Flashcards in Musculoskeletal/Skin Deck (191):
1
Superior Laryngeal Nerve
Nerve runs by the piriform recess in the larynx
- Mediates cough reflex
- Branch of the vagus nerve
2
Jugular Foramen
Jugular vein, CN 9, 10, 11
3
Foramen Spinosum
Middle menengial artery and vein
4
Foramen Ovale
CN V3
5
Foramen Rotundum
CN V2
6
Superior Orbital Fissure
CN 3, 4, V1, and 6, ophthalmic vein, sympathetic fibers
7
Radial Nerve Sensory Branch
Sensory branch comes off near mid-humerus, after that its all motor
8
Path of the Saphenous Vein
Medial leg, anterior over thigh, posterior to knee, then anterior again
9
Osteosarcoma aw/:
Pagets
10
Red Safranin O
Stains cartilage, mast cell granules, and mucin red
11
Femoral Hernias
More common in women (right sided), medial to the femoral vein
12
Indirect Hernia
Lateral to epigastric arteries and through the inguinal canal
13
Direct Hernia
Medial and through transversalis fascia (Hesselbech's triangle)
14
Femoral Hernia
Through femoral ring
- MC in women
15
Median Nerve Runs Between
Flexor digitorum profundus and Flexor digitorum superficialis
16
Gag Reflex
afferent CN IX (glossopharyngeal) and efferent bilateral CN X (vagus)
17
______ aw/ more Stress Fractures
Anorexia
18
Superior Orbital Fissure
V1
19
Foramen Rotundum
V2
20
Foramen Ovale
V3
21
Foramen Spinosum
Middle meningeal artery and vein
22
Myasthenia Gravis
- aw/ thymoma; Abs to Ach receptors
- Test with edrophonium (AchE inhibitor)
- Decreased motor end plate potential
23
Lambert- Eaton Syndrome
- aw/ small cell carcinoma (paraneoplastic)
- Abs to Ca2+ channels
24
Median Nerve Function: : Thumb
flexion, opposition, and ABduction of the thumb
25
Ulnar Nerve: Thumb
Adduction
26
Radial Nerve: Thumb
Extension (longus and brevis)
27
anti-centromere Ab
CREST
28
Cleft Lip
failure for the lateral maxillary prominence to fuse with the medial nasal prominence
29
Reflexes: tendon tap sensed by _____
spindle afferents
30
Empty Can Test for _____
Supraspinatus
31
Lipsarcoma MC located in:
thigh and retroperitoneum
32
Malignant Hyperthermia
- Muscle rigidity due to intracellular release of and hypersensitivity to Ca2+ in skeletal muscle and generation of heat
- Soon after surgery w/ general anesthesia (especially inhaled anesthetics like halothane)
- AD inherited susceptibility
- Tx. Dantrolene: blocks ryanodine receptors preventing released of Ca into cytoplasm of muscle cells
33
Injection in superomedial quadrant of buttock may injure ______
Superior gluteal nerve (to gluteus medius and minimus)
34
Septic monoarthritis
caused by gonococcus usually (if not septic, most likely gout or pseudogout)
35
Middle meningial artery is a branch of:
maxillary artery
36
Osteomyelitis Causes:
- Hematogenous spread typically to Metaphysis
- In sickle cell disease → caused by salmonella
- In vertebral body (Pott’s disease) → caused by TB
37
Myosin light chain kinase and calmodulin
only in smooth muscle
38
Acute Gouty Arthritis Tx:
NSAID first (unless contraindicated), colchicine next (2nd line)
39
Bursitis: Prepateller and Anserine
- Prepatellar bursitis from kneeling
- Anserine bursa is medial
40
Bone Alkaline Phosphatase is Specific to:
Osteoblast activity
41
Osteocytes exchange nutrients and waste via:
gap junctions
42
PTH effect on Osteoblast vs Osteoclasts
acts on osteoclasts indirectly; acts directly on osteoblasts which will produce RANKL to stimulate osteoclasts
43
Golgi tendon Organ
- monitors and maintains a muscle force
- Sudden muscle relaxation if there is too much force
44
Muscle Spindle System
- feedback that monitors and maintains muscle length
- Reflexes (detects hyperextension)
45
Cori Disease
