibitors [infliximab, adalimumab])

90
Q

Lab findings of Sjogren’s?

A

SS-A and/or SS-B (anti-Ro/La).

91
Q

Presentation of Sjogren’s?

A

Xeropthalmia (dec. tear production -> corneal damage), xerostomia (Decreased saliva production), b/l parotid enlargement. Complications include caries, MALTs, lymphoma

92
Q

Treatment of gout?

A

Acute attack treat with NSAIDs, glucocorticoids, and colchicine. Chronically, use xanthine oxidase inhibitors like allopurinol and febuxostat.

93
Q

Gout crystal characteristics?

A

Negatively birefringent (yellow on parallel, blue on perp.). Needles. Monosodium urate crystals NOT uric acid crystals!!!

94
Q

Overproduction of uric acid etiologies of gout?

A

Lesch-Nyhan (HGRPT), PRPP excess, tumor lysis syndrome, von Gierke disease (Glucose-6-phosphatase)

95
Q

Tophus formation where?

A

MTP of big toe (podagra), external ear, olecranon bursa, Achilles tendon

96
Q

Gout vs. pseudogout?

A

Uric acid vs. calcium pyrophosphate. Needle neg-birefring vs. basophilic rhomboid weakly pos-birefring. Small joints vs. large joints.

97
Q

What are the seronegative spondyloarthropathies?

A

Arthritis w/o RF. HLA-b27 associated. PAIR - Psoriatic arthritis, Anklyosing spondylitis, Inflammatory bowel disease, Reactive arthritis/Reiter syndrome.

98
Q

Ankylosing spondylitis clinical features?

A

Chronic inflammation of spine, sacroiliac. Uveitis. Aortic regurgitation.

99
Q

Lab tests with good sensitivity for SLE?

A

ANA. Anti-histone for DRUG-induced.

100
Q

Lab tests with good specificity for SLE?

A

Anti-dsDNA (poor prognosis). Anti-Smith = Anti-snRNP (not prognostic).

101
Q

Type of glomerular disease in lupus nephritis?

A

Diffuse proliferative glomerulonephritis and membranous glomerulonephritis.

102
Q

Why do SLE patients get positive VDRL/RPR?

A

Because of anti-cardiolipin antibodies.

103
Q

Sarcoidosis lab findings?

A

Elevated serum ACE. Hypercalcemia 2/2 to increased 1-alpha-hydroxylase activity in macrophages -> vitamin D activation

104
Q

Polymyalgia rheumatica?

A

Pain and stiffness of shoulders and hips with fever, malaise, WT loss w/o muscle weakness associated with temporal arteritis. Inc. ESR and CRP but NOT CK. Tx with low-dose steroids.

105
Q

Mechanistic differences between polymyositis and dermatomyositis?

A

Polymyositis has endomysial (around fiber) inflammation of CD8+ cells whereas dermatomyositis has PERImysial (around fascicle) inflammation and atrophy with CD4+ cells.

106
Q

Exam findings on dermatomyositis?

A

Malar rash, gottron papules, heliotrope rash, “shawl and face.” Progressive symmetric proximal muscle weakness.

107
Q

Lab findings in poly/dermatomyositis?

A

inc. CK. Positive ANA, anti-Jo-1, anti-SRP, anti-Mi2.

108
Q

Mechanistic differences between myasthenia gravis and Lambert-Eaton?

A

Autoab’s against post-synaptic Ach receptor vs. autab’s against pre-synaptic Ca2+ receptor (to decrease Ach release)

109
Q

What test would differentiate between MG and LE?

A

Edrophonium (AChE inhibitor) test. MG would reverse. LE would not.

110
Q

Differences in associated conditions between MG and LE?

A

MG associated with thymoma and thymic hyperplasia whereas LE is associated with small cell lung cancer.

111
Q

Myositis ossificans?

A

After muscular trauma, a metaplasia of skeletal muscle INTO BONE.

112
Q

CREST syndrome?

A

Calcinosis, Raynaud, Esophageal dysmotility, sclerodactyly (thickening and tightness of skin around fingers and toes -> ulceration), Telangectasia. Associated with anti-Centromere antibody.

113
Q

Diffuse scleroderma vs. limited scleroderma?

A

Diffuse is more widespread, rapid, associated with anti-Scl-70 (topoisomerase I). Limited is CREST and associated with anti-centromere.

114
Q

Acanthosis vs. acantholysis?

A

Acanthosis is epidermal hyperplasia (spinosum layer) while acantholysis is separation of epidermal cells. Acanthosis nigricans vs. pemphigus vulgaris

115
Q

What is spongiosis?

A

The accumulation of edematous fluid in intracellular spaces.

116
Q

Etiologies of albinism?

A

Decreased melanin production 2/2 bad tyrosinase activity or defective tyrosine transport. OR failure of neural crest cell migration (meaning low numbers of melanocytes)

117
Q

Verrucae?

A

= Warts 2/2 HPV.

