Musculoskeletal - Skin - Connective Tissue_1 Flashcards Preview

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Flashcards in Musculoskeletal - Skin - Connective Tissue_1 Deck (351):
1

What are the epidermis layers from surface to base?

Stratum Corneum (keratin • Stratum Lucidum • Stratum Granulosum • Stratum Spinosum • Stratum Basale

2

what are the spines in the stratum spinosum?

desmosomes

3

which epidermal layer is the stem cell site?

Stratum Basale

4

what are the 3 epidermal appendages?

Sebaceous gland • Eccrine gland • Apocrine gland

5

mechanism of sebaceous gland secretion?

holocrine secretion of sebum

6

sebaceous gland associated with what?

hair follicle

7

eccrine gland secretes what?

sweat

8

eccrine glands are found where?

throughout the body • Eccrine glands are every where

9

apocrine glands secrete what?

milky viscous fluid

10

apocrine glands are found where?

axillae, genitalia, areolae

11

when are apocrine glands functional?

do not become functional until puberty

12

why are apocrine glands malodorous?

because of bacterial action

13

functions of tight junctions?

zona occludens: • prevents paracellular movement of solutes

14

tight junctions are composed of what?

claudins and occludins

15

where are adherens junctions?

zonula adherins: below tight junctions

16

adherens junctions form what?

belt connecting actin cytoskeletons of adjacent cells with Cadherins

17

what are Cadherins?

Ca++ dependent adhesion proteins

18

loss of E-cadherin does what?

promotes metastasis

19

what is the function of desmosomes?

structural support via keratin interactions

20

atoantibodies to desmosomes cause what?

pemphigus vulgaris

21

components of desmosomes?

keratin • desmoplakin

22

what happens in gap junctions?

channel proteins called connexons permit electrical and chemical communication between cells

23

function of a hemidesmosome?

connects keratin in basal cells to underlying basement membrane

24

autoantibodies to hemidesmosomes cause what?

bullous pemphigoid

25

what are integrins?

membrane proteins that maintain integrity of basement membrane by binding to laminin in BM

26

how does unhappy triad happen?

common injury in contact sportsL lateral force applied to a planted leg

27

unhappy triad includes which injuries?

tear of ACL, MCL and meniscus (classically medial, but lateral more common)

28

treatment for unhappy triad?

often requires surgical reconstruction

29

A and P in ACL and PCL refer to what?

sites of tibial attachment

30

positive anterior drawer test means what?

ACL tear

31

abnormal passive abduction at the knee means what?

MCL tear

32

what is the important landmark for pudendal nerve block?

ischial spine

33

what is the important landmark in finding the appendix?

2/3 of the way from the umbilicus to the anterior superior iliac spine (McBurney's point)

34

what is the important landmark in lumbar puncture?

iliac crest

35

what are the shoulder muscles that form the rotator cuff?

Supraspinatus • Infraspinatus • teres minor • Subscapularis • SItS (small t is for teres minor)

36

what is the most common rotator cuff injury?

Supraspinatus

37

action of supraspinatus?

abducts arm initially (before deltoid)

38

which rotator cuff muscle is a common pitching injury?

Infraspinatus

39

action of infraspinatus?

laterally rotates arm

40

action of teres minor?

adducts and laterally rotates arm

41

action of subscapularis?

medially rotates and adducts arm

42

rotator cuff muscles are innervated by what?

C5-C6

43

what are the bones of the wrist?

Scaphoid • Lunate • Triquetrum • Pisiform • Trapezium • Trapezoid • Capitate • Hamate • Some Lovers Try Positions That They Can't Handle

44

what is the most commonly fractured carpal bone?

scaphoid

45

scaphoid is prone to which complication?

avascular necrosis owing to retrograde blood supply

46

dislocation of which wrist bone may cause acute carpal tunnel syndrome?

lunate

47

what is carpal tunnel syndrome?

entrapment of median nerve in carpal tunnel

48

what is the pathogenesis of carpal tunnel syndrome?

nerve compression → paresthesia, pain, and numbness in distribution of median nerve

49

cause of lesion in upper trunk of brachial plexus?

trauma

50

cause of lesion in C7 root of brachial plexus?

compressed by cervical disk lesion

51

cause of lesion in axillary nerve?

fracture of surgical neck of humerus • dislocation of humerus • intramuscular injections

52

cause of lesion to lower trunk of brachial plexus?

compressed by cervical rib or by pancoast tumor of lung

53

lesion of lower trunk of brachial plexus leads to what?

