musculoskeleton Flashcards
(160 cards)
0
Q
desmosome is in which layer of skin?
A
stratum spinosum
1
Q
epidermis layer
A
Californians Like Girls in String Bikinis Corneum Lucidm Granulosum Spinosum Basale
2
Q
melanocyte is in?
A
stratum basale
3
Q
stem cell is in
A
basale
4
Q
anucleated layer
A
corneum
5
Q
sebaceous glands
A
Holocrine secretion sebum
associated with hair follicle
6
Q
eccrine gland
A
secrete sweat,
found in the whole body
watery discharge with little orotein
cholinergic
7
Q
apocrine
A
found in axillary, genitalia and areolae secrete miky viscous fluid, odor malordorous because of bacterial action does not become fuctional until puberty innervation by adrenergic
8
Q
Tight junction
A
prevent paracellular movement of solutes
BBB,BSB
compose of clausin and occludin
zonula occludens
9
Q
adheren junction
A
belt connecting actin cytoskeletons of adjcent cells
cadherins(Ca dependent adhesion protein)
loss of E-cadherin promotes metasis
10
Q
desmosome
A
macula adherens
structural support via keratin interaction
Auto antibodies–>pemphigus vulgaris
11
Q
gap junction
A
channel protein call connexon permit electrical and chemical communication between cells
Ex: communication between osteocyte of Ca
12
Q
Hemidesmosome
A
keratin in basal cell to basement membrane
Ab-bullous pemphigoid
13
Q
SK muscle fiber covering
A
epimysium: entire muscle
perimysium: bundles of muscle
enclomysium: each muscle
14
Q
M line
A
myosin filament
15
Q
Z line
A
actin filament
16
Q
I band
A
myosin does not overlap eith actin
17
Q
muscle contractration conduction
A
action potential–>depolarization in the motor end plate–>travels along muscle and down the T tubule–>depolarization of the voltage-sensitive dihydropyridine receptor+ryanodine receptor(SR)–> confrontation change in SR–>Ca release–>bind troponin C–> conformation change–>move tropomyosin out of the myosin-binding groove on actin filaments–>myosin relased bound ADP and displaced on actin filament
18
Q
contraction result in change of line?
A
shorten of H I and between Z
A do not change
19
Q
type 1 muscle
A
slow twitch red fibers posture maintain increase mitochondria and myoglobin concentration, increase oxidative phosphorylation
20
Q
type II muscle
A
fast twitch white fiber decrease mitochondria and myoglobin concentration increase anaerobic glycosis short terms skill motion
21
Q
jobe’s test
A
supraspinatus injury
22
Q
painful abduction of arm
A
subacromial bursitis
supraspinatus tendinitis
23
Q
supra spinatus
A
abducts arm initially
most common injury
C5-C6
24
Infraspinatus
laterally rotation
pitching injury
C5-C6
25
Teres minor
laterally rotation
adducts
C5-C6
26
subscapularis
medially rotation
adducts
C5-C6
27
step deformity
acromioclavicular joint
28
wrist bone
some lover tri positions that they can't handle
| scaphoid lunate triquetrum pisiform trapezium trapezoid capitate hamate
29
most commonly fractured wrist bone?
scaphoid
| avascular necrosis
30
dislocation in wrist bone
lunate
| acute carpal tunnel syndrome
31
fall on out stretched hand is likely to result in?
