Term
| What are the orders of the epidermis layers? |
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Definition
Californians Like Girls in String Bikini's
Corneum, Lucidum, Granulosum, Spinosum, Basalis |
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Term
| What is present in the zona adherens? |
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Definition
Surrounds the perimeter just below the zona occludens
Cadherins connect to actin (CADherins are Ca-dependent ADhesion molecules) |
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Term
| What is injured in the "unhappy triad"? |
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Definition
ACL, MCL and Lateral Meniscus
From a blow from the lateral side |
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Term
| How do integrins contribute to the epithelial cell junction? |
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Definition
| Maintains integrity of the BM --> interact w/ ECM via collagen, fibronectin and laminin in the BM |
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Term
| What muscle initiates abduction? |
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Definition
Supraspinatus
(deltoid finishes) |
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Term
| Where is the supraspinatus usually impinged? |
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Definition
| B/w the head of the humerus and the acromioclavicular joint |
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Term
| What are the actions of the rotator cuff? |
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Definition
Supraspinatus = initiates abduction
Infraspinatus = lateral rotation
Teres Minor = adducts and laterally rotates
Subscapularis = medially rotates and adducts |
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Term
| Fracture of what bone in the hand will cause ulnar nerve injury? |
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Definition
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Term
| Dislocation of what carpal bone will cause median nerve damage? |
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Definition
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Term
| What nerve is injured with incorrect use of a crutch? |
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Definition
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Term
| What is the lesion that leads to Erb's palsy? Klumpke's palsy? |
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Definition
Erbs = C5/C6
Klumpke's = C8/T1 |
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Term
| What nerve supplies the hand intrinsics? Damage to it causes what defect? |
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Definition
Ulnar n
Claw hard (Pope's blessing) |
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Term
| What muscle protects the brachial plexus from injury? |
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Definition
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Term
| Fracture where in the arm can cause median nerve palsy? |
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Definition
Supracondylar humerus
Injures the proximal median n |
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Term
| What does the median nerve supply to the hand? |
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Definition
Sensory
Lateral finger flexion
Wrist flexion
Opposition of the thumb
Mucles of the thenar compartment and lateral 2 lumbricals |
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Term
| What does the ulnar nerve supply to the hand? |
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Definition
Medial finger flexion
Abduction and adduction of fingers (interossei)
Adduction of thumb
Extension of 4th and 5th fingers (lumbricals)
Injury = ulnar claw hand --> can't straighten fingers 4/5 (lumbricals supplied by ulnar) |
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Term
| What nerve roots are the musculocutaneous? |
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Definition
| C5-C7 --> supplies lateral forearm |
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Term
| What is thoracic outlet syndrome? What causes it? |
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Definition
Caused by cervical rib compressing subclavian artery and inferior trunk (Klumpke's palsy - C8/T1 takes out Ulnar and median n)
Atrophy of thenar and hypothenar eminences
Atrophy of interosseous muscles
Sensory deficits on medical side of forearm and hand
Disappearance of radial pulse upon moving the head ipsilaterally (compresses subclavian) |
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Term
| How are ulnar claw and median claw different? |
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Definition
Ulnar = can't extend 4/5
Median = Can't extend 2/3
Both are distal lesions |
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Term
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Definition
| Proximal median n lesions --> lose opponens pollicis |
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Term
| Klumpke's is loss of what? What does it cause? |
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Definition
C8, T1 loss Lose all lumbricals (ulnar and median n), lose forearm flexors (Median and ulnar) and radial n (finger extensors) is UNOPPOSED
Clawing of all digits
Lumbricals flex MCP and extend DIP/PIP
So get extension of MCPs and flexion of PIP/DIP |
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Term
| What do the dorsal and palmar interossei do? Lumbricals? |
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Definition
DAB and PAD
Dorsals ABduct, Palmars ADduct
Lumbricals flex MCP and extend DIP/PIP |
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Term
| What are the nerve roots of the Obturator, Femoral, Common peroneal, Tibial, Sup and Inf Gluteal? |
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Definition
Obturator/Femoral = L2-L4
Common Peroneal/Tibial = L4-S2
Sup Gluteal = L4-S1
Inf Gluteal = L5-S2 |
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Term
| What do the Common Peroneal and Tibial nn do? |
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Definition
PED and TIP
Peroneal Everts and Dorsiflexes (injury = foot dropPED)
Tibial Inverts and Plantarflexes (injury = can't stand on TIPtoes) |
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Term
| What is the sensory innervation to the lower leg? |
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Definition
Anterolateral leg and dorsal foot = peroneal