Klumpke's palsy

54

cause of lesion to radial nerve in spiral groove?

lesioned by midshaft fracture of the humerus

55

cause of radial nerve compression in the axilla?

incorrect use of a crutch

56

cause of lesion in proximal median nerve?

compressed by supracondylar fracture of humerus • pronator teres syndrome

57

cause of lesion to deep branch of radial nerve?

stretched by subluxation of radius

58

cause of proximal ulnar nerve lesion?

lesioned by repeat minor trauma • fracture of medial epicondyle of humerus

59

caused of lesion to anterior interosseous nerve?

compressed in deep forearm

60

cause of lesion in distal median nerve?

compressed in carpal tunnel syndrome and by dislocated lunate

61

cause of distal ulnar nerve lesion?

lesioned by trauma to heel of the hand • fracture of hook of hamate

62

cause of lesion to recurrent branch of median nerve?

lesioned by superficial laceration

63

nerve root of top of shoulder dermatome?

C4

64

nerve root of lateral humerus dermatome?

C5

65

nerve root of medial arm → lateral forearm→ thumb and index finger dermatome?

C6

66

nerve root of middle finger and middle palm dermatome?

C7

67

Nerve root of ring/little finger and medial palm dermatome?

C8

68

Nerve root of medial forearm and distal medial arm dermatome?

T1

69

nerve root of medial proximal arm and inferior shoulder dermatome?

T2

70

cutaneous sensory nerve distribution on hand of the ulnar nerve?

little + 1/2 ring finger on palmar and dorsal surface of hand

71

cutaneous sensory nerve distribution on hand of median nerve?

thumb → half of ring finger on palmar surface • inner half of thumb, distal half of index to 1/2 ring finger on doral surface

72

cutaneous sensory nerve distribution on hand of radial nerve?

proximal edge of palmar thenar eminence on palmar and whole dorsum of thenar eminence

73

lesion to long thoracic nerve causes what?

winged scapula

74

lesion to upper trunk of the brachial plexus causes what?

Waiter's tip (Erbs palsy)

75

lesion to lower trunk of brachial plexus causes what?

Claw hand (Klumpke palsy)

76

lesion to posterior cord of the brachial plexus causes what?

wrist drop

77

damage to the axillary branch of the brachial plexus causes what?

deltoid paralysis

78

damage to radial branch of the brachial plexus causes what?

Saturday night palsy (wrist drop)

79

damage to musculocutaneous branch of brachial plexus causes what?

Difficulty flexing elbow, variable sensory loss

80

damage to the median branch of the brachial plexus causes what?

decreased thumb function (pope's blessing)

81

damage to the ulnar branch of the brachial plexus causes what?

intrinsic muscles of the hand, claw hand

82

roots that contribute to the long thoracic nerve?

C5, 6, 7

83

roots that contribute to upper trunk of the brachial plexus?

C5-6

84

roots that give rise to middle trunk of brachial plexus?

C7

85

roots that give rise to lower trunk of brachial plexus?

C8-T1

86

how many divisions in the brachial plexus?

6

87

trunks that contribute to the lateral cord of the brachial plexus?

upper • middle

88

trunks that give rise to posterior cord of the brachial plexus?

upper • middle • lower

89

trunks that give rise to medial cord of the brachial plexus?

lower

90

nerve roots that give rise to lateral cord of brachial plexus?

C5, 6, 7

91

nerve roots that give rise to posterior cord of brachial plexus?

C5, 6, 7, 8, T1,

92

nerve roots that give rise to medial cord of brachial plexus?

C8, T1

93

trunks that give rise to axillary branch of brachial plexus?

upper • middle • lower

94

trunks that give rise to radial branch of brachial plexus?

upper • middle • lower

95

trunks that give rise to musculocutaneous branch of brachial plexus?

upper • middle

96

trunks that give rise to median branch of brachial plexus?

upper • middle • lower

97

trunks that give rise to ulnar branch of brachial plexus?

lower

98

cords of brachial plexus that innervate flexors of forearm?

lateral • medial

99

cords of brachial plexus that innervates extensors of forearm?

posterior

100

nerve roots that contribute to axillary nerve?

C5-C6

101

nerve roots that contribute to radial nerve?

C5-T1

102

nerve roots that contribute to musculocutaneous nerve?

C5-C7

103

nerve roots that contribute to median nerve?