4-10 yrs: tourus fracture of distal radial metaohysis
11-16yrs: salter-Harris II fracture, physeal plate
17-40yrs: scaphoid fracture
>40yrs:colles-type fracture, sliver fork
32
fracture of neck of humerus dislocation of humeral head
axillary damage
| deltoid: abdustion at shoulder
33
Fracture at mid shaft of humerus
radial nerve injury
34
saturaday night palsy
radial nerve injury
35
wrist drop
radial nerve
36
frcture of supracondylar humerous
median nerve injury
37
ape hand
| pope's blessing
median nerve
38
fracture of medial epicondyle of humerus
ulnar nerve
39
funny bone
| proximal lesion
ulnar nerve
40
upper trunk compression
```
musculocutaneous nerve
bicep
branchlis
coracobrachialis
C5 injury present as Musco nerve injury
```
41
Erb-Duchenne palsy
| waiter's tip
C5 and C6 tear, infant in delivery trauma
limb hang by side, abductor
medially rotated, lateral rotator
forearm is pronated, bicep
42
disappearance of the radial pulse upon moving the head toward the ipslateral side
ipsilateral horner sigh
defect of inferior trunk of branchial plexus, C8 T1
cervical rib can compress subclavical artery and inferior trunk-->
thoracic outlet syndrome, Klumke's palsy
cuzed by: hyper abduction, anomalies, scalene muscle, tumor of neck, pancoast tumor
43
falling and grab something
lower trunk of branchial plexus
| hand weakness
44
outward pulling and pronate, help a baby to stand up
nurse maid hand, wrist drop
| radial head subluxation
45
ulnar claw
inability to extend 4th and 5th digits when try to open hand
| longstanding injury to ulnar nerve ar hook of hamate, falling onto out streched hand
46
cannot extend the 2nd and 3rd finger upon opening the hand
median claw
carpal tunnel syndrome
dialocated lunate
47
Pope's blessing
proximmal median nerve lesion-->loss of lateral finger flexion and thumb opposition
make a fist-->extended thumb and 2nd, 3rd finger
48
Ape hand
proximal median nerve lesion
loss of opponens pollicis muscle function
unable to oppose thumb
49
klumpke's total claw
```
lesion of lower trunk, C8 T1 of branchial plexus
function of all lumbricals
```
50
winged scapula and ipsilateral lymphedema
serratus anterior
anchors to thoracic cage
innervated by long thoracic nerve
damage through mastectomy
51
dorsal interosseous muscle
abduct the finger
52
palmar interosseous muscles
adduct the fingers
53
lumbrical muscles
flex at MCP joint
| extend PIP and DIP
54
which muscle is innervated by both ulnar and median
flexor digitorium
55
short limb
| large head
```
chondroplasia
FGFR3 inhibits chondrocyte proliferation
advanced paternal age
may be AD
normal life span with fertility
```
56
osteoporosis fracture common happen in?
femoral neck fracture, distal radius fracture
57
oteopetrosis
| marble bone disease
defective osteoclasts->unable to generate acidic environment->failure of normal bone resorption-->thicken dense bone-->fracture
bone fills marrow space->pancytopenia, extramedullary hematopoiesis
mutation in carbonic anhydrase
XR: bone in bone appearance
cranial nerve impingement and palsies(narrow foramina)
BM transplant
58
osteomalacia
defective mineralization/calcification of osteoid
decrease Ca
increase PTH
decrease phosphate
increase alkaline phosph(hyper osteoblasts)
59
head enlarging, hearing loss
paget's diseas of bone
osteitis deformansincrease activity of osteoblastic and osteoclastic activity
Ca phosph PTH all normal, increase ALP
mosaic, woven bone pattern
long bone chalk-stick fracture
increase blood flow from AV shunt-->high output heart disease
osteogenic osteosarcoma
60
Otosclerosis
familial
| fibrous ankylosis followed by bony overgrowth of little ossicles of middle ear
61
polyostotic fibrous dysplasia
McCune-Albright syndrome
bone is replaced by fibroblasts, collagen and irregular bony trabeculae
MAS: unilateral bone lesions, endocrine abnormal(precocious puberty)
cafe au lait spot
62
giant cell tumor
20-40
epiphyseal end of long bone, proximal tibial
Double bubble/ soap bubble on X-ray
locally aggressive benign tumor
spindle shaped cells with multinucleated giant cells
osteoclastoma
63
osteochondrroma
<25yrs
exostosis, mature bone with cartilaginous cap, metaphysis
most common benign tumor, malignant tranformation is rare
64
osteosarcoma
M>F, 10-20
metaphsis of long bone, distal femur, proximal tibial, knee