debranching enzyme deficiency; will see small dextrin like material
46
Guyton's Canal
ulnar nerve runs between hook of hamate and the pisiform bone → injury will cause weakness on ulnar side of hand and intrinsic hand muscles
47
Injury to Ulnar Nerve near Medial epicondyle
Claw hand deformity
48
• Median (thumb) and Ulnar (pinky) Nerve problems: Proximal Lesion
can’t flex affected side
49
Median (thumb) and Ulnar (pinky) Nerve problems: Distal Lesion
can't extend affected side
50
Phases of Pagets
1. Osteoclast
2. Mixed Clast and Blast
3. Osteoblast
51
Slow Twitch Muscle Fibers
- Type I Fibers
- Red, lots of myoglobin and mitochondria
- in postural muscles (paraspinal) or soleus muscle
(Type IIa are intermediate, Type IIb are fast)
52
Artery that Runs w/ Radius Behind Humeral Shaft
Deep Brachial Artery
53
Myasthenic Crisis
When a patient is being undertreated for their condition
- edrophonium temporarily fixes improves their condition
- patient should be given a higher dose of their ACHE inhibitor
54
Femoral Nerve
IPSQuad
Flexion of Hip
Extension of Knee
Sensory on anterior thigh and anterior/medial leg
55
Decreased Risk of Osteoporosis in:
African American Women
56
Ankle Reflex
S1
57
Patellar/Knee Reflex
L4
58
Posterior and lateral thigh and leg pain shooting to inner foot
L5 root compression (of sciatic nerve)
59
Strictly posterior thigh and leg pain shooting to foor
S1 root compression (of sciatic nerve)
60
Uricosuric agents should be avoided in:
- Acute gouty arthritis
- Patients who excrete large amounts of uric acid (to prevent uric acid nephrolithiasis)
61
Teres Minor
Lateral rotation and adduction
62
Infraspinatus
Lateral rotation
(pitching injury)
63
Subscapularis
Medial rotation and adduction
64
Supraspinatus vs Deltoid
Supraspinatus: initiates abduction
Deltoid: continues abduction
65
+ Tinel or Phalen Test
Carpal Tunnel Syndrome
66
5 causes of Carpal Tunnel due to decreased space:
Dialysis (B2 microglobulin)
Pregnancy (fluid buildup)
Hypothyroid (gag buildup)
Diabetes (CT thickening)
RA (tendon inflammation)
67
Median Nerve Innervates
LOAF + all flexors (except flexor carpi ulnaris and 1/2 of flexor digitorum profundus)
68
Ulnar Nerve Innervates
All intrinsic hand muscles (except LOAF) and Flexor carpi ulnaris and 1/2 of flexor digitorum profundus
69
Radial Nerve Innervates
All extensors, brachioradialis, supinator, and anconeus
70
Erb palsy
Upper trunk problem (waiter's tip)
- lateral traction during delivery of infant or trauma
71
Klumpke's Palsy
Lower trunk problem
(total claw hand)
- upward force or grabbing a tree branch
72
Sensory Part of Musculoculateneous Innervates
Lateral forearm
73
Sensory part of Radial Innervates
Posterior arm/forearm and dorsal hand (thumb side)
74
Actions of Tibial Nerve
Plantar flexion and inversion
(common peroneal does dorsiflexion and eversion)
75
Sensory Part of Tibial Nerve Innervates
Bottom of foot
(common peroneal does dorsum of foot)
76
Artery that the Median nerve runs with
Brachial Artery (distal humerus)
77
Artery that Axillary nerve runs with
Posterior Circumflex artery (surgical neck of humerus)
78
Most of blood supply to femoral neck
Medial Circumflex artery
79
Power Stroke
Release of ADP
(new ATP binding causes myosin head to detach from actin)
80
Smooth Muscle Contraction
- Action potention depolarization opens up L-type Ca2+ channels
- Ca2+- calmodulin complexes --> myosin light chain kinase
- Myosin gets phosphorylated --> contraction via cross bridging
81
Membranous Ossification
Calvarium and facial bones (woven bone formed directly without cartilage and is later remodeled to lamellar bone)
82
Endochondral Ossification
Axial and appendicular skeleton