C5-T1

104

nerve roots that contribute to ulnar nerve?

C8-T1

105

brachial plexus is protected from clavicle fracture by what?

subclavius muscle

106

typically injury of axillary nerve?

fractured surgical neck of humerus • dislocation of humeral head

107

motor deficit in axillary nerve injury?

Deltoid- arm abduction at shoulder

108

sensory deficit in axillary nerve injury?

over deltoid muscle

109

sign associated with axillary nerve injury?

atrophied deltoid

110

what is the typical injury of the radial nerve?

fracture at midshaft of humerus • extended compression of axilla by back of chair or crutches

111

motor deficit seen in radial nerve injury?

BEST extensors • Brachioradialis • Extensors of wrist and fingers • Supinator • Triceps

112

sensory deficit seen in radial nerve injury?

posterior arm and dorsal hand and thumb

113

sign seen in radial nerve injury?

wrist drop

114

typical injury to the median nerve?

fracture of supracondylar humerus

115

motor deficit in proximal lesion to median nerve?

opposition of thumb • lateral finger flexion • wrist flexion

116

sensory deficit in proximal lesion to median nerve?

dorsal and palmar aspects of lateral 3 1/2 fingers • thenar eminence

117

sign seen in median nerve lesion?

ape hand • popes blessing

118

typical injury to ulnar nerve?

fracture of medial epicondyle of humerus • funny bone

119

motor deficit in proximal ulnar nerve injury?

medial finger flexion • wrist flexion

120

sensory deficit in proximal ulnar nerve lesion?

medial 1 1/2 fingers • hypothenar eminence

121

sign seen in proximal ulnar nerve lesion?

radial deviation of wrist upon wrist flexion

122

typical injury to musculocutaneous nerve?

upper trunk compression

123

motor deficit in musculocutaneous nerve injury?

biceps • brachialis • coracobrachialis • flexion of forearm at elbow

124

sensory deficit in musculocutaneous nerve injury?

lateral forearm

125

what causes erb-duchenne palsy 'waiters tip'?

traction or tear of the upper trunk of the brachial plexus (C5-C6)

126

erb duchenne palsy 'waiters tip' seen in who?

infants following trauma during delivery

127

findings in erb-duchenne palsy 'waiters tip'?

limb hangs by side (paralysis of abductors) • medially rotated (paralysis of lateral rotators) • forearm is pronated ( loss of biceps)

128

what are the causes of Klumpke palsy and thoracic outlet syndrome?

an embryologic or childbirth defect affecting inferior trunk of brachial plexus (C8-T1) • cervical rib can compress subclavian artery and inferior trunk, resulting in thoracic outlet syndrome

129

findings in klumpke palsy/thoracic outlet syndrome?

atrophy of thenar and hypothenar eminences • atrophy of interosseous muscles • sensory deficits on the medial side of the forearm and hand • disappearance of the radial pulse upon moving the head toward the ipsilateral side

130

clawing of the hand is conceptualized how?

as loss of the lumbricals, which flex the MCP joints and extend both the DIP and PIP joints

131

ulnar claw can be caused by what?

long-standing injury to ulnar nerve at hook of hamate (falling onto outstretched hand)

132

pathogenesis of ulnar claw?

distal ulnar nerve lesion → loss of medial lumbrical function→ inability to extend 4th and 5th digits when trying to open hand

133

median claw can be caused by what?

carpal tunnel syndrome or dislocated lunate

134

pathogenesis of median claw?

distal (after branches containing C5-C7 branches off to feed forearm flexors) median nerve lesion→ loss of lateral lumbrical function→ 2nd and 3rd digit are clawed upon attempted finger extension

135

what causes pope's blessing?

proximal median nerve lesion causes loss of lateral finger extension and thumb opposition

136

finding in pope's blessing?

when asked to make a fist, 2nd and 3rd digits remain extended and thumb remains unopposed, which looks like the hand of benediction

137

pathogenesis of ape hand?

proximal median nerve lesion → loss of opponens pollicus muscle function → unopposable thumb

138

pathogenesis of klumpke's total claw?

lesion of lower trunk (C8-T1) of brachial plexus → loss of function of all lumbricals; • forearm finger flexors (fed by part of median nerve with C5-C7) and finger extensors (fed by radial nerve) are unopposed→ clawing of all digits

139

muscle innervated by LTN?

serratus anterior

140

action of serratus anterior?

anchors scapula to thoracic cage • used for abduction above horizontal position

141

LTN can be injured how?

mastectomy

142

what happens when LTN is injured in mastectomy?

winged scapula and ipsilateral lymphedema

143

what innervates the muscles of the thenar eminence?

median

144

what innervates the muscles of the hypothenar eminence?

ulnar

145

what are the muscles in the thenar eminence?

