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UWorld > MSK & Derm > Flashcards

MSK & Derm Flashcards

1
Q

What changes occur in collagen with aging?

A

Decreased production

NOT decreased cross-linkage

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2
Q

Small, white, scaly lesions on sun-exposed areas
Sandpaper texture

Hyperkeratosis (increased stratus corneum)
Parakeratosis (increased nuclei in corneum)
Atypical keratinocytes (pleomorphic + mitoses)

A

Actinic Keratosis

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3
Q

Actinic Keratoses are precursors to…

A

Squamous cell carcinoma

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4
Q

Brown, “stuck on” lesions

A

Seborrheic Keratoses

“Barnacles of old age”

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5
Q

Flaccid bullae that spread laterally with pressure

New bullae form with traction (Nikolskly sign)

A

Pemphigous vulgaris

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6
Q

Pemphigous vulgaris involves autoantibodies to…

A

Desmosomes

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7
Q

Edema in intercellular spaces as a result of contact dermatitis

A

Spongiosis

contrast superficial dermal edema of hives

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8
Q

Type of sunscreen that absorbs UVB only

A

PABA

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9
Q

Type of sunscreen that blocks UVA

A

Avobenzone

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10
Q

Glands that mature at puberty, secreting sweat into hair follicles from dermis/fat of breast, axilla, genitals

A

APocrine (At Puberty)

Smelly secondary to bacteria in these areas

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11
Q

Glands found through the body that secrete watery NaCl onto skin

A

Eccrine (Everywhere)

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12
Q

Glands that discharge entire cell, breaking it to release

A

Holocrine

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13
Q

What nerve does Nursemaid’s Elbow (extension and pronation of the arm) injure?

A

Deep branch of Radial Nerve

  • Innervates extensor compartment of forearm
  • Wrist drop or inability to extend results
  • No sensory deficit (superficial br. of radial)
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14
Q

What is the technical term for Nursemaid’s Elbow?

A

Radial Subluxation

- Extension and pronation of the arm

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15
Q

Small, tender, blue proliferation under the nail bed

A

Glomus Tumor

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16
Q

From what type of cell is a glomus tumor derived?

A

Smooth muscle cells that control the thermoregulatory function of dermal glomus bodies

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17
Q

Rx for general skin and soft tissue infection

A

Nafcillin

Naf for Staph (usual cause of folliculitis and abscesses)

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18
Q

What is Pellagra?

A

Vitamin B3 (Niacin) deficiency

- Dermatitis
- Diarrhea
- Dementia
-Death

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19
Q

From where is B3 (Niacin) derived?

A

Diet and synthesized endogenously from tryptophan

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20
Q

What does B3 produce?

A

NAD and NADP, coenzymes for fat, carb, and aa metabolism, as well as HMP shunt of glucose metabolism

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21
Q

Salmon colored plaque with silver scales

Associated with arthritis

A

Psoriasis

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22
Q

Prolonged, repetitive muscle contractions

Commonly of neck, eyelid, or hand

A

Dystonia

Cervical dystonia, blepharospasm, writer’s cramp

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23
Q

Presents with ptosis + diplopia
Worse with activity and at end of day
Associated with thymoma

A

Myasthenia Gravis

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24
Q

From where does the tibial nerve descend?

A

Popliteal fossa

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25
Q

What is the motor fx of the tibial nerve?

A

Plantar flexion and inversion of the foot

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26
Q

What is the sensory fx of the tibial nerve?

A

Divides into medial and lateral plantar nerves, supplies skin on plantar foot

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27
Q

What is the MOA of Etanercept?

A

Decoy receptor that grabs TNF-a

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28
Q

What is the indication for Etanercept?

A

RA in those who have seen no improvement with MTX alone

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29
Q

Explain “An Interesting Zoo Must Have Mammals”

A

Actin in the I band attaches at the Z line.

Myosin in the H band attaches at the M line.

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30
Q

What hand joints does osteoarthritis affect?

A

PIP + DIP (Heberden’s and Bouchard’s nodes)

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31
Q

What hand joints does RA affect?