(woven bone made over a cartilaginous model which is lated remodeled to lamellar bone)
83
Osteoclast Differentiate from:
monocytes/macrophages
84
Osteitis Fibrosa Cystica aw/
Primary hyperparathyroidism
85
Spike of PTH vs Constant PTH
Spike: blast & clast stimulation --> build
Constant: clast stimulation --> breakdown
86
Osteoprotegerin (OPG)
Antagonist of RANK-L receptor --> inhibits clasts
87
Denosumab
Antibody to RANK-L to inhibit clasts
88
Thick, dense, weak bone w/ unmineralized spongiosa in medullary canals
Osteopetrosis
- bone fills marrow space causing pancytopenia
89
Osteoid (unmineralized) --> soft bones and rosary chest
Osteomalacia/Ricketts
- Vit D deficiency
- too much blast activity
90
Increased risk of Osteogenic Sarcoma or High output heart failure w/:
Pagets Disease of bone
- heart failure due to increased AV shunt
91
Mosiac or woven bone w/ increased hat size and hearing loss
Pagets Disease
92
Lab Values w/ Osteoporosis
All normal but have decreased bone mass (trabecular thinning)
93
Epiphyseal Bone Tumor
Giant Cell tumor (usually near knee)
94
Diaphysis Bone Tumors
- Ewings
- Chondrosarcoma
95
Metaphysis Bone Tumors
- Osteosarcoma
- Osteochondroma
96
Young adult female w/ benign aggressive bone tumor in epiphysis
Giant Cell Tumor (soap bubble appearance)
97
Young male w/ the most common benign tumor
Osteochondroma (in metaphysis)
- has cartilaginous cap
98
Maligant tumor showing Codman's triangle/sunburst on metaphysis
Osteosarcoma
99
Young boy w/ a malignant tumor w/ small round blue cells w/ onion skin appearance
Ewing Sarcoma (in diaphysis)
100
Ewing sarcoma translocation
t(11;22)
101
Older male w/ a malignant bone tumor that looks like a glistening mass
Chondrosarcoma (in diaphysis)
102
Baker's Cyst aw/
Rheumatoid Arthritis
103
anti-CCP highly specific for:
Rheumatoid Arthritis
104
Rheumatoid Factor
Anti-IgG antibody
105
Activating mutation of PRPP synthetase --> __________
Increased frequency of gout due to increased production and degradation of purines
106
Drugs that decrease uric acid excretion
Aspirin and Thiazide Diuretics
107
Drugs that may exacerbate Gout
Azathioprine and 6-MP due to metabolization by xanthine oxidase
108
Febuxostat
Non-purine xanthine oxidase inhibitor (more potent than allopurinol)
109
Probenecid
Increases uric acid excretion by competing w/ OAR/URATI transporter
110
Pegloticase
Uricase enzyme that converts uric acid into allantoin (water soluble metabolite)
111
Cells responsible for the inflammation seen w/ gout
Neutrophils
112
Overproduction of Uric Acid seen w/: (4)
Lesch Nyhan, Von Gierke, Tumor lysis syndrome, and PRPP excess
113
Enthesopathy
Limited chest expansion due to costosternal and vertebral pain (due to inflammation of tendon insertion sites)
- aw/ ankylosing spondylitis
114
Complication of Sjogren's
Dental caries and MALT lymphoma
115
Causes of Reactive Arthritis (5)
Chlamydia, Campylobacter, shigella, salmonella, yersinia
- conjunctivitis, urethritis, arthritis
116
Nephritic syndrome in SLE:
Diffuse proliferative glomerulonephritis (DPGN)
117
Nephrotic syndrome in SLE:
Membranous glomerulonephritis
118
False Positive VDRL:
virus, drugs, rheumatic fever, lupus, leprosy
119
Drug Induced Lupus:
Anti-histone antibodies
Procainamide, hydralazine, isoniazid
(drugs metabolized by N-acetylation in liver)
120
Antiphospholipid Antibody Syndrome:
False + syphilis test
Thromboembolisms
Recurrent pregnancy loss
121
Polymyositis vs Dermatomyositis
Poly: endomysial CD8+ w/ proximal muscle weakness
Dermatomyositis:
- perimysial CD4+
- muscle weakness w/ malar rash, gottron's papules, shawl and face rash, increased risk of occult malignancy
