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Flashcards in Musculoskeletal Deck (150):

lunate vs scaphoid bone position

both carpal bones articulate with radius. lunate is immediately medial to scaphoid


thumb swings on which carpal bone?



which bone is in center of wrist



lunate vs triquetrum bone

both carpal bones articulate with ulna, triquetrum bone is medial.


explain collagen synthesis

1) pre-pro alpha chain is translocated into RER. signaling protein is cleaved. now called pro alpha chain
2)hydroxylation of proline and lysine residues (vti C dependent)
3)glycosylation of selected lysin residues
4)assembly of procollagen triple helix (disulfide/hydrogen bonds)- problem here=osteogenesis imperfecta
1)terminal propeptides cleaved by N- and C- procollagen peptidases. now called tropocollagen
2)collagen fibrils form spontaneously
3)fibrils are reinforced by covalent cross-linking (lysyl oxidase)- requires Cu2+. problems here=Ehler's Danlos and Menkes


older pt with bone pain and increased phosphatase level-disease, cells involved, cancer risk

Paget's disease-increased osteoclastc activations followed by increased activity of osteoblasts. increased risk for osteocarcoma

histo-haphazardly oriented, prominent cement lines, mosaic pattern of lamellar bone



cells found in healthy cartilage


neonate with agenesis of sacrum, flaccid paralysis or legs, dorsiflexed contractures of feet and urinary incontinence. associated with what maternal disease?

caudal regression syndome, poorly controlled maternal diabetes


what abdominal muscle is needed to increase intra-abdominal/intrathoracic pressure during Valsalva maneuver?

rectus muscle.


how does valsalva maneuver help with paroxysmal supraventricular tachycardia? if this fails use what drug?

increases vagal tone to increase refractory period in AV node (slow conduction) andprevent reentrant circuit. if this fails use IV adenosine (increase K+ out of cells)


describe muscles and nerves involved in abduction of arm

0-10 supraspinatus (suprascapular nerve)
10-90 deltoids (axillary nerve)
>90 serratus anterior (long thoracic nerve)

note: paralysis of trapezius (spinal accessory) prevents upward rotation of scapula and inability to arm arm above the horizontal


-great auricular nerve and transverse cervical nerve, -greater occipital nerve

-branches of cervical plexus don't innervate any muscles in the neck, provide cutaneous innervation only.
-dorsal ramus of 2nd cervical spinal nerve cutaneous innervation to skin in back of head, no muscles


terres minor-innervation and movement. muscles that help and oppose this action/nerve

axillary, adducts and laterally rotates
infraspinatus (suprascapular nerve) works with terres minor to laterally rotate the arm
and subscapularis (subscapularis nerve) opposes causing medial rotation


action of palatoglossus and palatopharyngeus/ nerve

palatogossus-draw tongue and soft palate together (as occurs during swallowing)-CN10
palaopharyngeus-elevates pharynx (as occurs during swallowing)-CN10
buccinator-holds food against teeth while chewing-CN 7 (paralysis can lead to food and saliva b/t teeth and check)


muscles of mastication innervated by CN5

3Ms elevate jaw-masseter, temporalis, and medial pyerygoid
1 L lowers jaw-lateral ptyergoid


aneurysm of axillary artery within axilla may compress what part of the brachial plexus? why not trunk of brachial plexus?

any of the cord-they are all enclosed within the axillary sheath the first portion of the axillary artery. get their name b/c of their relation to the artery (lateral, medial and posterior).

lower trunk of the brachial plexus is above the clavicle. not in axillary sheath.


temporalis muscle in innervated by CN located where? not lower pons because?

CN V located in mid pons (along with 6). lower pons contains CN 7 (muscle of facial expression and stapedius muscle) and 8.