A

MCP + PIP

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32
Q

How is glycogen degraded during skeletal muscle contraction?

A

Increased Ca activates phosphorylase kinase >
Glycogen phosphorylase >
Glycogen is de-P and degraded

Note: Epi and NE also degrade glycogen through activating phosphorylase kinase

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33
Q

What is the most commonly injured rotator cuff muscle?

A

Supraspinatous

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34
Q

Injury to Supraspinatous/rotator cuff makes it difficult to…

A

ABduct the arm

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35
Q

How are collagen fibrils inked?

A

Covalently linked by lysyl oxidase after being secreted into extracellular space

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36
Q

What is the Rx for RA?

A

Glucocorticoids for short term/immediate relief

Sulfasalazine, Minocycline, Hydroxychloroquine for mild

MTX for moderate-severe

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37
Q

What is the short term Rx for RA?

A

Glucocorticoids

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38
Q

What is the long term Rx for mild or seronegative RA?

A

Sulfasalazine, Minocycline, Hydroxychloroquine

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39
Q

What is the long term Rx for moderate-severe RA?

A

MTX, but effect takes weeks

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40
Q

Trouble lifting quads, knee buckling, patellar reflex lost
Loss of sensation over ant/medial thigh, medial leg

What nerve is injured?

A

Femoral

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41
Q

Injury to femoral nerve results in what motor impairment?

A

Trouble lifting quads, knee buckling, loss of patellar reflex

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42
Q

Injury to femoral nerve results in what sensory impairment?

A

Loss of sensation of anterior/medial thigh, medial leg

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43
Q

Child holding elbow pronated at side indicates injury to…

A

Annular ligament

Nursemaid’s elbow, radial subluxation

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44
Q

Myasthenia gravis involves antibodies to…

A

ACh Rs on motor endplate

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45
Q

The amount of acetylcholine in Myasthenia Gravis is…

A

normal, but the Ach has less ability to bind

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46
Q

Decreased compound muscle AP amplitude with repeated stimulation
Rapid restoration with rest
Increased strength with AchE-Is

A

Myasthenia Gravis

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47
Q

What is the Rx for Myasthenia Gravis?

A

Pyridostigmine

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48
Q

What are the 3 phases of Paget’s Disease of bone?

A
  1. Osteolytic
  2. Mixed
  3. Osteosclerotic
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49
Q

What occurs in the Osteolytic Phase of Paget’s?

A

Increased RANK signaling and NF-KB activation > osteoclast activation

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50
Q

What occurs in the Mixed Phase of Paget’s?

A

Blasts + Clasts active

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51
Q

What occurs in the Osteosclerotic Phase of Paget’s?

A

Mostly blast activity
Mosaic Pattern
Cement lines

52
Q

What is the function of ATP in muscle contraction?

A

Required to release myosin from its bindign spot on actin (not contraction itself)

53
Q

What is the effect of no ATP on muscle contraction?

A

No ATP = rigor mortis

Constant contraction

54
Q

Direct blow to anterior tibia and posterior drawer sign

A

PCL injury

55
Q

What is heteroplasmy?

A

Different organellar genomes in a single cell (ex. mut and WT mitochondria in one cell)

56
Q

What is mosaicism?

A

Some cell mutant, others wild type

57
Q

What indicates the severity of a mitochondrial disese?

A

% defective mitochondrial genomes in a given cell

58
Q

What is the most abundant aa in collagen?

A

Glycine (> proline > lysine)

59
Q

What is the structure of collagen?

A

(Gly-X-Y)333

60
Q

What part of the brachial plexus supplies the hand?

A

Lower trunk

61
Q

With knee dislocation, must consider injury to:

A

Popliteal artery (highest risk)
Tibial Nerve
Common peroneal nerve

62
Q

Wing scapula indicates injury to what nerve and muscle?

A

Long thoracic

Serratus anterior

63
Q

Fall on outstretched hand often results in fracture of the…

A

Lunate

  • Medial of the 2 carpal bones that articulate with the radius
64
Q

Fall on outstretched hand + avascular necrosis injures the…

A

Scaphoid

65
Q

What is the MOA of Colchicine

A

Inhibits microtubule polymerization in leukocytes > decreases neutrophil chemotaxis

66
Q

What is the use of Colchicine?