Opponens pollicus • Abductor pollicus brevis • Flexor pollicus brevis

146

what are the muscles in the hypothenar eminence?

opponens digiti minimi • abductor digiti minimi • flexor digiti minimi

147

function of the dorsal interosseous muscles?

abduct the fingers

148

action of the palmar interosseous muscles?

adduct the fingers

149

action of the lumbrical muscles?

flex at the MCP joint • extend PIP and DIP joints

150

roots of obturator nerve?

L2-L4

151

roots of femoral nerve?

L2-L4

152

roots of common peroneal nerve?

L4-S2

153

roots of tibial nerve?

L4-S3

154

roots of superior gluteal nerve?

L4-S1

155

roots of inferior gluteal nerve?

L5-S2

156

cause of injury to obturator nerve?

anterior hip dislocation

157

motor defect in obturator nerve injury?

thigh adduction

158

sensory deficit in obturator nerve injury?

medial thigh

159

cause of injury to femoral nerve?

pelvic fracture

160

motor deficit in femoral nerve injury?

thigh flexion and leg extension

161

sensory deficit in femoral nerve injury?

anterior thigh and medial leg

162

cause of injury to common peroneal nerve?

trauma or • compression of lateral aspect of leg or • fibula neck fracture

163

motor deficit in common peroneal nerve injury?

foot eversion and dorsiflexion; • toe extension; • foot drop, foot slap, steppage gait

164

sensory deficit in common peroneal nerve injury?

anterolateral leg and dorsal aspect of foot

165

what is the cause of injury to tibial nerve?

knee trauma

166

what is the motor deficit in tibial nerve injury?

foot inversion and plantarflexion; • toe flexion

167

what is the sensory deficit in tibial nerve injury?

sole of foot

168

cause of injury to superior gluteal nerve?

posterior hip dislocation or polio

169

motor deficit in superior gluteal nerve lesion?

thigh abduction (positive trendelenberg sign)

170

cause of injury to inferior gluteal nerve?

posterior hip dislocation

171

motor deficit in inferior gluteal nerve injury?

cant jump, climb stairs, or rise from seated position • can't push inferiorly

172

mnemonic for common peroneal nerve?

PED= Peroneal Everts and Dorsiflexes; if injured, foot dropPED

173

mnemonic for Tibial Nerve?

TIP= Tibial Inverts and Plantarflexes; if injured, can't stand on TIPtoes

174

root of sciatic nerve?

L4-S3

175

course of sciatic nerve?

posterior thigh,splits into common peroneal and tibial nerve

176

6 steps in muscle excitation/ contraction?

1. AP depolarization opens presynaptic VG-Ca channels→ NT release • 2. postsynaptic ligand binding → muscle cell depolarization in motor end plate • 3. depolarization travels along muscle cell + down T tubule • 4. depolarization of VS-DHPR, mechanically coupled to ryanodine receptor on SR→ conformational change → Ca release from SR • 5. released Ca binds to troponin C → conformational change that moves tropomyosin out of myosin binding groove on actin filaments • 6. myosin releases bound ADP and is displaced on the actin filament (powerstroke). contraction → shortening of H and I bands and between Z lines (HIZ shrinkage), but the A band remains the same length

177

which band of sarcomere is always same length in contraction?

A band

178

which bands shrink during muscle contraction?

HIZ

179

what are the types of muscle fibers?

Type 1 muscle • Type 2 muscle

180

action of type 1 muscle?

slow twitch

181

;how do the morphologic features of type 1 muscle correspond to its action?

red fibers resulting from ↑ mitochondria and myoglobin concentration (↑OxPhos)→sustained contraction

182

action of Type 2 muscle?

fast twitch

183

morphology of type 2 muscle?

white fibers resulting from ↓ mitochondria (↑ anaerobic glycolysis)

184

weight training results in hypertrophy of which type of muscle?

type 2

185

4 biochemical changes that drive mechanical skeletal and cardiac muscle contraction?