Codman's triangle, sunburst pattern
aggresive,2nd most common malignant
associated: retinoblastoma, Paget's disease, bone infarction,radiation
treat with surgery and Chemo
65
Ewing's sarcoma
<15yrs boys
commonly appear in diaphysis of long bone, pelvis, scapula, ribs
anaplastic small blu cell malignant tumor
onion skin appearance in bone
associated witht(11;22), EW gene:transcription factor, FLT 1
aggressive with early metastasees, responsive to therapy
66
chondrosarcoma
30-60
diaphysis pelvis, spine, scapula, humerus, tibia, femur
malignant cartilaginous tumor,expansile glistening mass within the medullary cavity
67
osteoarthritis
```
wear and tear
subchondral cysts, sclerosis, osteophytes,eburnation,
herden's nodes(DIP)
Bouchard's node (PIP)
no MCP involvement
```
68
Rheumatoid arthritis
HLA-DR4, anti-IgG antibody, anti-cyclic citrullinated peptide Ab, type III hypersensitivity
pannus formation in joints MCP PIP, no DIP
subcutaneous rheumatoid nodules (fibrinoid necrosis)
ulnar deviation of fingers, subluxation
baker's cyst, poplital fossaincrease sfnovial fluid
69
Sjögren's syndrome
40-60 female
lymphocytic infiltration of exocrine glands lacrimal and salivary
Xerophthalmia, Xerostoma, Arthitis
Parotid enlargement, increase risk for B-cell lymphoma,dental caries
Ab to ribonucleoprotein antigens, SS-A(Ro), SS-B(La)
70
Gout
monosodium urate crystals
crystals are needle shaped and negatively birefringent=yellow crystals
painful mtp of big toe (podagra), Tophus formation(ear,olecraon bursa, Achilles' tendon)
acute attack after big meal or alcohol
Treatment:NSAID, glucocorticoids, xanthine oxidase inhibitor
71
pseudo gout
```
Ca pyrophosphate crystal in joint space
basophilic rhomboid crystal, positive birefringent: blue
large joint, knee,
>50yrs
Treat: NSAID, steroid, colchicine
```
72
infectious arthritis
S, synovitis
T, tenosynovitis
D, dermatitis
N. Conococcal
73
osteonecrosis
infearction
mostcommon: femoral head,obturator
cuzed by: trauma, high dose corticosteriod, alcoholism
74
hlA-27
```
PAIR
psoriatic
ankylosing spondylitis
inflammatory bowel disease
reactive arthritis, reiter's
```
75
dactylitis
sausage finger
pencil in cup on X ray
psoriatic arthritis
76
bamboo spine
```
Ankylosing spondylitis
musculoskeleton
respiratory: enthesopathy
cardiovascular: aortitis
eyes: anterior uveitis
```
77
can't see,
can't pee,
can't climb a tree
conjunctivitis
urethritis
arthritis
campylobactor, shigalle, salmonella, yerinia, chlamydia
78
SLE kidney involvement
Diffuse proliferative glomerulonephritis, nephritic
| membranous glomerulonephritis, nephrotic
79
False positive for syphilis because?
antiphospholipid antibody
| cross react with cardiolipin
80
anti-histone antibody
drug induced SLE
81
Antiphospholipid antibody syndrome
venous thomboembolism
arterial
increase fetal loss
antiphospholipid
82
sarcoidosis
immune-mediated noncaseating granuloma
increase ACE level
common in black female
enlarged LN on CXR, bilateral hilar adenopathy, reticular opacities
associated: restrictive lung, erythema nodosum, Bell's palsy,uveitis, microscopic schaumann and asteroid body, hyper Ca(increase Vit D activation in epithelioid macrophages)
83
polymyalgia rheumatica
pain and stiffness in shoulders and hips, morning stiffness
fever malaise and weight loss
no muscular weakness,
associated with temporal arteritis
increase ESR, normal CK
rapid response to low dose corticosteroid
84
fibromyalgia
20-50
| chronic widespread musculoskeletal pain associated with stiffness, paresthesia, poor sleep, fatigue
85
polymyositis
progressive symmetric proximal muscle weakness,
characterized by endomysial inflammation with CD 8+ T cell
often in shoulder
increase CK, + ANA, =anti-jo-1 Ab
86
Dermatomyositis
```
polymyositis, involves malar rash
Gottron's papules
helitrope rash
shawl and face rash
mechanic hand
perimysial inflammation and atropy with CD4 + T cells
increase CK, + ANA, =anti-jo-1 Ab
```
87
myasthenia gravis
NMJ disorder
autoantibody to ACh
ptosis, diplopia, weakness
thymoma, thymic hyperplasia
88
Lambert-Eaton myasthenic
autoantibodies to presynaptic Ca channel-->decrease ACh release
proximal muscle weakness, improve with muscle use
small cell lung cancer
89
myositis ossificans
metaplasia of skeletal muscle to bone following muscular trauma
uppper or lower extremity
90