118
Q

Ephelis?

A

= Freckle. Has increased melanin pigment.

119
Q

Skin changes in psoriasis?

A

Acanthosis with parakeratotic scaling (nuclei still in corneum). Thickened stratum spinosum but DEC stratum granulosom.

120
Q

Leser-Trelat sign?

A

The sudden appearance of many seborrheic keratoses indicating an underlying malignancy

121
Q

What is cellulitis an infection of exactly?

A

Dermis and SQ tissue. Strep pyogenes (GAS) or Staph aureus.

122
Q

Pemphigus vulgaris

A

IgG against desmoglein -> flaccid intraepiderma bullae caused by acantholysis. Affects mucosa. + nikolksy

123
Q

Path findings of pemphigus vulgarism vs. bullous pemphigoid?

A

Pemphigus vulgarism with net-like pattern on IF whereas linear pattern at epiderma-dermal junction for bullous pemphigoid.

124
Q

Bullous pemphigoid

A

IgG against hemidesmosomes. TENSE blisters with EOS. NEG nikolsky.

125
Q

Dermatitis herpetiformis

A

PRURITIC papulse, vesicles, bullae. IgA deposides at tip of dermal papillae. Celiac disease

126
Q

Erythema multiforme look?

A

Target lesions (rings and dusky center of epithelial disruption)

127
Q

Erythema multiforme associations?

A

Mycoplasma, HSV, sulfa drugs, Beta-lactamas, phenytoin, ca, auotimmune

128
Q

Stevens-Johnson syndrome

A

Fever, bulla formation, skin sloughing, HIGH mortality rate. Associated with mucosa. If > 30% of body surface area, called “toxic epidermal necrolysis.”

129
Q

Erythema nodosum?

A

PAINFUL inflammatory lesions of SQ fat usu. on ant. shins. Associated with sarcoid, coccidiodomycosis, histoplasmosis, TB, strep, leprosy, Crohn

130
Q

Lichen Planus

A

Pruritic, Purple, Polygonal Planar Papulse and Plaques. Sawtooth infiltrate of LYMphocytes at derma-epidermal border.

131
Q

Pityriasis rosea

A

Herald patch -> christmas tree pattern of plaque.

132
Q

Tanning vs. Suburn?

A

UVA in tanning and photoaging. UVB in sunburn.

133
Q

Molecular aspects of melanoma?

A

Often driven by BRAF activating mutation. If V600E, could use vemurafenib (BRAF kinase inhibitor)

134
Q

Histology differences between basal cell and squamous cell carcinoma?

A

Palisading nuclei vs. keratin pearls

135
Q

Leukotriene functions?

A

LTB4 is for neutrophils chemotaxis. C4,D4,E4 for bronchoconstriction.

136
Q

TXA2?

A

TAXI’s are congested. Thromboxane for inc. PLT aggregation, vasoconstriction, and bronchoconstriction.

137
Q

Zileuton?

A

Inhibits lipooxygenase to decrease leukotrienes.

138
Q

Mechanism of action for aspirin?

A

Irreversible inhibition of COX-1 &2 via acetylation.

139
Q

Usage of COX-2 inhibitors?

A

RA, OA. Patients with gastritis or ulcers benefit because TXA2 production is dependent on COX-1.

140
Q

Acetaminophen mechanism?

A

Reversibly inhibits cycloxygenase mostly in the CNS b/c inactivated peripherally.

141
Q

Toxicity of bisphophonates?

A

Corrosive esophagitis. Therefore, pt’s need to take with water and remain upright for THIRTY minutes.

142
Q

Allopurinol drug interactions?

A

Will increase concentrations of azathioprine and 6-MP b/c xanthine oxidase metabolizes these drugs.

143
Q

Probenacid?

A

Inhibits resorption of uric acid in PCT. Also inhibits secretion of penicillin (stronger concentration)

144
Q

Etanercept vs. infliximab/adalimumab

A

Cept is a receptor for TNF-alpha fused with IgG Fc = decoy receptor. Used for RA, psoriasis, akylosing spondylitis. Inflix/ada used for IBD + others.

145
Q

Hypothyroid myopathy

A

Muscle pain, cramps, and weakness of proximal muscles along with features of hypothyroidism. CK is high. TSH high. Myoedema.

146
Q

Topical vitamin D analogs?

A

Calcipotriene, calcitriol, and tacalcitol. Bind vitamin D receptor (nuclear transcription factor ) -| KERATINOCYTE proliferation and stimulates their differentiation. Also mediates T-cells. Used for Psoriasis.

147
Q

Juvenile hemangioma

A

“Strawberry hemangioma”. 1/200. Initially GROW in proportion to child, then regress at or before puberty. (usu. before age 7)

148
Q

Jaw pain that starts in the middle of a meal?

A

Think temporal arteritis. During meal, arteries cannot respond to increased blood requirement. Tongue pain may occur during means = tongue claudication.

Step 1 (19 decks)

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