CNs in medulla



CNs in midbrain

3, 4



I-contains actin
H-contains myosin
A-contains actin + myosin


explain organization of sarcomere

An Interesting Zoo Must Have Mammals (Actin in the I-band attache to the Z-line, Myosin in the H-band attaches to the M-line)


cafe au lait spots, polyostotic fibrosis dysplasia, precocious puberty, multiple endocrine disorders

McCune-albright (mosaic G protein signaling mutation)


examples of muscluskeletal diseases with
-no contraction in response to intracellular Ca2+
-uncoordinated contraction of myofibrils
-poor force generation on repeated stimulation
-impaired relaxation after a single contraction
-impaired energy production during contraction

-abnormality of troponin C or myosin
-T-tubule malformation
-myasthenia gravis
-myotonic dystrophy
-McArdle disease (glycogen storage disease type V)- defect in myophosphorylase


location of psoas vs erector spinae

-originates from anterior surface of transverse processes and lateal surface of corresponding vertebral bodies (T12-L5)
-large muscle group behind vertebral bodies-causes spine extension.


which bone fracture is common in elderly? CXR finding? artery damaged? why not obturator, why no femoral?

-femoral neck fracture
-look for shortened femoral neck
-medial femoral circumflex artery
-not femoral b/c femoral gives rise to medial and lateral circumflex arteries-also more extreme symptoms (lower extremity claudication etc... would be expected)
-obturator artery give rise to an artery that supplies the femoral head- vessel is esp important in chidren b/c is supplies blood to region of femoral head proximal to the epiphyseal growth plate


name 3 bisphosphonates- analogue of, toxicities, uses

anything that ends in"dronate"
-alendronate* risedronate, and ibandronate
-analogue of pyrophosphate PP- important component of hydroxyapatite (component of bony matrix)
-esophagitis and jaw bone necrosis
-Paget's, osteoporosis, malignancy-induced hypercalcemia


describe "empty-can (muscle name) test"? what muscle is it use to test for?

-pt abducts arms to 90 degrees and flex them to 30 degrees with thumbs pointing to the floor. doc applies a downward force to arm
+ sign=pain or weakness
indicates a tear in muscle or tendon, tendonitis, or pinching tendon between acromion and head of humerus


serum sickness-hypersensitivity, mech, presentation (6), when, can be caused by which drug?

-type III hypersensitivity
-deposition of circulating complement-fixing immune complexes and resulting vasculitis
-fever, urticaria, arthralgias, glomerulonephritis, lymphadenopathy, low serum C3 levels
-5-10 days intravascular exposure to antigen


risk of damage to what artery and nerve:
-midshaft fractures
-supracondylar fractures

-deep brachial artery and radial nerve-travel together
-brachial artery


nurse's elbow-def, mech, pt pop, presentation, structure that's torn and displaced

-radial head subluxation
-sudden traction on outstretched and pronated arm of child
-arm is close to body, elbow extended and forearm pronated, children are in little distress unless elbow it moved
-annular ligament tears from attachment at radial neck and slips into radiohumeral joint


"popeye" deformatity-def, muscle ruptured

palpable mass in mid upper mass; bicep tendon rupture


intense stress valgus stress at elbow (i.e throwers and baseball picthers) injures which ligament

ulnar collateral ligament


where should injections in buttocks be given to avoid injury? what structures are present in other sites?

-superolateral quadrant is safe
-superomedial quadrant risks injury to gluteal nerves
-inferior medial risk injury to sciatic nerve
-inferior lateral quad risk injury to tendinous insertions of gluteal muscles


organism that causes gas gangrene vs organism that causes ecthyma gangrenosum

-c. perfringens (myonecrosis)
-pseudomonas aeruginosa (necrotic cutaneous lesions)


c. perfringens causes what two disease?

late onset food poisoning accompanied by transient watery diarrhea
clostridial myonecrosis (gas gangrene)


most common cause of septic arthritis in sexually active adults? other cause?

other cause is rheumatic fever from untreated group A strep


-myasthenia gravis
-post streptococcal glomerulonephritis
-good pastures
-hypersensivity pneuomonitis
-contact dermatitis
-atopic dermatitis



in health individuals differences i bone density curves can best be explained by

genetic factors
-calcium intake, exercise etc... has a smaller role


where is sternocleidomastoid muscle located?

-originates on medial clavicle (cleido) and manubrium of sterum (sterno)
-inserts on mastoid process of skull (mastoid)


serratus anterior vs rhomboid muscle. how does winged scapula occur?