Sole of foot = tibial (is POSTERIOR) |
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Term
| Influx of what cation causes muscle contraction? |
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Definition
Calcium
Ca-induced Ca released from SR
Depol opens voltage-gated Ca channels and induces nt relase --> down T-tubule --> depol dihydropyridine rec --> ryanodine rec (SR) --> Ca release from SR |
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Term
| Slow twitch muscle fibers are what type? |
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Definition
Type 1
"One Slow Red Ox"
uses oxidative phosphorylation
(type 2 uses anaerobic) |
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Term
| ATP hydrolysis causes what in muscle contraction? |
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Definition
Cocks the myosin head so it can then bind in the cross-bridged state
Power-stroke occurs when ADP is loss |
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Term
| In smooth muscle contraction, Ca binds to what? What does this do? |
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Definition
Calcium binds Calmodulin
This activates myosin light-chain kinase (P allows cross-bridge formation) |
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Term
| What is the source of osteoblasts? What do they make? |
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Definition
Mesenchymal stem cells in periosteum
Make type 1 collagen and osteocalcin (alk phos mineralizes)
Produce RANK-L and M-CSF that stimulates osteoclasts |
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Term
| What stimulates osteoblasts and osteoclasts? |
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Definition
Osteoblasts = TGF-beta and IGF1
Osteoclasts = IL-1 (osteoclast stim factor), IL-6 and TNF (all also released by macros)
Differentiation of osteoclasts by RANK-L and M-CSF |
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Term
| What causes achondroplasia? What is it associated with (genetically)? |
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Definition
FGFR3 mutation
Inhibits chondrocyte proliferation
Assoc w/ advanced paternal age |
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Term
| What are the lab findings assoc w/ osteopetrosis? |
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Definition
Normal serum Ca, PO4 and Alk Phos
Less marrow space = anemia, thrombocytopenia, infection
Increased extramedullary hematopoiesis |
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Term
| What is the cause of osteopetrosis? |
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Definition
| Genetic deficiency of Carbonic Anhydrase II |
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Term
| What is the suspected cause of Paget's Disease of bone? |
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Definition
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Term
| What are the bone findings w/ Paget's? |
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Definition
Cement lines
Increased alk phos |
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Term
| What are the complications assoc w/ Paget's disease of bone? |
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Definition
High-output heart failure (increased arteriorvenous shunts)
Osteogenic sarcoma
Hearing loss --> auditory foramen narrowing (similar to osteopetrosis) |
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Term
| What is the major laboratory difference in osteopetrosis and Paget's disease? |
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Definition
| Paget's has increased alk phos (increased osteoblast action) whereas osteopetrosis it is normal (normal osteoblasts, just no osteoclasts) |
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Term
| What is McCune-Albright Syndrome? |
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Definition
Polyostotic fibrous dysplasia.
Precocious puberty
Cafe au lait spots
Short stature (bone replaced by fibroblasts) |
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Term
| What are the benign primary bone tumors? |
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Definition
Osteoma - Gardner's sx
Osteoid osteoma
Osteoblastoma
Giant Cell Tumor
Osteochondroma
Enchondroma |
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Term
| What is the different between Osteoid Osteoma and Osteoblastoma? |
|
Definition
Osteoblastoma is in the vertebral column (stem cells)
Woven bone surrounded by osteoblasts --> nidus w/ bone around it
Osteoid Osteoma is in PROXIMAL tibia and femus |
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Term
| What are the malignant tumors of bone? |
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Definition
Osteosarcoma - 10-20yo, distal femur/prox tibia, Codman's triangle
Ewing's sarcoma - boys <15, onion-skin t(11;22)
Chondrosarcoma - men 30-60 |
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Term
| What are the risk factors for osteosarcoma? |
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Definition
| Paget's dx, bone infarcts, radiation, familial reinoblastoma (lose Rb tumor suppressor) |
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Term
| What joints in the hand do Osteoarthritis and RA affect? |
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Definition
OA = DIP and PIP (Heberdens = DIP, Bouchard's = PIP)
RA = MCP and PIP |
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Term
| What are the differences in presentation of OA vs RA? |
|
Definition
OA = DIP/PIP + morning stiffness of <30min
RA = MCP/PIP + morning stiffness that persists for hours |
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Term
| What are the immunologic findings of RA? |
|
Definition
Type III hypersensitivity
Anti-CCP, anti-IgG (Rheumatoid Factor)
HLA-DR4 |
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Term
| Morning stiffness >30min and improving w/ use, symmetric joint involvement, systemic sxs (fever, fatigue, pleuritis, pericarditis), vasculitits, lymphadenopathy |
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Definition
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Term
| What are the immunologic findings of Sjorgren's sx? What are pts at increased risk for? |
|
Definition
Anti-SS-A (Ro) and anti-SS-B (La)
Hypergammaglobulinemia
Increased risk of B-cell lymphoma |
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Term
| What infectious agent can cause a syndrome that resembles RA? |
|
Definition
Parvovirus B19
Fever, rash in kids, arthritis in adults in PIPs, MCP, knees and ankles.