A

Gout (2nd line)

67
Q

What are the adverse effects of Colchicine?

A

N/V/D, abdominal pain

68
Q

Injury to what artery in a femoral neck fracture results in avascular necrosis?

A

Medial circumflex artery, provides most blood to femur

69
Q

Fracture to what part of the femur results in avascular necrosis?

A

Femoral neck

70
Q

What is the MOA of Allopurinol?

A

XO inhibitor

71
Q

What is the use of Allopurinol?

A

Chronic tophaceous gout

1st line, and safer that uricosurics in renal disease

72
Q

Characterized by loss of epidermal melanocytes

Autoimmune correlation

A

Vitiligo

73
Q

Autoimmune condition (anti-Jo) associated with overexpression of MHC class I on the sarcolemma, which is attacked by CD8+ T cells, causing myocyte damage

A

Polymyositis

74
Q

Symmetrical proximal muscle weakness with inflammation, regeneration, and regrowth of muscle fibers on biopsy

A

Polymyositis

75
Q

Bilateral stiffness in shoulder and pelvic girdle muscles
Fever, weight loss, increased ESR
Associated with temporal arteritis

A

Polymyalgia Rheumatica

76
Q

What are the levels of Ca, Phos, and PTH in Osteoporosis

A

ALL NORMAL

77
Q

Muscle closely associated with vertebral body + transverse processes
Combines with iliacus inferiorly to flex hip

A

Psoas

78
Q

What bone disease involves cells:

  • With up to 100 nuclei
  • Staining for tartarate resistant acid phosphatase (TRAP)
  • From the mononuclear phagocytic lineage
  • Stimulated by MCSF
A

Paget’s Disease of Bone

Osteoclasts!

79
Q

Fibers that do aerobic metabolism (ox phos)

Red because of increased myoglobin and mitochondria

A

Type I, Slow Twitch

80
Q

Slow Twitch fibers are mostly found in what kind of muscles?

A

Structural muscles

81
Q

Fibers that do anaerobic metabolism

Forceful movement

A

Type II, Fast Twitch

82
Q

An activating mutation in phosphoribosyl pyrophosphatase (PRPP) synthase causes…

A

Gout

  • Increased purine production & degradation
  • Hyperuricemia
83
Q

Main type of invasive cell seen in gout:

A

Neutros

84
Q

Rx for Gout:

A

NSAIDs + Colchicine

  • Both inhibit neutrophil chemotaxis
  • Colchicine also prevents phagocytosis by preventing microtubule formation
85
Q

Anti-CCP (citrullinated peptides) are specific for what immunologic disease?

A

RA

86
Q

What substances are responsible for wound contraction?

A

Matrix metalloproteinases (MMPs) and myofibroblasts

87
Q

What is responsible for wound contracture (excessive contraction)?

A

Excessive matrix metalloproteinases (MMPs)

88
Q 
Inflammation at tendon insertions (pain, swelling, tenderness, esp. at Achilles)
Limited chest wall expansion (+/- lung fibrosis)
Ascending aortitis (> insufficiency)
A

Ankylosing Spondylitis

89
Q

What is the pathogenesis of osteomalacia?

A

Decreased MINERALIZATION of osteoid

Decreased Vitamin D, therefore decreased Phosphate

90
Q

Increased WBCs in large joint fluid + absent crystals indicates…

A

Septic Arthritis

91
Q

What is the most common cause of Septic Arthritis?

A

Gonococcus

92
Q

What is the empiric Rx for Septic Arthritis?

