Musculoskeletal and Derm Flashcards by Ashley Quinn

What type of mutation and in what gene causes achondroplasia?

Activating mutation in FGFR3

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What is the probability two heterozygous achondroplasia parents will have a child with the disease?

50% because homozygous dominant dies in utero

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What bone tumor appears as a peduncle with a cartilage cap?

Osteochondroma

“osteoCHondroma = CHunk of bone”

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What bone tumor has a soap bubble appearance on X ray?

Osteoclastoma (giant cell tumor)

“osteoCLastoma = CLean = soap bubbles”

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What bone tumor has Codman’s triangle and sunburst appearance on X ray?

Osteosarcoma

“osteoSarComa = Sunburst, Codman’s triangle”

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What bone tumor is found in the diaphysis and has an onion skin appearance?

Ewing sarcoma

“chicken wings (ewing) and onion rings (onion skin)”

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What translocation is associated with ewing sarcoma?

t(11;22)

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What is the average age of presentation for the 4 primary bone tumors?
Osteochondroma, osteoclastoma, osteosarcoma, ewing sarcoma

Osteochondroma:

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What metastatic cancers are found in bone?

“Permanently Relocated Tumors Like Bone”

Prostate, renal cell, testes/thyroid, lung, breast

GU association - kidney, prostate, testes

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What GI drugs can increase risk for osteoporosis?

PPIs or H2 blockers - need acid to absorb Ca

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What are the 2 side effects of bisphosphonates?

Erosive esophagitis and osteonecrosis of the jaw

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What is the mechanism of Teriparatide?

PTH analog that when given as pulsitile stimulates osteoblast bone formation

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What is the mechanism of Denosumab?

Monoclonal antibody against RANKL (blocks osteoclast stimulation)

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What gene mutation causes osteoporosis?

Carbonic anhydrase 2 (osteoclasts cannot make the acidic environment needed to resorb minerals)

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What is the pathogenesis of Paget’s disease of the bone?

Lytic - osteoclasts overstimulated
Mixed - osteoblasts activated to catch up
Sclerotic - osteoclasts burn out

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Increased hat size and hearing loss

Paget’s disease of the bone

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How is ALP affected in osteoporosis, osteoporosis, and Paget’s disease of the bone?

ALP is a marker of osteoblasts
Osteoporosis (decreased osteoblasts) - normal
Osteopetrosis (decreased osteoclasts) - normal
Paget’s disease (increased osteoblasts and clasts) - increased

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What causes Osteitis Fibrosa Cystica?

What 4 changes are seen in the bone?

High PTH
Brown tumors (cysts lined with fibrous tissue and filled with blood = due to fast osteoclast breakdown), subperiosteal bone resorption in middle fingers, tapered distal clavicles, salt and pepper skull

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What is McCune Albright Syndrome?

Precocious puberty + cafe au lait spots + polyostotic fibrous dysplasia

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What is polyostotic fibrous dysplasia?

Bone is replaces with fibroblasts and collagen

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What is Albright Hereditary Osteodystrophy (pseudohypoparathyroid)?
What bone pathology is associated?

Renal PTH resistance - high PTH + low Ca/high PO4

Causes Osteitis fibrosis cystica

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What 4 structures may be injured in a posterior hip dislocation?

Circumflex femoral arteries (medial and lateral)
Femoral vein
Femoral nerve
Head of the femur

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What ligament is most commonly damaged in an ankle sprain?

What other two are also common?

The 3 lateral ligaments are more common than the medial deltoid ligament.
Most common - anterior talo-fibular ligament
“Always Tears First”
Other lateral ligaments - calcaneo-tibular, posterior talo-fibular

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What 2 antibodies are most useful in diagnosing RA?

RF and ACPA (anti-citrullinated protein Ab)

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What HLA gene is associated with RA?

HLA-DR4

What two ways can NSAIDs cause renal damage?

Ischemia (loss of PGs that dilated the afferent arteriole and control RBF) and interstitial nephritis

What joint disease can lactic acidosis cause?

Gout - organic acids compete for the same renal transporter as uric acid

What is the most common trigger for an acute gout attack?

Alcohol consumption - competes for the same renal transporter as uric acid

Allopurinol can increase the toxicity of what two drugs?

6-mercaptopurine and azathioprine

What is the mechanism of Febuxostat?

Xanthine oxidase inhibitor

What is the mechanism of Probenecid?

Inhibits uric acid resorption in the kidneys

What effect does Colchicine have on microtubules?

Stabilizes them

What pathology is associated with chonedrocalcinosis?

Pseudogout

What pathology is associated with a pencil-in-cup deformity of the DIP joints?

Psoriatic arthritis

What type of arthritis is associated with dactylics?

Psoriatic arthritis

What type of arthritis is associated with uveitis, aortic regurgitation, and conduction abnormalities?

Ankylosing spondylitis

What is reactive arthritis? | What triggers an episode?

Conjunctivitis, urethritis, and arthritis "Cant see, can't pee, can't climb a tree" Post GI infection (shigella, salmonella, yersinia, campylobacter) or chlamydia

What is used to treat the seronegative spondyloarthropathies?

TNFa inhibitors (etanercept, infliximab, and adalimumab)

Child

Systemic-onset Juvenile idiopathic arthritis (initially looks like leukemia, then the arthritis comes)

What type of arthritis is caused by gonorrhea? | What other finding is associated with gonococci arthritis?