1. Ca binds troponin C→ conformational change→displacement of tropomyosin and actin/myosin cycling • 2. Pi is released, changing myosin head conformation, causing power stroke • 3. ATP binds myosin head→ release from actin filament • 4. ATP hydrolysis cocks myosin head

186

4 states in mechanical skeletal muscle contraction?

1. cocked state • 2. cross bridged state • 3. power-stroke state • 4. released state

187

what does lack of ATP do to muscle contraction?

causes rigor mortis

188

what are the 2 types of bone formation?

endochondrial ossification • membranous ossification

189

where does endochondrial ossification take place?

bones of axial and appendicular skeleton • base of the skull

190

what happens in endochondrial ossification?

cartilaginous model of bone is first made by chondrocytes • osteoclasts and osteoblasts later replace with woven bone and then remodel to lamellar bone

191

in adults, woven bone occurs when?

after fractures • Paget's disease

192

where does membranous ossification take place?

bones of calvarium and facial bones

193

what happens in membranous ossification?

woven bone formed directly without cartilage • later remodelled to lamellar bone

194

action of osteoblasts?

build bone by secreting collagen and catalyzing mineralization

195

origin of osteoblasts?

differentiate from mesenchymal stem cells in periosteum

196

what are osteoclasts?

multinucleated cells that dissolve bone by secreting acid and collagenases

197

osteoclasts differentiate from what?

monocytes/macrophages

198

effects of PTH on bone at low, intermittent levels?

exerts anabolic effects (building bone) on osteoblasts and osteoclasts (indirect)

199

effects of chronic high PTH on bone?

catabolic effects (osteitis fibrosa cystica)

200

effect of estrogen on bones?

inhibits apoptosis in bone forming osteoblasts and induces apoptosis in bone resorbing osteoclasts

201

what happens to bone in estrogen deficiency (surgical or postmenopausal)?

excess remodeling cycles and bone resorption lead to osteoporosis

202

pathogenesis of achondroplasia?

failure of longitudinal bone growth (endochondral ossification)→ short limbs • membranous ossification is not affected → large head relative to limbs

203

molecular cause of achondroplasia?

constitutive activation of FGFR3 actually inhibits chondrocyte proliferation

204

inheritance of achondroplasia?

>85% of mutations occur sporadically and are associated with ↑ paternal age • also demonstrates AD inheritance

205

achondroplasia is a common cause of what?

dwarfism

206

prognosis of achondroplasia?

normal life span and fertility

207

what happens in osteroporosis?

trabecular (spongy) bone loses mass and interconnections despite normal bone mineralization and lab values (Ca and PO4)

208

osteoporosis can lead to what?

vertebral crush fractures- acute back pain, loss of height, kyphosis

209

what is type I osteoporosis?

post menopausal- ↑ bone resorption due to ↓ estrogen

210

injuries common to type I osteoporosis?

femoral neck fracture • distal radius (colles fracture)

211

what is type II osteoporosis?

senile osteoporosis- men and women >70yo

212

prophylaxis for type II osteoporosis?

regular weight bearing exercise and adequate calcium and VitD intake throughout adulthood

213

treatment for osteoporosis?

estrogen (SERMs) +/- calcitonin • bisphosphonates or pulsatile PTH for severe cases

214

what meds are CI in osteoporosis?

glucocorticoids

215

osteopetrosis AKA?

marble bone disease

216

pathogenesis of osteopetrosis?

failure of normal bone resorption due to defective osteoclasts → thickened, dense bones that are prone to fracture

217

hematologic complications of osteopetrosis?

bone fills marrow space → pancytopenia, extramedullary hematopoiesis

218

molecular cause of osteopetrosis?

mutations (carbonic anhydrase II) ↓ ability of osteoclast to generate acidic environment necessary for bone resorption

219

Xray findings in osteopetrosis?

bone in bone appearance

220

osteopetrosis can result in what?

cranial nerve impingement and palsies as a result of narrowed foramina

221

tx for osteopetrosis?

BM transplant is potentially curative since osteoclasts are derived from monocytes

222

what causes osteomalacia/rickets?

vitamin D deficiency

223

pathogenesis of osteomalacia/rickets?

defective mineralization/calcification of osteoid→ soft bones that bow out

224

hormonal changes in osteomalacia/rickets?

↓ VitD→ ↓ serum Ca → ↑ PTH secretion → ↓ serum PO4

225

result of hyperactive osteoblasts in osteomalacia/rickets?