-originates from 1st through 8th ribs laterally and inserts into medial border to scapula. loss of innervation (long thoracic nerve) causes winged scapula
-major and minor rhomboids originate on vertebral bodies and spines and inserts into medial boarder of scapula


repeated and prolonged kneeling can cause damage to which bursa? aka? pt pop? symptoms?

-prepatellar bursitis, "housemaid's knee"
-most commonly seen in roofers, carpenters, and plumbers
-pain, erythema, swelling, and inability to kneel on affected side


role of rank receptor/rank ligand. effect of estrogen on expression of rank receptor

-essential for formation and differentiation of osteoclasts
-hypoestrogenic states leads to over expression of rank receptor causing increased bone resorption due to increased osteoclastic activity


clinical presentation of achondroplasia. genetic inheritance?

-"disproportionately short arms and legs", normal spine length, large head, saddle nose
-autosomal domininant


deposition of
-calcium pyrophosphate
-monosodium urate
-calcium hydroxyapaptite

-pseudogout; rhomboid shaped crystal; positive bifurengence; blue when parallel
-gout needle shaped crystals (negative bifringence; yellow in parallel light and blue in perpendicular light
-calcific tendonitis, mc location is rotator cuff


intramembranous ossification vs endochondral ossificaiton

-lack of cartilaginous bone intermediate


effective anti-inflammatory agent in acute gouty arthritis? mech? toxicity? use when?

-inhibits tubulin polymerization and microtubule formation in leukocytes (this prevents chemotaxis of neutrophils)
- b/c of side effects use in ppl who can't take NSAIDS due to renal failure or peptic ulcer disease


presentation of lesions in CN III

eye deviated down and out
diagonal diplopia (or "both horizontal and vertical diplopia at same time"), dilation of pupil and loss of accommodation, ptosis


presentation of lesion in CN IV

eye deviated and upward, vertical and torsional diplopia


presentation of lesion in CN VI

eye deviated medially, horizontal diplopia


presentation of appendictis, 1st event in pathogenesis, causes of this?

right lower quad pain that begins at umbilicus, nausea, vomiting, diarrhea, and fever
-fecaliths, hyperplastic lymphoid follicles, foreign bodies, or tumors


presentation of serotonin syndrome, drugs that cause (just main examples), precursor

confusion, agitation, tremor, tachycardia, clonus*, hyperrflexia, hyperthermia, and diaphoresis
-SSRIs and MAO inhibits
-tryptophan is a precursor


another name for vitamin B6. what poisoning can cause it's elevation?

pyridoxal phosphate
lead (in heme pathway)


mech of entacapone, another drug in this class? toxicity?

-COMT inhibitor increases bioavailability of levodopa by inhibiting peripheral methylation
-tolcapone peripheral and central COMT inhibitor, hepatoxicity for tolcapone but not entacapone


alendronate vs raloxifene

-synthetic form of pyrophosphate. inhibits bone resorption, doesn't protect against breast cancer just osteoperosis
-SERM (binds to estrogen receptors) in bone it's agonist to prevent osteroporosis, in breast it's antagonist to protect against estrogen receptor-positive breast cancer


type 1 vs type 2 muscle fibers (muscles, content, primary mech of nrg production)

-aka slow twitch. fibers that require low level sustained actions. high myoglobin (oxy storage) and mitochondria. primarily use aerobic metabolism
-fibers that generate rapid forceful movement. type IIB use anaerobic. type IIA (aka fast twitch) aerobic metabolism


what is CREST? antibodies vs those seen in diffuse sceroderma

-calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias
-anti-centromere seen in 40%
-anti-DNA topoisomerase I (Scl-70) antibodies


anti dsDNA
anti histone
anti Ro/SSA and anti-La/SSB
anti phospholipid

-systemic lupus erythematosus
-drug induced lupus
-Sjogern syndrome
-SLE and in antiphospholipid syndrome


explain glucose-alanine cycle

alanine is major amino acid responsible for transferring nitrogen to the liver for disposal
-during catabolism of protein, amino groups are transferred to alpha-ketoglutarate to form glutamate
-glutamate is then processed in liver to form urea


presentation of fibromyalgia, pt pop, more severe when?