Symmetric and resolves spontaneously |
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Term
| What is used to treat acute and chronic gout attacks? What DON'T you use in an acute attack? |
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Definition
Acute = NSAIDs, colchicine (inh glucose oxid, decreased lactin acid and increase pH that inh xstal formation)
Chronic = allopurinol, probenecid
Don't use chronic tx's w/ acute flares --> can't trigger a flare! |
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Term
| Negative birefringence is what? |
|
Definition
| YeLLow xstals under ParaLLel light |
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Term
| What are the arthropathies associated with HLA-B27? What does HLA-B27 code for? |
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Definition
Psoriatic arthritis, Ankyllosing spondylitis, IBD and Reactive ARthritis (Reiter's)
Gene codes for HLA MHC I |
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Term
| What are the findings with Sarcoidosis? |
|
Definition
GRAIN
Gammaglobulinemia, RA, ACE increase, Interstitial fibrosis, Noncaseating granulomas
Hypercalcemia
+ enlarged hilar LNs, ant uveitis, erythema nodosum, polyarthritis |
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Term
| What disease is polymyalgia rheumatica associated with? |
|
Definition
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Term
| What causes polymyositis? What lab findings? |
|
Definition
CD8+ T-cell induced injury to myofibers
Increased CK, increased aldolase, positive ANA, anti-Jo-1 |
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Term
| What tumor is myasthenia gravis associated with? |
|
Definition
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Term
| What is Lambert-Eaton Syndrome? |
|
Definition
Anto-antibodies to pre-synaptic Ca channels --> causes decreased ACh release leading to prox muscle weakness. No reversal of sx's w/ AChEi's
Myasthenia is Ab's to POSTsynaptic, Lamber-Eaton is Ab's to PREsynaptic Ca channels |
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Term
| What does CREST stand for? What Ab's are CREST and diffuse scleroderma associated with? |
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Definition
Calcinosis, Raynaud's, Esophageal dysmotility, Scleroderma, Telangiectasias
CREST = Anti-Centromere
Diffuse = anti-topoisomerase I |
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|
Term
Acantholysis is what?
Acanthosis? vs. Hyperkeratosis?
Parakeratosis? |
|
Definition
Acantholysis=Separation of epidermal cells
Acanthosis = hyperplasia of spinosum
Hyperkeratosis = increased thickness of corneum
Parakeratosis = hyperkeratosis w/ retention of nuclei in corneum |
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Term
| What is the Auspitz sign? What is it associated with? |
|
Definition
Assoc w/ Psoriasis
Bleeding spots when scales are scraped off |
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Term
| What is the sign of Leser-Trelat? |
|
Definition
Sudden appearance of multiple seborrheic keratoses indication an underlying malignancy
Goljan! |
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Term
| What is the difference between albinism and vertigo? |
|
Definition
Albinism = nl melanocyte # but decreased melanin production (decreased tyrosinase or failure of NCC migration)
Vitiligo = decrease # melanocytes |
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Term
| Hairy leukoplakia is caused by what virus? |
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Definition
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|
Term
| Dermatitis herpetiformis is associated with what disease? |
|
Definition
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|
Term
| What is Erythema multiforme? What causes it? |
|
Definition
Target lesion
Hypersensitivity - IgM complex deposition on superficial microvasculature following an infection or drug exposure |
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Term
| Fever, bulla formation and necrosis, sloughin of skin and a high mortality rate. |
|
Definition
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|
Term
|
Definition
Pruritic, Purple, Polygonal Papules. Sawtooth infiltrate of lymphocytes at dermal-epidermal junction.
Assoc w/ Hep C |
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Term
| What diseases is Erythema nodosum associated with? |
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Definition
Coccidioidomyocisis, Histoplasmosis, TB, Leprosy, Strep infections, Sarcoid
Think systemic mycoses in west, TB/Lep, Strep and Mom |
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Term
| What cutaneous finding is sometimes found w/ Basal Cell Carcinoma? |
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Definition
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|
Term
| What is the tumor marker for melanoma? |
|
Definition
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|
Term
| What are the main side effects of aspirin? |
|
Definition
Renal failure, interstitial nephritis, upper GI bleed, aplastic anemia (all NSAIDs).
Reye's sx in kids (rash, vomit, fever, hypervent, fatty liver, coma, respt arrest, seizure) |
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Term
| What SHOULDN'T you take if you have gout? |
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Definition
Diuretics and low dose ASA
Depress uric acid clearance (decreased tubular secretion) |
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