↑ ALP (osteoblasts require alkaline environment)

226

Paget's disease of bone AKA?

osteitis deformans

227

what is Paget's disease of bone?

common, localized disorder of bone remodeling caused by ↑ in both osteoblastic and osteoclastic activity

228

lab values in pagets disease of bone?

serum Ca, PO4, PTH= NL • ↑ ALP

229

findings in pagets disease of bone?

mosaic woven bone pattern • long bone chalk stick fractures • hat size ↑ • hearing loss due to auditory foramen narrowing

230

CV complication of pagets disease of bone?

↑ blood flow from ↑ arteriovenous shunts may cause high output cardiac failure

231

pagets disease of bone carries ↑ risk of what?

osteogenic sarcoma

232

lab values in osteoporosis?

↓ bone mass with normal Ca, PO4, ALP, PTH

233

lab values in osteopetrosis?

thickened dense bones with • ↓ Ca • ↑ ALP • normal PO4 and PTH

234

lab values in osteomalacia/rickets?

soft bones with • ↓ Ca and PO4 • ↑ ALP and PTH

235

lab values in osteitis fibrosa cystica?

brown tumors of hyperparathyroidism • ↓ PO4 • ↑ Ca, ALP, PTH

236

lab findings in paget's disease of bone?

abnormal bone architecture with • ↑ ALP • normal Ca, PO4, PTH

237

what happens in polyostotic fibrous dysplasia?

bone is replaced by fibroblasts, collagen, and irregular bony trabeculae

238

what is McCune-Albright syndrome?

form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and cafe au lait spots

239

what are the benign primary bone tumors?

1. giant cell tumor (osteoclastoma) • 2. osteochondroma (exostosis)

240

epidemiology/location of Giant cell tumor/osteoclastoma?

20-40yo • epiphyseal end of long bones

241

presentation of giant cell tumor/osteoclastoma?

locally aggressive benign tumor often around the distal femur, proximal tibial region

242

Xray appearance of giant cell tumor/osteoclastoma?

double bubble or soap bubble appearance

243

histopathology in giant cell tumor/osteoclastoma?

spindle shaped cells with multinucleated giant cells

244

what is the most common benign primary bone tumor?

osteochondroma (exostosis)

245

epidemiology of osteochondroma?

males <25yo

246

characteristics of osteochondroma?

1. mature bone with cartilaginous cap • 2. commonly originates from long metaphysis • 3. malignant transformation to chondrosarcoma is rare

247

what are the malignant primary bone tumors?

osteosarcoma • ewings sarcoma • chondrosarcoma

248

what is the 2nd most common primary malignant bone tumor?

osteosarcoma (1st is multiple myeloma)

249

epidemiology of osteosarcoma?

M>F • 10-20yo 1°

250

what are the predisposing factors for osteosarcoma?

pagets disease of bone • bone infarcts • radiation • familial retinoblastoma

251

location of osteosarcoma?

metaphysis of long bones, often around distal femur, proximal tibial region

252

xray findings in osteosarcoma?

codman's triangle (from elevation of periosteum) or sunburst patten

253

prognosis of osteosarcoma?

aggressive

254

tx for osteosarcoma?

surgical en bloc resection (with limb salvage) and chemotherapy

255

epidemiology of ewings sarcoma?

boys <15yo

256

ewings sarcoma commonly appears where?

in diaphysis of long bones, pelvis, scapula, ribs

257

severity of ewings sarcoma?

extremely aggressive with early metastases, but responsive to chemotherapy

258

histopathology of ewings sarcoma?

anaplastic small blue cell malignant tumor • onion skin appearance in bone • 'going out for ewings and onion rings'

259

genetic cause of ewings sarcoma?

t(11;22) • 11+22=33 patrick ewings jersey number

260

epidemiology of chondrosarcoma?

men 30-60yo

261

location of chondrosarcoma?

usually located in pelvis, spine, scapula, humerus, tibia, or femur

262

what type of cancer is chondrosarcoma?

malignant cartilaginous tumor

263

where does chondrosarcoma come from?

may be of primary origin or from osteochondroma

264

histopathology of chondrosarcoma?

expansile glistening mass within the medullary cavity

265

epihphyseal bone tumor?

giant cell tumor (soap bubble)

266

metaphyseal bone tumor?

benign= osteochondroma -exostosis • malignant= osteosarcoma- codmans triangle

267

diaphyseal bone tumor?

malignant: • ewings sarcoma • chondrosarcoms

268

etiology of osteoarthritis?