-diffuse m/s pain, insomnia, and emotional disturbances, 11 of 18 "painful points" (touch spine, lateral epicondyle, medial fat pad for example) are required for diagnosis
-women 20-50yrs
-more severe in morning and exacerbated by exercise (don't confuse with RA)


presentation of dermatomyositis, elevated levels of?

bilateral proximal muscle weakness (combing hair, climbing stairs)
-heliotrope rash on eyelids, gotoron papules on knuckles
elevated EC levels


CD14, CD4, CD8, CD20

-surface marker for monocyte-macrophage cell lineage
-T-helper cells
-T-killer cells
-B-cell surface marker


what do macrophages look like in caseating granulomas

large epitheliod cells with abundant pink pale cytoplasm


name enzymes in heme pathway. wht diseases to they cause if missing to poison that can disturb then?

-delta aminolevulinic acid synthase- sideroblastic anemia (X-linked)
-deta aminolevulinic acid dehydratase-lead poisoning
-prophobilinogen deaminase-acute intermittent porphyria
-uroporphyrinogen decarboxylase-porphyria cutanea tarda
-ferrochelatase-lead poisoning


what substrates accumulate in lead poisioning? leads to what type of anemia?

inhibit delta-aminolevulinic acid dehydratase and leads to increased delta-ALA
-inhibits ferrochelatase causing increased propophyrin IX
-this leads to decreased heme production and microcytic anemia b/c of no heme


target which cells in treatment of gout? not mast cells b/c. give example of drug?

-target neutrophils microtubules to prevent chemotaxis
-target mast cells to treat asthma and allergic rhinitis


which nerve provides sensation for diaphragmatic pleura. how does pain here present? not long thoracic nerve b/c?

-phrenic nerve
-sharp pain, worse on inspiration in C3-C5 distribution (referred to neck and shoulder)
-long thoracic innervates serratus anterior and is responsible for winged scapula if damamged


how is pleura divided? divide one of the subtypes into 4 more types?

-visceral pleura which covers all lung surfaces including the parts within fissures
-parietal pleura which covers remainder of parts and is not in contact with lung


presentation of congential hypothyroidism vs phenylkeotnuria

-6Ps (pot bellied, pale, puffy faced, protruding umbilicus, protuberant tongue, and poor brain development) other signs include (hypotonia, poor feeding, jaundice and constipation)
-developmental delay, mental retardation, mousy body odor, and fair skin coloring "Pee Kacasian U stink and dumb"


-loss of total bone mass that results in trabecular thinning
-cystic degeneration with subperiosteal resorption
-excessive unmineralized osteoid
-primary unmineralized spongiosa in medullary canals

-vit D deficiency


musculocutaneous nerve provides sensation to? not thenar eminence b/c

-lateral forearm
-innervated by reccurent branch of median nerve


medial forearm is innervated by?

-medial cutaneous nerve of ulnar branch


pulmonary damage in scleroderma? manifests how?

-causes pul HTN due to damage to pulm arterioles
-accentuated pulmonary component of second heart sound and signs of right-sided heart failure


anti-cyclic citrullinated peptide



anti-phospholipid antibodies

SLE and anti-phospholipid anitbody syndrome


causes of clubbing? not bronchial astham b/c

-thickening of distal phalanges due to diseases that cause hypoxia
-lung diseases-lung cancer(large cell carcinoma), TB, CF, bronchietasis, Pul HTN, empyema
-heart diseases-cyanotic congenital heart disease, and bac endocarditis
-other-IBD (Crohn's and UC) hyperthyroidism, and malabsorption
-bronchial asthma is not associated with clubbing (look for atopic dermatitis, nasal polyps or hives instead)


bilateral parotid enlargement, erosion of tooth enamel, and irregular menses

bulimia nervosa



-physicians are paid a fixed amt per enrollee not per service.
-incentive to contain costs due to fixed budget
-motivated to provided more preventative care to catch illnesses early


fee for service vs discounted fee for service

-paid a fixed amt for every service provided (do all tests)
-physicians are reimbursed a discounted amt for every service provided (avoid doing expensive or less discounted tests)



-paid fixed amt, regardless of enrollees or services
-no incentive to change treatment patterns


what are antibodies in RA? not anti-centromeres b/c?

