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Flashcards in Musculoskeletal Deck (119)
1

Unhappy triad

MCL, ACL, Medial meniscus

2

The term anterior and posterior in ACL and PCL refer to what?

Where they attach to the tibia

3

If looking down on the tibia where would we see the PCL attaching?

Posterior pretty much in the dead center

4

Between the ACL and PCL, which stays mostly in the midline and which sweeps side to side?

PCL is more confined to the midline, ACL goes from lateral (superior) to medial (inferior)

5

Bones of the hand (include position)

(proximal thumb side) Scaphoid, Lunate, Triquetrum, Pisiform (proximal pinkie side). (Distal thumb side) Trapezium, Trapezoid, Capitate, Hammate (distal pinkie side)

6

What nerve is compressed by incorrect use of crutches?

Radial

7

What does the lower trunk of the brachial plexus innervate and what is the consequence of this?

All intrinsic muscles of the hand. Damage leads to hand clumsiness

8

Damage to which nerve leads to wrist drop?

Radial

9

Damage to what structure leads to waiters tip (Erbs Palsy)?

Upper trunk of brachial plexus

10

What structures will likely be damage by the following injuries: fracture of surgical neck of humerus, dislocation of humeral head, fracture of midshaft humerus

Surgical neck - axillary nerve, humeral head - axillary nerve, midshaft - radial nerve

11

What structures will likely be damaged by the following injuries: fracture of supracondylar humerus, dislocated lunate, fracture of medial epicondyle of humerus, fracture of hook of hamate, and upper trunk compression

Supracondylar humerus - median (prox), lunate - median (dist), medial epicondyle of humerus - ulnar (prox), hook of hamate (ulnar - dist), upper trunk - musculocutaneous

12

If you have a fracture at midshaft of the humerus, what two structures are at risk?

Radial nerve and deep brachial artery

13

Causes of carpal tunnel

Repetitive stress (most common), fluid retention (renal failure, hypothyroid, pregnancy), DM, RA, dialysis-associated amyloidosis

14

Course of the median nerve

Between humeral and ulnar heads of pronator teres then between flexor digitorum superficials and flexor digitorum profundus, then enters carpal tunnel

15

Complications of mastectomy

Winged scapula (serratus anterior, LTN), lymphedema, inability to abduct shoulder past 90 degrees (serratus anterior, LTN)

16

Nerve responsible for thigh adduction

Obturator (L2-L4)

17

Trendelenberg sign

Contralateral hip drops when standing on leg ipsilateral to lesion. Problem with superior gluteal nerve (L4-S1)

18

Where should you give butt injections?

Superolaterally. Superomedial quadrant endangers superior gluteal nerve (may get trendelenburg sign)

19

Sciatica in posterior thigh with diminished ankle reflex

Compression of S1

20

Which is the thin filament and which the thick?

Actin is thin filament (lighter), myosin is thick (darker)

21

What system in skeletal muscle ensures coordinated contraction of myofibrils?

T-tubules

22

Type 1 and Type 2 muscle

1 - slow twitch, red. 2 - Fast twitch, white

23

Short limbs with a normal spine

FGFR-3 mutation

24

Short limbs with a short spine

GH or IGF-1 mutation

25

Histology of osteoporosis

Trabecular thinning with fewer interconnections

26

Histology of osteopetrosis

Spongiosa filling medullary canals with no mature trabeculae

27

Which type of osteoporosis is post menopausal?

Type 1

28

Histology of osteomalacia/rickets

Osteoid matrix accumulation around trabeculae

29

Bony prominance at costochondral junctions with bowed legs

Rickets (prominences are called rosary chest)

30

Histology of Pagets disease of bone

Lamellar bone structure resembling a mosaic

31

Complications of Pagets disease of bone

Hearing loss (auditory foramen narrowing), increased hat size

32

Genetic deficiency and labs in osteopetrosis

Deficiency of carbonic anhydrase 2. Calcium, phosphate, and alk phos are normal. Anemia, thrombocytopenia, infection, extramedullary hematopoiesis

33

Lab values in Pagets disease of bone

Normal except Alk Phos, which is high

34

Appearance of osteitis fibrosa cystica

Brown tumors

35

Marker for Pagets disease of bone

High Alk Phos with (sometimes) TRAP positivity

36

McCune-Albright

Polyostotic fibrous dysplasia. Multiple unilateral bone lesions with endocrine abnormalities (precocious puberty) and cafe-au-lait spots. Bone replaced by fibroblasts, collagen, and irregular bony trabeculae

37

Age, location, and predisposing factors in osteosarcoma

Males ages 10-20. Metaphysis of long bones (femur, proximal tibia). Associated with Pagets, bone infarcts, radiation, and familial Rb

38

What causes Codmans triangle (sunburst pattern) in osteosarcoma?