mechanical- joint wear and tear destroys articular cartilage

269

etiology of RA?

autoimmune- inflammatory destruction of synovial joints • type III HSR

270

joint findings in osteoarthritis?

subchondral cysts • sclerosis • osteophytes (bone spurs) • eburnation (polished, ivory like appearance of bone) • Heberden's nodes (DIP) • Bouchard's nodes (PIP) • no MCP involvement

271

joint findings in RA?

pannus formation in joints (MCP, PIP) • subcutaneous rheumatoid nodules • ulnar deviation of fingers • subluxation • Baker's cysts • no DIP involvement

272

pathology in subcutaneous rheumatoid nodules in RA?

fibrinoid necrosis

273

location of Baker's cysts in RA?

popliteal fossa

274

predisposing factors for OA?

age • obesity • joint deformity

275

predisposing factors for RA?

F>M • 80% RF (+) • anti-cyclic citrullinated peptide antibody is more specific • strong association with HLA-DR4

276

classic presentation of OA?

pain in weight bearing joints after use (EOD) improving with rest • knee cartilage loss medially (bowlegged) • noninflammatory • no systemic symptoms

277

classic presentation of RA?

morning stiffness > 30min improving with use • symmetric joint involvement • systemic symptoms

278

systemic symptoms of RA?

fever • fatigue • pleuritis • pericarditis

279

Tx for OA?

NSAIDs • intra-articular glucocorticoids

280

Tx for RA?

NSAIDs • glucocorticoids • disease modifying agents (MTX, sulfasalazine, TNF-α inhibitors)

281

what happens in Sjogrens syndrome?

lymphocytic infiltration of exocrine glands, especially lacrimal and salivary

282

classic triad of sjogrens syndrome?

xerophthalmia (dry eyes, conjunctivitis) • xerostomia (dry mouth, dysphagia) • arthritis

283

sjogrens causes what complications?

parotid enlargement • ↑ risk of B cell lymphoma • dental caries

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markers present in sjogrens syndrome?

autoantibodies to ribonucleoprotein antigens: SS-A (Ro), SS-B (La)

285

sjogrens predominantly affects who?

females 40-60yo

286

sjogrens associarted with what?

RA

287

what are the findings in gout?

precipitation of monosodium urate crystals into joints due to hyperuricemia

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hyperuricemia that causes gout can be caused by what?

lesch-nyhan syndrome • PRPP excess • ↓ excretion of uric acid (thiazides) • ↑ cell turnover • von gierkes disease

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percentage of gout due to underexcretion?

90%

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percentage of gout due to overproduction?

10%

291

features of crystals in gout?

needle shaped and negatively birefringent = yellow crystals under parallel light

292

gout is more common in who?

men

293

symptoms of gout?

asymmetric joint distribution • joint is swollen, red and painful • painful MTP joint of the big toe (podagra) • tophus formation

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common location of tophus formation in gout?

external ear • olecranon bursa • Achilles tendon

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acute attack of gout tends to occur when?

after large meal or alcohol consumption

296

why does alcohol precipitate a gout attack?

alcohol metabolites compete for same excretion sites in kidney as uric acid, causing ↓ uric acid secretion and subsequent build up in blood

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treatment for acute gout?

NSAIDs (indomethacin) • glucocorticoids

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treatment for chronic gout?

xanthine oxidase inhibitors (allopurinol, febuxostat)

299

pseudogout is caused by what?

deposition of calcium pyrophosphate crystals within the joint space

300

pseudogout forms crystals with which features?

basophilic, rhomboid crystals that are weakly positively birefringent

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typical location of pseudogout?

usually affects large joints (classically the knee)

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pseudogout affects who?

>50yo, M=F

303

treatment for pseudogout?

NSAIDs for sudden severe attacks • steroids • colchicine

304

difference between gout and pseudogout crystals under parallel light?

gout= yellow • pseudogout=blue

305

what are the common causes of infectious arthritis?

S aureus • Streptococcus • Neisseria gonorrhea

306

what is gonococcal arthritis?

STD that presents with migratory arthritis with asymmetric pattern

307

presentation of gonococcal arthritis?

affected joint is swollen, red and painful • STD= Synovitis (knee), Tenosynovitis (hand), Dermatitis (pustules)

308

cause of osteonecrosis (avascular necrosis)?

infarction of bone and marrow

309

symptoms of osteonecrosis?

pain associated with activity

310

osteonecrosis is caused by what?

trauma • high dose corticosteroids • alcoholism • SCD

311

most common site of osteonecrosis?

femoral head

312

what are the seronegative spondyloarthropathies?