Septic migratory arthritis | Pustules on the skin

Painless oral ulcers + non-erosive arthritis + pericarditis + psychosis + low blood cells or hemolytic anemia

SLE

ANA+ (6 conditions)

Sjogrens syndrome, scleroderma, polymyositis/dermatomyositis, RA, juvenile idiopathic arthritis, and mixed CT disease

anti-dsDNA Abs

Lupus nephritis

anti-Smith Abs

Specific for SLE

anti-histone Abs

Drug-induced SLE

What drugs cause drug-induced lupus? | "SHIPP"

Sulfonamides, hydralazine, isoniazid, phenytoin, procainamide

anti-phospholipid (anti-cardiolipin) Abs

Hypercoagulability in SLE

What immunologic change is seen in SLE?

Decreased C3 and C4 = increased risk for infection

What can be used to treat SLE?

Glucocorticoids, cyclophosphamide, NSAIDs, hydroxychloroquine (antimalarial and DMARD)

Ulcerated fingers with telangectasias

Sclerodermas

anti-DNA topoisomerase 1 (anti-scl-70) Abs

Diffuse scleroderma

anti-centromere Abs

CREST

What is seen in CREST syndrome?

Calcinosis (subepithelial Ca), raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangectasias

What triad of symptoms is seen in Sjogrens syndrome?

Dry eyes + dry mouth + arthritis | "Cant see, can't spit, can't climb up shit"

anti-Ro, anti-La

Sjogren syndrome (Ro = SSA, La = SSB)

What third autoAb is seen in Sjogrens?

Proximal joint pain without weakness + systemic symptoms (fever, malaise, weight loss) in a little old lady Labs - elevated ESR, normal CK

Polymyalgia rheumatica

What other condition is associated with polymyalgia rheumatica?

Temporal (Giant cell) arteritis

Proximal joint pain with weakness + systemic symptoms (fever, malaise, weight loss)

Polymyositis

What is the pathogenesis of polymyositis?

CD8+ T cell inflammation of endomysial muscle

anti-Jo1 Abs

Polymyositis

Purple heliotrope rash, shawl rash, and gottrons papules

Dermatomyositis

What 2 other conditions are associated with fibromyalgia?

Depression and anxiety

What is parakeratosis? | What condition is associated with it?

Nuclei retained in the stratum corneum | Psoriasis

What is the pathogenesis of psoriasis?

Overproduction of new skin cells

What skin pathology is described as "stuck on"?

Seborrheic keratosis

Keratin filled cysts

Seborrheic keratosis

Horn growing from the skin

Seborrheic keratosis

What is the Leser-Trelat sign?

Sudden appearance of multiple seborrheic keratoses that signified an underlying visceral malignancy (classically GI)

What pathology is associated with decreased melanin? | What pathology is associated with decreased melanocytes?

Decreased melanin - albinism (tyrosinase deficiency) | Decreased melanocytes - vitiligo (autoimmune destruction of melanocytes)

What is the first step in management of a patient with necrotizing fasciitis?

Surgical wond debridement

anti-desmoglein Abs

Pemphigus vulgaris | "DAMN is a vulgar word" Desmosomes, Acantholysis, Mouth, Nikolskys sign

anti-hemidesmosome Abs

Bullous pemphigoid | "BPH" Bullous Pemphigoid Hemidesmosomes

What does Erythema multiforme look like? | What can trigger it?

Many things, including targetoid rash with central necrosis | Drug reaction, HSV

What drugs are known for causing SJS?

Seizure drugs, Sulfa drugs, penicillins, allopurinol

Saw-tooth lymphocytic infiltrate at the dermal-epidermal junction

Lichen planus

What infection is associated with Lichen planus?

Hepatitis C

Papule's that feel like sand paper

Actinic keratosis

What anti-cancer drug is used to treat actinic keratosis?

5-flurouracil

What pathology is most strongly associated with Erythema nodosum?

Sarcoidosis

Herald patch followed by christmas tree distribution of plaques

Pityriasis rosea (HHV6/7 Roseola reactivation)

Keratin pearls

Squamous cell CA

What skin cancer presents as an ulcer?

Squamous cell CA

Waiter's tip

Erb-Duchenne palsy (C5/C6 root) 1. Arm hangs to side (axillary - deltoid, suprascap n - suprascap m) 2. Internal rotation (acillary - teres minor) 3. Pronation (musculocutaneous - biceps)

Claw hand

Klumpke's palsy (inferior trunk) 1. PIP extension + DIP flexion (lumbricles) 2. Intrinsic muscle atrophy (ulnar - interosseous) 3. Thenar/hypothenar atrophy (median, ulnar)

What is the difference between the ulnar claw and pope's blessing hand?

Ulnar claw = at rest (ulnar nerve damage - lumbricles 4/5) | Pope's blessing = only when making a fist (median nerve damage - lumbricles 2/3)

What is the difference between median claw and OK gesture?

Median claw = at rest (medicine nerve damage - lumbricles 2/3) OK gesture = only when making a fist (ulnar nerve damage - lumbricles 4/5)

What nerve is damaged with fracture of the humerus at the surgical neck? At the shaft?

Axillary nerve | Radial nerve

What nerve is damaged in a pelvic fracture? | What would you find?

Femoral nerve | Loss of hip flexion/knee extension (can't kick a ball), sensation loss over anterior thigh and medial leg

What nerve is damaged in anterior thigh dislocation?

Obturator nerve

What nerve is damaged in a posterior thigh dislocation? What clinical finding would be seen? What infection can cause damage to the same nerve?

Superior gluteal nerve Trendelenberg gait Polio

Loss of sensation on the sole of the foot

Tibial nerve injury

Foot drop

Common fibular nerve injury

Wrist drop

Radial nerver injury

Musculoskeletal and Derm Flashcards

(94 cards)