-cartilage components serve as autoantigens that activate CD4+ cell to make rheumatoid factor, an IgM antibody specific for the Fc component of self IgG
-these anti-bodies are seen in CREST


anti microtubules

primary billiary cirrhosis


anti-phospholipid antibodies

SLE and anti phospholipid syndrome


anti-dsDNA antibodies

just SLE


mech of colchicine, side effects

tubulin polymerization
nausea and abdomial pain and diarrhea


alkaptonuria-inheritance, enzyme def, presentation (3)

-autosomal recessive
-homogentisic acid (homogentisate to maleyacetoacetate)
-pigment deposits and connective tissue throughout body
-arthritis, urine is black when exposed to air


older gentleman with pain an deformity in bony area and hearing loss (skull)



which molecules play an important role in osteoclasts differentiation? not transforming growth factor (TGF-beta) b/c?

-TGF leads to increases osteoblasts, collagen synthesis, and osteoclastic apoptosis


marker of bone formation

osteocalcin- protein secreted by osteoblasts


fibroblast growth factor (FGF), abnormalities cause?

increase bone formation by stimulating osteoblast, neovascularization, and wound healing
-abnormalities cause achondroplasia


hereditary angioedema-enzyme loss, role of enzyme (2), drug to avoid

-low serum C1 esterase inhibitor
-leads to increased bradykinin activity b/c C1 esterase inhibits kalikrein (converts kininogen to make bradykinin) and C1
-don't give ACE inhibitors (more bradykinin)


which meds are strongly associated with medication induces body fat redistribution? define this

-redistribution of fat from extremities to abdominal viscera and subcutaneous adipose tissue of the thorax, posterior neck and supraclavicular region
-HIV-1 protease inhibitors and glucocorticoids


examples of non-deoplarizing NMJ blocking drugs and how to reverse them?

-pancuronium and beta tubocurarine
-reverse with neostigmine at anytime (there's no phase 1 or phase 2 to worry about)


example of depolarizing NMJ blocker? mech? which pt pop to look out for? how to reverse effects?

-has phase 1 (equal depolarization in all responses in train of 4) and phase 2 (decreasing depolarization in all response similar to non-depolarizing NMJ blockers)
-in slow acetlylactors (metabolism by plasma cholinesterase) transition to phase 2 takes longer (1-3 hrs in stead of 10 mins)
-neostigmine will augment effects in phase 1 but reverse effects in phase 2


where does posterior cruciate ligament attach? where does anterior cruciate ligament attach?

-attaches to posterior part of intercondylar area and anterior part of lateral surface of medial epicondyle of femur
-attaches to anterior portions of intercondylar tibia to the posterior medial side of the lateral femoral condyle


which nerve exits at the obturator foramen?



exits through greater sciatic foramen

inferior gluteal nerve


perifolicular hemorrhages and coiled (corkscrew hairs)

vitamin C deficiency, alsolook for petchiase, eccymoses and poor wound healing


damage to long thoracic nerve can be caused by? not clavicular fracture or anterior dislocation of shoulder joint because?

-mastectomy (deep axillary lymph node dissections)
-clavicular fractures usually in third middle clavicle do not cause and nerve injuries
-this injuries axillary nerve


mc cause of osteomyelitis in pts with sickle cell anemia? why? not staph aureas b/c?

-capsule (along with other SHiN-shoot should make this pneumonic SHiNS)
-capsule has Vi "virulence" antigen
-mc cause in normal healthy adults and 3rd mc cause in sickle cell pts (E. coli is 2nd)


presentation of H. O? mc location for hematogenous osteoyelitis in children? in adults? name common disease in this location in adults?

-fever, problem using joint, passive range of motion does not elicit pain, no joint effusion
-vertebral body (Pott's disease, osteomyelitis of this bone due to TB)
-metaphysis of long bones
-due to decreased blood flow in this area?


what does protein A due? found in which bac?

binds to Fc portion of IgG at complement-binding site leads to decreased C3b production and opsonization
-s. Aureus


signs and symptoms of psoas abscess-signs? pt at rest will have which motion?

fever, back pain, inguinal madd, difficulity walking
-psoas sign pain when hip is extended
-pts will arrange body to lessen psoas stretching (hip flexed and lumbar lordosis)


abdominal wall muscles

deepest is transverse
-then internal oblique and rectus abdominus in middles
-outer most layer is external oblique (hands in pockets fiber direction)


what metabolic disturbance can succinylcholine cause? which pts to avoid?

hyperkalemia, (phase 1 causes continued depolarization and Na+ goes in while K+ goes out)
-pt at high risk for hyperkalemia (burns, crush injuries, and denervating injuries or disease-quadriplegia and Guillian-Barre syndrome)


mech of etanercept? check what in pts before administration?