scleroderma
fibrosis and collagen deposition
puffy and taut skin, with ulceration, absence of wrinkles
1. diffuse scleroderma, rapid progression, early viseral involvement, anti-Scl-70 antibody
2. CREST syndrome; Calcinosis, Raynaud's phenomenon, Esophageal, Sclerodactyly, Telangiectasia. antiCentromere Ab
91
Macule
flat lesion with well-circumscribed change in skin color<5 mm
92
patch
macula>5mm
93
papule
elevated soild leision<5mm
94
plaque
papule>5mm
95
mesicle
small fluid containing blister<5mm
96
Bulla
large fluid containing>5mm
97
wheal
transient smooth pappule or plaque
98
scale
flaking off of stratum corneum
99
crust
dry exudate
100
purpurae
5mm-1cm
| cutaneous/subcutanous collection of extravascular blood
101
petechiae
cutan/subcutan
<5mm
vein high pressure places like feet
102
ecchymoses
>1cm
| skin and subcutaneous
103
Lenrigo
smal tan/brown seen on sun-exposed skin of middle aged/elderly person
104
hyerkeratosis
increase thickness of stratum cornum
| psoriasis
105
parakeratosis
hyperkeratosis with retension of nuclei in stratum corneum
| posriasis
106
cantholysis
seperation of epidermal cell
| pemphigus vulgaris
107
canthosis
epidermal hyperplasia
spinosum
acanthosis nigricans
108
dermatits
inflammation of the skin
109
albinism
+tyrosinase: chrom15
-tyrosinase: chrom 11
decrease melanin(neural crest)
110
vitiligo
decrease melanocyte
111
verrucae
wart
hpv
epidermal hyperplasia, hyperkeratosis, koilocytosis
112
melanocytic nevus
common mole
intradermal nevi:papilar
junctional nevi: macules
113
urticaria
wheal
hives
mast cell degradation
perivascular without epidermal involvement
114
ephelis
freckles
| normal number of melanocyte, increase melanin pigment
115
atopic dermatitis
eczema
pruritic eruption on skin flexures
associated with other atopic disease, asthema allergic rhinitis
starts on the face in infancy
appears in the antecubital fossae there after
thickening of the skin
116
allergic contact dermatitis
type IV
| site of contact
117
psoriasis
papule and plaques with silvery scaling
knees and elbow
acanthosis with parakeratotic scaling: nuclei still in stratum corneum
increase stratum spinosum, decrease granulosum
auspitz sign-pin point bleeding spots from exposure of dermal papillae when scraped off, nail pitting and psoriatic arthritis
118
seborrheic keratosis
flat greasy pigmented aquamous epithelial proliferation with keratin-filled cysts, horn cysts
stuck on ish
common benign neoplasm in older person
119
leser Trelat sign
sudden sppesrance of multiple seborrheic keratoses
| underlying malignancy
120
pustular acne vulgaris
pilosebaceous unit and is characterized by pustoles, nodules, comedones, papules
systs and scarring
121
pemphigus vulgaris
IgG Ab against desmoglein 3, a part of desmosomes
IF: Ab around epidermal cells in reticular or netlike pattern
Acantholysis--flaccid blisters
+nikolsky's sign
122
bullous pemphygoid
```
IgG Ab against hemidesmosomes
IF: linear
eosinophils within tense blisters
less severe than pemphigus
-Nikolsky sign
seperation of epidermas and dermis
```
123
dermatitis herpetiformis
pruritic papules, vesicles and bullae, extremities and buttocks
deposits of IgA at the tips of dermal papillae
associated with celiac disease
124
epidermalysis bullosa
congenital lead to severe blistering in neronatals
| defect in epidermal basement
125
erthyma multiforme
infection:mysoplasma, pneumoniae, HIV
drugs:sulfa, beta-lactam, phenytoin
cancer and autoimmune
mulriple types of lesionmalsules, papules, vesicles, target lesion(target with multiple rings and a dusky center showing epi distribution)
deposition of immunocomplex, IgM
126
stevens Johnson syndrome
fever bulla necrosis sloughing of skin and high motility
2mucus membranes are involved and skin lesions may be appear like target as seen in erythema mulriforme.
associated with adverse drug reaction:PEC SLAPP
>30% of the body surface area involved is toxic epidermal necrosis
+Nikolsky sign
127
Acanthosis nigrican
associated with increase insulin and visceral malignancy
epidermal hyperplasia,spinosum
hyperpigmented, velvety thickening of skin especially on neck or axilla
128
actinic keratosis
premalignant lesion caused by sun exposure
Sand paper like, small rough erythmatous or brownish papules or plaques, with central pearly gray-white scaly lesion.