122
ANA, anti-Jo, anti-SRP, anti-Mi2
Polymyositis and Dermatomyositis
123
Myositis Ossificans
Skeletal muscle metaplasia to bone following trauma
124
Melasma
Hyperpigmentation aw/ pregnancy and OCPs (mask of pregnancy)
125
Junctional Nevi
Flat macules
126
Intradermal Nevi
Papular
127
Seborrheic Keratosis
Stuck On appearance
128
Leser Trelat Sign
Sudden appearance of multiple seborrheic keratosis indicates an underlying malignancy
129
Necrotizing Fasciitis
Deeper tissue injury form anaerobic bacteria or S. pyogenes
- crepitus from gad
- bullae and purple skin color
130
Difference between Staph Scalded Skin Syndrome and TEN syndrome
SSS destroys attachments in stratum granulosum only
- toxic epidermal necrolysis destroys epidermal-dermal junction
131
IgG to desmoglein of desmosomes (reticular/net-like on IF)
Pemphigus Vulgaris
(Nikolsky +, does not spare oral mucosa)
- acantholysis
132
IgG to hemidesmosomes
Bullous Pemphigoid
(spares oral mucosa)
133
Erythema Multiforme
-Target like lesions
aw/ mycoplasma, HSV (usually), and drugs (sulfa, beta lactams, and phenytoin)
134
Erythema Nodosum
Painful inflamed subcutaneous fat on shins
- can be aw/ sarcoidosis, coccidioides, histoplasma, TB, strep, leprosy, and Crohn's
- usually idiopathic
135
Lichen Planus
Pruritis, purple, polygonal, planar papules and plaques
- Mucosal involvement (Wickham striae/reticular white lines)
- aw/ Hep C
136
Acanthosis
Aw/ psoriasis
137
Dyskeratosis
Aw/ Squamous cell carcinoma
138
Hyperkeratosis
aw/ Actinic Keratosis (can become squamous cell carcinoma)
139
Hypergranuloses
aw/ lichen planus
140
Spongiosis
aw/ eczematous or contact dermatitis
141
Vitiligo
due to loss of epidermal melanocytes
- Autoimmune
142
Cafe Au Lait
Increased melanosome aggregation
143
Albinism
Decreased melanin production due to defective tyrosinase
144
Stasis Dermatitis
From incompetent venous valves
- Erythema and scaling/ progressive dermal fibrosis and hyperpigmentation near feet
- Varicose veins
145
Tx for Skin/Soft Tissue Infections w/ Staph Aureus:
Nafcillin
146
Calcipotriene
VitD analog that can be used to treat Psoriasis by inhibiting keratinocyte
147
Osler-Weber-Rendu Syndrome
Hereditary hemorrhagic telengectasias
- Skin and mucosal telengectasias and recurrent nosebleeds
148
Sturge-Weber
Port wine stain w/ seizures, mental retardation, tram track calcifications on skull radiographs
149
Waardenburg
Piebaldism w/ deafness
150
Layers of Skin
Corneum
Lucidum (in acral regions)
Granulosum
Spinosum
Basale
151
Pityriasis Rosea
Herald Patch followed by Christmas tree distribution
152
Lichen Planus is aw/
Hepatitis C
153
Pearly nodule w/ telangectasia, rolled borders, central ulceration, & pseudopalisading nuclei
Basal Cell Carcinoma
(MC skin cancer)
- rarely metastasizes
154
Ulcerative red lesion w/ frequent scale & keratin pearls
Squamous Cell Carcinoma
(2nd MC skin cancer)
155
Actinic Keratosis
Small brownish yellow, sandpaperlike (rough)
- Premalignant lesion due to sun exposure
- can progress to squamous cell carcinoma
156
Keratoacanthoma
Variant of squamous cell carcinoma that grows rapidly (4-6 weeks) then may spontaneously regress
- Solitary flesh colored nodule w/ central keratin plug
157
Melanoma Metastatic Potential
Depends on vertical growth
(Breslow and Clark level)
158
Vemurafenib
BRAF kinase inhibitor used for metastatic or unresectable melanoma in BRAF V600E mutation patients
159
Chronic draining sinuses aw/
Squamous cell carcinoma
160
COX-2
Inducible enzyme that is normally not detectable except in tissues w/ inflammation
161
Low-Dose Aspirin
Anticoagulation
-decreased thromboxane and prostaglandin synthesis
162