Elevation of periosteum

39

Translocation in Ewings sarcoma

11,22

40

Onion skin appearance in bone

Ewings sarcoma

41

Bone tumors by location and malignant status

Epiphysis - Giant cell tumor (benign). Metaphysis - Osteochondroma (benign) and Osteosarcoma (malignant). Diaphysis - Chondrosarcoma (malignant), and Ewings sarcoma (malignant)

42

Where are Heberdens nodes and Bouchards nodes and what disease are they associated with?

OA. Heberden - DIP, Bouchard (PIP)

43

RA treatment

NSAIDs, COX-2 inhibitors, glucocorticoids (short term), DMARDS (MTX, Sulfasalazine, hydroxychloroquine, TNF-a inhibitors)

44

Autoantibodies in Sjogrens

SS-A and SS-B

45

Birefringence of gout and pseudogout

Gout - negative, Pseudogout - weakly positive

46

Precipitants of gout

Lesch-Nyhan, PRPP excess, decreased excretion (eg thiazides), increased cell turnover, von-Gierkes disease

47

Give the color of crystals in gout and pseudogout

Gout - yellow when parallel, blue when perpendicular. Pseudogout - yellow when perpendicular, blue when parallel

48

Crystals in pseudogout

Calcium pyrophosphate

49

Causes of infectious arthritis

Septic - s aureus, streptococcus, n gonorrhoeae. Chronic - TB, lyme

50

Causes of osteonecrosis (avascular necrosis)

Trauma, high dose corticosteroids, alcoholism, sickle cell

51

Seronegative spondyloarthropathies

Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease associated spondylitis, Reactive (Reiters) arthritis

52

Where is inflammation common in akylosing spondylitis and what is the consequence of this?

Sites of tendon insertion. May lead to reduce chest expansion and hyperventilation

53

Presentation of Reiters syndrome

Conjunctivitis with anterior uveitis, urethritis, arthritis and sacroilitis. Cant see cant pee cant climb a tree

54

SLE is associated with antiphospholipid antibodies. What is the clinical consequence of these?

Venous and arterial thromboemboli. Also recurrent miscarriages (which is how SLE may present)

55

Common antibodies in SLE

Anti-dsDNA, anti-smith, antiphospholipid

56

What is the accuracy of ANA in SLE?

Sensitive but not specific

57

Which antibody in SLE is most prognostic?

Anti-double stranded DNA. Indicates poor prognosis (anti-smith is specific but not prognostic)

58

Antibodies associated with drug induced lupus

Antihistone antibodies

59

Restrictive lung disease, hilar lymphadenopathy, erythema nodosum, Bells palsy, uveoparotitis, hypercalcemia, elevated ACE levels

Sarcoidosis

60

Treatment for sarcoid

Steroids

61

Lab findings and treatment for polymyalgia rheumatica

Elevated ESR with normal CK. Treat with prednisone

62

What disorder besides SLE includes a malar rash

Dermatomyositis

63

Findings in dermato and polymyositis

High CK, high Aldolase, positive ANA and positive anti-jo-1

64

Finger ulceration and telangiectasias in a woman

CREST syndrome

65

What causes the esophageal dysmotility of CREST syndrome?

Fibrous replacement of the muscularis

66

Antibodies in diffuse scleroderma and CREST syndrome respectively

Diffuse scleroderma - SCL-70 antibody (which is anti-DNA topoisomerase 1). CREST - anti-centromere antibody

67

CREST syndrome

Calcinosis (and anti-centromere), Raynauds, Esophageal dysmotility, Sclerodactyly, Telangiectasia

68

Which has a worse prognosis, diffuse scleroderma or CREST?

Diffuse scleroderma

69

Histologic appearance of warts

Epidermal hyperplasia, hyperkeratosis, koilocytosis

70

Nevocellular nevus

Common mole. Benign

71

Eczema location, triggers, and histology

Skin flexures. May be triggered by foods or other environmental factors. Will see spongiosis on microscopy

72

Psoriasis location, and histology

Knees and elbows. Acanthosis with parakeratotic scaling (nuclei in cornuem). Increased spinosum, decreased granulosum, occasional neutrophils

73

Vitiligo

Irregular areas of complete depigmentation. Caused by a decrease in melanocytes

74

Infectious organisms of impetigo and potential results of the infection

S aureus or strep pyogenous. May result in rheumatic fever or post-strep GN

75

What does PABA sunscreen block?