TNF-alpha inhibitor
-PPD test b/c latent TB can be reactivated


major depressive disorder mnemonic? number of symptoms needed and length of time

need 5 symptoms for at least 2 wks
-sleep disorder, interest deficit (anhedonia), guilt (worthlessness, hopelessness, and regret), energy deficit, concetration deficit, appetite disorder, psychomotor retardation or agigtiation, suicidality
-for at least 2 wks


comedomal rash and inflammatory eruption is aka



best drug for acute treatment of RA? best drug for chronic treatment?

-NSAIDs (not longterm b/c of side effects)


urine turns black-disease, impaired enzyme,

-impaired honogentisic oxidase (homogentisic acid to maleylacetoacetisic acid)
-can't convert tyrosine to fumarate (tyrosine to homogentisic acid to maleylacetoacteic acid to fumarate)


name rash on hands and feet associated with Reiter's disease aka reactive arthritis

-keratoderma blennorrhagicum=vessicles on an erythematous base which become sterile pustles and then keratotic scale


define enthesopathies? requires monitoring of what in pts with ankylosing spondylitis?

-inflammation at site of tendon insertion
-involvement of costovertebral and costosternal junctions may cause limitation of chest movements, resulting in hypoventilation


which muscle is most important in hip flexion? other muscles involved (4)

iliopsoas (contains psoas maojr, psoas minor, and iliacus)
-rectus femoris, tensor fascia lata, sartorius and medial compartment of thigh


which muscles are need for standing up from supine position?

external abdominal obliques, rectus abdominis, hep flexors


which muscles are most important for hip extension. not obterator externus because?

gluteus maximus, semitendinosus, semimembraneous, biceps femoris (long head)
-this muscle is responsible for thigh lateral rotation


which muscles are most important for abduction of hip?

-gluteus medius, gluteus minimus


which muscles are most important for adduction of hip?

-adductor brevis
-adductor longus
and adductor magnus


presentation of polymyositis. mech?

-proximal muscle weakness
-myocytes over express MHC class I proteins on sarcolemma leading to inflitration of CD*+ T-lymphocyte and myocyte damage


suffix meaning of biological agent

-receptor molecule
-kinase inhibitor
-monoclonal antibody


monoclonal antibody target substem meanings



monoclonal origin substem meaning

chimeric (human constant regions foreign variable regions)
humanized (human constant and variable regions except the complementarity determining regions)
chimeric/humanized hybrid


T or F cholchicine has an effect on metabolism and urinary excretion of uric acid?

-false. even though this is used to treat acute gouty arthritis and prophylaxis of recurrent gouty arthritis
-instead it inhibits leukocyte migration by blocking tubulin polymerization
-this blocks symptoms by disrupting chemotaxis and phagocytosis and inflammation


rachitic rosary

bony prominence at costochondral junctions (rosary chest)
associated with vit d deficiency


lecithinase aka

produced by C. perfringens
-degrades lecithina compoment of cellular phospholipid* membranes leading to membrane damage cell death and necrosis and hemolysis


achrondroplasia-mc defect, effect on chondrocytes? axial vs appendicular skeleton length?