High-Dose Aspirin
Anti-inflammatory
163
Intermediate Dose Aspirin
Analgesic and anti-pyretic
164
Aspirin vs NSAIDs
Both inhibit COX 1 and 2
Aspirin is irreversible (covalent acetylation)
NSAIDs are reversible
165
COX2 inhibitors (celecoxib)
- Spares COX1 so: platelets unaffected (don't have an effect on TXA2 which depends on COX1) and gastric mucosa unaffected
- sulfa allergy and increased risk of thrombosis
- used in patients w/ gastric ulcers
166
Acetaminophen
Reversible inhibition of COX (mostly in CNS)
Antipyretic and analgesic but NOT anti-inflammatory
167
Side Effects of Bisphosphonates
Corrosive esophagitis and Osteonecrosis of Jaw
168
Avascular necrosis of femoral head aw/
Sickle cell disease, SLE, high-dose steroid therapy, and alcoholism
- no swelling, erythema, or warmth; only pain
169
Procollagen Peptidase Deficiency
Form of Ehlers Danlos
- joint laxity, loose skin, and easy bruising
- impaired cleavage of procollagen N and C termini results in a more soluble form of collagen that cannot properly crosslink
170
Succinylcholine
-Can cause Malignant Hyperthermia (esp w/ halothane)
- severe hyperkalemia in burn patients
-augmented by neostigmine in Phase I
- blocked by neostigmine in Phase II
171
Stewart Treves Syndrome: Chronic lymphedema is a risk factor for:
Cutaneous angiosarcoma
172
Injections in the Gluteal Region
Should be given in the Superolateral quadrant of the buttock (safest site)
173
Cardiac abnormality aw/ Ankylosing Spondylitis:
Aortic regurgitation from ascending aortitis and aortic ring dilation
174
Cricothyroid is innervated by:
Superior Laryngeal Nerve
- Everything else is the Recurrent Laryngeal Nerve
175
Osteogenesis Imperfecta
AD abnormality or deficiency in Type I collagen
- blue sclera, brittle bones
- primary defect is in bone matrix production
176
Recurrent Laryngeal Nerve Runs With:
Inferior Thyroid Artery
177
Superior Laryngeal Nerve Runs with:
Superior Thyroid Artery
178
CREST: pulmonary symptoms
Pulmonary Hypertension due to intimal thickenings of pulmonary arteries
179
Deep Fibular Nerve
Dorsiflexion and sensation between the big toe and 2nd toe
180
Superficial Fibular Nerve
Eversion and sensation on the majority of the dorsum of the foot
181
Elasticity
4 Lysine crosslinking
182
PABA protects from:
UVB radiation only
183
Osteoclasts require _______
Carbonic anhydrase to produce H+ ions that are pumped into the resorptive pit to create an acidic environment for bone demineralization
184
Muscles on Lateral End of Clavicle
Deltoid (pulls clavicle inferolaterally) and Trapezius (pulls clavicle superomedially)
185
Abscess in Psoas Muscle
May lead to formation of an abscess in the groin and pain referred to that region
186
Dysplastic Nevus Syndrome
Number dysplastic nevi in a young person with a family history of melanoma
- mutation in CDKN2A gene on chromosome 9p21
187
+ Psoas Sign on iliopsoas Test
Patient flexes hip against resistance
- pain suggests psoas inflammation possibly due to appendicitis, psoas abscess, or peritoneal inflammation
188
Structures through the Diaphragm
IVC at T8
Esophagus and Vagal trunks at T10
Aorta, Thoracic Duct, Azygos Vein at T12
189
Hyperemia
- Overcompensation of reperfusion after occlusion
- Blood flow increases during exercise
- The more anaerobic metabolism you use and lactate build-up you have, the more hyperemia you need to clear out the waste products
190
Osgood-Schlatter
- also known as apophysitis of the tibial tubercle
- due to chronic stress/irritation at the insertion of the patellar ligament on the tibial tubercle
- classically seen in the teenagers doing repetitive vigorous activity (running, jumping)
191