UVB (but not UVA)

76

Pemphigus vulgaris

IgG against desmosomes (3 and 1). Positive Nikolskys sign

77

Bullous pemphigoid

IgG against hemidesmosomes (epidermal basement membrane). Negative Nikolskys sign. Does not affect oral mucosa (unlike pemphigus vulgaris)

78

Histology of actinic keratoses

Hyperkeratosis, parakeratosis, basal cell layer atypia. Risk of carcinoma is proportional level of dysplasia

79

Mutation in melanoma

BRAF mutation in 40 to 60 percent

80

What do prostaglandins and prostacyclins respectively do to uterine tone?

Prostaglandins increase uterine tone, prostacyclin decreases uterine tone

81

What is the only LOX related drug approved for asthma in young kids?

Montelukast

82

How big is COX-2 and when is it detectable?

72 KD. Only expressed during inflammation (COX-1 is constitutively expressed)

83

List the NSAIDs (4)

Ibuprofen, naproxen, indomethacin, ketorolac

84

Toxicities of NSAIDs

Renal damage, fluid retention, aplastic anemia, GI distress, ulcers

85

What effect does celecoxib have on platelet aggregation?

None. It is anti-inflammatory without impairing platelet function

86

What drug is used to prevent recurrence of colonic adenocarcinoma?

COX-2 inhibitors (may decrease adenomtaous polyp formation)

87

Acetominophen

Reversibly inhibits COX (mostly in CNS). Not anti-inflammatory. Use to avoid Reyes syndrome. N-acetylcysteine is antidote

88

List the bisphosphonates (5)

Etidronate, pamidronate, alendronate, risedronate, zoledronate (IV)

89

Mechanism of bisphosphonates

Inhibit osteoclastic activity

90

Uses and toxicities of bisphosphonates

Malignancy-associated hypercalcemia, Pagets disease, postmenopausal osteoporosis. Corrosive esophagitis, nausea, diarrhea, osteonecrosis of jaw

91

Mechanism of Probenacid, Allopurinol, Febuxostat

Probenecid - inhibits reabsorption of uric acid in PCT. Allopurinol and febuxostat inhibit xanthine oxidase

92

What should you not give with allopurinol?

Salicylates (all but highest doses depress uric acid clearance)

93

Mechanism of colchicine

Stabilizes tubulin, impairing leukocyte chemotaxis and degranulation

94

Etanercept

TNF-a inhibitor. Use in RA, psoriasis, AS

95

Infliximab

Anti-TNF antibody. Use in Crohns, RA, AS

96

Adalimumab

Anti-TNF antibody. Use in RA, psoriasis, AS

97

Complication of TNF-a inhibitor therapy

Infection, especially reactivation of TB

98

What structure may be damaged in a femoral neck injury

Medial circumflex artery

99

What type of antibody is Rh factor?

IgM against IgG

100

In which condition do you get fixing of the joint, RA or OA?

RA

101

Why does alcohol make gout worse?

Metabolic acidosis. Uric acid has to compete with lactic acid and keto-acids created by alcohol for excretion

102

Why are patients with AS often hunched over?

Because they have restrictive lung disease due to limitation of movement

103

Dowagers hump

Osteoporosis

104

Difference between osteomalacia and osteporosis (besides just degree)

Osteoporosis affects both mineral and organic component, osteomalacia is decreased mineral with normal organic component

105

Most common benign bone tumor

Osteochondroma (exostosis)

106

Most common cause of HCC in children

Alpha-1-antitrypsin deficiency

107

What is going on in the thymus in MG

Germinal follicles (which is abnormal since B cells shouldnt be in thymus). Removing thymus helps MG. 10-15 percent will develop a thymoma, but B-cell hyperplasia is best answer for this

108

If you have CREST plus kidney involvement, what is the diagnosis?

Progressive systemic sclerosis. CREST cannot involve the kidneys

109

Racoon eyes, elevated serum CK, rash over PIP

Dermatomyositis. High association with cancer

110

Type of hypersensitivity in atopic dermatitis

Type 1

111

Cause of seborrheic dermatitis (dandruff)

Malassezia furfur

112

Most common cause of tinea capitis

Trichopyton tonsurans

113

All superficial dermatophyte infections besides tinea capitis are due to what?

Trychophyton rubra

114

Rash on butt, oblong with red outside and pale in middle. Negative KOH prep

Pityriasis rosea. Non infectious. 3 days later it will return with rash in christmas tree distribion

115

Which type of malignant melanoma can african american patients get?

Acrolentiginous (most aggressive, not related to radiation)

116

Malignant melanoma on the face of an older patient

Lentigo maligna melanoma

117

Most important prognostic factor in melanoma

Depth of invasion (will not metastasize if less than .76 mm)

118

Contractures developing over a period of hours

Black widow bite (look for history of being in a basement or area which might have spiders)

119

What type of toxins do the black widow and brown reculse respectively have

Black widow - neurotoxin, brown reculse - necrotoxin