PAIR • Psoriatic arthritis • Ankylosing spondylitis • Inflammatory bowel disease • Reactive arthritis

313

what are seronegative spondyloarthropathies?

arthritis without rheumatoid factor ( no anti-IgG antibody)

314

seronegative spondyloarthropathies have strong association with what?

HLA-B27 (gene that codes for HLA MHC class II)

315

sernegative spondyloarthropathies occur more often in who?

males

316

what is psoriatic arthritis?

joint pain and stiffness associated with psoriasis

317

how does psoriatic arthritis present?

asymmetric and patchy involvement • dactylitis (sausage fingers) • pencil in cup deformity on xray

318

frequency of psoriatic arthritis?

seen in fewer than 1/3 of patients with psoriasis

319

pathogenesis of ankylosing spondylitis?

chronic inflammatory disease of spine and sacroiliac joints→ ankylosis (stiff spine due to fusion of joints), uveitis, and aortic regurgitation

320

common presentation of ankylosing spondylitis?

bamboo spine (vertebral fusion)

321

why is IBS considered a seronegative spondyloarthropathy?

Crohns and UC are often accompanied by ankylosing spondylitis or peripheral arthritis

322

classic triad in reactive arthritis (reiters syndrome)?

conjunctivitis and anterior uveitis • urethritis • arthritis • can't see can't pee can't climb a tree

323

when does reiters syndrome occur?

post GI or chlamydia infection

324

epidemiology of SLE?

90% are female 14-45yo

325

SLE most common and most severe in who?

black females

326

presentation of SLE can include what?

fever • fatigue • weight loss • Libmann-Sacks endocarditis • hilar adenopathy • Raynauds phenomenon

327

what is libmann sacks endocarditis?

verrucous, wart like, sterile vegetations on both sides of valve

328

what is the common cause of death in SLE?

nephritis

329

what type of nephritis causes death in SLE?

DPGN if nephritic • MGN if nephrotic

330

SLE pts test false positive for what?

syphilis RPR/VDRL due to antiphospholipid antibodies, which cross react with cardiolipin used in tests

331

Lab tests for SLE detect the presence of what?

ANA • Anti-dsDNA • anti-Sm • antihistone Ab

332

use of ANA test for SLE?

sensitive (primary screening) but not specific for SLE

333

use of anti-dsDNA test for SLE?

very specific, poor prognosis

334

use of anti-Sm test for SLE?

very specific, but not prognostic

335

use of antihistone test for SLE?

more sensitive for drug induced lupus

336

mnemonic for SLE?

I'M DAMN SHARP • Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid) • Malar rash • Discoid rash • Antinuclear antibody • Mucositis • Neurologic disorders • Serositis • Hematologic disorders • Arthritis • Renal disorders • Photosensitivity

337

sarcoidosis is characterized by what?

immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels

338

sarcoidosis is common in who?

black females

339

typical presentation of sarcoidosis?

often asymptomatic except for enlarged lymph node. incidental findings on CXR of bilateral hilar adenopathy or reticular opacities

340

sarcoidosis is associated with what?

restrictive lung disease (interstitial fibrosis) • erythema nodosum • bells palsy • epithelial granulomas containing microscopic Schaumann and asteroid bodies • uveitis • hypercalcemia

341

what causes hypercalcemia in sarcoidosis?

elevated 1α-hydroxylase-mediated vitD activation in epitheloid macrophages

342

what is the treatment for sarcoidosis?

steroids

343

what are the symptoms of polymyalgia rheumatica?

pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss • does not cause muscular weakness

344

polymyalgia rheumatica is more common in who?

women >50yo

345

polymyalgia rheumatica is associated with what?

temporal (giant cell) arteritis

346

findings in polymyalgia rheumatica?

↑ ESR • normal CK

347

treatment for polymyalgia rheumatica?

rapid response to low dose corticosteroids

348

fibromyalgia is most commonly seen in who?

women 20-50yo

349

presentation of fibromyalgia?

chronic widespread musculoskeletal pain associated with stiffness, paresthesia, poor sleep, and fatigue

350

what is polymyositis?

progressive symmetrical proximal muscle weakness, characterized by endomysial inflammation with CD8+ T cells

351

polymyositis most often involves which location?

shoulders