risk for squamous cell carcinoma, hyper parakeratosis
129
Erythema nodosum
inflammatory lesion of subcutaneous fat, usually on anterior shins
sarcoidodsis, coccidioidomycosis, histoplasmosis, TB, streptococcal infection,leprosy, CD
raised painful nodules
130
Lichen planus
Pruritic Purple Polygonal Planar Papule and Plaques
sawtooth infiltration of lymphocytes at dermal-epi junction, hyper granulosis, excessive granulation and instratum granulosum
associated with hep C
131
pityriasis rosea
herald patch fllowed days later by christmas tree diatribution
multiple plaque with collarette scale
self resolving in 6-8wks
132
honey colored crusting
Impetigo
| bullous impetigo-->S. aureus
133
cellulitis
acute, painful spread of dermis and subcutaneous tissue
134
necrotizing fasciitis
```
deeper tissue injury
from anaerobic bacteria or pyogenes
crepitus from methane and CO2 production
flesh eating bacteria
bullae and a purple color to the skin
```
135
SSSS
exotoxin destroys keratinocyte attachments in the stratum granulosum
fever and generalize erythematous rash with sloughing of the upper layer of the epidermia that heals completely
seen in new borns and children
136
hairy leukoplakia
white painless plaques on the tongue that cannot be scarped off
EBV mediated
occur in HIV
137
basal cell carcinoma
```
1. most common skin cancer
found in sun-exposed areas of body
2. locally invasion, but do not meta
3. pink pearly nodules, telaniectasias, rolled border, central crust/ulcer
nonhealing ulcer and scaling plaque
4. palisading nuclei
```
138
squamous cell carcinoma
1. 2nd most common
excessive exposure of sunlight: face, lower lip, ear, hand
2. locally invasive, spread through LN and rarly meta
3. ulcerative red lesion with freq scale, sinuses
4. keratin pearls
139
actinic keratosis
scaly plaque
a precursor to squamous cell CA,
on face
140
Keratocanthoma
variant of squamous cell CA
that grows rapidly, 4-6 wks
regress spontaneously over months
141
Actinic cheilitis
precursor of squamous CA that grow on lips
142
Melanoma
common tumor with risk of meta, increase rick with sunlight.
S100 marker, BRAF kinase()
depth of tumor correlates with risk of meta
ABCDE:asymmetry, Border irregular, Color variantion, Diameter>6mm, Evolution over time
treatment:surgery, BRAF V600E:vemurafenib
143
unhappy triad
ACL
MCL
meniscus, medial or lateral
requires surgery to repair ACL
144
ACL is attached?
nterior tibial
145
PCL is attached to
posterior, fibular
146
positive anterior drawer sign
ACL tear
147
abnormal passive abduction
MCL tear
148
kneeing result in injury to?
prepatellar bursa
149
anterior hip location injures?
```
obturator n
thigh adduction,
innervates medial compartment: abductor magus longus and brevis,
gracilius,pectinous
sensory:medial thigh
```
150
pelvic fracture result in?
femoral nerve damage
thigh flexion and leg extension
quadriceps, sartorius, pectinous?
sensory: anterior thighs and medial leg
151
trauma or compression of lateral aspect of leg or fibula neck fracture
common peroneal nerve, fibular nerve
innervated foot eversion and dorsiflexion, toe extension
fib brevis and longus
innervation-->anterolateral thigh and dorsal foot
152
foot drop, foot slap, steppage gait
common fibular nerve
153
knee trauma result in
injury to tibial nerve,L4-S2
innervation of foot inversion and plantarflexion, toe flexion:
sensory: sole of foot
154
posterior hip dislocation injury
superior gluteal,L4-S1
thigh abduction
+trendelenburg sign
inferior gluteal, cant jump, cant climb or rise from seated position, can't push inferiorly
155
sciatica nerve injury result in?
S2-S4 knee reflect disappear
156
Legg calve perthes
avascular necrosis of femoral head
capital femoral epiphysis and femoral head blood supply decrease
limp with anterior thigh pain sometimes
157
anterior compartment syndrome injuries?
superficial and deep fibular
158
psoas muscleTB
spread from spine
159
pudendal nerve block landmark
pain for delivery
| ischial spine