A

Ceftriaxone

Prevent jt destruction, osteomyelitis, and sepsis

93
Q

Substance that accumulates in pseudogout

A

Calcium pyrophosphate

94
Q

Substance that accumulates in gout

A

Monosodium urate

95
Q

Crystal arthropathy that usually first affects the knee

A

Pseudogout

96
Q

Crystal arthropathy that usually first affects the big toe

A

Gout

97
Q

Crystal arthropathy with (+) birefringence

A

Pseudogout

98
Q

Crystal arthropathy with (-) birefringence

A

Gout

99
Q

Presents as difficulty combing hair

Proximal muscle weakness

A

Polymyositis

100
Q

What muscles are most important to performing Valsalva?

A

Rectus abdominis

101
Q

IgM antibody against Fc portion of self IgG

A

Rheumatoid Factor

102
Q

Antibody secreted by B cells responding to T cells that attack cartilage components

A

Rheumatoid Factor

103
Q

Succinylcholine is a deplolarizing NMJ blocker … by Neostigmine in Phase I.

A

Augmented

104
Q

Succinylcholine is a deplolarizing NMJ blocker … by Neostigmine in Phase II.

A

Reversed

105
Q

The duration of Succinylcholine blockade depends on proteins called…

A

Plasma Cholinesterase

  • Succinylcholine is usually very short acting
  • Can be prolonged to 1-3hrs due to atypical PC
106
Q

What is the MOA and use of Calcipotriene?

A

Vitamin D analog used in Rx of Psoriasis

Binds Vitamin D receptors >
Inhibits keratinocyte proliferation >
Stimulates differentiation

107
Q

Muscles that arise from the pubis + ischium and insert on the femur perform what function?

A

Adduction

108
Q

What causes muscle atrophy (ex. in broken leg immobilized for a long time)?

A

Increased protein degradation

109
Q

What are the components of CREST syndrome?

A 
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia
110
Q

Tretinoin is an analog of…

A

Vitamin A

111
Q

What is the MOA of Tretinoin in reducing wrinkles?

A

Binds nuclear Rs > Increased gene expression of collagen

112
Q

What are the levels of IL-1 in osteoporosis?

A

Increased

IL-1 activates osteoclasts >
Bone resorption >
Vertebral collapse

113
Q

What nerves innervate the anterior and medial compartments of the leg (distal anterior thigh, knee, medial leg, foot)?

A

Femoral (L2-4)

Obturador (L2-4)

114
Q

Face rash with telangiectasia and papules
Intermittent flushing
Maybe triggered by spicy foods (histamines)

A

Rosacea

115
Q

Rash and dry skin with flaking on face and scalp

A

Pityriasis Rosea (dandruff)

116
Q

Herald Patch following URI and then scattered rash

Self-limited, 6-8 wks

A

Seborrheic Dermatitis

117
Q

“Water warts” spread via person to person contact
Firm, smooth, umbilicated papules 2-4mm, in clusters
May have eczema surrounding

A

Molluscum contagiosum

118
Q

What is the cause of Molluscum contagiosum?

A

Poxvirus

119
Q

What are the two collagen defects in Ehler-Danlos?

A

Lack of:

  • Procollagen peptidase (more soluble collagen that doesn’t cross link)
  • Lysyl hydroxylase (decreased hydroxyl lysine in tissue)
120
Q

What is housemaid’s knee?

A

Prepatellar bursitis

  • Also seen in gardeners
  • This is a subcutaneous bursa
121
Q

What is the MOA of cyclosporine?

A

Inhibits calcineurin > decreased IL-2

Immunosuppressant used in RA

122
Q

Why do osteoclasts need carbonic anhydrase?

A

Provide H+ to acidify and resorb bone

123
Q

What is a synthetic retinoid that is used as systemic therapy for Psoriasis?

A

Acitretin

124
Q

What is the MOA of Acitretin?

A

Synthetic retinoid that promotes cell differentiation

- Teratogen

125
Q

What muscles attach at the lateral clavicle?

A

Deltoid (inferolateral movement) and trapezius (superomedial movement)

126
Q

What bone disease presents with bony prominences at costochondral jx, indentations in lower ribs, softening of skull, and “osteoid matrix accumulation around trebeculae”?

A

Ricketts, vit. D def.

127
Q

What are the lab findings in Ricketts?

A

Hypocalcemia, hypophosphatemia, because of vit. D def.

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