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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

Sweat Gland Secretion

Apocrine
initially odorless but can become malodorous secondary to bacterial decomposition on skin surface