-FGF-3 activation (fibroblast growth factor receptor 3),
-inhibits chondrocytes
-axial (spine) length is normal
-appendicular (limbs) are short and thick and tubular


axial and appendicular skeleton length in FGF-3 activations vs IGF deficiency and GH

-IGF-1 and GH def=both axial and appendicular bone length affected
-FGF-3 activation only appendicular, axial is normal


parovirus presentation in adults vs children

-adults- arthritis that self-resolving
-children-5th disease


why is calcium elevated in granulomatous diseases?

b/c activated macrophages activate T lymphocytes
-tymphocytes secrete gamma interferon which increases activity of alpha-1 hydroxylase
-this leads to increased Vit D and increased Ca2+ which suppresses PTH secretion


myleoperoxidase def vs chronic granulomatous disease

myelo-both catalase positive and negative organisms survive
-CGD only catalase positive organisms survive (bac produce hydrogen peroxide and myelo can produce free radials from this)


examples of alpha-globins

haptoglobin and ceruloplasmin, and alpha macroglobins


define dsytonia? examples of focal dystonia

neurological movement disorder char by sustained involuntary muscle contractions
-cervical aka spasmodic torticollis
-blepharospasm (forcible closure of eyelids, uncontrollable blinking)
-writer's cramp


myoclonus-def and 2 examples

sudden brief sever shock-like muscle contration
-epilepsy and C-jacob's disease


hemibalism-def, damage where?

flinging of limbs on one side of body
-damage to subthalamic nucleus (contralateral side)


when asked whether someone is your pt what should you say?

-don't lie
-just neither confirm or deny


which RA drug can lead to reactivation of TB?

-TNF-alpha inhibitors etanercept, infliximab, and adalimumab


toxicity of MTX give what to reduce it?

-liver function abnormalities and stomatitis (painful mouth ulcers)
-folinic acid


pyrrolidonyl arylamidase (PYR) positive

GAD strep pyrogens


histological appearance of sporothrix?

-fungus spreads along lymphatics creating surface nodules


name 6 diseases tht cause childhood rash and main thing to tell them apart

-chickenpox-puritic, vescular rashe
-erthema infectiosim- macular rash-slapped cheek
-german measles (rubella)-occipital and postauricular lymphadenoapthy (maculopatular rash that starts on head and progressed down)
-measles (rubeola)-Koplick spots (maculopapular rash that starts on head and progresses down)
-scarlet fever (sandpaper-like rash, begins on neck, armpit, groin and then generlaizes)
-rosela infantum-rash appears once fever subsides (macules and papules on trunk that spreads)


shaken baby syndrome vs skull fractures

-subdural hemorrhage (bridging veins) with bilateral retinal hemorrhages
-epidural hematoma (tears in middle meningeal art)


what is used to measure osteoblasts? osteoclasts (3 and most specific?)

-TRAP, urinary hydroxyproline (most reliabile), urinary deoxypridinoline


gottron papules-def, disease, what else to look for? (2)

-flat topped violaceous papules over joints of fingers
-seen in dermatomyolitis
-also look for heliotrope rash (upper eyelid and periorbital skin) and proximal muscle weakness


acute avacular necrosis of fermoral head is associate with

-sickle cell disease, steroid therapy, and SLE and alocholism


name causes of osteomylities in
sickle cell disease
-pott disease

-staph aureaus
-salmonella and S. aureus


golgi muscle tendons vs muscle spindles (intrafusal muscle fibers)

-arranged in series on tendon, sensitive to tension (holding large amt of force)
-arranged in parallel within muscle, sensitive to changes in length (deep tendon reflexes)


sublimation vs displacement

sumblimation is mature (redirect emotion at something considered appropriate)
-displacement is immature (redirect anger at something more acceptable but still inappropriate)


nerve that courses between
-biceps and coracobrachialis
-flexor carpi ulnaris and flexor digitorum profundus muscles
-flexor digitorum superficialis and flexor digitorum profundus
-olecranon and medical epicondyle of humerus
-supinator muscle and head of radius
-humeral and ulnar heads of pronator teres muscle

-musculocutaneous nerve
-ulnar nerve
-ulnar nerve (funny bone)


risk factors for osteoperosis

-corticosteroid therapy
-physical therapy
-caucasian race
-low total body weight
-alcohol use


whose has greater risk for bone fracture white or black?

white increased risk of osteroperosis


pain in hip when hip motion is fine and pain is exacerbated by flexion and internal rotation of hip and direct palpation over lateral aspect of hip? disease and pt pop?

trochanteric bursa inflammation
look for people who run on uneven pavement
palpation over lateral hip (palpation of greater trochanter)


drug induced lupus has been linked to what types of drugs?

drugs that are metabolized by N-acetylation in the liver
-slow acetylators are at higher risk